Chronic pain can be scary. Just the names alone are frightening - degenerative disc disease, spinal stenosis, fibromyalgia, ankylosing spondylitis, osteoarthritis, thoracic outlet syndrome, and spondylolisthesis among many others. The prognosis can be even more scary - most chronic pain diagnoses are considered "progressive", meaning they will only get worse over time - it's like a never ending horror film! Pharmaceutical drugs can offer temporary relief from symptoms, but do nothing about fixing the problem and the side effects of long-term use are frightening. Many chronic pain symptoms are eventually treated with surgery, but outcomes are spooky with many showing little long-term pain relief and most treating symptoms that often reappear over time requiring repeated surgeries. 

Statistics on chronic pain in America will send chills down your spine:

• 100 million Americans suffer from chronic pain
• Annual cost of healthcare due to pain ranges from $560-635 billion
• Back pain is the leading cause of disability in Americans under 45 years old
• Over half of chronic pain sufferers feel they have little or no control over their pain
• Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008 (3 times more than the 4,000 killed in 1999)
• From 2002-2007 the rate of complex surgery for spinal stenosis rose 15-fold and is reportedly more closely tied to money rather than outcomes

Even with all these ghoulish facts, I do not believe chronic pain has to scare you. Halloween is about tricks and treats, so let's look at the sweeter side of chronic pain:

• None of the chronic pain names above are actual diseases you can catch from someone else, they are merely names given to conditions, and conditions can change
• Conditions are considered progressive because that is what is normally seen because most people only treat symptoms not causes
• All of these conditions have to do with improper functioning of the musculoskeletal system which can be improved
• Your body is a living organism that is constantly rebuilding itself and healing can occur

I have personally seen clients with each of these seemingly progressive disorders go from having chronic pain to significantly less pain or even no pain. I have seen clients who were on 20 plus drugs for their condition become drug-free and pain-free. I have seen clients - who were told by several doctors that surgery is their only hope - avoid surgery and become pain free. How did they do it?

First by not being scared. Not being scared into thinking there is nothing they can do. Not being scared into thinking it will only get worse. Not being scared into aggressive or invasive procedures before trying simple common sense approaches first. Not being scared to voice their opinion and listen to their intuition and instincts. 

Second, they decided that this is their body and they should take full responsibility for their health. They decided that since they got themselves into this condition, they can get themselves out of it. As Pete Egoscue said in his book "The Egoscue Method of Health Through Motion": 

Every musculoskeletal disorder that leads to chronic pain is caused by something, and very often that something is simple postural imbalances we have developed throughout our lives. Degeneration of the spinal discs is caused by a loss of hip function, proper spinal movement, and a functional shoulder girdle which all lead to increases pressure, stress, and wear-and-tear on the intervertebral discs. Years of the dysfunctional posture and movement leads to the eventual diagnosis of "degenerative disc disease". Drugs, surgery and chronic pain can often be avoided by ignoring the symptoms and treating the underlying cause: postural imbalances. 

Postural Alignment Therapy is highly effective at correcting muscular imbalances, restoring functional joint movement, and relieving pain but it takes time, effort, and hard work on the part of the individual. Postural imbalances that cause chronic pain conditions take years to develop and will take weeks, months, and sometimes years to correct. But it can be done. 

This Halloween you have a choice, let chronic pain scare you or treat yourself to the joy of a fully functioning and healthy body for years to come. 

The human foot is amazing! The foot is an intricate structure, with each of your feet containing 26 bones, 107 ligaments, 19 muscles, 3 strong arches, 125,000 sweat glands, and over 100,000 nerve endings.

If Leonardo da Vinci was right that the human foot is a masterpiece of engineering, why do foot problems effect millions of Americans each year?

75% of Americans will suffer foot problems during their lifetime and Americans visit podiatrists over 60 million times a year for foot ailments. 

Common foot problems include: bunions, hammer toes, neuromas, tailor's bunions, crooked toes, ingrown toenails, corns, plantar fasciitis or fasciosis, achilles tendinitis, metatarsalgia, and arthritis. 

