The bicep is made up of two heads. The long head attaches to the shoulder blade on the supraglenoid tubercle. The short head attaches to the shoulder blade on the coracoid process. Both run together and attach to the forearm on the tuberosity of the radius. The main movement is flexion of the elbow with supination of the forearm. Two Tests Which May Indicate the Pain is Coming from your Neck: Neck Compression Test: Spurling Test: Extend your head back. With your neck extended, tilt your head to the painful side. Hold this position for 30 seconds. If you feel neck pain, pain, tingling that radiates down the arm, or numbness, then you have tested positive. Median nerve tension test: Test non-painful arm first. Extend your arm (elbow) out to the side of you. Turn the wrist outward so the palm is facing away from the body. Extend your wrist and laterally bend your neck away from the arm. Side bends your neck away from the pain while extending the wrist and hand. Repeat the same test on the painful arm. If you cannot extend the elbow or the wrist without increased pain and/or symptoms you have tested positive for the median arm tension test. This could be a pinched nerve in your neck. Radial nerve tension test: Test unaffected arm first. With the arm at your side, take your hand and twist so it is facing palm out. Flip your hand up so the palm is now facing the ceiling. Side bend neck away from hand. Repeat the same test on the painful arm. If you cannot obtain the described position without increased pain and/or symptoms you have tested positive for the radial arm tension test. A bicep strain occurs when the bicep muscle becomes stretched beyond its limit. This excessive stretching may cause a “muscle strain”, a “muscle tear’, or a “muscle pull”. All three descriptions refer to damage to a muscle or its attaching tendon. The injury to the hip muscle or muscle tendon may be graded according to the severity: • 1 st degree o The hip muscle may be sore but there was only mild over-stretching of a muscle. • 2 nd degree o Mild swelling and bruising but possible severe muscle pain and tenderness. Moderate over-stretching of the bicep muscle with some tearing of the fibers. • 3 rd degree o Severe pain and swelling. Muscle or tendon is torn all the way through. The muscle is either ripped into two separate pieces or sheared away from the tendon. This can cause a complete loss of function and may require surgery. Anyone can strain their bicep muscles from just daily tasks, but more often a tear occurs while lifting something heavy. The strain or tear can occur at the tendon which is the thick band that attaches the bicep muscle to the bone or in the muscle itself. The injury can occur at the end of one of the heads (long or short) (in the shoulder). Or it can occur at the attachment in the forearm. Both can happen because of age-related wear and tear. And finally, the injury could happen in the muscle belly itself. How to make sure the pain is not coming from your neck: You have a higher chance of experiencing a bicep strain if: 1. You have had a prior bicep strain or tear. 2. You have muscle tightness. 3. You fail to warm up before an athletic or work event. 4. You attempt to lift too much with exercise or work. Signs and Symptoms of a Bicep Strain or Tear: 1. Swelling and bruising (discoloration) 2. Muscle spasms 3. Previous bicep strain or tear 4. You can feel point tenderness. 5. Might feel an indentation or bump in the muscle. 6. Pain when that muscle is used. 7. Weakness when that muscle is used. 8. Hearing a “pop” sound when the muscle or tendon was injured. Three self-tests you can do: 1. Hook test a. Elbow is held at 90 degrees. Try to hook your opposite finger under the tendon by the elbow. If able to do so the tendon is intact. If the tendon is injured it may be tender. 2. Popeye’s sign a. If you have a rupture at any of the bicep attachments the muscle may bunch up in the middle of the arm. A rupture at the long or short head usually does not have to be repaired. A rupture near the elbow usually is repaired. 3. Feel for point tenderness over the muscle belly (tenderness may indicate a muscle tear). X-rays may be ordered to make certain a bone fracture did not occur with a strain or tear. Treatment: 1. If tender, cross fiber friction massage over the long head tendon, short head tendon, insertion tendon in the forearm, or muscle belly. 2. Try massage, (use finger over the finger, or side to side). Be aggressive over the tender area and deep. If tender massage for 30-60 seconds and assess. If plateauing or decreasing you may continue. If increasing you must stop and try another day. 3. In all cases you should also massage the nontender areas of the bicep muscle belly. 4. If able to tolerate the cross-fiber massage may do up to 20 minutes or 5 minutes (4x a day) every other day. Use of massage gun - ball or pointer attachment. This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), T2 Massage Gun, EM-19 Massage Gun, Q2 Mini Massage Gun (US), X6 PRO Massage Gun with Stainless Steel Head Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. 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This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2021. For the original video go to https://www.youtube.com/watch?v=6wGH54vd8Lg Bob: So, are you over 50? Here are the five exercises you can do. You can do these if you're under 50, too. We're not going to exclude anybody. So, as you get older, strength really becomes important because your strength starts to wane. Brad: Wax and wane. Bob: Wax and wane, yeah. As you get older, you know, if you don't do anything or if you do things the same way, your strength is going to go down, so that's really a bummer. Brad: Yeah, it's the aging process. That’s one of the ugly facts. Bob: And that's true if you're 60 too, so we'd like to see you lifting some form of weights, maybe body weight, which we're going to show you today, or bands, or kettlebells. I'd like to see you doing it twice a week, at least. Brad: Twice a week? Okay. That's doable. Bob: Maybe three if you're ambitious. Brad: If you don't like the word "weights," don't worry. I strength train and I do not use weights. I have no interest in weights. Bob: You use bands. Brad: Yeah, and it works very well. There are some advantages either way. Bob: So, we're going to start off with squats. Squats are so functional. You're bending over throughout the day to pick things up off the floor or anywhere, and you've got to maintain that leg strength. So, you can start off by doing squats without holding onto anything for extra weight. Brad: Just body weight. Bob: Now, one thing I want to show is don't bend your knees first. Bring your hips back first and then go down. Brad: So, when you do that, you are kind of arching the back. The low back, right? Bob: You're arching the back a little bit and you're not bending your knees as much, which I'm fine with you bending your knees now. I've become a knees-over-toes guy. All the great weightlifters tell you, for squats you want to go headfirst and bring your hips back and then squat down. And you're trying to keep your back straight. Brad: Yeah, so, if you look at this. There! There you go, the Booyah Stik is touching in three places. You know, if you have a stick that's long enough, this could be a great way to force your body into good body posture while you're squatting. We call them "posture squats." Bob: And once you get that down, then you can add weight. I've got a 30-pound weight here. And you can do goblet squats with it. You actually bring the kettlebell up to your chest, like here, and actually add some weight to it. And Brad's going to show another way. Brad: Yeah, if you don't want to do weights and you want to do bands, this is the way I do mine. I stand on it and I squat. The nice thing about bands is as you go up, the resistance gets more and more, which is actually functional for strengthening. And if you drop this on your foot, it doesn't hurt. Bob: Yeah, you don't scream. Now, this is actually a loop, or I guess we call it a pull-up assist band. You can also, we'll use the loop or the band for the next one, which is the band pull-apart. So, this is a great one for posture and strengthening the muscles in the back that help hold your posture. So, you want to be in a good posture when you're doing it. And then you can just grab the band like this and pull it apart. Brad: You know, with the bands, there are the handles, which come in handy for a lot of things. But for this particular exercise, they're too far apart. You know, unless you're going to use the anchor that goes in the door or the wall anchor. Bob: You want to show, Brad, what I'm doing here? Brad: Squeezing! Those shoulder blades coming together is so critical. I always tell my patients, I say, "Squeeze your shoulder blades together and think about your sternum or your chest going out in front of you." And you really want to emphasize that. Feels good, too. You can tell it's good exercise. Bob: Yeah, yeah. It's a really portable one, too, you know? You can bring the band along with you almost anywhere. You could almost fit it in your pocket. All right, the next one is the split squats. I like to hold on to the edge of a bed or something. Brad: Anything for balance. Bob: Yeah. So, basically, you're going to get into the lunge position and you're going to bring the leg down like this. Now, if you want, you can train to have the knees go over the toes. I don't want any pain at all, though. If this hurts, you don't do it this way! Then you might do it where you go straight down and keep the knee behind the toes. Because if you don't have pain, you're strengthening your knee so that when this does happen when you do go knees-over-toes, which happens when you're going down stairs, it won't hurt as much. Because you have the strength in that position. So, obviously, you're going to do both sides. And it's interesting, Brad. I actually get up off the floor using the other leg up first too, and this one is really a lot weaker on this side. I really must start working on this. Brad: Because you've always done it without thinking about it, right? Bob: Right, right, exactly. Brad: If you wanted to, you could have a chair on both sides if you felt more stable. I like to use the Booyah Stik. Whatever so you feel stable with. Bob: Right, right, exactly, safety first. So, Brad, do you want to show a pushup? Brad: A pushup? Of course! Bob: Okay. So, we're going to actually do it, you want to do knees first? Brad: Sure. This is an excellent place to use Pete's Choice pad, because it hurts, especially if you have a hard floor. This is much more comfortable on my knees. All right. So, when you're doing these, you want to try and get your body straight. Have someone else look at you to make sure you're not arched. Because a lot of times, people are unaware of that, including us. And so, we're going to go down, and tighten up your core and keep that tight. And this takes practice, I think, is that you need to learn to breathe while you're doing your pushups and maintaining a tight core. So you breathe out when you push up, breathe in when you go down. And when you're talking, you do whatever you can do to get it done. Bob: And for a more advanced push-up, you can squeeze your buttock a little bit. That gives you a little more push, believe it or not. According to Pavel, the strength coach. You strengthen your abdominals and your buttocks and that helps get more pushups. Brad: Get those glutes going! Bob: Now, Brad, what is your record again so far? Brad: Well, my goal is to get 59 of them when I turn 59, which is in October. Bob: Sure. Brad: So, I'm at about 53 right now at max and I only do that once a week at the most. Usually, it's every two weeks and then I break it up. It's just more fun. Bob: Sure. Now, we're going to do side planks here. And we'll just reach down and reach up with it. Now, you can obviously do them on your knees. Bob: For more advanced, get up on the legs. Now, I wouldn't do them on this type of surface. I wouldn't do it on a bed. I would possibly do it on the floor or on a mat. Brad: You can't see it very well, but there is a gap there. Bob: I'm feeling it! We do it on both sides, of course, 10 to 15 reps or 10 to 20 reps, depending on what you're doing. Take it to fatigue, but there's also the philosophy, don't do it to fatigue. Go half of what you could do to fatigue. So, let's say you could do 20 pushups. You only do 10. But you do them more often throughout the day. Which is harder for people because I think they forget. Brad: You know, if you're doing pushups, you could just do 10 in the morning right after breakfast or before, and do 10 later, you know, say you could do only 20 maximum. Do 10 before you eat and do 10 after, even if you're out to eat, just get right down on the floor. Bob: There you go! Do it on the table. Why not? Get up on the table. Make a spectacle of yourself. All right. Brad: Tell them we told you to! Bob: Keep strong! Was that it? Bob: Yeah, that's it. That was five Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. 