Watch a toddler pick up a ball and then ask an adult to do the same task. What's the most obvious difference you notice? The toddler hinges at the hips, sitting back and down into a deep squat to grasp the ball, pulling it close to the body.

The toddler powers through the hips, glutes and thighs in returning to the starting position. It's all in the hips!

The adult flexes forward at the waist and lumbar spine with little to no involvement of the hips, glutes and thighs. The altered mechanics of bending at the waist, as opposed to the hips, places extreme vector loads on the lumbar spine, leading to microtrauma, dysfunctional movement patterning, and eventually pain.

Optimal movement patterning and proper lifting techniques never had to be taught to the toddler. They simply lifted without thinking. Functional movement is innate to the nervous system in pre-programmed stages of development. So, what happens during the time frame from toddler to adulthood that contributes to lifting technique going horribly wrong? Quite simply: We forget how to move. Add to that the laziness factor and countless hours people spend sitting in our culture, and you have a recipe for inefficient movement. Essentially, our rear-ends have now become our feet!

Toddlers have to yet experience these outside contributors to movement dysfunction, otherwise known as life, and therefore move efficiently. The problem is adults don't' know they move wrong! They have crossed over to subconscious dysfunction; their brain perceives the abnormal movement patterning as normal. This inefficient movement leads to microtrauma, pain and injury.

The Hip Hinge

The hip hinge is a fundamental part of this reprogramming. The hip hinge, generally speaking, is any flexion / extension movement originating at the hips where there is a posterior weight shift. The hip hinge allows a person to maintain a neutral spine by moving at their hips instead of their low back.

Most people will find it difficult to do the hip hinge correctly. Using a dowel rod for neural feedback during the hinge allows you to "feel" the movement and re-establish proper patterning without overloading the nervous system. Here's how to do it:

• Stand with feet shoulder-width apart and a dowel running along the spine.
• One hand should be holding the dowel on the neck while the other hand holds the opposite end on the low back. (Alternate hand positions between sets.)
• Flex forward at the hip with slight knee bend. The dowel must remain in contact with the head, thoracic spine, and sacrum.
• Stretch should be felt in the hamstrings. Stop movement as soon as the rod leaves contact with head, thoracic spine or sacrum.
• Assistance may be added to "regress" the movement by placing a 1-2-inch block under the heels. This forces forward weight shift of the body so the client must sit back into the hips to prevent falling. Ankle support also removes the barrier of possible mobility issues in ankle dorsiflexion, which may prevent the squat patterning.

Research has shown that previous injury is the number-one risk factor for future injury. Motor control limitations such as balance, stabilization and basic coordination, right-to-left asymmetries in muscle activity and flexibility are the next highest indicators associated with risk of future injury. Since previous injury is unavoidable, we should focus on motor-control limitations and asymmetries as priorities for prevention or reduction of risk factors. Assume you move poorly and take steps to help master fundamental movements like the hip hinge; then watch the magic start to happen.

Ready for your wake-up call to why prescription medications – and their accompanying health dangers – are an increasing part of your daily life? From the Annals of Family Medicine comes one of the most important studies to date in the effort to define and understand how drug companies are influencing both the practice of medicine and the health of patients who seek care from medical providers.

Conducted by a pair of anthropologists from Michigan State University, the study examines the impact of lower diagnostic thresholds, clinician rewards systems and the prescribing cascade on the health of patients diagnosed with diabetes and hypertension.

The authors lay the foundation for their study by noting, "Spending on prescription drugs in the Unites States has risen nearly 6-fold since 1990, reflecting substantial increases in treatment of chronic conditions and subsequent polypharmacy. As many as 45% of Americans have at least 1 diagnosed chronic condition, and 60% of the most prescribed medications were for hypertension, high cholesterol levels and diabetes. The Centers for Disease Control and Prevention estimates that 11% of the US population and 40% of people older than age 60 take 5 medications or more."

In conducting the study, the authors studied primary care clinicians and their patients over a two-year period (2009-2010), with specific emphasis on management of type 2 diabetes and hypertension, two of the most common chronic health conditions. As the study progressed, the authors realized the overwhelming prevalence of prescription drug use in managing these two conditions and thus focused on their influence more closely.

