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.

The Importance of a Morning Routine

If I were to pick one lifestyle intervention for anyone looking to enhance their energy levels, increase productivity, and improve relationships with friends and family, a consistent morning routine would be my top choice.  An effective morning routine will set you up for success throughout the rest of your day. If you start the day by completing small, productive tasks you will establish a feeling of accomplishment immediately after waking up. By finishing these tasks at the beginning of the day, other, more daunting projects related to your work or personal life will seem less intimidating. You will establish a task completion mindset first thing in the morning which will increase productivity throughout the day. Lastly, you will practice gratitude in your morning routine, which will help you appreciate your life and the people in it.  

The five tasks you should complete every morning are: 

  1. Make your bed
  2. Drink a glass of cold water
  3. Five minutes of light exercise
  4. Meditate
  5. Journal

Next, let’s talk about the specifics of each task in your morning routine. 

1. Make your bed

I recommend watching this link of a speech by US Navy Seal Admiral William McRaven titled, ‘If You Want to Change the World, Start Off by Making Your Bed.’ McRaven stresses the importance of completing one small task (making your bed) in the morning, to set you up for success in completing other, more difficult tasks throughout your day. He also discusses how learning to do the small things in life correctly allows you to complete the big things in life correctly. Making your bed does not need to be a lengthy ordeal of tucking in 3 layers of sheets and organizing 12 throw pillows, but rather make your bed presentable enough to give you peace of mind that you completed your first task of the day successfully.  

2. Drink a glass of cold water

You are dehydrated when you wake up and your body is thirsty. Do not drink coffee right away as coffee is a diuretic and will cause you to expel out more fluids than you are taking in. Instead of coffee, start your day with 16-24 ounces of cold water immediately after waking up. By giving your body the hydration it needs first thing in the morning you will notice more stable and consistent energy levels throughout the day.  

3. Perform 5 minutes of light exercise

To assist in waking your body up, perform 5 minutes of light exercise first thing in the morning.  Your movement flow may include stretching, body weight strength exercises, breathing, or yoga. This is not meant to exhaust you, but rather to stimulate your body’s awake hormone, cortisol.  Cortisol gets a bad rap as the body’s stress hormone, but this is not entirely true. Cortisol is normally elevated in the morning and helps to wake up the body and mind for the day ahead. Cortisol becomes problematic when it remains high into the afternoon and evening due to chronic stress, poor nutrition, and excessive exposure to blue light emitting screens. Two of the strongest stimulants for proper cortisol release in the morning are direct sunlight exposure and exercise. By performing light exercise in the morning, you are ensuring an adequate cortisol release in the morning. My 5 minutes of light exercise includes 3 sets each of push-ups and bodyweight squats. In the past I’ve incorporated other movements such as planks, wall-sits, hip stretching, and kettlebell deadlifts. I find that these movements are enough to get my blood and heart pumping without tiring myself out for workouts I have planned later in the day. 

4. Meditate

Perhaps the most important yet difficult task in a successful morning routine is meditation.  Meditation is a mindfulness technique that teaches the individual how to be present in the current moment. Headspace defines meditation as the “intention to be present in the here and now, fully engaged in whatever is happening, free from distraction or judgement, with a soft and open mind.” Guided meditations on apps such as Headspace or Calm use a form of meditation called ‘Vipassana’ which aims to help the individual gain self awareness of body and mind.  

Guided meditations often start with deep breathing exercises utilizing slow, controlled, nasal breaths. Next, the guided meditation will ask you to mentally scan different parts of your body, noticing areas that are relaxed as well as areas that are tense.  Finally, the guided meditation may ask you to count your breaths, with the ultimate goal of focusing on nothing besides the breath. Guided meditations typically end by completely letting go of your focus, allowing your mind to run wild, before bringing your intention back to the breath for a final 2-3 focused breaths.  Many people notice an immediate change in their day to day lives when starting a daily meditation practice. People who meditate are more calm throughout the day, their interpersonal communication is improved, their breathing patterns are better, and they are less agitated by the stress of daily life. Taking just 5-10 minutes to perform a guided meditation first thing in the morning may be the best way to set yourself up for success throughout the rest of the day. 

5. Journal

Another beneficial task to complete every morning is a short journal entry.  You can get creative with this one, but there are two key pieces that are essential. First, use your journaling as a way to reconnect with your ‘why’.  If you read my last blog post Effective Goal Setting 2020, you know the first step towards creating your goals is to establish your why. Your why is your purpose, cause or belief – it is the reason you get out of bed in the morning. Reconnecting with your why using journaling may include writing a quote everyday that reminds you of your passion in life, physically writing out your most important goal, or listing out positive qualities about yourself and the person you want to become. Second, develop a practice of gratitude in your morning journaling. For me, I list three things I’m grateful for every morning. Some days it reads ‘a loving and supportive family,’ or ‘a career that challenges me mentally and physically,’ and some days it’s as simple as ‘a healthy breakfast to fuel my body and mind throughout the day.’  Writing out what you are grateful for first thing in the morning will remind you how good your life truly is and place you in a positive, optimistic mindset.

