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  Dr. Jake Caldwell
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Simplifying the Complexity of Shoulder Pain

10/27/2015

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The shoulders are very complex joints. They are designed for motion. They can move through large circles, requiring all sorts of intricate and detailed motions. But because of all this flexibility, they are not very inherently stable. There’s a lot that can go wrong in the shoulders. Basically, the shoulder joint wiggles around too much and slams into the surrounding tissues, tearing rotator cuff muscles, pinching tendons, tearing labrums, and inflaming joints.

Fortunately, almost all shoulder problems are related to a few common root causes. First of all, the shoulder blades are the platform from which the shoulders move. If the shoulder blades aren’t strong and flexible, then the shoulders themselves have no hope of being safe. Rowing exercises are great for the shoulder blades and help to stabilize them so that they form a nice platform for the shoulders themselves. But there’s a big problem with rowing exercises: If the mid-back isn’t flexible, then it’s almost impossible to row properly. Most people end up doing very little for their shoulder blades when they row. Instead, they overwork their shoulders and especially their neck muscles, injuring not only their shoulders but also their necks. The mid-back must be flexible enough to allow the shoulder blades to move properly when we row. Essentially, the ribs have to get out of the way in order for the shoulder blades to slide backwards. That’s the only way to do rows properly, and so that’s the only way to form a nice platform for your shoulders to get healthy.

One other major root cause of shoulder problems is the forearms. Most of us have extremely tight forearms which inhibit our ability to turn and pivot our hands. Since we need our hands to be able to move all over the place in our daily lives, such as when turning the steering wheel of a car, or when reaching all parts of our heads to wash our hair, our poor shoulders are forced to hyper-rotate all day long. Tight forearms are one of the most commonly overlooked causes of shoulder problems.
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In the ACTIVE100 program, we address each of these root causes in turn. We spend a great deal of time working on the mid-back and the shoulder blades. Each of these regions of the body are so important that they receive an entire routine just to themselves. We have a routine for the arms in which we primarily focus on the forearms. And we have a routine devoted to the shoulders themselves.
Regardless of what type of shoulder pain you have, and regardless of what exercises you do to help take care of it, make sure that you are working with your mid-back, shoulder blades, and forearms also. There’s very little hope of helping shoulder pain without these important regions also being addressed.

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How and Why You Should Keep Your Hips Moving

10/8/2015

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Your hips are the center of your body. They are, or at least they should be, the engines, the workhorses, of your body. The hip muscles are the largest and strongest muscles in the body. They generate the force for all that we do. Rising up from a sitting position, lifting an object off the floor, jumping, running, throwing a baseball, almost anything you can name involves the hips as the primary generator of power.

Unfortunately, most of us have lost not only the strength of these important muscles, but also the flexibility and mobility of our hip joints. We've effective lost our engines. Not only do they not have any power to give us, but they are rusted and sticky. When we can't use our hips, then we have only two options. We either don't do much activity at all, or we risk severe injury when we do so. If you can’t rotate your hips very much, then to throw a baseball or to swing a golf club is begging for an injury. All the rotation is forced into the knees or into the low back (or both), causing excessive demand on these poor regions of the body and causing injury. In fact, the most common cause of both low back and knee injuries are poor hip motion and strength.

If we try to run without the help of our hips, then all the force of pounding on the ground gets absorbed by the other parts of the body, instead of by what should be the powerful shock absorbers of our hip muscles. We end up with arthritic knees, aching shins, and injured spines.

The bottom line is that maintaining and restoring one's hip mobility and strength is one of the most important ways of preventing injuries and prolonging one's ability to stay active. There are two main things to do. First we need to keep and improve the range of motion of our hips. Gently moving the hips through their range of motion on a regular basis is absolutely necessary to maintain their ability to move. Without motion, there's no hope of keeping them flexible or strong.

In addition to gently moving the hips, we must also keep our hips strong. There are many ways to strengthen the hips, but the most effective way is to do squats. As much as I'd love to see everyone holding a heavy weight to do deep, below-parallel squats on a regular basis, I know this is not going to happen. Fortunately, we can keep our hips strong enough for daily life without even using weight. Just squatting down, as low as we safely can go, five to ten times per day, can do wonders for hip strength. We all have very little excuse to not put in this small effort to keep our hips healthy.

In the hip routine and in the leg routine of ACTIVE100™, we work with the necessary range of motion and do the necessary hip strengthening to maintain and restore the hips to a high level of functioning. I encourage everyone to check them out. But either way, everyone should be doing some basic hip motions and a few squats on a regular basis if they want to stay active and free of injuries. We should all think about our hips on a daily basis, thank them for their great service to us, and do a few things to tend to their needs. The hips are just too important to waste.

