Mobilizations to get rid of SI joint pain

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Chronic SI joint pain is no fun, so here are some techniques to try to realign the pelvis and get rid of the pain.

Before we get to the topic at hand, I want to announce that my long awaited nutrition course entitled “Why the Food Guides are Wrong: How to Find Health and Lose Weight”, is now available online. By the end of the roughly two hours it takes to go through the course, your confusion over food and what is healthy to eat will have disappeared because the lens through which you look at food will have changed. Suddenly the conflicting nutrition messages that are everywhere won't be a problem anymore and you won't be pulled from one diet to another depending on what diet guru you happen to be listening to at the time. Everything will seem so obvious that you will wonder how you could have possibly been confused before. I echo Paul Chek’s suggestion that food is the drug we take three times a day. Eat poorly and your health will be taken from you. Eat right and your health will be restored.

The feedback I have received from people that have attended the course in the past have included sentiments like "life changing", and "I didn’t really expect to learn anything, but found out I didn't know anything at all", and “I don’t think I’ll bother taking the other nutrition course I signed up for - I now know all I need to know”. People have come up to me months after taking the course and thanked me for the presentation and changing their lives.

The introductory offer is $39USD, which includes the slide presentation and lecture, as well as additional reference materials and resources that you can print off to help you get started. Sign up by going to http://WellnessTips.digitalchalk.com.

Now to the topic of SI joint pain. Thursday I was sitting at a coffee shop in a business meeting with a colleague without the “butt lift” that I need (one side of my pelvis is slightly smaller than the other, so I usually sit with a pad under one sit bone to keep my pelvis level), and I felt my SI joint go out of alignment. Instantly I was back to that left-sided low-back pain I had felt on a daily basis many years ago. That night I was lying in bed thinking how ironic it was that the following day I would have no time in my day to fit in a chiro appointment to realign my pelvis and resolve my pain, because it was jammed with people coming to see me to fix their back problems. Aarg! I don't have time for back pain! I decided that surely I knew enough about the SI joint to fix myself, even if I couldn’t assess myself properly to determine exactly what had happened. So at three in the morning I was crawling around the floor in the dark with my cat, trying to fix my back.

If the SI joint hurts, chances are mighty good that the pelvis is out of alignment. The pelvis forms a ring, with the two outside bowl-like bones (iliums) hugging the triangular sacrum in between them in the back, and the transversus abdominis muscle completing the top of the ring, the pubic bone the bottom of the ring in the front. The sacroiliac joints are held together with very strong ligaments, but the joints are supposed to move a bit as we move. If the pelvis ring distorts to any greater degree than is appropriate for the SI joints, pain can result.

For those of you interested in the technical stuff, keep reading, and those of you that just want to get to the exercises, skip to below.  My pain was exactly where it used to be - left SI joint, and I remembered over ten years ago, when I took Diane Lee and LJ Lee's low back, hip and pelvis course (which changed my life by taking me out of chronic pain), Diane Lee told me that my right sacral multifidus (very deep muscle that stabilizes the spine and sacrum) had atrophied greatly and was not firing at all.  With nothing pulling the right side of the sacrum back, the sacrum would then be free to rotate to the left within the iliums, and this in turn would create an inflare of the left ilium (ASIS moving medially), and an outflare (ASIS moving laterally) of the right one, as they are tugged out of place by the ligaments attached to the now faulty positioned sacrum. Lying on my back, I felt my sacrum, and sure enough I had to go further to hit bone on the right side than the left, indicating to me that probably my sacrum had rotated to the left. And if the sacrum was rotated left, I figured my lumbar spine probably was as well. Please note the image on the left shows a nicely aligned pelvis, and the image on the right shows a right inflare pelvic distortion.

I needed to pull the left ilium back out, and rotate the sacrum and spine back to straight. So I lay down with my left side about 6 to 8 away from a wall, bent the knee of my left leg and pushed it into the wall for 10 to 15 seconds, activating my left external hip rotators to try and correct the left inflare. After repeating this a few times, and I turned my attention to my sacrum. I got into an elbow plank, body straight, legs straight, toes firmly connected to the ground, and I lifted my right foot reaching it back to activate the right multifidus, but more importantly to activate the left psoas via the left foot stabilizing me, since it attaches to the front of the spine and would be very powerful in rotating it back to neutral. I did as many 10 second holds as I could manage while maintaining excellent form. I then did the Don Tigny knee brace a few times on each side to ensure my SI joints were in their best position and I finished off by doing some Swiss ball supermans, to make sure I was connectng to my multifidus and other deep local stabilizers properly. I then went back to bed. The next morning my back felt much better!

If you have SI joint pain, these mobilizations may help, but please understand that there are many pelvic distortions so there are no guarantees. If you decide to try these, you are making the choice to try these without being assessed first. They may not be right for you at all if your back pain is more complicated than simply an SI joint problem. To be safe, see a physical therapist to find out if these exercises are appropriate for you. I think the may work if your distortion is an obliquity of the pelvis - an inflare/outflare distortion. If you do find these mobilizations helpful to realign your pelvis, do them before you do your stabilization exercises. If your SI joint continually goes out, you are doing your stabilization exercises correctly and you have been doing them for a while, there is probably an underlying problem such as an anatomical leg length discrepancy or smaller hemipelvis on one side that is putting constant stress on the SIJ and needs to be sorted out. Call Neurosomatic Educators at 1-866-597-3772 to find an Integrated Neurosomatic Therapist near you to find out if this is why you can't get better.

1) Don Tigny knee brace: Lie on your back in a doorway, one foot on the door jamb, knee pointing slightly out to the side, other leg reaching into the other room. Push through your heel into the doorjamb using your buttocks and hamstrings. Push for 6 seconds, rest for 6 seconds, repeat 6 times. Move over to other side of doorway and do the other side. This alone may do wonders for SI joint pain. If this has helped, leave out exercise 2 and 3 and skip to the Swiss ball superman.

2) Inflare correction: Do on the SORE side. If both sides are sore, don't do this at all. Lie with sore side about 6 to 8 inches away from a wall, knee bent, foot on the floor, other leg straight. Push side of knee into the wall, activating the hip muscles on the sore side. Allow your trunk to rotate the other way. Push for 6 seconds, rest for 6 seconds, repeat 6 times or more.

3) Plank: This is a VERY challenging exercise so evaluate your abilities carefully before attempting this! You can modify it by doing a plank from the knees if you need to. Get into an elbow plank (or high plank on the hands if you prefer), making sure the trunk is straight from the shoulders to the toes or knees. The hips are not hiking way up into the air. If you are able to, lift and reach the leg of the side that is NOT sore, without allowing anything to move in the pelvis. You should feel the front of the hip working hard on the sore side. This will work even better if you can turn the tops of the toes under like a yoga up-dog to do this, but very few people have that kind of flexibility. If you can't lift the leg, push the SORE side toes or knee into the floor for 6 to 10 seconds, feeling the front of the hip working. Hold the position for 6 to 10 seconds, rest for 6 to 10 seconds, and repeat if possible. Do NOT do the opposite side. If both sides are sore, just do a plank without lifting your legs.

4) Swiss Ball Superman: Balance your belly on a small Swiss ball such that you have even weight between your hands and feet, and your spine remains neutral. Anchor those toe pads down and feel the connection to your pelvic floor. Lift the "not sore" leg and reach it back without allowing your trunk to rotate or side-bend on the ball, and without allowing the ball to move. If you are successful, lift the opposite arm off the floor and reach it forward without allowing any movement in the trunk or ball. Hold for 6-10 seconds and repeat. If your trunk or ball is moving, you are not stabilizing correctly, so try smaller movements, and check to make sure you are holding in your pelvic floor. Sometimes it helps to do the "easy" side a few times, to teach the brain how to connect for the "hard" side. If both sides are sore, do both sides equally.

I suggest finishing off with the Don Tigny knee brace again. If these exercises work, do them a few times a day. If you have longstanding SI joint pain and the bones simply won't move, see a soft-tissue therapist before trying again.

There, you see? Sometimes pain serves a purpose. Forced me to think hard, and I think I learned something useful because of it. Movement practitioners out there, feel free to comment and let me know if you think I am completely out to lunch on this, or if you have found anything else that works well that you would like to share. And those with SI joint pain, feel free to let me know if these ideas work for you … or if they don't.