Many of these problems are blamed on having flat feet or high arches which can then cause overpronation or underpronation (supination). What causes flat feet and pronation or high arches and underpronation/supination? 

First let's figure out what your feet are doing right now...
Self Test:

1. Take your shoes and socks off and stand up on a hard surface in a natural and relaxed position. 
2. Close your eyes and feel where the weight is distributed in your feet. Is there more weight in one foot than the other? Is your weight toward the inside or outside of your feet? Does your weight rest in your heels or towards the front of your feet? What is different left to right?
3. Now open your eyes and look down at your feet. Are they straight or turned out? Is one foot more turned out than the other? Is one foot in front of the other? How far apart are your feet from each other?
4. Lastly take a walk down and back in a hallway several times and try to get in touch with your foot strike. Don't change anything, but notice what part of your foot hits the ground first, where does the weight roll through, and where does the push-off come from? Notice what is different in your right foot than your left.

Now that you know what your feet are doing, let's see how they compare to what's anatomically and biomechanically normal. Your weight should be evenly balanced left to right 50-50, evenly balanced from inside to outside, and evenly balanced front to back with slightly more weight toward the balls of your feet. Your feet are designed to be parallel and pointed straight ahead and about 5 inches apart allowing them to sit directly under your hip joints. During walking gait, we are designed to land on the center back of the heel, roll straight through to the ball of your foot and push off all five toes. 

If your weight wasn't perfectly balanced and your feet were not perfectly aligned, what is causing the imbalance? Most people assume it's a foot problem which causes people to start searching for a foot solution like different shoes, orthotics, and foot surgery. While shoes can have a big impact on foot shape and function and orthotics and surgery have their place, most people overlook the most basic and easy cause of foot problems and imbalances...postural alignment of the rest of the body. 

We all know that the foot bone's connected to the ankle bone and the ankle bone is connected to the shin bone but when faced with a foot problem we usually don't look higher than the ankle. What if your shoulder position was effecting your feet and causing your foot pain? It's possible, lets test it out.

Self Test #2:

1. Stand up on the same hard surface as a minute ago with bare feet. Interlace your fingers together and put them behind your head with your elbows out to the sides. Pull your elbows back and hold this position.
2. Close your eyes and feel where your weight is in your feet again. Front to back? Left to right? Inside to outside? Now compare the weight distribution you feel now with your hands behind your head to the weight distribution you felt with your arms relaxed at your sides. What's different? What has changed? 
3. Keeping your hands behind your head and elbows pulled back, take a walk down and back in your hallway again several times and sense your foot strike. How does your foot strike compare with your hands behind your head to when your arms were relaxed? 
4. How is your pain? If your feet hurt standing or walking earlier, what has changed with your hands behind your head in this second test? What is different? 

Most people will feel that their weight is more evenly distributed when standing with their hands behind their head and elbows pulled back than when their arms were relaxed. And while walking those same people will often be able to feel that they roll straight through their foot and push off all five toes more equally in the second test. Many people will also notice that their feet hurt less in the second test and are amazed that putting their hands behind their head could decrease their pain. 

What does this tell us? First, your feet and what they do are very related to your shoulders and the position they are in. By putting your hands behind your head and pulling your elbows back you were able to create a more symmetrical upper body posture and improve your vertical loading (head sitting directly on top of your shoulders, hips, knees and ankles from the side) which changes how your feet interact with the floor. Second, trying to correct "foot problems" by only looking at your feet (or shoes) and not your entire body will not be successful longterm. You must treat the body as a unit and correct postural and movement imbalances up and down your whole body if you want to take stress off your feet and allow them to function the way they are designed. Third, if your pain did decrease with the second test, this shows you that your pain is not because of something "wrong with" or "broken" in your feet but rather because of bad posture (especially upper body posture). 

Your feet being a "masterpiece of engineering" as Leonardo da Vinci says, are only a masterpiece when your entire body is posturally aligned as it is designed. Postural imbalances do to the "masterpiece" of your feet what throwing a bucket of paint on the Mona Lisa does to one of Leonardo da Vinci's greatest masterpieces. Luckily for you, correcting postural imbalances is a lot easier than removing the splattered paint from the Mona Lisa!

