Tea is drank for a variety of reasons- to improve blood flow, eliminate toxins, increase resistance to various diseases, and simply because it tastes good. In recent years the proposed benefits of tea, specifically green tea, have come into light for public consumption. Interestingly, how the tea is steeped and the quality of tea leaf both play a role in the benefits you receive.

What are the benefits of green tea?
The green tea root is rich in polyphenols - an antioxidant also found in wine. The polyphenols contain flavonoids, specifically, Epigallocatechin (EGCG), which has the most widely known health benefits. EGCG contains high levels of antioxidants, protecting the body from free radicals and toxins that enter our body through our diet and environment. Medical research has found a high association between the presence of free radicals and cancer, which is why many studies have found negative correlations between green tea consumption and the risk of cancer. The benefits of green tea go beyond decreasing one’s risk of cancer. Green tea has shown a positive correlation with heart health as well. A pharmacokinetics Japanese study showed a decrease in low density lipoprotein cholesterol by 36% versus those who did not consume green tea. 

Drinking green tea is a simple strategy to fight your risk of high cholesterol, curb the effects of high blood pressure, and ultimately decrease your risk of cardiovascular disease. Other research has shown green tea to protect the liver from toxic substances. One of the most common toxins that our livers fight is alcohol. With all the breweries in Colorado, maybe a cup of green tea before indulging in your favorite beverage could jumpstart your liver! 

Maximizing the benefits of green tea
Green tea has exceptional health benefits, but if the tea is not prepared properly, all of nutritional benefits and desired taste cannot be extracted. Green tea is best prepared between 140-185 degrees Fahrenheit. Cooking tea at a higher temperatures will affect the bitterness and acidity levels of the tea. If you have ever drank green tea and had the residue of a dark red wine on your palate, you likely overheated your water. At higher temperatures, the polyphenols (tannins) dissolve and create a dry bitterness on the palate. In addition to temperature, consider the quality of tea you are purchasing. Generally, higher quality tea can be brewed at a lower temperature. Finally, steep time will change the balance of your green tea. Steep your for 1-3 minutes to achieve optimal flavor and benefits.

Almost four out of five people will experience back pain at some point during their lives. Of this population, one in three will have a recurrent episode of low back pain. Acute back pain (new onset of pain) is terrifying. It can persist for several days to weeks before subsiding. A patient told me the other day, "it is the most excruciating pain I have ever experienced...and I have had broken bones, torn ligaments, and more." Fortunately, we now know that there are some simple steps to expediting the pain process. 

Why does back pain occur?
In perfect conditions - muscles, ligaments, and other structures operate at their optimal length and strength. To ensure this relationship, every muscle has an opposite muscle which helps stabilize proper movement. One of our most common postural imbalances effects the muscles of the hips and low back. This posture is commonly seen in those who sit at a desk for long periods of time.  Generally, a shortened muscle becomes overused and strong. A lengthened muscle becomes weak and inefficient. To understand this relationship, compare the muscles of the body to that of a sail on a sailboat. A gust of wind will transfer all the weight of the sailboat toward one side of the boat. If the strength of the wind is too strong, the sails will snap and the boat will collapse. Now imagine the sail is your spine. If you place all your weight on your back, the muscles on the front must support your weight. Your lower back muscles are especially vulnerable to this prolonged posture. When your back fails to accommodate to the repetitive loading, pain is the result.

What should you do after back pain occurs?
Gentle movements, graded exercises, and a gradual return to activity is the best combination of self-care. To expedite this process, physical therapy can identify the cause of the pain and implement pain management strategies sooner. Additionally, retraining the core muscles is essential after an acute low back pain episode. See the video below regarding other tips and cues to expedite the pain process. 

*Pain should be investigated by a trained medical professional. The information contained in this blog post is intended to be a general approach to mechanical low back pain. It is best to discuss your pain with a medical provider prior to performing any exercise or training.

Whenever a topic receives a large amount of attention, the good, bad, and ugly are all spewed into mainstream media. This often leaves the consumer lost and confused regarding the truth. Many misconceptions exist surrounding the causes of back pain and best treatment options. 

While traumatic disc herniations can be the source of pain, many times a disc herniation is not the cause of one's pain. A 2014 study, found that >50% of individuals from 30-39 years old without low back pain had degenerative changes and bulging discs. The participants in the study were completely asymptomatic young people, yet still demonstrated some spinal changes! Disc herniations should be thought of as ‘internal gray hairs.’ Just as our body ages on the outside, it also ages internally. The internal aging process is natural and not the source of our pain

Considering disc surgery? Get a second opinion! A 2011 study was published evaluating the outcomes of individuals who had surgery vs. conservative therapy for disc herniations. While pain was reduced earlier in the surgical population, at 1-2 years of follow-up the outcomes were the same. 

