Time for a Little “Me Time”

At what point did your life become more about everyone else – work, family, etc. – and far too little about you? It’s OK to be selfish when it comes to your health; after all, if you lose your health, you won’t have the ability to do all the things you do for all the people in your life. So take a little “me time” with these tips to get away from your busy day (week, month, year, life) and focus on becoming a healthier you:

1. Hit the Road: We talk a lot about the benefits of working out at home, but the disadvantage to that strategy is that unless you have a dedicated gym space, away from the hustle and bustle of the family, you never really get to enjoy you own private time. So schedule gym time 3-4 times a week and stick to it; that hour or so out of the house (even when surrounded by other gym enthusiasts) will feel like a refreshing, reinvigorating break from the daily household grind.

2. Wind Down: Even the busiest day can end the right way if you plan for it. Dedicate a good 45-60 minutes every night to an activity of your choosing that not only gets you “away from it all,” but also allows you time to wind down, relax and prepare for restful slumber. Prepare a hot bath, read a good book, do some yoga, or even just take a brisk solo walk and “discuss your day” with.

me time - Copyright – Stock Photo / Register Mark

3. Make a Plan: Dinner and the movies is a great plan that too often stays a great plan, rather than manifesting into reality. So schedule a date night and make it happen. Even the act of scheduling will do wonders for your day. Once you know it’s on the calendar, you’ll look forward to it – and worry less about the hectic moments in between.

4. Keep Learning: When we’re young, we’re always learning – new activities, new projects, new information. But somehow after a certain age, we’re too likely to stick to the “same old, same old.” That leads to boredom, burnout and dissatisfaction with the state of affairs. The solution? Try something new! Whether it’s a new hobby, a new jogging route or a new certification to take your career to the next level, you’ll be amazed how good you’ll feel.

We all need more “me time” in this crazy, overworked world – so make sure you’re getting enough. If not, you could pay the emotional and physical consequences.

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A Deadly Way to Manage Your Pain

You’re probably aware of the opioid crisis by now, notably the fact that for years, opioids have been overprescribed, overused and abused – with deadly consequences. Here’s one consequence you may not be aware of: Opioid users are significantly more likely to be involved in fatal car crashes than non-users. Let’s look at the latest evidence suggesting opioids are actually your No. 1 enemy when it comes to managing pain.

Drivers prescribed opioids are more than twice as likely to be involved in deadly two-vehicle accidents compared to drivers not prescribed opioids. In reviewing data from the Fatality Analysis Reporting System, researchers analyzed two-vehicle crashes on U.S. public roads that took place over a 25-plus-year period (1993-2016), including whether drivers had tested positive for prescription opioids. Among 36,642 drivers involved in 18,321 fatal two-vehicle crashes during that time period, drivers who were deemed the initiator of the crash were significantly more likely to test positive for opioids than non-culpable drivers.

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The most common reason for crashes by opioid users (more than half of all fatal crashes): failure to keep in the proper lane. These findings were independent of any alcohol or other drug use, implicating opioids as the primary culprit. Even worse: Although opioid awareness (including studies such as this one) will hopefully make a dent in these horrific statistics in years to come, researchers, summarizing their findings in JAMA Network Open, noted that in the past two decades, when opioid prescribing flourished, “the prevalence of prescription opioids detected in fatally injured drivers has steadily increased to more than 7%” (compared to only 1 percent in the mid-1990s).

The lessons: 1) Opioids are a deadly way to manage your pain. 2) Non-drug pain management options (such as chiropractic care) should be your first choice, not your last. Talk to your doctor for more information about the opioid crisis and why chiropractic care is becoming the first choice for effective pain management.

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Making Contact: The Right and Wrong Way to Use Exercise Machines

Exercise machines that isolate individual muscles are great for general strength training. Muscle isolation helps you understand the different muscles of the body and their actions. The machines are also user-friendly, safe and efficient.

Diagrams for how to perform the exercise / movement are provided on most machines. You need only to sit or lie on the padded portion of the machine, move the weight pin to the desired resistance and proceed. Time is never spent on lifting, loading and unloading heavy weights.

All of the above make these machines popular in most fitness centers. The machines require minimal supervision and the safety features are beneficial to gym patrons and owners. The potential for gym-related injuries is minimal compared to use of free weights like barbells and dumbbells.

With this said however, minimal risk means there is still risk. Injuries do occur. In most of these cases, the cause is user error. One of the most common of these errors is failure to utilize proper form. Proper form involves stabilizing the body areas that are not exercised by a machine.

Use Exercise Machines - Copyright – Stock Photo / Register Mark

Diagrams on the machines usually depict proper form. Unfortunately, most exercisers only use the diagrams to get the “general idea.” Proper form requires a closer look. You need to look at all regions of the body depicted in the diagrams, not just the region that will be involved in performance of the exercise.