Lower Diagnostic Thresholds

Simply put, lower diagnostic thresholds mean that more people are diagnosed with a disease they didn't previously have. The authors point to changes in the diagnosis of diabetes, hypertension and their "pre-" conditions as increasing the number of people subjected to intense prescription management, suggesting that an estimated 10 million additional people are being treated for diabetes, and an additional 22 million for hypertension, due to these lower thresholds.

In 1998, the fasting plasma glucose level that defined a person as diabetic was lowered from 140 to 126. This resulted in an additional 10.3 million people being medically defined as diabetics. The prediabetes fasting glucose level was established at 110 in 1998 and changed to 100 in 2003, resulting in many more pre-diabetics.

In 1993, the blood pressure definition for hypertension was lowered from 160/95 to 140/90 in non-diabetic patients. In 1998, the hypertension blood pressure definition for diabetics was established at 130/80, lower than that of non-diabetics. These changes resulted in an estimated 22 million additional hypertension diagnoses. The prehypertension definition was also established in 1998 at 120/80.

Rewarded to Prescribe?

Medical doctors are monitored and rewarded for keeping their patients below certain standards that stem from established guidelines. But "the committees and organizations setting the standards often have substantial pharmaceutical industry support and include many individuals with industry ties." According to the authors, "many insurance companies assess individual clinicians on the basis of whether their patients meet these standards, often paying substantial bonuses that encourage clinicians to respond to marginal test results with aggressive use of pharmaceuticals."

The Prescribing Cascade

Prescription drugs can have adverse health impacts on patients, producing symptoms that prompt the prescribing of additional drugs. This is particularly true for patients of clinicians who fail to recognize these adverse reactions. Two-thirds of patients "reported experiencing symptoms they attributed to their diabetes medications, hypertension medications, or both," with several patients hospitalized because of symptoms, prompting a medication change.

In this study, 89% of the patients "reported taking multiple medications, averaging 4.8 prescriptions with more than half (51%) taking 5 or more." In many cases, the patients were expected to continue taking these medications "permanently."

Real People, Real Problems

One of the things that makes this paper so interesting is the approach taken by the authors. They interviewed 58 clinicians and 74 patients for about an hour each, providing insightful clinician comments and patient vignettes that are included in the study:

A 61-year-old man is taking "3 medications for hypertension, 2 for diabetes, 2 for high cholesterol levels, 1 for acid reflux, and daily doses of aspirin and ibuprofen, and uses an inhaler for chronic bronchitis, for a grand total of 11 medications. ... Since starting the hypertension and diabetes medications, he has developed severe indigestion and breathing problems."

A family practice physician stated, "I tell most new diabetics the sad news is that they're going to be on 5 meds."

A 54-year-old woman is "currently taking 8 prescription medications: 3 for hypertension, 2 for diabetes, 1 for high cholesterol levels, and 2 for depression. She also had 5 visits to the emergency department in 1 month for excruciating headaches before they were determined to be an adverse effect of the additional hypertension medication she had been prescribed."

Another clinician noted, "I've got patients on 4 different medications and their blood pressure is still uncontrolled. We try sending them to the cardiologists, and they say, 'Just keep adding stuff because there's really nothing we can do about this.' Some people whose blood pressure that we get normal again, they don't function very well at all. I'm not sure why."

A Chance to Change

In their concluding remarks, the authors call for a reform on how much influence the pharmaceutical industry has on the practice of medicine: "At a minimum, we urge policies excluding individuals or organizations with financial conflicts of interest from involvement with guideline-writing panels. The presumption that mere disclosure resolves such conflicts must be rejected." They also suggest that physicians "be discouraged from seeing drug representatives."

So, armed with this information, what's your next step? The next time you see a drug ad on TV, think about this study. The next time your medical doctor recommends a prescription drug for your health problem, think about this study and ask if there's a better, safer, natural way that doesn't require medication.

Are you suffering from back or neck pain? You're definitely not alone, and we mean on a global scale. A series of studies emerging from the Global Burden of Disease 2010 Project, a massive collaboration between the World Health Organization, the Institute for Health Metrics and Evaluation, the University of Queensland School of Population Health, Harvard School of Public Health, Johns Hopkins Bloomberg School of Public Health, and the University of Tokyo, Imperial College London, clarifies the worldwide health burden of musculoskeletal conditions, particularly back and neck pain, in crystal-clear fashion, with low back pain identified as the number-one cause of disability worldwide and neck pain the number-four cause. Overall, musculoskeletal conditions represent the second leading cause of global disability.