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Lee, Diane The Pelvic Girdle Churchill Livingston, 2004.

Travell, Janet and Simons, David Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 2., The Lower Extremities Williams and Wilkins, PA. USA, 1983.

Lee, Diane and Lee, Linda Joy An Integrated Approach to the Assessment and Treatment of the Lumbopelvic-Hip Region DVD, 2004

Lee, Diane and Lee, Linda Joy Postpartum Health for Moms - An Educational Package for Restoring Form and Function after Pregnancy CD ROM 2006.

St. John, Paul and Clark, Randall, and Jones, Tracy Integrative Approaches to Low Back Pain Neurosomatic Educators

Lee, Diane Assessment Articular Function of the Sacroilac Joint VHS

Lee, Diane Exercises for the Unstable Pelvis VHS

Richardson, C, Hodges P, Hides J.Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain Churchill Livingston 2004.

DonTigny, Richard Pelvic Dynamics and the subluxation of the sacral axis at S3 The DonTigny Method.

Myers, Thomas Body Cubed, A Therapist’s Anatomy Reader “Poise: Psoas-Piriformis Balance” Massage Magazine, March/April 1998.

Myers, Thomas Body Cubed, A Therapist’s Anatomy Reader “Fans of the Hip Joint” Massage Magazine, Jan/Feb 1998.

Myers, Thomas Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists Churchill Livingston, 2001

Chek, Paul CHEK Level 1 Advanced Back Training Chek Institute.

Johnson, JimThe Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count New Harbinger Publications Inc. Oakland CA, 2002.

Lee, Diane Understanding your back pain - an excellent article explaining the concept of tensegrity and its importance in stabilizing the pelvis and spine.

DeRosa, C.Functional Anatomy of the Lumbar Spine and Sacroiliac Joint 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.

Copyright 2010 Vreni Gurd

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How many ways can you get up off the floor?

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In order to maintain our ability to participate in the physical activities we enjoy throughout life and to keep leg, hip and back pain away, we need to be able to get up off the floor at least three different ways.

From a physical ability perspective, the toilet was a dastardly invention. We are designed to poop by squatting right down to the ground, so before the toilet, from the time we learned to squat poop as a child until the time we died, we had the flexibility and strength to do so. We pooped often enough to keep ourselves adequately limber to squat low, and strong enough to easily get up from that position.   Now a-days many of us stop getting down onto the floor altogether once the kids are past the toddler age. The chair is about as close to the floor as we get. Then some years later we find ourselves on the floor for some reason or another, like looking for something that rolled under the sofa, and we realize that getting up off the floor is suddenly quite hard work.

In those intervening months or years of no floor time, our leg muscles have tightened up to the point that we can’t bend our knees, ankles or toes as far as we used to, and we have lost the strength to easily get up from the floor. So we rely on our arms to either pull ourselves up onto the furniture, or we push our hands down on our thighs to get our trunk up. And then the grandkids come along, and we want to be able to crawl around the floor with them like we did with our kids, but somehow the effort is too much. We attribute it to ageing and accept this as an inevitable part of life, and we try and keep up with the grandkids while staying on our feet. But for some, even that is challenging, as the knees, hip or back hurts.

The question is whether the knee, hip, or back pain is the reason for the lack of ability or whether the lack of ability is the reason for the knee, hip or back pain. More frequently than is acknowledged, the lack of ability in terms of flexibility and strength is the underlying cause of the pain. If the pain came on gradually as opposed to a sudden trauma such as a car accident or fall, it is quite possible and even likely that the pain is due to being too tight and/or too weak. Interestingly enough, if one is flexible enough to squat right to the ground and stay there comfortably, it is easier to recruit the correct muscles in the right order when getting up, which would reduce the chances of getting low back, hip and knee pain. One of the biggest mistakes well-meaning adult children do is move their parents out of a home that has stairs into a home that does not, thinking that a stair-free environment will be easier on them. But having stairs keeps one able to do stairs, and once there are no stairs to climb on a regular basis, the ability to climb stairs is lost. Soon stepping up or down a curb becomes a problem, and getting into or out of cars is impossible without help. And so the life closes down even further.

This gradual loss of function is not an inevitable part of ageing and can be avoided all together. The saying “If you don’t use it you’ll lose it” is true, but so is its opposite, “If you use it you will regain it.” The miracle of our bodies is that with consistent, appropriate daily practice targeted to one’s current ability, function can be regained.

I believe everyone should be able to get up from lying on their back on the floor in at least three ways. They are listed here from easiest to hardest:

  1. Bend technique: Rolling onto the belly, pushing up onto all 4s, lifting the knees off the floor and using the hands on the floor to push the hips back until the heels are down, and rag-dolling up to standing.
  2. Squat technique: Doing a full sit up, pushing oneself forward onto the feet
    into a low squat, and standing up by pushing the feet into the floor, and keeping the chest higher than the hips at all times.
  3. Lunge technique: Getting onto the knees, lifting one foot forward, pushing through the whole front foot and back toes to stand up. One should be able to do this on both legs.

In my experience, many people are impaired in their ability to do the squat and lunge technique due to a lack of flexibility in the hips, knees, ankles and toes. Many don’t have the strength in the abdominals to do even one full sit up from the floor in order to get into the squat position, and many don’t have the strength in the buttocks and legs to push up to standing from the floor without using the arms. I’ve seen this in people in their early 20s, so this is not only a problem for those in middle age and beyond.

For some people there are good reasons why certain techniques should not be practised (if you have an acute disk problem, the bend pattern and the very bottom of the squat may be problematic for example), so see your doctor for clearance. Then hire a trainer who can help you stretch your tight muscles and strengthen you to the point you can do these movements effortlessly. And watch how your life expands!

Very soon I'll be offering my nutrition seminar online - people have told me they leave the course with complete clarity on how to know whether or not a food is healthy to eat. And months later when I run into those that have taken the course, I am told what a difference the information has made to their lives. So look out for it soon!

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc. If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

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Forget the food guides

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The one-size-fits-all food guides do not work for most of us. We are all different, and a diet that works well for one person won’t work at all for someone else. By listening to what our bodies are telling us, we can figure out the best way to eat for ourselves.

The USDA is working towards putting out its 2010 Dietary Guidelines, and so far based on what I’ve seen, I’m thinking they are still heading down the wrong path. For the first time the guidelines are going to be geared towards the unhealthy, obese and type 2 diabetes population, and rather than lowering the intake of grains which would make a huge difference for that population, they are lowering fat intakes even further. Surely after 30 years of food guides that have suggested high carb low fat diets along with concurrent increasing rates of obesity and type-two diabetes, it is abundantly obvious that this strategy isn’t working? Perhaps the powers that be need to review Albert Einstein’s famous quote “Insanity: doing the same thing over and over again and expecting different results.” US citizens and organizations have until July 15th to submit commentary and research to the panel that is going to be putting out the guidelines. Perhaps there is still time to change them for the better. Scroll down to June 18th and find a letter sent by someone with Type 2 Diabetes. I think he is bang on with his critical commentary and kudos to him for stepping up to the plate. You will notice as you scroll through the list that much of the input and commentary for the new food guide is from the food industry pushing their agenda.

The USDA is making some positive changes, like lowering salt intake guidelines to 1500mg per day, shifting to whole grains from refined, and lowering added sugar and trans fats. But the biggest changes in the new guide look to be lowering saturated fat (hard fats) consumption from 10% to 7% and trying to get people to eat more vegetable oils instead. Olive oil is fine, but increasing consumption of omega 6 polyunsaturated plant oils will increase body inflammation and is a very bad idea. And decreasing overall fat intake further tends to increase intake of processed starch, which also diminishes health by increasing problems with insulin.

Food guides in general can't work, because we are all different metabolically speaking. We need individualized food guides. The current food guides work for maybe 15 to 20% of the population, but they are quite wrong for the majority of us. Switching the guide to put veggies as the most important (not fruit), animal foods as the next most important, and whole grains less important than both would help 80 to 85% of the population in my opinion. But even that wouldn't work for some. The only guideline that would help absolutely everyone would be to suggest a diet that consists of only unprocessed food, something that is unlikely to happen as governments need to pander to the food companies. Food politics plays a big role in what we are told to eat.

