Movement is Medicine

 

Conventional wisdom in the past has been that all joints "wear out" at some point, so you probably shouldn't use them too much.  For example, I have had numerous patients tell me that their primary care physician has told them to stop running due to their knee arthritis. This is actually the opposite of what most recent research has shown.  We are now finding that sedentary joints become worse due to atrophy (disuse).  This is because the movement of the joint actually nourishes it.

The joints in the spinal column, hips and knees are synovial joints. The bones of a synovial joint are surrounded by a synovial capsule, which secretes synovial fluid to lubricate and nourish the joint while acting as a shock absorber. The ends of the joint bones are covered with smooth, glass-like hyaline cartilage which reduces friction during movement. So moving them is the best way to keep them nourished. 

In fact, in a 2018 study of marathon runners, LESS knee and hip arthritis was found in the runners when compared to the general population. ( The Journal of Bone and Joint Surgery: January 17, 2018 - Volume 100 - Issue 2 - p 131-137doi: 10.2106/JBJS.16.01071)

Not everyone needs to be a marathon runner.  But I believe that if someone wants to run for exercise, they should be able to. You may be asking yourself, "If moving the joint makes it healthier, why does it hurt when I move it?"  I would respond with "How can you be sure it's the joint that hurts?"  With literally dozens of muscle tendons, nerves and other soft tissues involved with a knee joint, how can you be sure it is "in the joint?"  The short answer is - you can't.  But now that we know it may not be the joint, it helps us get a bit closer to the truth.

Conveyor Belt Chiropractic

One thing I cannot understand is why any patient would continue to go to a chiropractor, or any clinician, who does not take the time to listen to you, the patient.  Or if that chiropractor does not modify the treatment plan when progress is not being made.  It has become apparent to me that some patients are impressed with the size and décor of these new chiropractic clinics. They conclude that the chiropractor must be good if the clinic is big and fancy.  But about once per week I get a new patient in my clinic because their previous chiropractor did not listen.  No time to talk, just adjustment, and out the door you go. Or maybe they did not take the time to address new problems. Or to make any significant improvement on the patient’s condition. It seems that some of the biggest, most impressive clinics are often made from an automation of the treatment process, not necessarily from patients’ success.  One patient described it as feeling like she was on a conveyor belt. “One size fits all and everyone gets the exact same treatment”.

There is no law to say that such a clinic is doing anything wrong.  But to keep doing the same thing (same adjustment, same, frequency, no exercises) and expect different results is the very definition of insanity.  Even some clinics that do prescribe exercises may be giving the exact same exercises for everyone.  "OK Mr. Smith, her is 'our exercise program'. Let us know if you have any questions."  And then you are on your own to try to make sense of them. Is it likely that everyone has the same condition for the same reasons, requiring the same exercises? Was there any protocol to see if those exercises were actually needed? You feel as if you are on and off the conveyor belt before you are even able to ask any relevant questions. 

Ultimately I feel as though finding the path to success is often like a recipe.  My first chiropractic treatment is equivalent to the first time I make the dish. And how the patient feels when they come back tells me how tasty the dish was.  Sometimes the recipe is perfect and patient feels great after one visit.  But oftentimes the patient feels about the same, or is somewhat unsure of any progress after one treatment. Then it's time to tweak that recipe. Maybe it's missing an ingredient like a stretching exercise for a tight muscle? Or maybe manual therapy or massage therapy should be added to boost the overall flavor? Or maybe we need to review the patient's computer workstation ergonomics for a little extra spice.

How a new chiropractic patient feels on their first visit should not dictate the treatment forever.  Ongoing reassessment is essential.  Listening to the patient is just as much a science and an art as is the chiropractic treatment.  People skills are as important as adjusting skills.  And improving patient outcomes is more important than having the biggest and fanciest clinic in town. 

So the question is...is it time you got off the conveyor belt? 

Pound pressure : painful weight

I sometimes get patients who believe that their painful conditions are brought on, at least partly, by their excessive bodyweight. They are not wrong, but what I sense is that many of these patients are frustrated. They are frustrated because they are aware that their excessive bodyweight is a factor in their pain, yet they have put their overall health on the proverbial back-burner. Life has a way of making us feel overloaded to the point where don’t feel like we have the time or effort to improve our own health. Yet if we don’t, our ability to get through each day diminishes due to pain and fatigue. 

So when patients ask me specific questions on diet, I am happy to give them the best information I have. While I am not a dietician, it seems to me that most people need to focus on eating real food, and less processed foods. Yes, quantity is often part of the problem, but I doubt that any of my patients are overweight because they eat too much raw broccoli. Plus, avoiding processed foods leads to less overall inflammation in your body, which can improve both pain levels and mobility. Studies confirm that when we overeat, it is usually on easily digested highly processed foods. So while caloric restriction, or fat reduction, or carbohydrate elimination may each work for some people, focusing more on the wonderful REAL foods that you can eat, is a much more positive approach. 

Overall, I feel that sometimes too much emphasis is put on the number that pops up when we step on the scale. Healthy people come in many shapes and sizes. Bodyweight is one measurement of health, but is it really the most important? If all your blood tests and biometrics like blood pressure and heart rate are within normal limits, what does it really mean? After all, I myself have been technically clinically obese most of my adult life. At 5’9” and over 205 lbs., I have completed a marathon, a sprint triathlon, and a cyclocross race. Currently I am also doing cross country skiing, and indoor rock climbing. I passed my last medical checkup with flying colors.  Some would say its probably muscle, and not fat, but the clinical guidelines for bodyweight don't take that into consideration.

So what is the secret to my success? Don’t stop moving! And don’t stop trying new activities. That being said, if you have not exercised for years, don’t assume that you can pick up where you left off. If the last time you ran for exercise was in college, you will be in for a rude awakening if you try to match your performance from decades ago.  What is the best type of exercise you ask? It’s the one you will do the most consistently. So what is the exercise that you love the most? (Or maybe hate the least?)