The Outcome

The goal is to complete all five of these tasks every morning.  You will be busy some mornings and may only have time to complete two or three of these tasks.  For me, I notice that the quality of my day directly correlates to how many of the morning tasks I complete. The more I successfully complete, the better my day tends to be.  When you establish a consistent morning routine you will notice improvements in your energy levels, productivity, interactions with other people, sleep quality, and overall happiness with your life. Attached is the template for the morning routine I use every day. Enjoy!

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

The new year is a popular time for setting goals, health and lifestyle improvement, and new beginnings. We believe New Year’s resolutions offer an excellent opportunity to achieve your health and fitness objectives. Goal setting can be a tricky business, so we want to provide you with the tools you need to define, execute, and achieve your goals.  Make 2020 your best year ever and bring in the new decade with clear, focused intentions that push you towards a healthier and more fulfilling life. 

Establish Your Why

Before you start writing out your goals, you need to start by defining your ‘why’. Popularized by Simon Sinek’s excellent book, Start with Why, the idea of defining your why, or overall purpose in life, is the essential first step in goal setting.  What motivates you to succeed? Who do you want to help? What is your purpose in life? What are you truly passionate about?  Until you answer questions like these, the goals you set will lack a deeper meaning and you will be less likely to achieve them. Once you have established your why, you can align your goals with the vision for your life and how your goals directly relate to that why.

Write It Down 

In modern society seemingly all written documents are stored electronically. Everything from doctor’s chart notes, financial budgets, to the newest book on Kindle are digitized and meant to be read off of a screen. Instead of typing out your goals on a computer or cell phone, take the time to write them down on a piece of paper. There is value in writing your goals down on paper – a paper document is concrete, solid, and cannot be deleted with a stroke of your finger.  

Place this piece of paper somewhere you will see it everyday – on your desk at work, attached to the fridge, or take it a step further and tape a laminated copy of your goals on the inside wall of your shower! By seeing your goals in writing EVERYDAY you will be reminded of your goal, your why, and the ultimate purpose for achieving it. 

Write Out Action Steps for Each Goal

You can think of this as a to do list for each goal. Make one of these action steps something you can do TOMORROW. Examples of immediate action steps include purchasing a gym membership, cleaning up your resume, cleaning the junk food out of your fridge and cabinets, or calling a job or business lead. Make this first task simple to complete, so you will have zero excuses not to complete the task by the end of the next day. Subsequent action steps can be more complex and time intensive but should still have specific time frames for completion.  Giving yourself concrete deadlines will increase the likelihood you complete the action steps and ultimately achieve your goal.  

Create Goals that are: SMART

S= Specific: 

Your goal needs to be simple and specific. You should be able to answer the following questions: What do I want to accomplish with this goal?  Why do I want to accomplish this goal? What are the resources (people, monetary, time, etc.) needed to accomplish this goal? How will I know when I have completed this goal?  Once you have answered these questions you will have a clear vision of what you need to do to start on the path towards achieving your goals. 

M= Measurable:

Use specific facts, events, or metrics to clearly define your goal.  A clear and well-defined goal will better provide you with the blueprint you need to complete it. Instead of making a goal like, ‘I want to lose weight this year’, make a more specific goal such as:  ‘I want to lose 10 pounds by March and decrease my body fat percentage by 2-3%.’  

A= Attainable: 

While it’s okay to shoot for the stars, having practical goals you honestly have the resources to achieve are much more likely to be met. An unrealistic goal may demotivate you because you are asking too much of yourself. Use realistic timeframes. If your goal is going to take some time to complete, don’t give yourself a tight deadline which will ultimately end up stressing you out.  Conversely, don’t pick a goal that is overly easy to achieve. Find the sweet spot. You want a goal that will push you hard and motivate you, but not one that is so difficult it will cause stress and decreased confidence in yourself.

R= Relevant: 

Make sure your goal aligns with your life and career aspirations. Goals that do not push you towards your why feel empty and are less likely to be achieved.  By the time you’ve reached this step you should have already defined your why, and you can make sure your goals and your why are working for each other. 

T= Time Bound: 

Utilize a time frame and concrete deadlines.  As stated earlier, pick an action step to be completed by the end of the day tomorrow.  Pick another to be completed by the end of the week. Pick yet another more complex action step to be completed by the end of the month.  You can even pick goals that fall into different time frames. Write out a 1 month goal, a 6 month goal, a 1 year goal, a 5 year goal, and a 10 year goal. These goals can be interrelated or entirely separate.  Again, make sure these goals align with your why. Your 5 and 10 year goals should be intimately associated with your why because you will have had the most time to plan and execute these monumental goals.  

Ask for Help 

One of the best resources you have for completing your goals is your family and friends. Let them know what your goals are. Simply telling someone you have a certain goal is a powerful motivational tool. For added accountability, ask a family member or friend to check in with you periodically on the progress on your goal. If you have a career or skill acquisition oriented goal, find a mentor. Mentors can be a valuable asset in achieving your goals as they have likely had similar aspirations for themselves. Most mentors are more than willing to help an individual in their field as it gives them an opportunity to share the information they have worked so hard to learn. 

