Sports Spine Specialist Chiropractic Team: Athletes strive to achieve their body’s maximum performance by participating in numerous training regimens consisting of strenuous exercises and physical activity and ensuring they meet all of their body’s nutritional requirements. Through proper fitness and nutrition, many individuals can condition themselves to excel in their specific sport. Our training programs are designed for athletes that look to gain a competitive edge in their sport.
We provide sport-specific services to help increase an athlete’s performance through mobility, strength, and endurance. Occasionally, however, the excess workouts can lead many to suffer injuries or develop underlying conditions. Dr. Alex Jimenez’s chronicle of articles for athletes displays in detail the many forms of complications affecting these professionals while focusing on the possible solutions and treatments to follow to achieve overall well-being.
Occlusion training involves restricting the flow of blood to a muscle group while training. That is why it is also commonly called �blood flow restriction training.�
Basically you take a wrap or band and apply it to the top of your limb.
The aim of this�isn�t�to completely cut off circulation to the area as that is dangerous and painful.
This means that you aren�t restricting arterial flow to the area, but you are restricting the venous return from the muscles.
Arteries are what takes the blood from your heart to your muscles and it is then returned to your heart through a system of veins.
Restricting the blood flow back to your heart causes a pooling of the blood in the area that you are working.
This is what occlusion training uses to create an�anabolic effect�on your muscles.�
HOW DOES OCCLUSION TRAINING WORK?
The bloodstream is the network that connects the muscles in your body, providing oxygen and nutrients and carrying away waste products
Muscles require a steady flow of blood to operate.
That is why we aren�t cutting off the flow to the muscle, we are only slowing the rate at which the blood releases from it.
When performing any kind of resistance training your body directs more blood to your muscles performing the exercise.
The reason you get a �pump� when working out is that the speed at which your body is pumping blood into your muscles is faster than the amount of blood going out of them.
Your pump reduces when you rest between your sets as more blood is released from your muscle groups.
Blood flow restriction training prolongs and intensifies your pump.
This is done by placing wraps in one of two places during your working sets.
You wrap above your bicep for movements that involve your bicep�s, triceps, forearms, and even chest and back can benefit from this.
While wrapping in this position it makes sense that it would benefit your arms but how does it help your chest and back?
There is no possible way that you can restrict blood flow to your chest and back because of the positions they are located in.
However wrapping your arm allows you to pre-fatigue your arms and as a result chest and back exercises that you perform are going to require more involvement from those muscles rather than your biceps or triceps.
Wrap your upper thigh for movements that involve your quads, hamstrings, glutes and calves.
Building Muscle With Occlusion Training
During training you have two�types of muscle�that are responsible for all muscle growth in the gym.
Fast twitch fibers and slow twitch fibers.
Slow twitch muscle fibers are smaller muscle fibers and generate less power and strength than fast twitch fibers. However slow twitch fibers fatigue slower and can sustain activity for longer.
Fast twitch fibers are larger muscle fibers, generate more power and strength and have the most potential for growth.
Fast twitch fibers are recruited last during contractions and mostly don�t use oxygen. Slow twitch fibers on the other hand use oxygen and are recruited first in the movement.
This means that by restricting the blood flow to a muscle group you are pre-fatiguing the slow twitch fibers and forcing the fast twitch fibers to take control even when you�re using low weights.
Occlusion training seems to�trick your body�into thinking you are lifting heavy weights. This means you can get very�similar benefits�of heavy training by using 20-30% of your 1 rep max.
There are two main factors that lead to muscle growth during training. These are:
Metabolic Stress
Cellular Swelling
Metabolic Stress
When you�re working out your body is burning energy. As your body chews through its fuel stores, metabolic by-product accumulates in your muscles.
Metabolic by-products act as an anabolic signal, telling your body to increase size and strength.
Under normal training most of these by-products would be washed out by blood flow.
Occlusion training keeps them near the muscle helping to increase the anabolic effect that the by-products have on the muscles.�
Cellular Swelling
During resistance training your cells expand and fill with fluid and nutrients. This is known as cellular swelling and has also been shown to be an anabolic�signal for muscle growth.
Occlusion training isn�t a better option than heavy training, but that said it is a nice supplement.
Regularly pushing your muscles to the point of failure or at least close to it (1-2 reps) is an important factor of increasing your strength and muscle mass.
Occlusion training allows you to replicate this without putting anywhere near as much strain on your joints, ligaments and tendons as you would to get the same result from lifting heavy.
This means that you can do more volume without the risk of�overtraining.
Here are a couple of scenarios where this could be really beneficial for you:
If you suffer from joint issues
If you�re travelling and only have access to hotel weights
If you�re injured or have nagging aches and pains.
In short your body might not always feel up to another heavy training day. Occlusion training can be a great way to get a good workout in and help you maintain muscle mass.�
How To Do Blood Flow Restriction Training
As I mentioned earlier you only ever wrap yourself at the top of your biceps and the top of your thighs.
Elastic knee wraps, medical tourniquets and exercise band �are good options to use for your wraps.
Here�s two videos explaining how to wrap your arms and legs
Blood flow restriction training works best when with isolation exercises. If you are going to do compound movements do them at the start of your workout and save the blood flow restricted exercises for the end.
