Checkmate

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In chess, checkmate occurs when a player’s king is under attack and has no safe place to go. The king is threatened and every possible escape route is blocked. Such an existential condition, an allegorical “no exit,” is known as checkmate.

In life, a person may be similarly threatened by a serious illness. For example, a person may receive a diagnosis for which there is no effective long-term treatment. Short-term, temporary solutions may be available, but these usually require enormous expenditures of resources, both financial and personal. Most often, when the temporary fix has run its course, the illness persists and the long-term outlook remains the same. Optimally, we would prefer to avoid such medical “checks” and avoid being faced with an untimely “checkmate.” As in chess, obtaining success with respect to our health and well being depends in large part on having a sound strategy in place.

Successful chess players think several moves ahead. High-level chess players such as grand masters have the ability to envision combinations involving ten or more future moves. Fortunately, being successful at the game of promoting personal health and well being is much less complicated. There are only a few elements involved in developing a strategy that works.

These elements are well known and include (1) regular, vigorous exercise; (2) a healthy diet¹; (3) sufficient rest; and (4) a positive mental attitude. But despite being well known, only the minority of people actually implements these critical “moves.” The evidence for such lack of action may be seen in the United States, for example, where one-third of Americans are overweight and additional one-third are obese. Merely knowing something is not sufficient to obtain a result.

What is required is actual action.² In terms of exercise, evidence-based guidelines agree that 30 minutes of vigorous exercise, done five days a week, will provide a sound foundation for health. Optimally, such exercise consists of both cardiovascular and strength training sessions, but the most important point is to do five 30-minute sessions per week. With respect to diet, all the evidence affirms that men, women, and children should follow specific calorie-intake guidelines.³ For example, a moderately active man, aged 31-50, should consume, on average, 2500 calories per day. A moderately active woman, aged 31-50, should consume, on average, 2000 calories per day. A man intending to lose weight, and then maintain an ideal weight, should take in about 1800 calories per day. A woman intending to lose weight, and then maintain an ideal weight, should consume about 1600 calories per day. Regarding daily food intake, the most important rule to follow is to consume at least five portions of fresh fruits and vegetables per day. It is also important, on a daily basis, to eat foods from all the major food groups. In terms of rest, most people require seven to eight hours of sleep a night. This may not be possible every night, of course, but over time people need to obtain the right amount of rest for them. The criterion is simple: if you do not feel rested after a night’s sleep, then you did not obtain sufficient sleep. Obtaining sufficient rest is an often-neglected component of a well-rounded health and wellness strategy.

Our strategy for helping ensure our long-term health and wellness contains only a few components, and involves many less moves than does a winning chess strategy. It should be easy to put such a strategy into place. What is required is a commitment and dedication to ourselves, our families, and our loved ones.

¹Voeghtly LM, et al: Cardiometabolic risk reduction in an intensive cardiovascular health program. Nutr Metab Cardiovasc Dis 23(7):662-669, 2013
²Carson V, et al: A cross-sectional study of the environment, physical activity, and screen time among young children and their parents. BMC Public Health 2014 Jan 21;14:61. doi: 10.1186/1471-2458-14-61
³Wang YC, et al: Reaching the healthy people goals for reducing childhood obesity: closing the energy gap. Am J Prev Med 42(5):437-444, 2012

Entropy, the Gym, and You

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Let’s say you've been taking some time off from the gym. Maybe you reached the end of your 12-week training cycle and you’re taking a week off. It’s possible that one week turns into two or even three or four weeks. Life happens, you need to attend to some pressing matters, and going to the gym starts to take a back seat. Before you know it, two or three months have passed by. Suddenly, you’re no longer a person who goes to the gym, but a person who needs to figure out a way to get back to the gym on a regular basis. “What happened to me?” you wonder. “Where did the time go?” Now you have to actually exert effort to fit “workout time” into your schedule. You scratch your head and ponder. “I thought I had this all covered,” you think, not for the first time.

What happened to you and your well-made plans was entropy, that insidious force in the universe that turns order into disorder. The basic rule is that any organized system, left unattended, will immediately begin to break down. As a mundane example, those piles of papers on your desk keep reaccumulating as a result of entropy. The weeds in your garden? Entropy. The dust bunnies in your attic and basement? Entropy. The collapse of your plan for doing regular workouts? Entropy.

