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What is a Structural Shift?

We all know that, in terms of health, normal ranges exist. A simple way to understand this concept is to think of blood pressure. Normal blood pressure doesn’t have to be an exact number, but once those numbers cross the normal threshold, we know that a person has high blood pressure. This is the same concept as running a fever. Normal ranges have been established all around us, and in most areas of our life.

The dashboard of your car has warning indicators to let you know when the sensors or gauges detect something abnormal in the inner workings of your car. The body uses symptoms in a similar manner to the warning indicators on your dashboard; to alert you to a potentially more serious condition.

A Structural Shift is exactly that type of condition, which may, in fact, be the cause of your symptoms. When the alignment of a joint displaces, it impacts the associated structures like muscles, discs, ligaments, and other joints. A Structural Shift is the collection of these changes which ultimately impact the function of the body. Our office works to detect and correct Structural Shifts to allow your body to heal and you to not just be symptom free, but to actually function at a higher level.


Structural Chiropractic VS. Traditional Chiropractic

There are some major differences between the traditional chiropractic approach and our office. The easiest place to start is by explaining the goals of conventional chiropractic care.


Traditional care has 3 major goals – 1) Temporary reduction in pain, 2) Reduced muscle spasm, and 3) Increased range of motion. While these are great goals, and traditional chiropractic is very good at achieving these goals; our goals are a little bit different.


Align Chiropractic Clinic has made our focus Structural Chiropractic Correction.


What we have found, through both experience and education, is the underlying structure is directly tied to function. When patients find our office, frequently via a referral from friends, family, or their doctor, it is because of some sort of “symptom” is what started the conversation – or what Structural Chiropractors refer to as Secondary Conditions. The people who refer to our office understand that the secondary condition is typically associated with a Structural Shift. Structural Chiropractic Correction focuses exclusively on the correction of that underlying cause – Structural Shifts. At our office this means addressing all components of a structural shift, including the changes to the bones, muscles, ligaments, tendons, discs, and nerves.



Quick Fitness Test – Sit Rising Test

by Dr. Willemin 0 Comments

TL;DR – You should be able to go from standing to sitting on the floor and back to standing without using anything to help you up or down. The older you are, the more it matters.

The Test

Okay, I’m sure you are all masters of the 2 minute plank now. If not, maybe it’s because you didn’t read this. It is time to take a look at our second quick fitness test. The Sit Rising Test (SRT). The test is very simple. Go from standing to sitting cross legged, and then from sitting back to standing. The goal is to perform the movements WITHOUT losing your balance or using anything to stabilize yourself (i.e. putting your hand or knee on the ground). If you can’t picture what I’m saying watch this https://youtu.be/1tdtHWURId0 video. Remember I said simple, not easy. Scoring is straightforward as well, for every body part you need to use to brace yourself, you lose a point, and if you’re wobbly you lose a half point. A perfect score is 10 (5 points for the standing-to-sitting portion and 5 points for the sitting-to-standing portion). The benchmark is a score of 8 or better. Some voices in health and fitness feel there are some concerns that pre-existing injuries to the hips, knees, and ankles, or bone fragility are good cause to avoid performing this test. While I certainly encourage everyone to exercise caution, I don’t believe that this test has to be avoided. I encourage people to aim for an honest assessment. What that means is that if you need to use your hand on the ground, then use it. You can test your hip, knee, and ankle flexibility simply by trying to get into a cross legged position from an already seated position. If you have bone fragility issues to the point that just sitting down might break them, then you should be addressing this with a doctor.

Uh-Oh, I didn’t score an 8 or higher

Being able to do the SRT with a score of 8 or better is an indicator of good musculoskeletal health. If your score was less than this, it means you need to improve. This movement series will test hip, knee, and ankle flexibility, lower body strength, and core stability. A great way to start improving those things are with squats. Read this earlier post about why I love squats and really recommend adding them to your routine. At Align Chiropractic we are focused on improving the underlying structural issues that may be occuring in your musculoskeletal system – a low score is an indicator that you might have a structural problem holding you back. Also, don’t try and rush into a perfect score. Take your time making small, but steady, improvements, and then try the test again after giving yourself adequate time to improve. Note where you have difficulties and look for specific improvements in those areas.

Why Do We Care?

