Copyright © 2020 Dr. Javier A. Carlin & Marissa Case, MS, RD.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

CONTENTS

About the Authors

Acknowledgements

Foreword

Introduction

Chapter 1 What If Everything You’ve Been Told About Aging Is Wrong?

Chapter 2 The Most Common Mistakes People Make About Their Health

Chapter 3 Back Pain

Chapter 4 Knee Pain

Chapter 5 Shoulder Pain

Chapter 6 Neck Pain & Headaches

Chapter 7 Food For Thought

Chapter 8 Nutrition Fundamentals

Chapter 9 Fitness

Chapter 10 Wellness, Health, & Everything Else

Chapter 11 Finding The Right Healthcare Provider (And FAQ’s)

Chapter 12 Knowledge is NOT Power

References

End Notes

ABOUT THE AUTHORS

Dr. Javier A. Carlin is a physical therapist and co-owner of Tampa Bay’s leading specialist physical therapy practice, Renewal Rehabilitation (www.renewalrehablargo.com), for those over the age of 50 who want to live an active and mobile lifestyle well into their 60s, 70s, 80s, and beyond.

Javier attended Florida International University, where he received a bachelor’s degree in Biological Sciences. During this time, he worked vigorously as a student so that one day he could have the opportunity to help people with their health needs without the use of medications, injections and at times, unnecessary surgery.

He went on to earn his Doctorate of Physical Therapy from Florida International University, at Nicole Wertheim College of Nursing and Health Sciences in Miami, FL. After graduation, he spent a year at South Florida Rehab and Training where he developed his skills further, and specialized in diagnosing and treating musculoskeletal conditions.

Frustrated with the hospital and corporate clinic setting, he decided to start his own practice in order to give patients better care with highly personalized solutions. Focused on getting people back to the things they love: walking on the beach, running a 5K, playing 18 holes of golf, or sleeping comfortably. He also works closely with local businesses such as, iLoveKickboxing® and Orangetheory Fitness®, and helps their employees and clients stay healthy for years to come.

In his free time he enjoys exercising, reading, traveling, spending time with family and friends, and is a strong supporter of the Girls on the Run® mission. Girls on the Run® is a non-profit girls empowerment program that works to encourage pre-teen girls to develop self-respect and healthy lifestyles.

Marissa Case is a registered dietitian and founder of Roots of Nutrition, a private practice which helps women who are just starting their health and fitness journey feel confident in their own skin and enjoy life, without sacrificing the foods they love. Marissa is also the co-founder of Registered Dietitian Approved, a company which mentors dietitians and teaches them non-traditional skills so they can create a fulfilling career for themselves and impact more lives through nutrition.

Marissa was a competitive gymnast and dancer for 15 years. Growing up she noticed some of her teammates struggle with their nutrition and body image due to the demands and pressures from the sport. She also saw many of her family members struggle to lose weight for years and watched as they tried diet after diet with no success. Marissa was able to recognize that nutrition was a key factor in all of these situations and knew that one day she wanted to help those like her teammates and family members, that she cared for so deeply.

Marissa attended Florida International University, where she received her bachelor’s degree in dietetics and nutrition and completed a dietetic internship. After graduation she passed her board exam, became a Registered Dietitian, and landed a job as a clinical dietitian at one of the top hospitals in Miami.

While working full time as a clinical dietitian, she went back to school to receive her Masters Degree in Sports Nutrition from Nova Southeastern University. After 5 years as a clinical dietitian, she uprooted and moved to Tampa, Florida to pursue her dream of building her companies.

In her free time she enjoys traveling, exercising, spending time at the beach, trying new restaurants, and spending time with friends and family.

ACKNOWLEDGEMENTS

T here are countless people who have helped lead me on this journey. So for those I do not mention in the limited space I have here, thank you! I want to credit Pedro Salas, RN for introducing me to and inspiring me to become a physical therapist, thank you for challenging me through my formal education, opening up my mind and making me think bigger.

I want to give a huge shoutout to my clinical mentors, including Mike Anastases, Carly Jo Haley, Joses Ngugi, Gabriel Carvajal, Maria Gaitan, and Pedro Lopez. Thank you to my professors for pushing me to be the best I could be throughout my time in graduate school, Erasmo Alvarez, Lisa Roberts, David Capote, Mark Rossi and Thomas Eberle.

Thank you Greg Todd, Paul Gough and SSPT Nation for helping me realize the true impact and value I can give to the world. Thank you for all the support from the amazing communities I’m honored to be apart of, including SSPT, GT’s Elite Mastermind and the Renewal Rehab family. Thank you Ryan Stran, and Anna Song for helping me with all the photos in this book.

Of course, I want to thank my family. Dad, Chris, Valeria, my wonderful grandparents and Marissa (who co-authored this book with me), you’ve all always supported me, have always cheered me on and told me I could do anything I set my heart and mind too. Words can’t begin to express how much your loving support means to me. I couldn’t be more grateful for each and every one of you.

Finally, Mom, where do I even begin. You are the kindest, most joyful, funniest, free-spirited person I have ever met. You have a positive energy that radiates to all of those around you. You have taught me how to smile, laugh and stay happy and not take things too seriously even when times are tough. I truly believe that you have allowed me to become the best version of myself by showing me how to be kind and generous to every single person that steps into our life. Thank you, Mami.

FOREWORD

I f you are suffering from pain or injury that’s been ongoing for days, months, or years, this is the book for you to read! And this is the Doctor and therapy team for you to see to help you get back to your old self!

I have suffered from neck, knee and foot pain on and off for many years and have tried all the standard remedies: NSAIDs, acupuncture, pain management, traditional physical therapy (from a different doctor), and more. At best, I would get temporary relief but the pain and discomfort would return and I would be back to square one. It was so depressing and frustrating to not be able to live the life I was accustomed to living because of pain. It stopped me from walking, hiking, sailing, kayaking, and playing with my grandkids the way I wanted to.

Orthopedists and other specialists were recommending surgery but I was determined not to go that route if at all possible. Then a small miracle occurred when my wonderful pain management doctor, Dr. Jennifer Bunch recommended me to try physical therapy again, but this time she recommended a different therapy team.

I reluctantly made an appointment to see them because my luck with physical therapy had not been very successful in the past. After an initial assessment, this new Physical Therapist, Dr. Javier Carlin, assured me he could help me, so I started PT with him immediately. And so my story of becoming pain-free and getting my life back began that first day when I met Dr. Carlin.

Upon meeting Dr. Carlin and the rest of the team, I immediately knew this experience would be different. My first go-around with my new therapy team was focused on helping me with the severe neck pain I had been experiencing for over two months. Dr. Carlin provided a thorough explanation of what he felt was going on with my neck and what we could do to correct it. More importantly, he gave me hope that there was something we could do to give me my life back. They were the first “hands-on” physical therapy clinic I have ever had as they stayed close to me during every session and explained to me what we were accomplishing every step of the way.

I was feeling so much better after about three weeks and I was completely pain-free within 8 weeks. I was so impressed with this, that I was planning on returning to them so they could put me on their maintenance program to prevent anything like this from ever happening again. But before I had the opportunity to do that, I hurt my knee while hiking and returned straight to them so they could take care of my knee.

REPEAT...within two weeks I was in so much less pain and within 2 months my knee pain was gone. So now I am finally free to start the maintenance program with him as long as I don’t go hurting myself again! I am so excited to start their TheraFit program to keep my body strong and flexible so that these unexpected injuries don’t keep happening to me.

MOST IMPORTANTLY, Dr. Carlin and the rest of the team treats you like a friend from the moment you walk in the door and you can tell they sincerely care about every patient’s well-being. I keep trying to understand why they have gotten results with me while every other physical therapy clinic was never able to. All I can surmise is that it’s because they realize that every person is unique and every person’s treatment plan needs to be tailored to their particular needs. The icing on the cake is that I have made a good friend forever, who I feel truly cares about me.

—Debbie , late 60’s, former patient

INTRODUCTION

Y our Golden Years. These are the years that are less focused on career accomplishments and more on leisure and family. It’s a time for interacting with your loved ones and enjoying different activities, trying new hobbies, traveling to dream destinations.

Whether you’re already in those golden years or are slowly approaching them, there are some disturbing trends, especially those over the age of 50. People are struggling with poor health and chronic pain that is limiting their ability to be active. It stops them from living a mobile lifestyle. It affects their independence and overall quality of life. Worst of all, many people believe it is normal. Many people just accept it or ignore help from experts because they believe it won’t work for them or because they believe their problem is somehow different. Many people give up.

Poor health and chronic pain normally develop because of one reason: decision making. Deciding to hit the snooze button on your alarm instead of waking up to exercise. Deciding to take pills to mask pain and stiffness. Deciding to eat that extra piece of cake or drink a soda when you are trying to stick to better lifestyle choices. Deciding to take advice from a friend or family member instead of a health professional.

These small decisions over time can lead to heart disease, diabetes, unnecessary joint surgeries, a dependency on medications, and other health problems. Your chances of maintaining independence and mobility while living free of painkillers will always come back to these decisions. When facing them, it’s important to have reliable information from a specialist. That’s what this book is all about.

This book is for those who are looking to better understand their bodies. It’s for those who value their health and plan on being active and independent into their 60s, 70s, and beyond. It’s for those who are willing to put in the time and take action towards becoming the healthiest version of themselves. It’s to help you age smarter while avoiding things like pain pills, injections, and surgeries.

There is such a vast amount of information on the internet and YouTube that it can be difficult to decipher what information is actually true and what isn’t. This book was created to provide more clarity.

The information and recommendations given here are not conjecture. Everything is based on the exact methods that have helped hundreds of my patients get incredible results. However, this book was not created to diagnose yourself. It is for those that feel stuck and have “tried everything” without getting the solutions they’re looking for. It is written to help guide you on the path to better health without using complicated medical and anatomical terminology.

I can’t make any big, bold guarantees without knowing your exact health background, but I can tell you that after reading this book you will have much greater clarity. My goal is to give you quality information so that you can have confidence in making the best decisions about your health. The advice given in this book may not be considered “sexy.” There are no revolutionary techniques to acquire better health, just simple guidelines that are often overlooked. In fact, you may believe many of these recommendations are too simple to do any good, but I promise that if you put them into action, the difference will be remarkable.

Let’s get started!

CHAPTER 1

What If Everything You’ve Been Told About Aging Is Wrong?

T he human body is one of the most intricate and misunderstood structures in existence. Although many medical advances have been made over the past decade, healthcare practitioners are still trying to understand how each system in the body operates in unison, especially when pain and stiffness begin to affect our lives. With the power of social media and the internet, more and more bad information is out there. I want to provide you with good information so you can make better decisions about your health.

Having low back, neck, shoulder, knee, or hip pain should not be a life sentence, and you shouldn’t accept a lower quality of life because of it. There are a TON of false beliefs out there. Let’s go through the most common ones I hear from family and friends as well as current and past patients.

“Being in pain is just part of getting old. ”

I once heard a patient say, “My doctor told me that if you’re over 50 years old and you wake up without any pain, something is significantly wrong with you.”

Yikes!

Where does this belief come from? A multitude of places. In American society, we portray aging as a negative stereotype. From birthday cards to movies, “old people” are made out to be weak and feeble creatures, always needing a walker or cane to get around. They are painted as forgetful, hard of hearing, constantly repeating the same story over and over again.

Meanwhile, throughout our lives we are told by parents and grandparents how we should cherish our youth because when you get older, “everything hurts.” Many physicians then tell us that after age 50, being in physical pain is normal.

When the media, loved ones, and physicians all promote the misconception that being in pain is just part of getting old, it’s easy to believe it’s a fact of life. This negative belief can have dramatic consequences. But what if you refused to accept this fate? What if you decided to look at aging as a privilege? As a great opportunity for INCREASED mental and physical activity?

A study done in the Journal of Gerontology found the beliefs about aging itself can have an enormous effect on your quality of life. Researchers followed 433 people aged 50 over an 18 year period and found those who had positive self perceptions about aging were significantly healthier and lived, on average, 7.5 years longer than those with a negative self perception about aging. [1]

The negative belief from patients and healthcare providers leads to those over the age of 50 being vastly undertreated for pain and stiffness.

Many of you reading this may already have some sort of ache, pain, or stiffness. Maybe you have trouble just getting out of bed because you currently feel like the Tin Man from the Wizard of Oz. Activities that used to be simple–putting on pants, donning a bra, or putting on a shirt–are dreadful because everything hurts. Some days are better than others, but your pain is slowly worsening and becoming more constant. You finally decide to see your doctor.

You’ve always trusted your doctor. Why wouldn’t you? From when you were a kid seeing your pediatrician to now going to your general practitioner, you have never been let down. At your physician’s office, he or she listens to your story, gives you a prescription for anti-inflammatories, tells you to rest, and says to come back in 6 weeks if it hasn’t improved. Unfortunately, you don’t really know what “rest” means. Can you still exercise? Are you supposed to lay in bed all day? What if trying to do your favorite activity still makes your pain worse? It’s all incredibly frustrating. The pain improves a bit with the medications, but as soon as the pills wear off, it all comes roaring back.

Six weeks pass, and you still feel the same, so now you begin to be concerned that the pain hasn’t healed. You begin to wonder whether something more serious is going on. Am I going to need surgery? Am I always going to have to take these painkillers? Back at the doctor’s office, you are told, “Well, you know, you aren’t in your 20’s anymore. This is the normal.”

PAUSE.

I have heard this story or a close variation of it HUNDREDS of times. People believe that nothing can be done to help their situation except take pills, get an injection, or go under the knife. That it’s just time to accept it. That diagnosis of arthritis, osteoarthritis, or degenerative disc disease is a lifetime curse.

Being in pain is NOT a normal part of getting older. With appropriate treatment, you can get back to golfing 18 holes, playing tennis, being active with your grandkids, walking on the beach, and traveling.

There are cases of people doing extraordinary things well into their 50s and beyond. A few years ago, an 80-year-old hiked to the top of Mt. Everest. Or maybe you’ve heard of Ernestine Shepherd? She is currently the oldest female bodybuilder at age 80, and she didn’t start exercising until she was 56! As I’m writing this book, supreme court justice Ruth Bader Ginsburg is 85 years old, and her workout routine consists of push ups, planks, and the bench press.

I know what you’re thinking, “But Javi, they are all genetically gifted. The average person can’t do that.” If you honestly believe that, please go ahead and close this book now. My most successful patients are the ones whose doctors have told them nothing could be done but who refused to accept that answer. They strongly value their health and have specific goals to stay active and independent for as long as possible. They don’t want their kids to worry about them. More importantly, they don’t just want to live–they want to THRIVE .

Not all healthcare providers are created equal.

My goal isn’t to bash on other healthcare providers, but it’s critical to understand that there are good and bad practitioners out there, and it can be difficult to recognize the difference.

It’s similar to taking your car in to see the mechanic. If you’re someone like me who can barely check their oil, you go to the mechanic without a clue of what’s wrong with your car and nod when he tells you, “The reverse main seal is leaking,” pretending you know what he’s talking about. You don’t really know if it’s true, but you trust the mechanic because he has a bunch of 5 star reviews on Google and a couple plaques on the wall. Secretly, you’re praying you aren’t getting ripped off and going to end up on an episode of 60 Minutes.

You don’t really have a reason not to trust your doctor. He or she is wearing a white coat and has a ton of degrees up on the wall. It’s his job to know what’s best for you, right?

But it’s not always so simple. Most physicians are well intentioned–we all get into medicine because we love to help people–but the current healthcare landscape makes it difficult to provide high-quality patient care. Physicians today are vastly overworked and forced to document behind a computer screen for hours each day. Many physicians can only provide 7 or 8 minutes of interaction time with their patients before they have to see the next one.

Your physician is asked to make an accurate diagnosis very rapidly after asking you a few questions and doing minimal to no physical examination of your pain or injury. Forget about having the time to ask all the questions you may have. Heck, Dr. House isn’t even that good. He always needs a one-hour episode to solve all his patient’s ailments. To give you a frame of reference, I spend at least 30 minutes to get a solid understanding and perform an examination in order to determine the root cause of your particular problem. You can see why it’s easier to give the quick answer of arthritis or that it’s just part of getting older.

Am I telling you that your physician is a hack and you should stop seeing him or her? Absolutely not! I have the privilege of working with some incredible primary care physicians and orthopedic specialists who help hundreds of people. I just want to bring to your attention that even if you have been let down in the past, there might be another solution for your problem.

Maybe your physician has referred you to try physical therapy and you didn’t get the results you were looking for. Remember, not all physical therapists and physical therapy clinics are created equal either.

The story goes like this: you get a referral from your doctor for PT. At that point, you are given a list of physical therapy clinics, and you decide on one that’s close to your house or has the most reviews on Google or Yelp.

When you call the clinic, the very first thing they ask you over the phone is for your name, date of birth, group policy number on your insurance card. THEN, what body part hurts? At your first appointment, you are given 43 pieces of paper to sign and fill out.

After your hand aches from all the paperwork, you finally get called back by a physical therapist. They seem nice enough. You talk to them for about 20 minutes while he or she types away on a computer with minimal eye contact. You do a few physical tests and are given an elementary explanation of what’s going on, they don’t explain the phases of rehab to you and how tissue actually heals and they send you on your way without a clear plan of action and ZERO lines of communication established, not giving you the ability to reach out to your therapy team when you are not in the clinic and need your questions answered and concerns addressed the most!

I tell you this because I was part of this system. It’s why I left it to create a business that truly focused on patients and their personal goals, not billable insurance units. Yes, we do accept all major insurances however we do not practice “insurance therapy.” Insurance therapy is when physical therapy clinics make decisions about your health based on what the insurance company says is best for you.

I’m sorry but if your insurance company, who has no idea what is going on with you, and your health and who honestly could care less about you, does not authorize the number of visits you truly need in order to heal your body, the LAST thing we will do, is tell you that you are ready to go home when we know you are not back to your full potential.

Find yourself a practice who can offer you a solution and tell you exactly how many more sessions you will need depending on the diagnosis and the specific healing time of the area that is injured.

These healing times are determined by a set of rules. Just like there are rules in sports, and governmental laws in place to protect us, the human body has them too. If we follow those rules, a physical therapist can get you back on track, and help you return to doing all the activities you love to do. If those rules are not followed, you might get some pain relief but it will last just as long as all of the other “quick fixes” you may have tried in the past .

Although there are different styles of physical therapy, I am a firm believer that hands-on, soft tissue work by itself is only one piece of the puzzle. There must be a proven movement and exercise framework that is followed in order to correct muscle imbalances and allow the body to heal properly.

The body must be viewed as a whole. The way you stand, sit (especially at work), lay in bed, lift things off the ground, and grab items off the shelf all must be taken into consideration to truly get to the root cause of a problem.

I have heard from people who have seen their chiropractor for years with the exact same back or neck problem. They continually go back just to get temporary pain relief. A chiropractor once told a friend of mine that if she doesn’t keep going back for adjustments, her organs will shut down. What a claim! Have you ever turned on the news and heard, “Local woman, aged 54, dies today from organ failure due to not returning to see her chiropractor?” Yeah, me neither.

If your chiropractor tells you something like this or if your chiropractor isn’t always striving to get you back to your favorite activity by changing the way you move, strengthening weak muscles, or stretching tight muscles, their motives may not be pure.

Sometimes people believe that their pain is hereditary because their mom or dad or family member had similar issues. This is also not true!

Chronic pain isn’t something that is passed off into your DNA from your parents or grandparents. The assumption that when you get older you’re supposed to be in pain is a false one. Like a classic car, you may need more maintenance, but pain isn’t an automatic fact of life.

Another thing I hear all the time is, “Javi, my MRI or x-ray shows I have arthritis (or degenerative disc disease or stenosis or a herniated disk), so what can you really do to fix it?” It has been ingrained in most of us that when you’ve had pain for a significant period of time and conservative treatment hasn’t helped, an MRI is the next logical step because it will tell you exactly what’s wrong. Yet, more and more research shows that MRI’s and x-rays are terrible at discovering the source of your pain.

In 2014, a huge research study was performed with 3000 people without low back pain. These were completely pain-free adults aged 20 to 80 without any history of low back pain. All 3000 subjects were given some sort of radiology, either an MRI or CT scan. Researchers found 80% of people in their 50s showed disc degeneration of their lumbar spine. Even 37% of people in their 20s had some form of disc degeneration. Disk bulge prevalence increased from 30% of those at age 20 to 84% of those at 80. Remember, not a single subject had ANY low back pain . [2]

Maybe you’ve been diagnosed with a rotator cuff tear? A patient of mine had an MRI resulting in the diagnosis of a full thickness rotator cuff tear and significant pain in his right shoulder. He went under the knife, only for his surgeon to find his entire rotator cuff was normal and intact, with no tear whatsoever .

Maybe you’ve been told you have knee arthritis and are “bone-on-bone”? Most people who are told this believe nothing can be done or they have to get a total knee replacement. Yet many patients I work with who are diagnosed with “bone on bone arthritis” can get back to walking as far as they like without pain or difficulty.

So when people tell me they had an MRI or some sort of radiology done showing arthritis, rotator cuff tears, meniscus issues, degenerative disc disease, etc. it’s just a tiny piece of the puzzle. Studies continue to show even people without pain have these diagnoses. What’s important is how you move. How long have you had pain? Do you have significant weakness? Is your pain constant or does it come and go? All these questions must be answered to get to the root cause of your problem. The human body can accomplish incredible things when you start to factor in posture, body mechanics, and the quality of your movement.

Am I some sort of magician or guru? Far from it. I just believe people don’t know that quality care exists and that surgery or pills isn’t the only answer. Does this mean nobody should get a total knee or hip replacement? Absolutely not! But what if you could delay surgery for another 2, 3, 4 years? What would that mean for your quality of life?

Just remember that when you get a consult from an orthopedic surgeon, the surgeon only has a couple options. He or she can prescribe you medications, give you an injection, or cut you open to perform surgery. Many times people believe surgery is a relatively quick fix. It’s just a couple hours on the operating table. How long can rehab actually take, right? Well depending on the type of surgery and what your goals are you’re talking months to more than a year to get back to all your favorite activities .

More and more studies show that for operations such as rotator cuff repairs and knee meniscus surgeries, the results are the same or even better when getting physical therapy instead of going under the knife. There is an appropriate time to get surgery, but I always recommend quality conservative treatment first.

“What about cortisone injections?”

Cortisone injections can be very useful when there is inflammation present, especially for knees, shoulders, and low backs (they are referred to as epidurals when injected into the low back). Unfortunately, the effects of cortisone injections tend to be temporary when you don’t have a specific incident that caused your pain or injury, such as falling off a ladder or lifting something too heavy.

You may not know how your pain started. Maybe it gradually got worse with time until you finally decided to do something. Normally, when injuries start this way it’s because there is some sort of movement imbalance, meaning the way you are sitting, standing, lifting things off the ground, or taking off your shirt is not correct and causing pain. If these movement faults aren’t fixed, the cortisone injection won’t matter, and the pain will slowly creep back into your life.

My recommendation for cortisone injections is that if you are suffering from excruciating pain which limits your ability to sleep or walk, it’s okay to get an injection. But go see a qualified healthcare specialist like a physical therapist to help make sure you keep the pain away for good so you can return to your favorite activities. Don’t depend on cortisone injections every few months as your sole source for pain relief. A recent study showed receiving a cortisone injection every few months for a long period of time for knee pain has been linked to accelerating cartilage loss. [3]

All the information discussed thus far may lead you to ask the million dollar question: why has my pain or injury not healed?

Understanding this is vital to improving your health. I try to explain it to each of my patients. To illustrate this, let me tell you about Nicole. She was in her mid 50s and had struggled with chronic back pain for many years. It got to the point where Nicole couldn’t walk or stand for more than 15 minutes because she had pain and a feeling of tightness going down both of her legs.

