"Endocannabinoid System"

Hemp has been outlawed in the U.S. since 1938 and thankfully a recent Federal Farm Bill signed into law at the end of 2018 makes it legal again.

Don’t be confused! There is a difference between hemp and marijuana from which cannabidiol (CBD) products are made. Mistakenly, many people believe hemp and marijuana are the same, but actually are two different plants. Both are considered cannabis sativa by their genus and species, but that’s where the similarity stops. Hemp has been farmed and cultivated for food, clothing, fiber, and fuel. But the hemp plant, also contains naturally occurring active compounds called “phytocannabinoids,” of which CBD is one. The other naturally occurring phytocannabinoid found in hemp is tetrahydrocannabinol (THC), but at less than 0.3%.

Marijuana, on the other hand, has been cultivated primarily for tetrahydrocannabinol (THC), the “psychoactive” phytocannabinoid found at greater than 0.3%. However, it too contains cannabidiol (CBD). Even with the vast differences in THC, hemp was outlawed in this country for many years. With the passing of this Federal Farm legislation, hemp has been deregulated unlike marijuana except in certain states where marijuana is legalized.

Because it was outlawed in the U.S. for so many years, most of the research on hemp and marijuana has been done by Europe and Israel. It was from their research that the body’s own cannabinoid system called the “Endocannabinoid System” (ECS) was discovered.

In order to understand what CBD can do for health and well-being, it is important to understand the ECS. Simply put, the ECS is a signaling or message system within the body that works to enhance “homeostasis” and balance of the body especially during those times of stress. Homeostasis comes from the Greek words for same and steady and refers to any physiological process that the body uses to actively maintain stable conditions within the internal environment of the body. When talking about homeostasis, we are talking about maintaining a steady body temperature, blood pressure, respiration rate, and heart rate. Also, sustaining normal rates of water, salt, sugar, protein, fat, calcium, and oxygen in the blood in order to maintain homeostasis.

In simpler terms, think of the body’s ECS like the conductor of an orchestra and the orchestra is the body’s nervous and organ systems. The discovery of the body’s ECS is probably one of the most important medical discoveries to date and it is now believed one cannot live a life of health and well being without a well functioning ECS. Therefore, it is vital that we understand the enormity of this system and what it does and how it can influence the health and well-being of the body.

Again with the research done in Europe and Israel, it found that the human body has its own endogenous cannabinoids and that the body naturally makes its own cannabinoid-like substances called “endogenous cannabinoids or endocannabinoids.” These endocannabinoids are chemical messengers or signals produced on demand when there is the need to maintain homeostasis and balance within the body. The endocannabinoids found are called “anandamide (AEA) and 2-arachidonoglycerol (2-AG) and the AEA is actually referred to as the body’s neurotransmitter of homeostasis and balance.

Within the ECS, these same researchers found receptor subtypes called CB1 and CB2. Think of these receptor subtypes as “message receivers.” The CB1 receptors were found in abundance within the body’s central nervous system (CNS) which includes the brain and spinal cord. They also found these CB1 receptors in parts of the brain related to anxiety, fear, motor coordination, cognition, and memory.

Let’s step back for a moment and look at the part of our CNS called the “autonomic” nervous system (ANS) to understand how CBD works. It supplies the body’s internal organs including the blood vessels, stomach, intestines, kidneys, liver, bladder, genitals, limbs, pupils, heart, sweat, salivary, and digestive glands.

Whenever one mentions anxiety and fear, it is the “sympathetic division” of the ANS that is involved. The sympathetic division increases blood pressure, heart rate, and respiration rate in an emergency situation, working automatically without the conscious mind. In general, the sympathetic division is referred to as the “fight or flight” system giving the body what it needs when under stress. In short, all reactions that will protect the body and its survivability in times of stress.

On the other side of the coin, there is the parasympathetic division of the ANS. It is the polar opposite of the sympathetic division and should actually be in control of the body processes during everyday life. Two words can sum up what the parasympathetic division allows to happen in the body and they are “conserve” and “restore.” It decreases blood pressure, heart rate, and respiration rate. It also stimulates the digestive tract to process the food we eat and eliminate the wastes. From the energy of the food consumed, the parasympathetic division allows the body to restore and rebuild.

