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Top Three Exercises for Lower Back Pain

Let me address the first part of this blog to all the lawyers out there (my wife included, hi honey!) and mention that everyone is different and that two people with similar lower back pain symptoms might have two very different sources of pain. Therefore, if you are experiencing lower back pain, the most responsible course of action is to seek out a thorough evaluation with a chiropractor, physical therapist or sports medicine professional.

With that being said, now that getting into the blog…

You may have heard that lower back pain is one of the most common musculoskeletal afflictions in the modern age. If you are reading this, you may be experiencing discomfort at this very moment, or you are a health and fitness professional gaining new knowledge and perspective. Whatever you motivation, thank you for taking a moment to lean. I hope I don’t disappoint.

It’s true, sitting for long periods of time has a profound negative effect on the amount of pressure our disc has to withstand. Sitting also puts your hamstrings in shortened position, which can pull your pelvis into a posterior tilt, thus weakening your deep core and putting your lower back in a precarious position. A common misconception when it comes to sitting is that your hips flexors and lower back become tight, leading to what is termed as ‘lower crossed syndrome’. While, LCS is a real thing and should be assessed, there is very little correlation between sitting and the need to stretch out your hip flexors and lumbar erectors. In fact, I argue that if you sit a lot, it would be behoove you to build lower back endurance in addition to glute and anterior core activation. Think about it. For instance, if you are sitting down right now as you ready this blog, where is your lower back positioned? Is it extended, neutral or flexed? If it is neutral, just give it a few minutes. Your core will eventually fatigue and your pelvis will dump backwards and round your lower back, leaving your erector spinae group stretched and prone to weakness over time.

My point is sometime lower back pain can stem from weakness in your lower back. All lower back pain? Absolutely not. However, whether your suffering from sacroiliac pain, lumbar disc bulge or herniation, lumbar strain, facet syndrome, or many other common lower back ailments, there is very little downside to at least understanding principles of movement and roles muscles play in supporting good posture. If you suspect that you may need further evaluation, consider visiting our Seattle chiropractor and functional rehab center here at Tangelo!

Below are the top three exercises for lower back pain. Are they right for you? The only way to know for sure is to consult your chiropractic, physical therapy or sports medicine expert.


Diaphragmatic Breathing

As cliche as it sounds, movement does start with the core. However, maybe not the core muscle that get the most publicity like your obliques, rectus abdominis or even the multifidus. The muscle I want you to draw attention to is one that should be contracting and relaxing with each breath when you are cycling through your 25,000 to 28,000 breathes per day. That muscle is your diaphragm, a plunger shaped muscle that, among many things, helps preserve proper alignment and stability around your lower back.

 

 

Cat Cow

It’s a classic for a reason. The Cat Cow is a great exercise to draw brain-body awareness to any discrepancy that may be taking place between how your pelvis rotates forward (anterior pelvic tilt) and how it rotates back (posterior pelvic tilt). Restriction moving in any direction could have to do with muscular motor control, but it could also be a symptom of something not right within the spine itself. Regardless of the cause of dysfunction, this exercise draws awareness to the issue that can be helped with the assistance of a  medical professional.

 

 

Hip Hinge

Alright, now it’s time to make like a door…. and hinge. In the decade I have had the privilege of serving  patients, the reality is that for every one patient that has come in from deadlift related lower back pain, fifty have sustained lower back injuries from performing simple daily tasks such as picking laundry off the floor. The simple reason for this disparity is that when you deadlift, you naturally put yourself in the most optimal position to be stronger than the weight is heavy. In short, you are prepared. When it comes to normal simple tasks, you just do it with very little concern for proper form. That is when injury comes knocking at your door.

The hip hinge is a great way to help you become confident and proficient at the most functional movement you will need to perform your entire life. Whether you are 18 months or 81 years old, you need to know how to hinge. In addition to building endurance in your lower back, the hip hinge also helps reset the length-tension relationship in your hamstrings, which helps you weight shift properly so your lower back can remain healthy and happy.

