Healing Chronic Shoulder Pain

(This newsletter issue for March 2013 is brought to you by Life Wellness Center)

As we get older, years and decades of mechanical stress may lead to deterioration of joints, ligaments, and tendons. This degenerative process, commonly known as arthritis, primarily affects weight-bearing joints such as the hips and knees and those found in the lumbar spine. The shoulder, too, is especially prone to undergo arthritic changes owing to its extreme mobility. The extensive range of motion at the shoulder is built-in to the design of this structure, but the tradeoff is instability. The design of the shoulder sacrifices stability for mobility.

Degenerative disorders of the shoulder typically involve the rotator cuff. This broad, flat structure is composed of the muscle-tendon units of the four rotator cuff muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. The thick covering of the rotator cuff surrounds the head of the arm bone and supports and strengthens the shoulder joint. But owing to the shoulder's inherent instability contrasted with its great mobility, the soft tissues of the rotator cuff undergo repetitive stress and strain. Ultimately, degenerative changes may occur, leading to the two prominent symptoms of pain and restricted range of motion.
An entire orthopedic sub-specialty focuses on treatment of chronic shoulder pain and includes long-term use of anti-inflammatory medication, corticosteroid injections when medications do not provide sufficient relief, and eventually surgery to repair tears in the various rotator cuff tendons. "Revision" surgery is commonly performed when the benefits of prior surgery are exhausted.1

The good news is that in many cases, a more optimal approach is available, one that utilizes the body's own natural recuperative powers. For many people, chronic shoulder pain can be reduced and chronic loss of mobility can be improved by engaging in specific activities and performing specific rehabilitative exercises. The goals of rehabilitation are to increase shoulder range of motion and build up shoulder strength. As these goals are accomplished, the likely result is reduction of intensity and frequency of occurrence of shoulder pain.
Engaging in an overall strength training program is an important general approach to managing chronic shoulder pain.2,3 Strength training should be done progressively, starting with light weights and building up over time. Exercises specific to the shoulder include seated dumbbell or barbell presses, dumbbell or cable lateral raises, seated bent-over rows, and internal and external rotation exercises done with very light dumbbells on a flat bench. If one has experienced an acute shoulder injury, early rehabilitation should precede rehabilitative strength training. Early rehabilitation includes pendulum exercises and finger-walking up a wall in both forward-facing and side positions.

Your chiropractor is experienced in injury rehabilitation and will be able to help you design an effective flexibility and strengthening program for improved shoulder function.

1. Keener JD: Revision rotator cuff repair. Clin Sports Med 31(4):713-725, 2012
2. Lewis JS: A specific exercise program for patients with subacromial impingement syndrome can improve function and reduce the need for surgery. J Physiother 58(2):127, 2012
3. Andersen LL, et al: Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain 152(2):440-446, 2011



Exercise of the Week: Push-ups on Exercise Ball

Quote of the Week:

“Nothing will ever be attempted if all possible objections must be first overcome”~ Samuel Johnson

Topic of the Week: The Health Benefits of Moving Naturally

Most of us live in an urban environment designed for comfort and convenience, an environment shaped by certain technologies, tools and transportation options that dictates how we move through the world from day to day. Some of our greatest achievements in modern living, though, have made it more challenging for us to connect with the natural world and realize our true health potential. Many of us no longer use the full scope of physical abilities that nature endowed us with and this loss of function has affected our collective spine, joint and overall health. Your chiropractor understands the importance of you moving your body’s joints and limbs through all their various ranges of motion and he or she can work with you to rediscover the natural health heritage to which you are entitled.

“Green Exercise”: Description & Principles
Green exercise is the name given to physical activity performed in nature. Both physical activity and exposure to nature affect health in a positive way. A 2005 study published in the International Journal of Environmental Health Research concludes that there are distinct synergistic health benefits that occur when these unique factors are combined and that green exercise has important environmental and public health consequences. A 2007 study published by the same authors in the Journal of Environmental Planning and Management notes that green exercise (including such things as walking, cycling, boating, and certain conservation activities) helps boost self-esteem and reduces anger, confusion, depression and anxiety.