Are You Exercising Properly? Maintain Five Points of Contact

Gym members frequently resemble contortionist while using strength machines. They twist, lunge, heave, jerk and strain their entire bodies while using the equipment. This is a sure indicator that the individual is attempting to lift too much weight. The twisting, lunging, heaving, jerking and straining are efforts to recruit other muscles to help lift the weight. The isolation principle is lost, the exercises lose their effectiveness and the possibility of injury escalates.

The key to success when using a weight machine is establishing specific points of body contact with the machine for both action and stabilization. Action contact points are created by the arms and legs as they grip, push or pull the parts of a machine that move during the exercise. For exercises involving the trunk, the abdomen or back may create the action contact points. The action contact points are easy to establish, as without them the machine will not move.

The Chest-Bench Press Exercise - Copyright – Stock Photo / Register Mark

Figure 1A and 1B: The Chest-Bench Press Exercise. 1A: Proper contact; the hands are the active points of contact, while the stabilizing points of contact are the feet, buttocks, upper back and head. 1B: Improper contact; the hands are the active points of contact; however, the stabilization points of contact are not well-established. The feet are not set properly, and the upper back and head are not in contact with the machine. Photo credit: Leigh Ann Osborne, Vinton, Virginia.It is the stabilization contact points that are the primary focus here. There are five common stabilization contact points; the two extremities not involved in the exercise movement, the buttocks, the upper back and the head. These areas should be in contact with the padded portions of the machine.

For example, if the exercise involves the arms, the feet, buttocks, upper back and head are the stabilization points. If the exercise involves the legs, the hands, the buttocks, upper back and head are the stabilization points. (See the table and images in this article for example points of stabilization contact, along with visual examples of proper and improper contact while using weight machines.)

When you employ proper form utilizing appropriate points for active and stabilization contact, exercises using strength machines are safe and effective. Otherwise, there is risk of injury and gains in fitness are minimal.

Changing Your Stabilization Habits to Maximize Your Workout

A frequent response by exercisers attempting to change from poor to good stabilization habits is, “I can’t lift as much weight the new way. I’m stronger than that.” It is true; they are not lifting the same amount of weight as before – but, reiterating a previous point, they were not lifting the previous weight with just the muscles the machines are designed to isolate. They were lifting (heaving, straining) with their entire bodies. Proper form in strength training cannot be overemphasized.

Some strength machines require that you lie on your abdomen or back. Contact points are important in these exercises as well. For these machines or any others you may choose to use, follow these simple rules for stabilization contact points.

Try to maintain as much body contact with the padded portions of the machine as possible.

The Leg-Press Exercise - Copyright – Stock Photo / Register Mark

Figure 2A and 2B: The Leg-Press Exercise. 2A: Correct contact; the feet are the active points of contact while the stabilization points of contact are the hands, buttocks, upper back and head. 2B: Incorrect contact; the feet are the active points of contact; however, the stabilization points of contact are faulty. The upper back and head are not in contact with the machine and the exerciser is pushing downward with their arms. Photo credit: Leigh Ann Osborne, Vinton, Virginia.

Keep the spine as straight as possible during the entire exercise. This includes the neck. Alignment from the back of the head to the lower back should be as straight.

The head should be in a neutral position. The chin should not be flexed to the chest, and the head should not be tilted back or rotated to the right or left side while performing the exercise.

Exercise is safer, more effective and more enjoyable when it’s done correctly. The result is that you are more likely to continue to exercising and maintaining a healthy lifestyle. Following these simple instructions will help in this endeavor. Remember, whenever you have questions about which exercises you should be doing or how to do them correctly, ask a fitness professional with training and experience for help. Exercise is important enough to do it right.

Points of Stabilization Contact for Strength-Training Exercise Machines
Exercise Type (Examples)Points of Stabilization Contact
Seated arm exerciseButtocks, upper back, back of the head and both feet
Seated leg exerciseButtocks, upper back, back of the head and both hands

By K. Jeffrey Miller, DC, MBA and Matthew Marry, DC

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Steroids for Sciatica: More Trouble Than They’re Worth

Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).

Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure as it relates to sciatica or pain affecting the sciatic nerve, which extends from the lower back down the back of each leg.

Small Relief, Big Potential Side Effects

In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups.

Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, cataracts and increased risk of fracture.

Tainted Steroid Injections: The Framingham Outbreak

In September 2012, the CDC and the FDA began investigating a multistate outbreak of fungal meningitis and other infections among patients who had received contaminated steroid injections. The contaminated vials were tracked back to a New England compounding center in Framingham, Mass. The cases included fungal meningitis; localized spinal or paraspinal infections, including epidural abscess, basilar stroke, vertebral osteomeylitis and arachnoiditis; and infections associated with injection in a peripheral joint space such as the knee, shoulder or ankle. Ultimately, the outbreak resulted in 751 cases and 64 deaths in more than 20 states.

This last complication is certainly not emphasized in clinical circles. Therapeutic steroids may reduce pain, however the use of steroid injections seem to promote deterioration of skeletal quality, which is not surprising since other forms of steroid medication have long been associated with osteoporosis.