 

 

Thank you for taking time for read this blog. If you live in the PNW and looking for Seattle Chiropractor or Portland Chiropractor, we would be honored to be on your team.  Keep moving and #gotangelo

So You Want To Pistol Squat?

by Tyler Wall

The elusive pistol squat. The bane of many a CrossFitter’s existence. One in very few can get them on their first try, but that most likely isn’t you.

Being able to squat on one leg is no easy feat. It requires balance, mobility, stability, coordination, and strength.

But with practice, it’s a fun and impressive movement. There are many benefits to the pistol squat; it’s a fantastic movement for the development of strength and balance through the leg and hips. You don’t need any equipment and you can literally do it anywhere. What more could you ask for?

NOTE: If you have any current injuries or issues at any of the joints in the leg, take care of those first. Heal yourself up before you dig a deeper hole.

First, the soft tissue areas to focus on:

  • Plantar Fascia

  • Anterior Tib

  • Calves

  • Hamstrings

  • Quads

  • Glutes

  • Thoracic Spine

Always test and retest after doing soft tissue work and mobility.  See what works and doesn’t work.  Give it some time, sometimes the results aren’t instant.

Next, take a look at the mobility requirements, from the bottom up:

  • Deep dorsiflexion of the ankle

  • External rotation at the hip

  • Extension at the thoracic spine

The Ankle

Often times, lack of ankle mobility can be tied to lack of stability in the foot.  Chances are, if you have flat feet, then you’ll have “tight” ankles.  Even if you don’t have flat feet, they can present themselves as tight.  If the body can’t find stability (and therefore balance) in the feet – our direct connection at the Earth at all times, then it will create stability elsewhere, oftentimes in the ankles.  Here is a foot strengthening exercise to get you started.

 

 

Spend some time every day, multiple times a day practicing your short foot.  Build those arches up.  If you are diligent with them, you’ll see results in a short period of time.

Think about the foot: it is under constant use and stress.  Therefore, it has to adapt quickly to the imposed demands placed upon it.  Walk around barefoot whenever you can and connect with your feet.  It will make a world of a difference.

If you already have great arches, you should practice some short foot anyway. In addition to that, you can also work on some banded ankle distraction.

 

 

Using a simple tool like a small band, you can distract the joint capsule at the ankle and work through some new ranges.  Make sure to drive your knee over the third and fourth toes.  Try 1-2 sets of 15-20 reps, both standing and kneeling.

The Hip

If you can’t externally rotate your hip to keep your knee over your middle toes, then you’ll quickly run into some issues and potential danger for your knee.  It’s key to avoid having it cave inside the toes.

This tactical frog mobility exercise will help with this movement. And, pigeon pose is always a good one too.

 

 

Another exercise to practice that will have a direct carryover is a simple bodyweight squat.  This will provide you some guidance as to your foot position, knee position and torso position.

“What about the non-supported leg?”

Oh yeah – that one.  Super important.  You’ll need to keep it flexed at the hip, and extended at the knee so it doesn’t touch the ground.

To insure you have adequate mobility, lie flat on your back and lift one leg straight up.  If you can’t get it to 90 degrees, you have an issue.  More than likely, this is due to a stability issue in the trunk. Remember earlier when I was talking about lack of stability in the foot creating stiffness in the ankle? The same thing can happen with the trunk and the hamstring.

 

 

When we are able to breath and brace, we’ll open up new ranges of motion through our extremities (shoulders too – we’ll discuss that another time).

 

 

Thoracic Spine

Lastly, we need to have adequate control and range through the spine to maintain balance and an upright torso for the pistol squat.

 

 

 

Strength

As far as building strength through the hip and legs, I recommend beginning with a 90/90 split squat.  Not only does the split stance help develop balance, it improves glute timing as well.

