Goal setting has been touted as the most effective way to achieve success in life.  We’ve been told to write them down, stick them to our refrigerator door and even to write them on our bathroom mirror.  You’ve heard that goals should be SMART – specific, measurable, attainable, realistic, and time oriented.  I even wrote a blog post on effective goal setting.  Recently, I’ve moved away from goal setting with both myself and my patients, focusing instead on daily habit formation and the implementation of routines that set you up for success now and in the future.  The inspiration for this change came after listening to the Atomic Habits audiobook by James Clear.  Clear argues that goals are easily procrastinated upon, and can often be too daunting to even get started in the right direction.  By focusing on daily habits and routines, you will improve yourself each day, setting yourself up to achieve success and ultimately to conquer even the loftiest of goals. 

The problem with goal setting

One of the main problems I see with goal setting is that time oriented goals are susceptible to procrastination.  If my goal is to lose 20 lbs. by the end of the year, it’s very easy to let myself wait until 6 or even 3 months are left in the year to start working towards the goal.  Why start now when I have an entire year to accomplish my goal?  A goal that is set out over a year may lose steam after a couple of months, which is what I commonly see with patients looking to make health changes at the beginning of the New Year.  Everyone knows that you will see more people out walking in your neighborhood or exercising at the gym in January, February and March only for it to taper off as the year progresses.  Rather than setting a time oriented goal, instead pick daily habits that will incrementally help you achieve whatever you envision for yourself.

Define your ideal self

Before completely throwing away your list of goals, make sure you have a clear idea in your mind of what you want for yourself.  Envision your ideal job, body composition, and skill set.  Where do you see yourself in 5 or 10 years?  Where do you want to be financially?  How do you define your ideal self?  Once you’ve established these parameters, you are better suited to implementing daily habits that align with this vision.  If you envision yourself as having a fit and healthy body, implementing a daily habit that helps you save money or be more organized doesn’t necessarily bring you closer to your vision.  Instead, for weight loss, pick habits such as a consistent gym routine, a healthy breakfast at the same time each morning, or reading a book before bed to help promote optimal sleep and recovery.  

Do this instead

As stated previously, the alternative to goal setting is the implementation of daily habits and routines.  Habit formation is beneficial because it focuses on daily growth.  If we aim to grow and improve ourselves little by little each day, the culmination of consistent work will be incredible in the long term.  We may not notice the improvements on a day to day, micro level, however, if we step back after a year and look at the macro improvement the results are substantial.  True growth and change does not come with drastic lifestyle changes such as an extreme 10 day fast or juice cleanse but rather with small steps each day in the right direction.  

 

Next, I show you how to reframe your goals into daily habit formation.

Goal #1: ‘I want to lose 20 lbs. before summer’

Habit: I will work to implement a habit where I do 3 sets x 15 push-ups in the morning followed by drinking a 16 ounce glass of water.  

Habit: Weather permitting, I will go outside in the morning for a 10 minute walk in the sunshine before work.

(First morning exercise and sunshine stimulates cortisol release and helps to regulate our circadian rhythm.  Sufficient cortisol release in the AM will decrease cravings for fried and sugary foods in the evening which occurs if cortisol levels remain high.)

Habit: I will place a pan, plate, and eating utensils out in my kitchen before I go to bed each night.  Already having the pan on the stove increases the likelihood that I will cook a homemade breakfast and adopt a more consistent eating schedule that includes breakfast each day.

 

Goal #2: ‘I want to increase my sales at work by 15% this year’

Habit: I will wake up at the same time every day to ensure a consistent sleep schedule and to increase my productivity at work. 

Habit: I will call 2 potential new clients each day prior to leaving for lunch.

Habit: I will send a thank you card to 2 existing clients each week thanking them for their business.  

For work related goals, consider setting up a daily, weekly, and monthly checklist in a binder or whiteboard to track progress of tasks to be completed.  Make these tasks part of your habits at work and you will see your productivity increase.

 

Goal #3: ‘I want to improve my relationship with my parents’ 

Habit: Each morning I will practice gratitude by writing down 3 things in my life that I am grateful as part of a journaling routine. 

Habit: I will call one of my parents every Friday after work to check in.

 

Goal #4: ‘I want to be more organized’

Habit: Each morning I will make my bed as the first task to be completed in my day.  Making your bed each morning sets yourself up for success throughout the rest of your day and helps you to establish a task completion mindset.

Habit: Each morning when my coffee is brewing I will take 5 minutes to tidy up my living room so I leave for work with an organized living space. 

 

Goal #5: ‘I want to get better sleep this year’

Habit: I will develop a habit where I turn off all electronics at least 1 hour before bed time.  Blue light exposure stimulates cortisol release at the wrong time of day and will make falling and staying asleep more difficult. 

Habit: Prior to going to bed I will write out tomorrow’s ‘To Do’ list in a journal that I keep by my night stand.  Getting tomorrow’s tasks written down will give you peace of mind and allow your brain to turn off before going to sleep.

Habit: I will read for 20 minutes before bed.  Reading, especially fiction, gives your brain a singular point of focus, and helps you get your mind off of the day’s stresses.  

 

I hope this article gives you valuable insight into daily habit formation and the power it can have.  I finish with a quote from W.H. Auden – ‘Routine, in an intelligent man (or woman), is a sign of ambition.’

Post written by Dr. Riley Kulm, DC.  Check out his bio here

My Least Favorite Exercise Part 2 – The Quadricep Knee Extension

Continuing with the theme of our last blog post My Least Favorite Exercise – The Clamshell, I’d like to highlight another popular exercise that should be avoided at all costs.  This week, my least favorite exercise is the quadricep knee extension exercise.  I regularly see people at the gym using the quadricep knee extension machine, and I truly worry about their orthopedic health when I’m watching them.  To perform the machine based knee extension exercise, people sit in a chair with a pad on their shins.  Next, they kick their legs straight against the resistance of the machine, contracting the quadriceps muscle.  People perform this exercise because they want to improve the strength and size of their quadriceps muscle – some may even think it’s healthy for their knees; however, the biomechanical consequences of this exercise can be highly detrimental to the health of your knees.  

Open vs. closed chain exercises

The machine based knee extension is a single joint, open chain exercise.  Open chain exercises refer to movements where the distal extremity (hand or foot) is not fixed and is freely moving in space with or without external resistance.  Examples of open chain exercises include a bicep curl, hamstring leg curl, and shoulder fly.  Open chain exercises cause an isolated muscle contraction over a single joint of movement, which some believe to be beneficial in the early stages of an injury rehabilitation program.  Open chain exercises are in contrast to ‘closed chain exercises’ where the hand or foot is fixed to the floor.  Examples of closed chain exercises include the squat, deadlift, or push up.  Closed chain exercises involve multiple muscle groups and require coordinated muscle contractions to complete the compound (multi-joint) movement.  

