Helios Natural Healthcare

In recent months, I’ve begun to seriously evaluate my own running technique and form, both for selfish reasons and for bringing on some insight that I might share with others. As I started to focus on maintaining good posture throughout the runs, especially at increasing distances, I quickly learned just how central core stability is to any activity we want to do well. Along with flexibility, cardiovascular fitness, and repetition (practice), a strong core provides an incredible foundation for anything that involves productive motion. It also frees up our focus for making subtle changes that lend to improving technique, rather than having all of our resources dedicated to remaining vertical.

Core stabilization is the general term used to describe how the muscles of the torso secure the spine, providing a solid foundation for movement in the extremities. This, in turn, helps us to stay upright and balanced when we move. The core muscles lie deep within the trunk of the body, and, when they are strong and activated, work automatically to synchronize our every movement. They attach to the spine, pelvis, and scapula, stabilizing these areas to create a firm base for coordinated movement of the legs and arms. When the core muscles are strong, they contract immediately whenever the arms and legs initiate motion, balancing the body and decreasing the likelihood of injury, even when an unexpected force or unevenness in the terrain catches us off-guard.

Especially when used in the context of back injury prevention and rehabilitation, core strength, has become a term that most people recognize, but how many of us incorporate it in a meaningful way to everyday life? Even though it is known to prevent injury, core exercises are most frequently introduced during rehabilitation for an injury that has already occurred. Why is that? Would daily core exercises be more interesting if there was a chance that a strong and activated core could improve athletic performance and stamina? How about if it could maximize power while minimizing injuries? Based on my experiences, I think these are all likely outcomes with a simple daily ritual of partial sit ups (crunches), leg lifts with knees bent, and sustained bridge and plank poses (30-60 seconds each). I would also add leg and arm stretches to ensure balance around all the moving joints. All together, this wouldn’t take more than 20 minutes of your day. If you are in good health and already exercising regularly without any problems, I challenge you to add regular core exercise to your workouts, at least 3x/week for 6 weeks, then share any changes you notice by leaving a comment to this post. If you would like suggestions for stretches and exercise, send me an email and I will send you a handout with instructions and pictures. As someone who has experienced the benefits of a strong core, I can tell you this is worthy of your effort.

I’ve been off-line for a while doing field research for the next set of blogs I have planned; a series of articles about finding bliss and building a strong mind and body, while practicing the primitive and “no props required” sport of running. Armed with a solid understanding of human biomechanics, and some select training advice I had picked up over the years from articles in publications like Runner’s World and Running Times, and books like Born to Run (by Christopher McDougall) and Chi Running (by Danny Dreyer), I took to the trails, tracks, and streets with the intent of running a relatively competitive marathon, while remaining (and this is key) injury-free. I chose the marathon because it is a run that fascinates me, but I think useful information for any length of run, walk or jog can be taken from what I learned. My hope in sharing the ups and downs of my training adventures is that I will incite another to get out and find the physical activity that makes her feel like she can fly.

The venue I chose for this undertaking was the Inaugural Oakland Running Festival Marathon, as I felt the excitement of a first ever event might conjure up some extra inspiration for me. I started training in December 2009, following recovery from an injury-filled marathon that I had recently, and just barely, finished. Using the Less is More Marathon Plan from the August 2004 issue of Runner’s World, I committed to three days of running per week, and two days of cross-training. Some weeks I made better than good on this pledge and other weeks, not as much. Regardless, I continued forward, leaving those perceived failures in my dust. Earlier in the year, I had happened upon what proved to be a very useful lecture along these lines during a continuing education course. The talk was given by a chiropractor, Dr. Eric Plasker, about his book, The 100 Year Lifestyle. He made several points that resonated with me, but one particular idea proved invaluable to my training psychology. In explaining his proposed principles for living long and with quality, he said something like “aim for progress, not perfection.” He went on to explain that dwelling on past shortcomings is completely useless, and that we generally accomplish our goals, not in one large jump, but in a series of smaller steps. We also fall off course sometimes – this is normal human nature, not failure. When this happens, the only focus we need is that of getting back on track. As long as we have net forward motion at the checkpoints, we are successful. And, without the baggage of all that dwelling, forward motion is likely. Using Dr. Plasker’s advice, I progressed through this training schedule, trudged at times, and didn’t worry about the lack of perfection in my training. At the end of it all, I felt strong, prepared and, most importantly, incredibly excited for the event.

In addition to running and cross-training, which included cycling, walking, hiking, and yoga, I focused as much on daily core stabilization exercises and stretching. From basic biomechanics, I knew that good posture during motion is critical to injury prevention, and also that good posture is impossible without optimal mobility of the joints, muscles and connective tissues, as well as strong and activated core musculature. Danny Dreyer talks about this at length in his book, Chi Running, and I will write more later about how this made all the difference for me. I gave equal attention to nutrition, both in my overall diet for building strength and endurance over the training period, and in the specifics during the longer runs for preventing “bonking” at the higher mileage. I had experienced the pitfalls of electrolyte imbalance and nutrient deficit in past events, and was impressed by the difference a little planning could make for this one. I didn’t get the race day nutrition perfect, but was content with the extra insight this shortcoming provided.

