the-arena

The Un-Scratchable Itch

Many times I see patients that have been unsuccessfully treated for one or several conditions, and are coming for a second (sometimes 3rd or 4th!) opinion. I had an interesting case of a patient who had been treated for a very common type of heel pain (plantar fasciitis), but had minimal improvement. She had an array of typically very good treatments (stretching, shoe gear modification, oral medication, injections, physical therapy, etc.), but her symptoms persisted. She had pain in her heel and arch, and the pain was sometimes present in the morning or after periods of rest (typical of a plantar fasciitis), but also occurred at seemingly random times throughout the day. Sometimes walking/running would illicit no pain, sometimes it was unbearable. The pain was often burning in nature, sometimes sharp. After going through a thorough history, the patient also related an interesting tidbit… she had an annoying, persistent itch on the bottom of her foot, and had seen foot specialists and dermatologists and been treated with various creams but to no avail. The itch was present without any other dermatological signs or symptoms, and nothing seemed to relieve it.

the-arena-1Many patients will have very clearly identifiable symptoms and exacerbating factors which they can lucidly describe, and that correlate nicely with a specific condition. Sometimes, however, the patient has a difficult time describing the nature of their pain, and exactly what makes it worse (or what makes it feel better). While the patient above had obvious symptoms, they did not fit nicely into any diagnosis box. I see this difficulty many times when people are dealing with pathology involving nerves.

The above patient was examined, and sure enough a specific examination of an area known as the Tarsal Tunnel elicited a shooting, electrical type pain into her heel and arch, and also increased the “itchiness”. Is this case, the patient was not suffering from a plantar fasciitis, and had no dermatological reason for the itch, but was suffering from a condition known as tarsal tunnel syndrome.

Many people have heard of carpal tunnel syndrome. Tarsal tunnel syndrome (TTS) is a similar phenomenon that occurs in the foot. The tarsal tunnel refers to a specific anatomical area on the inside part of the foot and ankle. There is a specific ligament in the area (the laciniate ligament) that attaches from the medial malleolus of the tibia, to the heel bone (calcaneus). Thus a tunnel is formed with the ligament as the roof, and the bones as the floor of the tunnel. All the tendons, arteries, nerves and veins that travel to the bottom (plantar) foot pass through this tunnel. The main nerve passing through this area is known as the tibial nerve, which eventually branches to provide innervation to the bottom of the foot. For a variety of reasons, the tibial nerve can get compressed which will then cause pain to the bottom of the foot. This pain can present very differently for different patients, but most commonly will cause burning, or electrical type pain. Many times, it can also be associated with numbness, tingling, or hard to describe sensations which we refer to as paresthesias. In this particular case, the patient’s pain and “itching” sensation were both caused by a tarsal tunnel syndrome.

TTS can be a diagnosis of exclusion; where everything else is ruled out as a cause of pain. A focused exam needs to be performed over the tarsal tunnel, including percussing the area and looking for radiating pain or paresthesias to the heel, arch or toes (referred to as Tinel’s Sign) or, (less commonly) Valleix Sign, which is pain radiating up the leg. Physical exam and x-rays will often show a foot and ankle position which can increase pressure on the nerve (many times a patient will have a flat foot with excessive pronation which keeps the laciniate ligament taut, increasing pressure on the nerve). An MRI may be useful if there is a structure impinging on the nerve such as a ganglion cyst, accessory muscle belly, or inflammation of nearby tendons. Many times, an MRI is inconclusive, and a patient will be sent for a neurological exam known as an NCV/EMG to evaluate for nerve pathologies. This is often an important test, as it will also determine if there is nerve pathology from any were else in the lower extremity. Sometimes, compression of a nerve originating in the back can lead to similar foot pain and strange sensations.

Treatment for the condition can also vary based on the etiology. If it is simply a positional issue, proper shoe gear and custom orthotics and avoiding compression on the area simply will help. Many times, a topical or oral anti-inflammatory medication is needed. A doctor may need to use steroid injections as well. In cased when there is a mass in the tarsal tunnel, this will typically need to be removed surgically to provide relief. Sometimes, a surgical release of the ligament and any strictures around the nerve is necessary.

