 Phase II Exercise: Single Leg RDL with foam roller assist What are the “hamstrings”? The hamstrings are a bundle of three separate muscles: semimembranosus, semitendinosus, and biceps femoris. All three of them are located on the back of the thigh. The main action of these muscles is to bend, or flex, the knee as well as internally rotate and adduct the leg. Injuries to this muscle group are extremely common unfortunately, and can happen to individuals of all activity levels; however 29% of sports injuries can be classified as hamstring strain injuries. Usually people will feel the onset of pain while running or sprinting and can hear or feel an audible pop. Bruising is also not uncommon depending on the severity of the strain.
These injuries are very susceptible to a risk of reinjury, so it’s essential to determine the true cause of the injury. Whether it be due to a muscle imbalance with the quadriceps, or a lack of flexibility and strength. Little evidence exists to show that over the counter anti-inflammatory medications are beneficial as well. Low level laser therapy, and working on the appropriate rehabilitation plan can provide long-term effects. With rehabilitation the goal is to address the biomechanical dysfunction that led to the initial injury. Eccentric strengthening has been shown to be the most effective at reducing re-injury. Eccentric contractions occur when the muscle is being activated while also lengthened at the same time. In addition to eccentric strengthening of the hamstrings, working on core and lumbo-pelvic stability and balance should be a focal point. The initial phase of rehabilitation begins immediately after the injury and can last for four weeks. In this phase regular activity should be modified to reduce extraneous stress on the tissue, however movement and mild exercise can prevent full atrophy and decreased neural drive. In this phase exercises will be geared towards range of motion and include mainly open-kinetic chain movements. The second phase of rehabilitation aims to restore maximal strength contractions with pain-free repetitions. This second phase can last for several weeks. The third, and final, phase includes dynamic and advanced exercises to re-establish athletic movements in full capacity. The overall prognosis of hamstring strain injuries is very good as long as the appropriate rehabilitation is performed. Phase I Exercises
Phase II Exercises
Phase III Exercises
-Danirose Billings
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 A Dowager's hump, also known as kyphosis or hyperkyphosis, refers to an excessive outward curvature of the upper spine, resulting in a rounded hump-like appearance in the upper back and neck. While reversing a Dowager's hump entirely is not always possible, there are measures individuals can take to improve posture, strengthen muscles, and potentially reduce the prominence of the hump. The best medicine of course would be the avoidance of developing such a hump in the first place. A hyperkyphosis can lead to other significant problems such as headaches, neck pain, numbness/tingling, spinal stenosis, disc herniations/bulges, spinal degeneration and arthritis. Prevention and Management Strategies 1. Posture Correction:
  Image by pressfoto on Freepik In our quest for optimal health and wellness, we often focus on nutrition, exercise, and mindfulness practices. However, there's one crucial aspect of wellness that is sometimes overlooked: chiropractic maintenance care. Chiropractic care isn't just for alleviating pain; it's a cornerstone of preventive healthcare that can unlock a host of benefits for both body and mind. Chiropractic care is founded on the principle that proper alignment of the spine is essential for the body to function optimally. Through adjustments and other manual techniques, chiropractors aim to restore alignment, relieve pressure on nerves, and facilitate the body's natural ability to heal itself. While many people seek chiropractic care to address specific issues like back pain, neck pain, or headaches, maintenance care takes a proactive approach. Rather than waiting for symptoms to arise, individuals engage in regular chiropractic visits to maintain spinal health and prevent future problems. Just as we service our cars regularly to prevent breakdowns, our bodies also benefit from routine maintenance. Here's why regular chiropractic care is so vital:
