In this day and age everyone seems to be selling a new detox formula. Over the counter products touting a healthier you though their detox formulas line the aisles of almost every grocery store. But, have you ever tried foot pads? Ironically this type of detox system has been around for centuries. It could very well be one of the first forms of detox ever created. So, what’s the deal? Do they really work and how do detox foot pads really work?
The body is a unique in that it works best when it is fueled by nutrients that it craves. Unfortunately many of us fill our bodies with foods that are processed, high in fat and cholesterol and are generally horrible for our bodies. The reason? Our bodies become accustomed to the food we feed it. When we eat food at places like fast food establishments, we are fueling ourselves with food high in sugar and other processed products that is not healthy. It is also the reason our bodies become toxic. Along with smoking and alcohol, food can in itself be extremely toxic. So, detoxifying your body takes a couple steps. The first, obviously is to change eating habits. Secondly, use a detox system that works.
Although detox foot pads have been around for centuries, many people still think this is a ridiculous way to detoxify the body. However, if you think about how the body works it may not be as crazy as it sounds. Detoxifying the body through foot pads uses the same premise as trees which absorb nutrients and water through roots. The pads are placed at points of the foot the same way as acupuncturists place needles to target certain organs and muscles. The feet have points where nerve endings stop. From our heads to our toes, nerve endings are throughout our bodies and end at our feet. Foot pads were designed by Chinese who believed that by rubbing the feet, blood circulation improves and helps with the central nervous system as well as improves organ function.
So, you may be wondering if there is some validity to all of this. Can foot pads actually detox your body? Ironically foot pads have received some pretty positive reviews from the people who actually used them. The key is to actually go through the process. It’s recommended to wear these pads at least eight hours a night and for five days minimum. As you use the pads, at first they will be discolored and dark in color. This is from the toxins which are being absorbed through the pads. After a few days the pads will eventually become lighter in color. This means they are working and your body is in fact become less toxic. These pads do need to be changed regularly after each use.
Detox foot pads can and do help to detoxify your body, however as much as you detoxify the body you have to also eat right and exercise. This is probably the most important part of the detoxification process. It’s imperative that you actually follow the plan to the best of your ability. Quitting smoking, eating healthy foods like vegetables and foods with low sodium, low fat can benefit you threefold. Detox foot pads can rid the body of toxins but keeping the toxic out means eating the right foods. The majority of all toxins comes from ingestion, meaning we take them in. So, the choice is yours, eat right, exercise, and detoxify your body the right way. Start detoxifying yourself with detox foot pads. You’ll be glad you did!
- Ari Vinograd, CEO, Wise Choice Health, Inc
Who else would like to know everything about preventing premature ejaculation and yoga in order to get more stamina in bed?
Did you know that a recent study has shown that there is a strong connection between preventing premature ejaculation and yoga? Find out the two best how to last longer in bed exercises by reading this article!
Premature ejaculation is the most common sexual problem affecting men under the age of 40. It is so common in fact, that according to researchers more than half on the planet have experienced it as some point in their lives. As with any problem, scientists and common people alike have been trying to find ways to solve it. In this case, we are talking about ways of providing more stamina in bed.
It should be noted that there currently is no FDA approved cure or treatment of PE, which means that even doctors as sort of improvising. What we do know however, is that since PE is caused mostly by psychological factors, the best way to deal with it is by coming up with natural ways to last longer in bed, like psychotherapy and behavioral therapy. Despite that however, a lot of men and doctors prefer the easy solution, yet temporary, solution of SSRI pills which as also known as antidepressants.
A recent study however has shown that there is a very powerful connection between preventing and controlling premature ejaculation and yoga. The study was done on men with premature ejaculation problems, half of whom took SSRI pills, while the other half did Yoga exercises that are known to prevent premature ejaculation. At the end of the study, there was an 86% success or improvement rate reported by the group that took the pills, while that rate was 100% (!!!) for the met who tried the how to last longer in bed exercises! So without further ado, let’s see those exercises that got perfect results:
- Sarvanga Asana or the shoulder stand
- Lie in a supine position with your palms flat on the floor and as close to your body body as possible. Your toes should be touching.
- Start inhaling. While you inhale a lift slowly both your legs, while making sure that you don’t bend the knees.
- Now, put some pressure on both your palms and try to lift your body as much as possible, while keeping it as straight as you can.
- Stay at this position for a few seconds and then go back to the original position by first bending your knees and then slowly lowering your body back to the floor.
This posture essentially reverses the blood flow and makes your blood flow to your tissues, cells and organs.
- Supine head knee posture
- Sit upright with your legs straight in front of you.
- Fold your right leg at the knee and place the heel firmly under your left thigh.
- Take a deep breath, then bend down over your left, while slowly exhaling. Grab the toes with your fingers and bring your head as close to the knee as you can.
- Stay in this pose for a while and then take your body back to the original position.
- Make sure that you do not bend your knee at any time.
This is one of the most effective how to last longer in bed exercises, because it enhances the working of the reproductive organs.
As you can see, Yoga is one of the best natural way to last longer in bed, since it is more effective than the drugs that doctors prescribe to PE patients. Keep in mind though that it’s only one of the many natural techniques and methods to prevent premature ejaculation. If you would like to find out more on how to overcome PE, then you should definitely read the two best guides about overcoming it: Ejaculation Trainer and Ejaculation On Command. Those books have helped countless men with their PE problem and they will definitely do the same for you.
By The Canadian Vaporizer Shop
Smoking marijuana is a bad idea. Vaporizing it using a marijuana vaporizer, however, is a smarter idea that can get you high quicker and easier and can get you the medical benefits you want with fewer side effects.
