Take Control of Your Health

10 little steps you can take to stay healthy.

It Starts With the CORE

By Dr. Jeffrey Tucker

The core is the center of the body, where all movement begins. When you lift a heavy grocery bag, reach for a suitcase, pick up one of your children, move a bookcase or throw a ball, the core muscles should activate even before your limbs are in motion. Healthy core muscles will provide your body with the structural integrity and support to your spine for everything from walking and running to lifting to standing to sitting.

During most activities, do you feel that the way you are using your body is efficient and coordinated or inefficient and uncoordinated? The core should work in an efficient and coordinated fashion to maintain correct alignment of the spine and pelvis while the limbs are moving. As you move your arms and legs, the core muscles create a solid base of support to hold the spine still. If you feel uncoordinated and have a weak core, you are susceptible to lower back pain, poor posture and a whole host of muscle injuries. Strong core muscles act as a "brace" or support to help prevent pain and injury. Strong core muscles increase the recruitment efficiency of the smaller, deeper "stabilizing" muscles around the abdominals, low back, hips and pelvis. They protect your back from potential injury. Strengthening weak core muscles can reduce existing back pain problems. Core training will help runners avoid hamstring and knee injuries; gymnasts, soccer, football and rugby players avoid groin injuries; dancers, golfers and weight-lifters avoid back injuries; and help you become stronger, fitter and healthier.

How to Perform Core Exercises

The overall core exercise prescription is 1) Create a muscle contraction that involves reduction in the muscle's length and contributes to healthy joint motion. 2) Isometrically hold this position to sustain postural alignment or support functional trunk or limb load. 3) Control the smooth return to the beginning of the motion (limb lowering against gravity). The muscles are required to control the back and forth motion, or decelerate rotational strain at all joints, especially the trunk and girdles. 4) Control whatever functional range of motion is available.

Your doctor of chiropractic can help you identify and fix your core weakness and provide you with the proper treatment approach that includes chiropractic mobilizations and adjustments to the joints to make sure they have proper movement; teach you stretches to relax tight, overactive muscles; and train you how to perform exercises for your underactive or weak core muscles. In conjunction with core stability training, as an injury prevention tool, plyometric exercises (fast, powerful muscle movements/contractions) are recommended to improve proprioceptive and reactive capabilities, which may reduce the likelihood of lower-extremity injuries.

The proper progression begins with exercises that teach you to handle your own body weight. Static body-weight exercises focus on developing stability and/or strength endurance in certain postures. The "bridge" (see description later on in this article) is an example of an exercise requiring co-contraction of the small stabilizer and larger mobilizer muscles. Next, you'll improve your overall fitness by progressing to a variety of exercises by adding resistance bands. The next progression adds stability balls, which are an excellent tool for adding instability to torso stabilization exercises or upper-body exercises such as push-ups. Finally, you'll add an unstable surface, such as a 12-inch half foam roller or soft mats, changing the lever arm, balancing on one leg or utilizing one arm. (Your doctor can give you more information on all of these exercises.)

You never know how strong you can be until you challenge yourself, which is why it's important to continually provide new stimulus to your muscles. A wide variety of movements that progressively become more and more challenging is a key component to a long-term successful exercise program.

It's important to train the core while standing on both feet as well as on one leg at a time. The lunge is a good example of a dynamic core stability exercise. It requires coordination of all the trunk and pelvic muscles. Maintain a neutral lumbar spine (not rounded, twisted, etc.) throughout the whole movement. When simple balancing exercises are familiar, you can try to perform core exercises on a soft foam pad. This can increase your trunk muscle activation. Since many sporting actions require strong rotational movements (baseball, tennis, golf), we can add weighted medicine ball exercises during stability ball training and soft pads surfaces to help guard against injuries.

If you haven't already begun core training, or you aren't sure if your current exercises are safely progressing your core strength and flexibility, you should try the following program. Complete three workouts a week, resting at least a day between sessions. On the days you do not do this core program, you can perform cardio workouts such as walking, biking, interval running or sprints. Talk to your doctor before getting started, particularly if you have a pre-existing health condition that could affect your ability to perform any of these exercises.

