All Posts tagged www.DrJeffreyTucker.meta-ehealth.com

Weight loss

I spend a lot of my free time keeping up with the world of health, healing, fitness, and weight loss. I have heard about  most diet programs out there. In fact, at this point I’m pretty skeptical of any new diet program that comes across my desk. Look, we both know weight loss is not easy and the truth is, most diets are hard to follow.

I don’t have a ‘new weight loss program’,  rather I teach my clients the things that I have seen really work over my 27 years of practice – which is why I recommend either the Paleo diet or the Mediterranian Diet. Both are highly successful protocols. I recommend one or the other, or a combination of both. It all depends on who is sitting in front of me or who’s lab work I’m looking at. 

I typically help clients manage consistent, reliable weight loss. I have programs that can help my clients lose 1-2 pounds of FAT per week, or lose 3-5 pounds per week!  

I don’t want you to be  HUNGRY. I’m after seeing you enjoy more energy… and finally break the craving cycle that dooms almost every diet.

The problem with most diets is that without the optimum carb level, insulin spikes and your body stores fat instead of losing it. I encourage exercise and personally teach it to my clients, that way you won’t lose precious muscle mass.

If you want the summer of 2010 to be the year you finally regain your energy and health, call my office 310-473-2911.

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Leptin & Ghrelin Lessons

You know my hat’s off to you if you are trying to lose weight. You know I want you to stay away from sugar-added foods, fried foods, other simple carbohydrates. 

Have you heard about ghrelin? You need to know this stuff. When it comes to desire for food, you’re largely at the mercy of the hormones leptin and ghrelin. A rising ghrelin level prompts your brain to register the sensation of hunger. As you eat and fulfill your body’s need for nourishment, leptin rises, ghrelin drops, and hunger fades.

I wish it was that simple. A 2002 New England Journal of Medicine study followed subjects’ ghrelin levels over the course of a six-month weight reduction effort. After the first three months, each of the overweight subjects had lost an average of nearly 40 pounds. By the end of the study they had managed to maintain that level of weight loss.

One of the key reasons dieters typically regain lost weight is that as body weight dropped, ghrelin output increased. At the end of the study, the subjects’ LOWEST ghrelin levels were almost as high as their pre-meal ghrelin peaks before their weight-loss program began.

 There are three steps you can take to help control ghrelin levels.

1) Get enough sleep

Research shows that ghrelin levels are generally higher and leptin levels are lower in people who regularly get inadequate sleep. As a result, hunger is more pronounced during the day. And worse: Sleep-deprived people tend to desire calorie-dense, high-carbohydrate foods.

But for most people, a full eight hours of sleep each night may not be necessary to moderate ghrelin/leptin levels. A 2006 sleep study shows that many overweight people may experience benefits by adding just 20 minutes of additional sleep each night.

2) Avoid fructose

Fructose makes ghrelin rise. And fructose shows up in a wide range of processed foods.  High fructose intake is linked to higher ghrelin levels, and lower leptin and insulin levels.

3) Don’t attempt a crash diet

A weight-loss diet that starts right in with a steep drop in calories is a shock to the system – a shock that’s more likely to prompt ghrelin increase. If you ease into a new regimen of less caloric intake your body adjusts incrementally. And of course, avoiding simple, refined carbs is a must. Consumption of inferior carbs just makes you hungry for more carbs.

I wish you the best on your diet journey!

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Suggestions for Irritable Bowel Disease (IBD)?

“Dr. Tucker, do you have suggestions for Irritable Bowel Disease (IBD)?” 

1) Avoid fructose. A fructose-free diet significantly reduces IBD symptoms. Fructose is poorly absorbed in the digestive tract of many IBD patients. So fructose passes into the colon where it’s consumed by bacteria. This produces gases that trigger IBD symptoms such as bloating, cramping, and diarrhea.  This is not easy because high fructose corn syrup is in just about everything; even honey,  fruit and even some vegetables need to be avoided. Other foods that may cause problems include alcohol, caffeinated beverages, milk products, and the inferior fats in junk foods.

