This article appeared in the California Chiropractic Journal
In-Office Rehab and Balance Training by Dr. Jeffrey Tucker, DC
The doctors that I get to teach, and those that I meet who include exercise therapy in their practice appear to create better client satisfaction and experience better patient retention. Patients enjoy the participation in their care that exercise therapy provides.
More than thirty-five years ago, when I was a teenager, going to the gym and working out was for kids and parents who already had an active lifestyle. The typical ‘old school’ gym program included a ten minute bike or treadmill warm up, a 40-50 minute strength training regime—usually in a muscle group split, and then on “off-days,” 20-30 minutes of cardio.
Today’s ‘new school’ exercise programs consists of foam roll therapy (self myofascial release) for 10 minutes, stretching of overactive muscles for 5-10 minutes, core stability exercises for 5-10 minutes, balance training for 5 minutes, reactive training and speed, agility and quickness training for 5-10 minutes, intense strength training for 20-25 minutes, metabolic/cardiovascular training for 10-15 minutes and 5 minutes for cooling down.
Many clients that come to us may already be doing any or all of these exercise strategies on their own at home or in the gym. My role as a rehab specialist is to write corrective exercise programs, teach clients how to perform the exercises and guide them into progressions that help eliminate pain.
Additional therapeutic goals may include injury prevention, decreased body fat, increased lean muscle mass, increased strength, increased endurance, increased flexibility, and enhanced performance.
You can have a very successful exercise practice in your office using Therabands, especially the ones with handles, a barbell, dumbbells, kettlebells, a sturdy exercise bench that inclines, a swiss ball, a wobble board, or rocker board, or bosu.
I break up each of the “new school” categories of exercise in my in-office treatment sessions. After the acute care phase, I start by training clients in the use of the 3-foot-by-6-inchwide foam roll. This method of self myofascial release is used to inhibit overactive muscles. Holding pressure on the tender areas of tissue (trigger points) for a sustained period of time, usually 30 seconds per tender point,can diminish trigger point activity. Patients are expected to use the foam roll at home on their own. This is followed by a session where I teach clients how to stretch.
Following use of the foam roll, the application of a lengthening technique (static stretching) resets the muscle lengths and provides for optimal length-tension relationships. Once patients are foam rolling and stretching at home, the subsequent in-office session is used to teach isolated strengthening exercises. This session time is used to teach clients how to isolate and exercise a particular muscle. For example, a common underactive muscle is the gluteus medius. The side lying hip abduction exercise would be taught to increase the force production capabilities through concentric-eccentric muscle actions.
Isolated exercises focus on the muscles of the body that have synergistic function of the stabilization and mobilization system.
Additional sessions are required to train clients in integrated dynamic strengthening exercises. This will ensure an increase in intra- and intermuscular coordination, endurance strength and optimal force-couple relationships that will produce proper arthrokinematics.
An important exercise therapy often overlooked by clinicians, is that prior to resistance training, balance training should be performed, because it has preconditioning effects
on strength training. Our everyday clients face the challenges of keeping balance to perform activities such as playing with their children or grandchildren, walking on uneven surfaces or even taking a walk in their neighborhood.
‘New school’ exercise programs realize balance is a skill-related component of physical fitness. It is important to incorporate balance training in every client’s corrective exercise program as an integrated component to a comprehensive training regimen.
Balance can be influenced by many factors. As we age, our ability to balance or maintain postural control decreases. Watch seniors maneuver steps and stairs. Those who lack the ability to decelerate and control their center of gravity have a significant risk potential of a devastating fall. Prior injuries, especially after ankle sprains, ligamentous injuries to the knee, and low back pain can also decrease an individual’s ability to balance.
A joint dysfunction in the ankle, knee, shoulder, or low back can lead to muscle inhibition. An acute joint injury may cause joint swelling, which results in an interruption in the internal communication process of the body–sensory input from receptors such as articular, ligamentous, and muscular mechanoreceptors to the central nervous system. In turn, this changes our proprioceptive capabilities. When sensory input to the central nervous system is altered, our movement system may become imbalanced.
Repetitive recruitment of the wrong muscle fibers, in the same ROM/Plane of motion and at the same speed, creates tissue overload and eventual injury. Consequentially, this can lead to neuromuscular inefficiency, resulting in decreased balance and postural instability.
Recovery from injury needs to include repairing faulty movement patterns (alterations in stability) and correcting inefficient neuromuscular control. Through balance training,
the central nervous system can be exercised to change and improve a lack of joint stabilization that is causing functional instability.
Don’t forget to address balance as a component of a training program. Balance training may be used not only for reconditioning clients post injury, but also as a preventative measure to increase postural stability and reduce the chances of injury.
Dr. Jeffrey Tucker, D.C., D.A.C.R.B, is
a rehabilitation specialist, author,
lecturer, and healer best known
for his holistic approach in supporting
the body’s inherent healing
mechanisms and for integrating
the art and science of chiropractic,
exercise, nutrition and attitudinal
health. He instructs for the National
Academy of Sports Medicine and
the Chiropractic Rehabilitation Association.
He practices in West Los
Angeles, CA.
I am not in favor of expensive, ineffective and potentially dangerous “treatments” for chronic pain while ignoring causes and prevention of chronic pain. I devote my time spent with clients on examining the causes and most importantly, focusing on how we can prevent acute pain from becoming chronic pain.