When you can correct your posture and return your shoulders and upper back into their functional position, you are giving your feet a chance to function they way they are designed to. This can eliminate pain, speed healing of injuries, decrease your chance of future injury or pain, and help improve performance.  When you correct your posture, your feet - those masterpieces of engineering - can work as they were designed. 

Note: Walking with your hands behind your head is only a test to let you feel and experience how upper body posture is related to foot function. For a longterm cure to upper body posture issues and foot pain and foot dysfunction contact us today for a free consultation where we can determine the right postural alignment therapy option for you and set you up with a personalized program.

High school sports are entering the playoff season, the World Series is in full tilt, the Portland Timbers are heading into the playoffs with the #1 seed in the Western Conference, the Oregon Ducks Football team ranked #2, and the NBA season starting. Sports and sports injuries are at the top of many peoples minds. Are sports inherently dangerous and are injuries inevitable? If so, the sports we play are to blame for the injuries and pain. 

I think, if we take concussions in football out of the picture, most sports are not inherently dangerous, injuries should not be the expected norm, and sports are not to blame for injuries. I think the human body is designed perfectly for running,  kicking, swinging, throwing, twisting, turning, cutting, jumping and falling. I believe the human body is designed to withstand the demands of sports and most injuries are avoidable. 

Injuries happen when the athletes body is not working the way it was designed to work. When an athletes body is posturally aligned injuries are rare, but when an athlete has lost postural balance, injuries are inevitable. It's like using a knife to drive in a screw. The knife will quickly break because it's not designed to do the job of a screwdriver. We don't blame the knife. We don't blame the screw. We blame the user who isn't using the knife as it was intended. When a knee joint is out of alignment the muscles that are designed to support it cannot do their job, the ligaments are strained and twisted, and this means the knee is very unstable and an ACL injury is waiting to happen. We don't blame soccer or football for the ACL injury, we blame the misaligned posture. When a shoulder is rounded forward and down limiting scapular rotation, and then asked to make hundreds of throws, the rotator cuff tendons, cartilage, and shoulder ligaments are put under much more stress than they are designed to handle and injury is common. Baseball or football is not to blame, the faulty shoulder position and poor posture are to blame. 

Your body is designed to line up posturally as shown in the correct functional alignment on the left. All eight major load joints (ankles, knees, hips, shoulders) are vertically and horizontally aligned and balanced. When your bones are in this alignment your joints are able to move through their full range of motion unimpeded and muscles, tendons, and ligaments can move and stabilize your joints through every movement needed in sports. 

But if you have dysfunctional alignment as shown in the righthand picture, where your joints are not aligned vertically or horizontally as designed, your joints cannot move through their full range of motion without creating strain, stress, and wear-and-tear on cartilage, ligaments, tendons and muscles. Taking this misaligned posture to soccer, football, baseball, basketball or any other sport will result in pain and injury along with decreased performance because of the inefficiency of misaligned posture. 

Correcting posture, restoring joint position, and strengthening muscle imbalances will allow current injuries to heal faster and help prevent future injuries. Maintaining a balanced posture will allow you to stay in the game and continue to enjoy what you love for years to come. 

Tennis Elbow or Lateral Epicondylitis is defined as an overload or overuse injury causing inflammation of the extensor tendons of the forearm that attached to the outside of the elbow (used for wrist extension during a backhand stroke). When the condition exists chronically it can lead to degenerative changes at the elbow. 

The pain associated with tennis elbow shows up on the outside of the elbow near the bone (lateral epicondyle) where the extensor muscles attach and can be felt when gripping something, shaking hands, or extending the wrist. The pain is often blamed on the Extensor Carpi Radialis Brevis (ECRB) but is a symptom of a much larger problem than weakness or overuse of the extensor muscles. 

The typical treatments of rest, ice, and anti-inflammatories might help relieve the symptom, but are doing nothing about the cause of the pain.

Tennis elbow effects about 40% of tennis players some time in their life but only 1 in 20 people with tennis elbow play tennis. Tennis elbow is much more likely to effect recreational players than professionals and is most common in the 40-60 year old age range. These statistics tell us there must be something else causing tennis elbow than just playing tennis and the term "overuse" must not be the whole story. 