Key Exercises to Develop Your Core

Traditional Ab Curl: This builds good abdominal strength and co-contraction of the abdominal wall musculature to hold the lumber spine and pelvis in correct alignment. Muscles targeted in the curl-up are the rectus abdominis and abdominal wall (transverse abdominis and internal obliques). Lie on your back with your hands behind the low back. Don't flatten the back to the floor. Keep one knee bent and the other knee straight. Tighten the abs and slowly crunch up from the sternum (that T-shaped bone in the center of your lower chest, also known as the breast bone), bringing your shoulder blades off the ground. Don't forget to breath in and out. 12-15 repetitions, 1 set.

On-Your-Back Bent-Leg Knee Raise: Lie on your back with your head and neck relaxed and your hands above your head, holding onto the sides of a bench or a piece of heavy furniture. Your feet should be flat on the floor. Use your lower abdominal muscles to raise your knees up toward your rib cage and face, the heels toward the butt, and toes to the shin. This will activate the external obliques, hamstrings and anterior tibialis (the muscle on the front of the lower leg/shin). Then slowly lower your feet back to the starting position. As your feet lightly touch the floor, repeat. 12 reps, 1 set.

Plank: The plank is a good example of an isometric exercise (static contraction of a muscle without any visible movement in the angle of the joint) that focuses on the recruitment of the core stabilizing muscles. In the beginning it might feel like a challenge without moving an arm or a leg occasionally.

Start to get in a push-up position, but bend your elbows and rest your weight on your forearms instead of your hands. Your body should form a straight line from your shoulders to your ankles. Pull your abdominals in; imagine you're trying to move your belly button back to your spine. Continue to brace the abdominals and put the low back in the neutral position. Hold this position for an increasing length of time up to a maximum of one minute, breathing steadily. As you build endurance, try to do at least a 60-second set. 2-3 sets, 1 minute per set.

Progressions/variations: The plank has many variations: You can plank starting out on the forearms and toes, then progress to more difficult challenges such as a plank with single-arm support or single-leg support. Planks can become even more challenging to the core with the use of a stability ball and challenge balance as well. Plank on a stability ball with the elbows on the ball or hands on the ball; plank on a stability ball with hands on the ball and feet on a bench.

Side planks can start out in static holds and progress to side planks with single-leg support; side plank on a stability ball with your elbows on the ball; progress to alternating side planks to the elbow or hand; plank on the elbows and walk to a push-up; or plank on elbows on the ball. You can even perform stability ball kneeling rollouts from your elbows.

Plank on ball: To really activate your abdominal muscles, kneel in front of the stability ball and place your elbows on the top of the ball (in the center). Slowly roll the ball away from your body until there is a straight line through the knees, hips and head and your weight is being supported through your elbows down on to the ball. Once in this position, it may be necessary to tilt the pelvis so that it is held in neutral with correct lumbar spine alignment. Also be careful not to round off the shoulders: aim for a "long spine." Build up to holds at the far point for 30 to 60 seconds. 2-3 sets, 30-60 seconds per set.

 

Stability Ball Push-Ups: These are your basic push-ups, but you're doing them with your feet on a stability ball. Keep your body straight - don't let your hips sag or stick your butt up in the air - to max out on the exercise's core-strengthening benefits. Do as many as you can with strict form. 1 set to failure.

Side Bridge: The side bridge is a safe and effective exercise for the obliques and quadratus lumborum (a key lumbar stabilizing muscle). It also targets the lower abdominal muscle. Lie on your nondominant side with your forearm on the floor under your shoulder. Support your weight with that forearm and the outside edge of the same side foot (your legs should be stacked one on top of the other). Your body should form a straight line from head to ankles. Contract your abs and glutes in as far as you can, and push your hips off the floor. Create a straight line from ankle to shoulder and keep your head in line with your spine. Hold this position for an increasing length of time up to a maximum of one minute, breathing steadily. Relax and lower under control. Repeat on your other side. 2-3 sets, 1 minute per set.