 

 

With that, you should work on your one leg hinge for balance, coordination and pure awesomeness.  When you conquer that, add some weight.

Lastly, you should train Heel Drops as they’ll teach you about body position awareness and strength through the full range of motion.

 

 

As always, focus on form.  Take your time.  Make sure that knee is tracking properly.  If you have access to risers, use those and build up the height over time.  If you only have boxes at your box, use those.  Don’t try to drop down all the way on your first time.  Take it slow.

This one will really build the necessary strength to get down to and out of the bottom position of the pistol.

There you go, folks.  Once you are able to master the pistol, go for reps.  Once you can get 10+ reps, add some weight like a kettlebell in the same side hand of the non-supported leg.

Trail Running 101: Pros & Cons

Trail running is a fast growing sport. As it gains in popularity, a lot of you are thinking about giving it a shot! But, where do you start?!? Different shoes, nutrition, training and gear – some may find this overwhelming! Or, maybe trail running seems like it would be just be too hard; “That’s cool but it’s not for me!”

What Makes This Guide Different?

We thought it would be good to put together a content series covering some of the questions people new to trail running may have, and to encourage those who don’t think can with examples of how it might be easier than you might think!

Over the coming weeks, we’ll be covering the pros and cons of trail running, trail running shoes, hydration, nutrition and training!

Just like anything in life, a balanced approach is key. Let’s go over some pros and cons.

Pros of trail running…

PRO: Enjoy Nature, Wildlife & Fresher Air (Duh!)

One of the best things about trail running is simply getting out and enjoying nature. The race is the result at the end of your training, but some of your best memories from trail running will probably be taking your time training and exploring new areas. As you get deeper into your training you will find that you can go out and train on popular hiking routes and finish them much faster than if you were hiking. Training on hiking trails can get you deep into National parks, forests and reserves. You will be treated to some great views, pristine lakes and forest and spectacular mountains.

PRO: Less Impact On Your Body!

As you train you will also notice that your body will feel better after a trail run than after spending a similar time training on roads. This is because the trails are generally much softer than running on hard asphalt, so you put less impact stress on your body. As a result you can recover faster and train more!

PRO: You Don’t Have To Be Usain Bolt.

When it comes to racing you don’t have to be a speedster, and you don’t have to run the whole race. Walking is totally acceptable and many of the top ultra-runners will hike portions of their big races, especially the hills when it can be more efficient.

PRO: Great Community!

The atmosphere at a trail race is one of camaraderie where the people are friendly and jovial. There is a great community and the races are a good chance to catch up with friends or make new ones. Everyone is welcoming so if you are new start up a conversation at race, you’ll probably get some great tips from experienced runners, or even find a new training partner. Another highlight of racing is the aid stations. When racing your body is mostly running on carbohydrates so there are plenty of simple sugary foods available. Some aid station staples are fruit, M&M’s, cookies, PB&J, soda, as well as water and electrolyte. I personally always look forward to watermelon and coke!

…cons of trail running

CON: “I’ll Get Injured”

Some newcomers may have some legitimate worries before start trail running. First, what if I get injured, roll my ankle etc? Well as with anything new you should start with moderation. Start with incorporating some easy trail runs into your training program. Get used to running on the trails which can often be slippery or contain hazards such as roots and rocks. As you spend more time on trails you will get better at identifying these hazards and planning your steps to best avoid them. You can also spend time preparing your body for the trails by doing exercises to strengthen your ankles, stabilizing muscles, and posterior chain. Doing these exercises will give you better endurance and make you less prone to minor injuries such as ankle rolls.

CON: “I’ll Get Lost”

Another worry is that you might get lost while training. There are a few ways to avoid this. First off preparation is key, it is a great idea to plan a route and take a map with you. As a fall back take your phone so you can access maps or call for help if needed. A great way to get oriented on the trails is to go with a knowledgeable friend or join a running group. Many of the local running stores and clubs will have organized trail runs that are always accommodation for newcomers. Lastly you don’t have to go out and run into the middle of a National park on your first run. Local parks such as Discovery Park and Carkeek park off some great trails to get started on.