What advantage do professional tennis players have over your average recreational player? First professional tennis players spend their entire day doing what it takes to play tennis at the highest level. This includes doing strength training exercises and stretching and range of motion movements that together keep their bodies fairly functional, flexible, and strong allowing their bodies to handle the demands of the sport. They also play tennis daily for many hours and pay particular attention to their technique which trains their body to move in an efficient and smooth way on the court. 

The average recreational player is a lot less flexible than most professional players as Novak Djokovic and Maria Sharapova.

Professional tennis players tend to be a lot stronger than weekend warriors as seen in Serena Williams and Rafael Nadal.

In this amazing 54 shot rally between Rafael Nadal and Novak Djokovic shows the fitness, athleticism and endurance most professionals have:

Because typical recreational tennis players do not have the flexibility, strength and fitness of professional tennis players this causes their extensor muscles and tendons to often get overworked because their shoulder doesn't have the function to help support the elbow, wrist, and hand in the tennis stroke. The cause of tennis elbow has more to do with your shoulder position and function than your elbow. When your shoulder is out of postural position it starts to lose it's natural range of motion and intrinsic strength and the inability for your shoulder to do it's job creates excessive stress on your elbow and the muscles of the forearms. 

Self Test:
You can do a simple self test of shoulder position by standing in front of a mirror with your arms in a relaxed position. Here are several thing to look for:

1. Are your hands hanging in front of your body rather than on the sides of your body? This would mean your shoulders are rounded forward. 
2. Do you see the back of your hands in the mirror instead of your thumb and index fingers only? If so, your arms are in an internally rotated position.
3. Is one hand or shoulder lower than the other? Often your right arm will be lower if you are right handed (and left lower if you're left handed) and this means you have developed imbalances between the right and left side of your body.

If you found any of these imbalances in your posture it means you have shoulder dysfunction that is not allowing your shoulder(s) to do their job while playing tennis (or doing anything else) and this can lead to increased work demand and stress put on your elbow, wrist and hands. 

Correcting your shoulder position through Postural Alignment Therapy will allow your shoulder to do it's job correctly and allow your tennis elbow to heal and you to play pain free again. 

Aging is associated with many chronic things in our society: chronic pain, chronic inflammation, chronic sleep problems, chronic constipation, chronic heart disease, chronic respiratory infections, chronic muscle and bone loss, chronic balance issues, etc. Everyone would agree that none of these chronic things are a good thing (what causes them is another discussion all together). But there is one chronic thing that has amazing benefits for aging people...chronic exercise.

Most research on aging has been done on sedentary populations and so the results of most studies up to date have shown that "normal aging" causes muscle mass and strength to decline. But what if we looked at active older people? Would we still see the normal loss of muscle size and strength from age 40 to 70? 

Researchers decided to do just this and look at an active population of men and women between 40 and 80 years old and measure their muscle mass and muscle strength. The results show that chronic exercise can have amazing benefits for older people and even completely stopping and possibly reversing muscle mass and strength normally associated with aging. 

As they say, a photo is worth a thousand words:

The authors of the study discuss the results of their study:

This study shows us that aging is not to blame for loss of muscle mass and strength and if we stay chronically active we can maintain our strength even into our 70s and 80s. If you have pain with exercise, remember it also is not because of age or wear-and-tear, but rather imbalances in your movement patterns, function and posture which can be corrected. Correcting your musculoskeletal imbalances and balancing your posture will allow you to continue to exercise and stay active and thus maintain your muscle strength as you age. 

https://physsportsmed.org/sites/default/files/rpsm.2011.09.1933_secure.pdf

Choosing Wisely® is an initiative from the American Board of Internal Medicine Foundation that aims to promote conversations between physicians and patients by helping patients choose care that is:

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary

Choosing Wisely has lists of recommendations from The American College of Physicians, The American Academy of Orthopedic Surgeons, Society for Vascular Medicine, and the North American Spine Society among 34 others about "The five things physicians and patients should questions" regarding that speciality. 