CBD can alter the “tone” between the sympathetic and parasympathetic divisions allowing the parasympathetic division to dominate. Besides this, it has been found that the CB1 receptors of the ECS can impact some of the body’s most well known neurotransmitters such as dopamine, GABA, and serotonin.

Research has found that the body’s own endocnnabinoid, anandamide (AEA), is a strong CB1 receptor agonist meaning it binds directly with receptors just like keys in a keyhole that facilitate or initiate the physiological reactions needed for homeostasis. CBD promotes the body’s production of AEA, as already mentioned the body’s neurotransmitter of homeostasis.

The CB2 receptors, on the other hand, are most abundant in the peripheral nervous system (PNS), especially involving the cells of the body’s immune system. The PNS works via peripheral nerves acting like a relay between the brain and spinal cord and the rest of the body. In the research, it has now been established that activated CB2 receptors can reduce inflammation of the body.

In what you have just read, you can understand why I have chosen to make CBD available at my facility. I feel it is an important adjunct just as diet and exercise to one’s health and well-being. The product line of CBD I have chosen is CV Sciences. I chose this product line for many reasons, but most importantly because it crosses the blood brain barrier more effectively than other CBD products.

Now, “Why is that important?” More than 100 years ago, scientists found that not everything injected in the human bloodstream would reach the brain and spinal cord. They also found that this blood brain barrier is semi-permeable allowing some materials to cross into the CNS, but prevent others from doing so.

The research found that CBD can actually help to move chemicals across this blood-brain barrier. The innate ability of CBD to naturally move across this barrier also indicates there are endocannabinoid receptors in the human brain, which we now know facilitates the neurological system to achieve homeostasis.

CBD is now being used in reducing anxiety and other related disorders inhibiting the sympathetic division of the ANS and the body’s “fight or flight” response. A relationship has also been found between the body’s ECS and omega-3 status. People who are endocannabinoid and omega-3 deficient, experience more pain, inflammation, anxiety, and depression. Finally, research has found that CBD stimulates the CB1 receptors facilitating the brain-to-bone communication by slowing the brain from releasing norepinephrine which alters bone homeostasis. This is important information for someone with a diagnosis of “osteopenia” or “osteoporosis.”

As we age, it is a known fact that our bodies tend to become less and less efficient in creating the compounds needed to maintain homeostasis, optimal health, and well-being. This statement also holds true for the body’s endocannabinoids, AEA and 2-AG, causing what is referred to as “endocannabinoid deficiency.” This deficiency has now been identified in people who have migraines, fibromyalgia, irritable bowel, neurological and inflammatory conditions, and a variety of other treatment resistant conditions. In addition, endocannabinoid deficiency has been been found to be a positive indicator of stress induced anxiety.

In my practice of physical therapy, however, I deal more specifically with patients that have joint and muscle pain as well as functional limitations usually caused by inflammation. Inflammation is a normal immune response to injury, illness, or infection that initiates the body’s healing process. When the healing is complete, the process of inflammation should shut down. However, sometimes that is not the case.

When inflammation does not cease and continues out of control, trouble follows. Trouble from the sense that the inflammation could take a toll on the rest of the body. The research has found that most of the chronic conditions facing our society today share a common feature in inflammation as an underlying cause. Whether it is coronary artery disease, hypertension, diabetes, depression, rheumatoid arthritis, or Alzheimer’s disease, inflammation is seen as the underlying cause.

It is easy to recognize the signs and symptoms of acute inflammation like with a sprained joint or a strain of a muscle. One will initially experience redness, swelling, heat, pain, and often times loss of function. However as the healing process advances, these signs and symptoms decrease. But with chronic inflammation, the signs and symptoms are oftentimes hidden and can have a long term and whole body effect on health. It is this type of systemic inflammation that can contribute to the development of disease over time. All told, researchers now believe that chronic inflammation is responsible for 7 out of the top 10 leading causes of death in the U.S.

When someone is living with higher levels of chronic inflammation, it increases the production of damaging “free radicals” within our bodies creating a situation called “oxidative stress.” When oxidative stress runs unchecked overtime, it damages the cells of our bodies at its foundational level. Over the years the extensive research has found that by increasing the availability of antioxidants, the body can protect itself from the damaging effects of these free radicals. The research also showed that by reducing dietary sugar and carbohydrates and at the same time increasing the dietary consumption of good fats and fiber, one can reduce inflammation too.