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This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2022. For the original video go to https://www.youtube.com/watch?v=UgZYEVzP218&t=237s Brad: We going to talk about congestive heart failure. As a therapist, over the last 25 years, I've worked with many people, particularly elderly people with this diagnosis. As a therapist, you deal with it often, but as a patient or people out there not as familiar with it, Chris is going to go through the details. He's done a lot of research and will talk to you about what it actually is, and how it's treated. And I'll interject a little bit about what we may do with therapy in regards. Take it away, Chris. Chris: All right, well, congestive heart failure or heart failure, that's kind of the topic of discussion today, guys. I guess the simple understanding of it is, that your heart, it's a pump. It's one of the muscles that just never stops in our bodies, the heart and our diaphragm I think are about the only two that I can think of that do that. Well, digestive, but that said, it's constantly pumping all the time. And what happens with that particular pump is, that it doesn't pump properly for our body's needs. And so then, when it doesn't work properly, and you're not getting good circulation, congestion occurs. So just like a running nose or congestion in traffic, fluid builds up, and basically, that creates a lot of damage, weakness to the heart, and a lot of other problems and complications associated with it. Brad: So, in other words, the heart, for a number of reasons, is not efficient anymore, it's not pumping out enough blood, or it's not receiving it. Chris: A little bit of both. There are multiple reasons, we'll kind of touch on how and why it got there. But the reality of it is, is that the body has needs, it has to get oxygenated blood that carries all the nutrients and everything else. When the pump is weakened it doesn't make it all the way through the loop to get back. As a result of that, you're going to get fluid back up. And a lot of people when they present to a hospital at that point, if it's an acute crisis, they're going to have swollen hands, feet, probably difficulty breathing, fluid in the lungs directly. They can be coughing up a kind of pink sputum. Brad: And this is all due to the heart being weak? Chris: Yes. As a result of it, the heart is failing. The pump itself, for a variety of different reasons within the heart, whether it's the heart muscle itself, getting too thick, the septum, which is what divides the chambers in the heart, getting a little too thick, it can crowd. And when they base it on diagnosis, and you and I were talking about ejection fraction, what happens is, that pump when your heart, if this is, let's say your left ventricle, it squeezes, it doesn't necessarily squeeze completely because the contractility of the heart muscle itself is either stiffened or it's not as flexible. So the heart itself is really supple and it kind of constantly is moving. And so when it tries to fill up with blood, it's not stretching to fill that blood up as well as we need to. And then it's not contracting properly. Brad: So, we're talking about the blood on the left side of the heart, which is actually the oxygenated blood with nutrients, that's going out to the rest of the body. And that's the system you're talking about. Throughout the whole body, we need that oxygenated blood. And after it's old, it comes back through the veins and then goes back to the heart and then to the lungs. And that's a system. Chris: Yep. And it makes a perfect loop. That's the other thing we can talk about, there's a left-sided failure and there's a right-sided failure. Usually, it's more common to have a left-sided failure, and then the right side can happen at the same time or it can happen in and of itself. Again, a cardiologist will be breaking all of these things down. But at the same time, what's important to recognize is that the heart itself is just not beating the way that it should and pumping the blood through the body the way that it should. Brad: So you had mentioned some symptoms which is important. If people are wondering if their loved one or if they themselves or someone is having swelling, does that always mean you have CHF? Chris: No, generally, it's a hallmark sign, but you're going to get probably a bunch of other things. And the problem is that we have kind of an umbrella of things that can cause conjunction heart failure. And from start to finish, it's kind of a culmination of things that happened over a lifetime. But, we see it in kids, in pediatric patients, that maybe have a genetic anomaly, where something is abnormal with their heart. Brad: When they're born with it? Chris: Exactly. But it's most common in people over the age of 65. And that's usually when it's going to occur. You're talking about roughly 600,000 Americans a year who are diagnosed with it. Brad: Let's just generalize, typical symptoms, that may be from CHF. Chris: Yeah. A lot of people, all of a sudden, "Man, my fingers are swollen," "My wedding ring doesn't fit properly," or, "Wow, look at my feet, they look huge," you see swelling all the way up the legs, you have a really plump hard abdomen, so it's very full. You can be gaining weight, significant amounts of weight. All of a sudden you can gain 2 to 4 pounds in a day. You know, 5 to 10 pounds in a week. Brad: So that's fluid, that's not fat. Chris: That's fluid, you didn't eat too much. You didn't have six pizzas. Brad: You retain the fluid. Chris: Yeah, as a matter of fact, when they start to retain fluid like that, they are actually losing their appetite and maybe even feel nausea. A lot of times the complications are, that they can have some chest pains, and difficulty breathing, because there's fluid actually in those lungs. And so it backs up. When you present to the emergency room, a skilled doctor's going to recognize it immediately. Actually, the nurses will recognize it immediately, and they're going to get the ball rolling. And there are a lot of things that happen when you're in an acute congestive heart failure crisis. Brad: I do want to bring up one thing so that people don't get too concerned as far as ring becoming tight as one of the possible symptoms. My wife, she's got ring issues. We just got her a new ring, she tried to get upsized, and it's fit and tight, and I'm 99% certain she does not have CHF. So don't get excited if your ring starts fitting tight. Chris: Yeah. It's just an example. Brad: But it's one of the things, along with maybe other parts swelling. Chris: And it's going to be profound. I mean, your fingers would kind of look like puffed-up sausages. You could have a salty meal and your ring might not fit properly. So I mean, and even as we age, if you've stood on your feet all day, you're going to have some swelling in your feet and ankles. I mean that's power for the course. Brad: Any other pain symptoms that are typical? Chris: You can be having a heart attack when you present to the office. You know when you go to the hospital. Brad: You're talking about chest pain? Chris: Yeah, you can have chest pains, you can have shortness of breath, you can have a cough, you can feel overwhelming fatigue in a lot of cases. And again, I think the other thing to delineate, there's chronic and there's acute. And it's a chronic progressive disease, and there are four categories. Brad: This is over weeks, months, or years? It didn't happen overnight? Chris: It happens over years and years and years. You know, an ounce of prevention is a pound of cure, is kind of the thing. Brad: Is it typically lifestyle or is it genetic or a little bit of both? Chris: Well, if you have a genetic predisposition towards CHF, so your dad, your grandpa, your mom had it, there's going to be a high likelihood that it's probably going to happen to you, but what can you do to prevent that? Well, lifestyle changes are going to be number one, stop smoking, and don't drink are things that you can just cut out. But then it's going to become, staying physically active and eating a healthy diet. Probably lots more fruits and veggies. And if you look up the DASH diet, I think that's the diet that's most profound. That diet specifically is low sodium and lean protein. Lots of fruits and veggies. That's the diet in a nutshell. Brad: Sure. Chris: And that's been championed by most of the American Medical Association, the American Heart Association, you name it. They're going to stand behind it because they know that when you're eating that type of diet, the salt intake is at a minimum. So that's helping your heart. We're going to do a video about potassium in a little while, talking about the balance of that. So we'll explain that, but to a degree, when we have a diet that has natural potassium in it, it's going to help to balance your blood pressure out. One of the causative factors of congestive heart failure is long coronary artery disease, and high blood pressure itself. So it can be a side effect of diabetes, it could be organ problems. You could have kidney failure leading to this. So it's not just a one size fits all example, multiple things can cause congestive heart failure. Brad: That's the information when you see your doctor and you've been diagnosed, they're going to look at you specifically. Chris: Correct. Brad: And we really can't do that here at all. Chris: No, that's above our pay grade. But the reality of it is, is that, if you have the symptoms, you want to get medical treatment right away. We do want to see your doctor consistently as we age because these are the things that, we want to pick up early. That's the key, if we can pick things up early, maybe it doesn't develop into a full-blown problem. Brad: If you change your lifestyle, your diet, and exercise. Chris: Yeah. If you listen to this and you're a young person, get your exercise, it's going to be 30 minutes, five days a week, where you're sweating and breathing hard. You know, most days of the week, usually five days is ideal if you can. But sometimes schedules are crazy. Eating well, good food choices. Those are going to be kind of the thing. It's not that hard, but you know, we are busy and the Americanized diet is not necessarily the most conducive, because we're busy, but heck, Europeans are too. It's not exclusive to just us. Brad: So, I just want to say if you're in your 50s or 60s, and you're thinking you're not an exercise person, you don't have to go out and exercise and get sweaty and breathing and put the sweatsuit on. If you're sedentary and you go out and you walk five days a week, it's going to work great. Chris: And gradually build. I think that's the important thing too, is Rome's not built in a day. So if you're somebody that's not accustomed to exercise, I think the other thing that's important is to find something you enjoy. Yard work, is a phenomenal workout. Taking a walk, ballroom dancing, swimming, exercise bike, treadmill, lifting weights, all these types of activities. Just find something that you can hold onto, that you know you can do. And vary it, do something different. If you take a walk, maybe take a bike ride the next day, if it's nice. You know, go walk on the beach, walking on sand is tough because it's unstable. Brad: Right. You know, and if you're at the level where you're watching this and your balance is not so good, you use a cane or a walker just to get up and move. I know our channel has a lot of videos for the elderly, but not just ours, they're all over the place. Just to get up and walk, like, where my mother lives, walking up and down the hallways because she doesn't get outside very much is wonderful, wonderful. Chris: Yeah. Find a friend, you can have a nice conversation while you're participating. But anyway, long story short is, you want to get out there and do, that's one of the biggest things. Brad: Should we go into what some typical treatments as a doctor, if you're diagnosed, what they're going to talk to you about, so you can understand it? Chris: So once you've gotten the diagnosis of congestive heart failure, and once they've gotten you stabilized. That's usually a pretty big deal when you go into the hospital with an acute crisis. Brad: So, when you say acute crisis, you're saying the swelling is there, maybe difficulty breathing. Chris: The breathing. They had to get your heart muscle stabilized. They had to do a lot. Brad: A lot of people will tend to wait because they don't want to go in. They're going to say, "It's going to get better." And then they go in. Chris: And that's the problem. There's a really good study that I read that came out many years ago, in 2008. Most people take about 13 hours before they go in. 13 hours, they're just not feeling well. You know, and whether it's a heart attack or congestive heart failure, I mean, chest pain, shortness of breath, fatigue, swelling, all those things kind of come into it. You know you have kind of that pale color, you're sweating. People will just think, "Oh I must have a little bug, or I ate something funny." Because you don't always have crushing chest pain. Sometimes you do, sometimes you don't. Sometimes you get pain that radiates into your jaw. So, these are all symptoms of heart attack too, guys. You can get the pain down your arm. It's hard to tell if you're having a heart attack or if it's leading to it. So I mean, if you have any of these things go see your doctor. Brad: Yep. I just want to tell this little story, it's a true story. Five years ago, we were up at a cabin, a bunch of guys. My father was there. He was 79, or 80 at the time. He woke up, he went to bed early, he wasn't feeling well. He had soup with a lot of salt in it. We're out with the guys. We're not thinking about eating healthy, we're just thinking, about having a good time. He comes down the stairs, very wobbly, and it was about 10 o'clock at night. Same symptoms, kind of sweaty, not feeling well, couldn't even talk very well. It was like, "This is bad." So we put him in the car, we didn't call the ambulance. Maybe we should have, but we drove, we called the ER and said, "My dad's coming, he's got these symptoms." We had an RN in there, he went with him and he had some ER experience. So we got him to the hospital. They got him as stabilized as they could and put him in a helicopter. We were in Northern Wisconsin, a small little hospital that couldn't do it, put him in a helicopter, two-hour ride in a helicopter down. And he ended up being fine, not back to normal, but he was stabilized. And then he eventually, did get back up and around and he went back to hunting again. Chris: It's one of those things where people tend to put things off. And I think that the sooner that you can get treatment, particularly in acute settings where it's immediate. There's nothing to be embarrassed about. "I'm going to the doctor because I had chest pains," or "I'm just not breathing well," or "I'm not comfortable." Go. I mean, let the pro sort it out. They're highly trained, they're gifted, caring people, that are going to do the best things that they can do to get you stabilized. And hopefully, minimize, maybe it would be a smaller problem to a much bigger one, that as time goes by and more swelling, more backup of blood and fluids, it can create more damage. And that's what we want to avoid. So the key is recognizing it early. We're not all trained to necessarily recognize, "Oh yeah, I think I'm having a heart attack." Just understand chest pains, shortness of breath, fatigue, weakness, you know, kind of coughing weird sputum, things like that. Where it's just not natural. These are things that are, "Hey, this is a big red flag," and these are the things that we want to pay attention to, to get the care that you need. So once you get the care that you need and you get stabilized, it's going to be medications. Medications and lifestyle changes. And the doctor's going to preach that. They're going to get you on certain blood pressure medications to try and ease the load on the heart, slow down vascular resistance or lessen it, so that the heart muscle itself can fill up properly and pump more blood efficiently through your body to help to maintain that. So, we talk about degrees of congestive heart failure. American Heart Association uses A, B, C, and D. A, being the best, which is actually a pre-stage. D, being the absolute worst, which is kind of end-stage. The New York Heart Association, which is the other one, uses 1, 2, 3, and 4. And the stages themselves have little nuances in between. Your cardiologist and your doctor will know all of these things off the top of their head. They're going to be using those as a part of their treatment plan to help you to live your best life. Brad: Sure. Chris: And at the end of the day, when we hear congestive heart failure or heart failure, you know, it becomes a quality-of-life equation. As patients, we want to make sure that we're maximizing the medications and doing our part. So it's eating well, it's trying to get exercise, what our bodies will allow. Sometimes as we get further down into those levels of congestive heart, and you get into C and D or 3 and 4, it's much more difficult to do certain things. Just walking upstairs can be a challenge. So