2) Many IBD patients do well on high fiber diets.

3)  Smaller more frequent meals also help.

Acupuncture and yoga have also been shown to improve IBS symptoms for some patients. And (no surprise!) chiropractic adjustments should be considered part of the program.

Natural remedies such as UltraInflamX PLUS 360 is a powerful medical food for this condition. Order from www.DrJeffreyTucker.meta-ehealth.com

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Leaky Gut Syndrome

The lining in your small intestines is only one cell thick. When this delicate surface barrier is damaged by a poor diet, inflammation, environmental toxins or overuse of medications, partially digested food particles can “leak” into your bloodstream.

This means that material in your intestines can leak into your bloodstream. When this happens it activate your immune system, causing you to become allergic to foods you normally should be able to digest. This can cause you to become sick, overweight, and even depressed. Some people even feel forgetful and describe ‘brain fog’.

It’s not just about what we eat, but more importantly what and how well we absorb nutrients. If your gut is damaged, your body cannot absorb the nutrients it needs, like omega-3 fats, magnesium, zinc, and vitamins D and B12. These key nutrients, which are critical for normal brain operation, have the most trouble being absorbed when things go wrong in the gut.

What can you do to fix leaky gut syndrome?

1) Start with eliminating gluten and dairy from your diet for 6 weeks.

2) Take UltraInflamX Plus 360 (Metagenics) every morning as a breakfast shake (2 scoops) for 6 weeks.

3) Take LactoFlamX (1 capsule daily) probiotics daily for 6 weeks.

These 3 suggestions have helped repair my clients damaged intestines and bring the digestive system and brain back into balance.

www.DrJeffreyTucker.meta-ehealth.com

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Eating Right For Working Out

Question for Dr. Tucker: “I am a 40 year old female weighting 150 pounds and I’m 5’ 7”. My eating habits are getting better. I want to know what you recommend I might eat before and after a boot camp class or kettlebell workout? I want to lose fat and keep my muscle.”
Dr. Tucker’s response: Decide on a protein shake or bars vs turning to your fridge: One cup of lowfat chocolate milk or lowfat fruit yogurt will likely provide an athlete/active individual with the amount of Essential Amino Acids (EAA) and carbohydrate they need to enhance muscle growth.
• For those who need more specific calculations for estimating quantity of protein and carbohydrate to consume, research recommends 0.045 grams of EAA per pound of body weight in combination with 0.23 grams of carbohydrate per pound of body weight.
• For example: For a 150-pound woman, a simple cup of lowfat, fruit-flavored yogurt will work. I prefer the UltraMeal shake (www.DrJeffreyTucker.meta-ehealth.com) with approximately 15 grams of high quality protein. This provides the appropriate amount of protein and carbohydrate with a comprehensive spectrum of essential vitamins and minerals in every serving. It also gives me the insurance to know that you will lose fat and not muscle.

During Workout Nutrition:
The research here has actually been similar in that we want to feed the body a product with a 2:1 ratio of carbs:protein . Here I recommend the UltraMeal Shake (2 scoops) with one scoop of UltraPure Protein (www.DrJeffreyTucker.meta-ehealth.com)

Other Pre- and Post Exercise Snack Ideas for Combining Carbs and Protein
• 2 slices whole grain toast and 2 tablespoons peanut butter
• Apple and 1 cup lowfat cottage cheese*
• 1 cup fruit yogurt and 1/4 cup granola*
• 2-egg omelet with 1 cup fresh vegetables, 1 whole-wheat English muffin*
• String cheese and 1 ounce pretzels*
• 1/4 cup nuts and an orange
• Hard-boiled egg and 1/2 whole-wheat bagel*
• Whole-wheat pita and 1/2 cup canned tuna*
• UltraMeal Bar (order at www.DrJeffreyTucker.meta-ehealth.com)
*These food combinations provide higher quality protein (that is, protein with all the nine EAA).

