Grade 1 Isthmic Spondylolisthesis

Spondylolisthesis is a condition where one of the vertebrae (usually L5) becomes misaligned anteriorly (slips forward) in relation to the vertebra below. This forward is caused by a problem or defect within the pars interarticularis. Occasionally, facet joint and/or posterior neural arch defects may also cause this syndrome as well. The forward slippage does NOT always occur; however, the par defect, which is considered a non-united childhood fracture still may be present. This non-slipped pars defect is called a "Spondylolysis" and is almost always a precursor to the actual forward slippage.

The structures - pars interarticularis, facets, neural arch are responsible for holding the anterior portion of the vertebrae (vertebral body) in perfect alignment. Maintaining this alignment is critical in order to keep the spinal exit-holes, (aka: neuroforamen), which are where the delicate spinal nerves exit the spine, large and open. Any narrowing of the neuroforamen may result in compression of the ultra-sensitive exiting spinal nerve root and dorsal root ganglia that in turn may well result in back pain.

The pars interarticularis, is the weakest and thinnest region of the lumbar vertebra.

5 healthy Golf Tips

Get in the game without the pain

One key to success on the golf course can’t be found at the pro shop. It’s the physical condition of the golfer. Pain shouldn’t be par for the course. Stay in the game by protecting your back.

When you consider the spinal rotation that goes into a golf swing and the fact that the speed of the club can reach 160 km/hour, it’s easy to understand that golf puts significant stress on your body.

Follow these tips to improve your game and prevent the pain.

1. Warm up and warm down
Take a few minutes to stretch (some good stretches found here) before and after your game. Start with a brisk walk — 10 to 15 minutes should do it. Then do some light stretching.
2. Stay hydrated
Drink plenty of fluids before, during and after your game. Remember that once you are thirsty, you are already starting to dehydrate.
3. Push, don’t carry, your golf bag
Pushing or pulling your bag and taking turns riding in a cart can help you prevent back injury. If you prefer to carry your clubs, use a double-strap bag that evenly distributes the weight. If your bag gets too heavy, put it down and take a break.
4. Choose the right shoes
Wearing a golf shoe with good support and the proper fit can help prevent knee, hip and lower back pain.
5. Take lessons
The right swing technique can do more than improve your game. It can also spare you unnecessary pain. Working with a professional is a great way to learn the basics.

Canada Chiropractic Association

Common Exercise Mistakes

...And How to Correct Them Before You Injure Yourself

By Chelsea Cooper, MPA, CPT
Did you know that more than 60 percent of people who begin working out for the first time, or pick it up again after taking some time off, hurt themselves in the first month? That's significant for several reasons, not the least of which is if you are hurt, how are you going to keep working out and reach your fitness goals? The most important goal when undertaking any exercise program is not to build muscle, burn fat, increase cardiovascular capacity, or anything else. Those are important, but the number-one priority is to keep from being injured. That's the only way you'll have a real chance of reaching your fitness goals.

The right way versus the wrong way to exercise; now this is a topic that needs to be discussed more often. Just the other day, a friend of mine told me she had injured her chest muscle while doing Pilates. Of course, her training was unsupervised; in her case, she was following along with a DVD. She went to the hospital and was diagnosed with a torn chest muscle. Who would think someone could seriously injure themselves by doing Pilates on a DVD? It happens more frequently than you think. And if you can hurt yourself doing Pilates, you can definitely hurt yourself while working out at the gym lifting weights or using any of the equipment.

It's a Question of Form

Common Exercise Mistakes All of my clients know I am a stickler for form. I don't care how much weight you are lifting or how many times you can perform an exercise; if your form is not correct, you need to reduce the amount of weight you are using and/or slow down. I'm a stickler on form for two important reasons:

#1 Safety. (Injury Prevention). Correct form is key when doing any exercise. In fact, it's the first thing you must master! If not, you will eventually injure yourself. If you aren't sure if you are doing something correctly, please get a competent professional to assist you.

#2 Effectiveness. If you want to get the most out of your workouts, you have to use correct form. There is a right way to exercise and a wrong way to exercise, and this applies to each and every exercise you perform. Exercising is an art form that takes years to master. But let's face it; the average person does not see it that way, and that is why so many injuries occur and/or motivation disappears.