Please consider developing habits based on what is healthy, rather than what will shed pounds. Given long enough, healthy habits will usually lead to weight loss.  And if you don't feel beautiful as you are right now, just remember that healthy people ARE ALWAYS beautiful. Beautiful people, just like healthy people, can come in all shapes and sizes. I have seen many people try some questionable methods to lose weight. sometimes it is obvious that their methods are truly unhealthy. Unhealthy and unsustainable weight loss will always lead to rebound weight gain.

Now, think of all the people that you love. Everyone in your life that you truly love. Do they all have “perfect bodies”? Probably not. Do you love them any less because they don’t? Probably not. If the people in your life can love you as you are, YOU CAN TOO! The first and most important step is to love yourself. Love your body. Love it enough to respect it. Love it enough to accept it the way it is right now, at this moment. That is the ONLY way ANY new healthy habits can start. 

Try this quick and easy stretch to cure your low back pain

       Sorry, there is no quick and easy stretch to cure your back pain. 

(Stop falling for click-bait!)  

      Why shouldn't you believe random people on social media?

It is because there are so many possible reasons why someone might have low back pain. There is absolutely no way there could be one solution for everyone.

Here is a list of some of the more common reasons for low back pain:

-too inactive/sedentary

-poor posture

-poor sleeping position

-muscle tightness due to being in one position too long

-muscle weakness due to not finding enough variety of movement or exercise

-overuse due to work 

-overuse due to exercise training error

-overuse due to recreational sports/hobbies

-traumatic accident

-slip and fall

-previous injury to foot

-previous injury to knee

You may notice that I did not mention things like intervertebral disc herniations or sciatica.  That is because these are classifications of low back pain, and not reasons.  One could have an L5 disc herniation due to being too sedentary, or due to overuse lifting/bending, or due to traumatic accident, or all of the above. If you have seen your physician about your low back pain, and have only been told a diagnosis, but not a reason, it might be time for a second opinion.

And stop falling for "quick and easy" solutions.  Find out why you hurt. (616) 301-3000.

What is your 2022 Fitness Plan?

Tis the season!

 Yes it is certainly the season for holiday celebrations, overeating, and family gatherings.  But it is also the season to plan for the next season -  New year's resolutions!

"So...what kind of exercise routine can you see yourself doing next year?"

I find that it helps if I put a seed in the patient's head. So that when the new year comes, they will already have a plan, and only need to execute.  If you fail to plan, then you plan to fail!

I don't expect everyone will do it. But I can attest that my patients that do exercise regularly have lesser pain overall once they get into a regular routine.  

I also don't expect that everyone will have access to a gym or health club.  But maybe that's not necessary. Some people love the outdoors in winter.  Maybe cross country skiing? Winter bicycling? Snow shoeing?  If you don't like the cold, there are still indoor malls you can walk. Most folks below the age of 60 should have loftier goals than just walking, but it can be a good part of a combination of exercises.  And starting with something small is way better than nothing at all.

Home gyms, treadmills, and spin bikes can all help to reduce the time needed to travel to a gym. But joining a new gym or health club really is the best way to get maximum variety if finances are not restrictive. 

There is also no shortage of exercise videos online.  Some are by subscription only, but there are plenty of good free ones.  I even posted some of my own on our Youtube page.  

https://www.youtube.com/channel/UCIc9cdNSrfxbF9h3lWOoMRw

 

Lastly, the latest technological gadgets that monitor your steps, heart rate, etc., are really good at tracking progress.   But truthfully they are often unnecessary.  Don't put off exercise because you don't have one,  or tell yourself  you can't start because the store ran out of Fitbits.  People have been exercising for a long time before these fitness devices became available. Who knows? If you have been good this year, maybe Santa will bring you one.

Cuboid Syndrome : pain on the outside part of the foot

What is cuboid syndrome?

Symptoms: Pain on the lateral (outside) part of the foot.  There is often no associated accident or injury to this area, though sometimes twisting one's ankle can exacerbate it.  Often it develops slowly and for no apparent reason.  It will usually feel worse when standing on the affected foot. Walking is also usually painful.  Wearing shoes that are tight around the forefoot can become unpleasant. 

Cause: It is theorized that the syndrome occurs when the foot pronates excessively, causing a misalignment of the cuboid bone.  Personal experience suggests that this is partly true. My most observation is that most commonly the affected side is the foot that is too far midline.  People rarely stand perfectly symmetrical.  Usually one foot is more medial. Or to say it another way, is that the foot is more underneath you. This usually results in excessive pronation, as well as more forces being absorbed by the affected foot in standing, walking and running.  Athletic activity increases one's chances of  getting cuboid syndrome. 

Diagnosis: Examination may reveal some swelling.  Cuboid pain and tenderness to palpation is typical. X-rays will often show nothing, as alignment is not always discernable.  Absence of fracture is a good indication. Whereas misalignment is the primary pain mechanism, radiological imaging is not often necessary for diagnosis. Considering the cost of soft tissue imaging techniques like MRI and CT scans, it makes more sense to attempt therapy before even considering these expensive options. 

Treatment: manual manipulation is extremely effective when performed by a skilled professional. Multiple treatments is usually necessary.  Total number of treatments is dependent upon how long the patient has had cuboid syndrome. 

Dr. Schafer's note:  As I previously stated, cuboid syndrome is usually due to asymmetrical stance and gait. When one foot is more medial (midline), not only is the foot misaligned, but so is the knee, hip, pelvis and spine.  Long term success depends on re-alignment of the whole system.  Chiropractic manual adjustments techniques are extremely helpful, as well as core exercises. Yes-core exercises are better than foot exercises for long term success. 

Does everyone need a chiropractor?

