I recommend yoga to my patients regularly. I believe it is one of the most complete forms of exercise for the entire body. It includes the body, mind and spirit.

I get a number of funny looks and responses when I recommend yoga. The most frequent response from patients is “I can’t do yoga because I’m not flexible.” Or I get the look that I’m big and strong, and yoga is for women or sissies.

I tell people yoga is not about being flexible. You don’t need to be flexible to do yoga. You may become more flexible as you do it, but you will learn a lot about how your body works and how to make it work better.

The strong guys will find out they may not be as strong as they think. I’ve found it to be the hardest exercise you can do without lifting a weight.

While I was visiting a friend in Montreal, his 20-year-old son was just coming out of his room all sweaty. He had just finished doing the P90X yoga workout session. He said it was the most physically demanding of all the workouts and the most fun.

One thing I always tell my athletic patients is there’s no finish line or scoreboard in a yoga studio. You aren’t competing with the person on the mat next to you. The only thing that matters is what’s happening on your mat.

This was a lesson I had to learn the hard way. I tried to go as deep into a pose as the woman on the mat next to me. I pulled the middle of my back between my shoulders.

It doesn’t matter if you go as deep as someone else. What counts is that you only do what your body is capable of doing. This way you are doing the pose correctly. Listen to your body.

I also let my patients know that breathing correctly is the foundation to yoga. You need to breathe through your nose slowly and deeply.

I teach them to take in a deep breath and push out their stomach at the same time. This is breathing with your diaphragm and it allows you to completely fill your lungs. This method of breathing will help my patients with their endurance.

If you can’t maintain your breath while in a pose, then you’re working too hard and need to relax in the pose. Don’t worry as you practice, you will improve your breathing while going deeper into the postures.

There are many types of yoga. Some are very gentle and relaxing while others can be very physically demanding. There are several studios that heat the rooms to almost 100 degrees. This allows for the muscles to warm up so you can go deeper into the postures.

One of my patients returned for care. I hadn’t seen him for almost a year. He wasn’t the athletic type. He never competed in sports or exercised regularly and was significantly out of shape.

When I saw him he had lost weight and had some muscular definition. I asked him what he was doing. He was going to Portland Power Yoga. This is a hot room yoga center and he loved it.

He said he never felt better. His energy level had improved and he was sleeping great.

My advice is to try yoga. It will improve your athletic performance and reduce the chances of injury.

You won’t be sorry.

 

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What should I use, Doc, ice or heat?

I have this question asked of me almost daily. Patients are so confused about what to use on their injuries. Many times they guess wrong and it will add to the length of their disability.

Should I use ice, heat or both? How long should I apply the therapy? When should I change from one therapy to another?

First, you have to determine if the injury is acute or chronic. An acute injury is an injury that happened within the previous 48-72 hours. A chronic injury is one that has happened at least several days ago.

My advice for an acute injury is to start with ice. When in doubt, always use ice. You will never go wrong using ice. I always tell patients you never see a heating pad on a football field.

When the body experiences an injury such as a sprain, muscle pull, contusion or bruise, it responds with inflammation. Many times the body overresponds to the injury and too much inflammation goes into the injured area.

Applying ice to the area will cause the blood vessels to constrict, reducing the inflammation going to the injury. Ice also has an analgesic effect, which reduces pain to the injury.

I recommend using an ice gel pack, a bag of ice cubes or a bag of frozen peas. These will conform to the injured body part, spreading the cold equally. Place a cloth between your skin and the ice. This will protect your skin from frostbite.

Apply the ice for 15 to 20 minutes. You can reapply the ice after resting for an hour. Continue to apply the ice if the typical signs of inflammation continue: redness, swelling and heat.

Also, compress and elevate the area when possible.

I recommend heat for most chronic injuries or conditions, such as arthritis. With a chronic injury, you will have muscle spasm, muscle tightness and scar tissue.

Heat feels best. It causes the blood vessels to dilate, bringing in more blood to the area. This blood will bring fresh nutrients to help heal the injury.

I also recommend my patients use moist heat. If they have a heating pad at home, I ask them to use a moist, warm towel between them and the heating pad. They can also use a hot water bottle with a warm wet towel wrapped around it.