The website also has 34 patient friendly resources on topics like when you need imaging and when it's a bad idea, what treatments are most effective, and what tests you should or should not get and why. 

I want to build my own lists for people suffering from chronic musculoskeletal pain that would like to eliminate their pain for good, return to an active lifestyle and maximize their physical health.

Five things to avoid if you want to live a pain free & active life: 

1. Avoid treating your symptoms - Any treatment that focuses on your symptoms alone is never going to lead to long-term pain relief and can give you a false sense of wellness that can lead to more injury and pain.
2. Avoid rest - Yes there are times when your body needs rest, but rest as a stand alone treatment is never as good as the appropriate amount of rest and active recovery. There are studies that show people who start loading their sprained ankle sooner get better faster, people suffering with osteoarthritis report less pain with regular exercise, and after any joint surgery active range of motion and movement speed recovery time.
3. Avoid pushing through the pain - Pushing through the pain is never a good idea because pain is a message from your body that is trying to tell you that something is not working the way it is supposed to and continuing to push through the pain will only lead to more injury and disability.
4. Avoid giving up - Giving up the painful activity (like golf, tennis, or running) or giving  up on yourself (thinking you'll never get better or find a cure) is taking you further away from living a pain free and active life. 
5. Avoid blaming - Avoid blaming your age, genetics, an accident, past treatment or doctor for your pain. That will only lead to frustration, anger, or depression because you can't do anything about those things and blaming will leave you hopeless. 

Five things to do if you want to live a pain free & active life:

1. Believe you will get pain free - Trusting that there is an answer to your pain and that you will find it will allow you to continue searching until you find the answer. 
2. Remember to move - Keeping moving is one of the most important things to do if you want to be pain free. Whether you love to dance, run, garden, swim or play sports, it is important to move every day and in a variety of ways to keep your muscles, joints, heart and lungs healthy. 
3. Do your e-cise menu daily - Doing your e-cise menu daily is the best way to keep your posture aligned and body functioning at its best. Realigning your posture will decrease negative stress on your muscles, joints and nerves and allow your body to heal itself.
4. Do the Egoscue Tower - Doing the Supine Groin Progressive in the Tower is one of the best ways to keep every joint aligned and every muscle balanced at its optimal length and tension. The Tower can play a key role in alleviating pain associated with: migraine headaches, degenerative joints, achilles tendonitis, rotator cuff injuries, and disc herniations. 
5. Have fun - Having fun and playing is what motivates children to move and all the movement they do daily is what keeps them flexible, strong, agile, and energetic. Following the example of children and finding a way to make movement and exercise fun and playful will keep us pain free and active for years to come. 

Postural Alignment Therapy is based on the idea that our bodies are designed with a certain structure and function that we all share and if/when this structure and function is compromised it will lead to pain, injury, and limitations. Postural Alignment Therapy is founded on the Egoscue Method® by Pete Egoscue who describes the human body has having 8 major load joints (2 ankles, 2 knees, 2 hips, and 2 shoulders) that are designed to line up vertically and horizontally as seen in the images at left. These 8 joints form the support structure that give us strength, durability, balance, and great mobility allowing us to run, jump, twist, turn, and throw. When we lose the balanced and upright position of these joints we put ourselves at increased risk of injury, pain, and disability. Postural Alignment Therapy is designed to bring the joints, spine, and body back into alignment and perfect posture. When the body is restored to its design posture injuries heal, pain disappears, and health, mobility, and joy return. 

There are many benefits of Postural Alignment Therapy that include:

1. Decreased musculoskeletal pain
2. Improved posture
3. Decreased chance of injury
4. Improved sports performance
5. Better flexibility
6. More energy
7. Better balance
8. Improved breathing
   
9. Increased strength
10. Heightened kinesthetic sense
11. Improved digestion
    
12. Improved mood
13. Improved joint health
14. Increased bone density
15. Improved immune system function
16. Improved core strength
17. Decrease in physical limitations
18. Increased self-esteem/self-confidence 
19. Feeling of getting younger not older
20. Peace of mind

These benefits are available to everyone who participates in Postural Alignment Therapy, but when and how each individual will experience these benefits will differ depending on the individual. The longer you practice Postural Alignment Therapy, the more benefits you will notice and experience as the effects of correcting posture and restoring function are cumulative. 