The forces imparted on the joints differ between open and closed chain exercises.  For open chain exercises (quadricep knee extension) the force imparted by the weighted resistance is transmitted back up the leg and into the knee joint.  This force can cause compression in the knee joint, putting increased pressure on the meniscus, ACL, PCL, and patella-femoral joint.  In contrast, with closed chain exercises (deadlift) the force imparted by the external resistance is transmitted into the ground.  For instance, in a deadlift, the force from the load is pressed through the feet into the ground rather than up the body into the knees and hips.  

The second problem with the exercise is that it is a repetitive concentric exercise.  Remember from my last post, concentric muscle contractions occur when the muscle is shortening and repetitive contractions over time can cause a shortening and tightening of the muscle fibers even while at rest.  Ignoring the eccentric (muscle lengthening) component of a muscle’s function can be detrimental to movement patterns and ultimately put you at an increased risk of injury.  Additionally, a short and tight quadriceps muscle can pull upwards on the patella, altering the mechanics of the patella-femoral joint and cause conditions such as patellar tendinitis which is also known as Jumper’s knee.  

What to do instead – deadlifts, squats, single leg squats, reverse lunges

If you want to strengthen your quads and the rest of the muscles in your leg, the best exercises are closed chain, compound movements that integrate the feet, hips, and core to create a functional and stable lower body.  My favorites are deadlifts and lunges because you can add a lot of weight without placing much force on the knee joint (when performed properly). 

As I said previously, closed chain exercises like the squat and lunge transmit force down into the ground, which is why they are popular for building speed and explosiveness in strength and conditioning programs. 

Post written by Dr. Riley Kulm, DC.  

Check out his bio here.

After a car accident your ‘to do list’ may be long – get your car fixed, find an attorney, file a claim with your insurance agent, find a rental car to get to and from work, etc. For most, the damages to your body are less of a concern in the initial stages following an accident. Unfortunately, many do not know where and how to find treatment for their injuries. Without the guidance of someone who understands the system, it’s possible to get taken advantage of as there are extensive legal businesses built around profiting from MVAs. In this post I’ll describe some of the most common injuries sustained during MVAs, as well as give you insight into the medico-legal process and how to make sure you get the care you deserve. 

Opt into MedPay

In Colorado it is state law every insurance company provides their drivers with a minimum $5,000 Medical Payments Coverage (MedPay) policy in addition to their automobile liability policy¹. MedPay should be included on any insurance policy by default and is against state law for an insurance company to deny a customer MedPay.  The $5,000 policy provides coverage for the driver, as well as the passengers in the insured driver’s car, regardless of which party is at fault. MedPay even covers you when you’re in a car that isn’t your own. Unlike other medical insurance, MedPay never carries a deductible or co-pay in the policy and is available immediately following the accident².  Colorado MedPay covers payments related to bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of the motor vehicle.  Colorado MedPay can be used to cover accident related expenses such as emergency or trauma care, ambulance rides, emergency room care, imaging services (X-rays, CT scans, or MRI’s), and conservative care treatments from chiropractors, massage therapists, and physical therapists. 

Despite being mandated by Colorado state law, some insurance companies find ways to avoid providing their customers with the required $5,000 MedPay coverage. I’ve had numerous patients tell me they unknowingly opted out of their MedPay coverage before being told what the payment meant or included. Insurance companies in Colorado are required to include MedPay by default into any new policy, however, if you’ve opted out in the past, the insurance company is not required to remind you of MedPay or to ask if you want to opt in. If you use MedPay for an accident where you were not at fault your insurance company cannot raise your premium following the accident. I highly recommend calling your insurance agent today and making sure you have not opted out of MedPay. MedPay should be of little or no extra cost to your policy, and will provide you with much needed, immediately available funds following an accident.  

Common injury patterns with MVAs

The injuries sustained in even minor MVAs can be severe. Many patients I’ve treated for a MVA report little to no pain the day of the accident, with symptoms hitting them hard the following morning. The shock involved with being in an accident is one explanation for the latency of symptoms, and oftentimes the brain is focused less on pain in the body and more on the financial and legal implications of the accident. Pain typically starts in the spine, with symptoms radiating down the extremities as the full effects of the injury are realized. I recommend waiting 2-3 days following a MVA to receive treatment. Waiting will ensure the treating physician gets the full picture of your injuries and can determine the appropriate treatment approach.  

The most common type of injury sustained during a MVA is a whiplash type injury.  Whiplash involves a sudden acceleration – deceleration force on the spine and muscles.  Cervical acceleration – deceleration injuries are very common in MVAs and the whiplash injury causes tearing of muscle and ligament fibers. The muscles damaged in a cervical acceleration – deceleration injury are typically the cervical deep neck flexors which include the longus colli, longus capitis, and also the sternocleidomastoid. These muscles are extremely important for normal biomechanical function of the cervical spine. Weakness and inhibition of these muscles due to injury can lead to instability in the cervical spine and poor healing outcomes. Exercises targeting the function of these muscles are critical following a MVA and the guidance of a trained therapist is recommended to determine which exercises will be most beneficial.  

Concussion

Concussions are another possibility after a MVA and are most often associated with a blunt force trauma to the head against the steering wheel, dash, side window, or even an airbag.  If the patient lost consciousness due to head trauma and post concussive symptoms are severe, a CT is recommended to rule out a more serious pathology such as an internal hemorrhage inside the brain. Any concussion, no matter how severe, deserves attention. Less severe cases warrant a neurologic examination by a trained therapist to assess for damage to the brain, spinal cord, or peripheral nerves. Some of the assessments used include a cranial nerve examination, ocular examination, and a high index neurologic exam that includes skin sensation, muscle testing, and deep tendon reflexes. The patient should also be taken through a verbal Sport Concussion Assessment Tool (SCAT 5) which helps determine severity of concussion and also to track treatment progress. Treatment of concussions often requires a nutritional component and an anti-inflammatory diet free of refined sugar and highly processed vegetable oils. High dose EPA/DHA from fish oil and vitamin D is also recommended to help heal brain tissue. Finally, our clinic uses a class 2 therapeutic infrared laser that can safely penetrate the skull and help to heal brain tissue via mitochondrial upregulation.  

How long will it take to get better?