While on a recent vacation to Ireland, we toured the Guinness factory in Dublin.  Near the end of the tour there was lots of old Guinness advertisements, and some artwork from local artists. I found one piece of art both striking and thought provoking: "A woman needs a man like a fish needs a bicycle".  Apparently it was a phrase found in graffiti on the streets of Dublin, and a local artist liked it so much he made it into this display.  The phrase is also used in a song by the (Irish) band U2 in the song "Tryin' to throw your arms around the world". I am sure there a some women who would agree with this, and some who would disagree. But I think the main point is that for some fish, uhm, I mean women, this is certainly true. There is no universal truth one way or the other. 

This made me wonder.  Does everyone need a chiropractor? Is it a universal truth that everyone needs to be adjusted on a scheduled basis all of the time?  I know there are plenty of chiropractors that will respond with an emphatic "yes!" But to say that (as a universal truth) would ignore the millions of people who have never been to a chiropractor, and seem to be in good health regardless. This does NOT MEAN NO ONE needs a chiropractor.  I have seen too many patients who were treated poorly by the medical system, or have tried every physical therapy exercise known to man, or have ignored the pain for years with opioids which they can no longer take.  And without regularly scheduled adjustments, their pain would quickly overwhelm them to the point of debilitation.  Some of these patients have had significant trauma for which there is no surgical "fix".  And some of them just have a genetic predisposition for musculoskeletal pain. Many of them have jobs which keep them sedentary, and this alone is the biggest contributing factor for their painful syndromes. 

 If you have a chiropractor that keeps you out of pain, by all means, continue treatment.  If you only need to be adjusted by a chiropractor periodically, that's great! Get treated "as needed".  When a new patient walks into my clinic, my goal is to figure out why they are hurting, not to figure out how to make them a patient for life.  I am not in the business of trying to convince a fish that they need to be riding a bike. But if you ask me this fish looks she wants to. 

  

How I Cured My Plantar Fasciitis Without Doing Any Foot Exercises.

 

About 10 years ago I completed my first marathon. It was a great experience. After the race,I took some time off from training, as many people do.  A few weeks later, I felt it was time to do something again.  I did not need to do marathon distances, but I figured my body could handle 5-10 miles at a time.  After doing this distance 2-3 times a week, I noticed some pain in my right arch and heel.  This made no sense to me.  It was apparently plantar fasciitis. But...why now?

The first thing to check was my shoes.  I had the same brand and model as I did when I was in training, but new.  I had purchased another pair of the exact same shoes. So that was not the problem.

Then one day I just happened to be at a "fun run" event at a local running shoe store.  This was a good opportunity to see video of my running form. They had the high speed video camera set up right by the treadmill.  I suspected it would reveal how my foot was striking the ground the wrong way. Maybe the foot was pronating too much.  Or maybe it was turned out, or turned in too much.  

So I recorded my stride, and what I saw was completely unexpected.    Every step with the right foot was on the far right edge of the tread. Every step with the left foot was directly in the middle of the tread.  Now I know that when I was on the treadmill, I was centering myself in the middle.  I know that my head and chest were centered in relationship to the console.  And yet the video showed something different. 

Initially this made no sense. But then I realized that it wasn't HOW my foot was striking the tread, it was WHERE. The far lateral position of my foot relative to my torso was causing the plantar fasciitis. The foot needing to create movement from a less than optimal position, and so it had to work much harder to achieve it.

I then surmised that the time I had taken off from all exercise had weakened my core muscles.  While it was smart to take some time away from running, I should have continued with some sort of core training.  Because I did not, the core was too weak to keep my hips and pelvis level. When my pelvis tilted, the left foot went midline and the right foot went too far laterally. 

So I did what I should have done the first time.  As I took time off from running, I worked on strengthening my core.  And I was treated by another chiropractor to help realign my pelvis. A few weeks later, I again started running again.  No plantar fasciitis.  

So to reiterate:

 I DID NOT DO ANY FOOT EXERCISES TO CORRECT MY PLANTAR FASCIITIS! 

The best doctors and therapists know that where the pain is and where the problem is are often two different areas.  I can only imagine that if someone like me had gone to a foot and ankle specialist or podiatrist, they would have never found the true cause of my condition.  If the clinician never looks past the area of pain, it is impossible to see the big picture.  I am sure some foot and ankle stretches would have helped, but I am also certain  that I would have never recovered so quickly without looking to the core. 

If you are interested in some examples of core exercises click here for a link to my Youtube page.  Everyone needs to work their core muscles. Call us for an appointment if you are interested in starting a new core routine. (616) 301-3000.

Heavy Breathing for Injury Prevention?

Most people don’t get hurt from a lack of core strength. They do get hurt from a lack of core coordination.

What is core coordination, you ask? 

Core coordination is when muscles fire in the right patterns with the right timing so as to stabilize the torso and spine. This is because MUSCLES NEVER WORK IN ISOLATION.  Muscles always work together in integrated systems. When systems fail, the dysfunction creates pain through overuse of certain muscles. But these patterns also need to coordinate with your breathing.

Why, you ask?

Well, breathing is kinda necessary.  And just about ALL of the core muscles ARE ALSO muscles involved with active breathing.  That is to say breathing when NOT at rest.  Look up "accessory muscles of respiration", and you will see what I mean.

According to Physiopedia, "The accessory expiratory muscles are the abdominal muscles: rectus abdominis, external oblique, internal oblique, and transversus abdominis."

So forcefully breathing out turns out to be a great way to activate all of the major core muscles.

Also, the accessory muscles to inspiration (aka inhalation) are:

sternocledomastoid, scalenes,  serratus anterior, pectoralis major and pectoralis minor, trapezius, latissimus dorsi, erector spinae, iliocostalis, quadratus lumborum, serratus posterior superior, serratus posterior inferior, levatores costarum, transversus thoracis, and subclavius.

So are all of these muscles "core"?