So, if one can't rely on the food guides because the one-size-fits-all approach simply doesn't work for most of us, what can one do? No problem. It really isn't too hard to figure out how to eat in a way that makes us feel great if we take the time to pay attention.

When we are hungry, our body is telling us it needs NUTRIENTS. But what we tend to do is eat anything that will fill us up to take away the hunger pangs, not thinking much about nutrients. Often a muffin or a cookie will do the trick. But there isn't much in that muffin or cookie to nourish us, and as soon as the body realizes that the nutrients it was looking for did not arrive in the snack, it makes us hungry again. So, should we repeat the process, we will be eating lots of calories, leaving the body still hungry.

A meal should last a minimum of three hours. If you are hungry before those three hours are up, either there were nutrients missing in your meal that your body needs, or there weren't enough of certain nutrients. The easiest way to ensure you are providing adequate nutrients is to only eat unprocessed food, and to make sure you have a mix of animal foods and plant foods in each meal. Then play with the ratio of animal to plant foods to see which ratio keeps you satisfied longer. Include fresh vegetables to ensure you are getting the vitamins and minerals too. By paying attention to what our bodies are telling us, we can create our own personalized food guide which might turn out to be quite different from the one the governments are suggesting.

In my experience, most people need to eat some animal foods at each meal, and some people actually need a surprisingly large ratio of flesh foods to vegetables at each meal to be at their best and to last at least three hours. And for those people, that high protein/fat diet will actually make them healthier (lower blood sugar, triglyceride levels, decrease inflammation markers, improve LDL to HDL ratio etc). I think that people that decide to become vegetarians initially do really well because they move from a diet of processed food to unprocessed food which drastically increases nutrition. But not many do well long term on a vegetarian diet as there are some nutrients in animal foods that are difficult to obtain from plant foods. Supplementing a plant-based diet with some animal foods can make all the difference.

The point is some people do well on a plant-based diet supplementing with a bit of meat, and others do well on an animal-based diet supplementing with some vegetables, and most of us need a diet that lies somewhere between those two extremes. We each need to figure out for ourselves what ratio of plant foods to animal foods works best for us by listening to what our bodies tell us and eating the ratio that makes us feel good and keeps us satisfied for at least three hours. The only valuable food guideline that can be generalized to everyone is that we need to eat the best quality food we can access in its least processed form, preferably from our own garden, farmer's market, food coop. Eating healthy requires time in the kitchen. Any animals or animal products we eat should have eaten their natural diet during their lifetime - stay away from factory-farmed meats, poultry, eggs and dairy. And finally, if you are not hungry, don’t eat!

Very soon I'll be offering my nutrition seminar online - people have told me they leave the course with complete clarity on how to know whether or not a food is healthy to eat. And months later when I run into those that have taken the course, I am told what a difference the information has made to their lives. So look out for it soon!

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc. If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

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Comments (2)

Which hormone is responsible for your fat distribution?

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Contrary to popular belief, hormones play a greater role in weight control than calories do. If you are trying to lose weight, it would make sense to focus your efforts on controlling the hormone responsible for your excess weight.

Most people that decide they want to lose weight try the “eat less, exercise more” approach, and a few people get results. Many others just feel hungry and tired, not to mention frustrated. Eating less calories than one burns might work for some, but if the diet is not sufficient in protein, vitamins and minerals, the body will reallocate its resources eating up your muscle tissue and taking minerals from your bones in addition to burning that body fat in order to keep the body functioning. If you are hungry, your body is telling you it needs nutrients. Losing muscle mass will decrease your metabolism and make it easier to put on weight once you go off the diet. And we also probably all know of someone who eats next to nothing yet simply does not lose any weight despite consistent effort. Controlling calories is usually not the answer. So rather than starve yourself, why not look at which hormones might be responsible for your fat pattern, and work towards controlling those hormones in particular?

There are primarily three hormones that control fat deposition, and where one carries the excess weight can be a clue as to which hormones are involved. Often more than one hormone is involved, but the description below can give a starting point.

  1. Insulin: People that tend to get fat all over - fat neck, fat ankles, fat wrists, fat back of the hand - tend to be fat due to a problem controlling insulin.
  2. Cortisol: People that tend to get fat around the trunk and belly yet have skinny legs and arms are likely to have an issue with cortisol. A distended belly without too much excess fat around the back of the ribs is more likely due to a food sensitivity. (Of course one can have a food sensitivity and have a cortisol issue at the same time.)
  3. Estrogen: People, usually women but not always, that tend to put on fat around the hips and upper legs, yet are relatively slender in the waist and upper body tend to have a problem of excess estrogen, or a problem of estrogen not being balanced adequately with progesterone.

Insulin is the easiest of the three hormones to control, but it requires strict diet change to do so. Because insulin's job is to take sugar out of the blood stream and store it as fat, the obvious way to control insulin is to stop eating foods that convert into sugar quickly, including all foods that contain sugar and flour. Read labels and avoid foods that contain ingredients that end in "ose" like glucose, fructose, sucrose, lactose, galactose, maltose, dextrose etc., and ingredients that end in "accharides" like disaccharides or monosaccharides. Many processed foods including frozen diet meals contain sugar, so even though they may be low in calories and fat, they will still make you fat. Avoid products that contain flour, like bread, pasta, crackers, cakes, cookies etc. Make sure every meal and snack also contains protein and fats in order to slow the sugar into the bloodstream and to blunt the insulin response. Doing some exercise, even simply a walk after meals can help burn off the blood sugar so it is not stored as fat. Going on a strength-training program to increase muscle mass will also improve insulin sensitivity.

If you have this fat pattern, do what you can now to alter how you eat, because you are on your way to Syndrome X and Type 2 Diabetes. If you already have Type 2 Diabetes, talk to doctor about keeping you off insulin, as injecting extra insulin may lower blood sugar, but it will just make you fatter and less healthy in the long run. Remember that high insulin levels, whether secreted by the body or injected, not only store excess blood sugar as fat, but also increase blood pressure, increase the body's fight and flight response, and decrease thyroid function by decreasing T3 production, all of which makes one more prone to cardiovascular disease. No matter what the fat pattern, everyone can improve their health by controlling for insulin.

Cortisol is our stress hormone, and if cortisol levels remain chronically high, fat tends to be deposited around the organs, which is a particularly dangerous fat distribution pattern. Many people that have been put on corticosteroid type drugs like prednisone, probably notice that they put on weight and can't take it off no matter how little they eat and how much they exercise. First step would be to ask your doctor for another kind of drug, or better yet, work towards getting off all drugs by finding the causes of the problems and addressing those rather than treating the symptoms with drugs.

Cortisol is released as a response to any kind of stress, from physical stress such as pain, to nutritional stress such as too much or too little of particular nutrients, to emotional stress, so anything that can be done to eliminate causes of stress should be addressed. Going to bed too late is an example of a stress that will increase cortisol levels, and studies show that those that tend to burn the midnight oil tend to be fatter than those that don't. Stimulants like coffee, tea and sugar also increase cortisol levels. The type of exercise that works best for this fat pattern is lower intensity long duration exercise like walking, yoga, tai chi, and qi gong. Running and other very intense cardiovascular exercise will probably make the situation worse. And having a coffee after your exercise session is a bad idea. Examine all aspects of your life for stress inducers and do what you can to reduce or eliminate them. Have those difficult conversations so you can move on, and learn to only concern yourself with things that you can control.

Cortisol levels should be high first thing in the morning, and should gradually diminish as the day goes on. In order to address a poor circadian cortisol rhythm, it can be very worthwhile to seek out a Functional Medicine doctor for a circadian salivary cortisol test. Once your cortisol rhythm is known, a treatment protocol can be suggested to help you. This is a long process, so do not expect overnight results. Please note that low calorie, low fat diets are more likely to negatively impact cortisol levels rather than improve them, which might explain why some people on these diets do not lose weight.

Estrogen dominance, either from excess estrogen or estrogen unbalanced by progesterone tends to cause fat to be deposited in the hips, buttocks and upper legs, and people with this fat pattern are more sensitive to estrogen than others. If this is your fat pattern, you need to do all you can to limit your exposure to estrogen by avoiding use of oral contraceptives, plastics which are high in xenoestrogens, soy products which are very estrogenic (soy is in many processed foods so read labels carefully), as well as meats, eggs and dairy from factory farms where hormones are used to fatten up the animals and to increase milk production. Finding non-medicated, pasture-fed meat, dairy and eggs would be a priority for this fat pattern.