A retrospective study published in the Journal of Bone and Joint Surgery looked at lumbar epidural steroid injection (LESI), and the potential impact on bone fragility and vertebral fractures (spinal fractures). Researchers identified a total of 50,345 patients who had medical diagnosis codes involving the spine; within that group, a total of 3,415 patients had received at least one LESI.

Three thousand patients were randomly selected from the 3,415 injected population and 3,000 additional patients were selected from the non-injected group as a control group. There was no significant difference between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or corticosteroid use.

When incidence of vertebral fractures was assessed, researchers discovered that an increasing number of injections was associated with an increasing likelihood of fractures, and each successive injection increased the risk of spinal fracture by 21 percent. Based on this evidence, LESIs clearly exacerbate skeletal fragility. They promote deterioration of skeletal quality similar to the use of exogenous steroids, which is the leading cause of secondary osteoporosis. In fact, the rate of vertebral fracture following epidural steroid injections may be underestimated.

Both European and American guidelines, based on systemic reviews, conclude that epidural corticosteroid injections may offer temporary relief of sciatica, but do not reduce the rate of subsequent surgery. This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates. Facet joint injections with corticosteroids seem no more effective than saline injections.

Rising Costs, Limited Benefits

Despite the limited benefits of epidural injections, Medicare claims show a 271 percent increase during a recent seven-year interval. Earlier Medicare claims analyses also demonstrated rapid increases in spinal injection rates. For patients with axial back pain without sciatica, there is no evidence of benefit from spinal injections; however, many injections given to patients in the Medicare population seem to be for axial back pain alone.

Charges per injection have risen 100 percent during the past decade (after inflation), and the combination of increasing rates and charges has resulted in a 629 percent increase in fees for spinal injections. Yet during this time, the Medicare population increased by only 12 percent.

It all begs the question: Why such a huge increase in the use of a procedure that has limited benefit?

Take-Home Points

  • Epidural steroid injections have little clinical benefit (short or long term) and are associated with significant risks.
  • Steroid injections cause deterioration of bone quality, elevating the risk of spinal fracture.
  • Use of epidural steroid injections has increased dramatically despite lack of evidence to justify the procedure.

Talk to your doctor of chiropractic for more information on sciatica and nondrug alternatives to your pain.

By Deborah Pate, DC, DACBR

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Chiropractic Better Than Medication for Neck Pain

A study published in the research journal Annals of Internal Medicine and widely reported by mainstream media suggests chiropractic spinal manipulation is more effective than over-the-counter and prescription medication for relieving acute and subacute neck pain.

Spinal manipulative therapy was more effective than medication in both the short and long term.

The study involved 272 adults ages 18-65 with neck pain of two to 12 weeks’ duration. Participants were recruited from a university research center and a pain management clinic in Minnesota. Spinal manipulation was provided courtesy of a doctor of chiropractic. According to the study, six chiropractors, each with at least five years’ experience, provided treatment, with the specific spinal level to be treated and the number of treatments provided left to the discretion of the individual chiropractor.

Instead of chiropractic care, some patients in the study group received medication as monitored by a licensed medical physician. Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (aspirin), or both served as the first line of pharmacological therapy. With patients who did not respond to or could not tolerate these drugs, narcotic medications and muscle relaxants were prescribed. With each patient, the MD determined the type of medication administered and the number of patient visits.

neck pain - Copyright – Stock Photo / Register Mark

Self-reported outcomes, including pain, were measured six times during the 12-week treatment period: at two initial (baseline) appointments; two, four, eight and 12 weeks after treatment began; and on two occasions post-treatment (weeks 26 and 52). Objective measures of cervical spine motion were measured at four and 12 weeks by seven trained examiners who were unaware of which treatment the patients were receiving.

After 12 weeks of treatment, a significantly higher proportion of the SMT group experienced reductions of pain of at least 50% [compared to the medication group]. Specifically, at week 12, more than 82 percent of the SMT group reported a 50 percent or greater reduction in pain; 57 percent reported at least a 75 percent reduction and 32 percent reported a 100 percent reduction. By comparison, the medication group reported reductions of only 69 percent, 33 percent and 13 percent, respectively.

In terms of long-term improvement, 75 percent of the SMT group reported at least a 50 percent reduction in pain after 26 weeks, while nearly 81 percent reported at least a 50 percent reduction at 52 weeks. The medication group’s improvement fluctuated from 59 percent reporting pain reduction of 50 percent or more at 26 weeks to 69 percent reporting the same reduction at 52 weeks.

“Participants who received medication seemed to fare worse, with a consistently higher use of pain medications for neck pain throughout the trial’s observational period,” said the study authors. In other words, chiropractic was a much better choice than medication for neck pain.

Interestingly enough, a third group of patients who received home exercise advice instead of chiropractic care or medication also fared better than the medication group during the study period. That means two forms of conservative, drug-free care – both of which are commonly provided by doctors of chiropractic – were more effective than over-the-counter and/or prescription drugs. The moral of the story? The next time you or someone you know is suffering from neck pain, don’t turn to the medicine cabinet or a medical doctor; turn to your doctor of chiropractic.