That really depends on your definition of core. Various sources will cite many different muscles as being part of the core.  There is much grey area here. My opinion is that a core muscle is any muscle that takes part in stabilizing the spine in one of the six major planes of motion. To be clear, there are two planes of motion for each of the planes seen here:

The case can be made that just about all of the accessory muscles of inspiration are also core muscles.

So how does one incorporate heavy breathing into their exercise routine?  The best way to do that is to exercise to exhaustion.  Not to the point of collapse, of course, but until you are "out of breath".  Just about any cardio exercise will do.  Any movement that elevates your breath rate and volume.

This would go a long way in explaining why distance runners seem to always benefit from a weekly "sprint" workout.  Core activation improves running efficiency and reduces injuries. But you don't have to be a runner to do this.  You could challenge yourself to do a "sprint" on the elliptical, or stationary bicycle, or rowing machine.  Doing this weekly is best.

Start with a mild warmup for 5-10 minutes.  Then go as fast as you can for 1 min.  Then recover and catch your breath. This may take 1-3 minutes.  Then repeat two more times.  You can start with 3 one minute "sprints" and work your way up to as many as you want.  Just keep in mind that if can do this for more than 8 sprints you are probably not going as fast as you can. Keeping up that intensity for many repetitions is just not possible.

Whereas this is certainly an intense workout, it does not take very long.  I recommend incorporating stretches to be done afterward.  The increased intensity may otherwise create soreness in muscles that you never knew you had.

Top 3 Exercises to Avoid at the Gym. Part 3: Preacher Curl

   There have been a few documented cases of biceps muscle rupture while doing the "preacher curl", but that is not the only reason I think it is a poor exercise. As a general rule, one should not "isolate" a specific muscle to develop it. In reality, muscles never work in isolation, so why train them that way? As someone who has been a regular at various gyms and health clubs for 30 years, I have seen one thing to be consistent. In every new gym I go to, there is always the one guy who sits at the preacher curl bench for way too long, doing way too many reps and sets. It has been no surprise to me to see that usually, this person has a scar on one or both shoulders. The scar is usually from a shoulder surgery. As a general rule, I know that getting accurate medical history from a guy in a gym is not likely, so I rarely ask questions about it. But it never surprised me. 

   The whole purpose of putting the arms on such a device is to "stabilize" the elbow joint. But in "stabilizing" the elbow joint, we can expect that the shoulder and back muscles, which usually aid in such stabilization under normal circumstances, will be inactive. This is the perfect example of someone whose main purpose of going to the gym is for visual appearance. Excessive emphasis on the muscles most commonly desired such as chest (pectoralis major), arms (biceps brachii) and stomach (abdominus rectus) is the hallmark of someone more interested in muscular development for the sake of muscular development.  They are not really interested in overall health, strength, or athletic capabilities. 

   Integrating all of these muscles together will help protect one from injury. Only without injury, and with muscular balance, can someone achieve optimal physical capabilities. Isolation for the sake of visual muscle appearance will eventually lead to injury. If you are looking for a replacement exercise, try literally any other biceps exercise, where the elbow is not stabilized on a pad, bench or your knee.

Top 3 Exercises to Avoid at the Gym. Part 2: Lateral Deltoid Raise

The lateral deltoid raise has been around since the beginning of weight training. Which is one of the reasons I don't recommend it. Weight training has its roots in bodybuilding and strongman circus shows. Some of the exercises that come from this era are focused on muscular development for the sake of muscular development. As such the premise is to "isolate" a specific muscle. In terms of function, however, it needs to be stated that MUSCLES NEVER WORK IN ISOLATION.

The above picture, taken from Fitnesstogether.com, shows the exercise performed to 90 degrees, as it is usually performed in the gym. If you are confused, think of this exercise relative to how your shoulder functions. The shoulder joint has the greatest range of motion of any joint in the human body. Given that most of our musculoskeletal aches and pains stem from a lack of movement and inactivity, wouldn't it make sense to use our joints to the greatest degree possible without strain? The rationale for stoppping at shoulder height is based on how much the deltoid muscle is being activated as the weight is lifted. Past 90 degrees, the deltoid muscle activation starts to derease and the trapezius muscle activation starts to increase. But as I stated earler, muscles never work in isolation in real life movements and activities. So why in the world would you train it to? And why not train the trapezius AND the deltoid with one exercise?

To be clear, I am recommending to go all the way up with this exercise, as seen in this photo taken from Muscle and Fitness website. I have no research to point to that suggests that this exercise performed to 90 degrees leads to shoulder injury. But I have seen numerous patients who have had shoulder problems, AND they are currently doing this exercise to 90 degrees, AND they don't want to stop wieght training. In every case, getting the patient to go to a full range of motion lateral raise, with lighter weights, has helped.

Top 3 exercises to avoid at the gym : Part 1

Are you heading back to the gym after a long layoff? You are in good company. It's time to turn our Covid bods into beach bods. Which makes this a good time to review Dr. Schafer's list of most common gym exercises to avoid. Let's dive right in. #1 Seated leg press

To be clear, I am not saying that everyone who goes near this machine will wreck their back permanently. But I have observed it to be a major factor in people who like to weight train, but have periodic problems with their back. It seems like a safe exercise because you are seated. But that is exactly what is wrong with it. This exercise tries to replicate a squatting motion without having the person stand. If you turn the image 45 degrees clockwise and imagine the person has her feet on the floor, you start to get the idea of the problem.

To be lifting any weight withe the spine is this position is less than ideal. This obviously does not resemble a squat. The person invariably rounds their low back in order to perform the lift. This changes the curvature of the lumbar spine to a more flexed position, which is commonly associated with intervertebral disc injury. Also, in this position, the low back muscles are stretched out. They remain in this position during the entire motion. Muscles are known to be stronger when they get shorter. To have them lengthened throughout this movement sets them up for fatigue and failure. Skip this one and do some dumbell deadlifts instead. Stay with lighter weights if you are concerned about straining your back. To be continued....

