How to Use the TENS Unit for Elbow Pain (Tennis Elbow, Golfer’s Elbow, General Elbow Pain): If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at BobandBrad.com and click on the TENS series, or click the link below. Under the series look for the videos with the 1313, 5050, and 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for a Small Area of Elbow Pain (Tennis Elbow or Golfer’s Elbow): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or directly below the pad (at least a pad’s width apart). Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain. General Guidelines for a Large Area of Pain: In our examples channel one has yellow pads and channel two has green pads. See Photo for Elbow Example One pad from channel one in the upper right corner of the area of pain and one pad from channel one in lower left corner of the area of pain. One pad from channel two in upper left corner of the pain and one pad in lower right corner of the pain. This arrangement forms an X pattern. General Guidelines for Pain Referred from Another Area: An example would be elbow pain that is coming (referred) from the neck. Using channel one, place the two pads along the nerve pathway. Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. One treatment recommendation: Cross-fiber friction massage For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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.

New Research Shows the Best Way to Warm Up May be to Lengthen and Strengthen Your Tendons. Twenty years ago, when a group of runners got together for a workout, a few would casually be stretching either their hamstrings or calves, but the stretches seemed pretty random and inconsistent. It was almost as if the runners knew they were supposed to stretch, but didn’t really want to. Now, it’s not uncommon to see runners performing elaborate stretches with special straps and/or splayed out moving back and forth over oddly-shaped foam rollers. The question is, are the new pre-exercise warm-ups actually worth the time and energy spent performing them? And if so, should the stretches and/or foam rolling be performed before or after a workout? In February of 2019, Smith et al. (1) evaluated the acute and long-term changes in calf flexibility following six weeks of static stretching, foam rolling, or combination of static stretching and foam rolling. At the end of the study, all three training groups had increased their calf flexibility by nearly 20%, with no differences between the three groups. The authors reference additional studies showing that foam rolling in particular can significantly increase range of motion, especially when it is performed more vigorously (2). The important question is: does increasing your muscles’ range of motion reduce injury rates? Without doubt, the overwhelming body of research says absolutely not (3,4). The one exception to this is a study by Daniel Pereles (5), who had almost 3000 recreational runners assigned to either a stretch or non-stretching pre-run routine. Not surprisingly, there was no significant difference in injury rates between the runners who stretched versus the runners who didn’t stretch (which is typical of all studies on stretching). However, if a runner who routinely stretched was assigned to the non-stretch protocol, he/she was nearly twice as likely to sustain a running injury. Because of the number of participants, this single study proves that if you feel that stretching reduces your risk of injury, you should continue to stretch in spite of what experts tell you. The same is true for foam rolling: if you feel it helps you avoid injuries, you’re probably right. While foam rolling immediately before exercise has been shown to produce a temporary reduction in muscle stiffness that may reduce the risk of injury (6), other experts recommend foam rolling after a workout (7), as the vigorous massage associated with foam rolling can raise cortisol levels, which acts as a natural anti-inflammatory to accelerate recovery. In my opinion, if a runner really wants to decrease his or her injury rate, they would be better off ignoring the flexibility of their muscles and do everything they can to improve the strength and flexibility of their tendons. Until recently, it was believed that muscles lengthen then suddenly shorten to generate the force necessary to propel you forward while running. To prove otherwise, researchers from Brown University placed special sensors in the calf muscles and Achilles tendons of turkeys and forced them to run on treadmills (8). The sensors revealed that just before the calf muscles generated peak force while running, they isometrically tensed forcing the Achilles tendon to rapidly lengthen and snap back to return energy. The lengthening Achilles tendon essentially acted as a rubber band, storing energy from the forward motion of the leg only to return it to improve efficiency while running. The Achilles tendon is especially well suited for storing and returning energy as it rotates nearly 90° before attaching, so it can store energy like a spring. In young athletes, tendons are so efficient they are able to return 93% of the force needed to stretch them. Interestingly, the capacity of tendons to store and return energy decreases with age (i.e. running economy is significantly reduced in older runners because muscles are unable to compensate for the stiffer tendons) and in immature tendons (explaining why kids are so bad at sprinting). The reduced elasticity present in older tendons explains why the perceived effort associated with running increases as we age, and why we slow down so much as we get older. Resilient tendons also protect muscles from injury as a flexible tendon acts as a buffer to store energy that would otherwise go into the neighboring muscle. The good news is that researchers are coming up with ways to specifically improve tendon flexibility. Using ultrasonography to evaluate muscle and tendon flexibility, Anthony Kay and his colleagues from the UK had 17 volunteers perform a variety of different stretches, including conventional static stretches and the more complicated contract/relax stretches, while observing real-time changes in muscle and tendon resiliency (9). Not surprisingly, conventional static stretches slightly improved muscle flexibility but had no effect on tendon resiliency. In contrast, stretches using muscle contractions prior to initiating a stretch improved muscle flexibility about the same amount as static stretching, but also increased tendon flexibility by nearly 20%. The authors claim the most effective way to improve tendon flexibility is to place a muscle in a midline position and isometrically tense it for 5 seconds. This is immediately followed with a 10-second stretch. You then return to the original starting position, tense the muscle again for 5 seconds, and repeat the stretch for another 10 seconds (see Fig. 1). When performed 3 times, the entire stretching routine takes less than a minute and results in substantial improvements in both muscle and tendon