CON: “I’m Not Fit Enough”

Finally you might be worried that you are not fit enough or not prepared. If that’s the case get out and train! If you want to lock in a commitment date then entering a short race in the future is a good idea, although this is not essential. Alternatively you could set a date with a friend to run a route you would find challenging. Once you are ready to start training lace up and get out the door! We will be putting together some content on how to put together a basic training program, but a good start is to aim to do 3 easy runs per week to start building an aerobic base. Easy runs should make up most of your training, up to 80%, and should be done at a pace where you can maintain a conversation with a training partner.

What I Love About Trail Running

Personally I love to get out on a technical trail and find the best sets of foot placements to maintain my pace. I love to hit a steep grinding climb that leads to an awesome summit, or hit a winding trail that follows the contours of a mountain side giving me time to check out the valleys below. At the end of the day trail runners and trail races are pretty chill. So we encourage you to get out there and give it a go, and find out what you love about the trails!!

But Who Am I To Be Giving You Advice? Well, Here’s A Little Bit About Me…

I moved to Seattle from New Zealand in 2014. While growing up I had done some trail races and Orienteering in New Zealand, but no long trail races. After spending a year in Seattle I felt obliged to start exploring the outdoors we have such great access to. With some motivation from Chris McDougal’s book Born to Run and the film “Unbreakable” I started to increase my training load, explore my local trails and get into the sport of ultrarunning. Early in the year I started working with Kinetic Sports Rehab to address tight areas in my legs that I didn’t want to develop into injuries. By working with Kinetic throughout the year, as well as doing my recommended home exercises, I was able to avoid any major injuries and increase my training load significantly on the previous year. I doubled my mileage and more than tripled my elevation gain. I completed my first three 50km trail races, averaging 5 hours per race and visited all the colors of the podium. With the help of Kinetic I have been able to change from a casual runner to an amatuer trail racer. I’m looking forward to what 2017 will bring.

What Is Voodoo Floss?

by Dr. Michael Smith

On May 23, 2015 I gave a brief presentation for the Biohackers – Seattle MeetUp group. The following is a brief overview of my talk. For the biohackers in attendance, I promised a few videos showing more applications of the recovery tool, Voodoo Floss, I demo’d at the meet up.

Early this spring, James Caldwell reached out to Kinetic and told us he was organizing a MeetUp.com group in Seattle for Biohackers and if we would be interested in attending.  Of course, we were like “Absolutely!!!” and then we were like “wait…what’s biohacking?”

James, who is actually from Vancouver, Canada, passionately explained that there is a group of people whose “sole purpose is to bring together like-minded people obsessed with the pursuit of better living and optimal performance through biohacking and self-tracking.”

“Better living?”

“Optimal performance?”

Yes, Mr. Caldwell, count us is.

Still, I didn’t know exactly what to expect. But upon arrival, I quickly found out this group of people were all about sharing and seeking knowledge and having a fun time doing it. Like James said, biohacking at it’s core is simply to find ways to be the best version of yourself – on a macro and micro level – through nutrition, exercise, meditation, prayer, supplementation, hard work, dedication, floating, having fun, cellular biology, personal relationships, bioneurofeedback, technology, gadgets, etc. It was a pretty cool group of people!

The title of my presentation was  “Using Functional Approaches and Modern Techniques for Restoring Motion, Improving Movement Quality, and Recovering Faster.” Which is a suuuuper fancy title for me showing you how to use Voodoo Floss Compression Bands. So, here is an overview of what Voodoo Floss Bands are, what they do, and some videos showing proper applications and use.

