southgaspine

As adults, most people realize how much their childhood experiences, good, bad and everything in between, influenced who they are today. Sometimes the seeds are planted early in life – even during the first few years.

Of course, that doesn’t mean parents know how to raise their own children the right way, even with the best intentions. Even the best parent needs assistance, guidance – a road map, if you will – to help get their children on course for optimal health and wellness.

Enter the World Health Organization (WHO), an agency of the United Nations devoted to public health. The WHO recently released its very first Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children Under 5 Years of Age. The guidelines, based on a scientific review of the available research, recommend the following (per day):

Children Younger Than Age 1

• Physical Activity: Active several times a day in a variety of ways, including at least 30 minutes of tummy time
• Screen Time: Not recommended; reading and storytelling by parents encouraged
• Sleep: 14-17 hours, including naps

Children Ages 1-2

• Physical Activity: 180 minutes or more; children should not be restrained (sedentary) for more than one hour at a time
• Screen Time: Not recommended for 1-year-olds; one hour or less for 2-year olds; reading and storytelling by parents encouraged
• Sleep: 11-14 hours, including naps; consistent sleep and wake times

Children Ages 3-4

• Physical Activity: 180 minutes or more, at least 60 of which involve  moderate- to vigorous-intensity activity (frequent running, jumping, etc.).
• Screen Time: One hour or less; reading and storytelling by parents encouraged
• Sleep: 10-13 hours, including a nap; consistent sleep and wake times

If you have a young child, how closely are you adhering to the WHO guidelines? If your child is older, did you come close to meeting the guidelines … or were you not even close? As the body of research supporting the benefits of physical activity, high-quality sleep and limited screen time grows ever-larger, these guidelines are a reminder for parents of young children – and children / adults of all ages – that simple lifestyle behaviors can make a big difference when it comes to health and wellness.

Text messaging, video gaming, surfing the Internet – with technology comes repetitive behaviors and body positioning that can have dramatic health consequences, not the least of which is a condition known as forward head posture. Just think about it: hours on end with your head down, neck scrunched, staring at a tiny phone, iPod or other device; you’re just asking for trouble. Your body is sending you a message – it’s time to answer it before you end up in pain.

Neck Pain Caused by Texting
About two years ago, I started to notice that more and more young people were coming to my office with similar complaints. They all had neck pain, headaches, shoulder pain, and/or numbness and tingling into the upper extremity. While discussing my findings with one of these young patients, her mother asked me, “Well, what does she have?” I looked over at the patient and noticed that she was buried in her cell phone with her head flexed forward – texting. With that, I replied, “It’s simple. She has text neck.” I pointed out to the patient’s mother that at 16 years old, her daughter had a reversed cervical curve with mild degenerative changes, and that she was too young to be experiencing these bony changes. I then asked the patient how often or how much she texts. She replied that she texts all day long, and that it is her primary mode of communication.T

Technology Overload
These days, people are constantly “connected” to their hand-held devices, whether it is their cellular phones, portable video games like Nintendo DS, e-readers such as Amazon Kindle, or they are just using apps on an iPhone. A Kaiser Family Foundation surveyfound that young people 8-18 years old spend in excess of seven-and-a-half hours a day using some form of mobile media. As a result, this younger demographic will surely be developing a condition known as forward head posture (FHP), which can cause the above symptoms and more. As technology advances in the market of hand-held mobile devices, it’s important to understand that where the head goes, the body will follow. If you have forward head posture, then you will have rolled shoulders. With rolled shoulders, a concave chest can follow, and often a pelvic tuck, all of which can contribute to progressive pain and dysfunction over time.

Text messaging was reported to have addictive tendencies in the Global Messaging Survey by Nokia in 2001, and was confirmed to be addictive in a study conducted at the Catholic University of Leuven in Belgium in 2004. Since then, a study at the University of Queensland in Australia has found that text messaging is the most addictive digital service. It has been compared to being as addictive as cigarette smoking. The text reception habit introduces a need to remain connected, called “reachability.”

Because the demographic of people ages 13-27 is one of the largest groups of texters, we can expect to see a large increase of medical and chiropractic conditions within the next decade. The amount of time spent in a forward head tilt while texting or gaming, surfing or browsing the Web has increased as hand-held mobile devices such as cell phones, video games, and MP3 players have become smaller, mobile and essentially a direct extension of the person.