Tissue healing times are different for every patient and depend on age, injury history, genetics, nutrition, and lifestyle status. The severity of the accident and associated discrepancies in physical forces placed on the body are also a factor. As a general rule, the below gives the healing times for different tissue in the body which may be injured in a MVA³: 

Muscle Strain (Grade 1): 0-2 wk

Muscle Strain (Grade 2): 4d-3mo

Muscle Strain (Grade 3): 3wk-6mo

Ligament Sprain (Grade 1): 0-3d

Ligament Sprain (Grade 2): 3wk-6mo

Ligament Sprain (Grade 3): 5wk-1yr

Bone: 5wk-3mo

Many insurance companies try to fit every client into the same recovery timeline which is not realistic. If you are still in pain and someone handling your case says you need to be finished with care, advocate for yourself and demand the care you need. 

At our clinic we use passive therapies such as acupuncture/dry needling, active release technique, therapeutic laser, cupping, and instrument assisted soft tissue manipulation among others to help you heal faster. We also use a wide variety of physical rehabilitation exercises to treat the specific deficits caused by the MVA. The focus of care after a MVA is to build strength, stability, and resilience in the cervical and lumbar spine and other body regions affected by the accident. Our goal is to make the patient stronger and more functional than they were before the accident.  

Post written by Dr. Riley Kulm, DC.  Check out his bio here

Sources and References

  1. Colorado Revised Statutes Title 10. Insurance § 10-4-636. Disclosure requirements for automobile insurance products offered–rules.
  2. Med Pay Insurance in Colorado.
  3. Potential Applications of Hyaluronans in Orthopaedics.

With the recent passing of Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020), the cost of using tobacco products in the state of Colorado is higher than ever. For smokers in Colorado, the estimated increase in taxes will be $222 in the state budget year 2021-22, increasing to $291 by state budget year 2027-28¹. The minimum price for a pack of cigarettes will be $7 in 2021, and will increase to $7.50 by 2024². Tobacco products will see the current 40% tax rate increase to 62% by 2027, and the new nicotine tax aimed at e-cigarettes will be applied at 30% starting in 2021 and go up to 56% starting in July 2024. These taxes are mainly incurred on Coloradans in lower income brackets. Of the 14 percent of Coloradans who use tobacco products, 80% of those individuals make less than $40,000 per year.  Financial incentives aside, smoking is the leading cause of preventable death in the US, accounting for 1 out of every 5 deaths in the US each year or 480,000 deaths³.  For context, the covid-19 pandemic has taken the lives of 269,763 Americans in approximately the last year⁴, many of whom were significantly immunocompromised and suffering from two or more comorbidities. These statistics beg an important question – why is smoking cessation not a greater public health concern?

Why you should quit smoking

Smoking is strongly linked to chronic diseases such as cancer, heart disease, and stroke. Smoking damages your hair, skin, and nails leading to premature aging on the inside and out. Smoking eats away at the cartilaginous cushioning between our joints and promotes arthritis and joint pain.  Smoking promotes a chronic chest and neck dominant breathing pattern leading to headaches and muscle tightness in the upper shoulders and neck. Second hand smoke exposure can create these problems for family members and friends.  

The detrimental effects of smoking are related to oxidative stress, which occurs when the delicate balance between pro-oxidant and antioxidant systems in our bodies can no longer be maintained. Regular smoking increases the amount of reactive oxygen species (free radicals) in the body, overwhelming the antioxidant defense systems in the body.  Free radicals are circulating molecules that have an unpaired electron. In an attempt to bind the unpaired electron, free radicals steal electrons from normal, healthy cells in the body and alter their structure and function. Damaged cells do not function properly and are flagged by the immune system for destruction resulting in widespread inflammation. Damaged cells can also become cancerous as normal cell replication processes are disrupted. The cell walls of our arteries and veins are damaged by smoking, increasing the likelihood of artheroscletoric plaque formation and subsequent heart disease and stroke. The good news? Your body starts healing within one day of quitting smoking. 

How does acupuncture help you stop smoking?

Acupuncture helps you quit smoking by decreasing the mental and physical stress involved with quitting, as well as helping to diminish cravings. The most powerful detox points for alcohol abuse, drug addiction, and nicotine are located on the ear. The treatment of these areas is referred to as auricular acupuncture, and the protocol I use is based on the National Acupuncture Detoxification Association (NADA) nicotine cessation protocol. I also incorporate specific body points which help improve blood flow, decrease stress, and increase the likelihood of successfully quitting. Additionally, we use semi permanent acupuncture needles (seeds) which are implanted into the ear like a small piercing and stay there for 3-5 days providing constant stimulation of the acupuncture point. I use seeds at the designated nicotine point which is located on the lower tragus and can be manually stimulated by the patient when a craving is felt.  

Combining acupuncture with patient education seems to be more effective than acupuncture or education alone⁵. I encourage my patients to adopt some of the strategies found on state sponsored quitting websites, like Colorado QuitLine. Beneficial strategies I’ve used with patients include telling loved ones when and why you are going to quit, making a list of all of the items or experiences you can buy with the money normally spent on tobacco, disposing of all tobacco or tobacco related products at the house or in the car, setting a strict quit date instead of trying to slowly wean yourself off, and to write out a daily health journal to track improvements in energy, mood, and pain levels.

Case Study 

I recently treated a patient at the clinic for smoking cessation. For this case study, we will refer to the patient as Laura. Laura is a middle aged female who has been a pack a day smoker for 20 years. She was spending upwards of $1,000 per month on tobacco products. Laura came to me wanting more than anything to quit smoking. She had tried everything from nicorette to patches, and had even tried hypnosis. However, nothing seemed to work and the nicorette made her nauseous. She was open to the idea of acupuncture because it had been a helpful treatment for a low back injury I was seeing her for.  We settled on a treatment plan of 8, 30 minute visits over a 4 week period. Laura set her quit date in conjunction with her first day of acupuncture. 

Within a week, the immediate improvements in her health were palpable. Her skin was clearer and was less red and inflamed. Her stiff and leathery muscles felt relaxed and pliable. Her breathing was slower, deeper, and less labored. She seemed less stressed, and had a calm nature about her. The acupuncture helped her deal with the day to day stress of quitting, and also mitigated cravings and withdrawal symptoms. On top of this, the chronic low back pain she was experiencing dramatically improved as her body’s internal healing mechanisms were better allowed to do their job. Overall, her transformation was inspirational. It motivated me to want to help more people struggling with nicotine addiction create lasting change in their lives. I’m happy to report it is now 3 months since her quit date and she has not had a cigarette since.

If you or someone you know smokes and wants to quit but doesn’t know where to start, please direct them to this article or me personally. It would be a privilege to assist you or a loved one quit for good and to help you realize the immense financial and health benefits of quitting today.  