Nicole has two beautiful grandchildren, and her goal was to be able to be able to walk her grandkids to and from school everyday, which was approximately half a mile away. When you initially start having pain, you begin to move differently. No matter what part of you hurts, your body will do everything it can to avoid being in pain. For Nicole, when she walked into my clinic, I noticed she was limping mildly. She said she had been walking like that for many years without realizing it.

When you limp or change the way you naturally move for long periods of time, you begin to create muscle imbalances. Some of Nicole’s low back muscles had begun to shorten and tighten up. While those muscles tightened up, her glutes, had become weakened. This issue had to be addressed, or her pain would never truly go away .

With Nicole, we were able to fix these muscle imbalances, mobilize her stiff joints, and allow her not just to walk her grandkids to school but also train for a 5k! Your case may be different, but you shouldn’t be satisfied living in pain and discomfort. There are always more options, no matter what you’ve been told.

“I’ve had pain for YEARS and have tried everything. Nothing can be done!”

I hear something along these lines almost every day. Normally, it’s from people who have done injections, pain pills, physical therapy, chiropractic, acupuncture etc. but are still being limited by pain or stiffness. This belief causes people to feel hopeless and stuck. It leads them to live a lesser quality of life than they deserve. Just because you’ve tried some things and were let down doesn’t mean you are doomed.

I tell patients with this belief that even if your problem can’t be 100% solved, what if it could improve by 10%? 20%? 30%? Wouldn’t that be worth your time? What would it mean for your quality of life if you could spend 15 to 20 more minutes walking with a loved one? To be able to go upstairs with significantly less pain? To get a bra on and off without pure agony? To bend over to put on shoes without fear?

There is always something that can be done. It starts by reading books like this one. Just by reading this you are someone who is motivated to improve their quality of life. Someone who strongly values their health. Someone who is looking for answers. That’s more than half the battle. You are going to keep trying everything you can to live the happiest and most active life. If you understand these false beliefs and the mistakes commonly made, you can avoid them and work on getting your energy and life back. Now let’s keep going!

CHAPTER 2

The Most Common Mistakes People Make About Their Health

T he false beliefs from the previous chapter lead to mistakes that can keep you in pain and stop you from living a life where you are excited to get out of bed every morning and filled with energy, drive, and passion. A patient once told me, “You live in pain for so long, you do everything you can to ignore it, and when if finally does disappear, the results are life changing.” Having back, neck, shoulder, or knee pain is not a life sentence. Natural solutions are out there, but first, let’s talk more about the things you shouldn’t be doing.

Mistake #1: Rest is almost NEVER the answer

This is BY FAR the most common mistake I see. One day while you are driving your car and reach to grab something out of the back seat, you feel a bit of a shoulder ache. You don’t think anything of it at the time, but the next day the shoulder ache is still there. Initially, it’s not too concerning. Maybe you can take a couple ibuprofen, ice it, and everything is fine .

Weeks pass and the shoulder ache doesn’t improve. The ibuprofen just seems to mask the symptoms. Sleeping has become wildly uncomfortable, and you feel a jolt of pain in the shoulder every time you take off your shirt or reach to pick up a gallon of milk. Now you begin to become more worried. Did I tear something in my shoulder? Am I going to need surgery? So you begin to use your shoulder less and less because you don’t want to do any further damage.

At this point, several months have passed before talking to your physician. When you finally can’t take it anymore, you set up an appointment, only to get a prescription for an anti-inflammatory and asked to return to the doctor’s office in 6 weeks if the shoulder pain is still there. This is a story I hear all the time from patients.

It doesn’t matter whether it’s shoulder pain, back pain, or knee pain. When pain strikes, our brain goes into protection mode. Our parents always told us as little kids to “stay off it” or “put some ice on it” or “rest.” Yet the key to solving your pain is actually the opposite. One of my favorite phrases is, “motion is lotion.” For a ligament that is sprained or a muscle that is tight, incorporating some gentle movement will greatly accelerate the rehab and healing process.

If you are struck with low back pain, you may have the urge to lay in bed, but that’s always a recipe for disaster. To eliminate back pain for good, walking (aka motion) is vital to recovery. It increases blood flow to the whole body and allows for improved healing.

Are there exceptions to this? Of course, and I’ll be discussing some of them in upcoming chapters .

Mistake #2: Painkillers and the opioid epidemic

If you’ve watched the news, then you know the United States has a huge opioid problem right now. The majority of patients I see have been prescribed at least one opioid medication in their past. Some patients absolutely hate taking pain pills, which is a big reason why they come to see me. But other patients with severe cases of chronic pain and long surgical histories use opioids just to get out of bed in the morning.

Opioids are medications chemically similar to endorphins, a substance we make naturally in our body to help alleviate pain. Opioids are prescribed to treat severe to moderate pain and include drugs you’ve probably heard of: oxycodone, oxycontin, percocets, morphine, vicodin, and fentanyl. These drugs are prescribed by physicians to help patients with pain after surgery, pain from cancer, or chronic pain.

Opioids block pain messages sent from the body to the spinal cord and into the brain. They have also been shown to cause a large release of dopamine in the brain, which triggers feelings of euphoria and relaxation. You can begin to see why these pills have the potential to be so addictive and dangerous.

The most common side effects include depression, significantly slowed breathing, addiction, severe withdrawal symptoms, and of course overdose. These drugs do not help with inflammation. These pills aren’t improving the way you move, walk, or lift things off the ground. They are strictly used to mask your pain. In fact, several musicians, including Tom Petty, Prince, and rapper Mac Miller, all passed away from overdoses involving opioids, specifically fentanyl .

The critical part I want to bring to your attention is that pain is always a symptom . Pain is never the root cause of your problem. For example, you may have pain shooting down the back of your leg, which is known as sciatica. The sharp, shooting pain isn’t just there for fun. The sciatic nerve is being irritated somewhere along its path. The cause of sciatica is normally significant stiffness in the lower part of your back (the lumbar spine) or tightness in the piriformis muscle in your butt (piriformis syndrome), which aggravates your sciatic nerve leading to pain down the leg. Opioids aren’t going to make the joints in your lumbar spine less stiff or your hip muscles move better. They are just going to cause a temporary traffic jam and stop the pain signals from getting from your sciatic nerve to your brain. Yet opioids are normally the first line of defense when seeing your physician.

Opioids are being prescribed more and more in the United States, and according to the Centers for Disease and Control Prevention (CDC), in 2017, there were almost 58 opioid prescriptions written for every 100 Americans. That’s a lot of dangerous pills being prescribed!

Is there ever an appropriate time to take opioids? Of course. They can help cancer patients feel more comfortable and help us feel better after significant surgical procedures. However, if you’ve had chronic pain for more than 90 days and all you’ve been given are a combination of opioids, muscle relaxants, and anti-inflammatories, it could be time to find a healthcare provider who can understand where the root cause of your pain is coming from rather than trying to mask your symptoms with pills .

Mistake #3: Trusting the Internet

Thanks to Steve Jobs and Apple, we all have small computers in our pockets with access to an infinite amount of information. If you want to know who won the gold medal in the shot put at the 1992 Olympics, find a new recipe for baking asparagus, or hail a ride to the airport, it can all be done on our phones with a few taps of our thumbs.

The answer to any question we could possibly have is only a Google search away. So when things like back or knee pain creep up, it’s normal to head to Google to find out what’s going on. Websites such as WebMD and the Mayo Clinic allow you to plug in your symptoms and instantly get a diagnosis. Unfortunately, reaching an accurate diagnosis on the internet is never that easy. There are so many other factors involved when making an accurate diagnosis, especially with musculoskeletal pain. It’s necessary to consider stress, diet, exercise, other diseases such as diabetes, and more.

Then there is YouTube, which is quickly becoming more popular than Google itself. Anything you need, from how to wallpaper your house to how to fix a leaky faucet, can be found on Youtube. Many people search “best exercises for back pain” and get THOUSANDS of video results. Normally these videos are titled “The 5 BEST Low Back Pain Stretches To Erase Back Pain In 5 Minutes Or Less!!” If these videos actually worked, I would be out of a job and a lot less people would be walking around with aches and pains.

I also know that these websites frustrate many healthcare practitioners because people come in convinced they have a certain problem or diagnosis. Personally, when patients come to me with self-diagnoses from WebMD or the Mayo Clinic websites, I actually get excited. It tells me that the person values their health and is actively looking for a solution to their problem.

All that is needed is a bit of education on the true source of your pain or dysfunction from a specialist who is known to get the results you want.

Mistake #4: Getting General Advice or Exercises

A generalist such as a primary care physician has to know about a TON of things, from understanding medications to diagnosing different diseases. I have great respect for primary care physicians and the stress that is put upon them. Many are asked to see 3-4 patients an hour, chart all their notes, write prescriptions, communicate with staff, etc. all while trying to listen to their patients and make the most accurate diagnosis possible. That’s a tall order!

It’s easy to give you an answer of resting for 6 weeks while taking a pain or anti-inflammatory medication. Many times, physicians won’t even recommend seeing a musculoskeletal specialist, mainly for two reasons.

One, some physicians are actually incentivized to reduce expenses of your insurance company by not recommending physical therapy. They are also incentivized by pharmaceutical companies to prescribe certain medications. Said another way, physicians are offered a bonus at the end of the year from insurance companies for not recommending other treatment options and from pharmaceutical companies for prescribing certain medications. Neither of these have your best interest at heart.

Am I saying your physician is cashing checks every Christmas? Absolutely not. I know a ton of them with incredible integrity, but many are affected by the incentives whether they realize or not, and some doctors cash in intentionally. Dateline has done several reports on it if you’d like to investigate for yourself.

The second reason is that most physicians are not thoroughly trained to know orthopedic injuries or understand certain physical pains well enough to determine who would actually benefit from physical therapy. Shocking, but very true nonetheless.

Therefore, getting specialist advice is critical to recovering from pain and returning back to your favorite physical activity. Be sure to look for someone who takes the time to really listen to what’s going on and has had success with your type of injury. The key to discovering a true specialist is to ask questions. What is the root cause of my problem? How long will it take to fix? What’s the exact rehab plan to get to my goal? If they cannot answer those three questions with confidence, look for another provider.

Too often, friends and family ask me for “some exercises to fix my back pain.” Unfortunately, without spending the time to truly understand the root cause of your problem, general exercises won’t help you like you hope. One of the most common mistakes I see is people doing exercises at the wrong time, for the wrong diagnosis, and with improper technique. There is definitely a time and a place for exercises, but to give you “cookie-cutter” style exercises in this book or online would be irresponsible and potentially dangerous for your long term health.

Mistake #5: “Javi, have you ever heard of….?”

If I had a dollar for every time a friend or patient asked me, “Hey Javi, have you ever heard of…(fill in the blank)?” I’d have enough to take an Uber from LA to New York. These devices or treatments usually include in version tables, laser therapy, KT tape, cryotherapy, traction machine, knee or lumbar braces, a new topical cream, or a “breakthrough” treatment that was featured on Dr. Oz.

All of these are marketed as quick fixes that require minimal work from the potential buyer, you. Buy the product, slap on the cream or brace, and VOILA! Your knee pain will vanish! Sadly, there is no academic research that supports most of these devices, but they are wisely marketed using testimonials of people portrayed to be oddly similar to you. The commercial or online ad will show a video of someone that looks like you and mention the exact things you are feeling and have someone using the product with INCREDIBLE results. Then they will have paid physicians tell you they recommend the product to all their patients.

Please do not fall victim to this kind of marketing. Understand that these things don’t ever fix the root cause of the problem. They are band-aids at best. They will provide some pain relief and maybe make you look cooler if you are wearing different colored KT tape. Do I recommend KT tape or certain braces? Yes, I do. However, it’s always in conjunction with quality physical therapy treatment. Moving the joints that need to be moved, strengthening weak muscles, doing soft tissue work on tight muscles. fixing how you sit, stand, walk, or run. That’s how you get better and stay healthy for the rest of your life.

Mistake #6: Forcing A Yoga and Pilates Routine

“I feel so stiff all the time. If only I were more flexible, I’d feel better. I need to do yoga or pilates.”

This is another statement I hear frequently, and one that can cause more harm than good. I love doing both yoga and pilates myself, but caution must be taken before performing either of them when you’ve had pain for more than a few months.

Back, neck, shoulder or hip pain can be aggravated during yoga and pilates, especially if your teacher isn’t properly trained to deal with complex pain and injuries. Every yoga and pilates studio is different; some teachers are also physical therapists and understand when it’s appropriate to do a certain maneuver over another while rehabbing from an injury. Others do not, in which case you might have to come see someone like me after things have worsened.

I always recommend to see a specialist before going to a yoga or pilates studio. Many times, my patients are able to do both simultaneously as long as they are following certain guidelines based off their specific pain or injury. Other times, I have them wait until they have done a proper rehabilitation program before sending them off to yoga or pilates. Both are incredible workouts, but my advice is that it’s better to be safe than sorry.

Mistake #7: Going to the Gym and Working Through It On Your Own

I tend to see this more often with men with women, but it can happen with anyone. You have been working out in a gym for years and have always been able to work through aches and pains. I’ll be honest, many times this strategy can work. Unfortunately, if you are dealing with something like an Achilles’ tendon or rotator cuff injury, there is a risk you can completely rupture a muscle–not good! Both of those injuries take close to a year or more to get back to full participation of activities such as playing volleyball or running a 5k .

The other statement I hear quite frequently from people is, “Yeah, I just avoid squatting or lifting anything heavy so that I don’t aggravate my (insert body part) pain.” I normally say, “If we could eliminate your pain and minimize the chance of it coming back, would you go back to lifting heavy?” There is usually a long pause. This thought doesn’t often cross people’s minds. The belief is that, when you reach a certain age, pain is supposed to start setting in and you have to live with limitations. That’s not true!

Now, you might not be able to bench 300-plus pounds like you could in your 20s, but you should feel more than capable of doing the bench press comfortably well after your 50s and 60s. Don’t forget 80-year-old Ernestine Shepherd, who started lifting at 56 years old and can still bench press 115 pounds! Discussing your problem with a specialist to figure out how to appropriately modify and scale exercises is the key component to avoid injuring yourself while working out.

Mistake #8: Indecisiveness and Doing Nothing

You may be suffering with some pain or stiffness right now and know you should do something about it. Unfortunately humans have this terrible tendency to do nothing when we are overwhelmed with information on how to solve a problem. Nobody likes making the wrong decision, myself included. When bombarded by recommendations from loved ones, WebMD, Youtube, chiropractors, acupuncturists, physical therapists, etc., a sense of anxiety can set in over trying to make the best decision for your health. If this sounds like you, you’re not alone. Most people I work with tell me a similar story.

Finding a healthcare provider you trust can be difficult these days. And with all these “cutting edge” treatments being marketed, it’s hard to know what’s real and what’s not. But continuing to do nothing only makes the recovery process more arduous. While you wait, your problem may begin to worsen, leading to a decreased quality of life.

If you’ve been let down in your past by other types of treatment, you may feel stuck or that nothing can be done. Remember, there is always something that can be done. There are plenty of different types of treatment methods out there. You just may not have found what works best for you yet.

Understanding why these mistakes occur and how to properly avoid them can help you prevent pain and injury or expedite the healing process if you are currently suffering.

Next we are going to move into more specific topics, including back pain, knee pain, shoulder pain, neck pain/headaches, wellness, nutrition, and fitness. If you are suffering from a specific type of pain or you’re interested in a specific topic, you may be tempted to jump ahead to that chapter, but please consider reading everything in its entirety. A better understanding of your body as a whole will help you achieve long term health!

CHAPTER 3

Back Pain

T o say that low back pain is an epidemic would be a vast understatement. Low back pain remains the most common cause of disability and lost work time among working-age adults in industrialized countries. [4] Another study showed that chronic low back pain (pain lasting more than 3 months) in the United States may be as high as 30%. [5] That’s a TON of people suffering unnecessarily!

My goal is to help you better understand your back pain and why it may not have healed properly. Even if you don’t have low back pain, it’s still incredibly useful information to help protect you from it.

All Back Pain Isn’t Created Equal

There are many different types of back pain. Just because someone in your family or your neighbor has back pain doesn’t mean it’s the same kind of back pain you have. That’s why there is no one-size-fits-all approach when trying to fix low back pain, but there are patterns to help you recognize what kind of back pain you have so you can beat it once and for all.

How long you’ve had low back pain can greatly affect your recovery. When you initially get low back pain from lifting up your 5-year-old granddaughter or a heavy laundry basket, it is considered acute low back pain. Most of the time, acute low back pain tends to improve in anywhere from a couple weeks to a couple months.

Unfortunately, after having acute low back pain once, you are significantly more likely to have occasional flare ups or the feeling that your back “goes out.” It’s important to know that flare ups are normal , but the key is to recognize any triggers to these episodes and then utilize the right tools to recover from them. Many times the pain not only affects the low back but can shoot down your leg, causing increased numbness and tingling. This is commonly known as sciatica.

When these flare ups aren’t dealt with correctly, acute back pain quickly becomes chronic back pain, or back pain lasting more than 3 months. Acute low back pain is like having common cold. A common cold can be frequent in nature, annoying, but it goes away quickly.

Chronic low back pain is the equivalent to developing persistent low-grade pneumonia and can be described as continued pain and disability. Luckily, no matter how long you’ve had low back pain, you can make a full recovery. Your body is an amazing machine, and given the right inputs and proper movements, you can get back to the life you deserve .

Words Are Powerful

A mentor of mine taught me that the words we use are incredibly powerful in how we make ourselves and others feel. The right words can make us powerful beyond measure, but the wrong words can hurt and weaken us. In medicine, the words we use are critical, and too often I see healthcare practitioners who are lazy with their communication.

For example, if you went to your physician in your mid 50s and were told you “have the back of a 90 year old” or “this is the worst case of degenerative disc disease I’ve ever seen!”, how would that make you feel? I know if I were told that, I’d be terrified and begin to label myself as old and broken.

Or maybe somebody told you that your hips are out of alignment or your S.I. joint is “out”? This terminology is not doing anything for your recovery, and if your S.I. joint or hips were actually out of alignment, you would be in excruciating pain and on your way to a hospital.

These words and labels are not helping you, especially with low back pain. I once had a patient in her late 50s who, after hurting her back picking up her 3-year-old granddaughter, was told by a physician that she had herniated a lumbar disc. She saw a chiropractor, who then told her she was not allowed to bend over or lift anything over 5 pounds for the rest of her life and would require weekly sessions for the foreseeable future. Fearful that she would need back surgery, she had to have her husband and kids help her with everything from putting on pants and tying her shoes to doing all the grocery shopping and cooking.

It began to negatively affect her relationship with her husband, and she couldn’t be as active with her grandkids due to fear and pain. She was taking pain pills daily, wearing a bulky back brace, and was barely sleeping. She lived like this for two years before a friend sent her my way. During our first meeting, she seemed distant and initially believed there was nothing that could be done.

I let her know that back pain is not a lifetime curse but can be beaten with the right steps. We also discussed how herniated or “bulging” discs naturally reabsorb after several weeks and that bending over isn’t going to re-injure anything in her spine. We then developed a plan just for her and took baby steps, first reintroducing how to bend over safely, how to turn on the core muscles properly, and then improving hip and leg strength. After one month, she was able to walk a mile without difficulty, and after 8 weeks she could lift heavy laundry baskets without ANY pain.

If she came in and I told her, “This is the worst case of bulging discs I’ve ever seen; I don’t even know how you are standing right now!” her recovery would be doomed before she even started. Instead, I explained that what she had was common and that she just had some normal wear and tear. This allowed her to relax and focus on the rehab process. So please be mindful of which healthcare practitioners you’re seeing and, more importantly, how you define yourself.

You Are NOT Your MRI

Earlier, I discussed how MRI’s and x-ray exams are not all they’re cracked up to be. After a few weeks of having back pain, the first reaction people have is to want an MRI. It makes sense. We believe the MRI will identify exactly where the source of our pain is coming from so it can be eliminated. Unfortunately, that is normally not the case .

MRI’s and x-rays are only snapshot images, meaning when you get an x-ray or MRI, you are laying down and perfectly still. As you know, back pain is never 100% constant. It fluctuates up and down depending on the activity you’re doing and the position you are in (i.e. sitting or standing). A great physical therapist named Jason Silvernail gave an explanation to better understand this. MRI’s show you how the tissues of the low back LOOK, not how they FEEL, and it’s critical to understand this difference.

If I were to take a picture of you at the park, the picture would tell you what you looked like but not what you felt like at that exact moment. It couldn’t show whether you were anxious or happy, annoyed or craving food. In the absence of a major injury, these scans don’t do a great job of actually identifying your pain.

Back pain is almost always aggravated by a certain posture or movement. The way you lift things off the ground. The way you stand. The way you walk. The way you sit in a chair for long periods of time. You don’t do any of these things in an MRI scan, and it is a big reason why they are not the end-all-be-all when determining the source of your low back pain.

When they’re debating getting an MRI, I ask my patients, “There is a good chance that you’ll have a diagnosis of degenerative disc disease (arthritis) and possibly a herniated disk or spinal stenosis, so if this is the case...then what?”

Usually, it comes with a confused look and a response along the lines of, “What do you mean? After I get a diagnosis then you and the physician can better treat it!” Unfortunately, it doesn’t quite work like that. You don’t really treat bulging discs or spinal stenosis .

What I help people with is walking further, increasing their activity, safely bending over to put on their socks and shoes. And getting them back to picking up their grandkid without having the fear or expectation of excruciating low back pain. My most successful patients are always the ones who don’t focus on an exact diagnosis. They understand that they have chronic low back pain and have a positive mindset that their situation WILL improve. Because with the right help, it usually does.

Surgery is always the LAST Option

According to the Agency for Healthcare Research and Quality (AHRQ), about 500,000 Americans go under the knife each year for low back pain problems, spending approximately 11 billion dollars for these operations. Yet the John Hopkins Medicine team recently released a report that fewer than 5 percent of people with back pain are good candidates for surgery .

That’s a pretty startling statistic! If you believe you are in that small 5 percent of people appropriate for back surgery, then you may have any of the following signs or symptoms. These guidelines come from world famous back pain researcher Stuart McGill.

• At any point in time you begin to lose bowel or bladder control that is considered a medical emergency and need to go to the emergency room ASAP

• SIGNIFICANT neurological issues–if you begin notice one or both of your legs buckling when you’re walking or significant muscle atrophy (muscle loss) of one of your leg muscles

• SIGNIFICANT trauma, broken bones/vertebrae from a car wreck or a brutal fal l

• Severe and UNRELENTING pain for an EXTENDED period of time, meaning at least six months

If none of the above applies to you, you more than likely fall in the 95% of people who are not good candidates for low back surgery. Here are some of the signs and symptoms of people with low back pain that SHOULD NOT get low back surgery.

• If you have ever described your back pain as having many “good and bad days,” you are NOT a good surgical candidate.

• If you haven’t completely exhausted ALL your conservative options. Even though you may have had physical therapy, chiropractic care, acupuncture, or massage once and it didn’t work, that doesn’t mean there aren’t other therapies or trained professionals more appropriate for you.

Beware of “Institutes” that offer to view your scans and advise you on surgical options without fully assessing you, meaning they don’t actually assess how you move/walk/stand/etc. in person. You also want to be on the lookout for any new “cutting edge” treatments or “technological advances,” as more often than not they don’t pan out.

Every couple years the surgery field will have a new type of procedure or new type of equipment to use; laminectomy, foraminotomy, discectomy, lumbar disc replacement, or a new type of fusion. These are all to be avoided at all costs, especially fusions. Your lower back joints, the lumbar vertebrae, need to be able to move, slide, and glide a bit. When they can’t do that, you begin to stress the joints above them (your upper lumbar spine) and below them (the SI joint, tailbone, and hips) in a way they are not designed to handle. This isn’t good and can begin to cause pain in different areas of the body .

Those who get low back surgery, many times, have the same pain they had prior to surgery, and sometimes their pain actually gets worse. If you’ve already had low back surgery in your past and are still being held back by pain and discomfort, don’t worry. We’ll get you going in the right direction in the next section.