While there are many people who already understand and prefer vaping, it might be time for more to learn about it. In some circles, vaporizing is a common and proven way of getting marijuana into your body without taking in all the other substances in cannabis smoke as well. You see, vaporizing gets you all the psychoactive and medical benefits with none of the unfortunate effects that happen when smoke is created.
Devices called marijuana vaporizers are designed especially for the purpose of allowing active cannabinoids to be released without releasing certain harmful things that naturally exist in marijuana flowers. While these elements are invisible, that doesn’t mean they can’t be harmful if inhaled.
A cannibus vaporizer works very simply: it heats the material to just the right temperaure to release the cannabinoids and their psychoactive and medical benefits without reaching the point where smoke can be produced. That means the temperature reaches about 375 degrees F or so — and no tar or carcinogenic gases are ever released, eliminating many negative side effects.
In addition to reducing potential long-term health effects, there’s no irritation to the lungs, throat or mouth when using a vaporizer. Interestingly, water pipes — which seem like similar devices — provide no such benefit in long-term or short-term side effect reduction.
Take note, also, of the difference in the quality of vapor versus smoke. Vapor contains perhaps 95 percent cannabinoids — the things that provide the health and psychoactive benefits.
Smoke, on the other hand, is perhaps 88 percent “other” things — that is, things besides cannabinoids that don’t provide any benefit and could cause you problems.
So which sounds better to you: smoking or vaporizing?
Shopping for health products can be troublesome if you are not looking in the right place. People usually shop for these health products at the nearest retail stores. In that case, it is not easy to find the exact product for your requirement. You may have to use the nearest alternative to the product you are looking for, because the retail store may not have the stock for your product. Many people face this situation on a daily basis. Even if you manage to get the product you are looking for, the price of the product may not be the best one available in the market. However, you cannot roam around the entire market to save some money. To avoid all these hassles, you should ideally choose the online method to shop for health products. When it comes to health products in the online space, iherb is one of the best companies available in the market. You can also use the iherb coupon code to save a lot of money and get lots of discount on every purchase of health products.
Get huge discount with online shopping
The best method to save money while shopping for health products is to go for online shopping with iherb coupon code. Even with online shopping, there are many products and companies which offer these service. If you are confused about how to choose the best one, you should carefully look into some of the features of these companies. Ideally, you have to check the amount of discount available with these online portals. Another important factor to look out for is the inventory of the company. Some companies may offer huge discount but may not have all the products under one roof. You should make sure that the company has a large inventory of health products under one roof so that you can complete all your shopping in one place. This will also add up to your discount if you shop for all products in one place. The largest inventory of health products and nutritional supplements is with iherb company. You can use the iherb coupon code while shopping and get all the benefits of a huge variety of products under one roof. They have more than 35000 products to suit the requirement of different customers.
Another big advantage of using iherb coupon code is the free shipping available with the company. Most of the times, getting the product at your doorstep will be a huge challenge. This company has one of the best distribution network and when you shop for health products using iherb coupon code, you can be rest assured that your products reach your place in time and in perfect condition. All these factors are the reason behind the growing popularity of iherb products in the online world. You will also save a lot of money every time you shop with iherb. The iherb rewards program will ensure that you get credits every time your referral makes a purchase. You can later redeem these points while shopping with the company.
Iherb coupon is a word mentioned all over the web today because the demand for natural health products is raising up like never before. For that reason people are searching for this iherb coupon code in order to save a quick buck or two when buying supplements or other products from iherb.com
How did this iherb coupon even get so popular? This was because iherb.com decided that instead of giving Google all their money they could employ a system also known as affiliate system or multi-level affiliate programs. The system works like this. You buy a product from their website and after that you get an iherb coupon code to share. You can then share this with all your friends or even promote it on any media platform. Most people wants to share it online because it is a very effective strategy in order to share iherb coupons with as many people as possible.
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If you watch the American Crime Series Drama ‘CSI’ you will be aware that DNA testing is a fundamental tool used in solving crime today. However, it was nearly two decades previous to the crime drama that DNA testing was first used in a US court to convict Tommy Lee Andrews of rape in 1987, matching his DNA from a blood sample with that of semen traces found on the rape victim.
Since the introduction of DNA testing in 1985, biological matter i.e. hair, skin, blood and other bodily fluids have arisen as the most reliable physical evidence at a crime scene, particularly for violent or sexual assaults. DNA testing is used to determine distinctive patterns in the genetic evidence from a crime scene with the DNA of a potential perpetrator with a degree of 99% accuracy.
Following the success of DNA testing, law enforcement agencies around the world are amassing DNA databases, finding matches that investigators would have almost certainly have missed. The FBI now has millions of DNA records for convicted offenders and sex offenders that are required to submit DNA samples to law enforcement.
However, there has not always been such trust in the reliability of DNA testing, for example the O.J. Simpson trial in 1995 when Simpson was acquitted, partly due to the doubts about the reliability of the evidence based on blood found at the murder scene. But professionals say that doubts have eased as scientific advances have greatly improved and the public have become more familiar with the practice through TV and Movies.
DNA testing has not only proved extremely reliable in convicting criminals but in exonerating the innocent. More than 240 convictions have been overturned in 33 states and people have even been released from death row after DNA evidence had cleared them.
Over the past couple of years, geneticists and scientists have uncovered greater accuracy in DNA testing and testing laboratories have realised a fall in production thus relaying a greater price competition in what is becoming a rapidly growing market. This has led to DNA testing being used as a leading method to determine paternity (especially for daytime TV fans on shows such as Jeremy Kyle). DNA evidence has also been influential in identifying human remains and authorities have established a massive genetic database following the World Trade Center tragedy – using DNA testing to give closure to the relatives of the victims. Underlining DNA testing as an strong force for good.