Post Written by Dr. Riley Kulm, DC.  Check out his bio here

Sources and References 

  1. Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020)
  2. Proposition EE: Taxes On Nicotine Products, Explained
  3. Centers for Disease Control and Prevention, Current Cigarette Smoking Among Adults in the United States.
  4. CDC COVID Data Tracker
  5. Auricular Acupuncture, Education, and Smoking Cessation: A Randomized, Sham-Controlled Trial

Despite the chaos of 2020, the coming holiday season brings with it a time for self reflection, family bonding, and solidarity within the community. For many, personal health initiatives such as dietary, lifestyle, or exercise improvements go on pause during the holiday season, only to be resurrected come the new year.  To avoid taking steps backwards during the holidays, I’d like to offer some suggestions to make the end of 2020 your healthiest yet.

Gym Alternatives

Many people still feel uncomfortable going to the gym. However, not having access to a gym is not an excuse to let your fitness goals go unaccomplished. There are numerous ways to get an excellent workout from the safety and comfort of your own home with no equipment at all. One option is to perform a 15 to 30 minute guided yoga, tai chi, or qi gong class.  Each practice combines controlled movements with deep breathing and can help with stress and anxiety, as well as improve blood flow throughout the body. There are hundreds of free classes you can take on YouTube, turning your home into your own yoga studio. I personally enjoy the  Yoga With Adrienne YouTube Channel which has classes for all different skill levels and even has sports specific classes that cater to what you love most.

Another excellent alternative to going to the gym is to perform an at home bodyweight exercise circuit. You can create a challenging workout with no equipment necessary. Make sure to include movements such as the body weight squat, body weight forward and reverse lunge, wall sits, planks, side planks, and push-ups. Here is a sample home exercise routine that is a great alternative to going to the gym: 

Perform 3 rounds of: 

10 body weight squats

20 reverse lunges (10 each leg) 

15 push-ups

30 second wall sit 

30 second front plank 

30 second side plank (each side) 

(Rest for 2 minutes between each round)

Once this circuit becomes easy, you can add additional rounds, increase repetitions, extend the time for the planks and wall-sits, and decrease rest time between each round. You can also add more explosive movements such as jump squats, speed skaters, jumping lunges, clap push-ups, and burpees. If you have someone to join you for a home workout, have them provide manual resistance to make exercises such as the push-up and planks more difficult. 

You’ll be amazed at the quality of workout you can get once you start being creative and learn how to use your own body weight to your advantage!

Holiday Sweets Alternatives

Make this holiday season your healthiest yet by choosing these delicious alternatives to the sugar laden treats of Halloween, Thanksgiving, and Christmas. Each of these options is low in refined sugar and absent of harmful vegetable oils. These ‘desserts’ will leave you feeling energized instead of fatigued and mentally sluggish.

  • Dark chocolate and nut butter 
    • Opt for a dark chocolate that is 85% cocoa content or higher to limit the amount of sugar. 
      • Cocoa is an excellent source of nutritional antioxidants, bioflavonoids, and arginine which helps improve blood flow. It is also a great source of healthy saturated fat.
    • For the nut butter, do your best to choose a freshly ground, organic option.  Make sure the sugar content is 3 grams or less per serving or more ideally, none.  
      • Nut butters are an exceptional source of healthy fats and also are protective against heart disease and type 2 diabetes due to their high fiber and magnesium contents.  
  • Sliced apples fried in coconut oil with cinnamon
    • Over medium heat, sauté your thinly sliced apples in coconut oil until golden brown on each side. Sprinkle with cinnamon and enjoy by themselves or with unsweetened greek yogurt or whipped heavy cream from an unpasteurized milk source.
      • Apples are a great source of vitamin C, fiber, and potassium.  Regular apple consumption is consistently associated with lower rates of heart disease, cancer, asthma, and type 2 diabetes.
      • Cinnamon’s health benefits, which come from the oils in its barks, include reduced risk of heart disease, improved insulin sensitivity and decreased risk of type 2 diabetes. It also acts as a nutritional antioxidant and anti-inflammatory.  
      • Coconut oil is a top choice for healthy saturated fats and also has a high smoke point which makes it ideal for cooking.  
  • Paleo nut energy bars 

Connect with your family and community 

Staying connected socially is very important not only to the health of the body, but also the mind. Human beings crave connection, social interaction, and a sense of community. Consequently, the health of our bodies will suffer if we cannot maintain these connections. Having a positive interaction with your community is vitally important for your health. Steps you can take to improve your personal relationships, as well as with your community include sending a handwritten letter to a relative you haven’t spoken to for awhile, volunteering at a local food or clothing drive, helping an elderly neighbor with landscaping or other small maintenance job at their house, or preparing one of the desserts above to surprise your neighbors with a healthy treat! 

This holiday season could not come at a more vital time in our society. I encourage you to use these next couple months to treat your body and mind with care and to create a greater sense of unity in your family and communities.

Post written by Dr. Riley Kulm, DC.  Check out his bio here.

Patients often ask what the ideal treatment frequency is for getting adjusted. However, if you asked ten different chiropractors this question, you might get ten different answers. Within chiropractic, many different technique systems and schools of thought exist. Chiropractic treatments and treatment plans are not standardized within the profession and there is a high level of variability from doctor to doctor. With this in mind, the answer to how often you should get adjusted is it depends on your situation. Factors such as your age, health status, activity level, and diagnosis all factor into how often you need to be adjusted. For this post, I will address the question for someone who has mild or no symptoms and is looking to chiropractic for maintenance care and promoting overall health.  To begin, I’ll describe the typical treatment plan for a new patient at our clinic. 

Typical Treatment Plan

When a new patient comes to our clinic with a common complaint such as low back, neck, knee, shoulder, or elbow pain, we typically see them twice a week for 1-2 weeks, once a week for 3-4 weeks, and then reassess after 6-8 visits over 4-5 weeks. Adjustments will be performed at each visit. If the patient is markedly improved, we will push visits out 2-3 weeks and start seeing them on a less regular basis. Most patients feel substantial relief in just 2-3 visits, however, the underlying functional issues (posture, movement, breathing) causing the injury in the first place, take longer to reverse.  Once the pain is gone and the patient is passing all of the functional tests relating to the original injury, we place the patient on a maintenance care plan where they come in once a month. The purpose of the maintenance care visit is to make sure the patient has not re-injured themselves or sustained any new injuries. We will also review exercises they have been prescribed in the past and check their spines to see if an adjustment is needed. At our clinic we use a mixture of chiropractic adjustments, physical therapy exercises, nutrition and supplements, and soft tissue therapies such as instrument assisted technique, active release technique, dry needling, laser, and acupuncture. By combining multiple therapies, we decrease healing times, allowing for a shorter and less costly treatment plan.  

