North Dallas Chiropractic Blog – All Injury Rehab

Spondylolisthesis pronounced (spon-dee-low-liss-thesis) is a condition of the spine where one vertebral body segment slides forward in relation to the one below. There has been some recent buzz about this condition, but it is nothing new.  Chiropractors have been treating this for many years with great success, and having this myself and experiencing great results with treatment, I can attest to the benefits of Chiropractic care.

Dynamic Chiropractic – November 20, 2005, Vol. 23, Issue 24

Spondylolisthesis and Chiropractic Care
By Kim Christensen, DC, DACRB, CCSP, CSCS

Although much has been written in the health care literature regarding spondylolisthesis, the clinical decisions required for management remain challenging. This condition, which affects adolescent athletes, adults, and the geriatric population, is not necessarily associated with a pars defect and has a wide range of treatment options – from bracing to spinal manipulation to fusion surgery. So, what is the best and most effective treatment for chiropractic patients with a spondylolisthesis? How can we go beyond symptomatic care to provide long-term support for the spine with spondylolisthesis?

What, Where, Why

Traditionally, spondylolisthesis is defined as an anterior displacement of a vertebral body in relation to the segment immediately below.1 There are several types of spondylolistheses, with the most common being spondylolysis of the pars interarticularis, occurring in the young, and degenerative, which occurs in older patients.2 The vast majority of spondylolistheses are found in the lower lumbar region, with rare occurrences in other spinal regions.

We now understand that most spondylolistheses seen before the age of 50 are due to a break in the pars that occurred during childhood or adolescence (often during athletic activities requiring lumbar extension). When seen after the age of 50, a degenerative cause becomes more likely.

Categorical Classification

Classifying spondylolisthesis from a clinical viewpoint is very helpful. One system describes four classical presentations: recent spondylolytic spondylolisthesis (RSS); pre-existing spondylolytic spondylolisthesis – stable (PSS-S); pre-existing spondylolytic spondylolisthesis – unstable (PSS-U); and degenerative spondylolisthesis (DS).3 By placing each patient in one of these four categories, clinical decision-making is simplified and effective treatment can be provided. Another useful approach is the use of an algorithm to assist in determining imaging and treatment options.4

Response to Chiropractic Care

The primarily young athletes who comprise the RSS group have an active stress fracture of the pars, and benefit most from avoidance of hyperextension. Activity restrictions and use of a rigid lumbosacral brace often will produce a successful outcome.5 The most common type of spondylolisthesis seen in chiropractic offices is the stable pre-existing type (PSS-S).

Response to chiropractic care is often excellent. Studies have shown that when a spondylolisthesis is found in an adult, specific side-posture manipulations to the dysfunctional joints are quite effective, and that the prognosis is not significantly different from other patients.6 These researchers reported that the spinal segments most commonly needing adjustment were the ones above or below the spondylolisthetic segment, as well as the sacroiliac joints. Flexion-distraction also has been found to be a successful treatment method, as long as the patient does not demonstrate instability (PSS-U); in unstable patients, the treatment provided little benefit.7

Improving Stability and Control

An important approach to the treatment of patients with spondylolisthesis is to strengthen and re-coordinate the deep support muscles of the lumbar spine. An attempt is made to improve the dynamic stability and segmental control of the spine. These muscles include the multifidus muscles and the internal oblique and transverses abdominus muscles.8 Exercises to train the co-contraction patterns of these muscles often are called “spinal stabilization” exercises. Specific maneuvers include: posterior pelvic tilt; lower abdominal hollowing; and abdominal bracing.

The exercises are started non-weight-bearing while lying supine and/or prone, and then progress to quadruped (on all fours) if the position does not worsen symptoms, and finally to upright sitting and standing positions. They are described as low-resistance, isometric exercises whose focus is on precision of performance and re-learning of function. A 10-week program of supervised exercise sessions designed to progressively incorporate these postures into daily activities was found to reduce back pain and disability levels significantly over more than two years in subjects with spondylolisthesis.9

Postural Correction

Many patients with spondylolisthesis develop postural asymmetries over time. One important factor in treatment is the correction of any loss of the normal upright alignment of the pelvis and spine. While there is no standard “spondylo posture,” it is not unusual to see a change in pelvic alignment (often a forward-flexed pelvis) or in lumbar spinal curve. The lumbar changes can be either a hyperlordosis or (in some cases) a lack of normal lumbar lordosis. Patients will need to be shown corrective exercises specific for the postural imbalances they have developed.