At the onset of this project, I hoped for good subject matter to write about and an experience that would either support or refute my previously held ideas about endurance training. As I progressed through the plan, however, I found more; that the positive side effects of exercising in a deliberate and self-preserving manner, for reasons other than winning or firming up the thighs, completely steamroll any other motivations one might have. I wasn’t crushed by the heaviness of the commitments, but instead felt empowered, energized, and elated. I came to understand the runner’s high, but it didn’t come from where I thought it would.

A friend of mine from chiropractic school wrote this article. I thought it was excellent and, so, am sharing it here. She practices in Tewksberry, MA and is expecting her first child.

Most expectant mothers will experience some degree of lower back pain during their pregnancy. In order to make room in the pelvis for the growing baby and prepare for delivery, a pregnant woman’s body secretes a hormone aptly named relaxin, which causes the ligaments to relax and loosen. Add to this the extra weight, weakened abdominal muscles, and shifted center of gravity that are unavoidable during pregnancy, and you have a recipe for back pain. While you may not be able to completely avoid back pain during pregnancy, there are some ways you can help make it more manageable.

First of all, prevention is key. Although heavy lifting will not hurt your baby, it is likely to hurt you. Even though I know better, I stupidly tried to move a 300 lb table during my first trimester and ended up spraining my pelvis. Please don’t follow my example! Let someone else do the heavy lifting. How often in life do you have such a great excuse for sitting back and letting others do the work? If you must lift something, make sure to bend your knees and lift with your leg muscles.

Proper foot wear is also essential to prevent back pain. Heels may look cute, but they are horrible for your back, especially during pregnancy. High heels push your center of gravity forward, causing you to arch your back in order to keep from falling over. During pregnancy, your back is already arched due to your big belly, so adding heels to the equation effectively causes you to squish the facet joints in your spine- ouch! My advice: ditch the heels at least during your pregnancy (but preferably forever!) Get some supportive flats, sandals, and walking sneakers. On a side-note, it is also a good idea to have your feet measured before making your purchase. Chances are, your feet have grown a size or two!

So what can you do if you find yourself with back pain despite these precautions? My four recommendations are: exercise, bracing, chiropractic, and massage. Gentle exercise such as walking, swimming, and yoga can do wonders for back pain. A few specific exercises that may be helpful are: lunge stretch, tailor stretch, cat-cow, and leg extensions. To do the lunge stretch, go down on one knee with the other leg bent in front of you at a 90 degree angle with the foot on the floor. Lunge forward slowly at the hips but keep the torso up straight. You should feel a stretch in your hip/groin area. Hold for 30 seconds and repeat on the other side. You can do the tailor stretch while seated. Cross one ankle over the opposite knee and lean forward, keeping the back as straight as possible. Cat-cow and leg extensions are done on your hands and knees. To do the cat-cow, arch your back up like an angry cat and tuck your buttocks under for a few seconds, then let your back relax and your belly sag for a few seconds. Repeat 10-20 times. For leg extensions, slowly move one leg straight behind you, hold for a few seconds, and then return to starting position. Repeat on the other side. Do 10-20 of these, making sure to keep your back as flat as possible.
If you find yourself getting sudden twinges of pain in your pelvis/buttocks whenever you stand up from sitting or if it feels like your hip sometimes “gives out” when you are walking, you may benefit from a sacroiliac brace. Essentially this is a belt that goes around your pelvis and helps hold the joints in place. The best ones that I have found are the “SI-LOC” and “Mother-to-Be” belts. Both can be found online at www.OPTP.com. The SI-LOC is better for earlier stages of pregnancy. The Mother-to-Be is better for the later stages of pregnancy when the belly is very big, or for women who are overweight to begin with. Both can be worn inconspicuously under your clothes.
Chiropractic treatment is another safe, effective option for back pain during pregnancy. A chiropractor can mobilize the joints in your spine and pelvis that have become stuck in the wrong position, thereby reducing inflammation and pain in the joints and helping the surrounding muscles relax. Theoretically, a well-aligned pelvis also maximizes the size of the pelvic opening, which many women have said leads to an easier delivery. Some chiropractors can also adjust your aching feet and address other problems you might be having, like headaches or carpal tunnel disorder. When shopping around for a chiropractor, ask if they regularly treat pregnant women and whether or not they have a special table or pillows to accommodate your expanding belly. Ask if you can meet with or talk to the doctor before making an appointment. It is important to find someone you like and trust. Chances are, you’ll need your chiropractor after having the baby as well; holding and breastfeeding an infant tends to cause some upper back tightness and pain.

Last but not least, I recommend that every mother-to-be gets at least one massage during her pregnancy. Growing a baby puts a lot of strain on the body. Muscles tend to get tight and sore, and you may be retaining water. You also may be feeling tense and anxious about your upcoming bundle of joy. A good massage can not only reduce muscle tension and reduce pain, but also provide mental relaxation and decrease swelling. And besides, every pregnant woman deserves a little pampering, right? Look for a licensed massage therapist who specializes in prenatal massage. He or she will know how to accommodate your changing body, either by doing the massage in a side-lying posture or using special pillows to support your breasts and belly.

In most cases, pregnancy related back pain will resolve several weeks after delivery, when you have lost some of the pregnancy weight and your ligaments have tightened back up again. That being said, there is no need to just wait and suffer throughout your pregnancy. By trying some of the tips that I have mentioned here, you will be more comfortable and able to enjoy the miracle that is happening within you.