But now, researchers found another tool in combating inflammation and that is CBD. It can limit inflammation and its effects in terms of reducing these free radicals. Therefore, CBD is now considered being helpful in managing inflammation under the same breath as turmeric and ginger. CBD is effective in reducing systemic inflammation because it talks to every major organ system via the endocannabinoid system thereby restoring body homeostasis.

The skin, the body’s largest organ, also produces endocannabinoid molecules such as AEA and 2-AG. These endocannabinoids are constantly released in specific amounts, depending on the needs of your body, resulting in the skin’s endocannabinoid tone. That is one reason I have chosen to carry only topicals of CBD at my facility. However, CBD can be taken by sub-lingual drops, gel capsules, and gummies with the CV Sciences’ brand.

But no matter how it is taken, remember the “Endocannabinoid System” (ECS) is essential to a life of health and well-being communicating messages or signals that affect how humans relax, eat, sleep, forget, and protect. Remember, CBD more than anything else promotes homeostasis and balance of the body.


•MYTH-Lower than 0.3% THC is the only difference between hemp and medical marijuana.

•FACT-Hemp is a tall and skinny plant that is high in fibers and low in cannabinoids and resins. Marijuana is a shorter, bushy plant rich in cannabinoids and resins. Distinct genes that code for these traits can be used to distinguish food/fiber hemp from medical marijuana.

•MYTH-Higher milligrams of CBD are always better.

•FACT-Start low and slow for best results and titrate up until you find your “sweet spot!”

•MYTH-CBD derived from marijuana is superior to CBD derived from hemp.

•FACT-NO. CBD is CBD, no matter what source it is from.

Well, there you have it! The most recent scoop on CBD. Remember that despite the modern-day stigma, cannabis whether hemp or marijuana based has been used for centuries as plant medicines. With the research and development of cannabinoids (CBD) by companies like CV Sciences, more and more people will be able to better manage their stress, inflammation, and pain enhancing their health and well being. For more information, you can look up CV Sciences’ website at cvsciences.com or pick up information on CBD at my facility. Thank you. Be Healthy! Be Well!

Terry Kern, P.T.

“Your Energy Body”

This may come as a surprise to you, but you are not just an organic, bag full of nerves, bones, muscles, tendons, ligaments, and organs. You are “energy.” Yes, you heard me correctly, you as well as all matter in the universe is comprised of energy. Therefore, understanding and treating your “energy body” maybe just as important as the proper nutrition, exercise, and rest to your health and well-being.

Believe it or not, you are energy and because of the recent discoveries with science, energy has been determined to be all there is. Understanding and recognizing that you are an energetic being first and foremost is an important step for you to take while on your personal journey to optimal health, wellness, and fitness.

Because of the scientific discoveries in physics, we now know energy is the foundational, building block of all matter or any substance that has mass or takes up space by having volume. The same energy that composes us is the same energy that composes trees, plants, and animals. Yes, that same energy composes all of creation as we know it. In fact, it is the same energy found throughout our universe. There is no isolated energy of the tree, plant, animals, and humans, but everything is integrated together with the same foundational energy. An energy that is always and constantly flowing, interacting, and changing form.

Life indeed can be defined as an energetic process. Everything from sub-atomic particles to the amino acids, peptides, and the DNA of your cells that make you. The cells that make you resonate with their own unique and signature frequencies.

Albert Einstein was the first to recognize the recipe for the amount of energy necessary to create the appearance of matter as we know it. He found that there are two fundamental physical entities, something material and another immaterial, but only one energy. Everything is energy.

Yes, everything in our world as we know it is energy first and foremost. Anything that you can hold in your hands, no matter how dense, how heavy, and how large. In its most fundamental or core level, everything in our universe can be broken down to a collection of electric charges interacting with a larger background sea of electromagnetic and other energetic fields.

Everyone and everything is constructed of energy, no exceptions. Taking it to more personal level, you are surrounded by a vast sea of energy fields that flow through and/or interact with your energy holding onto and exchanging information. We are all integrated in this vast sea of energy. In fact, there is an incredible, constant “energy dance” that is going on right now inside your body with your energy communicating with all the cells of your body and to the world around you.

