“Dr. Tucker’s Healthy Meal Plan for a Optimal Weight and Lifestyle” continued from Newsletter . . . .
I usually start my deconditioned clients out with a walking program five days a week, building up to 30 minutes per session. Once they start a walking program and are consistent for three weeks, clients are ready to start to learn how to lift free-weights or kettlebells. I enjoy teaching this one-on-one training in the office. We schedule half hour sessions together and I slowly progress clients to learning a complete whole body exercise program builds cardio, tones, strengthens, and creates flexibility.
In your quest to lose those extra pounds and achieve good health, proper nutrition and exercise is simply part of the process. What you eat and when you eat it can make all the difference. I have designed a healthy meal plan to make things easy.
The following is a typical daily meal plan I recommend. I especially like this plan because it helps control hunger, which is one of the most difficult issues facing people who are trying to lose weight.
Six Meals is Successful
This is what has worked! An ideal healthy meal plan involves eating six meals a day so you’re never hungry. These six meals should be broken down into two whole-food “regular” meals, two whole-food snacks and two high-energy, nutrient-dense, low-calorie meal replacement shakes. Daily scheduling of these meals could be as follows:
- Breakfast: meal replacement shake
- Mid-morning snack: whole-food healthy snack
- Lunch: whole-food regular meal
- Afternoon snack: meal replacement shake
- Dinner: whole-food regular meal
- Evening snack: whole-food healthy snack
Your Regular Meals
Your whole-food regular meals should consist of lean protein (meat or vegetarian) plus salad and/or vegetables. You can enjoy whole-food regular meals any time during the day; however, most people find it best to eat them for lunch and dinner. You can prepare them yourself, grab them on the go, or enjoy them in a restaurant, as long as you follow the following general guidelines in terms of content:
Protein: Choose any of the following and prepare it grilled, baked, or poached (not fried):
- 7-9 ounces of cooked, lean meat, such as chicken, turkey, fish (salmon, mackerel, sardines, trout), beef, pork, lamb or shellfish.
- Meatless options include eggs and garden burgers. You don’t have to be a vegetarian to enjoy meatless meals.
Complex Carbohydrates: Select any three servings from the vegetable list below:
- Celery (1/2 cup)
- Cucumber (1/2 cup)
- Lettuce, butter (1 cup)
- Lettuce, iceberg (1 cup)
- Mushroom, white (1/2 cup)
- Mushroom, portabello (1/2 cup)
- Radishes (1/2 cup)
- Romaine lettuce (1 cup)
- Spinach, fresh/raw (1 cup)
- Spring mix (1 cup)
- Alfalfa sprouts (1/2 cup)
- Asparagus (1/2 cup)
- Cabbage (1/2 cup)
- Cauliflower (1/2 cup)
- Spinach, cooked (1/2 cup)
- Broccoli (1/2 cup)
- Cabbage, red (1/2 cup)
- Green or wax beans (1/2 cup)
- Peppers: green, red, yellow (1/2 cup)
- Tomato, red ripe (1/2 cup)
Your healthy snacks could consist of a small portion of lean protein (1-2 ounces) or a small portion of vegetables, such as celery, cucumber, radishes or peppers (green, red, yellow, etc.). You can also choose one serving of lentils, legumes, sweet potato, almonds, cashews, flax seed, walnuts, pecans, pumpkin seeds, sunflower seeds or nut butters made from the above ingredients.
Remember, fruits have more sugar content than vegetables, which may increase your hunger. Always choose whole fruits; avoid sugar-sweetened fruit cups, juices, etc., and do not substitute fruit juice, which doesn’t have the fiber and complete nutrient content of a whole fruit. Enjoy your healthy snack at a mid-morning break or in the evening. Limit yourself to two fruits per day.
This healthy meal planner doesn’t rely on whole grains or similar carbohydrates. Allowed grains are arrowroot, tapioca, brown rice, buckwheat, millet, quinoa, amaranth, and teff. I am still surprised at how many people have not tried these delicious foods yet. I ask my clients to avoid bread, period! Eating too much grain cereal can slow down or prevent weight loss. Stick to eating a majority of lean protein and vegetable-based carbohydrates. Avoid refined grains and sugar.
Convert Fat to Muscle with Nutrient-Rich Shakes
I recommend the UltraMeal high-energy, low-carb meal replacement shakes any time during the day or whenever you get hungry. Most people use them at breakfast, as an afternoon snack, or in the evening. This is a meal replacement shake that contains a quality vegetarian protein source, a vegetarian form of essential fatty acids for healthy oils, and does not contain sugar or synthetic sweetener. UltraMeal tastes delicious when mixed in just cold water, but it can be mixed with unsweetened fruit juice, rice milk, almond milk, or hemp milk.
Tips for Success
- Don’t skip meals: Make sure you eat all six meals each day to keep you body well-nourished and your metabolic rate high.
- Eat every two to three hours: Eating on a regular basis will keep you feeling full and help you lose weight/maintain a healthy weight.
- Eat slowly: Spend at least 15 minutes eating each whole-food meal; eat snacks and drink your meal replacement shake as slowly as possible.
- Drink lots of water: Drink at least eight cups (64 ounces) of water each day.
When you incorporate a healthy meal plan with a daily exercise routine, you’re taking an important step toward long-term health and wellness. Good luck!
“Winning Without Weights” continued from Newsletter . . . .
Getting fit and training without going to the gym is possible when you follow a proper progression and give yourself a variety of exercises. You can benefit your core strength by becoming your own personal trainer and identifying and fixing muscle weaknesses. The core is the area around your trunk and pelvis where your center of gravity is located. A strong core gives you better posture; more muscle control; better ability to perform the activities necessary to daily living; helps you prevent injuries; and improves sport movements. Foam rolls, your own body weight, stability balls, bands, tubing, and medicine balls are tools that you can use at home, on your own, to create a solid foundation for developing dynamic strength in your torso, shoulders, arms and legs.
It is not always necessary to use free weights or weight machines to increase your core strength. The foam roll can relieve tension in tight, overactive muscles. Body weight exercises such as squats, lunges, push ups, and pull ups can target the small and large muscles that influence the spine. Working out with balls and bands can provide you with toned muscles, a lean torso and abdominals, develop muscles in your pelvis, lower back, hips, abdomen, and arms, and create flexibility.
It doesn’t require much equipment to start your home training program! I have worked out at home on a daily basis for the past 15 years or more and have found that a disk used to move furniture becomes the perfect tool to perform sliding lunges. A chin-up bar replaces lats machines that can cost as much as $2,000. A chair or a bench becomes a platform to perform step-ups. An 8-pound medicine ball can be thrown against an outside wall while performing a chest press. A padded surface or a rocker board/balance board can be used to perform single leg stance movements and helps improve joint stability. A stability ball can be used instead of a flat bench and this will providenew stimulus to muscles and variety of movement. A band with handles can be used instead of barbells or dumbbells. Band training also provides an alternative to exercises often performed on machines, like pressing, rowing, and squatting. Maneuvers like the ‘plank’ exercise, are great for the abdominals.
If you work out with another person, you can practice speed and agility drills. Speed is the rate at which an exercise is performed or a movement occurs. Agility is the ability to move your body quickly in many directions and speeds with great control. All forms of tag and chase games improve reaction time.
Whenever you work out, check yourself for muscle weakness and imbalances from the right side to the left side. Asymmetries cause problems. Exercises that balance your muscles help you avoid injuries, especially those involving the back, groin, hamstrings and knees. A combination workout consisting of foam rolling, band and tubing exercises, medicine ball training, and stability ball exercises can improve your spine’s strength and help increase power and performance.
Most people are familiar with Pilates and yoga. These are systems that provide stretching, strength training (especially for the core muscles), balance training, and endurance. Home exercise programs should include these elements as well as cardiovascular training (walking, bike, elliptical), reactive training, and speed/agility training.
It’s important to change your workout program every eight to ten weeks. One of the biggest mistakes I see my patients make is repeat the same workout over and over again. Variety is vital! Often, clients’ workouts are still the same workouts they were doing several elections ago.
What are some good exercises for beginners? The National Academy of Sports Medicine recommends starting a workout using the foam roll for what is known as “self myofascial release.” When using the foam roll, hold pressure on tender points within the muscle for 30 seconds. This allows for optimal muscle lengthening and acts as part of the warm up phase. Next, perform lengthening or stretching exercises. After stretching tight, overactive muscles, perform basic exercises and then progress to advanced strength movements. Pick exercises that target the front, rear and side muscles of the trunk. Here are three bodyweight exercises to get you started:
1) Plank: Start to get in a pushup position, but bend your elbows and rest your weight on your forearms instead of your hands. Your body should form a straight line from your shoulders to your ankles. Pull your abdominals in; imagine you’re trying to move your belly button back to your spine. Hold for 20 seconds, breathing steadily. As you build endurance, you can do one 60-second set. One or two repetitions is one set.
2) Side Bridge: Lie on your side with your forearm on the floor and your elbow under your shoulder. Beginners can start with their knees bent at 90 degrees. For an advanced pose, keep you knees straight so that your body forms a straight line from head to ankles. Pull in your abdominals as far as you can, and hold them stiff throughout the pose; raise your hips off the floor. Hold this position for 10 to 60 seconds, breathing steadily. Relax and lower yourself slowly. If you can do 60 seconds, do one repetition. If not, try for any combination of repetitions that gets you up to 60 seconds. Repeat on your other side. Repeat one to two times on each side.
3) Traditional Abdominal Crunch: Lay on your back with your knees bent and your hands behind your ears. Slowly crunch up, bringing your shoulder blades off the ground. Perform one to three sets of 12 to 15 repetitions each.
The exercises above are safe and effective exercises to get the obliques and quadratus lumborum (a key lumbar stabilizing muscle) working.
Everyone always wants to learn more “butt” or gluteal exercises. The Gluteus maximus and gluteus medius are important muscles of the body and often need extra work. The following are good exercises to target the gluteals:
Gluteal Bridge on the Ball: Lay on the ball with your head and upper back resting on the ball. Place your feet on the floor with your knees bent. Squeeze your gluteals and then push your hips up until there is a straight line through knee and hip to upper body. Shoulders remain on the ball. Beware of rising too high or of flaring your ribs, which pushes the back into hyperextension. Hold the up position for two breaths. Let your butt come down and repeat. Perform two to three sets of 10-12 repetitions.
Supine Ball Bridge: Lay on your back with your heels on the top of the stability ball, hip-width apart to aid stability. Suck in the abdominals and squeeze up from your gluteals, lifting your hips until there is a straight line from heels to upper back. Your shoulders and head stay firmly on the floor. Take care not to lift your hips too high or flare your ribs so that your back hyperextends. Hold for 30 seconds and lower. Perform two to three sets.
Lateral Thera-Band Walking: With elastic tubing around both ankles, stand with your toes straight ahead, knees over feet and hands on hips. Draw in your abdomen and step to the right while maintaining an upright posture. Don’t rock your upper body when stepping. Step again with the right foot, bringing your feet back to shoulder-width distance. Repeat for six steps to the right and then six steps to the left. Perform sets of six steps to each side until you feel a slight burn in the gluteal muscle. This exercise strengthens glutes, core, abductors and adductors.
Training the important posture muscles of the thoracic (upper) and lumbar (lower) portions of the spine can be done on the ball:
Back Extension on the Ball: Position yourself with your chest against the ball and hook your feet under a leg anchor or put them up against the bottom of a wall. Hold your arms straight out in front of you. Your body should form a straight line from your hands to your hips. Raise your upper body until it’s slightly more than parallel to the floor. At this point, you should have a slight arch in your back, and your shoulder blades should be pulled together. Pause for a second, then repeat. Perform one set of 12 of 15 repetitions. You can perform this exercise with your arms in a 10 o’clock and 2 o’clock position, and 3 o’clock and 9’clock pose.
If you want to build big arms, especially the triceps, stability ball push-ups will take you to the next level. Do a push up with your feet on a stability ball. Keep your body straight; don’t let your hips sag or stick your butt up in the air. Do as many push ups as you can with strict form. You can challenge your core by switching positions so that your feet are on the floor and your hands are on the ball. The instability of the ball increases the levels of trunk muscle activation.
