Wearing Depends is Not a Rite of Passage!

Shhhhhh don’t tell anyone. Just hide it. It’s normal. I REALLY hope I don’t have to do Double unders today”

I work with women who have babies, teens, and grandchildren. Women who cross-fit, Ironman athletes, soccer moms and grandparents who just want to play with their grandchildren.

We talk about almost everything but no one talks about leaking. Leaking when they laugh or cough, leaking when they jump, run, or pick up a toddler.

IT IS NOT NORMAL, although sadly it is common.

I would love to open the door and discuss a topic that is so important but shied away from in conversation. So let’s understand the problem first in Part I and then later learn some basic tips in Part II

Part I – The Problem

I have friends and patients who go to the bathroom twice before they lift, jump or run. Some who wear the biggest pads they can buy when they have a cold, and others who are super dehydrated because they do not want to fill their bladder just in case.

I quote, “I thought that [Leaking] is just what happens after you have kids”, or, “It’s fine. It’s only when I exercise, or have a bad cough”.

Having children, old back injuries, sitting all day, lifting incorrectly, training incorrectly, can all put strain on the body. While our bodies are amazing in how they get us from point A to Point B pretty much no matter what, it may not be very efficient. People will compensate, then that compensation

creates bad movement habits. Over a period of time can result in injury, or dysfunction. A mirad of dysfunctions can occur but the one I want to address today is leaking when you lift, run, jump, cough, or laugh. This dysfunction is very common, but in no way normal.

My patient said to me the other day,” I didn’t know there was anything you could do about it”. YES! There are ways to address the problem and change it but first let’s understand this dysfunction.

Leaking urine is a muscular dysfunction. Imagine this; A beautiful ballet at the theatre where the prima-ballerina leaps gracefully in to the air and her partner (probably a very handsome prince ?), bounds over to catch her, but he is a millisecond too late… He doesn’t stick the landing without a bobble and a step back to catch her. So, while she doesn’t fall to the ground, it is not the graceful catch you’d expect. If the muscles in the body are coordinated in timing and sequence, he sticks the landing and the catch is flawless. If the timing is not there, it’s a stumble and regaining your balance to perform. That is essentially dysfunction and compensation.


From ballet to the muscular dysfunction in our body. Our body likes stability. Our stability system allows us to move our bodies into the position to be able to control our muscular balance. I am not just talking about balance that keeps your butt off the floor, but the balance of all the muscles moving supporting our skeletal structure, and keeping our bodily functions in control.

We have all heard about “the core”, but what really is “the core”? Most people think of it as the abdominals, a six pack. What I am referring to today is the deep core, a TEAM of muscles that must work together, the starting line-up. This line-up is composed of the diaphragm, pelvic floor, transverse abdominals, and lumbar multifidus. These muscles work synchronously, meaning they are team that are meant to fire in a specific sequence so the body can do what it is supposed to, like run, jump, lift your kids and hold in your pee all at the same time.

Julie Weibe ( www.julieweibe.com) explains this system by the visualization of gears. The gears must all move in a sequence to create force and stability. In the past few decades fitness and healthcare professionals have been teaching people to “hold the core” (navel to spine), or isometrically contract pelvic floor, called a Kegel, to strengthen the pelvic floor to help with incontinence. The problem with this is we are asking the muscles to just to “hold”, when really the goal is to move, (like in a kickboxing class or to chase a toddler). One example Julie Weibe gives is that would be like asking someone to hold the quad tight (lock out the knee) and still run.

This technique is in the same vein as “tighten” the abdominals and brace for a lift. New research has shown that static isolated bracing puts increased pressure on the pelvic floor, decreasing its ability to keep the urine in. The other big new discovery is that while for years people have been told to bring the navel to the spine, this “hollow” or “flat back” position puts the pelvic floor muscles in a poor mechanical position to fire. When these muscles are inefficient, dysfunction happens, and as I said before – this can result in many various symptoms that include not only incontinence, but also back, hip, shoulder, rib, and cervical pain, as well as decreased athletic performance.

So now what? The biggest point I want you to get from this article is don’t hide, talk about it. I will include links to find a pelvic floor Physical therapist or sports medicine PT who is educated in this area (not all are) to help you get awareness to re-coordinate your patterns, this is crucial. It will not get better with denial.