Find out more at DNA Testing Choice
Q: How is spinal stenosis different in the upper back and the lower back?
The principles are similar but there is an additional factor of concern, meaning when we go back to the anatomy lecture, there’s that one additional structure that runs through that central canal that is more important than any other nerve and that’s the spinal cord. On one end of the spectrum the key component is to make sure that spinal stenosis does not going to point where it is affecting the spinal cord, it starts causing issues with balance, with bowel and your bladder. Having said that the idea in principle is very similar when we were talking about equating issues with the neck and the shoulders versus your back and your hip flexibility. We see very commonly, we share patients quite a bit, that have issues of both the neck and the shoulder and they’re tough nuts to crack because you got to address them both together. The idea is that you can have rotator cuff tear and a little bit of a quote unquote, pinched nerve coming from your neck and one influences the other and biomechanically you need to address both. But which do you address first? Is there a surgical repair that needs to be done on that shoulder as you keep putting pressure on your neck? Or does the neck need to calm down and then you can do a rehabilitation program that addresses both together?
Q: What is that about sleeping on the side that is not good?
Not that it’s not good. It’s just when we lie on our side we have a tendency to kind of curl up in a fetal position and in fetal position you are bringing your knees closer to your chest and that has the same principle of sitting in a chair where the muscles, the hip flexors can tighten down through the night. Now people ask me all the time “What position is best one to sleep in? What kind of pillow should I get? Should I spend $9000 on a [inaudible]?” And I’m like “Are you doing your exercises? Why don’t you start there?” But the idea is this, you want to try and sleep comfortably. Don’t try and force yourself into a position because that’s the right one for you. But there’s certain things to think about and the bottom line is that when we’re talking about the neck, you want to be in relatively neutral position. The pillow, if you’re a side liner, if you think about it needs to be a little bit bigger in order to keep you in a neutral position versus if you’re lying on your back you need a relatively smaller pillow to keep you in a central posture position. The back itself is different. Nothing is good about sleeping on your stomach. That is the only [inaudible] out of all of this. I used to love to sleep on the stomach and it’s just not good. But the idea is that when you’re sleeping on your side you can have a tendency to get those hip flexors a little bit tight. That’s kind of an issue.
Q: How much calcium is recommended for an adult male?
It’s the same dosage for men and women. Its’ a 1200 to 1500mg a day of calcium and there’s basically two forms: calcium carbonate also known as OsCal and calcium citrate also known as Citracal. The calcium citrate is easier to digest and tends to produce less gas, which I can tell you from personal experience as we get older, is a good thing. What I tell patients is go to the drug store and find an OsCal or Citracal and right next to it will be the store brand which is just as good and costs half as much. 1500mg of calcium a day and 800 units of vitamin D.
One thing that I was told, maybe you can [inaudible] on this, is in my understanding and I’m no osteoporosis expert, but I understand our gut can’t absorb more than 500 or 600 of the calcium in one sitting? You actually need to split it up throughout the day?
It is better to split it up, to do it that way. Unfortunately most of us have a hard time remembering to take something more than once a day but from a physiological point of view, yes, it’s better to split it up.
Q: Do pillow wedges or support braces help relieve night back pain and discomfort?
Yes, so here’s the thing today, you know, I do tell patients to get relief from their back symptoms to sometimes do that. I think that’s more to get things to calm down in the acute stage when you’re experiencing a flare. But in general, once again, you don’t want to be doing that every night because the idea and the component is the same. You are facilitating those flexibility issues, such that then during the days as soon as you wake up and start to stand up those muscles have been tightened down all night long. But it does, the same principle of “Oh, my back’s bothering me let’s go sit down.” And it opens up that canal. So that’s why you can get through relief that you get. Less pressure’s put through the spine when you’re in that position.
Q: When confronted with a sport’s related injury…would you recommend heat or ice?
Usually from my experience, acute injuries, when you’ve just hurt something, ice is always the answer. 3 days of ice is pretty standard. Even after you’ve done running and something’s sore, ice is an anti-inflammatory and analgesic, it means it decreases the swelling plus it makes it feel better. Heat generates blood flow, swelling. It can actually make thing stiffen and hurt more. Heat is sometimes more chronic lower back kind of thing. Dr Kooch can answer about that but in general I almost always universally say that if it’s hurting, I go with ice.
I never go with heath, with one exception, prior to exercise. You’re trying to relax the muscle, get things to loosen up a little bit, so that you can do the exercise but I feel the same way. The literature and this is where the problem is, and why you’re asking the question because you might talk to and get 3 doctors to say ice and 3 doctors to say heat. My principle is the same, we’re trying to reduce inflammation and ice is a natural anti-inflammatory. To complement the deduction they were trying to achieve with anti-inflammatories, I stick with ice. In general I leave any heat application to whatever therapy I’m getting a patient into whether it’s chiro initially or a physical therapy. Targeting that area for a purpose then always follow with ice after wards.
Q: Is there a fitness program or machine that would work best to keep me in shape?
It’s between your ears. It’s educating you about what your body needs. I want you to understand what your problem is. Where is your problem? Where your flexibility issues are? Where are your strength issues? When you go into a gym, you already have a basic routine that you can do without a lot of equipment. But then there’s a lot of equipment that’s out there. There’s not just one piece of equipment that can take care of all your problems. Each of these pieces of equipment have a different, you know goal. The idea is that if you understand the principle of what you’re trying to achieve to reach your goal, you can use that equipment whatever way you need it. In other words, if you understand that you should be thinking about postural awareness during a certain activity, then if you are keeping your postures correct, then you’re safe and you’re actually building up the muscles the right way. I always use the analogy of wading into the shallow end. You don’t just go into a new gym and try every piece of equipment in the place. It’s what happens with Curves. Not that I have anything against Curves but you’re kind of forced to do x, y and z instead of your body telling you what you should do.