resiliency. Although the illustration depicts the stretch being performed on the Achilles tendon, it can be modified to be done on any tendon. Because the muscle is always tensed while in a midline position, I refer to this stretching technique as “neutral position stretching.” Figure 1. Using a belt or strap, place your ankle at a 90° angle to your leg and isometrically tense your calf for 5 seconds (isometric contractions involve tensing a muscle with no movement of the joint). Follow the 5-second contraction with a 10-second stretch by pulling with your hands (arrows). When repeated 3 times, this routine will improve tendon flexibility by 20% (9). While neutral position stretching is good for improving tendon flexibility, several papers have shown you can significantly increase tendon strength by performing isometric contractions with the muscle maintained in its lengthened position (10,11). Using the Achilles tendon as an example, stand on the stairway while holding a weight in one hand (or wearing a weighted backpack) and lower your heel so it is positioned slightly below horizontal (Fig. 2). You should use enough weight so you are fatigued after 15 seconds. Repeat this maneuver 6 times on each leg. In just a few months, this exercise routine has been proven to markedly increase tendon resiliency and strength (11). While neutral position stretching is good for improving tendon flexibility, several papers have shown you can significantly increase tendon strength by performing isometric contractions with the muscle maintained in its lengthened position (10,11). Using the Achilles tendon as an example, stand on the stairway while holding a weight in one hand (or wearing a weighted backpack) and lower your heel so it is positioned slightly below horizontal (Fig. 2). You should use enough weight so you are fatigued after 15 seconds. Repeat this maneuver 6 times on each leg. In just a few months, this exercise routine has been proven to markedly increase tendon resiliency and strength (11). Figure 2. While wearing a weighted backpack or holding a weight in your hand, make yourself stable by holding onto a nearby wall or handrail (A), and slowly lower your heel off the edge of a stair step so it is slightly lower than horizontal (B). Hold this position for 15 seconds and repeat 6 times on each leg. There should be enough weight so you are fatigued after each repetition. Another option is to perform the exercise on a ToePro platform (C), which works the tendons of the toes, calves, and peroneals while they are all in their lengthened positions (arrow). If you are interested in Tom's book Injury Free Running visit: https://amzn.to/2TLzEas References: 1. Smith J, Washell B, Aini M, et al. Effects of static stretching and foam rolling on ankle dorsiflexion range of motion. Med Sci Sports Exerc. Feb 23, 2019. 2. Škarabot J, Beardsley C, Štirn I. Comparing the effects of self-myofascial release with static stretching on ankle rangeof-motion in adolescent athletes. Int J Sports Phys Ther. 2015;10:203–12. 3. Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ, Davis IS, Lopes AD. What are the main risk factors for running-related injuries? Sports Med. 2014;44:1153-1163. 4. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469-480. 5. Pereles D, Roth A, Thompson D. A large, randomized, prospective study of the impact of a pre-run stretch on the risk of injury on teenage and older runners. USATF Press Release 2012. 6. Morales-Artacho A, Lacourpaille L, Guilhem G. Effects of warm-up on hamstring muscles stiffness: cycling vs foam rolling. Scand J Med Sci Sports. 2017; 1-11. 7. Macdonald G, Button D, Drinkwater E, Behm D. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46:131–142. 8. Roberts, T, Marsh, R, Weyand, P, et al. Muscular force in running turkeys: the economy of minimizing work. Science. 1997;275:1113–1115. 9. Kay A, Husbands-Beasley J, Blazevich A. Effects of PNF, static stretch, and isometric contractions on muscle-tendon mechanics. Med Sci Sports Exerc. 2015,47:2181-2190. 10. Oranchuk D, Storey A, Nelson A, Cronin J. Isometric training and long-term adaptations: Effects of muscle length, intensity, and intent: A systematic review. Scand J Med Sci Sports. Dec 2018. 11. Kubo K, Ohgo K, Takeishi R, et al. Effects of isometric training at different knee angles on the muscle–tendon complex in vivo. Scand J Med Sci Sports. 2006;16:159-167.

This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2017. For the original video go to https://www.youtube.com/watch?v=xORPFVXv6_M&t=187s Bob: Okay, Brad, we are going to talk about big toe pain and stiffness. It’s also known as hallux rigidus. We are going to show you 10 steps to cure this. Brad: Exactly. Bob, we should be correct in our terminology. The big toe is really not the big toe. It’s called the great toe. Bob: The great toe! Like the great Brad Heineck. Brad: Oh, wow. It’s good to be compared to the toe. Bob: The captain. He’s the captain of the foot. Brad: Anatomically, it is the great toe. Most people call it the big toe though, so we will say that. So, the first MPT joint; metatarsal phalanges. This is the phalanges; your toes are the phalange and the metatarsal is this long bone right here and this black line represents the joint with the motion. That’s the joint that gets the pain, the stiffness, the arthritis and worst-case scenario, which happened to a friend of mine, they actually fused the joint together. So she has no more range of motion. Bob: Surgically they fused it? Brad: Yes. Bob: Because she was having so much pain? Brad: Yep. Bob: Not a minor thing because you can’t take a step without that flexing. Brad: It really changes how you walk, your balance; everything. It’s the last thing you want to do, so, we’re going to show you some of the things you’re going to do to prevent the surgery. The earlier you get at this, the better off you are. So as soon as your toe is getting stiff, we are going to talk about some things to do. One is, what is causing the pain in the joint? There could be a number of things, but one of the big things is footwear. If you have a shoe, and they come in at a tight angle, or a narrow toe, and your big toe is being pushed inward. Also with high heels, that’s even a double whammy because you have the pointed shoes and the weight of your body pushing down. This is just one of the problems. There are other problems that can go along with this, but we are going to stick to the subject. Bob: It’s a real problem with fashion. My wife worked as a manager at a hotel, and she wore high heels every night with the narrow toe base and now she’s got bunions. That’s all in the same family, wouldn't you say, Brad. Brad: The other thing that happens is it takes the joint out of alignment but also there’s tendons that make your toe push down which is important for walking and balance. The tendons have two little bones, on the bottom of the foot, and there’s grooves that those bones need to go into to work properly and when the toe gets pushed over, they go out of alignment so that kind of