Maintenance and Support

Patients with spondylolisthesis should be taught to perform a general fitness exercise program for the lumbar support muscles on a once-a-week basis. A general and usual recommendation for maintenance exercising is a series of exercises using heavy-duty elastic tubing. These isotonic resistance exercises, performed in an upright (seated) position, will activate all of the stabilizing and major mobility muscles of the lumbar spine.

Another important consideration for long-term support of the spondylolisthetic spine is the use of custom-made orthotics. Since many of these patients have low or absent arches in their feet, the additional support from a pair of custom-made orthotics frequently is necessary. In fact, lower-extremity misalignments such as leg-length discrepancies and pronation problems are often are associated with chronic pelvic and low back symptoms.10

References

Yochum TR, Rowe LJ, eds. Essentials of Skeletal Radiology, 2nd ed. Baltimore: Williams & Wilkins; 1996:327.
Souza TA. Differential Diagnosis for the Chiropractor. Gaithersburg, MD: Aspen Pubs; 1997:132.
Hyland JK. Clinical classification of spondylolisthesis. J Am Chiro Assoc 1993;30(8):67-71.
Yochum TR et al. Natural history of spondylolysis and spondylolisthesis. In: Yochum TR, Rowe LJ, eds. Essentials of Skeletal Radiology, 2nd ed. Baltimore: Williams & Wilkins; 1996:365-367.
Blanda J, Bethem D, Moats W, Lew M. Defects of pars interarticularis in athletes: a protocol for nonoperative treatment. J Spinal Disorders 1993;5:406-411.
Mierau D, Cassidy JD, McGregor M, Kirkaldy-Willis WH. A comparison of the effectiveness of spinal manipulative therapy for low back patients with and without spondylolisthesis. J Manip Physiol Therap 1987;10:49-55.
Cox JM. Chiropractic adjustment results correlated with spondylolisthesis instability. J Man Med 1991;6:67-72.
Richardson C, Jull G. Muscle control-pain control. What exercises would you prescribe? Man Therapy 1995;1:2-10.
O’Sullivan PB, Twomey LT, Allison GT. Evaluation of specific stabilizing exercises in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 1997;2:2959-2967.
Rothbart BA, Estabrook L. Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists. J Manip Physiol Therap 1988;11:373-379.
Kim Christensen, DC, DACRB, CCSP, CSCS
Director, Chiropractic Rehabilitation and Wellness Program
PeaceHealth Hospital
Longview, Washington
kchristensen@peacehealth.org

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Click here for more information about Kim Christensen, DC, DACRB, CCSP, CSCS.

To Your Health
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When Work Causes Back Pain

We’re all subject to back problems ­ it’s one of the drawbacks (no pun intended) of walking upright on two legs. Couple that with life’s variety of daily stresses, and it’s all but guaranteed that most people eventually suffer from back pain.

No matter what your occupation is, no doubt it¹s a source of daily or near-daily stress. Work-related factors have long been implicated as potential contributors to back pain, a hypothesis supported by recent research in the journal Spine. Four hundred and eighty-four men and women participated in a 24-year study to determine specific occupational factors related to low back pain (LBP). The study also evaluated whether interactions between psychosocial and physical factors, and between work-related and leisure-related factors, affected LBP. Results showed that:

€ Heavy physical workload and sedentary work (i.e., jobs involving prolonged sitting or limited movement) increased the risk of LBP among men and women.

€ Among women, smoking and the combination of “whole-body vibrations” (a phrase used by researchers to designate jobs involving driving, operating machinery, etc.) and low influence over work conditions increased risk of LBP.

€ Among men, high perceived load outside work (i.e., exercising, household responsibilities and/or repair, etc.) and the combination of poor social relations and overtime increased risk of LBP.