I like Curves because we get a lot of patients from Curves. Zumba too. You probably want to do activities that are lower impact. You are going to be better on perhaps an exercise bicycle, or an elliptical, or a Nordic track than a treadmill. If you’re going to use a treadmill you want to go low and slow rather than crank up the elevation. If you’re going to use a weight type machine, just because you could bench-press 400 pounds 20 years ago, that’s probably not where you need to start. You need to start very low and go up in maybe 10% increments every couple of weeks. And then you can avoid having to see one of us.
Cross training is important too. Don’t just fall in love with one machine. [inaudible] that’s all you do. You got to cross train and I think exercise physiology has changed a lot since the days of arm curls and dumbbells and light presses. Now I think things are a lot more core strength [inaudible] that’s even more important and that has a lot to do with a lot of cross training and not doing the same thing over and over. That goes not only for the aging athlete but then year olds that we see constantly that decided that soccer is their sport at ten and all they do is play soccer 24 hours a day, 365 a year. That’s a whole other topic for a whole other group but it has to do with the same idea of cross training and not doing the same sport or the same activity as your only exercise.
Q: Is there a test to detect what joint needs to be addressed first?
I think any of us has enough training and enough know how on an initial evaluation. Go through a reasonable checklist of the areas where the problems are and even based on just the history trying to determine “Hey listen, let’s start picking [inaudible] in this area first” because of a concern stand point. Really, that’s the key thing. It’s from a medical stand point. What area is of greatest medical concern? If you have just back pain, quote unquote, just back pain as we’ve talked about, then the nerves are not involved. But your arm is not able to lift up above this area. Obviously your shoulder is going to be of more concern because you might have torn a rotator cuff. The idea is that any of us should be able to go through a reasonable checklist to try to determine, with you, about the right course of treatment. The idea is that if there’s a back issue, these guys will send them to me. If there is an issue with a shoulder or knee, I send them back to these guys.
Q: Kettle bells for a person that needs to build up their back and stomach muscles. They are bad?
It depends on how you’re doing it and how much you do it. Things like that are difficult because it’s really how you do things more so than what you do. In other words, additional resistance, if I understand what a kettle bell is [inaudible]. The idea is that additional resistance [inaudible] in lot of the exercises you can do you don’t even need to use additional equipment like that to kind of get the same results. It’ll be safer.
Q: Is a treadmill better than walking outside?
I would actually say that a treadmill is better because they usually go with padding and so it’s going to absorb a little bit of the impact. Whereas outdoor walking we do that most of the time on pavement which absorbs no impact. The other advantage of a treadmill is, if 10 minutes into your workout you’re having pain if you want to stop, you’re fine. If you’re outdoors and you’ve decided you are going to do a 2 mile walk, and 10 minutes out you realize you have to turn around and go back home, you’ve got another 10 minutes to do that. I think that a treadmill is a more controlled environment and is more environmentally controlled in terms of temperature.
If you do the grades you are increasing the stress on the knee, particularly that patellofemoral joint that I’ve talked about which is more important in women. Lower elevation, you’re better off.
Q: Free-weights versus machines?
It’s the same type of principle as far as the kettle bells are concerned. I’m a big advocate of trying to do activities and exercises that don’t involve even you having to go to the gym, using your own body from resistance standpoint. In general, there’s distinct advantages to each of them and disadvantages to each of them. Free weights in general I like them because they are free weights and the idea is that you can move and do whatever you want to do using those weights and there’s certain amount of balance in what we call proprioception that we didn’t even talk about which is a huge issue when we’re talking about aging population. Strength is why we lose battles. If you don’t use it you lose it. The free weights can be an avenue to address that. Now, it can get you into some problems if you’re doing too much or you lose your balance. And that equipment, you’re usually sitting down and you’re safer sometimes by doing so. You lose some from that proprioceptive balance stand point but there’s a safety factor that is not replaceable.
Q: Stop the running, start jogging or start to walk? Is it all functionality?
There’s really no good studies that say that runners let’s say get more arthritis than non-runners. I think you listen to your body. Instead of running marathons maybe you cut down to half marathons or just have a slower pace. There’s not a hard and fast, “At 50 you can run, at 60 you can jog, at 70 you should be walking.” If you have been a runner, don’t give it up. If at 70 you decide you want to run, maybe you ought to rethink that.
Q: When should I ask my doctor about physical therapy?
It’s hard to individualize these things because, we both talked about it, if you have meniscus tear and nothing else, no arthritis…[inaudible] That’s a difficult answer for us to give without treating he whole person. Arthritis pain overlaps with the meniscus pain. Sometimes you can get meniscus pain better with certain procedures and arthritis pain with other things. Pretty hard to individualize on which to go. Therapy is never a bad thing. Therapy is always good for multitude of reasons. It gets you moving and stronger and things more flexible but then again therapy isn’t the answer for every problem either.
Since time immemorial Garcinia cambogia has been used as a medicine by the ancient natives of Myanmar, Indonesia, and India. Scientific studies have shown that this supplement is rich in hydroxycitric acid and of late Garcinia cambogia has stood out as the best weight loss booster, however, many people ask themselves the question, can I take Garcinia cambogia with other supplement? Indeed studies that have been conducted have pinpointed out that Garcinia cambogia can be taken with other natural weight loss supplements.
Here are some reasons why you should buy Garcinia cambogia.