Most people know that cardiovascular disease and cancer are the leading causes of death, by a large margin, in the United States [1]. It is also common knowledge that these conditions are highly preventable diseases of our modern lifestyles. Modes of prevention are simple and well known too. So, instead of waiting for that grave diagnosis, how about incorporating a few changes, little by little, into your daily life? It could make the difference between continuing a life that you enjoy, and embarking on some radical green juice diet and intensive exercising in a sauna program, for the sole purpose of saving your life, down the road.

We’ve all heard the stories of people who’ve abruptly changed their nutrition and lifestyles after a scary diagnosis, and have completely turned the illness around and become healthier from it. This phenomena has even been studied. In a 2009 article published in the Journal of the American Medical Association (JAMA), Yale researchers found that “people newly diagnosed with health problems were more likely to change their health habits than those without a new diagnosis.” For example, “smokers newly diagnosed with at least one condition were 3.2 times more likely to quit than those without a new diagnosis [2].”

In 1990, Dean Ornish, MD published a study showing that “heart disease could be not only slowed down, but actually reversed with a plant-based diet and other lifestyle changes. People learned they could literally take their life in their own hands and cure themselves of a debilitating life-threatening disease once thought to be incurable [3].” More recently, in a study of men diagnosed with prostate cancer, Dr. Ornish studied the impact of a plant-based diet, “predominantly fruits, vegetables, whole grains, legumes and soy products,” on patients who already had cancer. “Dr. Ornish found 93 men with early biopsy-proven prostate cancer who volunteered to forgo radiation, chemo and surgery. He then randomized the cancer patients into a lifestyle modification group, which included a strictly plant-based diet along with other healthy behaviors such as walking 30 minutes six days a week, or a control group which just watched and waited. A year later the results were tallied and published in the September 2005 issue of the Journal of Urology. By the end of the year-long study, six of the control group patients had dropped out because their tumors were growing (MRI’s or diagnostic tests of cancer activity showed that their tumors were growing at such a rate that they decided they could wait no longer and opted for a combination of radical surgery, chemotherapy or radiation). However, not one of the vegan diet group suffered the same fate. In fact, while on average cancer activity increased in the control group, as measured by PSA tests, the cancer markers DECREASED in the lifestyle modification group. By the end of the year the cancer growth rate, as measured by these tests, was highly significantly different between the two groups [4].”

Of course, genetics and previous environmental exposures play a role, but people have more power than they might think over their health destiny. So, are you wondering yet, what are these simple changes that can be incorporated? According to the American Cancer Society (ACS), and many other experts and panels, eating right, being active, and maintaining a healthy weight are important ways to reduce your risk of cancer, as well as heart disease and diabetes. In short, it is recommended that you maintain a healthy weight, eat a healthy diet that is high in plant sources, adopt a physically active lifestyle, don’t smoke, and don’t drink too much alcohol.

In regards to eating a healthy diet, you can start immediately by replacing any sugary, salty, high-fat, processed foods in your diet with the whole food versions of them. A good rule of thumb, taken from author, Michael Pollan’s, 7 Rules for Eating, is “eat food, not too much, mostly plants. Don’t eat anything your great grandmother wouldn’t recognize as food,” i.e. “choose food over food-like substances.” Also, drink plenty of clean, pure water and few or no sugary beverages. Don’t drink diet beverages at all.

For exercise, the long term goal is to engage in 30 or more minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week. Start small, though, by doing anything active, such as walking or biking in place of driving whenever possible (that’s good for the environment too), taking the stairs instead of the elevator, jumping in place while waiting for your computer or applications to start up, taking an exercise break at work, going out dancing with friends, or spending time playing with your kids (if applicable). Your increased activity levels will feed your energy capacity and, before you know it, you’ll be out running, biking, or playing a pick-up game of your choice with colleagues over lunch. Maybe you’ll even join a sports team, cycle a century, or run a marathon!

The last two changes, don’t drink too much alcohol and don’t smoke, can be tough, even though they sound pretty straightforward. The American Cancer Society (ACS) writes that moderate to heavy drinking is known to contribute to cancers of the mouth, throat, larynx (voice box), esophagus, liver and breast, and may contribute to colon and rectal cancers. The ACS recommends that people who drink alcohol limit their intake to no more than 2 drinks per day for men and 1 drink a day for women, with a drink being defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. Quitting smoking is one of the best things you can do for improving, not only your health, but the health of the people around you. To kick the habit for good, you need motivation, dependable support, and sound strategies, and you don’t need to do it alone. There are so many resources available, including these from the Centers for Disease Control (CDC) and the ACS.

At the end of the day, it’s a simple decision to make. Do you want to take control of your long term health status, or would you rather just do nothing and wait to see how it all turns out, as the subject of your own experiment? There’s always week-long cleanse after week-long cleanse if it doesn’t work out.

