Archive for September, 2011

Car Accidents!

Posted on September 27, 2011. Filed under: Pain | Tags: , , , , , , , , |

Alright, the tires squeal – you see it coming….you swerve as best you can, but it’s all so fast there is nothing you can do about it. Not enough time to be really afraid, and Smash! Your body is jerked, some parts of you bang against the car, and if it’s not too bad you get out of the car at least a little shocked, maybe angry, hoping the other party isn’t a nut case….and you debate what to do. You can walk away, and you pride seems hurt more than your body.

What do you do first? Call your doctor…or your lawyer??

Are you OK because you could walk away? If you hurt just a little, does that mean you are damaged only a little?

There are several key stages to injury: the immediate after-effects, intermediate problems, and finally long-term issues that may not surface for some time.

Just after a wreck the issues are shock and trauma, if any. Whatever is broken needs immobilized, whatever is bleeding needs stopped, and shock needs to be managed. Of course, sometimes it’s bumps and bruises, and still a little shock. If it’s bad – it’s to the ER, and if not, to the family doctor or emergency-clinic. You may be x-rayed if there is suspicion of neck or back injury, and probably sent home with pain killers. Ice or heat application is often useful at this stage.

What I’ve seen time and time again are problems that pop up later – from a couple of weeks to months down the line. Sometimes these issues are far enough removed in time that a patient really doesn’t quite believe that a car wreck a year ago could possibly have anything to do with their pain….but they finally admit that prior to the accident they were in quite good shape with no such issues.

What are some of these symptoms? Neck pain is the obvious one, but back pain from twisting in the seat belt, shoulder pain from having the shoulder jammed, hip pain from the same type of thing, as well as headaches, sleeplessness, anxiety, and even pains shooting down the arms or legs if the jolt injured a disc and nerve.

The reasons some symptoms take time to develop are several. Some tissues are torn badly and hurt right away. Some deeper tissues, e.g. ligaments – may be over-stretched and torn just a little, and those tissues are slower to ache, and slower to recover. Bones can be bruised, cartilage can be damaged, and a useful image to keep in mind is that while acute injuries “leak,” slow-onset pains come from tissues that “ooze” and slowly build up pressure and inflammation.

End result: headaches, numbness, heavy-headedness, very uncomfortable stiffness, difficulty in breathing, and fatigue. All of these things can become chronic – meaning that they form a “system” of long-lasting pain for you to deal with.

Not all accidents are big deals, but some that look quite minor turn out to be quite a problem if the deeper tissues are damaged. The worst part is this: if the deep tissues are damaged and uncorrected, it sets up the very nasty predisposition to early arthritis of the bones of the skeleton, in which case motion is permanently lost as the stoop sets in.

Any but the most minor accidents are worthy of a check-up by someone who has expertise in how the muscles and skeletal systems of the body move and work; this implies some past the ER or emergency-clinic, because that type of exam isn’t their job anyway. They are to keep you alive and basically OK, but for correction and treatment you need the specialist input.

Living in a metro area means that potential accidents are a daily possibility, and my best advice to look left and right at intersections twice – and get yourself checked for emergency issues and structural problems if an accident happens. Your older-age depends on it…..

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Stand Up Straight! Good Posture Basics…

Posted on September 27, 2011. Filed under: Aging, Joints | Tags: , , , , , |

By Dr. Greg Steiner

Usually I hear from moms and wives: “I keep telling him (her) to stand up straight! Quit slouching, or you’ll end up like your cousin Betsy who is the little old lady who is all bent over in the front row of the church!”

Ok, maybe that’s a paraphrase, but the essential worry and complaint that a Family Member A has noticed and is starting to worry about Family Member B’s slouch that isn’t going away.

It usually starts in high school, and sometimes even before – the teen age slouch. Sometimes it comes from a pain in the back caused by prolonged sitting; sometimes by sheer laziness; and sometimes from a psychological factor – either looking cool or being shy.

Regardless of the cause, what does good posture look like and how do you measure it?

Ok, grab Loved One B and stand them up and have them face a wall. You stand to their side. If they are standing correctly you should see a person that looks poised, balanced, and at ease all at the same time. Military people usually make a habit of standing very straight, but at times their stance is excessively rigid. Dancers who do modern and jazz usually stand very well – just as straight as the military folk, yet more relaxed. The surprise is that the people who lift weights in the Olympics usually have very good posture – athletic, straight, and very strong for all their size.