1. Prevents Fat Cell Formation
Basically, there are a number of liver processes that are linked to conversion of excess energy in the body into fat cells. Garcinia extract inhibits enzymes in the liver from converting the excess energy in the body into fats thus channeling them to the muscles where they are used up. This therefore, prevents the formation of excess fats in the body which increases ones weight.
2. Suppression and Controls Appetite
Scientific studies conducted shows that Garcinia extract contains an active ingriedient hydroxycitric acid which stimulates serotonin production in the brain which in turn signals your body that you are full. This therefore, eradicates that urge of eating some of the unhealthy foods such as chocolate, chips, biscuits and other foods which are saturated with a lot of sugars and fats. This mere control of eating a lot of unhealthy food by hydroxycitric acid eventually leads to effective weight loss.
3. Improves Ones Well-Being
Indeed, we normally resort to emotional eating as we try to counteract emotional imbalance because of stress, sadness, disappointments, anxiety among other things. In such a case, HCA ingredient perks up serotonin level in the brain which improves our mood safely and naturally. To that effect, Garcinia cambogia is best for those people who are always emotional eaters.
4. Improves the immune system
Additionally, Garcinia cambogia extract is rich in vitamin C which helps the body in responding to illness and infections. In fact clinical studies have shown that, Garcinia cambogia helps in treating patients suffering from both flu and common cold. To that effect, the extract can be used with other supplements which are beneficial to our bodies.
5. Lowers cholesterol level in the body
Last but not the least, the ingredient HCA which is present in Garcinia extracts helps in lowering cholesterol production by the body which are responsible for weight gain.
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They can’t dampen the forces enough and then the forces come up through the spine and that’s what creates degenerative changes or the injury. Component number 3. In order to understand what happens to the aging spine, we need to know what happens to young, healthy spine and when injury starts to occur and identifying patients before that actual injury occurs. The spine itself is under forces. We’ve decided that. But what ends up happening is that a number of things start happening after we grow up a little bit and aren’t doing sports on a day to day basis. When we’re young and we’re in high school, we’re playing sports every day or we’re out in the back yard, everybody’s active and muscles are strong and flexible and you really don’t care what you’re doing and you injure yourself. The idea is that we get older and we start getting a job, we got other priorities, we got families. And the idea is that our activity level starts to go down. We start working out then just on weekends, we still think that we can run marathons or play taekwondo and you start injuring knees like me, things like that. The idea is that as a result of that you start getting aches and pains. Those aches and pains are little bit of a warning sign that certain things are happening. In general, when it’s just back pain, most of the time in the initial phases here, it’s an injury to the muscles or the ligaments and you get over it. You wait a few days, you don’t even see a doctor usually and it just goes away. You initially have a contribution of the muscles and ligaments injury. But then two other things start happening and they are, you start to get weakness of the muscles that are surrounding the spine. Cause again, if you don’t use it, you lose it. You generate forces, walk around all day, well, what’s generating the forces? Your legs. Your legs stay relatively strong as your activity level goes down. Those muscles in your legs stay strong, the weakness in your core creates the forces now instead of generating from your core muscles out to generate your power and forces during an exercise activity, and now the muscles in your legs are generating forces and causing further and further damage to your spine. This is core. Decrease meaning strength. And then your lower extremities no change in strength or minimum. The last component though is flexibility.
I cannot stress that one enough. The idea is that, especially when you’re an athlete, you use a lot of muscles and especially with running one of the most strong muscles that you rely upon for your exercise and activity are your hamstrings, those muscles in the back of your thighs. And as your activity level goes down those muscles get really, really tight. And they are not very flexible anymore. The idea is that if you’re going back to the principle of the spine now, how does that influence it? The idea is that if you’re moving and bending forward to do any type of activity, whatever it is, and your hips are not now moving, and you’re kind of stuck, then what do you move? Your back. And that starts putting additional pressure where? On that front joint being the disk. That’s pretty important to understand. Again, if you’re not moving through the hip which is the next joint below the spine, then it starts influencing your spine. If the hamstrings are not letting you bend over at the hips and they’re stuck, they you’re going to bend at the waist. What ends up happening is that disk, you start pushing…putting pressure through that jelly donut, the jelly squirts out. Anybody know what’s that called? Herniation. The disk herniates. That hurts but you’re young, you survive, keep going, you don’t go see the doctor. 5 years down the road you’re feeling a little bit better. That jelly itself probably stays a little bit there but essentially the jelly on the inside of the jelly donut starts to dry up a little bit. Now this disk herniation, HNP which is a herniated nucleus pulposus, is the big issue. That thing heals up. Now what we’re dealing with here is repeated episodes that are continually getting worse, either severity wise or just biomechanically. And they start taking toll, and toll and toll again. Yeah, you continue to get over it but each episode is taking its toll. So now we’re going to go down to the aging spine. Now what’s happening here? That disk kind of remodels a little bit and although that jelly starts to reabsorb a little bit, the disk itself, just because of repeated forces through it starts to do this thing where it kind of starts to look more like a pancake rather than a jelly donut. Starts to flatten out. As the result of that jelly starting to dry up just because of age, then it’s not dampening the forces that are going through that [inaudible]. So, [inaudible] they identified that you can’t injure or change biomechanically one joint of the spine without starting to affect the others. Inevitably what ends up happening are these little hinge joints start become arthritics and they start to enlarge too. Now your core muscles continue to get weaker. There’s that imbalance. The lower extremities are still doing pretty good to maintain you, you still have repeated injury to your first and second line of defense to the spine. Now there’s a different type of flexibility issue. Because now you’re less and less and less active. And when you are less and less and less active, what are you doing? You sit. Right? You sit a heck of a lot more. I know. I need to sit down every time I go see a patient. I take a seat as soon as I walk in a door. The idea is that unfortunately something happens with the flexibility when you sit for too long. Also when you lie on your side when you’re sleeping kind of fetal position but inevitably when you sit, the muscle that actually helps you flex that leg of yours, called the hip flexor, gets tight.