"Cobra" or "Arch-Up": This is more of a low back exercise than a gluteal exercise, but it will train you to recruit the gluteals as well. Lay face down on the floor with the arms beside the hips. Activate the core by drawing in the naval toward the spine and squeezing the glutes. With the core and glutes activated, lift the chest off the floor. Keep both feet on the floor. Pause momentarily at the top of the lift while targeting the buttocks (gluteus maximus) and erector spinae/multifidus (muscles in the back).

Progress to changing the arm position. Hold your arms straight out in front of you. Your body should form a straight line from your hands to your hips. Raise your upper body until it's slightly above parallel to the floor. At this point, you should have a slight arch in your back, and your shoulder blades should be pulled together. Pause for a second, then repeat. 12-15 reps, 1 set.

Progression: Kneel over a stability ball with thighs and stomach in contact with the ball and head and shoulders dipping over the front of the ball. With your back straight and parallel to the floor, position the lumbar spine in neutral and then set your hips so they do not move.

Allow the chest to drop and fall over the ball, flexing the upper back. Place your hands at the sides of the head, elbows bent. From this position, lift your chest up, extending your upper back until it is higher than at the starting position. Maintain abdominal contraction throughout to fix the hips and limit hyperextension of the lumbar spine. 10-20 reps, 2-3 sets.

Gluteal Bridge: This maneuver has many progressions. Start by lying on the floor with your knees bent. Squeeze your gluteals and then push your hips up until there is a straight line through the knee and hip to the upper body. Shoulders should remain on the floor. Beware of raising up too high or flaring the ribs, which pushes the back into hyperextension. Hold this position for an increasing length of time, up to a maximum of one minute. After you can hold this pose steady for one minute, bridge up and down repeatedly concentrating on squeezing the glute muscles and not using the lumbar spine for hip motion. 2-3 sets of 1 minute per set.

Progression 1: Progress to lying with your upper back and head on the floor with your heels on the top of the stability ball, hip-width apart to aid stability. Suck in the abdominals and squeeze up from your gluteals, lifting your hips until there is a straight line from heels to upper back. Shoulders and head should stay firmly on the floor. Take care not to lift the hips too high or flare the ribs so that your back hyperextends. Build up to holds of 30 seconds and lower. 2-3 sets of 30 seconds per set.

Progression 2: Progress to bridging with your back and head on the top of the stability ball. Hold the back in a static table-top position with the feet on the ground (hip-width apart), the knees bent 90 degrees. Squeezing up from the gluteals, lift hips until there is a straight line running through the knees, hips and shoulders. Do not lift the hips too high or flare the ribs so that your back hyperextends. Hold for a count of five and lower. 15-20 reps.

Progression 3: Combine the stability ball and a small weighted ball: Hold a light weight medicine ball between your palms and keep elbows straight. Keeping both arms straight bring arms back behind your head, and back up to the starting position. This re-establishes proper scapular glide and promotes thoracic extension.

Quadruped Birddog: The quadruped opposite arm/leg raise is effective for the lumbar and thoracic portions of the erector spinae muscles. This exercise also requires co-contraction of the abdominal wall muscles to stabilize the pelvis. Start with hands below shoulders and knees below hips. Set your low back into neutral and brace your abdominals slightly. Slowly slide back one leg and slide forward the opposite arm. Ensure that the back does not slip into extension, and that the shoulders and pelvis do not tilt sideways. Hold for two slow breaths in and out. Slowly bring your leg and arm back and swap sides. You can progress to using resistance bands around the hands or ankles. Build to 15-20 reps per side.

 

One-Arm Rotational Row: This is a strength exercise that you'll feel throughout your back, torso, shoulders, and arms. Use an anchored resistance band with a handle to a low point near the floor. Kneel perpendicular to the anchored point, with your right knee and left foot on the floor. With your right hand, reach across your body to grab the handle, turning your hips and shoulders. Now rotate your right shoulder back and pull the handle to your right hip. Maintain a tall spine. Slowly reverse the motion. 12 reps per side.