If you want more intensity, performing pull moves and push moves with the bands is ideal. The band lunge-press improves strength, endurance, balance, coordination. There’s not much this exercise doesn’t hit. With a band securely in place behind you, grip the handles and hold them at shoulder level, palms facing each other, and elbows bent. Feet should be shoulder-width apart. As you step forward into lunge position, press the handles forward, and finish the press with outstretched arms. Return to the starting position. Form is key: make sure your front knee is aligned over the heel in the lunge position and concentrate on keeping your upper body erect, chin up, eyes staring forward throughout, as if you were trying to balance a book on your head. Do 10-15 lunges with each leg.
Swimmer’s Lat Pull is a back exercise that you’ll feel throughout your entire body. Use an anchored resistance band station. With feet shoulder-width apart and knees slightly bent, lean over at the hip – don’t roll your back – until your upper body is almost parallel with the floor. Extend your arms in front of you and grab the band handles. Dynamically draw your arms down and extend them in back of you, until they’re at hip level. Think of the motion of a swimmer doing a butterfly stroke – the arm breaking the surface of the water and then continuing down and back. Slowly reverse the motion.
Up-chop Kneel develops excellent core stability and trunk rotation strength. Kneel with a band or tubing handle attached to an anchor below hip height. Grasp the handle in both hands to the side of the hip nearest the band. Lift your arms up and at the same time rotate the shoulders away from the anchor, keeping your hips facing forward and arms straight. Complete two to three sets of eight to ten repetitions on both sides. Aim to increase the resistance for eight repetitions.
Down-chop Kneel is the opposite of the up-chop. Begin with the handle attached to an anchor above head height, grasping the handle in both hands above your head to the side of the band. Keeping your hips facing front and your arms straight, pull the hands down and turn your shoulders away from the band. Complete two to three sets of eight to ten repetitions on both sides. Aim to increase the resistance for eight repetitions.
Medicine Ball Slams are a great abdominal exercise. This exercise involves integration of your whole body. It will also teach you power development from the ground up and get your heart racing. Take a medicine ball and get in your athletic ready position. Bring the ball overhead really fast and slam it down as hard as you can. Make sure you do a few slow first to get a feel for the bounce of the ball since you have to catch it.
||1 or 2
||1 for 60 seconds
|Traditional Ab Crunch
||12 to 15
|Glute Bridge on Ball
||10 to 12
|Supine Ball Bridge
||10 to 12
|Lateral Band Walk
||6 per side
|Back Extensions on Ball
||12 to 15
|Stability Ball Push Up
||10 to 15
|Band Lunge Press
||10 to 15 per leg
|Swimmer Lat Pull
||10 to 15
|Up Chop Kneel
|Down Chop Kneel
|Medicine Ball Press
||10 to 12
||10 to 12
One Patient’s FirstLine Therapy Results!
by Jeffrey Tucker, D.C., D.A.C.R.B.
FirstLine Therapy is a food and nutrition program that is easy for clients to integrate and, best of all, my patients are really feeling and enjoying positive results. I have been using FirstLine Therapy in my practice for the past three years, especially for weight loss and increasing energy. The program helps patients with serious health problems such as Type 2 Diabetes, high blood pressure, obesity, and fatigue. Diet, medical foods, vitamins, minerals and exercise offer a natural alternative way of improving other than drug therapy. Most importantly, the program teaches people how to be healthy for the rest of their lives.
Recently, a 50-year-old female called my office in desperation. “Please help me. The doctor is going to put me on medication because I have borderline Type 2 Diabetes and I am overweight. I don’t want to take drugs. Can you do anything to help me? My doctor said I have to go on Lipitor and Metformin…I’ll do whatever is necessary to get better.”
Obviously, she had arrived at dire circumstances. Diabetes is a serious illness. Blood sugar problems cause inflammation and affect the vascular system. “Diabetes confers an equivalent risk to aging 15 years” – a quote from the medical journal The Lancet in 2006. People with diabetes are two to four times more likely to have a stroke than those without the disease. Poorly controlled blood sugar may lead to glaucoma and blindness. Gum disease and high blood sugar are related. Diabetes, particularly in conjunction with high cholesterol or high blood pressure, may lead to heart disease. Kidney damage may result from diabetes, especially in combination with high blood pressure. Diabetes has been linked to male sexual dysfunction (impotence). Nerves in the feet may also become damaged.
Prior to this “wake up call”, this woman thought she was doing pretty well regarding her over-all health. What originally brought her to my office was neck and shoulder aches and pain. She had frequent episodes of insomnia and painful menstrual periods. She knew she could stand to lose 20 pounds. She also complained of frequent fatigue. She prided herself on thinking that she was eating a healthy diet and that she didn’t get “sick” very often!
Not surprisingly, this woman’s medical doctor was not trained in integrative medicine….
“One Patient’s First Line Therapy Results!” continued from Newsletter…
Traditional medical treatment often looks to drugs as the only solution. I believe you have choices and it is intelligent healthcare to provide the best of traditional western medicine plus integrative alternative healthcare. The solution I recommend is FirstLine Therapy. Together, this patient and I discussed the FirstLine Therapy program details and she decided that she was willing and able to begin the program.
She began following the treatment plan that combines the Mediterranean diet, nutritional supplements, and healthier living practices along with incorporating a series of simple exercises that I taught her.
The following list briefly summarizes the action plan she followed:
- Avoid high glycemic index foods such as pasta, candy, soft drinks, and desserts.
- Limit dairy products, avoid gluten, and other foods that cause inflammation.
- Eat fresh (and canned) organic vegetables of any type including beans, peas and legumes.
- Eat fresh fruit – berries, apples, pears, bananas, mangos, and pineapple.
- Eat small amounts of chicken (remove skin) and generous portions of oily, free-swimming small ocean fish. (These foods are considered non-inflammatory.)
- Drink lots of water or green tea without sugar or sweetener. The bulk of beverage intake should be between meals to avoid diluting desirable stomach acid.
Natural Supplements: Begin taking UltraGlycemX Plus 360 medical food as a shake two times per day, Insinase, and Omega 3 fish oil. These supplements will help to improve blood sugar levels, reduce inflammation and improve energy.
(My favorite Omega-3 product is EPA-DHA 720. All of the products mentioned above are Metagenics products and are available through our website. To order online and receive a 10% discount, please click here.)
Physical Activity: Maintain normal daily activities and include 20 minutes of walking or a gentle Gymstick routine along with 10 minutes of gentle body weight exercises using the core muscles and joints five days per week.
Mental Emotional Spiritual: Practice breathing relaxation time, twice daily. Each 5-minute “relaxation imagery” session assists in becoming more aware of bodily sensations and the sensory experience of voluntarily relaxing mind and body.
Special Procedures: Use moist heat packs on the neck-shoulder areas for symptomatic relief.
Within two weeks the patient’s energy was improving, she lost 4 pounds of fat and gained lean muscle mass. All of her neck-shoulder pain stopped.
At Week 4, she reported doing well with the Low Glycemic Load Diet (Mediterranean Diet). She was eating smaller, more frequent meals and exercising 1 hour 5 days/week. Fasting blood glucose was still around 120 to 128 mg/dL, with 105 to 110 mg/dL at night. (A normal fasting blood glucose level is less than 110 mg/dl.) She felt better with more energy, but exercise had increased her neck-shoulder symptoms.
At Week 8, the patient was doing extremely well on the Low Glycemic Load Diet with a total weight loss of 12 lb. After 9 weeks, her fasting blood glucose was ranging 107 to 120 mg/dL. She reported a lot more energy and no menstrual cramps since starting the program.
At the 14-Week visit, the patient had lost a total of 17 lb and reported sustained energy and absence of insomnia. The patient was advised to continue on UltraGlycemX and the food program and to add a multivitamin/mineral supplement.
Please feel free to call me with any questions or concerns you may have about starting our FirstLine Therapy program. Please call: 310-473-2911.
Deep Muscle Stimulation!
A New Treatment Offered
Recently, I had the honor of becoming an appointed instructor for the National Academy of Sports Medicine (NASM). Since 1987, the National Academy of Sports Medicine (NASM) has been a leader in certification, continuing education, solutions and tools for health, fitness, sports performance and sports medicine professionals. Over the years of my participating with this organization, I have studied the most current treatments and techniques in sports medicine and for performance enhancement.
I am very excited to “give back” by being one of the NASM instructors and in the next few months, I will have the opportunity to travel to visit the Phoenix Suns and be a part of a small team of doctors instructing the Suns on soft-tissue techniques. Stay tuned for further news!
With my NASM association, I have been exposed to cutting-edge treatments and products utilized by the NFL, NBA, NHL… teams and their players – and one of the treatment modalities that I have had much success with is the Deep Muscle Stimulator (DMS). I am happy to announce that we now offer this treatment to our patients.
DMS – A NEW TREATMENT OFFERED IN OUR OFFICE
For those of you who have already tried the Deep Muscle Stimulator (DMS) treatment, I would like to share this information and explain some of the benefits. For those who have not tried it yet, I encourage you to come in and try this treatment to help ease pain.
WHAT DOES THE DMS DO?
“Deep Muscle Stimulation!” continued from Newsletter…
Much of muscle pain stems from various conditions: strains, sprains, lactic acid build up, swelling, scar tissue and adhesions. The DMS uses percussion and vibrations over the skin, penetrating deep into the muscle tissue to stimulate blood flow and oxygen.
Most of you know what it’s like when I perform deep tissue therapy on you. The DMS provides deep muscle tissue with percussion and concussion vibration, which is relaxing and more comfortable than other procedures. This facilitates the patient or athlete with the benefits of:
- Increased circulation
- Reduced pain
- Faster rehabilitation from injury
- Increased lymphatic flow
- Break up of muscular scar tissue
- Reduced lactic acid build up
- Tissue regeneration
- Soft & active tissue release
The DMS can be used in effective management of acute and chronic pain. I have used the device for clients with headaches, sciatica, TMJ, carpal tunnel syndrome, tendonitis, bursitis, swelling and myofacial pain and frozen joints. Most of all, the DMS helps to loosen contracted, shortened muscles and can stimulate weak, flaccid muscles. This muscle “balancing” can help posture and promote more efficient movement. Some clients prefer this technique over regular massage. I have a wonderful massage therapist that comes to my home every two weeks or so. She has been using it on me instead of her regular technique, I feel less tightness and more flexibility during my workouts, and I love the results!
Listen, Love and Understand….
A Touching Story!
This is an old story that I was told as a young man. It is just as true today as it was back in the 1970’s. I guess its time to share it once more with everyone here.
A farmer had some puppies he needed to sell. He painted a sign advertising the 4 pups and set about nailing it to a post on the edge of his yard. As he was driving the last nail into the post, he felt a tug on his overalls. He looked down into the eyes of a little boy.
‘Mister,’ he said, ‘I want to buy one of your puppies.’ ‘Well,’ said the farmer, as he rubbed the sweat off the back of his neck, ‘these puppies come from fine parents and cost a good deal of money.’
The boy dropped his head for a moment. Then reaching deep into his pocket, he pulled out a handful of change and held it up to the farmer.
‘I’ve got thirty-nine cents. Is that enough to take a look?’
‘Sure,’ said the farmer. And with that he let out a whistle. ‘Here, Dolly!’ he called.
Out from the doghouse and down the ramp ran Dolly followed by four little balls of fur. The little boy pressed his face against the chain link fence. His eyes danced with delight.
“Listen, Love and Understand” continued from Newsletter…
As the dogs made their way to the fence, the little boy noticed something else stirring inside the doghouse. Slowly another little ball appeared this one noticeably smaller. Down the ramp it slid. Then in a somewhat awkward manner, the little pup began hobbling toward the others, doing its best to catch up.
‘I want that one,’ the little boy said, pointing to the runt. The farmer knelt down at the boy’s side and said, ‘Son, you don’t want that puppy. He will never be able to run and play with you like these other dogs would.’
With that the little boy stepped back from the fence, reached down, and began rolling up one leg of his trousers. In doing so he revealed a steel brace running down both sides of his leg attaching itself to a specially made shoe.
Looking back up at the farmer, he said, ‘You see sir, I don’t run too well myself, and he will need someone who understands.’
With tears in his eyes, the farmer reached down and picked up the little pup. Holding it carefully handed it to the little boy.
‘How much?’ asked the little boy.