While the Sit Rising Test has some detractors, according to a study in the European Journal of Preventive Cardiology, the test is a good predictor of musculoskeletal fitness. The study showed SRT actually was a good predictor of all-cause mortality in 51-80 year olds. The study did a 6 year follow up on participants and found that there was a strong relationship for death and a lower score. The higher your score the lower the risk of death. (1) This means that at the 6 year follow up people with lower scores were more likely to have died than those with higher scores regardless of the specific cause of death. Now further study is certainly warranted, but this isn’t the first study to associate musculoskeletal health and mortality rates. The Journal of the American Geriatrics Society found that a hyperkyphotic posture (anterior head posture) was also a significant predictor of mortality in older persons. (2) Clearly your musculoskeletal health matters, and it isn’t just about aches and pains.



Quick Fitness Test – Plank

by Dr. Willemin 0 Comments

TL;DR: You should be able to hold a spine neutral plank position for 2 minutes. Train by a combination of short intervals and longer holds.

We are going to spend a few blogs going over some basic fitness tests to see where you fall on the spectrum and help identify how you can improve. Today’s blog will discuss plank.

There is a lot of debate and discussion regarding the risks and benefits of plank. In order to dive into the topic we first have to have a baseline understanding of what the plank exercise actually is. The basic plank is when your toes and forearms are on the floor and you are supporting your body and head in a neutral spine (straight line) looking down at the floor.

What’s not to like?

I’ve read articles that discuss the pressure put on the lumbar spine (low back) and the risk of costochondritis (inflammation of the cartilage between the ribs). In one article, Dr. Michael Durtnall, a chiropractor in London, was even quoted saying, “Planks are for the super-fit and athletes, not for soft, desk types to go bananas with once a week.” (1) I don’t agree. While I would agree with the sentiment that it is not a good approach to go wild with plank once a week; I would say the same is true for almost any exercise, especially when first starting. The statement implies though that working at a desk is mutually exclusive of being fit or an athlete. I know a lot of people who are active athletes in a variety of sports that work desk jobs. I myself play pickup basketball when I can. I have participated in flag football leagues, kickball leagues, and play tennis regularly when the weather permits. The goal with any exercise is to work up gradually. The risk of injury with plank is substantially lower than with many exercises since there is no motion and there are no additional weights being used. I do agree with the sentiment out there that just trying to exercise to overcome low back pain is not a good approach. Having said that, not doing an exercise because of a current injury doesn’t make the exercise inherently bad. If I had a broken leg I wouldn’t be doing squats, but that doesn’t mean squats are bad (in fact I Love Squats)

What’s the good news then?

The good news is that there is good evidence that planks are pretty beneficial. You see it isn’t actual strength that seems to be important with your core, but rather your core endurance. In the research article, “Core Stability Training for Injury Prevention” by Bliven et al. (2) Planks can help train core endurance which may help reduce certain injury risk. Stuart McGill published in the June 2015 issue of the Journal of Strength and Conditioning Research “…an isometric training approach was superior in terms of enhancing core stiffness. This is important since increased core stiffness enhances load bearing ability, arrests painful vertebral micromovements, and enhances ballistic distal limb movement.” (3) Think of it like this – if you compared it to holding a weight at arm’s length in front of you, it isn’t about how heavy the weight is, but how long you can hold it. Also, one of my favorite things about plank is it is NOT a massive time consuming exercise. This means it is easy to incorporate on a daily basis. Now there is a bit of debate regarding how much is enough/too much. Top End Sports lays out a guide in which they state that excellent core strength is the ability to hold the plank position for over 6 minutes! (4) If you’ve ever tried plank you know that is a LONG time, and fortunately, most exercise experts would disagree. An article published in Women’s Health reads, “Albert Matheny, R.D., C.S.C.S, co-founder of SoHo Strength Lab and advisor to Promix Nutrition, says you can plank daily, but the length you should hold a plank can vary from 10 seconds to one minute.” (5) Men’s Health contributor and strength coach Dan Johns feels strongly that anything over two minutes is a waste of time, but not being able to hold a plank for two minutes is a problem.

The Test

I agree with Johns, the benchmark is two minutes. To perform the test get into the plank position with a time directly in front of your face, or with a partner timing you. If you have appropriate core endurance then you should be able to hold a perfect form plank for 2 minutes. This doesn’t mean it won’t be hard. You might shake, you might hate every second, but if you can hold a neutral spine while in the plank position for 2 minutes then your core endurance should be adequate. If you can’t then you need to get better. Going over 2 minutes doesn’t really indicate anything better in terms of injury prevention or overall fitness.