Maintenance Care 

How often should a patient get adjusted for maintenance care and promotion of overall health? As stated previously, one chiropractor’s answer may differ from another’s, and our answer is based on the combined clinical experience of nearly a decade from the two doctors at Mile High Spine and Sport, Dr. Ryan Dunn and Dr. Riley Kulm. For maintenance care and promotion of overall health, we suggest patients come in for a full spine assessment and adjustment once per month. Maintenance care visits also include a functional movement exam to see if any limitations in muscle strength, stability, and range of motion exist predisposing the patient to future injuries. The purpose of the full spine assessment and functional movement exam is to identify issues before they surface to help prevent pain or injury. Similar to how it is necessary to go to the dentist every 6 months for a cleaning and exam, you should go to the chiropractor once per month to have your spine assessed for restricted joints and muscle imbalances to help prevent issues down the road. For quality preventative maintenance care, chiropractic is one of your best, and most cost effective treatment plan options.

Can I get adjusted more than once a month? 

As a result of the numerous health benefits of getting adjusted, many of our patients decide to come in for adjustments more than once per month. Patients report improvements in breathing, energy, digestion, and sleep following their treatments. If you’d like to learn more about how the chiropractic adjustment can positively affect multiple areas of your health, please check out my post, Beyond Biomechanics: Exploring the Hormonal Benefits of the Chiropractic Adjustment.  

From a safety perspective, it is entirely fine to get adjusted on a regular basis. However, I would not suggest getting adjusted more than three times per week as you run the risk of causing hypermobility in the joints. Hypermobility means the joints are moving too much and lack the muscular stability for normal motion and can lead to a variety of orthopedic issues. In general, we rarely see maintenance care patients more than once per week. We encourage patients to come in more than once per month if they find the benefits of regularly getting adjusted enhances their lifestyle and well-being. 

Post written by Dr. Riley Kulm, DC.  Check out his bio here

One of the questions I frequently ask my patients is whether or not they self adjust their spines. Self adjusting refers to cracking or popping your own joints by twisting and rotating your spine. Many patients answer yes to this question, and often say it is something they are unconsciously doing. Most people find temporary symptomatic relief when they self adjust their own necks or low backs, but what are some of the long term orthopedic consequences of self adjusting your spine? 

What is self adjusting? 

Self adjusting of the spine is when an individual twists or rotates their spine to a sufficient degree some of the joints in the area pop or what chiropractors refer to as ‘cavitate’.  The ‘cavitation’ is essentially noise made by small bubbles popping within the synovial fluid of your joints and is completely safe. Individuals who self adjust may experience temporary relief with self adjusting because the mechanical stimulation of the joint popped momentarily blocks pain, tension, and tightness signals being sent to the brain.  Muscles around the joint will temporarily relax as well.  These all sound like positive outcomes, however, they are only temporary and typically last 5 to 10 minutes.  The long term orthopedic consequences of self adjusting last much longer and are more damaging to your spinal health.  

What is the problem with self adjusting?

The problem with self adjusting is when an individual adjusts their own spine, they lack the specificity to adjust the joints actually needing to be adjusted.  Chiropractors are specifically trained to feel or ‘motion palpate’ joints and assess their ability to move in the directions they are designed to. Once a chiropractor identifies a joint is not moving properly or ‘restricted’, the chiropractor applies a high velocity low amplitude (HVLA) thrust to the specific joint in the direction it is not moving. Learning the skills of motion palpation and adjusting take years to master and should only be performed by trained professionals. 

You are not adjusting the joints needing it the most when you self adjust. In fact, the joints popping are likely ones already moving too much! We call joints moving too much ‘hypermobile joints’ and these joints lack control of movement and muscular stability. Chiropractors identify ‘hypomobile joints’ or joints not moving enough, and adjust these joints to restore normal movement. The problem with adjusting the hypermobile joints with self adjustments is when you pop these joints you make them more hypermobile. Muscles surrounding a hypermobile joint have to work harder to stabilize the joint, and patterns of muscular pain, tension and tightness often arise. Additionally, adjusting hypermobile joints will make any adjacent hypomobile joints even more restricted. Over time, self adjusting will cause severe imbalances in the spine and decrease the spine’s ability to withstand the compressive forces of life and sport.  The result is more serious conditions such as disc herniation, nerve compression, and severe instability among other serious spinal pathologies. Repetitive self adjustments in the neck can lead to chronic tension type headaches and migraines. In summary, adjusting your own spine will make the hypermobile or unstable joints move even more, and it will cause the hypomobile or restricted joints to be even tighter.

What should I do instead? 

If there is an area of your spine feeling like it constantly needs to be adjusted, I would recommend consulting with a chiropractor trained in motion palpation and functional movement assessment. This individual can determine which areas of your spine need to be adjusted, and which areas need to be stabilized. In general, hypermobile joints are moving too much and need to be stabilized with a functional exercise focused on improving muscular control around the joint. Hypomobile joints need to be adjusted by a chiropractor in the specific direction of movement they are lacking. So remember, please think twice before the next time you are about to self adjust your neck or low back!

Post written by Dr. Riley Kulm, DC.  Check out his bio here.

As we move into summer and start spending more time outdoors, it’s important to educate yourself on proper sunscreen usage, as well as the health benefits from sensible sun exposure. It is important to find a balance between harnessing the health benefits of sunshine while protecting your skin and body from UV radiation damage. Excessive sun exposure is linked to multiple forms of cancers including basal cell carcinoma, squamous cell carcinoma, and melanoma. To help prevent these skin cancers, the American Academy of Dermatology (AAD) suggests applying sunscreen of SPF 30 or higher 30 minutes before going outside and then reapplying every 2 hours while outside. Sunscreen is to be applied to all areas of the skin not covered by clothing. While these guidelines from the AAD should not be ignored, it is critical to address the consequences of effectively eliminating all sun exposure, such as vitamin D deficiency. The goal of this article is to move away from the ‘sun is dangerous’ paradigm which is promoted by the AAD.  While excessive sun exposure may cause skin damage, the negative health consequences with avoiding sunshine are much more concerning for our overall health.  