We hope these simple steps help you to define and conquer your goals in the New Year.  Make 2020 the best year of your life!

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

Over the past weekend, Dr. Ryan and I had the pleasure of attending the annual Colorado Chiropractic Association (CCA) convention.  Speakers from all around the country discussed the benefits of receiving chiropractic, specifically the hormonal benefits of receiving regular chiropractic adjustments. Chiropractic adjustments have a beneficial effect on your endocrine (hormonal) system, resulting in far reaching health benefits you may not previously have associated with the chiropractic adjustment. 

The topics covered in this blog post are inspired by two lectures given at the 2019 Colorado Chiropractic Association (CCA) convention. The first is a lecture given by Dr. John Minardi, DC on 10/26/2019 and was titled ‘The Power of Chiropractic.’  The second is a lecture given by Dr. Monique Andrews, MS, DC, DNM on 10/25/2019 and was titled ‘A Potential Role for Chiropractic in the Neurobiology of Autism.’

How chiropractic adjustments affect your brain.

First, it’s important to explain that the chiropractic adjustment does not only affect the joints of the spine and extremities, but also the brain.  When a joint is adjusted, special nerve receptors embedded in the joint capsule called mechanoreceptors are activated and fire signals to the brain.  These signals are received and integrated by the brain, and the brain’s activity is noticeably changed in response to the sensory input from the adjustment.  Studies have shown increased glucose uptake (a marker for metabolic brain tissue activity) in the frontal lobe of the brain following an adjustment (Inima et al, 2017).  The frontal lobe of the brain is responsible for executive functions such as decision making, personality and emotional expression, problem solving, and also controls our ability to communicate and connect with others.  This may explain why chiropractic is an excellent, yet underutilized, adjunct therapy for children dealing with autism.  

When an adjustment is performed and mechanics in the spine improve, signals are sent to the brain conveying the new, corrected position and/ or motion of the vertebrae in the spine.  The brain accepts and integrates these signals, producing an output signal that will have far reaching effects in the body. When joints are aligned and moving properly in the spine, the brain produces signals to the body that promote health and decrease inflammation.  When joints are not aligned and are not moving properly, the brain produces signals that decrease health and increase inflammation.

How the brain functions after an adjustment.

Now that we know adjustments affect the brain, let’s talk about the positive changes that occur in the brain after an adjustment.  The hypothalamus is a small region located at the base of the brain near the pituitary gland. The hypothalamus is important for the regulation of body temperature and other homeostatic systems such as hunger, thirst, sleep, and circadian rhythm.  The most important role of the hypothalamus is the linkage of the neurologic system to the hormonal or ‘endocrine’ system via the pituitary gland. The hypothalamus receives sensory information from the body, and produces ‘neurohormones’ that activate or inhibit the release of hormones from the pituitary gland.  When we adjust the spine we improve the quality of sensory information that is sent to the hypothalamus. Here is where the magic happens. As I previously described, when you are adjusted, small nerve endings in the joints called mechanoreceptors are activated and send signals to the brain. These signals provide your brain with valuable information about where the body lies in space, the structure and integrity of your spinal column, and can even block or mask pain signals being sent to the brain by other sensory nerve endings!  Adjustments positively affect the brain and nervous system, improving the quality of sensory information sent to the hypothalamus. The end result is an improvement in the quality of hormonal release that is governed by the hypothalamus.

How the brain functions when things are off-balance.

Spinal malposition and/ or decreased joint range of motion is perceived as a stressor by the brain. The brain sits on top of the spine and thus relies on the spine for its structural stability.  Imagine you were trying to replace a light bulb, but did not have a ladder. You need to get the job done, so you decide to stack boxes on each other for you to climb until you can reach the light bulb.  After stacking the boxes, imagine that one of these boxes is rotated and has slid out of alignment compared to the other boxes. How confident do you feel about climbing the boxes to change the light bulb now?  I’m guessing you’d be a little more nervous and stressed standing at the top of the boxes. In this metaphor, the boxes are your spinal vertebrae and the person standing on top of the boxes is your brain! If the boxes are not in proper alignment, you will perceive standing on top of the boxes as danger and your stress hormones will dominate.  The body acts in the same way. When the brain does not sense healthy alignment of your spine, poor information is sent to the brain and stress hormones are released.   

When the brain is stressed, hormones such as cortisol and norepinephrine dominate.  These are the hormones released in the body’s ‘fight or flight’ response and are very useful in situations where the body needs to respond to a threat to survival.  These hormones increase heart rate and breathing, shunt blood to the heart and skeletal muscles and away from the digestive and reproductive organs, dilate the pupils, and cause metabolic changes that increase energy delivery to skeletal muscles.  The problem is that in modern society many individuals are in a chronic state of stress, and thus their ‘fight or flight’ system is always on. Hormones such as cortisol and norepinephrine are essential to life, however the constant presence of them in our bloodstream due to a stressed state is highly damaging.  Improper cortisol release timing is one of the main implications for weight gain and an inability to control cravings for sugar and highly processed foods.