Ok, you have them there – what do you look for?

Look at the tip of the ear, the tip of the shoulder, the tip of the hip (usually along the seam line) and the tip of the ankle. If their posture is right, all these “tips” should be aligned along one vertical line.

If it’s wrong, many times the head is forward (called “Forward Head Tilt”).

At first there may not be more than an inch of misalignment, but given time this can develop into a slouch, and finally a great stoop and shuffling walk.

The way it works is like this: the human head weighs as much as a bowling ball. If all that weight starts to shift forward, something else in the body must adapt for you to keep balance. Imagine if your head flopped forward – without a counterbalance you would fall forward on every step. So, in order to move with balance your low and upper back change curve to keep you in a state of basic balance.

The problem is that this mechanism is a compensation for a problem, not a fix for it. In other words, if the forward head isn’t corrected and maintained, for every inch the head tilts the curve in the changes by an inch. Eventual result: back pain to go along with the likely neck pain and headaches!

Kids have it worse, if they carry a backpack that makes them bend too far forward; the load hastens the wear on the spine. If you do take the extra caring step and examine your family, you will be doing them a great favor if you help them correct the issue as soon as possible, before anymore wear takes place. Not one of those stooped, shuffling little old ladies started out that way or suddenly changed on their 60th birthday. No, they were once standing tall and straight. While it’s never too late to achieve some success with slouch and stoop, early detection and correction is always best.

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Emergency Room!

Posted on September 13, 2011. Filed under: Uncategorized |

A day in the ER

Professional life as I knew it changed forever when I made my entry to work in the emergency room of McKinney Medical Center only a short few weeks ago. The first day is supposed to be “Orientation” and Triage, in which you assist at the front desk helping decide which patients are priority, and which are less urgent. As I headed into the entrance and asked where I was to go, a friendly staff member pointed me down the hallway, where I was met by a quickly-walking nurse who asked: “Do you have your trauma shears? Follow me.”

Down the hall and into a room we went, to be confronted by a young woman moaning in severe pain, with her right leg bent up and out at an impossible angle. Immediately we went to work cutting the tattered remains of her trousers off her twice-broken leg, to prepare her for a through examination and placement of her leg into what’s called a traction splint, which holds the leg and broken bones in place, and relieves much of the pain. The removal took only seconds, and within another minute or two several nurses both male and female had the splint ready to be placed. Try as we all might, there was just nothing pretty about it – her thigh bone had been broken in two places as she had desperately jammed on the brake trying to avoid hitting the woman who had pulled out in front of her as she drove her usual route to work, on a country road just north of McKinney. The impact at 50 mph was incredible, with her leg taking the brunt, though she had also been placed in a cervical collar as a precaution.

Several minutes passed as we pulled, help, and tugged – and finally we were able to place here leg securely. Amazingly, soon after her leg was stabilized much of her pain subsided, and soon family members were showing up to offer support. Her stay wasn’t long though, as shortly after x-rays revealed the damage that had been done she was once again transported to Dallas, where trauma orthopedists were preparing to insert a metal rod into her snapped femur.

Welcome to “Orientation!”

As I walked back up the hall and introduced myself, all hell was breaking loose near the ambulance entrance, as several paramedics were working furiously but calmly to transfer a flatline patient into the cardiac room – one managed a bag to keep the man breathing, and the other was pumping and compressing his chest to keep his heart moving.

The cardiac room was like a scene from ER. Nurses, techs, paramedics, and a very calm and confident doctor guiding the action. I was performing the chest compressions, standing on a stool to get better leverage, with several of us rotating as the exertion took its toll. Inject epinephrine here, start an IV there, stop CPR, administer a defibrillation shock, resume CPR, start bicarb…..   The patient – an overweight diabetic with open sores on his partially bandaged feet had experienced cardiac arrest – would get a pulse, lose the pulse, get a pulse – while for part of the time anxious family members stood at the doorway. After 20 minutes he finally established a pulse that took, and then his blood pressure began to rise to a normal level. The floor of the ER was a mess from all the wrappers of equipment that had been used, and as the doctor and nurses moved on the other cases, I assisted in helping the patient breathe while the respiratory therapist hooked him up to a ventilator.

