“A Path to a Healthy and Fit Lifestyle”

Being healthy and fit isn’t a fad or a trend. Instead, it is a “lifestyle.” When you look around today, it is evident that many of us are not on the correct path to achieving health and fitness. It is a well known fact that a healthy and fit lifestyle leaves one more energetic and at a reduced risk for disease. Such a lifestyle is based on the choices one makes about their daily habits and behaviors. It’s no secret. But just what constitutes a healthy and fit lifestyle?

First, one has to look at the word “healthy.” If one looks in a dictionary for the definition, it’s not much help. It states, “in good health.” There are similar words such as well, fine, fit, in good trim, in good shape, and the picture of health that helps one understand the meaning of healthy. However, it does not answer the “nuts and bolts” of being healthy and fit. To me, a healthy and fit lifestyle addresses how one choses to eat, hold themself, sleep, and reduces stress.

As the old saying goes, “you are what you eat” is the notion that to be healthy and fit, one needs to eat good and nutritious food. The various bodily systems including the cardiovascular, musculoskeletal, and immune systems to name just a few rely on the continual supply of nutrients to feed cell growth and metabolism. To get the multiple and essential forms of protein, vitamins, carbohydrates, minerals, and fats it is advised to eat a well balanced and varied diet. According to guidelines by the U.S. Department of Agriculture, such a diet should contain mostly whole grains, fruits, vegetables, and fat-free or low-fat dairy products. Also, one should consume lean meats such as chicken and turkey, along with legumes, eggs, and healthy nuts.

Another important detail to living a healthy and fit lifestyle especially as one ages is to keep an eye on the portion size at every meal. It is the simplest way to control weight and reduce the risk for cardiovascular and other diseases. The FDA chose a nice, round number of 2000 calories for the average American to consume on a daily basis. On average, it has been found that American’s consume 2500 calories a day. Keep this in mind only as a starting point when trying to make changes.

Yet another important detail related to diet is hydration, especially for many of us who live in the Southwest. It is a known fact that the body is two-thirds water, so it is vital to stay hydrated. Everything that one drinks contributes to their hydration level to a greater or lesser degree. Even the food one eats hydrates.

Of course, the first thing that one thinks of when speaking of hydration is water. Drinks other than water often contain undesirables such as calories, sugars, and/or caffeine. These ingredients can impact one’s health in other ways such as contributing to weight gain and damaging teeth. Therefore, water is undoubtedly the best drink for hydration. Water is all one needs to maintain a healthy level of hydration. One only needs to to consider energy drinks or other specialty drinks if one does a particularly strenuous activity for a long period of time. Water is perfect for hydration purposes during normal exercise and daily routines. To prevent hydration, health experts feel one should drink eight 8oz. glasses or two liters or a half gallon of water a day.

Surprisingly, researchers have found milk either full fat or semi-skimmed to be very good in hydrating. Milk is better at hydrating than water because it is retained in the body for longer periods. It also provides essential nutrients including calcium, protein, and B vitamins. However, it has a higher caloric content. Like milk, fruit juices and smoothies have a higher hydrating factor, but again have a higher caloric content. In addition, they have a higher sugar content.

Yes, carbonated soft drinks that are so popular in our country are hydrating. But many of these options too contain high calories and even higher levels of sugar that can have a negative effect on one’s health. Therefore, moderation is again the key when consuming these types of beverages for hydration. That is not as easy at it sounds since the servings at most restaurants are a large. For example, a large Coca-cola at a popular, national fast food chain contains 310 calories. Just keep in mind that water has 0 calories.

I would be remiss if I didn’t mention alcoholic drinks. Alcohol is one of those drinks that causes the most confusion when it comes to hydration. All alcoholic drinks contain water, so they are hydrating. However, drinks with a higher alcohol content have increased diuretic effects (produce urine) so their impact on hydration is seen as limited. That includes spirits and wines. Also, don’t forget alcoholic drinks are high in caloric content and high in sugar.

Remember, all drinks hydrate because they contain water. For example, full fat milk is 88% water. They can, therefore, be part of a moderated diet but with water at the centre of the hydration efforts.

Calories have already been mentioned because they accompany nutrition in what one eats and drinks. It is a known fact that if one doesn’t expend all the calories that are consumed, weight gain will surely occur. Studies have shown that carrying extra weight increases the risk for heart disease, type 2 diabetes, and cancer. Therefore, ones lifestyle should support a constant healthy weight with the key being active on a daily basis to burn calories. According to the U.S. Department of Health and Human Services which outlined the Physical Fitness Guidelines for Americans, it suggests 150 hours of exercise a week that includes muscle strengthening and aerobic exercise. However, they have left out another important aspect of exercise, a stretching program.