Certain principles govern the performance of green exercise, or help to define it, including the principles of:

1) Adaptivity (the movements performed are dictated by environ mental demands);

2) Practicality (the movements performed are useful in many different life situations that require a physical response);

3) Universality (the movements performed could be part of every human’s life experience, regardless of gender or age);

4) Efficiency (the movements performed are safe and skillful); and

5) Vitality (the movements performed can be used in times of emergency to ensure safety).

Exercise performed according to green exercise principles is intended to improve your strength, fitness, mood and physical, mental and spiritual health.

Natural Skills & Movements
Natural skills and movements can be divided into two principle categories: Movements that involve locomotion and movements that involve manipulation. Walking, running, crawling, jumping, swimming and climbing are all examples of locomotive skills, whereas key manipulative skills or movements include catching, carrying, lifting and throwing, among others.

Our ancestors had to be adept at many of these natural skills, as they used them in their day to day lives. Today, few people, except for children, engage in this wide range of activities, to the detriment of our musculoskeletal well-being. Inactivity is a major factor in reduced joint range of motion and joint health, including spine function and health.

The Restorative Power of Nature
Performing natural skills in the natural world is a powerful way to combat or prevent chronic musculoskeletal problems but simply spending time in nature is, by itself, an effective way to develop better health. Perhaps not surprisingly, a study published in the journal Environment and Behavior reports that the restorative effects arising from experiences in nature are greater than those arising from vacation experiences in urban environments or situations involving simple passive relaxation.

Engaging in active play in the natural world is a powerful way to restore physical health, but green exercise positively affects mental health too. According to a 2010 study published in the journal Environmental Science & Technology, green exercise helps significantly boost mood, especially when performed in the presence of water. This study also noted that the mentally ill showed the greatest improvements in self-esteem among all study participants participating in green exercise and that the environment provides an important health service.

Green exercise is an effective way to re-establish a connection with the natural world that, for many of us, has been lost from years of sedentary, urban living. Performing ancient skills in a natural setting can improve all facets of health and remind us of our inherent strengths and abilities. It is important to remember that moving naturally is not risk-free and so you should always talk with your chiropractor first to determine the green exercise activities that are most appropriate for you.

Disclaimer: Information contained in The Wellness ExpressTM newsletter is for educational and general purposes only and is designed to assist you in making informed decisions about your health. Any information contained herein is not intended to substitute advice from your physician or other healthcare professional. Copyright © - The Wellness ExpressTM

Quote of the Week:

“When our memories outweigh our dreams, we have grown old”~ Bill Clinton

Exercise of the Week: Abdominal Bridges (part 3)

Topic of the Week: Chiropractic Care for Seniors

Chiropractic care is a suitable complementary healthcare option for people of all ages including older individuals. The safe, gentle and effective techniques along with the comprehensive head-to-toe approach used by many practitioners makes chiropractic the perfect profession to address seniors’ musculoskeletal health problems. A 2012 study published in the journal Chiropractic & Manual Therapies agrees, stating that chiropractors can play an important role in managing older adults’ health conditions. The role of chiropractic care for seniors extends beyond relief of aches and pains to influence key quality of life issues that almost every senior faces at some point. As our population ages, chiropractic will be there to provide quality care and support to our seniors and to ensure their best possible quality of life.

Reduced Pain or Discomfort
Reduced pain or discomfort is one of several important health benefits chiropractic care offers seniors. Pain in the spine and its surrounding soft tissues, or elsewhere throughout the body, is an unfortunate (though not necessarily inevitable) daily experience for many seniors. According to a 2011 study published in the journal Rheumatology, the risk of disabling back pain rises in older age, and seniors who have had a previous bout of back pain or who report poor self-rated health may have a greater risk of experiencing future back pain.
Chiropractic care, through the use of various manual techniques, provides seniors with a safe and effective way to treat or prevent pain in the spine and elsewhere throughout the body, and it helps bolster general health in this group, too.

Increased Range of Motion
Reduced range of motion in the spine and extremities is common among seniors and, for many, has a direct effect on the ability to perform activities of daily living, including gardening, playing with grandchildren or performing other cherished hobbies.