Testosterone and Estrogen.

By decreasing the stress response to the brain, adjustments decrease the amount of cortisol released by the adrenal cortex via the pituitary gland.  Inappropriate cortisol release wreaks havoc on the endocrine system. Hormones such as testosterone, estrogen, dopamine, and serotonin are all measured at lower levels when cortisol is too high.  Testosterone is often singled out as important for male sex drive and energy, and while this is true, research also suggests that men with higher levels of testosterone show more compassion and are more loving to their partners.  When cortisol levels are high, testosterone levels plummet. Estrogen is highly important for bone formation in women and also for achieving and maintaining pregnancy. Cortisol kills off estrogen and progesterone, another important hormone for maintaining pregnancy. 

Dopamine and Serotonin.

Dopamine is our anticipation hormone.  It governs the motivational component of reward-motivated behavior.  Dopamine fuels the anticipation of a future reward. Dopamine is released when we are particularly excited for an upcoming event, i.e. seeing a loved one, going on a long anticipated vacation, etc.  Dopamine is also released when we are particularly anxious for an upcoming event. Proper cortisol and norepinephrine levels are necessary to maintain balance in the dopamine system. When cortisol and norepinephrine are high, due to stress on the brain, dopamine release goes awry and can cause depression, thrill seeking, unhappiness, decreased immune function, excessive worrying and bickering. 

Serotonin is the body’s satisfaction hormone.  It governs happiness, satisfaction, and fulfillment in life.  Serotonin is even boosted when in the presence of a particularly friendly or happy person.  Excessive cortisol decreases the amount of serotonin and can contribute to depression and chronic pain syndromes such as fibromyalgia. 

Excessive cortisol and norepinephrine throw the entire endocrine system out of whack.  Cortisol will decrease sex defining hormones such as testosterone and estrogen, dampen the effect of dopamine, our motivation-reward hormone, and serotonin, our happiness hormone.  The good news? Chiropractic adjustments and other forms of manual therapies decrease the amount of cortisol and epinephrine released by the adrenal cortex and medulla via the brain and thus increases the levels of all these highly necessary and beneficial hormones. As a result, many of my patients report improvements in breathing, energy, digestion, and sleep following a chiropractic adjustment.  Even if you are not in pain, regular chiropractic adjustments are highly beneficial for your health and should be received at least once monthly. By getting assessed at least once a month you are ensuring the health of the joints in your spine and extremities, and drastically decrease the risk of future injuries, and the need for costly orthopedic surgeries.

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

Citations: Evid Based Complement Alternat Med. 2017;2017:4345703. doi: 10.1155/2017/4345703. Epub 2017 Jan 12.

So you’ve recently scheduled your first chiropractic visit. Having never been to a chiropractor before, you aren’t sure what to expect. You’ve seen the YouTube videos, heard many stories, both good and bad, with everyone seemingly having a unique experience with a chiropractor.  In this post I’ll outline what you can expect on your first chiropractic appointment.  

The following article outlines a typical new patient exam at Mile High Spine & Sport.  Most evidence based chiropractic clinics will follow a similar plan for a new patient visit. 

History (10-15 minutes)

Once in the treatment room, the doctor will ask you a series of questions related to your area of complaint. Questions asked will include the location of pain and if there are any referred symptoms. Referred symptoms refer to pain, numbness, tingling, and/ or weakness that may be stemming from the main area of pain. The doctor will ask for a detailed description of how the pain came on, whether it happened in a single traumatic incident, or if it came on more gradually over time. The doctor will ask which activities specifically make the pain worse (i.e. sitting vs. standing, bending forward, turning, lifting an object off the floor, etc.) and also if there’s anything specific that makes the pain better (heat vs. ice, Advil, relieving postures or positions, etc.). The doctor will ask about your treatment history – any past injuries or surgeries, and whether any imaging (X-ray, MRI, CT) have been taken recently, so be prepared with this information if necessary. 

A doctor who treats the entire body and not just the site of pain will ask you a variety of other questions regarding your overall health and lifestyle choices. The doctor will ask about your diet because the foods we eat can affect the way the body experiences pain and recovers from injury. They will ask about any medications or supplements you are currently taking, as well as what you like to do for exercise because activity modifications may be necessary while you recover from your pain. The doctor will ask about your sleep quality as sleep is the most fundamental human function necessary to heal. Additional questions will be asked regarding any drug/ alcohol/ or tobacco use, as abuse of any of these can magnify the inflammatory pain response and slow healing. Interview over! Now the doctor has a clear picture of your current chief complaint, your past medical history, and knows the kind of lifestyle you are living. 