What Voodoo Floss Compression Bands Are:

Voodoo floss is an awesome tool. It’s a tool we use and recommend in and outside of our clinic. Basically, we are making positive subjective changes to our joints and soft tissues through compression + tension + movement. These changes will often increase joint mobility, decrease pain, and speed up recovery. Thus, optimizing performance and improving movement quality.

Did you catch all the vague language there (often, changes, tissues), nothing specific? That’s because we do not know exactly what is happening on a physiological level. There are several really good hypothesis – fascial shear (myofascial release, well, kinda), occlusion and reactive hyperemia (rush of good blood in, garbage out), joint centration (tension creates stability within joint, stability = greater mobility, kinda) – but for the sake of this blog I’ll bypass the science… not very biohacker of me.

But, what we do know, is that we can get results! By educating our patient on when, why and how to properly use this tool, the patient can then be empowered for self corrective care and higher level recovery and performance….very biohacker of me.

Disclaimer

  • The bands are made of latex rubber, do not use if allergic.

  • Avoid using on head, neck, chest, belly, or back.

  • The band is compressing, if you feel like your blood is being occluded too much, your limbs are turning purple or faint, or your have numbness/tingling… please stop using immediately.

When to Use Voodoo Floss:

  • The Voodoo Floss can be used really at anytime, warm up, cool down, and in between workouts.

  • I usually floss before a workout utilizing exercise specific movements, depending on the workout, I get more out of it than a lacrosse ball or foam roller. Second, I’ll use after a lift, it really seems to keep soreness down and help initiate and speed up recovery.

  • Finally, I use the day(s) after a tough workout. When I’m really sore, and laying down on a foam roller sounds miserable, I’ll use the floss.

  • I also floss every night before I go to sleep….. get it? Floss. Love you, Dad.

How to Use Voodoo Floss:

  • Wrap anchor strip around the joint or soft tissue area.

  • From there, use roughly 50% tension or pull and overlap the bands.

  • Tuck the end of the band under.

  • Move in OPEN chain, all ranges of motion.

  • Move in CLOSED chain, loaded and exercise specific ranges of motion.

 

 

Now here is the question you always need to ask yourself…. WHY? Why do I always get sore in my shoulder, even when it’s not a shoulder workout? Why do my hips and hamstrings always feel tight, even though I floss/stretch/foam roll/mobilize/etc. allllll the time?

Just like with pain, a lot of times feeling “tight” or “immobile” is the body’s way of saying,  “Hey, we have a problem!”  The “tightness” is often a protective mechanism or compensation for instability or a dysfunctional movement pattern. Those compensations equal decreased efficiency or energy leaks and decreased performance…. Not very biohacker of you.

So as always, if you need help finding out the “why”, go talk to your favorite movement specialist (sports chiropractor, physical therapist, strength coach, etc). At Kinetic, we pride ourselves in finding out the “why” and empowering our patients with the knowledge and tools to get them to the best version of themselves. That’s the fun stuff. We may have a chance at biohacking after all…

– Dr. Mike Smith, Seattle Chiropractor

Voodoo Floss is a tool to help with recovery. But, if you’re experiencing chronic pain, there’s underlying issues that need to be addressed. Click below to schedule an appointment at one of our three clinic locations in Seattle.


Insurance 101

Ooohhh, insurance.

Some people love it, some people hate it. And mostly everyone who has it is a 50/50 mix of both.

I’ll admit, when I first started on the Tangelo team I knew absolutely nothing about insurance and the benefits that came with it. Words like co-insurance, deductible and premium sounded like a foreign language. I thought I would never begin to understand.

Nearly three years later I definitely wouldn’t define myself as an expert by any means, but I do know enough that I feel confident explaining benefits to our clients.

When most clients go to schedule their first appointment, one of the common questions I get is “Do you accept my insurance?” We are in-network with most major insurance companies however, the cost per visit varies from client to client. It is purely dependent on the type of plan and benefits that you have.

The goal of this blog post is to answer the common questions about insurance coverage so you have more knowledge about what your benefits can do for you.