All this by 10 am. A very, very different experience than in my serene, Oriental-motif clinic which acts as a healing sanctuary for patients who often come in for chronic conditions. In my clinic I never rush, and we take what time we need. Not so in the ER!

These were dramatic moments, and much of the other work involved patients in various stages of long-term health degradation, so much apparently self-inflicted and the product of long negligence and outright denial of personal responsibility for taking care of one’s own, God-given body.

ER lessons are very hard, on both patient and doctor!

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Tired all the Time….

Posted on September 13, 2011. Filed under: Fatigue |

Often people who suffer from chronic fatigue – whatever the cause – experience an additional burden of dealing with a problematic family or work dynamic. Often again, family members don’t know what happened to the energetic, vivacious person they now see lying in bed at every opportunity. As might be expected the addition of interpersonal stress only increases the fatigue problem; people who suffer from chronic fatigue feel guilty that they are neglecting friends and loved ones; that their work isn’t up to its usual quantity or quality; and sooner or later they start to feel self-judgmental in a negative way.

While there is a linkage to depression – many chronic fatigue patients feel depressed – these same patients feel that their doctors often put the cart before the horse. I’ve been told from countless patients that on meeting with their physician – whether allopathic, osteopathic, or chiropractic – that they are many times assessed as depressed, and thereby treated accordingly. While this diagnosis certainly is valid at times, many of the patients state quite adamantly that they weren’t depressed before feeling tired, pained and just plain “cruddy” so much of the time.

No one wants to carry around the self-label of “depressed person,” or at least very few people do. However once a person’s self-image changes and the chronic fatigue patient accepts that image healing will either accelerate or come to a screeching halt; it depends on that person’s individual character traits, values and how others treat him or her.

In the negative sense, a person who deeply and truly accepts the “depressed” label adopts the beliefs and actions of a depressed person even more – hopelessness fuels helplessness. Such a person attempts little in the way of self-help, and those efforts are rarely whole-hearted.

In the positive sense some people feel utterly annoyed with their situation and embark on a path of learning and self-healing to the extent they are able. Though I don’t see this as much as the negative expression, it’s people cut from this cloth that stand a real chance of whole or partial healing. In other words, any doctor can only work with what the patient gives him to work with.

In acupuncture terms chronic fatigue describes a condition in which the body’s energetics are out of balance and stuck in that unbalanced state. Over the years I’ve noticed that adults act just opposite of kids – when kids get out of balance they often go “hyper,” and adults get tired. If I see the opposite – a listless child or a hyper adult I sense that there is a really big imbalance working below the surface; this will likely be harder to treat.

In Oriental medicine health is all about motion and balance; balance in motion; balanced motion. If the energy system is balanced and moving sure, an “invader” (as the ancient texts describe those things that create illness) will attack the body, but the body will adapt. If it gets sick, it will heal. If injured, it will repair. If stressed, it will cope. Such is

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Are Hot Flashes A Result of Hormonal Imbalance?

Posted on September 13, 2011. Filed under: Hormone |

Surprisingly, these unwelcome bouts of sweat and general discomfort don’t always come with the aging body – over the years I’ve seen any number of ‘young’ (choosing words carefully here!) women experiencing mild to major discomfort. Even the total symptom picture varies among women – for some the heat is the only issue, and for others there can be accompanying nausea, various levels of headache, and mood changes which are usually negative.

Hot flashes are symptomatic of a hormonal imbalance, often involving estrogen. Of course there is more to the story – much more. Of all the systems of the body the hormonal or ‘endocrine’ systems is one of the hardest to understand, diagnose and treat. The important thing to understand is that hormones – all 60+ of them – interact in amazingly complex fashions that are yet to be fully mastered. If you ask a well-educated and experienced endocrinologist about it, he or she will tell you that though more research is being done all the time, it raises as many new questions as it gives answers.  The point: only at times are there simple answers to endocrine issues.

In the case of estrogen imbalances generally, depending the exact situation estrogen can promote unwanted weight gain, and even be implicated in certain types of back and hip pain that is alleviated by hormonal ‘balancing.’  In men, excess estrogen also promotes fat gain, especially in the chest area. An interesting paradox to illustrate the action in males is that when large, super-muscular bodybuilder types take in too much testosterone, while they build massive muscles on the one hand, the excess testosterone converts to estrogen and creates fat growth on the chest, giving the appearance of small female breasts overlaid on a large chest muscle. Powerful stuff, hormones.