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How “The Biggest Losers” Keep the Weight Off (and How You Can, Too)

Anyone who’s followed the popular TV series, “The Biggest Loser,” over the years understands two things instantly: 1) Even people who are significantly overweight / obese can lose dramatic amounts of weight by changing their diet, exercise and other habits.

2) Once they lose the weight (and leave the weight-loss-conductive confines of the show), it can be difficult to maintain the weight loss. That’s why in too many cases, on the show and in “real life,” people end up in a vicious cycle of weight loss, weight gain, weight loss and so on.

A new study may provide an important clue as to how people who lose weight can keep it off. The study actually tracked some of “The Biggest Loser” participants and determined that while many actually regained some or all of their original weight after leaving the show, the ones who were able to maintain their weight loss (or even lose more weight) did so because they modified an important variable: exercise. Specifically, participants who successfully kept the weight off six years after the show (average weight loss: 13 percent compared to pre-show weight) had increased their physical activity by 160 percent compared to 34 percent in weight “regainers,” who were actually 1.1 percent heavier, on average, than their pre-show weight.

weight loss - Copyright – Stock Photo / Register Mark

The moral to the story? Keep exercising! If you’re trying to lose weight, burning calories is key to dropping pounds; if you’re trying to maintain it, a physically active lifestyle not only keeps you fit physically, but also keeps you in the fitness mindset, which is equally as important when it comes to maintaining a healthy weight in the long term.

Note: Experts suggest that when first trying to lose weight, particularly significant amounts, diet may be more important than exercise, since poor eating habits – particularly excessive consumption of high-calorie, nutrition-sparse foods – often cause more weight gain than exercise can burn off. For example, a cheeseburger with fries and a milkshake could account for 1,000 calories or more, depending on the fast-food establishment; whereas burning 1,000 calories could require several hours of physical activity (depending on the exerciser’s weight and activity intensity). It’s also vital to change eating habits because in today’s processed, fast-food world, it’s far too easy to give in to temptation. Your doctor can tell you more about how to combine proper diet and regular exercise to take the weight off and keep it off for good.

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Chiropractic Care for Common Sports Injuries

Have you ever had a sports injury that limited you from playing your favorite sport? If so, you aren’t alone. Whether you are a weekend sports enthusiast or an athlete, getting back to playing again is the most important thing. That’s why an injury can take time to heal and really frustrate us. We want to be back playing yesterday. That’s why chiropractic care is so important. Getting your injury assessed and treatment will not only get you back on your feet faster, but also screen out any bad habits that can lead to further injury. Let’s look at some of the most common sports injuries out there, and review what you can do to get it better.

Injury: Hamstring Strain

Treatment:

  • Follow RICE principle if injury happened within last 48 hours
  • RICE: (Rest, Ice, Compression, Elevation)
  • Electrotherapy, Ultrasound for swelling control
  • Stretching for increasing flexibility
  • Chiropractic adjustments to address joint tightness
  • Muscle tissue work to break up scar tissue
  • Active exercise to get back to full strength and prevent further injury

Key points to remember:

Sports Injuries - Copyright – Stock Photo / Register Mark

Hamstring pulls and strains are most commonly due to lack of flexibility and adequate warm up before beginning your sport. Apart from treating the area of injury, your Chiropractor will examine to see if there’s any muscular imbalances. Having a tight thigh and weak hamstrings will lead to recurring injuries unless you get your muscles and joint motion back to normal.

Injury: Low back strain

Treatment:

  • Chiropractic adjustments to increase range of motion and decrease pain
  • Low back stretching exercises
  • Strengthening and core training

Key points to remember:

Majority of sports injuries to the back involve sudden twisting motions. Core strength is one of the most important goals you need to achieve if you are going to continue playing. Avoid any forward bending movements in sports, since this puts a lot of stresses to the spine and can increase risk of injury, especially if  you are being hit

Injury: Tennis Elbow

Treatment:

  • Ultrasound or laser to help with tissue healing
  • Spinal manipulation around the elbow joint to increase joint motion
  • Muscle tissue work to break up scar tissue around the area of injury
  • Stretching exercises to increase range of motion
  • Strengthening forearm exercises

Key points to remember:

The pain on the outside of the elbow is known either as lateral epicondylitis or tennis elbow. This area has one of the least amounts of blood supply to the body. That’s why it may take longer to heal. It’s important to get back into activity slowly. You may even need to wear a brace to limit stresses on this area in the beginning. It’s best to follow the advice of your chiropractor on your timing of return to sports. Getting back too quickly with this injury can lead to reinjury and further frustration.

