Thanksgiving: Time to Count Your Blessings?

This is a good time of year to reflect and count our blessings from the past year. Thanksgiving is in a few weeks,  a time for friends and families to share a meal and celebrate the holiday season.  We are lucky to live in this great country and to have the opportunities we do.  This year I have had the privilege to teach manual therapy courses and travel both around the country and internationally.  When you get out of your home environment you can compare other regions of the world to what you have at home.  Even if it is going to the next town or across the state, there are differences, both good and bad. 

It’s all about your perspective.  Our perspective shapes our thoughts and feelings about things.  Those of us used to living in the United States take a lot of things for granted based on our perspective and experiences.  For instance, it costs about $35 to fill up the gas tank in my car here in Sarasota. When I was traveling in New Zealand this year, it cost $70-$80 to fill  my rental that had a smaller gas tank than my car at home!  So when we think gas prices are high here in the states, it’s all relative.

I had the great fortune to teach two courses in Canada this year. I am grateful they have such a good educational system for the therapists in Canada. It made teaching advanced work much easier because of the skill sets of the therapists taking my classes.  Teaching in the U.S. is different because each state has different standards and educational requirements. Yet, when I was in the Cook Islands, the therapists didn’t even have educational requirements. It’s all about your perspective.

So I can say I am truly grateful and blessed to live in this country and have the opportunity to teach around the world.  I love my manual therapy practice in Sarasota, Florida and grateful for the patients who honor me by trusting their healthcare to me. I am also grateful for my wife, family, and friends.  These are just a few of the things I am grateful for. 

What are you grateful for?

Hurricane Safety Tips For Your Back

Yes, we are in the middle of yet another hurricane season.  It is important to prepare for rain, high winds, and possible flooding when a storm is approaching your area.  But you also need to take care of your body and back when preparing for storms.  I see a lot of patients this time of year due to back spasms and strains from lifting and carrying heavy objects in preparation for storms. 

Here are some does and don’ts when preparing for the next big storm.

Give yourself plenty of time to prepare.  If you do a little each day to get ready, you are less likely to over exert yourself with your preparations. Take your time and do a little over several days, instead of trying to get everything ready in a few short hours.  This will be less strenuous on your back.  We get at least a week’s notice if a storm is heading our way. Use that time wisely.

Ask for help. Remember you don’t need to do everything by yourself.  If you need things moved or storm shutters put up, ask a friend or neighbor to help you. During emergencies people are more willing to help out, but you need to ask.  It will make them feel good knowing they helped out a friend or neighbor in need. So don’t be embarrassed to ask for help.

Now for the don’ts.

Don’t lift objects that you normally would not if a storm was not coming.  I ask my patients how they hurt their back and they tell me all the things they did to prepare for the storm.  They lift and carry things they normally would not try to lift if a storm was not coming. Watch this video to see why your back gets hurt from lifting things that are too heavy.   Just because a storm is coming it doesn’t give you superhero strength. 

Don’t be inundated by the news and weather reports.  Yes you need to stay informed but you don’t need to be obsessive with watching the news.  The stress of news can make your whole body tighten up. Your psychological state of mind has a physiological reaction in your body. That reaction to emotional stress is tighter muscles.  So when you are stressed form watching too much news you are more likely to hurt your back because you are starting out with tight muscles before you do an activity.

What Are the Essentials for a Long Plane Flight?

After a trip to New Zealand, 24 hours of travel time door to door, I have learned a few things about the essentials needed to make your trip more comfortable.  Travel has changed a lot over the years and more people are flying.  So, your comfort on the plane will make a big difference in how you arrive at your destination. I found these items essential to being comfortable, or as comfortable as possible on a plane for a 15 hour leg, from Houston to Auckland New Zealand!

Starting with items from your head down to your feet-

  1. BLANKETS & PILLOWS. If you fly on a long flight the airline will provide a blanket and pillow. However, you will still need a neck pillow. Keeping your neck supported on the flight will make it easier to sleep. You ask why don’t I use the airline pillow? I do use it, but for my lower back. Airline seats have gotten smaller and have NO lumbar support. So I use the airline pillow to provide lumbar support. Then you will need a neck pillow to keep your head supported and prevent a stiff neck.
  2. NOISE-CANCELLING HEADPHONES. I didn’t realize how much the noise on planes disturbs your ability to sleep. My wife had a pair on our last trip and she let me try them. So I ran out and got a pair for this latest trip.  And I can personally testify that you sleep much better on the plane when you can block out all the noise for the engine and other passengers.
  3. CHANGE OF CLOTHES, Fourth is a change of clothes and socks in your carry-on. You never know if the plane will be too hot or too cold. So having a change of clothes will give you options to keep your body temperature at a comfortable level. And traveling for long periods increases our chances for spilling food or drinks on yourself if the plane hits turbulence, or the flight attendant has an accident. The extra socks are important so you can take off your shoes while you are seated. Taking off your shoes can help your feet and legs be more comfortable while flying.
  4. TOOTHBRUSH/TOOTHPASTE. When you travel for 24 hours straight, it’s nice to be about to brush your teeth along the way. Something so simple make you feel more refreshed when you get to your destination.