So, if you have pain or funny feelings, and are being treated for a foot condition with limited success, make sure you inquire about tarsal tunnel syndrome.

fascial-manipulation-sapiens-potens-est-manus-85304718

Why Your Workouts May Not Be Working

Have you ever exercised and felt that you were not achieving the results you expected? Or worse, have you developed pain or worsened an already painful condition with exercise that was supposed to help? Have you been told by a trainer or physical therapist that your glutes are not firing or you have poor balance and you just can’t correct the problem?

These are very common issues that I hear about in my practice that can have multiple causes. The first thing to examine is the program itself – what exercises are being done and are they even appropriate for the individual based on their health history and present condition. Very often I see people doing exercises that they should definitely not be doing because they are harmful and will cause injury. Unfortunately, I also see many trainers and specialists prescribing these exercises.

The second thing to examine is form – are the exercises being done properly. A good exercise, if done incorrectly, can be a bad exercise. Always be meticulous with form. The purpose of exercise should be to improve our health, whether the goal is increasing strength and endurance, rehabilitating tissue, or correcting movement patterns.

The above are the very obvious reasons and should always be ruled out first. But if the exercises are appropriate and being done with correct form and the issue is still present, there may be another less obvious culprit. This hidden hijacker of a good workout results could be fascial tension.

You may have heard of fascia recently, as it getting much attention due to research, which it deserves. Fascia is connective tissue that literally wraps and connects every structure in the body. To visualize this, imagine removing every organ, muscle and bone. If we were to leave all the fascia intact, we would have a 3D outline of the entire body – a completely continuous web.

Fascia transmits energy and force, in addition to holding everything together. We often think of muscles contracting independently to perform an action. For example, flexing our elbow we attribute to the biceps and brachialis muscles. But in reality, it is much more than that. Tension is created throughout the entire arm and shoulder, into the trunk and down to the hand through fascial connection. Other muscles are also performing at different levels in order to stabilize the arm. So really, everything is working, but at different levels of intensity.

We often think of muscle contraction generating force in the tendons (which attach the muscles to bones) in order to produce a movement. Studies have recently demonstrated that only 70% of the generated force of a muscle contraction is transmitted to the tendons. The other 30% is transmitted outward to the fascia surrounding the muscle by way of attachments along its entire length. Because fascia is completely continuous throughout the body, this force is transmitted to other muscles and structures. This shows that when a muscle acts, it is doing much more than its attributed movement. It is communicating with and working in conjunction with other muscles along a line.

Fascia is also a sensory organ. Another recent discovery is that there there are more sensory nerve endings in the fascia than there are in the muscle. These nerve endings provide information to the brain and spinal cord about position, tension/stretch and pressure – a sense of where we are in space and what is happening to keep us there. Keep in mind that most of this is happening without us even realizing it.

Fascia is made up of different layers that need to slide over each other in order for movement to happen, and in order to have accurate information exchange with the nervous system. If there is restriction of this sliding, usually due to a densification of hyaluronic acid, the substance that lubricates the fascial layers, overall movement can become restricted. Muscle activity can become inhibited due to the lack of efficient communication through the nerve endings that live in the altered fascia.

The densifications causing this altered function can be a result of old trauma/injuries, surgeries, scars or repetitive strain. For example, an old ankle sprain that didn’t heal properly may subtly cause dysfunction either locally in the foot/ankle, or above in the knee, hip, pelvis or even in the shoulder on the opposite side of the body. These densifications may be difficult to detect because they are often found in different areas than where the symptoms manifest. In this case it would be helpful to be evaluated by a professional who understands this process to properly determine the dysfunction and correct it.

Fascial Manipulation is a diagnostic and treatment system developed by the Stecco family in Italy. It sees the body as an interconnected network of points along the fascia that make up different motion planes. The points are centers of coordination for underlying muscles. Interestingly, many of these are also acupuncture points. Densification, or dysfunction, in these points can alter the muscle activity. Fascial Manipulation practitioners find these areas of densification and remove them through a very specific, deep massage technique. When normal sliding is restored to these points, or centers of coordination, very often pain is relieved and muscles function much more effectively with less stress. It is worth noting that Fascial Manipulation has the most scientific research behind it than any other manual soft tissue technique.

