How Do You Rate?

Come visit your Orange County Chiropractor

In the field of statistics, a five-point rating scale is commonly used to evaluate all sorts of personal responses, feelings, and assessments. This frequently used tool is known as the Likert scale, and most people have completed such a rating device on numerous occasions, most typically in consumer after-sales surveys. The Likert scale asks a person to respond to a statement such as “I would recommend this restaurant to my friends”, choosing from the predetermined answers of “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” and “strongly agree.” The Likert scale was developed in 1932 and has been consistently validated over many decades of use. We can effectively apply this rating system to our own state of health by answering the statement, “I enjoy high levels of health and well-being.” We can than employ our truthful answers to make sound decisions on our own behalf regarding future health-promoting activities.

If your truthful response is “strongly agree,” you probably have been engaged for a year or more in a regular, vigorous exercise program and consistently follow a nutritional healthy eating plan. You do at least 30 minutes of vigorous exercise five times a week, on most weeks. You are probably at or very near your target body weight (based on a calculation of your body mass index, readily done at numerous online resources) and consume an appropriate amount of calories on a daily basis. Overall, you feel fit. You sleep well and wake up refreshed. You have abundant energy to do all the things you need to do for yourself and your family, every day.

At the other end of the Likert rating system, if your truthful response is “strongly disagree,” you probably haven’t done any form of exercise for some time. Of course, such a circumstance might be the result of a serious illness. But if your lack of engagement in regular exercise and healthy eating is related to apathy or some other form of ennui, or in itself is a personal choice, it’s useful to consider the consequences of such inaction. Or, rather, it could be personally beneficial to consider the value in taking on new habits that result in your becoming a person who responds “strongly agree” to the statement, “I am healthy and well.”

How do you get to “strongly agree”? The solution is three-fold. The first part is to make a choice that you want to enjoy high levels of health and well-being. No one is ever going to make such a commitment because someone else told him or her they should, no matter whether that someone is a spouse, other family member, or a physician. The decision must be a personal choice. The second and third components are to begin an exercise program¹ and a healthy eating plan^2,3. Exercise needs to be vigorous (“vigorous” is relative, based on your age, overall health status, and other considerations) and done five times per week. Healthy eating encompasses a wide range of selections and options. One of the key elements is to consume at least five servings of fresh fruits and vegetable every day.

The good news is that every person who begins and stays with such a course of healthy living will soon reap the benefits. And not too long after that, you’ll find you’ve become a person who sleeps better, has more energy, and has, day by day, more fun in living. This is what healthy eating and exercise is really all about.

¹ Chilton WL, et al: Acute Exercise Leads to Regulation of Telomere-Associated Genes and MicroRNA Expression in Immune Cells. PLoS One 2014 Apr 21;9(4):e92088. doi: 10.1371/journal.pone.0092088. eCollection 2014

² Michas G, et al: Dietary fats and cardiovascular disease: Putting together the pieces of a complicated puzzle. Atherosclerosis 2014 Mar 27;234(2):320-328. doi: 10.1016/j.atherosclerosis.2014.03.013. [Epub ahead of print]

³ Yoon U, et al: Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: a systematic review of randomized controlled trials. Metabolism 62(2):303-314, 2013

Inside Out Vs. Outside In

Come visit your Orange County Chiropractor

If a patient has high blood pressure, a standard medical approach would be to choose a drug that lowers blood pressure, and ask the patient to take the drug. This may serve to lower the blood pressure, but ignores the underlying cause that is making the blood pressure high, and runs the risk of side effects complicating the person's recovery. Whether it's a nutritional issue, faulty control by the nerve system or a manifestation of stress, the medication could decrease the blood pressure, leaving the problem causing the symptom of high blood pressure unaddressed.

The Wellness Approach

Wellness is a state of optimal conditions for normal function...and then some. The wellness approach is to look for underlying causes of any disturbance or disruption (which may or may not be causing symptoms at the time) and make whatever interventions and lifestyle adjustments would optimize the conditions for no
rmal function. That environment encourages natural healing, and minimizes the need for invasive treatment, which should be administered only when absolutely necessary. When the body is working properly, it tends to heal effectively, then there is another level of health that goes beyond "aymptomatic" or "pain-free" which reveals an open-ended opportunity for vitality, vibrant health, and an enhanced experience of life. This is true for mental and physical health. Which some people may suffer psychological disorders, creating an atomosphere of mental and emotional wellness will address all but the most serious problems.

Repairing an Injured Rotator Cuff

Visit your Orange County Chiropractor

As we get older, rotator cuff injuries become more common, a result of the natural aging process. A similar mechanism operates in the discs separating the vertebrae in your lower back. These cartilaginous structures lose water over time, becoming less flexible and more brittle as the decades roll by. In the case of the shoulder, the rotator cuff tendon is pulleyed to and fro as the arm swings forward and back and up and down. As the years pass, this constant motion may cause fraying in the rotator cuff tendon and inflammation in the muscles that comprise the rotator cuff. Eventually, partial or full thickness tears may develop in one or more of these musculotendinous units, causing pain and some loss of function. Importantly, conservative care may be all that’s needed to reduce pain and restore needed motion.

The shoulder joint is beautifully designed and a marvel of engineering. Its construction makes possible a full 360-degree arc of motion in both the sagittal and frontal planes. In other words, you can swing your arm in a complete circle from front-to-back and to-the-side-and-up-and-around. In the third, horizontal, plane, 180 degrees of motion is available. The overall combination of movements in three-dimensional space makes the shoulder joint the most freely movable joint in your body. However, as with all freedoms we enjoy in this life, there is a price. The shoulder joint’s great mobility is countered by its very limited stability.

The shoulder’s lack of stability needn't concern us in our average day-to-day tasks. Protection to the joint is built-in by way of the rotator cuff muscles, which form a strong hood that envelops the intersection of the arm bone and shoulder blade. Falling on an outstretched arm may result in a dislocated shoulder, so we need to have some care in this regard.

If you’re a young athlete and have suffered a rotator cuff tear, surgery may be an appropriate option.¹ But for the vast majority of people, especially for those over age 40, most rotator cuff injuries are chronic rather than acute and can be treated with rest and rehabilitative exercise. Again, if you’re a 60-year-old skier who has torn his or her rotator cuff in a downhill accident, surgery could be indicated. For the rest of us, rehabilitative exercise is the key.^2,3

Four or five primary strength training exercises are involved in shoulder or rotator cuff rehabilitation. The three basic shoulder exercises are (1) seated overhead press, which trains all the shoulder girdle muscles simultaneously; (2) standing side [lateral] raise; and (3) seated or standing bent-over raise. The lateral raise specifically trains the middle deltoid muscle and the bent-over raise specifically trains the posterior deltoid muscle. Specific rotator cuff strength training exercises include internal rotation and external rotation on a flat bench using very light dumbbells. More painful injuries with greater loss of mobility may require (1) Codman pendulum exercises and (2) finger-walking (up a wall) to the front and to the side.

The goals of rotator cuff rehabilitation, as for any mechanical injury, include decreased inflammation, decreased pain, return to more full active range of motion, return to more full muscular strength, and restoration of function.

¹ Plate JF, et al: Rotator cuff injuries in professional and recreational athletes. J Surg Orthop Adv 22(2):134-142, 2013

² Escalmilla RF, et al: Optimal management of shoulder impingement syndrome. Open Access J Sports Med 5:13-24, 2014

³ McMahon PJ, et al: What Is the Prevalence of Senior-athlete Rotator Cuff Injuries and Are They Associated With Pain and Dysfunction? Clin Orthop Relat Res 2014 Mar 12. [Epub ahead of