Chiropractic care - joint manipulation or mobilization, soft tissue work, functional exercise prescription – may help improve joint range of motion, flexibility and mobility in the elderly and help seniors better perform their activities of daily living. One case study, published in 2011 in the Journal of Chiropractic Medicine, reports that a 12-week course of chiropractic care improved range of motion, balance and gait speed and decreased disability in a 70-year-old female with hip osteoarthritis.

Improved Balance & Coordination
Improving balance and coordination in seniors is a major goal for all chiropractors. Boosting a senior’s balance and coordination can help reduce his or her risk of falling and give him or her the confidence needed to pursue a variety of physical activities that can enhance quality of life. According to a 2008 study published in the journal Clinical Chiropractic, the optimal approach to fall prevention in seniors involves improving joint mobility, patient mobility, and addressing the fear, depression and inactivity that may lead to falling. All these approaches are commonly used by chiropractors with older adult patients for this very purpose. Chiropractic care may help give seniors a better sense of body awareness as well as the confidence needed to prevent falls and live more fully.

Enhanced Sense of Well-Being & Independence
One of chiropractic’s greatest gifts to seniors is an enhanced sense of wellbeing and the ability to continue living an independent life for as long as possible. The ability of an older individual to remain healthy and independent can significantly affect his or her perceived quality of life, happiness and sense of well-being as well as reduce the costs associated with assisted living. Chiropractors work with seniors to improve musculoskeletal function so that these individuals can continue living active and full lives. Chiropractors may be the best positioned of all healthcare providers to ensure continued independence in seniors, due to the hands-on nature of the profession and the strong doctor-patient relationships in which health and lifestyle recommendations are comfortably and effectively discussed.

Disclaimer: Information contained in The Wellness ExpressTM newsletter is for educational and general purposes only and is designed to assist you in making informed decisions about your health. Any information contained herein is not intended to substitute advice from your physician or other healthcare professional. Copyright © - The Wellness ExpressTM

Your Personal Health Insurance Policy

(This newsletter issue for March 2013 is brought to you by Life Wellness Center)

Everyone is aware of the extremely high cost of most health care services. These costs can be measured not only in cash outlays, but also in time spent at a doctor's office. Waiting times can often be an hour or more for a comprehensive physical examination at a family physician's or internist's office. If you have a problem that requires same-day attention, the waiting time at a local hospital emergency room is open-ended and can easily range into several hours or more.


Those fortunate enough to have health insurance are able to buffer some of the monetary expenses. But even with an individual or family health insurance policy, annual out-of-pocket costs continue to rise steeply as monthly premiums, co-payments, and deductibles increase substantially year-over-year. For example, during the past five years monthly premiums for many policies have increased 15% or more annually. This means that monthly payments in 2013 would be approximately double those paid in 2008. Twice the cost for the same coverage. That's a tough situation. Of course, the fees don't stop at the monthly premium. Many policies have deductibles in the range of $5000 or more.

Thus, if we want to enjoy good financial health as well as good physical health, we might consider getting a "personal" health insurance policy. Such a "policy" requires more effort than that involved in writing a check. Your personal health insurance policy involves taking action in the two main lifestyle areas of diet/nutrition and exercise. A third lifestyle area, often ignored, involves personal well-being. This area includes building increasingly positive family relationships and friendships and developing a broader set of interests beyond one's favorite television stations and websites.

It is now well-established that lifestyle matters greatly to one's long-term health and well-being.1,2 Numerous studies have shown that one in three Americans have one or more chronic diseases - diabetes, heart disease, and cancer. The personal and family costs, the financial costs, and the costs to society of chronic disease are high. By establishing habits of good nutrition, regular vigorous exercise, and rewarding relationships and activities, we help prevent these major health problems.3 By engaging in healthy lifestyles, we are taking action that will reap many rewards for ourselves and our families down the years.

The only requirement to begin receiving the benefits of improved health is the willingness to get started. Even if you haven't done any regular exercise for many years, or if you can't remember the last time you ate a serving of broccoli, fennel, or kale, you can still start the journey to better health today. And if you begin, it's very possible that you'll look back after 12 months, 6 months, or even 3 months and be very glad you did.