How to Train

McGill recommends training in repetitions of 10 seconds (6), while Matheny recommends simply holding the position until your form breaks down. I recommend both. To give an analogy to running, if you’re training for a marathon, don’t only run sprints. If you’re trying to make your body as fit as possible, don’t only run long distances. All of the exercises we discuss are designed to promote healthy and normal function. Our goal isn’t just to be able to hold a plank for two minutes but to actually improve the function of our core so that we reduce injury risk and promote wellness. If you alternate days between training intervals and longer holds, or want to mix both together on the same day, you will make positive steps with either approach. If you really want to maximize your training though try using plank variations like side bridge or one foot planks. Your body is dynamic and your training should reflect that by challenging your body in a controlled manner to improve overall fitness.

1. http://www.dailymail.co.uk/femail/article-3030983/The-ultra-competitive-exercise-fad-ruin-health-called-planking-suddenly-sweeping-gyms-Pilates-classes.html

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/

3. http://journals.lww.com/nsca-jscr/Abstract/2015/06000/Effect_of_Long_term_Isometric_Training_on.8.aspx

4. http://www.topendsports.com/testing/tests/plank.htm

5. https://www.womenshealthmag.com/fitness/how-long-to-hold-plank

6. https://www.menshealth.com/fitness/truth-about-extreme-planking

Structural Care for Pregnancy

by Dr. Willemin 0 Comments

My wife is amazing. No questions, no debates. While there are a plethora of reasons why I say this, I am currently referring specifically to her giving birth to both of our wonderful children. I will avoid straying too far down memory lane, but I want to take a minute to discuss my wife’s experience with pregnancy. For our first child, our daughter, my wife had an uneventful (relatively speaking) pregnancy. She had a lot of the norms – nausea, fatigue, etc, but on the whole things marched along pretty smoothly.

For our son, pregnancy marched along fairly smoothly until we found out that at 38 weeks our son was in the breech position. We had a conversation with our OB that included her telling us that my wife would need a cesarean section, and me informing the OB that before we just agreed to that, there was some structural chiropractic work that I wanted to do with my wife. While the OB agreed, she clearly didn’t understand the purpose or even the goal. For the next week my wife and I employed a rigorous structural correction plan. I addressed shifts in the bony structures and spent a lot of time working on the soft tissues as well. The goal of the structural care was focused on allowing my wife’s pelvis to achieve a normal position which would remove a secondary condition known as intrauterine constraint, and allow our son to achieve the normal position for delivery. At our follow-up appointment ultrasound confirmed that our son was no longer breech, and could be delivered without a cesarean section, which for us was terrific news.

Now let me make a few quick, but essential, points here. First, I did not, do not, will not ever treat to turn a breech baby. There is a medical maneuver for that called an External Cephalic Version (ECV). It is where a medical doctor attempts to turn the baby manually into a head down position.(1) The goal of structural care is to create normal structure which facilitates normal function. Second, I am in no way criticizing or disparaging any woman who has had, or will have, a cesarean section. The procedure can be a life saving intervention for the mother, for the baby, or for both. For my wife, she wanted to avoid a cesarean section if possible and was happy to be able to do that.

So now that you have our backstory, let me dive further into why structural chiropractic care during pregnancy is so effective.

Ultimately the main reason we chose to utilize structural chiropractic care for my wife’s scenario is that the Webster Technique has been shown to be much more successful than ECV. With structural chiropractic care demonstrating an 82% effective rate in research (2) and ECV showing less than a 56% success rate in 2016 according to statistics from the CDC. Additionally, there are some drawbacks to ECV which made my wife uncomfortable. While the risk associated with ECV is small, 1 in 286 results in the need for emergency delivery, typically via cesarean section. Other complications such as cord prolapse, vaginal bleeding, and water breaking are infrequent, but associated with the maneuver. (3)

Using structural care during pregnancy is not just for a breech presentation of the baby either. Common complaints like low back pain and sciatica are also associated with the structural shifts that naturally occur during pregnancy. The mechanism of structural shifts is pretty simple. In basic terms the fetus grows in the woman’s uterus it expands, which in turn pushes and strains everything in that area. These shifts result in changes to normal movements – think of things like the late pregnancy “waddle”. All of this is occurring while the woman is carrying the additional weight of pregnancy. This is why structural focused care during pregnancy can be so helpful – it helps to compensate for the inevitable changes of pregnancy. Research also supports that chiropractic care is very safe during pregnancy. (4) In fact evidence exists which shows that getting manipulative therapy during pregnancy is associated with improved labor and delivery outcomes. (5) This indicates that structural care can be beneficial during pregnancy even without a secondary complaint.