Layne Norton recommends performing lifts at 20%-30% of your 1rm for 20-30 reps of the first set and then the next three sets at 10-15 reps. Have a 30 second rest between sets before going again.
You want to keep the cuffs on your limbs for the entire 4 sets and then release them at the end.
If you�re in pain before the exercise starts that�s a good sign that your wraps are too tight.
Also if you can�t complete the prescribed sets either the wraps are too tight or the weight is too heavy.�
Conclusion
Blood flow restriction training has been getting a lot of hype lately.
While it isn�t better than regular strength training, it is a good supplement for it and can be beneficial when used in conjunction with your regular training.
This is more of an advanced training technique so if you are just starting out lifting it probably won�t give you any more benefits than your normal heavy training.
If you�re an advanced lifter, are injured, or don�t have access to heavier weights than this training technique could benefit you.
Deadlifts are one of the best strength and mass building exercises that you can perform.
When performing the deadlift you are working more muscles than any other exercise, including the squat.
Deadlifts have many different variations and forms. In this article we are going to focus on the difference between the Romanian Deadlift and standard deadlifts.
There are lots of valid arguments as to which exercise is better in a Romanian Deadlift vs regular deadlift battle.
Keep reading to learn the differences.
Romanian Deadlift Vs. Standard Deadlift
The Romanian Deadlift is one of the most�commonly used among the various deadlift techniques.
In fact a lot of people that think they are performing a deadlift are sometimes actually doing a Romanian Deadlift.
Both the conventional and Romanian Deadlifts are great strength and muscle building exercises.
Even though they are both deadlifts�variations the setup, execution and muscles activated are different.
Here�s a quick video that highlights the differences in form and setup between the two.
Regular Deadlift
As the name suggests the deadlift is a strength training exercise that involves�lifting dead weight.
The regular deadlift is one of the best total body exercises you can do as it works just about every fiber in your body.
The deadlift requires you to lift a weight off the ground�and lower it back down again. Although it may sound simple there is a lot going on in the movement and incorrect form can cause injuries.
One of the most common causes for injury while deadlifting is rounding the back. Your lower back must stay neutral during the whole movement. Rounding your lower back during heavy deadlifts puts uneven pressure on your spine. Always lift with a neutral lower back, allowing for the natural inward curve of your lower spine.
Don�t try and rush to lift heavier weights. the quickest way to improve your deadlift is through correct form. By pulling more efficiently you can use more muscles and deadlift heavier. So start out practicing correct form and build your way up.
The best way to approach the exercise is to think as if you were leg pressing the floor as opposed to�using your upper body to lift something. This will help you mentally focus on using your legs rather than your back (which can cause rounding) for the exercise.
The �dead� in deadlift stands for dead weight so each rep must start on the floor, from a dead stop. �Deadlifts are different to other exercises like the bench press or squat where the weight starts at the top. The deadlift movement�starts from the bottom and and you pull the weight up then return it to the floor�for one rep.
Here are�Stronglifts�5 steps to proper deadlift form:
Walk to the bar.�Stand with your mid-foot under the bar. Your shins shouldn�t touch it yet. Put your heels hip-width apart, narrower than on Squats. Point�your toes�out 15�.
Grab the bar.�Bend over without bending your legs. Grip the bar narrow, about shoulder-width apart like on the Overhead Press. Your arms must be vertical when looking from the front.
Bend your knees.�Drop into position by bending your knees until your shins touch the bar. Do NOT let the bar move away from your mid-foot. If it moves,�start from scratch with step one.
Lift your chest.�Straighten your back by raising you chest. Do not change your position � keep the bar over your mid-foot, your shins against the bar, and your hips where they are.
Pull.�Take a big breath, hold it and�stand up with the weight. Keep the bar in contact with your legs while you pull. Don�t shrug or lean back at the top.
Lower the bar by moving your hips back while keeping your legs almost straight. Once the bar is past your knees, bend your legs more. The bar will land over your mid-foot, ready for your next rep.
Rest a second between reps while staying in the setup position. Take a deep breath, get tight and pull again. Every rep must start from a dead stop on the floor. Don�t bounce the weight off the floor or you can end up lifting�with�bad form.
Ever felt pain in your hip, the center of the buttocks, or pain down the back of the leg, you’re likely suffering, at least partly, with piriformis syndrome. The piriformis is a muscle which runs from the sacrum (mid-line base of spine) into the outer hip bone (trochanter). This muscle works overtime on runners.
The muscles in and about the gluteal area help with three areas
� rotation of the hip and leg;
� balance while one foot is off the ground
� stability of the pelvic region.
Needless to say, every one of these attributes are highly needed by runners and everyone else.
Piriformis Injuries
RMI or repetitive motion injury occurs when a muscle has to perform beyond the level of its capability, not given time to recover and doing it again and again. The normal response from a muscle in this situation is to tighten, which is a defensive response of the muscle. This stimulation, however, manifests itself several ways.
First Symptom�indicating piriformis syndrome could be pain in and about the outer hip bone. The tightness of the muscle generates increased pressure between the bone and the tendon which produces pain and either discomfort or an increased tension in the joint which produces a bursitis. A bursitis is an inflammation of the fluid filled sac in a joint caused by tension and strain within that joint.
