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.

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.