Everett Chiropractic Center Blog

May 18, 2019

The Context of “Exercise” – Rehab Phase “Core Strengthening”

First there was when to stop.

Then Relief Care context.

Then Rehab, the transition.

Now, finally, strengthening the ‘core’ muscles. To begin, there are the following four assumptions: (1) you are pretty much out of pain, (2) you are in adjustment, pretty much, (3) there is little to no pain with palpation during visits to the office, and (4) you do know how to move properly and can demonstrate that.

You can argue whether stretching hamstrings belongs in the Rehab or the Relief phase, but when it comes to core strengthening exercises, failing to factor in the above assumptions can come at a cost.

All of these ‘phases’ overlap in real life. That is where it becomes and ‘Art’.

If you are following the research, then strengthening the core begins with “The Big 3”. These are tried and true exercises that work. They have been studied enough to know that as a way of strengthening, they will work. The Big 3 amounts to abdominal strengthening (ala Stuart McGill if you are absolutely on the straight and narrow). (Personally, this is where I make sure that the Reverse Back Crunch is in place, effective and not painful, then I move patients into the McGill stomach exercise. Second, is the Bird Dog – on the hand and knees, then one arm and the other leg extended. (Like everything else here, we could spend all day talking about the Bird Dog – technique is everything!) Third is the Side Plank: a tough exercise, one which I always give last and bite into carefully. Here too, bracing (but this time the shoulder as well as the trunk) is critical to correctly doing the exercise. Don’t use anything that I have put in a Blog Post as instructions on how to do an exercise: get professional instruction from someone who knows what they are doing.

Strengthening can then proceed, typically, to the repetitive squat, lunge, one-legged standing, and eventually, the gym ball exercises that involve back muscle endurance.

One nice thing about many of these exercises is that they double as balance tests, or tests of what a normal. So if you fail the test, you know that you need to do the exercise – and you have not fully rehabilitated your back.

A reasonable time doing all of these exercises (at least to test), without pain, is the evidence that you have rehabilitated a back pain episode to the point where you can think about “going to the gym to get in shape”.

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May 16, 2019

The Context of “Exercise” – Rehab Phase of Chiropractic Care

First I talked about when to stop an exercise…

Then the context of exercises given during the Relief Phase of care…

And then there is Rehab. I have been Blogging for 14 years – there are more than 2,000 Posts here. Given that it would probably be safe to say that half have to do with Tai chi, all toll I would guess 75% of all Posts on this Blog could, in some way, shape, or form, being incorporated into a discussion of rehab. The scope of this Post is typical patients, typical exercises, and the typical thought process.

Transitioning from Relief to Rehab is a step into the grey zone. As a chiropractor, I keep track of where, how many, and how often various levels of the spine (or extremities) need to be adjusted. Whether the patient is still in pain or not. And whether there is pain when I touch the injured area with a little bit of pressure. A chiropractor’s first priority is the subluxation. When a person returns for several visits and the same parts of the spine continue to need to be adjusted, that is the time to consider giving the patient a way to keep the joints moving, themselves, in between visits. These exercises are designed to articulate the joints, primarily. They also restore reflex patterns to normal, and retrain muscles and movement patterns. In addition, there may be stretching, and finally – only after all of the rest has been done, strengthening.

Exercises to Articulate Joints

That is a little oversimplification, but it will do. And it is not a category of exercises usually discussed. But, to the chiropractor, it is a very important consideration: it will help patients hold adjustments – and that is how they get the results that they do. Some of the exercises that we recommend you can find on the internet: Brugger’s comes to mind (although when I looked for a video that I could put on my Blog, I was not happy with any of the videos that I saw). It is usually better to discuss, demonstrate, and have the patient perform it in the office. They will do it correctly that way; and I will know that they know how to to it correctly before they are off on their own. Brugger’s Maneuver is the exercise that counteracts many of the ill effects of a sitting desk job, crouched over a computer. It stretches everything on the front side of the body, while it strengthens everything on the back side: and it moves joints at the same time.