Second Symptom suggesting piriformis syndrome would be pain right at the middle of the buttocks. Although this is not as common as the other two symptoms, this pain can be brought on within the fatty part of the buttocks region with direct compression. A tight muscle becomes a sore muscle upon compression because of reduced blood flow to that muscle.
Third Symptom indicating piriformis syndrome would be a sciatic neuralgia, or pain from the buttocks down the back of the leg and at times into different parts of the lower leg.
The sciatic nerve runs directly through the belly of the piriformis muscle and in the event the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, numbness and tingling.
Physiology
Any muscle constantly used has to have an opportunity to recover. This recovery can be natural with time, or could be facilitated and sped up with treatment. Continuing use will make it even worse since the muscle is tightening due to overuse. This injured muscle needs to relax and have blood flow encouraged into it for a rapid recovery. The tightness� lessens the normal blood flow going to the muscle. To encourage new blood into the muscle is the way of getting the muscle to begin to unwind and operate normally. Massages daily to this area is greatly supported.
The next step in this “recovery” process is to use a tennis ball under the butt and hip area. Roll out from the side of engagement while sitting down on the ground and set a tennis ball inside the outer hip bone under the buttocks area. Note areas of pain and soreness, as you start to allow your weight onto the tennis ball. Trigger points will have a tendency to collect in a repetitively used muscle, and till these toxins are manually broken up and removed, the muscle will have an artificial well being concerning flexibility potential and recovery potential. Consequently, if it’s sore while your sitting on it, you’re doing a good job. Let the ball operate under every spot for 15-20 seconds before transferring it to a different place. After 4-5 minutes place cross legs with the ankle of the affected leg over the knee of the non-affected leg. Then place the tennis ball just inside the outer hip bone and work the tendon of the muscle. Although this pain requires some time to reduce and is excruciating, the advantages are enormous. Be patient and good things will happen.
Treatments
Due to how the sciatic neuralgia and the hip bursitis or tendonitis are both inflammatory in character, ice therapy, or cryotherapy, within the involved region 15-20 minutes at a time will be beneficial. This should be performed multiple times each day.
Once the acute pain is gone then start with gentle stretching, like a cross-legged stretch while pulling up on the knee. The muscle should have improved flexibility.
Finally the use of pharmaceutical anti-inflammatories are not encouraged. One the intestines are greatly aggravated by them, but they also suggest an artificial wellbeing that can lead to larger problems. Proteolytic enzymes, such as bromelain, extremely beneficial without any side effects and are organic.
Clinicians recognize that lifestyle changes can be difficult for patients. Research is currently helping us understand what patients actually need to have in order to produce effective and sustainable changes in their diet and physical activity.
How is nutrition and exercise effective for well-being?
Two intervention studies suggest direct access to healthy food enhance emotional well-being and metabolism respectively. When patients with chronic disease learn by performing lifestyle modification behaviors, even over a brief period of time, both their well-being and wellness improve.
Nutrition & Exercise Research Study
At a randomized controlled trial over a two-week interval, researchers investigated the effects of giving a group of young people a $10 voucher for fruits and vegetables and twice per day text-reminders versus giving yet another group of young people received the real fruits and vegetables worth $10 with no reminders.
Despite both classes consuming relatively the same amount of fruits and vegetables, such as a greater amount than ordinary even, only the group who had been given fruits and veggies flourished and showed improvements in their vitality and motivation. This study suggests that direct access to healthy food might be necessary for successful dietary modification, even if the clinician is providing “high-touch” support. Quite simply, clinicians might wish to think about exploring their patients’ access to standard meals prior to giving them other tools to help them eat better.
In a different study, over a 12-week period, a randomized controlled trial of 24 breast cancer survivors split them to either a fitness program or a management group instructed to continue their regular exercise routines. The exercise group saw increased muscle strength and endurance, as well as decreased body fat percentage, waist circumference, visceral fat area, insulin levels, leptin/adiponectin ratios, and DKK1 and SFRP1 levels. The researchers indicate that DKK1 and SFRP1 may be useful biomarkers to ascertain both long-term exercise’s advantages along with the prognosis of patients. In addition they suggest exercise might have a therapeutic advantage in those with chronic illnesses.
Fortunately, many integrative and functional medicine practitioners find innovative methods to place new science into practice, and new programs make it possible for clinicians to apply the results from studies such as these right away from the clinic. Many integrative and functional medicine practitioners offer a toolkit containing more than 200 items that help enhance patient compliance to professionals. General ill-being and chronic disorder decreases, when patients learn lifestyle modification behaviors.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Even though the effects of overweight and obesity on diabetes, cardiovascular disease, all-cause mortality, and other health outcomes are widely known, there is less awareness that overweight, obesity, and weight gain are associated with an increased risk of certain cancers. A recent review of more than 1000 studies concluded that sufficient evidence existed to link weight gain, overweight, and obesity with 13 cancers, including adenocarcinoma of the esophagus; cancers of the gastric cardia, colon and rectum, liver, gallbladder, pancreas, corpus uteri, ovary, kidney, and thyroid; postmenopausal female breast cancer; meningioma; and multiple myeloma.1�An 18-year follow-up of almost 93?000 women in the Nurses� Health Study revealed a dose-response association of weight gain and obesity with several cancers.2
Obesity Increase
The prevalence of obesity in the United States has been increasing for almost 50 years. Currently, more than two-thirds of adults and almost one-third of children and adolescents are overweight or obese. Youths who are obese are more likely to be obese as adults, compounding their risk for health consequences such as cardiovascular disease, diabetes, and cancer. Trends in many of the health consequences of overweight and obesity (such as type 2 diabetes and coronary heart disease) also are increasing, coinciding with prior trends in rates of obesity. Furthermore, the sequelae of these diseases are related to the severity of obesity in a dose-response fashion.2�It is therefore not surprising that obesity accounts for a significant portion of health care costs.