Look around you and you will see people with FHP using hand-held mobile device at tables in restaurants, at red lights in their cars, walking through the mall, in line at the grocery store, and even sitting in doctors’ reception areas. We are a society that is “connected,” now more than ever before, and we are suffering the health consequences.

The problem is getting worse each year. According to data released Dec. 15, 2009, by the Census Bureau, Americans sent 110 billion text messages in December 2008. In the same month in 2007, Americans sent 48 billion messages. Amanda Lenhart, a senior research specialist for the Pew Internet and American Life Project, is not surprised that the trend is especially prevalent among teenagers. In a Los Angeles Times article (Dec. 16, 2009), she stated: “Teens are still developing their communication habits. Adults have preset ones already.”

The world is becoming more mobile. Children are getting mobile phones at younger and younger ages due to affordable prices and parents wanting to stay in touch. Hand-held mobile devices are performing more daily functions and are more portable than ever. Google’s vice president of engineering and mobile applications, Vic Gundotra, has noted: “We are seeing a very fundamental shift where increasingly, particularly among the young demographic and in Asian countries, the primary access to the Internet is not through the PC but through mobile devices.T

The Problem’s Not Going Away
Research performed by Informa Telecoms & Media reported that in 2008, almost 162 million smartphones were sold, surpassing laptop sales for the first time. The research also suggests that smartphone sales will continue to be immune to the global economic downturn. With technology advancing, sales of the hand-held mobile device staying strong and people’s desire to stay connected, FHP will be more prevalent than ever.

Of course, forward head posture is not a new condition. Chiropractors have been treating and educating patients on the dangers of FHP for years, and the health conditions that FHP or anterior head carriage contribute to are well-researched and documented.

With all this said, it’s important to understand the negative effects of a repetitive stress syndrome and appreciate how many hours you are using your hand-held mobile devices and how many hours your children are using these devices. Talk to your doctor about forward head posture, the dangers of text messaging and other behaviors that put your body in stressful positions, and how you can avoid the pain before it starts.W

When Texting Turns Deadly
Can’t stop texting? If forward head posture doesn’t concern you (even though it should), the Federal Motor Carrier Safety Administration has found that of 17 activities that can drawn a driver’s attention from the road, texting puts you at greatest risk for suffering a serious car crash. According to the National Safety Council, an estimated 28 percent of crashes (1.6 million annually) are attributable to talking and/or texting on cell phones while driving.

According to Dr. John Callaghan, president of the American Academy of Orthopedic Surgeons, “The problem with the use of 24/7 communications devices is that every driver believes he or she is immune to slip ups, but isn’t. Orthopaedic surgeons want to prevent the pain and suffering associated with texting-and-driving accidents. To say this habit can be deadly is the truth; it is an outcome we unfortunately see every day.”

Dean Fishman, DC, practices in Plantation, Fla., focusing on the treatment and prevention of forward head posture related to the use of hand-held mobile devices and similar technology. He is the founder of the Text Neck Institute.

Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it’s also the most likely to be taken inappropriately.

In fact, improper use, coupled with the drug’s narrow safety margin, means “a large fraction of users [are] close to a toxic dose in the ordinary course of use,” according to the Food and Drug Administration.

But for the sake of discussion, let’s ignore the safety issues for a moment. Is acetaminophen an effective pain reliever in the first place? Not for low back pain and pain attributable to knee / hip osteoarthritis, conclude the authors of a recent meta-analysis. The just-published review of 13 randomized trials has yielded “high-quality evidence” that paracetamol (acetaminophen) does not reduce pain intensity or disability, and does not improve quality of life, in the short term for people experiencing LBP; and provides only “minimal, short-term benefit” for people suffering from hip or knee pain caused by OA, stating that “the small effects … are not likely to be meaningful for clinicians or patients.”

Back to the safety issues surrounding acetaminophen, which the meta-analysis did little to dilute. According to the review researchers, “high-quality” evidence suggests paracetamol use results in a fourfold risk of an abnormal liver function test. Not surprising, since acetaminophen misuse (overdose) is now the most common cause of acute liver failure (exceeding all other medications combined) and the second most common cause of liver failure requiring transplantation.