Freed movement in the fascial planes leads to normal coordination of muscle activation. This can allow workout results to be more consistent with the targeted actions of exercise and desired goals. If you feel you are not getting the most out of your workout and you know you are doing the proper exercises with good form, consider a fascial evaluation.

Robert Inesta, DC, L.Ac, CCSP

painful ankle

Ankle Injuries – The most common athletic injury

Almost every week a player in an NFL game sprains his ankle. This is a common injury in most running sports including soccer, rugby and track. It occurs commonly in court sports like tennis and racquetball. It is seen often in gymnastics and on a trampoline.

Ankle Injuries occur typically from twisting your ankle in inversion. This means your foot comes under your body or actually your body goes over your foot and ankle which is planted on the ground. You may hear a “pop” or just have sudden sharp pain. The ankle will typically swell immediately or within 2 hours as the blood leaks from the torn ligament to underneath the skin. An ankle sprain is just stretching or tearing the ligament that connects 2 bones of your ankle, namely the fibula and the talus. Most ankle sprains are on the outside part of the ankle, but these can also be on the inside part.

If you injure your ankle, it is important to make sure it is not broken. If you can walk on it with minimal pain, it is not likely to be fractured. If it hurts a lot or you cannot walk on it, you need to get an x-ray. It is not urgent to go the hospital emergency room unless it is an open injury or you think you may have dislocated it. Immediately ice it and elevate it and call your local orthopedic specialist to be seen ASAP. My office policy is if you need to be seen urgently, we will see you the same day. We will take an x-ray to confirm that there is no fracture.

If it is just a sprain, you should be able to get back to full normal activities including sports anywhere from a few days to up to 6 weeks after the injury. If you don’t recover quickly, therapy may help. Strengthening the tendons around the ankle will help with the healing. If you are not improving, you should get an MRI to make sure an occult fracture was not missed.

As with other injuries, the best way to treat an ankle injury is to prevent it. Wear good shoes, sneakers or cleats that are tied snugly and fit well. Once your footwear has worn down, throw them out and get new ones. Most injuries will occur when you are fatigued, so be more careful at the end of a game or workout.
If you injure your ankle, ice it and elevate it. If you cannot bear weight on it, get it checked and get an x-ray. Keep your local orthopedic sports medicine specialist’s office number on your cell and don’t hesitate to call and get checked.

Rick Weinstein, MD, MBA

protien-powder

Which Protein Powder Should I Buy?

There are many different types of protein powders and brands of powders on the market, and it can be difficult to decipher which is the best one to purchase. Protein powders are derived from various sources, such as whey, egg whites, soy, rice, kemp, pea, and flax. There are pros and cons to each type, depending on individual needs and preferences. Additionally, there are an endless number of brand names to choose from, and it may be overwhelming to decide what to purchase.

Whey is the most common and cheapest protein powder available on the market. Whey protein is derived from milk; it is the liquid extracted from milk when cheese is made. Whey is a complete protein and contains all the essential amino acids. It is also rapidly digested and good for muscle synthesis. Whey is available three forms: whey protein concentrate, whey protein isolate, and whey protein hydrolysates. Concentrates usually have less protein and more carbohydrates and other components than isolates. Isolates have been purified in an attempt to get to the purest form of whey protein. Whey hydrolysate has similar protein levels to isolates, but the protein has been broken down into small peptide chains and amino acids, which makes it easy to absorb and hypoallergenic, since it denatures the protein. It also can be more expensive. Casein, which is also derived from milk, can also be used to make protein powders. Casein is more difficult to digest than whey, and therefore it takes a longer time for the body to utilize it.

Egg whites is another type of protein, and it is especially good for those avoiding dairy, soy, or gluten. It is a high quality protein for leaning out and building muscle. Some people complain about the taste.

Soy protein is a complete protein that is easily digested, but it is not digested very quickly. It is lactose and gluten free. Some brands use GMOs, so look on the label if you do not want to use genetically modified soy. Soy contains isoflavones, which may potentially reduce the risk of cancer and cardiovascular disease. Despite this benefit, some studies show that in excess, isoflavones can interact with estrogen and affect hormone levels. In men, this may cause a decrease in their testosterone levels.