The anatomy: The “gears” that work in a sequence,

a. the anticipatory musculature is the pelvic floor (PF), the sling of muscles from front to back of pelvis. This is what is engaged in a Kegal exercise. It should be contracted dynamically not a static hold.

b. On to the diaphragm. Seriously, who thinks about strengthening the diaphragm, no matter how much I work that one it never gets ripped ?, but breath holding is one of the biggest contributors to leaking, and lowering athletic performance with regard to decreased speed and strength. As thediaphragm engages it dips down into the abdominal cavity to pull the air into the lungs. When the breath is held in, breathing with the chest vs the ribcage more pressure is pushing in to the poor pelvic floor. It’s just like stepping on a water balloon, just pushing the urine out. If we hold our breath the gears stop, it’s not dynamic movement.






c. The Transverse Abdominis: very low, low abdominals. Often when trying to contract this muscle people will bring the belly button to spine or flatten the back, that’s not quite right, instead it’s the muscle that engages with a cough or laugh. As I said before we (the fitness industry) have taught a generation to isometrically hold that muscle in the wrong position for effective stability.








d. Multifidus: Deep spinal musculature in between each vertebral segment this is the deep muscle that is so important for stabilization and correct positioning of the spinal segments.






2. The actions:

  • The beautiful coordinated ballet goes like this: the Pelvic Floor is the anchor, it sets itself up for all movements before they happen. You go to reach for a door your PF is ready, you go to kick a soccer ball your PF is engaged.
  • The Diaphragm: In the right alignment, you take a proper breath, the diaphragm should move down and out. A deep breath should feel like you are opening an umbrella upside-down in the bottom of your ribcage. As this happens the PF should descend into the pelvis and the TA (the belly) should be pushed out a bit. This action sets those muscles up for a recoil response. For example, think of a broad jump or a box jump. Squat down first (loading the muscles of the legs) to get a great burst of strength to jump. Same thing with the pelvic floor and TA we must first load them with breath then they recoil to hold the spine, pelvis and leg in a safe stable position to move.

3. Where the most common problems occur with poor posture or alignment:

Tucked in: Posture is slouchy, tush tucked under









Extended military: Chest is out and forward in front of hips









Lordosis: A huge curve in the low back tush pushed out.







When the alignment is off then the muscles are not in a good position to work effectively or efficiently. The muscles that control the stability system aren’t loaded or engaged correctly, leading to the compensation we spoke of at the very beginning of the article.

The Fix

First find your neutral spine.

1. Ribs stacked on/over your pelvis

2. pelvis in neutral. Tailbone not tucked under nor tailbone reaching for the stars. A good thing to check is boobs should point forward not down or up.

In neutral spine, take a deep breath feel your lungs expand, belly pop out and then chest rise. IF your ribs are forward over the pelvis your chest will rise before your belly. Play with the breathing in various postures: feel the diaphragm push down then as you exhale the recoil of the abdomen and the pelvic floor.

IF you can’t feel your pelvic floor, the ski jump position is a great trick Julie Weibe uses to put the body in a place to automatically engage lower abdominals and pelvic floor. Stand in facing a wall or a desk, lean forward from your ankles keeping the trunk stable as you begin to lean forward from your ankles this will make your brain engage the pelvic floor and TA to stop you from falling over (stand in front of a wall so you don’t feel as if you are going to fall) just feel the muscles in the front of you pelvis turn on then lean back to center. See if you can find that muscle again.

Here’s a video to help

If leaking is an issue for you then this is just the beginning… I want to shine a light on this topic, but to make changes there is a lot of work to do. I would like to direct you to a few great videos to help find the issues. Now you can train to be stronger than yesterday!


Resources for further understanding and investigation




Use this link to find a women health or pelvic floor specialist near you.


Make this Year’s Resolutions Stick…for Good

We’ve all said it before, “Starting January 1st I’m going to get healthy!” or “I’m going to drop 20 pounds by March!” Unsurprisingly, the top New Year’s resolution is some variation on getting fit or losing weight, what’s notable is how much doesn’t stick.

  • Fewer than 8% of resolutions are kept past March
  • Thousands of pounds are lost, yet 90-95% gain the weight back plus some
  • People spend upwards of $60 billion annually trying to lose weight through diet and gyms

So, how are you going to make this year different?

First, look at the big picture of health – weight loss should be viewed as a positive side effect of a healthier life. You don’t need to lose weight to get healthy, once you are healthy you will lose weight. This means lifestyle changes must happen to achieve overall health and I’m not talking about drastic, overnight changes. In my 25 years of experience with fitness injury, every January is exactly the same. People are pumped up and start like a bat outta hell. They take on huge diet restrictions (no fat or sugar and fewer than 1500 calories a day) and add intense exercise all while maintaining family and life responsibilities on 6 hours of sleep.

This is a recipe for disaster on so many levels because the changes are unsustainable. I know this because my office is quiet in January and February, but by March there’s a waiting list full of tendonitis’s and back injuries.