These are just a few tips to make your long flights more enjoyable and arriving at your destination more rested and refreshed.

What Happens to Your Body When You Experience Trauma?

Have you ever had a fall, injury or other trauma? It could be as simple as a fall off your bike, a slip on the ice, or something bigger, like a car accident. 

When your body experiences trauma there is a physiological response the body goes through to protect itself.  The body’s response is always the same if the trauma is severe enough. Here is a Trauma Flow Chart that explains the process.

Trauma Flowchart






When you have a TRAUMA to your body, an inflammatory response occurs to the injured tissues.  The damaged tissues create a chemical response in the body. Typically when your tissues are damaged by trauma the blood and proteins leak out of the blood vessels. These proteins attract water and cause INFLAMATION and swelling in the region of the trauma. 

This triggers an immune response that starts a change in the tissue structures.  The body starts laying down more collagen tissue to help repair the damaged area. The collagen is stiff, FIBROUS TISSUE that acts as extra support for the damaged area.  This tougher, denser tissue will start to RESTRICT normal movement of the injured area.

Typically, muscles and connective tissue are made up of elastin and collagen. The elastin give us flexibility and the collagen gives us stability.  So when we have a trauma the body tries to protect and support the area by laying down more collagen fibers, leading to a CHANGE IN TISSUES.

Because this change in your tissues is made up of stiffer, more ridged connective tissue, your normal function is impeded. Because we don’t have the same flexibility in the traumatized area, our body has to COMPENSATE for these changes.  The compensation leads to SYMPTOMS locally at the sight of trauma and in many cases, if left untreated, the symptoms can manifest anywhere in your body.

That explains why the trauma to your tailbone, when you fall on the ice, can lead to headaches, if left untreated.

Why Do Sprained Ankles Take So Long To Heal?

Have you ever sprained your ankle? Maybe twisting it on the edge of the curbstone?  If you have a minor injury to your ankle it can swell, turn black & blue, and sometimes be painful to walk on. But why does a simple injury like a sprained ankle take so long to heal?

To understand the complexity of an ankle injury you need to look at the anatomy.

The ankle is made of several bones held together by ligaments. The ligaments give the ankle stability and have less flexibility than a tendon or muscle. The tendons are what attach the muscles to the bones of the foot and ankle.

Depending on the severity or grade of the injury to the ankle, some or all of the anatomical structures can be damaged when you sprain your ankle. The tendons and ligaments are less vascular, meaning they have less blood flow.  This is because they are more like ropes or cables. In comparison, muscles are more like sponges and are more vascularized.

Circulation is one of the keys to healing. So, when you injure a tendon or ligament, it will take longer to heal because tendons and ligaments are less vascularized. A muscle, on the other hand, naturally has more blood flow which can promote faster healing. So a sprained ankle can take up to 12 weeks to heal if you injured the ligaments and tendon.

If you sprain your ankle it is best to use ice, rest, and elevate the foot and ankle to help reduce swelling.  Sometimes wrapping it with an ace bandage can reduced the pain when you walk. After your ankle starts to heal you may need to do some exercises to help stabilize your ankle. Watch this simple ankle exercise to speed your recovery.

How Long Will It Take?

How long does it take to get better? I get that question all the time in my practice, from patients seeking treatment for everything from headaches and back pain, to plantar fasciitis. Unfortunately, there is no easy answer to that question. There are several factors that have to be considered in order to provide an answer to that question. Let’s explore these factors and discuss when you should seek help in the first place.

Nervous executives waiting for interview

One of the first things I ask my patient about their condition is, “How long ago did it start?” I have patients who come to see me the day after a car accident. Then I have patients who tell me they have had back pain for the past 30 years! The length of time you have had this pain plays a large role in how fast you will heal. The quicker you can get treatment, the faster your body can heal. The longer you wait to seek help, the more your body learns to compensate for an injury. Compensation patterns will increase the amount of time your body needs to heal.