Many patients I see have had SEVERAL low back surgeries and were severely limited in regards to their overall mobility. It’s a story I hear all the time! With a customized plan and a little time, we can get them back to living a more active lifestyle with their loved ones.

Getting Back to the Basics

We’ve talked about the background info of low back pain, but let’s move into some actionable advice you can start doing right away. Every back pain patient I have starts with these same strategies regardless of their diagnosis or how long they’ve had back pain.

There are 168 hours in a week. You could be a professional athlete getting treatment everyday for 3 hours a day and it would only equal 21 hours of treatment a week. That still leaves 147 hours where you still must consider how you are moving and what position your low back is in. Therefore, these 3 steps are incredibly critical to defeat low back pain.

Step 1 : Breathe better! “Javi, I have been breathing my whole life. I’m pretty sure I’ve got this breathing thing figured out.” Well, let’s find out. Lie down on a flat surface with one hand on your belly and the other on your rib cage. (See picture below)

Now, take a deep breath and notice which hand goes higher. Is it your top hand that’s on your rib cage or your bottom hand on your stomach? If it’s your top hand, you would be classified as a “rib breather.” If your bottom hand goes considerably higher, you are classified a “diaphragmatic breather.” If you can’t tell or feel like it’s about even, that’s okay, because with back pain (as well as shoulder and neck pain for that matter) we want to be breathing with the diaphragm.

This means you want your bottom hand to be moving higher than your top hand. The reason that this is important is when we fill up our bellies with air, we create increased air pressure in our midsection, adding increased support to your lower back. Not only does this kind of breathing help with your lower back, but it also helps with decreasing stress, as this kind of breathing is closely associated with meditation .

Step 2 : Since we now know that breathing with the diaphragm is vital to the low back, change your hand position. Place both hands on your sides as in the picture below.

When you inhale, expand your stomach into your hands in an outward direction. Consciously think about filling up your abdomen like a balloon and letting the air press into your low back, stomach, sides, and even your pelvic floor.

This is how you want to breathe from now on!

Step 3: Brace for impact! Now that we’ve gotten breathing going in the right direction, it’s time to learn how to brace your core muscles correctly .

First, it is helpful to understand what exactly is your core. Many people believe it’s just the six pack muscles you see on the cover of Women’s or Men’s Health magazines, but it’s actually all the muscles of your midsection, low back, glutes, and hip flexors. These muscles, used in unison with one another, can help provide your low back with increased support and decrease low back pain.

It’s easy to believe that having a strong core means you’ll never get back pain, but that’s not the case. What’s significantly more important is your ability to activate these muscles at the right time. If you learn how to do this, you won’t need to wear a back brace because these muscles all serve as your internal back brace.

How do we activate these muscles properly? Whenever I ask patients to “brace their core,” they suck in their stomach or pull their belly button into their spine. I’m here to tell you that there is a more effective way to properly engage our core.

Lay on your back, keep your knees bent, and place your index and middle fingers about 2 inches to either side of your belly button (see photo below).

Now, press your abdominal muscles into your fingers as though another person were going to punch you in the midsection and you are going to break their fists with your strong trunk muscles. This is a proper abdominal brace! Side note: please DO NOT hold your breath!

The key is to combine the diaphragmatic breathing from step 2 and combine it with proper abdominal brace. You will feel like you can’t take as big an inhale and you’ll want to let go of your brace as you exhale. That’s normal! You are now using your diaphragm and core muscles in a way you haven’t in the past, so your body is adjusting. This is a difficult skill to learn initially, but it gets easier with practice.

It’s one thing to be able to do this while laying on your back, but it’s critical to start applying the breathing and bracing to everyday life. If you are lifting up a box of groceries from Costco, your back will thank you for activating those abdominal muscles properly while breathing correctly. When you get good at bracing, you should begin to use it like a volume dial, adjusting how much force you are putting into your brace.

When you want to pick up a grandkid who is quickly approaching the 100 lb threshold, you may want your abdominal brace turned up to an 8 or 9 out of 10. But if you’re just pulling a couple of small items out of the back of the refrigerator, your brace only needs to be a 2 or 3 out of 10. Start practicing, and play with your volume dial! Your back will thank you for it!

Are You Practicing Spinal Hygiene?

Here is another term I am shamelessly stealing from back pain researcher Stuart McGill. Spinal hygiene is similar to dental hygiene but for your spine. It’s something that must be performed daily, and the quicker you can incorporate these strategies into your daily life, the better off your back will be. This is a critical component to back health, and this advice alone has helped many of my patients improve their back pain immediately. They may seem trivial and unimportant, but don’t be fooled. Doing all of these things properly can drastically improve or eliminate back pain.

Sitting

As soon as you read the word “sitting,” you may have immediately worried about how you sit with bad posture. I’m actually here to tell you that sitting with perfect posture is overrated. Your body does not like to stay in any one static (or frozen) position for long periods of time, so even if you sat with perfect textbook posture for 8 hours at work and never moved from that position, you would still feel like the Tin Man from the Wizard of Oz when trying to go home at the end of the day.

The key is to move around more often. Try standing up every 20-30 min to allow your muscles and joints to loosen up. If you’re at a standing desk, work in a sitting position for a bit, or vice versa. Your spine loves position changes! Now, if you can combine position changes with sitting with a little better alignment, then you’ll be cooking with gas.

Everyone knows sitting in a slouched position like you see in the photo below isn’t the best for your low back (or shoulders and neck for that matter).

I would argue the bigger mistake I see is those that are sitting with an overcorrected posture. Yes, you can sit with an overcorrected posture, and I see it quite frequently with my patients who have low back pain. Overcorrected posture looks like the photo below, with the low back overly arched, causing the muscles on the left and right side of our spine, called paraspinals, to be hyperactive. When these muscles are hyperactive, it compresses the joints in your low back, which can aggravate low back pain.

The goal is to be somewhere in the middle of these two postures, in a position called neutral spine. To find neutral spine, slouch or round your back as far as you can, then arch your back like I described earlier, and finally find a comfortable spot in the middle of these two positions. This is neutral spine. To help sit in the most ideal posture, you should sit in chairs with good lumbar support or utilize a pillow or small, folded dish towel. You don’t need a large pillow for good low back support. It can look like this.

You can see there is a small curve of the low back, but it’s not too rounded or overarched. It’s right in between. Perfect! Moving around every 20-30 minutes or so is much more helpful than sitting in one static position, but if you have to sit for long periods of time, ensure you are in neutral spine with good lumbar support. When sitting at your desk chair, ensure that your feet are resting flat on the floor with your knees and hips at 90 degree angles. Your ears should be in line with your shoulders and your arms in line with your body with your elbows at 90-degree angles.

Standing

Standing is another critical position that we take for granted, and something that we do all the time. If you have back pain when standing in a long line for a cup of coffee, for example, it definitely doesn’t feel great. Standing in a pain-free, optimal position is helpful to healing .

Normally, those that have back pain have overactive low back muscles, similar to the overarched or overcorrected lower back I discussed when sitting. To assess this yourself, stand up right now. With one hand, feel your low back just to the left and right of your spinal column. If these muscles are hard as a rock and feel like cords, you must learn how to relax them to decrease pressure on your low back.

Keeping your hand on those low back muscles, SLIGHTLY lean backwards until those muscles shut off and feel soft and relaxed. Now slowly lean forward until the low back muscles become hard again. The goal is to find the most UPRIGHT standing posture without your low back muscles turning on.

In the photo on the left, you can see my left hand assessing the low back muscles or paraspinals. When he is leaning forward, his paraspinals are working too hard and are tight like cords. In the photo on the right, you can see he is standing more upright and there is less paraspinal activity, meaning more comfort for your low back. (Note: if you’re having trouble, try standing with one foot in front of the other to see if it works better for you). This will be your new safe standing position. Again, being as upright as possible with the low back muscles turned off is ideal.

Your neck positioning also affects the low back muscles. If your head or neck naturally protrudes forward (sticks out), it will also force all your back muscles to turn on. So while standing in your new, relaxed position with one hand on the lower back muscles, try sticking your head and chin until your back muscles engage. Now draw or pull your chin in until they turn off like the photo below.

Remember, keeping the low back muscles turned “off” is always ideal so keeping your chin and head pulled back and keeping your head in line with your shoulders and hips is ideal for your low back. Additionally, If you allow your shoulder to round, your lower back muscles will turn on. If you pull the shoulders back, then the low back muscles will relax.

The low back muscles will also activate if you cross your arms over your chest. They will then relax if you put both hands behind your back.

Hopefully, this experiment shows you how small adjustments can force your back muscles to engage or relax. Keep experimenting until you are in a comfortable, upright position that allows your low back muscles to stay relaxed. This can be difficult to do yourself, so if you have trouble, please consider seeing a trained specialist such as a physical therapist.

Lifting and Bending

Bending over to put on shoes or lift things off the ground can both be painful and difficult when not done correctly. The key is to perform a good hip hinge whenever you bend over. What’s a hip hinge? Great question!

Normally, when people bend over to pick things up off the ground (especially with back pain), it looks something like the photo below.

In this photo, you can see that his trunk is vertical and his knees are collapsing over his toes. This puts excess stress on the back and knees.

The way to perform a hip hinge properly is to begin with your feet a little wider than shoulder width apart. Then push your hips back as if you were going to sit in a tiny chair behind you. When your hips are far enough back, the knees will naturally begin to bend.

If you are having difficulty doing this, place your hands on your thighs. Then slide your hands down until they are resting on top of your knees. You are now performing a perfect hip hinge.

Important note: the hips move first and then your knees next! It should look like this photo below.

His hips are back as though he is sitting in a chair, and his trunk is leaning forward and not vertical as in the previous photo. The hip hinge is critical for protecting your low back. When people use the phrase, “lift with your legs,” this is to what they are referring to. In this position, your hips and glutes are doing the work instead of your low back.

Another note: if you are lifting anything off the ground, it should be directly underneath you. The farther away the object from your center of mass, the more stress you put on your low back. So please be cautious when grabbing heavy grocery bags out of the back of your car.

Don’t forget that when you lift anything with significant weight, always use your abdominal brace and proper breathing. For heavier items, your inner abdominal brace should be turned on more forcefully. For smaller items, having a lighter abdominal brace is perfectly fine. Just be sure to use the brace!

Sleeping

We spend a third of our lives sleeping, yet it is often overlooked when it comes to a healthy lifestyle. Getting 7-8 hours of sleep allows your body to heal itself when it’s injured. Unfortunately, having back pain can affect your ability to sleep. Quite the conundrum, I know. Luckily, there are several things you can do to help get more comfortable.

First, we can break down sleeping positions into three separate categories: back sleepers, side sleepers, and stomach sleepers. If you switch into more than one position, it only matters what position you start in. For example, I consistently wake up on my side, but I always start sleeping on my back, so I’m a back sleeper .

For back sleepers, place pillows under your knees and thighs to elevate your legs. By elevating your legs, your low back is placed in a less compromising position, allowing maximum comfort. Experiment with the amount of pillows you use. Some people will feel more comfortable with just one pillow where others feel more comfortable with two or three. If your mattress has the ability to lift the foot of your bed, experiment with it as well. Just try it out.

At this point, someone usually asks me “Javi, what if I end up kicking the pillows?” This is normal, and it’s ok. Even if your pillows only last an hour or two, that is an extra hour or two of improved sleep quality.

After the pillows, the next best thing to do is to get a small dish towel and place under the small of your back when you’re sleeping. Having this small towel under your back may seem silly, but many times it allows your low back muscles to relax so you can actually get some shut-eye. Experiment with this prior to bedtime. Grab pillows and a towel and figure out what is the most comfortable for you. It should look something like this:

For the side sleepers, placing a pillow between your legs will keep your pelvis in an optimal position. Many people place pillows in a horizontal position, but it’s best in a vertical position, meaning the pillow should go from your upper groin area all the way down to your ankles. Similar to back sleepers, putting a rolled up dish towel underneath your side, below your ribs and just above your pelvis, will give your back more support.

For stomach sleepers, place the center of your pillow underneath your belly button. This will allow your back to be in good alignment and let you sleep in significantly more comfort.

“I Have Back Pain Because My Hamstrings Are Tight!”

I hear this from patients and have read it on the internet, so let’s nip this back pain myth in the bud right away. There is NO research that shows a correlation between hamstring tightness and low back pain. [6] If you’re spending a large amount of time on a foam roll or lacrosse ball to work those hamstrings, please stop .

If you are feeling a constant tightness wrapping around your hips, it’s easy to assume it’s due to tight hip flexors or tight hamstrings. The perception of tightness is a protective mechanism from your nervous system that indicates another group of muscles is not working properly. It’s generally a sign that you have weak glutes (and poor abdominal bracing/endurance, as we discussed earlier).

Most patients with back pain have weak hips, specifically weak glutes or butt muscles. The glutes play a vital role in stabilizing your pelvis and supporting your lower back when you walk, hike, go upstairs, lift things off the ground, etc. The risk for back pain increases when your glutes are weak and aren’t activating correctly. This can be attributed to the significant amount of sitting we do on a daily basis and a lack of appropriate strength training. We sit at desks. We sit on couches. We sit in our car. We sit at the toilet. All of this sitting weakens our glutes and increases the amount of work our low back has to do. Not great for long term spine health. So in addition to getting better at doing your abdominal brace, don’t forget to strengthen your butt!

If you want more in-depth low back pain tips, go to our webpage at https://www.renewalrehablargo.com/back-pain to download your free report titled, “5 Simple Ways To End Back Pain & Stiffness Without Painkillers Or Injections.”

If you want more tips for dealing with sciatica, go to our webpage at https://www.renewalrehablargo.com/sciatica-hip-pain to download your free report titled, “7 Natural Ways To Ease Sciatica & Hip Pain Even If You’ve Had Pain For Years. ”

Summary

• Having an episode of low back pain is normal, but chronic low back pain (lasting more than 3 months) is not. Chronic low back pain doesn’t go away by itself and will take more than just rest or painkillers to solve.

• Words are powerful. Be careful working with healthcare practitioners that tell you your back is “out of alignment” or that you “have the back of a 90-year-old.”

• Don’t put too much weight into your MRI exam. Discs reabsorb. Arthritic joints can be mobilized. Weak muscles can be strengthened.

• Learning to breathe with your diaphragm and activate your core muscles will help support your low back.

• Practice good spinal hygiene. Sit, stand, sleep, and lift with good form and technique. Your back will thank you.

• Don’t forget about your hips and glutes, which play a vital role in supporting your entire spine.

CHAPTER 4

Knee Pain

O ne of my favorite phrases about the human body is, “little hinges swing big doors.” I can’t think of a more accurate way to describe the knee joint. The knees allow you to sit, stand, walk, jump, and exercise. Your knees are designed to absorb and cushion whatever impacts you throw at it. Unfortunately, your knees can take a pounding over the years from running on hard surfaces, playing golf, or intense hiking.

This can lead to wear and tear on the cartilage in your knees, causing it to wear thin and possibly creating clicking or popping noises. Enough damage to the knee can lead to significant pain and stiffness. In fact, after low back pain, knee pain is the most common diagnosis we work with at Renewal Rehabilitation.

In this chapter, I’ll go over an in depth look at knee pain to give you a more thorough understanding of why knee pain happens and the strategies to eliminate it .

Between a Rock and a Hard Place

Your knee doesn’t have a lot of options. The knee is connected to both your hip and your ankle/foot. If your hip is weak, your knee will have to take on more force to help stabilize your leg when you do activities such as walking or climbing stairs. If the ankle/foot are in poor positioning, as with flat feet or a bunion, it can also play a role in the alignment of the knee and the amount of force the knee must absorb. So when I see clients with knee pain, the hip and foot must be assessed as well.

If you look at the illustration below, you can see what I mean about the knee being influenced by your hip and foot. This drawing represents a still shot of a person with knee pain walking, the moment the right foot is planted as the left leg is swinging. Look up near the pelvis. See how the pelvis is not horizontal but is tilted at an angle? The pelvis dropping due to a weak right hip, more specifically due to a weak right glute (the gluteus maximus). When the pelvis drops like this, the femur (the thigh bone) will begin to turn inwards, causing excess stress on the inner portion of the knee.

Someone with a history of knee pain and significant hip weakness will normally present with “knock-knees,” anatomically known as “knee valgus.” To test this, stand in front of a mirror with your feet shoulder-width apart. If your knees look like they want to kiss each other, you would be considered knock-kneed or having knee valgus. Having knee valgus for years can add a significant amount of stress on the inner portion of your knee, leading to increased knee pain.

Foot problems can also cause knee valgus. Take a look at the foot in the picture above. When the arch of your foot excessively collapses, it can cause the tibia (the big lower leg bone) to turn inwards, causing knee valgus. Arches excessively collapse if the small muscles of your feet are weak or if you don’t wear proper shoes with good arch support.

If this happens every time you step down on that leg and you walk like this for thousands of steps per day, day after day, it can add up rapidly. Also notice how everything, especially in the lower half of your body, is connected. Having a problem at one joint, such as the knee, can cause problems at other nearby joints, and vice versa.

Knee valgus and knee pain can be improved. When working with a specialist healthcare provider, they shouldn’t just be treating your knee but also looking at the hip and foot to improve overall alignment and strength.

What Kind Of Shoes Are You Wearing?

Here in beautiful Tampa Bay, Florida, the weather is perfect 90% of the time. As you can imagine, being outdoors and going to the beach with friends or family are pretty popular activities.

Unfortunately, a common mistake I see with those suffering from knee pain is a poor selection in footwear. Although sandals may be fashionable, they are not friendly to your knees in the long run. The majority of sandals do not have proper arch support and can cause the knee to have excessive, unnatural movement, which then can lead to knee pain.

I always recommend wearing sandals as little as possible, but if you are adamant on wearing them, please be sure to invest in a good pair with proper support. Also, avoid the thong sandals that are worn between your first and second toe. Thong sandals tend to create imbalances between the small muscles in your foot and your glutes (aka your big butt muscles). When your glutes aren’t working the way they should, it can lead to an array of problems, including in the knees, back, ankles, feet, and hips .

To all the ladies reading this, please sit down and gently brace yourself before reading this next sentence...

Wearing high heels is not good for your knees. When walking with high heels, you put increased weight on your knee joints, and they aren’t designed to take on that much force. Not only that, but when your heels are up that high, it can begin to shorten your Achilles tendon, which can lead to calf tightness and to Achilles tendonitis issues down the line.

I also understand that sometimes you have to wear high heels, whether at a formal event or work. If you are wearing heels at a formal event, please bring a pair of sneakers or flats so you can change as soon as the event has ended. If you have to wear heels at work, (politely) inform your boss that wearing heels is making your knee pain worse and that you must wear sneakers. Most companies are trying to avoid spending money on employee injuries and should acquiesce to your request. (Side note: you will more than likely need a physician’s note to bypass your office dress code policy.)

My go-to recommendation for footwear is a store like St. Pete Running Co.®. They will give you a custom walking or running shoe recommendation based on your type of feet. Great shoe brands include Saucony®, Hoka One One®, Asics©, Altra® and Brooks®.

The other recommendation I make is to try foot orthotics. They can help put your foot in better positioning, which will then allow your knee to move better. Orthotics are great because you can slip them right inside any pair of shoes you have. Many of my patients love buying multiple pairs for their work, walking, and exercise shoes. Don’t worry about getting custom foot orthotics unless you have a significant history of foot problems or have foot deformities. The general orthotics at a sporting goods store or online are fine. My recommendations are Vasyli® or SuperFeet®.

If you would like more tips specifically on foot or ankle pain, you can check out my free report, “The 6 Essential Tips To Reduce Foot And Ankle Pain In 14 Days” at https://www.renewalrehablargo.com/foot-and-ankle-pain . It has all my best tips for ending foot and ankle pain naturally.

Arthritis Isn’t Your Enemy; Pain & Stiffness Are

“Javi, I have bone-on-bone arthritis! I saw the x-ray. Isn’t physical therapy and exercise going to make it worse? I just know I’m going to need a knee replacement!” I’ve heard this countless times, especially from those over age 50 with knee pain. A total knee replacement sometimes is the answer, but not always. Let me tell you a story.

I once had a patient who we’ll call Janet. She was 55 years old at the time and came to me after having more than 10 years of right knee pain. In her late 30s, Janet had a meniscus surgery on that same knee after twisting it during a hike. Janet began to tell me how excruciatingly painful it was to go upstairs or walk more than 10 minutes. Getting out of bed in the morning was torture due to the stiffness, and she could only stand in line at the grocery store by putting all her weight on her grocery cart.

Janet came to me out of desperation. Her daughter had just gotten a new job and had asked Janet to watch over her two beautiful grandkids while she was at work. She was terrified that she would end up being in a wheelchair and wouldn’t be as active and independent as she wanted .

So she was determined to find a solution to her knee problem. Unfortunately, she had been let down in her past. Cortisone injections. PRP. Synvisc shots. KT Tape. A copper sleeve. Knee brace. None of them worked. She even tried physical therapy at another facility for a few weeks but felt ignored. She saw a certified physical therapist for 10 minutes before being given exercises to do at home.

Janet, still determined, ended up finding me on Google and liked what I had to say on the phone, so she came in for a free consult that we call our Discovery Session. During the Discovery Session, she told me all about her “bone-on-bone” arthritis and how she was going to need a knee replacement.

Janet was determined to avoid surgery at all costs, but she was terrified her family and friends were passing her by, that instead of taking care of her grandkids, she would need someone to take care of her.

Watching her walk around, you didn’t need any medical training to see the severity of her limp and how she appeared to be sinking while walking. Janet’s right knee was stuck in a slightly bent position, causing her to be unsteady.

Her balance was poor, quadriceps were weak, and glutes not activating properly. Her painful right knee could not straighten or bend half as much as her left knee. But she did have one thing going for her. She was open to the idea of trying something different and committed to getting a natural solution so she could avoid or put off a total knee replacement.

We developed a customized plan of care, and I let her know that arthritis isn’t really the enemy. Again, arthritis happens in every joint of your body over time. It’s the normal wear and tear of aging. However, sometimes arthritis can lead to stiffness, which leads to pain and inflammation. So it is stiffness that is the true enemy.

When you have stiffness, your joints can’t move as freely as they are designed to. Picture an old, creaky door in your house that won’t open or close all the way. The door continues to get stuck, but you have to get in and out of it, so you keep forcing it open and closed, causing increased stress on the door hinge. The same thing is happening to your knee when arthritis has turned into stiffness. You have to keep walking and doing your daily activities, but the knee doesn’t always want to cooperate.

The knee joint stiffness then begins to cause pain and inflammation. In order to get the knee joint moving again, we have to apply some lubricant (think WD-40) to get the knee moving again. How do we do that? With proper hands-on work to improve knee mobility and then with specific corrective movements to keep the knee moving the way it’s designed to. It involves getting the big hip muscles strong and resilient while improving the stability of the foot and ankle.

After explaining all this to Janet, she was excited to get to work. Was it easy? Nope. Was it an overnight fix? Nope. But Janet invested in her health and did everything she was asked. With the help of the hands-on work and specialist guidance, Janet is now able to walk as far as she wants without a limp. More importantly, she is active with her grandkids, all without knee pain. I still stay in touch with Janet, who is quickly approaching 60 and has maintained her health without getting a total knee replacement, taking pain pills, or getting more injections .

Can I guarantee that success for you? Unfortunately not. Occasionally, I do turn away patients with knee problems. Normally, it’s because of one or more of the following reasons:

• They’ve waited too long to get specialist help

• Their pain is constant and doesn’t change whether they are sitting, standing, or lying in bed

• The knee (or knees) is constantly swollen, severely limiting range of motion

• The knee joints are significantly bowed in or out

Please don’t let yourself get to this point, Reach out for help sooner rather than later!