Most people have no clue how to do a proper squat, push-up, lunge, leg press, chest press - you get the idea. Lack of proper form is the number-one cause of injuries. Most people in the gym look around for someone who has a body they want and then try to mimic the same exercises the person is doing. Sometimes the person they are looking to as an example does have the correct form, but that doesn't mean you can mimic it correctly. It may have taken them years to learn how to do it the right way. But most of the time, the person they are looking too as a model saw someone else do the exercise and they are doing it wrong as well. It's a vicious cycle.

Repetitions/Sets

The general rule for repetitions and sets is straightforward: If you are trying to gain muscle or get stronger, you want to do low reps and higher sets. For example, you may be doing a leg press and you are trying to get stronger (hypertrophy), so you put on a heavier weight and do 6-8 reps per set for 4-5 sets. On the other hand, if you are just trying to build endurance and lean out, then you should do higher reps and lower sets; typically 15-20 reps per set for 2-3 sets. Now there are some middle reps and sets as well, like 10-12 reps/5-6 sets, but these are the basic rep/sets. The point is, it's important to understand how different sets, reps and even the types of exercises you perform affect your body. Again, talking to an exercise specialist will help you determine the best way to achieve your fitness goals.

Right Way, Wrong Way: 9 Exercise Mistakes

* Lat pulldown. The wrong way: pulling bar behind neck can cause serious injury to the shoulder. The right way: Pulling bar down in front of you while squeezing your back muscles (the rhomboids and latisimus dorsi).

* Push-ups. The wrong way: You should never have a dip or arch in your back or lock your arms. The right way: Arms should be underneath you and not locked, back parallel to the floor. Engage your "core" the entire time (squeeze your glutes and draw in your belly button).

* Walking lunges. The wrong way: When performing a lunge, extending the front knee past the front foot will cause injury at some point. The right way: When you are in a split stance, go straight down and do not let your front knee go past your foot.

* Leg press. The wrong way: Your knees should not be by your ears; that is not a position your knees are used to being in, especially under heavy weight. The right way: Keep 80 percent of the weight in your heels; press out and go a little past 90 degrees.

* lady doing push-up Abs (crunches). The wrong way: Pulling the head up as you're doing a crunch. The right way: Relax your head and bring your shoulders off the ground, engaging your abs and rotating your hips to the ground.

* Squats. The wrong way: Knees coming forward over your toes. The right way: Perform this exercise as if you were sitting back on a chair and putting 80 percent of your weight on your heels. Then lean slightly forward so you won't fall back.

* Chest press. The wrong way: Lifting the weight using your back (high arch). The right way: Keep your back flat and relax your shoulders while lifting the weight.

* Cardio. This isn't really a specific exercise, but it still is something that lots of people do wrong in the gym: doing an hour or more of cardio. No, I'm not crazy; the only people who should do an hour of cardio are marathon runners. If you aren't planning to be in a marathon anytime soon, then I wouldn't do an hour. In fact, I recommend high-intensity training - for example, a 30-second sprint or quick walk followed by a 60-second jog, then another 30-second sprint, and so on; repeat that cycle about 10-12 times and you will get way more out of your cardio workouts in half the time. It works, trust me. Try it!

* Frequency: Being too zealous and working out 6-7 days a week for an hour or more each time. Your body needs rest and repair after a workout, so pace yourself and make exercise a healthy habit, not an obsessive one. If you don't take this advice, you will start to develop chronic injuries or just get burned out and stop working out, which is not what your exercise program was designed to achieve.

Start Off Right

And let's not forget about the right and wrong way to exercise in general. As I mentioned earlier, exercise is an art form and since most of us have not taken the time to master the proper techniques, we should get some expert advice prior to working out. Most gyms have personal trainers who will give you a free consultation and show you some basic machines and correct postures. Your doctor can also be a good source of information, particularly if they specialize in exercise and rehabilitation protocols. After all, you wouldn't just jump into a pool and expect to start swimming, right? Learn the right way to exercise from day one. When it comes to fitness goals, it isn't about how quickly you achieve them, because more often than not, going too quickly will end up being the slowest, most painful route. Exercise the right way, stay safe, and enjoy the journey.