Exam (15-20 minutes)

Vladimir Janda, a renowned Czech physician, always taught that ‘Time spent in assessment, will save time in treatment.’  With this in mind, chiropractors like to perform detailed, in depth exams to determine what specifically is causing your pain or dysfunction. It’s important to assess the entire body and not just the site of pain, because dysfunctions elsewhere in the body may be contributing to the site of pain. For instance, a shoulder problem may be related to poor function of the hip on the opposite side of the body, a chronic knee issue may be stemming from poor ankle mobility on that side, or low back pain may be related to diminished mobility and/or stability in the hips. 

The doctor will start by taking your vitals, which includes blood pressure, heart rate, respiratory rate and body temperature.  More specific exams such as an eye exam, cranial nerve exam, ear exam, lung exam, cardiac auscultation, abdominal exam, and nasal exam will performed on an as needed basis. 

Next, the doctor will perform a comprehensive neurologic exam.  They will test your deep tendon reflexes (think patellar knee jerk as a little kid), muscle testing, and sensation testing of your skin. These tests are meant to test the integrity of your nervous system. Other neurologic tests include single leg balance testing, your ability to stand with the eyes closed, the ability to sense vibration in your fingers and toes, and even your ability to distinguish smells such as coffee and cinnamon. The purpose of these tests are to screen for any pathology that is damaging your central nervous system and may include a disc herniation, spinal or brain tumor, or disease process. The vast majority of neurologic exams come up as normal, and the vast majority of positive findings in a neurologic exam are related to non-pathologic processes that can be corrected in the chiropractic office.  

The next portion of the exam is the orthopedic exam.  These tests help the doctor figure out exactly which tissues are injured, i.e. is it the meniscus, ACL, PCL, joint, or muscle? Orthopedic exams are meant to elicit pain and will most likely recreate your pain. Do not be worried about these tests damaging your tissues, they are only performed once and will help the doctor figure out the best course of treatment for you. 

The final portion of the exam will be the functional movement exam. The doctor will take you through a series of functional tests such as a SL squat, SL balance, lunge, push-up, active range of motion, passive range of motion, and muscle testing among many others. These tests are meant to recreate the demands of daily living and the basic requirements for healthy human movement.  When a dysfunction is found in the functional movement exam, the doctor is given valuable insight into which specific exercises will be beneficial for you. 

Will X-rays be taken as part of the exam?

At our clinic, we do not take X-rays on the majority of our patients.  Most presenting problems can be diagnosed and treated without the use of X-rays.  While radiation exposure during an X-ray is minimal, we still opt to only order X-rays or advanced imaging when absolutely necessary. Minor anomalies and asymmetries will be found on the majority of X-rays, but these issues rarely correlate to pain and can often confuse the patient into thinking they should have pain because of what the image shows

Review of findings (5 minutes) 

After completing the exam, the doctor will have a solid idea of what is driving the pain and the best course of treatment. The doctor will suggest which tissues are damaged and what other contributing factors are adding to the pain or dysfunction. Additionally, the doctor will explain the different treatments they want to use, including potential adverse side effects such as soreness or mild bruising for 1-2 days after treatment. 

Treatment (20-25 minutes) 

With the history, exam, and review of findings complete, the doctor can start the treatment.  Treatments will address the joints, nerves, muscles, tendons, ligaments, and any movement compensations you may have. The most commonly utilized treatments used at our clinic include: 

Active Release Technique (ART) – considered the gold standard in soft tissue therapies. 

Dynamic Neuromsucular Stabilization (DNS) – functional movement protocol based on principles of neuro developmental kinesiology. 

Instrument Assisted Soft Tissue Manipulation (IASTM) – the use of metal tools to decrease tone of tight and tender muscles. 

Acupuncture – needling technique used for thousands of years to treat pain and organ dysfunction. Acupuncture is based on needling along specific ‘meridian’ pathways that have specific uses for healing in the body. 

Kinesiology taping – special type of tape that provides support to joints and muscles without causing disuse atrophy of the muscles as is the case with traditional orthopedic braces. 

Cupping – effective decompressive technique which lifts the skin away from the muscles allowing increased blood flow and lymphatic drainage at the site of treatment. 

Internal medicine blood testing – functional medicine blood testing to assess for specific nutrient deficiencies, digestive irregularities, and hormonal imbalances that can be an underlying cause of pain and chronic disease. 

A typical treatment plan at our clinic is 2x/ week for two weeks, 1x/ week for two to four weeks, once every other week for 2-4 weeks, then once a month for maintenance care if the chief complaint pain is resolved. Most patients feel significant relief after 6-8 visits. Additionally, most patients feel even stronger and more flexible compared to their first visit because of the exercises they’ve been given at our clinic.

Now you know what to expect in your first chiropractic visit, hope to see you soon!

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

Many patients come to me with the goal of losing weight. They have seemingly tried everything from complex dieting, hiring personal trainers and life coaches, to intense calorie restriction and juice cleanses, yet nothing seems to work. Many methods work for a month or two and then the patient reverts back to their previous way of eating, often consuming more of the unhealthiest foods as a means of compensation for months of dieting. This cycle is repeated many times until the patient is discouraged and feels like lasting change will never happen. However, with proper education and dedication towards taking small steps in the right direction, lasting change is possible. In the following blog post, I’ll outline simple ways to take steps toward losing weight and keeping it off for years to come. 