Other good sources of vegetarian protein are from peas, rice, hemp and flax. Sometimes quinoa, millet, and lentils are added as well. They usually come in a blend since none are complete proteins on their own. However, they can be sold separately as well. For example, pea protein is deficient in cysteine, even though it has the same amount of protein per serving as whey. It is also free of cholesterol, fat and gluten. Rice protein is also deficient in some amino acids, especially lysine. However, it is gluten free and inexpensive. Hemp protein powder comes from hemp seeds and cannabis, though it does not contain a significant amount of THC, the active ingredient in marijuana. Hemp is high in protein and omega 3 and omega 6 fatty acids. However, it is also very high in fat and calories. It can also be expensive, since growing hemp products in the US is illegal. There are many vegan powder blends on the market, which combine hemp, peas, rice, quinoa, etc. Vegan powders are dairy-free, gluten-free, and soy-free, and when combined, they are complete proteins. They can be a bit more expensive than whey products.

Besides the source of the protein you choose, it is also important to look at the QUALITY of the protein powder, which differs brand by brand. It is important to avoid a lot of artificial ingredients and fillers, so the fewer ingredients on the label the better. Consumer should also look at the calorie content and types of flavors and sweeteners used in the products. You should also pick a brand that has been tested for quality and purity so that you know that what is listed on the label is actually in the product. The supplement industry is not regulated by the FDA, but many are certified by GMP (Good Manufacturing Practice). This is a system to ensure that the products meet certain quality standards during its production and manufacturing.

No matter what you choose, it is important to remember that the body needs adequate protein. Protein plays a crucial role in the body and do most of the work in the cells. They are also required for the function, structure, and regulation of the tissues and organs in the body. So do your research, and buy a protein powder that fits your lifestyle, tastes, and needs.

Tarsal Coalition

The Atypical Flat Foot

Sometimes, a patient can present with a “sudden flatfoot”.  They relate functioning normally, then suddenly, typically after a trauma (large or small), their foot flattens and heel rolls with associated pain in the rear-foot and ankle.  This rarer type of flatfoot is typically caused by a spasm of the peroneal tendons on the outside of the ankle/rear-foot, and is referred to as peroneal spastic flatfoot.  Many times, this condition is a symptom of something called a tarsal coalition. A tarsal coalition is an irregular union of two bones of the rear-foot which should not be present. The coalition could be made of fibrous tissue, cartilage or bone.  Many people who have tarsal coalitions don’t know about it until they somehow injure the coalition.  This typically occurred in teenage years, as patients become more active in athletic activity. However, it can also present earlier or in adulthood.  As the coalition is damaged, the peroneal tendons go into spasm as a splinting mechanism. Essentially, as the tendons pull tighter, they restrict the range of motion of the painful joint. This pulling motion causes the foot to flatten as it pulls the heel outward and the arch downward. Sometimes the foot goes through period of spasm and relaxation, while other times the foot stays in a flattened position.

Conservative measures aim to reduce pain and attempt to release the spasm. These measures usually include rest, ice, anti-inflammatories, a period of casting, and injection of nerves to help release the spasm.  However, once symptoms start, many patients end up requiring surgical intervention. Depending on the severity of the coalition and the joints involved, some patients will have the coalition removed (many times placing a spacer between the joints). Other times, after resecting the coalition, the joints involved may need to be fused together to diminish pain and prevent re-occurrence.  If you develop he sudden flatfoot, seek medical attention ASAP.

Stress

7 Smart Strategies for Stress Management

What is stress?

Stress is a feeling that we all experience on a regular basis. Whether we are athletes, coaches, or administrators, it feels as if it invades us no matter what we do. If I said that stress is good, some of us may be skeptical given that we associate stress with feeling uncomfortable. However, our bodies secrete stress hormone, called cortisol, so we can get our muscles moving. Any activity that we perform requires an automatic physiological mechanism to allow us to react. Being alert to the referee’s whistle, running back to play defense, and sprinting the last 50 meters would be impossible to execute unless our bodies provided us with the energy to do so. However, it is a completely different experience when we perceive any one of those tasks as excessively negative or potentially threatening.