‘No charge,’ answered the farmer, ‘There’s no charge for love.’
The world is full of people who need someone who understands.
When you come into my office, I recognize your potential and I hope you feel understood.
Remember to listen, love and understand your family, friends and co-workers.
Look for miracles and opportunities every day!
All My Love,
The REAL Cause of Disease
by Jeffrey Tucker, D.C., D.A.C.R.B.
I turned 50 years old this past January. I have been in continuous private practice for 25 years now. That means I have spent more than half of my life in Chiropractic and health care.
I have seen great changes in clients’ lives, yet I am also seeing clients coming in to my office in worse shape than even 10 years ago. WHY? People sit too much, drive too long, eat too much. People have less quiet time, aren’t getting enough sleep and have low energy.
Maybe you are someone with a pain in the neck and shoulders, with no history of trauma. Yet your posture tends to look like your head is carried forward, your shoulders appear rounded, the rib cage appears crowed, you might even have a mild scoliosis, your pelvis may feel “off”, you have short or tight hamstring muscles. You come in hurting!
Such a person may not be breathing fully and deeply, they may be an upper chest breather only, not taking air into the deeper, lower parts of the lungs and moving the belly up and down; this can lead to an altered carbon dioxide-oxygen ratio and even change a person’s pH to alkalization of the blood. The result of such a change in blood chemistry would include heightened pain perception, anxiety, over use of accessory breathing muscles causing you tight upper trapezius and scalenes muscles (top of the shoulders and front-sides of the neck muscles). These tight muscles around the neck and shoulders could cause a lack of blood flow to your head and hence not enough oxygen getting to the brain. This causes a feeling of “brain fog” or fatigue.
Apprehension and anxiety is an almost automatic result of increased alkalinity, leading to reinforcement of an upper-chest pattern of breathing. In some clients, a slumped posture might be from the anxiety at work from a stressed out boss, or the depression of work or a situation at home. Stress is all of the above.
Stress negatively impacts the immune function, negatively impacts your state of mind, negatively impacts your body composition, and negatively impacts recovery. Stress is the real cause of disease.
“The Real Cause of Disease” continued from Newsletter…
What have I learned in 25 years of practice:
- Everything works!
- Nothing works forever.
- Time magnifies all errors made.
- A healthy program is not a bunch of exercises or techniques put together.
- Positive and negative changes will happen in your body and mind if you are weak and deconditioned, are in good shape, or even if you push the limits of your body in the quest for super health, fitness or performance.
What will help you recover from some of your lost health? Realizing what you are doing over and over again that is harming you is the first step. Examine what each thing in your workout/job/relationship/diet does to you that may be harming you. Attempt to remove habits that produce and maintain dysfunction in your body and mind.
Another solution is to create good time management, improve your nutrition, your sleep, and get enough variety of movement in your life. If you enjoy yoga stretching, understand that activity improves flexibility. A yoga practice alone will not build strength like free weights will. Running, biking, or swimming by themselves is good for the heart (cardio), but causes the body to become tight and stiff and creates a need for extra stretching time.
My treatment goals are to help you:
- prevent injury
- decrease body fat
- increase lean muscle mass
- increase strength
- increase endurance
- increase flexibility
- increase performance.
Here are some of my suggestions:
- Use a foam roll to mobilize joints and stretch tight myofascial tissues.
- Perform corrective stretches concentrating on tight muscles only. The best way to stretch is to maintain an anatomical neutral spine. (I like to spend about 20 minutes using the foam roll and stretching together.)
- Perform core exercise training movements. These include bodyweight exercises. I particularly like squats and lunges.
- Perform strength and resistance training. I prefer free weights because where in real life do you sit down and push weights other than on a machine in a gym! When you train with weights I think you should train hard.
- Perform your cardio routine following your weight training. I have been advocating Interval Training for the past 2 years and all of a sudden it’s very popular.
- Schedule enough time to regenerate. Ninety-nine percent of my clients do not get enough sleep. More healing takes place during sleep than any other time. (Eight hours of sleep is the suggested minimum.)
- Evaluate and create your nutritional intake. Just start eating 5-6 smaller meals a day rather than 3 big ones – just start that for now.
You have seen how I keep changing the way I practice and adding new information to assist us in getting healthy and staying healthy. Ask me about any of the above and how I can help you reach your health goals.
Healing Techniques and Therapies Available
A Variety of Joint Mobilization and Soft Tissue Techniques and more!
Below you will find techniques utilized in my treatments:
- Joint Mobilization and Manipulation
- Promotes improved joint mobility and range of motion using a variety of treatment philosophies including: McKenzie, Mulligan, Muscle Energy, and Janda.
- Soft Tissue Mobilization
- Mobilization of the skin, muscle, nerve, and fascial layers to break down scar tissue and adhesions. This is also known as transverse friction technique.
- Myofascial Release
- Deep tissue palpation using a small surface area to promote fascial stretch and muscle relaxation.
- If a muscle is in spasm it can lead to imbalances such as leg length discrepancies or rotation/obliquities in the pelvis, hips or shoulders. I am now using Deep Muscle Stimulator as part of my practice.
- Trigger Point Release
- Deep palpation to promote muscle relaxation in an area of hyper-irritability and contracture. This is also known as “ischemic compression” or trigger point therapy.
“Healing Techniques and Therapies Available” continued from Newsletter…
- Dynamic muscular release
- Deep palpation to the origin (attachment site) of a muscle as the patient contracts to engage in the muscles intended action.
- Promotes improved muscle function.
- Can eliminate musculoskeletal imbalance.
- AKA “Flossing” or “Gliding.”
- Helps decrease inflammation in nerves.
- Breaks up adhesions around nerves that result from inflammation
- Can eliminate the sensation of “pins and needles”, “weakness” or “numbness and tingling”.
- Therapeutic exercise and activities
- Exercises with the intent to improve injury prevention, muscle recruitment, strength, flexibility, and endurance.
- Promotes proper technique in performing functional activities (example: lifting).
- Gait training and mechanics
- Analysis of walking to optimize form and make sure that your gait is not a repetitive trauma.
- Neuromuscular training
- Enhances the function of the body by balancing the muscle activation patterns about a joint.
- Free weight training for weight loss and osteoporosis prevention
- Specific exercise prescription based on your individual body type.
- Balance training
- Decreases fall risk.
- Improves coordination for increased performance.
- Core trunk stabilization training
- Improves the recruitment of specific muscle groups that stabilize the hip, pelvis and lumbar spine.
Some specialty treatments include:
- Temporomandibular treatments
- Scar/tissue, capsular adhesion mobilization
- Diet, nutrition, vitamin recommendations
- High-powered warm laser
Certified to Perform the Functional Movement Screen!
Do you ever wonder which corrective exercises you should be doing to improve your posture, performance or to prevent injury? By performing the Functional Movement Screen, I can quickly ascertain potential risk when an individual’s movement patterns are limited or altered. These patterns often go undetected in conventional testing. I look at movement patterns to identify those who may be at risk for an injury as activity levels are increased. Others need the Functional Movement Screen to figure out which corrective exercises will help them get out of chronic pain.
A focal point in my program is that significant limitations or right and left imbalances exist in some individuals at very basic levels of movement. These limitations and imbalances should not be overlooked. The body should be free of restrictions and free of imbalances prior to exercise training, conditioning, competition and fitness activities. They rob the body of efficiency and are very often hidden by those individuals who learn to compensate and substitute with other movement patterns.
“Certified to Perform the Functional Movement Screent!” continued from Newsletter…
How close are you to a perfect score? 3 is the best you can do for each of 7 tests. 7 x 3 = 21. What is your score? Schedule an appointment and tell the front desk you want the Functional Movement Screen.
The benefits of performing the Functional Movement Screen and teaching you core training exercises:
- Improves functional and athletic performance.
- Helps to reduce the potential for training and sports injuries.
- Provides a simple grading system to assess your movements.
- Easily utilized exercises.
- Identifies physical imbalances or weaknesses.
- Rehabilitates imbalances and strengthens weaknesses with corrective exercises.
- Provides individual training exercises.
- Prevention of injuries.
- Identifies potential cause and effect relationship of micro-trauma as well as chronic injuries in relation to movement asymmetries.
The Interactive Healer February 2008
The FirstLine Therapy Difference
A Therapeutic Lifestyle Program that Works!
As we discussed in the January 2008 newsletter, feeling good in body, mind and heart is definitely connected to the choices we make daily. In this issue, we will continue the FirstLine Therapy (FLT) discussion along with touching on matters of the heart.
Different Than Other Lifestyle Programs!
Our FLT program is a comprehensive treatment program. We will start by measuring your body composition
(see BIA Testing PDF) and thoroughly analyze and design a friendly personalized health program which will address diet and exercise, along with stress-reduction and attitudinal healing techniques. While other lifestyle programs are narrowly focused, our program addresses the full you!
Not Just Another Diet! FirstLine Therapy’s eating plan is specifically tailored and closely monitored for ease and optimal results. Most food plans are restrictive – no carbs, no fats and no variety. Most plans severely limit the amount of food you eat and the types of foods you eat – their success is primarily based on “willpower”.
FLT is different! Our plan emphasizes the need to eat and to eat often. The focus is on eating the types of foods that are best for you – the right quantities and qualities of carbohydrates, proteins and fats. The diet also incorporates a low-glycemic-index food plan allowing for optimal blood sugar and energy levels.
Studies show that low-glycemic diets are more effective than low-fat diets in treating obesity, insulin resistance, high cholesterol, cardiovascular disease, and type-2 diabetes. Additionally, FLT has been demonstrated to be effective in controlled clinical trials, while most other diets have not.
Increase Lean Muscle and Reduce Body Fat
Whether weight loss is your goal or not, the FLT plan will help you lose unwanted and unhealthy fat while maintaining and building lean muscle. Just because you’re thin, doesn’t mean you’re healthy – the research now clearly demonstrates that a major factor in determining health is the fat to lean muscle ratio, not your weight….
The FirstLine Therapy Difference continued from Email Newsletter…
A healthy body weight is where you feel healthy and fit, have no eating disorders to maintain that weight, and have a healthy functioning immune, hormonal and reproductive system. It is also a weight that you can realistically reach and maintain with healthy lifestyle efforts. One of the most important components of good health is your muscle-to-fat ratio. Over the last 25 years, body composition analysis has become a primary factor in the assessment of health status and the risk potential of developing certain diseases. The research suggests that there are direct correlations between high body fat measurements and the onset of chronic conditions such as heart disease and diabetes.
To effectively manage body weight and body composition, it is important to know your daily caloric requirements. A bioelectrical impedance analysis (BIA) test can tell us body composition and basal metabolic rate. Accurate assessments using BIA, allows me to determine each client’s unique personal caloric requirements and better plan and evaluate weight management, exercise programs and comprehensive FirstLine Therapy programs.
The optimal body fat range for women is between 12%-25% and ranges between 5%-20% for men. Through eating and exercising properly, you can effectively bring your muscle-to-fat ratio into a healthy range. Our FLT program addresses the muscle-to-fat ratio issue and so much more!
FLT focuses on lifestyle factors that are the underlying cause of most health problems. Since your FLT program will be designed specifically for you, you will begin to feel better and see results within the first week or two. Most people report less hunger and more energy, making it easier to stick to the program. Working together, we can realistically design a program that fits your needs and lifestyle.
Questions? Please feel free to call me with any questions or concerns you may have about starting our FirstLine Therapy program.
Start the New Year off right!
Schedule your body composition test today!
To schedule your appointment, please call 310-473-2911
Have You Been Doing the Best Cardio Fitness?
One of the first changes to a cardio program I do is to have my clients eliminate conventional aerobics. For example, if a client is spending 60 minutes on a treadmill, elliptical, or swimming, I recommend that they spend that hour of time performing: 10 minutes on the foam roll; 10 minutes isolated stretching; 35-40 minutes doing a combination of body weight exercises, work out with the Gymstick, and/or lift free weights; and 15-20 minutes on cardio training using interval training techniques.
Body weight exercise can mean squats, lunges, push-ups, pull ups, etc. When I train my clients to lift free weights, I want them to lift heavy weights – not light weights. When I teach free weight training, I recommend creating circuits of 5 exercises, performing 6 repetitions of each exercise and then performing the circuit 3 times. The 6th rep of each set should be difficult to complete if you are using the correct amount of weight.
