Movement assessments have become a clear and comprehensive evaluation and approach to my Chiropractic therapy. It begins with me looking at each clients standing posture. I then ask my client to perform a series of postures. You know this portion as ‘range of motion’ evaluation. For example, I say to the client, “Bring your chin to your chest”, etc., or “bend forward to touch your fingers to the floor” or “raise both arms over your head” bla bla bla! It is old school, but I realize I need to document how far they move and if any sensations present themselves. I have become a keen observer of these movements, one who is not just interested in how far they move, but more interested in the way they move and what there movement pattern can tell me. The evaluation continues with a series of dynamic and static postures to observe how the muscles and joints move. Through this process I generate a sequence of home exercise programs for my clients. Please realize, the movement assessments can be performed prior to any hands on work that you do, or the assessments can conclude with a mobilization or manipulation that you feel is necessary.
If you have read my previous articles you will know that I start with the squat assessment. Observe the client perform a squat several times. Simple say “Let me see you do a squat with your arms out in front of you.” The benchmarks that I look for on this evaluation are that the:
If they cannot accomplish the above criteria I start the correction process with the following training: I call this the supine120 degree knee to chest maneuver. Client lays supine in the 90/90 position. The knees are over the hips and the legs are parallel to the floor. Doctor stands at the feet of the client and uses a knife edge contact along the clients ankle crease. The Doctor resists at the ankle crease while the client is instructed to “pull your knees to your chest.” The Doctor allows the client to move into a knee to chest position. The doctor is providing resistance, not overpowering the client. The client’s lumbar region should remain in the neutral spine. Instruct the client to focus using the lower abdominals, especially the area slightly above and below the inguinal region. Allow the hips to get to at least 120 degrees. This maneuver is a great way to get clients to re-awaken this area. Bring awareness of tightness to this area while you tell the client to release tension or resistance in other areas such as the neck or shoulders that are not needed for this maneuver. Repeat this maneuver as many times to client tolerance.
The next progression is a pose called ‘Find your stance’. This is used as a foundation of all standing postures and movements. I want this to become the natural way to stand. It cultivates a sense of strength and stability. Begin with your feet (shoes off) between your hips and shoulders – go with what feels natural and comfortable. Slightly angle your feet outwards with your weight evenly spread through the balls, lateral edge and heel. Avoid your arches collapsing inwards. Try to feel the medial and longitudinal arches lift up.
Assisted Squats: Doctor and client face each other. ‘Find your stance’, or spread feet to shoulder width or slightly wider if needed; client holds arms and hands out in front of there body; Doctor holds hands with client and assists client to squat. The command is “pull your butt down.” The Doctor is providing assistance so the client doesn’t fall down. However, the client may fall to the floor the first or second time and that is perfectly normal and O.K. to do. Simple get back up and attempt it again. The idea is to allow them to go as deep as possible. Get the client to engage the groin crease muscles to pull them down. The goal of doing this squat is to reach back with the buttocks and down, ex. Sit back on a chair with control. If you have a rope or Theraband (at least the strength of a black theraband), you can wrap it around the clients back and underarms while you hold the ends in the front of the client and ask then to “sit down against” that resistance. Doctor coaches the client to keep the back straight, in this case as vertical as possible. FIGURE 1 Rubber tubing under the arm pits and you assist client to sit down against this resistance. The knee should not bow inward.
“Pull the hips out of the socket” routine to squat. This maneuver requires two assistant partners (the doctor plus an assistant). The client is instructed to squat down in a wider than shoulder stance. The Doctor is to the left of the client and the assistant on the right side. Each assistant places one flat hand behind the posterior leg just below the knee crease. The other hand is placed in the inguinal fossa/ligament crease with a knife edge contact. Assistants use enough pressure to guide the client into a deeper squat. Ask the client to feel like they are pulling the hips out of the socket as they descend. This allows the client to understand and feel the proper joints and muscles to use to accomplish this squat. Allow the client to learn in a wide stance and go as low as they can. As they improve strength they can get into a more narrow stance. Less core muscle is required in a wide stance than a narrow stance. Repeat this maneuver several times. Do a simple test on yourself. Stand in a wide stance and go narrower and narrower until you are in a one legged stance. Feel how the core is participating. Eventually we will get clients to have there feet closer and closer together and this will demand greater core strength.
Right after this maneuver, it will help your client if the Doctor rubs his/her index fingers along the spinous processes while the client does several more squats. This is performed starting at approximately the middle of the back with both index fingers. At the same time rub one finger headward and the other caudal along the spinous process while the client squats down and up. While you rub the spine, instruct the client to stay in a “tall spine” posture. They need to imagine creating more room in the hip socket. Tell the client to think of one thing and only one thing on the way up and that is “gluteals.” You don’t need to suck the stomach in if you elongate the spine, it will automatically come in if they are working to resist extension.