I find out what my clients vitamin D levels are. If they are low, they must be elevated to within normal levels. I recommend omega 3 fish oils to all my chronic pain patients. I figure out what exercises clients will do consistently. Diet & supplement recommendations are vitally important. I also recommend my clients eat a low-glycemic diet.
Chronic low back pain or neck pain is a disease we often give to ourselves. Poor posture and a lack of variety of movement are two of the most common causes I see in most cases.
In Most Cases, Chronic Pain is Preventable…
In the absence of trauma or other known disease, most pain that I treat is caused by lifestyle and environmental factors. That means that pain can be improved by eliminating these factors. Some of the risk factors for low back pain are possible to avoid. Maintain good sitting posture, avoid slumping over while sitting, and use proper mechanics while lifting.
In just about every degenerative disease the cause is from the poor choices we make and the habits we develop over a lifetime.
Let’s talk about how you can improve your quality of life.
My patients know I recommend a low-carb diet. Some of the benefits of low carb plans are that it reduces risk of type 2 diabetes better than low fat; LDL is reduced & HDL improves. BUT the low-carb diet is significantly more effective in lowering blood pressure.
I want people to know that they can try a diet instead of medication and get the same weight loss results with fewer costs and potentially fewer side effects.
I am so inspired by what world class, elite level, competitive athletes can do and what they look like. If you think you might like to perform like they do or have the bodies they have, you had better quit your day job.
The Wall Street Journal reported on the workout of Lindsey Vonn: “Red Bull provides Vonn with two trainers who travel with her around the world ensuring she sticks to her regimen. Vonn trains six to eight hours a day, six days a week. Most days she gets in three hours of cardio, usually on a bike.”
And, she follows a very rigid diet and deviates from it very little. That’s a job.
And most other athletes at her level train the same way. Hours per day.
It comes down to what you want, knowing what it takes to get there, and what you’re willing to do to get it.
Let me know when you are ready to talk about improving your diet & exercise program!
What YOU Can Do To Bring Your Blood Pressure Down
I do think regular Chiropractic Adjustments helps – this maintains vital nerve flow to the cardiovascular system; reduces mechanical stress to the nervous system; enhances all nutritional and dietary suggestions by allowing for optimal assimilation.
Lose 5-10 pounds because excess weight can often lead to increased blood pressure.
Give up “empty” calories like sugar, white bread, cake, cookies, pie, hard alcohol.
Try eating more fish, lean meat, vegetables, use butter, and eggs are OK.
Avoid corn and corn syrup (liquid corn oil, fructose corn syrup, etc).
Cut Down on Salt. Try to decrease the salt you add while cooking and not add any salt at the table. Avoid salt-loaded foods, such as chips, crackers, and canned foods high in sodium. Instead of salt, try cooking with other flavorings such as lemon juice, mint, mustard, herbs, curry, etc. Use your imagination!
Get More Exercise. Walk up and down stairs rather than taking the elevator. Walk the few blocks to the store rather than hopping in the car, etc. Try to be physically active every day, and be more intense about it.
Control Your Caffeine Intake – Coffee, tea, colas, and analgesics contain caffeine which can elevate blood pressure. A cup or two of coffee is not harmful, it contains lots of antioxidants.
Increase Consumption of Calcium, Garlic, Magnesium, Potassium-Rich Foods. Studies show that calcium, magnesium, garlic, and potassium may be more helpful in lowering blood pressure than salt restriction.
Increase Omega-3 Fatty Acids. Studies indicate that oils in fish may help lower blood pressure.
High blood pressure is a dangerous disease. If not brought under control, it can lead to strokes and heart attacks.
Here is a list of the supplements I recommend: You can order these from my website @ www.DrJeffreyTucker.com and link to Metagenics. They will mail these to you.
Wellness Essentials for Men/women formula — 2 packets daily
Vasotensin — 2 tablets twice daily with food. Vasotensin provides active peptides from bonito fish to help prevent the formation of angiotensin II, a potent vasoconstrictor, through their interaction with angiotensin converting enzyme (ACE). This activity supports healthy vascular function for optimal blood flow and healthy blood pressure levels.
NanaoCellQ — 1 teasspoon 1-2 times daily with meals. Highly Absorbable Coenzyme Q10 with Natural Vitamin E. Studies show that CoQ10 deficiency is present in 39% of people with hypertension. CoQ10 lowers blood pressure by lowering cholesterol levels and stabilizing the vascular membrane via its antioxidant properties.
Cardiogenics Intensive Care — 1-2 tablets 2 times daily between meals with juice. Nutritional support for healthy circulation and cardiac function. Calcium has been shown in studies to not only lower blood pressure, but also to help to prevent it. Some scientists have stated that calcium counteracts the effects that sodium has on blood pressure. Magnesium is another valuable mineral for controlling hypertension. Numerous studies show that magnesium has a positive effect on hypertension. It works by relaxing and smoothing the muscle of blood vessels and also plays a role in cell membrane permeability to sodium and calcium. Potassium is perhaps the best-known natural remedy for lowering blood pressure. One study published in the Journal of the American Medical Association found that low potassium levels contribute to the development of hypertension.
ActiFolate — 6-12 tablets daily with food. Actifolate is comprehensive folate nutrition in the active forms. Several studies have demonstrated that high-dose folic acid acutely lowers blood pressure and enhances coronary vasodilator function in patients with coronary artery disease.
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