compounds the problem. Bob: So, everything is out of alignment. The ligament, the tendon and bones. Brad: The joint itself. So, get a shoe with a wide toe box. And don’t get high heels; you have to stay away from that if you happened to wear those in the past. Also, if you’re walking and you’re to the point where every time you walk, that joint bends and it’s painful and it’s really interrupting your life, you’re going to want to get a shoe that’s really stiff. If you pick a shoe up and you put your one finger at the end and you can bend it easily, that’s not very stiff. If you get a shoe that is stiff, or a motion control shoe. If you talk to a salesperson that knows their shoes, they’ll know exactly what you’re talking about. They are typically walking shoes. Otherwise, you want to put an insert inside to stiffen up the shoe, you can get a carbon fiber insert. That you’re going to have to look around for. I don’t know if you are going to find that at any old store. But it’s an insert that slips in and it makes the shoe base more rigid. Bob: So, wide toe box, rigid insert, no heels. Brad: Right, exactly. The next thing is getting that joint moving again. What happens is, the joint will become sore and irritated and since it’s sore when you’re moving it, you move it less. Anytime you move a joint less, it becomes more arthritic, more painful and tighter. It’s a compounding thing and eventually you get to the point where you can hardly touch it and just laying in bed and having the covers touching it will make it painful and then it’s hard to sleep. We want to get that joint moving. First thing, if the toe is going laterally or toward the other toes, we want to pull that toe back in line and do some stretches on it. There are some muscles and connected connective tissue between the toes you want to get and stretch it out. Do it within reason. If it’s really sharp pain, you’re going to have to be gentle. This isn’t going to just take one treatment. It may take a number of days or weeks to get this feeling better. Bob: Is this a bad time to bring this up, where you may put gauze in place? Brad: It’s a perfect time! You can just take some gauze and roll it up and you can put that in between your toes. You can buy this gauze at any pharmacy. Bob: Dr. Scholl’s has these little rubbery type things that you can stick in between your toes. Brad: That’ll hold the toe in place. Bob: You want to get that toe realigned again. Brad: Exactly. You'd have your wide toe shoe and this can be used in addition. It should feel better as a result of it. Bob: That’s going to work on it all day long, as opposed to the short time your during the stretch now. Brad: Exactly. Now the next one is how to mobilize this. Now this is where therapists are trained to do joint mobilization. However, I think this is simple enough that you can do this at home. Bob: You certainly can try some of these. Brad: You have the tarsal bone, it’s a solid bone. You can grab it and feel it. Get a hold of that bone. Thumb on top, fingers on bottom. It’s right by the big toe. Bob: Lined up with the big toe. Along the same line. Brad: So that stabilizes it. Imagine that’s like a vice and I'm just going to hold it steady. Now we are going to work this joint where the black line is. Now, you don’t have to do these in this order, but the first thing I do is relax this foot and pull the toe. Pull your toe up and give it some traction. Hold that for 10-20 seconds. You can do it longer if you can tolerate it and don’t get cramps in your fingers. Brad: The next one I’m going to do, and you can combine it with some of these, I’m going to do some rotations. Rotate to the right and rotate to the left. I’m going to turn my foot this way. This is like if you imagine a nut on a screw that is all rusted and you have to work it back and forth to loosen it. That’s kind of what you are doing with your toe joint. Bob: Now, if it really hurts in one direction, I would probably work it the other way more. Brad: Good point, Bob, exactly. That’s why it’s nice to have two people doing this. One person forgets to say something but the other usually remembers. If I go in one direction and it’s really painful but going the opposite way I get more range of motion, I’ll go that way more. Then I’ll go back to the other direction and see if it loosened up. Bob: It often does too. Brad: The next thing I’m going to do is called inferior superior motion. The foot stays stationary and the toe goes up and down. It’s going to be very limited, not a lot of motion there. But you get that joint moving. Again, if it really hurts one way, work the other way more. Then you go back and assess the sore direction again and eventually it’ll get looser. Bob: It’s amazing how much this helps. It shocks me sometimes. You just start moving that joint around a little bit and it helps. Brad: Then we go to the major motions. The dorsiflexion or extension and the plantar flexion. I’ll go up and stabilize here and then stretch it. You should be able to get about 90 degrees on a normal toe. If you’re only going up 10-20 degrees you’ve got some work to do. Bob: By the way, this is something we also do with plantar fasciitis. If you have plantar fasciitis you often find that your toe is tight and will not go up into that extension. It’s a good one to go ahead and stretch it, pressure on, pressure off. Brad: After that, you may get flared up a little bit. You may need to take some ibuprofen. Bob: You can ice it too. Brad: Yes. That may take a week or two and by the time you get the toe moving again where you can actively move it, it’s getting closer to that 90 degree or at least halfway there. Then we want to start strengthening it again. Then we go to our favorite, stretch band, TheraBand; whatever you want to call it. Get just around that big toe, this is kind of cute. Bob: The great toe. Brad: The great toe! You should get the yellow band. This red one is a little aggressive. Bob: If this hurts, you can’t do it. Brad: Right right. There’s another technique where you put a towel on the floor and try to take all your toes and scrunch the towel. Put wrinkles in the towel with your toes. Another one you can do, get something under your toe (like shaking dice) and you try and squeeze it. Pick it up with your toes. You can go over there and put it down. If you have four or five dice, you pick them up and move them. Just for something to do and it’s working those muscles. Brad: Remember, that downward motion on that toe is really important for balance. The upward motion is important when you walk. The toe needs that normal range of motion, so you have a normal walking pattern, or gait. If you have the great toe pain, hallux rigidus, that’s the whole treatment method to get through. Good luck with it! We want you out there walking smoothly. Bob: Thanks. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: COMING SOON! 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Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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.