1. National Center for Health Statistics, Deaths and Mortality Data for the US
2. Disease Diagnosis Can Spur Change in Lifestyle, HealthDay News, SOURCE: JAMA/Archives journals, news release, Feb. 9, 2009
3. Ornish D, et al. 1990. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336(8708):129-33.
4. Ornish Takes on Cancer (from Dr. Greger Newsletter, Fall 2005)

Did you know that female athletes who play popular competitive sports, such as soccer, basketball and volleyball, are at up to 8 times greater risk for injury of the anterior cruciate ligament (ACL) of the knee than their male counterparts? Or that, while some of these injuries come about following an external impact, such as a lateral blow to the knee by another player, the majority occur without any contact at all? These statements are both true and disturbing, but there is good news too. With proper conditioning, these injuries are preventable.

Before delving into more details, let’s all get on the same page with some basic information. The ACL is a tough band of tissue that runs from the thigh bone (or femur) to the shin bone (or tibia). It plays an important role in stabilizing the knee joint. When the ACL tears, it’s often the result of a sudden, forceful twist, such as an awkward landing from a jump that torques the knee. Athletes in sports that require quick pivots and jumps have the highest rates of ACL injury.

Following the well-known “pop” and the scream that often follows, the scenario for most of these injured athletes involves reconstructive surgery and a difficult six to nine months of rehabilitation, as well as a pre-disposition to irreversible posttraumatic degenerative joint disease in early adulthood. ACL injuries among young female athletes have reached epidemic levels in many countries, which has athletic trainers, coaches, athletes, parents, and administrators concerned. The prevalence of these injuries has also motivated the athletic and sports medicine communities to work on uncovering the mechanisms underlying the increased susceptibility in these athletes, and developing preventative measures. Many theories have subsequently been proposed, having found significant variations between female and male hip and knee anatomy, muscular balance around the knee, and movement patterns. Female sex hormones, including estrogen, progesterone and relaxin, are also thought to play a role, as they are known to fluctuate considerably during the menstrual cycle, most extremely at the onset of menses (first 1-2 days). Reportedly, these swings in hormone levels result in increased ligamentous laxity, and subsequent compromise of neuromuscular coordination, due to inconsistent tautness of these passive tissues.

While nothing can easily be done to change anatomical differences, muscular balance and movement patterns are pliable. Awareness is key as well. Some recent results, including those from a Centers for Disease Control commissioned study using an ACL injury prevention regimen called the PEP program (Prevent injury and Enhance Performance) on a season of NCAA women’s soccer players, suggest that balance and neuromuscular control play the central role in knee joint stability. Through the PEP program and others, successful methods that can be learned and practiced have been identified. The result? Protection of the knee joint complex and prevention of ACL injuries. Several high school and college level teams have incorporated such programs, consisting of a series of proprioception, plyometrics, agility and strength training exercises, into their training, and have seen significant decreases in ACL injuries among their athletes.

Further information regarding the PEP training program, including a complete PEP conditioning schedule with descriptions for all activities, can be found at the Santa Monica Orthopaedic and Sports Medicine Foundation website.

References
1. Am J Sports Med August 2008 vol. 36 no. 8 1476-1483. A Randomized Controlled Trial to Prevent Non-Contact ACL Injury in Female Collegiate Soccer Players
2. Training May Cut Risk Factors for Knee Injury. Reuters, New York. Copyright © 2009 ABC News Internet Ventures.
3. Female Athletes are Beginning to Implement an ACL Injury Prevention Regimen. Jim Rapier. Reuters Blog. Sept 24, 2009.
4. Arthroscopy. 2007 Dec;23(12):1320-1325.e6. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. Illinois Sports Medicine & Orthopaedic Centers, Glenview, Illinois 60025, USA. research@ismoc.net
5. Orthop Clin North Am. 2002 Oct;33(4):637-51. The female ACL: why is it more prone to injury? Ireland ML. Kentucky Sports Medicine, 601 Perimeter Drive, Lexington, KY 40517, USA. ksm@kysportsmed.com
6. Curr Womens Health Rep. 2001 Dec;1(3):218-24. Prevention of anterior cruciate ligament injuries. Hewett TE, Myer GD, Ford KR. Children’s Hospital Research Foundation, Room 3057 TCHRF, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. tim.hewett@chmcc.org
7. Instr Course Lect. 2007;56:397-406. Dynamic neuromuscular analysis training for preventing anterior cruciate ligament injury in female athletes. Hewett TE, Myer GD, Ford KR, Slauterbeck JR. Sports Medicine Biodynamic Center, Cincinnati Children’s Medical Center, Cincinnati, Ohio, USA
8. Am J Phys Med Rehabil. 2005 Feb;84(2):122-30. Sports-related knee injuries in female athletes: what gives? Dugan SA. Rush Medical College, Chicago, IL 60614, USA
9. J Orthop Res. 2006 February; 24(2): 124–131. Absolute Serum Hormone Levels Predict the Magnitude of Change in Anterior Knee Laxity across the Menstrual Cycle. Sandra J. Shultz, Bruce M. Gansneder, Todd C. Sander, Susan E. Kirk, and David H. Perrin
10. Sports Med. 2000 May;29(5):313-27. Neuromuscular and hormonal factors associated with knee injuries in female athletes. Strategies for intervention. Hewett TE
11. J Athl Train. 2002 Jul–Sep; 37(3): 275–278. The Menstrual Cycle, Sex Hormones, and Anterior Cruciate Ligament Injury. James R. Slauterbeck, Stephen F. Fuzie, Michael P. Smith, Russell J. Clark, K. Tom Xu, David W. Starch, and Daniel M. Hardy

From Medscape Medical News
News Author: Laurie Barclay, MD

“Our 2007 Cochrane review showed that physical interventions (personal hygiene, barriers, and distancing) are highly effective,” write Tom Jefferson, MD, from the Acute Respiratory Infections Group, Cochrane Collaboration, in Rome, Italy, and colleagues. “However, the current mainstay of pandemic interventions still seems to be vaccines and antiviral drugs, with no evidence supporting their widespread use, especially against a seemingly mild threat such as the novel H1N1 virus.”