 

Up-chop /Down-Chop Kneel: This exercise develops excellent core stability and trunk rotation strength. Swimmers and runners will appreciate this exercise. For the up-chop, kneel next to a band with a handle attached below hip height.

Grasp the handle in both hands to the side of the hip nearest the band anchor. Lift the arms up and at the same time rotate the shoulders away from the band, keeping hips facing forward and arms straight. 2-3 sets of 8-10 reps, both sides.

 

As you might expect, the down-chop is the opposite of the up-chop. Begin with the handle attached high up above head height, grasping the handle in both hands above the head to the side of the band anchor. Keeping the hips facing front and the arms straight, pull the hands down and turn the shoulders away from the anchor. 2-3 sets of 8-10 reps, both sides.

Dumbbell Lunge-Press: Strength, endurance, balance, coordination: There's not much this one doesn't hit. With a neutral grip (palms facing toward each other) and elbows bent, hold a dumbbell in each hand at shoulder level. Feet should be shoulder-width apart. As you step forward into a lunge position, press the dumbbells toward the ceiling and finish the press with palms facing forward. Step forward with the back leg while lowering the dumbbells to return to the starting position. Form is key: Make sure your front knee is aligned over the second toe in the lunge position and concentrate on keeping your torso erect, chin level, eyes looking straight ahead throughout, as if you were trying to balance a book on your head. If you have trouble doing that, reduce the weight; if that still doesn't work, switch to a single plateless barbell instead of dumbbells. 10 lunges per leg.

Medicine Ball Slams: Believe it or not, this can be a great ab exercise. Take a medicine ball and get in an athletic-ready position (knees slightly bent, ball held with both hands at lower chest level or so). Bring the ball overhead as fast as you can under control and slam it down as hard as you can. Make sure you do a few slow ones first to get a feel for the bounce of the ball, since you have to catch it. This exercise involves complete integration of the total body. It will also teach you power development from the ground up and get your heart racing. 1-2 sets of 12-15 slams.

If you haven't figured it out by now, core training is important; in fact, it should always be a part of your exercise routine. Don't be afraid of core training, even if you're a beginner. Actually, if you're just starting an exercise regimen, core training is the place to start, because it will make everything easier. Your doctor can answer any questions you may have regarding the value of core exercises and how to properly perform the exercises mentioned in this article. Now get out there and start training your core!

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A Sample Routine to Tone and Tighten Your CORE (see step-by-step descriptions throughout this article)
Exercise	Repetitions Per Set	Total Sets
Curl-Ups	12-15	1
Bent-Leg Knee Raises	12-15	1
Planks (toes/forearms)	60 seconds	2
Stability Ball Planks (elbows on ball)	20 seconds	3
Stability Ball Push-Ups	10-12	1
Side Bridge	60 seconds	2 per side
Arch-Ups	12-15	1
Glute Bridges (back on ball)	15-20	1
Birddogs (opposite-arm leg raise)	15-20	1 per side
Up Chop Kneels	10-12	2-3 per side
Down-Chop Kneels	10-12	2-3 per side
Lunges	10-12	1 per side
Medicine Ball Slams	10	1

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Jeffrey Tucker, DC, is a rehabilitation specialist who integrates chiropractic, exercise and nutrition into his practice in West Los Angeles. He is also a speaker for Performance Health/Thera-Band (www.thera-band.com).

This article was taken from the December issue of "To Your Health"

Flu Shot Facts to Share With Your Patients

By Claudia Anrig, DC

Every year just before the weather turns colder, the U.S. Centers for Disease Control and Prevention begins an advertising campaign geared toward motivating the masses to get the flu vaccine.