How to Use the TENS Unit for Shoulder Pain (Impingement, Rotator Cuff Injury, Arthritis): If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at BobandBrad.com and click on the TENS series, or click the link below. Under the series look for the videos with the 1313, 5050, and 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for a Small Area of Shoulder Pain: Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or directly below the pad (at least a pad’s width apart). See Photo for Shoulder Example Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain or place one pad on each side of the pain. See Photo for Shoulder Example General Guidelines for a Large Area of Pain: In our examples, channel one has yellow pads and channel two has green pads. Option one: one pad from channel one placed above the area of pain and one pad placed below the area. One pad from channel two placed in front of the area of pain and another pad from channel two placed behind the area of pain. This arrangement forms a cross pattern. Option two: one pad from channel one in the upper right corner of the area of pain and one pad from channel one in the lower left corner of the area of pain. One pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Exercise: Statue of Liberty or hanging. For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 If you are interested in the Booyah Stik visit: https://store.bobandbrad.com/collections/products/products/bob-brad-booyah-stik DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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.

Dynamic warm-up drills may be the single best way to prevent injuries and improve performance. As a rule, runners tend to be well informed when it comes to understanding the best ways to stay healthy and avoid injury. Most runners pay close attention to their diet, monitor their weekly mileage, and replace their running shoes at regular intervals. Yet, when a group of nearly 100 experienced recreational runners were re­cently asked to name the most common cause for running-related injuries, the overwhelming majority of them cited “failure to stretch regularly” as the most common cause of running injuries(1). The authors of this study were concerned because the runners seemed to be unaware of the overwhelming body of research showing that stretching does not alter injury rates(2,3). To make matters worse, the belief that stretching protects you from injury is becoming even more prevalent(4). So, with dozens of studies proving that stretching is a waste of time, why do so many experienced runners con­tinue to stretch? To begin with, they may be right. While researchers are quick to point out that conventional static stretching is useless, Daniel Pereles and colleagues recently proved that runners intuitively know whether or not they should stretch5. These authors randomly assigned 2,729 recreational runners to either a stretching or a non-stretching pre-run routine. Not surprisingly, there was no significant difference in injury rates between the runners who stretched versus the runners who didn’t stretch (which is typical of all studies on stretching). However, if a runner who routinely stretched was assigned to the non-stretch protocol, he/she was nearly twice as likely to sustain a running injury. Because of the number of participants, this single study proves that if you feel that stretching reduces your risk of injury, you should continue to stretch in spite of what experts tell you. The somewhat surprising outcome associated with Daniel Pereles’s stretching study may have something to do with an inherent flaw in the way studies evaluating stretching and injury prevention are designed. Because of time constraints and compliance issues, almost every study on stretching has evaluated outcomes over a short period of time (usually less than 12 weeks). While research has shown that flexible people are less prone to ex­ercise-induced muscle damage6, other studies suggest that stretching for less than 3 months does not convert a stiff muscle into a flexible muscle. In fact, some great research proves that when stretched for just a few weeks, muscles respond by temporarily lengthening with no change in the muscle’s architecture(7). In order to physically lengthen muscles, some experts suggest it is necessary to stretch for four to six months. In theory, when a muscle is repeatedly stretched for several months, cellular changes take place within the muscle allowing for a permanent increase in flexibility. Animal studies have shown that the increased flexibility associ­ated with repeat stretching results from a lengthening of the connective tissue envelope surrounding the muscle fibers (the perimysium) and/or an increased number of sarcomeres being added to the ends of the muscle fibers(8) (Fig. 1). Apparently, converting a stiff muscle to a loose muscle is a long-term commitment. Rather than spending months attempting to convert your stiff muscles into flexible muscles (with no guarantee that this will actually change your potential for being injured), the easiest way to avoid injury is to increase your body temperature prior to running9. One of the few sports to take advantage of this research is professional football. Look at the sidelines of any NFL game and you’ll see players riding stationary bicycles prior to going out on the field. Because most runners do not have access to a stationary bike before they begin their routine run, the simplest way to increase your body temperature is to initially run with a slow jog. Slow running with a high cadence and a short stride length significantly decreases impact forces while your muscles gradually warm up. Since older runners tend to be stiffer, the length of time you spend warming up is age-dependent: 30 to 40-year-old runners should consider warming up for 5 to 10 minutes, while the 50 and older group should run slowly for up to 15 minutes. Another way to increase your body temperature is with active dynamic running drills (Fig. 2). Popular with elite and sub-elite runners, these drills allow you to slowly warm up your muscles and can even improve performance. A recent study found that compared to a control group, runners who performed 14 repetitions of each of the exercises listed in figure 2 had a 6% improvement in running endurance and a 3% increase in 3 km race perfor­mance (10). This research suggests that regardless of whether or not you incorporate static stretching, dynamic warm-up drills may be the single best way to prevent injuries and improve performance. Fig. 1. The components of a muscle. Reproduced from Injury-Free Running by Tom Michaud. Fig. 2. Dynamic stretching drills10.The abductor, or grapevine drills, were not part of the study but they are important for warming up the hip abductors so I’ve included them in the illustration. Reproduced from Injury-Free Running by Tom Michaud References: 1. Saragiotto B , Yamato TP, Lopes AD. What do recreational runners think about risk factors for running inju­ries? A descriptive study of their beliefs and opinions. J Orthop Sports Phys Ther. 2014;10:733-738. 2. Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ, Davis IS, Lopes AD. What are the main risk factors for running-related injuries? Sports Med. 2014;44:1153-1163. 3. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and deter­minants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469-480. 4. Herbert RD, de Noronha M. Stretching to pre vent or reduce muscle soreness after exercise. Cochrane Data­base Syst Rev. 2007: CD004577. http: //dx.doi.org/10.1002/14651858.CD004577. pub2. 5. Pereles D, Roth A, Thompson D. A large, randomized, prospective study of the impact of a pre-run stretch on the risk of in jury on teenage and older runners. USATF Press Release 2012. 6. Malachy P, McHugh M, Connolly D, et al. The role of passive muscle stiffness in symptoms of exercise-in­duced muscle damage. Am J Sports Med. 1999;27:594. 7. La Roche D, Connolly D. Effects of stretching on passive muscle tension and response to eccentric exercise. Am J Sports Med. 2006;34:1000-1007. 8. Kubo K, Kanehisa H, Kawakami Y, Fukunaga T. Influence of static stretching on viscoelas tic properties of human tendon structures in vivo. J Appl Physiol. 2001;90:520-527. 9. Fradkin AJ, Gabbe BJ, Cameron PA. Does warming up prevent injury in sport? The evidence from ran­domised controlled trials? J Sci Med Sport. 2006;9:214-220. 10. Turki O, Chaouachi D, Behm D et al. The effect of warm-ups incorporating different volumes of dynamic stretching on 10-and 20-M sprint performance in highly trained male athletes. J Strength Cond. 2012;26: 63­71. If you are interested in Tom's book Injury Free Running visit: https://amzn.to/2TLzEas

How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at BobandBrad.com and click on the TENS series, or click the link below. Under the series look for the videos with the 1313, 5050, and 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for a Small Area of Knee Pain (Medial or Inner, Lateral or Outer, Back of Knee, Patellar Tendonitis): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or directly below the pad (at least a pad’s width apart). Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain. General Guidelines for a Large Area of Pain: In our examples channel one has yellow pads and channel two has green pads. Option one: one pad from channel one placed above the area of pain and one pad placed below the area. One pad from channel two placed in front of the area of pain and another pad from channel one placed behind the area of pain. This arrangement forms a cross pattern. Option two: one pad from channel one in the upper right corner of the area of pain and one pad from channel one in lower left corner of the area of pain. One pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. General Guidelines for Pain Referred from Another Area: An example would be knee pain that is coming (referred) from the back. Using channel one, place the two pads along the nerve pathway. Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Knee Exercise: Stretching into extension- internal rotation, external rotation, straight For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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 December of 2020. For the original video go to https://www.youtube.com/watch?v=9FTn8JWH-6I&t=583s Brad: Today we're going to talk about blood pressure. How high is too high, possibly life-threatening, and top three options to correct it safely. This is a serious topic. I've dealt with a borderline of blood pressure myself and been able to successfully treat it without medications, but we need to know the big thing, blood pressure, what is too high and what's not too high, but let's go back. There's two numbers with blood pressure. Let's kind of clarify this, systolic, diastolic? Chris: Systolic, diastolic, top and bottom, whatever way is easier for you to remember. But basically the systolic is the first number that we see up here, that 120/80, that's a normal blood pressure, but that one is when the heart beats. So think of your heart as a pump, as soon as it presses that pressure that they feel in the vessels, that's what that top number is measuring. Brad: So that's the big push. Chris: Yep, that's the big push of the heart. And then when the heart is relaxed and it's filling back up with blood, that's what the diastolic number is measuring. So that's what that 80 is. Brad: We don't need to know this, but it's in millimeters, that's a technical measurement. Chris: Millimeters of mercury is how they recognize it. Brad: I always remember diastolic, D for down. So that's the lower number. Chris: Yeah, that's an easy way to remember it. Brad: But you really don't need to know that, but you do need to know the numbers and where you're safe and where you need to be concerned, and then of course the extreme. Chris: Absolutely, absolutely. Brad: So we've got the chart here. Chris made this really nice chart. Let's start out with the normal blood pressure that is acceptable and you're safe. Chris: Absolutely. We'd like to see that 120/80 with everybody. I think that's just a reasonable standard number that the American Heart Association, American Cardiology Associates, they all kind of recognize that. And it can be lower, it can be a little bit higher. As we progress through the whole chain here, that's where we want to strive for. And when people are healthy, that's what we see. Brad: Now we're talking about high blood pressure and sometimes it's called hypertension. Are there any other terms you might hear? Chris: No, I think high blood pressure and hypertension are used interchangeably. So I think that most physicians and nurse practitioners and PAs would probably say hypertension, but for you and me, high blood pressure. Brad: Okay, so let's start out. We've got normal and then these are actual classifications that I recognized and the first one says elevated. So that's, if you're just a little over normal. Chris: A little bit over normal. Brad: But it's not dangerous yet? Chris: Not dangerous yet, but it's a sign of things to come. So we do want to make sure that we're paying attention. When you go into your doctor's office and all of a sudden these type of numbers pop up, doctors will do a couple different things. They're going to measure it in a couple of different occasions. They might measure both arms just to kind of see what's going on because there's a thing called lab coat syndrome which suddenly or white coat syndrome. Basically when somebody walks in the room and they're in a very formal looking doctor and I say, "Oh my gosh he's going to figure out that something's wrong with me." People do get tense and it does raise your blood pressure. It's a known fact unfortunately. Brad: Sure, it's just a natural feeling. Chris: Yep, it's