But the question remains, “How does exercise benefit ones health?” Researchers are still in the discovery mode of the ways exercise benefits ones health. Below are just a few ways one may benefit from exercise:

•Reduces risk of heart disease-A 15 year study found replacing sedentary activity with just 30 minute a day of high activity reduces the risk of death from cardiovascular disease. It reduces blood pressure and improves muscle function and strength including the heart muscle.

•Helps insulin sensitivity-Research has found those with diabetes and low-cardiorespiratory fitness are at increased risk for overall illness and death; exercise helps protect against that by improving insulin sensitivity.

•Improves mood-Physical activity may effectively prevent depression and enhance ones mood and lifts ones spirits.

•Improves cognitive skills-Regular activity increases the size of the brain’s hippocampus, the area responsible for verbal memory and learning.

•Affects mitochondria biogenesis-Mitochondrial function is vital to ones overall health. Exercise enhances mitochondrial biogenesis in skeletal muscle and brain.

•Strengthens bones and muscles-Weight bearing activities makes bones and muscles stronger, reducing the potential of “osteoporosis.”

•Improves sleep-It has been found sleep and exercise are interrelated as one exerted a positive effect on the other; and moderate exercise may increase the amount of deep sleep one can enjoy.

•Reduces stress-Researchers have demonstrated exercise does reduce anxiety and stress, potentially in part from enjoying a “time out” from daily worries.

•Improves digestion-Researchers have found exercise to contribute to positive changes in gut microbiota, which may provide benefits to ones health and help in the prevention of disease.

•Get an energy boost-As little as 20 minutes of aerobic exercise three times a week over six weeks may help improve ones energy levels and help one feel less tired.

•Reduces overall risk of death-Data has confirmed that regular exercise is effective in the prevention of chronic disease and premature death.

•Raise self-esteem-In a study of 264 adults, researchers found physical activity was directly and indirectly associated with self-esteem.

•Reduces the risk of falls and disability-Falls are a significant cause of disability in the elderly, and exercise plays an important role in prevention.

Another important detail of a healthy and fit lifestyle that is often overlooked is “posture.” Most of us have heard the timeless advice, “Sit/stand up straight!” These words are worth heeding. Good posture is the foundation of ones skeletal and structural balance. By sitting and standing up straight, it enables one to get the center of gravity (COG) for the body closer to the ideal. This helps one to maintain correct structural biomechanics while moving and exercising resulting in fewer injuries and greater physical gains.

Poor postural habits can lead to back, neck, and other musculoskeletal conditions. As already mentioned, it can lead to poor structural balance increasing the risk of falls especially as one gets older. However, there is one aspect of poor posture that has become more prevalent today which involves breathing. I specialize in postural and movement dysfunction and I know that the first movement one acquires is breathing. It is foundational to our neurophysiological development.

Researchers are also looking into whether posture affects mood, sleep, fatigue, and jaw alignment. However, there are other problems related to poor posture that may surprise many:

•Incontinence-Poor posture promotes stress incontinence. Slouching increases abdominal pressure and that pressure is transmitted to the bladder. This slouched position decreases the ability of the pelvic floor muscles to hold against that pressure that leads to bladder, bowel, and pelvic floor dysfunction.

•Constipation-Poor posture on a toilet such as hunched over with the knees lower and higher than the hips can promote constipation. Either position affects the tone of the pelvic floor muscles and muscles around the anus making it more difficult for the abdominal muscles to work in moving the feces out. Constipation is characterized by fewer than three bowel movements per week. Remember, hydration can be factor in constipation.

•Heartburn and slowed digestion-Slouched posture during or after a meal can trigger heartburn caused by acid reflux when stomach acid squirts back up into the esophagus.

Keep in mind as you get older, the most important thing is posture. It’s the way you walk, the way you stand, the way you sit that defines you. Nothing ages one faster and more than poor posture. So if you want to grow old gracefully, pay attention to posture.

Sleep is also a vital detail to a healthy and fit lifestyle. Daily metabolism perpetuates the decline and rejuvenation of cellular tissue, and the body’s self-repair takes place when one is asleep. Memory consolidation and appetite regulation also occur during this time of reduced physical activity. The National Sleep Foundation considers seven to nine hours of sleep nightly criterion for a healthy and fit lifestyle.

Finally, stress and how one handles stress has an effect on one’s health, especially over time. Ones body responds to the stress of everyday life with release of hormones that prepares one to react. If one does not relieve this constant state of reaction through relaxation, the effects build up and accumulate creating muscular pain, headaches, sleep disturbances and other symptoms.

A lifestyle that includes regular stress management breaks this cycle before it can progress to unhealthy levels. The U.S. Department of Health and Human Services suggests limiting some activities of daily living to make room for relaxation. One can achieve physical release to such stress through stretching, massage, yoga, or enjoyable and recreational exercise. Connect with friends and family to hopefully relieve mental pressures, take time out to read, and pursue a hobby or experience another activity that makes one feel good.