Physical measures were highly effective in the prevention of transmission of severe acute respiratory syndrome, according to a meta-analysis of 6 case-control studies. The interventions included the following:

• Handwashing more than 10 times daily
• Wearing surgical masks
• Wearing N95 masks
• Wearing gloves
• Wearing gowns
• Handwashing, masks, gloves, and gowns combined

The combination of handwashing and use of masks, gloves, and gowns also effectively interrupted influenza transmission within households. In younger children and within households, hygienic measures can prevent respiratory tract virus transmission, according to results from the highest-quality cluster randomized trials.

There was limited evidence that the more uncomfortable and expensive N95 masks were more effective than simple surgical masks, but they caused skin irritation. Any additional benefit of adding virucidals or antiseptics to normal handwashing was uncertain, and global measures, such as screening at entry ports, were not properly assessed.

It appeared that social distancing might be effective if used in relationship to the risk for exposure (the higher the risk, the longer the distancing period), but evidence was limited.

“Routine long term implementation of some of the measures to interrupt or reduce the spread of respiratory viruses might be difficult,” the review authors write. “However, many simple and low cost interventions reduce the transmission of epidemic respiratory viruses. More resources should be invested into studying which physical interventions are the most effective, flexible, and cost effective means of minimising the impact of acute respiratory tract infections.”

Limitations of this study include methodologic limitations of the included studies.

“In situations of high risk of transmission, barrier measures should be implemented such as wearing gloves, gowns, and masks with a filtration apparatus, and isolation of likely cases,” the study authors conclude. “Most effort should be concentrated on reducing transmission from young children through regular education at school on hygiene. In addition, society should invest in more comfortable and better designed face masks and barrier apparatus, which would increase compliance with their use.”

The National Health Service research and development programme and the National Health and Medical Research Council of Australia supported this study. The review authors have disclosed no relevant financial relationships.

BMJ. 2009;339:b3675.

Without the good health of its citizens, how strong can a nation really be? If the US people are unable to structure a plan for providing health care coverage to the population, I think we may soon find out. With approximately 47 million US citizens not covered by any form of health insurance, and many more who are under-insured, low-cost preventative care is not accessible by a significant number of us [1]. Instead, many seek care only during crisis in one of our expensive and overcrowded emergency departments. Contrary to the beliefs of some, it is not predominantly the poor who are falling under this statistic. Rather, it is many from the working classes. How did a country with our history of innovation get here, and why are we so bad at managing our health care economy? Does anyone really think it’s acceptable that more than 17% of our gross domestic product is spent on health care [1]? Especially when what we get in return is an infant mortality rate that is higher than that for most other developed countries, and a gap between the U.S. infant mortality rate and rates for countries with the lowest infant mortality that appears to be widening [2]. I think most people would, without hesitation, answer “no” to all of these questions. So why are we having such difficulty agreeing on a plan for health care reform?

I think that there is confusion around the meaning of comprehensive health care reform. Many in the media and government (no finger pointing here) have equated the idea of reform to socialized medicine, and worry that it will both be expensive and take away our freedom to choose private health insurance plans. Over and over again, it has been reiterated by President Obama that this will not be the case. The President admits that health care is complicated, and so, instead of drafting specific proposals, he has set forth general principles and has called on Congress to draft appropriate legislation [1]. These guiding principles are as follows:

• reduce long-term growth of health care costs for businesses and government;
• protect families from bankruptcy or debt that is due to health care costs;
• guarantee choice of doctors and health plans;
• invest in prevention and wellness;
• improve patient safety and quality of care;
• assure affordable, quality health coverage for all Americans;
• maintain coverage when people change or lose their jobs;
• end barriers to coverage for people with pre-existing medical conditions.

John Mackey, co-founder and CEO of Whole Foods, has offered some thoughtful plans for solving our health care dilemma too, which he wrote about in a Wall Street Journal Op Ed. He states in the title that these ideas are an alternative to “ObamaCare,” but I think many of his proposals are well-aligned with the President’s guidelines, and should be seriously considered. They are [3]:

• “Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems.”
• “Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.”
• “Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.”
• “Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.”
• “Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?”

Regardless of anyone’s particular stance or perspective on the issue, I think we can all agree that the status quo for health care in this country is not working. American citizens may not be entitled to health care, but it is likely that we would be better off as a nation if a humanitarian approach to this problem was taken. “The stakes are high,” says Jessie Gruman, PhD, President of the Center for Advancement of Health in Washington, DC. “Essentially this debate is about whether having a bad diagnosis like cancer bankrupts your family, whether people have to choose between feeding their kids and getting health care, whether being sick and losing your job means you also lose your health care. This is what’s on the table. That’s why it’s vital [1].” For those who haven’t yet been affected by health care issues in life, it’s easy to be apathetic at this point. Keep in mind, however, that if too many of our citizens fall, eventually we all do. Let’s get started with the basics for everyone before we’re all feeling the pain.