Cancers
A report released on October 3, 2017, by the US Centers for Disease Control and Prevention assessed the incidence of the 13 cancers associated with overweight and obesity in 2014 and the trends in these cancers over the 10-year period from 2005 to 2014.3�In 2014, more than 630?000 people were diagnosed as having a cancer associated with overweight and obesity, comprising more than 55% of all cancers diagnosed among women and 24% of cancers among men. Most notable was the finding that cancers related to overweight and obesity were increasingly diagnosed among younger people.
From 2005 to 2014, there was a 1.4% annual increase in cancers related to overweight and obesity among individuals aged 20 to 49 years and a 0.4% increase in these cancers among individuals aged 50 to 64 years. For example, if cancer rates had stayed the same in 2014 as they were in 2005, there would have been 43?000 fewer cases of colorectal cancer but 33?000 more cases of other cancers related to overweight and obesity. Nearly half of all cancers in people younger than 65 years were associated with overweight and obesity. Overweight and obesity among younger people may exact a toll on individuals� health earlier in their lifetimes.2�Given the time lag between exposure to cancer risk factors and cancer diagnosis, the high prevalence of overweight and obesity among adults, children, and adolescents may forecast additional increases in the incidence of cancers related to overweight and obesity.
Clinical Intervention
Since the release of the landmark 1964 surgeon general�s report on the health consequences of smoking, clinicians have counseled their patients to avoid tobacco and on methods to quit and provided referrals to effective programs to reduce their risk of chronic diseases including cancer. These efforts, coupled with comprehensive public health and policy approaches to reduce tobacco use, have been effective�cigarette smoking is at an all-time low. Similar efforts are warranted to prevent excessive weight gain and treat children, adolescents, and adults who are overweight or obese. Clinician referral to intense, multicomponent behavioral intervention programs to help patients with obesity lose weight can be an important starting point in improving a patient�s health and preventing diseases associatedwith obesity. The benefits of maintaining a healthy weight throughout life include improvements in a wide variety of health outcomes, including cancer. There is emerging but very preliminary data that some of these cancer benefits may be achieved following weight loss among people with overweight or obesity.4
The US Preventive Services Task Force (USPSTF)
The US Preventive Services Task Force (USPSTF) recommends screening for obesity and intensive behavioral interventions delivered over 12 to 16 visits for adults and 26 or more visits for children and adolescents with obesity.5,6�Measuring patients� weight, height, and body mass index (BMI), consistent with USPSTF recommendations, and counseling patients about maintaining a healthy weight can establish a foundation for preventive care in clinical care settings. Scientific data continue to emerge about the negative health effects of weight gain, including an increased risk of cancer.1�Tracking patients� weight over time can identify those who could benefit from counseling and referral early and help them avoid additional weight gain. Yet less than half of primary care physicians regularly assess the BMI of their adult, child, and adolescent patients. Encouraging discussions about weight management in multiple health care settings, including physicians� offices, clinics, emergency departments, and hospitals, can provide multiple opportunities for patients and reinforce messages across contexts and care environments.
Weight Loss Programs
Implementation of clinical interventions, including screening, counseling, and referral, has major challenges. Since 2011, Medicare has covered behavioral counseling sessions for weight loss in primary care settings. However, the benefit has not been widely utilized.7�Whether the lack of utilization is a consequence of lack of clinician or patient knowledge or for other reasons remains uncertain. Few medical schools and residency programs provide adequate training in prevention and management of obesity or in understanding how to make referrals to such services. Obesity is a highly stigmatized condition; many clinicians find it difficult to initiate a conversation about obesity with patients, and some may inadvertently use alienating language when they do. Studies indicate that patients with obesity prefer the use of terms such as�unhealthy weight�or�increased BMI�rather than�overweight�or�obesity�and�improved nutrition and physical activity�rather than�diet and exercise.8�However, it is unknown if switching to these terms will lead to more effective behavioral counseling. Effective clinical decision support tools to measure BMI and guide physicians through referral and counseling interventions can provide clinicians needed support within the patient-clinician encounter. Inclusion of recently developed competencies for prevention and management of obesity into the curricula of health care professionals may improve their ability to deliver effective care. Because few primary care clinicians are trained in behavior change strategies like cognitive behavioral therapy or motivational interviewing, other trained health care professionals, such as nurses, pharmacists, psychologists, and dietitians could assist by providing counseling and appropriate referrals and help people manage their own health.
Achieving sustainable weight loss requires comprehensive strategies that support patients� efforts to make significant lifestyle changes. The availability of clinical and community programs and services to which to refer patients is critically important. Although such programs are available in some communities, there are gaps in availability. Furthermore, even when these programs are available, enhancing linkages between clinical and community care could improve patients� access. Linking community obesity prevention, weight management, and physical activity programs with clinical services can connect people to valuable prevention and intervention resources in the communities where they live, work, and play. Such linkages can give individuals the encouragement they need for the lifestyle changes that maintain or improve their health.