If you want to see whether your knee situation can improve, schedule a phone call at https://www.renewalrehablargo.com/free-telephone-consultation to talk more about your knee suffering and how we can help.

Be Wary Of Injections, Knee Sleeves, and Supplements

You’ve probably seen the commercial with Brett Favre wearing his copper knee sleeve. He is loading hay into the back of his truck, talking about his aches and pains since retiring from football, and ends with him playing catch with his dog. It’s pretty cheesy, but the commercials are everywhere, as are commercials for different “joint health” supplements and “NEWLY APPROVED, CUTTING EDGE” injections. These are all A+ marketing tactics, but you should be wary of using any of them .

Let’s start with the knee sleeve. This is normally one of the first things people try when suffering with knee pain. Hop on Amazon, look for the knee sleeve with the most 5-star reviews, add it to your cart, and get your sleeve in 2 days (because Amazon Prime is the best). You slide it on and start feeling great! Like you can conquer the world. But the pain relief from the sleeve is always temporary, and it doesn’t give you the long term solution you are looking for. The same can be said of the more bulky knee braces. Neither are fixing the root cause of the problem. You are only putting a band-aid on a leaky faucet.

The same can be said of supplements. There are probably more commercials for supplements than there are for knee sleeves or braces. The magic pills from a small foreign country that doctors just discovered can eliminate knee pain and arthritis! Or the more classic supplements, glucosamine and chondroitin. There is nothing wrong with taking these pills, and if they make you feel better, continue to take them. But these supplements are exactly that...supplements. They are used to help supplement your health. It is not a true fix to knee pain.

Last but not least are knee injections. There are several different kinds out there. Cortisone, Synvisc, and PRP are the most common, but by the time you’re reading this book I’m sure there will be a new injection out on the market. Each type of injection is used slightly differently.

Cortisone is predominantly used for inflammation, and most physicians will allow you to get 3-4 injections per year. Synvisc injections are done in a set of three injections over the span of a few weeks or there is Synvisc-One®, which is a single injection. The Synvisc injections are designed to help improve lubrication the knee joint .

With Platelet Rich Plasma, better known as PRP injections, a small portion of your blood is removed, put into a machine called a centrifuge to separate the various components, and then the platelets, the cells responsible for healing in your body, are injected back into your knee.

It doesn’t matter whether or not you haven’t had any injections or all three different types of injections. Just like the knee brace, knee sleeve, and supplements, the injections alone are normally not enough to get you back to walking on the beach, running in your neighborhood, or playing with your grandkids.

All those things can help you feel better, but none of them will truly fix the underlying problem. The knee is a complex joint, and there are many factors that must be considered.

So What Do You Do About It?

There are many recommendations to help with knee pain. I can’t promise what has worked for most of my patients and clients over the years will work for you. However, reading and following these tips will be better than spending another day just resting, accepting it, and thinking it’s just your age.

First, be mindful of what surfaces you are walking on. It’s best to avoid walking on uneven surfaces such as at the beach or in the hills. Flat, even surfaces will always be the most friendly for your knees. If you are having pain when walking up stairs, here’s a trick to significantly decrease knee pain .

When we walk upstairs, 99% of the time we stand straight, pressing up through the balls of our feet with our heel in the air, just like this photo below.

Going up stairs in this manner is similar to walking around in high heels. You put a large amount of body weight and force on your knee joints that can worsen knee pain. To decrease the force on the knee, you want to do a couple of things. First, instead of putting your heel up in the air, put your foot flat on the step and when you push up make sure the force is coming through your heel. Then you want to lean your trunk slightly forward. Doing both of these things will instantly engage your glute muscles and take significant force off your knee joints. It should look like the photo below.

In the photo above, my foot is flat on the step, and my trunk is leaning forward. When I drive up, I’m pressing through my heel and squeezing my right butt cheek. This allows my hips to work more and let’s my knees take a break, meaning less pain. Your glutes are much better equipped to help you go upstairs than your knees and quadriceps muscles. Give it a try and feel the difference!

My next recommendation is that if you’re overweight, shed a few pounds . Research has shown when you lose weight it decreases force on the knee joints and can lead to decreased pain. [7] The two biggest factors in losing weight? Nutrition and exercise. In chapter 7, we’ll go over in-depth nutrition principles that I commonly see people overlook and which stop them from achieving their weight loss goals (and why I hate the word “diet”).

On the topic of exercise, working out can be difficult when you have significant knee pain. High impact activities that include a ton of running and jumping can aggravate your knees if not performed correctly. However, there are several safe cardio exercises that can be done.

One of the best exercises for cardiovascular health and decreasing force on your knees is swimming. Swimming or even walking in a body of water, whether the pool or the ocean, is great for your knee joints. The best part about being in water is that you partially float. That takes bodyweight off of your knees, allowing you to exercise safely. Other things you can try are an exercise bike or elliptical. Both of these are gentle on the knees and great for cardiovascular health.

All of those things I mentioned can be found in commercial gyms, and if you are a baby boomer over the age of 65, you more than likely qualify for a program known as Silver Sneakers. A Silver Sneakers membership offers a massive network of gyms with no cost to you, so you can use the pool, bike, or elliptical.

Now that we’ve discussed a little bit of cardiovascular exercise, what about strength? Yes, having strong knees is important for living the active life you want. Unfortunately, many people believe just doing some simple exercises is the answer to fix any problem or physical pain. Yes, exercises are one of the secrets to heal knee pain naturally, but there is a right way and wrong way to go about it .

If you’re doing exercises that increases your knee pain or causes the knee to become swollen, this is the wrong way to go about it. Swelling and inflammation of your knee is not your friend, and I see too many people try to push through it, believing in the old mantra, “no pain, no gain.” This is not only foolish, but it’s stopping you from getting any closer to reaching your goals.

My advice is to strengthen your quads (your big thigh muscles) and your glutes (the butt). The quads help support your knee, and when they are strong, they can decrease wear and tear on your joints. Just as important are your glute muscles, which are the “role model” for the knee. If the glutes are strong, they positively influence your knee to be in good alignment, but if the glutes are weak, they negatively influence your knee to begin to bow in or out. The knees bowing in or out isn’t good for long-term knee health.

Regardless of your method, exercises alone will not solve your knee pain. It’s one part of the healing process. There are many different types of knee pain, from meniscus and ligament injuries to patellofemoral issues and osteoarthritis. Each of these requires a different treatment protocol and specific exercises, but everyone with knee pain can benefit from strengthening their glutes and quads. We have created individualized maintenance programs such as our TheraFIT program that is tailored to your specific needs and can be performed on-site at one of our clinics. It can also be found online at www.myhealthtransformation.co or contact javier@physicaltherapist.pro for more information.

“A Song Of Fire And Ice”

One of the most common questions I get asked when it comes to knee injuries is, “Should I use heat, or should I use ice?” The answer I always give is, “It depends.” If you just went for a long walk and are struggling with pain AND swelling, ice will be your best bet. Swelling and inflammation are not your friends, and they limit your knee’s ability to move freely, which isn’t great for being able to walk or do your favorite types of exercises. Use ice 15-20 minutes at a time a few times per day.

If your knee is stiff and there isn’t any significant swelling, heat can help it feel looser. Using a heating pad or hot pack first thing in the morning when the knee is the most stiff can help you start your day, but as with the knee sleeve, this is a temporary sensation. When it comes to knee stiffness, riding the exercise bike for 10-15 minutes is a much better option because it increases blood flow and provides more lubrication to the knee joint.

Meniscus and Total Knee Replacement Surgery

Meniscus repairs and the total knee arthroplasty (also known as a total knee replacement) are two of the most common knee surgeries performed today. When people are told by their physicians that they have a meniscus tear or that it’s time for a total knee replacement, they often believe they don’t have any other options. I want to bring your attention to a few things you may not know about these surgeries. But first, we need some helpful background information.

The meniscus consists of two cartilage rings that sit on top of your tibia (the big lower leg bone) and provide a cushion for your knees. Meniscus issues tend to occur in the younger population (under 50), usually while playing sports or running and attempting to change directions too quickly while the knee is in a bent position. Those with meniscus issues tend to complain of the classic signs of “catching” or “locking” while they are walking and have difficulty pivoting to change directions .

When the meniscus is torn, you have to have surgery to get it fixed, right? Maybe not. In 2013, the New England Journal of Medicine performed a study comparing meniscus repair surgery vs. physical therapy in adults over 45 with knee meniscus tears and mild-to-moderate osteoarthritis. Half of the patients in the study had a surgical meniscus repair while the other half of the patients had a standardized physical therapy regimen. After 6 months and 12 months, the researchers found no significant difference in pain or overall function. [8]

The New England Journal of Medicine published another article in 2013 in which they compared meniscus surgery versus a “sham” surgery by placing people into two groups. [9] In the sham surgery group, patients were taken in the operating room and the surgeon simulated meniscus surgery using suction and a mechanized shaver (without the blade) but didn’t actually repair anything. The other group had a traditional meniscus repair surgery. What did they find?

There were no significant differences in knee pain or function between the two groups.

This means that you always have more options and that surgery isn’t always the answer. If your physician tells you that you need surgery, ask to try physical therapy first. It’s a cheaper, less invasive option, and if it doesn’t work, you’ll still have the ability to have surgery after. I have plenty of patients who were able to save themselves from getting meniscus surgery after receiving specialized physical therapy. In chapter 9, I’ll let you know what quality physical therapy care looks like so you be sure to pick the right facility for you and your needs.

If you’ve had a meniscus or ACL surgery in your past, there is a higher chance to later develop the “Big 3”: pain, stiffness, and swelling. When the Big 3 begin to take their toll, your ability to walk and do other everyday activities becomes increasingly difficult. By far the biggest mistake I see people make with chronic knee pain is to procrastinate on making a decision to do something about it.

They secretly hope that tomorrow will be a “good day,” although it rarely is. I cannot stress enough that there is always something that can be done, and even if your knee pain improved by 10, 20, or even 30 percent, what would that do to your quality of life?

Too often people come to me after it’s too late. Please don’t let that be you!

If you want to find out how we can help you, go to https://www.renewalrehablargo.com/free-discovery-session for information on a free session, where you can get the confidence and clarity to understand what’s going on with your knee(s) and make the best decision about your health.

Summary

• The knee is influenced by your hip and foot, so both body parts must be considered when caring for your knees

• Having arthritis is normal, but if you suffer from the Big 3 (pain, stiffness, and swelling), that is abnormal, and getting specialist help sooner than later becomes critical to long-term knee health

• Be wary of knee sleeves, braces, injections, and supplements. They can all be helpful but normally won’t provide a long-term solution

• If you have knee pain and want to exercise, try swimming, riding a stationary bike, or using an elliptical

• Ice and heat can help reduce knee pain. Use heat if you’re stiff and have minimal to no swelling; use ice if your knee is swollen and painful

• It’s always a good idea to strengthen your quads and your glutes to help support your knee joints

• Many times, trying physical therapy can get you the same or better results than knee surgery

• When in doubt, get a specialist to check out your knee to help you make the best decision about your health

CHAPTER 5

Shoulder Pain

T he shoulder is one of my favorite joints of the body. Unlike the knee, the shoulder has significantly more freedom of motion. It can go up, down, behind your back, sideways, rotate inwards, or rotate outwards. These motions allow us to eat, lift stuff, play sports, and do our daily activities. Unfortunately, because the shoulder joint allows for more motion, it has a higher risk for injury and pain.

Shoulder pain happens for many different reasons. Things like frozen shoulder, impingement, rotator cuff tears, labrum injuries, and tendonitis, just to name a few, can cause you to grab your shoulder in agony. In this chapter, I want to give you a better understanding of the shoulder and ways to ease your shoulder pain .

Sometimes shoulder pain starts after a big incident occurs. For example, spiking a volleyball over a net, lifting something heavy with a jerking motion, or falling on your outstretched arm. More often, though, shoulder pain begins to creep up on you with no warning and no explanation. When it first occurs, you don’t think anything of it, but it slowly gets worse and worse until it becomes so unbearable you can’t sleep at night .

How did this shoulder pain creep up without telling you it was going to affect your active, on-the-go lifestyle? It’s usually an accumulation of damage done over many years of repetitive motions and poor body positioning (aka bad posture). It may be sitting at a computer all day, scrolling through Facebook on your phone, reading in bed, or cleaning the house. These small, trivial motions and positions slowly begin to take a toll on your body.

When shoulder pain strikes, we naturally begin to use our other arm to do the majority of our daily activities. And why not? That’s why we have two arms, right? Not exactly. As you use the painful shoulder less and less, it begins to become stiffer. When you try to move your arm to get rid of the stiffness, you feel a sharp, stabbing pain. This cycle can continue until you develop something known as adhesive capsulitis, more commonly known as frozen shoulder.

I’ll be blunt; frozen shoulder sucks. It takes a large amount of hands-on work and appropriate stretching to fix. Please don’t let your painful shoulder get to that point. I’m not trying to do any fear mongering. My goal is to bring awareness to letting unnecessary shoulder pain linger around for longer than it should. Nor is the purpose of this book is to assign you a diagnosis. Diagnosing shoulder pain is much more complex, and you should always see a specialist when getting help.

Posture Problem?

Let’s take a closer look at your posture. Stand to the side of a mirror. Are your shoulders rounded forward? Is the upper part of your back starting to develop a small hump? Are your head and neck protruding forward? If you said yes to any of these questions, your posture may be greatly affecting your shoulder’s ability to move properly. Let me show you why .

Keep standing in front of the mirror, round your upper back as if you are curling up into a little ball. At this point, you should look something like the Hunchback of Notre Dame. Now reach your arm up in the air as far as you can while you’re hunched over. Not very far, is it?

Now, stand at attention with your back straight as an arrow. Reach your arm up in the air again as high as you can. Notice the difference? When your standing in an upright posture, your shoulder can move higher and more freely. This is why, when trying to improve shoulder health, it’s critical your upper back, also known as your thoracic spine, must also be thoroughly examined and fixed to get the long-term relief you want.

Your neck is another body part that must be closely examined. The shoulder and neck greatly affect one another. Many times, people come to me thinking they have a neck problem when they actually have a shoulder problem. Or vice versa, people come to me with a shoulder problem when it’s actually a neck problem. If you are having any numbness, tingling, or burning sensation shooting down your arm and affecting your fingers, you more than likely have a neck problem, not a shoulder problem. Don’t worry, I will discuss more about your neck in the next chapter.

If you’ve read everything so far, you may begin to notice a pattern that everything in your body is connected. My patients get the best results when treatment isn’t centered around the symptom, in this case shoulder pain, but treating the whole body. This allows people to get back to living an active and mobile lifestyle. When the stiff joints of your neck and upper back are unlocked, your shoulder is able to move freely and comfortably .

Everything You Need To Know About Your Rotator Cuff

The rotator cuff is one of the more misunderstood structures of the body. It’s a group of four small muscles that surround your shoulder and keep it centered in the joint, allowing it to perform all of its amazing different motions. When these tendons are pulled on or stressed repeatedly, they can become irritated, leading to tendonitis or possibly a rotator cuff tear.

“If my MRI says I have a rotator cuff tear, the only way to fix it is surgery, right?” Not necessarily. What if I told you that having a rotator cuff tear could be a normal part of aging? In multiple studies, researchers found that after the age of 50 there is a 1 in 5 chance you already have some sort of rotator cuff tear but don’t have ANY symptoms. [10] [11] And as you continue to get older, these odds drastically increase. What does that mean for you? It means there is a possibility that you already had a rotator cuff tear prior to having any shoulder pain.

How is that possible? Because your body is an incredible machine. The reason the shoulder can have a rotator cuff tear without pain or weakness is quite fascinating. When something in the human body doesn’t work properly, the body will adapt and ask another part to help out. For the shoulder, this is usually a muscle called the deltoid, which has the strength and ability to substitute for a compromised rotator cuff. Your shoulder has the ability to do this automatically, without pain or loss of strength.

Other times, as I mentioned earlier, MRI’s aren’t as accurate as you may think. I once had a client in his early 50s who had been a construction worker his whole life and gradually began having right shoulder pain. His MRI results came back with the diagnosis of a full thickness rotator cuff tear, and his surgeon scheduled him for an arthroscopic rotator cuff repair. When the surgeon went in to perform the repair, he found no tear whatsoever in the shoulder. The surgeon just cleaned up a bit of scar tissue and then sent him over to me for treatment. After several weeks of treatment, we were able to eliminate his pain, regain his motion, and improve the strength in his shoulder, which allowed him to go back to work and provide for his family.

Does this mean your MRI always lying to you or that you can always avoid surgery by getting physical therapy? No, not always. The shoulder is complex, and there are times when rotator cuff surgery is necessary. There are many factors that must be considered when assessing the shoulder. What kind of tear do you have? A partial tear? Full thickness? Do you have significant shoulder weakness? Are you over the age of 50? How long have you had the tear? Are you a diabetic (diabetes affects healing time)?

The answers to these questions must all be considered in combination with seeing a trained specialist. But what if you could avoid costly surgery and get back to being as active as you want? If you’ve been diagnosed with a rotator cuff injury, ask your physician about getting specialist physical therapy. I’ll discuss what specialist physical therapy looks like more in chapter 9. In the meantime, keep reading for more tips on what to do and what NOT to do when you have shoulder pain .

Sleep Like A Baby

One of the most common complaints I get with the shoulder is the inability to sleep comfortably without pain. When you can’t sleep at night, it drains your energy. Your mood decreases, you become irritable, and the relationship with your loved ones is affected. I once had the sweetest woman with shoulder pain tell me, “I need to be able to sleep again! I feel exhausted and am acting like a real b*tch towards my husband!” Luckily, after a few short weeks of working together, she was able to return to sleeping comfortably throughout the night, no longer fearing the deep, agonizing ache. (And they are still happily married!)

Poor positioning is the number one reason shoulder pain happens at night. When the muscles, tendons, and nerves of the shoulder are irritated, trying to stay in one position all night is a tall task. You may sleep with your arm tucked underneath your pillow or just let it lay by your side without support. Doing this puts the muscles and nerves of the shoulder in a slightly stretched position. After a few hours of being in this state, pain can rear its ugly head. The position of your shoulder matters.

To get in the optimal sleeping position, place a small, flat pillow underneath your armpit while keeping your elbow at a 90-degree angle. If you start your night on your back, I also recommend placing a rolled up dish towel or an additional small pillow underneath your upper arm. These two things help create more comfort for your shoulder, allowing you to improve the quality of your sleep. Your sleep setup should look something like the photo below.

Another mistake I see frequently is lifting everyday objects when your arm is in an outstretched position, what I call “No Man’s Land.” I commonly have patients come see me after reaching into the back seat of the car to grab something or lifting a heavy grocery bag from deep inside the trunk, causing a jolt of pain to the shoulder.

The reason this is harmful for your shoulder is because it puts extra force on your rotator cuff muscles, which aren’t designed to lift that much weight when your arm is outstretched from your body. Whenever you reach out to grab something, the shoulder is in a position where it has minimal stability and strength, a perfect recipe for an injury. The following photo is lifting in “No Man’s Land.”

When it comes to lifting, make sure to do heavy lifting with your legs, not your back or arms. Your arms should serve to secure objects close to your body so that your legs can do the hard work. Next time you need to get something in the backseat, please get out of the car and walk to the closest car door to grab it. As for groceries or any other heavy objects, get as close as possible and hug the object with your arms while letting the legs do the lifting. Or hold it by your side.

Speaking of heavy lifting, many of my female patients carry incredibly heavy purses. I’ll sometimes tease them that they’re carrying mini suitcases, because they have everything from Kleenex to chapstick to allergy medicine in there. When I ask if they carry their purse on one shoulder more than the other, the answer is generally yes. Carrying a purse or other heavy objects on your shoulder for long periods of time stretches the muscles, tendons, and nerves of the neck and shoulder. Doing this over many years can eventually take a toll on the shoulder as well as the neck and begin to cause uncomfortable shoulder pain.

If you are going to use a purse, please make it as light as possible. Yes, I understand that can be a tall task for some of you, but your body will thank you for it. My other suggestion is to constantly switch carrying your purse from one shoulder to another. This will even out the force the weight of the purse puts on your body .

What About Cortisone Shots?

We briefly discussed cortisone in previous chapters, but when it comes to the shoulder, cortisone can be an effective tool to help improve shoulder pain. A cortisone injection consists of some sort of anesthetic, such as lidocaine, and a corticosteroid, which is a powerful anti-inflammatory agent. The purpose of a cortisone shot is to help reduce inflammation inside the joint, hopefully decreasing the pain.

I have had some patients who had a traumatic incident, got a cortisone injection, and POOF! The pain went away and stayed away. Unfortunately, for most of you reading this who’ve had a gradual onset of shoulder pain with no big inciting incident, the injections are never quite as successful. Getting a cortisone injection usually will give you temporary relief, sometimes lasting months, sometimes weeks, or sometimes just days before that pain begins to creep back.

Why? If you spend years and years of sitting at a desk or watching TV, certain muscles of the shoulder will begin to tighten up, affecting your ability to move your arm freely. These tight muscles can then lead to your shoulder not moving properly. If you get a cortisone shot but don’t fix the tight muscles and the quality of the shoulder motion, your pain more than likely will return, causing even greater frustration.

Cortisone injections also do have some possible side effects, including nerve damage, joint infection, weakening of nearby bone (osteoporosis), temporary increase of blood sugar (important for diabetics), and muscle tendon weakening or rupture. Therefore, physicians will normally limit the amount of injections to 3 or 4 per year .

What’s my recommendation? It always depends on your personal situation. If you are adamant about not getting any injections and don’t want to risk any of the side effects, definitely look into getting individualized treatment from a specialist. If you like the idea of getting a cortisone injection, talk to your physician first to see if it’s appropriate for you. If it is, my patients get the best results when getting physical therapy treatment in conjunction with the injection. The shot helps with the inflammation so we can work on loosening those tight muscles and getting your shoulder to move safely.

Side note: even if your shoulder pain decreases to a 0/10 after the injection, it’s still a good idea to get looked at by a specialist to ensure the shoulder is moving correctly and all the appropriate shoulder muscles have good strength. If those things aren’t corrected, you are at risk for the shoulder pain to return.

“What If I Have Arthritis?”

As I mentioned throughout this book, having arthritis is normal but being in pain is NOT. Being diagnosed with osteoarthritis doesn’t mean a life of stiffness, pain, and misery. I’ll give you an example.

Another client, whom we’ll call him Dave, came to me after severely injuring his shoulder doing heavy weightlifting back in the 1980s. Now in his early 70s, he suffered for almost 30 years with shoulder pain and stiffness. He couldn’t lift weights like he wanted and decided to come see me when he could no longer put on his shirt or lift up his morning cup of coffee. His MRI and x-rays showed he had “severe arthritis” and “significant rotator cuff damage.” His physician said all that could be done was to get total shoulder replacement surgery. Dave was adamant about not getting surgery and had the goal of going back to lifting free weights.

We developed a customized plan just for him, and Dave was able to get his motion back and return to the gym with minimal to no pain. How did we get there? A combination of treatments involving plenty of hands-on work, loosening stiff joints and muscles, followed by precise exercises to get the shoulder moving properly and safely.

Most of the time, especially with shoulder problems, people are able to live with the pain that they are suffering with–they just don’t want to. To ensure we are the right people to help you, we always recommend starting with a phone call. We love spending at least 15-20 minutes on the phone to truly understand your problem and allow you to express your concerns and ask questions. To schedule a time to talk to us on the phone, please go to https://www.renewalrehablargo.com/free-telephone-consultation .

Is There Anything Else I Can Do?

Absolutely! Ice and heat are both your friends and can be utilized to help control pain and stiffness. If your shoulder is feeling achy or painful, use ice for 15-20 minutes. If your shoulder feels stiff and you’ve had shoulder pain for longer than 3 days, use a heating pad or hot pack for 10-15 minutes at a time.