Health Care Fact Sheet (.pdf)
What You Can Do to Reform Health Care (.pdf)

References:
1. Zablocki, E; Pathways to Healing; Townsend Letter, July 2009, pp. 23-25
2. MacDorman, M and Mathews, TJ; Recent Trends in Infant Mortality in the United States; CDC National Center for Health Statistics Brief; Number 9; October, 2008; http://www.cdc.gov/nchs/data/databriefs/db09.htm
3. Mackey, J; The Whole Foods Alternative to Obama Care; The Wall Street Journal Opinion Journal; August 12, 2009; http://online.wsj.com/article/SB20001424052970204251404574342170072865070.html

Overuse injuries occur when connective tissues, such as muscles, tendons and ligaments, are damaged as a result of repetitive motion over the course of time. These injuries occur in occupational, recreational, and ordinary daily activities. With normal use, tissues adapt to the stresses placed on them, and are able to return to their normal form when given time to rest and repair. When increased demand is placed upon them, however, and/or sufficient rest is not allowed, these tissues begin to fatigue. For these cases in which injury results, the rate of tissue damage simply exceeds the rate of adaptation and healing.

Overuse injuries have traditionally been treated as inflammatory conditions, even though they rarely show the signs generally present with inflammation, including swelling, heat, and redness of the surrounding tissues. Rather, the prevailing symptoms are pain, painful weakness, and decreased range of motion. One study that looked at surgeries for tendon pain found little evidence of inflammation, but obvious signs of frank tissue damage, including thin, frayed, and fragile tendon fibrils that were separated from one another. Current therapies for overuse syndromes recognize that these conditions have a non-inflammatory basis, and, for this reason, concentrate on supporting repair and overall physical condition of these tissues.

Focused nutritional support has been shown to hasten the tissue repair process, expedite healing time, and prevent further injury. The following are recommendations for addressing connective tissue overuse injury.

Dietary

• Ensure adequate hydration: Dehydration places additional stress on tissues, especially the collagen containing connective tissues, which are comprised of 60 to 80% water. Tension that is provided by water pressure in these structures enables them to be strong, somewhat flexible, and to function at full capacity. As a rule of thumb, the number of ounces of water taken in per day should be equal to 1/2 of your body weight. For example, a 120 pound person should drink about 60 ounces of water per day. Clear juices, teas and other beverages count towards this volume, as long as they are free of caffeine and alcohol.

• Fish: 2-4 servings per week. Fish is an excellent source of omega-3 fatty acids, which help to boost the immune system, increase pain tolerance, and prevent overproduction of inflammatory chemicals. Avoid completely, or limit to one 8 oz. serving per month, large fish that tend to live longer and are known to contain high levels of mercury. These include canned white tuna, swordfish, shark, bass and brown trout. Fish with the highest concentrations of omega-3’s are salmon, mackerel, and anchovy. Remove the skin, and bake or broil the fish for best health benefit.

• Flax seeds: 5-7 servings per week. A vegetarian source of omega-3 fatty acids, flax seeds can be found in a variety of breads, cereals, crackers and other grain products.

Supplementation

• Daily Multivitamin that contains 100% RDA of most ingredients, particularly the antioxidants (A, C, E, and Selenium), those that support overall bone and muscle health (calcium, magnesium, and vitamin D), and vitamin B6 for promotion of collagen repair. Make sure to choose a natural vitamin with high bioavailability of the nutrients, such as those available at Whole Foods Market or Pharmaca Integrative Pharmacy.

• Fish or Flax Oil. Dose: 1 gel capsule or 1 tsp of oil, 2-3 times per day, as an alternative to adding these as foods to your diet. Both are available as straight oil that can be taken by the teaspoon, or in a gel capsule form. Cod liver oil is another good source of omega-3’s and is available in several flavors for increased palatability. Flax oil is available for use in salad dressings or as a dip for bread, but is not suitable for cooking. Be aware that most healthy fats, such as those present in fish and flax oil, turn rancid quickly, within about 6 weeks of pressing. To prevent spoilage, purchase only refrigerated flax oil stored in black containers, keep your flax oil in the refrigerator with the lid on tight, and minimize exposure to heat, light, and air. Allergic reactions to flaxseed have occasionally been reported, but are considered very uncommon. At the time of writing, there were no well-known drug interactions with flaxseed oil.

References
1. Oregon Department of Human Services. Expectant Mother’s Guide to Eating Fish in Oregon. 2006.
2. Khan, K., et al., Time to abandon the “tendinitis” myth. BMJ, 2002. 324(7338): p. 626-627.
3. Laker, S. and W. Sullivan, Overuse Injury. eMedicine, WebMD, 2006.
4. Mindell, E. and V. Hopkins, Prescription Alternatives. Second ed. 1999, Los Angeles: Keats Publishing.
5. Oregon DHS Environmental Toxicology Program, Fish Advisories: Consumption Guidelines. 2006.
6. Souza, T., Differential Diagnosis and Management for the Chiropractor. Third ed. 2005, Boston: Jones and Bartlett Publishers.