What’s worse, entropy takes a serious toll on your physical fitness.^1,2 If you miss enough time from the gym, all your fitness gains begin to melt away. First, your muscles begin to lose their stores of energy. Glycogen, the complex sugar that supplies energy for muscle work, is broken down for use elsewhere. Arterioles and capillaries, small blood vessels that were needed to supply nutrients to your growing muscles, are no longer required and rapidly disappear. Muscle fibers that were continually added to support your exercise activities are cannibalized, so that their constituent parts may be used for other physiological processes. Entropy launches a process of randomization that breaks down your carefully built-up muscular structure. Your body, being very smart, metaphorically swoops in and moves all those metabolic components to other structures and systems for more efficient use.

The superficial result is loss of muscle definition. The deeper result is loss of muscle tone.³ Your cardiorespiratory system (heart and lungs), digestive system, and metabolism are all affected, as these physiologic systems are no longer required to be functioning at peak to support a regular vigorous exercise program. Entropy sets in to all these systems, as well. The overall result is a profound impact on your health and well-being.

The good news is we can help keep entropy at bay. But doing so requires attention and determination. We want to attend to our bodies as carefully and regularly as we attend to the environment of our home, office, and garden. Just as our cars, motorcycles, and bicycles require periodic maintenance, our bodies require much more frequent care, care on a daily and weekly basis. It’s fine to occasionally skip a week or two, or even a month if needed, of exercise. But we must make sure we get right back on schedule to ensure benefits to our short-term and long-term health.

¹Barwais FA, et al: Physical activity, sedentary behavior and total wellness changes among sedentary adults: a 4-week randomized controlled trial. Health Qual Life Outcomes 2013 Oct 29;11:183. doi: 10.1186/1477-7525-11-183

²Loprinzi PD, Lee H: Rationale for promoting physical activity among cancer survivors: literature review and epidemiologic examination. Oncol Nurs Forum 2014 Mar 1;41(2):117-25. doi: 10.1188/14.ONF.117-125.

³Ricci-VItor AL, et al: Influence of the resistance training on heart rate variability, functional capacity and muscle strength in the chronic obstructive pulmonary disease. Eur J Phys Rehabil Med 49(6):793-801, 2013

Chiropractic Care, Your Nerve System, and Pain

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The experience of pain causes all sorts of unpleasant physical reactions. Tight muscles are one such response, and muscular tightness may progress to localized knots, known as trigger points, and even muscle spasm. These responses are never a good thing, and usually result in more widespread and more intense pain.

The solution to most types of musculoskeletal pain involves getting at the underlying cause of the problem. Often, the underlying cause is biomechanical. Neck pain or low back pain, for example, frequently results from a lack of full mobility of spinal vertebra's and the resulting irritation and inflammation of spinal muscles and spinal ligaments. Bigger problems may ensue when this irritation and inflammation begins to affect spinal nerves. Nerve inflammation may then involve other tissues and organs, with subsequent development of various symptoms and disorders.

By addressing the underlying cause of biomechanical pain, regular chiropractic care helps restore maximum function to both your spinal column and your spinal nerves. The long-term result is enhanced health and well being for you and your family.

Making Sense of Guidelines for Care

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Not too long ago, the Eighth Joint National Committee (originally commissioned by the National Heart, Lung, and Blood Institute) released a new set of evidence-based guidelines for evaluation and treatment of hypertension (high blood pressure). The guidelines committee, comprised of 17 academics, spent five years reviewing evidence as preparation for developing the new recommendations.

The committee’s report represents nothing less than a sea change in the treatment of patients with higher-than-normal blood pressure readings. The primary shift is from a long-held standard of implementing treatment when a person’s blood pressure is higher than 140/90 mmHg. The new guidelines recommend beginning treatment only when blood pressure readings are higher than 150/90 mmHg. The new standard is a huge modification of decades-old practice methods, and has generated substantial controversy.^1.2 Of course, a good portion of the pushback is from those who have a vested interest in maintaining the status quo, such as physicians who dispense medications from their office and earn substantial income from selling antihypertensive drugs at multiples of their wholesale costs. In addition to physicians who act as pharmacies, drug companies who manufacture antihypertensive medications also stand to lose significant revenue. But aside from considerations related to the practice of medicine as a business, the real issues should be focused on the benefits and harms to patients. In this context, it may be reasonably stated that fewer medications are, by and large, a good thing.