First it’s imperative to understand the physiology of the body parts you aim to change: for strength it’s muscle, for weight loss it’s metabolism, for energy it’s cardiovascular fitness. Also understand that all of these systems work together. Metabolism, is an especially tricky system that is different for everyone and finding the unique balance will lead to success.

We must consider what makes your body work? Where is your tipping point? What’s the quality of the food you eat? Are you sleeping well or enough? Are you exposed to excessive environmental toxins? Are you not exercising enough to stimulate change, or are you exercising too much?

Imagine a wheel. The image on the left has the some of the big factors we need to focus on for a successful fitness program. The wheel on the right shows the imbalance of the pieces in the wheel. Rate your wheel in this manner are all the pieces balanced? Will your wheel roll or is it more like a stone, edges all jagged?

Health Wheel Health Wheel

When all the factors of the wheel are out the balance, wheel (or in this case the body) doesn’t roll right.
We need to factor all the systems together to find what fits for our own individual bodies (not your spouse or your neighbor or the MD on Dr. OZ)

Cortisol is the hormone that regulates stress. Cortisol is what stimulates the Biochemical processes for us to run from a tiger (Flight or fight). Starting or changing an exercise program will increase cortisol production. When this system is stimulated appropriately weight will fall off, we will sleep well, we eat normally, cravings will disappear, need for caffeine and sugar decreases.
If we over-stress (which 80% of Americans do) the stress modulating system becomes over taxed and the body will spike cortisol levels for a certain amount of time. Unfortunately, the body can’t keep up the production of cortisol resulting in a sharp decrease in the production of cortisol, or a crash.

Symptoms of this crash can include: reduced immune system (colds sinus infections) fatigue, food cravings, joint pain, muscle pain, weight loss plataue/ weight gain( rebound) mood imbalances, anxiety, depression, and brain fog to name a few.
The challenge is to balance enough stress to grow without so much stress we break down. This is the fine line we need to walk when starting a new fitness program.
Hormonal balance depends on:

  • Cortisol regulation: Normal production is based on circadian rhythm and stress response
  • Small stressors are healthy (quick run/exercise burst, learning something new/problem solving, occasional intermittent fasting)
  • Chronic stress this is what does us in (daily 90min commute in traffic, physical pain, fighting with spouse, unhealthy eating patterns, not enough sleep, over exercise)

Calorie restriction is a huge factor in metabolism. You need to be aware of how much you are consuming, but excessive restriction will make matters so much worse. Looking at the nutrient value of what you are eating will continue to fuel your body for the new activities you are asking it to do.

Excessive caloric restriction combined with exercise is a disaster in the long run. Your body will find the nutrients somewhere in the system. Catabolic (breakdown) processes will begin, your body will breakdown muscle tissue and bone to get fuel. Therefore, destroying the results from your workouts.
Realistically you may see weight loss quickly. Unfortunately, continual deficits in nutrient intake is impossible to keep up and the rebound effect of weight gain will be greater than the loss.

Components of a well-rounded fitness program


My least favorite question what is the best exercise? It ranks up with what is the one best food… There isn’t one best. We need a combination of it all. You must be muscularly strong to tolerate the stress of the activity you want to do. You need to be flexible to move safely in to certain positions. You need to be balanced on each side of the joint (biceps to triceps, pectorals to rhomboids) to avoid uneven strain and inflammation.

To be fit the answer is NOT ”Eat less and work out more”.

Benefits of appropriate exercise:

  • Psychological benefits
  • Increased endorphins (only if you like what you do)
  • Increased social interaction
  • Mental clarity
  • Physiological benefits
  • Vanity benefits slim, muscles,
  • Better performance
  • More resistant to injury

Symptoms associated with over training:

  • Fatigue
  • Chronic reoccurring Tendon and muscular injury
  • Weight gain or weight loss resistance
  • Sleep disturbances
  • Increased susceptibility to infection (more frequent colds, respiratory infections and “flu-like” illness
  • Increased food cravings or disordered eating patterns

A balance program needs to incorporate strength training, flexibility and cardiovascular endurance training.
The body respond to variance vs consistency. Meaning that you should start an exercise program but switch it up frequently. Once our bodies learn how to do something the effort is diminished and so are the returns.

Ways to optimize your workouts:

  • Change the intensity,
  • Change the movement,
  • Change the resistance,
  • Change the speed.

Some options are:

  • Strength training, body weight or Olympic lifting, make sure your form is correct!
  • Injury happens when the weight and speed are too much causing form break down.
  • Interval training, such as Tabatas, or HIIT training, this can be as simple as running lines on the basketball court
  • Yoga for mind and body, strength and flexibility

Here are the big do’s and don’ts I have found to help start and stick with healthy lifestyle changes.