If you're new to chiropractic care or considering incorporating maintenance visits into your wellness routine, here are a few tips to get started:
TEXT or call 203-842-88502 to schedule your chiropractic "tune-up" today!  Image by freepik -- By Erica Sastre, LMT  YES Understanding Carpal Tunnel: Carpal tunnel syndrome is characterized by numbness, tingling, or pain in the hands (particularly the thumb, index finger, middle finger and the thumb side of the ring finger, as this is the part of the hand innervated by the median nerve). The irritation or pain can also refer up the arm, affecting more than just the hand and wrist. The onset might be during sleep, after prolonged activity, or seemingly random. Persistence or recurrence of these symptoms should definitely be addressed! Un-addressed carpal tunnel will lead to a steady increase in these symptoms, and eventually weakness and atrophy of the hands. True Carpal Tunnel is an irritation of the median nerve at the transverse carpal ligament. Carpal tunnel affects about 1 in 10 people, making it the most common nerve compression syndrome! Carpal tunnel syndrome often affects, machinists, hairdressers, musicians, massage therapists, even chiropractors! Anyone making prolonged repetitive use of their hands, fingers and wrists. Now that everyone is texting and typing as much as typists used to when this syndrome was identified... It can really affect anyone.   Understanding Nerve Compression Syndromes: When you have symptoms of numbness or tingling, this usually indicates a nerve problem. Nerves run from the spine throughout the body to give us sensation and feeling, giving our brains vital information about the world around us. When a nerve is compressed or pinched, it interferes with these signals. This is what happens when your arm or foot falls asleep after sitting on it for a long time. Except with carpal tunnel you can’t quite shake it out the way you can a sleeping foot. The more frequent and persistent numbness and tingling become the more severe the problem is. Carpal Tunnel Syndrome specifically compresses the median nerve at the wrist. There are other syndromes that have the same symptoms as carpal tunnel, for example, the median nerve can be compressed at the elbow such as in pronator teres syndrome, or at the shoulder such as in thoracic outlet syndrome, or in the neck due to a subluxation or misalignment in the cervical spine. That is why it is important to get a proper diagnosis for your symptoms. There have been many cases of patients receiving surgery for carpal tunnel but, the surgery did noting for their symptoms as they actually had one of these other conditions. What's happening in the 'tunnel'? The transverse carpal ligament is a round band of fascia that hold the flexor muscles in place. Imagine a rubbery calamari ring in your wrist, and that your muscles and nerves are strands of spaghetti strands are running through it! (Are you hungry yet?) The wrist is a high traffic area! You’ve got carpal bones, you’ve got the tendons of the flexor muscles, you’ve got the median nerve… When this area gets over-crowded the other tissues in the space will compress the median nerve and cause these symptoms. There are several things that can cause a jam-up in this area include edema, subluxation of a carpal bone, fascial adhesion, inflammation of the flexor muscle tendons, and inflammation of the transverse carpal ligament itself. How can this condition be treated? Manual therapy can be really effective in treating carpal tunnel. Calming the overworked tissues, reducing inflammation, breaking fascia and adhesions, and reducing pain. Massage, acupuncture, chiropractic adjustment of the wrist, stretches and exercises, using a wrist brace to splint the wrist, resting the wrist, cortisol shots, and even surgery are all options. Should I get evaluated for carpal tunnel? You can give yourself the following simple tests: If any of the above exercises causes numbness, tingling, or pain in the hands, make an appointment to get checked for carpal tunnel.