natural. A lot of us experienced that. So they want to take a couple of different readings and they'll eve n maybe at the end of the appointment they'll strap you up on a cuff again, kind of catch you off guard, so you're more relaxed. Because you've been talking about some things and I'll say, "Oh, look at that, it's normal." So sometimes it's just due to the stress. Maybe you walked up a couple flights of stairs to get the office. Brad: Sure. Then we'll go to the stage one. Chris: Stage one. Brad: So that's another step in the wrong direction. Chris: Yep, another step in the wrong direction. And you know I guess what I should mention is that in 2017, they changed all these numbers. It used to be the old norm before stage one. It used to be just 140/90, was like, "Okay, that's bad." Well, they decided to add this designation, this 130-139/80-89. That's stage one hypertension or a stage one blood pressure. And so it's kind of that first stage that when your doctor gets a couple of measurements, because they aren't going to put you on blood medication right away. They're going to look at it and observe it. They might have you come back in three or four weeks and do it again and all of a sudden, oh it's still there. So at this point, the doctor's in a lot of times they probably would have had this discussion about your lifestyle changes and things of that nature. What can we do to affect this? We'll move on to that. Brad: Okay, we'll talk about what you can do without, so you can avoid medication. Chris: Yes, yes. This group I think is a really good one to focus on and then we're in that point. And that's kind of the hallmark what most cardiologists and physicians are going to talk to the patients about. Brad: But you could come in maybe you have progressed to stage two or maybe you came in before that and all of a sudden you see these numbers 140/90. Okay, so things are starting to open your or at least the doctors. Chris: Oh yeah, you got 24 million Americans in this group right here, stage two. Brad: So what percentage is that? Chris: Probably right in that 30% range. Brad: Okay, are touching up into that? Chris: All adults. Yep, so it's something. And this is definitely going to require medication, at stage two. So this is the one we're still going to stress lifestyle changes but there's definitely going to be medications added. And they might even add medication depending upon your circumstances, genetics, cardiac risk factors. So there's a lot of other things that go into this. Brad: Individual factors. Chris: Yeah, but for the ease of simplicity, this is something that your doctor will probably at one point, you're going to be on medication to try and help to control that and keep you safe. Brad: Right, because you might say, "Well can I do this with diet and exercise?" But you're saying maybe you can but you're putting yourself at risk. Chris: Yeah, I mean, your doctor's going to have to be on board with your exercise plan and keep in mind exercise can be something as simple as a 30-minute walk. So I mean, that's enough, you got to raise your breath a little bit and get that heart rate pumping. And I think that's going to do a nice job of helping and it's exercise and diet are pillars of treating hypertension at any one of these ranges. So we have to make sure that when we're using that and then your doctor is going to be paramount. He's, like I've said before in other videos, he's your quarterback. So you're the team, he's the quarterback. And basically you're going to work together to try and make sure that we can bring it back towards this level. Brad: Right, right. So let's say, because a lot of people may be living at this. They don't even know it. And if that goes on for a number of years, that's actually causing problems with your arteries which can lead into strokes, other cardiac issues. Chris: You name it, stroke, heart attack, vascular dementia, kidney problems, organ failure, vision problems. I mean, it's a big umbrella that hypertension all of a sudden, you hear hypertension and everything underneath that umbrella kind of fills in. So there's lots of other things that can happen. Brad: All these diagnosis is that you're associated with it. And so if you can correct that higher blood pressure early that doesn't eliminate, but reduces your risk for all these other problems that can come down the road. Chris: Correct, and yeah, just to kind of put that in perspective. I mean you get 3 million Americans each year are getting diagnosed with high blood pressure or hypertension. So that's a lot of people. Brad: So that means they're at stage two. Chris: Not necessarily, it could be one, two. But they're going to call it hypertension one and two. So there's 3 million patients a year. We lose 500,000 to hypertension related conditions. Brad: So you're saying 500,000 people, half a million. Half a million people die every year worldwide or in the United States? Chris: United States of America. Brad: So a half a million people die as a result of hypertension or associated causes. Chris: Correct. Yep, hypertension with associated causes. Brad: Okay, so that could be a stroke. It could be vascular problems, heart attack. Chris: Exactly, exactly. So it's all encompassing. We have to be careful. Brad: So now we're getting to that part of the title, life-threatening. So we got it in red, Hypertensive crisis. Chris: Yup, that's the big word that they use, and it's nothing to sneeze at. This is a big deal. So if you are testing your blood pressure at home and you're caught popping in with a 180/120, it's kind of like monopoly, you go directly to jail or you go directly to the hospital. So you should certainly call your doctor if you feel it's necessary. Brad: Would that mean that an emergency room or urgent care? Chris: I would say an emergency room probably at this point, because they're going to be the ones that are going to decide. I mean, you got here for a reason. We don't know why. And if it goes sideways, stroke, heart attack could be eminent. So it's something that we just don't want to mess around with. Brad: I always think of this as a therapist, I've worked with a lot of people with strokes. I don't work with people with heart attacks except for after the fact, if the rehabbing, but a stroke I see them very quickly after the event. It makes so much sense because what happened is the pressure is getting so high it bursts through the arteries, the vessels, the blood vessels in the brain, starving the brain of blood and oxygen, and then you have a stroke and it's a life changing issue. And it could be fatal. Chris: Yup exactly. Brad: So there's no joke about high blood pressure when you get this high Oftentimes people are feeling symptoms like headaches. There are some other things. Chris: Well actually the scary thing about all of this, more often than not people don't feel anything. And that's the scariest part about this