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Sleep: It Does a Body Good

Sleep is becoming an increasingly important issue for Americans.  35% of American adults are getting less than the recommended minimum of 7 hours a night.  This affects a wide range of health issues: hormone levels, weight gain, cognitive function, depression, anxiety, irritability, and heart disease. 

 

If you have trouble sleeping here are some tips to help you get those all important ZZZZZsss. Improving your sleep hygiene will improve your life!

  • Prioritize sleep, plan to get at least 7 hours a night and schedule yourself accordingly. 
  • Pick a bed time. Go to bed at the same time every night, even on weekends.
  • Make sure your bedroom is very dark. Use blackout curtains.
  • Avoid screen time before bed, and don’t check your social media in bed. The blue light from screens will keep you up.
  • Keep your room cool- we humans sleep better in a cool environment.
  • Limit caffeine in the afternoon.
  • And avoid alcohol for several hours before bed. 

Try these tips and see if your sleep doesn’t improve over the next week or two. Let us know your results!

Exercise Is For Everyone

Exercise. Some of us love it, some of us don’t. But we all need it. Truth. It was part of daily life for previous generations before technology stepped up and made simple functions far easier. So, now we need to be more intentional about getting our bodies movie for good mental and physical health.

The US Department of Health and Human Services established recommended guidelines for exercise activity to include 150-300 minutes of moderate activity or 75-150 minutes of vigorous/intense activity per week. That’s about 2.5-5 hours of moderate activity and 1.25-2.5 hours of intense exercise per week. Moderate exercise, like a brisk walk or hike, should keep your breathing labored but you should still be able to talk.  Intense exercise should have heavy breathing and you shouldn’t be able to talk.

We believe movement is medicine. That’s why we focus on it with our patients. Research tells us it’s good for your heart, brain, and body. It can boost your immune system, balance your emotions, increase your productivity, and helps you maintain a healthy sleep schedule. Exercise brings all of this good for you, but also takes time and many of us find precious time in short supply these days.

So, here are a few of my top tips to help you get your exercise on!   

Walk – Take the stairs and park at farthest from entrances. Those extra few minutes of walking will really add up by the end of the week. This is a kind of exercise snacking (see below).

Have a “snack” – Research suggests that even very brief bouts of activity can accumulate to meaningful benefits. The New York Times shares ways you can fit these “snacks” into your daily routine.

Chores – Doing chores like vacuuming and scrubbing the bathtub is great exercise. You can add mowing the lawn to that list as well. So combine those chores with exercise needs and burn 165-200 calories/hour – and you can swap out that yoga class. 

Micro workouts  – We’re huge fans of the NYT 7-Minute Workout. This high intensity workout takes only a few minutes a day, and can be modified if the intensity is too challenging for your fitness level. We even gave it a try right here in our clinic!

Do something you like or find something new – I love jiujitsu and my love for it motivates me to exercise to keep up with my training partners. There are so many activities that speak to a number of different personalities and interest – martial arts, tennis, basketball, salsa, rollerblading, yoga, hiking, climbing, you name it. If you enjoy doing it, you’re more likely to make time doing. We’ve pulled some local resources together to help you find your groove.

 

Workout with a friend – It’s a great way to catch up on the latest, and get some good emotional well-being at the same time. Exercise partners help keep us honest with our commitment, and can make that accountability a little more fun at the same time.

Staying in good health is important for physical and mental. So make exercise a priority, because there is no better medicine for life!

Sam Spillman, DC

Frozen Shoulder: The Culprit Causing Your Shoulder Pain

Frozen Shoulder is real, and doesn’t only occur in the winter! Medically termed: adhesive capsulitis, frozen shoulder is a condition that affects the capsule surrounding the shoulder joint. The capsule is actually a sheath of tissue that maintains joint pressure and fluid within the joint. With frozen shoulder, inflammation causes the capsule to become fibrous and thicken. This causes limitations in range of motion and pain.