4 Movements to Avoid When Exercising

1. Using jerking motions, especially when lifting. Speed is fine when done appropriately, but you should always have fluid motion and proper form when performing any and all exercises; otherwise you could strain or even tear something.

2. Using body parts not required for the exercise. Have you ever seen people doing biceps curls and rounding their shoulders or arching their backs? Those are just two of the big no-no's that can lead to injury.

3. Locking out your knees or elbows. Never lock your joints when working out; keep them slightly bent so the weight will not be transferred to the joints.

4. Arching your back. Picture someone on the barbell bench press, lifting a weight that is actually too heavy for them. Chances are that eventually, they will start arching their back. Sooner than later, that back is going to give out and they won't be able to exercise for days, weeks or even longer.

Chelsea Cooper, MPA, CPT, is certified by the National Academy of Sports Medicine as a personal trainer, performance enhancement specialist, and rehab and exercise specialist. To learn more, visit www.trainwithchelsea.com.



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Jessica's " Daily Affirmation"

I wish we all had this ability to love ourselves.

Self-Care for Back Pain: Exercises to Help the Healing Process

By Marc Heller, DC
When it comes to back pain, your first thoughts may be to take over-the-counter pain medication and rest whenever possible. Two bad options. First, medication is only going to temporarily relieve the pain, if at all, and may be accompanied by various unpleasant side effects attributable to drugs. Second, rest may actually hurt more than help. While you're seeing your chiropractor, there are a few things you can do at home to help the healing process. Believe it or not, it's based on the simple principle of movement.

Whenever I see a patient with back pain, I always ask, "What do you do when you are in pain? What exercises help your pain?" I am continually surprised that very few patients know what self-care to do when they have an acute episode of pain. That includes motivated patients and patients I have seen before and carefully shown the right exercises. Maybe it is because when you hurt, you stop thinking clearly; or maybe it is fear that the pain will get worse. Both are valid excuses. Most of them just rest, ice the area, and use non-steroidal anti-inflammatory drugs (without realizing that NSAIDs actually block healing). Many of them say, "I hurt too much to exercise."

Why Movement Matters

The problem with this is that when you stop moving, when you are still, everything tightens up, circulation slows down, and pain chemicals accumulate in your muscles and joints. It's like waking up after sleeping in a cold room on a lousy mattress with a draft. If you get moving, you'll typically start to feel better.

So, here's the number-one rule to remember: Don't stop moving when you hurt. I know, you are in pain and afraid to move, and sudden movements may cause your back to "grab" or spasm. I am not telling you to ignore the pain. What I am saying is that you need to find movements that will ease your pain. In many cases, the most important thing to do when you hurt is to keep moving. The body often tightens up and limits your motion. If you find a motion that doesn't hurt you, it will probably help you. When you are hurting, you may not be able to do your usual activities, but you must keep moving. Try walking slowly, especially on flat and even ground. Try walking up a hill (you can walk up a hill without walking down, on a treadmill). Try swimming or simple motions in chest-deep water. Try basic pelvic tilts, staying within a pain-free range.

Here are some basic principles. The movement should be pain free (or at least cause minimal pain while being performed). When you have finished doing the exercise, your pain should be somewhat diminished. You should feel that you can move more freely. Your back should feel straighter and less "kinked."

Backward bending is a great exercise when you're suffering from low back pain. Start on the floor or other stable surface (top picture), then slowly raise your upper body up while keeping your lower body stationary (bottom picture). The final step involves extending your arms up (much like a push-up). Basic Exercises for Low Back Pain

Here are two basic examples of self-care exercises that have stood the test of time. Many of my patients have found variations on these and other types of movements that act as "reset" buttons for their typical pain. You are the one living in your body; you are the most likely one to know what is working for you.

Lower back diagnosis is often very difficult and confusing. For the sake of this article, let's divide low back pain exercises into two categories: exercises that make your back feel better when you bend backward, and exercises that make your back feel better when you bring your leg toward your chest.

Backward Bending (extension of the lumbar spine). An exercise called the McKenzie extension is the first thing you should try if you have sciatica (pain running down your leg). If these exercises work, your pain will diminish and may centralize, which is a good thing. Centralize means your pain goes less far down your leg, and you may feel it closer to the spine. Bending backward may not feel good at first, but you should feel better immediately afterward. If you feel worse afterward or the pain goes farther down your leg, stop, as this is not the exercise for you.