Injury: Runner’s Knee

Treatment:

  • Specific stretching of the muscles around the knee
  • Strengthening of inner knee muscles to improve tracking of the knee cap
  • Deep tissue massage techniques to help break up scar tissue
  • Examine the feet for altered gait and improper walking form
  • Address any low back joint problems that alter proper leg movement

Key points to remember:

Runner’s knee is not only something runners get. Any form of sport that involves running or sprinting can lead to Runner’s knee. Apart from stretching and strengthening exercises, its important to get good advice on proper footwear. Think of the feet as the foundation from which everything is built. Improper foot wear and bad form in walking can lead to increased stresses in the knee, hip and low back.

By Jasper Sidhu, BSc, DC

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Take Time to Stretch

Let’s face it, most people do not enjoy stretching. If you think about it, it’s probably close to the bottom of your list of priorities when you work out or do any other type of physical activity. In fact, stretching is probably the most overlooked aspect of physical fitness, and yet it is one of the most important. I continually stress the benefits of stretching to my clients, and the ones who take my advice see a difference in their workouts and everyday lives. By the end of this article, you will have the information and the tools to put together a great stretching program, too.

Why We Need to Stretch

Lady stretching on the floor - Copyright – Stock Photo / Register Mark

As we age, our muscles tighten and range of motion in our joints decreases. This can impact even the most active lifestyle and hinder your normal day-to-day activities. Tasks that used to be simple, like zipping up a dress or reaching for a can off the top shelf, may become extremely difficult. A regular stretching program can help lengthen your muscles and make daily activities routine again.

The word flexible comes from the Latin word flexus, which means “to bend.” Flexibility is the degree to which an individual muscle will lengthen. Stretching increases flexibility, which will help you perform daily activities and reduce the risk of muscle, joint and tendon injuries. Stretching also improves circulation, increasing blood flow to the muscles. Increased blood flow provides more nourishment to the muscles and gets rid of more waste by-products in the muscle tissue itself. Improved circulation can also help speed up recovery time if you suffer a muscle injury.

What’s more, stretching can help eliminate or decrease low back pain, one of the most common kinds of structural pain, affecting a large percentage of the population. Muscle tightness in the quadriceps, hamstrings, hip flexors, and low back muscles is a common cause of low back pain. Stretching these muscles will often eliminate the pain. Keep in mind that every joint is tied to another joint, so if one muscle is tight, it is going to affect another joint or muscle.

Man stretching - Copyright – Stock Photo / Register Mark

One of the greatest benefits of stretching is that you’re able to increase your range of motion, which means your joints can move further before an injury occurs. Stretching after you exercise (at least after you’ve warmed up a bit) has proven to be much more effective than pre-workout stretches, because by the time you’ve completed your workout, the muscles are “warm.” Post-exercise stretching also helps reduce soreness, improves workout recovery, and ensures muscle and tendons are working properly.

Different Ways to Stretch

There are three main types of stretching/flexibility programs: static (corrective) stretching, active stretching and functional stretching. No matter what type of flexibility program you are on, in the end it will help with posture, relieve muscle tightness and imbalances, prevent injury and improve the quality of everyday activities we take for granted from time to time.

Corrective/static stretching addresses your individual muscle imbalances, which increases extendability in muscles that are chronically tight. Typically, you will perform static stretches, meaning you hold the stretch for 20-30 seconds. Each stretch should be performed 2-3 times. The main goal of static stretching is to alleviate muscle imbalances, improve posture and prevent injury.

Active stretching gradually increases joint range of motion by moving into and out of stretches in a more rhythmic fashion. You hold each stretch for only 2-4 seconds, performing between five and 10 repetitions of a particular stretch. One of the added benefits of an active flexibility routine is that it strengthens and stretches at the same time. Active flexibility helps improve posture and your quality of movement.

Functional stretching uses muscles and the body’s momentum to take a joint through its full range of motion in dynamic, multiplanar (all directions) ways. Movement mimics those you do in everyday life or your training program, and make for great warm-up activities. Functional flexibility improves posture and the quality of your everyday life.

Lady stretching in front of window - Copyright – Stock Photo / Register Mark

Static Stretches

Static Calf Stretch

Preparation: Stand facing a wall or sturdy object. Bring one leg forward, using your upper body to lean against the wall and keeping the outstretched rear leg straight.

Movement: Draw the belly button inward and keep the rear foot flat and pointed straight ahead; do not allow the rear foot to cave inward or roll outward. Bend the arms, move chest toward the wall and tilt pelvis forward. Stop the movement when slight tension is felt. Hold for 20-30 seconds, switch sides and repeat.

Static Kneeling Thigh and Hip Stretch

Preparation: Kneel with front leg bent at a 90-degree angle. Rotate the back leg slightly inward.

Movement: Draw belly button inward, keeping the rear foot flat and pointed straight ahead. Do not allow the rear foot to cave inward or roll outward. Bend the arms, move chest toward the wall and tilt pelvis forward. Stop movement when slight tension is felt. Hold for 20-30 seconds, switch sides and repeat.

Static Abdominal Stretch Over Ball

Preparation: Lie supine (on your back) on a stability ball, with arms outstretched.

Movement: Draw belly button inward and slowly allow body to drape over the ball, extending legs and reaching with arms. Hold for 20-30 seconds.

