Course Correction for a Healthier Year
LIFESTYLE
By Kevin M. Wong, DC
If your patients are like most people, their New Year’s Resolutions included goals to live healthier. How are their plans coming along? According to a 2016 study, of the 41% of Americans who make New Year’s resolutions, only 9% feel they were successful in keeping them by the end of the year. An earlier study in 2007 showed that only 12% of people who set resolutions are successful, even though 52% of the participants were confident of success at the beginning1. Within the first months of a new year, most people have abandoned their plans. The reasons cited for failing include the goals needing to be more realistic; forgetting about making the resolutions; and having too many resolutions to follow.
As chiropractors, we tend to be sources of motivation for our patients. We want to help them feel better and achieve optimal health. We are part of the healthcare movement that encourages patients to get and stay active. This puts us in a unique position to support our patients’ health resolutions throughout the year and help them course-correct to get back on track.
In an effort to encourage and nurture those goals, I look to stack the deck in our favor. Let’s look at some of the aspects of their daily lives that are easily identified and modified. These will help set the stage for larger accomplishments that can come sequentially with time. This is your opportunity to be your patient’s supportive partner in proactive health and key ally in meeting their wellness goals.
We can begin by analyzing some specific activities of daily living (ADLs) that create stress on their bodies of which they may not be aware. Interestingly enough, many healthcare practitioners from whom our patients seek care will fail to identify and analyze ADLs effectively. These stresses confound your chiropractic treatment plan and destabilize the patient’s body. Such stresses also negatively affect the spinal/extremity adjustments, exercises, and home care you are so carefully providing.
Sitting/Standing Ergonomics:
Sitting is the new smoking. It’s an age-old enemy of the body that is a necessary evil to some degree. Many jobs and ADLs demand we sit down. I always encourage people to limit the amount of sitting to 30to 45-minute increments so they can get up and move around. However, when an average person gets engrossed in what they are doing, has a meeting, or is under a deadline, they forget to stand up. It’s not uncommon for patients to indicate many hours will go by before they stand up.
Many of you have suggested your patients get a standup desk. Often these desks come with the ability to be low for sitting and then convert to a higher level for standing. This encourages and allows the patient to mix standing with sitting, easing the stress on their bodies.
Please help teach your patients to make good choices when they do sit. Have them use the right kind of chair. A fully adjustable chair (armrests, seat height/tilt, etc.) for their desk would be preferable. For casual settings, ask patients to avoid the sofa or couch. Most of these furniture pieces are unsupportive and put the pelvis, hips, and lower to middle back under mechanical stress. Even a dining room chair or the floor can be better choices to sit on than a softer surface.
By the same token, we don’t want someone standing all day. That is too much pressure on the body over time, even with a great pair of custom, flexible orthotics beneath their feet. I encourage one-hour blocks of sitting and standing when someone has a convertible desk.
Sleeping:
It may not surprise you to learn that 54.1% of people sleep on their side (fetal position), 37.5% sleep on their back and 8.4% sleep on their stomach2. Sleeping position significantly affects our bodies and how well adjustments are supported or thwarted. Sleeping on the back puts the least amount of stress on the body. Side sleeping puts strain on the TMJ, neck, shoulders, ribs, hips, and knees. Sleeping on the stomach is rough because the person tends to turn their head to the same side every night in order to breathe, and it strains on the lumbosacral spine.
It can be very difficult to take someone from sleeping on their side to their back. Try your best to convert them. It is so much healthier for them to sleep on their back. The problem is people who snore. Snoring is amplified on their back, which is why so many sleep on their side. If they have to sleep on their side, then it’s time to talk about the pillow.
Pillows are one of the most important things I discuss with a patient who has headaches or neck, upper back, or shoulder pain. Many pillows are garbage, and patients don’t know how to look for a good pillow because no one taught them. They are susceptible to marketing from these companies, and they are all easy pickings. As a chiropractor, you are an expert in alignment and posture, so have your patients bring in their pillow for you to assess.