How to Do It: Lie face-down on the floor, arms bent at your sides (sort of like a starting push-up posture). Straighten your arms up slowly, lifting your upper body off the floor as you do so. Your legs and feet should stay on the ground. Hold for 3-5 seconds, then slowly lower your upper body back down. Repeat 10 times, as often as once per hour.

If your pain or restriction is on one side, a variation on McKenzie extension (lying on a raised surface with one leg on the floor, slightly bent) may be more comfortable (keep the elevated leg straight).

Flexion Exercises (bringing the leg toward the chest). People with lower back pain can also feel better with various types of leg flexion, bringing the bent leg toward the chest, or doing contract-relax and then bringing the bent leg toward the chest. These people usually have sacroiliac joint problems. (The SI joints are located on either side of the spine in the lower back.) These are also called Tigny exercises.

How to Do It: Lie on your back with one leg bent and then other flat on the floor. Bring the bent leg up toward the chest. Wrap your arms around the leg and then try to lower it toward the floor for 3-5 seconds, resisting with your arms. Relax, and then pull the bent leg up farther toward the chest. Repeat the entire process three times.

Flexion exercises are another great way to relieve lower back pain. Lie on your back with one leg bent and the other leg flat on the floor. Raise the bent leg toward the chest, wrap your arms around the bent leg, and then try to lower it toward the floor as you resist with your arms. Repeat with the opposite leg. I have included a series of links at the end of this article; the first two go to videos describing the basics of McKenzie extension. The third one goes to an article I wrote describing the basic McKenzie extension exercise, and a couple of other variations. The fourth link goes to Dr. Craig Liebenson's site, LA Sports and Spine, where you can download his article and pictures on McKenzie self-treatment for sciatica. The fifth and sixth links relate to the Tigny flexion exercises, including a one-minute video demonstration.

So, here is the bottom line: When your lower back starts to hurt, find one or more simple movements or exercise that helps. Do the exercise over and over until you are back to normal. If you are not getting better quickly, call your chiropractor.

With that said, please use common sense. Stop immediately is you hurt more during or after doing any exercise. Exercise is not without risks. These or any other exercises may cause pain or injury. As with any exercise program, if at any point during your routine you begin to feel faint, dizzy, or have physical discomfort, you should stop immediately. To reduce your risk of injury, consult with your doctor before doing these exercises for the first time, particularly if your pain is new and/or you would like further explanation of how to perform the exercises correctly.

Links to Exercise Demonstrations and More Information

• Video of McKenzie lumbar extension.
  


• Sciatica self-care, by Dr. George Best, six-minute video.
  


• "Pain-Relief Exercise: The Lower Back."
  


• See the McKenzie self-treatment for sciatica; the other exercises are also useful.
  


• "Sacroiliac Joint Correction - A Different Model." A description of the Don Tigny model of the SI, with pictures of his various exercises.
  


• Video of flexion exercises.

---

Marc Heller, DC, maintains a chiropractic practice in Ashland, Ore. He is a nationally recognized expert in treating tailbone, sacroiliac and lower back pain.

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Exercise and the Prevention of Low Back Pain

ChiroACCESS Article

Many occupations in modern society require prolonged sitting which has been shown to be a risk factor for low back pain. There are numerous studies that suggest that exercise can play an important role in preventing occupational and non-occupational low back pain. An innovative approach was published this month (April 2010) in The Spine Journal that used an office chair exercise that is performed while seated. The exercise, described in the article by Jerome Fryer, D.C., provides a brief decompression of the lumbar spine by moving forward on the chair seat, placing the hands on the seat of the chair, pressing downward with the arms to take pressure off the lumbar spine, and arching the back and shoulders backward at the same time. This decompression maneuver held for 5 seconds followed by 3 seconds of reloading (sitting normally) and was repeated 4 times. Sequential MRI demonstrated a marked increase in vertical height of the lumbar spine using this decompression strategy. The authors concluded that “Seated upright MRI and stadiometry, as performed in this study, appear to be feasible methods for detecting compressive and decompressive spinal changes associated with normal sitting and, alternately, seated unloading exercises. Larger studies are encouraged to determine normative values of our study measurements and to determine if morphological changes induced by seated unloading predict treatment response and/or reductions in the incidence of sitting-related LBP.”