You should never use heat for more than 20-30 minutes. Using heat for an extended period can cause congestion to the injury, slowing the healing process and increasing the pain.

Do not fall asleep with a heating pad. I have seen second-degree burns as a result. The prolonged heat will cause a numbness in the skin and you will not feel the tissue burning.

I had one female patient with chronic lower-back pain. During my examination I noticed the skin on her lower back was discolored to a light brown. She told me she sits in her chair with a heating pad on while she watches TV or reads.

She uses her heating pad several hours per day. She had actually cooked her skin.

The good news is she responded to my care. She then stopped using her heating pad and her skin returned to a normal color. I joked with her that she had cooked herself to medium rare.

I will even recommend using heat for 10 minutes, followed by ice for 10 minutes, then resting for an hour.

This is an excellent way of transitioning from an acute to chronic condition.

Elite and professional athletes train specifically for their sport. They want to excel and stay one step ahead of the competition. This takes discipline and dedication.

Natural talent will only take you so far. You need to set goals so you can track your progress. Remember your competition is also training. Train smart and train right.

Patients will often say to me, “You are in good shape, what are you training for?” My response is, “Old Age.”

Many people look forward to the time that they can retire. They have great aspirations to do the things they have not been able to do while they have been raising a family and/or working full time.

Many of us have financial goals so we may retire at some point in our lives. Do you have health goals so you can do all the things you dream of doing when you retire such as traveling, gardening, enjoying a hobby or even start another business?

I work with my patients to get them to recognize the need to start exercising and eating right for the long run. I call it a “health account.” It is just like a retirement account but you are doing healthy things now so you can draw on your savings later. Then you can do all the things you dreamed of doing in retirement.

One patient I have seen intermittently over the years is a great example. Before he became a patient he went from 240 pounds to 185. He was in his 40s.

He did this by running, weight training and eating right. He became a student of healthy living. He was on blood pressure medication before he started training and now no longer needs the prescription.

He told me about a party he and his wife attended. The people that he knew came up to him and asked him if he was sick because of the weight loss.

He was very proud of the results he achieved with his training. He was dismayed by people’s response to his achievements. I told him that many of these people are out of shape and sickly. Why would they want to be around someone as fit as you?

You are like an alcoholic who quits drinking. Many times they have to find a new circle of friends because the old drinking buddies do not want a sober guy around. I told him he may have to find a new circle of health-oriented friends.

He is now in his 50s and heavier. He told me he is back on blood pressure medication. He continues to train but he changed how he trains.

He started lifting heavy and was trying to compete with the young guns in the gym. He reduced the amount of cardio and was now doing mixed marshal arts. He changed his diet to include muscle and weight-gain supplements such as creatine.

He has gone from 185 to 215 pounds. I asked him, “Are you nuts?”

This is when I told him that he needs to reassess his training and his goals. Who cares if you can bench 300 pounds? What is important is to live a long healthy and fully functional life.

He got off all the supplements for muscle and weight gain. He will stop lifting heavy and add yoga into his routine. I referred him to Justin Warren, the owner of Bear Essentials Gym in Saco for a new workout.

This patient’s natural weight is 185 and this is his goal, which we believe will allow him to get off his medications and live that long healthy functional life.

 

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One injury may lead to another.

Detective work is how I describe developing an initial diagnosis and the best treatment plan to help my patients. Taking a detailed history of the injury is where it all starts.

The history is where I need the help of my patients. In the case of an athletic injury I need to know how the injury occurred and whether my patient had any similar injuries in the past.

I will want you to describe the type of pain you are experiencing. Is the pain dull, sharp, constant or intermittent? Does it radiate or is it localized? This is just the beginning of the process. It is important for my patient to be as descriptive as possible.

Such is the case of one 16-year-old boy. He’s brought into the office by his mother. They tell me last summer he was playing in a lacrosse game in Harvard Stadium on artificial turf.

He was running with the ball along the sideline and planted his right foot to stop from going out of bounds. An opposing player hit him lightly from the back. At the moment of impact his right femur (thigh bone) snapped in two.

He was taken to Boston Children’s Hospital where he underwent surgery. The surgeon placed a titanium rod down his leg. The material of this rod would allow the leg to continue to grow like his left leg. The procedure worked beautifully.