Another factor to consider is your resting posture. Sitting or slouching for long periods of time can cause the muscles of the neck and shoulder to tighten up. My first suggestion for posture-related issues is to avoid being in any one specific posture for too long. For every 30 minutes you spend sitting, spend a couple minutes standing up and moving around. Roll your shoulders forward and backward. Pinch your shoulder blades back and hold for a few seconds. Lift both your arms in the air and stretch (as long as it’s relatively pain-free). These small things can go a long way into helping you feel better.

If you do have to sit for long periods of time (for example, working at a desk job), you want to be in good positioning. When sitting at a desk, your feet should rest on the floor, not dangling in the air. Your hips and knees should create nice 90-degree angles. You want your chair to give a bit of low back/lumbar support. Keep the upper parts of your arms down to your sides with your elbows at a 90 degree angle. Therefore your keyboard should be 8-12 inches from your body. Then keep your shoulders slightly pulled back and your ears in line with your shoulders. It should look something like this photo below.

If your office offers an ergonomic service, definitely take advantage of it so you can maintain good sitting health .

You may be wondering whether I can give any stretches or exercises, and I could give you 50 of them. But without knowing your individual condition and understanding your medical history, I would be doing you a disservice by giving you exercises that could possibly make you worse and cause you more pain. If you would like more advice and tips on shoulder pain, go to https://www.renewalrehablargo.com/shoulder-pain .

Summary

• The shoulder can do a wide variety of incredible movements, but that can also increase the risk for shoulder pain/injuries.

• Your neck and upper back (thoracic spine) play a significant role in shoulder health. Make sure your sitting and resting postures don’t include rounded shoulders or a head protruding like a turtle.

• When sleeping, use a pillow and dish towels to help prop up your shoulder in a safe resting position so you aren’t waking up every hour with pain.

• Be careful when lifting heavy objects with your arm outstretched from your body (“No Man’s Land”), and always keep everything you lift as close to your body as possible. Side note: when driving don’t reach into your backseat to grab stuff.

• A cortisone injection can help decrease inflammation and pain, but it’s normally temporary (and has side effects). Always think about getting specialist help in conjunction with the injection, even if you don’t have any pain.

• Don’t accept arthritis as a curse; there is always something that can be done to improve your situation .

• If you work at a desk all day, make sure you are sitting with optimal alignment. If your office offers an ergonomic assessment, do it!

CHAPTER 6

Neck Pain & Headaches

Y our neck has a ton of responsibility. Similar to the knee, your neck is between a rock and a hard place. It has to hold up your head, which weighs between 8-12 pounds on average, while also helping support your shoulders. First, it’s important to understand your neck and shoulders are closely related. What seems like shoulder pain may actually be a neck problem. Or a neck problem could actually be a shoulder problem. This chapter will help provide you with a little more clarity on all things neck pain and headaches.

As we age, the frequency of neck pain increases, with the greatest prevalence occurring in our 50s, and it’s estimated 22-70% of the population will have neck pain some time in their lives. [12] [13]

By far the most common complaint I get with necks is the overwhelming feeling of tightness in the upper traps and surrounding neck muscles. Many people believe that it’s where they “carry their stress,” which can be partially true but is usually not the root cause of the problem. The feeling of tightness is the effect. The cause is often a combination of factors. It’s an old neck injury that didn’t quite heal right, sleeping with two pillows instead of one, spending years at a desk staring at a computer, or looking down at the phone to text or read the newspaper every day.

You may believe these things are trivial, but the combination of them all over many years can cause a compound effect leading to neck pain, especially for those over the age of 50. Again, the average human head weighs somewhere between 8-12 pounds, which is the equivalent of a bowling ball. Picture a bowling ball balancing on a bamboo stick, which is your spinal column. Life is good when the bowling ball is balancing on a relatively straight, vertical bamboo stick. However, if you begin to let the bowling ball drift forward when you look down to text or use a laptop, then the bamboo stick, your spine, begins to bend. The further your head drifts forward, the more bending and force is placed on your spine.

While it’s fine to do this occasionally, spending 8 hours in this position at work for 40 hours a week over many years can cause pain and tightness in your neck and all the muscles around it. It can also lead to horrible headaches.

I had a patient, Barbara, who came to me in her early 60s. She worked as a secretary at a dentist’s office. In her free time she loved sewing, especially making quilts, and spending time with her four grandkids. Unfortunately, she suffered from severe right-sided neck pain. It started at the base of her skull and radiated down to the inside of her right shoulder blade .

Barbara told me how painful and unsafe she felt driving because she couldn’t turn her head to the right side. Her pain affected her quality of sleep, and she was starting to get headaches at work. Barbara and her husband planned to work for a few more years before retiring and moving to Arizona, but her pain was beginning to jeopardize that future. She tried going to a massage therapist to work out all the tight and painful muscles but only got temporary relief. Barbara hated taking pain pills, but felt she had no other options, until a mutual friend recommended she come see me.

Barbara’s situation is an increasingly common problem. I explained that the cause of her neck pain stemmed from years of sewing and sitting in front of a computer at work. We created a plan to optimize her desk and sewing setup to make sure the neck was in a safe position. Then we began working on moving the stiff joints of the upper back and neck as well as strengthening the shoulder muscles that help support the neck. Barbara was an incredible patient who was determined to get better. After a few short weeks and some mild ergonomic changes, Barbara was able to reclaim her health. To this day, she still sews without pain or discomfort and is getting closer to her plan to retire in Arizona.

Deskwork and Posture

In general, posture doesn’t matter as much as you may think. Don’t let the media fool you; there is no such thing as “perfect posture.” The key with posture, forever and always, is to not be in one static position for an extended period of time. If you’ve been sitting at your computer desk for an extended period of time, stand up and move around. If you’re at a standing desk and haven’t moved anything but your fingertips for an hour, go for a walk. Why do many people feel so stiff in the morning? Because you’ve been in bed, hopefully sleeping like a log, and your joints haven’t moved for 6+ hours.

If you absolutely must be in a sitting position for an extended period of time, for instance, when sitting in your car during rush hour traffic, then your sitting posture becomes much more important. Whether you are at a traditional desk or sitting in your car, the rules of good sitting remain the same. We already discussed the first step: keep your ears in line with your shoulders. You should also have some sort of small low back support. Many chairs and car seats already provide this, but if yours does not, place a folded towel between your chair and the small of your back.

Next, your torso should be upright or slightly leaning backwards. Your knees should be at a nice 90-degree angle with your feet resting comfortably on the floor. If you are driving, you shouldn’t be reaching for the gas pedal and shouldn’t be a mile away from your steering wheel with your arms outstretched. When in doubt, being a little bit closer to the steering wheel is better for overall alignment of your spine and neck.

If you are at your desk, keep your monitor just slightly below eye level. Also, ensure that your monitor is directly in front of you. This is vital for your neck. I have a friend, Jaime, a contractor, who came to me one day with severe neck pain. He told me he was struggling turning his head side-to-side and was nervous to drive because his neck hurt so much when trying to switch lanes or parallel park. Jamie, by trade, does a ton of manual labor and thought he must have injured it while lifting something heavy or working underneath a sink he was building.

After investigating further and asking him more questions, he told me that although he spent a ton of time building things, the majority of his time is sitting at a desk looking at a computer. When I asked about the location of his monitor, he told me he had 2 monitors but the one he spent the most time looking at was located approximately 60 degrees off to his right side.

Picture sitting at your desk with your body facing forward but your head turned to the right. Then imagine sitting in this position for hours, every single day, for months, even years. It’s no wonder Jaime’s neck was very unhappy and led to intense neck pain. I actually didn’t do any hands-on work or give him any exercises. I just told him to move his monitor so it was directly in front of him. In one week, 100% of his pain went away.

Can I guarantee the same results for you? No, but I can promise that if you don’t optimize your environment, no amount of physical therapy, massage, chiropractic, or acupuncture will be effective. You’ll end up being a hamster on a wheel, cycling between short periods of pain relief followed by increased pain.

The goal is to always try to keep your ears in line with your shoulders no matter what position you’re in. Improving neck positioning is that easy. For example, if you are reading or texting, stop holding your phone down by your belly button. Lift it up towards eye level. Will you look funny texting this way? Probably! But your neck will love you for it. Same thing if you like to read prior to going to bed. Personally, I love reading before falling asleep. Unfortunately, laying flat and holding my book on my stomach while looking down isn’t great for my neck. Therefore, I force myself to sit upright and hold my book at eye level .

Get Some Quality Shut Eye

When sleeping at night, I always recommend using one pillow. If you want some more neck support while you sleep, grab a small dish towel and wrap it around your neck. Having this towel around your neck provides support and tells your neck muscles to relax. When these neck muscles are relaxed, the vertebrae in your neck are less compressed, which can decrease neck pain and give you better quality sleep. It should look something like the photo below.

Many people ask me all the time what the best neck pillow is? There is no one-size-fits-all pillow. There are TONS of them out there, ranging from bamboo pillows to custom-fit ones. The best recommendation I can make is to try a couple different kinds. When in doubt, purchase a flatter pillow that also provides some neck support. If the pillow doesn’t provide enough support, remember to try using a dish towel .

If you wake up throughout the night because of numbness or tingling in the forearm, hand, or fingers, this can be a sign the nerves around your neck are being irritated. Normally what I find is that people who have these symptoms sleep in the position below.

Sleeping in this position for a few hours compresses nerves in the neck which connect all the way down to your fingertips. Like an electrical wire, it can cause an uncomfortable numbness and tingling sensation, causing you to wake up. Not fun! Instead, try hugging a pillow. By hugging a pillow, you place your shoulders and neck in a friendlier position for your nerves, allowing them to breathe. Is there a good chance you throw the pillow away after an hour or so? Yup. But being in a better position, even for a few hours, will allow you to sleep better and increase your energy levels. In case you need a photo of what hugging a pillow looks like, check out the photo below.

Car Accidents, Severe Neck Pain, & Whiplash

Car accidents do happen, often leading to pretty severe neck pain and tightness. Normally, the pain and tightness doesn’t kick in until the day after the accident. Right after an accident, your body goes into “fight or flight” mode, and your adrenaline levels shoot up. When the adrenaline levels decrease as you go to bed that night, the muscles around the spine and neck will begin to tighten and can lead to headaches and a feeling of deep pain. These symptoms together are more commonly known as whiplash.

By the way, it’s always a good idea, after being in a significant car accident and your head does a “snapping” movement backwards, to get an x-ray to rule out any kind of neck fracture. Nobody likes to wait in the ER, but having the x-ray will give you peace of mind that nothing more serious has occurred .

In regards to whiplash, the best recommendations I can give you involve what NOT to do after symptoms have set in. The first thing I want to tell you is if you don’t have a neck fracture, PLEASE avoid wearing a neck brace. Although your neck will feel better in the short term, as you wear a neck brace, the muscles of the neck can begin to turn off and weaken. This can end up causing even more pain and dysfunction down the line. If you do have to wear a neck brace per physician order, try not to be in one for an extended period of time.

There was a randomized study done where a group of subjects with a whiplash injury were separated into two groups. One group of those with whiplash were told to return to their normal activities, meaning no sick leave from work and no cervical collar. The other group of those with whiplash were told to go on sick leave from work for 14 days and be immobilized with a cervical collar. At 6 months, the “act as usual” group had much better results in regards to pain, stiffness, memory, and concentration. [14] So avoid wearing that neck brace and get back to living your life!

Next up, be wary of getting any kind of massage in the first two weeks after your car accident. When a car accident occurs, your body automatically does everything it can to protect your central nervous system (aka your brain and spinal cord). Your body does this by tightening up all the muscles surrounding your skull, neck, and often your low back as the accident is occurring. Your body is pretty cool, right?

Unfortunately, these muscles tend to stay tight and stiff for weeks after the accident occurs, and when this happens, pain can come with it. So it’s normal to believe that if the muscles are tight and stiff, a massage will loosen up these muscles and make you feel better. And it does...temporarily. The day you get a massage you’ll feel like you are walking on a cloud, and you’ll begin to feel like your normal self again. Then the next day arrives, and you feel like you’ve been hit by a ton of bricks.

This happens because in the early phases of whiplash recovery, those muscles surrounding your spine like to stay in protection mode. Many times, a massage can temporarily loosen these muscles, but the body will slowly revert back to being tighter than ever. Therefore, I normally recommend waiting 2-3 months, depending on the severity of the car accident, prior to getting a massage.

In the meantime, the best thing you can do to help speed up recovery is to have a positive mindset and keep moving! Many people think they have to rest and lay in bed all day. This is never a recipe for success. Reengaging in your normal activities as soon as possible is the best solution. Take a loved one on a brisk walk for at least 10 minutes. If you are at work, be sure to take movement breaks every 20-30 minutes. If you’ve been standing for a while, sit for a few minutes. If you’ve been sitting for awhile, stand and move around. Just don’t allow your body to stiffen up.

On the other end of the spectrum, if you enjoy high-intensity exercise and weightlifting, hold off until the deep ache, tightness, and headaches significantly decrease in intensity, normally around 2-3 months. You want to allow your body to heal safely, and the demands of high-intensity exercise can trigger more pain.

If you want to further speed up your recovery, go see a specialist who works with car accident victims. Someone like a physical therapist will not only help you get back to sleeping more comfortably and exercising safely but will give you the confidence and peace of mind in making the best decision for your health.

Headaches vs. Migraines

Understanding the difference between a headache and a migraine can help you make a better decision on treating the root cause of your issue. Headaches (more specifically, tension headaches) can be treated with interventions such as physical therapy. True migraines are normally more severe and tougher to diagnose, but the frequency and severity of migraines can improve with specialist help.

Symptoms of tension headaches include the following:

• Pain or stiffness at the base of the skull

• Restricted neck movement and ability to turn your head side to side

• Symptoms caused by being in one position for too long (e.g. sitting at a desk with your forward head and rounded shoulders)

• Tender or aching muscles in the shoulders

• Pain shooting down to the shoulder blade

• Difficulty finding a comfortable sleeping position

Symptoms of a migraine headache or a “migraine aura” normally consist of the following:

• Nausea

• Pain behind the eyes

• Pain in the temples

• Vomiting

• Seeing flashing lights or spot s

• Extreme sensitivity to light

• Temporary loss of vision

People often tell me they have migraines and are taking migraine medications when they actually have a tension headache. The cause for tension headaches normally goes back to your resting posture. If you spend hours everyday with your head protruded forward and your upper back and shoulders in a rounded position, the joints of your neck and spine get stiff and can lead to tension headaches.

If you are suffering from true migraines, it’s important to avoid your migraine triggers. These are different for each person but normally include things such as emotional anxiety, contraceptives, alcohol consumption, or menopause. Stress reduction techniques such as meditation and a warm compress can help control symptoms as well. In addition, physical therapy can also help decrease the intensity and frequency of migraines.

If you would like a more in depth look with even more tips and advice on neck pain and headaches, download them at https://www.renewalrehablargo.com/neck-pain

Summary

• Years of looking down while reading and letting your head protrude forward like a turtle when using the computer can eventually lead to neck pain, headaches, and tightness of the upper traps.

• Perfect posture doesn’t exist; the goal is to have frequent breaks where you can stand up and move around. If you are required to sit for long periods of time at work or in your car, be sure to :

o Keep your ears in line with your shoulders

o Trunk at 90 degrees or your chair slightly leaning backwards with good lumbar support

o Make sure your feet can easily rest on the ground

o Keep your computer screen directly in front of you, just below eye level

• When sleeping, use a dish towel to provide support for your neck and keep your spine in good alignment. Please use ONE pillow under your head.

• After a car accident, try to resume your regular life activities and be careful of getting a massage or returning to high-intensity exercise too soon. Better yet, go see a physical therapist to help you get more guidance and recover more quickly.

• Understand the difference between headaches and migraines. Know both can improve significantly with the right relaxation techniques and help from a professional.

CHAPTER 7

Food For Thought

P roper nutrition plays a key role in keeping yourself healthy and strong for years to come. Nutrition encompasses a physical, mental, and emotional component. The physical component is what we are actually eating on a day to day basis. The mental and emotional components are the conversations, language we use, and thoughts we have which surround food. All three components need to be addressed in order to foster a healthy relationship with food.

The funny thing is, most of you already know HOW to eat better, but the act of actually doing it day in and day out is a challenge. However, if you follow the principles in this book, that challenge will become easier and easier over time. That’s what we are going to dive into. You can absolutely sustain a healthier lifestyle, but first you must set yourself up for success.

Food Is Fuel

Just like a car needs gas to drive, the body needs food (or as I call it, “fuel”) to function. Imagine if a car was topped off with gas right before a long drive...it could drive for hours before having to stop for gas again. Now, imagine if your gas tank was only a quarter of the way full and you had to make that same long drive. Your car probably wouldn’t make it, right?

The same goes for our bodies. You need to properly fuel throughout the day so that your body can function at an optimal level for a greater period of time. If you are continuously under-fueling, your body is essentially “running on fumes”. If you wouldn’t want to drive your car on “E”, why would you do that to your body?

Take a minute to reflect on your eating patterns. Are there large gaps between meals? Are you eating lunch at 12:30pm then going straight from work to the gym from 5:30-6:30pm with no snack in between? If so, that’s 6 hours without fuel plus a 1-hour workout! Chances are you are running on empty. Take a moment to reflect on your mood and feelings. Are you cranky? Do you have a headache? Do you have low energy levels? Again, these could all be signs that you need more “gas in your gas tank”.

Food Is Not Good. Food Is Not Bad.

Yep, you read that right...food is not “good” and food is not “bad”. Contrary to popular belief, food has no moral value. Food simply serves a purpose: to give us energy so we can live! Although there are no “good” foods and there are no “bad” foods, there are foods that are better for us compared to others and it’s important to make the best choice for us as often as we can.

Let’s take pasta for example...some people may think pasta is “good” and others may think pasta is “bad”. What we actually have to do is put pasta into context. For example, for an overweight individual who does not exercise, a large bowl of pasta might not be the best choice for dinner. On the other hand, for a very active individual who is scheduled to compete in a triathlon the following morning, a bowl of pasta might be the perfect dinner for them.

Although this was an extreme example, this illustrates that food is neither good nor bad, it simply fuels us. However, some fuel sources are more optimal than others. When we are talking about food, we have to look at the entire picture. It’s not fair to say that a single food is always “good” or a single food is always “bad”.

Identifying Your Emotional Eating Triggers

In order to improve our relationship with food, we must first step back and reflect on our current relationship with food. Only once we tune into WHY we eat and WHY we tend to gravitate towards certain food choices, then can we take appropriate steps to improve our choices.

To get started, remove all distractions and grab a pen and paper (or my personal favorite, a whiteboard). Think back to times your previous attempts at healthier eating failed. Was it after you were assigned a stressful project at work? Maybe it happened after you went out to eat with family at a restaurant. Maybe after a long day you got home and didn’t have any healthy food prepared, so you just grabbed fast food. Whatever it is, don’t spend time judging yourself for past failures. Just write.

Now look at your paper or whiteboard. Notice any patterns? Think back to how you were feeling during those times. Do you tend to stress eat? Did you eat more processed foods or sugary foods when you were nervous, anxious, or at an event? Did you turn to food for a temporary sense of comfort? How did you feel after you ate these foods? Did you have a stomach ache or feel a sense of guilt? Once you recognize your own patterns and hone in on your triggers it will be much easier to see where you can improve. Don’t skip this exercise!

Let’s say you noticed that you tended to reach for sweets when you were stressed or anxious. It’s incredibly difficult to stop this habit cold turkey. It’s much easier to start to replace a bad habit with a good one. Now, brainstorm some activities that you enjoy doing that you can easily replace this anxious eating with. Could you go for a walk? Could you walk your dog? Could you do a 10-minute yoga session? Do you enjoy puzzles or crossword puzzles? Talking to your best friend or a family member on the phone? Next time you find yourself about to reach for those sweets due to anxiety, see if you can try one of these other activities instead.

The Power of Positive Language

Nutrition is a complex subject and how we talk about food and the words we use to describe food impact our food choices and our relationship with food. In order to foster a healthy relationship with food, we must be careful about the words we use to describe food and the effect that foods have on our bodies. The best way to talk about food is by focusing on the positives. It is important to spread a positive message that food fuels our bodies and is needed for us to be healthy and strong. Take a moment to look at the two columns of words below:

Negative

Positive

Guilt-Free

Allowed

Cheat

Bad

Junk

Fattening

Reward

Balanced

Delicious

Satisfying

Enjoyable

Tasty

Fresh

Nourishing

Which words do you use most often when describing food? Which words do you use least often when describing food? Typically, when a food is labeled negatively or “off-limits”, you’re more likely to think about that particular item and crave it more intensely. We have to be careful with the words we use to describe food and make sure we are always talking about food positively. We do not want to foster feelings of fear, shame, or guilt surrounding certain foods because that does not create a healthy relationship with food.

Food is fuel, and fuel is necessary to live! Take a moment to reflect on your word choices surrounding food. Challenge yourself by trying to use more positive words when talking about food and less negative words.

One Size Does Not Fit All

There is no “one size fits all” approach when it comes to nutrition. A certain pattern of eating may work best for one person and a totally different pattern of eating may best work for another person. Some people love breakfast, while others don’t like to eat first thing in the morning. Some people love to graze all day, while others prefer just 3 meals per day. Some people tend to gravitate towards more carbohydrate items, others prefer higher protein and fat foods .

This is one of the reasons why some people have seen success on specific diets, and others have failed with the same exact diet. Dietary patterns that restrict certain foods, have many rules to follow, and/or are only meant for a short period of time are not sustainable. The goal isn’t to jump from diet to diet, but to consistently make good quality food choices by understanding how to develop good habits and discipline. Each time someone goes on a diet they temporarily change their way of eating, lose weight, and then gain it all back. It is a vicious cycle which impacts your self-esteem, plays with your emotions, and negatively impacts your metabolism.

The ONLY “diet” that is right for you is an eating pattern that you can sustain for life. Sustainability is the key to success. A personalized approach to nutrition, with the guidance of a registered dietitian, will provide the best long-term health benefits.

Focus On Non-Scale Achievements

A number on the scale is just that, a number. That number does not tell you what you’re composed of, it does not tell you how much muscle you have, how much fat mass you have, how much your bones or organs weigh, or how much of you is water. It’s just a number.

Studies have shown that individuals who weigh themselves often have lower self-esteem, as well as increased likelihood of depression and dissatisfaction with their bodies. All of these negative effects and emotions build up over time and can lead to disordered eating patterns and an unhealthy relationship with food. Additionally, phrases such as “I have to exercise to lose this gut” create a negative picture of food, exercise, and weight management. Phrases like this send a message that exercise is a punishment for what you ate, not a reward for what your body can do .

Instead of focusing on the number on the scale, focus on non-scale achievements. Non scale achievements are reflecting on improvements in areas other than your weight. This can include areas such as your moods, your emotions, energy levels, ability to focus, hunger levels, and the quality of your workouts.

Begin by taking mental notes of these trends for a few days and reflect on what you’ve been eating. Most likely, if you are experiencing mood swings, negative emotions, lack of energy, inability to concentrate, and poor workouts, these could be signs that you’re either under-fueled and/or not eating the most nutritious foods. Begin by making small changes to improve the quality of your food. Over time, you may notice your energy levels increase, your moods shift to a more positive note, your ability to focus may improve, and your workouts may become more enjoyable. Focusing on non-scale achievements is more important than a number on the scale will ever be.

Food is Not A Reward

Food is not a reward; it’s a privilege! We should not be rewarding ourselves with food, nor should we be punishing ourselves with food. Many times I hear people say phrases along the lines of “once I lose 15 pounds, I’m going to treat myself to some ice cream” or “I’m not eating pizza again until I fit into my size 6 jeans.” Once we say phrases like that, we are placing limits on food. When we do this, we begin to crave that food more intensely and once we reach our goal and are able to eat that food again, chances are we will over indulge.