In fact, the FDA has mandated that all acetaminophen-containing prescription products feature a “black box” warning (the administration’s strongest safety statement) noting an overdose can cause liver failure and even death; and have been urged to place similar language on OTC acetaminophen products.

How often do you use acetaminophen-containing over-the-counter and/or prescription medications for you LBP and OA pain, even as you pursue relief through chiropractic care? How often do you take these drugs for your spinal / OA pain instead of visiting a chiropractor? As this meta-analysis suggests, acetaminophen is ineffective for these types of pain. So give chiropractic a try – a proven natural pain reliever.

Resources

• Machado GC, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised, placebo-controlled trials. Brit Med J, 2015;350. Full text available online.
• Dal Pan GJ. “Acetaminophen: Background and Overview.” FDA Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, June 29, 2009.
• Greenlaw E. “Your Guide to Over-the Counter Pain Relief. OTC Pain Relief: Understanding Acetaminophen.” WebMD.com.
• Healy M. “Acetaminophen in Rx Drugs: For Liver’s Sake, Lower the Dose.” Los Angeles Times, April 28, 2014.
• Gerth J, Miller TC. “Use Only as Directed.” ProPublica, Sept. 20, 2013.

Raising kids to be responsible, independent and yes, healthy adults is as challenging as it’s ever been. A short list of complicating factors in the 21st century includes the Internet, social media and mobile technology; sugar-overloaded, processed, nutrient-deficient foods; and too-distracted, too-overloaded lives (parents and kids alike).

With those factors alone in mind, let’s see if we can develop a simple game plan to help your kids grow up right. We’ll keep it simple: 4 Tips for Healthy Kids.

1. Turn Them Off: Every parent’s No. 1 priority in the Age of Technology should be limiting your children’s “screen time” to a healthy amount each day. What’s “healthy”? According to the American Academy of Pediatrics, it’s essentially no screen time whatsoever (except for video chatting) before age 2. After that, the recommendations are less about time spent and more about the what, when and where of screen time: media-free dining and driving, “shut off” times (e.g., no computer / phone at least one hour before bedtime), media-free locations (e.g., the bedroom), co-viewing of media, and understanding what constitutes healthy vs. unhealthy screen time, both in terms of what kids are viewing and how it can affect them (social media, inappropriate websites, etc.).

2. Kick Them Out: Kick your child out of the house every day for at least an hour of physical activity, not to mention sunlight (but don’t forget the sunscreen) and fresh air. The couch is no place to live, so don’t let your children set up shop there. If you don’t have a backyard or immediate access to a playground or other  outdoor area, commit to walking with your children after dinner every night for at least 30 minutes. Good for you, good for them.

3. Show Them How: The fitness / healthy-eating market has expanded tremendously over the past few decades, but don’t be fooled: Children and adults alike are still constantly bombarded with subtle and not-so-subtle messaging that compromises their health and wellness efforts. Processed foods. Sugar-sweetened beverages. Even products labeled “all natural,” “multigrain,” “sugar-free” or “low fat” that don’t come close to telling the whole story when it comes to their nutritional value (or lack thereof), and overall impact on short- and long-term health. As a parent, it’s up to you to show your children how to eat right. The most important step: show yourself how. Remember, kids learn from their parents, for better or worse. In fact, sometimes what you’re not doing can have a greater impact than what you are doing.

4. Build Them Up: Social media, comment forums, reality television and more; what’s a parent to do when trying to raise a confident, respectful child? Besides limiting their exposure to these types of scenarios (see tip #1 above), it’s your job to build them up every day and in every interaction. Every parent is a teacher, so teach your kids why they matter in this world, and that no one can take their worth and self-value away from them unless they let it happen.

5.  Keep Them Close: When was the last time you had a real conversation with your child? When was the last time you walked out of a room and said to yourself, I really feel like I made a difference? There are plenty of opportunities for distance and disengagement these days. Keep your kids close by creating moments of interaction and sharing: family dinner every night (or at least on certain set days); movie night; or even just 10 minutes of set time a day with your child (especially if a teen) to let them talk about their hopes, fears and everything in between. Your children want you to stay closer than they’ve ever admit to you. Your ability to always be there is your ultimate tip to help them grow up healthy.