They talk about the number of deaths each year that are attributable to the flu and the number of missed work days that cost employers hundreds of thousands of dollars. This year, that campaign will likely be even more urgent due to outbreaks of the "swine flu" virus, which have spread from one country to the next in the past six months or so. This article is not intended to decide for parents (and their children) whether to vaccinate or not to vaccinate for the flu, but rather to provide information so they can decide for themselves.

What Is the Flu?

Influenza is a contagious respiratory illness caused by influenza viruses. The most common symptoms are fever, headache, fatigue, cough, sore throat, runny or stuffy nose, and body aches, as well as diarrhea and vomiting. The flu can cause complications such as pneumonia or dehydration and may aggravate existing conditions like asthma and heart disease. It is spread from person to person in respiratory droplets when people who are infected cough or sneeze.

What Is the Flu Shot?

The flu shot is an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot has been approved for use in people older than 6 months of age, including healthy people and people with chronic medical conditions (such as asthma, diabetes, or heart disease). What the CDC doesn't tell you is that the other ingredients in the flu shot include, but are not limited to the following:

• Ethylene glycol - antifreeze
• Phenol (also known as carbolic acid) - a disinfectant and a dye
• Formaldehyde - a known carcinogen (cancer-causing agent)
• Aluminum - associated with Alzheimer's disease and seizures, and has produced cancer in laboratory mice, but is still being used as an additive to promote antibody response
• Thimerosal - a mercury disinfectant and preservative that can result in brain injury and autoimmune disease
• Neomycin and Streptomycin - used as antibiotics and have been known to cause allergic reactions in some people

What Are the Potential Side Effects?

Just like all vaccines and medications, there are potential side effects associated with the flu shot. The CDC and other health care organizations would have you overlook them for the supposed benefit of being inoculated against the flu. However, it's important to at least be familiar with these potential side effects and weigh the potential risk vs. benefit when deciding whether to receive the shot.

Minor side effects can include but are not limited to soreness, redness or swelling at the injection site, low-grade fever and other aches and pains. More severe, life-threatening complications have proven to be rare, but the danger still exists that someone can suffer severe effects from this alleged beneficial vaccine. The most common dangerous side effect is an allergic reaction. Since the vaccine is grown in eggs, it is more dangerous for those who have had an allergic reaction to other vaccines in the past. These reactions can include breathing problems, hoarseness or wheezing, hives, paleness, weakness, and a fast heartbeat or dizziness. The CDC has recognized the danger and recommends that those who have had an allergic reaction to a vaccine in the past not get the flu shot before speaking with their health care professional.

An even more serious side effect is Guillain-Barre syndrome (GBS). This is a disease in which the body damages its own nerve cells, resulting in muscle weakness and sometimes paralysis. While most people eventually recover, some have permanent nerve damage and 5 percent to 6 percent of those who develop GBS will die. The CDC would remind you that only six of every 1 million people injected with the flu shot will develop GBS.

The American Academy of Pediatrics Warns...

The AAP provides guidelines for circumstances under which patients should not be vaccinated with the flu shot or nasal spray. According to the AAP, a patient should not get vaccinated if any of the following applies (whether restriction applies to flu shot, nasal spray or both is noted in parentheses):

• Less than 6 months of age (flu shot); less than 5 or older than 49 (nasal spray)
• Moderate to severe febrile (fever) illness (both)
• History of Guillain-Barre syndrome (both)
• Hypersensitivity, including anaphylaxis, to eggs, to any influenza vaccine dose, or to any of its components (both)
• Asthma, reactive airway disease, or other chronic disorders of the lungs or cardiovascular systems (nasal spray)
• Have underlying medical conditions including metabolic diseases, such as diabetes, renal dysfunction, and hemoglobinopathies
• Received other live vaccines within the past four weeks (nasal spray)
• Known or suspected immunodeficiency disease, or receiving immunosuppressive therapies (nasal spray)
• Take aspirin (nasal spray)

Are the Side Effects Worth It?