It is good to have a reward system in place. It provides constant motivation and keeps you focused on your goal. Rewards should be non-food related. Some examples of non-food related rewards would be: treating yourself to a manicure, buying yourself a new item of clothing, treating yourself to a movie night, treating yourself to a massage, buying a new book, or taking a day off work.

Take a minute to reflect on what you’ve done in the past. Have you ever used food as a reward or as a punishment? If you currently have a goal in mind and are using food as a reward, can you think of a non-food reward instead?

Small S.M.A.R.T Steps

The saying “Rome wasn’t built in a day” goes for your eating habits as well. Your eating habits have been formed and molded over time. It took years and years to form them, and they won’t change completely overnight. One of the biggest mistakes I have seen people make when they want to change their eating habits is that they try to change everything at once...and fast! They will clean out their fridge, clean out their pantry, buy all new groceries, and set unrealistic and extreme goals. Typically, this new way of eating is only sustained for a few weeks before they start falling back to their old ways.

Compared to large changes, small changes are more realistic and feasible to achieve and maintain. Since small changes are easier to accomplish, this also increases the belief you have in yourself which may foster additional changes and ultimately lead to larger changes over time.

The best way to begin to change your dietary habits is nice and slow over a period of time and setting “S.M.A.R.T” goals. Also, make sure you accomplish one goal before moving onto the next.

S.M.A.R.T. goals are goals that are :

• S pecific - Direct, detailed, and meaningful

• M easurable - Quantifiable so you can track your progress

• A ttainable - Realistic and you have the tools and resources to accomplish it

• R elevant - Aligns with what you’re trying to accomplish

• T imely - Has a deadline

Take a moment to write down some of your general nutrition (or fitness) goals. This could be anything from eating more fruit, cooking more meals at home, or exercising more. After you write down some goals, pick one goal that you want to start working towards and make it SMART. Here are some examples of SMART goals:

• This week at work (Monday through Friday) I will eat one whole piece of fruit with my lunch every day

• For the next two weeks, on Tuesdays and Thursdays when I get home from work at 5:30pm, I will immediately change my clothes and go for a 20 minute walk outside before I cook dinner

• For the next two weeks, on Monday and Wednesday nights at 9:50pm I will meditate for 10 minutes before I go to bed at 10:00pm

Remember, set one SMART goal and accomplish it before moving on to the next one. Small changes over time tend to produce the best results compared to drastic changes in a short amount of time.

If You Fail To Prepare, Prepare To Fail

One of the best ways to set yourself up for success is to plan! We all have to make hundreds of decisions per day, from picking out what we are going to wear to what kind of gas we are going to put in our cars. Making these decisions uses up brain power, and the end of the day is normally when we are at our weakest.

One thing you can do to minimize urges and sustain healthy eating patterns is to meal prep one or two times per week. Taking time one day per week to write down what you’re going to make and what groceries are needed goes a long way to reaching your healthy eating goals. Choose one or two days of the week that work best for you to grocery shop, cook, and package your meals. Having food ready after a long day of running errands or working is incredibly helpful. There are also great kitchen appliances which make cooking a breeze! Some of my favorites are a crockpot, the Instant Pot, and an air fryer!

Grow Your Own Food

Fresh herbs and spices offer a variety of health benefits and add great flavor to your meals. One way you can ensure that you always have fresh herbs and spices available is by growing them yourself. There are many herbs that can be grown in small pots, indoors, right on your kitchen counter. They do not take a lot of work to maintain and they do not take up a lot of space. If you have more time, or have some space outside, tomatoes and pineapples are easy to grow as well.

One of the best parts about growing your own food is that you don’t have to spend more money at the grocery store on these items! Sometimes, herbs can get pretty pricey and often times they go bad before you can even use them all. By growing your own food at home you’ll always be able to add great, fresh, flavor your dishes and you’ll be saving money at the same time. This is a win-win in my book !

An Individualized Approach

Nutrition advice and recommendations should be individualized. A registered dietitian is the nutrition expert and has been trained in this field. A registered dietitian will assess your meal patterns, work schedule, exercise routine, foods you like/don’t like, food allergies/intolerances, commute schedule, access to grocery stores, home environment, budget, and your knowledge and ability to prepare healthy meals. Although generalized, the information in the following chapter is a great place to start if you’re looking to make changes to your diet. The nutrition information in this book should be used as a reference, not as direct medical advice. It is best to consult a registered dietitian for further individualized recommendations.

Summary

• Nutrition encompasses a physical, mental, and emotional component, which all need to be addressed.

• Food is FUEL and is neither good nor bad.

• Identifying your emotional eating triggers will help you improve your relationship with food.

• Foster a healthy relationship with food by using positive language when you talk about food.

• The number on the scale is just a number. Focus on non-scale achievements and reward yourself with a non-food reward.

• In order to achieve your nutrition goals, set SMART goals and achieve one goal at a time before moving on to the next.

CHAPTER 8

Nutrition Fundamentals

Back To Basics

F oods can be broken down into six main categories or “food groups”: grains, proteins, fruits, vegetables, dairy, and fats. It is important that we eat a variety of these foods to be strong and healthy. The more you understand how proper nutrition will improve the way you feel, the more inclined you will be to make healthier food choices.

The foundations of a healthy diet comes down to five key points:

1. Increased fruits and vegetable intake

2. Choosing whole grains more often than processed/white grains

3. Choosing lean proteins (from animal and/or plant sources)

4. Reducing consumption of processed/packaged foods

5. Saving some room for “fun” foods - You have to enjoy yourself every once in a while !

Grains

The first food group we are going to cover are the grains. This encompasses foods such as bread, rice, pasta, cereal, oatmeal, popcorn, and crackers. Grains contain carbohydrates. Carbohydrates are our bodies main source of fuel and the majority of our energy should come from carbohydrates. Grains are also a great source of fiber, B-vitamins, and minerals. Without enough carbohydrates in the diet, you may feel hungry, tired, moody, experience headaches, or all of the above.

There are three components to a grain: the bran, the endosperm, and the germ. The bran is the fiber-rich outer layer of the grain that protects the seed and contains B vitamins and some minerals. The endosperm is the middle portion of the grain which contains carbohydrates and some protein. The germ is the small, nutrient-rich core that contains more vitamins and healthy fats. A “whole” grain contains all three components where as a “white” grain has had the bran and germ removed, only leaving the endosperm. As you can see, if you remove the bran and germ, you are missing out on essential vitamins, minerals, fiber, and healthy fats.

When choosing grains, try to choose “whole” grains more often. The word “wheat” on a label may not necessarily mean whole wheat. In order to ensure you are choosing a whole grain with all three nutritious components intact, look for the word “whole” on the label. Some great sources of whole grains are cereals such as Wheaties, Cheerios, Total, and Kashi, oatmeal, whole-grain breads such as whole-wheat, rye, or oatmeal-based breads, whole grain crackers, and my personal favorite, popcorn!

Now, there are a few foods that are “white” that are perfectly healthy to eat and can be part of a healthy balanced diet. One example of this is white rice. Surprisingly, white rice and brown rice have almost the exact same nutritional profile! You may also be surprised to learn that, sweet potatoes are not always superior to white potatoes. Sweet potatoes and white potatoes both contain unique nutritional properties which are both beneficial. Sweet potatoes are very high in Vitamin A, while white potatoes contain more potassium. Both types of potatoes are rich in fiber, carbohydrates, and vitamins B6 and C. So, don’t be afraid to eat white rice or white potatoes from time to time.

Sometimes, people need to follow a special diet that does not contain wheat or wheat products. If that is the case, it is best to work with a registered dietitian. A registered dietitian can help construct balanced meals and snacks to ensure that you are consuming the most nutritious and balanced diet.

Protein

Protein is another very important part of a balanced diet. Protein can come from animal or plant sources. Animal sources of protein include foods such as chicken, fish/seafood, beef, turkey, eggs, and dairy products. Plant sources of protein include foods such as soy, tofu, tempeh, edamame, lentils, chickpeas, beans, nuts, and seeds. Protein serves many functions in the body such as building muscles, repairing tissue, and building hormones and enzymes. Protein contains iron, which helps to prevent anemia, a condition in which the blood does not have enough healthy red blood cells that carry oxygen throughout your body. Protein also contains zinc, a mineral needed not only for muscle growth and repair, but for wound healing, and to help keep our immune system strong.

Chicken and turkey are both great, heart-healthy protein choices. For the healthiest option remove excess fat before cooking and do not eat the skin. Both chicken and turkey are mild in flavor and versatile. They can also be purchased ground and are great additions to pasta sauces or can easily be made into meatballs or burger patties. Fish (either fresh, frozen, or canned) is another great source of protein and contains omega-3 unsaturated fats, which are great for your health. Aim for at least 2 servings of fish per week. Try to choose “freshly caught” fish rather than “farm-raised” fish if possible. Be sure to use healthier cooking methods such as grilled, baked, or sauteed, instead of fried.

Eggs are another fantastic source of protein. They are a very versatile, inexpensive ingredient and can be prepared a wide variety of ways. Eggs are a great addition to breakfast and hard boiled eggs travel easily and can be eaten in the car or as a snack. Eggs can also be chopped up and used as a topping to a salad or made into an egg salad.

Meat that has been smoked, salted, cured, dried, or canned is considered a “processed” meat. This would include foods such as hot dogs, salami, bologna, peperoni, bacon, sausage, and canned meats. Although packed with protein, processed meats contain various chemicals that are not present in fresh meat. Processed meats are also very high in sodium and saturated fats, which are not good for our health. It is best to limit, reduce, or completely remove these processed meats from our diet.

Plants can provide us with protein as well. Some of the top plant-based protein sources are soy, legumes, beans, nuts, hummus, tofu, tempeh, and edamame. There are numerous types of soy products on the market these days, anywhere from soy milk, soy yogurt, soy-based protein bars, and soy nuts. Tempeh is a fermented soy product which has a dry and firm, yet chewy texture and slightly nutty taste. It can be steamed, sauteed, or baked and is often marinated to add more flavor. When prepared with a variety of herbs and spices it makes for a delicious and protein-packed portion of a meal. A three-ounce serving of tempeh has 15 grams of protein! Tempeh is also a great source of iron, calcium, and prebiotics .

Edamame beans are whole, young soybeans. They can be bought fresh in the pod, shelled, or frozen. They make for a great appetizer, can easily be added to soups, stews, salads, casseroles, or eaten as a side dish. Edamame are an excellent source of protein, iron, calcium. Half a cup of edamame (4 ounces) provides approximately 9 grams of protein.

Beans are a great addition to any meal and are another great plant-protein source. There are so many beans to choose from! Some of the most popular are: black beans, navy beans, pinto beans, kidney beans, chickpeas, and cannellini beans. When buying canned beans, be sure to choose low-sodium or reduced-sodium options. Besides being a great source of protein, beans are also a great source of fiber, zinc, iron, and magnesium. Beans can easily be added to rice, salads, tacos, made into a chili, or served as a side dish.

Vitamin B12

Vitamin B12 helps keep the body’s nerve and blood cells healthy, helps make DNA, and the genetic material in our cells. Vitamin B12 also plays a vital role in helping our body produce red blood cells. Animal products naturally contain this vitamin so if you eat animal products, chances are you are consuming adequate amounts of Vitamin B12. If you do not consume animal products, you should look for foods that have been fortified with Vitamin B12. Some foods that are typically fortified are plant milks, soy products, some breakfast cereals, and nutritional yeast. Nutritional yeast is sold in the form of flakes or a yellow powder. It can be used as an ingredient in recipes or as a condiment. It has a nutty and cheesy flavor and works really well in mac-and-cheese dishes or as a topping for popcorn .

To find out if Vitamin B12 has been added to a food product, check the label. Vitamin B12 is also available in supplement form. Before you take a supplement, it is best to work with a registered dietitian, consult with your doctor, and get some blood work done to see if the supplement is right for you.

Fruits and Vegetables

All fruits and vegetables are healthy. Fruits and vegetables pack a large amount of vitamins and minerals, contain fiber, and are good for our heart. They also contain carbohydrates, which is our bodies main source of energy. Two vitamins which are in many fruits and vegetables are Vitamin A and Vitamin C. Vitamin A helps keep our eyes and skin healthy and Vitamin C helps heal cuts and wounds and keeps our teeth and gums healthy.

Fruits and veggies can be cut into different shapes and sizes and dipped in a small amount of dressing for a great addition to any meal or snack. Fresh fruits and veggies are always a great option as many of them do not need to be refrigerated and travel well such as bananas, apples, and pears. Fruits can be easily blended into smoothies for a quick on-the-go snack or eaten as part of a balanced meal. If you make smoothies, you can even try adding in a handful of spinach or kale. Don’t worry! The spinach or kale will only change the color of the smoothie, not the taste! Dried fruits or canned fruits in water or light syrup are great portable snacks as well.

Frozen vegetables can easily be heated up and served as a side dish to dinner. When buying canned vegetables, make sure to choose the low or reduced sodium versions. If canned reduced sodium vegetables are not available, you can still buy them, just rinse the veggies under water before cooking with them. This will help to reduce the amount of sodium.

Vegetables can be broken down into two categories: starchy vegetables and non-starchy vegetables. Starchy vegetables include corn, peas, potatoes, and beans. Non-starchy vegetables include foods such as broccoli, cauliflower, asparagus, zucchini, mushrooms, celery, spinach and more. The key distinction between the two lies in their total content of starch, a type of carbohydrate. Starchy vegetables are slightly higher in calories than the non-starchy vegetables. But remember! You need calories and carbohydrates for energy! Both starchy and non-starchy veggies pack a wide variety of nutrients and should be included in a balanced diet.

There are a wide variety of cooking methods for vegetables. Some popular methods are: microwaving, steaming, baking, air-frying, roasting, grilling, and stewing. Any cooking method that works for you is the best choice.

Different colored fruits and vegetables provide different types of vitamins and minerals. Dark, colorful vegetables (ex: peppers, carrots, broccoli) pack more nutrients than paler/lighter colored ones (ex: celery, onions, iceberg lettuce). If you are looking to boost your nutrient intake choose darker colored veggies more often. In no way are pale vegetables bad for you; the darker/colorful ones are just more nutrient dense (providing more vitamins and minerals).

In order to ensure you are getting adequate vitamins and minerals, make sure to “eat the rainbow” by eating different colored fruits and vegetables. For example, if you are only eating green items such as green beans, broccoli, and zucchini, you’d be missing out on all the wonderful vitamins and minerals in red fruits and vegetables such as red bell peppers, tomatoes, strawberries, and cherries.

Color

Fruit

Vegetable

Red

Strawberry, Watermelon, Cherry, Raspberry, Red Apple

Red Bell Pepper, Tomato*

Orange

Mango, Peach, Cantaloupe, Orange, Apricot, Nectarine, Papaya

Carrot, Sweet Potato, Pumpkin, Orange Bell Pepper, Butternut Squash

Yellow

Pineapple, Starfruit, Yellow Apple, Lemon, Yellow Pear

Summer Squash, Corn, Yellow Bell Pepper

Green

Kiwi, Honeydew, Avocado, Green Apple, Green Grapes, Lime, Green Pear

Peas, Spinach, Broccoli, Kale, Green Beans, Zucchini, Green Bell Pepper, Artichoke, Asparagus, Brussels Sprouts, Celery, Cucumber

Blue/Purple

Blueberries, Purple Grapes, Prunes, Blackberries, Fig, Plum

Eggplant, Beets, Purple Cabbage, Purple Potatoes

White

Banana, Pear

Garlic, Onions, Cauliflower

*Technically, tomatoes are a fruit

Aim for at least 3 to 5 servings of fruit or vegetables per day. One easy way to accomplish this to make sure you are eating one fruit or vegetable with breakfast, one with lunch, and one with dinner. If you also eat at least 1 snack during the day which contains a fruit or vegetable, it puts you right on track to hit the target of 3-5 servings per day. An example of a simple snack you can easily incorporate into your day would be apple slices with peanut butter, carrot sticks with dressing, or a banana. If you follow this pattern, you’re guaranteed to hit your recommended servings of fruits and veggies each day!

Dairy

The dairy food group contains many health benefits as well. The most common dairy products are milk, cheese, and yogurt. Dairy products are rich in calcium and Vitamin D, which are important for building and maintaining strong bones. Dairy products are also another great source of protein.

Choose milks which are reduced fat such as 2% milk, 1% milk, or skim milk. When choosing cheeses, opt for low-fat or reduced-fat options. Yogurts make great snacks or can be eaten as part of a healthy and balanced meal. Check the label on the yogurt and choose yogurts which have more protein than sugar per serving. Examples of this would be Oikos Greek yogurt, Siggi’s, and Fage Total 2% Greek yogurt. All grocery stores carry different yogurt brands and flavors so check to see what your local store has available.

Some people are sensitive to, or cannot tolerate dairy products. Dairy product alternatives which have been fortified with calcium and vitamin D are a great alternative. Fortified soy milk and fortified lactaid milk are great options for those who are lactose intolerant or sensitive to lactose.

Fats

Fat is necessary in our diet, but in small amounts. There are a few different types of fats: monounsaturated, polyunsaturated, saturated, and trans-fats. The healthiest types of fats for us are monounsaturated and polyunsaturated fats. These can be found in foods such as avocado, coconut, fish, nuts/seeds, and oils made from plants such as canola or olive oil. Unhealthy fats are saturated fats and trans-fats. These can be found in food items such as cookies, cakes, butter, cheese, cream and processed meats. We want to make sure to keep our intake of saturated fats and trans-fats to a minimum and choose foods which are higher in monounsaturated and polyunsaturated fats.

Hydration

Our bodies are almost entirely made up of water, and the benefits of water are countless. Some of the benefits of water include: carrying nutrients and oxygen to your cells, flushing bacteria and waste from the body, helping with digestion, preventing constipation, stabilizing heart rate, improving blood pressure, cushioning your joints, protecting organs, and regulating body temperature.

Unfortunately, many of us aren’t getting enough water to drink, especially older adults. Why not? Research suggests one reason is that older adults don’t sense thirst as much as they did when they were younger. [15] This can be a serious problem if you are using a medication that may cause fluid loss, such as a diuretic. When I make the recommendation to drink more water to patients, they normally ask, “How much?” The old school way of thinking was to drink eight 8-oz glasses of water, but some people may need more or less than the standard 64 ounces of water depending on a variety of factors. Medications, exercise, sex, and environment can all influence the exact amount of water you need .

Don’t base how much water you should drink by thirst, because as I mentioned, your sense of thirst decreases as you age. One simple way to tell if you’re hydrated enough is to monitor the color of your urine. The color determines how hydrated you are, the lighter the better. If your urine is a darker yellow, you are more than likely dehydrated and need to increase your water intake.

Another recommendation is to carry a LARGE water bottle with you throughout the day. I constantly see people with small 12-24 ounce water bottles, which is great, but too often people don’t refill the bottles throughout the day. If you start your day by carrying a larger water bottle that holds 48 to 64 ounces of water, you increase your chances of drinking more.

Food, Inflammation, and Pain

One of the biggest movements in nutrition today is decreasing inflammation in the body. Why is that important? It is said that cardiovascular disease, cancer, and diabetes account for almost 70% of all deaths in the United States, and all these diseases share inflammation as a common link. [16] Diets that increase inflammation are normally high in refined starches, sugar, saturated and trans-fats while being low in omega-3 fatty acids, natural antioxidants, and fibers from fruits, vegetables, and whole grains. [17]

If you are suffering from back, neck, shoulder, or knee pain, then you will want to do everything you can to reduce inflammation in the body and promote healing. You already know what foods you should be cutting back on, and which foods you should be eating more of.

Foods that are high in omega-3 fatty acids, fiber, and whole grains are rich in natural anti-inflammatories, and consuming them daily can help your body with recovery. Don’t try to add everything in at once. Just add one or two at a time and build from there.

I often have patients ask me what other supplements to take to help improve recover from pain and injury. The popular ones for joint health include fish oil, chondroitin, and type-II collagen. The honest truth is I would be less concerned with the supplements and more focused on the actual food you’re eating first.

If you want to learn more about certain supplements, check out Examine.com. They have the largest database of nutrition and supplement research available. They are not affiliated with any supplement or food company and are independently funded, so all their recommendations are as unbiased and science-based as possible. No gimmicky marketing or commercials with over the top testimonials. Just facts. As their website says, “We’re not here to tell you what to do. Instead, we simply tell you what the evidence says. And in cases where the research is mixed, we make that clear too.” I can’t recommend their website enough when it comes to anything related to supplements.

Practice Gratitude

As I mentioned earlier, it is important to always be appreciative of food as it gives us energy so we can live. Food is a privilege, not a punishment. One way that I incorporate this into my life is before I sit down to enjoy a meal, I always take a moment to recognize and reflect what is on my plate, the nutrients the food is providing me with, and how it will benefit my body. For example, if I am about to eat yogurt with granola and strawberries for breakfast my reflection would something to the effect of…

Yogurt has calcium and vitamin D, which are important for my bones. It also contains protein for keeping my muscles strong. The granola and strawberries are both carbohydrates which give me energy. The strawberries provide me with vitamins and minerals.

Taking a moment to appreciate what is on your plate will help you retain your nutrition knowledge as well as foster a stronger sense of appreciation for food and your health. Try incorporating this practice of gratitude into your day and you’ll be amazed at how your perception of food changes.

Summary

• The foundations of a healthy diet consist of: increased fruit and vegetable intake, choosing whole grains more often than processed/white grains, choosing lean proteins, reducing consumption of processed/packaged foods, and saving some room for “fun” foods! (You have to enjoy yourself every once in a while)

• All fruits and vegetables are healthy! Try to eat fruits and vegetables that are all different types of colors so you get a wide variety of vitamins and minerals

• Don’t forget to hydrate! The benefits of water are countless. Carry a large water bottle with you so you can stay well hydrated throughout the day

• Inflammation in the body leads to a series of terrible diseases, so be sure you are minimizing sugar and processed food and incorporate more lean proteins, whole grains, fruits and vegetables

• If you want to try a certain supplement, talk to your physician, assess your diet, seek guidance from a registered dietitian, and check Examine.com to see if there is academic research that supports what the supplement claims to do

• Practice gratitude. Food is a privilege, not a punishment!

CHAPTER 9

Fitness

Fitness

I choose the word fitness instead of exercise because exercise can be misinterpreted and is a bit too general. The term fitness is defined by the Center for Disease Control and Prevention (CDC) as “the ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and respond to emergencies.” This includes cardiovascular fitness, muscular endurance, muscular strength, flexibility, balance, speed, etc.

Since you are reading this book, you are someone who values their health and understands the benefits of fitness and consistent exercise. Too often I see people, especially over the age of 50, who are making one of the following 3 mistakes:

1. Not exercising enough (or at all)

2. Not exercising with enough intensity

3. Only doing one type of exercis e

Not Exercising Enough (Or At All)

This is probably the most common and (theoretically) the easiest to fix. Everyone wants to exercise and start on the path to being fit, but they either don’t know where to start or are currently struggling with some sort of lingering pain which limits their activity.

If you don’t know where to start and don’t like going to a traditional gym, I recommend you start with walking. Even if you suffer from back pain and can only walk for 10-15 minutes prior to pain setting in, you should still go for walks. Just incorporate periodic sit breaks before the pain starts. Getting a Fitbit is a wonderful way to track how many steps you take per day, and challenging a loved one is an even better way to ensure you take enough steps.

The key is to not overcomplicate it. Just get out and walk. I normally advise creating a routine and doing it at the same time every day. Whether it’s first thing in the morning or right after work with a significant other, you have to make it non-negotiable. No matter what, it has to get done! Create a steadfast rule for yourself that you are going to walk (or do some sort of exercise) every single day, rain or shine. If you don’t trust yourself, tell somebody your goal and make them hold you accountable. This is your health and your life; you can do this!

After you start building momentum, you’ll want to walk further. Then start incorporating different types of exercise. Maybe ride a bike, start running, or go to a bootcamp class. Use the momentum to your advantage and get moving!

