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Frequently hip and sacroiliac joint pain can be the result of toes that don’t extend enough which causes a flat-footed walk, resulting in the pelvis tilting forward, and over-use of the hipflexors in walking, unlocking the SI joint.

I wrote a post a couple of years ago about how hip pain and SI joint pain can be the result of a pelvis that is tilted forward forcing a very effortful walk, and an unhappy wearing of the hip socket.

Through working with people in bare feet, I’ve recently noticed a common pattern in people with SI joint and hip pain – many have very poor flexibility and openness in the feet and toes, and I think it is at least possible if not quite likely that this lack of toe flexibility is forcing poor walking mechanics and a poor pelvic position, leading to SI joint and/or hip pain.

While kneeling on the floor, toe pads down, one should be able to easily put full weight through the toes by sitting on one’s heels. The toe fold should be about 90 degrees. One should be able to control the muscles of the toes, spreading them all apart.

Also the tops of our feet and ankles should be open enough to be able to tolerate kneeling and sitting back on one’s heels. Better yet, one should be able to grab the floor with the tops of the toes, pulling the toes forward until the ankles are flexed to about 90 degrees and then sit back on the heels with the toes turned under. Quite a painful experience for most of us!

In standing, when the feet are on the floor, all the pads of the toes should be in good contact with the floor. Because we tend to spend most of our life in shoes, many times shoes with very inflexible soles, it is not surprising that we lose foot and toe flexibility.

In walking, all the toes should be in contact with the ground at push-off, lightly pushing the body forward just before the swing phase of gait. This activates all the muscles in the back of the leg in sequence, starting with the toe flexors, then the calf muscles, followed by the hamstrings.

After the toe push, the leg swing should be quite passive with the leg feeling like it is hanging from the hip socket and swinging like a pendulum. If the toes are not in contact with the floor or there is a lack of flexibility in the toes making it impossible to use them to push, gait is changed completely.

With the toes are taken out of the equation, the walker is less able to push and is therefore more inclined to move the leg forward from the hip joint instead by using the hipflexors and the quads, making the swing phase of gait active and effortful.

Once this manner of walking becomes a habit, the hipflexors and quadriceps tighten and shorten which tilts the pelvis forward, changing the angle of force through the hip joint and making it impossible to dangle the leg from the socket during the swing phase.

So instead of a welcome period of decompression in the hip socket every time the foot is off the ground, the leg is compressed into the joint continually because the hipflexors are pulling the leg bone into the socket during the swing phase, and the leg bone is pushing up into the socket during the stance phase.

This constant pressure can cause the joint to wear, especially since the pelvis is tilted over the leg putting the force through a less ideal part of the joint.

Sacroiliac problems can also result from a lack of toe push because the when there is little to no activation of the hamstrings (back of the thigh), there is little to no tension put through the sacrotuberus ligament which is important to SI joint stability.

Combine this lack posterior stability with overly active hipflexors and quads from a pelvis that is overly tilted forward, and the SI joint is quite likely to unlock, causing pain and dysfunction.

Furthermore, an anteriorly rotated pelvis makes it nearly impossible to have a proper heel strike, causing the foot to land almost flat. One is supposed to hit the ground with the back of the heel, then roll over the foot and push off the toes keeping the back line engaged and the SI joint stable throughout the entire stance phase.

A flat-footed landing shortens the stride necessitating the hipflexors to move the leg creating a shuffling look to gait, and makes it harder to find the toes for push-off. The lack of toe off combined with the lack of heel strike both feed into each other and potentially making gait worse and worse over time as the pelvis is pulled further into anterior rotation (think of the pelvis as a bucket pouring water out the front).

In the past I’ve recommended hipflexor and quadricep stretches (and low back stretches for those stuck in lumbar extension) which is definitely very important, but if the toes and ankles are inflexible I’m not convinced the correct pelvis position can be maintained and proper gait restored.

So I would add calf stretches (particularly the straight-leg calf stretch or gastrocnemius) and the toe stretches described above. Toe spreaders are a great idea – the kind used to put toe polish on are perfect to start. Once they are no longer painful to wear and walk with, one can graduate to "intermediate" toe spreaders, and then finally to “advanced” toe spreaders, which will really help open the feet.

Also rolling the bottom of the foot on a tennis ball or racquet ball can stretch and loosen the plantar fascia. Strengthening glute medius posterior so the opposite hip joint can be held high enough to allow the leg to passively swing is very important as well.

Once the appropriate muscles are loose enough to make it possible to hold the pelvis in the correct position the hard work begins, as one must teach the brain a different way of walking.

Regularly concentrating on the landing on the back of the heel, then rolling over the foot and pushing off the toes, along with feeling the swing leg hang from the hip socket is what will do it.

When getting up from the floor from a kneeling position, one has two choices. One can do a “split squat” where the weight stays evenly split between the two feet. In this case, the back toes, both ankles, both knees and the forward hip should form a 90 degree angle, with the trunk being vertical. One pushes down evenly through the front foot and the back toes to move to a standing position. Flexible toes are needed to tolerate the weight going through them.

The usual method of getting up from the floor from a kneeling position is to transfer the weight to the forward foot, and step forward. The knee needs to come in front of the toe, and the ankle must be passive for this to happen. When there is not enough calf flexibility, the heel will have to come up a bit. This is fine as long as the ankle is soft, the muscles at the front of the lower leg are not activated, and the foot is puddled on the floor.