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Do I Have Temporomandibular Joint (TMJ) Disorder?

TMJ is a collective term for a broad range of disorders displaying a variety of signs – radiating pain in the face, neck, or shoulders; limited movement or locking of the jaw; painful clicking or grating when opening or closing the mouth; and a significant change in the way the upper and lower teeth fit together. Other common symptoms include headaches, earaches, dizziness, hearing problems, and difficulty swallowing.

The Jaw Symptom Questionnaire consists of the following questions:

? Does it hurt when you open wide to yawn?
? Does it hurt when you chew or use the
jaws?
? Does it hurt when you’re not chewing or
using the jaws?
? Is your pain worse upon waking?
? Do you have pain in front of the ear, or
earaches?
? Do you have jaw muscle or cheek pain?
? Do you have pain in the temples?
? Do you have pain or soreness in the teeth?
? Do your jaws make noise so that it
bothers you or others?
? Do you find it difficult to open your mouth
wide?
? Does your jaw ever get stuck/lock as you
open it?
? Does your jaw ever lock open so that you
cannot close it?
? Is your bite uncomfortable?

In my experience if a patient answers more than three of the above questions they will benefit by education, an anti-inflammatory home care program including dietary changes, nutritional supplements, heat or ice applications, avoidance of mechanically stressful activities, and resting the jaw (practice the “lips apart and jaws relaxed” procedure).

In office treatment that I provide include: warm laser, soft-tissue therapy and specific muscle massage. I also train clients in corrective exercise therapy.

General Nutrition for TM Disorders

• EC Matrixx™ is a mechanism-specific formula designed to support healthy connective tissues by supporting the extracellular matrix, a key structural component of connective tissues such as tendons, ligaments, and cartilage. Features berberine and tetrahydro iso-alpha acids (THIAA), which have been shown in laboratory research to influence MMP-13, an enzyme involved in the maintenance of connective tissue structure.
THIAA has also been shown to beneficially influence multiple cellular signaling processes related to connective tissue health.
Supports biochemical processes that influence the health of the extracellular
matrix.
• Chondro-Relief Intensive Care — 3-6 capsules daily with food. Joint & soft tissue support with MSM, Green Lipped Mussel, Hyaluronic Acid and ASU.
• Inflavonoid Intensive Care — 3-9 tablets daily with meals. For relief of minor pain.
• E-Complex 1:1 — 2-4 softgels daily. 1:1 ratio of alpha and gamma tocopheryls.

Order at www.DrJeffreyTucker.meta-ehealth.com

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Neck Pain Exercises

Neck Flexors

With a rolled towel under neck, gently nod the chin without lifting the head.

Hold for 10 seconds.
Repeat 10 times per set.
One set per session.
Complete 3 sessions per day.

Neck Extensors

With hands grasping the base of the neck, extend the chin as far as possible.

Hold for 3-4 seconds.
Repeat 10 times per set.
One set per session.
Complete 3 sessions per day.

Neck/Pelvis Rotation

Feet and knees together with arms outstretched. Rotate knees to one side, turning head in the opposite direction until a stretch is felt. Repeat on other side.

Hold for 3-4 seconds.
Repeat 10 times per side, per set.
One set per session.
Complete 3 sessions per day.

Upper Trapezius Stretch

Gently grasp right side of head while reaching behind back with other hand. Tilt head away until a gentle stretch is felt.

Hold for 30 seconds.
Repeat 2 times per set.
One set per session.
Complete 1-3 sessions per day.

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Overhead Deep Squats: Understanding Movement & Function

by Jeffrey H. Tucker, DC, DACRB

What are the most common imbalances patients present with? The obvious answer is musculoskeletal imbalances. This article discusses the functional assessment of stability and mobility to movement re-education. Assessment of the overhead deep squat for stability and mobility imbalances will improve your awareness of the patient’s movement dysfunction. Training stability and providing manual mobilization and/or self mobilization are current concepts of movement dysfunction.