In terms of the physical body, it is the energy that differentiates a corpse from a living, human being. A strong “life force” that makes us totally alive, alert, and present. To put it in perspective, your energy which is vibrant and flowing, communicates within you while interacting with the universal energy fields ultimately determining your degree of health or lack of it.

For thousand of years, other cultures have described various forms of the same “life energy.” The Chinese call it “qi or chi” while Indians and Tibetans refer to it as “prana” and the Japenese as “ki.” While these cultures may argue their definition of this “life energy” is unique, we are talking about the same thing. It’s all the same energy.

Your body indeed speaks this energy language with the world around you and the entire universe. Before your physical body gets sick as we know it, it gets sick energetically. Therefore, keeping your energetic body balanced and healthy is a vital and important precursor to keeping your physical body healthy and vibrant.

Just as homeostasis is the codeword for health in the physical body, balance is the codeword for your health in the energy body. Balancing the yin and yang energy is the key to a healthy, vibrant energy body. In fact, your energy body has built in energy channels and centers that distribute the “life energy” to the organs of the body called meridians and chakras.

All life is ruled by the interplay of the two dynamic, polar opposite energy forces that are defined as the yin and yang in Traditional Chinese Medicine. Yin can be described as negative and passive while Yang is positive and active. Again, even though they are described as polar opposites, they are complementary forces, never equal, cycling together in harmony.

Since everything is energy, everything you eat, everything you come in contact with, and everything you are around affects you energetically in some way or another. Even with all the advances in our modern, medical system today, these treatments will be of little use to you if you have disruptions and/or blockages in your energy system. Why do you think acupuncture has been so vital and effective in many cultures outside of our own for thousands of years to restore one’s state of wellness?

Acupuncturists try to stimulate and balance the “life energy” by putting needles into the energy channels called meridians with the goal to bring about a change in one’s energy health. It is based on the premise that a blockage or disturbance in the flow of the body’s “life energy” as we have just discussed or “chi” can cause physical, health issues if not treated. By inserting the needles into specific points along a meridian that are blocked, acupuncturists restore the flow of “chi”, balancing the body’s energy, stimulating healing, and promoting relaxation.

However, the use of needles in acupuncture is not the only way to balance the “chi.” The ancient Chinese practices of “Tai Chi” and “Qi Gong” by combining slow, deliberate and fluid movements, meditation, and breathing can also balance the body’s “life energy” or “chi.” The routines were not designed to build muscle mass, burn calories, or raise one’s heart rate as one does at the gym. But, these movements are designed to enhance your circulation, balance, and alignment. Most importantly, they help to balance your “life energy.”

Tai Chi and Qi Gong are not muscle workouts as one would think, but instead are working with the body’s fascial or connective tissue system. The energy that we have been discussing is actually carried throughout your body via this web of fascia running from the bottom of your feet to the top of your head. In fact, the fascia can be thought of as the fiber optics of the body. It is designed to move energy, envelope and isolate muscles, tendons, organs, and blood vessels and to provide protection and support within the physical body.

Until recently, fascia has been vastly overlooked as a system of the body until Thomas W. Myers and his book “Anatomy Trains” came out that has given its due. Simply put, fascia is the biological fabric that holds our bodies together. In fact, your body is made up of 70 trillion cells, all humming, vibrating, and resonating in relative harmony encased by fascia.

However one may define fascia, it is everywhere within the human body. Birth to death and micro to macro. Listen to this quote by Ida Rolf to fully understand the importance of fascia: “Fascia is the organ of posture. Nobody ever says this; all the talk is about muscles. Yet this is a very important concept, and because this is so important, we as Rolfers understand both the anatomy and physiology, but especially the anatomy of fascia. The body is a web of fascia. A spiderweb is in a plane. This web is in a sphere. We can trace the lines of that web to get an understanding of how what we see in a body works. For example, why, when we work with superficial fascia does this change the tone of the fascia as a whole.”

Fascia indeed is one network both anatomically and embryologically providing the unity, the integration of the human, physical body. But more importantly, it is the conduit, the fiber optics for the movement of energy. The movement of energy within our bodies as well as the movement of energy from the universe outside of our bodies.

The fascial system actually starts about two weeks into human development as a fibrous gel that pervades and surrounds all cells within the developing embryo with its center being at the physical body’s center of gravity around or near one’s umbilicus. From there, it progressively develops into complex layers of fascia in an adult. In fact, there is no discontinuity in the layers of fascia going from the deepest which is the dura of the central nervous system to the most superficial just below the dermis of the skin.