Fun Facts:
That's a wrap for our blog this week! We hoped you learned a little more about this common condition. Stay tuned for our next blog, and send your questions to [email protected] --- By Erica Sastre, LMT  Yes! Chiropractic has been proven to help manage both acute and chronic pain. Pain management, in general, is a big issue in healthcare. Let’s look at some facts: Low back pain is the single leading cause of disability. According to the US bone and Joint initiative study, back pain was cause for over 264 million days off of work. That is all without considering any other type of chronic pain condition. Pain affects more Americans than diabetes, heart disease and cancer combined. When looking for solutions to chronic pain, the first thing we tend to reach for is over-the-counter aids such as Aspirin, Advil, or Ibuprofen. Then if these conditions worsen and we go to the doctor we are typically directed to stronger prescription medications, which, can be concerning to many patient situations. Many people are looking for ways to treat their chronic pain without resorting to drugs of the traditional medication protocol. With alternative care we can lessen our dependency on over the counter drugs and even opioids.  Back pain is also one of the most common conditions that opioids are prescribed for with over half of opioid users reporting back pain among their symptoms. Why is this connection between back pain and opioids so concerning? While prescription opioids are certainly helpful to many patients in complex severe conditions, however, we need to also be looking at the big picture of the opioid crisis: In 2016, illicit and prescription opioids were responsible for more than 42,000 fatal overdoses across the country. According to the Centers of Disease Control and Prevention, those numbers have quintupled since 1999, which means the problem is just getting worse. The good news is that, alternative medicines are already making great improvements to these dire statistics.  Let's take a look at some strategies the VA has been using in order reduce opioid addiction among veterans. After launching one initiative, they were able to reduce overall opioid prescriptions by 41% over the past five years. The project was focused on non-drug treatment for chronic pain, such as acupuncture, spinal manipulation therapy, chiropractic care, and yoga. It is also good news to know that patients who received services from a chiropractor were less likely to fill a prescription for opioid medication, and, there was a 51 percent lower likelihood of an adverse drug incident compared to non recipients of chiropractic care.   A visit to the chiropractor may also be more cost effective for sufferers of chronic pain. In one study, "those who initiated treatment for low back pain with chiropractic rather than a regular MD had 40% in reduced healthcare cost!" In general “Healthcare plans that incorporate chiropractic typically realize a 2:1 return for every dollar spent.” There are numerous research studies, reports, and surveys proving how effective chiropractic can be for pain: "In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care." Korthals-de Bos et al (2003), British Medical Journal “Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.” Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutic The evidence and anecdotes are solid. If you are suffering form chronic or acute pain, chiropractic care may well worth a try! Send us your questions! Yours might be answered next week. [email protected] Sources and Further Reading:
NIH Fact Sheet -- Pain Management The Center for Disease Control and Prevention -- Drug Overdose Deaths VHA Pain Management -- Opioid Saftey Initiative Boss Magazine -- Corrective Care for the Opioid Epidemic American Chiropractic Association -- What Research Shows About Chiropractic -- By Erica Sastre, LMT  Did your massage therapist hit a particularly tender spot in your glutes? Did you have pain or tingling running down your leg? Why is your chiropractor trying to make you do so many squats? This week we are putting the spotlight on the piriformis muscle! The piriformis muscle is a muscle under the gluteus maximus, it attaches at the anterior surface of the sacrum, and the superior aspect of the greater trochanter (SI joint to the top of the femur). It Latterally rotates the hip (twists your thigh outward) , and abducts the hip when the hip his flexed (pulls your thigh away from the body center-line).  What could possibly go wrong? Piriformis can be a literal pain-in-the-butt! A tight or knotted up piriformis muscle can cause pain on its own, or limit strength and flexibility. However, this small muscle can cause much bigger problems. The Piriformis is often to blame for sciatic pain symptoms. The sciatic nerve runs right past the piriformis muscle, and sometimes even through the piriformis muscle. Due to its placement in the body, tightness in the piriformis and adjacent muscles can pinch the sciatic nerve. This can send pain, numbness, or tingling down all or parts of the leg! If you have ruled out a spinal issues as your source of sciatic, it's time to address the piriformis muscle. How does the piriformis affect my posture? Check out your toes! If your feet tend to turn in when you are standing, walking, running, or squatting you may have a weak piriformis muscle. Likewise, if you see that your feet tend to turn outward when standing, walking, running, or squatting, it may be a sign that your piriformis is overdoing it. Either one of these postures can cause problems in the legs, hips and knees, especially with load-bearing exercise. Squatting and lifting weights with misalignment can spell disaster for the knees! Keep in mind that if it is a hip/piriformis weakness, the positional problem will originate from where the hip and thigh meet. If the positional problem originates in the knee or ankle, we will have other muscles to look at! That's why it's a good idea to see a professional, like your chiropractor, to help evaluate postural problems. How do I stretch it? Pigeon pose is everyone’s favorite piriformis stretch! There are a number of modified pigeon poses you can try if you are less flexible. If floor stretches are uncomfortable, try doing a pigeon pose on a chair, couch, or low table. The 'figure 4' can be done sitting or supine (on your back), or even standing if you have good balance!