Squat against the wall. This is such a new take on the old school method of a wall squat. Once a person can accomplish the “static wall squat” also known as the “wall sit”, “wall chair,” “airbench” or “back against the ball squat” for one minute, they are ready for this maneuver. Find the distance away from the wall so that when you squat down your sacrum stays in contact with the wall. The key is to keep the sacrum touching the wall. Squat down with arms on the inside of the thighs until the elbows can push against the inner thighs. Put your hands in a prayer pose and push the elbows against the inner thighs. Pry the hips apart as you wiggle side to side going lower and lower. Continue this gentle rocking side to side and attempt to go lower and lower opening the hips. You should feel this in the most proximal attachments of the adductor muscles and hamstrings. Hold this pose for as long as you can and then concentrate on getting back up using the gluteals and keeping the sacrum in contact with the wall. Try this maneuver several times. One minute in this pose really gets you feeling warm. Attempt this with a narrow stance compared to when you are away from the wall. The next progression is to repeat the squat away from the wall.
PIVOTS: These help open the hips. Standing with your feet more than 3 feet apart, with outstretched arms (abduction) to your sides away from the body (the feet should be under the wrists distance). The feet will need to be angled slightly outward approximately 15 degrees. Keep the torso facing forward. Lunge gentle to the left until your knee is bent in a right angle above your left foot. Lengthen the spine upward (“tall spine” concept). Move side to side going more and more lateral (lower). The opposing forces of your legs provide balanced stability. Don’t lean the body towards the bent knee, try to keep the torso upright as much as possible. Imagine the hands pulling further side to side. Allow the sitting bone to be pulled backwards. The legs, both pushing forwards and pulling backwards, allow the hip to hinge and become stable at the same time, two opposing forces balancing one another. Shoulder blades should be kept down.
I recommend clients practice these maneuvers daily. I want my clients to observe subtle changes in posture, decreased pain, increased range of motion, feelings of stability, and a greater capacity for work and sport. As individuals vary in strength, flexibility, and coordination so the practice of functional exercises will be unique to each individual. Using progressive movement as assessments in your practice will tell you where the client is strong or weak, symmetrical or asymmetrical, balanced or imbalanced, coordinated or incoordinated, and which areas need more practice.
As we discussed in the January 2008 newsletter, feeling good in body, mind and heart is definitely connected to the choices we make daily. In this issue, we will continue the FirstLine Therapy (FLT) discussion along with touching on matters of the heart.
Our FLT program is a comprehensive treatment program. We will start by measuring your body composition
(see BIA Testing PDF) and thoroughly analyze and design a friendly personalized health program which will address diet and exercise, along with stress-reduction and attitudinal healing techniques. While other lifestyle programs are narrowly focused, our program addresses the full you!
Not Just Another Diet! FirstLine Therapy’s eating plan is specifically tailored and closely monitored for ease and optimal results. Most food plans are restrictive – no carbs, no fats and no variety. Most plans severely limit the amount of food you eat and the types of foods you eat – their success is primarily based on “willpower”.
FLT is different! Our plan emphasizes the need to eat and to eat often. The focus is on eating the types of foods that are best for you – the right quantities and qualities of carbohydrates, proteins and fats. The diet also incorporates a low-glycemic-index food plan allowing for optimal blood sugar and energy levels.
Studies show that low-glycemic diets are more effective than low-fat diets in treating obesity, insulin resistance, high cholesterol, cardiovascular disease, and type-2 diabetes. Additionally, FLT has been demonstrated to be effective in controlled clinical trials, while most other diets have not.
Whether weight loss is your goal or not, the FLT plan will help you lose unwanted and unhealthy fat while maintaining and building lean muscle. Just because you’re thin, doesn’t mean you’re healthy – the research now clearly demonstrates that a major factor in determining health is the fat to lean muscle ratio, not your weight….
A healthy body weight is where you feel healthy and fit, have no eating disorders to maintain that weight, and have a healthy functioning immune, hormonal and reproductive system. It is also a weight that you can realistically reach and maintain with healthy lifestyle efforts. One of the most important components of good health is your muscle-to-fat ratio. Over the last 25 years, body composition analysis has become a primary factor in the assessment of health status and the risk potential of developing certain diseases. The research suggests that there are direct correlations between high body fat measurements and the onset of chronic conditions such as heart disease and diabetes.
To effectively manage body weight and body composition, it is important to know your daily caloric requirements. A bioelectrical impedance analysis (BIA) test can tell us body composition and basal metabolic rate. Accurate assessments using BIA, allows me to determine each client’s unique personal caloric requirements and better plan and evaluate weight management, exercise programs and comprehensive FirstLine Therapy programs.
The optimal body fat range for women is between 12%-25% and ranges between 5%-20% for men. Through eating and exercising properly, you can effectively bring your muscle-to-fat ratio into a healthy range. Our FLT program addresses the muscle-to-fat ratio issue and so much more!
FLT focuses on lifestyle factors that are the underlying cause of most health problems. Since your FLT program will be designed specifically for you, you will begin to feel better and see results within the first week or two. Most people report less hunger and more energy, making it easier to stick to the program. Working together, we can realistically design a program that fits your needs and lifestyle.
Questions? Please feel free to call me with any questions or concerns you may have about starting our FirstLine Therapy program.