Seeing a Functional Medicine Doctor to get tested for estrogen and progesterone balance might be a good idea. Sometimes bioidentical hormone creams can be helpful although they are very difficult to dose correctly which in my opinion is a problem.

It should be noted that children are particularly susceptible to estrogen which can cause severe problems later in life, so reducing exposure to endocrine disruptors that mimic estrogen is extremely important.

This post is undeniably very simplistic. As becomes obvious when the studies below are examined, all the above hormones affect the others, and most of us have more than one hormone imbalance; we are indeed complicated beings. However working towards improving our hormone function will lead to greater weight loss as well as overall better health than going on low calorie, low fat diets which may indeed stress hormonal systems further.

If you are in the Vancouver area, my colleague Judy Chambers is doing a seminar entitled "Hormone Hell-p" June 7 from 7-8h30pm. Click here to register.

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc. If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

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McAuley KA et al. Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women.Diabetologia 2005 Jan;48(1):8-16. Epub 2004 Dec 23.

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Yancy WS Jr et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004 May 18;140(10):769-77.

Wilson, James Adrenal Fatigue: The 21st Century Stress Syndrome Adrenal Fatigue, 21st Century Stress Syndrome Smart Publications, Petaluma, CA 2001.

ELISSA S. EPEL, PHD et al. Stress and Body Shape: Stress-Induced Cortisol Secretion Is Consistently Greater Among Women With Central Fat Psychosomatic Medicine 62:623–632 (2000) 623

Julie Anne Chinnock et al. Cortisol Patterns and DHEA Levels of Patients with Obesity, Prediabetes, and Type 2 Diabetes Int JNM 4(1): 2009

Roland Rosmond* and Per Björntorp Occupational Status, Cortisol Secretory Pattern, and Visceral Obesity in Middle-aged Men Obesity Research (2000) 8, 445–450; doi: 10.1038/oby.2000.55

García-Prieto MD Cortisol secretary pattern and glucocorticoid feedback sensitivity in women from a Mediterranean area: relationship with anthropometric characteristics, dietary intake and plasma fatty acid profile. Clin Endocrinol (Oxf). 2007 Feb;66(2):185-91.

Tsigos C, Chrousos GP.Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002 Oct;53(4):865-71.

Dallman MF et al. Feast and famine: critical role of glucocorticoids with insulin in daily energy flow. Front Neuroendocrinol. 1993 Oct;14(4):303-47.

Brown LM et al. Metabolic impact of sex hormones on obesity. Brain Res. 2010 May 1. [Epub ahead of print]

AM Andersson and NE Skakkebaek Exposure to exogenous estrogens in food: possible impact on human development and health European Journal of Endocrinology, Vol 140, Issue 6, 477-485 1999

Ropero AB et al. The role of estrogen receptors in the control of energy and glucose homeostasis. Steroids. 2008 Oct;73(9-10):874-9. Epub 2007 Dec 27.

Aksglaede L et al The sensitivity of the child to sex steroids: possible impact of exogenous estrogens. Hum Reprod Update. 2006 Jul-Aug;12(4):341-9. Epub 2006 May 3.

Nadal A et al. The pancreatic beta-cell as a target of estrogens and xenoestrogens: Implications for blood glucose homeostasis and diabetes. Mol Cell Endocrinol. 2009 May 25;304(1-2):63-8. Epub 2009 Mar 9.

Copyright 2010 Vreni Gurd

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Osteoporosis. What has posture got to do with it?

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The bone-thinning disease that affects so many in their older years may be helped by ensuring one is actually putting weight through the bones while standing or sitting.

Before I get into this topic, I want to let you know that I have created a
Wellness Tips Page
on Facebook, where I post and comment on various health articles I find interesting. Would love to see you there!

We have probably all seen photos of what the inside of bone looks like - kind of like honeycomb with lots of tiny holes. This keeps bone light and strong, with the boney web lining itself up according to the forces put through the bone. In someone with osteoporosis the holes in the web of bone become bigger, and the bone that forms the web becomes thinner making the bone more prone to fracture.

In the upper spine where fractures are common, a vertebrae may simply crush through the weakest area of the bone web, usually changing the shape of the vertebrae to a wedge forcing more roundness in the upper back and the head to come forward. Unfortunately, when one vertebrae is crushed, it makes the others more prone due to the change in forces going through the area. These vertebrae fractures can be excruciatingly painful. The other common fracture sites are the neck of the femur (the long bone in our thigh at the top close to where it attaches to the pelvis) and the wrist.

Mechanical stress going through the bones helps the boney matrix create bone to counteract those stresses, which is why “weight-bearing exercise” is strongly suggested to keep bones strong. Exercise aside, I have noticed that many people’s natural standing posture does not actually put much weight through the bones. The pelvis is often shifted forward, the ribcage is tilted back, and the head is forward. When I stand behind a person standing this way and push slowly but forcefully down both shoulders, the body tends to buckle sending the pelvis even further forward and the ribs further back. This suggests that the weight is going through the soft tissue rather than through the bones. Maybe the first step to maintaining and building bone mass is to make sure one is standing in a way that actually loads the bones!

The goal is to stack the bricks by trying to become as tall as possible, reaching the base of the skull up. Most people will need to bring their pelvis back to find their full height, which will in turn straighten ribcage. The pelvis should be directly over the legs in such a way that the thigh and buttock muscles are not contracting. You know you've got it right when there is no buckling in the body when someone pushes slowly but forcefully down on the shoulders. I find I can actually feel the pressure going through the bones when this is done to me.

This concept is important in sitting as well. We often tend to sit behind our sit bones instead of on them, which rounds our back so the weight of our trunk and head is no longer going through the ideal load-bearing parts of the spine. So, sit tall on your sit-bones so that there is a little arch in the low back, and figure out where to keep your ribcage so that when someone pushes on your shoulders nothing buckles in the trunk. You can even have someone push slowly yet with some force on the top of your head to see if your neck is lined up correctly. Nothing should buckle anywhere if the forces are being carried by the bones instead of the soft tissue.

Because we spend the majority of our day sitting, standing and walking, it makes sense to ensure that we are loading our bones while doing these activities. Weight training in the gym will be that much more effective if one starts from a place of good posture. And spending some time regularly on all 4s can help load the arm bones in order to prevent wrist fractures.

As for the belief that calcium supplementation is the key for preventing or reversing osteoporosis, Charles Poliquin had a good analogy in his article on the topic, where he suggested that when building a building, one can keep supplying 2 by 4s to the building site, but unless you also supply all the other stuff needed to build the building including the workers to put it together, those 2 by 4s will remain on the ground. They don't magically turn into a building. We need a functioning endocrine system (the workers) to get the calcium into the bones. A dysfunctional endocrine system is probably the most important cause of osteoporosis, and is most frequently completely overlooked. I wrote about it in more detail in my other post on osteoporosis.

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I can’t find any references that discuss the effect of standing and sitting posture on bone mineral density. Surely I’m not the only one that has thought of this??

Copyright 2010 Vreni Gurd

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Butt gripping and low back, SI joint and hip pain

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Butt gripping is a common unconscious habit that may be at the root of low back, SI joint and hip pain.

Do you have chronic low back or hip pain? If you are female, did you notice that you developed your back pain during pregnancy or after giving birth? Maybe a fall or car accident triggered the back pain and now it is ongoing? Whatever the initial cause it may be worth checking yourself to see if you are a butt gripper. Butt gripping is a term coined by Diane Lee and Linda Joy Lee, used to describe a back stabilization strategy that involves squeezing the buttocks together. This habit is completely unconscious, and is a common strategy the brain uses to try and stabilize the spine if the muscles that are supposed to do the job are not functioning as they should, or if there are significant digestive issues that may be causing gas. Butt grippers are easy to recognize in other people - not only do they look like they are squeezing their butt cheeks together, but they also frequently walk like a duck with the toes pointing out.