Frequently people bend at the hip to try to get the weight over the forward foot, rather than staying tall at the hip and bringing the knee and pelvis forward. Keeping the back knee and the front foot quite close together can allow the transition to weight bearing through the front foot to happen more easily. The back toes, as long as they are flexible enough, can help by pushing the body forward.

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All adults should be involved in a strength training program due to the multiple health benefits. "Time Under Tension" is a technique that is useful in ensuring you get the results you want from your weight-training program.

I remember being a fly on a wall many years ago, listening in on a conversation between two exercise physiologists at the University of Toronto, arguing over which is more important for overall health, a weight training program or a cardiovascular training program. I think weight-training program wins the argument hands down, especially when one considers that if the exercise program is designed well, the participant will be getting a cardiovascular workout at the same time. So unless you are training for a particular athletic event such as a triathlon or 10km race, why bother spend all that extra time doing cardio? Most of us have better things to do with our time, and furthermore, aerobic training tends to break down muscle tissue which is counter-productive if you are trying to build strength.

As we age we tend to get weaker, and it is frequently a lack of strength that limits our function and closes down our life. The average 75 year old has difficulty carrying a 10lb bag of groceries much more than a block. Putting aging parents into a home that has no stairs is a big mistake in my opinion, because within a few months, they will not be able to do stairs at all, and will have more difficulty with curbs and getting in and out of cars etc. Our bodies respond to the demand imposed upon them, and if the demand is decreased, our strength will diminish. Use it or lose it!

Thankfully, the reverse is also true. Increase the demands on the muscles, and the body will get stronger. It is NEVER too late to begin a strength-training program and reap the benefits, which include:

• increased muscle strength and endurance, which translates into an
  ability to do things more easily, and to better enjoy life
• increased bone density, important in preventing osteoporosis
• improved balance and coordination
• increased calorie burn (1 lb of muscle burns 50 calories per day, so put on 10 lbs of muscle you burn 500 extra calories per day)
• decrease in body fat
• improvement in body shape
• improvement in mood
• decreased blood pressure because of improved muscle blood flow, which opens capillary beds
• decreased insulin resistance (important for type 2 diabetes / syndrome X)
• improvement in blood lipid profiles (lower triglycerides, higher HDL levels)
• improvement in digestion
• decreased fatigue levels
• improvement in sleep
• improvement sports performance

For strength training to be effective and in order to prevent injuries the exercises need to be done correctly and medical history and postural habits need to be considered, so hire a CHEK Practitioner or a qualified personal trainer to select the appropriate exercises and teach you how to do them right. The biggest mistake women tend to make, is to wave around itty bitty weights and expect to get a shapely body. To get stronger, the exercises must be CHALLENGING by the end of a set. Doing a set of 12 repetitions of bicep curls with 2 lbs is a complete waste of time. Women are frequently afraid of lifting heavy weights because they think they will get too muscular, but due to the low amounts of testosterone that women have, it simply won’t happen. Lifting heavy enough weight will create shapely, toned muscles – exactly what most women want. The biggest mistake men tend to make is to try and lift too heavy a weight, thereby using momentum to lift the weight rather than the muscle, resulting in less of a training effect. Using a slightly lighter weight that can be controlled throughout the entire range of motion will squeeze more tension out of the muscle resulting in better results. Only if one is training for a power or speed sport is it necessary to heave weights around very quickly. (Having a coach experienced in this type of training is highly recommended if power or speed training is what you want, as good technique is critical for injury prevention.)

Time-Under-Tension can be a useful method to ensure that the exercise is challenging enough to actually cause a training response, and is an interesting way to change up a tired 8-12 rep, or 15 to 20 rep weight-training program. By manipulating the speed of the repetitions and the time the muscles are
working, one can target specific goals, such as muscle endurance, body shaping (hypertrophy), strength and power. Movements must be done smoothly and with control, with no rest between repetitions, and with a weight that is heavy enough to be very challenging by the end of the time in question in order to maximize results. Beginners will have more success avoiding injury by moving quite slowly (at least 3 seconds up and 3 seconds down), and as exercise technique and fitness improves, and exercise goals dictate, exercise tempo can be increased. Beginners will gain strength on a muscle endurance program, as they are at the lowest level of their strength-gaining potential. After about 3 months their tendons and ligaments will have adapted adequately to progress safely to a hypertrophy program as long as exercise technique is good.

Although the times above are approximate, and ideal times may vary slightly depending on the individual, they do provide a useful starting off point. So, if your goal is to put on muscle mass or shape your body, you need a bare minimum of 30 seconds of time under tension to achieve that goal. If you are rushing through 10 reps at a tempo of 1 second up, 1 second down, you will be done in 20 seconds which is not enough time to get the results you want. So, next time you are in the gym, set a timer to a minute, do the movements slowly and with control with a weight that will tire you by the time the minute is up. Training according to time by adjusting exercise tempos and set times instead of repetition numbers ensures enough time under tension to get the results you want. Pay attention to rest times as well. Don't forget to raise the weight as you get stronger to keep the exercise challenging, and to change the exercises you do every four to six weeks.

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Car accidents frequently result in whiplash type injuries, where the head and neck are violently thrown forward and then back again upon impact, injuring the soft tissues of the neck.