What can you do about back pain? First, be aware of “red flags” ­ factors at work and at home that may increase your risk. Second, schedule regular chiropractic appointments. Your doctor of chiropractic can evaluate any current back pain you might be experiencing and help prevent future back pain from occurring.

Reference:

Thorbjornsson CB, Alfredsson L, Fredriksson K, et al. Physical and psychosocial factors related to low back pain during a 24-year period. Spine, Feb. 1, 2000: Vol. 25, No. 3, pp369-75.

Dynamic Chiropractic – October 7, 2011, Vol. 29, Issue 21

Asking the DoD for a Level Playing Field

While access to chiropractic services within the Department of Defense and Department of Veterans Affairs is by no means inclusive, which explains current legislative efforts to expand access to chiropractic care at both military and veterans health care facilities (H.R. 409 and H.R. 329, respectively), the casual observer might be inclined to believe DCs are treated equally in either system. Not so, according to a letter signed by 15 members of the House of Representatives Committee on Armed Services. The letter, sent to Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson, suggests distinct disparities exist, with doctors of chiropractic employed by the DoD getting the short end of the bargain. According to the letter:

“We are informed that pay and job classification disparities have resulted in doctors of chiropractic being compensated at much lower pay scale rates than health care providers with comparable, or even lesser, training, skill sets and health care responsibilities for patients within the military treatment facilities. We also understand that certain institutional biases among certain health care provider officials against doctors of chiropractic have resulted in more difficult access to the active-duty military patient population and  unnecessary restrictions placed upon such doctors of chiropractic in performing their services for the military.”

The letter states that such disparities/biases do not appear to be occurring within the Department of Veteran Affairs (DVA) health care program (according to the letter, DCs within the DVA are Title 38 employees, have an assigned salary grade, a professional standards board and a DC director of the chiropractic program, among other standards and procedures) and urges the DoD “to carefully examine the existing system at the [DVA] for integrating chiropractic into the health programs for veterans and adopt pay, job classification and coordination systems comparable to those under
VHA Directive 2009-059 within DoD’s chiropractic health care program for our active-duty military personnel.”

Two other requests by Committee on Armed Services members who signed the letter: that the DoD consider “having a Doctor of Chiropractic as the chiropractic service leader for each branch of the military, as is done with every other specialty in military medicine.” and that the department “look into any instances of supervision of doctors of chiropractic .. to ensure that there are no instances of bias against such doctors of chiropractic in providing full access to chiropractic care at the military treatment facilities.” The American Chiropractic Association and Association of Chiropractic Colleges both supported the committee’s letter and commented on its significance in an ACA press release:

“I would like to thank congressmen Mike Rogers and Dave Loebsack for spearheading this effort,” said ACA President Dr. Rick McMichael. “The benefit provided by doctors of chiropractic to our brave men and women in uniform is integral to their recovery from injuries and their overall health and well-being. Impeding DCs from providing this care is a disservice to our troops.” “The Association of Chiropractic Colleges applauds this expression of support by members of the House Armed Services Committee for continuing the full integration of the services provided by doctors of chiropractic into the DoD,” said ACC President Dr. Richard Brassard. “We are optimistic that this strong letter will spur positive change.”

In addition to Reps. Rogers (R-AL) and Loebsack (D-IA), other letter signees included Reps. Todd Aiken (R-Mo.), Robert E. Andrews (D-N.J.), Roscoe G. Bartlett (R-Md.), Madeleine Z. Bordallo (D-Guam), Hank Johnson (D-Ga.), Walter B. Jones (R-N.C.), Larry Kissell (D-N.C.), Frank A. LoBiondo (R-N.J.), Silvestre Reyes (D-Texas), Tim Ryan (D-Ohio), Jon Runyan (R-N.J.), Bobby Schilling (R-Ill.) and Niki Tsongas (D-Mass.).

H.R. 409, the Chiropractic Health Parity for Military Beneficiaries Act (introduced by Rep. Rogers), would require that the Secretary of Defense develop a plan to expand the chiropractic benefit within the DoD to apply to any beneficiary covered under TRICARE, rather than only active-duty service members. H.R. 329, the Chiropractic Care to All Veterans Act [introduced by Rep. Robert Filner (D-Calif.)], would require that the VA staff a chiropractic physician at all major VA medical facilities no later than 2014. Both pieces of legislation are currently in congressional subcommitee; for the latest on either bill, visit www.govtrack.us.