Unfortunately, human anatomy atlases and kinesiology texts tend to reduce the human, physical body down into Newtonian biomechanics of forces, vectors, and levers as if we are just machines with parts. This is a very limited viewpoint explaining only some behaviors of our bodies while obscuring others. Einstein’s relativity, fractal mathematics, synergistic system’s theory, and tensegrity geometry as applied to biological systems is now transforming how we see the human body today.

To explain the importance of fascia and our energy body, I want to share my personal story. As I have mentioned in the past, I have dysfunctional knees causing me intermittent pain from the years as a competitive ski jumper and the falls I experienced while training and competing. Over the years, I have tried to manage my knee dysfunction and pain with exercise focusing on my strength, endurance, flexibility, and alignment by working with the neuromuscular system that affects the joints, tendons, and ligaments. Because of the integrative nature of the physical body, I was also indirectly affecting the fascial system. That is, until I started to learn Tai Chi Chih that would directly affect my fascial system.

Tai Chi Chih is the work of Justin Stone, someone who practiced and taught for many years Tai Chi Chuan which is a martial arts system. Over the years, Justin realized that Tai Chi Chuan was just too difficult for most people to learn. However, he strongly believed in the benefits of the ancient yin-yang system of energy and having observed for himself the gains from the circulation and balancing of “chi”, he developed Tai Chi Chih from the principles of Tai Chi Chuan in 1974 while living in Albuquerque, New Mexico. He reduced Tai Chi Chih down to one pose and nineteen movements to generate, circulate, and balance “chi,” the life energy.

Recently, I started instruction in Tai Chi Chih with the ultimate goal of rehabilitating my dysfunctional knees and hopefully avoid future surgical intervention. While learning the initial movements, I noticed that both my knees were cracking and popping more than usual and at times causing more pain. When I was working with the neuromuscular system, my symptoms were different than what I was now experiencing working directly with the fascia through the Tai Chi Chih movements.

Being the analytical person that I am, I started to look for answers on why this was happening. I came to realization that the focus of Tai Chi Chih as well as with Tai Chi, and Qi Gong is on the fascial and energy systems of the body more than the neuromuscular system.

In watching the videos produced by Justin Stone, I remember him always stressing to take the “effort” out of the movement. In short, I understood it as dampening the muscle activity that occurs with each movement. Coming from my athletic background where muscle activity dominated, that was difficult for me. After all, we are taught that human movement is the product of muscle contraction and force.

With the Tai Chi Chih movements, there is a fluidity of movement. A flow that can only come from dampening the force production and work of the muscles in movement by utilizing the integrated tension and control of the fascial system. Have you ever watched a great athlete or a dancer perform their skill with what seems like no effort. Their movements are so fluid and as Justin Stone describes there is “Joy” in their movements. I feel this is because they have been able to tap into the balance of tension provided by their neuromuscular and fascial systems. More importantly by achieving balance between these two systems of posture and movement, they have balanced the flow of their life energy, “chi.”

I am now in about my seventh session of my Tai Chi Chih instruction and happy to report things are changing. I am no longer experiencing the intensity of popping and cracking and the pain is gradually diminishing. I think by working more directly with the fascial system in Tai Chi Chih, some of the fluidity of movement that I have lost because of the compensation stemming from my dysfunctional knees is returning. In that regard, it is truly bringing the “Joy” back to my movements.

Isn’t it time you started to recognize and work with your “energy” body? If you are interested in Tai Chi Chih instruction, call the Tai Chi Chih Center here in Albuquerque at 505-299-2095 or check out their website at taichichihassociation.org. Also starting in January, Ann Rutherford, will begin instruction of a Beginning Tai Chi Chih class. She can be reached at 505-292-5114.

Terry Kern, P.T.

“My Dysfunctional Knee”

I want to share with you my own recent, personal experience involving the atlas and axis, the first two cervical vertebrae of the spine. I have written about these upper cervical vertebrae previously on my website, but its importance in skeletal, structural stability really hit home with me this week.