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Announcing ACTIVE100™

10/1/2015

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After many years of hard work, ACTIVE100™ is finally released! It is a an at-home fitness program designed to get you in the healthiest, most active shape of your life. It is a series of ten DVDs, one for each region of the body (the neck, shoulder blades, shoulders, arms, mid-back, low back, hips, and legs), and it includes the Active Index, which is a test of your overall mobility. I am extremely proud of this product!

The exercise routines on these DVDs will help you move better, have less aches and pains, and prevent future injuries. My primary reason for making this product is to help people catch minor problems before they become big problems.

Check out the ACTIVE100™ website, like it on Facebook, and let your friends and family know about it.

Below is a sample video.
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Tending the Low Back in Sitting

10/1/2015

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We all know that sitting is not the best thing to do all day, and it's even worse for the low back than it is for the rest of the body. Sitting inhibits the low back stabilizing muscles, puts significant force on the low back tissues, and stops the normal flow of fluids through the region of the lower back, causing stagnation and stiffness of the low back. The simple movement below can relieve much of these problems, allowing us all to take better care of our lower backs even while sitting.
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Don't Roll on Rock

10/1/2015

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Soft tissue work has become very popular. Everyone is rolling on foam rollers these days, and rightfully so. Keeping your soft tissues mobile is one of the most important things that you can do to keep your body moving well. But there’s a new fad that is spoiling the benefits of soft tissue work: using a Lacrosse ball.

Rolling on a standard foam roller and using a tennis ball to knead your own muscles is great. The pressure from these two objects provides a safe and very effective mobilizing force. But if a little is good, more is not necessarily better! There is a new fad of using harder and harder objects to rip into the soft tissue, and the Lacrosse ball is the most popular of these objects. Rolling on a tennis ball is like getting a massage from someone who knows what they’re doing, someone who provides the right amount of pressure to help the tissues to move better without causing them harm in the process. But rolling on a Lacrosse ball is like rolling on a rock! It’s like getting a massage from a wrecking ball! The Lacrosse ball is way too hard of an object to use for self-massage. It bruises the muscles, irritates the tendons, rips the fascia, and hurts the bone.

Years ago, before the fad of the Lacrosse ball had become popular, I had to talk many of my patients out of the idea of ‘graduating’ from using a tennis ball to using a golf ball for self-massage. I would give my patients who suffered from plantar fasciitis a tennis ball on which to roll their feet, and almost without fail they’d come back feeling much better. But they’d also usually come back with the idea of ‘upgrading’ from a tennis ball to a golf ball. The idea was that if the tennis ball no longer makes the tissues hurt, then we’ve got to find something harder that will still make them hurt. But the nice thing about a tennis ball is that if it doesn’t hurt anymore, then the tissues probably aren’t tight anymore. ‘Graduating’ from a tennis ball means that we don’t need to do as much soft tissue work anymore, because the tissues are now reasonably supple. We don’t need to press harder just to keep making it hurt. Pain is not the point of self-massage, the relaxation of the tissue is the point.

The point of self-massage is to relax the muscles, not to make them hurt. If they hurt when pressed with a tennis ball, then they're probably too tight. If they don't hurt when pressed with a tennis ball, then they probably aren't too tight. Try to burn these statements into your mind.

We all have this idea that if pressure is good, then more pressure must be better. But that’s simply not the case. In my newest book, What Would Hippocrates Say?, I quote Galen, the physician for the Roman Emperor Marcus Aurelius and one of the great father's of medicine:
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​"... rub [the body] with the bare hands, which are midway between hard and soft, so that the body may be neither contracted and constricted nor relaxed and dilated more than is desirable, but may be kept within the bounds of nature" (Galen, Hygiene).
The idea is to use the proper amount of pressure in order to help the body, not to assault the body with unreasonable amounts of pressure. A tennis ball, much like the bare hands of a skilled bodyworker, provides a reasonable, balancing amount of pressure. It is the safe, healthy way to do self-massage. A basic, standard, white foam roller does likewise.
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Our muscles do not appreciate being assaulted. Treat them well by rolling with a standard white foam roller and with a tennis ball, both great ways to tend to the needs of the body. Don’t fall for the fad of rolling on a rock. Use Lacrosse balls to play Lacrosse, and use golf balls to play golf. Don't brutalize your body when your intent is to help it.
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    Dr. Jake Caldwell, DPT

    I have a doctorate degree in physical therapy, an advanced certification in Functional Manual Therapy™, a bachelor’s degree in biology, a bachelor’s degree in psychology, and a bachelor’s degree in history. I draw from these diverse fields in my approach to working with the body.

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