From: http://texasjournalofchiropractic.eznuz.com/

On June 28, 2011, Senate Bill 7 was passed by the Texas Legislature. SB 7 contains language to protect the rights of patients being treated by a doctor of chiropractic from discriminatory reimbursement practices. The bill was sent to Governor Rick Perry for his signature and it is expected that Governor Perry will sign the bill into law.

By working together the profession has won a significant victory for patients and the fair reimbursement for chiropractic care.

The house adopted the Conference Committee Report for SB7 by a vote of 96-48. The senate adopted the Conference Committee Report for SB7 by a vote of 22-8!

More information will be provided when the Governor has taken action upon SB7.

Visit us at All Injury Rehab for more information and to set up an appointment.

To Your Health

February, 2009 (Vol. 03, Issue 02) Share |

Perfecting Your Posture

By Brian Jensen, DC

If you don’t have good posture, what do you have? Poor posture can lead to a variety of health problems over time, and yet too many people have bad postural habits. It’s time to understand the fundamentals of proper posture and how you can stay healthy from head to toe.

Sit up straight! Stop slouching! Don’t stare at the floor when you walk! These are the classic phrases children hear from their well-intentioned parents regarding posture. As children, we learn early on that posture is important, but generally never fully understand its role in our health, what causes poor posture or how to positively influence it. Let’s start with a simple definition from the Merriam-Webster dictionary, which defines posture as “the position or bearing of the body whether characteristic or assumed for a special purpose.” Want to know more? Read on…

Ideal Posture

Let’s focus for just a moment on the characteristic aspect of posture, the basic form we take while standing or walking. The human body is designed to stand with the eyes level with the horizontal plane of the Earth. Viewed from the front, the shoulders and hips are level and the spine is vertical. From the side view, the ear is over the shoulder, the shoulder is over the hip and the hip is over the knee, which is over the ankle.

Think of it like the foundation of a house. The foundation can settle, creating structural stress that can crack the plaster on the walls or ceiling. The same is true for our bodies. Unequal support in the foundation of our body, our feet,can create stress in our structure that can show up as poor posture. This poor posture can lead to tight muscles, stiffness and ultimately contribute to joint degeneration in the knees, hips and spine. Basically, small imbalances over time can lead to big problems for our bodies.

Common Postural Problems

The most common signs of postural stress are one ear being higher than the other and unlevel shoulders or hips. You can also detect postural stress from the side if the ear looks as if it has moved forward of the tip of the shoulder or if the hips appear to have moved forward.

The first thing to do is find out where your postural stress is coming from. Certain jobs require you to sit, stand, twist or bend in repeating patterns, which can create postural stress. If you sit at a computer for long periods of time, that can have a tendency to create a forward head positioning, causing stress in the neck and upper back. Bending and twisting motions can cause an overdevelopment of muscles on one side of the body compared to the other side, which can also be a source of postural stress.

The foundation of posture is actually the feet. It is very common for there to be slight differences in the arches of the feet, which create a slight imbalance. This imbalance can cause a chain reaction all the way up the spine, affecting postural balance. One sign of foot imbalances is when one foot flares out more than the other. Both feet should point forward with only the slightest outward flare when you walk.

Flat feet, a condition also known as excessive pronation, can produce slight twisting movements in the knees and hips, causing one hip to be higher than the other. This is usually more pronounced on one side and is not typically painful, but it explains why one knee or hip can develop soreness or stiffness more than the other one.

A Few Things You Can Do

Get checked – If your posture is breaking down as a result of improper foot balance, it is important to have your feet examined to determine if a custom-made, flexible shoe orthotic will be beneficial. Orthotics create a solid foundation for your pelvis and spine by limiting excessive motion in the feet. Having a stable foundation helps to improve your posture. Your doctor can provide you with more information.