Top 5 Things To Avoid When Stretching

To say that I often get asked about stretches is an understatement. About half of my patients are already stretching, and they want more. But should they be? Do they need more? Here are the most common things to avoid.

1. DON'T stretch a muscle that doesn't need stretching. How do you know if it needs stretching? In reality, it takes a trained eye. The best method is to find out which, if any, muscles are shortened. Is the range of motion in the associated joint less than what it should be? Is it less than the other side? If you have a muscle that is overused, it may feel tight. But daily stretching of a chronically overused muscle does not solve the problem. Its best to figure out why its overused, and to try to change your behaviors in some way to allow it to heal. 2. DON'T assume that if a muscle feels tight or taught, it should be stretched. Just because a muscle FEELS tight, does not automatically mean that it is SHORT. You also need to compare this to the overall genetics of the person. Are they flexible overall? Is there right hamstring worse than their left? What about compared to hp flexors? There is a wide range of normal for how flexible someone is overall. Not everyone needs to stretch everything all of the time. 3. DON'T hold your breath while stretching. I don't have much research to back this up. But I do have personal and professional observation. In my observations, stretching never seems to improve muscle length if the person is holding their breath. I suspect it is because when you hold your breath, you are telling your body "this is an extreme position, don't bother getting used to it". By breathing through the entire stretch, you are signalling to your body that the new muscle length position is OK, and it will not cause harm. 4. DON'T stretch a muscle 10 times a day or more. I see this mostly with patients with neck an upper back pain. Especially if the pain is one sided. The patient is stretching their neck to one side only numerous times a day, in an effort to stretch an overused, but not shortened, muscle. This patient usually asks for more stretches. But more stretching will not solve the problem that is causing their pain. 5. DON'T bounce. This was a thing. I think in the 1970's it was common. I see it rarely, but It still concerns me when I do see it. Technically it's called ballistic stretching and their is research to suggest it increased your chancs for straining the muscle. I don't think you want that. www.schaferchiropractic.com

What does it mean if I have one leg longer than the other?

A recent visit to my local seamstress got me thinking about leg length difference. She seemed (no pun intended) surprised when I objected to her measuring each leg individually, and cutting the pant lengths according to those measurements. I think there is a large misunderstanding about leg length difference. What does it really mean?

"Oh, and I have one leg longer than the other." is something I have been told many times by new patients. They are all eager to relay to me what previous chiropractors have told them, and most of this information IS helpful. Yet I sense that many of them don't really grasp what it means, because they appear surprised when I explain it.

"Unequal leg length is usually an indicator that the pelvis is tilted or twisted, and an adjustment is needed to make them equal" is my usual explanation. I have seen some chiropractors and physical therapists try to account for the leg length discrepancy by giving the patient a heel lift. This is usually a bad idea, as it is only perpetuating the misalignment.

However, there is occasionally a patient who actually has one leg longer than the other. I have seen this only twice in my 20 year career. Both times the person had a fracture of one of the long bones in the leg. One patient had fractured the femur during childhood, effectively halting the growth in that leg. The other one had shattered both the tibia and the fibula (lower leg bones) in an auto accident, and the surgeon was unsuccessful in recreating the pre-accident leg length.

There are conflicting opinions on how to measure leg length. Some involve a tape measure. Some involve a full lower body x-ray. My method is a bit more simple. If I can't get the legs to even out by spinal, pelvic, and limb adjustment, then there is a good chance they are just different lengths. But like I said, I have seen this only twice in twenty years.

Before adjustment:

After adjustment:

Misalignment of the pelvis truly is common, and is often due to:
-Sleeping on your stomach (This torques the torso considerably, because you need to do so in order to breathe.)
-Sitting with one foot tucked under your pelvis (see photo)

-Always crossing one leg over the other when sitting.
-A previous injury to a leg or foot. This will often result in the person hiking up the pelvis on the side of pain, so as to not to put weight on that limb.

So the next time you are getting fitted for pants, and the seamstress says that they want to sew one pant leg longer, because they measured one leg longer than the other, tell the seamstress to split the difference. You are going to see your chiropractor.

Foot Pain AND Low Back Pain? Try this simple stretch.

Many of my patients are surprised to find out that Chiropractic care can help those with foot and ankle pain. Common problems such as plantar fasciitis, sprained ankles, and achilles tendonitis, often improve with foot adjustments and home exercises. Sometimes orthotics or inserts can help as well. Yes many chiropractors are taught adjustments for just about any joint in your body, so if you are unsure, please ask.

Whats even more surprising for some people is how their foot pain is related to their low back pain. To be clear, I am not talking about a pinched nerve in the low back creating pain in the foot. That is possible. But even more common is when systems of muscles develop a weak link.

One common example is when muscles behind the knee become short and tight. This is not the same as a tight hamstring. There is a system of muscles that starts at the bottom of the feet, then goes to the calf muscles, then to the hamstring muscles, then to the gluteal muscles, then to the low back, then upper back, then neck. Keep in mind that muscles NEVER work in isolation. They have to work in systems. So to isolate them for therapeutic purposes is counterproductive. There is often no pain behind the knee when this happens, so you likely don't know that you have it. This tight and short area of muscles and fascia are responsible for some people's achilles tendonitis, or plantar fasciitis, or gluteal pain, or low back pain. The weak link behind the knee is making the other painful areas work harder.

But stretching this area effectively is the key.