The new blood pressure guidelines have two primary impacts. First, for people over age 60, treatment for presumed hypertension should be initiated when blood pressure readings are higher than 150/90 mm/Hg. More than 7.4 million Americans over age 60 will be in the new safe range. Many of these millions of people have been taking antihypertensive medication for years, possibly needlessly as implied by the new guidelines. Next, for all those under age 60, there is insufficient medical evidence that a systolic blood pressure (the first number in the reading) threshold exists that would dictate treatment. In other words, for many years the systolic threshold had been 140 (as in 140/90 mmHg). Higher systolic readings virtually mandated antihypertensive treatment. Although the committee expressed its opinion that the systolic threshold of 140 mmHg ought to be maintained for those younger than age 60, even though evidence for such a threshold is weak. Thus, it may be that many millions more people have been taking antihypertensive medication without such recommendations being backed by sound scientific research.

The point here is not that people should stop taking their blood pressure medication.³ All such types of decisions should be made in consultation with the prescribing physician. The main consideration is having the ability to make informed choices. Some medication regimens may be appropriate. Some may not. Some may need to be reevaluated. As always, regular chiropractic care is of value by providing you with the best opportunity to achieve maximum good health.

¹Mitka M:Groups spar over new hypertension guidelines. JAMA 311(7):663-664, 2014
²Kieldsen SE, et al: Hypertension management by practice guidelines. Blood Press 23(1):1-2, 2014
³Sheppard JP, et al: Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study. Br J Pract 2014, Jan;64(618):e38-46.

The Best Treatment for Trigger Points

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Trigger points are painful nodules in muscular tissue, commonly found in the upper back, low back, and gluteal muscles. Trigger points are frequently chronic, persisting from day to day without much relief. When someone says, “My muscles are all in knots”, those knots are most likely trigger points.

The formal definition of a trigger point describes a localized region of tenderness, located in a tight band of muscle, which is associated with a palpable twitch in response to deep pressure over the tight band.¹ Such deep pressure usually results in pain radiating from the trigger point to the surrounding soft tissues. Formally, if the twitch response is not present, the localized muscle tightness cannot accurately be termed a trigger point. It may also be argued that characterizing a local muscle “knot” as a trigger point requires the presence of the above mentioned radiating pain. These definitions are of importance when making decisions about appropriate care for painful muscle knots.

As with any care management decision-making process, some procedures make sense and others do not. Many so-called pain management physicians will recommend injecting painful trigger points with an anesthetic or even botulinum toxin.^2,3 Such an invasive procedure is rarely required. Pain management practitioners and even specialists in internal medicine will recommend muscle relaxers such as Robaxin, Flexeril, or even Soma in attempts to diminish muscular pain in the shoulders or low back that may or may not be associated with the presence of trigger points. The problem with such medications is they do not address the underlying cause of the painful muscle knots. Further, their efficacy with respect to muscular pain is questionable.

The mistake, as is frequently the case, is in thinking of trigger points as a real entity. But trigger points do not exist in a vacuum. These painful muscle knots arise as a consequence of mechanical disturbances and stress in the rest of the body. Attempting to treat the trigger points themselves with injections or medications misses the real problem. Trigger points have arisen in a person’s shoulders or low back owing to chronic issues elsewhere, typically involving the spinal column itself and the small muscles that enable those vertebras to move in three-dimensional space.

Trigger points are best managed by directing care to the underlying issues, primarily involving loss of full mobility of spinal vertebras and resultant inflammation in spinal muscles. As with many other biomechanical problems, chiropractic care is often the best solution. By utilizing a specific, highly targeted, noninvasive approach, chiropractic care helps alleviate the factors that have led to the painful muscle spasms known as trigger points. As the underlying biomechanics improve, the trigger points themselves begin to resolve, all without the need for injections or medications.