The condition is often debilitating. If your shoulder is feeling stiff and painful, with loss of motion in multiple directions, you may be facing frozen shoulder. Identifying it early is the best way to help effective progress.

Who gets it?

It is most prevalent in women ages 45 and older and people affected by glandular conditions (diabetes, hypothyroidism, etc.).  Adhesive capsulitis can also be caused by immobilization of the shoulder following certain shoulder surgeries.  This condition can also develop after a minor shoulder injury. There are 3 overlapping stages of the condition called the freezing; frozen; and thawing phases. Each stage has interventions that may be beneficial to speed recovery.

Recovery from the condition generally takes anywhere from 6 months to 2 years, and has the following stages and interventions that can help at each stage.

Freezing (months 1-6)

Freezing is the most painful of the 3 stages. This is when the inflammation and fibrosis of the capsule worsens, causing the tissue to become irritated and sensitized thus causing an increase in pain. Range of motion also becomes progressively worse and daily functional activities can be extremely uncomfortable.

In this stage seeing a physical therapist for a few visits to learn exercises to maintain range and slow the decline is advisable. Use the shoulder as normally as possible without exacerbating symptoms. Intense stretching or manipulation techniques are not advisable in this stage as they can lead to greater losses in mobility and increases in pain. Gentle is the watchword. 

Frozen (months 4-12)

This is the stage where the range of motion limitations slow in progression and pain begins to improve. Gross range of motion limitations are notable with external rotation usually being the most affected followed by abduction and internal rotation.

During this stage you may begin stretching and manual therapy at a tolerable level. Strengthening exercises  to begin improving shoulder strength and muscle activation for function. Leaving the shoulder untreated can lead to other consequences later down the road.

Thawing (months 6-24)

Thawing is when the shoulder begins to return to normal function. Here motion limitations improve and function begins to return and become less painful. This stage can take up to 2 years to complete, and some people may be left with minor losses in range of motion following this condition.

More intensive stretching and manual therapy are recommended to improve range of motion to baseline levels. Strengthening exercises are progressed to improve shoulder mechanics and function. Exercises should be tuned towards your goals in order to restore normal shoulder movements and strength for specific goal-related tasks.

Treatment of frozen shoulder can be long and arduous, but arming yourself with information can be one of the most effective tools. Make an appointment with your physical therapist or chiropractor to learn more about the condition and how you can manage it effectively. Remember, early intervention and education is essential for recovery. If your shoulder has been nagging you form months don’t wait any longer to take care of it! If you have questions, email me at [email protected]

Bryan Esherick PT, DPT 

Headaches: Cause and Relief

Nine out of 10 Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 95 percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease; the headache itself is the primary concern.

The majority of primary headaches are associated with muscle tension in the neck. Today, Americans engage in more sedentary activities than in the past, and more hours are spent in one fixed position or posture (such as sitting in front of a computer). This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.

What Can You Do to Prevent?

The American Chiropractic Association (ACA) offers the following suggestions to prevent headaches:

  • If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion.
  • Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics.
  • Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headaches.
  • Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.
  • And of course make sure you are getting regular check ups with your chiropractor! Research shows that spinal manipulation improves migraine and cervicogenic headaches.(1)

 

(1) Bryans R, Descarreaux M, Duranleau M, et al. Evidence based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011; 34: 274-89.

CBD Oil: Newest Tool for Chronic Pain

CBD oil is gaining in popularity and is showing up everywhere – across the web and on store shelves everywhere. But, many of us are just hearing about it and have some questions – so let’s take a closer look.

CBD stands for cannabidiol – and it is a compound found in both cannabis and cannabis sativa (better known as hemp).  

While both plants have hundreds of compounds that may be pharmacologically active, the best known is THC, which has a psychoactive component. However, both plants also contain CBD which also has pharmacological effects but NO psychoactive component.  The CBD products at health food stores, grocery stores, and doctor’s offices are sourced from hemp and have no psychoactive properties.

OK, but why is it suddenly all over the place?