Take a moment to sit on the ground with your legs extended. Slowly reach forward to touch your toes by flexing your spine and lowering your head to your knees. In this position, you should feel a stretch along the back of your legs. Tight hamstrings right? Not so fast. This tightness could be your nerves being stretched to their limit. This prevents your muscles from stretching any further before damage sets in. The nervous system consists of an interconnected highway that originates in the brain. Healthy nerves require regular movement to stay lubricated and mobile. When nerves become trapped or compressed, especially for prolonged periods, they become immobile, tight, and more likely to become injured. During periods of immobility, the brain sends pins and needles to the neglected neural area. This signal lets you know that one of its’ nerves is agitated. This response is commonly seen when your foot falls asleep after sitting in one position for a period of time. Fortunately, your brain sends these signals before any real danger exists.

What Happens When You Stretch?
Stretching places tension on more than the muscles. For example, when stretching your hamstring muscles, you are also placing tension on the hip joint, the sciatic nerve, and other posterior ligaments.  While you may be stretching the hamstrings, if the nervous system is over-active, you may be exciting a defensive muscle spasm from your brain. Similar to when your leg falls asleep, the nerves send a protective signal against aggressive stretching. Trying to push past this neural response may damage your nerves and cause increased pain and soreness afterward. It is important to realize that the sensation of tightness does not mean that the muscles are short, but a nerve, joint, or soft tissue may be the issue.
 
So Should You Stop Stretching?
No way! If you enjoy stretching or yoga, we absolutely recommend it. However, a proper (nerve mobility) warm up will go a long way in lubricating the nerves before more dynamic stretches. Sliding exercises warm-up the nervous system which minimizes the potential for a a localized inflammatory response. Similar to flossing your teeth, sliding exercises allows for excursion of a nerve. They are great for loosening the nerve and are less aggressive than stretching. Check out the video to learn how to lubricate your nervous system prior to more aggressive stretching. 

When it comes to stretching, you cannot follow the no pain, no gain mentality. Start with slow, gentle movements and prime the nervous system before aggressive stretching.  Motion is lotion for your nerves. They require movement to stay healthy and receive adequate blood flow and nutrients. In the words Todd Hargrove, “If you mobilize a nerve (without injuring it) it will increase circulation and get healthier because the movement may help squeeze out local inflammation. If you move a nerve pain free, it will be easier to do in the future.” 

References:
Hargrove, Todd. "BETTER MOVEMENT." Nerve Mechanics Part II. Better Movement, 2 Feb. 2009. Web. 25 June 2014.

With the emergence of Fitbit, Jawbone, and other activity monitoring devices, the definition of physical fitness has begun to shift. Instead of measuring one's level of fitness based off overall strength, mobility, and cardiovascular endurance, America has simplified their view of fitness to completing 10,000 steps/day. While the benefits of walking are irrefutable, physical fitness is much more than counting steps.  

Activity trackers represent a step in the right direction for fitness, yet they are only the first step. Current activity trackers do not adequately measure other metrics of physical activity. For example, resistance training has proven,  profound effects on the muscles and bones, decreasing one's risk of osteoporosis, muscle breakdown, bodily aches and pains. Weight training has also been shown to increase metabolism and expedite fat loss. These benefits are lost if one simply prioritizes counting steps! In addition, people are now settling for 10,000 steps. I have had discussions with several patients who reach 10,000 steps early in their workday. Because their tracker shows they have reached their daily goal, they feel complacent foregoing an afternoon workout.  This mindset prevents them from obtaining cardiovascular and strength training benefits.

The Fitbit and other activity trackers are NOT making people fat
Activity trackers have helped many people become active again. They have brought awareness to the obesity epidemic and helped people return to fitness. Companies are continually developing their technology to help change people's lives. Most importantly they have brought daily recognition to activity level and calorie expenditure. The activity trackers are not making people fat, but they may be giving people a false sense of fit. 

Recommendations
1) Keep variability in your workouts. Frequently change your routine so that your body must adapt
2) Add Weight training to your routine, this benefits both your muscles and bones 
3)  Do not forget about exercises that require lateral movements (ex. side to side jumps, lateral stepping)
4) Do not settle for 10,000 steps, 30 minutes of physical activity is recommended
5) Don't forget to rest!

​Shoulder pain is one of the most common orthopedic injuries seen by physical therapists. While there are dozens of possible sources regarding the cause of shoulder pain, many symptoms can be traced to shoulder impingement syndrome. Shoulder impingement is decreased space for the rotator cuff muscles to pass underneath the top of the shoulder bone. This decrease in space literally causes an impingement or pinching of the structures.