The high prevalence of overweight and obesity in the United States will continue to contribute to increases in health consequences related to obesity, including cancer. Nonetheless, cancer is not inevitable; it is possible that many cancers related to overweight and obesity could be prevented, and physicians have an important responsibility in educating patients and supporting patients� efforts to lead healthy lifestyles. It is important for all health care professionals to emphasize that along with quitting or avoiding tobacco, achieving and maintaining a healthy weight are also important for reducing the risk of cancer.
Corresponding Author:�Greta M. Massetti, PhD, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341 (gmassetti@cdc.gov).
Conflict of Interest Disclosures:�All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflict of Interest. Dr Dietz reports receipt of scientific advisory board fees from Weight Watchers and consulting fees from RTI. No other disclosures were reported.
Disclaimer:�The findings and conclusions in this report are those of the authors and not necessarily the official position of the Centers for Disease Control and Prevention.
References
1. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K; International Agency for Research on Cancer Handbook Working Group. Body fatness and cancer�viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794-798. PubMedArticle
2. Zheng Y, Manson JE, Yuan C, et al. Associations of weight gain from early to middle adulthood with major health outcomes later in life. JAMA. 2017;318(3):255-269. PubMedArticle
4. Byers T, Sedjo RL. Does intentional weight loss reduce cancer risk? Diabetes Obes Metab. 2011;13(12):1063-1072. PubMedArticle
5. Grossman DC, Bibbins-Domingo K, Curry SJ, et al; US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426. PubMedArticle
7. Batsis JA, Bynum JPW. Uptake of the centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988. PubMedArticle
8. Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? public perceptions of weight-related language used by health providers. Int J Obes (Lond). 2013;37(4):612-619. PubMedArticle
Question: My parents are elderly, and both hurt their backs. What type of doctor or physician should I look for?
Chiropractic care is safe and effective for elderly adults with back pain, according to new research. To better understand the risk and benefits of chiropractic care in elderly individuals, El Paso, TX. Chiropractor, Dr. Alexander Jimenez, answers questions regarding chiropractic care for elderly individuals with back pain.??
Q: Is Chiropractic Care Safe For Elderly People?
Dr. Jimenez: Chiropractic care is one of the safest interventions for the care of back pain. The dangers of a serious problem after a chiropractic adjustment would be like the danger of having a serious problem after an immunization–exceptionally small. However, minor side effects lasting up to approximately 3 days are very common, most commonly muscle stiffness and soreness. These side effects are similar to those you get when you begin a workout program. People have a smaller chance of severe side effects from manipulation and manual treatment than they do from medication taken for the very same ailments. You should always discuss any side effects from treatment with your chiropractor right away.
Q: What Are The Benefits Of Chiropractic Care For The Treatment Of Low Back Pain In Older Adults?
Dr. Jimenez: Chiropractic care has been used for over 100 years to assist patients with back pain. One of the best benefits of trying chiropractic care first is that you can avoid the risk of side effects from taking medications for pain. Opioid drug addiction is a serious crisis in America. Trying non-drug therapies, such as chiropractic care first may help to reduce the high rates of opioid dependency in the USA.
Actually, the most recent treatment principle for low back pain (from the American College of Physicians), specifically states that people should attempt non-drug options first. The health dangers of pain medications are even greater for older adults compared to younger people, since many older people have other illnesses that affect their wellbeing, and their own bodies process drugs more slowly. Also, many drugs, particularly opioids, increase older people’s risk of falls, which is a very considerable risk in this age group.
Q: What Questions Should I Ask My Chiropractor Before Receiving Treatment?
Dr. Jimenez:�When first talking with a chiropractor, inquire which sort of treatments he or she may use for back pain. Chiropractic care incorporates many different non-drug approaches in addition to spinal manipulation, including other kinds of manual therapy in addition to exercise. �Ask the chiropractor to explain or illustrate the type of spinal manipulation he or she uses (many chiropractors have photographs or can demonstrate what they do), so that you feel comfortable with it. Should you feel uncomfortable with the therapy, feel free to ask whether there are alternate kinds of manipulation he or she may use as there are many different ways to perform spinal manipulation for optimum patient comfort, and also achieve the same targets.
Q: What Should I Tell A Chiropractor About My Medical History, Medicines, & Spinal Condition?
Dr. Jimenez: First of all, since chiropractors are trained to choose a thorough patient history, including questions regarding medication, past injuries or surgeries, and any recent changes in your health, most likely you won’t have to volunteer this information. You’ll be asked about your health history on a patient intake form. Then the doctor will ask you more questions in person. Make sure to talk about all health information about current and previous conditions, drugs, history of accidents and surgeries or alternative therapy, and current changes in your health, even if you think they are not important, they may be.
The chiropractor will also inquire what makes your pain worse or better, and if you have had changes in strength, recent falls, or balance issues, changes in your bowel or bladder function along with other relevant health factors like eating and sleep habits. The chiropractor should then perform a thorough physical examination, including your neurological system, to be certain that spinal manipulation is ideal for you. He or she’ll also see what kinds of adjustments will make your pain better or worse. The chiropractor will use all of this information to develop a treatment plan that’s specific for you to help you fulfill your goals for returning to a normal lifestyle.