Living a healthy and fit lifestyle doesn’t mean following a specific diet or exercise regime, it means finding out what works best for someone and their lifestyle and making choices that helps to energize, treat ones body with respect, and fuel with correct nutrients. Being healthy means feeling fit, strong, and confident.

A healthy and fit lifestyle looks different on everybody. All of us have different things going on in our lives, so it’s important to make choices that help one live a positive life, rather than cause stress or discomfort in trying to live a certain way. Happy travels on your never ending journey to a healthy and fit lifestyle!

“Musculoskeletal Pain, Inflammation, and Turmeric”

I have been a physical therapist for thirty-seven years with my focus on treating musculoskeletal pain and inflammation. Recently, there have been more articles published about the negative side effects of a group of medicines called n-saids that are used by many of my clients to manage their musculoskeletal pain and inflammation. Over the years, my clients have asked so many questions about musculoskeletal pain, inflammation, and n-saids, that I felt it was time to clear the air and help them make sense of it all.

First, “What is musculoskeletal pain?” Musculoskeletal pain is unavoidable because everybody will experience it at one time in their life. It has three main causes: 1) Activities of daily living that put unusual or repetitive strains on your muscular, fascial, neural, and skeletal systems. 2) Acute or traumatic events causing injury to these tissues. 3) Musculoskeletal diseases

Musculoskeletal pain affects your bones, muscles, ligaments, bursae, tendons, fascia, and nerves. All of these tissues that allow you to perform your activities of daily living. Musculoskeletal pain can be “acute” having a rapid onset with severe, intense symptoms or it can be “chronic” with a slow, insidious onset over time. The pain can be localized in one area of the body or referred or widespread.

Lower back pain of course is the most common type of musculoskeletal pain experienced. Other common types of musculoskeletal pain include myalgia or muscle pain, myositis or muscle inflammation, sprains of ligaments, fascitis, tendonitis, bursitis, neuritis, and stress fractures. Just a reminder, anything that has the suffix “itis” means inflammation.

Musculoskeletal pain has various symptoms and causes, but the most common include: 1) Bone pain which is described as deep, penetrating, or dull. Usually, it is the result of a traumatic event or overuse. 2) Muscle pain is often described as less intense than bone pain, but can still be debilitating. It can be caused by an acute, traumatic, event or overuse causing a muscle strain, an autoimmune response, loss of blood flow to the muscle, infection, or a tumor. Muscle as well as bone pain can be accompanied by muscle cramping and spasms. 3) Tendon and ligament pain are also caused by traumatic, acute injuries or overuse. 4) Fibromyalgia is a condition that may cause pain in the muscles, tendons, fascia, or ligaments and is usually in multiple locations as well as difficult to describe. It is usually accompanied by other symptoms. 5) Joint pain, injuries, and diseases usually are described as a stiff, aching, “arthritic” type of pain. The pain may range from mild to severe in intensity and worsens with movement. Swelling of the joint may also occur. 6) Tunnel syndromes refers to musculoskeletal disorders that cause pain due to nerve compression or entrapment. These disorders include carpal tunnel syndrome of the wrist, cubital tunnel syndrome of the elbow, and tarsal tunnel syndrome of the ankle. 7) Neuritis is described as pain from the inflammation of a peripheral nerve caused by entrapment, compression, or any other physical irritation of the nerve. The irritation is usually caused by the surrounding soft tissue which may include the muscle, tendon, fascia, ligament, or even bone. The pain experienced usually travels along the path of the irritated nerve and is often described as a burning sensation. The sciatic nerve may become entrapped by the piriformis muscle as an example. 8) Bursitis is a condition when the bursae, a small fluid-filled sac near the joint, gets irritated and swollen. The purpose of the bursae is to help the joints move more smoothly and efficiently. When working right, they cushion certain bones, tendons, and ligaments especially at the hip and shoulder joints as they move on each other.

As already mentioned, anyone can experience musculoskeletal pain. It does not discriminate being experienced by the young and old. It is most often caused by an acute, traumatic injury to the bones, joints, muscles, tendons, ligaments, fascia, and nerves. This can be caused by quick, jerking movements, car accidents, falls, fractures, sprains, dislocations, and direct blows to the joints or muscles.

However, musculoskeletal pain can also be caused by chronic overuse as well as poor postural habits or prolonged immobilization. Pain from chronic overuse affects about 33% of the adults in the U.S with lower back pain being the most common area of pain. Lower back pain is also the most common work-related diagnosis in our Western society.

So, “What is the cause of musculoskeletal pain?” The answer is “inflammation.” Inflammation is an essential and dynamic tissue response by the cells of the muscles, fascia, tendons, ligaments, cartilage, bones, and nerves to damage. It is an extension of the cellular and metabolic involvement of these tissues. In fact, it is actually a protective response by these tissues with the aim of restoring their structural and functional integrity after being damaged. Simply put, it is a defense mechanism or self-protective reaction by the body in which the immune system recognizes damaged cells and begins the healing process.