DO                                                                                                              DON’T

Eat real food: veggies, organic meats, fruits Rely on Frankenfoods: weight loss shakes and frozen dinners
Eat healthy fats: coconut oil, avocado oil, olive oil, smaltz, tallow, ghee. Eat fake sugars, diet foods, and vegetable oils
Sleep at least 8 hours every night Forgo sleep for extra workouts
Take recovery days:  exercise 2-3 days in a row then take 1-2 days off Workout every day at maximum capacity
Feel good after exercise, feel invigorated Push to exhaustion, feel drained all day after training session
Vary the type of workouts throughout the week: Cardio, strength training, yoga, balance Do the same activity at the same intensity every day.  Your body will react and adjust to change, but doing the same workout will lead to a plateau.
Choose activities you enjoy Exercise you hate will never make you thin and happy
Create realistic short and long term goals for each quarter of the year. Haphazardly begin a program with no structured focus.
Exercise inside and outside. Smell the trees, feel the sun, get dirty – it’s all good for you! Exercise through pain. Muscle burn is ok, but pain is a sign of something wrong

Change is good, and resolutions can be a great way to initiate change. Be mindful of why you want to change and have a plan for executing it in a realistic manner. Make 2017 the first year of your new healthy life!

Check out our blog for recipes and ways to get stronger than yesterday!

Battle Born Health

Freedom from Muscle Pain: It’s Not a Christmas Miracle, It’s Mechanics

Patients often come into the clinic because they are in pain, let’s say their shoulder hurts. When we ask what happened, we often hear answers like “I don’t know, I just woke up with this.” Left untreated, the muscle pain won’t go away and may worsen over time.    

First, the physical therapist will perform an evaluation to determine the issue. We ask a lot of questions, ask you to move in various directions, and build a 3D picture of what is happening inside your body.    

The Mechanics of Muscle Pain in the Body

To understand what we’re looking for, picture the construction of a skyscraper. Cranes move huge beams at all different heights and angles to construct the structure, or skeletal system of the building. This is accomplished by strong cables and pulleys manipulating the beams and structure, similar to the way muscles and tendons act on bones and joints. 

Now, picture one of the beams getting snagged or hung up on something as it’s being moved – the cables will continue to lift and pull, but the stuck area will prevent movement, placing extra strain on the pulleys and cables. In the body, when the tendons or muscles are strained, an inflammatory process begins. This process rushes cell-rich blood to the area resulting in a warm, red and sore joint. Rest is beneficial so that the biological response can perform its functions, but it can’t fix the root cause of the irritation – the mechanical hang-up within the body’s bone and joint structure.    

Physical Therapy Can Restore Joint Mobility

A physical therapist is able to perform manual techniques to get the joints moving, which may feel like an aggressive massage. These techniques allow the physical therapist to unstick the metaphorical beam and restore normal mobility of the joint. After treatment, or a series of treatments, the patient discovers that they’re finally able to move their shoulder without muscle pain, they’ll patient exclaim “it’s a miracle!”  NOPE it’s mechanics! Now the beams and cables are moving freely, no strain and no pain.   

That’s just part one of the solution.   

Part two involves re-educating muscles to move in the correct patterns so the joints don’t get stuck again.  When the joint has improper mobility for an extended period of time, the muscles will find a way to compensate, producing bad habits. Without correcting those bad habits, the hang-ups are likely to just recur, which is why your PT will work with you to help train your muscles to activate and move in the correct sequence to keep the joints healthy and moving properly. 

Neuromuscular Reeducation Creates Lasting Improvements

Physical therapists are specifically trained in neuromuscular re-education. Neuromuscular reeducation is the process of identifying bad movement habits, then training and the appropriate, coordinated patterns of movement.  Exercise with good form will promote strength, speed and pain free range of movement. This is not a quick fix, and requires dedicated work on the part of both the physical therapist and from the patient, but it is the best and only way to create real and lasting improvement toward the goal of becoming pain free. 

If you have a recurring injury, or aches and pains that refuse to go away despite plenty of resting and careful exercise, your body mechanics are likely off.  The physical therapists at Battle Born Health are ready and excited to offer you the one-on-one time and attention that’s needed to properly identify the problem and its root causes, create a personalized plan for recovery and prevention, and get you through your injury with a full and lasting recovery.  Every session puts you in their capable hands, one-on-one, with the goal of reducing your overall muscle pain. 

With Battle Born Health, there’s no techs, no time in another room with another patient while you do exercise. It’s just you and a Doctor of Physical Therapy.   