At Align Chiropractic, we have specialized equipment to help pregnant women – tables with drop away abdominal pieces, tables that raise and lower to make getting on and off the table easier, gentle adjusting equipment for women that do not want or cannot physically handle manual adjustments, soft tissue tools used to address tight ligaments and muscles. If you have questions, I would be happy to sit down and have a consultation with you. As always, at our office a consultation is a conversation, not a commitment.

1. https://www.acog.org/Patients/FAQs/If-Your-Baby-Is-Breech

2. https://www.ncbi.nlm.nih.gov/pubmed/12183701

3. https://evidencebasedbirth.com/what-is-the-evidence-for-using-an-external-cephalic-version-to-turn-a-breech-baby/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647084/

5. King H.H., Tettambel M.A., Lockwood M.D., Johnson K.H., Arsenault D.A., Quist R. Osteopathic manipulative treatment in prenatal care: a retrospective case control design study. J Am Osteopath Assoc. 2003;103(12):577–582.

Why Structural Care for Low Back Pain?

by Dr. Willemin 0 Comments

People are continuing to experience low back pain at an incredibly high rate. Current statistics show that 8 out of 10 Americans will experience low back pain at some point. (1) If that weren’t bad enough, low back pain doesn’t seem to really have a preference regarding who it affects. The CDC reports that of people who have experienced low back pain in the past three months there is less than a 4% difference between males and females. A common misconception is that low back pain is a problem that develops as we get older, but 1 in 5 people aged 18-24 reported having low back pain. (2) So it isn’t surprising that people are looking for an answer.

So what are the options? Over-the-counter drugs? Prescription drugs? Surgery? Physical therapy? Chiropractic? Something else? Each approach has pros and cons. Let’s dive a bit deeper into each and see what might be the right choice for you.

Medication – Short term prescription pain medication demonstrated modest relief of pain, and limited improvement in disability. Long term use of opioids can actually be associated with an increase in disability. Also, most prescription medications did fare any better in relieving low back pain than simple over-the-counter ones. (3) What we can take from this is that while the medications might help for a little while, they don’t seem to provide a good long term solution. With growing concerns regarding addiction and side effects caution has to be used when treating low back pain with narcotics.

Physical Therapy and Traditional Chiropractic – A little over half (54%) of people who saw a chiropractor for their low back pain reported getting effective results. Physical therapists did similarly although slightly worse with 48% reporting their care as fairly or very effective. (1) Unfortunately that still leaves a lot of people still suffering. The initial thought might be that those patients just had more severe cases that needed surgery. Let’s take a look.

Surgery – University of California, Irvine, School of Medicine clinical professor of orthopedic surgery, Charles Rosen, M.D., was quoted saying “An enormous number of back surgeries don’t give patients long-term relief.” He even went as far as to say, “”Maybe 5 percent of patients with back pain need surgery.” Another study drew the conclusion that, “This Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor [Return To Work] status.” This conclusion came after the study showed that only 26% of people returned to work 2 years following a spinal fusion whereas 67% were able to return to work if they did not have surgery. (4)

So what’s left? Well at Align Chiropractic we feel a different approach, the structural approach, is our best chance for a positive outcome. We address the underlying structural issues that cause the cascade of events that lead to low back pain, disc herniations and/or degeneration, or symptoms down the leg. We take an in-depth analysis of the patient before us, and then address the structural shifts to create our best outcomes. Research shows that structural rehabilitation of the spine has more evidence supporting it than traditional chiropractic. (5) By incorporating treatments designed to not only improve the objective measurements of the spinal column, but also to facilitate healing and restructuring of the associated soft tissues (discs, muscles etc) we see success in much higher numbers than the reported 54%. We have invested heavily into the techniques and equipment that have been shown to have the best outcomes. We offer spinal decompression therapy, which is backed by studies showing resolution of symptoms in 86% of patients who completed decompression therapy, while improvement was shown in 92% of patients. (6). We don’t stop there. We also incorporate Class IV Laser Treatments which have been shown to improve blood flow, improve tissue healing, reduce inflammation, and ultimately reduce pain. (7)(8 )

Our goal is to restore normal structure. With normal structure your body is set up for success allowing for normal, pain-free, function.