Sometimes it is more challenging to recognize the habit in oneself. If you are not sure, have a friend help you. Lie on the floor on your back, completely relaxing your leg and buttock, and have your friend pick your leg up and hold it bent to 90 degrees, at the knee and at the ankle. Your friend can then try and move your upper leg side to side. It should swing completely freely with no movement in the pelvis at all if you are not butt gripping. If the leg moves stiffly as if one were churning butter, or if the pelvis moves with the leg, that means the buttocks are hanging onto the leg and you are indeed a butt gripper. Check both legs, because occasionally the problem can be one-sided.

Why would this habit increase low back and hip pain? Try squeezing your butt cheeks together hard, and walk across the room. Notice how your legs cannot swing freely, and how you need to rotate your spine in order to move a leg forward. This puts extra wear and tear on the vertebral joints - not good. Contracting the piriformis, a deep rotator muscle in the buttock that runs from the sacrum (triangular bone at the bottom of the spine) to the big bump on the outside of the upper leg bone (greater trochanter), puts a strangle hold on the bottom of the sacroiliac joint, compressing it and creating pain. Furthermore, because the sacrum is a triangular bone and butt gripping squeezes the bottom part of the joint, the top of the SI joint opens up making it unstable. And with the sciatic nerve being so close to the piriformis muscle in the buttock, occasionally overuse of this muscle will create sciatic pain.

Although not in the right place to mimic piriformis properly, the bungee cord in the photo simulates a butt gripping strategy, and one can clearly see how this opens the top of the SI joint. This might also destabilize the joint between the top of the sacrum and the lowest vertebrae, and possibly the lumbar spine further up. Also, the piriformis might pull the front of the lower sacrum forward, unlocking the SI joint, destabilizing it. Massaging the external hip rotator muscles will help temporarily, but until one stops using a butt gripping strategy the pain will not go away permanently.

transversus strategyIn order to stop butt gripping permanently, one must replace the butt-gripping stabilization strategy with one that is more optimal. Ideally we want to create a ring of support around the top of the pelvis by using the deepest abdominal muscle called the transversus abdominis. Notice in this photo how the bungee cord simulating the action of transversus abdominis, closes the SI joint, and how using this muscle would stabilize the pelvis in a way that does not compromise the ability of the legs to move freely. This muscle, along with co-contraction of multifidus and the pelvic floor form the optimal way to stabilize the low back and SI joint.

Find transversus abdominis by getting onto all 4s, letting your belly hang out, pulling in the tissue just above the pubic bone, feeling a slight muscle contraction there, and holding it while breathing. The contraction should be well below the belly button. Drawing the navel to the spine activates the wrong muscle according to Real Time Ultrasound research, and therefore does not provide the needed stabilization to the spine. One should be able to hold this deep, low contraction and breathe quite easily. Once you can find this abdominal muscle, lean back so your butt cheeks open. Then try finding your connection to transversus in various positions including sitting and standing. Transversus should be on at very low intensities pretty much all the time, so build up hold times rather than contracting and relaxing it.

Frequently practice finding transversus abdominis in standing, and then practice letting go of your buttocks so your legs can swing freely. Teaching your brain to use your body differently can take a few weeks to a few months of diligent practice, so be patient. Best practice for a minute 6 times an hour rather than an hour a day, so set a timer to beep at you every 10 minutes. Over time as your brain learns a new way of stabilizing your back and pelvis your pain may very well dissipate. This is tricky stuff, so do find a good physio or CHEK practitioner to help ensure you are doing this correctly.

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Lee, Diane The Pelvic Girdle Churchill Livingston, 2004.

Lee, Diane and Lee, Linda JoyAn Integrated Approach to the Assessment and Treatment of the Lumbopelvic-Hip Region DVD, 2004

Lee, Diane and Lee, Linda Joy Postpartum Health for Moms - An Educational Package for Restoring Form and Function after Pregnancy
CD ROM 2006.

Lee, Diane Assessment Articular Function of the Sacroilac Joint VHS

Lee, Diane Exercises for the Unstable Pelvis VHS

Richardson, C, Hodges P, Hides J.Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain Churchill Livingston 2004.

DonTigny, Richard Pelvic Dynamics and the subluxation of the sacral axis at S3 The DonTigny Method.

Myers, Thomas Body Cubed, A Therapist’s Anatomy Reader “Poise: Psoas-Piriformis Balance” Massage Magazine, March/April 1998.

Myers, Thomas Body Cubed, A Therapist’s Anatomy Reader “Fans of the Hip Joint” Massage Magazine, Jan/Feb 1998.

Myers, Thomas Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists Churchill Livingston, 2001

Chek, Paul CHEK Level 1 Advanced Back Training Chek Institute.

Johnson, Jim
The Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count
New Harbinger Publications Inc. Oakland CA, 2002.

Lee, Diane Understanding your back pain - an excellent article explaining the concept of tensegrity and its importance in stabilizing the pelvis and spine.

DeRosa, C. Functional Anatomy of the Lumbar Spine and Sacroiliac Joint 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.

Gracovetsky, S. Analysis and Interpretation of Gait in relation to lumbo pelvic function 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.

Dananberg H. Gait style and its relevance in the management of chronic lower back pain 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.

Online at www.kalindra.com A fantastic website devoted to sacroiliac dysfunction.

Copyright 2010 Vreni Gurd

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Our adult appearance is determined by our childhood nutritional status

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What both our parents ate before we were conceived, as well as our prenatal and childhood nutrition impacts not only our adult health, but also determines what we look like. So if you want your kids to grow up healthy and good looking, choose their food carefully.

I had always thought that our appearance was determined by the genes we received from our parents, and that is obviously true, but I had not realized how large a role nutrition played in determining the full potential of our genes until I studied nutrition in a historical context.

The easiest way to understand this is to look at the issue from an architectural point of view. You have the plans for a beautiful and strong building that must be built by a particular date. (The Olympics are coming?) So, you set out to begin your task, but the materials required are not available in the quantities needed to build it to the specifications in the blue print. This building must be built, so you are forced to alter the plan to make best use of the materials that you do have. Hopefully better quality materials will come at some point, and you can try and improve the quality of the structure if that happens, but there are no guarantees.

The plans are asking for wide doorways going into large rooms, but because there don’t seem to be any thick, long beams available to support the roof over such large rooms, the rooms must be made smaller to accommodate the strength of the support struts that are available. Suddenly, the beautiful and strong building is looking smaller and more ordinary.

The same thing happens in the human body. Our genes provide the blueprint for a beautiful and strong body, but if we don't provide the raw materials (food) needed to create what is in the blueprint, the body must reallocate its resources and do what it can with what is available. This shows up in the skull by a narrowing of the width of the head and jaw, resulting in less room for all the teeth. Teeth are forced to fight for bone space and often come in crooked, or they overlap, resulting in large orthodontist bills. In adult bodies, inadequate raw materials in childhood shows up also as a smaller pelvis and ribcage, and long limbs. Smaller pelvises in women make child birth more difficult. If the bone structure of the trunk is narrow, the internal organs are permanently more squished, and there are potentially smaller openings for nerves and blood vessels heading into the limbs, making them more susceptible to irritation or damage. Also if the length of the nose is smaller than the forehead to the hairline or the distance between the chin and the bottom of the nose (small middle third), the nasal passages and sinuses may be too small compromising breathing, which has enormous impacts on the health of the body. Not too much one can do about widening the skull or the pelvis as an adult, which is why feeding our kids properly is so important to preventing these issues later. ,

In the western world we have plenty of food and most of us eat more than enough calories, yet many of us including our kids are still malnourished. How is that possible? Weston A. Price came up with the saying "Proteins and fats make us GROW, and carbohydrates make us GO". Our cells are made structurally with protein and fats, while carbohydrates provide most of the energy to run the system. So if the raw materials needed to build bones are quality animal proteins and fats, and a child is eating a diet too low in those nutrients to fulfill his/her genetic blueprint, his/her body will be forced to decrease the amount of bone it can make. Bones become thinner, therefore less strong, and generally smaller in size. Because bone forms the framework for our body, an inability to make enough bone while growing compromises our structure and our appearance as adults. It is important to note that one can be quite overweight and still have a small pelvis and ribcage.