Now you not only have that tightness in your hamstrings but now you’re getting tightness of those hip flexors. So when you stand up you’re like… walking your hands all the way on up. Now what happens to the spine? As you are instead of bending forward putting pressure through the disks, cause you can’t stand up straight, those hips are laxed, you stand back and now you’re putting pressure more on those little hinge joints. What are those little hinge joints called? Facets. What’s the technical term? Zygapophysial joints. Alright. What ends up happening, those Z joints grow and grow and grow. They are not truly growing but they are laying down bone and calcium deposits and bone spurs. That disk starts to flatten out more and more and more. And the end result is, look that happens to that canal where those nerves live. That’s’ spinal stenosis. That’s’ the biggest issue that we’re worried about in the aging spine. Back pain, yeah. Muscles, ligaments, those Z joints create back pain. The thing I am concerned with is always the nerves. That’s’ what people go to surgery for. That’s’ what we’re trying to prevent. Bottom line is, what do we do? Well, if you don’t use it you lose it. The bottom line is that first stage first evaluation. The idea is that we need to figure out, biomechanically everybody is different, I’m giving you just kind of general guidelines what kind of gets tight over time, what kind of gets weak over time but everybody is an individual. We need to treat you as such and we need to come up with a specialized exercise program to cross train so that no matter what your functional activity is that you want to do, again, whether it’s washing the dishes or running the marathon, we need to train you appropriately to do that activity. It’s very sports specific. That’s what we understand as being the most common way for us to describe, it has to be what you like to do. If your goal is to do this versus this, tow totally different patients, we need to come up with a reasonable goal to achieve these things. The idea is that having a good therapist is the most critical component. That’s’ why this video is not all end all. It’s called Physical Therapy Assistant for a reason, the assist of physical therapist, but nothing replaces having the therapist look at you and say “Did you have a knee injury?” “20 years ago I did. Why would that be an issue?” Well, again, if you don’t truly recover from an injury in your legs, it starts impacting your back. The bottom line is this, you know, I as a physician like you to put you in one of two categories when you come in to see me. You got back pain, again, what do we use? We use NSAID medications to reduce the inflammation of those arthritic joints of the muscles and the ligaments, sometimes we use muscle relaxants. Once we get things to calm down, we start [inaudible] rehab program. The soon as we can. If there are ridiculous symptoms meaning those nerves are involved in some way, were on a different page here.
We need to take a little time, we need to get things to calm down in order for you to have success in increasing your activity. What I mean by success in reducing the nerve irritation varies greatly patient by patient. Sometimes you come in with that sciatica, everybody knows, thinks, they know what sciatica is. But in general sciatic nerve is just the nerve and then the irritation of that nerve. But in actuality the idea is that a pinch of a nerve here or an irritation of the nerve here could be of variety of different factors. Is there mechanical pressure, is there just chemical inflammation, [inaudible] arthritic. In which case the idea is that we give you anti-inflammatory, a lot of times we start off with non-steroidals, but sometimes we have to use steroids or injections of steroids to get things to calm down. The key component that I love in my business is that narcotics don’t work for this. They just don’t help pain that is nerve related. It’s been shown. So I don’t give any narcotics. I don’t think the work very well. There’s a very good use for narcotics, for other things, post surgically, for musculoskeletal injuries that are a component of that but I find that using a number of different medications to reduce inflammation, getting the muscles to relax, in addition to non-narcotics can be the main way to decrease the irritability so that you can have better success integrating into an exercise program that is sports specific no matter if it is tennis or pickleball.
Q: How does osteoporosis affect the spine?
Very good question. First and foremost there is, I’m not saying you have this, there is a little bit of a misunderstanding or miscommunication because there’s a confusing thing. Osteoporosis versus osteoarthritis. They both sound very similar but they are very different. First and foremost these joints back in here are kind of like an osteoarthritic issue. Osteoporosis is a density issue with the bones themselves. It really doesn’t impact as far as what we’re talking about here biomechanically unless those bones start to fail. Which is kind of like a completely different talk and what that failure of the bone essentially means is it starts to fracture. But sometimes we need to let that body heal. When there’s fractures involved, all bets are off. Sometimes even narcotics do work for this. That’s my exception. The idea is that there are additional treatments that are used for osteoporotic fractures. We can inject cement into the bone and cause that bone to become solid. These are things Dr Wagner, our spine surgeon does but the idea is that there needs to be an understanding that there’s two different things here that are kind of similar in name but very different in their effects on the spine. Osteoporosis versus osteoarthritis.
The answer is no. Does physical therapy cause the tear to heal? The answer is no. But what they do is reduce the symptoms down to a tolerable level and by retraining the other muscles in the shoulder; most patients can go on with their lives. You have to remember that about 1 out of 3 individuals over the age of 70 has a rotator cuff tear and not everybody has pain. Because if you look at the population here in Bethlehem, if 1 out of 3 people over 70 had a painful rotator cuff, we’d have people lined up from here down to [inaudible] waiting for treatment of their shoulder. Even with a rotator cuff tear, surgery is usually the last resort. I myself have a small rotator cuff tear in my shoulder, bothers me once in a while. I take a little bit of anti-inflammatory, take it easy for a little bit, gets better, I go on about my daily activities. Let’s talk about the elbow. Basically the most common elbow problem in us more mature athletes are what are called epicondylitis. And that’s a fancy way of saying tendonitis which is a fancy way of saying irritation or inflammation of tendon. In medial epicondylitis, bump of the bone here on the elbow on the inner side, we call that golfer’s elbow. Quite honestly, in 25 years of practice, I think I’ve taken care of 2 patients with golfer’s elbow who actually played golf. Everybody else gets it from lifting weights, work related activities, whatever. Then there’s lateral epicondylitis, that’s the bump of the bone on the outer side of the elbow. That’s also a tendonitis. That’s usually called the tennis elbow. In 25 years of practice I think I’ve taken care of 3 tennis players who had tennis elbow. Everybody else gets it from a lot of computer work, or repetitive things like checkout ladies [inaudible] for 8 hours a day. Or patient comes in and says “I have a pain here.”