After careful consideration of the risks associated with the vaccine, it's wise to weigh those risks against those of the flu. The CDC talks about the benefits of being vaccinated, but are those benefits backed up with the facts? The flu vaccine is always changing because the flu strains change from one year to the next. (The swine flu is once such variation.) The manufacturers of the vaccine take a shot in the dark and hope they'll hit the right strain each year, but the fact is the flu shot is only 70 percent to 90 percent effective.

Dean Eurich, a clinical epidemiologist and professor at the school of public health at the University of Alberta, recently considered the data and reported that over the past 20 years in the United States, vaccination rates among the elderly have increased from 15 percent to 65 percent, but hospital admissions and death rates from all causes have not declined proportionately. "Only about 10 percent of winter-time deaths in the United States are attributable to influenza, thus to suggest that the vaccine can reduce 50 percent of deaths from all causes is implausible in our opinion," Eurich said.

A further study by Sumit Majumdar, MD, reached the same conclusion. According to his research, after considering all the facts and taking into account immunizations, socioeconomic status, sex, history of smoking and the severity of the flu, the actual benefit of the flu shot is "reduced to a statistically non-significant level of 19%."

What About Flu Complications?

The CDC is very effective in communicating to the lay individual that if they are pro-active and vaccinate against the flu, it will help avoid the dangerous complications from the flu, such as pneumonia, but recent studies are debunking that theory. A recent article published in the Lancet medical journal suggests the flu vaccine is having little or no effect on the number of elderly people developing pneumonia each year, and a recent study led by Michael Jackson, MD, of the Seattle-based Group Health Center for Health Studies, that compared 1,173 pneumonia patients between the ages of 65 and 94 who had been vaccinated with 2,346 people who hadn't, determined that the risk of contracting the lung disease wasn't reduced by the shot.

As Simple as Practicing Good Health Habits?

The CDC and the AAP (and probably your Mom when you were growing up) all advocate simple health habits to prevent the spread of illnesses like the flu. Recommend your patients take the following four steps to minimize their risk: 1) Cover your nose and mouth with a tissue when you cough/sneeze; throw the used tissue away. 2) Wash your hands often with soap and water and as soon as possible after coughing or sneezing. 3) Keep yourself and any babies and children in your care away from people who are coughing or sneezing. 4) Try not to touch your eyes, nose, or mouth.

Resources

• Woloshin S, et al. "A Shot of Fear." Washington Post, Oct. 25, 2005.
• Jackson ML, et al. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study. The Lancet, Aug. 2, 2008;372(9636):352-254.
• Seasonal Flu Shot: Q&A. Centers for Disease Control and Prevention. www.cdc.gov/FLU/about/qa/flushot.htm.
• American Academy of Pediatrics. Preventing the Flu in 2007-2008.

This article is from Dynamic Chiropractic, October 21, 2009. Pg. 16

Whiplash Trauma and "New School" Isometrics

By Jeffrey Tucker, DC, DACRB
Dynamic Chiropractic, September 9, 2009

When I was in chiropractic college more than 25 years ago, I was taught to use isometric exercises for whiplash trauma recovery. The technique was pretty simple: Place one hand on the back of your head and push the hand and the head against each other. Keep the neck in a neutral position and don't let the head move backward. Build up to tension in 2 seconds, hold the tension for 6 seconds and gradually relax over 2 seconds, and then repeat for 10 reps. The exercise was also performed in flexion, rotation and lateral bending.

This form of exercise involves the static contraction of a muscle without any visible movement in the angle of the joint; the length of the muscle does not change. We'll call that technique "old school" because the old German model (Hettinger and Muller) of 6-second actions was used in the original experiments and was adequate for strength gains, but was insufficient to cause hypertrophy in muscles. If you were looking to get big, this was not the technique.

In a rehabilitation practice, it is not our job to train muscles for the sole purpose of making them bigger. The contemporary approach is to help train clients to improve movement patterns. Patients notice benefits to strength and power of "movements" - this is called "functionality." Functional training is any training that improves the ability to perform a target activity.