In three separate half hour in-office sessions (one per week for three weeks), I can teach my clients approximately 15 different Gymstick, body weight and/or free weight exercises. At the end of the three sessions, they have learned and practiced enough with me to perform a 15 minute, 30 minute, or a 45 minute whole body, customized workout routine.
The Gymstick is a fitness tool that combines a stick and exercise bands into one effective workout. You can do hundreds of different exercises and combination movements to improve strength and flexibility. Every Tuesday and Friday mornings, I teach a small group exercise class. My experience has shown that Band or Gymstick exercises can be performed for one minute intervals, then change to the next exercise for the next minute and continue this routine for 20-45 minutes. This provides a great cardio, strength and flexibility workout!
Have You Been Doing the Best Cardio Fitness continued from Email Newsletter…
Is there a better way to exercise than running to promote cardio and fat loss? Yes, the answer is Interval Training. What is interval training? Interval training is broadly defined as alternating brief periods of very high-speed or high-intensity work followed by periods of rest or very low activity. In interval training, high heart rates during work periods and low heart rates during recovery follow each other. This not only results in increased cardiovascular strengthening, but increases the energy expended per minute, increasing calorie output, and thus resulting in an increase of fat loss. Simply put, the concept of interval training is: go fast then go slow.
Unfit clients can’t run to get fit – you need to be fit to run. When people decide to start an exercise program they usually think of walking as a major form of exercise. Walking is an ideal place to start. How do you apply interval training to walking? If you’re in good shape, you might incorporate short bursts of jogging into your regular brisk walks. If you’re less fit, you might alternate leisurely walking with periods of faster walking. For example, if you’re walking outdoors, you could walk faster between certain mailboxes, light poles, trees, or other landmarks.
Have you ever noticed when people continue to do the same walk day-in and day-out and do not add periods of short bursts to increase metabolic activity to improve their fitness level, that they simple stay at the same weight, Body Mass Index (BMI), and body composition? If clients are just beginning an exercise routine I also suggest that they include bicycling in their routine. Since bicycling allows for maximum metabolic disturbance with minimal muscular disruption, one can easily increase their metabolic rate and increase the efficiency of their exercise activity. To apply interval training to cycling, you could pedal ‘all out’ for 60 seconds and then ride at a slower pace while you catch your breath for the next 2-4 minutes.
In my home gym where I work out, I have an Elliptical machine and I do my interval training on it. For example, I warm up at a speed of 5.5 for 5 minutes, then perform short fast (speed of 8-10) bursts for 30-60 seconds. I slow down for a minute and then repeat the fast burst again. This is performed for 15 minutes.
We will continue our exercise and interval training discussion in upcoming newsletters – so please stay tuned!
Daily Nutrition for the Heart!
MUSCLE PAINS & CHOLESTEROL LOWERING DRUGS
I have a lot of patients on cholesterol lowering drugs (e.g. statins) and I have to tell you, I’m really alarmed about this. These drugs deplete the essential nutrient CoQ10. Higher statin potencies and dosages shrink target LDL cholesterol, but the prevalence and severity of CoQ10 deficiency is increasing LDL too. Drug companies keep lowering the target cholesterol levels and this creates more candidates for statin drug therapy.
Statin induced CoQ10 depletion is well documented in animal and human studies with detrimental cardiac consequences in both animal models and human trials. This drug-induced nutrient deficiency is dose related and more notable in settings of pre-existing CoQ10 deficiency such as in the elderly and in heart failure patients.
Published data indicates that statins can cause myopathies (muscle aches and pains) and muscle breakdown with renal failure….
Muscle Pains & Cholesterol Lowering Drugs continued from Email Newsletter…
Moreover, on May 1, 2000, the FDA issued a warning about liver failure as an adverse reaction of statin use, based on reports that more than half of 62 patients with liver failure died. An estimate claims that the drugs can cause liver and muscle injury in up to 1% of users. For the US this will equal up to 130,000 patients with liver and muscle toxicity symptoms. Moreover, statin use is also implicated in the increased incidence of cataracts, neoplasia, peripheral neuropathies, and some psychiatric disturbances.
Statin-induced CoQ10 deficiency is completely preventable with supplemental CoQ10 with no adverse impact on the cholesterol lowering or anti-inflammatory properties of the statin drugs.
If you are on statins you must consider adding:
Metagenics’ CoQ-10 ST-100™ — 1-2 softgels daily. CoQ-10 ST features 30 mg of a stabilized, all natural encapsulation of coenzyme Q10 (CoQ10) manufactured to achieve exquisite quality, purity, and bioavailability.
Research demonstrates that CoQ10 supplementation supports numerous aspects of health:
- Promotes healthy cardiac and skeletal muscle bioenergetics and heart function
- Supports cellular integrity and endothelial health by protecting against oxidative stress
- Plays a key role in every cell of the body, assisting oxygenation, circulation, heart muscle strength, and much more
- Replenishes healthy CoQ10 levels in patients who may be deficient, such as those taking popular cholesterol-lowering agents and individuals over 50
- Supports healthy blood pressure levels already within the normal range
CoQ10 is commonly recommended for patients who:
- Take a popular cholesterol-lowering agent
- Could benefit from heart muscle function support
- May benefit from natural blood pressure support
- Could benefit from overall cardiovascular support
For over 10 years, I have recommended Metagenics products. More than ever I feel dedicated to your health and to keeping you informed of important healthy tips. In harmony with this dedication, I am committed to providing high quality formulations through the combination of the best of modern nutritional science and triple GMP (Good Manufacturing Practices)-certified manufacturing. You can purchase these products through our website at: Metagenics – Order Online.
Thank you for choosing me as your Doctor!
Langsjoen PH, Langsjoen AM The clinical use of HMG CoA reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. Biofactors 2003;18:101-111
Bliznakov E. Lipid lowering drugs (statins), cholesterol, and coenzyme Q10: the Baycol case – a modern pandora’s box. Biomed Pharmacother, 2002;56:56-9.
The Interactive Healer January 2008
A Therapeutic Lifestyle Changes Program
Feeling good in body, mind and heart is definitely connected to the choices we make daily. Throughout the year, I will be sharing with you the latest information and techniques on how to feel great now!
Headline News! In 2007, I completed a rigorous and thorough course in the latest clinical nutrition and therapeutic science program titled FirstLine Therapy (FLT). I am now a certified FirstLine Therapy Doctor, and I look forward to further sharing this ground-breaking knowledge with you and incorporating this powerful therapeutic lifestyle program into your treatment plan.
In upcoming newsletters, we will discuss the components of the FirstLine Therapy program and cover specific conditions of interest such as: heart health, obesity, weight-loss, blood sugar and diabetes, stress-related disorders, and fatigue…just to name a few.
So what is FirstLine Therapy?
FirstLine Therapy is a “therapeutic lifestyle program” developed by Metagenics. A ‘therapeutic lifestyle” means making choices every day that will enhance your health, help prevent the onset of disease, and assist you in living a full and healthy life.
A Healthy Lifestyle
Adopting healthy eating and lifestyle habits will lead to feeling better now and also into our older years. A recent poll shows that a majority of patients would like their doctors to help them with lifestyle changes. Our practice is dedicated to providing both the treatment and the education to assist you in living a healthy, happy and energetic life!
Our FirstLine Therapy program will put you on the path to feeling great through a combination of balanced eating, regular exercise, stress reduction, and appropriate nutritional supplementation…
The FirstLine Therapy Program!
FirstLine Therapy involves a comprehensive in-office evaluation. The program includes initial body composition testing along with follow-up testing, and a thorough consultation where, together, we will design your individual program of diet, exercise and nutritional supplementation.
Start the New Year off right!
Schedule your body composition test today!
To schedule your appointment, please call 310-473-2911
Body composition testing is a simple in-office procedure utilizing a bioimpedance analyzer. Bioimpedance analysis (BIA) is a reliable method for measuring your body composition to determine the percentage of body fat, lean muscle, and cellular fluids. Electrodes, similar to EKG electrodes, are placed on the right foot and the right hand while you are lying down on the treatment table. The procedure only takes a few minutes and the computer prints out your results.
The test is best performed when you follow the guidelines below:
- No food 4 hours before testing
- No exercise 12 hours before exercise
- No alcohol 24 hours before testing
- Do not drink caffeine the day of your test
- Drink 1 quart of water 1 hour before testing
Through careful analysis, I will suggest an appropriate diet and supplementation plan along with a suitable exercise program. It’s fast, fun and a great step in monitoring real-time health values!
Suggested program schedule:
|BIA Testing, initial consultation to review test results, determine your health goals and establish your course of lifestyle therapy. You will receive a FLT guidebook, instructions, and advice regarding diet, nutritional supplements, and exercise. Your Program begins!
|Weekly visits monitoring and fine-tuning your program!
|BIA retesting and adjustments to your program.
|Weekly visits monitoring and fine-tuning your program!
|BIA retesting, progress evaluated, and long-term guidelines discussed.
Please feel free to call me with any questions or concerns you may have about starting our FirstLine Therapy program.
Start the New Year off right!
Schedule your body composition test today!
To schedule your appointment, please call 310-473-2911
Read what other FirstLine Therapy patients are saying!
Click on one of the links below to find out more about FirstLine Therapy successes.
Patient Testimonials for FLT
- Toni’s Tale — This 30-year-old woman reduced her body fat by 9.6% in just 12 weeks, and was able stop taking her blood pressure medications, relieve anxiety and insomnia, and address the beginnings of insulin resistance. Read more.
- Paul’s Progress — In just 12 weeks, this 57-year-old man was able to better manage his diabetes, high cholesterol, and high blood pressure. In the process he greatly relieved lower back pain and rekindled his love life. Read more.
- Violet’s Victory — This 55-year-old woman reduced her body fat by 7.8% in 3 months, and was able to discontinue prescription medications and over-the-counter pain relievers for her rheumatoid arthritis and start living again. Read more.
- Clancy’s Conquest — It only took 12 weeks for this 39-year-old male to change his habits and to increase his enjoyment of life on the FirstLine Therapy program. Read more.
- Kay’s Comeback — This 65-year-old career woman was able to lose fat and address her elevated cholesterol, elevated blood pressure, and insulin resistance. In only 12 weeks, she also rediscovered the beautiful woman inside waiting to be set free. Read more.
- Patrick’s Prevention — In just 3 months, this 44-year-old man gained control of his eating habits and reduced his blood pressure and the risk of insulin resistance. Read more.
PLEASE NOTE: These cases describe the results of patients under the care of a licensed healthcare practitioner and may not be a typical response. The FirstLine Therapy program includes a low-glycemic-index dietary plan, exercise, stress reduction techniques, and nutritional supplements and/or medical foods.
by Jeffrey H. Tucker, DC, DACRB
My background is in Chiropractic, helping people get out of acute and chronic pain. I have spent twenty five years in private practice teaching clients how to decrease pain and improve their health. It has been a great job, and it is something I see myself going for the rest of my life and career.
About fifteen years ago I started taking a post graduate program at my Chiropractic College to pursue my first passion, which was musculoskeletal rehabilitation. I continued to work as a Chiropractor, but I started including more exercise therapy and nutritional therapy into my practice. In essence, I strive to become a Wellness Consultant rather than just dealing with people in pain.
Many of my clients are not ready for the gym yet and need a program that could transition them to the gym. Many of them get injured while working out and training. Sometimes clients have to take a step backward to move forward and sometimes their voyage is not so much about discovery as rediscovery of lost flexibility, strength or speed. I developed a progression of core exercises that I was teaching to my patients to help them get out of pain, create muscle balance, symmetry and strength. Eventually, I started teaching an exercise class at Dance Studio No.1 in west Los Angeles. Many clients needed a class to progress to stronger levels. I started teaching with the intention of preventing future back problems and prepare them to get into better shape and fitness. The people that came for help in improving their fitness levels for everyday life really liked the way that I presented things. So, I have continued with this program over the past four years.
