Everett Chiropractic Center Blog

May 20, 2019

The Context of “Exercise” – The Recovery Phase

First there was when to stop.

Then Relief Care context.

Then Rehab, the transition.

Then “core” stabilization or strengthening.

I kind of backed into this series of Posts inadvertently. Initially, I wanted to address some of the issues that could come up in the consideration of why or why not to do an exercise – when to stop doing it.

But, years ago, I did want to do a series on this cycle (injury-relief-rehab-recovery-reinjury). I began with the story about my own back injury and how I progressed to full recovery. (It took 15 years and had almost nothing to do with any of the health care professionals I came in contact with – the rehab and recovery phases didn’t that is.)

So why is it necessary to talk about recovery at all: you are ‘recovered’ after all. Well, in a word: relapse. In the tissues of a significant injury, aging is going to take place faster than in the surrounding, uninjured tissues. That injured spot is a weak link. Now might be the time to take a more global look. To find out if there are other weaknesses that need to be balanced out. Finally, the phrase, “I just want to ‘get in shape'” makes sense. This part is about your longer term future. The point I would make here is the same one I have made all along: what you do should be guided by why you are doing it. Elsewhere (all over) this Blog I have written about setting goals, assessing where you are now, “progressing” in steps to where you want to be. That is all covered. Use the search box on this Blog, using whatever key words seem appropriate, to find a list of Posts. (Start with “progressions” to get started.) Here, too, there are all kinds of ‘normals’ that can guide you into exercises that will give you meaningful benefits safely. And normal is a worthy goal: most people are far from it. It will keep you healthy. How you get there is a journey. And you know about journeys… they all start with a single step:-)

If you need help, let me know.

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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”.

May 15, 2019

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

The other day I wrote about when, and why to stop doing an exercise.

There I mentioned the Relief-Rehab-Recovery-Reinjury cycle. What I really wanted to talk about was the context of any given exercise, within each of the phases of care in the cycle. (It should go without saying that as a chiropractor, I offer a chiropractic perspective. A good reason for me to write it and a good reason, maybe, for you to read it: you might not get it anywhere else.)

That said, it also needs to be said that the chiropractic overall goal of care is to promote health (toward normal – a measurable normal). It bears reminding that we are the ones who have been talking about addressing the cause and not just the symptoms – for 124 years! Yes, patients are focused on the feeling. And, yes, we need to honor and respect that. And we need to deal with the pain (usually it is pain). But in keeping with our primary focus (health promotion), we also attempt to educate and increase awareness of function. Enough about all of that for now.

Speaking of symptoms, the Relief Phase of care is all about relieving them. That is where ice is recommended. We chiropractors find the joints that don’t move (subluxations) and we move them (adjustments). But that is not all we do. To the extent that pain allows, we begin the process of restoring function beyond just moving joints that were not previously moving (or not properly moving).

Keeping in mind that everything we recommend is a test: and the feedback from the patient after trying it is measure: Did they do it (a measure of compliance)? Did it increase, decrease, or have no effect on the symptoms, and what does that mean in terms of continuing, discontinuing, or modifying it.

In the Relief Phase, exercises such as bracing are described and discussed. Coughing engages those muscles and a patient can try that to find out how it feels. They also become aware of which muscles are involved, and begin to get acquainted with those muscles. This stiffening of the spine is an important feature of many important motions a patient is expected to do, usually, in there work. Bracing is also enhanced, and much else is learned, by an exercise called the Reverse Back Crunch (see Pain Free, by Peter Egosque, 1997 – a good book, a great exercise). While they are still in pain, this may be relieving. They can do it while they are on ice. It trains the abdominal muscles. All the while it is also increasing awareness and the patient is gaining control.

This has turned into 400 plus words already so I will do Rehab Phase and Recovery Phase exercises in additional Posts, but here, in the Relief Phase, proper moving technique (biomechanics) are also discussed. How to bend and lift, get up off the ground, and sometimes how to push and/or pull, are important movements patients often have to do all day every day at work. If they are doing them poorly, then relief and recovery are much harder to accomplish. If they begin to do them well, it is another opportunity for epiphanies as a patient becomes aware and gains control. They feel stronger and more stable, and they are less likely to get hurt again.

That is a start on the exercises in the Relief Phase of care. Does knowing the context help? It does help patients.

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 6, 2019

For Tai Chi Students: Fan Through The Back Application with Othmar

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 16, 2019

“Lifestyle Changes, Not a Magic Pill, Can Reverse Alzheimer’s”

From the Blue Zones site… By Clayton Dalton, MD, Massachusetts General Hospital

https://www.bluezones.com/2019/03/lifestyle-changes-not-a-magic-pill-can-reverse-alzheimers/?utm_source=BLUE+ZONES+Newsletter&utm_campaign=e4fa2d18bf-DEMENTIA-ALZ-LIFESTYLE.3.19&utm_medium=email&utm_term=0_9642311849-e4fa2d18bf-198896425&mc_cid=e4fa2d18bf&mc_eid=0d9ed4d239

March 9, 2019

For Tai Chi Students: Stephen Wooster

Running Thunder Hand

March 4, 2019

Vacuuming without Back Pain

Patients often show up in the office after vacuuming. Here is how to move, push and pull without undue stress to the back (here we won’t talk about all the other injuries that could happen, later if there is interest).

Vacuuming is no different than anything else; it is the basics that keep you safe: knee rule, neutral spine, pushing from the heel.

Use the stance to push: go from weight being on the back leg to weight being on the front leg: push with the heel of the back leg. Critical to back safety is the ‘line’ we always talk about in Tai Chi (this line is the signature characteristic of Wu style Tai Chi). DO NOT BEND AT THE WAIST! Reaching further than you can go by shifting your stance will require that you bend over at the waist. Instead, take a step.

Use the stance to pull: go from weight being on the front leg to weight being all on the back leg. In Tai Chi we call this the Back Stance. These stances: ‘back stance’ and ‘front stance’ are described in great detail with pictures elsewhere on this Blog (use the Search Box). Move your feet, generate the force from the heel, then leg, then waist.

Stiffen your spine with ‘bracing’ to add strength and increase safety. That just means to tighten the butt, gut, and pelvic floor muscles when you generate force. Bracing correctly is how the strong people squat, bench, and dead lift great weights – and you are welcome to make all of that noise that they make, too, no one will hear it over the vacuum cleaner.

Let me know if this helps.

March 3, 2019

For Tai Chi Students: Form (Cuong Sam)

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

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