Core chiropractor, Dr. Alexander Jimenez continues from part I through the core stability routines.
Menu 6: Pulley, Standing
This menu challenges pelvic stability during unilateral standing upper body movements. The kinds of arm movements undertaken in many sports create strong rotational forces that have to be controlled by the trunk and pelvic muscles. The aim of these exercises, therefore, is to develop co-ordination and control of the pelvis.
Research has shown that unilateral exercises increase the recruitment of the core musculature. The core and pelvic muscles will all be using static contractions to hold the required postures, while the upper body muscles will be producing the limb movements. The resistance load on the arm is secondary to the stability challenge of the core. Overall this menu is intermediate.
Rear Sling
Overview: The challenge of this exercise and its pair (see opposite) is to establish perfect pelvic alignment, while standing on one leg, against a rotational force from the upper body.
Technique: Stand on one leg to the side of the pulley column. Handle is attached at below-hip height. Grasp the handle with the hand on the opposite side (opposite to standing leg). Set perfect posture and pelvic alignment.
Brace the core and then pull the weight up and around the body, keeping the elbow straight, so that the arm rotates up
and out. Finish with hand above your head and out to the side slightly. The aim is to maintain perfect balance and pelvic
alignment as you raise and lower the arm diagonally. Reposition to repeat exercise for opposite leg/arm.
Perform 10 reps each side increasing to 20 reps; 2 to 3 sets.
Progression: Increase the weight.
Front Sling
Overview: This is the natural opposite of the rear sling exercise. It involves a forward arm rotation, which must be controlled.
Technique: Stand on one leg to the side of pulley column. Handle is attached at above shoulder height. Grasp the handle with the arm nearest the column (opposite side to standing leg). Set perfect posture and pelvic alignment.
Brace your core; pull the weight down and around the body, keeping the elbow straight so that the arm rotates down and round. Finish with hand next to your hip across your body. The aim is to maintain perfect balance and pelvic alignment as you lower and raise the arm. Reposition to repeat with opposite leg/arm.
Perform 10 reps each side, increasing to 20 reps; 2 to 3 sets.
Progression: Increase the weight.
One Leg, One Arm Rowing
Overview: The challenge of this exercise is to maintain stability while standing on one leg and controlling against a pulling force from the upper body. The pelvis must stay fixed when the upper back and shoulder are pulling backwards.
Technique: Stand on one leg, facing the pulley column. Handle is attached at waist height. Grasp the handle with the opposite arm (same side as lifted leg). Your hand will be out directly in front of you in the start position. Set perfect posture and pelvic alignment, standing tall with shoulders back.
Brace your core; pull on the cable, leading with the elbow in a rowing movement Finish with hand by your side and elbow behind you. The aim is to maintain perfect balance and pelvic alignment as you perform the rowing movement. Reposition to repeat with opposite leg/arm.
Perform 10 reps each side; 2 to 3 sets.
Progression: Increase the weight.
Menu 7: Medicine Ball, Floor
The four exercises in this menu all involve throwing and catching the medicine ball while performing a trunk flexion or rotation movement. The action of throwing the ball during the muscle-shortening phase of each of the exercises increases the force production of the trunk muscles. The action of catching the ball at the start or during the muscle-lengthening phase of each exercise not only increases the force production but also the overall stability challenge.
The impact that the catch has on the upper limb has to be controlled by the trunk. You should be aiming to maintain good spine alignment and correct movement while making the catch. Only use a weight of medicine ball that will allow you to perform the exercises with good technique. If the ball is too heavy, you will sacrifice core stability, irrespective of your arm strength.
Overall these exercises are advanced. However they are also safe and effective for young athletes using light medicine balls to develop dynamic trunk movement and control.
Sit Up & Throw
Overview: An advanced version of a sit-up exercise, in which the throwing action makes the crunch phase faster and the catching action adds load to the return phase.
Level: Advanced
Muscles targeted: Abdominals (Plus upper body)
Technique: You will need a partner to receive and pass the ball. Alternatively perform the exercise in front of a wall and use a medicine ball that will bounce back.
Start in the sit-up position (knees bent) with hands up ready�to receive the ball. Catch the ball and begin to lower back down. Do not collapse back down, control it with the abs and keep hands above the head as you lower down.
Once shoulders are touching the floor (keeping head up and eyes forward), reverse the movement. Throw the ball forward and crunch up at the same time. Follow the throwing action and complete the sit-up as fast as possible. Make sure you crunch as you throw so that the abs contribute to the force of the throw and help you sit up faster. Men should start with a 5kg ball; women with a 3kg ball.
Perform 10 to 20 reps; 2 to 3 sets
Progression: Progress to heavier ball once 3 sets of 20 reps is comfortable
45-degree Sit, Catch and Pass
Overview: A very tough stability exercise that requires massive trunk musculature co-contraction to hold a good spine alignment against the impact of making the catch.
Technique: Sit up with knees bent and lean back at 45 degrees. Aim to hold a �lengthened� spine, with lumbar spine in neutral, shoulders back and neck long and relaxed. It takes a fair amount of control and strength endurance simply to hold this posture perfectly. Aim to get this right before progressing on to the catch and pass.