If you suffer with ongoing pain, stiffness, or injuries, try physical therapy. There is no faster way to get back to living an active life doing the things you love than with the help and guidance of a certified physical therapist.

If you would like more information on recovering from the most common sports and running injuries, be sure to check out “The Ultimate Guide To The Most Common Running & Sports Injuries: Rehab Like The Pros And Get Back To Your Favorite Sport! ” at https://www.renewalrehablargo.com/sports-running-injuries

Not Exercising With Enough Intensity

You may have been in a gym and have seen an older gentleman (or two) sitting on an exercise bike holding up a newspaper who is kind of, sort of pedaling. He sits there for approximately 30 minutes, followed by talking to his buddy for 30 minutes, and then heads home. He probably does this 5-6 days per week and brags about how often he works out to everybody he possibly can. Please don’t be that guy (or gal)!

It’s great that he makes an effort to go to the gym, but glorified sitting is not the key to becoming fit and healthy. Let’s talk about ways to safely improve your exercise intensity. But please make sure to check with your physician if you have any current or previous cardiovascular issues before following any of these recommendations.

First, you need to get that heart rate up. What’s the ideal heart rate when exercising? To find your maximum heart rate, a good guideline is to do 220 minus your age. So if you’re 50 years old, your max heart rate would be 170 beats per minute (bpm). The rule is you want to be between 65-85% of your maximum heart rate. So 65-85% of 170 bpm you want to be somewhere between 110 and 145 beats per minute. Yes, you should be sweating, and yes, you should be breathing hard .

The best way to measure your heart rate is to purchase a heart rate monitor. The goal is to spend 30-40 minutes in your ideal heart rate zone after a proper warmup. If you do this 4-5 days per week, your life will improve across the board. The physical and cognitive benefits are numerous, and it can change your outlook on life. Do the physical activity you love the most, whether it’s tennis, running, or swimming.

Make sure to perform a nice warm-up and cooldown before and after exercising. Not doing these things often leads to pain and injuries, which will slow you down from reaching your health and fitness goals. If you want to learn more about how to safely perform a proper warm-up or cooldown, as well as other health tips, go to https://www.renewalrehablargo.com/blog and subscribe to our weekly updates.

Only Doing One Kind Of Exercise

The last mistake I see frequently are from the avid runners, swimmers, cyclists, tennis players, etc. They are die hard about a specific sport, and they do that activity four, five, or six days a week. If this sounds like you, then first let me tell you, “Congratulations, and keep being AWESOME!” You are getting that heart rate up and maintaining good physical fitness. I love working with people that actively value and take care of their health. What I want to bring to your attention is that doing one specific type of exercises with repetitive motion can take a negative toll on your body and joint health.

For example, when you run for miles and miles, you put excess stress on the knee joints. When you play tennis and overhand serve repeatedly, you put a ton of stress on the shoulder joint. If you like rowing, it’s a large amount of stress on the joints of the low back. This begins to take a toll as you pass the age of 50, and it commonly leads to pain and injuries. To improve joint health, it’s important as you age to incorporate something called movement variability.

Movement variability, simply put, is doing different forms of exercise. If you love running 5-6 days per week, try instead to run 2-3 days per week and swim 2-3 days per week. Swimming is great because there isn’t any hard impact on your joints. If you love weightlifting, make sure you incorporate some yoga and flexibility work. You get the idea. Just make sure you are mixing it up. Remember, fitness incorporates muscular strength, muscular endurance, cardiovascular endurance, flexibility, and balance. The more of those things you incorporate into your fitness regimen the better!

Summary

• When it comes to fitness, be sure to exercise consistently with appropriate intensity and to include some variability in your routine

• Perform a nice warm-up and cooldown before and after exercising. Not doing these things can often lead to pain and injuries.

• Only doing one specific type of exercises with repetitive motion can take a negative toll on your body and joint health.

CHAPTER 10

Wellness, Health, & Everything Else

S o far we have discussed different parts of the human body, why certain aches and pains occur, and ways to combat them. We also talked about nutrition and fitness. This chapter will be more of a smorgasbord of vital health topics that help with healing and can drastically improve the quality of your life. In fact, each section of this chapter could be its own book, but I’m going to give you the highlights.

First, a disclaimer. There is a large amount of information in this chapter. Please don’t be overwhelmed or feel the need to do everything I mention. If you do just ONE thing from this chapter, you’ll be doing better than the majority of people out there!

Mental Wellness & Stress

I’ll start with a story. Before starting my business and understanding the importance of mental health and stress, my days would look like the following. The alarm on my phone would go off. I’d hit snooze a couple times and tell myself, “PLEASE just a few more minutes!” After the third snooze button, I’d roll over, grab my phone, and then check my Facebook and Instagram to see what the world was up to.

After mindlessly scrolling through social media, I would scan my email inbox, which contained a combination of junk and requests from work. “Ugggh!” (Side note: I hate having the red notification bubble next to my apps on my phone. So yes, I read all my emails, and I might be a bit OCD). Finally, I would hop a quick shower and be off to the office, barely making it on time. Not a great way to start the day. After work, it was home for dinner and back to scrolling my phone while watching the news or Netflix. This would then lead to me going to bed way too late, starting the whole cycle over again.

Sound familiar?

Although technology keeps advancing and is allegedly supposed to make our lives easier, I would argue the exact opposite. We have never been more plugged in. From the time we wake up to the time we go to bed, we are constantly bombarded by emails, text messages, and notifications. Our bosses and clients want immediate replies. Kids and grandkids need to get picked up and dropped off for school, sports, and extracurricular activities. Trying to squeeze in a workout and eating healthy becomes a hassle because of the time commitment needed. This can cause a feeling of stress, the feeling that you are always busy, the feeling that you don’t have true control over your day.

How do you take back your day and improve the overall quality of your life? Before we take a closer look at my story, it’s important to understand cause versus effect. Running out of gas and being stranded on the freeway is an effect. The cause was not filling up the gas tank when the gas light came on .

My old feelings of stress and being overwhelmed were an effect. What was the cause? Many people would say it’s how I started my day by hitting the snooze button repeatedly. But I would argue that was still an effect. The actual cause goes back to the night before, mindlessly scrolling my phone while watching the news or Netflix, pushing my bedtime later and later. This was the first thing I had to eliminate in order to take back control. I’ll talk more about optimizing sleep in the next section, but getting 7-8 hours of shut-eye a night is vital for good health.

Was getting rid of the news and Netflix while scrolling through my phone easy? Hell no! But the effect of getting quality sleep will make you feel like Superman or Wonder Woman the next day. It gives you the energy to hit the ground running.

When waking up, the best recommendation I can make is to create a morning routine. The power of a morning routine will help improve your mood and give you a sense of control over your life, something which doesn’t happen when you sleep for 4 hours and have to hammer the snooze button. What makes a good morning routine? I’ll tell you mine to give you some ideas of things you can do.

Upon waking up, I immediately make my bed put on some coffee, because I’m a coffee addict. While the coffee is brewing, I’ll do a little bit of stretching for 3-5 minutes. When it’s done, I grab my coffee and meditate for 10 minutes. I also review my daily planner, seeing what tasks I need to get done that day, and I write down the 3-5 things that I’m grateful for. It may be a person from my past, a material possession, my health, etc. Then I work out for 45-60 minutes, normally a combination of weightlifting and running. I come back, shower, and start my day .

It helps to understand the reasoning behind all of these activities. Making my bed gives me the feeling that I accomplished a task. Although a small task, it’s all about developing momentum for the day. The coffee, in combination with a bit of stretching, gives me a bit more energy, which also adds to the momentum.

Afterward, meditating for 10 minutes is arguably the most important part of my morning routine. Meditation once had a stigma that it required a “spiritual awakening” or “finding your center.” And meditation can be that if you so choose, but the most powerful benefit for meditation is a better understanding of your own thought processes. Most of us spend so much time worrying about things that happened in the past or anxious about what might happen in the future. Meditation can give you the mindfulness to better recognize these thought processes and focus on the present.

Meditation has recently exploded in popularity. Everyone from CEOs to famous actors have made this a daily habit. Not to mention there is tons of research showing people who meditate have lower blood pressure, decreased cortisol (stress) levels, and are overall more happy. [18]

If you’ve never meditated before but want to start practicing, there are plenty of resources available. I strongly recommend starting with guided meditation. Guided meditation is when someone coaches you through the process of meditation, what you should focus on, what you shouldn’t focus on, etc. Some apps I highly recommend are Headspace (free), Calm (free), and my personal favorite, Waking Up (paid). Each of these have guided meditations that will help you through the process .

It may be difficult when you first start. Many days you’ll feel like you were zoned out and not paying attention at all. But if you keep at it and spend just 5 minutes practicing a day, you will begin to feel an incredible change in your life!

Continuing on in the morning routine, writing down 3-5 people or things you’re grateful for is an awesome exercise. The process of thinking about people and things you’re grateful for will immediately improve your mood. You’ll begin to stop worrying about the trivial things in life and focus on the people that truly matter, those who have always loved and supported everything you do. Whether that be a significant other, parents, kids, grandkids, or an influential mentor, it doesn’t matter.

Expressing gratitude for them on a piece of paper with the reasons why you are grateful for them can vastly improve your overall happiness. Trust me, you can’t be grateful and anxious at the same time. You can’t be grateful and stressed at the same time. I can’t recommend doing this enough!

Moving along, the daily task list helps keep my day organized. I am a firm believer that using an old school planner and a pen is best. Something about physically writing things out, at least for me, helps organize my thoughts and actions better compared to using a phone or tablet. Using the planner, you can more easily figure out whether you are truly working towards your goals or working on minutia.

Ask yourself everyday whether the tasks you are working on today are going to get you closer to your one-year, five-year, ten-year goals? If you don’t have goals written down, start there! What do you want to achieve personally in one year? Do you want to learn a new instrument? Maybe learn a new language? What do you want to achieve in your career? Maybe you want to retire soon? What do you need to do financially to achieve that? Then you can work backwards to break it up into monthly, weekly, and daily goals.

What about socially? Maybe you want to spend one day a week doing a fun activity with the kids or grandkids. Or you want to commit one night a week to having a date night with your significant other.

Writing down all your goals may sound stressful at first, but doing it will allow you to design the life you want to live. Many times, we get sucked into “putting out fires,” answering emails, talking to clients on the phone, running errands, etc. and don’t take the time to focus on the bigger picture of where we want to go.

Finally, I work out for 45-60 minutes. I like to run and lift weights. Maybe you like to swim, walk, or do bootcamp classes. Whatever it is, just get the heart rate pumping and remember the principles I talked about in the last chapter.

Do you have to do all these things? Of course not. I don’t get to all of them every single day, but if I can do at least two or three from that list, I consider that day a win. I also wouldn’t recommend trying to do all these at once. Pick one and try it for a month. Building a habit takes somewhere between 21-66 days, according to research. [19] So don’t overstretch yourself. Just try to be 1% better than yesterday.

Also, I would strongly recommend trying to avoid your phone at all costs in the morning. Getting sucked into social media and emails as soon as you wake up is not a great way to start the day. I like to use the out of sight out of mind method. If I can’t see my phone, I can’t be tempted to use it. So I keep it in the kitchen until my morning routine is over.

The Lost Art Of Sleep

A third of our life is spent sleeping, yet most of us never take the time to optimize the quality of our sleep. To meet life’s demands, we continue to sacrifice sleep in order to get more stuff done, and that can take a negative toll on our health. Getting a good night’s rest has countless benefits. Mentally, sleep improves energy, mood, alertness, and memory. Physically, sleep helps every tissue and system in your body, including stress hormones, growth hormones, your immune system, appetite, breathing, and cardiovascular health (to name a few). Therefore, getting quality shut-eye is imperative to recovering from injuries and chronic pain. It’s something I consistently stress to my patients early on in the rehab process. The ones who practice these things tend to get the best results.

On the other side of the coin, by some estimates sleep deprivation affects approximately 70 million Americans of all ages. A lack of sleep has been shown to increase the risk for depression, diabetes, cancer, and obesity. A study done in Occupational and Environmental Medicine showed sleep deprived subjects have slower responsiveness similar to those that are intoxicated. [20] Another study done in The Journal of Pediatric Orthopaedics linked adolescents who are chronically sleep-deprived have a higher risk for suffering a musculoskeletal injury. [21]

EVERYTHING health-related comes back to sleep and the quality of sleep. In fact, athletes such as Serena WIlliams, Lebron James, Roger Federer, Maria Sharapova, and Usain Bolt will sleep 10-12 hours a day!

How can you begin to optimize your sleep? Great question. Let’s dive in!

The first thing may be common sense, but it’s important. Drinking caffeine close to bedtime can be detrimental to your sleep quality. If you love caffeine like myself (I’m a big coffee guy), make sure you aren’t drinking any coffee or caffeine after 2 pm. This will give your body time to shut down appropriately when it gets closer to bedtime.

Speaking of drinking, I would also shy away from drinking too much wine or alcohol. Yes, the antioxidants in wine are good for you, but as soon as you cross the one to two glass threshold, you begin to risk not getting to the REM sleep cycle (the most important cycle of sleep).

Continuing on our list of things to avoid, minimizing nighttime “blue light” exposure is another critical component to awesome sleep. What is blue light? Look at a rainbow and you’ll notice it consists of red, orange, yellow, green, indigo, violet, and blue colors. Sunlight is the combination of all these colors to create a white light. Each of these colors have different wavelengths and different amounts of energy. Blue light has shorter wavelengths and higher energy .

Sunlight (and blue light) are great for you during the day. It enhances mood, reaction time, and attention. However, basking in blue light at night can be damaging to our internal biological clock, otherwise known as our circadian rhythm. It tricks our brain and our body into thinking that the sun is still up, not allowing us to shutdown for a good night’s rest. Blue light is emitted from our cell phones, laptops, TVs, and LED light bulbs.

Fortunately, there are many ways to decrease your nighttime blue light exposure. The easiest is to start by setting a “reverse” alarm clock for about 30-60 minutes before bed. This alarm will alert you to start turning off electronics, including televisions, laptops, and cell phone screens, to get ready for bed. I also recommend turning all your electronics to “night shift” mode. For you iPhone users, go to “Settings,” tap “Display & Brightness,” then “Night Shift” to automatically shift the colors of your phone to the warmer end of the spectrum. I would schedule it from “Sunset to Sunrise.” Laptops have the same capability. If you are a Mac user, you can go to the app store and download a free program called “f.lux” to turn on the same settings.

If you want to get extra fancy, purchase a pair of blue light-blocking glasses to wear during the evening. The glasses filter out blue light from your laptops, lights, cell phones, and other technology so you can increase your melatonin production. I don’t have any specific company recommendations, but I do have a pair of blue light-blocking glasses from Felix Gray that I love.

Speaking of melatonin, it’s a hormone that is naturally produced by your body. When it’s dark out, your body secretes increased melatonin. You can also take this as a supplement that normally comes in pill form to aid in sleep. However, before running to the drug store to buy melatonin, be sure to talk to your physician and pharmacist about the proper ways to take it. Another supplement that is great for sleep is magnesium. There are many different forms of magnesium to help with different body functions, but the magnesium shown to help with sleep is called magnesium citrate.

Again, please do not take any supplements without talking to your physician first. If you want more natural sleep supplements, try drinking a cup of chamomile or lavender tea, which you can buy at any grocery store.

How else can you optimize sleep? Go to bed at the same time every night and wake up at the same time every day (yes, weekends too). This allows your body’s internal biological clock or circadian rhythm to stabilize and allows you to feel more wakeful during the day and more sleepy at night. Sleeping in on the weekends may feel nice, but it can actually make you more tired and lethargic when you have to wake up earlier during the week.

When shutting it down for the day, having a regular routine is always best. Begin by shutting off all technology. In fact, I charge my cell phone in the kitchen to ensure I am not tempted to stare at the screen while trying to get a good night’s rest. My friends and patients always ask how I can do that? What if there is an emergency? I have been doing it for almost 5 years and have never had any issues, although I keep my ringtone set on loud, just in case.

After your reverse alarm clock goes off and technology is put away, I love to read for 15 or 20 minutes. Preferably something personal development-related to help prepare my mind for positive dreams. After reading, I do a brain dump. I get out a sheet of paper and begin to recap my day. What went well? What can I improve? What is currently causing me stress and what can I do to eliminate it? Good or bad, just get it all out on the paper. This helps clear the mind, which can accelerate your ability to fall asleep. Afterward, I brush my teeth and officially go to bed.

Your routine doesn’t have to go exactly like this. This is just what works for me. You can change the order. You can do some foam rolling. Or give your significant other your undivided attention and recap each other’s day. Whatever it is, just make it a consistent routine at the same time every night.

Now let’s talk about your bedroom. We have already discussed the negative effects of blue light, and when it comes to sleeping, the darker your room the better. Your room should be a cave with no light seeping in. Blackout curtains are great. I would also consider blocking any little red or white lights coming from your television or laptop. If you are someone who likes falling asleep to your television, PLEASE put on a sleep timer.

You also want your bedroom to be relatively cool in temperature. Somewhere between 66 and 68 degrees is ideal. Depending on where you live in the country, you’ll want to adjust accordingly. The cooler temperatures while sleeping helps improve your circadian rhythms.

A few other miscellaneous notes. Many people are raving about weighted blankets. The theory behind these blankets goes back to when we were infants. As an infant, when we cry or are upset, we are held tight by our parents or swaddled in a blanket. The pressure applied from our parents’ arms or a swaddle blanket decreases our sensory output, allowing us to calm down and, more importantly, stop crying .

The weighted blanket companies have proposed that they help decrease stress and anxiety. There really isn’t any academic research to defend these claims (yet), but I have patients who absolutely love their weighted blankets and tell me they literally “sleep like a baby.”

I have not personally used one of these before, but I plan on experimenting with them in the near future. If you are going to buy one, it’s recommended to get one that is approximately 10% of your body weight.

The other note I have is about white noise. White noise is a noise that contains every frequency a human can hear. White noise is utilized to help drown out any background noise that may come about while you’re trying to sleep, such as a noisy neighbor or a cat meowing. A fan can produce a nice white noise, and there are several different phone apps that can as well. Is this a necessity? No. But it is another tool you can use to improve sleep quality, especially if you’re a poor sleeper.

Finally, in regards to sleep is the power of naps. Not everyone reading this may be able to make naps happen due to family or work obligations, but short naps can definitely give you a significant boost of energy and brain power if utilized correctly. Naps should only last 20-30 minutes. No more, no less. The best time is usually between 1 and 4 pm. If these naps last any longer than 30 minutes, you risk the dreaded “grogginess” feeling. Studies have also shown that these power naps are more powerful than an afternoon cup of coffee when it comes to motor skills, memory, and learning ability. [22] So if you have the ability to take the occasional power nap...do it !

Totally Random (but Helpful) Tidbits

Everybody Poops

Have you ever had difficulty going to the restroom? Maybe you have difficulty with hemorrhoids or constipation? If that sounds like you, I would strongly consider getting something called a Squatty Potty®. In our Western culture, using a traditional toilet and sitting at a 90-degree angle isn’t optimal for going #2. When sitting, we are partially blocking our colon, which makes elimination difficult. Our bodies are designed to poop in a squatting position. While in a squat, the colon opens up and your rectum can relax. No straining or significant pushing needed.

That is where the Squatty Potty® comes in. It’s a company that makes foot stools to place under your feet while going #2. The stool lifts your legs up and puts you more into a squatting position. If you don’t want to buy the Squatty Potty®, you can just put a few books underneath your feet instead. Either way, your pooping experience will SIGNIFICANTLY improve when your legs are elevated, and you get closer to a true squat position.

Pick The Safest Home Possible

Are you close to retirement and looking to move? Maybe you want to move to a new state to avoid high taxes and cost of living, or maybe you’re helping your parent or grandparent pick a new home. Here are a few things to look for when picking your new residence. After you turn 65, the last thing you want to do is suffer from a fall. In 2016, it was reported that 30,000 people over the age of 65 died as a result of a fall. So let’s minimize the risk of this ever happening to you !

First, pick a one-story home or a bottom floor apartment. As you continue to age, stairs become more difficult to navigate, and there is always a risk of slipping or falling. Eliminate the risk by staying in a single-story residence. If you do have stairs, make sure there is a sturdy railing to hold onto as your go up or down.

Next, walk-in showers are always more favorable than those with a shower/bathtub combo. Stepping in and out of a bathtub in order to shower increases your risk for falling, and it unfortunately happens all the time. The walk-in shower eliminates this risk. Grab bars and somewhere to sit inside of your shower are also huge bonuses.

The last thing I recommend is to remove ALL throw rugs! Throw rugs move, so they have the potential to slide out from underneath you. This immediately puts you at a significant fall risk. Please get rid of them!

If you are concerned about yourself or a loved one falling due to weakness or poor balance, consider seeing a specialist physical therapist. They will be able to determine any deficits you may have by assessing your strength, checking for any nerve issues, and developing a customized plan to decrease the risk of falls.

Summary

• Develop a morning routine to get your day started on the right foot and help manage your stress. This might include:

o Practicing gratitude

o Meditation

o 45-60 minutes of exercis e

o Using a daily planner to discover what tasks need to get done to achieve your goals

o Avoiding your cell phone to focus on the things that truly matter

• Optimize sleep by decreasing your screen time prior to bedtime. Keep your room dark and cool while minimizing all light (especially blue light) so you can get a good night’s rest. When needed, a 20-30 minute power nap in the afternoon is a great tool to re-energize you.

• If you want to poop more efficiently, think about purchasing a Squatty Potty®.

• When you are deciding on a residence, consider choosing a single-story home with a walk-in shower and no throw rugs to decrease your risk of falling.

• When in doubt, see a specialist physical therapist.

CHAPTER 11

Finding The Right Healthcare Provider (And FAQ’s)

H as our healthcare system ever let you or a loved one down in your past? Do you hate calling to make a doctor’s appointment or getting a prescription refilled because of long wait times and talking to an automated robot who can’t understand you?

Maybe you were trying to tell a physician or another healthcare provider something but you know they weren’t really listening.

Have you been annoyed that your healthcare provider is always running late, appears rushed, and only spends 6-7 minutes with you before he or she is out the door? Does it bother you how deductibles keep skyrocketing while the quality of care is plummeting?

I worked in this system, and I hated it! I couldn’t give all the focus and care I wanted to before I had to move onto the next patient.

Maybe you’ve tried physical therapy in the past, but for those of you that haven’t, I’ll explain how the traditional process works. Let’s say you are suffering with back pain, so you go see your physician. Your physician recommends you try physical therapy. (Side note: only 7% of those with back pain are actually referred to physical therapy [23] ).

You are given a list of physical therapy clinics, and you call the one that has the best reviews on Google. Or you try a place that a friend recommends. When you first call the clinic and tell them your doctor said to try physical therapy, they’ll ask you for your name, date of birth, what body part hurts, and group insurance policy number. You are never asked how your back pain started, how it happened, or what you’ve already tried thus far. Time isn’t spent trying to truly understand the depth of your problem.

After getting the first visit scheduled, you go into a clinic, where you might not feel truly welcomed aren’t even offered a refreshment! You begin filling out your 43 sheets of paperwork that are required by insurance companies. When that is all done, you get called back for your initial evaluation. You spend a little time with a traditional physical therapist who barely makes eye contact with you as they type away onto their computer asking you generic questions that the insurance companies “forces” them to ask.

They use words you might not understand, they don’t truly listen to you and your needs and end up setting goals for you that you don’t really care about, such as getting your shoulder AROM to 180° degrees or getting your knee extension to WNL (what does that even mean??). When all you really want to do is get back to playing golf with your buddies or reach into the overhead cabinet to get the dishes out so that you can get the table ready for your yearly family get together .

On the next follow-up visit, the traditional physical therapist forgets to explain to you what the plan of action is going to be moving forward and does not properly communicate what he is doing and why. Many of them do not relay your plan of care to the rest of the therapy team and there is a lack of consistency and poor progression of your treatment.