Although vertebrae and disk injuries do occur often in this kind of a scenario, sometimes nothing obvious comes up on imaging tests, and the patient is left with neck pain without a concrete reason as to why. In other situations, the accident victim may feel surprisingly okay immediately post accident, and then a few weeks to months later may develop neck pain. In this scenario it may be harder to prove to insurance companies that the neck pain is actually a result of the car accident, even though there is a very understandable explanation for this pain pattern.

Our spine is meant to have three curves in it, one at the neck (cervical spine), another in the opposite direction over the ribs (thoracic spine), and finally another arch in the low back or lumbar spine. Just as having spinal curves that are too exaggerated can create painful problems, so can having segments of the spine that have straightened out. Whiplash-type scenarios frequently result in a straightening of the cervical spine in the neck. This makes the accident victim far more susceptible to developing disk herniations in the cervical spine, which can impact both upper body and lower body function.

After a violent whiplash, the muscles of the neck are severely traumatized. The head weighs between 12 to 20 pounds, depending on the size of the individual, and when the head is tossed forwards and then backwards with such force, and the muscles of the neck are unable to control the speed with which this heavy weight is being thrown around, the muscles become injured. The muscles frequently go into spasm and over time, tighten up, resulting in not only inadequate movement, but also compression through the vertebrae, squashing disks and narrowing the spaces through which nerves and blood vessels travel. When the deepest anterior neck muscles (longis colli and longis capitus) tighten up, they will pull the cervical spine straight. It may take a few weeks post trauma for the neck to straighten, but if this is not treated, the whiplash victim may eventually have disk problems, and potentially radiating pain into the arms, or TMJ (jaw) issues. Because the deep neck muscles also play a proprioceptive role in determining our position in space, injury to these tissues can be implicated in dizziness as well. (Of course, the cranium gets a major shake-up in a whiplash as well, so in my opinion it is important to examine and correct the position of the cranial bones as well.)

People frequently seek treatment from massage therapists that do an excellent job of releasing the muscles of the posterior neck, but unfortunately only a few massage therapists also treat the anterior muscles of the neck, which are just as badly injured, and also in desperate need of treatment. Massage therapists need to have training on how to move the trachea (breathing pipe) over, and how to avoid the carotid artery (blood vessel to the brain) to get right down onto the anterior surface of the cervical spine to release these muscles. Whiplash victims that complain of difficulty swallowing, dry mouth, dizziness, headaches, or a permanent tickle or lump in their throat, or whose posterior neck pain does not resolve once the posterior muscles are released, may need to get their longis capitus and longis colli treated as well. Certainly anyone who has lost the curvature in their cervical spine (obvious on X-Ray) should seek out someone who is able to release these muscles in order to restore the normal curve to the spine.

The superficial anterior neck muscles are also very important to treat in whiplash cases, as many of these muscles also attach to the jaw, and are involved in talking, swallowing, and can affect the function of the jaw, potentially creating TMJ problems. If the whiplash was at an angle, tension right to left in the neck muscles may be different, causing the floating bone in our neck (the hyoid bone, located at the fold in the neck) to be pulled in one direction or the other. Imbalances in the digastric, infra and supra hyoid muscles can also impact swallowing and jaw function, not to mention potentially impeding thyroid function. So, if you have suffered a whiplash, do make sure that as part of your treatment, you seek out someone that can release ALL the muscles of your neck, including the ones in the front.

Furthermore, for a more complete recovery, a motor-control based exercise program geared to learning how to recruit the neck muscles in the right order would be helpful, so that the outer neck muscles like the upper traps, levator scapula and scalenes learn to relax when they are not needed, reducing the likelihood of the muscle spasm coming back.

I am pleased to announce that I just passed my Paul St. John Integrated Somatic Therapy test, so I am official with respect to being able to treat these muscles, along with any other pain issues you may have. I have been providing personalized corrective exercise programs for over ten years now, so I can provide the complete package – both structural integration (massage) and exercise. So if you are in the Vancouver area, and would like me to help you, please do contact me by replying to this email. It would be my honour.

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

Related Tips:
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Travell, Janet G MD and Simons, David G MD Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual (2-Volume Set) Lippincott, Williams & Wilkins, Baltimore, 1999.

McKenzie, Robin and May, Stephen Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy (2-Volume Set) Spinal Publications, New Zealand LTD, Raumati Beach NZ, 2006.

Clark, Randall & Jones, Tracy Neuro ALP 1 Manual Neurosomatic Educators Inc. 2007.

Elliott JM et al. Characterization of acute and chronic whiplash-associated disorders. J Orthop Sports Phys Ther. 2009 May;39(5):312-23.

Pleguezuelos Cobo E et al. Postural control disorders in initial phases of whiplash. Med Clin (Barc). 2009 May 2;132(16):616-20. Epub 2009 Apr 22.

Armstrong B et al. Head and neck position sense. Sports Med. 2008;38(2):101-17.

Jull GA et al. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther. 2008 Sep;31(7):525-33.

Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004 Oct 1;29(19):2108-14.

O’Shaughnessy T. Craniomandibular/temporomandibular/cervical implications of a forced hyper-extension/hyper-flexion episode (i.e., whiplash). Funct Orthod. 1994 Mar-Apr;11(2):5-10, 12.

Copyright 2009 Vreni Gurd

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Maybe we should start each school day (and work day) with at least 20 minutes of aerobic exercise – it improves concentration, comprehension and learning.