Unreasonably worrying about facing an opponent, paying excessive attention to an error, or being overly concerned about losing the lead increases our cortisol levels. The more we ruminate on the negative consequences, the higher our cortisol. Our heart begins to race, hands feel sweaty, thoughts are racing, memory recalling becomes more difficult, and our mood is increasingly irritable. Inside our bodies, our overall health equally suffers: excessive sugar is produced by the liver increasing risk for type 2 diabetes; the heart needs to work harder elevating the risk for hypertension and blood vessel problems; headaches become recurrent; our immune system becomes compromised; and, we become prone to getting physically injured.

Stress is not a sign of personal weakness. It is a physiological response connected to how we perceive the environment around us. Rather than hoping not to get stressed out, we would be better off recognizing our bodies’ stress signals in order to take pro-active approaches to deal with stress. These changes start by becoming more self-aware of situations where we tend to become stressed. Then, we must disengage from our typical thinking or emotional responses. Lastly, practice at least one of the seven stress management strategies mentioned below.

1. Breathe

If we find ourselves being frustrated and pessimistic, take a pause and re-evaluate what is triggering such a stress response. Going with the emotions of the moment and being carried away into a negative spiral will only increase our stress levels. Hence, take a brief pause and breathe by taking simple, but conscientious breaths. My favorite trick is to start counting backwards starting from 100 by skipping in 7s. Example: 100-93-86-79-72, etc. I don’t have to reach to zero, but I stop when I get to a number where I’ve regained a sense of calm.

2. Use positive reframing

Reframing negative thoughts into positive ones is a very powerful tool. We often find ourselves being immersed in negativity as we picture a pessimistic outlook. Sometimes, we become so ingrained in our negative spiral that it consumes our energy and we find ourselves spreading it out to people around us. The final outcome is definitely not productive. Hence, if we find ourselves heading into a place of negativity, we can put a strong stop to it and reframe it. Most of the time, what we have negatively envisioned may not even happen. Taking a pro-active action NOW can surely alleviate potential future negative scenarios. On the other hand, if there is nothing that can be done now, then worrying will only increase our stress levels. Remember, use positive re-framing when faced with a stressful situation or a negative mindset.

3. Find time to turn electronics off

Our pace of life is often quite busy. In a society where we have become so electronically dependent, we are increasingly using our computers, tablets or phones to such an extent that is rapidly becoming an addiction. We seem to have difficulty putting the electronics away. We tend to believe that unless we respond to every text or email right away, we may be socially cut-off. As tempting as it is to remain on top of every text and email, it is surely stressful attempting to do so. We must learn the difference between urgency and importance when faced with an overwhelming amount of electronic communication. Many of our messages or emails are important, but maybe just a few of them are so urgent that require our immediate attention. The important ones can wait. If reducing stress is our goal, then differentiating between important and urgent texts or emails will certainly alleviate some of our stress.

4. Visualize a positive outcome

There is a direct relationship between how we visualize a future outcome and its eventual result. The more negativity we project, the more likely such a scenario will occur. Hence, there is no point in projecting defeat before competition started. Even if the odds are against you, give yourself the best you’ve got. You never know! There have been many films produced and books written depicting successful stories of athletes who beat the odds and came out winning. The silver lining of trying your best is to feel empowered by your own efforts and go home feeling proud about yourself.

5. Get a good night’s sleep

Along the lines of our “electronic” life, it’d certainly help if we could turn our computer or TV off at least half an hour before going to bed. The blue light from either object triggers the brain into thinking that it is still daylight. As a consequence, the melatonin hormones, which helps us to rest, drop and our sleeping difficulties increase. At the same time, stress hormones remain elevated throughout the night. This combination of elevated cortisol and drop in melatonin makes our bodies feel tired. To compensate for this tired feeling, we tend to jump start our day by drinking coffee, which increases our stress hormones even more. Therefore, remain disciplined to shut down electronics half an hour before bedtime. Our bodies and minds will be very grateful in the morning.

6. Meditate for 10 minutes a day

Research shows that meditation has multiple benefits. It allows our bodies to disengage from our stress, produces calmness, builds our immune system, and promotes healthy hormonal balance. We would all be better off if we took 10 minutes before going to sleep, close our eyes and pay attention to our breath. Bring awareness to the inhale and exhale of each of our breaths. As we pay attention to them, we will likely notice thoughts coming up. Rather than following these thoughts, just notice them and bring the attention BACK to the breath.