However, if this inflammatory response by the body becomes chronic and goes on for a long time, it can become problematic. Chronic inflammation has now even been linked to other systemic diseases like heart disease, stroke, and may lead to auto-immune disorders like lupus and rheumatoid arthritis.

So as you can see, chronic inflammation can have long-term and whole body, systemic effects if untreated. Chronic inflammation is also referred to as low-grade inflammation because it produces a steady, low-level of inflammation throughout the body and this type of systemic inflammation over time can contribute to the development of disease. The reason being that when these inflammatory cells stay too long in the blood vessels, they promote the build up of plaque and we all know what it can do to our health and well-being.

Acute inflammation on the other hand, like with a sprained ankle, is a short-term response having a localized effect, meaning it works at the precise place where the tissue damage occurred. The tell tale signs of acute inflammation include redness, swelling, heat, and sometimes pain and loss of function. In the case of acute inflammation, blood vessels dilate, blood flow increases, and white blood cells swarm the injured area to promote healing.

That brings us to, “What can you do to manage inflammation?” The most common answers I give all my clients daily is by improving your skeletal or structural alignment, good exercise habits, good sleeping habits, good postural habits, and good eating habits. However, the most often asked question by my clients is, “What can I take now for the pain?” Invariably, most of my clients say they take ibuprofen, advil, or motrin all of which are a group of medicines referred to n-saids or non-steroidal anti-inflammatory drugs. Most of my clients over the years would agree that these medicines are a significant help in managing their pain. The problem with these medications is that most people exceed the suggested daily dosage and they have side effects.

Recently in a New York Post article that was written on the unexpected side effects of popular pain killers, they wrote that in a study of 1,326 ibuprofen users, 1 out of 10 people exceeded the daily suggested limit. The author of this study, Professor David Kaufman stated, “The biggest pattern was people taking too much at once.” Kaufman went on to say, “Gastrointestinal bleeding and heart attacks are the two biggest concerns with ibuprofen and other n-saids.” Finally he states, “It’s always a good idea to take as little as possible.”

Well then, the final question has to be, “What is my alternative to taking n-saids?” The answer is “turmeric or curcumin.” In various studies that I have read on the efficacy of turmeric compared to ibuprofen, the results consistently showed that turmeric was just as effective as ibuprofen.

So while you are managing your musculoskeletal pain by changing your alignment, your sleeping habits, your exercise habits, your postural habits, and your eating habits, why not include a daily dosage of turmeric. Give your body all the tools it needs to manage inflammation and reduce your musculoskeletal pain. Just a reminder, before doing this it is always good to check with your pharmacist or doctor if you take other medications. Be well.

“Is Improving My Posture and the Way I Walk the Answer?”

1.5 billion people around the world suffer from chronic pain making it now the number one reason patients seek medical care. I have definitely witnessed this fact in my practice. In fact, studies have shown that pain leads to more than 50 million lost workdays each year. The cost of pain including medical bills and lost workdays is estimated at $100 billion per year world wide.

The pain I am talking about is associated with a wide range of injury and disease and is sometimes related to a disease process itself. The pain that I see in the clinic is due to the dysfunction of the musculoskeletal and neuromuscular systems. Many of my patient’s pain symptoms arise from a specific cause and injury. However, just as many describe their pain as gradual in its onset without any known cause.

No matter the cause and characteristics of one’s pain, the costs of unrelieved pain can result in hospitalization, increased outpatient visits, addiction to opioids, and decreased ability to function fully leading to the lost income and insurance coverage. These are the realities of pain!

So, I ask you, “What can you do about this?” The simplest answer I can give you is changing your posture and how you walk as a start. Our postural habits or how one carries themselves as well as the way one walks reflects so much of our journey through life. From the habits and behaviors of everyday life due to being right or left hand dominant to bearing the compensatory scars of accidents and injuries large and small, affects your musculoskeletal, neuromuscular, and connective tissue systems. The compensation that results affects these systems and their output which is your posture and movement of the skeletal system.

Our bodies are designed to work against the force of gravity and its effects during our activities of everyday life. Our bodies work in a pattern of posture and movement from the bodies center of gravity, but it doesn’t take much for it to lose its way. If your tire goes flat on your car, you are not going to go very far. However, the body doesn’t work that way. For example, if the inside of your foot is injured, your body will compensate in various ways that will allow you to keep walking. The problem is that the compensation causes a shift in your center of gravity affecting the tension of your neuromuscular and connective tissue systems. The output is a change in your posture and movements.

The human body has a tremendous capacity to change. It can change from dysfunctional posture and movement due to compensation to a more natural, neutral pattern. However, it needs to have the right input to change. Simply speaking, you don’t have to accept your compensation as what it is. The first step to changing your posture and the way you walk is “awareness.”