1Thorgeirsson T, Kawachi I: Behavioral Economics: Merging Psychology and Economics for Lifestyle Interventions. Am J Prev Med 44(2):185-189, 2013

2Anderson AS, et al: Promoting changes in diet and physical activity in breast and colorectal cancer screening settings- an unexplored opportunity for endorsing healthy behaviours. Cancer Prev Res 2013 Jan 16 (Epub ahead of print)

3Mitra A, et al: Mechanistic studies of lifestyle interventions in type 2 diabetes. World J Diabetes 3(12):201-207, 2012

Quote of the Week:

“Sports do not build character. They reveal it “ Heywood Broun



Exercise of the Week: Abdominal Bridge

Topic of the Week: Recovery Techniques for Athletes

Athletic activities place significant physical and metabolic demands on your body and affect your body’s energy levels and internal environment. Many athletes, both competitive and recreational alike, may benefit from sports recovery techniques. Athletes who participate in long events, who train twice daily, who engage in weight training, who compete regularly or who experience high levels of fatigue or tissue damage may benefit most from recovery techniques. How quickly you recover from a bout of exercise or an athletic event may have as much to do with the techniques you employ immediately afterwards as the duration of the event or the intensity at which you performed it.

Using effective recovery techniques is important for all athletes to reverse or minimize sources of fatigue and restore your body (and mind) back to pre-participation levels in the least possible amount of time. Recovery techniques, when used consistently and appropriately, may reduce fatigue, improve the frequency and quality of your training and elevate your gameday performance, notes the Australian Sports Commission. Your chiropractor understands the unique demands of your sport and is an important resource in helping you establish your recovery routine. Your chiropractor can also use a number of manual medicine techniques to support your musculoskeletal health before and after your athletic event or competition.

Stretching & Active Recovery
Stretching and active recovery (i.e., a warm-down) are commonly used recovery techniques. Gentle, static stretching for 10 seconds or more per stretch may help relax tight muscles, improve range of motion and reduce the likelihood of injury. The principle purpose behind this recovery technique is to reduce muscle tightness, not improve flexibility. Active recovery (i.e., light physical activity) has long been used to help dissipate excess heat post-exercise and enhance the removal of blood lactate, among other reasons.
According to a 2000 study published in the International Journal of Sports Medicine, active recovery (exercise at 50 percent maximal oxygen uptake) was better than both rest or massage for removing blood lactate following maximal effort cycling tests in 18 trained male cyclists.

Nutrition & Hydration
Getting the proper nutrients and staying hydrated are two key recovery techniques used by athletes. A 2008 study published in the Journal of the International Society of Sports Nutrition notes that athlete recovery following a cycling time trial was improved by consuming a liquid carbohydrateprotein supplement early in the recovery process (and produced greater recovery benefits than a carbohydrateonly drink containing an equal amount of energy or calories). The researchers also report that this liquid carbohydrate-protein supplement improved fat oxidation (the use of stored fats to produce energy) and subsequent same day exercise efforts in their study participants. Staying hydrated during physical activity is one of the best ways to ensure optimal athletic performance and restoration of water and electrolyte balance, states a 2004 study published in the journal Science & Sports, is a crucial part of the recovery process of any physical activity that results in sweat loss.

Rest & Relaxation
Rest and relaxation are among the simplest - and possibly most effective – recovery techniques for athletes. Good quality sleep may be the No. 1 recovery tool for athletes, as it helps regenerate damaged tissues, abolishes lingering fatigue and provides a mental break from competition. According to a 2009 study published in the journal Physical Medicine and Rehabilitation Clinics of North America, there is a growing body of scientific evidence confirming a link between sleep, cognitive processes, and metabolic function, as it relates to post-exercise recovery and athletic performance. The National Sleep Foundation states that getting a good night’s sleep is essential for peak athletic performance, regardless of activity and that less sleep may increase the likelihood of fatigue, low energy, poor focus and slow post-game recovery.

Other Recovery Techniques
Other sports recovery techniques include hydrotherapy, compression garments, massage and other types of bodywork. Ask your chiropractor about what recovery techniques are best for you and your athletic activity.