Running is tough on the body with the constant pounding that goes straight to your joints. Running mile after mile year after year causes wear and tear on your knees and leads to arthritis. Right? Maybe not according to research over the last couple years. To understand why runners don't get knee arthritis, lets first do a quick knee anatomy and function review...

Your knee joint can look very complex but is actually very simple in it's function and response to movement and environment. Your knee joint is a hinge joint, like a door hinge, and is designed to open and close (flex and extend). The knee joint is the meeting of your femur and its two femoral condyles with your tibia and its two tibial plateaus and the sliding of your patella in the femoral patellar groove. 

Your knee joint is a synovial joint which consists of a synovial membrane that surrounds the joint allowing your knee to be bathed in synovial fluid. Synovial fluid plays three main rolls for your knee joint:

• reduces friction
• absorbs shock
• supplies nutrients and carries away waste products

The bony surfaces inside your knee joint are covered with hyaline cartilage which ensures smooth movement by decreasing friction and fibrous cartilage (the meniscus) which helps deepen the tibial sockets and play a role in shock absorption. 

Knee injuries including cartilage tears (meniscus tears) and damage (arthritis) are common and often blamed on "wear and tear over time." Basically people are saying your knee will wear out like your car tires after so many miles. There is a major flaw with this line of thinking because the last time I looked my car tires are made up of rubber (i.e. a non-living substance) and my knees are made of many types of cells (all living). Living cells grow, divide, die and respond to their environment like all living things and the cells inside our knees are no different. 

Let's say you decide to start lifting weights several times a week for the next year. Then we compare your muscles of today with your muscles of next year, what changed? They are bigger! Why? Because they are responded in a positive way to the stimulus given to them, it's what our bodies do naturally and automatically. 

Let's say instead of lifting weights you decided to start running several times a week for the next year. Then we compare your knee cartilage of today with your cartilage of next year, what changed? 

Many people will say knees are damaged from the "pounding" and "wear and tear" and if you keep up your running eventually you'll end up with arthritic knees and probably need a knee replacement. But science is starting to tell us otherwise and has shown that runners have healthier knees (than non-runners), long distance running does not damage knees, running conditions the cartilage for load, and running decreases the incidence of knee arthritis. 

Why running is beneficial to cartilage in the knees was also discussed in a recent New York Times article "Why runners don't get knee arthritis" by Gretchen Reynolds: 

For me, all of this comes back to common sense: your body will respond and adapt to the environment and stresses put on it. You lift weights your muscles get bigger and stronger, you jump up and down and your bones get denser, you run and your knee cartilage gets denser, more resilient, and stronger. 

It's so easy to forget how amazing our human body is and how perfectly designed it is. Happy running!

Today October 9th, 2013 is National Walk to School Day across the United States and October is International Walk to School month with over 40 countries and millions of students participating. 

Walking is great for kids as it boosts mood, reduces stress, improves creativity, decreases restlessness in class, improves attention, and increases retention of material. Nine out of ten teachers report that students are much more ready to learn when they've walked to school. Walking also provides much needed physical activity for kids who typically are spending more and more time with electronics and less and less time outside playing and getting exercise. 

National Walk to School Day is a great way to learn how easy and fun it is to walk to school and will hopefully encourage a larger number of kids and parents to walk to school year round. If walking to school on a regular basis isn't an option, go for a family walk before or after dinner. It will not only help give everyone in the family much needed physical activity but also is a great time to talk and hang out as a family - just make sure to leave the cell phones at home!

Interesting facts about walking:

• Most healthy adults naturally select a walking pace of approximately 2.8 miles per hour
• Fat is the primary fuel source for speeds up to about 2.8mph
• 2.8 mph is the most efficient walking speed for the average adult
• Heart rate while walking often closely matches steps per minute
• Walking speed in people over 65 years old is a powerful predictor of life expectancy
• Your joints experience the same load whether you walk or run the same distance