Call today to schedule a complimentary consultation, and let us show you how we can help you meet your goals.

Headache Part Two: Desk, Driving and Sleeping Posture

Headache Part Two: Desk, Driving and Sleeping Posture

There’s a lot of talk about how good posture is crucial for a healthy body, but it’s tough to know what exactly is good posture. In this article, we will discuss the best posture for sitting at a desk, driving and sleeping. These tips are especially important if you suffer from headaches because the position of your head and spine have a huge impact on how you feel. If you’re new to this blog, I recommend looking back to the previous article Headaches Part One: A Pain in the Neck for some background on how headaches can be caused by posture.

headache cure Battle Born Health therapy

A “normal” spine has 4 curves – the inward (lordotic) curve of the cervical spine or neck, the outward (kyphotic) curve of the thoracic spine, the inward (lordotic) curve of the lumbar spine or low back and the slight outward curve of the sacrum.

Between time, gravity, our jobs and hobbies, we tend to develop a forward head and shoulders posture which changes the forces through the spine. Our chin pushes forward, followed by our upper back resulting in increased strain on the joints and muscles as well as weakening of the deep stabilizing muscles of the neck. This can result in headaches at the base of the head, the temples, radiating up the back of the head and aching in the neck and shoulder blades. Keeping your spine in a neutral position helps minimize the extra forces on the neck and prevent aches and pains as you work and play.

Battle Born Health therapy posture Reno

To maintain good posture, imagine a vertical line being drawn down through your body from head to toe. That line should pass through the center of your ear, your shoulder, your hips and your ankles. This puts your spine into a strong, stacked column which distributes the pull of gravity evenly and reduces strain in the joints and muscles.

Sitting at your desk

Tips Physical therapy Battle Born Health

  • Position your monitor so your eyes are looking 2 to 3 inches below the top edge, keeping your chin parallel with the floor.
  • Squeeze your shoulder blades together gently to support the upper back, then pull your chin directly backwards into your spine like you’re giving yourself a double chin. The goal is to keep your chin level (not letting it drop toward the floor as you pull it backward) and reverse the curvature that was caused by the forward-head posture that was mentioned earlier.
  • Sit with your hips against the back of the chair with a small towel roll supporting the natural curve of the low back.
  • Finally position your chair so your hips are slightly higher than your knees and your feet can rest solidly on the floor.


This posture is similar to sitting at your desk and the goal is to maintain a tall, neutral spine.

  • Adjust the height of your seat so you can keep your eyes looking straight ahead with the chin level with the horizon. Pull your chin back toward your neck to prevent the forward head posture. Use the headrest as a cue – the back of your head should gently rest on it, while keeping your chin level
  • Relax shoulders and let them drop toward the ground
  • Recline the seat to no more than 30 or 40 degrees
  • Support the low back with a small towel roll
  • Adjust the steering wheel so that your arms are supported on the wheel with roughly 90 degrees of bend in the elbow and shoulders relaxed


People often ask what’s the best position for sleeping and my answer is whatever position you can sleep in.

Left-sided or right-sided – the key is support

Imagine lying on your favorite side…start with the pillow under your head only (not under your shoulders). Next, tuck one end under your chin, pulling the middle section into the crook of your neck and the end around to the back of your head. Picture a horseshoe shaped pillow wrapping around from your chin to your upper back. A great way to achieve the support of an expensive feather or memory foam pillow is to take a hand towel and roll it into a log, then slide that into the pillowcase at the base of the pillow. This creates support for the neck while also being adjustable to your comfort.

headache relief
headache relief
headache relief

Next, support your top arm. Grab a standard pillow and tuck it all the way up under your armpit and so the length of your arm is comfortably resting on the pillow. Make sure all of it is supported by the pillow – upper arm, elbow, forearm and hand.

headache relief

If you’re a back sleeper:

The goal is to support your head and neck while also keeping your neck in line with the rest of the spine. In the picture below, you see how too many pillows can raise the head so it’s no longer in line with the rest of the spine. Another important point about this picture is that the pillows are there to support your head and neck, and need not be under your shoulders. Pull the pillow under your head so that it fills the curve under your neck.

headache relief
headache relief

Finally, if you have any shoulder issues, you can put a pillow under your arm from your armpit to your belly button to support the weight of the arm. This support will allow the muscles in the neck to turn off at night and rest because they no longer have to hold the weight of the arm.

headache relief

If this sounds like a lot of information all thrown at you at once, try it out one tip at a time – spend a few days at work focusing on getting your desk chair set up just right and see how you feel at the end of the week. Do the same with adjusting your car seat and being aware of where your shoulders are while driving. If you notice an ache in your head or shoulder blades, take a deep breath and let your shoulders drop toward the ground. The more often you check your posture, the more awareness you will develop and will be able to avoid headaches from the start. Also, experiment with pillows and sleeping position because a good night’s rest is crucial for health.
If you’ve tried all of these tips and still aren’t feeling the relief you hoped for, consult a physical therapist. It’s so easy to ignore headaches and hope they just go away, but resist the urge and be proactive about your health – be stronger than yesterday!