What is metabolism?

Metabolism refers to the caloric cost of all biochemical processes in the body: digestion of food, maintenance of blood pressure, regulation of body temperature, protection from pathogenic diseases, production of ATP for energy, etc.  As metabolic rate increases, the amount of calories burned each day increases as well. Basal metabolic rate or BMR refers to the amount of calories burned while at rest. If you were to lie in bed all day your body would still be using calories to perform it’s essential needs, and the amount of calories you’d burn would be your BMR.  A main goal of weight loss is to increase the patient’s BMR (metabolism at rest), that way they are using more calories during the day, even when not exercising. One of the best ways to increase BMR is through resistance (weight training) exercise.

When we perform resistance exercise of appropriate intensity, we increase the amount of lean muscle mass in the body.  An increase in lean muscle mass is important because the metabolic rate is directly determined by the amount of lean muscle mass in the body.  As the percent of lean body mass increases, the metabolic rate also increases, resulting in more calories used throughout the day.  

An important point to remember is that lean muscle mass weighs more than fat.  This means that when you start performing resistance exercise, your body weight may initially increase. It is important to not get discouraged. Even though you are gaining weight, your metabolic rate is increasing and your percentage of lean muscle mass is increasing.  As metabolic rate continues to increase due to a higher percentage of lean body mass, you will eventually start to lean out and lose weight. I’ve seen too many patients get discouraged from an initial increase in weight and they end up missing out on the true benefits of resistance exercise.  

As an added bonus, one of the best ways to maintain the structure and function of your bones is through resistance exercise. Bones grow and remodel in response to external force.  You need to utilize barbells, dumbbells, kettlebells, and machine weight training to stimulate growth and repair in your bones. 

‘The Fat Burning Zone’: 

There is a common misconception that the best way to lose weight is through long duration cardio at a slow pace, such as taking long walks, slow jogging, or low level cycling on a stationary bike.  Most people have seen the charts on the treadmill or bike that highlight the ‘fat burning zone’ which supposedly gives the desired percentage of heart rate (HR) max that burns the most amount of fat.  The target zone is typically around 60% of the individual’s estimated heart rate max. While there is truth to the fact that our body’s burn more fat at lower intensities of exercise, the total amount of calories burned is much less when staying within the ‘fat burning zone’.  The amount of calories burned is more important than the percentage of fat being utilized for exercise. Higher intensity exercise such as sprints, repetitive jumping, resistance weight training, and plyometrics, burn more calories in less time and thus are more beneficial for weight loss.  

I prefer patients to perform short duration, high intensity bouts of exercise.  I’m not suggesting they completely give up taking long walks, or other forms of lower intensity exercise, but rather know the importance of getting their heart rate up and muscles firing in order to achieve a successful fat loss workout regimen.  Commonly known as high intensity interval training (HIIT), this training model uses short bouts of high intensity exercise, interspersed with brief periods of rest to reset cellular energy levels. The purpose of HIIT is to utilize and grow the body’s fast-twitch skeletal muscle fibers (type II fibers).  These fibers are responsible for sprinting, jumping, and heavy lifting, and are highly active metabolically (meaning they burn lots of calories). HIIT can be performed with running, biking, or with body weight exercises.  

A popular form of HIIT training is a Tabata workout. The classic Tabata protocol is 20 seconds of max effort high intensity exercise followed by 10 seconds of rest.  Complete this cycle 8 times for a total workout time of 4 minutes. Exercises include squat jumps, burpees, lunges, push-ups, or any movement that can be performed repetitively and explosively.  If you are new to HIIT training, instead of jumping right into a Tabata, consider performing interval training starting at 30-45 seconds of a moderately fast pace, followed by 20 seconds of rest, for 6-8 cycles.

Decrease inflammation to lose fat

A growing body of research is linking inflammation and obesity.  Obesity leads to inflammation in the body, and inflammation makes weight loss more difficult.  Inflammation is the body’s response to injury or infection and is characterized by redness, swelling, heat, pain and loss of tissue function. Inflammation can be looked at as the body’s alarm system. While an important and essential response to injury or infection, the body can kick on the inflammatory process in the absence of injury or infection.  When our body’s alarm system is in a constant state of activation, damage to tissues can occur. The most likely culprits of increased inflammation are diet, poor or absent exercise patterns, physical and mental stress, lack of sleep, and lifestyle diseases such as obesity, type 2 diabetes, and heart disease.  