He followed up with physical therapy to restore the strength of his leg. His recovery went very well and he was allowed to return to running and playing competitive sports within a year of his injury.

After returning to the field he started to experience non-radiating lower back pain. This is why his mother brought him to my office. The pain was primarily in the center of his lower back and on the right side. Running and prolonged sitting aggravate the pain.

My examination revealed tenderness over the scars from his surgery in his buttocks. His postural examination showed his right hip to be rotated and slightly lower than his left.

There was a loss of motion of the right sacroiliac (hip) and muscle spasms in the lower back. There were no neurological findings to indicate a disc injury.

My diagnosis was mechanical low back pain as a result of compensating for his leg injury. The joints of his lumbar vertebrae and his hip were not in normal alignment and did not have a normal range of motion.

I recommended a short series of chiropractic adjustments combined with exercises to restore and maintain his alignment and motion of his joints. He responded well and was able to attend a weeklong soccer camp after a few visits to my office.

His parents would make sure he got follow-up care as needed when they returned to Boston for the school year.

Injuries can come in all shapes and sizes. It is important that you address them quickly and appropriately.

Your body can be described as one long kinetic chain. This means if there is a kink in the chain in one location of the body you compensate for this injury. This may result in another injury somewhere else.

This is why it is so important that I understand everything that is going on with my patient. After my examination, I want my patient to have a complete understanding of the injury and my treatment recommendations.

I want my patients to play an active role in their recovery. I cannot do it alone.

The next time you attend a professional or amateur sporting event please take a moment to admire the athleticism of the cheerleaders.

Recently in federal court a judge ruled that cheerleading is not a sport. Therefore a school could not use cheerleading to comply with Title IX. This federal law mandates equal opportunities for men and women in athletics.

Try telling a cheerleader that what they do is not a sport. They have coaches, go to practice and train hard to be able to do the routines. They even have competitions between other teams.

It has been reported cheerleading is more dangerous than any other sport for women. These injuries are not just sprained ankles. They can be disabling type injuries such as fractures and concussions.

College cheerleading for women leads all sports in serious injuries. Twenty-five percent of money spent by the NCAA insurance program for student-athlete injuries is for cheerleading.

One of my patients asked me to see his son who is a cheerleader for a large Division I college out of state. He was going to be home on school break.

His primary issues were lower-back pain and mid-back pain. At times he was having a difficult time taking in a deep breath. He would get headaches and also had groin pain.

He told me how intense his cheerleading schedule can be. His season starts with football and goes through basketball season. They now cheer for both men’s and women’s basketball games. Plus, he carries a full academic schedule. He has little down time.

In the offseason he is in the gym training. Since he started cheering as a freshman four years ago he has put on almost 20 pounds of chiseled muscle.

Cheering is serious and if the athletes do not stay fit they are cut from the team. The sport is too dangerous to have an undisciplined team member.

Fortunately most of his issues are structural in nature. He has a short leg on one side that causes his pelvis to tilt. This results in muscle imbalance in his mid-back and hips. This will lead to his groin issues. Misalignment of his ribs is making it difficult for him to take in a deep breath.

His headaches are of the muscle tension type and not migraine. He is most uncomfortable in the morning getting out of bed and at the end of the day.

I recommended spinal adjustments to realign his pelvis, ribs and neck. I chose not to use a lift in his shoe at this time. If his back pain did not become stable then a heel lift would be an option.

I stressed the need to stretch and to add some yoga to his training routine. I also asked him to use a foam roller which will smooth out and massage his muscles after a game or hard workout.

His teammate had similar complaints. I found the vertebrae to be very tender between his shoulder blades. I asked him about his digestion. He told me he was diagnosed with acid reflux and was on medication.

I told him how concerned I was that at age 20 he could not digest his food properly. He did not want to be on medication for the next 60-plus years of his life.

In my practice I have found that spinal misalignments between the shoulders can aggravate the patient’s ability to digest food properly. I asked him to follow up with the college’s chiropractor back to school.

Dr. Robert Lynch is a former president of the Maine Chiropractic Association and head of the Lynch Chiropractic Center in South Portland. “Staying in the Game” appears every other Thursday in the Press Herald.