As a small-framed female chiropractor, I’m often asked, “do you injure yourself at work a lot?” Between the physical nature of my job and my size compared to many of the people I treat, I can understand why this question comes up so frequently. My chances of disability due to practicing chiropractic are quite remote, though. From the very beginning of my education, the importance of ergonomics in practice were infused into my methods, which, by the way, are different from those of my six-foot-four, 200 pound, male counterparts. This is not to say that I never hurt myself. There are times when I let down my focus and, if the conditions are right, might “tweak” a shoulder or wrist, just like any athlete would when caught off guard. However, the majority of damage I cause to my musculoskeletal structures comes about just like it does for anyone else – from the repetitive motion and chronic postures of computer-ing. I can’t imagine life without these useful machines but, as a chiropractor, it is imperative, for my own peace of mind, that I learn from these workstation mishaps, and use any insights gained to prevent such injuries in anyone who will listen. There are so many different ways to injure yourself while working on your computer, but, in this article, I will focus on those that occur in the low back with too much sitting and slouching.

Before starting into the mechanisms of these injuries and prevention, let’s look at some definitions and statistics. The general term for injuries that occur while serving some function to the world are termed “ergonomic” in nature. Ergonomics are literally the laws (normos) of work (ergos), and are defined as the science of adapting the job and/or equipment to the human for the purpose of maximal safety and productivity. Today, computer workstations are the major area of relevance for ergonomic applications, though the principles apply with equal importance to cars, cockpits and factories [1]. Humans were not designed to sit at a desk, hovering over a computer for hours at a time. For this reason, the workstation and behaviors must be adapted to fit the human if we are to prevent injury.

To get an idea of the impact these injuries have on the livelihood of our population, consider the following statistics taken from a report on Ergonomic Injuries in California by the US House of Representatives Committee for Government Reform in March, 2001 [2]. “Ergonomic injuries account for 1/3 of all occupational injuries and illnesses and constitute the single largest job-related injury and illness problem in the US.” “The National Academy of Sciences has estimated that the costs of ergonomic injuries to employees, employers and society as a whole can be conservatively estimated at $50 billion annually.” “Ergonomic injuries cost California’s economy over $4 billion each year.” Additionally, mechanical low back pain (that means back pain related to musculoskeletal injury, without any underlying disease) is the second most common symptom related reason for seeing a physician in the United States, and 85% of the population will experience at least one episode at some point during their lifetime [3]. This is not new information, and many employers are well aware of the benefits, from a business perspective, of providing furniture, computing tools, and employee programs that support good ergonomics. Even so, there are still many companies and individuals who have not yet been informed.

So, how do these injuries of the low back occur? In general, back injuries result from one or more excessive load(s) placed on the supporting structures of the spine. These include the vertebral joints – or facets, intervertebral discs -  or discs, ligaments, the layers upon layers of muscles, and nerve roots (two at each vertebral level). The purpose of the spine is to provide stability for protection of the spinal cord, while allowing enough mobility for the moving around that is necessary for our continued survival. This trade-off for mobility compromises stability, which, while necessary, means there are inherent weak spots. Fortunately for us, we have nice big brains that are capable of learning how to outwit nature and make up for these slight imperfections.

With long periods of sitting, it is the discs that are most commonly compromised and, eventually, injured. Why? As the major shock absorbing structures of the spine, the fibers of the outer ring of the disc are subject to continuous stresses, which sometimes cause small tears to develop. If one of these tears is large enough, and the stresses inside the disc are strong enough, some of the inner nuclear material (the gel-like, shock absorbing substance located within the center of the disc) can leak through the tear. The disc is most vulnerable to injury postero-laterally, at the weakest parts of the outer ring, which also happens to be where nerves pass from the spinal canal and exit toward the legs (not the best design, in my opinion). If disc material compresses one of these nerves, there can be pain both in the back and down the leg, as well as deficits in neurological function [4]. Under a flexion load, the majority of the stress goes right to these postero-lateral weak spots. Flexion loads occur when we bend forward, lift something from the ground or a low shelf, or sit for long periods, especially if we sit without lumbar support. Rotation, or twisting, of the spine adds additional stress to the disc, such that turning to access file cabinets and/or pick things up further increases your chances of injuring a disc.

Slumped posture alone, though, over a long period of time, day after day, places tremendous stress on the disc. Furthermore, the constant strain that this chronic posture places on surrounding muscles and ligaments causes temporary deformity in the tissues, which lasts for a couple hours. As a result, instability in the region occurs for a time, forcing the disc to pick up the slack (remember, it’s the major shock absorber), and placing additional stress on it. This repetitive and sustained loading of the disc causes an accumulation of minor damage that, over the years, adds up. Finally, a single unguarded and seemingly innocuous movement, such as bending over to move a sprinkler in your yard, can result in sudden intense pain and disability; the type that lands some in the emergency room. Did I mention that painful spasms of the large back muscles accompany this type of damage to the underlying tissues? Both protective and painful, these muscle spasms are the most memorable part of throwing one’s back out.

Now that we know where things go wrong for the supporting structures of the spine, how can we prevent playing this scenario all the way through? First and foremost, we start paying attention to our postures and motions. All movement of the body is performed against a background of subtle postural adjustments. For this reason, good control of posture is important for spinal stability. Neutral posture is what you have when your spine has that nice S-shaped curve seen in all of the books and magazines. This is the posture that requires the least amount of energy for your body to maintain, and is also the position of which the least amount of strain is put into the supporting structures of the spine. The body is balanced and efficient when neutral posture is utilized, and, whether still or in motion, the supporting structures are afforded additional protection.