Now, I’ll walk you through some common terms in the world of insurance benefits.

PREMIUM

What’s a premium? A premium is the amount that (you) a subscriber  pays each month to have active insurance coverage. The cost of a monthly premium can vary based on the type of plan that is chosen. Therefore, it is important for you as a client to research and decide how often you think you’ll be using your insurance benefits while balancing the overall costs.

DEDUCTIBLE

What’s a deductible? Your deductible is a specific amount of money that you, as the subscriber must pay before your benefits kick in for specific services. Think of the deductible as a down payment for your year of insurance coverage. For example, if your plan deductible is $500 you will pay 100% for any services rendered until that amount is met. After that, the cost of medical services is shared between you and your insurance carrier. Thankfully, depending on your plan, the deductible doesn’t always apply…for instance, it may not apply to an office visit with your Primary Care Physician or favorite Tangelo Clinic (wink, wink). Keep in mind that if there are multiple members on one plan (ex: employee plus spouse and kids) the deductible may be higher and shared between everyone.

COPAY

What’s a copay? A copay is a flat rate that you pay at the time of service. If you have a co-pay, typically your deductible will not apply! The copay amount does not change regardless of the number or type of services that are billed out for each visit. At Tangelo we commonly bill out both chiropractic and physical therapy codes, this is due to the combination of adjustments, soft tissue work and rehab exercises done during your visit. However, even though multiple types of services are being billed to your insurance plan, only one copay will apply to your cost per visit (in most situations).

CO-INSURANCE

What’s a co-insurance? Co-insurance is a percentage amount (dependent on your plan) that you pay at each visit. If the co-insurance is 20% that means that the plan will cover the remaining 80% of whatever the total visit cost is. In general, the deductible will need to be met before co-insurance kicks in. The total amount owed is determined by the charges billed and allowed amounts by your insurance company for the services provided.

CALENDAR YEAR VS. PLAN YEAR

What’s the difference between calendar year vs. plan year? A calendar year plan will run from January 1st thru December 31st and then visit limits and deductibles will start over again. On a rarer occasion some people will have a plan year, which is usually based upon when a subscriber enrolls in their benefits…ie: July 1 2016-June 30 2017. With that said, don’t let your insurance benefits go to waste!! If it’s June and you have a calendar year plan and your deductible has already been met, take advantage of next six months and get the care you need!

VISIT LIMIT

What’s a visit limit? Visit limits vary from plan to plan. Your insurance company often times will give you a certain number of visits to use year for each type of service (chiropractic, PT, Massage, acupuncture, etc.). Remember, you are paying a premium for your insurance so be sure to use your visits before your plan re-sets!

OUT-OF-POCKET MAXIMUM

What’s an out of pocket max? Often times the out of pocket max is double the amount of your deductible, but it can vary. This represents the maximum amount of money that you have to pay for medical services throughout the year. If and when you meet your max, the insurance plan will cover any additional approved services for the year at 100% (no client responsibility). This rule generally has a number of stipulations, so it would be advisable to call your insurance company to learn more about this topic.

EXPLANATION OF BENEFITS (EOB)

What’s an EOB? An EOB stands for Explanation of Benefits. After your plan processes a claim (usually 2-4 weeks), you will receive an EOB in the mail showing the services billed to your insurance and what the client responsibility is. If you paid a co-insurance or co-pay at the time of service, and your EOB says there is a “Client Responsibility” don’t fret, they don’t know you have already paid your provider!

Well, there you have it; those terms are essentially the basics of every insurance policy.

Knowledge is power and I would highly encourage each client – existing and new – to dive into their benefits to learn as much as possible. The more you know the more you can take advantage of the insurance you have and plan for the insurance you will need.

If you still have lingering questions about your coverage don’t hesitate to ask the Client Experience Coordinator at your clinic. As always, the Tangelo Team is here to help in any way we can so you’re able to get back to the things you love.