aspect. That's why they call blood pressure the silent killer. So when you have high blood pressure, it's something that you just may not even notice. People go for years and let's say they had an appointment in their twenties and you're healthy as a horse and you're feeling good. All of a sudden they haven't been to a doctor in years which is oftentimes the case. All of a sudden their 45 years old, they go in and see the doctor and they're like, "Oh my gosh you're 170/98." "What's going on?" "I don't know, I feel great." And all of a sudden it becomes this type of issue, and there's lots of long discussions at that appointment to how can we get this better and keep you safe? Brad: And so I think nowadays, and this has been going on for years actually, people are taking their own blood pressure at home but it's easier now. I remember years ago with my father, he had high blood pressure and he'd be pumping that thing up around his arm and measuring his own at home to monitor. But now you just put the cuff on, push the button. Chris: Push the button, it's really easy. So, and you always want to make sure too when you're getting a blood pressure cuff, unless you have an absolute problem where you can't get the cuff around your arm, you never want to do the wrist one. The wrist one, basically these two bones in your arm, you have one over here and one over here, it does not allow it to squeeze properly to give you a good accurate measure of blood pressure. But when you get it around the arm, you get that good, accurate measure. I mean, same way in the doctor's office, they don't measure your wrist, they always measured around your arm. Brad: And if we're talking about this will minimize be comprehensive with this video. If you are taking your own, the same thing my dad had one of the wrists and the numbers weren't good. We ended up going back to the arm. And this was later on, just within the last 10 years, but you should take it in a consistent posture. Chris: Perfect posture. Brad: So you should be sitting with your knees bent at 90, with good posture and take it on the same arm, write it down or sometimes the digital ones have a history but if you're not comfortable with that, write it down. That's me, write it on paper so it's there and do it in the same location or same atmosphere. Chris: Yeah, I always want to be consistent with it. So you always want to sit for five minutes. So maybe a walk, you had some breakfast and then you're like, "Oh it’s time for me to do my blood pressure." So you want to sit again with both feet on the floor, like you said, perfect posture, just kind of sit and relax. Brad: Relax. Chris: And then wait five minutes and then put your cuff on your arm. And it's actually important to make sure your cuff is on your own properly too. So depending upon the unit that you use and I will tell you what consumer reports the most widely recommend one is made by Omron. So it's a fantastic machine. So it's the one that I recommend routinely at work because I just can trust their accuracy. So it's excellent, it rates well, they're reasonable in cost. You can get it anywhere, pharmacies, online, wherever you want to shop for something like that. The nice thing about the Omron product actually is they show you nice little pictures on how to use it. So you have your arm palm up resting on a table. You’re going to have your cuff round your upper arm and there's a little line, that's the tube that goes to the unit. And so you just want to make sure it falls down the center of your arm. And then while you're relaxed, you hit the button and basically about 35, 40 seconds, you're going to get your pressure and your heart rate. Brad: All right, so we know where that really high blood pressure is, get to the doctor right away. Let's go back in here and let's look at the second part of our title. What are the three options? Chris: Well basically, number one that, depending upon where you fall, it's always going to be exercise and diet, which are under that lifestyle changes. And sometimes if you use that exercise and diet as one and two, medications are probably number three. So from that standpoint, but medications you can easily become the primary course of treatment depending upon what your doctor and you decided is best for you and your particular case. Brad: Do you know how many people are on blood pressure medications in the United States right now? Chris: Yeah, roughly about 30 million people are on blood pressure medications right now or at least should be. And about many of those are actually falling in that 140 over 90 range. So, it's a large number. Brad: And success rate with blood pressure medications? Chris: 25 percent of people on blood pressure issues are well controlled. So everybody else is not. Brad: So they have to monitor it? Chris: They need to monitor it, and so that home monitoring, I think it's a very invaluable tool for us to utilize at home so that we kind of know where you are and you can always fill in the gaps with your doctor and just say, "Hey, I did really well." And you go to the office when it's up 10 points, so maybe it was you're just stressed out about seeing the doctor, but it helps them. Brad: So, you were talking top three, diet and exercise but really that's kind of they're two separate topics, but they fit together. Chris: They do, they do, and exercise is so critical because we want to get that heart rate up as long as your doctor approves you to do exercises. So that's one of the first things that we have to clear that hurdle before we just. I mean, it's always good to exercise, you and I are firm proponents of that. But I mean, it's something that if there's something cardiovascular in nature you want to make sure that what you're doing is safe for you, because if we're maybe somewhere between stage 2 and hypertensive crisis or really super high, your doctor might want you to ease into an exercise program because too much, too soon, too fast could have some very serious consequence. Brad: So you could escalate or even cause a problem? Chris: Cause some serious problems. Brad: Right, if you have not if you're not an exercise person historically, and you don't want to go on meds and you think, "Oh, I'm just going to get after this right now. You better think again and you're going to gradually. You're not going to go out and start running a marathon, you're going to start by walking. Chris: You're going to walk. Walking is great. I mean, 30 minutes, five days a week, just so that you're breathing a little bit harder than usual. It's probably the easiest way to kind of determine how hard am I really working? Well, if I'm kind of taking some deep breaths, you know you're working hard enough. So if you're not, you know. If it's too easy to have a conversation, I mean, you could exercise and have a perfectly good conversation, and that's probably the training range you want, but you're going