1. https://medlineplus.gov/backpain.html

2. https://www.cdc.gov/nchs/data/hus/2014/046.pdf

3. http://www.goodhousekeeping.com/health/a18687/back-pain-surgery/

4. https://www.ncbi.nlm.nih.gov/pubmed/20736894

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1840024/

6. Gionis, Thomas MD; Groteke, Eric DC. Surgical Alternatives: Spinal Decompression. Orthopedic Technology Review. 2003; 6

7. http://www.litecure.com/medical/2014/07/2-studies-that-will-make-you-rethink-laser-therapy/

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418129/

6 Steps to Permanent Diet Changes

by Dr. Willemin 0 Comments

There is so much information about how to lose weight floating around on the internet that it is easy to get lost and confused. I recommend a very simple approach to start, which can be refined as you go, versus a drastic change that is nearly impossible to maintain. This feeds into a lot of yo-yo dieting, which actually wreaks havoc on your body. For more information regarding that, read this (Yo-Yo Dieting and Heart Risk). Rather than trying to trim down 10 pounds for the beach, instead think of some lifestyle diet changes that can easily be made permanent.

Step 1 – Figure out your current lifestyle. How much do you currently eat? How active are you currently? Take a week and record exactly what you ate and exactly how active you were. Don’t try and make any changes yet, just keep a record. You will probably be tempted during this time to start eating a little healthier, but right now you are just trying to get an honest assessment.

Step 2 – This can be combined with Step 1, or just done at the end of the first week. Now it’s time to do some calculations. You need to find out how many calories you eat per day on average and how much time you spend being active. Be diligent and as honest as possible. If you ate out, most restaurants have nutrition information available, but if you are somewhere that doesn’t provide that information, check a similar meal at another restaurant. There are websites all over to help with this. They will give you a calorie count for almost any food item, can calculate your basal metabolic rate (BMR), and calculate how many calories you burned while active. Try to be as accurate as possible.

Step 3 – Find out how much you are supposed to be eating. Weight loss, gain, and maintenance is (almost) as simple as calories eaten compared to calories burned. While there are ways to tweak this, to start I just recommend finding out how much you should be eating to maintain your ideal weight. Once you know how much you currently eat and burn, you have to ask yourself a few questions. Can you restrict your diet to only eating the amount of calories needed to maintain your ideal weight at your current activity level? Be honest, because it will help you in the long run. If you can’t then you will need to incorporate a gradual step down approach. If you can, great, you are almost ready to go – skip to Step 5.

Step 4 – Set a realistic goal of how much you can restrict your diet. If you need to be at 2000 calories per day, but you are currently eating 3000, then it’s unlikely you can make that jump directly. If you think you can only cut 100 calories, then start there. If it is 250, then make that your goal. The next step is to start eating your reduced calories. Each month re-evaluate, and reduce your calories an additional amount. Continue this process until you get to the right amount of calories for your body and lifestyle. Don’t try to cut extra calories either. If your ideal weight requires 2000 calories, stick with 2000, don’t aim for 1600. Eating less than you need for your ideal weight will lead to burnout and can have undesired health effects.

Step 5 – Adapt to your lifestyle. Now that you are conscious of what you are eating and how active you are, feel free to add in more activity to try to burn some extra calories while you are getting down to your ideal weight. Here is the trick though, don’t try to add more activity than you are ready to handle and don’t count the extra calories burned towards your nutritional lifestyle change. This way if you don’t stick with the extra spin class per week, it won’t affect your overall weight management. Also, during this phase don’t be too hard on yourself. Did you go over on calories one day? Don’t fret, go right back to your appropriate calories the next day. Be aware of how much you went over and think about how many days of normal eating it will take to cancel out those extra calories. Did you skip a workout? No problem, since you are focusing on an improved diet, the weight loss should continue regardless of gym days. Plan for events. Are you going out to eat, or have a party to attend? Try and restrict your calories earlier in the day so you can indulge. If you want to have a snack in the evening, try cutting some calories from your lunch to leave room for that. At this point in the process, you should be figuring out what works for you and what you can consistently do. Don’t avoid foods you love, even if they are bad for you, just plan for them through the rest of your daily diet. Be aware of how portions affect calorie count too. Maybe you love having juice in the morning. Keep the juice, but try drinking 4 ounces instead of 8 or 12. You might find you’re just as satisfied if you mix even less with some water. Experiment and find what works for you.