Raise hands in front of your face and receive a pass from a partner, around this height. As you catch the ball you must hold the long spine position. Do not flex the low back, or become round-shouldered. Gently throw the ball back. Men should start with a 3kg ball; women with a 2kg ball.
Complete a few passes, holding the position for 30 seconds. Perform 2 to 3 sets.
Progression: Raising the hands to above head height makes the stability challenge of the catch significantly harder. Catches made to either side of the head are also more challenging.
Sit & Twist Pass
Overview: A trunk rotation exercise involving catching and passing the medicine ball, which provides a challenge to the obliques to produce powerful rotation, but also pelvic stability, so that the sitting position is stable throughout the movement.
Level: Advanced
Muscles targeted: Abdominals, Obliques
Technique: Sit up with knees bent and lean back at 45 degrees. Aim to hold a �lengthened� spine, with lumbar spine in neutral, shoulders back and neck long and relaxed. Your feet, knees and hips should remain reasonably still throughout this exercise, the rotation coming from your waist and not your hips.
Hold hands to one side ready to receive the ball. Catch the ball to one side and absorb the catch by turning your shoulders further to that side. Reverse the rotation, turning back to the middle and release the ball. Continue rotating to the other side; receive the ball the other side and continue. Ensure you�can hold good posture throughout the movement, with a long spine and wide shoulders. Men should start with a 4 to 5kg ball; women with a 2 to 3kg ball.
Perform 10 to 20 reps.
Progression: Increase the weight of the ball once you can perform a set of 20 reps comfortably with perfect technique.
Kneeling Twist Pass
Overview: To perform the rotation movement in this position demands a greater range of motion, helping to develop strength through the full range of trunk rotation. It may also help to develop trunk rotation range of movement.
Level: Intermediate to advanced
Muscles targeted: Obliques
Technique: Kneel upright with good posture (lumbar spine in neutral, chest out, shoulders low). Start with the ball in hands and twist shoulders and head round as far as you can. Then, under control, twist around to the other side as far as possible, and hand the ball to partner. Turn back to the start position, receive the ball again and continue.
The aim of the movement is to rotate through the biggest shoulder turn you have. You can allow the hips to rotate a little with the shoulders, but not too much. You should feel a stretch in the side at the end of each twist.
As you gain greater flexibility and stability you will be able to�fix your pelvis square to the front and rotate through an increasingly full range of motion. Men should start with a 5 to 6kg ball; women with a 3 to 4kg ball.
Perform 10 reps then take the ball to the opposite side and repeat.
Menu 8: Medicine Ball, Standing
The aim of this menu is to perform trunk movements while standing on one leg. This is functional training for balance in sports and daily living activities. These exercises are advanced because of the requirements for lower limb balance and body movement awareness, which makes controlled performance of these trunk movements quite difficult. These moves also use the hip rotator and abductor muscles for control and stability.
One-leg Twist Pass
Overview: A trunk rotation exercise performed on one leg. This requires good pelvic stability at the hip of the standing leg, for the trunk rotation to be dissociated from the pelvis.
Technique: Stand on one leg with hips facing square to the front. Hold medicine ball slightly out in front. Slowly twist from side to side. The rotation comes from the waist only,�head turning with the shoulders. Keep pelvis fixed square and knee in line with second toe throughout. Men should start with a 5 to 6 kg ball; women with a 3 to 4 kg ball.
Perform 10 slow reps; 2 to 3 sets. Repeat on other leg.
Progression: Swap the ball for a pulley machine and add resistance, once you have mastered the controlled balance on one leg.
One-leg Deadlifts with Rotation
Overview: An advanced exercise for the posterior chain of muscles, which includes rotation to challenge control of pelvis.
Level: Advanced
Muscles targeted: Erector spinae, Gluteals (max and med) Hamstrings, Piriformis
Technique: Stand on one leg. Flex the free leg a little at the knee to lift it off the floor, but do not flex or extend the hip of the free leg throughout the movement, in order to keep pelvis in control. Hold the ball in front of you.
Bend down, flexing at the knee and the hip. Lower down until the ball touches the floor by your foot, all the time keeping your arms straight and without reaching excessively with your upper back (ie, maintain a reasonably flat back). Stand back up, pushing down through the foot to use your gluteals correctly to extend the hips.
Alternate between touching the ball down on the inside and then the outside of the standing foot. This means you are internally or externally rotating the hip on alternate repetitions, challenging control of hip rotation. Keep the knee in line with�second toe as much as possible throughout. Men should use a 5kg ball; women use a 3kg ball.
Start with 5 slow controlled reps, 2 to 3 sets. Build up to 10 reps. Repeat on the opposite leg.
Progression: Increase the weight of the ball or use a dumb-bell as you get stronger.
One-leg Catch & Pass
Overview: The main aim of this exercise is to control the impact of the catch without losing balance or rotating excessively at the hips. It�s all about how effectively you can anticipate the impact and produce the required stiffness throughout the body to retain good posture and control. This is a very useful �reaction�-type stability exercise.
Level: Advanced
Muscles targeted: Everything
Technique: Stand on one leg with good posture (lumbar spine neutral, chest out, shoulders wide) and with hips square to the front. Hold hands up ready to catch. Receive catches anywhere within arm�s reach. Make sure the passes are varied in their placement. Aim to restrict movement to arms and/or turning your shoulders, keeping the pelvis and lower limb stable. Use a 2 to 3kg ball that is not too big, so it is easy to catch.