find little things that you can do to move, and your doctor and physical therapy team can provide you with exercises that you can do that aren't so taxing, but will still help to keep fluid moving, and keep that heart muscle doing what it should. Brad: Exactly. Chris: But the mainstay is, we want to be good patients in this. When we get this diagnosis, we want to be good patients. We want to listen to the advice that's given, because really at this point unless you can get a heart transplant, which is generally not on the table, it's difficult to manage, and it's a progressive disease state. So you end up at A, it's going to go to D at some point in life. Brad: Right. Chris: It's what can we do to slow down the steps? A to B, B to C, and C to D. And so if we use the medications appropriately. Talking back with your doctor, if the drugs don't agree with you. As a pharmacist, that's where I have an impact. I see people, "Hey, how are you doing with drug A, B or C? How's the combination?" That's usually what I'm listening for when I'm talking to people at the counter. Is, "How are you doing?" "Well, I'm doing all right." "Well, how's the activity level?" "Mmh, you know, it's been a little bit harder for me to get up and downstairs lately." "Oh, yeah? Have you talked to your doc?" "No, I haven't." "I think it's time to probably have a quick conversation." And you know, nowadays there are so many cool tools that patients have to communicate with their doctor. They can use it on their smartphones, they can use it on their computer and the old fashion phone call and make an appointment. You want to communicate changes right away. The sooner that they can make adjustments for you, whether it's a simple med adjustment or what have you, the sooner that you can hopefully get these things to calm down. Because the disease state itself fluctuates. You can have lots of good days in a row and suddenly you have a flare, and there's no real rhyme or reason. We haven't at least figured out what may cause it, I mean, "Yeah, maybe I ate more salty food than I should have. " Those can be the obvious things, but sometimes it's not obvious. And so, for whatever reason, your body just said, "Eh, we're going to swell, and we're going to make it hard to breathe." So you want to make sure we're addressing that. A lot of times doctors will give patients action plans, where they want them to weigh themselves every day. Brad: Okay. Chris: When we get to the later stages, there are probably some fluid restrictions and there are some dietary restrictions as well because there could be other co-factors in there that are creating some of these issues. So you really want to listen to what your doctor has to say, and be an active participant as a patient to make sure that you communicate, when there are changes, they need to know ASAP. I think that's kind of the key to managing it, and to having a quality life. The diagnosis can be scary and intimidating, but at the same time, you can still go out and enjoy your granddaughter's birthday, wedding, or retirement party. I mean, life is still there to be enjoyed and lived, and it's not going to stop you, as long as you are an active participant and make some of those changes, and listen to your physician, your pharmacist, take the medications the way they want you to. Brad: That's what I always find interesting. Just knowing Chris, the active, positive role pharmacists can have to recognize things or see things. And sometimes you'll call a doctor and say, "You know, I think things are going well, but maybe these drugs need to be changed or modified." You communicate and have a conversation. Chris: Every day. And actually, where I work now, I actually do a lot of compliance backing. And so, I see a lot of congestive heart failure now. I see more now, in my 27 years, than I've ever seen in my entire life. And so it's interesting to watch the interplay with the balance of the medications, additions, and subtractions. You know, and the key is compliance, guys. I mean, I can't stress this enough. I just had a conversation with a little old lady yesterday, and we sat down for 45 minutes. I'm not sure about my pharmacy partner if that was good for her workflow, but I took the time to spend with her and I think we've gotten them on the right track. I'm going to follow up tomorrow when I go back to work. But, it takes time, you have to be an active participant in your medicine therapy. That's going to be one of the hallmark things that's going to help us to help you to keep going forward and enjoying a quality of life. Brad: Well, I tell you, where you work now, that service you offer, that aspect to the patients is just unbelievable. And people may not have that at every pharmacy. So if you do, you're fortunate because it's going to be helpful. I mean, I always say Chris should be a doctor because he has the heart for one, he has the brains for one and, you know, those two things, that's what it takes. Chris: Oh, I don't have nearly the education for that. Brad: Yeah. Well, you know, get your kids out of college, and maybe you can go back. Chris: Yeah, yeah, a second career. Brad: All right, very good. I think we got enough information for everyone to be educated and understand it a little more. Chris: Yeah, hopefully. I think that's the key. Brad: Very good. Chris: Thanks a lot guys. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

The Triceps are made up of three heads. The long head attaches to the shoulder blade on the infraglenoid tubercle. The lateral head attaches to the lateral and posterior surfaces of the proximal humerus. The medial head attaches to distal two-thirds of the medial and posterior surface of the humerus. All three run together and attach to the olecranon process (bump on your elbow). Both run together and attach to the forearm on the tuberosity of the radius. The main movement is the extension of the elbow. But the muscle also extends and adducts the shoulder. Two Tests Which May Indicate the Pain is Coming from your Neck: Neck Compression Test: Spurling Test: Extend your head back. With your neck extended, tilt your head to the painful side. Hold this position for 30 seconds. If you feel neck pain, pain, or tingling that radiates down the arm, or numbness, then you have tested positive. Radial nerve tension test: Test unaffected arm first. With the arm at your side, take your hand and twist so it is facing palm out. Flip your hand up so the palm is now facing the ceiling. Side bend neck away from hand. Repeat the same test on the painful arm. If you cannot obtain the described position without increased pain and/or symptoms you have tested positive for the radial arm tension test. A triceps strain occurs when the bicep muscle becomes stretched beyond its limit. This excessive stretching may cause a “muscle strain”, a “muscle tear’, or a “muscle pull”. All three descriptions refer to damage to a muscle or its attaching tendon. The injury to the hip muscle or muscle tendon may be graded according to the severity: • 1 st degree - the hip muscle may be sore but there was only mild overstretching of a muscle. • 2 nd degree - mild swelling and bruising but possible severe muscle pain and tenderness. Moderate over-stretching of the bicep muscle with some tearing of the fibers. • 3 rd degree - severe pain and swelling. Muscle or tendon is torn all the way through. The muscle is either ripped into two separate pieces or sheared away from the tendon. This can cause a complete loss of function and may require surgery. Anyone can strain their triceps belly muscles from just daily tasks, but a tear can also occur from pushing activities such as bench press. A tear could also occur from a fall onto an outstretched arm. Less common a strain or tear can occur at the tendon which is the thick band that attaches the triceps muscle to the elbow bone (olecranon process). Both can happen because of age-related wear and tear. And finally, the injury could happen in the muscle belly itself. You have a higher chance of experiencing a triceps strain if: A. You have had a prior triceps strain or tear. B. You have muscle tightness. C. You fail to warm up before an athletic or work event. D. You attempt to push too much weight with exercise or work. Signs and Symptoms of a Triceps Strain or Tear 1. Swelling and bruising (discoloration) 2. Muscle spasms 3. Previous Triceps strain or tear 4. You can feel point tenderness in the muscle. 5. Might feel an indentation or bump in the muscle. 6. Pain when that muscle is used. 7. Weakness when that muscle is used. 8. Hearing a “pop” sound when the muscle or tendon was injured. 9. Feel for point tenderness over the muscle belly (tenderness may indicate a muscle tear). X-rays may be ordered to make certain a bone fracture did not occur with a strain or tear. Treatment 1. If tender, perform cross fiber friction massage over insertion tendon (on the elbow bone). 2. Try massage (use finger over finger, or side to side). Be aggressive over the tender area and deep. If tender massage for 30-60 seconds and assess. If plateauing or decreasing you may continue. If increasing you must stop and try another day. 3. In all cases you should also massage the nontender areas of the triceps muscle belly. 4. If able to tolerate the cross-fiber massage may do up to 20 minutes or 5 minutes (4x a day) every other day. Use of massage gun - ball or pointer attachment. This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), T2 Massage Gun, EM-19 Massage Gun, Q2 Mini Massage Gun (US), X6 PRO Massage Gun with Stainless Steel Head Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in September of 2018. For the original video go to https://youtu.be/xx3Jtmy4F-M Bob: This is the number one thing you should do after a corticosteroid injection. Brad: Right. And where are we going to get this injection? Bob: Well, from a doctor or you don't do this on the street route is same to get from your neighbor. Brad: Right? So, you may get it in your back, your knee, or your hip. Bob: Oh, I see. Is that what you're talking about? Yeah. It doesn’t matter where the location is. If you're having some pain and inflammation what we're going to recommend is that you first try the conservative treatment. Brad: Therapy. Bob: Yeah. Brad: Yep. Some things recommended by us or another therapist. Bob: But there was a guideline put out by the Royal Academy of GPs. That's general practitioners in Australia. They recommended that this is something you should try or could try, a corticosteroid injection, again generally after you've tried other things. Brad: Right. And this is oftentimes done with people who have severe arthritis in the hip or the knee. Bob: Or, you could have a meniscus problem. I could be for the shoulder; it is just anywhere. It's amazing. What you're trying to do is break the pain cycle. Because quite often what happens, a joint will hurt and so you don't move it and then you brace it, and then it starts hurting even more because joints want to move. Brad: Right, that's how they get their nutrition through movement. They get fluid coming in. Bob: The synovial fluid gets propagated. It helps with everything. If you just took your arm right now and held it up for a long period of time, it would start to hurt. Brad: Right. And then it would hurt when you initially moved it. But once you get it moving then it gets back into that movement cycle. Life is good again. Bob: So the number one thing you need to do after a corticosteroid injection is you want to take advantage of it and you want to start moving that joint. No matter where it is, let's say the shoulder. We're going to go over all the different joints and what they should do. The other recommendation we're going to make is if you have an injection into your back, I recommend that you get the image-guided lumbar epidural corticosteroid injection. Brad: Right. And you know, you can ask your doctor about it. It’s where they actually can see the needle and guide the needle. Bob: Yeah, they use X-ray or CT scan. Brad: Right. Bob: Brad and I are old enough that we remember the days where you come in and they go, “ah, your back is hurting. I'll give you an injection.” And they almost never worked. Brad: Yeah. You really need to get the fluid of the injection to the correct area. And the doctor who does it, they know what they're doing. Bob: They know what they're doing. I just see so much better results now, Brad, with these. I've seen it where someone can buy another year or two of pain relief. When they get an injection. And so, let's start off at the shoulder. The shoulder is kind of a good one because quite often I don't even know that you need image guiding because they know they can get it right in the shoulder joint itself. Brad: Right, and it may depend on the person, how their muscles are, or what kind of tissue there is around it. Bob: So, we're not going to go into detail but we're going to show you this one exercise that you want to do after the shoulder has been injected. You want to go ahead and do the Codman’s or pendulum exercise. Brad: Right. This is a simple general exercise. You just lean over and just let the gravity flex that arm forward here and then get your body moving, get your arm to move. You can go forward and backward, right to left with it. You can make circles. And it's a real gentle relaxed way to get the joint moving right after something like that. It's very common after surgeries and injuries as well. Bob: Exactly. It's just a great starting point. So, then we're going to go to the hip or the knee, or both even. But if you get those injected, you're going to want to start getting some movement. A good one to do is just plain old walking. If you're still getting pain with that, we're going to recommend a bike or what we have here is the elliptical that we use in our therapy department. That's why it's so beat up. I mean, we probably have had this one for three, or four years. Brad: Right. And it's used daily every time there's someone in here, typically they're using this for a part of their treatment. Bob: Yeah. And we like these. The disadvantage is they're heavy. Brad made a stand for this one because usually, you must put it up on a two-by-four or something like that. Brad: Usually, you want three inches because these are actually made for standing, is what they originally made for, but we found that, if you can sit down and you can pedal with it, you get really good ankle, knee, and hip range of motion without the weight bearing pressures, which is, in this case, what you want. Bob: So it's the InMotion E1000, again we've bought a ton of these because we use them all the time, and they move very smoothly. Again, the only disadvantage is they're very heavy. You're not going to move it around the house very easily but look how smooth this works. You can just easily start getting some knee motion and hip motion. Brad: Well, even the ankle, we got the knee, and we got the hip and you can vary how much you flex as far as how close you move the chair to it or if you slide the chair back. If you're in a wheelchair this is an excellent way to get your legs and hips moving if you're unable to walk and you are in a wheelchair