Back to hot flashes. In my clinical practice – 20 years at the time of this writing – I’ve seen both young and old women distraught and frustrated with apparent long-term ‘menopause.’ Many of these women were taking various combinations of hormone replacement therapy with limited or little result – that’s why they were seeking alternatives. While practicing in Europe I did observe that some of the younger women were able to significantly improve their condition and reduce their medication simply by cleaning up their diet, which in this case meant reducing ‘bad’ carbohydrate intake and increasing high quality omega oils (which are also called essential fatty acids, or EFA’s).

There are acupuncture methods for working with hormonal imbalances generally, and treating hot flashes specifically.  Herbs and supplements are often of use, but generally the most effective approach is to use specific combinations of these methods, fine-tuned and tailored to the person.

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Get Wet, Get Fit-Joint-Friendly Exercise

Posted on September 13, 2011. Filed under: Exercise, Joints | Tags: , , , , |

swim for joint friendly exercise

By Doctor Gregory Steiner~

No, I don’t mean going to the nearest water park and sliding down the tube, though as I write this article it sure sounds good in all the heat…..

What we’re talking about is exercising in the pool, sometimes called “water aerobics,” though there is much more to water exercise then aerobics. First we had better define our terms; that word – ‘aerobics’ – goes back some years now, and was originally coined to describe exercise that particularly stresses the aerobic  energy systems of the body.  Basically this means the heart, lungs, and blood vessels, though there are more parts involved than only those. These days we mean the same thing by ‘cardio.’ You get on the stepper or bike, run or pedal away, and if you get the right intensity and time you get fitter and burn fat, and your resting heart rate starts to drop. Good and necessary stuff this cardio, but there is a reason that most gyms have TV screens in front of the cardio section!

However, cardio by itself is not complete.  Usually among keep-fit people there are three main types – the strength lovers, the endurance-cardio people, and the flexibility folks who gravitate to yoga and often Pilates.  Each of these factors is indeed important, and it’s a fine, fit individual who is simultaneously strong, flexible and who has real staying power.

There is a ‘what if’ however, and that what-it is what happens if a person has painful joints? For example, if a knee or hip is worn away, too much strength stress will hurt the joint, impact from running type motions often jars the joint, and even stretching can be limited and very painful.

That’s one important way in which water exercise comes in. You will note we didn’t use the term ‘water aerobics’ this time and here’s why.  If a water work-out program is designed well, it won’t just be working the heart and lungs, but it will also be crafted to strengthen muscles and mobilize joints.

There are levels intensity to water exercise, ranging from tame to insane….to each his or her own! On the one hand, I have had a large number of older patients who just can’t perform standard gym exercises or cardio due to structural limitation, wear and tear, or just plain old pain. They almost always perform water workouts successfully and profit very much from doing so.

At the other end of the spectrum I have known very ‘serious’ work-out people who have approached water exercise with an extreme intensity to assist their primary athletic pursuits, which have included martial arts and track and field. These people tell me they are amazed at the amount of whole-body effort then expend in a water work-out.

The way you do water exercise varies, but what often takes place is that you put on some ‘flippers, fins and water wings’ – accessories that attach to various parts of your body – and which increase the resistance of the water to any and all motions that you make. This is a unique aspect of water exercise, that no matter how and where you move you are under constant resistance, so the whole body gets a new kind of workout. If you move fast, you get a lot of resistance, if you push less hard, less resistance. And, water being water, your body can move in and direction possible as it is not confined to the angles of the machine.

Easy on the joint, hard on the muscles and lungs – try water exercise for a joint-healthy change of pace.

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Old Knees Made New

Posted on September 13, 2011. Filed under: Joints | Tags: , , , , , , |

Recovery from knee surgery

As I looked down at what a nurse called my “very nice scar” my morbid sense of humor couldn’t help but think of the “$5 foot long” sub commercial. Foot long was close, but mine cost a whole lot more than $5, that’s for sure!

It’s hard to believe that it’s already been 6 months since that whopper of an operation to restore the pitted and worn cartilage pot-holes under my knee cap, and a year since the my cartilage was first harvested for growth in the lab and the later implantation.