Enter "new school" isometrics or maximal intensity isometric training (1-5 reps with 90 percent to 100 percent of your max), using sets lasting 20-120 seconds. This will stimulate strength, endurance and hypertrophy. This technique can be used in the early stages of rehab and then combined with repetitive-effort isotonics (6-12 reps with 70 percent to 90 percent of your maximum).

As an example, consider a patient who was involved in a rear-end motor vehicle accident. We'll say this patient is a 50-year-old female who sustained an injury to her neck, her right wrist is splinted due to carpal sprain, and she is deconditioned. In this case, there are numerous advantages of starting with isometrics in her rehab, along with a few disadvantages:

Isometrics: Advantages and Disadvantages

Advantages

• An injured or immobilized extremity can be tensed while in a cast or in a splint after the immediate pain has subsided.
• Ideal for people with no exercise experience.
• Can be used early in a rehab program.
• Great way to teach proper biomechanics.
• Helps prevent muscle and strength losses.
• Achieves maximum muscular contraction and increases strength faster than any other form of training.
• Builds strength in isolated areas or muscle groups without moving the joints (It may increase muscle size and develop more efficient muscle contractions).
• Works muscles with more intensity in a shorter period of time.
• Prepares the musculoskeletal system for more advanced activities.
• Increases neurological strength, recruits more muscle fibers for each movement.
• Good for enforcing movement patterns (especially in youth).
• Isometric workouts can be fast and can be done anywhere.
• Safer than conventional training (doesn't involve movement).
• Dramatically improves conventional training; improves lifts by as much as 14 percent to 40 percent.

Disadvantages

• Potential of reducing muscular endurance. (Progress patients to isometrics to avoid this.)
• Potentially reduces speed of muscle response, which will slow you down.
• Generally boring to perform.
• Increases blood pressure, which could lead to ruptured blood vessels or irregular heartbeat.
• Strength gains achieved occur only within 20 degrees of the angle; there is approximately a 10-degree overflow on each side of the muscle fibers being used.

This "everything old is new again" program still encourages active participation of the patient during recovery, provides patient education on proper posture and body mechanics, highlights proper nutrition, and teaches corrective exercise therapy the patient can do at home on her own.

Isometrics and Resistance Testing

Isometrics can easily become part of the exam process itself. You can test what you want to test and the tests are reproducible. The test and the exercise can involve the length of time the patient can hold a pose. As strength increases, time under tension will improve and this becomes an objective finding. For example, resistance in isometric exercises typically involves contractions of the muscle using the following (the neural patterns used in #2 below may have a bigger impact on concentric strength and #3 below on eccentric strength and muscle mass):

1. The body's own muscle (e.g., pressing the palms together in front of the body at varying heights).
2. Fixed structural items (e.g., pushing against a door frame). You can push or pull against an immovable resistance (e.g., pushing against the pins in a rack). Thus, there is no actual external movement while you are attempting to move the resistance.
3. The use of free weights, kettlebells, weight machines or elastic tubing (e.g., holding a weight in a fixed position). Hold a kettlebell weight in your hand with the weight at your side. Your objective is to prevent it from going down and avoid shifting your posture. Once again, there's no external movement; however, your intent is no longer to move the load, but to prevent its movement.
4. Pressure-type equipment that has a digital readout of maximal force (grip strength).

"Static hold" isometric exercises can also be included in patients' isometric routines. For example, during a set of rows, I have some clients hold their shoulder blades together when the handles are closest to their chest to "squeeze" the interscapular muscle in an effort to further strain the muscle. Depending on the goal of the exercise, the exertion can be maximal or submaximal.

A Treatment Plan Based on "New School" Isometric

Let's create a treatment plan for our 50-year-old patient involved in a rear-end motor-vehicle accident using "new school" isometrics. Here are some beginning exercises I use for cervical spine rehab patients who are deconditioned:

Stability Ball Bridge

• Head and upper back on a stability ball.
• Torso in a "table top" pose.
• Contract the gluts to create a bridge.
• The glutes should be the primary muscles recruited (also some abs and quads).
• No low back discomfort and no hamstring cramps.
• As the patient progresses, they can keep their head off the ball.
• Build up to holding each "squeeze" from 10 seconds to 30 seconds. Perform five reps.