You are probably thinking "Why am I not touching my toes?" It's because we are trying to stretch the muscles behind the knee, not the hamstrings! Yes the hamstrings are part of the problem, but so are the gastrocnemius, plantaris and popliteus muscles. Think of WHY this area is tight to begin with. It is because we sit too much. We live in a culture where it is often necessary to sit too much, and that is NOT going to change. The sitting position puts the knees in a bent position. This is why the muscles in this area shorten and become tight. The muscles at the top of the leg, where the hamstrings start, are NOT shortened in this sitting position. Once again, to be clear, you probably don't have pain behind the knee. But trying to stretch that area is often painful, and that is exactly why we DON'T like to do it.

Don't get too aggressive with the height of the foot while stretching this area. Stay with a low chair, ottoman, or the bottom stair of a staircase. Use the railing of the staircase, or another chair for stability. DON'T bend the supporting knee. DON'T twist out the foot of the supporting leg. DO stand tall and stick your chest out and your butt out slightly. And most importantly, let it relax and BREATHE.

This one stretch alone is a good start to resolving the problem, but often it is not enough. Adjustments and more corrective exercises are usually needed for long term success.

The Most Common Postural Problem ( that you've probably never heard of )

Many of my patients have alternating symptoms of neck pain, shoulder pain and low back pain. They come to my office for the symptom that is currently the worst, and tend to downplay the symptoms that are currently minimal. They don't realize that all of the symptoms are related to the same dysfunction. Their spine is too straight.

When you look at a spine from the front, you want it to be straight (see pic below). But if you do see curvatures here, it is called scoliosis.

When you look at a spine from the side, there are normal curvatures. In the picture below the person is facing right. The forward curve to the neck and low back are called lordosis. The backward curve of the upper back is called a kyphosis. The pelvis tilts forward slightly as well. These are all natural and necessary for normal pain free function. These curvatures, along with the intervertebral discs, help to provide normal movement as well as shock absorption.

Many of us have lost touch with our bodies to the point where WHAT WE THINK is straight and upright really IS NOT. This is most common in those that have a job which requires them to sit. Sitting usually tilts the pelvis back, slouches the low back, and gives our upper body a slight forward lean. With good intentions, many of us try to correct this posture. But instead of tilting the pelvis to initiate the change, we straighten our upper backs. This eliminates the natural and necessary kyphotic curvature.

This dysfunction results in elongated low back and neck muscles that can't do their job. Muscles get weaker as they get longer. They tend to fatigue more quickly. This position also puts more pressure on the intervertebral discs of the neck and low back. So not only can your muscles hurt, but your joints as well. The muscles around the shoulder blades (scapulae) also become painful because the joint surfaces don't match up. The scapulae have a concave underside to them, which glides along the ribcage. The backside of the ribcage should be convex to match the surface, as in the picture below. But with a flat back, it is not. As the scapulae are pulled away from the ribcage, the muscles are elongated. Again, an elongated muscle is weaker, and fatigues more quickly.

Flat back posture also makes it difficult to take in a full breath, as the ribcage cannot fully spread out like it should. Altered breathing patterns result in fatigue of the muscles of the neck and low back, as these are relied upon more often. This spinal flattening plus a slight pitch forward is the most common postural problem I see in the office today. I know what you are thinking - "What can I do about it?" Stay tuned. You get your answer in my next blog.

Washboard Abs vs.Strong Core

I must admit I don't have "washboard abs". I have what you would call a "two-pack" instead of a "six-pack". But is having washboard abs really the same thing as having a strong core?

To answer that question, one must first define what "core" means. I don't always agree with Wikipedia, but here is what they have to say on the matter: "Major muscles included are the pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) especially the longissimus thoracis, and the diaphragm. The lumbar muscles, quadratus Lumborum (deep portion), deep rotators, as well as cervical muscles, rectus capitus anterior and lateralis, longus coli may also be considered members of the core group. Minor core muscles include the latissimus dorsi, gluteus maximus, and trapezius."

So there is well over a dozen muscles listed there, even if you don't include the latissimus dorsi, gluteus maximus, and trapezius, which I do. There also a few more I would add to the list such as serratus anterior. I understand the temptation to look at what you can most readily see and identify it as the "core". But we all need to get over this idea that sit-ups, crunches, or planks are the go-to core exercises for someone trying to decrease their pain levels through core muscle development. It is my humble opinion that the world of fitness, exercise science, and physical therapy have been overly influenced by the bodybuilding. The idea that we need to "isolate" one muscle at a time is quite ridiculous. In real-life scenarios, muscles don't work in isolation. Therefore training and developing them in this way is likely to end up in pain and dysfunction. Certainly the muscles look good on bodybuilders, but these folks are not as athletic as they look. Just ask one of them to run and you will see what I mean.

Here is a link to my Youtube channel. In it you will find the three core exercises I give the most : Up Dog, Side Bridge, and Bird Dog. I explain them in the videos, and in previous blogs as well, and there is no need for redundancy. Notice that none of these three main core exercises directly targets the abdominus rectus muscle. This is because the abdominus rectus muscle is one of a dozen core muscles, and is not THE important muscle. But, of course, it is still wise to train this muscle. The best way to train them is to do "Frog Abs". This exercise, like most of my core exercises, puts you into a position and hold it for three audible breaths. The breaths are very important, and it is necessary to keep them audible for two reasons. Not doing so will lead to holding your breath, guaranteed. The second reason is because it helps to stimulate the core muscles, many of which are involved with forcible inhaling and exhaling. Passive breathing (what you are likely doing right now), does not stimulate these muscles.

Click here to see Frog Abs video.


The video posted above also shows a hip position that minimizes low back pain. The turn out of the hips fires up the gluteal muscles, so that they work in conjunction with the abdominus rectus. Otherwise it is possible that the low back muscles fire up instead of the glutes, creating low back tension. Also, the lack of movement minimizes any risk of jerking your head forward, and injuring your neck.

Doing planks can be a good core exercise as well. Yet there is one inherent problem with it. The person doing it can't see their own back. I think if they did see it they would be surprised. Most people have such a gap between the shoulder blades (scapula) and their ribcage, that you could stick your fingers in there and pick them up like a suitcase. This is a sign of weak serratus anterior. Scapular winging has other possible causes, but weak core is the most common.