The recap is this: many years ago as a product of the “no pain, no gain” school of exercise and a subsequent exercise-aholism the cartilage behind both knee caps developed pits, cracks and holes. Knee pain proper started perhaps 15 years ago, and a combination of finally learning good exercise technique with acupuncture and herbs gave me these extra 15 years of high-level, intense fitness training.

Even so, eventually every sin of youth must be paid, so when a little over a year ago when I could no longer get up off the floor after wrestling with my son because of the ground glass feeling in the joints, I knew it was time to get something else done.

I searched out multiple orthopedic opinions as to what to do. Two had not solutions other than injecting synthetic lubricating fluid in the joints and cleaning up the cartilage – basically to act as a tide-over until things deteriorated so badly in the rest of the knee to force a knee replacement. Another doctor suggested using a cadaver tendon to pad the holes. The doctor I chose had an entirely “next level” set of skills and was down to earth besides; he also has 4 children – so we understand each other!

The short story on the procedure is this: first, it’s actually a package of operations rolled into one long, involved stay in the operating room. “Welcome to Big Boy orthopedics” is how my surgeon described it.

In a preliminary procedure – for me one year ago – the defects in the knee are trimmed, polished, nipped and tucked – and cartilage is harvested for the future implantation.

The Big Boy operation is full blown, open knee surgery with general anesthesia and a several day hospital stay. The pits in the cartilage are prepped, patches stitched over the holes, and new cartilage cells grown from the harvested cells are injected by the million.

Meanwhile, they cut off a part of the upper shin bone where the knee cap tendon attaches, move it forward a few millimeters and screw it back in place. Other alignment procedures take place as well.

You awaken the next morning with itchy skin and an achy leg, though you don’t seem to care very much due to the morphine IV. You also find your leg is lying in a gadget that moves it up and down, and you very soon learn that good, old ice controls pain better than anything.

While I should have taken a month off work, I have a clinic to run and I know how re-energize faster, so I was back at the clinic one week later doing acupuncture from my wheelchair. Everyday I would do rehab at the level possible, take Chinese herbs, and do acupuncture to reduce swelling, gain energy or promote healing.

What followed were several weeks on crutches, then a rediscovery of the joy of walking without assistance or aids, which was a true, real Freedom.

As the weeks turned into months my healing progressed.

Much to the amazement of my surgeon and others who knew the extent and complexity of the surgery my pain was at worst “nuisance” level – again I attribute this to the acu, herbs and some strong mental visualizations.

My time out of the gym was only 6 days – I used the wheelchair to get to the machines to work upper body and the un-operated leg.

At this stage – 6 months later, the leg is getting much stronger and regaining some lost size due to the early weeks of disuse. Stairs feel much better, as do getting up from a chair and out of the car. It’s a fantastic thing to get a life back…..

Better rehab and recovery after surgery is nothing new or shocking for people familiar with Oriental medicine. People with back surgery, disc procedures, rotator cuff tears, and even abdominal surgery have gotten “unstuck” their healing in a very short time as the Oriental medicine works to improve and “unstick’ the body’s own healing energy.

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Allergy Misery Arrives Early and What to Do About It

Posted on September 13, 2011. Filed under: Allergies |

Acupuncture can help with allergies

Even as this is written in winter, already sensitive patients are suffering from early-season allergies. This winter has seen an increase in flu and upper respiratory infections to top it off, and what’s set in place is a situation in which oscillation occurs: sick, allergic, sick, allergic – the result is runny-nosed misery!

How Allergies Work

Let’s look at how an allergy actually works; it’s not all that complicated to understand the essentials. In really basic (but accurate) terms, you are exposed to a substance your body interacts with as though it were an enemy. If the substance really is an “enemy” such as an invading bacteria – good. Your immune system is working. However, if your body classifies ordinarily harmless substances (e.g. peanuts) as an enemy, your body immediately goes on alert, mobilizes troops, and you experience a runny nose and itching.

There’s more. Sometimes your body can so hate a substance that it chooses the nuclear option; we have all heard the stories about how someone gets bitten by a fire ant, finds he or she can’t breath, and has to be rushed to ER. Last year I had the opportunity to help a patient recover from this very dramatic and dangerous reaction. She came to the clinic after getting out of the hospital feeling very pained and drained, with substantial swelling on her ankle where the bites occurred. Acupuncture, herbs and some energy medicine techniques helped her get back to work quickly, but the sheer magnitude of her reaction to what is ordinarily a minor nuisance was truly remarkable.