Whole sources of carbohydrates provide our body the fuel to it needs to function, and the vegetables in particular are a good source of vitamins, minerals and phyto-nutrients. Carbohydrates can be converted into protein and fat in the body, and vegetarians that know about how to combine their grains and legumes properly can successfully make up all the amino acids (building blocks of protein) needed to make cells. A few vegetarians might be able to get enough protein this way to keep their structure healthy over the long term. I think it is risky to put growing children on vegetarian diets, because if the child needs more protein and saturated fat than a vegetarian diet can provide, their skeleton will be compromised. Most of us being omnivores, really do need to eat enough flesh foods and animal fats to obtain the raw materials to grow and keep our structure strong.

The problem with the current grain-based diet recommendations is that many of us are eating too many processed grains in the form of flour as well as sugars at the expense of vegetables, grass-fed proteins, wild fish and animal fats, so despite eating plenty of calories, our cells are malnourished. For example, a common breakfast might be Shredded Wheat with skim milk, a glass of orange juice and perhaps a piece of toast with jam. Except for some protein in the milk, everything else in this meal is carbohydrate - and the least healthy kind of carbohydrate at that. These foods turn into sugar very quickly in the body causing a spike of insulin, which will then store that blood sugar as body fat unless the individual exercises. In addition, high sugar diets pull calcium from the bones further compromising bone integrity. There is no animal fat in this meal, so none of the fat soluble vitamins will be absorbed, and no calcium will be able to get into the bones. Even the orange juice doesn't contribute much to nourish the body unless it is fresh squeezed, as pasteurized juices have next to no vitamins left in them, and are best considered as flavoured sugar water.

Compare that breakfast to one made up of a small bowl of steel cut oats soaked overnight then cooked and served with whole milk, and a fried egg served on a bed of steamed spinach with some cherry tomatoes on the side. One gets protein and animal fats in the egg and dairy, carbohydrates in the oatmeal and veggies, along with lots of vitamins and minerals in the veggies and fats. This meal will probably keep one satisfied longer because it is more nourishing. If you are hungry within two hours of your previous meal, most likely that meal did not give your cells adequate nutrition. They are starving for something, and that something is probably NOT more flour and sugar.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca. If you want to share this article, click on the “share” button below, at the bottom of the references

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Taubes, Gary Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health (Vintage) Alfred A Knopf, New York, 2007.

Dr. Price, Weston A. Nutrition and Physical Degeneration Price Pottenger Foundation, 1939-2006.

Fallon, Sally Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats New Trends Publishing, 2001.

Pottenger, Francis M Pottenger’s Cats: A Study in Nutrition Price Pottenger Nutrition Foundation, 1995.

Copyright 2010 Vreni Gurd

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10 body positions we should all find relaxing

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The following body positions most kids can relax in easily, but as adults we may stop being able to do them if we allow our muscles to shorten. That lack of flexibility impairs our ability to move properly making us more prone to injury. So if “relaxing” is not the word you would use to describe these positions, working towards being able to do them easily again may just change your life.

Here are my initial ideas on positions I think we should be able to do throughout our life. Do these in bare feet for best results, and keep any stretch mild.

squat to floorusing post1. Squat to the Floor We should be able to easily spend time in a deep squat keeping our heels down without falling backwards, body leaning between the legs as if we were pooping in the woods. If you cannot do this, try holding onto a sturdy post and lower yourself down leaning back just enough to keep your heels on the floor. You can always sit on a low step-stool for extra support and to make the position more relaxing. Keep your knees in line with your toes, ease into a stretch and wait for it to dissipate. In addition to pushing through your feet you can use your arms to help pull you up when you are done. (Please note: NEVER do a squat to the floor with added weight. Avoid if you have a disk problem in your back.)


Tripod Split Squattoe stretch2. Tripod Split Squat
From the squat position above, drop one knee to the floor and sit on the heel of that foot. This position is comfortable and stable as you have created a triangle on the ground with the points being one knee, the toes of the same leg and the other foot. Make sure you switch sides to work on both legs. This is the ideal position for lifting heavy objects off the floor as one can straddle the object being lifted thereby keeping it close to our body, the spine has a neutral curve, and it forces the use of the legs rather than the back to get up. But it requires good toe flexibility which is usually the limiting factor in this position. If this is too painful, work on your toe flexibility by going onto all 4s, tucking your toes under and leaning back until you can sit on your heels. Toe spreaders can also be very helpful.

kneelingkneeling3. Kneeling Come down onto all fours, tops of the feet down, but turn your hands around so the fingers are pointing back at your knees, palms down. Gently lean back to get a mild stretch in the forearms. When this range of motion is lost we lose the ability to weight-bear through our hands. When you have had enough of that, take the hands off the floor and sit down fully on your ankles and heels to stretch out the tops of the feet and front of the lower legs. If you can't sit all the way back, put your hands on the floor and lean back as much as you need to get a stretch. Once you can sit comfortably like this on the floor, you will be able to interact much more easily with babies and toddlers. Also being able to get up and down from the floor easily will keep your legs stronger than they otherwise would be.

crosslegged sitcrosslegged24. Cross-legged sit with forward bend Sit down on the floor and bring one heel into your perineum, and the other heel just in front of that foot. Your knees should be wide and your legs should feel relaxed. If not, try sitting on a phone book or pillow so that your knees are lower than your pelvis. Now lean forward and if possible, rest your elbows and forearms on the floor in front of you, keeping your sit bones down. If not possible, rest your hands on the floor. Avoid the temptation to look up, which would shorten the back of the neck. Most likely you will feel a stretch in the hip of the forward leg, and possibly the inner thighs and low back. Switch the feet to keep the other hip limber too. (Avoid bending forward if you have a disk problem.)

seated fold5. Seated forward fold Sit tall on your sit bones on the floor with your legs stretched out in front of you. If possible, gently fold forward keeping the knees soft and collar bones wide, until you feel a mild stretch in the back of your legs. Some people are able to relax with their chest on their thighs, while many of us may not be able to fold forward at all. If you are sitting behind your sit bones, sit on a phone book or pillow to raise you enough to make it possible for you to relax on your sit bones. Sitting on a block with your back against a wall to provide some support may be a very good starting point as one can easily relax and spend time in that position. (If you have a disk problem you need hamstring stretching, but this is not the best choice for you. See a physio, CHEK Practitioner or personal trainer who can teach you a hamstring stretch that keeps your spine in neutral.)

butterfly6. Supine butterfly with T-Y-I relax Lie on the floor on your back and lean the soles of your feet into each other, heels close to the perineum, possibly creating a stretch in your inner thighs. If the stretch is too great for the inner thighs, play with the distance your heels are from your perineum, or use pillows for support under your knees. If your head is tilted back to reach the floor, use a pillow so you can keep the plane of your face horizontal. Hopefully eventually you won't need the pillow. Rest your arms out to the side like the letter T, raising them up as high as you can while keeping them on the floor. Perhaps you will be forming the letter Y with your arms and trunk. The goal is to eventually have your upper arms up against your ears like the letter I, yet relaxed on the floor and feeling no stretch in your chest or armpits.


torso twist7. Supine torso twist
Lie on your back with your arms out to the side, knees bent, feet on the floor. Push through the feet to lift the pelvis up, and place it on the floor slightly to the left. Drop the knees to the right towards the floor, keeping the shoulder-blades down, possibly feeling a stretch in the left side and buttock. Ideally you should be able to relax with the legs on the floor in this deep twist. If you cannot, put pillows under your legs to support them so that you can relax, but still feel a stretch. Do the other side as well.


torso twist 28. Ankle across knee torso twist
Lie on your back with your arms out to the side, right knee bent, foot on the floor, left ankle resting on the right thigh so the left knee is pointing out to the side. Slowly drop the right knee down to the right side so that the left foot ends up on the floor and you can hang onto it with your right hand. The left knee should just hang away from the body. You may feel a stretch in the front or side of the left hip. Use pillows for support if needed. Do the other side.


c stretch9. Supine C stretch
Lie on your back with your legs stretched out, and your hands clasped overhead. Move your legs and arms to the same side so you are taking the shape of a banana, but do not allow your pelvis to rotate. Cross the foot of the leg that is on the outside side of the curve over the foot of the inside leg, relax and feel a gentle stretch through the lateral line of of the body. If you feel any discomfort in your pelvis, try holding in your pelvic floor as if you were stopping the flow of urine and draw in the tissue just above the pubis. Notice any differences side to side.


sphinx10. Sphinx with lower legs up
Lie on your belly and come up onto your elbows, forearms and hands facing forward, elbows at 90 degrees, while keeping your pelvis on the floor. Keep the back of the neck long, chin drawing into the front of the neck slightly. Try to arch your upper back by keeping the collar bones wide, lifting your sternum up and through your arms and feeling a stretch in the belly. If this is comfortable for your low back, try bending your knees so the flats of your feet are facing the ceiling. This position should be quite restful, but if your low back is bothering you, only come up as high as is comfortable, and try supporting your pelvis by drawing in the tissue just above the pubis. For some, lying on the floor with the forehead on the hands may be all that can be initially tolerated. Find the position you can relax in and progress from there.