¹Fernández-de-las-Peñas C, Dommerholt J: Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep 16(1):395, 2014
²Kim SA, et al: Ischemic compression after trigger point injection affect the treatment of myofascial trigger points. Ann Rehabil Med 37(4):541-546, 2013
³Zhou JY, Wang D: An update on botulinum toxin a injections of trigger points for myofascial pain. Curr Pain Headache Rep 18(1):386, 2014

Office Chair Advice

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For most people, it is quite a challenge to maintain good posture while sitting in an office chair and working for long hours in front of a computer. In fact, a surprising number of people sit at the front of their office chair and hunch forward in attempt to get closer to their computer screen. The computer is a very potent 'consciousness absorbing' device - it takes the mind away from the body and keeps it focused on what's on the screen instead.
This article reviews a simple, practical way to counteract this tendency to hunch forward and instead improve posture by keeping the body anchored to the back of the office chair.

Upright Posture

Both the abdominal muscles in the front of the spine and the back muscles in the back of the spine work to hold the body erect, like two elastic band positioned on either side of the spine. Forward leaning posture - hunching forward while sitting in an office chair - distorts this balancing system and places considerable strain on the back.
To illustrate the amount of strain on the back, think of the example of balancing a stationary motorcycle upright so that it doesn't tip over. If the motorcycle is properly balanced it can be held upright easily with one hand. Similarly, when one sits upright in an office chair, the abdominal and back muscles work in unison to maintain an erect posture with only minimal effort.
However, if the motorcycle leans over a bit there is a significant difference in the amount of effort it takes to keep the bike from falling over to the ground. The more the motorcycle leans, the more effort is needed to keep it from falling over. Similarly, when people hunch forward while sitting on an office chair their back muscles have to work much harder to hold the body up and keep it from falling forward.
Simply put, leaning forward 30 degrees in an attempt to get closer to the computer screen puts 3 to 4 times more strain on the back, causing advanced wear and tear on the joint surfaces, the ligaments of the spine, and the discs located between the vertebrae. The back muscles are also negatively affected as the continuous added strain causes them to tighten up, reducing optimal blood and nutrient flow to the back muscles. Over time this posture leads to the development of tight, rigid muscles and joints, which makes them more prone to injury.
One of the biggest misconceptions with sitting is that it doesn't require any muscular effort. This is absolutely false. The back muscles are continuously working to maintain the body in an upright posture while sitting. And for those who sit in an office chair and work for longs periods of time at a computer in a hunched forward posture, the structures in the back suffer considerable pain.

Technique to Avoid Hunching While Sitting in an Office Chair

To avoid the natural tendency to hunch forward while sitting in an office chair and working at a computer, this simple technique is fool-proof. Place a tennis ball between the middle back and the office chair on each side of the spine. Holding the tennis ball (or similar ball) in place while sitting and working at a computer accomplishes three things:

• Because the mind senses the ball, it remains with the body instead of being completely absorbed by what is on the computer screen. Maintaining more awareness of the body allows one to more easily maintain better posture.
• By leaning back into the tennis ball an acupressure effect is created, which stimulates blood flow into the area and physically releases contracted muscle and connective tissue. The pressure of the ball also creates a central nervous system mediated analgesic effect that is somewhat similar to acupuncture, loosening tight areas while sitting in the office chair and getting work done.
• Importantly, if one does get absorbed into work and starts to lean forward the tennis ball will fall out, serving as a concrete reminder to stop hunching forward and straining the back.

Please note that the above technique and the advice provided cost next to nothing, have no adverse side effects, and are quite easy to do. 

Healthy Backs and Regular Chiropractic Care

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Regular chiropractic care helps your body function at peak capacity. Your body is a dynamic structure and, as in all finely crafted machines, it's possible for subtle things to go wrong. The problem, of course, is that as these problems are subtle we don't know about them until, in a sense, it's too late. Too late, that is, from the point of view of how long it may take to get better now that the problem's been going on for some time.

By receiving regular chiropractic care you're helping to nip various physical problems in the bud. For example, low back stiffness, which if left unattended might develop into a mechanical problem and ultimately a herniated lumbar disc, is identified at the outset and lessened or resolved by regular chiropractic care. By helping you improve your overall health and well-being, regular chiropractic care is a modern implementation of the old proverb, "an ounce of prevention is worth a pound of cure".