How do I strengthen it? Piriformis is a lateral rotator. Meaning, it twists the thigh 'outward' from your hip. Working the gluteal region will generally build the piriformis, as well as create support for the piriformis with the other gluteal muscles. Squats are an easy way to develop the glutes. Add a band for extra resistance! Try a one-legged dead lift and keep in mind that the grounded leg is the piriformis that you are strengthening. Work one leg at a time, grab on to the back of a chair, bar, or ledge. Lift the other leg out to the side, you can do this exercise with your feet paralell (both toes facing forward) or 'turned out' (feet make a V shape with your toes pointing outward, like in ballet). Try this one with a band as well! 'Fire Hydrant' starts on all fours. Keep your knee at 90 degrees then swing your leg out to the side, keeping your frame strong to isolate and work the glutes. Fun facts about the piriformis
The piriformis is only one of six muscles in the lateral rotator group. The others are; gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus. In 17% of the population the piriformis muscle is pierced by all or part of the sciatic nerve. The word piriformis comes from latin, meaning ‘pear shaped’. Hopefully you learned something fun about the piriformis today! Stay tuned for our next Q&A, and send your questions to [email protected]! What muscle should we feature next? This weeks blog is actually a Vlog! This is the first of our warm-up series. Stuart is going to show off his personal warm up routine. Take notes, try some new things in your own routine, and stay tuned for more vlogs and featured guests! Don't forget to send your health and wellness questions in to [email protected] -- By Dr. Jason Queiros Detoxes or cleanses are often misconstrued as a quick weight loss mechanism. I treat a detox like hitting the reset button on the modem or restarting the computer. In this case the computer being my diet. It's an easy way to get back on the healthy track when you've strayed. I chose to do this detox after my son was born, a time of both extreme happiness and stress. I was getting less sleep, and my eating habits definitely took a temporary dive. This was a stressful time and I'm sure my decreased nutrition and changes in hormones had me feeling less energized, sluggish even. Making me less productive at home and work. This then carried to even occasional feelings of gloominess at times. At this point I knew it was time to hit the rest button. I asked a colleague at work about a detox she was purchasing and I thought, "Why don't we do it together." We referenced other popular cleanses and customized them to our preferences and to add more nutrients. We also decided that we would be making our drinks using the entire fruit and vegetable, not just the juice. This was important to me since most juices are sugar and water and lack valuable minerals, nutrients and fiber. By making the smoothies at home, it costs only a fraction of what it would if you were buying the juices at the store or smoothie shop. For a total of $75, opposed to paying $65-80 per day for juices, I was able to buy organic fruits and vegetables and make enough shakes for 2 people for 5 days. The amounts of each ingredient may vary, adjust to your taste! I made the shakes at home with my Nutribullet. The organization of our cleanse consisted of 4 smoothies (3 hours apart). Coupled with a large salad consisting of lettuce, mixed greens, spinach, mixed nuts, seeds, finished with a drizzle of olive oil & vinegar to complete the day and keep from late night snacking! The Schedule 7 AM - Green 10 AM - Orange 1 PM - Yellow 4 PM - Red 7 PM - Salad
Experiment with recipes and discover what you and your family like! Enjoy your smoothies, and send your questions to [email protected] for our next Q&A! 
-- By Erica Sastre, LMT
This weeks Q & A was inspired by Game of Thrones! Lots of us are excited for the final season to begin. If you have dragons and sports medicine on your mind, read on.
Q: Should I use FIRE (heat) or ICE (cold) treatment? A: Did you tweak a hamstring in the battle of Winterfell? Do you have neck pain after a long day of combing over old tombs in the Maester's library? Do you get headaches every time you Warg with your wolf? Read on and the choice will become clearer than a green dream. 
Let’s start by taking a look how heat and cold affect the tissues in the body!
FIRE/Heat/Thermotherapy on the body will...
You have lots of options with heat,
Heat is best for... Chronic conditions, sore muscles, stiff joints, and overall relaxation. 
ICE/Cold/Chryotherapy on the body will..