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Related Tips
Foot flexibility important to reducing hip and SI joint pain
S-t-r-e-t-c-h and feel better!

Copyright 2010 Vreni Gurd

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How to recover mobility and speech after a stroke

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A stroke occurs when there is a disruption of blood flow to the brain which starves the brain tissue of oxygen and nutrients, and causes that part of the brain to die. A disruption can be caused by either a rupture of the blood vessel (an aneurism) or a blockage within the vessel.  The larger the blood vessel that is involved, the larger the area of the brain that is affected. Strokes cause speech impediments, paralysis, unconsciousness and even death. Because the left side of the brain controls the right side of the body and vice versa, dysfunction as a result of a stroke occurs on the opposite side of the body. A heart attack is essentially the same thing, but the blood vessel that is blocked is in the heart, causing a part of the heart to die.

Before the discovery and understanding of the implications of neuroplasticity, the belief was that recovery from a major stroke or other brain lesion would only be minimal, since it was believed that certain parts of the brain controlled certain functions, and once a control centre for a particular function was disabled, nothing much could be done about it. Now we know that the brain is capable of reorganizing itself to such a great extent that remarkable recovery of movement as well as speech function is possible with the right therapy.

Edward Taub, a behavioural neuroscientist pioneered a method of stroke rehabilitation called “Constraint Induced Movement Therapy”, and thousands of stroke patients have recovered function to the point of being able to care for themselves and continue their careers.

Taub believes that part of the problem post stroke is learned; the patient quickly learns to stop using the limb which has lost function and relies instead on the “good” limb to do everything. If the brain is not challenged to try to use the affected limb, it will not change in order to learn to use it again. So Constraint-Induced Therapy involves immobilizing the “good” limb by using large, stiff mittens and slings so the patient is forced to use the limb affected by the stroke.

People go into therapy for two intensive weeks, and they are given simple tasks that mimic life activities starting with large motor movements, and with success moving gradually to fine motor skills. A patient may come into therapy with some ability to move an arm and extend a hand, and leave with the ability to do up buttons on a shirt. Absolutely astounding progress in just two weeks! Even people that had strokes many years ago can benefit from this kind of
therapy.

Patients wear their mitts and slings on their unaffected limbs 90% of the day while in therapy, and may start with exercises like wiping pots (the pot constrains the hand initially and helps teach the circular movement), wiping a table, putting large pegs into peg boards, picking up large balls, and later they put pennies into piggy banks for example. They learn to use a fork to pick up food and bring it to their mouths. Eventually skills are timed, so patients learn to be accurate and fast. By doing intensive work over two weeks, they get mass practice with incremental increases in difficulty which causes enormous brain (cortical) reorganization or plastic change. Function may not be quite what it was before the stroke, as neurons that are learning to take over a task may not be as effective as the ones that they are replacing, but all the same, it is possible to regain function to the point of giving someone back their life.

About 40% of those that have a left hemisphere stroke have damage to Broca’s area and therefore have speech deficits. How does one put a mitten on a tongue and jaw to help those who have lost speech function? Language rules are implemented into card games. As language skills improve, the rules become more stringent. The game is something like "Go Fish" with pictures of objects on them, where each in turn asks for the card they are seeking from a particular person. They would request the card with the rock on it, for example. Initially the only rule is they cannot use hand signals but must verbally request the card somehow. If they can't think of the name of the object they want, they can describe it instead. Once they have the pair they can discard it, and the person that gets rid of all their cards first wins.

More advanced versions of the game involve precisely naming the object they are looking for, or cards including colours and numbers so more
description is required. The participants that obeyed the rules of the game 3 hours a day for 10 consecutive days had a 30% improvement in
communication compared to the control group which got conventional therapy that involved repeating words.

This therapy works best if it is done all at once - mass practice over 2 weeks - rather than less frequent therapy over a longer duration.  It seems the brain needs to be deprived of the alternatives in order to be forced to rewire itself.

This kind of therapy is useful not only for strokes, but also for those with movement and speech problems caused by cerebral palsy, spinal cord injuries, brain tumours, Parkinson's, and multiple sclerosis.

I think the concept of forcing the brain to learn to move the body differently would be useful in physiotherapy and exercise rehabilitation as
well, since poor movement patterns lead to joint problems and pain. By finding a way to completely block the unwanted movement pattern and forcing the brain to use a better movement strategy, perhaps we can more quickly and more effectively break bad habits, rehabilitate injuries and possibly prevent some from occurring in the first place. I have figured out a way to block a quadricep strategy in a lunge pattern, but still need to work out how to block other poor movement strategies and force good ones in other movement patterns like the squat, bend, upward scapular rotation and gait.

The information in this post is from the fabulous book by Norman Doidge, M.D. entitled The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.  I absolutely loved this book, as it provides so much hope for those suffering from a huge variety of problems ranging from depression and cognitive issues to balance problems, to sight impairments to motor control impairments. One learns about the scientists at the forefront of neuroplasticity research, and the patients they have helped.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related Tips:
Foot flexibility important to reducing hip and SI joint pain
Walking, sacroiliac dysfunction and hip pain
Creating new habits

Norman Doidge, MDThe Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (James H. Silberman Books) Penguin Books, London England, 2007.

Gauthier LV et al. Improvement After Constraint-Induced Movement Therapy Is Independent of Infarct Location in Chronic Stroke Patients Stroke. 2009;40:2468.

Smania N et al. A modified constraint-induced movement therapy (CIT) program improves paretic arm use and function in children with cerebral palsy (Europa Medicophysica) 2009 December;45(4):493-500

Morris DM et al. A method for standardizing procedures in rehabilitation: use in the extremity constraint induced therapy evaluation multisite randomized controlled trial. Arch Phys Med Rehabil. 2009 Apr;90(4):663-8.

Mark VW et al. Constraint-Induced Movement therapy can improve hemiparetic progressive multiple sclerosis. Preliminary findings. Mult Scler. 2008 Aug;14(7):992-4. Epub 2008 Jun 23.

Mark VW et al. MRI infarction load and CI therapy outcomes for chronic post-stroke hemiparesis. Restor Neurol Neurosci. 2008;26(1):13-33.

Gauthier LV et al. Remodeling the Brain: Plastic Structural Brain Changes Produced by Different Motor Therapies After Stroke (Stroke. 2008;39:1520.)

Wolf SL et al. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial. Lancet Neurol. 2008 Jan;7(1):33-40.

Mark VW et al. Poststroke cerebral peduncular atrophy correlates with a measure of corticospinal tract injury in the cerebral hemisphere. AJNR Am J Neuroradiol. 2008 Feb;29(2):354-8. Epub 2007 Nov 16.

Meinzer M et al. Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia. NeuroRehabilitation. 2007;22(4):311-8.

Taub E et al. Pediatric CI therapy for stroke-induced hemiparesis in young children. Dev Neurorehabil. 2007 Jan-Mar;10(1):3-18.

Boake C et al. Constraint-induced movement therapy during early stroke rehabilitation. Neurorehabil Neural Repair. 2007 Jan-Feb;21(1):14-24.

Wolf SL et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006 Nov 1;296(17):2095-104.

Lum PS et al. A telerehabilitation approach to delivery of constraint-induced movement therapy. J Rehabil Res Dev. 2006 May-Jun;43(3):391-400.

Mark VW et al. Neuroplasticity and constraint-induced movement therapy.Eura Medicophys. 2006 Sep;42(3):269-84.

Morris DM, et al. Constraint-induced movement therapy: characterizing the intervention protocol. Eura Medicophys. 2006 Sep;42(3):257-68.