We have a neck exercise with the same primary objective: to move the joints and keep them moving while retraining normal reflex and muscle patterns. We call it the Figure Eight exercise. I learned it from a patient, who learned it from a book by an eye doctor, who credited his Tai chi teacher with teaching it to him. (Imagine that!)

Finally, for the pelvis (sacroiliac joints) there is an exercise that I got from a Yoga Therapist (I did not even know that there was such a thing until I met.) She didn’t have a name for it, so I made one up: you won’t find it on the internet.

The point here is, if you were subluxated, and that caused you to have symptoms, and getting adjusted relieved your symptoms, and there was an exercise that you could do to hold your adjustments longer, when do you think is a good time to stop doing that exercise?

Rehab (especially in the context of back pain) usually, or often at least, also involves the need to stretch the hamstring muscles. As a chiropractor concerned with joints articulating properly, I recommend stretches that also involve making sure that the hip socket moves properly. Here we discuss passive stretching and active stretching (again, it is already part of the Brugger’s conversation).

This Post is already over 600 words so I will take up Spinal Stabilization strengthening in a separate Post.

May 13, 2019

When can I stop doing this exercise?

A question almost no patient ever asked. (They just stop. They have lots of reasons to stop; and not enough reasons not to.) There are times to stop an exercise (progressions or a relapse comes to mind). But a better question to ask first is: “Why am I doing this exercise?”

If you think of each exercise as a solution to a problem, or answer to a question, that will help. Reasons for doing an exercise differ whether in Relief Care, Rehabilitation, or in Recovery. As the reasons for doing an exercise go away, so can the exercise. If the reason remains, so should the exercise.

Here are two examples from the Relief phase of care: the Cat/Camel and Bracing. At some point the Cat/Camel will become unnecessary – a patient will move on to more demanding exercises that incorporate all the benefits of the Cat/Camel but also have additional benefits. Until there is a relapse or re-injury there is no serious need to continue doing it – no prohibition against it, just no real need.

Bracing is different. It is supposed to be a natural, unconscious, normal, part of movement – especially movement that involves exertion. For most it is a forgotten art. So, we use bracing to stabilize the lower back in the Relief phase (if bracing does not hurt). By consciously training bracing a person gets good at it. Eventually, if they first consciously practice, it will become the second nature part of movement that it was always suppose to be. You never stop doing it, you just stop having to think about it.

So before you stop doing an exercise, ask why you were doing it in the first place. And if you do not know, ask.

April 9, 2019

Memory Lane, Tri-Cities, Bergstrom’s, and Tai Chi

ColumbiaRiverApril2019

40 Years ago Helen and I were married in Richland, attended Columbia Basin College, and each worked multiple jobs at the airport. We re-lived a few of those memories and visited some old haunts over the past few days, including a visit to the Naval Air Station Pasco Aviation Museum – what a history that place has!

My how things change!

Below is where I did my morning Tai Chi. A great spot!

Tai Chi Spot

April 3, 2019

People with Low Back Pain

Many people with low back pain, who receive chiropractic care to get relief, fail to understand a fundamental truth.

Because they have always responded well to adjustments, and rapidly, they believe that all they have to do is make it to the office and get up on the table and everything will be fine. It has always been the case for them. No matter how bad their pain has been: from the first visit to the last, over years, and even decades. When they get adjusted they feel a lot better. The back pain goes away. And they can return to thinking that they do not have a ‘problem’.

The truth that they fail to appreciate is that their pain is not their problem: their problem is that they have a spinal subluxation complex.

It is a progressive condition if not corrected. Which means that it gets worse over time, if not corrected. And however bad the symptoms, they can get a worse too. Possibly a lot worse.

The answer: everything this Blog is about. Prevention. Correction. And maintaining good healthy habits, breathing, bracing, bending and lifting. It also means not going 6 months (or several years) between visits to the chiropractor.

That is our message. But sometimes the aid car comes in handy; the surgeons gets to do their work; and the pharmaceutical companies get a little richer.