Active Stretches

Active Calf Stretch

Preparation: Stand near a wall  or sturdy object. Bring one leg forward for support; use upper body and lean against wall. The outstretched leg should form a straight line and the feet and ankle should be in a neutral position.

Movement: Draw belly button inward and keep rear foot on the ground, with opposite hip flexed. Slowly move the hips forward, creating controlled movement through the lower extremity. Hold for 2-4 seconds and repeat for 5-10 repetitions. Switch sides and repeat.

Lady stretching - Copyright – Stock Photo / Register Mark

Active Standing Hip Stretch

Preparation: Stand with one leg bent and slightly forward. Turn the back leg slightly inward.

Movement: Draw belly button inward and squeeze the glutes while tucking the hips. Stride forward slowly until a mild tension is achieved in the front of the hip being stretched. Raise and stretch the stride-side arm up and over the opposite side while maintaining pelvic position. Rotate to the back leg in a controlled manner, hold for 2-4 seconds for 5-10 repetitions, then switch sides and repeat.

Tube Walking Side to Side

Preparation: Stand with feet hip width apart, knees slightly bent and feet straight ahead. Place resistance band under feet.

Movement: Draw belly button inward. Keep feet straight ahead and take 10 small side steps without allowing knees to cave inward. Repeat in the opposite direction.

Lady stretching on exercise ball - Copyright – Stock Photo / Register Mark

Functional Stretches

Multi-Planar Lunge

Preparation: Stand in proper alignment with hands on hips and feet straight ahead.

Movement: Draw belly button inward. While maintaining total body alignment, step forward (saggital plane), descending slowly by bending at the hips, knees and ankles. Use the hips and thigh muscles to push up and back to the start position. Perform 10 repetitions, then repeat on opposite leg. Progress to side lunges (coronal/frontal plane), followed by turning lunges (transverse plane).

Russian Twist

Preparation: Lie on a ball with your head and neck supported and both feet straight ahead. Lift hips up until they are in line with knees and shoulders.

Movement: Draw belly button inward. Maintaining core control, slowly rotate trunk to each side. Perform 10 repetitions to each side.

Prisoner Squat

Preparation: Stand in proper alignment with hands behind head.

Movement: Draw belly button inward and lower to a 3/4 squat position (controlled); do not let the knees go forward or cave inward. Extend hips, knees and ankles to return to start position. Raise onto toes and then return to start position. Perform 10 repetitions of the entire move, start to finish.

Exercise ball - Copyright – Stock Photo / Register Mark

Well, there you have it in a nutshell: how to start stretching today and take your first steps down the path to a more flexible, healthier you. These stretches should get you started, but there are a lot more you can add to your flexibility routine as you progress. Which muscles are tight will determine what stretches you should be doing. The benefits of stretching are important, so make sure it’s a regular part of your fitness program. Talk to your doctor for more information.


Lady happy stretching - Copyright – Stock Photo / Register Mark

Safe Stretching: Four Things Not to Do

There are no disadvantages to stretching – unless, of course, you do them improperly, which is actually easy to do if you don’t know what you’re doing. Here are a few tips to keep in mind before starting any stretching program:

DON’T bounce when stretching; hold your position for the specified time.

DON’T stretch cold muscles; always do some type of warm-up for at least five minutes: jogging in place, walking on a treadmill, light jump rope, etc.

DON’T overstretch. There should be a little discomfort, especially if you’re not used to stretching, but it should not be painful.

DON’T stretch a muscle improperly. If you are not sure of the proper stretch or how to perform it, get some assistance from a professional.

By Chelsea Cooper

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You Deserve a (Micro)Break

Microbreaks are short breaks that are taken frequently throughout the workday. Properly used, they can reduce the strain on anatomical structures. They also have been shown to positively affect productivity.1 Obviously, not all jobs or tasks are amenable to the use of microbreaks. But for those that are, they make a great deal of sense.

Microbreak Basics

A microbreak is a break that lasts anywhere from 30 seconds to as long as 5 minutes, and is meant to be taken frequently – as often as every 10 minutes. Evidence suggests microbreaks actually reduce muscle fatigue by as much as 20-50 percent in an eight-hour day.2

It’s important to contrast the microbreak with the traditional break at work. As an example, workers often begin their shift at 8 a.m. Around 10 a.m., they take a scheduled 15-minute break, after which they return to work. At noon or so, they get another break for lunch (also scheduled). They return to their jobs at 12:30 p.m., with another 15-minute break scheduled at some point in the afternoon.

To illustrate the microbreak, I’ll use the following example. When someone uses a manual typewriter (remember those?), regardless of how fast a typist they are, at some point the sheet of paper runs out. The typist must stop the act of typing long enough to put in a new sheet. While this only takes a few seconds, it forces the typist to take a microbreak.