This week CBC news (Canadian Broadcasting Corporation) put out a very interesting story about City Park High School in Saskatoon, that put treadmills and exercise bikes into a math classroom, and before doing any math, the kids strapped on their heart-rate monitors and did 20 minutes of moderate intensity cardiovascular exercise. This is an alternative school for those with learning difficulties, and over half the students have ADHD. They couldn't sit still, many had behavioural problems, and they couldn't learn. Well, the cardio equipment went in the classroom in February, and by June, pretty much all the kids had jumped a full grade in reading, writing and math. After doing the exercise the kids were suddenly able to sit still and focus on what they were learning, and they were able to understand what they were being taught. The exercise altered their brain chemistry enough to make learning possible, AND it greatly improved their behaviour.

With physical education frequently being cut out of curriculums to make time for academics, this should give pause for thought. Taking 20 to 40 minutes a day for sustained physical activity improves learning and grades in academic subjects more than actually using that time for the academic subjects themselves. Sustained aerobic exercise of between 65 to 75% of one's max heart rate wakes up the frontal cortex of the brain, the part that is needed for behavioural control. (To figure out your child's correct heart-rate zone, subtract his/her age from 220, and take 65 to 75% of that to get the target heart beats per minute.) Exercise causes the brain to create more nerve cells (neurogenesis), makes those nerves stronger, and helps them withstand stress, and improves neurotransmitter function, which helps the brain work better. Dr. Ratey, one of the key researchers in this area, noted not only improvements in those with ADHD, but also in those with bipolar disorder and schitzophrenia as well.

Alison Cameron, the grade 8 teacher at City Park School, noted that between February and June, the attention span of her students increased from 10 minutes to 3 hours. Many of the kids got off ritalin, and the kids were coming to school every day so she had the opportunity to actually teach them, which also improved learning. The students reported feeling happier, less angry, and definitely smarter, which improved their confidence levels, and made them realize that they would be capable of succeeding in life if they applied themselves.

In this day and age where we are moving less and less, sitting at the computer more and more, and children are less frequently allowed outside to play on their own, we need to ensure that kids get daily physical education, and beyond that, we need to make sure that every child and teen is actually moving enough during PE. In most PE classes, 80% of the kids are standing around waiting for their turn, or simply trying to avoid participating. It takes at least 20 minutes of sustained activity three times a week to make the difference in behavioural and academic performance, and that should be an important focus of school PE class in my opinion.

We are meant to move, and if we don’t we are not as resilient and we can’t use our brains maximally. So parents, if you want your kids to be smarter and better behaved and your school does not provide adequate movement time for your kids, perhaps family-based physical activity should become a priority. Creating the exercise habit young will also help them maintain a healthy body weight, and set them up for a life of good health.

If you would like to see the CBC documentary, click here. I think it is an amazing, hopeful story.

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

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Poor posture not only leads to musculoskeletal pain, but can also impair organ function.

I discussed in another post how our function determines our posture (habitually sit in a slouched position and our posture hardens into having rounded shoulders and a forward head), and today I want to discuss the other direction – how our posture determines our function (how well our body works.)

I’ve just returned from a fabulous Integrative Neurosomatic Therapy course presented through Paul St. John’s clinic in Clearwater Florida, where this point was driven home. Poor posture does not only cause musculoskeletal pain, but can also impair organ function. Think about it. If one stands with one’s ribcage tilted to one side, the organs that sit on that side (like a kidney) are going to be squashed, which could very well impair its function. If one stands or sits with a collapsed chest and rounded upper back (the posture common to those suffering from depression) the diaphragm can’t descend properly with each breath, which may impact the lungs, and prevent proper oxygenation of the blood. Not only that, but the entire digestive tract would be squeezed making it harder to digest and assimilate one’s food. Also, with the chest tipped forward like that, the major blood vessels (aorta and vena cava) as well as the esophagus, (the tube the food goes down to get to the gut) may wind up slightly kinked as they go through the hole in the diaphragm designed for those vessels, potentially irritating the vagus nerve, which is near by. So maybe your acid reflux is not an acid problem but a postural problem! A flat cervical spine (neck) may be the root cause of a thyroid issue, because the area in the front of the neck may not be getting adequate blood.

If there is a functional or anatomical leg-length discrepancy that results in the pelvis being tilted in standing (one hip higher than the other), there will be a corresponding tilt in the opposite direction somewhere higher up in the spine to ensure that the head is sitting straight, and that the eyes are level. This is why frequently those will low back problems also have neck problems, and why leg-length discrepancies are often a primary cause of scoliosis. The areas that are tilted are vulnerable to wear-and-tear and injury, such as disk bulges, SI joint problems, hip degradation and pain (usually on the longer leg).

According to Friberg who studied army recruits and verified his findings on Xray, up to 60% of us have an anatomical leg-length discrepancy of 5mm or more. I had previously believed that most leg-length discrepancies were functional – a muscle imbalance problem in the pelvis – but if one takes the pelvis out of the equation by just examining the legs in standing, the numbers with anatomical leg-length differences are extraordinarily high. Many of us have a small hemi-pelvis – one side of the pelvis is smaller than the other, meaning that while sitting the pelvis is tilted. A high hip/pelvis in either sitting or standing may also result in squished organs on that same side. Anatomical leg length differences and smaller hemi-pelvises are very common structural issues that can cause all kinds of pain and possibly disease processes, they are easy to fix through shoe lifts (not heel lifts!) and butt lifts, and are generally not looked for at all by most health practitioners. Not everyone with a leg-length discrepancy is in pain, (those that are using appropriate stabilization strategies will be more able to dissipate the forces away from the joints), but a tilted pelvis will affect wear at the joints (hip, SI, spine, even possibly knee and foot) over time, increasing the potential for pain at some point. Children should be checked because if caught early enough before the epiphyseal plates in the bones close, a shorter leg can actually catch up with proper shoe-lift treatment.