There are two distinct yet interdependent muscle systems in the body, the stabilization system (stabilizers = local muscle) and the movement system (mobilizers = global muscle). Both the local and global muscle systems must integrate together for efficient normal function. Neither system in isolation can control the functional stability of body motion segments (vertebrae and bones). The stabilizers assist postural holding, anti-gravity, and joint stability (support) function. These are prone to inhibition and weakness. The mobilizers assist rapid accelerated movements like we use when training with Kettlebells. The mobilizers are large and superficial muscles (the ones we see on our body). They provide range of movement, and produce high force or power. The mobilizers are prone to over activity and tightness. Once a movement segment has lost functional stability and has developed abnormal compensatory motion, stabilizing structures (both connective tissue and contractile) around these joints become less stiff and more flexible, more lax and have more “give” thus making these segments at risk of abnormal stress and strain.
There are specific indications for low load training of the muscle system. Clients will present with mild discomfort to intense pain during normal daily functions; unguarded movements cause sharp pain; they have very specific pain and/or stiffness in muscles and joints; symptoms associated with static positions and postures (sitting, standing and lying). Some clients come knowing they have unstable backs; some have a history of bad backs. The name of my exercise program is Progressive Body Movement (PBM). PBM is actually a priority system of building strength and flexibility. It’s a very rational method for getting people out of pain, and keeping them out of pain by creating spinal stability and strength.
Many of my clients need to learn what exercises they can do without hurting themselves. As soon as they would start yoga, or Pilates or weight training exercises, they would get a flare up in there low back, shoulder or neck. They had become afraid to exercise because they always hurt themselves afterwards. These clients needed to exercise just so they could get ready to exercise. I learned how to progress people from low load body weight exercises to bands and free weights and Kettlebells.
My tag line is, “We were all given a lifespan, let’s create a healthspan.”
My clients enjoyed the way that I was teaching because it was very much back to old school stuff, low tech floor work, bands, balls, and bodyweight maneuvers. I don’t use any fancy gadgets or machines. I progress them to free weight and Kettlebells. They really liked that, and I made it fun for them.
The key to helping clients and what you can do on your own is practice form before function, and uni-planar motions before multi-planar motions. I have learned to see simple compensations when evaluating client’s movement patterns. I use isolation for innervation of the system and to improve function. But, isolation is great for testing & rehab, not training.
We need to physically train the stability muscles. Strengthening exercises alone will not likely affect the timing and manner of recruitment of muscles during functional activities. With proper stability it makes using heavy weights such as Kettlebells safer and enhances performance.
Recently, a band exercise device called the Gymstick has come in to my rehab and wellness practice. I was in San Francisco at a workshop on the hip, being taught by a British instructor. I asked him if he had any new equipment that he was using in his rehab facility. He said that they were doing a lot of creative exercises with a device called the “Gymstick” and that it was great for core training.
So, when I got home I did my research and ordered the Gymsticks on-line. When they came I started using it for five to ten minutes as part of my own workouts. The Gymstick came with a visual poster of exercises, and I ordered a DVD. I liked it so much I ordered more for my clients and to use in my classes. My clients and students really like it. So, I thought, “I want to become a distributor of this and create an opportunity for groups of people to have Gymstick classes.”
I have been to many workshops and conferences over the years. I have heard some of the best trainers and coaches in the U.S. and none of the presenters I met ever mentioned the Gymstick. It is popular in Europe and just not known here in the United States yet.
To have a great foundation for weight lifting I recommend band work as well. I recommend slow, low effort repetitions and only move through the range that the weak link can be actively controlled. Perform 20-30 slow repetitions or approximately 1- 2 minutes of a given exercise. Initially, when these low load exercises ‘feel’ difficult or high-perceived effort is used then it is likely that that muscles slow motor unit is inefficient and you need to do these maneuvers. If an exercise with body weight, Gymstick, or other bands looks easy and feels easy, then it means there is better facilitation of slow motor unit recruitment. It is best to do local muscle dominant recruitment (Gymstick) on different days than strength training days. This makes it a good tool for rest days.
I have personally taken it on to get the word out there and really promote Gymstick, and the way of training with them. In fact, I don’t feel like I have to sell Gymstick. They sell themselves. As soon as you get someone to come to a class, they are hooked. It’s amazing. The results are quick and fast for stretching, strengthening, and functional training!
One of my clients, she came into my program a size 12 and she’s an 8 now. She feels very happy wearing clothing she hasn’t fit into in a long time. She enjoys feeling healthier and more flexible.
Gymsticks are going to be a great tool for me to make a niche in the market and offer new classes among those training in Los Angeles. It has always been my passion and goal to educate people about diet, nutrition, body work, and training. Los Angeles is very much a Pilates and Yoga town. We have lots of hard core gyms as well. I applaud all of these, but I think the Gymstick offers a good balance for motor control training and increasing a muscle recruitment challenge, as well as improving flexibility, thus increasing the potential to generate force and power.
I am into minimal equipment and basics. I like floor work, Kettlebells, dumb bells and bands for overload training, power and endurance.
Why am I hoping to go to get people more into Gymstick and kettelbells or even body strength training, opposed to using machines? I have never been a proponent of weight machines. I encourage people to get off the machines and get into functional fitness where you are standing and you need to ground yourself and you need to use your core strength and stability. It’s NOT about sitting in a machine and pressing as hard as you can, because that’s not going to do anything except if you are sitting down and pressing against somebody. That’s not real life. Real life is: you’ve got to chase a child around a park or mall; you need to lift and carry heavy objects; and you have sit to long in awful chairs. Gymstick provides low load training and exercises that can optimize slow motor unit recruitment; efficiently teach you to really internalize your power and bring it out when you need to.
Gymstick will help you activate the deeper, more local muscles of the body that help you achieve increasing the segmental stiffness of the spine and decreasing excessive inter-segmental motion and maintaining muscle control during low load tasks and activities. In contrast, using the Kettlebells will help you achieve high physiological load. Both the local muscles and the outer muscles contribute to both stability and mobility roles. The combination of Kettlebells and Gymstick repetitions will help give you endurance and stamina. There is no longer a need to rely on machines, every training session can be done at home.
I think the combination of Gymstick and Kettlebells is so functional. Clients are creating their own drills that are sport specific.
“Gymsticks are here and you don’t know what they are right now, but I am an instructor and I will show you!” (See info for class schedule)
Dr. Jeffrey Tucker: “I have studied with some of the best teachers in the musculoskeletal and nutrition world. I continue to take post graduate courses and seminars and get some more certifications.” You can visit Dr. Tucker at www.DrJeffreyTucker.com where you can purchase the Gymstick he mentions.
My classes have progressed to a more general fitness population that wants to have a more challenging work out. They know that I push them quite hard, but with what I call “my watchful eye” making sure that they maintain good form. They know that I want them to succeed at their goals. Whether their goal is to get out of pain from a sports injury, loss weight, or to become fit, I am going to give them my undivided attention in getting them their safely and uninjured, but I don’t expect anything less than one hundred percent of their effort.
by Jeffrey H. Tucker, DC, DACRB
Can pain and dysfunction develop from a low-velocity collision without attendant injury? “Low-speed” impact refers to 1-2 miles per hour and goes up to 20-25 mph. “Moderate speeds” are 25-40 mph and “high speeds” are 40 mph and over.
Jackson16 and States13 estimate that 85 percent of all neck injuries seen clinically result from automobile crashes, and of those due to such collisions, 85 percent result from rear-end impacts. Morris reported that rear-end impacts of as little as five mph can give rise to significant symptoms.17 The dynamic and vehicle factors that contribute to rear-end collision injury are:
- vehicles involved
- speed differential
- vehicle weight
- location of impact
- direction of impact
- head restraint location
- seat failure
- seat back angle
- seat back height
Wiesel states that approximately 10 percent of the occupants of the stricken vehicle in rear-end automobile collisions will develop whiplash syndrome.10 Approximately 10-15 percent of patients suffering from cervical soft tissue injuries following motor vehicle accidents fail to achieve a functional recovery.
Emori and Horiguchi state: “Whiplash, in some cases, persists for years but usually no obvious symptoms show up with radiological or other quantitative diagnostic techniques.”9 Our present technology does not permit precise identification of deranged soft tissues.
Research quoted by White and Panjabe11 states that an eight mph rear-end collision may result in a two g force acceleration of the impacted vehicle and a five g force acceleration acting on the occupant’s head within 250 msec of impact. (One g equals an acceleration of approximately 32 ft./sec.) Car crashes happen in literally one/two eye blinks. The point is that the head and neck experience more g forces than the car in low-speed impacts.
Kenna and Murtaghsay state: “It is wrong to assume that maximum neck injury occurs in a high-speed collision; it is the slow or moderate collision that causes maximum hyperextension of the cervical spine. High-speed collisions often break the back of the seat, thus minimizing the force of hyperextension.”21
A major dilemma exists for the auto manufacturer, insurance companies, and the consumer of autos. Each would like the vehicle to provide the maximum protection for the occupant with the minimum material damage to the vehicles during a collision. Stiffer cars with spring-like rear bumpers that increase the rebound have less damage costs, however the occupant experiences an increased neck snap and the potential for greater injury. When a car gets struck from the rear by another auto, the very first thing that happens is the struck car is accelerated. The occupant of the struck care experiences higher speeds as it attempts to “catch up” with the car. Navin and Romilly state: “This relative movement of the head to the shoulder during the rebound is the likely cause of neck injuries as this is the point at which dynamic loading of the neck will be maximum.”8 They conclude: “Of major concern to researchers is the lack of structural damage present below impact speeds of 15 kmh. This indicates that the bumper system is the predominant system of energy absorption between the impact and the occupant. It was also observed that deflection of the seatback tends to pitch the occupant forward, with the shoulder displacement leading the head. This relative head to shoulder motion is the likely source of whiplash injury.”
Research has shown that high impact forces are transmitted directly to the occupant in low-speed impacts and that the vehicle does not begin to crush until impact speed exceeds 15 or 20 mph.1,13 Severy1 demonstrated a 10 mph impact produced total collapse of only 2 1/2 inches in the rear structures of the impacted vehicles. Therefore, minor property damage does not necessarily equate to minor injury. The most important question is not, “What is the damage to the vehicle?” but, “What was the acceleration to the vehicle that you were in?” Injury will occur because of the acceleration differences between the different inertial parts of the occupant’s body, especially from the person’s head, versus trunk inertial acceleration differences.
Navin and Romilly have demonstrated that, “Rear vehicle impacts between 5-12 mph indicate that some vehicles can withstand a reasonably high speed impact without significant structural damage. The resulting occupant motions are marked by a lag interval, followed by a potentially dangerous acceleration up to speeds greater than that of the vehicle.”8
Severy1 demonstrated conclusively that seemingly harmless low-speed rear-end collisions were capable of producing damaging forces to the head and neck. Severy and associates recorded head accelerations as great as 11.4 g. Most research evidence suggests that the major injuries are due to the hyperextension phase of the cervicothoracic spine.
Factors that Influence the Extent of Injury
Headrests are the best protection in rear-end collisions. However if the headrest is set too low, the head is able to roll over the top of the headrest, producing even more hyperextension.2
Emori’s experiments were to simulate relaxed necks of unexpected passengers in struck vehicles. Without a headrest, the neck extension can become almost 60 degrees, which is a potential danger limit of whiplash at collision speeds as low as two mph.9
The exact position of the head at the moment of impact is important to know. If the head is turned, the injury will be greater on the side it is turned to. When head rotation is present, the pattern of tissue injury is potentially more severe.19
A surprise collision will usually cause more injury because the ligaments will be injured more than the muscles. When a person knows they are going to be struck, they will tense up the muscles and therefore injure the muscles first. MacNab states: “In impacts up to 15 mph the right front seat passenger stands in greater danger of injury than does the driver, because the driver can brace himself to some extent by holding onto the steering wheel.”14
Common predisposing factors include degenerative joint disease and spinal stenosis. The potential for injury is increased because the neck is less resilient.
The seatback stiffness requires investigation. The harder/stiffer the seatback the less forward acceleration and therefore the less injury. The less stiffer the seatback the more forward acceleration and therefore the risk of increased injury.
Jackson states: “The belt has very little if any deterring effect on the cervical spine as the head and neck continue forward motion. Even the addition of a shoulder harness will not relieve but will only increase the forces which must be absorbed by the head and neck, although such a harness may prevent contact injuries.”12 Seat belts save lives by preventing occupants from going through the windshield, but they contribute to the neck injury.