There are a number of reasons. It has been found to help with certain seizure disorders and recently the Virginia board of medicine has added it to the legal formula and it can now be prescribed for this purpose.  But it is also available over the counter. The recent Farm Bill in 2018 among other things, designated CBD products to be “generally recognized as safe” or GRAS, which means it can be added to food stuffs and sold.  For the time being the FDA and DEA have not taken any steps to change that, although they could at any time. Common side effects may include tiredness, diarrhea and changes of appetite/weight.  

What can CBD oil do and why would anyone take it? Well in addition to the above mentioned anti seizure properties, there is some limited research that suggests that CBD oil can help people with chronic pain, as well as with sleep, and anxiety.  Now the research is far from conclusive and there are many more double blind random control trials that need to be performed before the science and medical communities are going to get behind this being a new cure-all. However, as it has been generally recognized as safe and there are anecdotal reports popping up everywhere with people touting its benefits, people are flocking in droves to try it. We began carrying these products after a few patients requested them and they’ve proven to be very popular with patients for pain relief.

Samuel S. Spillman, DC

Ankle Sprain: Is Status Quo Enough?

Most of us have tweaked our ankle at some point or another. Typically we’re told it’s best to either stay off of it or brace it for a few weeks and it will heal. However, all too often there is an underlying process lurking deep down in the tissues that isn’t going to allow your ligament to heal fully, and leave you predisposed to chronic sprains. 

Ankle sprains affect people young and old, in any population, and whether athletic or not. It may happen while playing – or cutting – during a sporting event; when walking on uneven ground or into a small hole in the yard; or you might miss-step off of a sidewalk. Sprains generally affect the outside of the ankle when the ankle rolls, making the anterior talofibular ligament (ATFL) the most commonly injured tendon – which attaches from your outside ankle bone to a bone in your foot.

Once an ankle sprain occurs, there is tissue damage. This can range from a few fibers tearing – causing minor discomfort for a day or two – to a full-blown tear. Unfortunately, with status quo treatments re-sprains are far too common.

We have sensors in all of the muscles, tendons, ligaments – and even in the joint capsules surrounding the joints. Sensors provide our brain with important information about stretch, muscle activation, and joint position. This information allows the brain to form an internal picture of how the joint is doing at that moment. When the initial injury occurs, these sensors get disrupted and stop working properly. When this happens, the brain is unable to create an accurate picture of how the joint is functioning. This altered picture causes the ankle to be less responsive to demands put onto it, preventing your brain to effectively stabilize the ankle. As a result, something simple you may have done thousands of times – like jumping and landing on a volleyball court – may be the cause re-injury. Minor re-sprains can also happen without you knowing. These small injuries usually occur with simple activities like walking in grass. Unfortunately, these minor injuries will continue the cycle of chronic ankle sprains and may delay healing.

So, bracing and rest may not always be the best treatment for ankle sprains.

Of course they have their place with more severe sprains. However, in the case of minor to moderate sprains, braces can actually decrease proprioception and strength, making the ankle more prone to even more sprains! Physical therapy – to build up strength – is often the best treatment for a patient with this condition.

Physical therapy in ankle sprains will help guide you through progressive exercises that will improve ankle muscle strength as well as retrain the joint sensors to perform their job properly. Treatments generally consist of balance and proprioceptive drills on a variety of surfaces and with targeted strengthening exercises. Treatments should be tuned to specific tasks that will be encountered often whether in sports (cutting) or in daily life (walking on uneven surfaces). This is the best route to train the ankle to react to different challenges and prevent chronic sprains.

Bryan Esherick PT, DPT

Spring Training and Reducing Risk of Injury

The official start to Spring is just days away and with it comes spring training. For some of us that means races and triathlons and for others it means golf, baseball, softball and tennis. Whatever your sport or activity, enjoying the warm Spring air and getting your body moving after the long, cold winter may be what you’re looking forward to the most. 