Improve flexibility – This is important because postural stress causes some muscles to work harder than others, creating tension and stiffness. Mirror image exercises are stretching and strengthening exercises designed to restore muscle balance by stretching in the direction away from the postural imbalance. If you are looking in a mirror and one shoulder is higher than the other, you will want to stretch and strengthen in the direction that makes the shoulders level. The same concept works for the lower back. (Note: For a list of easy stretching exercises to help keep the entire body flexible, read “You’ve Got to Be Flexible” in the January issue of TYH.)

Work with your chiropractor – Be sure to work closely with your chiropractor in developing a plan of action, and then check your progress with a postural analysis. It is important to remember that the body works best when it is in balance, so that should be the goal of all of your stretching and strengthening exercises

Good posture does a whole lot more than just allow you to stand and walk tall. It’s a full-body improvement that benefits you from head to toe.

Benefits of Good Posture:

Joint mobility

Injury prevention

Improved balance

Overall wellness

Consequences of Poor Posture:

Muscle tension

Pain

Fatigue

Degenerative arthritis

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Brian Jensen, DC, is a graduate of the University of Nebraska and Palmer College of Chiropractic. He specializes in structural biomechanics and has been in practice for 17 years.

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Source: http://www.baylorhealth.com/PhysiciansLocations/Plano/About/BaylorPlanoHealthBriefs/Pages/Nap.aspx

When you were a kid, you probably didn’t want to take a nap for fear you’d miss out on valuable playtime. Now, when 2 p.m. rolls along, a nap doesn’t sound half-bad! But is it really a good idea?

Jeff Taylor, M.D., a pulmonologist on the medical staff of Baylor Regional Medical Center at Plano, offers a few thoughts on daytime resting. Ask yourself these questions:

1.Do you struggle to sleep at night? Before lying down for some afternoon shut-eye, consider the possible repercussions later tonight. “If you suffer from nighttime sleep problems like insomnia, a nap could actually make it worse,” Dr. Taylor says. If you don’t have trouble sleeping at night, however, a 30- or 45-minute nap could help you get through a tough day (as long as your boss doesn’t mind!).
2.What time is it? Even for people with normal sleep habits, naps too close to bedtime can make it harder to fall asleep at night. Naps lasting longer than two hours can have the same effect.
3.Is there something more going on? “If you fall asleep with ease every night and you’re feeling tired during the day even after getting a full night’s rest, you could have sleep apnea,” Dr. Taylor says. “Talk to your doctor about a sleep study to get an accurate diagnosis, because in this case, naps won’t help.”

Visit us at All Injury Rehab for more information and to set up an appointment.

Got the flu, got a cough, well here is a helpful article for curbing that cough naturally.

Source (http://www.toyourhealth.com/mpacms/tyh/article.php?id=1400&no_paginate=true&no_b=true)

While we’re mired in the thick of another cold and flu season, it’s time to remind parents of two important points: First, the Food and Drug Administration says cough and cold medications are not appropriate for children ages 6 and younger and may actually be dangerous; and second, research suggests honey may be the best treatment of all for helping children suffering from cough and related symptoms.

Let’s deal with the safety issue first. Over the past several years, the FDA has progressively investigated over-the-counter cough and cold medications, many either with dosing instructions for adults and children or for children only, depending on the type/brand. With little research done involving children only (after all, what parent would want their child to be the guinea pig in one of those studies?), the general protocol was for dosing recommendations to be extrapolated from adults to children. In other words, there was little to no hard data providing any sort of a basis for how much of a given cough/cold medicine should be administered to children – or if it should be administered at all.

Eventually, the FDA figured this out and ruled that cough and cold medicines were inappropriate for children under the age of 2, then extended the ban to children under age 6 (and is considering a ban up to age 11, if not older).

In the past year or so, even the medications still considered appropriate for the 6-plus age group (at least for now) have come under fire, with more than a few product recalls for quality-control issues that resulted in a number of products (cough and cold, allergy, fever) made by several drug manufacturers being removed from the shelves for several months in 2010.