A January 2010 Cochrane review concluded that “There is moderate quality evidence that post-treatment exercise programs can prevent recurrences of back pain but conflicting evidence was found for treatment exercise”. There have been many studies published this past decade that support the value of exercise in primary, secondary as well as tertiary prevention of low back pain. These studies have been conducted with multiple age groups and multiple settings including sports venues and the workplace.

Exercise for the Primary, Secondary and Tertiary Prevention of Low Back Pain in the Workplace: A Systematic Review

Tell your doctor what you want

The other day I was explaining to a patient that the path of getting rid of chronic pain is rarely a straight course. Healing is normally a roller-coaster ride, beset with dips and valleys. This actually seems to surprise patients.

When people seek out treatment for chronic pain, they want immediate, direct relief of the pain. They want the quick fix for the knee, the back, or whatever is hurting. The patient wants that one part to be the focus of their treatment, and nothing else is considered. Patient’s often leave out important facts about their health, clues that may help the doctor in actually fixing the problem.

Traditional western medicine is to blame for this, continually breaking medical treatment into smaller and smaller specialties, in fact, in many orthopedic offices a knee doctor will not look at the hip or the spine. When treatment of the symptom does not succeed, the patient is often sent to another “specialist” without any continuity in the care. I have seen patients referred from one specialist to another like children playing a game of hot potato. All the while the patient is given addictive and dangerous pain medications to cover the symptoms and bury the underlining cause even deeper.


In most cases chronic pain is the result of a series of small events that, when looked at as a whole, leads to the real reason patients have pain. Muscle imbalance can lead to ligament and tendon problems, this then leads to joint and movement issues that are often the root cause of chronic pain.

In my office, careful functional assessment is made to determine the cause. The key for patient success is to be very clear with the history and onset of your condition. Be clear about the time line of events, each question that is asked is intended to discover the underlining cause. The symptoms you have could be the result of a seemingly un-related stress or injury.

Functional Medicine Model

The functional medicine model emphasizes the importance of eliciting the patient's full, unique story, and uses fundamental clinical imbalances to illuminate the common mechanisms underlying most complex, chronic illnesses.

In the blue inner circle, (above), you see the range of life experiences, signs, symptoms, diagnoses, and genetic predispositions that the patient brings into the therapeutic encounter. These are then filtered through the eight elements of the functional medicine matrix model shown in the green portion of the circle. In this disciplined methodology, prioritization occurs, which then leads to appropriate comprehensive management of the patient's problem.
Treatment options now include much more than surgery and pharmacology.

The full gamut of appropriate therapeutic modalities can be used, appropriately matched to the underlying mechanisms that are influencing the patient’s condition.
l
www.thespineline.com

Fish Oil vs Krill Oil

I was told by my vendors that KRILL oil is "3x better than fish oil" …I think a reality check is in order.

I have been teaching classes on Omega fatty acids for over 10 years. The marine source oils are without question beneficial. EFAs have two principal roles.

1- EFAs provide flexibility and stability to the cell membrane. All living organisms must be able to transport nutrients into and out of the cell. This biochemical processes is the key to life. TOXINS must be moved out and foods need to be moved in. If the cell wall is too thick, fat or inflexible then the cell will begin to die.

2- The second big role for PAIN and INFLAMATION EFAs are a precursor for prostaglandins, local tissue hormones that control various functions including blood clotting, repair.

As you see we take fish oil because it is the primary source of nutrients that help the body MANUFACTURE chemical precursors. They are named essential because we can’t live with out them.

Krill oil is now marketed as "1 krill oil capsule=3 fish oil capsules," DEAD wrong. While Krill does have some EPA and DHA, by volume it is very low.

In one 1,000 mg. capsule of krill oil only has a total 300 mg. omega-3 fatty acids! And the important reason to take fish oil which is the EPA and DHA, KRILL has barely 150 mg. EPA and measly 90 mg. of DHA.

Patient who are at risk for heart problems, or who have advanced joint arthritis should be considering taking at least 3 to 5000 mg Daily of EFAs and the amount of EPA in this dose should be about 1600 mg the amount of DHA should be around 1400

In populations of humans where quality of life improved quickly, our human ancestors ate primarily marine source proteins. *Humans did not eat Krill. *It has barely been studied in humans. *drdavesbest.com

Uncomplicate your Diet for Success!

