After the First Visit…

My guide for how to live healthy in an unhealthy environment

Workplace Ergonomics

Nothing is ideal when it comes to a stationary workplace setup because the human body is designed to move. That being said, having the monitor at eye level, feet able to be planted on the floor, a comfortable chair with a high cushion, and wrist support with a 90-degree elbow angle is “ideal”.

Standing desks are fine, but can sometimes make low back pain worse. The best advice I could give is to take breaks as often as possible and move your body. 

Posture  

Perfect posture is more of a social and emotional issue than a musculoskeletal health issue, meaning that how we carry ourselves is more of a reflection of how we feel about ourselves than how well our bodies perform. Many Olympic athletes have abnormal spines, arm length, and other issues that propel them forward and give them an advantage. 

In some cases, posture can affect the gravitational load of certain parts of your spine, leading to more issues—but more often than not our concern with posture is based on the way we look. The true goal when it comes to posture is to be able to get in and out of different postures and to not be stuck in a particular one 

Sleep

The amount of sleep you get per night is more important than sleep posture. If you’re waking up in the morning with back pain, your mattress could be the issue. In general, getting a medium-firm mattress is recommended. Too soft or too hard tends to put too much stress on your body. Here are two highly rated options.

https://helixsleep.com/collections/standar

https://purple.com/mattresses/plus

If your pillow hasn’t been updated in a while, my best recommendation is a pillow that has adjustable levels of support.    

https://coophomegoods.com/products/the-original-pillow

If you’re waking up and your body feels really stiff, it’s a sign of overuse or underuse of your muscles. 

Shoes

Shoes are complicated. Wear patterns, width, size, weight difference, arch are different for everyone. Finding your perfect shoe is important, and I suggest going to a place that can help you navigate the many choices available. Here is a suggestion for a store that is pretty close to my office.

https://stores.roadrunnersports.com/

Exercise

The best exercise is the one that you enjoy doing. If you’re not ready to jump into a gym, getting 8-10 thousand steps per day or increasing your total activity reduces pain and increases systemic function. It also has numerous benefits for inflammation and mental health.

If you are ready to hit the gym, start slow and make sure to document your progress. You might feel more uncomfortable and sore when you start out. That’s not a reason to give up, and that’s why I’m here to keep you moving forward. 

Group classes (HIIT, boot camps, etc) are okay but you need to advocate for what feels good and what doesn’t. Having modifications and progressions while you build up is a good idea to avoid early injury. I find a lot of people push themselves in a group environment. That’s great, but if you’re in the early stages of healing you can have a flare-up.

Food

I don’t recommend a specific diet, however depending on your situation, certain diets may be more beneficial short term. One big distinction I need to make is that weight loss is not the same as being healthy. If your goal is weight loss, a caloric deficit, stress and sleep management, and moderate exercise are the keys.  As a rule, consuming more protein is the best way to start. For more general advice, here’s a list of common diets and their benefits:

• Paleo – Cutting out overprocessed and refined foods is generally going to help a wide variety of people get more from their diet. Paleo seems to be sustainable and can be done long term.

• Keto – Keto can be beneficial for autoimmune disorders and quick weight loss in terms of water weight.  It is considered to be unsustainable due to logistics, but it also can cause constipation and dehydration. The first week can cause flu like symptoms.

• Intermittent Fasting – I recommend this approach for people with impulse control with food or who have trouble making healthy choices. Start at 16 hours fasting and 8 hours eating. Your first meal should be high in protein.

• Mediterranean diet – This is probably the most balanced and science-backed diet for overall health.

• Alkaline diet – This is very similar to the Mediterranean diet. It would be my top recommendation for people with type 2 diabetes.

Stress Management

Firstly, we need to define what kind of stress we are talking about. When speaking about stress, I’m referring to the negative cyclical chronic aspects of stress: the daily gnawing things that bother us, lead to anxiousness, and increase our sensitivity to everything in our environment, including pain.

If your stress is as simple as removal of the stressor, then take small gradual steps toward that. Here are some examples:

1. Having a resignation email written out to be sent 6 months from now

2. Start writing down a budget with a goal of saving 10% per year

3. Start setting boundaries with family members that overstep

If it’s not that simple—which it usually isn’t—having more things in your toolbox for self management is key. When you’re feeling overwhelmed in the moment, I recommend do this 5 times:

Breathe in 90% and then a second breath in to 100% as quickly as possible. Exhale slowly over the course of 10 seconds. Having longer exhales than inhales increases activity of the parasympathetic system (rest/digest) and reduces our sympathetic state (fight/flight)

You could technically do the opposite to increase alertness.