The common belief in human physiology for years was that after puberty, you are essentially stuck with the number of existing fat or ‘adipose’ cells in your body.  After puberty, the fat cells would only be able to shrink or grow, but the total number would stay the same your entire life. New research suggests this is not the case and that fat cells can die and even transform into other cell types such as muscle or neural tissue. This information should be very encouraging to an individual trying to lose weight. Even more interesting is the same research suggests that chronic low grade inflammation in the body makes fat cells more resistant to dying or transforming.  If the patient is seemingly doing everything, yet they are still not losing weight, look to inflammation as the culprit. Decrease inflammation in your diet by cutting out refined sugars and grains, corn, soy, pasteurized dairy, grain fed meat, and commonly used vegetable oils such as corn, peanut, safflower, and sunflower oil. Instead eat a diet rich in vegetables, fruits, grass fed meats, pasture raised eggs, sustainably caught wild fish, coconut oil, olive oil, grass fed butter, and a wide variety of spices (garlic, turmeric, cumin, cayenne, etc.).

Morning sunshine exposure

For each of my patients I recommend 10 minutes of sunshine first thing in the morning with as much skin exposure as possible. There are numerous health benefits to morning sunshine exposure, with the most important being the regulation of your circadian rhythm.  Think of your circadian rhythm as a giant clock, and at specific points in the day, certain hormones are released on a timed schedule. Cortisol, our ‘awake’ hormone, is released in the morning and is stimulated by UV light exposure from the sun on our eyes and skin. It’s important to get an adequate cortisol release in the morning to avoid elevated afternoon and night time cortisol levels. Cortisol is often wrongly referred to as our ‘stress’ hormone.  Cortisol release only causes stress when released in the afternoon and evening, when our body should naturally be shutting down and preparing for sleep. When cortisol levels are high in the afternoon, our body’s naturally crave refined sugars and unhealthy processed fats. You’ve probably noticed how you gravitate towards sweets and fast food when you are most stressed. You can avoid these cravings by making sure cortisol release in the morning is adequate.  

Leptin and ghrelin are two important hormones that also depend on an intact circadian rhythm to function properly. These hormones regulate appetite and need to be in balance if weight loss is going to be successful. Leptin is an appetite suppressor and ghrelin is an appetite stimulator. Leptin is released when our body has consumed enough energy from food and we no longer need to eat. Leptin is our satiety hormone, and tells our brain when we are full.  As you can imagine, if leptin release does not occur, we will not have the signal to stop eating and we will over consume calories and increase weight gain. Ghrelin does the opposite, stimulating appetite when our stomachs are empty. These two hormones work in alternate relationship to each other and both rely on a healthy Circadian rhythm to function. An excellent health initiative would be to visibly watch (no sunglasses/ no windows) the sunrise and sunset every day.  Balanced hormones, better sleep, improved energy, and better appetite regulation are some of the many benefits you’d get. 

In summary, three excellent ways to trigger weight loss are: 1) start performing a high intensity interval training (HIIT) program, 2) decrease inflammation through diet and exercise, and 3) regular sunshine exposure to optimize your circadian rhythm and hormonal balance. 

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

Do you struggle with neck or shoulder pain, headaches, poor sleep, snoring, rib pain, shortness of breath during exercise, pelvic floor dysfunctions, or persistent dental issues and bad breath? The issue may be simpler than you think.  Each of these conditions can be caused or worsened by poor breathing patterns, i.e. taking short, shallow breaths through your mouth instead of breathing through your nose. One of the quickest and easiest ways to improve overall health is to adopt more efficient breathing patterns!

Basic anatomy.

Developmentally, the mouth is connected to the digestive system, while the nose is connected to the respiratory system.  Food enters the mouth and passes through the back of the throat, down the esophagus, and into the stomach. Air enters the nose, passes through the pharynx, down the trachea, and into the lungs via a series of tubes called bronchi.  These passageways are distinct in the ways they prepare food and air for use in the body. An anatomical structure called the epiglottis, which acts like a folding door, ensures that food does not pass down the trachea, and that air does not pass down the esophagus.  For normal health, it is important we keep these two pathways separate. You would never consider eating through your nose, so why do so many people breathe through their mouths? Unless we are performing intense exercise, our mouths should be shut and we should be breathing through the nose.  There are numerous health benefits associated with nasal breathing, as well as numerous health issues caused by mouth breathing.

The benefits of nasal breathing.

Breathing through the nose prepares the air for use in the body in three ways.  First, the bony passageways and mucus lining of the inside of the nose act like a natural air filter, cleaning the air before it reaches your lungs.  This function is extremely important if you live in a city or are exposed to inhalants in your line of work. Secondly, the air is humidified as it passes through the inside of the nose, moistening the air, allowing better absorption of oxygen at the lungs.  Third, the air is warmed as it passes through the nose, further allowing a smooth diffusion of oxygen into the lungs. None of these vital preparatory functions occur when breathing through the mouth.

Nasal breathing forces you to use your diaphragm, the body’s main muscle of respiration.  The diaphragm is also an important postural and core stabilization muscle. When you breathe through your nose using your diaphragm, the belly should expand on the inhale and come back to a neutral position on the exhale. I never let my patients suck in their stomachs!  Sucking in your stomach drastically decreases the stability of your core and causes a shortening and tightening of the muscles in the abdomen. We want the muscles in the abdomen to be relaxed when we are at rest, gradually expanding on the inhale and returning to neutral on the exhale.  If you want a perfect example, watch a baby breathe while they are sleeping!