Contrast this to someone using a modern computer, who thus has a never-ending sheet of paper and can type for an indefinite period of time. With that in mind, it’s no real surprise that conditions such as carpal tunnel syndrome are more common in computer users.

microbreak - Copyright – Stock Photo / Register Mark

To offset the effects of constantly striking the computer keys, I’ve long suggested drinking a glass of water every hour. This has significant benefits for the typist. First, it stops the typist long enough to take a microbreak. Second, it forces the typist to stop periodically, leave their computer, walk (to get a new glass of water) and perhaps even go to the bathroom. In other words, it makes them become physically active. Finally and perhaps most importantly, it hydrates the typist, which is always a good thing.

Microbreaks as Prevention

Stanford University provides the following tips to minimize the development of health issues by taking microbreaks and/or changing up your routine3 (I’ve made a few changes):

  • Take microbreaks (approximately 30 seconds to 1 minute in duration) every 10 minutes.
  • Avoid extended periods of continuous tasks (e.g., typing) by taking short breaks or performing other tasks (e.g. filing, talking on the phone, etc.).

It is important to build microbreaks into the daily routine. As such, Stanford also provides the following ideas for making breaks a part of the workday:

  • Move the printer to an area that requires you to stand up and walk to get a printout. (My printer is in another room.)
  • Stand up when talking on the phone (the use of a stand-up desk is also helpful),
  • Go to the restroom or get a cup of coffee / water (frequently; remember the glass of water every hour),
  • Break up continuous computer time with tasks such as checking phone messages, reading reports, etc.

The folks at Stanford also provide the following exercises and stretches as suggestions:

Eyes – Eye strain is particularly problematic for those who stare at computer screens for long periods:

  • Eyes around the clock – Look straight ahead. Without moving the head or straining the eyes, focus on the 1 o’clock position of an imaginary clock placed in front of you. Next, focus on the 2 o’clock and 3 o’clock positions, and so on, until reaching the 12 o’clock position. Repeat the same exercise in a counterclockwise direction.
  • Close both eyes tightly for a second or two and then open them widely (repeat several times).
  • Refocus the eyes momentarily on an object at least 20 feet away.

Neck and Shoulders – We seem to live in an environment that places a constant strain on the neck and shoulders:

  • Shoulder circles – Lift the shoulders toward the head. Pinch the shoulder blades to roll the shoulders back, and let the shoulders drop down to the starting position. Try to move the shoulders in a circular fashion. Repeat.
  • Shoulder shrugs – Lift the shoulders toward the head. Hold for 1-3 seconds and then relax. Repeat.
  • Shoulder pinches – Pinch the shoulder blades together. Hold for 1-3 seconds and then relax. Repeat.
  • Slowly turn the head to the side and hold for 10 seconds. Alternate sides and repeat.
  • Slowly tilt the head to the side and hold for 5-10 seconds. Alternate sides and repeat.

Hands – Problems with the hands and wrists are endemic in the workplace:

  • Catch and release – Clench the fists slowly and hold for a few seconds. Slowly open the hand and spread the fingers. Hold this position for a few seconds and repeat.
  • Flex and extend – Raise the arms out in front with the palms facing down and the fingers flat. Slowly extend the wrists and fingers so they are pointing up. Hold this position for a few seconds. Slowly lower the wrists and fingers so they are pointed toward the ground and hold for a few seconds. Repeat.
  • Place the hands together with the fingers spread apart and fingertips at chin level. Slowly lower the hands, peel them apart and then reverse the process. Repeat.

Low Back – Even though we know more about low back pain than ever, it doesn’t seem to be going away:

  • Stand with hands on the hips and feet about shoulder-width apart.
  • Slowly lean the hips forward while keeping the shoulders slightly back. Hold the stretch for 5-10 seconds.

Chiropractic and Microbreaks

Exercise and other aspects of healthy living have always been a part of the armamentarium of the chiropractic profession. In my classes over the years, I’ve taught that many conditions have multiple causes and multiple solutions. It would appear that the use of microbreaks is one such part of the puzzle. Talk to your chiropractor to learn more.

By Paul Hooper, DC, MPH, MS

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Delayed Muscle Soreness: How to Recover (Without Drugs)

Delayed-onset muscle soreness (DOMS) is a common occurrence. Recovery strategies are designed to reduce pain and recover faster. Let’s explore some of the current research into the most popular and effective recovery strategies, and discuss why you need to balance their use with your overall goals (and after consultation with your doctor, of course).

Massage Therapy

Studies have generally shown massage to be effective for DOMS, reducing pain and in some cases improving function. However, the studies differ in the treatment duration and whether the treatment was performed before, immediately after or 48 hours after DOMS.

One study1 evaluated massage performed for 10 minutes approximately 30 minutes after eccentric exercise. Massage was shown to reduce DOMS by approximately 30 percent, but had no effect on muscle function. A comprehensive review2 asserted that massage may reduce DOMS, but questions whether force recovers more quickly.