Begin to take note of where you ache. What moves and what doesn’t move when you are walking? Does your right side feel the same as on your left side? More interestingly, begin to watch how other people walk and hold themselves. Try to develop a sense of what seems abnormal due to compensation and what is a normal, neutral pattern.

Posture is definitely underrated as a characteristic of a person’s daily life, but it can tell a lot about a person. Posture refers not only to the erectness of our skeletal structure, but also to our body orientation, direction of lean, and the degree to which our bodies are open and inviting.

A good, healthy posture while standing or sitting doesn’t necessarily mean the structure is straight up and down since the natural spine has curves, but it does reflect the spine is aligned and not twisted. There are natural curves between the thoracic (upper spine) and lumbar (lower spine) regions of the spine where the upper back curves slightly backwards and the lower back slightly forward. It’s all about balance. To be more technical, ideal, neutral alignment standing is when the ears, shoulders, hips, knees, and ankles align as if a plumb line were run from top to bottom along the lateral aspect of your structure. In an anterior and posterior view, the plumb line should also go through the body’s center of gravity which is the hypothetical point around which the force of gravity runs through to the ground. Ideally in standing, the body’s COG is located in front of the sacrum bone, at about the second sacral level or 2 inches below the navel. This is considered the neutral position because when the COG is located here in standing, the body is able to hold its posture without stressing the joints, muscles, and bones. What it really means is that the weight of the body is held by the bones and connective tissue and not by the muscles.

When the body is aligned over its COG, gravity will assist us in our posture and movements rather than being a stimulus to the muscles and tendons to alter their tension. Therefore, the second step to changing your posture and the way you walk is to learn how to use the power of gravity to your advantage rather than have it work against you.

Using a mirror is helpful. For standing, check where your COG is located by placing the tip of your index finger just above your navel. The height of your COG is three finger widths or about two inches below that point. Move your index finger of one hand to that point and then using your other index finger, trace a line around one side of your torso at the same height until you come to the midpoint of your back. Your COG standing is midway between your two index fingers.

To evaluate your COG standing further, inspect whether your navel falls equally between both feet or is shifted more to the right or left foot. It has been my experience that with a right handed person, the COG will have shifted more to the right and vice versa with a left handed person. Also, inspect to see if your navel is pointed straight ahead or turned to the right or left.

When sitting, learning the position of your COG is important too especially with all the negative information related to sitting. The COG is no longer two inches below the navel as in standing, but is located higher due to the fact your legs do not enter into the picture. Locate your seated COG by running a finger down your sternum (the flat bone in the center of your chest in which ribs are attached) until you encounter soft tissue. This is where the sternum ends and is closely positioned to your seated COG. Of course, it is located deep inside your chest cavity. Again, if you place your index finger on this spot and run the other index finger around your chest until it reaches the spine at the same height, a line running directly from front to back through these points is your seated COG. Again, you can use a mirror and inspect if your COG is perpendicular with the surface you are sitting on or has shifted to the right or left as we did with standing. Also, check to see if your navel and even your rib cage is turned to the right or left.

Come to realize that if one is standing or sitting in neutral position through their ideal center of gravity, the shoulder and pelvic girdles will be parallel with the floor. The head will be vertical without any lean or rotation. The body is then able to be symmetrical to the naked eye. However, I must let you know that the body is not perfectly symmetrical even if you are over your COG. That is just the way we are designed. But the more symmetry you see, the better the posture.

Imagine the structure of a house whose weight is carried down from the rafters to the side and supporting walls, then straight down to the foundation. A house that leans puts uneven stress over certain walls causing the risk of collapse. It is the same with the human skeletal structure. When the human structure is in a neutral position, the skeletal structure is parallel and perpendicular with the ground or the surface one is sitting on.

Good neutral posture in standing and sitting, promotes ideal breathing, circulation, and balance. Improper posture can lead to general discomfort, long term damage, and even deformities to the joints and spine of our skeletal structure.

Walking correctly is also a full body experience. If we move well while walking, the front and back of the body are equally broad and open, the legs are rooted equally to the ground as the head is lifting up to the sky, lengthening the skeleton and creating space in the joints. The lateral aspect or sides of the body are involved too because the arms are moving in all planes. The opposite arm and leg are always moving at the same time which creates a gentle rotation through the spine and your COG which is moving energy endlessly up and down the body in a spiral. When we do this while walking, everything starts to flow much more easily and we use gravity and ground reaction force to our mechanical advantage.