Supine Gut Contractions

• Supine position, legs extended.
• Contract the glutes to create a bridge.
• The buttocks should be the primary muscles recruited.
• No low back discomfort and no hamstring cramps.
• Maintain the cervical spine in various angles of slight flexion and extension.
• Build up to holding each "squeeze" from 10 seconds to 60 seconds. Perform five reps.

Sustained Wall Sit

• Back/shoulders/head flat against wall.
• Hip/knee/ankle flexed to 30 degrees. Progress to 60 degrees and then 90 degrees.
• Progress to one-leg wall sit.
• Maintain this position and add wall angels.
• Build up to holding the wall sit pose with the thighs parallel to the floor for 2 minutes. Perform one rep.

Sustained Plank (Isolates pecs and core)

• Use two 25-pound kettlebells or stands that are about 18" off the ground. (Push-up bars work great.)
• Slightly wider than shoulder-width apart.
• Hands below the nipple line.
• Keep back flat and cervical spine in neutral.
• Keep body/torso in alignment.
• Build up to holding the plank for 1 minute. Perform two reps.

Upper-Body Arm Hang (Advanced)

• Pull up on the bar and keep eyes horizontal to bar.
• Hand/wrist in neutral position.
• Elbows at 90 degrees.
• No movement in body.

Anterior Abdominal Wall

• Supine, knees bent; strap legs in while leaning on bolster.
• Must keep the ear/shoulder/hip in alignment.
• Remove support.
• Time begins when position can be maintained.
• Make sure the lower back does not hyperextend and the cervical spine stays in neutral.

Other testing and exercise examples include: sustained side bridge (right and left)), sustain V sit (test) and sustained back extensor (test). Patients enjoy it when I instruct them to hold a weight at a certain position in the range of motion and time them for form; for example, holding a "heavy" kettlebell statically in the "rack" position (thumb pointing to the clavicle with the elbow into the body) for a certain amount of time. They then progress to walking around with the kettlebell in the rack position while maintaining good posture. The next progression is holding the kettlebell overhead and walking around. This builds core strength.

Other exercises include pushing or pulling against an immovable external resistance (e.g., heavy-band pulls/pushes). I try to get patients to hold the pose for 10 seconds and then 20 seconds, eventually getting to 60-plus seconds. Example exercises using bands or kettlebells include the following:

Overhead Reaching

• Use a band with handles.
• Stand in a staggered leg stance.
• Grasp the handles at shoulder height with elbows bent.
• Brace your abdominals as you push the band (tubing) upward, extending the elbows.The arms are angled in front of the ears.
• Maintain proper cervical posture (do not allow forward head).

Overhead Pressing

• Double-leg stance.
• Grasp the handles at shoulder height with elbows bend.
• Brace your abs as you push the tubing upward, extending the elbows.
• Arms are hiding the ears (the movement is straight upward).
• Maintain good cervical alignment.

Diagonal Lifting

• Wide stance.
• Grasp the handle with both hands.
• Begin at the left knee level and rotate your trunk to the right.
• Continue to look at the handles as you lift your trunk and rotate upward and to the right.
• Stretch the tubing across your body.
• Keep the elbows straight.
• Keep your eyes and head turned upward.

Diagonal Chopping

• Wide stance.
• Grasp the handle above your shoulder by extending and rotating your trunk.
• Continue to look at the handles as you pull the tubing downwards.
• Rotate and bend your trunk.
• Stretch the tubing across your body.

Dr. Jeffrey Tucker is a rehabilitation specialist, lecturer and healer best known for his holistic approach in supporting the body's inherent healing mechanisms and integrating the art and science of chiropractic, exercise, nutrition and attitudinal health. He practices in West Los Angeles. For more information, please visit www.drjeffreytucker.com.

This article was taken from Dynamic Chiropractic. September 9, 2009. Pg. 8