This standard of care is not high enough to effectively treat chronic back, knee, shoulder or neck pain. Most people don’t see any results after a few sessions and give up. I don’t blame them one bit. Why would you waste your precious time on something that seems to not be working?

This is not what physical therapy should be. So after watching this process for many years, I decided to create a physical therapy clinic, Renewal Rehabilitation, that is dedicated to serving the most important person: YOU! My clinic’s process is a bit different.

When you call my clinic, we start with an in-depth phone call, there will be no mention of date of births or group policy numbers right away. No robot answering machine that you have to press a bunch of numbers or try to yell “Yes” or “No” a thousand times. You’ll be connected straight to one of my incredible staff members.

We want to spend AT LEAST 10 to 15 minutes on the phone getting to know you in order to gain a deep understanding of you and your problem. What you’ve tried. What’s worked. What hasn’t worked. What your pain or problem is stopping you from doing. What your number one goal is. Etc.

To schedule a phone call, go to https://www.renewalrehablargo.com/free-telephone-consultatio n

After talking on the phone, if we determine that we can help and are a good fit for you, we’ll give you the option to schedule you to come in for your first session, which is 100% free. We call it a “Discovery Session.” No obligations. No paperwork. No referral or prescription needed. You can come and get a feel for my clinic and gain a better understanding of your problem and how we may be able to help. We want you to have total confidence and clarity in making the best decision for your health.

At the free Discovery Session we will dive into answering more in-depth questions. What exactly is wrong? This could include stiff joints, weak muscles, poor quality of movement, etc. What are your options to fix it? What are your goals? How long it will take to reach your goal? What is the actual cost to solve your problem? What you can do at home to speed up recovery?

By the way, “get rid of my pain” isn’t the best goal. You can take pain pills for pain relief. A better goal is fixing knee pain so you can walk on the beach with your loved one for as long as you want without having to worry about your pain coming back. A goal is getting your back strong enough to lift up your grandchild without the impending fear that your back is going to go out. A goal is to get your shoulder to the point you can drive a golf ball 250 yards down the middle of the fairway. A goal is being able to work an 8-hour day without neck pain or headaches throwing off your focus and energy.

I tell patients, “Pain relief isn’t the best thing we can do for you; it’s just a happy byproduct. Guiding you to living an active, mobile, independent lifestyle with the confidence your pain won’t come back anytime soon is by far the best thing we can do for you. ”

To find out more about our Free Discovery Session, go to https://www.renewalrehablargo.com/free-discovery-session

At Renewal Rehab, we know that our patients get the best results when we use a combination of hot packs, cold packs, electrical stimulation units, cardio equipment, our hands, a table, resistance bands, and a few weights when appropriate. That’s it.

While the traditional PT clinics will never do hands-on work, we spend at least 5-10 minutes per session, when needed. Why? Because when you’ve been in pain and stiffness for an extended period of time, that’s what it takes to break down scar tissue, unlock stiff and creaky joints, and release muscle tightness. This is especially important early on in the rehab process.

What about exercises? That all depends on you. We will ask you at the beginning what it is you’re looking for. If you know that you aren’t great about being consistent doing exercises at home, we create a plan for that. If you are someone who loves doing things at home to speed up recovery, we create a custom plan for that too.

When it comes to exercises and homework, we will only ask for 10-30 minutes of your day. No more, no less. We respect your time and will only give you exercises that give you the most bang for your buck.

We work using a team approach at Renewal Rehab. We believe that having an entire team in your corner as opposed to just one therapist is ideal. Our number one priority is getting you better, our second priority is to create an environment where we can work together in a fun, upbeat atmosphere to make your experience of physical therapy a more enjoyable one .

Throughout the process, you will have access to our therapists 24 hours a day, 7 days a week through our text message service, where we respond within 24 to 48 hours of asking any questions or concerns you may have.

We believe it’s this process that gets our patients back to feeling young again. To a life where they aren’t dependent on pain pills or afraid of needing an unnecessary (and costly) surgery. To walking, hiking, running, swimming, or playing sports with loved ones and friends. To having the internal confidence that these aches and pains don’t have to be a daily occurence anymore.

Some of our most proactive patients who truly value their health will invest in our year-long plan of care to come back for checkups throughout the year. This allows them to keep their body in tip-top shape all year round. If any of this interests you, and you would like to inquire about cost and availability, go to https://www.renewalrehablargo.com/ask-about-cost-availability

Frequently Asked Questions

Here are some other frequently asked questions about physical therapy. It is compiled from years of questions left on my patient message board, from inquisitive email replies, from people who walk into our clinic in person, those who call in on the phone, and even “live chat” their queries to us. They all come from men and women who value their health enough to make a simple inquiry about what they can do at the first signs of ill-health and to ask exactly how physical therapy can help them achieve their goal of returning to great health .

Q1. What is physical therapy?

A: Physical therapy is a proven strategy for easing the worries and concerns of people suffering from aches, pain, and stiffness, helping that person move freely again, bend further, stretch easier, and live an active and healthy lifestyle into their 50s, 60s, 70s, and beyond.

More, it lets that person live free from the worry that the same problem will come back to haunt them anytime soon.

Q2. How can physical therapy help me?

A: There are two ways physical therapy can help, and a good physical therapist will lift your concerns and ease your worries by telling you what’s going wrong, often within 10-15 minutes.

Next, the speed at which the physical problem is eased is completely dependent upon your age, how long you’ve had it, how severe it is, your commitment, and the skills of the physical therapist.

Q3. Do I get personal support if I need it?

A: Yes. If you arrange to do physical therapy with us, you’ll be given almost unrestricted access to your own physical therapist, who will be on hand to take your call and reply to your emails and texts for as long as you need.

Q4. Does physical therapy help someone like me?

A: Here’s a list of the types of people physical therapy helps:

1. People still working (and who want to remain that way), especially salespeople, managers, civil servants, engineers, office workers, teachers, manual workers, nurses, healthcare workers, lawyers, even doctors. Why? Because they need to move easily and be able to sit comfortably for long periods in order to perform well in their jobs.

1. People aged 50+ who are determined to remain independent. Why? Because many people see the impact that poor physical health has had on their parents.

2. Active and involved grandparents. Why? Grandparents who play games with their grandkids, help with school work, walk with them to and from school, take them places, or babysit often tell us that’s why they felt the need to try physical therapy.

3. People who take their health seriously. Why? Many people who visit us are proactive about their health. That means they read up on foods, vitamins, health topics, try to eat right, take vitamins and other supplements such as cod or fish oil, and do their best to stay out of the doctor’s office.

Q5. What happens if I’m not happy with my physical therapy at the end of my session?

A: I will personally refund your payment back onto the card you’ve used or you can leave without paying, NO questions asked.

Q6. What if I book physical therapy today, but before I get to you there’s a positive change in my condition so that I don’t need to come and see you anymore?

A: That’s great! That’s what we’re shooting for. Just call and we will cancel your name in the schedule and ask that you keep in touch with your physical therapist to let us know how you’re doing .

Q7. Am I going to have to take off my clothes during physical therapy?

A: You never have to remove large portions of clothing. To make your physical therapy experience as comfortable as possible please, keep in mind the location of your injured body part.

For example, if you have a lower back injury, shorts and a loose shirt would be ideal. Or if you’re suffering from a shoulder or neck injury, a t-shirt would be great for guys or a tank top for ladies. Your physical therapist will always aim to remove as little clothing as possible, and we will never ask that you remove an item of clothing that may completely expose a large area of your body.

Q8. If I don’t want to make another appointment after my first visit, do you take it personally?

A: Not at all. That’s totally fine! My first priority is to tell you what’s going wrong and what you need to do next by creating a custom plan. Whether or not to continue with your treatment plan is totally up to you.

Q9. How likely is it that physical therapist will be able to help me?

A: If your problem or concern is one of pain or stiffness in the muscles or joints of the following areas, it’s 99% likely that physical therapy can help you, and there are various ways we might do that.

• Back

• Neck

• Shoulder

• Elbo w

• Knee

• Foot/Ankle

Q10. Can I talk to a physical therapist before I book, just to confirm physical therapy is right for me?

A: Absolutely! You schedule a call on our webpage at https://www.renewalrehablargo.com/free-telephone-consultation or email me personally at javier@physicaltherapist.pro

Q11. Will you do anything at the first session to help my pain?

A: Yes. It’s always my intention to start making progress on the pain and or stiffness you’ve got, as well as help ease any other concerns and frustrations.

Q12. Isn’t physical therapy just for younger people who are injured and who play loads of sports?

A: Absolutely NOT. I’ll be the first to say that physical therapy helps people who do play sports, but physical therapy is actually much more valuable and better suited to people who are aged 50+ and who want to keep an active lifestyle for as long as possible.

Q13. Will I get any exercises or anything like that to take home with me?

A: Only if the time is right and we think performing them is not going to make your pain worse, and I’ll give you as many hints and tips as possible to use when you go back home that night. We actually prefer to use videos to help guide you, and we will never ask for more than 10-30 minutes of your day .

Q14. What will happen if I don’t choose to go and see a physical therapist?

A: Your current predicament may continue, and you’ll run the risk of doing unforeseen and untold damage to the joints if they’re not taken care of properly or if surrounding muscles aren’t made stronger. A failure to adhere to the right recovery program post-injury could increase the risk of early onset of pain and stiffness in joints.

Q15. How long will it take for a physical therapist to get me active and healthy again?

A: Everybody’s a little bit different, but for most problems that involve joints and muscles that we see in our physical therapy clinics, we’ve worked out a way to get it down to as little as 6-8 weeks before a person is comfortable and safely active again.

Q16. My injury only happened the other day, and I’m in a lot of pain. When should I see a physical therapist for help?

A: ASAP. There will always be ways we can help. Sometimes it’s as simple as, “Do this, but don’t do that” advice. The first will be to tell you what NOT to do. So many people make poor, misinformed mistakes when it comes to dealing with acute pain. Every decision that you get wrong in the first few days will, very likely, add to the length of time it will take to get better.

Q17. Somebody mentioned a chiropractor to me, but what’s the difference between physical therapy and a chiropractor?

A: To be brief, a physical therapist looks for a cure. Our aim is to help you create an effective treatment plan so you will not need to constantly keep coming back to us. So a physical therapist will design a plan to work on stopping the injury happening again.

We do very similar techniques to osteopaths and chiropractors, such as mobilization of your spine, but we also add things such as massage and stretching and believe that the combination of that with exercises and posture correction will reduce your pain fast and also help you manage your pain in the coming years to avoid the need for repetitive visits to see us.

Osteopaths and chiropractors are both fantastically effective at reducing back pain, and many of the good ones will even refer their patients to a physical therapist for the things like massage and exercises that they don’t provide.

Q18. I can’t work this thing out. One minute I’m not bothered by it, then the next it can quite literally take my breath away. Just when I think it’s getting better, it hits me again! If I come in and see you at a time when it’s not hurting, will I be wasting my time?

A: Not at all. Immediate pain relief isn’t really what we do! Physical therapy is about finding the source of your problem, whether that is poor posture, bad movement mechanics, etc. And if your injury is now a few weeks old, two things are likely to be happening. The first is that the joints and muscles are locked stiff or jammed in one place, so every time you get to a certain point they don’t want to move, producing a sharp pain. The second is that now you’re likely to have tight and weak muscles. The combination of that plus locked joints equals long-term problems .

Q19. Is physical therapy guaranteed to help me like I hope?

A: There are no guarantees (like most things in life), and no decent physical therapist will ever claim such a thing is possible. It simply isn’t. But that’s why we offer a firm, money back guarantee in case you’re not happy with our efforts in doing everything we can to help you, we always offer you your money back in FULL if you feel like we haven’t give it our all.

Q20. Does this sort of thing happen to other people like me?

A: Yes, we see many people with the same sorts of injuries all day long, particularly in the 50+ age group who suffer from aches, pains, and stiffness

Q21. How quickly will I be seen?

A: Often within a day or two. If you need an emergency appointment, please let us know on the phone or in your email so that we can arrange for a physical therapist to work with you within 24 hours or less.

Q22. Do you still use your hands? I just went to another place recently and they told me they didn’t do that type of thing anymore. I left very frustrated and disappointed, as I know the hands-on style treatment really worked for me before when I was in pain.

A: Yes! The care that we provide includes hands-on, when necessary. We believe that the old-fashioned way of deep massages, stretching and mobilizing stiff joints, in combination with improved movement mechanics, and exercise is the fastest way to return you to enjoying better health .

Q23. I’m not in any pain per se, but I’m experiencing lots of stiffness and tightness and am worried that something’s not quite right. Am I right to be considering physical therapy?

A: You are PERFECT for physical therapy (and us). Some people think that physical therapy is about ending pain, but that’s only one thing we do, and it isn’t even the BEST. The aim is to stop you from ever getting to the point where you are in lots of pain by making you more supple, flexible, and stronger, able to withstand the amount of activity you want to do, no matter your age.

Q24. I’m a runner and not in any pain when resting or doing my daily activities, but it always flares up after a few minutes of running. Is that common, and do I need physical therapy?

A: Yes and yes. Most sports injuries settle down so that you can walk around and do simple everyday things without pain. But as soon as you step it up a level or two, if the problem is still there, it lets you know in the way of tightness, pain, swelling, or stiffness.

Q25. What’s the difference between a good physical therapist and a bad one?

A: Five things:

• The amount of care taken (easy to spot)

• The time spent listening to your specific needs

• Accessibility to your physical therapist, even outside of clinic hours

• Ability to accurately diagnose an injury

• The ability to create a clear, concise plan to achieve your goal s

Q26. Can physical therapy help me if I have arthritis?

A: Yes! But please understand that it can’t CURE it. It can very easily help manage the symptoms. Many people come to physical therapy aged 50+ and suffering from wear and tear (arthritis) inside their knee joints, low back joints, etc. After a few short weeks, they are able to do more than they could have imagined.

Q27. I have had clicking, clunking, and cracking noises happening in my joints for a few years now, and it’s beginning to cause pain. I’m 58. Is physical therapy for me?

A: Yes. You’re an almost perfect candidate for PT. This is a typical story. Most joint problems begin with warning signs such as the clicks and cracks you’ve been hearing. A few years later, pain can begin to settle in, so get help before that happens.

Q28. I’m in the early days of joint pain and stiffness. I’ve made it to 50 without any problems, but I’m now worried I’m next in line for joint troubles like the rest of my friends of a similar age. I’m really active and love to play pickleball, hike, walk, and swim. Can physical therapy help someone like me?

A: Yes. It’s a simple case of ensuring you have full movement of your joints and proper strengthening to limit the impact of arthritis. Physical therapy will give you hope and the confidence to get back to the activities you want.

Q29. Will physical therapy help me with my flexibility? I’m stiff as a board the first few hours after I’ve been out on my bike, and I know this is causing my achy lower back .

A: Yes. We’ll walk you through a simple set of exercise routines you can do every day to help eliminate this. Oh, and we’ll fix your achy back too!

Q30. Is there anyone that physical therapy ISN’T right for?

A: Yes. Anyone who is expecting a miracle and hoping to be fixed in one visit. This is rarely possible, particularly for injuries happening to men and women aged 50+.

Q31. Is physical therapy expensive?

A: It all depends on how much you value your health. Some people will shy away from getting specialist help because of the cost. But what is it costing you by not getting help? If your problem has caused you to be grumpy and irritable, what’s it costing in the quality of your relationships with your family and loved ones? What’s it costing you in the quality of your work? What’s a lifetime of pain medications costing you? What’s surgery going to cost?

It never makes sense to me that people will spend money to maintain their car or their house but won’t invest in their own bodies. I hope by reading this you choose to make the best decision for your health.

Q32. Is physical therapy painful?

A: Not really. It is true that physical therapy is a very physical experience, and treatments can be a little uncomfortable at times, but we always aim to be as gentle as possible and cause the least discomfort we possibly can to get your problem solved as quickly as we can .

Before we do any physical therapy techniques, we will tell you exactly what is about to happen and whether or not it is likely to hurt and for how long.

Q33. Will I be in any pain after the treatment (i.e. the next day)?

A: More often than not any pain stops as soon as we do, so you only have to tell us to stop and we will. Pain is a side effect to physical therapy that is often unavoidable, and most patients eventually concede that the pain is a nice sort of pain, one they know is doing them some good and is often no worse than the pain that they are already in.

The discomfort usually reduces as treatment progresses, and we always advise you on things such as ice and heat to help reduce the soreness that might be caused by the treatment. If it’s painful the next day, ice usually soothes it!

Q34. Will I get some tips that I can be doing at home to help myself get better more quickly?

A: Absolutely. The aim is to help you in every way we can. In the clinic, we will do everything for you, but you’re only with us for 30-60 minutes depending on the type of session you choose, so we aim to arm you with tools, tricks, and tips that you can use to make a difference you will feel very quickly and on your own.

Q35. How important are exercises to my recovery?

A: Not as much as you’ve been led to believe. They’re more important to stop the problem from coming back. They do play a role in your recovery, but most people do the wrong ones, at the wrong time, in the wrong order, for the wrong reasons. A good physical therapist will stop that from occurring.

Q36. Why did my doctor tell me NOT to try physical therapy and rest instead?

A: There are two common reasons for this to happen:

1. Physicians (in certain insurances) try to reduce the expenses of the insurance company, so rarely do any of them go out of their way to recommend physical therapy or any other form of treatment.

2. Most general physician practitioners are not trained to know the depth of orthopedic injuries and the symptoms of physical pains well enough to understand when one can benefit from physical therapy. Shocking, but very true.

Q37. How long does the session last?

A: Depends on which option you want to take. We have a 30-minute option as well as a very popular 60-minute session. The reality is that it will take as long as you need to get the help you came looking for.

Q38. Do I need a referral from my physician?

A: Nope. Just call us and book. If you’re willing to invest in your health, you’re very welcome to come see us without a referral.

Q39. Can I bring a friend or loved one in to the treatment room with me ?

A: Yes. No problem! You do not need to inform us of this decision in advance. If you are accompanied by a friend or family member, we will often ask whether you would like them to join you in the physical therapy room during treatment. Alternatively, they can wait in reception if you would prefer.

Q40. How often will I need treatment?

A: That is always dependent upon the nature of your injury and how quickly you want to improve. Our aim is for you to return to full activity as quickly and safely as possible. Your physical therapist will be in a better position to answer this following your first session.

Big tip: getting in early nearly always means less time to recover and less physical therapy sessions needed.

Q41. How long will it take for the physical therapist to relieve my pain?

A: As long as it takes you to call up and book! If you had tooth pain, I bet that you’d call the very first day you noticed the pain, because you know that’s the best possible way to get rid of that tooth pain quickly.

To answer the question, it will take as long as it takes you to make an inquiry and come in to see us. Know this: it will happen much quicker than if you leave it to time or chance by taking painkillers or going to see the doctor!

CHAPTER 12

Knowledge is NOT Power

“Knowledge is only potential power, only one thing gives you power, and that is ACTION!” - Tony Robbins

W e’ve been on quite a journey thus far. We debunked some of the most common health myths. We reviewed the most frequent mistakes made when pain strikes. We covered different parts of the body, including the causes for low back, shoulder, knee, back, and neck pain, not to mention ways to minimize and eliminate these pains. We discussed the basic principles of nutrition and fitness. We reviewed wellness topics ranging from sleeping to pooping. In the last chapter, we talked about what physical therapy is and how it may be able to help you get back to better health.

I appreciate you sticking around and hope you have found this book helpful. At the end of this chapter, I’ll be including a ton of healthy gifts and goodies you can have for FREE! But before I get there, let’s talk about THE most important thing you can do for your long-term health, and that is to take action !

Reading this book and learning new information is great, but it means absolutely nothing if you don’t decide to do anything about it. Too often I talk to people who want to try physical therapy, make better lifestyle choices, and have better exercise habits yet do nothing. They know they should do something, but they continue to let their health get worse and worse. One of my all-time favorite quotes is from the Dalai Lama. He was once asked what surprised him most about humanity:

“Man. Because he sacrifices his health in order to make money. Then he sacrifices his money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future. He lives as if he is never going to die, and then dies never really having lived.”

An incredibly powerful quote. Do you have to do every single thing mentioned in this book? Absolutely not! Start with one thing and decide to do it everyday. It doesn’t have to be physical. Meditating and working on mental wellness is just as important. Starting a new habit is hard, and the best way to maintain a new habit is to have someone hold you accountable. Somebody who will call you out when you try to make excuses. If you don’t have anybody, email me and I will personally hold you accountable. It’s javier@physicaltherapist.pro . Remember, habits take 21-66 days for them to become automatic. I know you can do it!

I’m throwing the gauntlet down and challenging you. Again, start with just one thing from this book. It could be trying physical therapy, walking everyday, eating better, or starting a gratitude journal. I know I’m repeating myself, but only because action is so vital. It will create a compound effect in your life when you begin to make healthier choices .

Imagine, if you continue to do nothing, what your life will look like 6 months from now? How about a year? 5 years?

Now imagine, if you started just ONE healthier habit per month, what your life would look like in 6 months? A year? 5 years? In this scenario, your life could be COMPLETELY different.

This Doesn’t Have To Be The End…

If you’ve enjoyed this book, you should know each week I write to hundreds of people from around the country on how to improve their health and overall well-being. The best part? The health advice is delivered right to your email inbox.

After reading a book like mine or watching a motivational video, it’s easy to be inspired and live healthy for a couple days. Unfortunately, motivation and inspiration are always temporary feelings, and it can cause us to slide back into unhealthy routines.To maintain momentum, you need a continuous stream of positive and helpful health advice.

So the best thing to do next is to visit my website and leave your name and email address, then I’ll know to send you more health tips like the ones you’ve enjoyed reading in this book. You can do that at https://www.renewalrehablargo.com/blog

FREE Healthy Bonus Gifts

If you would like more in-depth information and self help tips on common topics, please go to the website addresses below. When you get there, you’ll see a special tips report I have written for you containing even more information on ways to get the help you need .

• Back Pain And Stiffness: https://www.renewalrehablargo.com/back-pain

• Sciatica/Hip Pain/ Piriformis: https://www.renewalrehablargo.com/sciatica-hip-pain

• Knee Pain: https://www.renewalrehablargo.com/knee-pain /

• Shoulder Pain: https://www.renewalrehablargo.com/shoulder-pain

• Neck Pain Or Headaches: https://www.renewalrehablargo.com/neck-pain /

• Foot/Ankle Pain: https://www.renewalrehablargo.com/foot-and-ankle-pain

• Sports/Running Injury Guide: https://www.renewalrehablargo.com/sports-running-injuries

Talk To A Physical Therapist From The Comfort Of Your Own Home

If you would like to talk to a specialist about any health-related problem you are currently having, I can also offer you a free, 20-minute telephone consultation with a certified physical therapist from my own clinic.

You can schedule that by visiting https://www.renewalrehablargo.com/free-telephone-consultation and filling out a brief form.

Health Disclaimer

I make every effort to ensure that I accurately represent the injury advice and prognosis displayed throughout this book. However, examples of injuries and their prognosis are based on typical representations of those injuries that I commonly see in my physical therapy clinic.

The information given is not intended as representative of every individual’s potential injury. As with any injury, each person’s symptoms can vary widely, and each person’s recovery from injury can also vary depending upon background, genetics, previous medical history, application of exercises, posture, motivation to follow physical therapy advice, and various other physical factors. It is impossible to give a 100% accurate diagnosis and prognosis without a thorough physical examination. Likewise, the advice given for management of an injury cannot be deemed fully accurate in the absence of an examination from one of the licensed physical therapists at Renewal Rehabilitation.

Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this book.

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23 Fritz, Julie M., et al. “Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.” Spine 37.25 (2012): 2114-2121.

END NOTES

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Table of Contents

Cover

Title

Copyright

Contents

About the Authors

Acknowledgements

Foreword

Introduction

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

References

End Notes