So, who is your structural integrator? We all need a functional medicine doctor, a dentist, and I would argue, we need someone to help us with our structure. Integrated Neurosomatic Therapists are trained to look for leg-length discrepancies and smaller hemi-pelvises, and can help restore good structure through massage therapy techniques, by releasing tight muscles that are holding bones in a poor position. KMI Practitioners and Rolfers are also structural integrators and can help us realign our posture through massage. Corrective Exercise Specialists such as CHEK Practitioners can also help you improve your posture by suggesting particular exercises that will strengthen weak muscles, thereby bringing your body back into alignment. Yoga, with its emphasis on good postural alignment, can also be very helpful.

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

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By Cord Reisdorf

It is easier to condition your body to be a professional athlete than it is to condition yourself to be an executive. Let that sink in for a moment.

But how could this be true? Professional athletes are prime physical specimens (Offensive Linemen and Bowlers notwithstanding), they put hundreds or thousands of hours into training for their sport and their bodies are their business.

True. But that said, they also (for most sports) have a lengthy off-season in which they regenerate, have a team of professionals to take care of their physical needs (trainers, physiotherapists, massage therapists, personal chefs et al) and their off-season workday may only be the 2-5 hours they spend physically conditioning themselves for next season, while the rest of the day is spent recuperating.

Their in-season conditioning programs become less intense and less frequent as they spend more time competing in their sport. And if that chosen sport is football, hockey, soccer, basketball or golf, their contests are usually less than 4 hours.

Let’s compare that with a typical senior executive. First, in business, there is no off-season! Second, a typical workday can be anywhere from 8-14 hours. Third, during the workday, an executive needs to be mentally sharp and agile in order to make good decisions quickly, all day long. Very few have an entire team of health professionals tending to them yet the mental and often physical demands (think travel, long hours, time zones, inadequate sleep) rival and surpass that of most athletes. Add all of this to the wireless age where work is never more than a belt-clipped BlackBerry away and it is not a stretch to see the correlation of pro athletes and executives.

So what is the solution for the boardroom brawlers?

Physical training. Conditioning the body so that the mind has the opportunity to do what it needs to do. And not just any physical training, but intense physical training in the right doses at the right time with the right frequency.

Beyond slimmer waistlines and bulging biceps, it’s well documented that optimal fitness levels will increase everything from energy & stamina, to mood and a general sense of well-being. If you don’t have the physical wherewithal to endure long days, arduous meetings and the typical daily grind, you will not have the energy to go the distance…whether that means closing the deal or making the sale.

When we are fatigued, we make poor decisions. Athletes don’t just train so that they start every game in their best shape; they condition themselves so that in the 4th quarter they are able to make good decisions because their bodies are still fresh. This allows their minds to be clear and focused on the task at hand, rather than being preoccupied with how fatigued they may be.

Do you have as much energy and stamina as you would like? How would your next meeting or negotiation go if you were as fresh at the end as you were at the start? Perhaps increasing the intensity of your current exercise routine (or starting a new one) will give you the edge you need to help you perform at your peak.

Cord Reisdorf is the Principal of Peak Fitness Management. For more information, visit www.peakfitnessmanagement.ca

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Extra time in gym class does not appear to do anything to reduce child obesity. So, what can you do to help an overweight child? Or yourself, for that matter, if this is a concern for you?

This news from the Canadian Pediatric Society conference held in Victoria, British Columbia, at first glance may seem surprising. Exercise helps one lose weight, right? Well according to this analysis of studies of school activity interventions done on 10,000 children in BC comparing Body Mass Index (BMI) before and after the intervention, there was no change in BMI, even in the studies where the activity interventions lasted three years. The studies analysis did show improvements in health measures like blood pressure, bone density, aerobic fitness and range of motion, but none of the studies showed a drop in bodyweight. This follows on the heels of another study done on 900 teens in grades 10 to 12 in the Vancouver area studied by researchers at University of British Columbia and McGill University in Montreal, who found “… there appeared to be no link between body mass index (BMI) values and levels of physical activity”

Body Mass Index is a simple measure used to compare one’s height to one’s weight (Weight in kilograms divided by height in meters squared). A healthy BMI is considered to be between 18.5 and 25, overweight between 25 and 30, and obese, over 30. This measure is frequently used in studies, and is well understood by health professionals. I think the number can be very misleading, however. For example, a very muscular male can weigh a great deal (muscle weighs more than fat), and still be very lean, but may have a BMI over 30. I find waist/hip ratio or even simply a waist measurement to be far more useful for before and after measurements.

The study results are a blow to those who are advocating for daily quality physical education in the schools, as it may be harder to convince officials to take children away from reading, writing and arithmetic if physical activity does nothing to stem the obesity tide. I hope those officials see the big picture, however. I think the goals of a physical education program should be to help children learn to love moving their bodies, so that they continue to do so when they are adults.  And the health benefits of reduced blood pressure, increased bone density, improved aerobic capacity, improved range of motion about joints, not to mention improved mental concentration are worth the time spent on daily physical education. There is no question about the increased health benefits gained from better physical fitness.