A recent study, however, found massage did in fact help with function in the form of gait performance.3 Massage was provided for 15 minutes on the same day DOMS was introduced via isotonic exercises (going up and down stairs). Not only was there a reduction in pain, but also an improvement in gait on the same day DOMS and massage were applied. (It would be have been interesting if the study also had looked at the effects after 48 hours.)

exercise - Copyright – Stock Photo / Register Mark

What about applying massage prior to an intense exercise session? Shagufta, et al. (2014) compared vibration to massage therapy in terms of DOMS recovery.4 Fifteen minutes of massage, applied prior to the performance of an eccentric exercise, was effective in the prevention of DOMS, in addition to restoration of concentric strength (1 RM). However, it had no effect on maximal isometric force.

Massage therapy also was assessed for its impact on relieving muscle soreness 48 hours post-exercise. Andersen L.L., et al. (2013) examined whether massage therapy had any acute effects on muscle soreness, comparing massage to active recovery.5 Massage was provided to the upper trapezius muscle for 10 minutes. Perceived soreness significantly decreased 20 minutes after treatment. However, the effects diminished within the hour. Findings suggest massage is just as effective as active exercise in reducing muscle soreness.

With respect to massage and DOMS, timing of massage sessions need to be taken into consideration. Massage can be applied before, immediately after and over the next 48 hours. In the studies referenced above, the massage sessions provided also were short in nature. Experimenting with longer massage sessions may impact results differently.

A study by Kargarfard M., et. al. (2015) found body-builders who received a 30-minute massage after an exercise session demonstrated a better recovery rate.6 Working with athletes in the field can allow you to perform short massage sessions and have a positive effect on DOMS. In the clinical setting, experimenting with 30- to 60-minute massage sessions may provide better results.

Stretching

Stretching, static stretching in particular, has been used as a “warm-up” prior to exercise, and as a strategy to prevent DOMS. Does it work? The research overwhelmingly points to the answer being no. A Cochrane Review in 2007 included 10 studies and found no evidence that muscle stretching reduced delayed-onset muscle soreness in young, healthy adults.7 The study was updated in 2011 with two additional studies and reached the same conclusion.8

A study by Torres R., et al. (2013) noted favorable effects on muscle stiffness following repeated bouts of stretching days following exercise.9 However, there was no change with respect to DOMS. If the goal is to recover faster from DOMS, stretching may not be the best strategy to use. In recent years, there has been a shift in focus from static stretching to dynamic exercises in reducing DOMS. Again, timing may be the ultimate factor in its effectiveness.

Cryotherapy

Various cryotherapy strategies, such as ice packs, cold-water immersion and recently, whole-body cryotherapy, are quite common practices in rehabilitation and sports performance recovery. Their effects on DOMS are well-known. A recent systematic review by Hohenauer E., et al. (2015) confirmed that cryotherapy reduced DOMS up to 96 hours post-exercise and RPE (ratings of perceived exertion) up to 24 hours compared to passive controls.10 However, the use of cryotherapy may need to be assessed depending on what the ultimate goal is.

A recent study by Roberts L.A., et al. (2015) looked at the effects of cold-water immersion on long-term adaptations in muscle to strength training.11 Results showed that cold-water immersion attenuated long-term gains in muscle mass and strength. Although you may get better recovery, you could be sacrificing long-term strength and muscle gains. If this is the case, what other strategies can we utilize to maintain muscle and strength?

Active Exercises

Lower-intensity exercises prior to a maximal eccentric contraction may provide benefit against muscle damage. Lin M.J., et al. (2015) evaluated whether low-intensity eccentric contractions (performed with a load of 10 percent of maximal voluntary isometric contraction strength with reps in the 30 to 60 range) could protect against muscle damage.12 Results showed a 30-66 percent protection against muscle damage induced by maximal eccentric exercises. The protective effect lasted one week.

What about maximal isometric contractions? A study by Lima L.C., et al. (2015) found maximum isometric contractions performed 2-4 days prior to a demanding eccentric exercise provided a protective effect from post-exercise soreness.13 The authors recommended putting patients through these non-damaging isometric exercises prior to putting patients through unaccustomed exercises.

Chen H.L., et al. (2012) reached similar conclusions, finding two maximum isometric contractions performed two days before eccentric training could be an effective strategy to minimize muscle damage.14

Take-Home Points to Discuss With Your Doctor

Various recovery strategies can help your athletes recover faster. Massage therapy, cryotherapy, stretching and active exercise all appear to provide some form of relief from DOMS. However, while some may improve DOMS, they also may stunt muscle strength, power or growth. Timing of these strategies is also important. A certain strategy may work best after an exercise session or two days prior. As you can see, there are no straight answers to what works and what doesn’t.

In some cases, such as when using cryotherapy, new research is showing the benefits of recovery need to be weighed against long-term impact on muscle strength, power and hypertrophy. Applying massage therapy is practical before, during and after a training session, since the 15-minute time frame has been shown to be effective. Static stretching by itself may not be the best use of a patient’s or athlete’s time when other strategies are more effective. Finally, the use of isometrics is an important strategy to prepare you for the stresses of a more intense exercise program.

By Jasper Sidhu, BSc, DC

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