Histamines and Runny Noses

Let’s look a little deeper; everyone has heard of histamines, so we’ll look at the role they play in making you miserable!  When you come into contact with an allergy producing substance by touching, breathing, or swallowing it cells in your immune system sense it but don’t recognize it as “yourself.” The alarm goes out as alert chemicals are released! These cells collectively are called immunoglobulins, and are so named by function and shape: a cellular glob that functions in your immune system. There are many of these, and they are abbreviated by letters which you may have seen in articles on allergy medications. For example, immunoglobulin E is abbreviated IgE and IgE is involved in the process that ultimately releases histamines, which in turn acts in concert with other substances to start your nose running and skin itching.

So, the logical conclusion is that a runny nose is a bad thing, right? Wrong! A runny nose is messy and inconvenient, but what is a body to do when it contacts toxic junk? What a runny nose is all about is your bodies attempt to flush out the stuff that’s causing the reaction in the first place. You body secretes excess mucus in the attempt to wash the invader out before penetrating more deeply into the body. While in cases of strong allergic reactions antihistamines are useful in preventing the reaction getting worse, in cases of infection it’s actually best to skip the anti-histamine and let your body purge itself. Much better to let your nose (and your kids noses!) run and let your natural immunity do it’s work, if it’s socially acceptable to do so in your situation. Also, be sure to swallow as little infected mucus as possible; otherwise an intestinal upset is likely to occur.

Conventional treatment for allergies involves identification, medication and elimination when possible. Oriental treatment takes another approach, in which the body is “re-programmed” to reduce the over-reaction. Some patients live in allergic misery for many years, but there is really no need; relief is a definite possibility.

Next time: more on allergens, hypersensitivities, treatments and prevention.

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Too Hurt, Too Fat, Too Tired

Posted on September 13, 2011. Filed under: Weightloss | Tags: , , , |

If there are three things that bring patients into the clinic these are the Big Three, an un-holy trinity of suffering and illness.  You can experience one, both or all, and lots of times they work together; let’s have a look at how they work.

The easy one to understand is the ‘hurt.’ The easiest of all to understand is injury – you bend over at a funny angle, you hear a ‘pop – and next thing you know it you can’t straighten up any more. If there is no pain in the leg you have probably pulled a muscle. If you feel a pain in the leg you probably have torn a disc which is now pressing on a nerve.

Ok, you take an ibuprofen; put an ice pack on it and it feels better. Probably not a big-deal injury. You do those things and it still hurts or even starts getting worse – it probably is a bigger deal after all.

Weeks go by and let’s say you are one of those people who think ‘it will get better by itself.” (Translated – this usually means you have a fear that treatment will cost too much or you feel that you just don’t have the time to deal with an injury at this exact time).

During that time the pain keeps you awake. Did you know that sleep really is important? It’s not a myth – you have to sleep at a certain depth to turn on the repair process of the brain, which in turn on the repair processes of the rest of the body. So, if you can’t sleep, you can’t repair. As the weeks pass you start to notice a pervasive, general tiredness that caffeine only fixes for a short time.

You used to work out, but with a hurt back and a tired body , who can blame you if you don’t make it to the gym as much as before….or if you even don’t make it at all anymore?

You’ve got it – the weight starts piling on, a few pounds at first, and more later. And so the spiral starts. Injury has caused pain, pain has reduced sleep, both pain and reduced sleep have reduced the activity level, which retard whatever level of healing is going on, which increases and prolongs the whole negative spiral.

The good news is that the spiral can be broken at any point – if you can increase your sleep you can better your repair. If you can gently increase your activity you improve your circulation and also improve your repair. If you improve your nutrition you can also benefit both sleep and repair. Of course, if you fix the injury properly the other issues will benefit because you will have less pain.

Keep in mind that the interactions of these factors can work from any direction; for example, if you eat poorly you won’t repair well and will be more likely to get injured. If you neglect sleep you body won’t repair properly and again it’s easier to get hurt.

Therefore, a good thing to review are the very basics of good health – good food, good activity, and good sleep. Everything after that – including what I do – chiropractic for your spine, skeleton and nerves, and acupuncture –for balancing energy – is something extra, something therapeutic. Nature can use some healing help from time to time, but nothing beats the basics.

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