Step 6 – During this process, if you have consistently eaten the appropriate amount of calories, you will have lost weight until you hit your ideal weight. The reduced calories will assure you of it. It may have been a long process, weeks, months, even more than a year depending on where you started. The time frame isn’t important, because, as always, we focus on long term lifestyle changes, not short term improvements that are unsustainable. At this point, you probably have a pretty good idea of what portions and foods work for you. Now the goal is to ease away from having a strict calorie count each day and work towards just eating those foods in those portions regularly. Monitor yourself, if you start to creep up in your weight, then you probably aren’t being honest in what and how much you are eating.

Bonus — Remember this is a lifestyle change. This isn’t a program that you follow and complete, it ultimately should be a process that you continue to re-work and refine throughout your entire life. There is no exact approach that works for everyone, so be willing to try a number of things until you settle on what is most effective for you. Maybe you are prone to a mid morning snack, then you need to make your breakfast a little more protein heavy to keep you feeling full until lunch. Maybe if you want a nighttime snack while you unwind with your favorite TV show, you will need to trim your dinner down a little to allow for the right amount of calories. Figure out what works for you. While you are improving the amount you eat, you can start improving what you eat. As you become more calorie-aware you will start realizing how many calories some foods pack, or conversely how few calories some things pack. To get even more benefits from this process, you can start refining your diet to healthier foods and improve the quality of the food you are eating.

Warning — You might initially feel tempted to try to “maximize” your calories by eating the low calorie, low fat, fat free, or diet alternatives of foods. I highly encourage you to avoid this practice. For one, these products often use fillers that can have adverse health effects. ( See Diet Soda Intake and Metabolic Disruption) More directly relevant to this article is that these products are actually linked to long term weight gain (See Fueling The Obesity Epidemic). What I have found is that I get and stay full off of a smaller portion of the non-diet version of a food than the diet version. This helps lower my overall calorie intake throughout a day.

1. https://www.ncbi.nlm.nih.gov/pubmed/19151203: Diet Soda Intake and Metabolic Disruption

2. https://www.ncbi.nlm.nih.gov/pubmed/18535548: Fueling The Obesity Epidemic

Anterior Head Syndrome and Low Back Pain

by Dr. Willemin 0 Comments

Everything we do at Align Chiropractic has a purpose and reason. Today we want to shed some light on why we always analyze the entire spine for structural shifts, and address the shifts wherever they occur, even if some regions of the spine are pain-free.


Anterior Head Syndrome (AHS) is a growing problem in the modern world. A syndrome is classified as “a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms.” (1) AHS is a set of symptoms associated with anterior or “forward” displacement of the head relative to the rest of the spinal column. This is a common result of a structural shift in the cervical spine (the neck). While there are many aspects of this syndrome that we could explore today we are going to explore a less commonly explored aspect, which is LOW back pain.


The average head weighs between 8-12 pounds. (2) When the structure of the cervical spine is altered, and there is a reduction or reversal of the cervical lordosis (normal curve), the weight of the head gets shifted. This leads to a number of biomechanical changes in the spine. These changes actually compound dysfunction in the low back. Correction of the structural shifts which cause AHS have been shown to actually improve low back pain and lumbosacral radiculopathy (radiating leg pain). Research indicates that addressing AHS, when present, in conjunction with lumbar spine correction leads to improved outcomes.(3)


As you can see, it isn’t always just the low back that is structurally shifted, when you are suffering from low back pain. Maybe if you have unresolved low back pain, it is because you haven’t address the entire issue.

TL;DR – Having a structural neck issue can be a factor in low back pain, even if your neck is pain free.



1) https://www.google.com/search?q=definition+of+a+syndrome&ie=utf-8&oe=utf-8


2) Goldstein, Jonathan P. Goldstein Helmet Study. Biker’s Rights. May-June 2006.


3) http://www.ncbi.nlm.nih.gov/m/pubmed/25704221/?i=4&from=lumbar+lordosis+nerve+root

Arthritis and Fish Oil

by Dr. Willemin 0 Comments

TL;DR – Fish oil supplements have been shown to be effective in reducing pain from chronic arthritis.