Start with 30 sec bouts of catch and pass on each leg; 2 to 3 sets.
Progression: Receive more forceful passes so the impact of the catch is greater.
Menu 9: Resistance-Based
Menu rationale
The aim of these three exercises is to progress the loading in order to build high-level trunk muscle strength. These exercises can be performed in the 5- to 10-repetition range with a suitably high weight for this number of reps. As you get stronger, you should prioritize an increase in weight rather than an increase in the number of reps. Overall, these exercises are very advanced.
Crunch with Weight
Overview: The standard isolated abdominal exercise with increased load.
Level: Advanced
Muscles targeted: Abdominals
Technique: Perform the crunch in the usual way: knees bent, low back flat, head up and looking forward. Curl the shoulders up and down using just the abdominals. The weight (medicine ball, dumb-bell or barbell weight plate) should be held above or behind the head. Arms are fixed, all they do is hold the weight in place. Do not use arms to move the weight relative to head as the crunch is performed. Keeping the elbows out helps to achieve this.
Perform 5 to10 reps; 2 to 3 sets.
Progression: Increase weight, maintaining the range of 5 to 10 reps per set.
Reverse Hypers
Overview: An excellent hip and back extension exercise to which it is very simple to add load.
Level: Advanced
Muscles targeted: Erector spinae, Gluteals
Technique: Lie on your front on a horizontal bench, with hips just off the end of the bench. Grasp bench legs firmly for support. Your legs should be straight with a dumb-bell between the ankles for resistance. Squeezing the gluteals, extend hips and lift legs and the dumb-bell off the floor. Stop when your back is slightly hyper-extended and hips are fully extended. Lower slowly until feet are just off the floor and continue.
Perform 8 to 10 reps; 2 to 3 sets.
Progression: Increase weight, maintaining the range of 8 to 10 reps per set.
Reverse Crunch with Weight
Overview: This is a great exercise, as it requires good co- ordination and strength. Research shows that the obliques as well as the abdominals work very hard during this exercise, making it excellent value.
Level: Advanced
Muscles targeted: Abdominals, Obliques
Technique: Lie on back with hands behind head and elbows out to the sides. Knees should be bent and heels close to bum. Hold weight between your legs. Initiate the movement by curling the pelvis upwards (flattening the back into
the floor) and then continue to use the abs to pull the low back and pelvis off the floor. This is the bit that requires good co- ordination, as the temptation is to kick with the legs and pull the hips up with the hip flexors. Learn to focus on the abs before you add weight, as if you do this strictly it is very tough, especially for women (whose pelvises are relatively heavier).
Perform 5 to 10 reps; 2 to 3 sets.
Progression: Increase weight, maintaining the range of 5 to 10 reps per set.
Menu 10: Hanging Bar
Menu rationale
The aim of these three exercises is to work the abdominals as hard as possible with very advanced, gymnastic-style movements. Reasonable upper body strength is required for these exercises.
Hanging Leg Lifts
Overview: This exercise requires you to lift the full weight of your legs and (if possible) your pelvis, while hanging from a bar. Anyone who can perform these movements well through a good range of motion has achieved good strength.
Level: Advanced
Muscles targeted: Abdominals, Obliques, Hip flexors
Technique: Hang from a bar with arms straight. Lift knees, bringing them up as high as possible. At the top of the movement the knees should be near the chest and pelvis should be curled upwards (low back flexed). This extra curl of the pelvis ensures that the abdominals are working maximally. Do not kick legs up or swing the body excessively. Simply draw up knees, crunching as you lift. It is important to feel that the abdominals are doing the lion�s share of the work rather than the hip flexors or front of thigh muscles.
Perform 5 to 10 reps;, 2 to 3 sets.
Progression: Perform the same exercise with straight legs, lifting them up to 90 degrees in front of you, curling the pelvis at the top of the movement.
Windscreen Wipers
Overview: The ultimate ab-buster. Anyone who can do 10 reps of this exercise with good technique has a very strong core!
Level: Super advanced
Muscles targeted: Abdominals, Obliques, Hip flexors
Technique: Hang from bar with arms straight. Lift legs up in the air until feet are at approx head height. Maintaining the height of the lift, take the legs from side to side in an arc. The movement will look like a windscreen wiper, moving from side to side. Aim for at least 45 degrees of movement to each side.
Perform 5 to10 reps; 2 to 3 sets.
Progression: The straighter the legs, the harder the exercise. Increasing the range of movement to each side also makes it tougher.
Candlesticks
Overview: Another beauty! Lots of strength required to control this movement; only for the very strong.
Level: Super advanced
Muscles targeted: Abdominals, Obliques, Hip flexors
Technique: Lie flat and raise yourself up to a shoulder stand position, holding on to a bench/table leg/partner’s leg with your hands above your head. Establish a fully extended hip and leg position and then begin to lower your body down slowly to the floor. The body should move in an arc as a single unit (no sagging in the back, or bending at the hips or knees). Lower under control from vertical to just above horizontal.
Gripping firmly for stability, lift your body back up into shoulder stand, again keeping everything straight and aligned in a single unit.
Slow and controlled movement on the way down will help, and a maximal contraction of everything will get you back up.
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