To begin walking correctly, imagine your bones are stacked evenly on top of one another. Your ears, shoulders, hips, and ankles would all follow a straight line down the body. Instead, most of us have our calves fall backwards and our thighs sink forward, our lower back overarches, our upper back rounds toward the back, and our head juts forward. This is not using gravity as our ally, but rather it becomes our nemesis. Something to overcome. When we find the whole body working together through its COG as it should, these imbalances begin to disappear. There are many different techniques to use when trying to walk correctly, but I will use a three point plan to help you get with the flow of gravity rather than working against it.

• First, imagine a string is pulling you up from the back of the neck that will extend your spine up towards the sky. The string should lengthen your back and soften the front while relaxing the throat and softening the belly. This lengthening up should allow you to feel space between the bones and joints of your skeletal structure.

•Think of another string pulling you back from the base of the ribcage. Your breathing should engage the back of your body as well as the front and sides; try to breathe into the middle or upper back. Visualize that you are walking backwards as much as forwards, balancing all sides of the body.

•Align your pelvic girdle on top of your legs and keep them that way. We tend to let the legs rather than the trunk lead the way. Actually, visualize that your COG is leading the way. When one leg is forward of your pelvis, the other one should be an equal distance behind it.

Walking is the best way to bring permanent change to the body because we were designed to walk. Also it is an activity that most of us do routinely on a daily basis. And when we do it, we do it over and over and over again. The human body and its nervous system will accept any pattern you put into it whether the pattern is good or bad. This is how chronic injuries develop out of seemingly innocent or unknown events. The injuries become chronic because the body adapts a new movement pattern due to unconscious compensations. Learning to walk or actually relearning to walk allows you to put a different imprint on your nervous system to move in the direction that is more neutral and natural.

If you have a good walking pattern and decent posture then everything is good. Your breathing becomes improved, your circulation improves, your nerve energy improves, you are just going to be happier about life. Everything works together when you have good posture and a walking pattern. If you walk, stand, and sit well, you are going to minimize the wear and tear on your skeletal structure. You’ll minimize the likelihood of chronic injuries and the likelihood of poor conditioned patterns. You won’t do as much compensation resulting in the imbalance of muscle and connective tissue tension. You will then be able to use your body to its potential.

So now is the time to make changes in your posture and walking. No matter your age, it is never to late to change. Age is just an excuse.

Isometrics and Bone Health

Isometric exercise has been around for a long time in both the fitness and rehabilitation world, but is most definitely having a rebirth! After years of limited results and cumulative injury with dynamic, movement based exercise, health and fitness professionals along with a host of academic and medical journals are looking at isometric exercise as not only the safest, but most effective exercise available.

Isometric exercise is a contraction of a muscle without any visible movement occurring. It is a static exercise where the muscle is contracted in a fixed position against an immovable object. When doing workouts at the gym with free weights or machines, you are performing isotonic exercises. Both forms of exercise increase the tension of a muscle, but isotonic exercise also affects the muscle’s length. The benefits and results of an isometric exercise program have always been exceptional in increasing the tension of a muscle, but with advent of technology affecting the fitness and exercise world over the past forty years, isometric exercise has been virtually forgotten.

Now fitness experts and the most prestigious health and fitness journals in the world are publishing studies that endorse isometric exercise as an exceptional route to improving muscular strength, bone health, cardiovascular function, and athletic performance with minimal stress to joints, tendons, and the body’s other supporting structures.

Now with the focus on bone health, isometric exercise is again mentioned as a means to improve the status of your skeletal system and its bones. With that, there are two terms related to your bone health that I feel need to be clarified. That is “osteoporosis and osteopenia.” Simply put, osteoporosis suggests a disease process whereas osteopenia is a description of lowered bone density scores. Osteoporosis is not and I repeat not a normal response to aging. It is indicative of long term imbalances within the body’s systems that lead to a bone weakening disease process. When you have been diagnosed with osteoporosis, it means you have an actual disease or disorder that can be seen under the microscope. The word osteoporosis actually means “porous bones” since the bones look like Swiss cheese under closer inspection and lose their normal, healthy spongy appearance. This condition occurs when your body gets rid of more bone than it is creating. Some people are genetically prone to it having a family history. You are also more likely to get it if you are a woman. Osteopenia, on the other hand, is not a diagnosis. It’s a description of “low bone mass” and all it is doing is stating an observation that your bone mass is lower than that of someone who is in their late twenties. Someone who is at the peak of their bone building and strength.

Let’s clear up this confusion even further, osteoporosis warrants an extensive work-up looking for the cause of excess bone loss. Osteopenia may or may not be an early warning sign of bone weakening and generally does not trigger the need for a work up or conventional medical treatment with some exceptions. In fact, osteopenia is the result of statistics again comparing your bone density to the bone density of someone who is in their late twenties which is the considered the normal range.