Wouldn’t it be great if our kids had something natural to help them get rid of those nasty coughs, or at least minimize their duration? Well, perhaps they do: honey. For example, in a 2007 Pennsylvania State University College of Medicine study involving 105 children ages 2-18 with upper respiratory infections, children who were given buckwheat honey (between 1/2 and 2 teaspoons prior to bedtime, depending on age) coughed less and slept better than children who did not receive any honey or who received honey-flavored dextromethorphan (the primary active ingredient in many cough and cold medications).

Talk to your doctor for more information, and keep in mind that honey is not recommended for children in their first year because it may contain botulism spores, which can be harmful to young children’s underdeveloped immune systems.

Visit us at All Injury Rehab for more information and to set up an appointment.

I know that this isn’t a usual topic, but here it goes.
To Your Health
December, 2009 (Vol. 03, Issue 12)

Snow-Shoveling Safety Tips
By Dr. Douglas R. Briggs

If you live in an area of the country that sees snow during the winter months, or even if you’ve only visited a part of the country that does, you know fresh snow is one of the most beautiful and peaceful things to witness. However, you probably also know that with snow comes the need to remove it from driveways, walkways, and other traffic areas. That’s often where you – the snow-shoveler – come in.

Anyone who has shoveled snow before knows how good a workout it can be. When you consider that the average shovelful of snow weighs 5-10 pounds, the average driveway or walkway may hold hundreds of pounds of snow. But despite the benefits, shoveling snow can also be physically stressful; bending, lifting, and twisting, combined with the exposure to freezing weather conditions, can take a serious toll on the body.

Typically, the arms, shoulders and back get sore and may occasionally feel pain. The cold air invigorates most people into action; however, the same cold air can numb the sensations of pain and fatigue. Unfortunately, pain is a sign that an injury has already occurred or that mechanically you are doing something incorrect in shoveling the snow. In short, there is a right way and a wrong way to shovel snow, and paying attention to your technique can make a big difference in how you feel the next day. As with any project, the prep work is the most important. The following are some quick tips on how to shovel snow smarter:

Be prepared. Spray your shovel with Teflon so the snow won’t stick to it. The more snow that stays on the shovel, the heavier it gets and the more chance for injury – and frustration.

Do a warm-up first. A tight, stiff body is asking for injury. A few minutes of stretching can save you a lot of pain later. When you are shoveling, don’t forget to breathe. Holding your breath makes you tight and stiff.

Layer your clothing. Layered clothing will keep your muscles warm and flexible. You can shed a layer if you get too hot. Make sure you wear gloves that cover your wrists; if your wrists get cold, your fingers, hands and arms will be cold, too.

Wear the right shoes. Choose shoes with plenty of cushioning in the soles to absorb the impact of walking on hard, frozen ground.

Use the right size shovel. Your shovel should be about chest high on you, allowing you to keep your back straight when lifting. A shovel with a short staff forces you to bend more to lift the load; a too-tall shovel makes the weight heavier at the end. (Note: Save your money – don’t buy a fancy ergonomic shovel; studies have shown that in some models, the hook end is too deep. Twisting to unload a shovelful of snow with this tool may hurt your wrists.) Also keep one hand close to the base of the shovel to balance weight and lessen the strain on your back.

Timing is everything. Listen to weather forecasts so you can shovel in ideal conditions. If possible, wait until the afternoon to shovel. Many spinal disc injuries occur in the morning when there is increased fluid pressure in the disc because your body has been at rest all night.

Drink lots of water. Drinking water frequently throughout the day helps to keep muscles and body hydrated. Be careful with hot drinks like coffee or hot chocolate. Coffee contains caffeine, which has a dehydrating effect and adds even more stress to the body.

Use proper posture. When you do shovel, bend your knees and keep your back straight while lifting with your legs. Push the snow straight ahead; don’t try to throw it. Walk it to the snow bank. Try to shovel forward to avoid sudden twists of the torso and reduce strain on the back. The American Chiropractic Association recommends using the “scissors stance,” in which you work with your right foot forward for a few minutes and then shift to the front foot.

Take your time. Working too hard, too fast is an easy way to strain muscles. Take frequent breaks. Shovel for about five minutes at a time and then rest for two minutes.