for that reason. Bob: And then we're also going to have to put out the knee glide. Brad and I invented this, by the way, created it. The advantage of the knee glide is it is so lightweight. Brad: Right. It's lightweight and it's just versatile. You can take it with you. We use these all the time after knee replacements, ACL, and meniscus injuries, and it works really well. Bob: My wife, yeah, hurt her knee. We had her using this and she didn't like how much it stressed her ankle when it was flat, so she would flip it up on the handle. Brad: That little stilt will get an incline. Bob: And so now this was a lot easier on her ankles then. Then she could easily work the knee. Brad: Right. And it does make the quadriceps work a little bit more that way. If you want to flip it the other way, it emphasizes the hamstring effort and strength. And it's amazing, that doesn't look like much but when you do that you can really feel the hamstring, particularly if you've got an injury or something, you'll definitely feel a hamstring working harder. Bob: And then eventually you can add a little weight to it even, you can put an ankle cuff around it. Brad: Yup, and then you can easily just put it in the closet, hang it up and it weighs all of 2.96 pounds or something. Bob: Well, I always like to show how I can do a curl with it, Brad, I can do one finger curl. Look at that. Brad: Yeah. You could do one-finger curls and get that index finger going. Bob: All right, next thing We're going to talk about the back itself. Let's say you get a corticosteroid injection into your back. You want to start walking. I mean, that's, that's the number one thing but there's a lot of different exercises you can do laying down. Do you want to show the rotations and the knee to chest, Brad? And then I'll, I can show extension. Brad: Excellent. Yeah. Sometimes walking may not be an option. Maybe it's wintertime. You cannot get outside. You live in an apartment, but you can still get some good range of motion. Particularly, I have people before they get out of bed in the morning. Bob: Yeah, absolutely. This is a great one to do right before you get up for a lot of people. Even if you haven't had an injection, this is a great one to do. Brad: Yeah. Both knees up, feet together, knees together, gently and I always say, just pretend your legs are like a windshield wiper on a car going right to left. this is just breathing relaxed, nothing stressful on this. If it hurts in one direction, don't go that way. Just go in the direction that doesn't hurt so much. Work in a pain-free range of motion and gently as you work it more. Particularly after the injection, you should see that range of motion improving. And then the next one you bring a knee to your chest. You might just start out with one knee, and you can use your hands obviously to help that knee. I like 10 repetitions on all these exercises. If one's going well check the other one and do 10 repetitions. If it's feeling good, then it's nice to go to both knees and work that. That flexes the back even a little bit more, helping those facet joints get some movement and get that mobility moving again. Bob: Again, it should all be pain-free. If it bothers you to lift both at the same time, don't do that one. It could hurt your back, to do both. Brad: Yup. Sometimes that is uncomfortable. Pretty common. Bob: So, I'll do the extension, Brad. For a lot of people, especially if you don't have spinal stenosis or spondylolisthesis like Brad does, the movement will go on into your back to try to get some extension because this is a movement that a lot of you are going to be lacking. So, you put your hands below your shoulders and I'm pressing up and we've emphasized this one a lot. I do this one, at least three sets of 10 a day. At least. Brad: Now Bob's pretty old. And even though he's like an old man. I'm just kidding, Bob. He's only 50-something. Look at the range of motion in his back. This is incredible. Bob: I can go way up high. Brad: That's really good. Bob: Yeah. And a lot of people, what happens is, their pelvis starts coming off the bed because they don't have enough mobility. You want to work again in the pain-free zone. You want to make sure that you can eventually over time, get further and further. And a lot of times your pain levels will coincide and go down at the same time. So where are we at, Brad? Oh, in the neck. We've just got the neck left now. I don't know how often they give shots in the neck. I guess they do, don't they? Brad: Yeah. It, it's not as common as the other places. As far as my experience. Bob: So, with the neck, you're just going to make sure you have good posture, and just like the back, you're going to start some rotations. Brad: Some people, you think rotation in the neck and they're moving their shoulders. You're going to stabilize or think those shoulders are grabbed by two big steel claws. That's what I tell my patients. And it's holding you there gently. Bob: You tell your patients a lot of weird things. Brad: Well, you know, those things stick in their heads, Bob. Bob: I agree. Brad: They like it. They smile, they laugh. Bob: So yeah. Rotations and you could even do side bending too if you want to throw that one in there, and extension probably. Right. Brad: Yep. And, and all these you're going to do them in that pain-free range. Maybe a little stretch pain a little bit. But if there's some sharp pain, for whatever reason, that's a red flag. Bob: I always tell my patients to bump up against the pain. Brad: Oh, bump into it. Yeah. Bob: But don't go into it, just bump into it. I think we've talked enough now. Once again, we can fix just about anything but-- Brad: A broken heart. Bob: There you go. Brad: But we're working on it, say no more. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2022. For the original video go to https://www.youtube.com/watch?v=rPFpg4Cdv1E&t=266s Bob: Today, we're going to talk about low back pain. You know, there's really a lot of information out there. So we're trying to narrow it down to what we think you really need to know. So we think you need to know, are you a flexor, extender, shaker, or compressor? You might also be a combination of these. Brad: Right, right. Bob: So we're going to go over how you can determine what you are. This will help determine what exercises you should do. And it will also tell you what things you should avoid. Because they both could be harmful to you. Brad: Before we go further I think it's important to note that we're getting a lot of this information based on Stuart McGill. Bob: Stuart McGill and Robin McKenzie, a little smattering from each other Brad: Yeah they kind of piggyback off each other a little bit. They all work together with time. Bob: So the quick story: I, my wife, and I got a California king-size mattress from SleepOvation, and you know how they come, they come in a box and the box weighed over like north of 110 pounds. So pretty heavy. Brad: You have to be careful Bob. Bob: Right, so it's delivered to my door. I struggled to get it inside. I'm like, I’m not going to have my wife help me with this. She's going to hurt her back. Brad: Right? Yeah. You're a man. All six foot six. You should be able to tackle that. Bob: That's right. So I slid it up the stairs. Very difficult. I get to the top. I opened it up and you know how it expands. Once it expands, it's very difficult to move. Brad: Why didn't you put it in the bedroom and expand it? Bob: I did. Brad: Oh, okay. Bob: But I still had to slide it over onto the frame. So I started sliding it over on the frame. The last push, zap! I got a zinger. I mean, I couldn't even stand up straight. All I could do was lie on the bed. So I lay on the bed. And while I'm there, I'm thinking I have to host golf next weekend with 12 guys who are coming and I'm not going to be able to golf. There's no way. I couldn't even walk. Brad: So you're thinking about how this is going to affect your life. Bob: So I'm thinking about my life. I'm not going to be able to help my wife with chores. But you realize how it does affect your life. Tremendously. So Brad is on the other end of this. Brad: So you're saying you were actually bent over when the event happened? Bob: Yes. That's what caused my pain, flexion. Brad: So flexion or bending started it and irritates it. Bob: Right. So do you want to tell your story about being an extender?. Brad: Well, in other words, with my back, I have spondylolisthesis, although if you have stenosis or you may be an extender without those two diagnoses. You'll know if you're an extender if bending backward irritates your pain. Bob: We'll show this; we'll have you try that. But I mean, did you go through a period when you were dealing with this, I know you couldn't run for a while. Brad: Running, walking, I could not walk, which is a form of extension, not excessive, but a mild extension, I couldn't walk for more than three-fourths of a mile without getting sciatica down my right leg. And that was for about a year. Bob: Brad's a very active guy. And so this was greatly affecting him. Brad: But I could bike! I could bend over on my bike. So that didn't bother me, but things like laying on my stomach where my back went backward, standing for any period of time, or going shopping with my wife. Bob: Any overhead work, right? Brad: Working overhead I’d get a backache or anything where overhead, standing for a long period of time or walking, always irritated my back and I got sciatica with it. Bob: But did you start to realize your mortality, like I can't do these things? Brad: Yeah, I was actually considering going to see the surgeon, but then I figured something out, luckily. We'll get to that. Bob: We'll get to that. So let's talk about flexor first- flexor is probably the most common by far, right? Wouldn't you agree? Brad: I think so. Bob: So, I am a flexor and here are some of the common questions. If you answer yes. You may be a flexor. Are you generally worse when you're sitting? Like when you sit for a prolonged period and when you get up from sitting. Brad: Yeah, but then after you get moving, it settles down. Bob: Right, it feels better. Are you worse after prolonged bending like vacuuming or ironing or digging or gardening? Brad: Exactly Shoveling. Bob: Is it better with walking? Usually, it hurts at first, but once you get going, it feels better with the walking. It was funny for me, it actually felt better with running too. And I ended up being able to golf the next week because I went back to running the next day and it just seemed like it worked its way out. And generally, it's going to feel better when lying down. It might be worse at first, but once you get straightened out and things calm down, it feels better. Brad: And oftentimes, prone on your stomach feels good in that position. Bob: Yeah, a simple test is you could do repeated flexion. You could do it from a seated position or standing position. Or you could even hold for a prolonged period of time. Brad: So you might be like this and if it starts to irritate it. It might irritate it right away or it takes 10 or 15, 30 seconds, all of a sudden, whoa. Bob: You may be a flexor. Okay. If you're an extender, it could be a number of things like we talked about spondylolisthesis or arthritis or spinal stenosis. If it's spinal stenosis, usually you're over age 50. Brad: Unless you have spondylolisthesis too, then because of the shift of the vertebrae, you may have some stenosis. Bob: You got it younger than that, right? Brad: Yeah. I'd have to think about it, but I was in my forties. Bob: You got injured, and you remember the injury. So is the pain worse with the back extended for a while? So you want to show what the extension means, Brad? Brad: This is extension. But even just standing up is extension. If you're standing and pain, pain, pain, and you sit, and immediately the pain goes away you're probably an extender. Bob: It's also worse with walking, right? Brad: Now it isn't, but it was at one time. Bob: Generally, for people they call it shopping cart syndrome where they actually lean on a shopping cart and it feels a lot better. And as soon as they sit down it gets better. Brad: It doesn't have to be a shopping cart. You could lean forward in your car. Bob: Sure. One test you can do is you can actually lean back and to one side and you can even push down through the shoulders a little bit, just to see, add a little bit more compression to it. Now the other way. Do any of these bother you, Brad? Brad: No. Bob: So your pain tends to be bad with repeated extension Brad: Or static for a length of time. I know if I stood bent back for about three minutes, I would really want to sit down. Bob: Does it make it worse if you put your arms overhead and lean back? Brad: Yeah. If I do things over ahead, that's a good way for me to get a backache that will last for days. Bob: Right. So again, the spinal stenosis, spondylolisthesis, all those things will make it worse. Are you a shaker? This is what makes a shaker. So if you can take a look we have three discs here. Now one of these discs is a bulging disc and it's weakened. It's lost some of its stiffness. The top and bottom discs have normal stiffness. Now watch when I start turning. Brad: So we're looking at the middle disc. The blue lines are just references. So we're looking at the low back here. We're looking right about at the belt line level. Bob: Yeah and there's too much movement at one segment. So your back is unstable. So you're going to feel that, these are the questions that you're going to ask yourself. One, does your back have a feeling like it's giving way, or does it spasm on you? Brad: It's like you move a certain, and all of a sudden it hits you. It kind of takes your breath away, but it's short-lived oftentimes, and you can kind of work a way out. Bob: Right, you might feel some catching or locking while you're bending or twisting your back. A sign that’s really normal is twisting in bed. Brad: Rolling in bed, side to side and you go ouch! So you really take your time. Bob: Yeah, exactly. That's an unstable back, or going from sitting to standing, could be another one. So, all right. The final one is compression. Again, you can have a combination of these. So with compression, you don't like it when your spine is compressed together. And that happens when you're lifting something like weightlifters. Brad's going to show a test for that right now. While you're in a chair, you can first bend forward, straight, and then bend back and see how it is. No pain. Brad: Feels okay. Then I'm going to bend forward. I'm going to grab the chair wherever you can get ahold of it, and then I'm going to pull down and actually compress the spine in a flexed position and see how it responds. Does it feel good? Does it feel worse? Does it create pain? And if it creates pain with that, then you know, that's a compression issue in a flexed position. Brad: Then you can try good tall posture, grab again, pull down, see how it feels, and then extend backward and then pull down and see how it feels, and then note which one irritates it and if two don't irritate it. I would say the majority of people may experience pain with flexion