Caloric Intake:

Many times we over-complicate nutritional advice. The following is a very simple way to figure out how many calories you should eat based on activity levels.

If you follow it, you will be successful. It is that simple. If you need a meal plan please contact me.

basically - 4 to 6 small meals daily. Eat lean meats 3.5 Oz 2-3 times daily, vegetables, nuts and seeds, some fruit, little starch and no sugar. Keep intake to levels that will support exercise but not body fat.

To find out what intake levels will support exercise but not body fat, simply multiply your body-weight by:

o 10-12 if you are not active (have a sedentary job and do not exercise)
o 12-14 if you are somewhat active (have a sedentary job & exercise 3x/wk)
o 14-16 if you highly active (on feet all day, actively lifting 40 + lbs regularly)

This is a good starting place for you to begin the process of achieving optimal health and fitness.

6 things NOT to do while trying to lose weight

You may be working out regularly and trying to Lose WEIGHT but these 6 things will stop your fat loss program cold.

Number 1

Fast food. So you go to McArby's to get a salad. Better take it home and put some low cal dressing on it, and watch those dried cranberries.

There is enough of them in there to give you the sugar of two candy bars.

While you are at it add some broccoli to the salad as well.

Every attempt that any fast food chain has made to introduce a real low fat food or menu has failed miserably. Don't expect a major chain to make this mistake again soon.

Here is a fast food substitute. Morning star or other veggie burgers. They can go from frozen to hot in less than two minutes in the microwave.

Skip the bun, the fries and make two burgers with low or no fat dressing.

Have some green tea along with it and a piece of fruit.

Much much better.

Number 2

Super sized portions. If you ever go abroad you are likely to be appalled at the portion sizes.

How much do they give you over there? Just enough. You won't walk out of one of these places stuffed but you won't walk out hungry either.

Most of the people reading this were not born in the depression. It is not a sin to push food away. It's your body and your stomach. Listen to them.

Number 3

Scale watching. Since many popular diets have you lose water
weight first I think you should invest in a fat monitor scale. These days they are less than a hundred bucks and it's well spent.

If you go on Atkins or South Beach don't be too surprised if the weight goes down but the fat goes up. Water loss will do just that. Your fat loss will start after about 3 to 4 weeks on these diets.

With a fat scale you can't BS yourself and say, "I am going to the gym so maybe it’s muscle I am gaining."

Most workout programs will take a minimum of 6 weeks of dedicated
practice to actually start putting any measurable muscle on your frame.

The first couple of weeks you will be appearing to gain strength
rapidly as your body "learns" the exercise and recruits available
muscle fiber more efficiently.

Number 4

Eating at bedtime. This is pretty much the worst time you can eat. Not because you will extract more calories as you sleep as some people believe but because you are supposed to be resting. Dumping food in your body right before you go to bed will interfere with all the restorative actions of sleep including all the hormone secretions I talked about earlier.

This will leave you tired, listless and unable to get your metabolism to respond well to exercise.

Hint: take a Sleep Wizard and go to bed hungry. You'll spend quality time in deep sleep, max your body's natural hormone secretion and wake up ready to tear into the world.

Even if you were starving when you went to bed, you won't be hungry
when you wake up.

Number 5

I am not hungry but I need something to eat. Careful careful. Food is the good girls and boys drug. It can take the place of interest, excitement, stimulation, sex, happiness and all kinds of other things. And after you are done eating all you'll have is guilt.

Number 6

Skipping meals and waiting until you are hungry. Dietary pundits say you should eat 5 or 6 small meals for a reason. You eat less and this is what your body was designed for.

If you wait until you are ravenous I guarantee you you will make poor food choices especially if there is any prep time involved. You'll probably head for the nearest McArby's!

And under no circumstances should you go food shopping when you are hungry. You'll grab all the wrong foods, eat them on the way home and, betcha can't eat just one.

So, my friend, having the perfect body is really more about mindfulness than it is about discipline.

Think about and avoid these 6 fat foils and you'll stay on the straight and narrow.

And you know what, after a few weeks it will be habit and you won't even think twice about it.

You'll "Just Do It".

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