Findings emphasize the shift in global health that has resulted from disability making an increasingly larger footprint on the burden of disease compared to a mere 20-30 years ago. In addition, while more people are living longer, the flip side is that they do so with an increasing risk of living with the burden of pain, disability and disease compared to generations past.

Dr. Scott Haldeman, a neurologist and doctor of chiropractic, provides a summary of the project's findings that should make it abundantly clear that conditions many people may consider relatively harmless actually have tremendous potential for long-term health consequences:

• Musculoskeletal conditions such as low back pain, neck pain and arthritis affect more than 1.7 billion people worldwide and have a greater impact on the health of the world population (death and disability) than HIV/AIDS, tropical diseases including malaria, the forces of war and nature, and all neurological conditions combined.
• When considering death and disability in the health equation, musculoskeletal disorders cause 21.3 percent of all years lived with disability (YLDs), second only to mental and behavioral disorders, which account for 22.7 percent of YLDs.
• Musculoskeletal conditions represent the sixth leading cause of death and disability, with only cardiovascular and circulatory diseases, neonatal diseases, neoplasms, and mental and behavorial disorders accounting for more death and disability worldwide.
• Low back pain is the most dominant musculoskeletal condition, accounting for nearly one-half of all musculoskeletal YLDs. Neck pain accounts for one-fifth of musculoskeletal YLDs.
• Low back pain is the sixth most important contributor to the global disease burden (death and disability), and has a greater impact on global health than malaria, preterm birth complications, COPD, tuberculosis, diabetes or lung cancer.
• When combined with neck pain (21st most important contributor to the global disease burden – death and disability), painful spinal disorders are second only to ischemic heart disease in terms of their impact on the global burden of disease. Spinal disorders have a greater impact than HIV/AIDS, malaria, lower respiratory infections, stroke, breast and lung cancer combined, Alzheimer's disease, diabetes, depression or traffic injuries.
• Current estimates suggest that 632.045 million people worldwide suffer from low back pain and 332.049 million people worldwide suffer from neck pain.

"The Global Burden of Disease Study provides indisputable evidence that musculoskeletal conditions are an enormous and emerging problem in all parts of the world and need to be given the same priority for policy and resources as other major conditions like cancer, mental health and cardiovascular disease," said Dr. Haldeman.

The seven studies from Global Burden of Disease 2010, as well as accompanying commentaries, appear in The Lancet. To review the studies and all relevant material, click here. And by the way, when it comes to preventing and treating musculoskeletal issues, particularly back and neck pain, chiropractic care has been shown in numerous research studies to be an effective conservative option.

About half of all children will suffer from low-back pain at some point, with nearly 15% experiencing frequent or ongoing pain. In North America, the primary providers of spinal manipulation are chiropractors. More studies are now being done to evaluate the role of chiropractic in treating back pain in minors.

In a study appearing in the Journal of Manipulative and Physiological Therapeutics, 15 randomly chosen Canadian chiropractors provided data on their pediatric patients between the ages of 4 to 18 and suffering from lower back pain. Information was gathered on treatment type and outcome of care, based on patient-rated pain scales. Characteristics of the children with back pain included:

• The average age of sufferers was 13 years old.
• Nearly 60 percent were male.
• Half attributed pain onset to trauma (usually sports-related).
• One in four reported pain of over three months duration.

The most common diagnosis was a "subluxation," appearing in half of these children. Patients were almost universally treated with spinal adjustments, with few requiring other forms of therapy. After six weeks of treatment, major improvement (defined as "much improved" or "resolved") was seen in nearly 90% of patients, based on one of the pain scales, and there were no reported complications in any of the patients.

In children, as in adults, chiropractic treatment is extremely effective for back pain, regardless of the cause or characteristics. Your doctor of chiropractic can provide more information about treating childhood back pain.

Reference:

• Hayden JA, Mior SA, Verhoef MJ. Evaluation of chiropractic management of pediatric patients with low back pain: A prospective cohort study. Journal of Manipulative and Physiological Therapeutics 2003:26(1), pp. 1-8.

Flexibility is the ability to move the joints and muscles through a normal range of motion, and it's an important fitness measure; in fact, it's one of the five health-related components of physical fitness, along with muscular strength, muscle endurance, cardiorespiratory endurance and body composition. We lose flexibility as we age, which means we need to develop it while we're young and then maintain it when we're older.