Vitamin D deficiency and cancer

It is estimated that upwards of 40% of American adults are vitamin D deficient, which is defined as having a serum level below 20 ng/mL 4.  Using 30 ng/mL as the cutoff for vitamin D insufficiency, it is estimated 75% of American adults and teens do not meet this mark.  Most functional medicine doctors recommend an optimal range of 60-80 ng/mL, which would place more than 90% of Americans in the sub-optimal category for vitamin D levels. Optimal vitamin D levels are protective against many forms of disease including cancer, heart disease, infection, autoimmune diseases like lupus, celiacs, multiple sclerosis, and neurodegenerative diseases such as Parkinson’s, Alzheimer’s, and ALS.  Research shows breast cancer and vitamin D deficiency are closely associated, and one study showed women with a vitamin D level higher than 60 ng/mL were 83% less likely to develop the disease 9. Vitamin D is one of the body’s most potent anti-cancer fighting compounds. With most of America already vitamin D deficient or insufficient, and spending much more time indoors compared to our ancestors, it is dangerous to completely cover our skin with sunscreen.  In effect, we are blocking the production of one of our most potent anti-cancer fighting compounds by wearing sunscreen every day, placing us at an even greater risk of developing all forms of cancer, including skin cancer. Individuals with darker skin need even more exposure to sunshine because the increased melanin content in the skin slows the rate of vitamin D production. 

Nutrition and skin cancer

One of the best ways to protect our bodies from skin cancer is to make sure we are eating a diet rich in the antioxidants designed to protect us from cancer cell growth and proliferation. Excessive exposure to UV radiation can lead to free radical formation which damage all cell types and cause inflammation and the potential for cancer. Firstly, foods with high concentrations of the flavonoid proanthocyanidin are particularly useful in protecting our body from UV radiation damage and skin cancer 2.  Proanthocyanidins act in the body as an antioxidant, anticancer, antidiabetic, and antimicrobial compound 6. Foods highest in proanthocyanidins include blackberries, blueberries, marionberries, huckleberries, grape seeds, hawthorn berries, rose hips, and pine bark.  

Another food compound which is effective at preventing skin cancer is the flavonoid apigenin 1Apigenin also acts as an antioxidant and anti-inflammatory compound and specifically protects our skin from UV radiation damage.  The best food sources of apigenins include chamomile, apples, oranges, celery, onions, and endive. Opt for a bottle of iced chamomile tea during your next day out in the sun!  

The last compound to mention is resveratrol.  Made popular for the health benefits associated with drinking red wine, resveratrol is a potent anti-oxidant and anti-cancer fighting compound.  Resveratrol promotes healthy cell differentiation, and being that abnormal cell division is one of the bases for tumor formation, resveratrol is exceedingly important for protecting ourselves from all types of cancer. The best dietary sources of resveratrol include grapes, cranberries, blueberries, red and white wine, peanuts, and cocoa.  If individuals make a conscious effort to increase the consumption of these foods, skin damage and the potential for developing cancer will significantly be reduced. 

Benefits of sunshine

There are many health benefits from regular, sensible sunshine exposure. In addition to vitamin D production, UV rays from the sun stimulate the production of melanocyte stimulating hormone (MSH) which increases skin pigmentation and sexual arousal, as well as suppresses appetite 1.  For patients looking to lose weight, 10 minutes of direct sunlight exposure first thing in the morning assists hormone production and Circadian rhythm.  Additionally, UV rays produce beta-endorphins and natural opiates which help decrease pain and inflammation, and promote relaxation in the body 1.  Natural opiates and beta-endorphins produced within the body are stronger and more effective than pharmaceutical pain killers that often come with a host of side effects and risk of dependency.  Finally, UV rays help our body produce calcitonin, a vasodilatory peptide which helps protect the body’s cardiovascular system from problems such as high blood pressure (hypertension) and cardiovascular disease (CVD) 1.  With the multitude of drugs aimed at weight loss, sexual dysfunction, hypertension, CVD and chronic pain, more attention should be paid to direct sun exposure as a clinically viable intervention for these conditions. 

Avoid oxybenzone 

When purchasing a sunscreen, make sure to avoid products containing oxybenzone. Research shows that oxybenzone is an endocrine disruptor, meaning it alters your body’s hormonal system. Alterations in the hormonal system can lead to an array of detrimental health conditions including weight gain, chronic fatigue, altered pregnancy, sexual dysfunction and cancer among others 8.  Not only does oxybenzone act as an endocrine disruptor itself, it also enhances your body’s absorption of other hormone disrupting chemicals such as toxic herbicides, pesticides, and insect repellants 5.  Oxybenzone can damage our hormonal system and increase the risk of all kinds of cancer including skin cancer.  Other active ingredients highly absorbable into the bloodstream that can potentially pose a threat to your health include avobenzone, octocrylene, and ecamsule 10.

What should I use? 

After reading this article, you may want to throw away your sunscreen and lay in the sun for hours on end with minimal clothing. Do not do this!  While the benefits of sun exposure are immense, the potential for skin damage is still prevalent.  If you are planning to spend more than 20 minutes in direct sunlight, make sure to apply non-nanoscale zinc oxide or titanium dioxide. Non-nanoscale means the sunscreen will not easily absorb through your skin and into your bloodstream like traditional sunscreens with microscopic particles that easily cross the skin barrier.  If kept on the surface, zinc oxide and titanium dioxide are safe on your endocrine system.  That being said, if absorbed into your bloodstream, both compounds can have similar detrimental effects as oxybenzone, so make sure to buy the non-nanoscale version!  Pay special attention to areas like the nose, top of the ears, shoulders, and back of the neck, because these areas are often exposed to more sun.  We recommend the sun care products from the company Badger Healthy Body Care due to their high quality and avoidance of toxic chemicals like oxybenzone.  

Post written by Dr. Riley Kulm, DC.  Check out his bio here

References

  1. Greenfield, B. (N.d.) Is the Sun the Ultimate Source of Health and Vitality or just a Giant Orange Cancer Circle in the Sky?  Ben Greenfield Fitness.  Retrieved from: https://bengreenfieldfitness.com/article/lifestyle-articles/natural-sun-protection-foods/
  1. Katiyar, S.K. (2015).  Proanthocyanidins from grape seeds inhibit UV-radiation-induced immune suppression in mice: detection and analysis of molecular and cellular targets.  Photochemistry.  Photobiology., 91 (2015), pp/ 156-162. 
  1. Mercola, J. (2020). Sunscreen Safety Questioned Yet Again.  Mercola.  Retrieved from https://articles.mercola.com/sites/articles/archive/2020/02/05/oxybenzone-sunscreen.aspx
  1. Mercola, J. (2019).  Top 5 Signs of Vitamin D Deficiency.  Mercola.  Retrieved from https://articles.mercola.com/sites/articles/archive/2019/01/01/signs-of-vitamin-d-deficiency.aspx
  1. Pont AR, Charron AR, Brand RM. Active ingredients in sunscreens act as topical penetration enhancers for the herbicide 2,4-dichlorophenoxyacetic acid. Toxicol Appl Pharmacol. 2004;195(3):348‐354. doi:10.1016/j.taap.2003.09.021
  1. Rauf, A. Et al. (2019).  Proanthocyanidins: A Comprehensive Review.  Biomedicine & Pharmacology. Vol. 116. August 2019, 108999
  1. Sunscreen FAQs. (n.d.). American Academy of Dermatology.  Retrieved from: https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs
  1. The Trouble With Ingredients in Sunscreen. (N.d.).  Environmental Working Group (EWG).  Retrieved from: https://www.ewg.org/sunscreen/report/the-trouble-with-sunscreen-chemicals/
  1. McDonnell SL, Baggerly CA, French CB, Baggerly LL, Garland CF, et al. (2018) Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concentrations ≥60 vs <20 ng/ml (150 vs 50 nmol/L): Pooled analysis of two randomized trials and a prospective cohort. PLOS ONE 13(6): e0199265. https://doi.org/10.1371/journal.pone.0199265
  2. Matta MK, Zusterzeel R, Pilli NR, et al. Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial. JAMA. 2019;321(21):2082–2091. doi:10.1001/jama.2019.5586