Diaphragmatic breathing is beneficial for patients with conditions related to pelvic floor dysfunction (reproductive organ prolapse, incontinence, sexual dysfunction, etc.).  All of these conditions are characterized by weakness in the muscles lining the pelvic floor which are important for stabilizing the organs in the area. When we inhale and the diaphragm contracts downwards, pressure is directed against the pelvic floor muscles, which lay in parallel alignment with the diaphragm.  The pelvic floor muscles are activated in response to the increased pressure exerted against them during breathing. The pelvic floor muscles are difficult for many to isolate, and learning to breathe into these areas is the first step in recovering muscular function.

Another interesting benefit to nasal breathing is the increased nitric oxide (NO) production associated with nasal breathing.  Nitric oxide is important for the health of your blood vessels and heart. Nitric oxide ‘vasodilates’ or expands your blood vessels, ensuring blood can flow easily to all parts of the body.  A reservoir of nitric oxide producing cells is located at the back of the nose, so make sure to breathe all the way into the back of the nose. Actively flaring the nostrils when practicing breathing will help the air reach the furthest reaches at the back of the nose.

Issues with mouth breathing.

Hypertonicity and tightness seen in the upper trapezius and sternocleidomastoid muscles. Both are classified as ‘accessory muscles of respiration’ and should not be recruited at rest.

The main issue with mouth breathing is the muscle recruitment patterns that develop.  When people breathe through their mouths, it’s very hard for the body to use the diaphragm for breathing.  Instead, the body recruits other muscles to help with breathing which we call ‘accessory muscles of respiration.’  These muscles are located in the neck and top of the shoulder, and normally kick on only when the body is performing intense bouts of exercise.  However, with chronic mouth breathing, these muscles kick on even while we are at rest. When the muscles in the neck and top of the shoulder are used for respiration all throughout the day, they become short, tight, and overused.  Strained muscles in the neck place increased stress on the joints in the neck, causing issues such as headaches and neck pain. Receiving treatment for pain in these areas can be very effective, however if the root cause of the issue is improper mouth breathing habits, the main goal of therapy must be to correct breathing patterns.

Chronic dental issues and bad breath are also related to poor breathing habits.  If we constantly breathe through the mouth, pathogenic bacteria in the mouth are given a ready supply of oxygen to grow and duplicate.  Additionally, these bacteria thrive off of a dry environment, and the mouth becomes very dry with chronic mouth breathing. When the mouth stays closed, saliva is able to flush out the oral disease causing bacteria from the mouth and into the digestive tract where they can be expelled.  Amazingly, many indigenous tribes, who breathe primarily through their noses and speak less frequently, have very low levels of dental issues.

Rib pain is another common condition caused by a mouth and chest dominant breathing pattern.  If we breathe through our chest during the day even when at rest, the ribs are placed under constant stress.  You’ll notice minimal rib movement when you breathe strictly in the belly using your diaphragm. Patients that constantly need to see the chiropractor to have their ribs adjusted can benefit greatly from switching to a diaphragm driven belly breath.

Decrease stress with nasal breathing.

Yoga, meditation, tai chi, and qi gong are excellent practices that promote proper nasal breathing.

Breathing slowly and deeply through the nose activates a state of relaxation in the body.  The hormonal state related to relaxation is governed by the parasympathetic, ‘rest and digest’ system.  Unless we are hunting, competing in athletics, or performing manual labor, the body should be in a state of parasympathetic relaxation.  Focusing on slow, deep, nasal breaths is an excellent way to make sure we are in a state of relaxation when we should be. To ensure full recovery between exercise sessions or competitions, it’s vitally important the body is in the ‘rest and digest’ hormonal state.  Since nasal breathing is our best way to induce the ‘rest and digest’ system, nasal breathing is an excellent tool for athletic recovery!

Where do I start?

Lay on your back with your legs elevated and supported with the hips, knees, and ankles all at 90 degrees.  Place one hand on your chest and one hand on your belly. Take a large inhale breath, then exhale forcefully like you are trying to blow a candle out on the ceiling.  As you exhale, think about sending your ribs downwards and into the table. Taking the ribs out of a flared position and downwards toward the table will put the diaphragm in the optimal position to be recruited for breathing.  With the ribs in a down position, breathe through your belly. Do your best to only let the hand resting on your belly move, while the hand on your chest stays stationery. Take long, slow breaths through the nose, allowing the belly to rise on the inhale and to return to neutral on the exhale.  Stay relaxed through your abdominal muscles. Focus on breathing into the front and sides of your belly and even into your low back as well.

As stated previously, correcting your breathing patterns is one of the fastest ways to improve overall health.  Follow the steps in this post and you will notice the immense benefits right away. If you’d like to learn more: check out the excellent novel The Oxygen Advantage by Patrick Mckeown.

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