and compression. Bob: Right. Right. So another way to do this really quickly is if you have a weight like this, it's an 8-pound weight, and you keep it close and you bend, there's no problem. But if you put it out in front of you, that puts a lot more stress on your back. And this is the one that actually hurt my son's back. He extended and put the arm out like that. Brad: Now should that test be done seated or standing? Bob: Either way. Brad: But either way, you probably want to have a firm chair, not on a couch or something like that. Bob: Probably standing would be best. So now once you determine what you are, let's talk about the flexor first. So, you're going to avoid bending forward, you're going to keep the back straight when you bend forward. Brad: So, you're probably going to bend at the knees as opposed to bending at the waist, but you're going to keep the back straight one way or another. Bob: But the way you really round out, become a C, that's where you're really troublesome. Brad: You’ll feel it. Bob: So, you're going to learn to keep your back straight. We're going to have a series of videos on what to do when you're a flexor or extender, I'm just going to touch upon it slightly here. If you're an extender, you obviously want to avoid extension. That’s going to fire it back up. You want to stretch your hip flexors, believe it or not because if your hip flexors are tight, they'll extend your back. Brad: Sure. Bob: So if you're a shaker, you really want to work on your core strength. Brad: Right. Because it's like a back belt that's going to stabilize and keep that spine from moving around and giving you that sharp pain. So something you really have to think about is the position of your pelvis and your back and tighten things up and get to the point where you don't have to think about it. You just do it automatically. Bob: I think a really good example, Brad, is the people that turn in bed and it hurts. I had a patient like this. It worked just beautifully. He's like, I can't get out of bed without it really hurting. So all we had him do is tighten up as abdomen and then turn out of bed and he had no pain then. Brad: So he had his own back belt basically built in and he just used it. Bob: So that's all you have to do is start by tightening, you can put your fingers into your sides to see if you're tightening the abdomen. And if you're a compressor, you want to make sure your back is in neutral. It's not flexed. It's not extended. And you want to be in neutral and you want to tighten your abdomen too. Brad: You probably want to avoid lifting heavy things. Bob: Yes. Brad: Even light things until things get better. Bob: Yes. You know, unfortunately, some young guys often hurt their back because they use too much weight and they actually damage the end plates on the vertebrae. That's getting a little tech technical, but you know, that's what happens. Brad: You know; I've got my niece. She's about 35, an aggressive worker-outer. She's into CrossFit. I'll get in trouble here. That is an aggressive group. She's 35 and she just had back surgery. Bob: Oh, she did. Brad: Yeah. And it sounds like the surgery went well, but you know, I could talk to her until I'm blue in the face and say don't do this and that but. Bob: The thing is, with CrossFit, if you have a good instructor, they're going to teach you the right way to do things. Brad: And they're good at max everything out, because that's the mindset. Bob: Yeah, I know. Brad: I know, because I'm one of those people. I think I'd be in Crossfit if I was 25. For sure. Bob: So I like CrossFit though. I mean, I think it does some good things, but yeah, they go a little crazy. Brad: Pretty damn crazy. Bob: All right. Those are it. Those are the four things and we will have some future videos. We'll talk about if you're a flexor, and what you should do in great detail. Brad: Sure. You betcha. Bob: All right. Brad and I can fix just about anything. Brad: Except for.. Bob: A broken heart. Brad: And we're, well, we'll work on that. Bob: Thanks for watching. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

In this video, we are referring to the treatment of a specific type of headache that is caused by an issue with your neck. Cervicogenic headaches are different because they are caused by problems with the nerves, bones, or muscles in your neck. Although you may feel pain in your head, it does not start there. Instead, the pain you feel is referred pain from the neck. Self-Massage Self-Massage with ball or fingers. Using your fingers self-massage, the neck at the spot where the neck attaches to the skull. You should try circular motions and splaying. Remember the rule of thumb is never massage an artery. So, we are not going to perform any massage with the therapy cane or massage gun which could press into the vertebral artery. In addition to the massage, you may try these three exercises: 1. Chin Tucks: These should be performed throughout the day (ideally 6-8x) 2. Chin Tucks with overpressure (hand or towel) (sustained 30-45 sec and if no increased pain can increase to 2 minutes) 3. Rotation with a towel. Place the “selvage” (tightly woven edge of the towel) against your neck at the position where the neck meets the skull (about C1). Grab the two ends of the towel with your hands. You will be working on rotating in the restricted or painful direction. a. Rotating to the right. After you grab the two ends of your towel, your hands will switch with each other. After switching, your left hand should pull straight down on its towel end. The right hand will pull the opposite towel end across the left side of your face up near your eyes. This movement should be pain-free or do not continue. If pain-free, perform the rotation toward the painful side in 5-10 repetitions. Repeat 6-8 times spread out through the day. Do not let the left shoulder move forward during the rotation. b. Rotating to the left. After you grab the two ends of your towel, your hands will switch with each other. After switching, your right hand should pull straight down on its towel end. The left hand will pull the opposite towel end across the left side of your face up near your eyes. This movement should be pain-free or do not continue. If pain-free, perform the rotation toward the painful side in 5-10 repetitions. Repeat 6-8 times spread out through the day. Do not let the right shoulder move forward during the rotation. 4. Flexion with gentle overpressure (use both hands to grab the upper back portion of your head and gently stretch forward for just a few seconds - repeat x 3). 5. Flexion with fist under the chin. Place your left curled fist under your chin - thumb side up. Use your right hand to grab the upper back portion of your head and gently pull forward. Hold for 10 seconds and repeat 3 times. This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), Q2 Mini Massage Gun (US), T2 Massage Gun X6 PRO Massage Gun with Stainless Steel Head, EM-19 Massage Gun Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2022. For the original video go to https://youtu.be/2ca0sWPfibg Brad: Bob, I have a friend, who brags about how he lies down at night, and within seconds after his head hits the pillow, he’s out like a light until morning. It kind of makes you sick sometimes, doesn’t it? Bob: That’s a real talent. Brad: We’ve done several videos on sleeping, and how to get to sleep fast and this is going to go through a culmination of some of our favorites to help you get to sleep faster. So, hold on, and we’re going to be sleeping soon. If you have watched our videos you know if you watch enough of our videos, you’ll fall asleep quickly. No seriously, we have five things we’re going to go through. The first two are preliminaries that are important for always sleeping. We’ll go through those and then the last three are very specific ones that can help you and they’ve helped us out a lot. Number one, a lot of people know this, but some don’t. You need to eliminate the use of blue light. It comes from cell phones, tv, and LEDs. You need to eliminate that. Bob: At least lessen them. Dim the lights. Brad: Reduce that light as much as possible. Bob: You could wear glasses that filter that out. I have some. I also have clip-on ones. Bob: Oh yeah, they look kind of red or orange. I don't have glasses so I can't clip them on. I don’t have problems. I don’t watch too much television except sometimes in the evening so I must watch myself. Number two is the temperature in the room in which you’re sleeping. 68 degrees, is that kind of the tipping point? Bob: I think at least 68, lower if possible. Brad: Sometimes colder, too warm is no good. Then, if you’re going to have a light in the room, make sure it’s a red light. It’s going to be helpful. Even in your clock, if you have a clock in your room. I have a red light. Next, white noise. I know that helps me. Bob: I have a fan. Brad: We have a fan going all the time and it works out well. It gets some air moving as well. The other one that works well for me is tea. Not just any tea because you don’t have caffeine in it, it’s chamomile. Bob: Right. I’ve heard that many times before. Brad: It does have some sleeping quality. Drink that before you go to bed. Now we’re going to go onto the big hitters that you must really do something with, so hold on. The big “T”, tension. Tension and anxiety are one of the big things that are going to ruin your health and it’s certainly going to take the sleep away from you. Bob: Things are tight, and you don’t even know it. Brad: Oftentimes, it’s from the neck up. In my case, I know my temples get tight. I’ll do a self-massage with my finger and hands. Bob: Mine is the skull. Brad: Bob’s skull gets tense for obvious reasons. Bob: Big brain. Brad: Working on that brain so hard. One thing I find is if you do have tight temples when you rub, you get in deep. If it feels good, you know they’re tight. I go back over the ears. Bob: You can use fingertips, or you can use knuckles. Brad: I use the palms sometimes and I get in and do some rotation. It gets that fascia just above it, sometimes not even the muscle but that fascia that’s around it. What do you do on the top of your head? Bob: Just fingertips. Brad: A nice area is also the jaw. Bob: Right, a lot of tension there. That masseter gets tight. Brad: That one, it seems to me, is a good one for my knuckles. Last, but not least, where the neck muscles connect to the occipital at the back of the neck. You can do the circles, or splaying seems to do a good job where you get ahold of the skin with your fingertips, and you pull apart. You’ll find which area you need to work on. You probably aren’t going to work all of them. Spend a minute or two on it and get that relaxation started before sleep. Bob: Brad, do you want to mention this? Brad: Ah, yes. Now, you take one of your socks and put some rice in it. This costs you very little. I have about half a pound of rice or something in there, put it in the microwave for about 30-45 seconds depending on your microwave after you do the massage. Then lie, on your back, or if you’re in a recliner, and it’s amazing, it feels like moist heat, and lay it over your eyes. It covers the light, feels comfortable, and conforms perfectly to your nose and face. Bob: And it smells good. Brad: Oh yes, Bob. It’ll last a long time. It’s amazing what that does and how good it feels on your face. Okay, number four, this is just an evolution of number three. We want to get the room dark, as we mentioned with the sock. To add the massage, maybe some music, all these things can help. Obviously don’t play heavy metal, we’re talking about music that’s relaxing. Even just the sound of the ocean, whatever you like, you can get it on your little phone and all that stuff. Bob, you can show me what you do, and I'll show you what I do. Bob: This is the eye mask. I don’t use it when I go to bed. If I wake up at like four in the morning, it starts to get light out, I'll put the mask on and it blocks out the light and it’s comforting, and I fall right back asleep. Brad: People that work night shifts must sleep during the day, that can be very helpful. Bob: These are very comfortable. Brad: They were not very expensive either. If you want to go to the deluxe that does massage, music, and everything for you, you can use an eye massager. Now, I thought these were a big joke. I tried it and I’ve become a believer. I’ve had friends who use it and are very happy with it. What this does is, put it on. It blocks the light, hits the button and it’ll start massaging your temples and that’s what really sold me. It heats up across your eyes. It has a frequency that’s not the same, so it changes all the time, and a very relaxing tone is playing. There are five different options, you can hook it up to your cellphone and Bluetooth it. It’s a wonderful device. Bob: You know what I found out that it was funny, Brad, you tried it in the afternoon, and you kept falling asleep. Brad: Yeah. It goes for 15 minutes, and it turns off automatically. You do have to charge it every fourth or fifth use. Which is no problem, you just plug it in and there it goes. Now, we do have one more and this is the one where I get up in the middle of the night. Bob: This is the atomic bomb. Brad: Yeah, this is one that puts me to sleep when I have my mind rolling and it’s three o’clock in the morning and I want to get to bed, and I don’t want to use the eye massager and irritate my wife. In the middle of the night, if I wake up for whatever reason and I can’t get back to sleep because I have my mind on something. Bob’s been irritating me, my wife’s been irritating me, you know how it goes. You start ruminating and you can’t get to sleep! So, I’ll take my hoodie and put my hood over my head and I snuggle back into the corner of the couch, either on my side or on my back. If I'm on my back, I have two pillows and put them under my knees. I’m already starting to feel the calmness. If you have your heat pack, just lay it over your eyes or use the eye massager. I’ll cuddle up and life becomes very good. Bob: It's like you're back in the womb. Brad: Yeah, very comfortable feeling. Goodnight, all! I’m sure one of these is going to help you fall asleep when you need to most and feel grateful. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