It’s no secret we are living in unprecedented times with the COVID-19 pandemic. Now more than ever, individuals need to take every possible measure to ensure the health of themselves and their loved ones. This post will focus on the steps you can take to stay healthy by boosting your immune system with diet and supplementation, sunlight exposure, exercise, and staying connected socially without in-person contact. 

Double Down on Vitamin C

Vitamin C (ascorbic acid) acts in a multitude of ways in the body. Firstly, vitamin C is required for the manufacture of collagen, a protein which is responsible for holding body tissues together such as cartilage, connective tissue, ligaments, tendons, skin, hair, and nails. Additionally, vitamin C is exceedingly important for wound healing, healthy teeth and gums, immune function, and it also acts as a nutritional antioxidant. With specific focus on the immune system, vitamin C has been shown to improve white blood cell function and increase the body’s antibody response. It also increases interferon, which acts as the body’s natural antiviral and anticancer compound. In fact, interferon gets its name from its ability to interfere with viral replication. 

Foods highest in vitamin C include fruits such as guava, persimmons, strawberries, papaya, oranges, and grapefruit. Vegetables rich in vitamin C include red chili and red sweet peppers, dark leafy greens like kale, collared greens, and spinach, parsley, broccoli, Brussels sprouts, cauliflower, and cabbage². The food with the absolute highest vitamin C content is the Acerola cherry, which is often sold in powder or supplement form. The vitamin C content in fruits and vegetables is markedly decreased with exposure to air, so eating fresh fruits and vegetables is essential.

During times of extreme stress and risk of infection, dietary sources of vitamin C may not be adequate. When choosing a supplemental form of vitamin C, make sure to use ‘liposomal’ vitamin C. The bioavailability, or the amount of a supplement your body actually absorbs, may be 20% or lower for traditional vitamin C supplements. GI upset and diarrhea is associated with consumption of high doses of traditional vitamin C.  When liposomal vitamin C is ingested, a phospholipid coating surrounds the vitamin in the GI tract. The effect of the protective coating is a much higher percentage of vitamin C absorbed, as well as less GI upset. Here’s a link to our online supplement dispensary where you can purchase the liposomal vitamin C supplement I suggest to my patients. Our favorite product is the one made by Dr. Mercola. As you might imagine, quality vitamin C supplements are in high demand right now. Even if the product is back ordered, I recommend ordering the supplement now as suppliers are promising to get new product out within the upcoming weeks.

Get More Sunlight

Getting direct sunlight is an excellent way to naturally boost your immune system. Vitamin D is more accurately defined as a hormone rather than a vitamin, since it is produced by our body in response to direct sun exposure on our skin, and has various signaling effects on many cell types in the body. The vitamin D hormone is most commonly associated with upregulating calcium absorption in the small intestine, thereby increasing the strength of our bones.  However, the vitamin D hormone has a wide array of positive benefits elsewhere in the body, as a result of cells in our bone marrow, brain, colon, breast tissue, and immune system all expressing the vitamin D receptor (VDR). Specifically, B and T cells (the two major components of our adaptive immune response) directly respond to vitamin D and upregulate our body’s ability to fight off all forms of disease¹. Not only does vitamin D help protect us from viruses, it can also halt the progression of autoimmune diseases including multiple sclerosis, rheumatoid arthritis, diabetes mellitus, inflammatory bowel disease, and systemic lupus. Additionally, the sun’s energy produces beta-endorphins, neuropeptides and natural opiates that regulate pain, decrease inflammation, and promote relaxation – all positive changes that strengthen our immune system and help our body combat infection. Opt for 15-20 minutes of direct sunlight exposure on as much exposed skin as possible.

Cut Out Refined Sugar

Refined sugar has a host of negative effects on the body, perhaps the most important being damage to our mitochondria and the associated oxidative damage that occurs with overloading of the electron transport chain. Oxidative damage or ‘oxidative stress’ is the result of increased free radical production in the body. Free radicals are molecules with an unpaired electron. They attack and damage healthy cells in our body, creating a state of chronic inflammation. When our body is in a constant state of low level inflammation from excessive sugar consumption, our ability to combat disease and heal wounds is significantly impaired. In fact, research suggests after consuming sucrose (white table sugar), our immune system is inhibited for six hours. Additionally, the only viable fuel source for pathogenic viruses and bacteria is sugar. Viruses and bacteria feed on sugar and multiply when placed in a high sugar environment. One of the best ways to combat viruses and bacteria is to remove their food source!  

Eat More Fermented Foods

Fermented foods are rich in natural probiotics and help replenish the beneficial bacteria that line or GI tract. The beneficial bacterial lining, also known as GI flora in our digestive tract acts as a natural barrier between the foods we eat and the insides of our body. The healthier and thicker the GI flora, the less likely pathogenic substances can enter our body and cause disease.  Naturally occurring probiotics are produced during the fermentation process in foods such as kefir, miso, kimchi, yogurt, sauerkraut, kombucha, and raw, grass-fed organic milk. Load up on these probiotic rich foods and your immune system will thank you!

Eat Garlic

Garlic is a potent antiviral, anti-bacterial, and antifungal. According to The Encyclopedia of Healing Foods, garlic is rich in vitamin B6, manganese, selenium, vitamin C, phosphorous, calcium, potassium, iron, and copper – all of which are needed for a healthy immune system.  Many of garlic’s benefits are associated with a sulfur-containing compound called allicin, which is a powerful anti-microbial. In fact, garlic has been called ‘Russian Penicillin’ due to its strong anti-microbial activity. Make sure to chop or crush the garlic and let it sit for 10 minutes before eating or cooking. Letting the chopped garlic sit for 10 minutes helps trigger the enzymatic process that transforms alliin into its active and beneficial form, allicin. 