Next, we reinforce our stability. Remember? It’s a major function of your spine. The core muscles lie deep within the trunk of the body. They attach to the spine, pelvis and muscles that support the scapula, and stabilize these areas to create a firm foundation for coordinated movement of the legs and arms. The human spine was not intended to be the primary mover. That function was intended of the arms and legs. Every time we move, we depend on core muscles to hold us steady, and muscles of the arms and legs to actually move us. Core stabilization is the general term for how the muscles of your trunk keep your spine and body stable, which helps you stay balanced when you move. If your core muscles are strong and they contract when the arms and legs start initiate motion, your body is balanced and less likely to be injured.

The next issues are muscle flexibility and joint mobility. Short tight muscles perform less than optimally, add additional compressive load to the joints they surround, and decrease range of movement in the joints. Flexible muscles, on the other hand, allow reduced muscle tension, increased range of movement in the joints, enhanced muscular coordination, and increased circulation of the blood to various parts of the body. To maintain mobility and flexibility, muscles must be stretched and joints must be taken through their full range of motion daily.

The last component is activity and exercise. Aerobic activity builds stamina, which is important for maintaining postural control. It also promotes strength and flexibility, and supports a healthy circulatory system. Lastly, it stimulates and reinforces motor patterns. The complex neurological paths between the brain and moving body part involve an assembly of muscles, with subtle adjustments at the core and opposite side of the body to maintain balance, relaxation of antagonistic muscles to allow movement across the joint, and finally movement of all muscles along the kinetic chain to achieve a single action. Imagine how quickly this all must occur, one firing after another, to produce meaningful motion. Every one of the pathways involved becomes stronger, more hard-wired, each time a motion is performed, which is why attention to posture during activities is critical. Our brains remember the position of every joint involved during the motion and will replay it that way, unless there is conscious override. If we consistently perform sloppy and unfocused movements, which put stress into one or more of our tissues and/or joints, this will become our natural way of moving and will likely contribute to an overuse injury down the road. Conversely, the simple act of repeatedly focusing on how we move creates a subconscious ready position for the brain, such that unexpected external forces, like accidentally stepping off the side of the curb, will be easily compensated through motor coordination. Without this involuntary level of control, we might, instead, take a dive off the curb. I imagine that most people will prefer to stay on their feet if they can help it.

This is a lot of information to process, but it is fundamental to good musculoskeletal health and well being. Please refer back as often as you need. Now that you have this knowledge and the power that comes with it, please get back to work and save your back!

References:
1. Answers.com, Definition of Ergonomics, 07.22.09, www.answers.com/topic/ergonomics
2. Ergonomic Injuries in California, oversight.house.gov/documents/20040624115434-95141.pdf
3. eMedicine, emedicine.medscape.com/article/310353-overview, Mechanical Low Back Pain, 2006
4. Steadman, R., Lumbar Disc Herniation Overview. 2005, www.steadman-hawkins.com/spine_lumbarDisc/overview.asp

Here’s an article that is too appropriate for today’s climate not to share. If you’re one whose finding your stress levels on the rise, this quick and easy read is worth your time. Remember that you are always your number one priority, no matter what is going on around you. You’ll be totally ineffective without your health intact. My wishes for your good health! Dr. Morton

From The Medscape Journal of Medicine
Webcast Video Editorials
Seven Habits (to Break) of Highly Effective People

Posted 01/16/2009

George T. Griffing, MD

During these tough financial times, many people feel they have to push themselves to unhealthy levels in order to succeed. But high-pressure jobs and long hours take a real toll on their immediate and future health. Whether running for president, moving up the corporate ladder, or juggling the family’s activities, success may come at a hefty cost.

The 7 worst habits of these workaholics include:

1. Forgetting to relax: Some stress can be good because it keeps you alert and motivated; too much stress, however, will take its toll on your body.[1]

2. Eating on the go: Who has time to sit down for a healthy lunch? But beware of frozen meals, fast, and processed food that can be high in sodium, calories, and fat.[2]

3. Putting off sleep for work: Lack of sleep can cause irritability, difficulty concentrating, memory problems, poor judgment, and obesity.[3]

4. Not making time for exercise: Humans were not designed to sit at desks for 8 hours a day. Exercise has been shown to reduce the risk for nearly every major disease and to help fight anxiety and depression.[4]

5. Working when sick: 3 common-sense reasons to stay home: avoid spreading the infection, you’ll be less productive, and you need your rest to get better.

6. Drinking (too much): Moderate alcohol consumption has some proven health benefits , but excessive drinking can lead to alcoholism, liver disease, and some forms of cancer.[5]

7. Skipping annual medical checkups: Depending on age, family history, and lifestyle, a comprehensive medical checkup and special screenings is recommended every 1 to 5 years.[6]

Eventually, something’s going to give. If your patients keep burning the candle at both ends, the flame will burn out faster. But, if they maintain a healthy balance, they will be happier and healthier overall.

That’s my opinion. I’m Dr George Griffing, Professor of Medicine at St. Louis University and Editor in Chief of Internal Medicine for eMedicine.