Taub E et al. The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys. 2006 Sep;42(3):241-56.

Taub, E. et al.(2006). A placebo controlled trial of Constraint-Induced Movement therapy for upper extremity after stroke. Stroke, 37, 1045-1049.

Copyright 2010 Vreni Gurd

To subscribe go to www.wellnesstips.ca

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How good are you at choosing healthier fats?

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Take this quiz and see how you well you do at picking the healthier fats. What choice would you make in each pairing below?

a) stick margarine
b) butter

a) lard
b) shortening

a) coconut oil
b) grape-seed oil

a) olive oil
b) canola oil

a) peanut oil
b) palm oil

a) tub margarine
b) butter

a) 35% cream
b) creamer

a) corn oil
b) beef fat

a) fish oil
b) soy oil

If you picked butter, lard, coconut oil, olive oil, palm oil, butter, cream, beef fat and fish oil, congratulations, you know how to choose the healthier options!  Margarine, shortening and creamer are examples of trans-fats and should be avoided at all costs, as study after study shows how dangerous trans-fats are to our cardiovascular system, even in very small amounts. The most recent study discussed at the American Heart Association conference this past week suggested that trans fats increase the risk of stroke by 30% in post-menopausal women. When we hear the phrase "artery clogging", we should think immediately of trans fats, and not lump saturated fats in there as well. These are completely different fats that act very differently in the body, trans fats being extremely destructive, and saturated fats being vital for our survival. I'm not suggesting we need to eat large amounts of saturated fats to be healthy - just that we need not fear them and go out of our way to avoid them.  They havean important role to play
in a healthy diet.

Tub margarine often advertises that it has 0 trans-fats, but that is because food manufacturers are allowed to label it as such if the amount per serving is less than 0.5 grams. This does not mean they have no trans fats, and if one eats a lot of margarine and other products with such a label the trans fats can add up. Furthermore, the polyunsaturated oils in the margarines have to be altered somehow to solidify them, and if they are not hydrogenated, they are interesterified, which does not guarantee that they are healthy.

Shortening replaced lard (pig fat) in baked goods when the erroneous fear of saturated fats became the norm, and currently baked goods such as pastries, donuts, muffins, cookies, crackers, pie crusts and pizza dough contain trans fats much more often than not. Unless you bake your own and can control the ingredients, trans fats (along with the flour and sugar) in these products makes for a powerful health reason to not to buy and eat them. Look at the ingredient list, and if you see a "partially hydrogenated" or "hydrogenated" plant oil, that is a trans fat. If your pantry contains shortening, throw it out and buy lard for your baking needs. Yes, you can still find it in the grocery store, and it is a MUCH healthier choice.

We have known for at least 20 years that trans fats are deadly. Why have governments not yet banned them from the food supply considering the amount of money they would save in health-care spending? Another example of how governments give in to food-manufacturing lobbies rather than do what should be done for the health of their populations.

TThe other common misunderstanding with respect to fats and oils involves polyunsaturated omega 6 plant oils, which are widely believed to be healthy despite the growing evidence of systemic inflammation that they cause in the body. Most of the devastating diseases that are affecting us today have a large inflammatory component, and the dramatic increase in plant oil consumption since 1910 parallels the dramatic increase in diseases like heart disease, stroke, diabetes, and cancer. Before 1910 plant oils other than olive, coconut and palm oils did not exist, and our chronic disease rates were very low. Eating plant/seed oils like canola, safflower, soy, corn, grape seed, peanut, cotton seed oil and any foods that contain them is a very unhealthy practice in my opinion.

Dr. Lands said in his presentation at a recent NIH conference on omega 3 and omega 6 fats (scroll to minute 12 to see the start of the presentation) that "People that have more than half of their highly unsaturated fatty acids (HUFA) as omega 6 HUFA, they really have a very high incidence of cardiovascular death. Those that have less than half of their omega 6 HUFA in their membrane phospholipids predominantly, they really have low incidence of death." (Minute 26 in presentation). Dr. Lands suggested that one should think of these omega 6 plant oils as "insurgents" in the body, and omega 3 fatty acids as the "armour" to protect against "the insurgents". Eating sea foods which contain lots of omega 3s, or fish/krill oils do help protect the body from the systemic inflammation the omega 6 fats cause, but it makes more sense to stop eating the insurgents in the first place. All the same, the more omega 6 one consumes, the more omega 3 one needs to counteract the damage of the omega 6. So if one eats a salad dressing made with canola or soy oil, or food cooked in a vegetable oil, take some extra fish or krill oil as protection. Walnuts are considered to be a high omega 3 nut, but the amount of omega 6 in walnuts is 5X higher than the amount of omega 3, so trying to use walnuts to improve one's omega 3/6 ratio won't work, even though it has a much better ratio than any other nut.

Notice that all the fats and oils listed in the quiz above as unhealthy for us were all invented in the last 100 years. Stick to fats that we have been eating for thousands of years and avoid the newly invented fats in order to stay healthy.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related Tips:
Saturated fat, the misunderstood nutrient
Vegetable oils, friend or foe?
Oils and fats - the good, the bad and the ugly
Essential fats: omega 3 to omega 6 ratio
Food-Guide Fallacy

Total fat, trans fat linked to higher incidence of ischemic stroke American Stroke Association meeting report, Feb 27, 2010.

Charles Bankhead Review Calls for Reevaluation of the Fat-CVD Link Medpage Today, February 18, 2010.

Nutritional armor for the war fighter: Can omega 3 enhance stress resilience, wellness and military performance? Oct. 14, 2009.

Enig, Mary PhD, and Fallon, SallyThe Oiling of America A history of how the way we ate changed from 1900 to 2000. Jan 1. 1999.

Enig, Mary PhD Interesterification: Know your fats Weston A Price Foundation

Enig, Mary; Know Your Fats: The Complete Primer For Understanding the Nutrition of Fats, Oils, and Cholesterol Bethesda Press, Silver Spring, MD, 2003.

Soriquer F. et al.Hypertension is related to the degradation of dietary frying oils Am J Clin Nutr Dec;78(6):1092-7, 2003.

Online by Mary Enig, PhD, fats, oils and lipids researcher Fats and Oils and their impact on health

Taubes, Gary Good Calories, Bad Calories, Challenging the Conventional Wisdom on Diet, Weight Control, and Disease Alfred A. Knopf, New York, 2007.

Gardner CDComparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA 2007 Mar 7;297(9):969-77.

Felton C. et al.Dietary polyunsaturated fatty acids and composition of human aortic plaques Lancet, 1994, 344:1195

de Roos NM et al.Replacement of dietary saturated fatty acids by trans fatty acids lowers serum HDL cholesterol and impairs endothelial function in healthy men and womenArterioscler Thromb Vasc Biol, Jul; 21(7):1233-7, 2001

de Roos NM et al.Consumption of a solid fat rich in lauric acid results in a more favorable serum lipid profile in healthy men and women than consumption of a solid fat rich in trans fatty acids Journal of Nutrition Feb:131(2):242-5, 2001.

de Roos et al.Replacement of dietary saturated fat with trans fat reduces serum paraoxonase activity in healthy men and women Metabolism Dec;51(12):1534-7, 2002.

Temme EH. et al.Individual saturated fatty acids and effects on whole blood aggregation in vitroEur J Clin Nut Oct:52(10):697-702, 1998.

Knopp RF Saturated fat prevents coronary artery disease? An American paradox American Journal of Clinical Nutrition, Vol. 80, No. 5, 1102-1103, Nov 2004.

Simopoulos AP.The omega-6/omega-3 fatty acid ratio, genetic variation, and cardiovascular disease. Asia Pac J Clin Nutr. 2008;17 Suppl 1:131-4.

Simopoulos AP.The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 2008
Jun;233(6):674-88. Epub 2008 Apr 11.

Ghosh S et al.Cardiac proinflammatory pathways are altered with different dietary n-6 linoleic to n-3 alpha-linolenic acid ratios in normal, fat-fed pigs. Am J Physiol Heart Circ Physiol. 2007 Nov;293(5):H2919-27. Epub 2007 Aug 24.

Copyright 2010 Vreni Gurd

To subscribe go to www.wellnesstips.ca

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