Headache Part One: A Pain in the Neck

Headaches are one of my favorite issues to treat as a physical therapist because they are an everyday nuisance that are often completely fixable. The typical description I hear from patients is an ache at the base of head where it meets the neck that seems to get worse as the day goes on, especially while sitting at a desk.

As much as I’d like to tell everyone to just retire and the headaches will go away, that’s not sustainable for my patients. Their reports of aching and tightness at the base of the head often also includes a dull ache in the upper shoulders and shoulder blade region which improves briefly with massaging the area.

We all know that you can’t recruit someone to rub your neck and shoulders all day at work, so over the next few articles, I will offer tips for decreasing the pain and give techniques to manage it without medication or days off.

When dealing with headaches, it’s important to identify the cause or causes, so they can be treated effectively. Many times, there are a combination of issues which may include seasonal allergies, posture while sitting at your desk, driving or sleeping, stress, neurological problems and trauma. While not all of these causes are suited for physical therapy, there are many that can be improved and solved with physical therapy.

Headaches that are located behind the eyes, at the temples or radiate up the back of the head to the top are often caused by dysfunction in the neck and are called “cervicogenic headaches”. These types of headaches often respond very well to physical therapy. While the pain appears in these areas, it’s not actually caused by dysfunction there specifically.

Limited joint motion, tight muscles or instability at the joint can all cause these symptoms. A skilled physical therapist will utilize a variety of manual hands-on techniques focused on restoring normal joint motion, calming muscles that are overly tight or in a spasm, and re-educating the stabilizing muscles of the neck so that your body can maintain good posture.

Here are some basic ideas to get you started. In the next few blog posts, I will give advice on ergonomics at your desk, while driving and while sleeping as well as exercises to create a strong, stable posture, so stay tuned!

3 Tips

  1. Correcting the forward head posture

The problem: head or neck pain at the computer, while driving or reading.

headache relief

The reasoning: Posture is an important starting point because without restoring the neutral position of the spine, the joints and muscles will be perpetually strained and irritated which creates a pain cycle and forces your body to compensate with unhealthy patterns of movement.

When we sit at a desk or when driving, we all have the tendency to lean toward whatever we’re looking at, typically leading with the chin. This essentially shortens the muscles of at the base of the skull and overstretches the muscles on the front side of the neck. These muscles are deep; they bear the responsibility of stabilizing our spine. If you hold your head in the forward position long enough, those stabilizing muscles in the neck are unable to support the posture and you will begin to feel that ache at the base of your head.

The solution: Postural awarenessstart by sitting tall in a chair with back support, look straight ahead keeping your chin level with the horizon. Squeeze your shoulder blades together gently to support the upper back, then pull your chin directly backwards into your spine (think double chin). The goal is to keep your chin level (not letting it drop toward the floor as you pull it backward) and reverse the curvature that was caused by the forward-head posture that was mentioned earlier. Hold for 10 seconds, while breathing and relaxing. Keep this posture in mind as you drive, work at your computer or read.

headache relief
  1. Pain while sitting at the computer

The problem: working at the computer for hours at a time and ending up with a headache

The solution:

  1. Take frequent mini-breaks – stand up and walk around for a few minutes at least once every hour, or sooner if you begin to notice a headache or neck pain

  2. Good ergonomics – we will go in depth on this topic in the next blog post, but here are a few key points to keep in mind:

    • Sit in a chair with low back support that fills the natural curve of your spine. Using a rolled up sweatshirt or a few thin towels rolled together can accomplish this without needing to buy an expensive new chair.

    • The seat of your chair should be high enough that your hips are higher than your knees, but your feet are still fully on the ground. Try placing a few folded towels under your buttocks to achieve this position.

    • Your screen should be high enough so that you can see the most of the screen by looking straight ahead with your chin parallel with the floor, and without needing to tilt your head up or down.

    • Keep your chin tucked into your neck and avoid that forward-head posture we discussed before.

  3. Balancing flexion and extension – in our society we spend a lot of time bent forward at a computer, driving a car or just staring at our phones. Your body needs to spend time out of that forward bent position (called flexion) with backward bent positions (called extension).