I guess I can't expect too much from people. They have been taught the same core exercises for decades, and now Dr. Schafer wants to start from scratch. I get it. I don't have the washboard abs, so what do I know about core muscles, right? Well, for starters, I don't have back pain.

Top 5 Running Mistakes

In the fall of 2010, I started training for the Grand Rapids Marathon in 2011. I had never run for exercise before. Gradually and slowly increasing my distance allowed me to complete the goal. However, it took me 12 months to get there, and more importantly, to do it without injury. Here I am in the final stretch, when my daughter decided to join me. When we crossed the finish line, she was quite upset that she did not get a medal. I tried giving her mine, but to her credit, she would not take it.

I try to inspire people to exercise in whatever capacity they can. I want to help my patients help themselves. When they do, I know that their long term success in fitness and health will translate into less pain overall. Yet there are always road blocks on the journey. Knowledge is key. If you want to run for exercise but are afraid, don't be. But be smart about how you train. And don't expect to go from running 0 miles to 26.2 overnight. So here are the most common mistakes made by beginners, and by those who just haven't done it for awhile.


1. Too much too soon.
This is easily the most common problem. Everybody has physical limitations. Testing your limits occasionally is good, but don't do it every time you run. Follow the 10% rule- don't increase your total weekly mileage or pace by more than 10% per week. That means you can't jump from running 1 mile to running 2 miles. Nor should you run 2 miles twice in one week, and then three times the next. It is the same principles for increasing your pace. Expect injury if you go from 14 minute mile (4.3 mph) to a 10 minute mile (6 mph).

2. Stretching but not strengthening calves.
It is just as often that I find weak calve muscles as I do short and tight calve muscles. It is also possible to have both. To test yourself, see if you are able to stand on one foot, then lift the heel. A surprising number of people can't do this. Compare right foot to left foot for how high the heel goes up. Usually you will feel one foot is not as strong, and your balance is worse. For this problem, do one leg calf raises at the bottom on the stairs, and hang on to one railing for balance if you need to. You can do the same on a curb with a signpost nearby. Go through a full range of motion up and down and pause briefly at each end. Think of it as an exercise that something between stretching and strengthening. Not only can weak calves lead to plantar fasciitis and achilles tendonitis, but it can also create overuse injuries at the hip or knee.

3. Stretching hamstrings with knees bent
Going down to touch your toes is probably the most common stretch done by runners. But in trying to push the limits of how far down they go, they will often unknowingly bend the knees. If you cannot fully straighten your knee, then you cannot correctly push off every time you stride. Your push-off will become a twist-off as the hip muscles try to make up for lack of knee motion. This can lead to hip or knee pain. Instead, try putting one leg on a chair or bench. Make absolutely sure your knee is straight. Then bring your toes toward you. If you still don't feel much stretch then stick your butt and chest out. When done correctly, even a contortionist will feel the stretch.

4. Foot Midline Crossover.
If you frequent a shoe store where they have a video treadmill setup, try using it the next time you are there. You don't need to be a specialist to see how one foot will be in the middle of the treadmill and the other will be out near the edge. If you can, ask the salesperson to drop a line down the center of the treadmill running surface, and count how many times each foot touches the "midline". I have seen many injuries on both the midline foot and the lateral foot. The midline foot supports more weight, but the lateral foot has to push harder to complete the same movement. Once again, the overuse scenario can produce pain at the foot, knee, or hip. One way to help overcome this is by "straddling the line". Find a high school track to run on. When you do, see if you can keep your right foot on the right side of the line, and the left foot on the left side of the line. This is surprisingly difficult for most people.

5. Doing the same run every time you run.
You will help stave off injuries if you can vary the terrain, distance, and pace of your run. If you do not, you are setting yourself up for a repetitive stress injury . Try running on a trail. You will notice your foot lands in a slightly different position every time. Many roads have a slant or a pitch to them to help water run off. Running on the same side of the road every time can create problems as your body tries to adjust for that slant. Try alternating types of running shoes, with different heel heights and arch supports. This will again vary the positions of your foot for every stride. Varying the pace and distance also can help. There are plenty of free couch to 5k running logs you can find online. Use those as a general guide, but listen to your body.

You are different. Your body is unique. Not everyone can or should do marathons, but most people can and should run. Especially if they like to.

Runner's knee may not be a knee problem

The recent warm weather has certainly inspired people to start running more. The increase of knee pain complaints at the office is a sure sign that summer is almost here. Knee pain is by far the most common running injury, yet it has many possible sources. Conventional wisdom suggests that since the knee is a joint, then any knee pain must be a joint problem. Patients often claim that their pain is due to a partially torn ACL or meniscus from an accident which occurred years ago. Recent research, however, indicates that muscular strain or weakness is a common cause of knee pain. Even muscles that don't directly attach to the knee can be a problem. In fact, numerous studies have shown that hip strengthening exercises greatly reduces pain on the outside of the knee (iliotibial band syndrome).

Healthimage [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]

A quick look at the anatomy shows how some of the hip muscles are connected to the knee. The iliotibial band does exactly this. It is a thick band of fascia. Fascia is very strong connective tissue which does not contract. In fact, fascia also runs through your entire body. It is better thought of as a super strong spiderweb (or matrix) that permeates the entire musculoskeletal system. That's a fancy way of saying it goes through and connects muscles, tendons, ligaments, and even bone.

So, if fascia permeates and interconnects all muscles, tendons, bones, and joints, AND the source of anyone's knee pain can be far from the actual knee, one could theorize multiple other muscular scenarios where the problem is muscles other than the hip ones described above. A thorough check of strength and flexibility of all possible offending muscles is best done by a skilled specialist. However, one could make attempts to stretch or strengthen these areas with no real repercussions if they were wrong. The worst that would happen is that their muscles would get more flexible, or maybe stronger.