Fish oil supplements are very popular and for good reason, but a lot of people still don’t know why. We will explore some of the better known aspects of fish oil, and touch on some of the less well established claims as well. To be clear this is not intended to be a comprehensive review of all the benefits of fish oil, but rather we will focus on why arthritis sufferers should care about fish oil.


In order to get started we need to know what exactly is arthritis. Arthritis as a term can be broken down into two parts: 1) Arthro – a prefix that simply means joint. So anywhere two bones come together, and 2) Itis – a suffix that mean inflammation. Arthritis is a major problem in the US. In fact over 8 million working age adults report restricted work abilities due to arthritis. Unfortunately, arthritis is also on the rise – the CDC predicts that by 2030 the number of adults diagnosed with arthritis will rise to 67 million people.


So, why do we even care about fish oil? The answer is long chain omega-3 fatty acids – specifically EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) help reduce inflammation – the “itis” part of arthritis. This is achieved in two major ways – by blocking inflammatory substances called cytokines and prostaglandins, and by converting into anti-inflammatory chemicals called resolvins. If we reduce the amount of inflammation in the joint we reduce the amount of pain caused by arthritis.


So why supplement, why not just eat fish? I am actually a major supporter of trying to get our appropriate nutrition from the source rather than supplementation, but I also know that most of us fail to eat a diet that fully satisfies our all of our nutritional needs. Therefore, I am also a supporter of supplements. In order to get the 2.6 grams of omega-3 fatty acids per day that have been shown to have therapeutic effects, we would need to eat between 6 oz of fish like wild caught mackerel or salmon and 2.4 pounds of fish like tilapia, crab, lobster, shrimp – keep in mind that 3 oz is a standard serving of fish. Basically, you need fish at nearly every meal to do that, and that is a lot of fish to have everyday. Most people aren’t going to do that. A word of warning though – not all supplements are created equally. Higher quality supplements which have at least 30% EPA and DHA by volume and utilize better processing are more effective than other lower quality (and unfortunately lower priced) supplements.


But wait I heard… Like I mentioned at the beginning there is a lot of information out there, and some recent studies have shown some possible negative effects of elevated EPA/DHA levels in the blood. At this point more research needs to be conducted. The current studies have limited use because they did not do a great job of eliminating confounding factors (other reasons people might have had the negative effect). This among a few other problems with the studies leave us with our best science showing that fish oils benefits are real and the risk nearly non-existent. The most common side effect of fish oil is fishy tasting burps.


The bottom line. Research indicates that fish oil can actually replace the use of non-steroidal anti-inflammatory drugs (things like acetaminophen and ibuprofen) for chronic arthritis pain suffers.

Back to Basics – A Better Approach to Exercise

by Dr. Willemin 0 Comments

TL;DR – A basic exercise program (BEP) is a better way to get into (or back into) exercise, while short term high intensity programs (STHIPs) are better suited as a way to change up an already consistent exercise routine.


As with many of us, athletics are where I learned how to exercise, learned how to set fitness goals, and how to achieve them. My high school football team had a weightlifting program with attendance and performance goals. At the end of each summer we were able to determine if we had met our goals heading into the season. When I transitioned from high school to college, I no longer had these clear cut goals for exercise. My experience was that without the organization of a sport I was constantly falling short of the new goals I tried to set. If I did manage to reach a goal, I would then be thrown off track while deciding on a new goal.


As I’ve grown through my own health and wellness journey, I realized that I needed to totally re-orient my approach to exercise if I ever wanted to make it a truly consistent life-long pursuit. I learned that for most people the worst way to get back into exercise is with what I call a Short Term-High Intensity Program, or STHIP. These are programs like a 90 day fitness regime or 21 days to get shredded, or whatever other plan you’ve heard about. Now, before I delve any further into this topic, I can already hear the rants, “Well I did the 30 Day Furious Fat-Blaster 9000 and I lost 60 pounds, and now I work out every day!” If it worked for you, that is great! For most people that didn’t happen. If it did, there wouldn’t be a new program, a new piece of home exercise equipment, or a new diet coming out seemingly daily. I’m going to take a bit and examine the pitfalls of STHIPs, and why I strongly recommend NOT using them to get back into exercise.