Here is a simple exercise you can do at work to loosen the muscles on the front of your body and give the ones on the back a break:

Doorway Stretch

– Use a narrow doorway, place one forearm flat against each side of the doorframe with your elbows around shoulder height.

– Tighten your abdominal muscles and step into the doorway until you feel a stretch across your chest

– Hold this position for 30 seconds. You should feel the stretch in your chest and upper back. If you feel it in your low back, don’t step into the doorway so far.

– Repeat this stretch one to two times an hour as you go through your day

  1. Pain while sleeping

The problem: Restless sleep because of neck pain

The solution:

Left-sided or right-sided – the key is support

Imagine lying on your favorite side…start with the pillow under your head only (not under your shoulders). Next, tuck one end under your chin, pulling the middle section into the crook of your neck and the end around to the back of your head. Picture a horseshoe shaped pillow wrapping around from your chin to your upper back. A great way to achieve the support of an expensive feather or memory foam pillow is to take a hand towel and roll it into a log, then slide that into the pillowcase at the base of the pillow. This creates support for the neck while also being adjustable to your comfort.

headache relief
headache relief
headache relief

Next, support your top arm. Grab a standard pillow and tuck it all the way up under your armpit and so the length of your arm is comfortably resting on the pillow. Make sure all of it is supported by the pillow – upper arm, elbow, forearm and hand.

headache relief

If you’re a back sleeper:

The goal is to support your head and neck while also keeping your neck in line with the rest of the spine. In the picture below, you see how too many pillows can raise the head so it’s no longer in line with the rest of the spine. Another important point about this picture is that the pillows are there to support your head and neck, and need not be under your shoulders. Pull the pillow under your head so that it fills the curve under your neck.

headache relief
headache relief

Finally, if you have any shoulder issues, you can put a pillow under your arm from your armpit to your belly button to support the weight of the arm. This support will allow the muscles in the neck to turn off at night and rest because they no longer have to hold the weight of the arm.

headache relief
pain management

How Pain Can Make You Fat

This article originally appeared in the May 2016 issue of Live, Love and Eat Magazine. 

You’re trying to do everything right – you have been working out like crazy, haven’t eaten cake let alone bread for ages, you sleep 6 – 7 hours a night, you’re at the gym at 6 AM at least 5 days a week.  Your shoulder bugs you every time but it’s not so bad that a few Advil can’t ease it.  Despite ALL of this, the scale hasn’t budged and your pants aren’t any looser. The classic theory of counting calories in and out is outdated and can do more harm than good. To quote JJ Virgin, “your body is a chemistry experiment not a bank account.”

Metabolism is what drives the body’s fat burning system. How your body burns calories, uses energy and loses weight, is dependent on multiple factors. Metabolic function, and thus weight loss, is based on our hormones. Hormones are chemical messengers of the body; they send the signals to promote cellular function.  These hormones produce the chemical reactions that govern everything!

Long ago in the evolutionary process, our bodies held on to weight whenever it was under stress. This allowed our ancestors to survive periods of famine. Those who were able to hold on to fat survived and those people became our ancestors. That means you can thank your Great Grandma for making you SO very good at holding on to fat. Nowadays, if our hormone levels get out of whack (from illness, medications, diet, etc.) our body goes into that same protective mode as if it were preparing for famine, thus it holds on to weight

Now you’re probably thinking “what can I do to control this stress reaction?” First, you need to understand the connection between the brain and the body.  Imagine our nervous system as a 2-sided coin – one side is the sympathetic and the other is the parasympathetic. The sympathetic nervous system controls our Fight or Flight response (FoF) which shifts into gear when we are stressed. The parasympathetic is responsible for our Rest & Digest (R&D) phase.

Imagine this scenario: You’re out on a walk and you encounter a tiger. Your body immediately kicks into Fight or Flight mode and floods your system with cortisol, which is a stress hormone that helps mobilize glucose to the muscles so you can run, jump or fight. This rush of cortisol increases your heart rate and helps push more blood and energy to the muscles so you can dart to a tree and climb like your life depends on it.  When cortisol rises it stops the non-essential hormones from working. As you run from that tiger you really don’t need to ovulate, digest your food or regenerate healthy skin – you just need to get the hell out of there.

That’s the way it’s supposed to work. Once you get to the tree, the tiger goes to find someone else for dinner. Now it’s time for R&D so I hang out drink some coconut water and relax. The cortisol will drop and everything else starts to work again.  Cortisol is important for short-term stress, but when we have chronic stress, the continual release of it becomes a problem.