The Why

Here are just a few of the health benefits attributable to a regular flexibility and stretching program:

• Increased circulation: Stretching increases blood flow to muscles, nourishing them and eliminating waste products. It also helps shorten recovery time following a muscle injury.
• Improved posture: Stretching helps keep muscles loose, which allows you to maintain proper posture. Better posture means less discomfort caused by poor posture-related conditions such as back pain.
• Better coordination: Flexibility improves range of motion, which maximizes balance, coordination and mobility. This is especially important to minimize the risk of falls as we age.
• Stress relief: Because flexible muscles are loose muscles, they're less prone to tighten up during periods of excess stress and tension.

The How

OK, now you know why flexibility is so important. Let's talk about how to make stretching/flexibility a part of your weekly routine. According to the Mayo Clinic, there are six essential guidelines to keep in mind when stretching:

1. Warm up first. You're more likely to pull a muscle when it's cold. Start off with five minutes of walking, light limb movement or a favorite low-intensity exercise.
2. Hold each stretch for 30-60 seconds, remembering to breathe. Simply put, it takes time to stretch tissues safely. Go too fast and you could be in for trouble in the form of a muscle tear. For most muscle groups, a single 30-60-second stretch is adequate.
3. Don't bounce. Speaking of muscle tears, bouncing during a stretch can cause microtears in the muscle, leaving scar tissue as the muscle heals, which will only make the muscle tighter and more prone to future pain and inflexibility.
4. Avoid pain. You shouldn't feel pain during a stretch. If you do, you've gone too far and need to back off and hold the stretch in a pain-free position.
5. Stretch both sides. Joint range of motion needs to be as equal as possible on both sides of the body; after all, if only half the body is flexible, the other half can still cause problems.
6. Stretch before and after exercise. Stretch them lightly before a workout and then more thoroughly after your workout. Stretching before activity improves flexibility and reduces injury risk; stretching after exercise relaxes tired muscles and reduces muscle soreness and Simple Stretches

    

   With the why and how in your memory bank, all you need now is a few minutes a day at least three days a week, or every time you exercise, to get flexible and stay flexible. Here are a five simple stretches (again courtesy of the Mayo Clinic) you can start doing right away:

   Neck Stretch

   Bend your head forward and slightly to the right to stretch the left side of your neck. With your right hand, gently pull your head downward, stretching the back left side of your neck. Hold for 30-60 seconds and repeat on the opposite side.

   The Shoulder Stretch

   Bring your left arm across the body and hold it with your right arm above or below the elbow. Hold for 30-60 seconds, switch arms and repeat. To stretch the internal rotators of the shoulder (important if you participate in tennis, golf or other overhead/throwing/swinging sports), hold a rolled-up towel vertically with both hands. One hand should hold the top of the towel and the other hand should hold the bottom of the towel. Now gently pull the towel toward the ceiling with your top hand, stretching the shoulder on your opposite arm. Hold for 30-60 seconds, switch top hand and repeat.

   The Calf Stretch

   Stand at arm's length from a wall or any otherwise sturdy structure. Put your right foot behind your left foot and slowly bend your left leg forward, keeping the right knee straight and the right heel on the ground. Keep your back straight and your hips and feet facing forward. Hold for 30-60 seconds, and then switch legs and repeat.

   The Hamstring Stretch

   Lie on the floor near the outer corner of a wall or door frame. With your left heel resting against the wall and your left knee bent slightly, straighten your left leg until you feel a stretch along the back of your left thigh. Hold the stretch for 30 to 60 seconds, switch legs and repeat.

   The Knee-to-Chest Stretch

   Lie on your back on a firm surface. Your knees and hips should be bent, and the backs of your heels should stay flat on the floor. Slowly pull one knee to your chest until you feel a stretch in your lower back. Keep the opposite leg relaxed in a comfortable position, with your knee bent or the leg extended. Bring the knee as close to the chest as possible without experiencing discomfort, hold for 30-60 seconds and repeat with the opposite leg.

   Note: The Mayo Clinic recommends osteoporosis patients avoid the knee-to-chest stretch to prevent possible compression fractures of the vertebrae.

   And there you have it: why flexibility matters and what you can do to make sure you're as flexible as possible. If you have any questions regarding how to do a particular stretch or if you believe an existing health condition could limit you from safely performing a flexibility routine, talk to your doctor first.

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