If your pain is on the outside of the knee, it is likely due to weak hip muscles. A side laying leg raise is a good exercise to start with, just like the ones Jane Fonda would do. (Wow, I am dating myself with that reference.)

If your knee pain is on the inside part of the leg (medial), there is a good chance one of your groin muscles (hip adductors) is tight and short. Stretch'em.

If your knee pain is just underneath the kneecap (patella) in the front, there is a good chance that your front shin muscle (anterior tibialis) is either overused (usually from steel toe shoes), or it might be short and tight. Keep in mind that pain in this area could also be due to TMTS (Too Much Too Soon). Back off on the distance of your training by 2/3 and progress your mileage no more than 10% per week.

If your knee pain is under the kneecap (patella), but more to the inside of the leg (medial) it could be the posterior tibialis. This muscle is largely responsible for maintaining the arch of the foot. Have you been told you "pronate" too much? Strengthen this muscle by doing heel lifts while standing on one leg. Hold on to a chair or wall until you develop enough balance.

If your knee pain is in the back of the knee, it could be one of the hamstring muscles (biceps femoris) or tight calf muscle (gastrocnemius). Check to see if you are able to fully straighten your knee. Many people CAN'T do this, and usually blame previous knee injury. Yet they have never tried stretching the muscles BEHIND the knee. Try this stretch: stand with both feet pointing straight at a chair. Put one heel on the seat of the chair. That's all. Just keep in mind that your body will try to cheat the movement by twisting out out the supporting foot, or twisting the pelvis to the side of the supporting foot. Look at your foot on the floor to make sure that it is still pointing forward. Also look at your belt buckle to make sure that it is still pointed forward. If you can do this with a straight knee and no difficulty, then bring your toes toward you, and push your chest up. DO NOT TOUCH YOUR TOES!

Seeing a specialist for your knee pain is also a good idea. Finding one with experience in running is extremely helpful. Finding one who also runs themselves is better yet. Unfortunately, there are many "orthopedic specialists" who will focus solely on the knee. This is unfortunate because, as stated previously, often times the problem is starting somewhere OTHER THAN THE KNEE. It is true that many people with kne pain do have meniscus tears or other damage. Keep in mind that an MRI, X-ray, or CT scan can show where damage is. But it is no guarantee that the pain is coming from that damage. If the focus is only the knee, and no other changes are made to surrounding structures, it is just a matter of time before the pain returns.

If you have any questions about this blog, or any questions regarding running injuries, you may come to our class "Running Injuries and How to Avoid them". It will be held on Tuesday, May 21 at 6pm. There is no fee, but if you think you may be coming, let us know. Give us a call at (616) 301-3000. Or personal message us on our Facebook page here.

DON'T Make This Mistake During Core Exercises (Know Your ABC's)

As a personal trainer in the early 1990's, it was pretty standard operating procedure to give people sit-ups or ab crunches as part of their routine. I don't use these exercises much anymore, but honestly if done right they do have some benefit. I would always emphasize the breathing as I showed them the exercise. Nonetheless, EVERY SINGLE PERSON would hold their breath at some point. Then I would remind them. "OK Mr. Smith. Your form looks good, but just don't forget to breathe." Of course they would start breathing again. And of course, about 3 or 4 repetitions later, they would start to hold their breath again. EVERY SINGLE PERSON!

Fast forward to today. I am still giving people "core" exercises. By my standards "the core" means any part of the torso that connects one limb to another, or a limb to the head. That covers a lot of ground. Needless to say it's not just the "abs" anymore. Nowadays I give patients exercises which they are going to do at home without me. I can't be there to say "Breathe!". So how can I ensure that they are breathing? They need to know their ABC's

Active Breathing Core (ABC) is system of exercises that I developed in which the person holds a position, and counts breaths. They do not count repetitions. But they have to be big audible breaths. Not so big that they are hyperventilating, but big enough to challenge the respirator muscles beyond the "rest phase". It's really not as complicated as it sounds. It is similar to yoga, but you just have to count your breaths.

At rest, our breath is controlled at a subsconcious level. It involves the diaphragm, the elastic recoil of the lungs, and some parts of the intercostal muscles (the muscles between the ribs). This process happens even though we are not consciously aware of it. Therefore I call it a passive breath pattern.

Active breathing occurs when our heart rate goes up and our demand for oxygen increases. Most anything beyond sitting and resting can do this. Light activities like walking, washing dishes, or cutting the grass are good examples. Our bodies need to increase the volume of air that is taken in, and begin to use different muscles to do just that. This includes muscles of the neck and shoulders (SCM, scalenes, pec minor) for the inhale, and abdominal and low back muscles for the exhale. These "active" exhaling muscles are rectus abdominis, external oblique, internal oblique and transversus abdominis, iliocostalis and longissimus, the serratus posterior inferior and quadratus lumborum. All of those muscles are "core". Those muscles, which are activated in elevated breath patterns, are also necessary to help stabilize and support the torso during the activity. Therefore, these muscles need to be taught to be able to COORDINATE their function of breathing with their function of stabilizing!

Try this test. Stand up. Then squat down as if you are about to pick up a pencil. Then stand back up. Go ahead and do it now.
Done? Chances are you just held your breath to complete this movement. Your body should not need to shut down the breathing process in order to do such simple tasks. Now think about running. Do you think you need some core muscles during this movement? Do you think you also need to breath? Bingo!

So for simplification, I now give these positional exercises and have the person count three big audible breaths. Then come out of the position and relax for a breath or two. This is repeated at least 5 times. Coming out of position is often necessary. The longer someone holds a position, the less likely they are to hold GOOD position. So the small break helps them "reset".

Don't worry, though. You won't have to go back to school to learn your ABC's. You can see them here on Youtube.