So, if your child is overweight (and if you or someone you know is overweight), what are some strategies that may work to lower body fat?

1. Control blood sugar and insulin levels, in order to reduce fat storage and encourage fat burning by:
   1. Reducing or eliminating sugar as much as possible – soda pop, juice, fruit drinks, candies, cookies, cake, puddings, sweetened yogurts etc.
      1. replacing with fresh fruit (not dried or canned) if something sweet is needed
      2. Encouraging water and raw milk (if tolerated) from grass-fed cows as the beverages of choice
      3. de-emphasizing desserts
      4. Using an activity as a treat rather than sweets
   2. Eliminating junk food – chips, cheesies, crackers, boxed breakfast cereals, pop tarts, boxed waffles, pre-mixed sauces, dressings etc. – anything that comes from a factory.
   3. Limiting the starches like white bread, pasta, white rice etc.
   4. Reading labels and avoiding artificial sweeteners – the liver stores toxins in fat tissue.  Use stevia to sweeten if needed.
   5. Choosing REAL food snacks, like a generous piece of raw cheese with some carrot sticks or an apple, a chicken leg, a hard-boiled egg, veggie sticks with a home-made full-fat yogurt dip or unsweetened nut butters.
      1. Quality fats are nourishing, not particularly fattening, and they decrease hunger.  If not sensitive, give even obese children some full-fat dairy like whole milk, raw cheese, butter, ghee etc. Girls do especially well when quality fats are included in their diet, according to this article on children's nutrition by Dr. Tom Cowan. Quality fats are needed for neurological, immune and hormone system development.
      2. Protein foods like meat, poultry and fish help children grow, decrease hunger, and are especially important for boys according to this article on children's nutrition by Dr. Tom Cowan.
      3. Vegetables are often not liked by children, so mixing with real cheese (broccoli/cauliflower and cheese sauce) or cream (creamed spinach) may help. Broccoli and cheese sauce is a MUCH better choice than macaroni and cheese sauce.
   6. Reading labels on medications/multi-vitamins – they often contain sugar or sweeteners
2. Ensure bedrooms are completely dark – night-time light messes withhormones, and hormones determine bodyweight.
3. Reduce screen time (TV and computers), and get them out of the bedroom. Not only does TV watching often go hand in hand with munching, but also advertisers market directly to kids, changing their food preferences for poorer quality food. I don't think I have ever seen a TV commercial for broccoli!
4. Do physical activity as a family (bike riding, walks, hiking etc.) to encourage life-long activity, and also to stop the lounging on the sofa watching TV syndrome. Teens that have reached their adult height can incorporate weight training into their life, which will increase insulin sensitivity.
5. Reduce or eliminate food products and skin products that have a long list of chemical ingredients. The liver stores toxins as fats, so ahigh toxic load may prevent the body from losing fat.
6. Drinking a big glass of water before meals may help by filling the stomach, reducing hunger.
7. Give your child a quality probiotic to improve the gut bacteria. There are many studies now indicating that the wrong bacteria in the gut can be a risk factor for obesity. There are probiotics made for kids available.

If you want to learn how and what to feed your children from infancy through the teenage years, I cannot recommend highly enough this article called "Feeding our Children". Children fed this way will be healthy, vibrant, and will learn and appreciate how to nourish themselves as adults.

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

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Here is a story I hear ALL the time. “I have a back problem. I stopped my exercise program and my back pain went away. But every time I begin my exercise program again, within days, or sometimes a week, my pain comes back and I have to quit again. I’m so frustrated because I’m out of shape and gaining weight, and I don’t know what to do about it.” After I assess them, I frequently tell them I think I can help them. There is a very good reason this happens, and there is definitely something you can do about it to get back on track.

We essentially have two muscle systems in the body – the muscles that move us (movers ), which are the muscles we tend to exercise in the gym, and the muscles that hold our joints (stabilizers), maintaining proper axis of rotation during movement at the joint. These muscle systems are quite different in how they work.

Mover muscles

• tend to be larger
• tend to be further away from the joint (closer to the outside of the body)
• greater leverage
• can exert higher forces
• they move bones (body parts like arms, legs, the trunk, the head etc.)
• Act more like the gas pedal – you want to move, they move you
• they turn on when we need them, and turn off when we don't.
• turn on quickly (more fast twitch fibres)

Stabilizer muscles

• tend to be quite small
• very close to the joint so they are in an ideal position to be able to
  stabilize a joint
• very little leverage
• smaller forces (just enough to do the job)
• they control the joint motion
• act more like brakes to prevent excessive joint movement, rather than
  actually move bones
• they anticipate movement, so they turn on before we move
• tend to stay on at low levels most of the time
• turn on slowly (slow twitch fibres)
• Pain may result when there is an imbalance in the stabilizer function
  around a particular joint, resulting in the resting bone position being
  altered, or the bone movement pattern at the joint being dysfunctional

An easy example to understand is the rotator cuff of the shoulder. The job of those small muscles is not to rotate the arm, but rather to hold the arm bone (humerus) into the socket, and make sure your humerus is maintaining the proper axis of rotation in the socket while your larger muscles throw that ball.