A restricted segment can cause a compensation that leads to uncontrolled and increased motion. The uncontrolled segment or region is the most likely site of the source of pathology and symptoms of mechanical origin. Common dysfunctions within the movement system occur when the ankle, hip or thoracic spine needs mobilization, or when the knee, lumbar spine or glenohumeral joint needs stabilization.

There is plenty of evidence to support the link between uncontrolled intersegmental translation or uncontrolled range of motion and the development of musculoskeletal pain and degenerative pathology. Motor control dysfunction within the ankle, knee, hips, lumbar region, thoracic region and shoulder contribute to insidious onset, chronicity and recurrence of pain.

We need to restore ankle dorsiflexion, hip flexion/extension and/or hip adduction/abduction, and thoracic flexion and extension, because there is a frequent relationship between the loss of range of motion at one or more motion segments, and the development of compensatory excessive movement at adjacent segments. Learning to refine mobility and stability will reduce asymmetries and limitations as a means of injury prevention. It is important to establish stabilization prior to strengthening. Evaluate flexibility limitations and asymmetries between the left and right sides of the body. An individual conceivably could overcome a deficit in range of motion in one joint by using more ROM at another joint to achieve the specified goal.

The body is a “kinetic chain” of interconnected parts. I recommend overhead deep squatting as the primary assessment to evaluate whether mobility or stability is required.

The overhead deep squat: The ideal criteria for a well-performed overhead deep squat are:

    1. upper torso parallel with the tibia or toward vertical (back is relatively upright);
    2. femur below horizontal;
    3. knees aligned over feet;
    4. both arms overhead with the dowel aligned over feet;
    5. toes pointed forward; and
    6. knees don’t turn in or out.

Hypomobility at any joint in the lower extremity kinetic chain can challenge the motor-control mechanisms of the patient and lead to joint instability. Joint hypomobility can present as dysfunction of intra-articular motion, producing limitations of the accessory movements of roll and glide between the joint surfaces. Limited range of motion also can occur in the myofascial system (extra-articular in nature). These two components are interrelated and often occur together. The abnormal displacement or restrictive barrier to movement changes the normal pattern of movement of the instantaneous axis of rotation (IAR). Movement around an abnormal axis of rotation imposes abnormal compression or impingement on some aspect of the joint tissues and produces altered proprioceptive input to the central nervous system. The motor-control system must adapt to maintain function. These faulty movements increase microtrauma in the tissues around the joint, which, if accumulative, lead to dysfunction and pain.

After an ankle sprain, hypomobility may occur at the subtalar joint, talocrural joint, distal tibiofibular joint, or proximal tibiofibular joint. Limited dorsiflexion after lateral ankle sprain has been attributed to tightness in the gastrocnemius-soleus complex, capsular adhesions developed during immobilization, and subluxations or any combination.

Ankle: The hypomobility of the ankle or tissue tightness can be observed during the overhead deep squat if the heel of the foot rises while descending from a neutral starting position. This is the result of limited soleus muscle motion (e.g., ankle dorsiflexion). Motion can be restored and maintained despite restricted arthrokinematic motion. Restoration of dorsiflexion and normal gait patterns occurs after anterior-to-posterior (manual or self) mobilizations of the talus in the mortise.

If the patient’s toes turn outward while descending from the starting position, it means he or she may have weak, tight lateral gastrocnemius, hamstrings, weak inner thighs, and is at risk for Achilles tendonitis.

The progression of rehab to improve the foot dysfunction is to start the patient with ankle self-mobilization. The patient starts out in the double-leg stance. Take a single step forward onto a stool with the right foot. Ask the patient to flex the ankle and knee over the stool as far as they can go. Compare to the left side. The restricted side can be stretched and mobilized while on the stool by repetitively moving the knee over the foot. Altered movement of the subtalar joints and soft tissue tightness can be restored through self repetitive range of motion maneuvers. Next, have the patient perform a wall stretch. With their hands against a wall, feet flat on the ground and one foot at least 18 to 20 inches behind the other, have them bend the front knee. Hold the static stretch for at least 30 seconds. Do this at least two times per leg. The next exercise involves standing on one foot, turned in 45 degrees with the heel hanging off a step. The patient’s body’weight is on the forefoot. Have them hold onto a wall or rail handle and let their body weight drop down. Instruct the patient to hold this stretch for at least 60 seconds.