Connect with Others 

One clear benefit of modern technology is our ability to connect socially with friends and family without having to see them in person. Utilize apps like Skype and Zoom to stay in communication with your friends and loved ones during these trying times. Staying connected socially is very important not only to the health of the body, but also the mind. Human beings crave connection, social interaction, and a sense of community. Consequently, the health of our body’s will suffer if we cannot maintain these connections. There are positive, simple ways you can stay connected with society, such as offering to do a grocery run for an elderly or at risk individual. When at the grocery store, purchase only what you need and avoid buying in excess. The next customer (and your wallet!) will thank you. Take a moment to say a prayer or perform a moment of silence for all those affected directly and indirectly by the virus. Performing small acts of kindness will keep you connected socially and add positivity to a society that desperately needs it right now. 

References 

  1. Aranow, C. (2011).  Vitamin D and the Immune System.  J Investig Med. 59(6): 881-886.
  2. Aschan, S. (2006).  Sugar: The Real Deal.  ABC News.
  3. Murray, M. T., Pizzorno, J. E., & Pizzorno, L. (2006). The encyclopedia of healing foods. Pages 112-114.

Post written by Dr. Riley Kulm, DC. Check out his bio here.


Core Exercises – Do’s and Don’ts 

Many patients understand they need to strengthen their core in order to live functional and pain free lives. However, most do not know where to start. The popular opinion is exercises such as sit-ups, crunches, bicycle crunches, and Russian twists are the primary exercises to improve core strength. Unfortunately, these commonly performed exercises are not the best choice when looking to add strength and functionality to your core. 

The Problem with Sit-ups and Crunches

Sit-ups and crunches are perhaps the most regularly performed core exercises. These exercises are effective at increasing the tone of the six-pack or rectus abdominis muscle group.  While great for aesthetics, a tight and toned six-pack is not essential for a functional core and may even be detrimental. The issue with sit-ups and crunches are the forces placed on the spine during these exercises. Both involve repetitive flexion of the lumbar spine and most of modern society already gets too much ‘lumbar flexion.’  Lumbar flexion means rounding forward of the low back. The low back is in flexion when we are sitting in our car, at work, or on the toilet. The low back is flexed when we pick items up from the floor with improper form. The net result of so much lumbar flexion is placing undue stress on the discs, muscles, ligaments, and nerves of the low back. Sit-ups and crunches involve repetitive flexion of the low back and thus add fuel to the ‘flexion fire’ we get all throughout the day. 

The Problem with Rotational Core Exercises and Stretching 

The Russian twist and bicycle crunches are other commonly performed core exercises that are not ideal for the function of the core or spine. The Russian twist is performed by balancing on your pelvis with legs suspended in the air and knees bent while the upper body is held at roughly a 45 degree angle. Next, the athlete uses their hands or a medicine ball to twist back and forth in an attempt to work the abdominal obliques. Bicycle crunches are similar except the individual is on their back and the rotational crunch is combined with a straightening of the opposite leg and hip. The first problem with the Russian twist is it is extremely difficult to keep the spine in a neutral position and many individuals round their backs due to a lack of core strength and balance. Once again, many people are developing a detrimental position of lumbar flexion during this exercise.  

Another issue with the Russian twist and bicycle crunch is the forced rotational load it places on the spine. Functional movement specialists now agree the main purpose of the core is to resist forces placed against the spine rather than actually creating movement.  The lumbar spine only rotates 2-3 degrees per segment and thus requires more stability in the rotational (transverse) plane compared to mobility. I’ll explain exercises such as the Pallof Press and Cross Press in a future blog post, as both are excellent exercises for improving core stability in the rotational plane.

Basics of Effectively Performing a Core Exercise

Before we get into the specific exercises I teach my patients, I’ll explain why form is important for any core exercise you perform. First, the spine needs to be in a neutral position. A neutral spine may look different for each person, but the spine should be straight and may have a slight extension curvature. Extension is the opposite of a flexed and rounded position of the spine. The two variables that affect proper neutral spine positioning are your rib positioning and your pelvic posture. Many patients have what is called ‘flared ribs’. This means your ribs are protruding upwards and forwards and may even be visible. When the ribs are in this position the diaphragm muscle cannot function properly and core strength will suffer. Use an exhale breath to push your ribs downwards towards the floor to place them in a more ideal position. 

Secondly, you need to be aware of the position of your pelvis. Think about your pelvis as a fish bowl filled with water. If you have what we call an ‘anterior pelvic tilt’ your pelvis is dumped forward and water will be spilling out of the metaphorical fish bowl. Less commonly, patients may adopt a ‘posterior pelvic tilt’ where the water will be spilling backwards.  Both of these pelvic postures are detrimental to neutral spine positioning, as well as core strength. Always think about keeping your pelvis tucked under you so water cannot spill out of the fish bowl. By making sure your ribs and pelvis work together to maintain a neutral spine, you will safely perform core exercises.

Practice these Core Exercises:

3 Position Plank

The 3 position plank is a sequential exercise involving a front plank, right side plank, and left side plank. Each position is held for 10 seconds before switching positions.  Do your best to avoid dropping to the ground when switching positions. Switching positions every 10 seconds forces the brain and nervous system to react to a new stability pattern frequently and is thus more typical of how we move in life and sports. Additionally, by switching positions every 10 seconds we better guarantee perfectly executed reps. 

Dead Bug

The dead bug is another excellent option for building your core strength. Lay on your back with your hips, legs, and arms raised.  Simply holding this position is a difficult exercise in itself and is an effective way to exercise your core. Make the movement more dynamic by reaching one arm over your head and slowly lowering the opposite heel towards the ground.  Alternate sides, and perform in succession while making sure to keep your ribs down, low back glued to the ground, and head supported and slightly elevated to protect your neck. 

Bird Dog

The bird dog exercise teaches you to move your extremities while maintaining a neutral spine. The exercise does an excellent job of mimicking real athletic activities you will face in daily life. Get in a tabletop position with your hands stacked under your shoulders and your knees stacked under your hips. Your chin should be tucked and the back of your neck long with no creasing of the skin. Slowly move one of your arms forward while simultaneously extending the opposite leg backwards. The back leg only needs to be about 2 inches off of the ground to avoid hyper-extending your low back. Hold the completely extended position for a count of 2 and then return to neutral. Alternate sides while keeping a neutral spine and make sure to not let your pelvis rotate and shift excessively. Imagine there is a glass of water resting on the base of your low back and you do not want to let it spill! 

My goal with this blog post is to provide you with safe and effective exercises for improving the strength and function of your core. Enjoy!  

Post written by Dr. Riley Kulm, DC.  Check out his bio here.