Therefore, ICE is best for acute (new) injuries such as twisting your ankle, strained muscles, or back spasms. You should also use ICE after an activity that aggravates a chronic injury. The goal is to reduce swelling and keep the injury from getting worse.
Tip from Dr Q:
"Don't waste your money on an ice pack. Buy a frozen bag of peas, which will serve a triple purpose. It is effective cryotherapy for your injury, it will also act as a timer (by the time the peas melt it will be time to stop your cryotherapy), and then you have a healthy snack afterwards!" 
Within 24-48 hours of an injury, sprain, strain, or spasm, you will want to ice it. Apply cold no more than 15-20 minutes at a time to decrease swelling and inflammation to keep the injury from worsening. Wait 60 minutes between treatments.
After 24-48 hours, after the swelling has gone down post-injury or for chronic conditions, you will want to use heat. We recommend applying heat no more than 20 minutes at a time, and wait 60 minutes between treatments. Follow instructions for your hot pad or heating devices to keep a nice even temperature that will to increase circulation, tissue pliability, and cell metabolism for healing the injury over time. Still in doubt? Go with ICE. Although heat has more therapeutic benefits, you can do more damage when applied in the wrong situation or instance. Therefore, there is more room for error with ICE. Be cautious, as you can burn yourself with either. ​ That is our secret, we can only be victorious in our health and wellness treatment plans if we use fire AND ice! Have a great week! Send us your questions for next time to [email protected]! ​ -- by Erica Sastre, LMT A: The answer is… Probably! Let’s be honest, most of the time the answer is yes. Even if it is not the root cause of your back pain, wearing a backpack incorrectly can seriously worsen other conditions such as disc herniation, scoliosis, hip and shoulder disorders. Most people wear backpacks improperly, or are overloading their backs. How heavy are our backpacks? School books are just the beginning of spinal stress for students, most of whom are doing extracurricular activities. Imagine a 30 pound backpack, a tuba, a poster board presentation, and a soccer bag that all need to be transported to and from school! How heavy is ‘too’ heavy? “The American Academy of Pediatrics recommends that a child’s backpack weigh no more than 10 to 20 percent of a child’s weight.” Yikes, textbooks add up fast! Most parents are not checking to see if their kids backpacks are weighing too much, and few students are self monitoring their posture or the weight they are carrying. They merely accept whatever the coarse-load demands of them. In addition these same students spend a lot of time studying at a desk or computer, most of their day encourages a slouched, leaning forward posture. Schools are slowly changing with the times, some students have options to have electronic books, or share books at school so they don’t need to carry so much. Each situation is different, but most still need to carry all their books, and do their best. The WRONG way to wear Backpacks The Correct Way to Wear a Backpack  Correct posture: Spine is straight, shoulders are even, hips are even. Straps are used so that weight is evenly distributed between the hips and torso!  Photo by Mar Bocatcat on Unsplash Notice how the spine is straight, shoulders are even, hips are even. The straps are used so that weight is evenly distributed between the hips and torso! This is the part that most kids want to skip, but if you look at climbers, hikers, military, they all use straps with their packs to distribute the load properly, this helps them move more freely and prevent injury!  Why is this so important?
Most students spine are in the process of growing! Teens are experiencing their growth spurt, some don’t finish growing until their 20’s so this concern even applies to college students. The spine is supposed to be extending upwards as it grows There is a normal amount of curvature within the spine, but not too much (which is called Kyphosis in the thoracic spine and Lordosis in the lumbar spine). Nor is it supposed to grow into a twist, or a side-to side bend (Scoliosis). If we load up the back, and twist the spine because of weight, every single day, over time we are encouraging the spine to grow in a curve or twist. It much more difficult to correct posture later in life. What can we do if our children seem to be suffering from posture problems related to their backpack? 1) Lighten the load. Two sets of textbooks, electronic textbooks, sharing books with friends. Talk to teachers and administrators to work out viable solution for your child and the other students! 2) Corrective stretches and exercises, as well as regular participation in activities that encourage correct posture and body mechanics such as yoga, dance, martial arts & climbing are all great examples. Stay tuned for next weeks Q&A! If you have any questions yourself, please feel free to send in your questions to [email protected] |
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