First, bear with me as I give you a little background about my left knee. I injured this knee during December 1971 in a fall while ski jumping that required surgery to repair a torn medial collateral ligament and the joint cartilage. Since then, it has always been the weakest link in my skeletal and structural stability, experiencing intermittent symptoms of joint aching and pain, but nothing sharp and debilitating. I have always been able to manage these symptoms through exercise so it hasn’t limited my activities. That is, until this week.

After returning from Minneapolis/St. Paul to watch my “Twins” get embarrassed by the “Yankees”, I started to have more than the usual aching and pain of my left knee that would not let up. With each passing day, the symptoms increased and then I started to experience significant instability and pain of my left knee with each step I took. It got so bad, I was afraid to put any weight on my left leg. I continued to work on the muscles that impact the position and motion of my left hip, knee, and ankle with no change in the symptoms. That went on for several days until I changed my strategy remembering that the biology of physical, bodily pain is never straightforward, even when it appears to be.

I then started to look at my neck and focus on the atlas and axis. The atlas is the vertebra that articulates with the occiput at the base of the head and the axis is the second cervical vertebra. Just hearing the name, “atlas,” emphasizes its importance in maintaining our skeletal and structural stability.

Remember, Atlas is from ancient Greek Mythology who was a Titan responsible for bearing the weight of the heavens on his shoulders. He is usually portrayed as an enormous, bearded man, always slightly bent over and in pain under the weight of the heavens depicted as the globe sketched with the most famous constellations.

Bear with me again before I continue because an understanding of the anatomy, biomechanics, and neurophysiology of the atlas and axis is required to understand my story. The atlas and its articulations with the occiput and axis are described by many of the body experts as the “most complex joints of the axial skeleton both anatomically and kinematically.” The upper cervical spine as the atlas and axis are commonly referred to sacrifice stability for mobility as evidenced by 50% of cervical or neck rotation occurs between this atlantic-axial articulation.

The neurological dysfunction related to the misalignment of these two very important vertebrae involves mechanoreceptors. The mechanoreceptors are specialized nerves that perceive mechanical information due to positional change and motion at a joint such as the atlas-axis articulation causing reflex activity by the nervous system. Stimulation of these receptors results in reflex muscle contraction about the joint and in this case a group of muscles referred to as the sub occipital muscles as an adaptive control to the different stimuli from within and outside the environment of the body. These mechanoreceptors primary input is to the cerebellum of the brain from our bodies working with and against gravity and its effects.

It is known that the upper cervical spine has more mechanoreceptors per surface area than any other region of the spine. Also, there is direct evidence that these upper cervical mechanoreceptors feed into the vestibular system housed in the middle ear for control of skeletal, structural balance and equilibrium by affecting the muscle tone throughout the body.

It has been my experience in the past that misalignment of the atlas-axis articulation can manifest clinically in various forms of postural distortion such as a functional leg length difference, pelvic distortion, head and shoulder tilt and shift, and unequal weight distribution between the legs. It is the latter that I started to focus on with my sudden onset of left knee pain.

I then started to work on the muscle tone or tension of several sub occipital muscles including the rectus capitis lateralis, obliquus capitis superior, and the obliquus capitis inferior. Muscles that are really small in comparison to the size of the muscles that affect the position and motion of the hips and lower extremities. I started to do isometric exercises in order to facilitate these sub occipital muscles and affect their tone that would ultimately affect the position of my head.

I also knew from experiences in ski jumping the importance of head position in the performance of any bodily motion. When ski jumping, we were always instructed not to drop our heads when flying through the air unless we wanted to flip over in mid flight. I had always kept that in the back of my mind when treating my clients in physical therapy, but really did not understand its importance until this recent episode with my left knee. “The body follows the direction of the head!”

Once I started doing the isometric neck exercises with eye movements to alter the tone of the sub occipital muscles mentioned, my knee symptoms dramatically began to change. The eye movements done with the isometric neck exercises are referred to as the vestibular-ocular reflex in that the position of the eyeball will be opposite of the position of the head so as to give us a straight ahead gaze and level horizon.

In trying to understand the reason for the onset of my left knee pain without doing anything physical or experiencing a traumatic event, I came up with this scenario. I know that when flying by air in today’s world the body takes a beating because of the very poor ergonomically designed seats and the cabin pressure. These two factors affect ones skeletal and structural stability and posture even though it is only a two hour flight.