Just what is strength training? Strength training is the process of building muscle and its power through resistance training. Building muscle can help your body look better, perform better, and feel better. In addition, strong muscles can make exercise easier, while weaker muscle has a higher metabolic cost and is less efficient at using the energy you take in to get you moving. In particular, strength training will also increase your metabolism, so you burn more calories and fat as you exercise. Strength training is not just for those who want to be the strongest person around, or even the biggest and the baddest. It is also a way to build power and strength into your body while making it leaner and more ripped. Having a bigger and stronger body is more than just looking good. It's something someone can experience physical, mental, and social benefits from. In addition, building muscle mass has been shown to lower the risk of developing chronic diseases such as heart disease, diabetes, and some cancers. 7 Essential exercises for building power and strength If you're looking for an exercise that will really challenge your body, perform these seven exercises regularly. 1. Barbell Clean and Press The Barbell Clean and Press is a great exercise to strengthen your upper body. It's also a great way to build strength and power when performing the lift in a front squat position. The Barbell Clean and Press is an advanced Olympic weightlifting exercise that requires excellent core stability, strength, and flexibility. For example, you must have solid hip flexor flexibility to dip your knees without losing the ability to squat down deep enough to get under the bar for the lift. You'll also need good shoulder flexibility because when you press overhead with your elbows wide apart, your shoulders must move forward quickly and slightly at the top of the lift. For this powerlifting exercise, you'll use a loaded barbell on the floor to lift it overhead with an overhand grip. To perform this lift correctly, you'll drive through your heels to lift the barbell up to your chest while keeping your core tight. Then dip your knees as you press up through them, driving through your hands to catch underneath the barbell before standing up tall with weight in the front rack position. 2. Bulgarian Split Squat The Bulgarian split squat is a full-body exercise that targets the glutes, hamstrings, and quads. This full-body exercise helps build muscle strength, power, and explosiveness. It also targets your core muscles, which are extremely important in injury prevention. The Bulgarian split squat can help improve your balance and core strength. This is a great move if you're an athlete or want to stay healthy! To do it: -Stand with your back against a bench or wall with the heels on top of the bench and feet under your hips. · Lower yourself slowly by bending at the knees until they are below parallel to the ground. · Push yourself back up to starting position by extending your knees and hips as you stand tall. · It's important to keep your back straight and maintain a slight arch in your lower back. · If you feel any pain in the knee, stop immediately and consult a doctor.). 3. Goblet Squat Goblet squats are an excellent exercise for building strength and power. They challenge you to use your legs, core, and upper body in unison to lift more weight than you would normally be able to do. You should perform this exercise with a barbell across your shoulders—the same way Olympic lifters do when they squat heavy weights! If you don't have access to one, use dumbbells instead; simply hold them in each hand at shoulder height and walk forward until they're directly over your toes (or wherever else feels comfortable). Then bend down until there is no further bend, in which case: yes! You've done it right! Now stand straight up with good form so that all your weight rests on those heels instead of being supported by other parts of our bodies (i.e., us). 4. Deadlift The deadlift is a compound exercise that targets the entire backside of the body, including the hamstrings, glutes, and lower back. It's a great way to build strength in these areas as well as build upper-body power. To do a deadlift: Stand with feet shoulder-width apart or slightly wider if you have shorter legs; grab both ends of barbell or dumbbells (or trap bar) with hands about 6 inches apart from each other; keep core tight throughout the movement; pull the bar up until hips are fully extended; pause briefly at top position before returning it to the floor by bending knees and hips slightly forward while keeping upper body motionless (don't lean over). 5. Sumo Deadlift The sumo deadlift is very similar to the conventional deadlift. The main difference between the conventional and sumo deadlift is the position of the legs and arms. In a sumo deadlift, your feet are wider than your hands. How wide it will actually depend on your height. Sumo deadlifts are a great way to build strength in your hamstrings and glutes. They'll also help you build strength in your lower back, quadriceps, and other major muscle groups. These exercises are the epitome of compound movements that work on multiple muscles at once—they require more than one joint to be activated during each rep (i.e., you have to bend at the knees as well as straighten from standing), which increases their effectiveness at building overall muscle size.* 6. Trap Bar Deadlift Trap bar deadlift is one of the best exercises for building power, strength, and athletic ability. It's also great for your lower back health because it helps you strengthen the spinal erectors, which can help prevent injury. To do this move safely, use a trap bar instead of dumbbells or kettlebells (if you're using those). In addition, you should keep your back straight as you perform this exercise by keeping it aligned with your rib cage and shoulder blades. Don't let them sag down as they would if someone carried heavy weights over their shoulders! Also, ensure that when taking weight off the floor, both knees stay bent slightly at all times while lifting upwards into position before setting back down again after completing each rep. This keeps blood flowing properly throughout working muscles rather than just being stuck while resting!" 7. Recumbent exercise To do this exercise, you'll need a machine with a seat and leg restraints. You should be lying on your back with your feet flat on the ground so that you're in an extended position (comparable to lying down). You can either use free weights or a recumbent exercise bike to perform this exercise; whichever works best for you will depend on what equipment is available at your gym. When beginning this exercise, it's important not to use too much weight because it could cause too much stress on your lower body muscles and joints. Initially, start by doing fewer repetitions for each set rather than more repetitions per set! Conclusion The exercises in this list build muscle and strength throughout the body. They are compound exercises that work several joints at once, such as squats, deadlifts, and rows. They also engage all your major muscle groups: legs, hips, back, and chest. These moves can be performed with either dumbbells or barbells; however, many people prefer to use free weights for added resistance (especially if you're starting). If you're unsure which one is right for you—or if a friend has recommended something else—try doing some research online first! We hope you've enjoyed learning about these exercises and that they help you build the strength and stamina needed to enjoy your workouts! As always, if you have any questions or comments, please feel free to reach out. We'd love to hear from you!

The Pectoralis Major originates from the sternum and half of your collar bone along with the cartilage of the first 6 or 7 ribs and attaches to a bump on the bone of your shoulder. Its actions include adducting and rotating the arm toward the chest. How to tell if Pectoralis Major is tight: 1. Let arms drop by side. Palms should be facing each other. Not back. 2. Put arm out in T position. Should lie flat on the floor. 3. Put arm out in Y position. Should lie flat on the floor. 4. Clasp fingers behind the neck. Should be able to put elbows on the floor. The Pectoralis Miner originates from the third, fourth, and fifth ribs and attaches to the coracoid process of the shoulder blade. A tight Pectoralis Minor can cause the shoulder blade to rotate out of place and cause subsequent pain in the shoulder or neck. How to tell if Pectoralis Miner is tight: 1. Lie on your back -the back of your shoulder should be flat on the floor. a. If raised – pectoralis minor is tight. (Normal) (Tight Pec Minor) You can use the following: A. Lacrosse Ball B. Massage Gun This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), Q2 Mini Massage Gun (US), T2 Massage Gun X6 PRO Massage Gun with Stainless Steel Head, EM-19 Massage Gun Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in October of 2021. For the original video go to https://www.youtube.com/watch?v=ILW0JKUGfBc Brad: Today, we are extremely happy to have Chris here to compliment and upgrade our show. We've got some very good information that's going to be helpful for you as well as for me personally, about Alzheimer's and we're talking about treatment. Chris: Treatment. Brad: Treatment you can do medically as far as medications that are offered as well as what you can do without medications that can help hopefully slow the disease process down and help out your loved one, or your friend, whoever you may be interested in helping with. So before we go on any further, we need to go to Chris because I'm going to relax a little bit. Chris: Alright, well, I guess we're going to talk about Alzheimer's today and it's more about the treatments. Basically, Alzheimer's is the most common form of dementia worldwide. So we're talking about 60 to 70% of the patients. In the U.S., you're looking at about 5 million patients. Brad: Wait, 60 to 70%? Chris: 60 to 70% of dementia patients have Alzheimer's. Brad: Oh, I see. Chris: Then the next one is Lewy Body, and then there's vascular dementia, temporal frontal, there are several forms of dementia. If we think about it kind of like an umbrella term, but we're going to talk about Alzheimer's because I think it's the most prevalent. Brad: You said there are more women typically have it than men? Chris: Yeah, kind of interesting just from a statistical standpoint, it affects women more than men. So, for women, the ratio is about one in six, which is about 16%, and for men, it's one in 10, which is about 10% of the population may experience that. Again, with Alzheimer's, it takes six years just to get the diagnosis because we have to rule out several different things. It's going to be whether, your medications are causing it, had a head injury, or a mini-stroke. I mean, these are things that we have to be aware of. Brad: And it seems like oftentimes early on, especially memory is the biggest symptom of Alzheimer's, but it can be symptomatic with other things. Chris: Exactly. Brad: So that's why it's hard to define what it is. Chris: When you're busy and you just, you know, where'd I put my keys, I have no idea, why are they in the bread box? It doesn't make sense. Brad: As I mentioned, I literally put my socks in the refrigerator and I don't think it was a symptom of Alzheimer's, it’s because I was thinking about what I was doing at one o'clock in the afternoon and I was trying to get lunch, you know, all that kind of thing. So again, it's not easy to diagnose. Chris: And that's what makes it so tricky for doctors and neurologists to actually diagnose it. Brad: Sure. Chris: So there's a variety of tests that they kind of go through. One of the simpler things that are done, that's inexpensive is the SAGE Test. So the big fancy term, Self Administered Gerocognitive Examination. Brad: So S.A.G.E. Is this something that you could print off right off the internet? Chris: I printed that right off the internet. It's from The Ohio State University. Brad: So I could print this off, I could take this home, and do it with my mother tonight. Chris: Yup, you bet. It takes about 15 minutes and then basically, you can present that to your doctor. Then basically as scientific as you could, probably do it about a year apart or six months apart, so you have an interval to see if there's any decline going on. You don't have to do the same test all the time, although scientifically, it's probably going to be the best. Brad: Sure, because then you can compare historically how things are going. And I just want to say, if you do this, for example, I know my mother, she would have a hard time reading this because of her vision, so I would help her. And some of these questions on here, I would probably have to explain to her a little bit about it so she understood it and that's okay. You can make little notes on the back, so that later on, six months later, you kind of know where you're at. Chris: And sometimes, you can even set this up so that it's part of your appointment. So let's see, you're going to be seeing neurology. You do the test right before you go in or as you go in and then the doctor will grade your results and then they'll get at least a baseline. So, this is something that's inexpensive. It requires just a printer and a pencil and some paper. So it's something that's nice that you can definitely do and it doesn't cost an arm and leg, whereas a PET scan is an expensive test. Brad: Sure. Chris: So, when we come down to it, they're going to do cerebral spinal fluid tests, they're going to do PET scans to see what's happening in the brain. I mean, Alzheimer's is caused, what we think anyway, is by these amyloid proteins and these tangled tau proteins. If you think about our brain, it's a network of nerves and then when we get these damaged tau proteins, it's kind of like if I took a bunch of spaghetti and tried to make order out of it. And those brain signals don't necessarily communicate properly. Brad: So, they get mixed up. Chris: They get mixed up, so you're trying to follow one noodle, and all of a sudden, you're looping all over. It's the same thing with the way that your brain fires. And so what do we do? Well, we can certainly eat well, we can exercise, and try to stabilize sleep, but there are medications that we can try and use. There are not a lot of them out there. So it's a pretty short list. So you have Cholinesterase inhibitors and then you've got the Glutamate Brad: So there are two medications commonly used? Chris: Well the two that I most commonly see in the pharmacies that I work in are going to be donepezil and Memantine. So, they behave differently, but there is also Galantamine and Rivastigmine but well keep it simple. We'll use those two, donepezil and Memantine, because those are the most widely prescribed drugs and sometimes, they're used separately, and sometimes they're used in combination with one another. Brad: And the physician decides? Chris: The physician, yeah. When do you do this? Well, we've found that the earlier you get on these medications, the better, because, again, no cure, like we talked about, but it does put the brakes on. So instead of it coming down sharply, it's going to be a much more gradual thing. And so what does that do? Well, because we know that the average caregiver spends about five hours a day with the patient, it may allow the patient a little more freedom, a little bit more independence. And maybe a time occurs when something miraculous does happen. There are a lot of things in the research pipeline right now that they're discovering, there's a new, very expensive drug that at least it's out on the market, it's very expensive, it has not been proven to work, it's actually got the emergency authorization, kind of like the COVID vaccines, but we're not going to go in that direction. It got out on the market a lot sooner than it normally would. I mean, the ultimate results of this drug are not going to be fully processed until 2030. So it's 2021 right now, so that