Shoulder Impingement
The resting position of the shoulder joint can be compared to a golf ball resting on a golf tee. It seems as if the golf ball should fall off the tee with the slightest malposition. Fortunately the shoulder has many stabilizing structures surrounding the joint which create stability in different ranges of motion. These stabilizers are both static and dynamic. Normal shoulder movement requires a combination of both forces to work together. The bones need to be in good alignment to allow the muscles and ligaments to work in harmony. Using the analogy above, these forces keep the golf ball in the center of the tee. When the tee becomes off-centered, shoulder impingement, dislocations, and/or rotator cuff tears occur. ​

Treatment
​As a physical therapist, I address shoulder impingement using a cominbation of manipulative therapy, retraining movement patterns, and corrective exercises. Since individuals often have poor posture, I address their postural deficits first. This includes restoring normal movement in the middle back and neck as well as educating the patient on their posture throughout the day. Generally, people notice decreased pain within a few days and have significantly improved in 4-6 weeks. 

Abdominal strengthening and core muscle exercises have become increasingly popular over the years. Unfortunately, as with most things that become sensationalized, the hype is misdirected. The media focuses heavily on the six-pack muscles and forgotten about the deep, true stabilizers of the spine. In this post, we will discuss the different core muscles, specifically the rectus abdominus, transversus abdominus (TrA), and internal and external obliques. Many people have heard of the rectus and obliques, but the TrA is often forgot about. In this post, the reader will gain a better understanding of the feed-forward loop necessary to activate the Transversus Abdominus (deepest abdominal muscle) and receive evidenced based exercises to engage the core muscles most appropriately. 
 
What Muscles Make Up the Core?
The core muscles are comprised of three different layers, surrounding the abdomen like a corset. These muscles attach into the spinal column in the back to provide support between the front and back. Based on their location and size, certain abdominal muscles are better stabilizers while others act as movers. If one muscle is not performing it's intended function, the other muscles are compromised as well.

The rectus abdominus is located most superficially and  forms your six-pack muscles. This muscle group receives the most attention in today's fitness media. A common misconception people have is associating a six-pack with having a strong core. The rectus is important for performing large trunk movements like sit-ups, but provides little stability to the spine during dynamic activities such as lifting and running. Clinically, I see many individuals that are in great shape and have a strong rectus abdominus, but cannot activate their core muscles in a functional manner. I often see these individuals in pain because their deeper stabilizers are not working properly. 

The internal and external obliques are the second outer layer of muscles. They assist in rotation and twisting movements of the spine activated through exercises such as side planks or side crunches. When someone twists or turns to the left, the left internal oblique and right external oblique are activated together. In conjunction with the rectus abdominus the obliques provide some support to the spine, but still do not provide the necessary stability for dynamic spinal movements.

The deepest and most important muscle of the core is the transversus abdominus (TrA). This muscle is involuntarily engaged prior to any movement involving the spine. It contracts via feed-forward control, unconsciously in preparation for movement. This means that when you reach out to grab an object, the transversus abdominus automatically contracts before the movement begins. A plethora of musculoskeletal problems arise when this feed-forward loop is interrupted. Based off poor movement patterns or in the presence of pain, this muscle no longer engages involuntarily prior to movement. Studies have shown that individuals with low back pain have a slower and smaller contraction of their TrA compared to healthy individuals. In these instances, the TrA must be retrained. 
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Many people I work with are surprised to find this simple secret behind core stabilization.  As stated earlier, a primary source of pain arises when the more superficial abdominal muscles act as stabilizers, leaving the transversus abdominus unengaged. By igniting the feed-forward loop of the transversus abdominus, your risk of low back pain or other musculoskeletal injuries decreases.

As a physical therapist, patients often ask 'what is the single best thing I can do for my health?' As we all know, their is no single 'best answer.' Science has shown us that a combination of proper diet, exercise, minimizing stress, having positive relationships, and more all have positive indications for a healthy life. In the video below, Dr. Roberts investigates the single best variable for our health. Interestingly, he was able to find one key factor that was superior to any other at improving health. The best part? It's easy to do!  

A few keys points from the video below: 

• Exercise for 30 minutes/day is the single best thing you can do for your health. 
• Low cardio-respiratory fitness (CRF) and poor heart health have the strongest correlation with death. 
• Obviously, more activity is better; however, the most important gains are found in the first 30 minutes.
• Exercise does not have to be continuous, walking 10 minutes 3x/day is acceptable if you do not have time for 30 min continuously.
• For every increase in 10 minutes in walking, their is a 12% decrease in likelihood of getting high blood pressure.

Heafner Health continues to provide FREE injury prevention and back screenings! Click here to learn more! 

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Questions:
Call 618.604.3293 for more information or to schedule your appointment