So now the question arises, “When is osteopenia something to take seriously?” Remember, women have a higher incidence of osteoporosis and most of the studies have been done on women in their late twenties. Therefore, it only stands to reason that some amount of bone loss takes place with each passing decade. Whether or not slipping into “osteopenic” bone density range is a serious enough concern depends on each individual case. However, saying one has osteopenia does not necessarily say it is a precursor to osteoporosis. If you have ranges that have been defined as osteopenic, diet and exercise can help to change your numbers. Medication is not always warranted.

So the question then is, “What should you do if you have osteopenia? As just mentioned, diet and exercise can help your bone strength. I am not going to go into diet, but you can get information on dietary guidelines for bone health at https://americanbonehealth.org/nutrition/dietary-guidelines-for-bone-health/. As far as exercise is concerned, we are going to discuss osteogenic and isometric exercise. It is a given that bone responds to certain levels of physical strain making the bones stronger. Any type of activity that puts enough strain on bone such as gravity and ground reaction force or tensile forces from muscle tension to stimulate new bone growth is called “osteogenic loading.”

I am sure you have heard from your doctor that you need to do a weight bearing exercise program if you have been designated as osteopenic. Now, fitness experts and the most prestigious health and fitness journals in the world are publishing studies that endorse isometric exercise as an exceptional route to improving muscular strength and bone health. For example, the “Journal of the Facility of Medicine” in 2012 published that isometric exercises not only prevents reduction of bone density, but may also increase the mineral density of injured bone.

So you can see why I have become an advocate for “isometric exercise.” Therefore when treating your musculoskeletal pain and dysfunction at Terry Kern Physical Therapy, I will be using a combination of isometric and stretching exercises in order to alter the length and tension of your muscles with the goal of improving your musculoskeletal balance and health.

“A Paradigm Shift”

Over my 37 years as a physical therapist, I have come to the belief that our present medical system needs a change in its foundational philosophy. A “paradigm shift.” The buzz words today in health include integrated healthcare, integrated practitioner, and integrated health. These words refer to alternative medical practices. But what do these words really mean and what are the implications of these words to the development of integration within our healthcare system today?

The word integrate is defined as to make into a whole by bringing all parts together; unify. To join with something else; unite. To make part of larger unit. Words with similar definitions include combine, amalgamate, consolidate, and incorporate. According to the National Center for Complementary and Alternative Medicine (NCCAM) it refers to medicine as integrative or integrated when it “combines treatments from conventional and alternative medicine for which there is some high-quality evidence of safety and effectiveness.” According to Andrew T. Weil, M.D., a well known proponent of integrative medicine, “integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” Combining these three aspects of a person, integrated/integrative medicine would then be defined as: the evidence-based merging of conventional and complementary therapies for the good of the whole person.

However, the word integrate cannot only be used in the description of our healthcare system, but also in how the body is viewed. Our conventional medical philosophy is better defined as “reductionist medicine.” The driving principle behind our medical science is the paradigm of physical reductionism, which reduces medical issues to physical explanations and usually prescribes a purely physical solution. In this simplistic view of the body, it would be fair to say that the human body is seen as a machine; every time someone is sick, it’s simply because one of the body’s gears (body systems) is clogged. This reductionist view of the body is not in itself a bad thing and its focus on specialization is preferable to alternative medicine practices in circumstances such as emergency surgery or in triage situations as seen in our nation’s emergency rooms. On the other hand, holistic medicine, also known as alternative or complementary medicine, evaluates the entire person, physical (body) and non-physical (mind) and seeks to heal any imbalances between the two. It views the body as a complex system that is affected by both internal and external factors. It also emphasizes the body’s own ability to heal itself, as well as promoting healthy lifestyle changes and preferring naturally occurring remedies, such as meditation and herbal medicines, to synthetically produced compounds. Because it is not reductionist in nature, holistic medicine can also be used as a counterpart to modern medicine.

The problem with modern medicine is that its science and philosophy purposely excludes anything that does not fit its paradigm of physical reductionism. It cannot, by its very definition, consider that humans have both a physical and a non-physical nature. Because of this, many people feel that the mainstream, western medicine fails to evaluate them as a complete human being.

In discussing these various views of how the body is looked at, there needs to be a distinction made between the view of a M.D. (medical doctor) and a D.O. (doctor of osteopathy). A medical doctor practices allopathic medicine, the classical form of medicine, focused on the diagnosis and treatment of human diseases. Osteopaths, on the other hand, practice medicine that is centered around a more holistic view of medicine in which the focus is on seeing the patient as a “whole person” to reach a diagnosis, rather than treating the symptoms alone.

Early in my career, I worked at Heights General Hospital in Albuquerque, an osteopathic institution. I therefore came to incorporate their philosophy into my own physical therapy practice. That is, view the body as a unit, an integrated organism in which no part functions independently. Also, realize the body has an inherent capacity to maintain its own health and to heal itself. In addition, recognize that structure and function are interrelated in that the musculoskeletal and musculofascial systems reflect changes in and can produce changes in other bodily systems. Finally, rational treatment is based upon integration of the first three principles into total care of the patient.