Think you’re destined to die before your time because you’ve been sedentary (physically inactive) your entire life? Not so fast. While consistent exercise is associated with a host of health and wellness benefits including significant reductions in disease risk, new research suggests even middle-aged and older adults who haven’t been active their entire lives can benefit dramatically from a little more movement.

Researchers evaluated the exercise habits of more than 315,000 adults ages 50-71 by reviewing surveys each study participant had completed from adolescence, then tracked them for almost 15 years to see who passed away over that time period. Compared to participants who stayed essentially inactive throughout their lives (including the study period), participants who were not active previously, but became active from ages 40-61, were 35 percent less likely to die of all causes during the study period.

Interestingly, people who had been active from the start (youth through middle age) were only slightly less likely to die during the study period: 36 percent less likely compared to the permanently inactive group. In other words, the health benefits of physical activity (at least in terms of longevity) were essentially the same regardless of whether one exercised his/her entire life or became active starting in middle age or older.

With respect to two of the major causes of death, cardiovascular disease and cancer, the risk reductions were also remarkably similar: 42 percent lower risk of death from heart disease and 14 percent lower risk of death from cancer for always exercisers (compared to people who stayed sedentary their entire lives), vs. 43 percent and 16 percent lower risks, respectively, for late exercise adopters. Study findings were published in JAMA Network Open.

The moral to this story: You’re never too old to start exercising – and reaping the longevity benefits. Talk to your doctor for more information on why exercise matters, and ask for help designing a consistent physical activity program suitable to your health and fitness needs.

By Deborah Pate, DC, DACBR

Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure as it relates to sciatica or pain affecting the sciatic nerve, which extends from the lower back down the back of each leg.

Small Relief, Big Potential Side Effects

In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups.

Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, cataracts and increased risk of fracture.

This last complication is certainly not emphasized in clinical circles. Therapeutic steroids may reduce pain, however the use of steroid injections seem to promote deterioration of skeletal quality, which is not surprising since other forms of steroid medication have long been associated with osteoporosis.

A retrospective study published in the Journal of Bone and Joint Surgery looked at lumbar epidural steroid injection (LESI), and the potential impact on bone fragility and vertebral fractures (spinal fractures). Researchers identified a total of 50,345 patients who had medical diagnosis codes involving the spine; within that group, a total of 3,415 patients had received at least one LESI.

Three thousand patients were randomly selected from the 3,415 injected population and 3,000 additional patients were selected from the non-injected group as a control group. There was no significant difference between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or corticosteroid use.

When incidence of vertebral fractures was assessed, researchers discovered that an increasing number of injections was associated with an increasing likelihood of fractures, and each successive injection increased the risk of spinal fracture by 21 percent. Based on this evidence, LESIs clearly exacerbate skeletal fragility. They promote deterioration of skeletal quality similar to the use of exogenous steroids, which is the leading cause of secondary osteoporosis. In fact, the rate of vertebral fracture following epidural steroid injections may be underestimated.

Both European and American guidelines, based on systemic reviews, conclude that epidural corticosteroid injections may offer temporary relief of sciatica, but do not reduce the rate of subsequent surgery. This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates. Facet joint injections with corticosteroids seem no more effective than saline injections.

Rising Costs, Limited Benefits

Despite the limited benefits of epidural injections, Medicare claims show a 271 percent increase during a recent seven-year interval. Earlier Medicare claims analyses also demonstrated rapid increases in spinal injection rates. For patients with axial back pain without sciatica, there is no evidence of benefit from spinal injections; however, many injections given to patients in the Medicare population seem to be for axial back pain alone.

Charges per injection have risen 100 percent during the past decade (after inflation), and the combination of increasing rates and charges has resulted in a 629 percent increase in fees for spinal injections. Yet during this time, the Medicare population increased by only 12 percent.

It all begs the question: Why such a huge increase in the use of a procedure that has limited benefit?