Knee: If the knees drift inward while descending from the start position of the overhead deep squat it may mean the patient has weak glutes, tight inner thighs, and is prone to knee and low back problems. The patellofemoral joint may be influenced by the segmental interactions of the lower extremity. Abnormal motions of the tibia and femur in the transverse and frontal planes are believed to have an effect on the patellofemoral joint. The first progression for the knee is to use a foam roll on the adductor and abductor muscles. Firmly press and roll along the tight tissue for several minutes or until you feel a release of tight tissue. Have the patient perform a lunge at a 2 o’clock or 3 o’clock pose with the right leg and a 10 o’clock to 11 o’clock pose with the left leg. The patient should next perform side-lying leg raises. Do not allow the quadratus lumborum muscle to activate early. Raise and lower the top leg, keeping it straight. Isolate the TFL and glute medius. Only perform this on the side that drifts.

Hip: If the patient can keep the feet straight ahead or have only slight external rotation, plus the heels stay flat on the floor while squatting, but they cannot achieve the depth of getting the femurs below the horizontal, they may have tightness where the TFL attach into the glutes. The hip joints may be restricted. The rehab progression is to start with manual mobilization of the hips. Teach the patient how to perform hip range of motion on their own. Part of this solution is simply to do repetitive squats. Over time and many repetitions, the patient will break up the tissue tightness and be able to squat lower and lower.

If you suspect a patient is having a hip extension firing problem during gait, with the hamstrings dominating the movement pattern, rocker sandals can help retrain the gluteus maximus. There are a number of ways to “wake up” the gluts while squatting: for example, weight shift toward the heels, bridges up and down with a therapy band around knees to provide resistance to abduction; side steps with a band around the ankles; or bridges on a gym ball with alternate heel raises. Tight hip flexors will inhibit the gluteus, so these need to be evaluated for length.

For a stronger gluteal contraction, perform the Tucker test, the purpose of which is to help recruit a deeper and stronger contraction of the gluteal group. Test: Place a quarter on the outside of the patient’s clothes between the buttocks at the level of the anus, and have the client hold it in place with a strong gluteal contraction. Assess: Can the patient contract the gluteals strong enough and continuously while performing the bridge exercise up and down so the quarter does not drop to the floor? Relate: In order to hold the quarter in place, the patient must concentrate on performing a strong gluteal contraction. This forces the continuous contraction of the gluteus and initiates a co-contraction of the abdominals. Progression: Have the patient perform the overhead deep squat with the quarter held in the buttocks.

Lumbar: If the patient’s back bends into flexion while performing the overhead deep squat, it may mean they have tight hip flexors, a weak core and poor posture. This is such an important diagnostic tool. Why is this point so important? The lumbar spine may be more flexible relative to the hips in flexion due to lengthened erector spinae and shortened hamstrings. This can lead to a hamstring strain, but more importantly, the muscles that control excessive lumbar flexion (lumbar erector spinae) have more “give” than the muscles that limit hip flexion (hamstrings). Consequently, during trunk flexion the lumbar spine gives more easily than the hips and excessive flexion occurs in the lumbar spine relative to the amount and time of flexion at the hip joints, resulting in compensatory lumbar flexion and a potential lumbar flexion stability dysfunction. The patient complains of flexion-related symptoms in the lumbar spine. You can see how this will translate to their everyday life. See if you can detect the following possible flexion movement dysfunctions in the low back when the patient forward leans while performing the overhead deep squat:

    1. Shortened back extensor mobilizer muscles (longissimus and iliocostalis): The pelvis shifts more than 4 to 5 inches posteriorly during forward bending and the spine demonstrates limited flexion.
    2. Shortened hamstrings: The hips demonstrate less than 70 degrees of hip flexion during forward bending.
    3. Lengthened gluteus maximus: The hips demonstrate more than 90 degrees of hip flexion during forward bending.
    4. Lengthened back extensor stabilizer muscles (superficial multifidus and spinalis): The spine demonstrates excessive flexion during forward bending.