You determine they have tennis elbow. I’ll say “Any change in your activities?” “My husband and I were remodeling the house and it was my job to paint the trim and I did this for 8 hours a day.” The treatments for either medial epicondylitis, golfer’s elbow, or lateral epicondylitis, tennis elbow, are the same. It’s medication. Things like Advil or Relieve. There’s now a really nice rub on version of anti-inflammatories called Voltaren Gel, I prescribe it probably by the 55 gallon drum. It’s really good because it doesn’t, although theoretically they have to use same warning labels, it does not get into the blood stream like the oral medicines do. And patients who are on Coumadin or Plavix, who are just not very healthy, I’m still very comfortable having them use that medication. So you can treat it with medication, you can treat it with physical therapy, you can treat it with a little band that goes around. We call that a counterforce brace. You can buy them over the counter or you can get a really good version here at Coordinated. Cortisone shot is sometimes temporary but often works very nicely. And last but not least, surgery. Some years ago I went to a conference on upper extremity problems and one of the lectures the title was “Is there anything new in tennis elbow’?” and the lecturer spent half an hour talking about tennis elbow and the conclusion was – no. The high shock wave stuff and plasmapheresis are not really proven to work for tennis elbow. The point of his lecture was that if you take a 100 patients with tennis elbow, and you treat them with medication, or injection, or therapy, or surgery, and you look at that same group of patients a year later, the same percentage have gotten better no matter what you had done. The point is – don’t rush into surgery. I’ll talk briefly about the knee. Dr Rudolph covered that really nicely in depth. I’ll talk about the meniscus a little bit. You have to be careful in the older athlete because usually a torn meniscus or what we call meniscal pathology, coexists with arthritis. If the patient has mechanical symptoms like Dr Rudolph said, the locking or the catching, that might tend to [inaudible] surgically. The problem is that arthroscopy for the meniscal disease in the older athlete, 50, 60, 70, who also has arthritis; the success rate is only about 60%.
Success being defined as [inaudible] reduction in pain and getting back to your regular activities. I usually drag my feet about getting patient into surgery who has a meniscal tear and the arthritis. There’s other options to treat the arthritis. What are patellofemoral problems? The patellofemoral joint is in front of the knee, it’s between the knee cap and the thigh bone. Usually patients have pain in front of the knee. Their pain is worse going up and down stairs or getting u from a seated position. And even in the more mature population, the majority of patients who have patellofemoral pain are women. Why is that? I don’t need to tell you women are built a little differently than men, tend to be a little bit wider at the pelvis so you all tend to be knock-kneed, your knee cap instead of riding down the road straight wants to drive this way. 95% or more patients with front knee pain, patellofemoral pain, will respond to nonsurgical treatment. That’s’ another…if I tell you you have patellofemoral pain, I’m going to be kicking and screaming before you can drag me into the OR and operate on it because it doesn’t usually help. Therapy, medication, a good knee brace and the right kind of exercise is not the squats. Let’s talk about total joint replacement and sports participation. Definitely the top list of activities, definitely a no-no. Why is that? Because they all involve quick starts and stops, they involve repetitive impact. In the case of football, I believe it was Dion Sanders, there was a pro football player who had a total hip replacement and tried to go back into playing football and that was like…Bo Jackson? I’m sorry. Thank you. That was probably the craziest thing I’ve ever heard. Basketball, football, gymnastics, handball, singles tennis, jogging, volleyball and high impact aerobics. Again why? Remember your total joint is a mechanical product and like all machines it can wear out. Now yes, walking, swimming doubles tennis, golf and low impact aerobics. Why? Because again these are not repetitive heavy duty impact activities. Maybe if you’ve done these activities before joint replacement and you are reasonably proficient at them, then you might be able to go back to those activities after your joint replacement. That would be things like weight lifting, downhill skiing and skating. Now I’m a skier, if you can go back to downhill skiing, that means no moguls, you keep both skis on the ground. You know, don’t be crazy. This is Jerry Rice who at the age of I believe 42 played in his last professional football game. No it’s not 75 like a golfer but I can’t imagine at the age of 40 or 42 running down the football field with 10 guys who basically wanted to kill me. I have to say I think jerry Rice is my hero. Thank you.