See your chiropractor. Gentle spinal manipulation will help keep your back flexible and minimize the chance for injury. If you do overdo it, your chiropractor can help you feel better and prevent more injury.
So enjoy the snow this year, but remember that when it comes to shoveling snow, stay safe. Taking heed of these simple tips could make the difference between spending your day enjoying the new snowfall or lying in bed with a sore back, sprained ankle or other injury that could have been easily avoided. Talk to your doctor for additional information.

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Douglas R. Briggs, DC, Dipl. Ac., DAAPM, practices chiropractic, acupuncture and pain management in Wilmington, Del.

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3 Steps to More Energy (source http://www.toyourhealth.com/mpacms/tyh/article.php?id=1389)

Rise & Shine

If you aren’t an early riser and think the best way to increase energy is to stay in bed until noon or so, you’re missing out. Try rising with the sun on a more consistent basis and see how much more you accomplish (and how much energy you have doing it). Start the day with a brisk walk followed by a balanced meal, and your body and mind will be energized for the rest of the day.

Great Escape

There are countless energy sappers in life, but the way to fend them all off and retain energy throughout the day is to escape. Get away from the stress of your workload, the noise of the television, the constant demands of the kids. How do you possibly do that? Schedule time, whether it’s a five-minute escape from your desk every few hours or an hour of mandated quiet time at home.

Wind Down

No matter how much energy you start with and how well you replenish it, by day’s end, most people are exhausted. And mental and physical exhaustion can actually cause poor sleep, inadequate sleep or no sleep at all. The solution: wind down every night with a good book, your favorite music, a soothing bath, or even a calm review of the day with your significant other (or yourself).

Visit us at All Injury Rehab for more information and to set up an appointment.

Source: ThirdAge.com

It’s not uncommon for people to complain about sore joints in cold weather, although the “why” of it is still a mystery to experts.

Rhodes recommended wearing an extra layer of clothing, as well as wearing gloves outdoors in the cold weather.

“The hands seem to be the thing that bother people the most,” Rhodes said.

Rhodes said the heated pool at the OMHS HealthPark helps, too, because activity generates heat in the joints, and that improves pain and stiffness.

“Our natural defense to cold weather is to protect the core of the body (which) will actually shunt blood from the extremities to the inside of your body,” he said. “You don’t have a lot of blood going to the exterior portion of your limbs because it wants to conserve the heat that you have.

“Unfortunately, that makes it even worse when you are arthritic because now there’s even less blood flow to your hands, legs, arms and shoulders. People need to wrap up really well.”

Last week’s snow was fluffy and measured only a couple of inches, so it wasn’t hard clearing sidewalks and stairs, but if and when the heavier wet snow arrives, shovelers should take care not to overexert themselves.

“You should try not to do too much, particularly people with heart conditions,” Rhodes said. “They’re the most at-risk. It’s a fairly strenuous activity if you’re doing a lot of snow removal with a shovel.

“Go at a measured pace, take breaks, go in and warm up. It’s going to be there for a while, so take your time and get it done. Don’t try to do it all at once.”

Extreme cold has long been associated with conditions such as arthritis and joint pain, affecting hips, knees, elbows, shoulders and hands.

“People with good joints don’t have pain related to weather, but those who have any kind of trauma to their joints or some arthritis, it’s very common to have them tell you it’s worse when the weather changes, or even when the barometric pressure changes,” said Dr. Gayle Rhodes, the director for Owensboro Medical Health System’s WorkHealth division.

Researchers haven’t solved the puzzle of cold weather relating to soreness, but apparently joints contain sensory nerves that respond to changes in atmospheric pressure. It’s believed that cold weather causes the joint lining to constrict, perhaps causing the discomfort.

“That’s been a theory that’s been promoted, but I’m not sure why that causes pain in your joints, or why you’d have a mechanism like that in the joints to detect barometric pressure in a normal person,” Rhodes said.

The solution, however, is easy — keep warm.

“People with sore joints tend to want to set the thermostat up a little bit higher, and that’s prudent,” Rhodes said. “If you set it too low to conserve energy, you’re going to wake up and have sore joints all day long.”

Visit us at All Injury Rehab for more information and to set up an appointment.