Increased activity can bring injury – and while there is no such thing as injury “prevention”, there are measures you can take to reduce your risk of injury. Reducing risk is mostly about planning and timing.  You want to give your body ample time to adapt. Your risk of injury goes up when you make sudden large changes in activity or load over a short period of time.

Check out these tips to help you enjoy and injury-free season:

  • Don’t increase more than 10% a week. Don’t increase overall work capacity more than 10% whether you are training distance, or weight increase in strength training.
  • 4-6 runs a week is optimal, more frequent runs are better than less frequent longer runs.
  • Your shorter runs through the week should total more miles than your longest run
  • If you have pain during activity, stop and reset, then try again. If you have pain again, you should finish for the day.
  • If you have pain after your workout or the next day, don’t increase your miles/weight/repetitions until you are performing that day’s workout WITHOUT symptoms.
  • Get enough sleep! If you aren’t getting enough sleep, your risk of injury increases significantly. You should be getting at least 8 hours.
  • If you are taking anti-inflammatory medication to avoid/reduce muscle soreness your risk of injury is actually going UP. Inflammation is very necessary for healing and NSAIDs interrupt that process so you sacrifice long term gains as well as increase your risk of a muscle strain or tendinopathy.  The soreness you felt is your body’s way of limiting you so it has time to adapt to the forces you are asking it to handle. Listen to your body!
  • Your body systems adapt at different rates. Your cardiovascular system may adapt more quickly than your bones, muscles, joints and ligaments. Be willing to change your program to give your body more time to adapt.
  • Remember, the point of exercise is to be fun and to keep you out of the doctor’s office, not put you into it!

If you liked this, please feel free to share it. If you’ve got any questions about your spring training plan, feel free to ask questions: [email protected]

Samuel S. Spillman, DC

Not All Tendons are Created Equal

Not All Tendons are Created Equal

 

Have you ever experienced knee pain when beginning a new activity or increasing training volume? Does this pain go away after the warm-up, but come back the day after or when stopping the activity? You may have been of the lucky ones if these symptoms were short lived and went away within a few days. For many, this pain can become a chronic issue and affect everyday activities like sitting, stair climbing, and walking. This chronic condition is characterized by pain in the patellar tendon.

 

Jumper’s knee, runner’s knee, or patellar tendinopathy are all synonyms for this common condition. It generally affects the adult population ranging from 16-40 year olds, but can affect anyone if a training schedule is not properly developed. The tendinopathy is generally due to overstressing a poorly conditioned tissue, which can eventually lead to tendon dysrepair. Just like your muscles, bones, tendons, and ligaments also have to be trained to meet the demands you are putting on them. The reasons for pain with this condition is poorly understood, but it is believed that the brain and central nervous system play a big role in sensitization of the tissue. Once this process begins it is hard to reverse, which is likely why symptoms can last anywhere from a few weeks up to 2 years.

 

No matter the activity, whether you are increasing your training volume, load, surface, or equipment the degenerative process may begin. The importance of ramping-up training or allowing appropriate time for tissue adaptation can not be overstated. This is why this injury is more prevalent at the beginning of a sporting season or training regimen. Have you ever wondered why marathon runners are very calculated in their training regimens in terms of increasing mileage? This condition is one of the reasons, as all tissues take time to adapt. Remember, the preseason is what prepares your body, and may be the most important part of the season to reduce injury risk.. Check out our upcoming blog in the spring on how to prevent training injuries.

 

As always, better outcomes are seen with more timely interventions versus the wait and see method. Treatment is generally aimed at reducing pain, reconditioning the tissue, and improving proprioception in the joint and surrounding tissues. Eccentric and heavy slow resistance exercises have been shown to be the most beneficial in treating this condition, and certain protocols have been established. Since everyone’s tendon quality and pain levels may be different, it’s essential to ensure you are starting at the right level for your state; if the tendon is stressed too much during recovery, the tendinopathy cycle will repeat itself and may become worse. Remember, there is no established timeframe for recovery, so being patient with recovery is important. The good news is that you can usually continue training, but it is best to consult your physical therapist about possible changes in impact training, training load, or training volume. Cookie cutter approaches to treatment won’t work, so be sure treatment is properly adjusted to meet your needs.