J. E. Kooch:
I did my undergraduate degree at West Virginia University in exercise physiology. Then I went off to stormy Buffalo and I did 2 years of graduate school in biomechanics. Then I went out to cold, snowy Chicago and that’s where I did medical school. I’m an osteopath and then I went to Northwestern for my residency. That’s where I became what is called a physiatrist. Does anybody know what a physiatrist is? Anybody? What is it? It’s a rehab specialist, yes, but specifically the doctor of what is called physical medicine rehabilitation. We initially got training in things like stroke, spinal cord injury and brain injury and it’s really to deal with how to function on a day to day basis based on that impairment that you have. We also got a lot of expertise in musculoskeletal medicine. That’s kind of my area of expertise, obviously specializing in spine. The idea is that throughout my education a lot this is based on functioning and that kind of is the theme of this talk. It’s that functioning can be a lot of different things to a lot of different people. Your goals and aspirations are based on your functioning whether it is your activities of daily living, to try and make sure that you can wash the dishes or play Batman. Whatever that function is, that’s what we’re trying to restore. The exercise is the element that I’ve always used to try and be a means to the end. The idea is that, I’ll just start writing things down here. There are 5 lessons we’re going to go over. First lesson is anatomy. Let’s hand out some of these models here. I want you to kind of pass them around a little bit. This is the big one I’m just kind of show you briefly essentially what we’re looking at [inaudible] segments that I’ll pass out. The spine itself is a collection of bones that’s stacked on each other and these are the little bones’ segments. We are going to be talking primarily about the lower back cause it’s the most common area that we injure. The idea is that there are actually 3 joints in between every bone of your lower back or [inaudible]. The idea is that if you take things in cross sectional view and you start looking at them like this, you’re going to see a disk, it kind of looks like this, as being joint number one. It’s the most popular joint. Everybody’s like when you went to see Dr Kooch “How are your disks?” There’s more than just the disks but it’s a very important component. As we look here, this is the bone itself but the disk itself is in between that bone and that’s here. They key thing to that is you want to think of kind of like the jelly donut although it’s shaped kind of like the kidney bean. The jelly on inside helps out with compression. There’s two other joints that are pretty darn important also in the back part of the spine. These are little bones that you feel right on the middle line of your back. Right next to that on either side are two little hinge joints. They are called zygapophysial joints. I’ll quiz you later on that. But what we really do is we call them facets. And they are little hinge joints. They operate kind of like your knuckles.
There’s one on either side. This is a rudimentary drawing of your spine but the concept is that there are 3 joint here and they kind of form a triangle. The key component that is different in the spine than it is in any other quote unquote joint in your body is that it has another function that’s equally if not more important than any other joint in your body. And the fact that it houses and protects a very important nerve structure. It runs through this canal here. The spinal cord starts in your brain, runs down through the center of this canal and interestingly enough it ends just at or slightly above your belly button. Most people don’t realize that. The idea’s that from that point down is a series of nerves running through this canal here and these are the ones that exit the spine and head down south through your legs. Remember this model. That’s schematic. Our next question. Who can name lesson number two? Physics! Very good. This is tough, I know. The idea is physics is very important now to understand because we move. What happens to the spine when you move? The idea is that we are a product of what we do and how we do things. And that’s essentially what is called biomechanics. No matter what area that I was studying in, everything kept going back to this thing called biomechanics. That’s really what we do and how we do things. The idea is that you can get very involved and I’ll talk briefly about what happens in spine, but there’s other areas of biomechanics that are equally important. The idea is that if this your spine as you are facing this direction, one of the key things to understand is that when you bend forward you are loading that front joint being at disk. You’re going to be putting more pressure, I’m exaggerating, but the idea is you’ll be putting more pressure towards the front where that disk lives. Increasing the pressure at that disk. When you extend back, you’re going to be loading those facet joints.
The idea is that that’s really important because when we talk about injuries to the spine and how the spine degenerates, again, it’s all about forces, so we go back in history where we find out what was happening at the time of the injury or what biomechanically happens and changes throughout life that can impact that spine. The other component though is all the things these guys are talking about. The additional injuries that occur, in particular when we’re talking about lower back with all the injuries and degenerative changes that we start having in our legs and feet and in our arms when we’re talking about neck. Case in point, the idea is that if you bring it down to the forces or when we’re talking physics, every time you put your foot on the ground, it generates ground reactive forces, it’s what they’re called. But in general it’s forces that come up through the foot, they come up through your calf, thigh and then go up to your spine. If everything is working great you’ve got great dampening forces .You decrease forces. As soon as your foot hits the ground your foot beautifully dampens those forces, your knee dampens those forces, your hips dampen the forces and then the forces that go through the spine inevitably are much less. The key component is, you start injuring these areas.
The very low calorie diet that goes along with taking HCG may seem very restrictive, and it’s true that you’re limited to 500 calories a day. But you can still eat many of today’s most popular foods in moderation. The following insights are just a small example of the advice being offered by the experts at the Fort Myers weight loss clinic.
The day begins with only coffee or tea, but you can have as much as you like as long as you don’t add sugar. Only one tablespoon of milk is allowed each day, but saccharin and Stevia can be used if you like.
Then, your lunch and dinner is much more satisfying. You’re allowed a full 100 grams of lean meat like chicken breast, beef or fresh white fish. Just remove visible fat, boil or grill without oil. How much is a 100 grams? That’s about a half cup of ground beef or roughly 3.5 ounces.
Along with your meat at lunch or dinner, enjoy a single vegetable like spinach, beet greens, tomatoes, celery, radishes, cucumbers, asparagus or cabbage, plus a Melba toast or similar bread or cracker and some fruit for dessert. That could be an orange or apple or a handful of strawberries.
What about condiments or additions? There are limitations, but not as many as some people think. You can have lemon juice — up to a full lemon’s worth each day — plus pepper, salt, vinegars, garlic, basil and other herbs and even mustard powder. Just stay away from oils and butters.
Throughout the day, there’s no limit on the amount of water you can drink or the amount of additional tea or coffee you can consume either.
The general idea is to avoid fat at all costs, including fats in cosmetics like makeup and hair preparations.
Once you get used to these restrictions, you may continue some of them for the rest of your life. You’ll see that an HCG diet makes you feel good and allows you to function much better at your daily life than when you’re overeating and feeling heavy, bloated and sluggish.
For more information on your weightloss options, visit: www.weightloss-treatments.com