March 1, 2019

“Follow The Breath to Enter the Zone”

I put that in quotes because it comes from a book by Patrick McKeown entitled, The Oxygen Advantage. I share it because it is almost the exact verbiage I have use to teach tai chi students how to breath – in their first class. He didn’t get it from me; and I didn’t get it from him. It is fundamental to healthy breathing, as a starting spot. In tai chi it is part of getting centered and grounded before embarking of the journey that is the tai chi Hand Form. On this Blog I have also talked endlessly about the benefits of proper breathing; and the consequences of not doing so.

Here are his words…

“Following the breath involves observing the cycle of each inhalation and exhalation, and is a simple and useful method of internalizing your focus while shutting out any unnecessary thoughts. …

… The breath is the bridge between the mind and the body

February 27, 2019

Interval Training May Be Best for Weight Loss

Aside from the fact that exercise alone will never provide the long-term results in weight loss that most people would like (for that you would search this Blog for Jason Fung, MD) , this research is still useful.

January 30, 2019

Sleep Loss Heightens Pain Sensitivity and Dulls Brain’s Painkilling Response

new research

It is well known that chiropractic care will decrease pain symptoms (and others). It is equally well known that once you have less pain, you sleep better. Now researchers are looking more closely at that connection: you are going to feel pain more when you get less sleep.

For patients with neck pain, back pain and headaches, the cycle usually goes like this: first less pain; then more and better sleep; then better energy levels; then higher levels of activity.

The message from this new research is clear: get out of pain; get your sleep. Get your sleep and get out of pain.

The message of chiropractic care is also clear. We can help!

 

January 27, 2019

Truth: On Many Levels (Seth Godin)

Relentlessly lowering expectations

We always compare performance on a relative basis. “Well, it’s better than it was yesterday…”

Toddlers, for example, seem like geniuses compared to the babies they used to be.

Some people around us have embraced a strategy of always lowering expectations so that their mediocre effort is seen as acceptable. Over time, we embrace the pretty good memo or the decent leadership moment, because it’s so much better than we feared.

And some? Some relentlessly raise expectations, establishing a standard that it’s hard to imagine exceeding. And then they do.

If you’ve been cornered into following, working with or serving someone in the first group, an intervention can be rewarding. For you and for the person trapped in this downward cycle.

Raising our expectations is a fine way to raise performance as well.

December 18, 2018

“…a global public health threat…”

https://neurosciencenews.com/genetics-physical-activity-10322/

December 11, 2018

Kids and Chiropractic

The subject of children and babies getting chiropractic care is discussed in this month’s Newsletter (if you didn’t get that, sign up here).

A patient sent an email yesterday to ask about getting their, almost 3 year old, child in for care – wanting to know what I thought about that and how to make it happen.

So I thought I would review our unofficial ‘policy’ (actually more of a preference). Before I do that I will say that: (1) I would encourage everyone to have their children checked as early as is feasible, and (2) I refer to chiropractors who specialize in pediatrics when the patient is too little to lie on my table and hold still.

That said, here is how it usually happens and I like it when it works out this way. First, get the kid used to the office and what goes on here by bringing them in with you. That makes them comfortable, gets them used to the whole idea, and alleviates any fears that they may have. Plus, ‘if they are good’ they get treats: that helps. Second, if the child does not eventually insist on getting up on the table for ‘their turn’, we can gently bring up the subject, check for their reaction, and adjust our efforts accordingly. Usually, it is their idea to ‘be next’ and off we go. By the time they are old enough to lie up on the table and hold still while I check them, it is no problem, not drama ensues, and things go very well.

All of that assumes a kid that isn’t suffering or is obvious not right, and a parent that is onboard with the idea of preventing problems before they develop. Since I do not charge anything for the kids (up to a certain age), it is usually fine with the parents. (The last thing that I want is for the kid not to get checked because the parent is thinking about the fee.)

So there you go.

DrD

 

December 7, 2018

Figuring Shoes Size for the Natural Foot

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