The severity of your injury is the second factor that has to be taken into consideration. The more severe the injury, the longer it may take to heal. If your injury is minor, your potential to heal fast is greater. But that is not always the case.

Other factors that need to be considered are:
• Your age
• How many other injuries have you had in your life
• Your activity level,
• Your diet,
• How well you sleep
• and your mental state – just to name a few
Now you have to take all these factors, and few more, and see how the pieces of the jigsaw puzzle fits together. So there is no easy answer to how long does it take to heal after an injury.

But the general rule is, if you’re not seeing improvement in your condition after an injury within 2 weeks, you should seek outside help. Now that being said, if you have an injury and a bone is sticking out of your skin, you may not want to wait 2 weeks to see if it starts healing!

How Does The Time Change Effect Your Body Clock?

According to the American Massage Therapy Association, research has shown that massage therapy can help improve mood, alleviate feelings of anxiety and depression, and reset circadian rhythms. The result? Improved sleep and more energy.

Back relaxing massage

Improved Mood

The Research: A randomized study of 34 women with stage 1 or 2 breast cancer examined how massage therapy impacted depression and anxiety levels. The massage therapy group received a 30-minute massage three times per week for five weeks, which consisted of stroking, squeezing and stretching techniques to the head, arms, legs, feet and back. The control group received no intervention. Study participants were assessed on the first and last day of the study, and assessment included both immediate effects measures of anxiety, depressed mood and vigor, as well as longer term effects on depression, anxiety and hostility, functioning, body image and coping styles. A subset of 27 women also had blood draw to assay immune measures.

 The Results. The immediate massage therapy effects included reduced anxiety, depressed mood and anger. Longer term effects included reduced depression and hostility, as well as increased serotonin values, NK cell number and lymphocytes.

Serotonin, a neurotransmitter with functions in various parts of the body, works to regulate mood, appetite, sleep, memory and learning.

 Better Sleep

In another study examining the effect of massage therapy on the adjustment of circadian rhythms in full-term infants, researchers measured the rest-activity cycles of infants before and after 14 days of massage therapy, starting at 10 days old and again at six and eight weeks of age.

Rest-activity cycles were measured by actigraphy, and 6-sulphatoxymelatonin excretion was assessed in urine samples at six and eight weeks of age. The concentration of 6-sulphatoxymelatonin in urine correlates well with the level of melatonin in the blood, and melatonin is what helps control sleep and wake cycles.

At 12 weeks, nocturnal 6-sulphatoxymelatonin excretions were significantly higher in the infants receiving massage therapy than those in the control group, suggesting that massage therapy can enhance coordination of the developing circadian system with environmental cues.

Do You Feel Tired All the Time?

Do you regularly experience one or more of the following symptoms?

  • Constant tiredness?
  • Poor concentration?
  • Night sweats?
  • Weight gain?
  • Lack of energy?
  • Forgetfulness?
  • Sexual dysfunction?
  • Frequent urination at night?

Sound like you? If so, there may be an underlying cause that could have a dramatic impact on your health.  Women often suffer from other symptoms of this disorder.


According to ResMed and Mayo Clinic, Sleep Apnea could be one of the reasons you have some or all of these symptoms. Sleep apnea is a disorder that causes your body to stop breathing while you sleep. It’s a potentially fatal condition, with harmful short- and long-term complications, affecting more than 1 in 3 men and 1 in 6 women.1

While snoring is still the strongest predictor of sleep apnea in men and women,6 not everyone who snores has it. And even more importantly, not everyone who has sleep apnea snores.

In addition, women often show subtler, atypical symptoms such as insomnia, morning headaches, depression and anxiety.7 These symptoms often lead to misdiagnoses, such as depression, insomnia, or menopausal side effects.8

Obstructive sleep apnea (OSA), which more than 80% of sleep apnea patients have, occurs when enlarged and/or relaxed throat muscles obstruct your upper airway, blocking air from entering and leaving your lungs.

When the muscles relax, your airway narrows or closes as you breathe in. You can’t get enough air, which can lower the oxygen level in your blood. Your brain senses your inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it.

You might snort, choke, or gasp. This pattern can repeat itself five to 30 times or more each hour, all night, impairing your ability to reach the deep, restful phases of sleep.