Take-Home Points

• Epidural steroid injections have little clinical benefit (short or long term) and are associated with significant risks.
• Steroid injections cause deterioration of bone quality, elevating the risk of spinal fracture.
• Use of epidural steroid injections has increased dramatically despite lack of evidence to justify the procedure.

Talk to your doctor of chiropractic for more information on sciatica and nondrug alternatives to your pain.

Deborah Pate, DC, DACBR, is a San Diego chiropractor specializing in radiological assessment of the spine and musculoskeletal system. In fact, she was the first chiropractor accepted into a fellowship in osteoradiology at the University of California at San Diego.

You’re probably aware of the opioid crisis by now, notably the fact that for years, opioids have been overprescribed, overused and abused – with deadly consequences. Here’s one consequence you may not be aware of: Opioid users are significantly more likely to be involved in fatal car crashes than non-users. Let’s look at the latest evidence suggesting opioids are actually your No. 1 enemy when it comes to managing pain.

Drivers prescribed opioids are more than twice as likely to be involved in deadly two-vehicle accidents compared to drivers not prescribed opioids. In reviewing data from the Fatality Analysis Reporting System, researchers analyzed two-vehicle crashes on U.S. public roads that took place over a 25-plus-year period (1993-2016), including whether drivers had tested positive for prescription opioids. Among 36,642 drivers involved in 18,321 fatal two-vehicle crashes during that time period, drivers who were deemed the initiator of the crash were significantly more likely to test positive for opioids than non-culpable drivers.

The most common reason for crashes by opioid users (more than half of all fatal crashes): failure to keep in the proper lane. These findings were independent of any alcohol or other drug use, implicating opioids as the primary culprit. Even worse: Although opioid awareness (including studies such as this one) will hopefully make a dent in these horrific statistics in years to come, researchers, summarizing their findings in JAMA Network Open, noted that in the past two decades, when opioid prescribing flourished, “the prevalence of prescription opioids detected in fatally injured drivers has steadily increased to more than 7%” (compared to only 1 percent in the mid-1990s).

The lessons: 1) Opioids are a deadly way to manage your pain. 2) Non-drug pain management options (such as chiropractic care) should be your first choice, not your last. Talk to your doctor for more information about the opioid crisis and why chiropractic care is becoming the first choice for effective pain management.

Jogging at the same pace for hours and frustrated that you’re not losing the weight you hoped you’d lose? Try mixing your speed up and see what happens! Interval training – bursts of high-intensity exercise interwoven with recovery periods – appears to increase weight loss compared to training at a consistent intensity.

Case in point: a review study published in the British Journal of Sports Medicine that found people who participated in interval training for four weeks or more lost a greater amount of weight than people whose workout regimens consisted of moderate-intensity training based on continuous effort, such as jogging, walking or cycling at a steady, essentially unchanging pace. The additional weight loss also took less time: 28 minutes per session, on average, for interval training versus 38 minutes for continuous moderate-intensity sessions. Sprint interval sessions (alternating sprinting with recovery) only took 18 minutes per session.

According to the analysis, which included more than 40 studies and 1,100 participants, the most common interval workout alternated four-minute bursts of high-intensity exercise with three-minute recovery periods. Talk to your doctor to learn more about interval training, and click here for a few sample high-intensity interval workouts for beginners.

By K. Jeffrey Miller, DC, MBA and Matthew Marry, DC

Exercise machines that isolate individual muscles are great for general strength training. Muscle isolation helps you understand the different muscles of the body and their actions. The machines are also user-friendly, safe and efficient.Diagrams for how to perform the exercise / movement are provided on most machines. You need only to sit or lie on the padded portion of the machine, move the weight pin to the desired resistance and proceed. Time is never spent on lifting, loading and unloading heavy weights.

All of the above make these machines popular in most fitness centers. The machines require minimal supervision and the safety features are beneficial to gym patrons and owners. The potential for gym-related injuries is minimal compared to use of free weights like barbells and dumbbells.

With this said however, minimal risk means there is still risk. Injuries do occur. In most of these cases, the cause is user error. One of the most common of these errors is failure to utilize proper form. Proper form involves stabilizing the body areas that are not exercised by a machine.