With the patient lying on their pillow on my massage table, I can see exactly how the pillow supports them. An appropriate pillow for the patient will cradle their neck in neutral while on their back and keep their shoulders and cervical spine at a right angle (90 degrees) while on their side.
Exercising:
What I am really after in this section is identifying if your patient is engaging in the proper exercises. Often, we find patients performing exercises, sports, or activities at unhealthy levels because they think it is how they will get the best benefits and results. Some patients force themselves to keep doing certain activities even past the point of pain.
When it comes to exercising or getting back to being active as they get out of pain, I ask patients what activity they would love to do first. I know that if the patient enjoys that activity, they will have greater success following through with it. Whether it is yoga, swimming, walking/jogging, or pickleball, it is purely patient-specific. We will start with that activity whenever possible and get the patient excited and motivated. Keep in mind that I also want to make sure that the activity is appropriate and safe for their condition.
As a chiropractor, you are well versed in how you want them to start and advance with the activity. If someone is coming off of a bout of lower back pain, then going right back to running 10 miles at a stretch is not safe. Have them build up their walking before running or modify activities to get them where they want to be.
Obviously, if you can make their exercising and activities fun, the likelihood of them continuing and making it habitual is higher. If you feel they need stretching and strengthening, make it fun for them whenever possible. If you tailor the exercises to that patient’s motivation, they are less likely to make up excuses for not doing it.
Wearing Proper Foot Support:
Please take the time to check the various shoes your patients wear. I am not saying you have to examine 30 pairs of shoes on the next visit but ask the patient to bring in one or two pairs of athletic shoes and dress shoes (if they even wear dress shoes). Many people just wear athletic shoes now since they work from home, so that is even easier for you.
There are really no shoes made in any category that have proper, three-arch support. If you look into the shoe and remove the insole (if possible), you will see it’s essentially a flat pad. Your patients are pronating and supinating excessively inside their shoes. It’s up to you to look at this and show them they need to have better arch support that you can provide.
Flexible, custom, three-arch orthotics are critical in keeping the patient’s overall foundation stable. By including these for patients as part of their activity program and long-term goals, it will help their overall health and your practice.
Remember when we talked about shifting patients to a standing workstation earlier? Don’t forget to remind the patient to wear their custom orthotics in any shoes they wear. This is really more of an issue when people are working from home because they are often barefoot, in socks, or wearing slippers.
Patients are excessively pronating while standing inside their houses as much as they are when they are out in the world. So put those orthotics in their slippers or a clean pair of house shoes. It is equally important for people who cook, clean, or do any weight-bearing activities in their house. No more unsupported feet inside your house!
This is also a great time for you to check the state of their orthotics and examine or reexamine the athletic and dress shoes they wear most often. Orthotics wear out for patients in different timelines. Some patients are so hard on their orthotics that they need to be replaced after one year. Remember, patients will not get the maximum benefit from orthotics that are worn out or damaged. Is it time for a reorder or new scan?
Some patients cram the orthotics into the wrong shoes, which affects how long the orthotics will last. Be sure to encourage patients to get the right custom orthotics for all their activities for the best outcomes. Round-the-clock alignment supports chiropractic care and makes them feel their best. Patients also often wear shoes for too long. A worn-out shoe will reduce the effectiveness of the orthotic for the patient. Aside from using your eyes to identify shoe wear and tear, you can do a standing muscle test using the patient’s arms or a squat test with the patient wearing the orthotics/shoes. It might just be time to throw out those old shoes and replace them with new, more supportive ones.
Examining these various ADLs for our patients will provide tangible action steps to take that will enhance their overall health. Making the appropriate changes sets the foundation for other health goals. As chiropractors, we can help our patients become more active and healthier throughout the year. Our work will enable them to formulate goals and resolutions that will be achievable and attainable, empowering them to be proactive about their health.
Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA. As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting.
References:
1. https://discoverhappyhabits.co...
2. https://www.ncbi.nlm.nih.gov/p...