If the rotator cuff were not there, at best your arm would have slipped in the joint, and at worst your arm would have followed the ball! If there is an imbalance in the function and/or strength of the muscles that form rotator cuff, the humerus may not sit in the socket correctly, and when one moves the arm, pain may result.

The spine and pelvis is another location where imbalances side to side in the stability muscles can result in resting position of a vertebrae, or perhaps the sacrum being altered, creating pain, often one-sided. If the stability muscles on one side if the bone or joint are not working, the bone will be pulled towards the stronger side, outside its optimal functional position.

One can go to the gym and work the mover muscles all we want, but it probably won't resolve the pain unless the underlying dysfunction in the stabilizer muscle is also addressed. And working the movers in this scenario may make the painful condition worse, as the dysfunctional stabilizer won't be able to do anything to stop the excess movement at the joint. Movers may then go into spasm trying to stabilize the area, but because they are not in the right location to do the job, frequently more pain results.

So, do you have back pain, neck pain, shoulder pain, pelvic pain? If you live in the Vancouver please don't hesitate to contact me by using the contact page on my website if you would like one-on-one help. www.wellnesstips.ca. We would be happy to assist you.

If you live elsewhere, see a good physiotherapist or CHEK Practitioner who can assess you, figure out which stabilizers are not functioning optimally, and teach you what to do about it.

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

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The resting position of the shoulder-blade is important to the health and comfort of the muscles of the neck shoulder and upper back, and also to the nerves that run from the neck into the arm.

I recently taught a shoulder course, and so neck, upper back pain and nerve pain into the arm have been on my mind a lot. These are very common problems that many people suffer from, and although they can have many different causes, improving overall posture as well as the resting position of the shoulder-blade are frequently overlooked as potential solutions.

The shoulder blade or scapula is the triangular bone that sits on the back of our upper ribcage, which houses the arm socket. But unlike the hip socket which really is a cup that the leg bone (femur) sits in, the arm socket is shaped more like a tiny plate. Furthermore, the ball that forms the top of the arm bone (humerus) is a lot larger than the plate of the socket, so it is a bit analguous to a golf ball on a tee rather than in a cereal bowl. Except of course, when we talk about the shoulder joint, the plate is sitting on its rim. It becomes immediately obvious that the joint itself is inherently unstable, and it must largely rely on the ligaments, tendons and muscles that surround it to “strap” the arm to the body.

However, the angle of the plate can make a big difference to the strain the muscles are placed under. If the plate of the socket is angled up a slight bit, the humeral head (arm ball) can rest on the rim, whereas if the plate of the socket is angled down, the humeral head is essentially falling out of the socket, and the muscles have to work much harder to hold the arm in place.

Also, if the glenohumeral joint is pointing down as can be seen in the upper left diagram, usually the shoulder-blade will not rotate far enough when the arm is moved up overhead, and the arm bone (humerus) will bang up against the bony protuberance of the shoulder-blade called the acromion, creating an impingement problem, which may in time damage the supraspinatus (rotator cuff) tendon.

Furthermore, if the glenohumeral joint (arm socket) is angled down, the nerves that leave the cervical spine to go into the arm have a very long way to go – much further than if the glenohumeral joint were angled up. Nerves don’t like being stretched, and stretched nerves tend to be painful. I find that when I see someone that has a shoulder socket pointing down with radiating arm pain or sore neck/shoulder muscles , I tell them to relax, and I pick up their armpit (actually the upper arm near the armpit) and hold it up for a few minutes. Frequently their pain goes away, and then I know that providing an exercise program that improves the position of the shoulder socket will probably work.

So, how do you tell if your arm socket is pointing up or down? Tough to do on your own, but if you have very long, sloped shoulders you can be suspicious. If the outer end of your collarbone is lower than its attachment at the sternum, your glenohumeral joint is pointing down. Most of you will need to ask a friend or partner to look at your shoulder blades from the back. If the bottom corner of the shoulder blade is closer to the spine than the top part of that inner border as shown in the left upper diagram, then your shoulder joint is pointing down.

If you are in pain and you discover that your socket is pointing down, you need to find a good physiotherapist , CHEK Practitioner or an extremely knowledgeable personal trainer that can teach you how to build muscle endurance in serratus anterior, low traps, and upper traps without overusing levator scapula, rhomboids, and lats, and even more importantly, teach you how to move your arm and shoulder-blade so that you recruit the right muscles in the right order to keep your shoulder, upper back and neck happy.

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I've been meaning to do a list for some time, but always wondered if I had read enough to put together a complete list. And, I am definitely missing some topics, like books focused on food allergies and detoxification, both of which are the root causes of problems in many individuals, but so far, based on the books I've read, I think that the following reading list is a good place to start to learn how to maintain or improve one’s health. Choosing the books, and then selecting the order in which to rate them was REALLY HARD, as every book has much to offer, and choosing one book over another on a certain topic left many excellent books off the list that are also well worth reading. These books are all geared to the lay person, although many if not all would greatly assist physicians and others in the healing professions in helping their patients.

With no further ado, – drum roll – here is the list, starting from 10 and counting down to number 1!

Number 10:
Fast Food Nation by Eric Schlosser
A great book about how corporate profit and the systemization of food processing has resulted in a complete degradation in the quality of food being produced. Far more important to these companies than producing healthy food is finding ways to make you buy their product. It is frightening to learn the extent some companies have gone to to prevent regulations that would stop them from selling you contaminated food. Also talks about the social consequences of low-wage fast food and food processing jobs on communities. A book that will put you off fast food, which will definitely improve your health!