Prior to commencing with the isometric exercises for the sub occipital muscles, my left knee would intermittently give out stressing that surgically repaired medial collateral ligament from the 1970’s that runs along side the medial or inner aspect of my knee causing a very sharp pain that would at times take my breath away.

Therefore, I had to walk very slowly and guarded in attempt to control the forces due to walking aggravating my now very unstable, left knee. In an attempt to alter the mechanoreceptors at the knee, I applied “kinesiotape” along where the medial collateral ligament runs which did help the isolated stability of my left knee. But, it was the isometric exercises altering the tone or tension of the sub occipital muscles that stabilized my left knee and the rest of my skeletal structure.

By changing the position of my head in doing these very simple neck exercises, it altered the input from the mechanoreceptors at the atlas and axis resulting in a more vertical and neutral position of my head. As the position of my head changed, the distortion of my pelvic girdle and the weight bearing into my lower extremities changed. It changed the integrated reaction of my skeletal structure to ground and gravity.

Within several days, I started to experience less and less aching and pain. In addition, I was no longer experiencing the intermittent episodes of my left knee giving out and the resultant sharp pain. As a result, my anxiety and fear of pain I had with each step started to diminish. With each passing day, I grew more confident in my movements. That is because the “sympathetic chain,” a bundle of nerve fibers that run from the base of the skull to the tailbone just lateral to the vertebral bodies were no longer being stimulated. Remember, the “sympathetic nervous system” which is part of our “autonomic nervous system” is facilitated when the body is under stress such as with the instability and pain of my left knee. It’s the “fight or flight” response to this apparent threat of skeletal and structural instability.

Fortunately, I am now able to walk again without the instability and pain and I am getting back into my daily walks. Whew! I accomplished this without surgery and months of rehabilitation which I did before in the 1970’s. All it took this time was to put my “head on straight!” As long as I do that, my dysfunctional left knee will be able to function normally against gravity and its effects on a daily basis. It is my hope from this story that you can see how important the atlas and axis are to our skeletal and structural stability allowing us to perform the activities of our daily living.

“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.

“The Atlas”

The first cervical vertebra, called the “atlas” or C1, plays a primary role in the alignment of the spine and body, maintaining musculoskeletal and fascial balance, and keeping you vertical against the forces of gravity and ground reaction.

Misalignment of the “atlas” might have a “domino” effect on the entire musculoskeletal and fascial, circulatory, and nervous systems, by creating imbalances and dysfunctions in various parts of the body. These malfunctions might turn, over time, into serious health issues: The body is no longer able to function the way it could and should in a state of homestasis. The quality of life can become seriously compromised, even though no clear-cut organic cause might be identified and diagnosed.

When C1 or “atlas”, the spine, and the skeleton are in balance, gravity and ground reaction forces, the forces each one of us compete against each day are distributed evenly between the two sides of the skeleton.

The head’s considerable weight (as much as 11-13 pounds), which should not be underestimated, is entirely supported by the “atlas.” A misaligned “atlas” causes the cranium not to be perpendicular to the spine and most importantly to ground reaction force affecting how your body finds its vertical position when sitting and standing. The “atlas”, therefore, has a great influence on the balance of your entire skeleton and is directly responsible for your upright and vertical posture.

Misalignment of the “atlas” causes a shift in your body’s center of gravity and a musculoskeletal and fascial imbalance from head to toe leading to musculoskeletal dysfunction. The misalignment of the “atlas” causes a static, false posture in which one side of the body is more stressed than the other. This is why your pain is generally concentrated on one side of your body.

Due to the shift in your body’s center of gravity, the stress to your skeletal structure causes muscle tension, spasms, and pain, especially if the muscles are weak and untrained. This results in cervical problems, tension related headaches, vertigo, stiff neck, restricted or painful head rotation, musculoskeletal issues involving the shoulder and pelvic girdles, hips, and extremities.

The misalignment of the “atlas” may have secondary effects on the “axis” or the second cervical vertebra as well the other neck vertebra.  In fact, it also may affect the alignment of the thoracic and lumbosacral vertebra in a “domino effect.”

In this chain-reaction process, misalignment of the “atlas” may cause asymmetry of the entire, integrated skeleton, such as having one shoulder higher than the other or one side of the pelvic girdle being higher causing a leg length difference. In addition, it can cause scoliosis of the spine. Over time, these changes can lead to degeneration of the spine and joints.  Think about it!