Diagrams on the machines usually depict proper form. Unfortunately, most exercisers only use the diagrams to get the “general idea.” Proper form requires a closer look. You need to look at all regions of the body depicted in the diagrams, not just the region that will be involved in performance of the exercise.

Are You Exercising Properly? Maintain Five Points of Contact

Gym members frequently resemble contortionist while using strength machines. They twist, lunge, heave, jerk and strain their entire bodies while using the equipment. This is a sure indicator that the individual is attempting to lift too much weight. The twisting, lunging, heaving, jerking and straining are efforts to recruit other muscles to help lift the weight. The isolation principle is lost, the exercises lose their effectiveness and the possibility of injury escalates.

The key to success when using a weight machine is establishing specific points of body contact with the machine for both action and stabilization. Action contact points are created by the arms and legs as they grip, push or pull the parts of a machine that move during the exercise. For exercises involving the trunk, the abdomen or back may create the action contact points. The action contact points are easy to establish, as without them the machine will not move.

Figure 1A and 1B: The Chest-Bench Press Exercise. 1A: Proper contact; the hands are the active points of contact, while the stabilizing points of contact are the feet, buttocks, upper back and head. 1B: Improper contact; the hands are the active points of contact; however, the stabilization points of contact are not well-established. The feet are not set properly, and the upper back and head are not in contact with the machine. Photo credit: Leigh Ann Osborne, Vinton, Virginia.It is the stabilization contact points that are the primary focus here. There are five common stabilization contact points; the two extremities not involved in the exercise movement, the buttocks, the upper back and the head. These areas should be in contact with the padded portions of the machine.

For example, if the exercise involves the arms, the feet, buttocks, upper back and head are the stabilization points. If the exercise involves the legs, the hands, the buttocks, upper back and head are the stabilization points. (See the table and images in this article for example points of stabilization contact, along with visual examples of proper and improper contact while using weight machines.)

When you employ proper form utilizing appropriate points for active and stabilization contact, exercises using strength machines are safe and effective. Otherwise, there is risk of injury and gains in fitness are minimal.

Changing Your Stabilization Habits to Maximize Your Workout

A frequent response by exercisers attempting to change from poor to good stabilization habits is, “I can’t lift as much weight the new way. I’m stronger than that.” It is true; they are not lifting the same amount of weight as before – but, reiterating a previous point, they were not lifting the previous weight with just the muscles the machines are designed to isolate. They were lifting (heaving, straining) with their entire bodies. Proper form in strength training cannot be overemphasized.

Some strength machines require that you lie on your abdomen or back. Contact points are important in these exercises as well. For these machines or any others you may choose to use, follow these simple rules for stabilization contact points.

Try to maintain as much body contact with the padded portions of the machine as possible.

Figure 2A and 2B: The Leg-Press Exercise. 2A: Correct contact; the feet are the active points of contact while the stabilization points of contact are the hands, buttocks, upper back and head. 2B: Incorrect contact; the feet are the active points of contact; however, the stabilization points of contact are faulty. The upper back and head are not in contact with the machine and the exerciser is pushing downward with their arms. Photo credit: Leigh Ann Osborne, Vinton, Virginia.

Keep the spine as straight as possible during the entire exercise. This includes the neck. Alignment from the back of the head to the lower back should be as straight.

The head should be in a neutral position. The chin should not be flexed to the chest, and the head should not be tilted back or rotated to the right or left side while performing the exercise.

Exercise is safer, more effective and more enjoyable when it’s done correctly. The result is that you are more likely to continue to exercising and maintaining a healthy lifestyle. Following these simple instructions will help in this endeavor. Remember, whenever you have questions about which exercises you should be doing or how to do them correctly, ask a fitness professional with training and experience for help. Exercise is important enough to do it right.

K. Jeffrey Miller, DC, MBA,is an assistant professor of chiropractic at the University of Missouri Orthopedic Institute, a branch of the University of Missouri Health System. He is a graduate of Palmer College of Chiropractic and the author of several practitioner and patient texts.

Matthew Marry, DC, is a former athletic trainer for the National Football League’s Detroit Lions and a 2010 graduate of Palmer College of Chiropractic. He practices chiropractic at Foley Health and Fitness Training in Blacksburg, VA.