Here are some modalities to try to see if they help you. You can find free audio and video guides on YouTube or Spotify.

• Tai Chi or Qi Gong

• Yoga Nidra Meditation

• Binaural Beats (alpha/delta) 

Supplements

I can't necessarily give blanket supplement advice, because the recommendations vary depending on your age, hormones, diet, and many other factors including what prescriptions you may be on. There is a general consensus that getting micronutrients from foods is better than supplementation, but that may not be possible for some people or diets. If you’re interested in exploring some supplementation, I do ask that you email me so I can give you product recommendations and dosages.

These are common recommendations that people tend to be deficient in or need for maintenance:

• Omega 3 fatty acids - 1000mg has been shown to be as effective as some antidepressants. It is also good for brain health and inflammation management.

• Magnesium glycinate - helps with overall gastrointestinal health. The L Threonate form can have some cognitive benefits

• Vitamin D - Good for immune and bone health

• Creatine monohydrate - Used for muscle growth and cognitive benefits

Final Thoughts

This guide was created to be general advice, but if you have any questions more specific to your lifestyle or situation, please feel free to reach out to me.

5 ways to address back pain through chiropractic care

If you were to ask someone what a chiropractor does, their answer would likely have something to do with back pain. Back pain can feel debilitating. It can control your whole life and stop any progress you’ve made to better your habits. Back pain is an extremely common condition that affects up to 90% of people at some point in their life. The good news is that although back pain feels serious, it’s not usually due to a medically serious condition. 

Most people who come in to see me with back pain say that they have been resting, taking pain relievers, using creams, and not exerting themselves. While this is sometimes necessary, avoiding activity and taking pain relievers long term is actually the most dangerous aspect of chronic back pain. Often times, providers are quick to attribute back pain to one particular issue or problem that—coincidentally—only they can solve. The truth is that back pain is actually extremely complex, so taking a systemic approach is necessary to make sure people can get their life back as quickly as possible. Every visit with me involves a plan of action, because action and initiation is the only way to make long-term, sustainable changes in your life. This is what I do when people come in for their first appointment, and I’m the only chiropractor in the Bay that has a free first visit.

Here are the five steps I use in my practice to help patients recover from back pain:

1. Find out what happened
   As much as you would think back pain is caused by falls and accidents, that is not usually the case. The biggest factors that cause back pain in my opinion are not actions, but inactions: lack of quality sleep and increased sedentary lifestyle due to stress and depression. With a global mental health crisis and many still spending most of their time at home, inaction is unavoidable; however, our bodies have mechanisms that increase our perception of pain when we are under these conditions. Unfortunately getting out of pain isn't going to be as easy as taking a pill, but with incremental changes you can start building strength and resiliency both physically and mentally.

2. Provide a chiropractic adjustment
   It’s important to help your system calm down enough to decrease not only the pain, but to decrease your fears about over-exerting and reinjury. A chiropractic adjustment can lead to an adjustment of your current state of mind and body, leading to increased awareness within yourself—and therefore the world. By using chiropractic techniques to help temporarily alleviate pain or restore function, we can remind your brain of possibilities available to us once that injury is fully healed. When everything is working the way it was designed, you carry yourself with confidence and your body functions at a higher adaptive state. 

3. Work on soft tissue
   Soft tissue work increases neurological perspective of the area of concern and aids in circulation. Your brain is going to naturally focus on what hurts. When I do my exam, I focus on the entire body, not just the area of concern. Working on other areas that are tight can actually divert attention away from the problem area. Sometimes there are other areas that need to be focused on. Other times, soft tissue surrounding the injury may need support. 

4. Recommend exercises
   After injuries, you need a custom exercise and stretch program to prevent reinjury and help your body heal stronger than you were before. Sometimes complex problems require simple solutions. Even adding a 15 minute walk to your day could help reduce your risk of repeated back pain. When you come in for your first visit, you’ll get an individual set of exercises and stretches in a PDF and in app video demonstration to help keep the patterns we set in office. These exercises are designed to challenge the areas that will help your body be more resilient and adaptive. I will work with you to come up with a plan at a pace that works best for you.

5. Create a plan to reduce stress
   The hardest part of recovering from back pain is figuring out how to adapt your lifestyle so that your brain is as healthy as it can be. Part of my job as your chiropractor is to come up with a plan outside of our appointments, so you’re not stuck with me too long.  If you’re curious about my strategy, it’s based on what science has discovered over the past 20 years. 

My overall approach to this form of healthcare is simple.  I will do whatever I can so that you will eventually not need me.