kind of tells you, that it's a very embryonic process with learning, it's called Aduhelm. Brad: Yeah, because it's so far in the future, can we go into what you mentioned about food and diet? I'm thinking let's look at the diet because I was looking at some of this and as opposed to just good food, let's be more specific like you're going to eliminate or cut down on processed foods. Chris: Sugars. Brad: Sugar is, the big one, get those darn sugars out and yogurt has as much. Chris: Oh, yeah! Brad: You can buy yogurt and it has as much sugar in it as a can of soda, Pepsi, or Coke, whatever. So you really have to read the labels on what you're eating because sugar is in everything. Everything is processed, sugar and a bunch of the fat, the bad fat, trans fat, so boy, get after the food. It doesn't matter, it's going to make the person's body healthier, even if in theory, it doesn't help the mind, it's a good thing. Chris: Yeah, I mean, it's going to do all over it. I mean, really the time for this is probably now. You don't want to wait until you get to that point to just get started with healthy habits. If you're young enough, start today. I mean, really one of the simplest ones that I liked, is the Mediterranean diet, if you Google the Mediterranean diet, it's got a perfect blend of proteins and healthy fats and, nuts and things. Brad: Leafy greens like spinach. Chris: Exactly. So, it's going to give you that type of diet and pretty flavorful food, to be honest with you. Brad: I know I just heard one thing, and I've heard this and read about it in books is, the color of food is important. So you have your berries, your raspberries, blueberries, blackberries, all these berries, and nuts, and you're not going to overeat them. You're going to eat a handful or whatever, and that's enough. Chris: Yup, eat the rainbow. I mean you can have the flavonoids, they're all antioxidants which seem to show, and there are actually quite a few books now that do show that by eating well, does help to slow the progression of the disease. So again, it's going to be healthy for you, whether you have it or not. I mean, if you're talking about one in 10 or one in six, male or female, so not everybody's going to get it, but eating well is still something that we should strive for every day anyways. Brad: It's going to help your heart for sure. Chris: Yup, exactly. And that's actually, when you look at the list of things, cardiovascular disease, and cancer are one and two, Alzheimer’s, on the cause of death, is number six for older adults. So what happens is, again, it progresses from mild to severe, but along the way when we get to those milder stages and probably earlier is when we want to get on those medications. And so whether it's Donepezil or it's Memantine, those are the things that work differently to help brain transmission and the processing of memory. But I will tell you with Donepezil specifically, which is a Cholinesterase inhibitor, so for all you pharmacy nerds out there. It raises the neurotransmitter acetylcholine and as our brain's diminishing capacity, it helps to keep those levels up, to allow them to fire longer, but eventually that reservoir does run dry. So sometimes then they will go to, the Memantine, which works on glutamate, which is a different neurotransmitter, and actually, the brain seems to kick out too much, so what the Memantine does, is it kind of blocks that, so it leaves just the appropriate amount of glutamine in there. Brad: So you're trying to get things balanced in the brain? Chris: You can get so you can connect your thoughts and you can stay in the moment a lot more easily. And so these drugs do have an avenue and they seem to work best right now with current science, in the milder stages. We might find that with more advanced testing, which they're working on that we might see that they may be being prescribed to younger and younger people. We might just take some blood from you Brad, and just say, "yeah, we're going to look at this, and we've got these three genes here that suggest that maybe there's a possibility." Preventatively, maybe they'd do it. So hard to say there's a, there are just burgeoning amounts of research going on day to day, right now. So, it's not that there are a lot of different treatment things. So it's going to be staying well, and in your arena, physical therapy, and what can we do to keep those muscles strong, to keep us walking safely. Brad: And really you don't have to go out and do a 5K, these people are typically older. That's not appropriate anyways, but just some walking, whether you need a walker or a cane to stay safe because of falls, obviously we want to eliminate that risk. Chris: Absolutely. Brad: Memory things. I just want to say, there are some things, if you do have a loved one, they're walking fine, but they may forget how, like where my mother lives, she has issues, it's possible she has Alzheimer's, um, if you forget how to get to the dining room. So, you're going to walk with them multiple times so that hopefully the repetition is going to kick in. The brakes on a walker, the four-wheeled walker, we've done a lot of things in skilled nursing facilities like this, in big letters have a note "REMEMBER TO LOCK YOUR BRAKES" and we would tape this right to the walker, so the person can always see it. That repetition, repetition is one of the things that can help people remember and make them safer. A note that says, "Hang up the phone," you know some of these older people don't have cell phones, like my mother, she's got to have something she can hang up, but she forgets to hang it up and it just beeps and then there's a problem. These are just examples. Again, all these little things that you can do to help slow the process down and keep your loved one safe. Chris: Yeah, it's going to be, getting rid of clutter, keeping things organized, whiteboards and big checkout lists or calendars are an excellent non-drug tool that honestly probably almost more utility than even some of the medications at some points. Brad: How about throw rugs, man, that's a therapist's worst enemy. That's a big thing, get the throw rugs out because they're one of the biggest tripping hazards there is in a house. Chris: Absolutely. Head injury, hip injury, you name it, whatever can happen in a fall. There's a coffee table and you probably want to lose those too. I mean, that's just so that we keep things out of the way. Brad: And that can be a tough one because, like my mother, there are some things we asked her to do, and she says, "nope." Been doing it for all my life this way and I'm not going to change and that's just the way it is so that you have to kind of dance around the best you can. Chris: That is true and then you have to pick your battles, I think is probably the answer, but whatever we can do to de-stress, declutter, help around the house, pay bills, I mean, auto-pay, financial affairs in order, these are all things that are part of the treatment mechanisms. And so those are things that you can certainly do. Brad: Exactly. And just to finish this out, because it is a progressive disease, if they definitely have it, there's going to be a point where you are unable to care for your loved one or friend. There is going to be a time that they're going to have to go to a facility where there's professional care, 24/7 assistance to make it safe for them. And that can be a real battle as well because the person, often times does not want to leave their house. You don't want to make that decision for them. It's a very challenging situation. Chris: It's knowing when to punt is a hard question to ask yourself. Brad: It's a tough thing to work with and hopefully, you won't have to deal with that, but sometimes it goes smooth. I know with my mother, it went smooth, she was happy to go to this place, she's social. This is another big thing, you have to be social. Get that interaction. Isolation can be one of the big problems. Chris: I think it is, yeah, so anything you can do, stimulating: games, talking, walking, anything you can do to stimulate the brain, all good stuff. Brad: That's right. Alright, so these are some ideas, again, look below the video, there'll be some options, books you can read, other sites, and websites that you can go to for further information. So very good, good luck with your friends and family who may have these problems. Thank you. Chris: Thanks, everybody. Additional Resources Alzheimer's Association: https://www.alz.org/https://www.lbda.org/ Family Caregiver Alliance: https://www.caregiver.org/ Dementia Mentors: https://www.dementiamentors.org/ Memory People Facebook Page: https://www.facebook.com/Memory-People-126017237474382/ Alzheimer's & Dementia Alliance of Wisconsin: https://www.alzwisc.org/ Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. 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This article is a transcribed edited summary of a video Bob and Brad recorded in October of 2021. For the original video go to https://www.youtube.com/watch?v=ucQliFuYBtA Brad: Hello folks. I'm Brad Heineck physical therapist. Chris: Hey, I'm Chris, the pharmacist. Brad: Today we are extremely happy to have Chris compliment and upgrade our show with some up-to-date information and just a wealth of knowledge. He really researched this topic and we're going to have some information you'll want to know. This disease we're talking about is... Chris: Alzheimer's Brad: Alzheimer's disease, the seven stages of Alzheimer's, and what we want to look out for. Now, actually, before we get into it, I do want to say that personally, have a real curiosity, and in-depth interest in this topic. For number one, over the last 23 years, I've worked with people with Alzheimer's as well as I'm, sorry to say, I think my mother has symptoms consistent with what we're going to talk about. So it's a personal topic, more personal than when it's a patient. And for people out there, if you have a family member involved with this, it's personal to you as well. So pay attention. Hopefully, you'll learn some things about this. We're going to have another video coming up. That's going to have some treatment things you can do at home with your loved one or a friend who has already been diagnosed, or if you think maybe there's a possibility of it. With no further ado, we want to have a talk and let Chris take over and explain to us what information he's discovered. Chris: Yeah, well, there's a lot of things that come up, dementia is the umbrella word, and then everything else kind of comes underneath it. Of all those dementias, Alzheimer's is worldwide the most prevalent. I mean, you're talking 50 million people worldwide, in the United States about 5 million people. So it's 60% or 70% of the cases of dementia are Alzheimer's in nature. So what Dr. Barry Reisberg has set up is what they call the Global Deterioration Scale. And that's not my words. It's very Debbie Downer, but I do think that what this is going to do is just a series of seven stages that are going to give us examples of what you can be prepared with. And your loved one can be prepared, as you go through this journey together. And it really is a journey. It’s something that, hopefully, we're going to just provide some help and some ideas. And at the end, we're going to post some websites and areas for support so that we can get you the most possible, best effective care mechanisms that we can give because this is an interesting journey, to say the least, but we want to make sure that you're, as in the know, as possible and as comfortable as possible. Brad: Well, I do want to say, like, in my case, I've gone through these seven, I'm looking at these like, my mother is consistent with the first two or three. They don't always go on strict order. Chris: They don't go on a strict order and that's the one thing I was going to touch on, but that's true. Brad: My mother is scheduled to have an evaluation to see if the diagnosis is there or not. And it's weird because last July, they set up the orders and it's two and a half months later, or whatever now, and she still hasn't got the assessment because they're so backed up. They have to go through her chart and make sure that she gets set up with the right evaluation et cetera. I don't understand it all, but it is a lengthy process. And so that may be something you come in contact with. Chris: And that's what makes this so tricky, Brad, because the average diagnosis length of time to actually get the word Alzheimer's stamped on your record, takes six years for a patient. So it's not quick. They have to rule out multiple other things, whether it's medications, other disease states, or whether it was kind of a vascular issue. And, not to totally digress, but you know, Alzheimer's is certainly one thing under that umbrella of dementia. When they look at the brains of 80-year-old people that they've done autopsies on, it's mixed, in most cases. So you might see a vascular component, you might see the Alzheimer’s component, or you could see a Lewy-body component. So these are all different forms of dementia. It's not just a one-size-fits-all, cookie-cutter thing. And again, as you said, you can kind of go through these ranges in these seven steps and they can be kind of mixed. The world health organization uses just three. So they just say it's early, moderate, and severe. Brad: Okay Chris: So that's the simplest way to, and a lot of neurologists subscribed to that too, because at some point you're splitting hairs. I think the only thing with, the seven, the seven units that Dr. Rosenberg has pointed out is it just kind of walks you through each stage a little bit more with some specificity to maybe just allow you to have a little bit of knowledge. So you know that, okay, I see this is what I can do to support. Brad: So. Let's go to stage one. Chris: Yeah. So stage one, you know, it's interesting. It's just what they call normal outward behavior. So let's say I've got the condition myself. You're looking at me and I'm talking right now and you're not going to notice a darn thing, nor is the patient in that case. So it's just normal outward behavior. So it's very, very difficult. It's a silent onset. The damage that occurs, occurs many, many years further. So about the only thing we can draw parallels to is like with Parkinson's and we're not going to go down that path, but it's, just something that we know that somehow the brain just develops and goes along, whether it's nutrients, environmental toxins, or whatever, happens much earlier than probably what we think. Brad: So we're talking. Maybe people are in their fifties or sixties when they don't know. Chris: Well, they don't really know. And that's part of the problem. The research is tenuous. It's challenging. It's not easy. If everybody was, you know, if it was easy, everybody would be doing it but it's just a difficult, difficult subject. So when we move from there, you know, if you were going to get any type of diagnosis that early, it would be by accident. So they would have done a specific test. Maybe you had a fall, you hit your head, and they did a PET scan. Then all of a sudden they see, with these special tracers, they put