Patients at my facility will always be viewed and treated according to these principles. I recognize each person as a unit of body, mind, and spirit. I also look at the whole-person which emphasizes learning as much about the person with the disease as the disease itself. Finally, I understand that each body is capable of self-regulation, self-healing, and health maintenance.

Terry Kern, P.T.

January 2019 “Breathing”

As a physical therapist for thirty-seven years, I have become more aware of how poor posture along with poor alignment of the human, skeletal structure affects breathing. Dr. Karel Lewit states, “Respiration is our primary and most important movement pattern…and also the most dysfunctional.”

The diaphragm which is the primary muscle of respiration plays a major role in patterns of dysfunctional breathing. This dome-shaped muscle is located just below the lungs and heart separating the abdomen from the chest. As you breathe in and out, the diaphragm contracts continually generating a negative intra-thoracic pressure. In fact, the diaphragm will lower and establish increased abdominal pressure before any of your daily, functional movements. During inhalation, the rib cage increases it anterior, posterior, and lateral dimensions at the same time giving the diaphragm the room to fully contract. With MRI studies, researchers have found that when the diaphragm does not have the room to fully contract, intra-abdominal pressures are affected. As a result, other respiratory muscles or accessory breathing muscles have to be recruited more in order to compensate.

When you breathe in, the diaphragm should be able to fully contract and move inferiorly. This action flattens the dome-shaped muscle causing a decrease in pressure within your thorax or chest and an increase in air taken into the lungs. As you breathe out, the diaphragm relaxes restoring its dome-shape decreasing the air space in your lungs causing you to push air out.

This involuntary action of breathing works in close coordination with the thoracic spine, rib cage, and “core” muscles. Because of this close relationship, when your thoracic spine and rib cage become limited in their mobility, the diaphragm will not be able to fully contract with each breath and becomes weak affecting your breathing pattern. In addition, if your “core” muscles are not fully engaged, the diaphragm loses its ability to fully contract. The resultant weakness again affects not only your breathing, but also makes you more susceptible to musculoskeletal dysfunction and pain. According to a MRI study done in 2013 by Vostatek, “Dysfunction of the cooperation among the diaphragm and abdominal, pelvic floor, and deep, back muscles is the main cause of vertebrogenic disease and structural spine findings such as hernia, spondylosis, and spondyloarthrosis.”

The rib cage, “core”, and spine should work as a unit. Altered rib mobility can not only cause a dysfunctional breathing, but also limited shoulder mobility, reactive muscle guarding, and referred pain to other areas. The “core” which has become the focus of fitness and rehabilitation programs not only consists of diaphragm, but also pelvic floor muscles, transverse abdominis, quadratus lumborum (iliocostal), internal and external obliques, rectus abdominis, and deep, posterior back muscles including the multifidus and erector spinae. Other muscles that are considered “minor core muscles” include the gluteals, tensor fascia lata, adductors, and lateral hip rotators. The engagement of your “core” muscles is not only important in breathing, but vital in maintaining the vertical, upright, human posture. Without the engagement of the “core” muscles, the intra-abdominal pressure is not adequate enough to prevent distortions and compensations of your spine and can lead to the spines collapse as in osteoporosis and other pathological situations. The result is a compensation in your posture that further decreases your breathing capabilities.

It can’t be overemphasized enough how poor postural alignment, limited thoracic spine and rib cage mobility, and weakness of “core” strength affects your breathing. Think about it! The diaphragm, “core, and accessory breathing muscles of the neck and shoulder girdles produce upward of 21,000 breaths each day. When the diaphragm is without restriction when contracting, these accessory breathing muscles will not have to work as hard remaining soft and supple. However when the contraction of the diaphragm is compensated in anyway, increased resting tone of the accessory breathing muscles will occur. These accessory breathing muscles include the scalenes and sternocleidomastoid of the neck as well as the levator scapulae and trapezius of the scapula. In addition, the tone of shoulder girdle muscles including the latissimus dorsi and pectorals will be affected.

The main characteristic of a dysfunctional breathing pattern is that the abdomen will move in on inspiration and out on expiration. Just the opposite of what should happen causing shoulder girdle protraction, forward head position, and alteration of the spine’s normal curvature. The result is that these areas are now asked to bear excessive loads that over time cause musculoskeletal dysfunction and pain.

As you age, it is a given that your thoracic spine and rib cage will stiffen, your core will get weaker, and a dysfunctional breathing pattern will progress making you more susceptible to pneumonia and other lung related ailments. We take our breathing for granted so we usually do not focus on how we breathe. However, you can do something with specific exercises and postural modification no matter your age to change how you breathe and slow this progression. Learning the proper way to breathe with the emphasis on the diaphragm is an essential for optimal health and longevity.