One of the first changes to a cardio program I do is to have my clients eliminate conventional aerobics. For example, if a client is spending 60 minutes on a treadmill, elliptical, or swimming, I recommend that they spend that hour of time performing: 10 minutes on the foam roll; 10 minutes isolated stretching; 35-40 minutes doing a combination of body weight exercises, work out with the Gymstick, and/or lift free weights; and 15-20 minutes on cardio training using interval training techniques.
Body weight exercise can mean squats, lunges, push-ups, pull ups, etc. When I train my clients to lift free weights, I want them to lift heavy weights – not light weights. When I teach free weight training, I recommend creating circuits of 5 exercises, performing 6 repetitions of each exercise and then performing the circuit 3 times. The 6th rep of each set should be difficult to complete if you are using the correct amount of weight.
In three separate half hour in-office sessions (one per week for three weeks), I can teach my clients approximately 15 different Gymstick, body weight and/or free weight exercises. At the end of the three sessions, they have learned and practiced enough with me to perform a 15 minute, 30 minute, or a 45 minute whole body, customized workout routine.
The Gymstick is a fitness tool that combines a stick and exercise bands into one effective workout. You can do hundreds of different exercises and combination movements to improve strength and flexibility. Every Tuesday and Friday mornings, I teach a small group exercise class. My experience has shown that Band or Gymstick exercises can be performed for one minute intervals, then change to the next exercise for the next minute and continue this routine for 20-45 minutes. This provides a great cardio, strength and flexibility workout!
Is there a better way to exercise than running to promote cardio and fat loss? Yes, the answer is Interval Training. What is interval training? Interval training is broadly defined as alternating brief periods of very high-speed or high-intensity work followed by periods of rest or very low activity. In interval training, high heart rates during work periods and low heart rates during recovery follow each other. This not only results in increased cardiovascular strengthening, but increases the energy expended per minute, increasing calorie output, and thus resulting in an increase of fat loss. Simply put, the concept of interval training is: go fast then go slow.
Unfit clients can’t run to get fit – you need to be fit to run. When people decide to start an exercise program they usually think of walking as a major form of exercise. Walking is an ideal place to start. How do you apply interval training to walking? If you’re in good shape, you might incorporate short bursts of jogging into your regular brisk walks. If you’re less fit, you might alternate leisurely walking with periods of faster walking. For example, if you’re walking outdoors, you could walk faster between certain mailboxes, light poles, trees, or other landmarks.
Have you ever noticed when people continue to do the same walk day-in and day-out and do not add periods of short bursts to increase metabolic activity to improve their fitness level, that they simple stay at the same weight, Body Mass Index (BMI), and body composition? If clients are just beginning an exercise routine I also suggest that they include bicycling in their routine. Since bicycling allows for maximum metabolic disturbance with minimal muscular disruption, one can easily increase their metabolic rate and increase the efficiency of their exercise activity. To apply interval training to cycling, you could pedal ‘all out’ for 60 seconds and then ride at a slower pace while you catch your breath for the next 2-4 minutes.
In my home gym where I work out, I have an Elliptical machine and I do my interval training on it. For example, I warm up at a speed of 5.5 for 5 minutes, then perform short fast (speed of 8-10) bursts for 30-60 seconds. I slow down for a minute and then repeat the fast burst again. This is performed for 15 minutes.
We will continue our exercise and interval training discussion in upcoming newsletters – so please stay tuned!
I have a lot of patients on cholesterol lowering drugs (e.g. statins) and I have to tell you, I’m really alarmed about this. These drugs deplete the essential nutrient CoQ10. Higher statin potencies and dosages shrink target LDL cholesterol, but the prevalence and severity of CoQ10 deficiency is increasing LDL too. Drug companies keep lowering the target cholesterol levels and this creates more candidates for statin drug therapy.
Statin induced CoQ10 depletion is well documented in animal and human studies with detrimental cardiac consequences in both animal models and human trials. This drug-induced nutrient deficiency is dose related and more notable in settings of pre-existing CoQ10 deficiency such as in the elderly and in heart failure patients.
Published data indicates that statins can cause myopathies (muscle aches and pains) and muscle breakdown with renal failure….
Moreover, on May 1, 2000, the FDA issued a warning about liver failure as an adverse reaction of statin use, based on reports that more than half of 62 patients with liver failure died. An estimate claims that the drugs can cause liver and muscle injury in up to 1% of users. For the US this will equal up to 130,000 patients with liver and muscle toxicity symptoms. Moreover, statin use is also implicated in the increased incidence of cataracts, neoplasia, peripheral neuropathies, and some psychiatric disturbances.
Statin-induced CoQ10 deficiency is completely preventable with supplemental CoQ10 with no adverse impact on the cholesterol lowering or anti-inflammatory properties of the statin drugs.
Metagenics’ CoQ-10 ST-100™ — 1-2 softgels daily. CoQ-10 ST features 30 mg of a stabilized, all natural encapsulation of coenzyme Q10 (CoQ10) manufactured to achieve exquisite quality, purity, and bioavailability.
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Replenishes healthy CoQ10 levels in patients who may be deficient, such as those taking popular cholesterol-lowering agents and individuals over 50
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