 

Bryan Esherick PT, DPT

 

Cardio Health for a Longer Life

As heart health awareness month comes to an end, we want to highlight the wonders of cardiovascular exercise – help clarify exactly what it is – and remind you to keep your heart healthy all year long. 

Cardiovascular exercise – or cardio – is defined as any activity that gets your heart rate up. Now, that’s a pretty wide definition which is great because that means you can choose from a ton of different activities – some that you might enjoy more than others, and that means you’ll be more apt to get your body moving more. You could choose anything from: running; dancing; using the elliptical; rock climbing; swinging a kettlebell; playing tennis, basketball, soccer, football; practicing martial arts; taking classes like zumba, kickboxing, or jazzercise… and the list goes on and on – even sex can count! The idea is to choose activities you enjoy, and shift your mind from thinking it needs to be something you don’t like doing.

The benefits are cardio are huge. Most people immediately associate cardio as a weight loss tool, and it’s true that it is a big benefit. But there are so many other wonderful benefits to highlight as well.

Here is a list of health benefits you may have not have associated with cardio:

  • Mental Health:
    • improves mood
    • fights depression
    • relieves anxiety
    • improves cognitive function
    • stimulates nerve creation
    • boost self esteem
    • builds social relationships
  • Physical Health:
    • improves cardiovascular health
    • lowers risk of all causes of mortality
    • decreases risk of heart disease
    • improves blood pressure
    • lowers cholesterol
    • relieves pain as exercise increases pain tolerance

There is also some evidence to suggest that regular exercise effectively slows how quickly our bodies age by helping to repair the little proteins at the end of our DNA strands – called telomeres – which can help to keep us younger and fitter longer. Perhaps we have found the Fountain of Youth after-all!

The secret is to find something you enjoy and like doing, and stick with it. For me, it is martial arts. I’ve trained in it my whole life and get my cardio from Brazilian Jiujitsu and running. Bryan plays hockey and likes to use the rowing machine, while Dongjin plays soccer and Megan opts for aerobic dance. Think about what gets you moving – and of you’re not moving, give us a call and let us help you get started. Who knows, you just might find a new passion or hobby that will help keep you fit for life.

–Sam Spillman, DC

Tennis Elbow: What You Need to Know

If you’ve ever noticed an ache around the outside of your elbow that just doesn’t seem to go away, you might be experiencing a condition commonly known as tennis elbow. Once it starts, this type of injury can affect your strength and function in your arm. So, if you’re feeling that ache and haven’t done anything about it, now might be the time. 

Despite its name, this condition rarely affects tennis players.

It’s most common in sports and occupations that require repetitive movements – think computer work, climbing, heavy labor jobs, etc.  Tennis elbow is a form of a tendinopathy – affecting the tendons of the forearm muscles – classically called tendonitis.  The tendons undergo a degenerative process as a result of highly repetitive stresses. This process causes: increased blood to flow to the area; collagen creating cells; and ground substance. This cascade of changes can lead to pain and discomfort in the area – as well as poorly formed tendon structure which is then vulnerable to further injury.

Due to the nature of the injury, and the general inability to stop activities that aggravate the condition, it can take from a few months to up to two years for the tendon to fully recover and for pain to subside. It is possible for the condition to subside on its own, but there are steps you can take to decrease the duration of the symptoms.

Treatments for this condition vary greatly from surgery at the most extreme end, and to wait-and-see on the other, with everything in between. At Balanced we focus on rehabilitating the tendon through gradual loading of the tissue to reorganize collagen; and soft tissue work to relax overactive muscles; and education to empower our patients to heal quicker. We generally recommend avoiding bracing, cortisone shots, and surgery. By optimizing the environment for the tissue to heal, our patients often obtain quicker results and are able to return to normal activity and reach their goals within a more predictable time frame.  

Bryan Esherick PT,DPT