The progression of rehab is to use the foam roll on the anterior and lateral sides of the hips. Work out as much tissue tightness as you can on the foam roll. To stretch the hip flexors, teach your patient to do a lunge with an arm raised overhead. The precise steps are as follows: Leading with the right foot, the patient performs a lunge while raising the left arm overhead and rotating the upper body to the left. Instruct the patient to hold this pose for 30 seconds and to perform at least two stretches on each side. The most important solution for this movement dysfunction is to control movement at the site of the instability. This concept is a process of sensory-motor re-programming to regain proprioceptive awareness of joint position, muscle activation and movement coordination. This training is beyond the scope of this article. However, you can start by teaching clients to co-contract the mutifidus and transverse abdominus muscles.

Thoracic: During the overhead deep squat, the patient presentation of lack of mobility in the thoracic spine may include the inability to get the dowel directly over the feet. I usually find the arms way out in front of the feet. These patients lack thoracic extension. You will feel restricted motion on palpation of the thoracic spine into extension. The patient may have an obvious forward-drawn posture, anterior head and shoulder carriage (slumping) and/or an increased kyphosis. The rehab solution for this dysfunction is mobilization. The foam roll will allow for self mobilization into extension. The repetition of performing self-mobilization of the thoracic spine into extension, while the patient performs the overhead deep squats, is an exercise in and of itself. Another self-mobilization maneuver involves asking the patient to sit on a chair facing the wall, leaning the forehead on crossed arms against the wall. The patient’s knees and toes touch the wall. Taking deep breaths in and out, on the exhalation the patient forces thoracic extension movement, repeating the process about 10 times. I often find the thoracolumbar junction, T6 and above, as the key joints to manipulate to create flexibility.

Shoulder: The gleno-humeral functions. Stability is sacrificed to a large degree to achieve this mobility. During the overhead deep squat you will observe the patient pushing the dowel behind their back instead of over the head. To correct the instability in the shoulder we need to correct the length-tension relationship, improve muscle endurance and coordination of the rotator cuff muscles. These muscles act in a manner to generate a force balance to maintain centering of the joint throughout the range of motion.

Assessment of the overhead deep squat provides analysis of stability and mobility. An exercise program based on the assessment can be implemented to achieve stability and mobility. Stability is only tested reliably under low-load situations. Mobility is based on the ability to pass or fail the ideal criteria of the overhead deep-squat posture. The benefits of having good stability function of both the local and global stabilizer muscles, as well as good joint flexibility, are improved low-threshold motor control and reduced mechanical musculoskeletal pain.


Resources

  1. Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthopaedica Scandinavia 1989;230(60):20-24.
  2. 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 August 2002;16(30:428-32
  3. Cholewicki and McGill. Mechanical stability in the vivo lumbar spine: implications for injury and chronic low back pain. Clinical Biomechanics 1996;11(1):1-15.
  4. Clark M. “Introduction to Kinetic Chain Dysfunction.” Course notes, 2005. Copyright NASM.
  5. Comerford M. “Lumbo-Pelvic Stability.” Course notes, 2003. Copyright M. Comerford.
  6. Vermeil A. “Sports & Fitness.” Course notes, 2005. Copyright A. Vermeil.

Dr. Jeffrey H. Tucker graduated from Los Angeles College of Chiropractic in 1982. He is a diplomate of the American Chiropractic Rehabilitation Board and teaches a 14-hour postgraduate diplomate series on cervical and TMD rehab and lumbar spine biomechanics and rehab. Dr. Tucker practices in West Los Angeles and Encino, Calif.

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