Long term effect of sleep apnea can be daytime fatigue, high blood pressure, increased risk of heart attack or strokes, risk of developing diabetes, liver problems, depression and memory loss. Lack of sleep can have a dramatic effect on your pain levers too.

If you have these symptoms, be sure to ask your doctor about whether you might have sleep apnea. There are simple tests to determine if you have sleep apnea. And treatment can be easy.



Does Your Shoulder Hurt? Here’s Why

Happy New Year! I hope your new year is off to a great start.

Do you know that more than 4.5 million Americans visit their doctors every year complaining of shoulder pain? Are you one of them?

The 2 most common injuries contributing to shoulder pain complaints tend to be rotator cuff tears and impingement syndrome.  Even though back and neck pain are the most common pain complaints we see in my office, shoulder pain ranks third.  There can be several reasons for shoulder pain, so it is important to find a healthcare practitioner who can evaluate your condition and treat it properly.  Read the rest of my blog if you want to learn more about preventing shoulder injuries.

The shoulder joint is one of the most mobile joints in your body.  But because of its mobility we lose stability.  A knee joint flexes and extends in one plane. Your shoulder joint flexes, extends, abducts, adduces, internally rotates, externally rotates and many combinations of these movements in many plans of motion. Anatomically, the only place the shoulder bones attach to the trunk of your body is at the sternum and clavicle or collar bone to breast bone. So it is more susceptible to injury because of its instability.

shoulder joint

Your shoulder bones are held to your body by only one small joint. The rest of the shoulder complex is held to your body by muscles, tendons and ligaments. So repetitive stress and strains can easily injure your shoulder.

One of the most common shoulder injuries is a tear to the rotator cuff muscles. There are 4 muscles that make up the rotator cuff complex. If those muscles are weak or tight they can be injured more easily. The pain from a rotator cuff tear unusually shows up on the side of your upper arm.

The other common injury for shoulders is call an impingement.  This is when the muscles of the anterior shoulder are too tight and pull the arm forward. This over stretches the tendons and muscles of the shoulder.  The pain from this injury usually shows up in the front of your upper arm.

This simple shoulder stretch can help keep your muscles relaxed and prevent injuries.

Click Here To Watch Video

shoulder ex

The other changes you need to make to prevent shoulder injuries is to not do excessive overhead arm movements  or any repetitive arm movements can cause repetitive stress and strain to the shoulder joint.  So be careful if your use your arm repetitively for anything from using a mouse on the computer to painting your walls in your house.  It’s always better to prevent an injury than it is to treat it after it is broken.

Why Do I Have All These New Pains?

This time of year, it is very common for strange and unknown pains to start showing up. Are you one of the thousands of people who suffer from unexplained aches and pains this time of year? I see a common pattern this time of year in my clinic. Patients are complaining about old pains showing up again or new pains appearing from seemingly nowhere. And most people don’t know why. If you want to know “the why” read on.

My practice is focused on treating pain and dysfunction. So it is normal for patients to call for an appointment because something hurts. But this time of year more patients are calling for an appointment because all these new and unexplained pains are showing up for them. They have new neck pain, shoulder pain, low back pain or even cramping and pain in their calves. I always ask, “What started the pain?” For most patients they can’t think of a trauma or injury that could have led to their complaint.

But after asking lots of questions and doing a thorough evaluation and treatment I usually can pinpoint the cause of these new complaints. I call it “Holiday Stress and Strain Syndrome”. This is the time of year when people are putting up Christmas decorations and preparing for the Holidays. They put up lights on the house or decorate the tree. So they are up and down ladders and reaching above their heads to hang lights or put up decorations. Sometimes it’s just many hours in the kitchen preparing the Holiday meals.

XMas lights

Anytime you are doing something new or different with your body it can put a strain or stress on it. So it is not a major trauma that causes your pain, but lots of little stresses and strains that become cumulative that start new pains or lead to old ones returning. Up and down ladders can lead to calf pain and leg cramps at night. Click here for a good stretch for your calf muscles.  Reaching over your head to hang lights can stain your shoulders. And looking up to decorate the house or tree can strain your neck. Even standing in the kitchen for longer than you normally do can lead to low back pain from having a weak core.
These are just a few of the complaints I hear this time of year. But remember mental and emotional stress can also lead to physical pain too. The mental stress of the Holidays can lead to headaches or low back pain, to name a few. Our mental state of mind has a physical effect on our body.

So you don’t have to have a big trauma or injury to start the aches and pains to show up this time of year. It can be due to the mental or repetitive stresses and strains that can cause pain to ruin your Holiday plans.