7. Make time to socialize

Last, but not least, do maintain an active social life. Engage in face-to-face interactions with friends. Go out or invite them over for a pizza, or walk instead of drive. Any activity that promotes eye-to-eye interaction directly engages the right side of our brain, which leads to emotion regulation. The more we interact with others, the better our ability to manage our stress.

The Takeaway: Stress is unavoidable, but there are actions we can take that can certainly help us to mitigate its uncomfortable effects. The mentioned strategies can help us manage stress triggers in order to have better control over our emotions. As we begin to manage our stress, the people around us will less likely react in stress. As a result, there will be less stress to manage overall. Like any new habit, it takes commitment, but once we get used to following a stress reducing routine, we will feel more energized and ready to tackle any of life’s challenges.

 

Alex Diaz, PhD
Dr. Alex Diaz Consulting

Step-Up Exercise

How To Do Step Up

Emphasis

The concentric action is hip and knee extension. The primary muscles used during hip extension are the gluteus maximus  and hamstrings (semimembranosus, semitendinosus, and biceps femoris). During knee extension is quadriceps (vastus lateralis, vastus intermedius, vastus medialis and rectus femoris).

Starting Position

Begin the upward movement by stepping up with one leg. Keep trailing foot at start position and shift weight to the leg on the box. As the hip and knee extend on the box stand tall while simultaneously bring the opposite foot next to the starting foot.  The downward movement starts with shifting the body weight to the same start leg and stepping off the box with the opposite leg. Shift the body to the the opposite leg and the start leg will follow to starting position.

Movement

Training Tips

  • Keep torso erect and parallel to the tibia
  • Initial contact of lead foot with top of the box must be made by the entire foot
  • During upward extension push through the heels and squeeze the glutes
  • Maintain hip flexion, knee flexion, and dorsiflexion of ankle at top of movement

Warning Tips

  • Do not allow the heel to hang off the edge of the box

Charles DeFrancesco, NFPT, USAW, NASM
President & CEO of Pure Fitness Club, Owner of Fit and Functional

What do you expect

What Do You Expect?

Do you want to enjoy good health? It seems safe to say that the answer is most likely, “Yes”. Now, do you expect to enjoy good health? This answer may be quite different.

I recently heard an audio clip of a speech by a motivational speaker named Les Brown. He told a story about a conversation he had with his son in which Les asked if he wanted to be successful. Of course the answer was yes. He then asked if he expected to be successful based on his current behavior. His son fell silent and couldn’t answer. I found this simple conversation to be incredibly powerful and it really made me think.

The definition of “expect” according to Merriam-Webster’s Dictionary is, “to think or believe that something will probably or certainly happen.” If we want something that we don’t have, we must change our behavior in order to get it. When our behavior is in line with the results we want, we can then expect to have those results. When we have an expectation, our behavior should meet or even exceed the expectation. It is a very simple formula.

So I will ask again, do you expect to enjoy good health?

What are you feeding your body? How are you moving? How are you sleeping? How are you thinking? How are you feeling? How do you manage stress? What are you feeding your brain? What are you learning? Who and what are your influences? What are you reading? What are you watching? What are you listening to? What are you focused on? Are you focused on problems or solutions? Are you focused on what you want or what you don’t want? What are your dreams? What are you working towards? How are you spending money? How are you earning money? How are your relationships? What are you doing? What are you contributing? The list goes on, but I think you get the point. All of the above significantly affect our health. Taking a closer look at ourselves, it becomes evident that we have more control over our lives than we typically think we have.

I challenge you to take a look within and ask yourself some of these questions. Write them down. Write the answers. Then ask yourself what do you expect? This is a great step. If you don’t like the answer, then make a change. Take another step, then another, then another…

I’ll conclude with a great quote from one of my favorite Dr. Seuss books, “Oh, The Places You’ll Go”:

You have brains in your head.
You have feet in your shoes.
You can steer yourself any direction you choose.