The Office of the Chief Scientist (London), Department of Health and Social Security, had this comment regarding seat belts in 1985: “We predicted an increase in the case of two injuries: sprains of the neck and fractures of the sternum. Both were confirmed. The other apparent increase in a major injury which was not predicted was abdominal injuries of organs other than the kidney and bladder.”
Clemens and Burrow20 report that any shoulder restraint mechanism in front-end collision increases the degree of cervical flexion, with potential for injury.
The car fender or bumper is designed to avoid or reduce damage in a low-speed collision. It is not a safety device to prevent or reduce injuries to people in the car. The government requires bumpers on passenger cars to prevent damage to the car body and parts, such as headlights, tail lights, grille, hood and trunk latches, at barrier impact speeds of up to 2 1/2 mph. This is equivalent to a five mph crash into a parked vehicle.
Myofascial structures can be stretched; asymmetric increase in muscle tension can develop, causing altered joint movement; the facets can become affected, and posture altered.
MacNab did whiplash type research with monkeys and was able to describe these injuries:3 slight muscle tears of the sternocleidomastoid ruptures; ruptures of the longus colli; retropharyngeal hematoma; esophageal hemorrhage; cervical sympathetic plexus lesion; tearing of the anterior longitudinal ligament.
Dunn and Blazer7 concluded: “The most injurious head deflection in an acceleration injury is hyperextension. Even though sustained in low-velocity, rear-end collisions, this acceleration injury can produce forces significant enough to produce musculoligamentous tears with resultant hemorrhage and even disk disruption and avulsion fractures of the vertebral bodies. In addition, the integrity of the apophyseal joints may be violated.” They also conclude that in head-on collisions (flexion injuries): “In low- velocity flexion accidents, because the chin strikes the chest when the full range of physiologic flexion has been reached, minimal damage occurs.”
If present, degenerative changes should be noted as they may affect the prognosis. A claim of aggravation of a known pre-existing injury may occur after a low-speed impact.
Hohl4 and Hohl and Hopp5 found that complaints of interscapular pain, upper extremity pain, and numbness carried a poor prognosis, as did findings of a sharp cervical curve reversal, or restricted motion at one level on flexion/extension radiographs. Greenfield and Ilfeld15 also noted that shoulder pain and arm and hand pain indicated slower progress toward recovery, and that if upper back pain and interscapular pain present, a longer and more intensive treatment program was needed.
Norris6 found that the presence of objective neurological signs, significant neck stiffness and muscle spasm, and/or pre-existing degenerative changes adversely affected the outcome.
Hohl did a seven year follow-up after injury of patients without previous x-ray evidence of disc disease and found that 39 percent had developed degenerative disc disease at one or more disc levels since injury.4
We enjoy the thrill of driving bumper cars travelling at approximately 1-2 mph without a head restraint and without adequate seat belts at amusement parks. We like the feel of speedy roller coasters that whip our head and neck, and push our body to provide a sense of increased g forces. And if we should experience soreness or discomfort after these rides we have the ability to continue to go on and have fun the rest of the day. We relax and tell ourselves that it will go away. And so it could be with many of our patients involved in low-speed, low-impact collisions. The doctor must reinforce to the patient that it will go away. If the pain doesn’t go away we must be able to discuss the mechanisms of injury and substantiate the presence of injury/illness.
Insurance companies and the general population have a skeptical attitude about these types of cases. Television commercials are polluting the juries viewpoint and the public is frustrated with the cost of insurance premiums. Ask people what they think of rear-end collisions, jury awards, and attorneys. They will respond with a different value than 10-15 years ago.
We need to make sure that patients are being sincere in their complaints. Credibility on the patient’s side is very important. The issues of the low-dollar damage amount and low speed will come up. The doctor has a credibility image to maintain as well. Adjustors will look at the doctor’s records and the treatment plan; insurance companies want to see a treatment plan. The important issues are the type of treatment, the cost of treatment and the length of time. The diagnosis is not indicative of the extent of the injury. Reports to the adjustor should supply the diagnosis and prognosis. At this point it does not appear that the insurance industry cares that chiropractic can substitute for more expensive care.
The key to documentation is showing that the patient is receiving benefit from the treatment (getting pain relief and improving functional capacity). Documentation must justify the treatment for the injury. It must show that treatment was actually rendered, and substantiate the injury by detailing the subjective and objective findings on the examination; justify treatment by showing decreases in pain and suffering; increasing recovery time; decreasing the likelihood of complications; increasing the function of the person during the recovery.
- Severy DM, Mathewson JH, Bechtol CO. Controlled automobile rear- end collisions, an investigation of related engineering and medical phenomena. Can Serv Med J, 1995;11:727.
- Ewing C, Thomas DJ. Human head and neck response to impact acceleration. Navel Aerospace Medical Research Laboratory Monograph, #21, Aug. 1971.
- MacNab I. Acceleration injuries of the cervical spine. J Bone Joint Surg, 1964;46A:1797-1799.
- Hohl M. Soft tissue injuries of the neck in automobile accidents. J Bone Joint Surg, 1974;56A:1675-1682.
- Hohl M. Hoop E. Soft tissue injuries of the neck: II. Factors influencing prognosis, abstracted. Orthop Trans, 1978;2:29.
- Norris S. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone Joint Surg, 1983;65:9.
- Dunn EJ, Blazer S. Soft tissue injuries of the lower cervical spine. Instructional course lectures, Am Academy of Ortho Surgeons, 1987;36:499-512.
- Navin FP, Romilly DP. An investigation into vehicle and occupancy response subjected to low-speed rear impacts. Proceedings of the Multidisciplinary Road Safety Conference VI, June 5-7, 1989, Fredericton, New Brunswick.
- Emori RI, Horiguchi J. Whiplash in low-speed vehicle collisions. Vehicle Crash-Worthiness and Occupant Protection in Frontal Collisions. Society of Automotive Engineers, Feb. 1990.
- Wiesel SW, Fetter HL, Rothman RH. Neck Pain. Charlottesville, VA. The Michie Co., 1986, pp 10-26.
- White AA, Panjabi MM. Clinical Biomechanics of the Spine, New York, JB Lippencott, 1978, pp 153-158.
- Jackson R. The Cervical Syndrome. Springfield, IL. Charles Thomas Co., 1977.
- States JD, Korn MW, Masengill JB. The enigma of whiplash injuries. Proceedings of the 13th Annual Conference of the Amer. Assoc. for Auto. Med., 1969.
- Rothman RH, Simeone, FA. The Spine, 2nd edition. W.B. Saunders Co., p. 648.
- Greenfield J, Ilfeld FW. Acute cervical strain: evaluation and short-term prognostic factors, Clin Orthop 122:196, 1977.
- Jackson R. Crashes Cause Most Neck Pain. Amer. Med. News, Dec. 5, 1966.
- Morris F. Do head restraints protect the neck from whiplash injuries? Archives of Emergency Medicine, 1989, 6:17-21.
- Rutherford W, Greenfield T, Hayes HR, Nelson JK. The medical effects of seat belt legislation in the UK. Dept. of Health and Social Security, Office of the Chief Scientist, Research Report #13, 1985.
- MacNab I. The “Whiplash Syndrome.” Orthop Clin North Am 1971;2:389-403.
- Clemens HJ, Burrow K. Experimental investigations on injury mechanisms of the cervical spine at frontal and rear-end vehicle impacts (from the German). Acta Ortho Unfall-Chir, 1972;75:116-45.
- Kenna C, Murtagh J. Whiplash, Australian Family Physician, June, 1987; 16:6.
by Jeffrey H. Tucker, DC, DACRB
The psoas has segmental attachments posteriorly to all lumbar transverse processes, anteriorly at all lumbar vertebral bodies and to all lumbar discs except L5-S1 disc.1,2 Fibers that attach on the transverse processes are named the posterior fasciculi fibers. They range from approximately 3-5 cm in length. The fascicles that attach to the discs and bodies are called anterior. They are approximately 3-8 cm in length. The fascicles run inferolaterally to reach a central tendon, where they descend over the pelvic brim as it passes deep into the inguinal ligament and anterior to the capsule of the hip joint, sharing a common insertion with iliacus to the lesser trochanter of the femur.3 The tendon is separated from the pubis and the hip joint by a subtendinous iliac bursa. Along the pelvic brim, the lateral fibers of the iliacus and the fibers of the psoas come together. This is referred to as the conjoint tendon of the psoas major and the iliacus. Because the psoas muscle attaches to the anterior portion of the transverse processes of all lumbar vertebra and intervertebral discs, it can contribute to mechanical lumbo-pelvic-hip dysfunction and pain.
Proximally, fibers of the diaphragm and psoas are inter-related. The diaphragm’s medial arcuate ligament is a tendinous arch in the fascia of the psoas major. Distally, the psoas fascia is continuous with the pelvic floor fascia, especially the pubococcygeus.2
Based on his anatomic studies, Bogduk does not believe the attachment of the psoas muscle has a long enough level to act as a prime flexor of the lumbar spine. Bogduk’s analysis indicates that in the standing erect posture the psoas exerts an extensor moment on the upper lumbar spine and a flexor moment on the lower segments. The major forces acting on the lumbar spine are compression and anterior shear forces. The psoas has a primary stability role at the lumbar spine for axial compression and it has minimal movement function on the lumbar spine.4
|Local Stability Function
||Local Stability Dysfunction
|Muscle stiffness to control segmental translation.
No or minimal length change in function movements.
Anticipatory recruitment prior to functional loading provides protective stiffness.
Activity is continuous and independent of the direction of movement.
|Uncontrolled segmental translation.
Segmental change within cross-sectional area.
Altered pattern of low threshold recruitment.
Motor recruitment timing deficit.
In 1998, Dangaria and Naesh demonstrated that there is a significant decrease in the cross-sectional area of the psoas at a segmental level in patients with sciatica. The study determined there is an association between wasting of psoas and multifidus muscles observed on MRI scans in patients presenting with unilateral low back pain.
They took 50 consecutive patients presenting to a back pain triage clinic with unilateral low back pain lasting more than 12 weeks. They found the cross-section area of the psoas major was ipsilaterally decreased in unilateral lumbar-disc herniation. The reduction in the cross-section area (CSA) is positively correlated with the duration of continuous sciatica, rating of pain, self-reported function and the presence of neural compression.7
The results and data analysis compared the CSA between the symptomatic and asymptomatic sides. There was a statistically significant difference in the CSA between the sides. There was a positive correlation between the percentage decrease in CSA of the psoas on the affected side and with the rating of pain, reported nerve root compression and the duration of symptoms. Hodges also had reported on an association between decrease in the CSA of multifidus and the duration of symptoms.
Atrophy of multifidus has been used as one of the rationales for spine-stabilization exercises. They concluded the evidence of coexisting atrophy of the psoas and multifidus suggests that a future area for study should be selective exercise training of the psoas.
Exercises: Clients who do not suffer from an isolated psoas or iliacus muscle with a local stability dysfunction (meaning the muscle is allowing joint instability) can perform the following bodyweight exercises:
- Perform sit-ups with the hips and knees flexed. The iliopsoas participates as strongly during sit-ups with the hips and knees flexed as when they are extended.
- Perform push-ups. The psoas is activated more than the abdominals during push-ups.
- Seated hip flexion. Maximum activity of the psoas occurs with resisted hip flexion. This maneuver can be performed with the use of resistance bands (seated or supine).
Also, make sure the client maintains a neutral lumbar spine. However, if compression and shear are the sources of your client’s pain, avoidance of these three exercises is necessary. Selective exercise training, described as low-load exercises would be indicated.
Yoshio, et al., concluded that the primary role of the psoas major was for lumbar stability and that the psoas major contributed very little to hip flexion. He explained that the primary role for the psoas major is at the hip for stability. This was achieved through maintaining the femoral head in the acetabulum.8 The psoas can be said to be clinically deficient if it fails to segmentally hold the vertebrae in place at the level of pain in patients who have segmental lumbar dysfunction (hypermobile segments).
Low-load exercise facilitation of psoas is directed to the spinal neutral postures and segmental axial compression and spinal rotatory control, not hip flexion movements. Specific segmental psoas facilitation will improve lumbar segmental control.5
Action of psoas: The local stability role of psoas is to longitudinally pull the head of the femur into the acetabulum, with the spine fixed and supported in neutral alignment to produce axial compression along its line of pull.