Exercise is important, our bodies were built to move AND rest. When we move correctly our body will increase metabolic processes, allowing it to use energy and produce metabolic waste. Detoxing this waste is a crucial part of weight loss, so if we don’t rest and digest the liver can’t access the nutrient chemicals needed to detox the body. These metabolic toxins build up and the body thinks “I need to get this toxic stuff far away from my brain, my heart, and my lungs!” If the body can’t break down the fat-soluble toxins, it wraps them up safe and sound in a fat molecule and stores it somewhere safe, far away from the brain and heart…like on your ass.

In our society today, we tend overdo things. The first person to complete the 26.2 mile run to Marathon died, but for some reason we all think it is a rite of passage as an “athlete.”  It’s important to understand that stress to the system in small doses allows us to grow stronger; too much stress and we break down.

Physical stress such as exercise produces a spike in cortisol, which can be good. We need to exercise to break down tissues and encourage it to heal bigger and stronger. The problem occurs when we keep stressing the system without rest. The body cannot keep up with cortisol production and the adrenal system starts to fail (exhaustion).  When the adrenals are exhausted, sex hormone production is lessened so you can say goodbye to the idea of six pack abs.

Pain is also seen by the body as a stressor, depending on the intensity and frequency, a chronic stressor. Therefore, the body responds by increasing cortisol production and goes into flight or fight mode whenever it’s stimulated. Physical pain can continue to increase and spike cortisol which ultimately changes our body’s healing process and starts a chronic pain cycle.

pain management

As a physical therapist, I work to figure out why pain keeps occurring, then we work to change the patterns of muscular strain. Other important variables to address are diet and stress relieving activities to increase healing process and stop the downward spiral.

Remember: train smarter not harder. Pain is a signal from your body, begging you to stop (we’re talking about sharp, localized pain, not the muscular burn of activity). Your body will not get stronger through pain, it gets weaker, less tolerant and less efficient.

What can you do about all of this?
  1. Modify the movement or amount of resistance to reduce the pain
  2. Rest! Sleep at least 8 hours, try for that 7 days a week. If you are getting less than 7 hours a night, it isn’t worth it to get to the gym.
  3. Workouts should be short and intense, but not every day. Studies recommend 2 to 3 days consecutively then 1 to 2 days of rest. You can have active rest days using a walk outside or yoga for recovery.
  4. If you notice on an exercise day you are more exhausted, your body is showing signs of adrenal fatigue, force yourself to take a break.
  5. Eat nutrient dense whole foods – not processed bars, or shakes. Clean, organic proteins and LOTS of veggies for the nutrient profile that helps with anti-inflammation and detox.
  6. See a physical therapist to evaluate the movement dysfunction that is causing the pain. A good therapist can determine why the pain is continuing. With a good rehab program, the muscles can be re-trained and restored.
  7. Remember self-care is not selfish. When you spend time caring for yourself, you can recharge your own battery and then have time and energy for others.

Danielle is a Doctor of Physical Therapy and a Health Coach.  She is the co-owner of Battle Born Health in Reno, NV and has been practicing physical therapy for 20 years. Driven by her personal health issues, she completed training under the Kalish Functional Medicine Mentorship program and is certified as a Transformational Nutrition Coach. Danielle is passionate about finding the root cause of the problems, whether they are muscular, hormonal or dietary (and usually they are a combination of all) and helping people find the answers on how to become stronger than yesterday.

A Good Physical Therapist Is Pro-Active

Many people think of physical therapy as the follow-up activity their GP or orthopedic surgeon often prescribes after an injury, or an inquiry into mystery aches and pains. Certainly that’s one function of PT, but perhaps our most critical function is to be a holistic, preventative health partner for people who want to remain active and healthy throughout their lives.

We loved Dr. Chris Telesmanic’s perspective in his column for The Sentinel.

“The vision for physical therapy moving into the 21st century, as stated by the American Physical Therapy Association, is to ‘transform society by optimizing movement to improve the human experience.’”

Promoting the role of physical therapy as a proactive one focused not only on recovery but on prevention and vitality makes good sense. By nature, human beings are built imperfectly, and even the most fit and athletic among us either suffer from—or very likely will one day—deficiencies in movement based on our unique bone and muscle structure, use (and over-use) patterns, and regular age-related wear and tear. A good physical therapist will take a holistic approach to patient health and mobility, and look closely at the bigger picture to identify these potential problems before they develop.

Including physical therapy in the suite of preventative care services allows us to contribute to a healthier, more functional society—and saves time, money, and unnecessary pain for patients who might otherwise find themselves scrambling to fix and recover from acute problems down the road.

Give our Reno team of physical therapists a call at 775-747-2278 to find out how physical therapy can be an important tool in your arsenal to keep that body active forever!