Pitfall #1 – Most people don’t follow the program all the way through.

Pitfall #2 – These types of programs increase the risk of injury.

Pitfall #3 – These types of programs cause significant muscle soreness

Pitfall #4 – These types of programs have a designated stopping point.


To go from couch potato to gym hero, regardless of the time frame, is a challenging task. People who are typically drawn to STHIPs do not already have the habit of exercise. Using a STHIP allows people to convince themselves that in a limited time frame they can achieve their desired physical results, while ignoring the need for ongoing exercise. For sustained results we need to have integrated exercise into our NORMAL routine. With an STHIP, we are setting aside a short time frame to be ABNORMAL, so when life gets busy (which it always does), exercise is going to be the first thing we drop. Also, if we have been lax on performing vigorous exercise for months, or even years, we won’t have the strength, flexibility, or joint stability to perform intense exercise without a significant risk for injury. Injuries not only delay our short term goals, but they also lead to misconceptions about what exercises are safe to perform. This leads can have life-long ramifications. Even without major injury, STHIPs cause a LOT of muscle soreness. The type of soreness that interferes with daily life activities, like getting out of bed!



Even completing the program creates a problem – a designated stopping point. You then have to decide whether to re-do the same program again (boring), spend time looking for a new program (a new period of inactivity), or the worst yet, be satisfied with your accomplishment and go back to doing nothing The common theme between all of these pitfalls is they all MOTIVATE YOU TO STOP EXERCISING. Rather than using a STHIP which will likely end up demoralizing you, and reinforcing the idea of NOT exercising; I would prefer that when starting to exercise we shift our focus away from short term goals and towards a long term goal of health and fitness.


I personally think that the best way to motivate someone to become consistent with exercise over a lifetime is to create a Basic Exercise Program, or BEP. A BEP is a program which focuses on functional movement and strength – exercises like deep squats, lunges, planks, pushups, dips, dead lift, and/or pull-ups. I’m not actually too picky on what exact exercises you decide are right for your BEP, but it is important that the exercises work a variety of muscles throughout the entire body, especially core muscles, and utilize functional movement. The better your BEP, the easier all your other fitness goals will be to achieve. At this point I’m going to plug a program that I think is a great way to get into weight lifting and is a solid version of a BEP and that is StrongLifts 5×5. The website gives a great explanation of the program and even offers a free app for your mobile device to help get you started and keep you on track. I use this program as my BEP, and when I start to get bored, I will switch out and do a new program. Once my alternate program ends though, I know that I can jump right back into my BEP to keep consistently going to the gym. Having a BEP provides 3 major benefits.


1) You can build SLOWLY. When I am going through a structural correction with a patient we incorporate a VERY gradual exercise program to make sure that we achieve joint stability and avoid re-injury. You will also develop better form and maximize your exercise benefit this way.

2) A BEP will allow you to always have a workout ready to go. A BEP is composed of exercises that can be easily modified based on the time and equipment you have available. Even if it means doing body weight squats and push ups in a hotel room while traveling for work. This eliminates a commonly used excuse for not working out.

3) The biggest benefit though is, there is no set stopping point. With a focus on gaining functional strength and increased mobility through a BEP, you gain a long term goal of health and wellness. Health is not something we can achieve and then move on to the next thing. We have to consistently work to maintain our health.


Once you have used a BEP to gain some muscle strength, flexibility, and joint stability, then STHIPs become a great way to mix things up. You will have the lifestyle and physical ability to avoid the pitfalls, and the variety will keep it from being boring. Another great way to get variety in your exercise routine is by doing a physical activity that you simply enjoy. Love golf? Skip the cart and you just got a great low impact cardiovascular workout in by walking the course. If you don’t know what you would enjoy, join a slow pitch softball league, or take a tennis lesson. Your BEP will help you engage in these activities more successfully, and if you find you don’t love them, you can move onto the next idea. Sometimes they provide motivation to push yourself a bit harder in your normal exercise regimen because you want to improve your skills. Asking a friend to join you on your fitness journey is another great way to get, and stay, motivated while making exercise more fun.


In sum, having a BEP, is safer and easier when trying to form the habit of exercise. You will be able to achieve a level of fitness where challenging yourself with a STHIP is safe and fun versus demoralizing. Incorporating fun physical activities will also help you achieve the long term goal of being happier and healthier for life.