Disclaimer: Information contained in The Wellness ExpressTM newsletter is for educational and general purposes only and is designed to assist you in making informed decisions about your health. Any information contained herein is not intended to substitute advice from your physician or other healthcare professional. Copyright © - The Wellness ExpressTM

Exercise of the Week

Quote of the Week:

“No person who is enthusiastic about his work has anything to fear from life “ ~ Samuel Goldwyn

Topic of the Week: Spine Care Strategies at Work

Work tasks, especially tasks of a repetitive nature, can place significant demands on your spine and the soft tissues that support it. Over time, work tasks - everything from sitting to lifting to bending - can cause body structures and tissues to break down, leading to injury. The goal of spine care strategies at work is to alter your work environment to minimize the effects of repetitive tasks while training your body to stand up to the challenges of your work demands. It is important to use your body, to move your limbs and joints through their full ranges of motion but some work tasks present physical challenges that may overwhelm your body’s threshold for injury.

Chiropractors can offer employers a unique perspective on work demands and their effects on their employees. A study published in the journal Australasian Chiropractic & Osteopathy states that even one spinal care lecture delivered by a chiropractor in the workplace can reduce spine-related pain among workers and the cost of back injuries. Your chiropractor understands workplace injuries and is the perfect person to share specific spine care strategies with you to address your unique work tasks. We discuss several general work-related spine care strategies in this issue of the Wellness Express.

Strategy #1: Build Physical Activity into Your Routine
Carrying too much weight increases stress on your spine and may contribute to workplace injuries. According to a 2003 study published in the journal Spine, obesity is a key independent predictor of back pain and its severity. Another study, published in 2003 in the journal Obesity Research, notes that increased levels of Body Mass Index (BMI) correspond with increased levels of back, hip, and knee pain in adults over 60. Performing a sufficient amount of moderate aerobic exercise each week (approximately 150 minutes per week) and twice-weekly strength training sessions may help you lose excess weight and bolster your core strength - both of which can help you avoid common workplace spine injuries.

Strategy #2: Pay Attention to Your Posture
Paying attention to your posture may be one of the most effective ways to care for your spine while at work, especially if you sit or stand for long periods. A 2001 study published in the journal Clinical Biomechanics reports that spinal stability is affected by posture and that the control of spinal stability is decreased when asymmetric, or unbalanced postures are assumed for prolonged periods. If you stand at work for long periods, consider resting one foot on a stool for a short time to reduce the stress and strain on your spinal tissues. Holding reading material at eye level can reduce stress on your cervical spine and help improve your posture. Simple suggestions for maintaining healthy sitting posture include using a chair that allows you to keep your feet flat on and thighs parallel to the floor and removing any objects (cell phone, wallet) from your back pocket to reduce pressure on your low back. Ask your chiropractor about effective postural exercises you can perform while standing or sitting at work.

Strategy #3: Minimize Workplace Hazards
Falls, lifting injuries, inappropriate footwear and poor workstation design are all possible hazards in the workplace that can be minimized by taking action. To help prevent falls – a common cause of serious back injury among workers - remove objects from your work space that could cause you to trip and ask your employer to make sure slippery surfaces are clearly marked or have carpet or other non-slip surfaces installed. Lift heavy objects with your knees and engage your core muscles for this task. Keep the object close to the center of your body to reduce the stress on your spine and other tissues or ask a co worker for help in moving heavy objects. Wearing non-slip shoes without any heel elevation is another effective way to minimize workplace hazards.

Strategy #4: Modify Workplace Tasks
Modifying workplace tasks is the key to long-term spine injury prevention. It is important to find ways to perform your work activities that place less strain on your vulnerable tissues and prevent repetitive strain injuries. An ergonomics professional can perform an assessment of your workstation to help you do just this but there are many simple things you can do right now to modify your workplace tasks. Consider using lifting devices or adjustable equipment to manage packages or loads. Using adjustable chairs and desks can help reduce back and neck strain and can ensure that you are in an optimal position in front of your computer screen or monitor. Using a phone headset can significantly reduce neck strain, tension and muscle imbalances that cause problems over time. Ask your chiropractor about other strategies to preserve your spine health while at work.

Disclaimer: Information contained in The Wellness ExpressTM newsletter is for educational and general purposes only and is designed to assist you in making informed decisions about your health. Any information contained herein is not intended to substitute advice from your physician or other healthcare professional. Copyright © - The Wellness ExpressTM