Robert Inesta, DC, L.Ac, CCSP
Westchester Sports & Wellness
www.westchestersportsandwellness.com

Summer Weight Loss

Getting in Shape for the Summer

By: Rick Weinstein, M.D., MBA

As the weather gets warmer, it is apparent who has been hibernating and not kept in shape in the colder months. This is the time of year where most people want to get into better shape. This should be a year-round activity, but the warmer days definitely afford you more opportunities to work out.
The journey to getting in shape always starts with the first step. This may mean starting with walking. It is best to have a good pair of sneakers or running shoes and a softer surface, such as grass or a track, which is better than the streets. You should be able to get a sweat going and get your heart rate up to get a real work out. Many phones can measure your heart rate using one of the work-out apps that are readily available. Try and get your heart rate up to 60% of your maximum heart rate. Maximum heart rate is approximated as 220-age.

It is important to do the work-out that you enjoy doing. If you like running or biking, then do that. If you prefer tennis or soccer, go out and play. You should be working out 6 days a week. If you do only 1-2 days a week, you will not get much benefit at all.

Before you get involved in working out and playing sports, warm up and stretch out. Do not push yourself too hard initially, but as you get into better shape, you do need to continue to push yourself. Give yourself short challenges and try to meet goals. Studies have shown that tracking your workouts on a calendar is more likely to keep you on the track to getting into better shape.

If you want to lose weight, working out can help, but the only way to lose weight is to burn more calories than you take in. Pick a reasonable diet that you can handle and stick to it. Don’t switch diets every few weeks or you will not lose any weight.

The goal of getting shape is to be healthier and feel better. Working out will give you a psychological boost and it is a cure for sadness and depression. The weather is warmer and the days are more pleasant, so get yourself outside and do something good for you.

Stop Picking the Scab

When treating painful conditions, an essential, and often ignored factor is removing the irritants causing the problem. The unhealthy world we live in provides an endless supply of irritants and causes of imbalances and pain that we are not always aware of. Some of these include sitting, workstations, cars, mattresses, computers and smart devices, shoes, sports, exercise, hobbies, foods, certain people – the list goes on and on.

Many of us, especially as children, have been told, “Don’t pick the scab,” after cutting or scraping our skin. The reason being that as the skin heals, we do not want to disrupt the process by picking at the scab. If we were to consistently pick at it, the wound would continue to open and would not heal. This is what happens in painful conditions where either the causative factor is not determined, or it is determined but patient does not make the necessary changes to remove it.

“Picking the scab” is a term used by Stuart McGill, Ph.D, one of the top lumbar spine researchers in the world. One of McGill’s main points in treating lower back pain is determining the causative factors and making changes in the patient’s lifestyle that will protect the spine and prevent further irritation. This is what is meant by not picking the scab.

This sounds like a very simple approach when compared to extensive treatments, drugs, surgeries, etc, but is often much easier said than done. When looking at all the possible causative factors for our pain, it may seem impossible to avoid them all. The first step is awareness – identifying the factors. Once identified, one can then make decisions on altering lifestyle. If the causes cannot be removed completely, it is important to try to create as much balance as possible in order to counteract the negative aspects as much as possible.

A common mistake in dealing with pain is making generalizations such as, “I just have to stretch more”, “I just have to exercise more”, “I have to do Pilates”, “I have to get adjusted more”, etc. While sometimes there is some truth to these generalizations, we must realize that every individual is unique and has different needs. What is true for one is not necessarily true for another. And it is often not about getting more, it is about getting what is right for the individual – quality instead of quantity.

Here are some examples of questions to ask your healthcare providers:

What types of exercise would be most appropriate?
What type of stretching would be most appropriate and when?
What movements or positions should I avoid?
How can I alter my workstation?
How can my diet affect my condition?
What else can I be doing on my own to help myself?
What types of treatments would be best for my situation so that I improve function and get the most out of life?

Keep in mind that the healthcare provider is not the healer. The patient is the true healer. It is their body that is changing, doing what it was naturally designed to do. The provider has an important role in helping to guide the patient on his or her journey, advising and providing services/products that allow the patient to heal more efficiently. Patients must take responsibility for their health, and healthcare providers must empower them to do so. By understanding the underlying causes of our conditions, we can take action to create a healthier lifestyle allowing our bodies to heal and thrive.