Training of psoas: This can be practiced side-lying, incline sitting, supine, prone or standing; for example, while supine with the lumbar lordosis passively supported in neutral by the patient’s hands, a folded towel and the legs comfortably apart. If side-lying (with the dysfunctional side up), both legs are flexed with the spine and pelvis in neutral alignment in terms of tilt and rotation. The top leg is supported horizontal, with the spine, pelvis and upper trunk all neutral. Have the client shorten the leg or “pull the hip into the socket” or “suck the hip into the socket.” This will create a barely perceptible movement and yet will be felt by the client. This can be performed for 10-second holds and 10 repetitions.
Testing of the iliacus and hip capsule: Have the client stand against a wall, with heels (feet) apart, and shoulders and head touching the wall. Normal is the ability to posterior tilt to touch the small of the back against the wall. If the client cannot posterior tilt by flattening their back onto the wall with the feet apart and the hips and knees straight, but can do so with knees bent and the hip flexed, the restriction could be shortened iliacus or the anterior hip capsule. By bending the knees and unlocking the hips, this unloads the tension from the iliacus and the anterior hip capsule and allows the pelvis to posterior tilt.
Iliacus/hip capsule correction: The abdominal and gluteal muscles are contracted to posterior tilt the pelvis and flatten the back onto the wall. While maintaining the posterior tilt and flat-back position, the knees are slowly straightened (hips extended) to slide the body up the wall.
At the point that the back cannot be held on the wall, cease sliding up and actively restabilize onto the wall. Hold this position for 20 to 30 seconds, and repeat the maneuver three to five times. To isolate the right or left side of a weak iliacus muscle, ask the client to raise one leg at a time while maintaining a flat back against the wall. If an asymmetry exists, spend time on the weaker side.
Clinical application to this information is that the “overhead bilateral arm pull” test, as used in the Sacro-Occipital Technique (SOT) to test for a short or tight psoas, does not often correlate to the modified Thomas test.
Hip flexor muscle-length tests are performed by using the modified Thomas test.
Test: Patient is supine, with buttocks at the end of the table. The patient flexes one knee and holds the knee to the chest with both arms. The free leg hangs down to the floor. The position of the lumbar spine is flat on the table, not arching into extension or flexion.
Observe: If the patient has tight hip flexors, the thigh/hip will rest in some flexion or the lumbar spine will extend to allow the leg to rest on the bed. The modified Thomas test assesses the hip flexors, rectus femoris, quads and ITB muscle lengths. Patient is in the same position as the Thomas test, but should start by standing at the end of the bed and roll back onto it with one knee held to the chest while the other leg dangles off the end of the bed. Check that the lumbar spine is not extended.
Observe the degree of the hip flexion. If above neutral, either hip flexors or rectus femoris are tight. To differentiate, ask the patient to extend their knee. If it falls into more hip extension, the rectus femoris is tight. Also observe for increased tautness in the rectus femoris.
Check relative position of abduction/adduction at the hip and observe lateral structures. The thigh should lie in the neutral position, as if the client was standing. An abducted position indicates that ITB could be tight. On visual analysis, the ITB may present a groove in the lateral thigh. This would support overactive/tight ITB findings.
Check the knee flexion. Ask the patient to flex their knee further. A normal muscle length in quads will allow 90 degrees or more of knee flexion in this position. Watch for compensatory hip flexion. Tibial position also can indicate tightness in the ITB, especially in the distal components. It will be in external rotation if tight. Check the position of the tibial tubercle.
Another take-home value from this article: The supine straight-leg raise used for nerve tension signs also is affected by iliopsoas activity.
Test: Patient performs an active straight-leg raise test (utilizing hip-flexor muscles). Positive for neural tension is radicular pain into the leg before 60 degrees of hip flexion.
Retest: At the point of symptoms, the therapist supports the weight of the patient’s lower extremity while instructing the patient to totally relax their musculature. If the symptoms are alleviated or eliminated, this finding suggests the problem is the effect of shear or compression on the spine from the contraction of the hip flexors and not a true entrapment of the nerve (tethered nerve).
- Bogduk N, Pearcy M, Hadfield G. Anatomy and biomechanics of psoas major. Clinical Biomechanics, 1992;7:109-19.
- Gibbons SGT. A review of the anatomy, physiology and function of psoas major: A new model of stability. Proceedings of: The Tragic Hip: Trouble in the Lower Quadrant. 11th Annual National Orthopedic Symposium. Halifax, Canada. Nov 6-7, 1999.
- Gibbons SGT. The model of psoas major stability function. Proceedings of 1st International Conference on Movement Dysfunction. Edinburgh, Scotland. Sept 21-23, 2001.
- Bogduk N, Pearcy MJ, Hadfield G. Anatomy and biomechanics of psoas major. Clin Biomech, 1992;7:109-19.
- Review course notes: Comerford and Mottram, 2001.
- Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine, Nov. 15, 2004;29(22):E515-9.
- Dangaria TR, Naesh O. Changes in cross-sectional area of psoas major muscle in unilateral sciatica caused by disc herniation. Spine, 1998;23(8):928-31.
- Yoshio M, Murakami G, Sato T, et al. The function of the psoas major muscle: passive kinetics and morphological studies using donated cadavers. J Orthop Sci, 2002;7:199-207.
- Christensen K. Neuromobilization Course, May 2007.
by Jeffrey H. Tucker, DC, DACRB
The tensor fascia latae (TFL) acts through the iliotibial tract by pulling it superiorly and anteriorly. It assists in flexing, medial rotation and abduction of the hip and extension of the knee joint. The TFL arises from the anterior part of the outer lip of the iliac crest, the lateral aspect of the anterior superior iliac spine and the upper part of the anterior border of the iliac wing. Keep in mind that in addition to arising from the iliac crest, the iliotibial band (ITB) attaches into the posterior gluteus maximus muscle in the back. When the TFL and gluteal muscles contract, they increase tension on the band. Often, one muscle dominates the movement pattern causing an imbalance to occur, which may lead to injury. When a muscle imbalance exists, some muscles are short (overactive) and others are long (underactive).1-7
Muscle length imbalance (or muscle weakness) is a common occurrence that occurs in the synergistic muscles in the hip:
Flexors: The TFL becomes short and the iliopsoas becomes a long and/or weak muscle.
Hip abductors: The TFL becomes short; the posterior gluteus medius becomes long (and/or weak).
The difference in the length of two synergistic muscles contributes to compensatory joint motion and the development of movement impairment. The weak muscle (iliopsoas or posterior gluteus medius) usually is associated with pain in the muscle belly, which is noted upon contraction or with palpation. The long muscle (iliopsoas or posterior gluteus medius) synergist will cause the pain to usually occur during hip-joint motion because the pain generator is the faulty control of the head of the femur in the acetabulum. The gluteus medius is the primary frontal-plane stabilizer of the hip. When it’s underactive, the TFL, adductor and the opposite quadratus lumborum (QL) become overactive.1
Shortened muscles over time can become structurally short and mechanically incapable of lengthening to an appropriate level.1-7 Long muscles can become structurally long and incapable of shortening to an appropriate level.5,6 When muscles are incapable of firing correctly, compensation occurs, and this will alter joint motion from its normal path.
If you have been performing the overhead squat maneuver (described in previous articles), you will notice that the knees can drift inward or outward on the descent. The TFL is implicated as being overactive in both the knee moving inward and outward, which may seem to be a contradicting statement. The movement at the knee depends if the foot is in the open or closed chain. In the open chain, the TFL is a major abductor of the femur and is noted as being overactive when the gluteus medius and/or maximus are underactive.1,13,14 The gluteus medius and/or maximus have been shown to be prone to underactivity when the lack of activity leads to synergistic dominance or overactivity of other muscles.1,9,14 Overactivity (synergistic dominance) of the TFL, piriformis and biceps femoris can all stem from or lead to underactivity of the gluteus medius/maximus because they are each a functional synergists to the gluteal complex.1,9,14
In the closed chain, the knee could move inward if the TFL is overactive doing the squat evaluation. The TFL (and the soleus, lateral gastrocnemius, biceps femoris) attaches to the lower leg and has the ability to produce external rotation of the lower leg.13,14 The TFL (and the adductor complex, biceps femoris [short head], and lateral gastrocnemius) affects either the femur and/or the lower leg. When overactive, these muscles can cause altered knee position.14 In conjunction, the medial hamstrings (particularly at the knee), gracilis, popliteus, medial gastrocnemius, and the gluteus medius and/or maximus are muscles which, when underactive, will allow the femur to adduct (internally rotate) and/or the lower leg to abduct (externally rotate).14
The TFL (and biceps femoris [short head] and lateral gastrocnemius) crosses the knee joint (tibiofemoral joint) laterally. When overactive, as compared to the medial structures, it laterally pulls the femur and lower leg closer together in the frontal and transverse planes.14 Without adequate medial support, the knee is virtually pushed inward, resulting in the “knee-inward” compensation during the squat assessment.
The TFL, bicep femoris (long head), piriformis, gluteus minimus and medius all have an effect on the femur and when overactive can cause the knees to move outward during the overhead squat assessment.14
Intrinsic Factors/Causes of TFL-ITBS
- Tightness in the TFL-ITBS. This is detected by performing the modified Ober’s test. The client is positioned in side-lying, with the unaffected side down. The pelvis and spine in neutral alignment and the bottom leg flexed for support. The uppermost leg is extended (although the leg may be flexed as much as 10 to 15 degrees, and the test still will be valid) and needs to be above the horizontal. The hip is laterally rotated and extended, as far as no lumbar extension occurs. Tell the client to actively flatten the waist towards the floor and actively hold the leg in slight abduction and lateral rotation. The knee is not locked and the foot is relaxed. The client is then instructed to slowly lower the leg towards the floor until the iliotibial band hangs on the greater trochanter and cannot lower any further. The key to an accurate test is not letting the pelvis move, either into lateral tilt, anterior tilt or rotation. As the leg lowers, the hip should not flex or medially rotate. It’s essential to maintain the laterally rotated position of the hip. Ideally, the leg should lower into at least 10 to 15 degrees adduction (approximately two to three inches above the floor for females and one to two inches above the floor for males) without loss of proximal control of the pelvis or hip. The iliotibial band lacks extensibility if the leg does not adduct sufficiently.
- Myofascial restrictions in the hip and thigh musculature, which will increase tension on the band. The iliotibial band is not sensitive to mechanical stretch. The iliotibial band only becomes sensitive to mechanical stretch in the presence of inflammatory pathology. The client will describe fascial inflammation as “burning outer-thigh pain.” Manual palpation can detect tension in the band. Visual postural analysis reveals a deep groove along the iliotibial band when it’s tight. With the client in the Modified Thomas test position, the tensor fascia latae is tested by adducting the horizontal thigh until the pelvis moves. This should be 15 to 20 degrees. Iliotibial band tightness is confirmed by restricted passive extension/adduction of the thigh with the knee flexed to 90 degrees.
- Weakness in hip abductors (common in distance runners).
- Weakness or poor control of knee muscles.
- Dominance of anterior hip muscles, (TFL) over posterior hip muscles (gluts). Tight hip flexors cause the pelvis to rotate while walking. This leads to one side of the abdominals and one side of the gluteus medius shutting down.
- Excessively flat feet or high arches. Poor instep strength is a cause of Achilles tendon inflammation and chronic knee pain from the iliotibial band attachment at the knee.
- Bow legs or knock-knees.
- Leg-length inequality.
- Limited ankle ROM. During the overhead squat if the feet/toes externally rotate, this is usually associated with decreased ankle dorsiflexion and lateral gastrocnemius muscle tightness. During the overhead squat, when you observe the feet turn out, you likely may observe knee valgus (inward knee movement) due to increased hip adduction muscle activity. This must be resolved through mobilization, inhibition and muscle-lengthening procedures before moving up the kinetic chain. The biceps femoris (short head) and TFL also can cause the lower leg to abduct which can perpetuate eversion of the foot/ankle.14
Extrinsic Factors/Causes of TFL-ITBS
- Training errors (e.g. excessive mileage, sudden increase in mileage, sudden increase in intensity of training, too much hill work, running on crowned roads).
- Worn-out running shoes. Top runners replace their running shoes every 250 to 300 miles. I’ll see clients who wear shoes up to 500-plus miles.