Number 9:
Nonviolent Communication – A Language of Life by Marshall B Rosenburg, PhD
Relationship stress is often rooted in a communication style that stimulates an angry or defensive response in the other person. Learning to communicate in a nonviolent way that still allows you to express your feelings and get your point across can do much to reduce stress. Stress is implicated in heart disease, diabetes, depression, digestive issues, osteoporosis, immune disorders, thyroid problems etc., so learning to control stress is vital to improved health.

Number 8:
Loving What Is by Byron Katie
In situations where one is unhappy about something completely out of one's control, accepting the reality of the situation is the ticket to emotional happiness. What makes us miserable is the stories we tell ourselves about our problem or situation. Just as it makes no sense to get upset about the rain, it makes no sense to tie ourselves in knots about the career choice of one’s child, the relationship problems of a relative or friend, or the inability of our spouse to pick up after themselves. Ultimately the control lies with the other people involved, so although one can lend an empathetic ear, there is no point wasting emotional energy. Far better to devote energy to things within one’s control.

Number 7:
Nutrition and Physical Degeneration by Dr. Weston A. Price
This book was at the top of the list on my first draft. Dr. Weston Price traveled the world in the '30s studying primitive societies that had not yet come in contact with "white man's food", and discovered vibrantly healthy populations with good bone structure and minimal tooth decay. The diets were as varied as the societies he studied, but no society was vegetarian, and many societies actively sought out a particular food (usually a form of saturated fat) to give to their newly married couples, pregnant women and young children to ensure good development. If you are planning to have children, this would be a good book to read before conceiving, as the nutritional status of both parents prior to conception is very important to the lifelong health of the child.

Number 6:
Nutrition and Your Mind by Dr. George Watson
One of the early researchers in the concept of metabolic typing, Dr. George Watson is believed to be the one who discovered that different individuals oxidize their food at different rates, and that the type of food eaten can either slow down or speed up the rate of oxidation. Slow oxidizers need food that speeds up their oxidation rate, whereas fast oxidizers need food that slows down their oxidation rate. Both slow and fast oxidizers that are eating an inappropriate diet for them may develop similar symptoms of illness, but they require different diets in order to resolve their biochemical imbalances. Dr. Watson spent his career balancing the biochemistry of those with mental illness through food and specific nutrient therapy.

Number 5:
Why Zebras Don’t Get Ulcers – An updated guide to stress-related disease and coping by Robert M. Sapolsky
A comprehensive book on the topic of stress written for the lay person. Quite funny at times, but also quite involved, one learns a great deal about the physiology of stress. Lots of good suggestions here on how to reduce one’s stress levels as well. I put this book in the top 5, because I now believe that chronic stress, whether physical or psychological, results in a deterioration in hormone balance in the body, which eventually leads to disease.

Number 4:
Your Guide to Healthy Hormones by Daniel Kalish, DC
Particularly in middle-aged women, but also applicable to women and men of all ages, hormone imbalance is frequently the cause of a large variety of health issues including insomnia, overwhelming fatigue, lethargy, PMS, depression, hypo or hyperthyroid, osteoporosis, diabetes, cardiovascular disease, decreased libido, to name a few. This book gives a good overview of the hormone, digestive and detoxification systems and how they interact, how problems arise, and how functional testing can lead to appropriate diet and lifestyle recommendations and supplementation if needed, in order to rebalance the systems and get them functioning optimally again. The key is treating the individual’s imbalance rather than the general health problem.

Number 3:
Know Your Fats: The Complete Primer For Understanding the Nutrition of Fats, Oils, and Cholesterol by Mary Enig, PhD
This book is in my top three, because the topic of fats are SO misunderstood, resulting in much of the population choosing fats that cause free-radical damage and inflammation in the body, and avoiding healthful fats that are needed to transport nutrition into the cells, good fertility, and good overall health. So here is the truth about fats from a fat researcher that has never been paid by the food industry – what a different story she tells! I wish every doctor would read this book and pass on this vital information to their patients.

Number 2:
Lights Out: Sleep, Sugar and Survival by TS Wiley and Bent Formby
Circadian stress is epidemic in our society. Very few of us take enough restorative time, let alone dark time, and the consequences are destroying our health. Many of our hormones have circadian rhythms, some determined by the amount of light or darkness we are exposed to. Inadequate darkness and too much time in the light leads to hormone imbalance, carbohydrate cravings, weight gain, depression, and possibly cancer and heart disease. If you can get past the sensational style in which this book is written, the information is interesting, valuable, and definitely well researched, as over a third of the book is references.

Number 1:
How to Eat, Move and Be Healthy by Paul Chek
This, in my view, is the best book on general health and wellness that I have currently read. It covers everything from nutrition, to exercise, to sleep, to digestion, to chronic stress, and through questionnaires helps you personalize your nutrition as well as your exercise program, which is vital for success. It is easy to read, with lots of photographs and diagrams to help the reader understand the concepts. If you only want to buy one book, this is the one to get.

There you have it. It will be interesting to see how much I revise this list next year, after another year of reading under my belt.

For those of you that celebrate, have a wonderful, peaceful Christmas.

Please feel free to comment on this list or suggest your favourite health books! I have updated my website – do check it out at www.wellnesstips.ca.

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