radioactive tracers in there, go to the areas of the brain, and all of a sudden, "oh my gosh, we see all this", you know, beta-amyloid proteins, and Tal proteins and tangles and all those crazy things. Brad: So that would indicate, Alzheimer's? Chris: Yeah, and even having those in the brain scan doesn’t necessarily indicate that you're going to have Alzheimer's. So it's really early, but maybe. Brad: So what about stage two? Chris: Stage two. So then it's going to be just mild changes. And this is where it's tricky, because unfortunately, we have age-related changes. You know what I mean? The biggest thing with Alzheimer's specifically is age. So as we get over, you know, it's a 65 plus kind of disease state, and the longer we live, you know, it's a chance. And again, it's not everybody. I mean, the statistics are going to be one in six women, and one in ten men. Brad: Is that worldwide or the United States? Chris: No, that's worldwide. Brad: Okay Chris: So I went with a worldwide. The math seems to correlate with the United States as well. So what we could see is, that I can't find my wallet. “Where did I put my glasses? Where are my keys?” And I mean, we're all busy. I have two young kids, man, in my thirties, I was forgetting where I put my keys. So, it's difficult to say, "oh my God, I've got Alzheimer's", you may be progressing towards that, but it's still very, very tricky to see. So, you know, if you're finding that, "oh my gosh, I keep losing stuff all the time, I don't know what's going on", please reach out to your physician. And that's where we want to probably start taking some steps. If you feel like it's a problem, oftentimes people aren't going to notice it till you get to the third stage, which is what they call mild decline. So, that's where people around you are going to start to see, "oh gosh, Chris, keeps putting his keys in the refrigerator", and, you know, just kind of that outlandish stuff. Let's say my wife notices that I didn't balance the checkbook appropriately. Brad: Things that you normally could do. Chris: Things I normally would be very astute with and all of a sudden just start to slide. And it's easy as the patient, to say, "oh wow, I was just really busy or I was watching the football game, I was watching the Packer game, and I was just distracted.” Brad: I have to say, it's funny because I mean, this part of this is funny, but I put my socks in the refrigerator. Chris: Atta boy. Brad: This is a year ago, but I'm not too concerned about it. Chris: You had cold feet. Brad: Yeah, you're right. People are going to get upset with it because we're joking about this, but anyways. I put them in there and I looked all over the house for like 20 minutes. I finally found them in the refrigerator when I went for the milk. But again, I know my mind was very busy with other things I was thinking about the rest of the day So those things make it difficult. Chris: It does. It makes it challenging. And so as a patient, this stage is also tricky because there's self-awareness, I mean, you know what's going on. And at this point, you'll have been encouraged to probably see a doctor or you're already doctoring for this. And depending upon the situation, this could be many years that's been progressing towards this, right. Or digressing, I guess, as the case may be. And so really it's just going to be, so how do you help somebody at this stage? Well, if it's a character, a loved one now maybe help them pay the bills, set up auto-pay. I mean, this is an area where maybe you get your financial affairs in order your estate planning, wills, those types of things. You want to lock things up because this is the stage where, unfortunately, there are unscrupulous people out there you could be taken advantage of. And so right now it's kind of a protection mode. And I mean, you could, you know, and, and also more important than that, right now we want those healthy habits. We want a good diet. We want to remain active. We want to be doing, you know, playing the brain games. I mean, doing the things, and we'll talk about this, in another upcoming video, but what we can do. But you know, this is the area where we really want to start to focus on those things to try and reinforce and prolong. Brad: So yeah, the, like I said, we have the next video on more details on treatment. I know in therapy, we'll have people that are in say a skilled nursing facility getting ready to go home and we'll work with them, OT will, how to balance their checkbook, review it. And a lot of times they don't have Alzheimer's, but it’s because of whatever they went through their surgery, and the medications. They get through it and then they're fine. So again, it's where there's a fine line. Is it Alzheimer's or is it a side effect of a medication? Chris: It could be a medication. It could be a health condition. Maybe we had a small stroke, a TIA head trauma. I mean, there can be a litany of things. So I guess that's the one thing that as you go through this journey with family and loved ones, or even yourself, it's just things to be aware of. But, what else can we do? We want to try and declutter things. So, you know, whiteboards, checklists, having a med box if you take a couple of different medications or, anything that we can do that’s linear. You want to declutter the place. Brad: You're talking about, say they live in a house or apartment, open it up so it’s very clear. Chris: Yeah. So we're going to keep counters clear. We're going to keep everything in the same place. If you're going to go on an appointment, always try to make it the same day of the week, the same time. When you see your dentist every six months, let's say you see a chiropractor, you see your physical therapist, you know, it should always be Wednesday at noon or you know, consistent. Brad: And then there's the next stage for that. What happens then? Chris: Stage four is just an extension of stage three. It's just that the outward changes that you observe in your loved one become much more obvious. So it’s details about themselves, for example, “I don't remember my birthday. I think it's September.” And you're like, “oh yeah. It's December 1st.” “Oh no. Chris, it's September 1st.” “Oh yeah, yeah, yeah. It's September 1st.” Okay. And so that, that's kind of where you're going to start to see this and things that everybody knows around you. It's a difficult point for the patient at this point, too, because again, they have that self-awareness so they know. And so they can make an excuse. They can laugh it off or they can get very angry. So you can start to see some behavioral changes. You can start to see some of this, which is much more of the next stage. This is the stage we want to try and make sure we're protecting them. Probably no driving when we get to this point. Your physician will have stepped in at this point because you're going to see these outward signs that just show that it's difficult, reasoning becomes difficult. You're going to find those details about yourself, like trouble cooking. You guys go out to dinner. You go to our favorite restaurant and they normally get their usual meal and all of a sudden it's a challenge for them to get something. “I just don't know what I want. This is also overwhelming.” They get stressed and frustrated. And instead of having a nice night out at the restaurant, all of a sudden it becomes a stressful event. And then when that stress creeps in, it actually makes that thinking much more challenging. So we want to just say, “Hey dad, you always get the steak. Should we try the steak?” “Yeah. Yeah, that sounds great.” And so if he can flip the table, that’s something that usually helps. So I guess at this point we're starting to protect. And so that's kind of the key and that leads us really into number five, which is what they call moderate, severe decline. And this is the point where you're losing space and time, you can get lost if you were taking a walk by yourself. The seasons can be confusing when you get dressed. I mean, let's say it's summer and all of a sudden you're grabbing a coat when you normally wouldn't grab a coat on an 85 degrees, sunny day. Then again, sentences don't seem to be quite right or stories are a little bit different. But here's the interesting thing, you know, it's like what can we do to help them remain more independent? Let's layout their clothes for the day, keep reinforcing the whiteboard, and keep using the checklist. So independence is key, but you know, if mom or dad are telling you a story, let them go, listen to it and, encourage them. You know, well, and what happened next? And so what if it's wrong? Right? Enjoy it and be in the moment. This is the stage where they start to ask the same question over and over again, which as a caregiver can be very, very frustrating. But that question isn't so much about the answer you're going to deliver as it is just knowing you're there, it's a very lonely stage. Some of the things that we want to declutter at this point are mirrors because we're going to start to get some of those physical issues where maybe our gate isn't quite as strong. We're losing some of that muscle strength, swallowing and eating is a little bit more challenging, which really leads us into number six, which is what we call the severe decline. You know the face, but you don't know the name. So I can recognize you as one of my best friends, but I can't recall Brad. And it's hard, and at this point, it's much more difficult on the caregiver. The caregivers are going to be usually younger because they're typically children of the parent. And so, you add an eight-hour, 10-hour workday, and then another five hours with mom, dad, uncle, aunt, neighbor, whoever, you know, mowing the lawn, doing the dishes, helping. So I mean, it becomes difficult. That's why we'll have those websites posted again so that you guys can kind of find areas for resource support. And just even sometimes commiserating is just a good thing. Brad: I remember very clearly when my grandmother was in this stage and I was in high school, 17, 18 years old, and went to visit her. She had no idea who I was. I called her grandma. She said, are you one of those young kids that call old people, grandma all the time? I had no idea what it was. I didn't want to go visit her because it was scary. Chris: Yeah. It is scary. And that's why I'm hoping that these stages help people to just understand. I guess at this point; the patient really doesn't know what's happening from minute to minute. You're starting to see, in stage six, it's going to be some of those delusions. “I'm getting ready for work.” Well, you've been retired for seven years. You might call your wife, your mom. You're starting to see difficulty eating. You want to go to the softer foods, swallowing, choking, aspiration pneumonia. I mean, these are the points where these health issues start creeping up. Brad: At this point, it's typically time to move the person to a skilled facility. Chris: Yes, because it's just overwhelming. Brad: It is. You can oftentimes I've seen a number of people through professionally that would get combative. And I would say it's probably at this stage and that's very difficult. As a professional, it's easier to deal with that than if you're a family member, more than likely. So you really need to get the proper help at this point. Chris: Yeah. It really is. Things that you can do to still remain close with your loved ones, music is a wonderful thing and it stimulates the brain. Looking at old photos is a wonderful thing to spend time with. And they may not be able to communicate that this was little Billy when we were at the fair, but there'll be some glimmer of recognition at some point. And they still enjoy just seeing different things. Reading to them, these are things that you can still spend quality time, even though it may not feel that way. But it's a moment. In that moment, I think there's a connection there that may be a little bit more spiritual than scientific, but I do think that it's a very important step for everyone, right? Brad: It's something you just need to work with. I like what you said about if they're telling you the history of the family and you know it's all wrong, you know. I've experienced this now with my mom, she's talking about things that happened a few years ago and it's like, mom, this is not even close to being accurate. I do not interrupt her. I let her go on, and then I'll go onto something else. And maybe I'll remind her and, get things to click and whether it's right or wrong, I'm not going to Badger her and say, mom, you got that all wrong. It's okay. Chris: Yeah. I mean, there's no right or wrong at this point. I mean, the key at this point is just to focus on the quality, just being there. I think that's the key because as we go into the last stage, number seven is what they call very severe decline and the basics are gone. You know, can't sit up, can't move. Brad: This is almost 24/7 care. Chris: It is 24 7 care. I think, realistically you want them in skilled care. You can't do it by yourself. Brad: And this is hard to talk about if you're not familiar with it. For me, I've been working with it for 23 years, it’s to the point where they don't know enough, or can't remember to push the button, which is going to bring an aid in or a nurse in to get some help. That part is oftentimes, I just don't know. You have to be careful about, are they going to roll out of bed and fall? And there are all kinds of physical precautions that you can work with. It's a tough stage, but the reality is it's there. And you know, it's probably pretty close to the end. Chris: It is. And I mean, the key is comfort and what can you do to love and support. Brad: This is a spiraling disease, it's a downward spiral. And there is no cure at this point. That’s probably going to be years down the road. But if you're in an early stage, like I feel my mother is probably at three, somewhere in there plus, or minus, but there's a number of things you can do at the early stages. I would never tell anybody you have Alzheimer's, if you're not a professional. All these things that we're going to talk about in the next video that you can do to help are good for anybody. Yes. You know, playing word games, scrambles. Chris: Scrabble, crosswords, playing checkers, playing chess, cards. I mean, just anything socially engaging is good. Brad: Taking a walk, walking. Chris: Just go to the park and take a nice walk. I mean, getting outside and doing. Brad: Check out the shirt I got here. Chris: Life is tough. Let's help each other. Couldn't be more appropriate. Brad: I'm going to help each other out with that. So very good. Enjoy the day and be careful. Chris: Thanks, everybody. Additional Resources Alzheimer's Association: https://www.alz.org/https://www.lbda.org/ Family Caregiver Alliance: https://www.caregiver.org/ Dementia Mentors: https://www.dementiamentors.org/ Memory People Facebook Page: https://www.facebook.com/Memory-People-126017237474382/ Alzheimer's & Dementia Alliance of Wisconsin: https://www.alzwisc.org/ Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. 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