- Failing to warm up or cool down.
Functional Testing of the TFL
Have the client stand two to three inches from a wall with their feet together, with the sacrum and thoracic spine on the wall. The client should be able to contract the abdominal and gluteal muscles to flatten the lumbar spine onto the wall and hold it there. This test reveals the ability to self-correct a lumbar lordosis. If the client can’t posterior tilt the pelvis to flatten back on the wall, then the tensor fascia latae (TFL) and iliotibial band could be the cause. Have the client repeat the test with their feet shoulder-width apart. This unloads the TFL and IT band and enables the client to posterior tilt the pelvis to flatten back on to the wall. To correct this dysfunction, have the client repeat the test procedure with their feet shoulder-width apart, actively posterior tilting the pelvis and holding this position for 20 to 30 seconds and repeat the stretch three to five times. Over time, gradually bring the feet closer together. When the client can do it with their feet together have them rotate the hips out while actively posterior tilting the pelvis. A unilateral shortness of the TFL muscle can contribute to sacroiliac joint problems and restrict external hip rotation and extension. In terms of performance, it affects the swing phase of the leg during sprinting, because it causes the foot to swing out at toe-off and the foot to go medial and pronate at touchdown. This can be the cause of shin splints because of the rapid deceleration.
Treatment and Rehabilitation of TFL-ITB Syndrome:
- Anti-inflammatory diet and supplements to reduce inflammation.
- Activity modification. Stop the perpetuating factors that caused the irritation.
- Sleep with a pillow between the knees to decrease tension on the ITB.
- Massage, myofascial release techniques.
- Address tight areas and trigger points. A foam roll is best for this.
- Stretch the TFL-ITBS. The Modified Thomas maneuver is one way to manually stretch the TFL-ITBS. I prefer teaching clients the “standing self-stretch” method. For the right TFL-ITBS, stand in a split-leg stance with the right leg behind the left in a full stride stance. Externally rotate the right foot, leg and hip and maintain weight on the right foot. Raise the right arm straight overhead with the palm facing forward. Place the left hand on the left iliac crest and push with enough pressure from left to right to feel the stretch. Stand with a “tall spine” and slightly rotate the left shoulder anterior. You may need to slightly extend your torso to gain a greater stretch sensation. Hold this pose for 20-30 seconds and repeat this maneuver two to three times. Performing a gluteal bridge with the toes raised with adduction gets a stretch to the TFL as well.
Strength and Stability Phase
- Bridging with single-leg raise. Repeat the movement up and down. Build up to one to two minutes of slow continuous movement.
- Clam shell. The aim is to strengthen the gluteus medius. Lie on your side with your hips stacked one on top of the other and your legs together with the heels connected. Extend your lower arm, palm up, so that you can rest your head. Now angle your stacked thighs forward 30 to 45 degrees, without changing the position of your spine, which must be still in a straight line from your head to your tail. From this position, pre-contract the gluteus medius and lift the top leg. In the beginning, allow the heels to stay in contact. Do not let the pelvis rotate forward or backward. Lift the thigh up from the hip to its maximum height. Hold it up for 10 seconds and slowly bring it back down. Repeat this 10 times.
- Standing with an elastic band around the knees, perform a single-leg/thigh abduction (one at a time) in a semi-squat position. Keep the big toe down on the ground. Build up to one to two minutes of continuous movement.
- Step downs. Step down from a 2” to 6” stable step very slowly.
- Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, Inc., 2002.
- Liebenson C. Integrated rehabilitation into chiropractic practice (blending active and passive care). In: Liebenson C, Ed. Rehabilitation of the Spine. Baltimore: Williams & Wilkins, 1996:13-43.
- Comerford MJ, Mottram SL. Movement and stability dysfunction – contemporary developments. Man Ther, 2001;6(1):15-20.
- Panjabi MM. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement. J Spinal Disord, 1992;5(4):383-9.
- Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing and Function, with Posture and Pain. 5th ed. Baltimore: Lippincott Williams & Wilkins, 2005.
- Janda V. Evaluation of muscle imbalances. In: Liebenson C, Ed. Rehabilitation of the Spine. Baltimore: Williams & Wilkins, 1996:97-112.
- Sahrmann SA. Posture and muscle imbalance. Faulty lumbar pelvic alignments. Phys Ther, 1987;67:1840-4.
- Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective. J Orthop Sports Phys Ther, 2003;33(11):639-46.
- Janda V. Muscles and motor control in low back pain: assessment and management. In: Twomey LT, Ed. Physical Therapy of the Low Back. Edinburgh: Churchill Livingstone, 1987:253-78.
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by Jeffrey H. Tucker, DC, DACRB
*This article was submitted to DC on 1-20-07. Accepted for publication 2-27-07. Printed May 2007.
Movement assessments have become a clear and comprehensive evaluation and approach to my Chiropractic therapy. It begins with me looking at each clients standing posture. I then ask my client to perform a series of postures. You know this portion as ‘range of motion’ evaluation. For example, I say to the client, “Bring your chin to your chest”, etc., or “bend forward to touch your fingers to the floor” or “raise both arms over your head” bla bla bla! It is old school, but I realize I need to document how far they move and if any sensations present themselves. I have become a keen observer of these movements, one who is not just interested in how far they move, but more interested in the way they move and what there movement pattern can tell me. The evaluation continues with a series of dynamic and static postures to observe how the muscles and joints move. Through this process I generate a sequence of home exercise programs for my clients. Please realize, the movement assessments can be performed prior to any hands on work that you do, or the assessments can conclude with a mobilization or manipulation that you feel is necessary.
If you have read my previous articles you will know that I start with the squat assessment. Observe the client perform a squat several times. Simple say “Let me see you do a squat with your arms out in front of you.” The benchmarks that I look for on this evaluation are that the:
- Upper torso is parallel with the tibia or toward vertical (back is relatively upright).
- Femur below horizontal.
- Knees aligned over feet.
- Toes point forward.
- Knees don’t turn in.
If they cannot accomplish the above criteria I start the correction process with the following training: I call this the supine120 degree knee to chest maneuver. Client lays supine in the 90/90 position. The knees are over the hips and the legs are parallel to the floor. Doctor stands at the feet of the client and uses a knife edge contact along the clients ankle crease. The Doctor resists at the ankle crease while the client is instructed to “pull your knees to your chest.” The Doctor allows the client to move into a knee to chest position. The doctor is providing resistance, not overpowering the client. The client’s lumbar region should remain in the neutral spine. Instruct the client to focus using the lower abdominals, especially the area slightly above and below the inguinal region. Allow the hips to get to at least 120 degrees. This maneuver is a great way to get clients to re-awaken this area. Bring awareness of tightness to this area while you tell the client to release tension or resistance in other areas such as the neck or shoulders that are not needed for this maneuver. Repeat this maneuver as many times to client tolerance.
The next progression is a pose called ‘Find your stance’. This is used as a foundation of all standing postures and movements. I want this to become the natural way to stand. It cultivates a sense of strength and stability. Begin with your feet (shoes off) between your hips and shoulders – go with what feels natural and comfortable. Slightly angle your feet outwards with your weight evenly spread through the balls, lateral edge and heel. Avoid your arches collapsing inwards. Try to feel the medial and longitudinal arches lift up.
Assisted Squats: Doctor and client face each other. ‘Find your stance’, or spread feet to shoulder width or slightly wider if needed; client holds arms and hands out in front of there body; Doctor holds hands with client and assists client to squat. The command is “pull your butt down.” The Doctor is providing assistance so the client doesn’t fall down. However, the client may fall to the floor the first or second time and that is perfectly normal and O.K. to do. Simple get back up and attempt it again. The idea is to allow them to go as deep as possible. Get the client to engage the groin crease muscles to pull them down. The goal of doing this squat is to reach back with the buttocks and down, ex. Sit back on a chair with control. If you have a rope or Theraband (at least the strength of a black theraband), you can wrap it around the clients back and underarms while you hold the ends in the front of the client and ask then to “sit down against” that resistance. Doctor coaches the client to keep the back straight, in this case as vertical as possible. FIGURE 1 Rubber tubing under the arm pits and you assist client to sit down against this resistance. The knee should not bow inward.
“Pull the hips out of the socket” routine to squat. This maneuver requires two assistant partners (the doctor plus an assistant). The client is instructed to squat down in a wider than shoulder stance. The Doctor is to the left of the client and the assistant on the right side. Each assistant places one flat hand behind the posterior leg just below the knee crease. The other hand is placed in the inguinal fossa/ligament crease with a knife edge contact. Assistants use enough pressure to guide the client into a deeper squat. Ask the client to feel like they are pulling the hips out of the socket as they descend. This allows the client to understand and feel the proper joints and muscles to use to accomplish this squat. Allow the client to learn in a wide stance and go as low as they can. As they improve strength they can get into a more narrow stance. Less core muscle is required in a wide stance than a narrow stance. Repeat this maneuver several times. Do a simple test on yourself. Stand in a wide stance and go narrower and narrower until you are in a one legged stance. Feel how the core is participating. Eventually we will get clients to have there feet closer and closer together and this will demand greater core strength.
Right after this maneuver, it will help your client if the Doctor rubs his/her index fingers along the spinous processes while the client does several more squats. This is performed starting at approximately the middle of the back with both index fingers. At the same time rub one finger headward and the other caudal along the spinous process while the client squats down and up. While you rub the spine, instruct the client to stay in a “tall spine” posture. They need to imagine creating more room in the hip socket. Tell the client to think of one thing and only one thing on the way up and that is “gluteals.” You don’t need to suck the stomach in if you elongate the spine, it will automatically come in if they are working to resist extension.
Squat against the wall. This is such a new take on the old school method of a wall squat. Once a person can accomplish the “static wall squat” also known as the “wall sit”, “wall chair,” “airbench” or “back against the ball squat” for one minute, they are ready for this maneuver. Find the distance away from the wall so that when you squat down your sacrum stays in contact with the wall. The key is to keep the sacrum touching the wall. Squat down with arms on the inside of the thighs until the elbows can push against the inner thighs. Put your hands in a prayer pose and push the elbows against the inner thighs. Pry the hips apart as you wiggle side to side going lower and lower. Continue this gentle rocking side to side and attempt to go lower and lower opening the hips. You should feel this in the most proximal attachments of the adductor muscles and hamstrings. Hold this pose for as long as you can and then concentrate on getting back up using the gluteals and keeping the sacrum in contact with the wall. Try this maneuver several times. One minute in this pose really gets you feeling warm. Attempt this with a narrow stance compared to when you are away from the wall. The next progression is to repeat the squat away from the wall.
PIVOTS: These help open the hips. Standing with your feet more than 3 feet apart, with outstretched arms (abduction) to your sides away from the body (the feet should be under the wrists distance). The feet will need to be angled slightly outward approximately 15 degrees. Keep the torso facing forward. Lunge gentle to the left until your knee is bent in a right angle above your left foot. Lengthen the spine upward (“tall spine” concept). Move side to side going more and more lateral (lower). The opposing forces of your legs provide balanced stability. Don’t lean the body towards the bent knee, try to keep the torso upright as much as possible. Imagine the hands pulling further side to side. Allow the sitting bone to be pulled backwards. The legs, both pushing forwards and pulling backwards, allow the hip to hinge and become stable at the same time, two opposing forces balancing one another. Shoulder blades should be kept down.
I recommend clients practice these maneuvers daily. I want my clients to observe subtle changes in posture, decreased pain, increased range of motion, feelings of stability, and a greater capacity for work and sport. As individuals vary in strength, flexibility, and coordination so the practice of functional exercises will be unique to each individual. Using progressive movement as assessments in your practice will tell you where the client is strong or weak, symmetrical or asymmetrical, balanced or imbalanced, coordinated or incoordinated, and which areas need more practice.
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- Caterisano A, Moss RF, Pellinger TK, Woodruff K, Lewis VC, Booth W, Khadra T. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res 2002 Aug; 16(30: 428-32
- Comerford M 2003 and 2006 Lumbo-pelvic Stability. Course notes. Copyright Comerford.
- Tsatsouline, Pavel 2007 Stretch Course. Copyright Tsatsouline.
- Vermeil A 2005 Sports & Fitness. Course notes. Copyright Vermeil.
- All the coaches, sports medicine, and sports scientists who have shared their knowledge with me.