to want that heart rate bumping a little bit too. Brad: Not a casual, stop and look at the birds walk. Chris: No, a brisk walk where you're moving. Something that if it's a nice, cool morning, it helps you warm up. Brad: I want to mention, we're going to do another video, follow up on this probably in a couple of weeks. And we're going to go into more detail about diet and exercise and the medications I do want to come up with the good news is I looked at mine in my twenties and I was always in this range, the elevated range. Chris: Back then it wasn't a big deal. It changed that 2017. Brad: But actually at that point because my dad had it, I was looking at it and it was a little red flag for me. So I started back when I was about 30 years old, I started running. I didn't like running because boring. I was in karate at the time punching and kicking people is a lot more fun. Chris: Its always more fun. Brad: But it wasn't a rollback enough necessarily a lot of times. So I started running, went back to college. I needed something (indistinct) desk board anyways, started running and I dropped down 10 to 15 points at both ends. Dropped it down since I started running and actually my heart rate dropped way down too which is another benefit of cardiovascular exercise, you know, aerobics. Chris: Yeah, exactly. Brad: So, and I haven't had a problem since. So I think if you catch it in here and you're motivated to change your lifestyle, and then recently I've changed my diet, which probably has helped, but I haven't had a problem anyways. So get in early, get in that normal range and you don't have to get to the medication. I'd forget to take them, that's a problem. Chris: Well, and that's a big thing in my world. Brad: Is it really? Chris: Oh yeah huge, 60% of people don't take the medications properly. Brad: They don't take them daily or they forget. Chris: Just forget, taking them the wrong time, maybe not consistently. Actually we do things called adherence calls and things of that nature. So it's actually how insurance companies reimburse pharmacies now. So it's a big deal. Brad: If people don't take their meds on time then- Chris: We don't get paid. Brad: Insurance doesn't pay the pharmacy as well. Chris: Not as well. Brad: Yeah, that interesting. Chris: It's a big deal. Brad: Yeah, do you have to make sure you call people and see if they are taking them on time? Chris: Yeah we do. And it's actually more with Medicare part D patients. So this is a long sideways sidebar, but it probably puts people to sleep. Brad: We're getting at the end of the video anyways but there's a lot of things that revolve around this, so stay tuned, we're going to have another video on details of diet, exercise, and some more on meds as well. You know, what people that view this I think are hoping to stay away from the medication like most people are. Brad: Well, you know and exercise and diet are a huge component of that. And if we work at it, if you treat yourself like your own best investment, I think it can be very doable, but you got to work at it. It's not just something you're just going to hop off the couch and run a marathon and I'm good. I mean, once you stop exercising, all those good benefits that you received go away. So it's a lifestyle change, means forever. Brad: Now, I don't know if this fits right in, we can fix just about anything- Chris: Except a broken heart. Brad: But we're right on there. Chris: We're working on it, we're working. Brad: All right, very good. Take care. Chris: Thanks everyone. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad Steem It: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: COMING SOON! 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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.

When using a new massage gun it’s important to familiarize yourself with the different head attachments, to know which one to use depending on the treatment you want. *NOTE: The massage gun head attachments discussed below use the Bob & Brad C2 and Q2 Massage Guns as reference. Massage Guns: At-Home Physical Therapy Massage guns are one of the latest tools used by physical therapists, athletes, and ordinary people that wish to treat their muscles to better health from the comfort of their home. These nifty hand-held massagers are perfect for loosening-up tight muscles, treating sore muscles, and breaking down scar tissue. Though visiting physical therapists is a great way to get professional guidance for muscle recovery, it’s not always convenient. A quick massage on the calves before a run or a relaxing massage after an intense workout can easily be done from home. Massage guns are the perfect personal therapy tool to take exercise and relaxation to the next level. By having a massager and knowing how to use its different settings and attachment heads, you can be your own physical therapist! Why Use Different Massage Heads? Massage guns are an effective tool in performing at-home percussion therapy. In order to increase their benefits, it’s important to use the right attachment head. This way, you can adjust the intensity and pressure on a targeted area. Doing so can help alleviate and heal muscles faster. It’s also very easy to start. By simply becoming familiar with the different attachment heads and what their intended use is, you can play with different techniques until you find the one that works best for you. Different Types of Massage Heads and the Best Time to Use Them: *IMPORTANT: Never use a massage gun on your head or neck. Even with lower intensity massage guns, these areas are very sensitive and require greater caution. If you wish to treat these areas it’s preferable you use your own fingers and thumbs in order to take proper care when massaging. 1. Round head (large and small) Likely the most well-known and commonly used, the round head attachment is firm and targets a large surface area. This kind of head is ideal for bigger muscle groups. While the round shape does offer slightly more pressure at its center, it still provides enough flexibility so that a wider surface area benefits. If a muscle is too tender for a more targeted attachment head, like the bullet head attachment, then this provides a less intense option. Often these round heads will come in two sizes, large and small. Once an area has been massaged with the larger head, the smaller head can help target more-specific sore areas, knots, and other areas that require greater attention. 2. Round head (semi-sphere) After the classic round head, which has a completely spherical shape, is the semi-sphere round head. This head offers similar benefits as the round head. It also targets a wide area which is best used with large muscle groups. However, its flat backside provides slightly more give and is therefore safer to use on thinner muscles. 3. Pneumatic (large, flat, and cushioned) In contrast with the round sphere heads, both large and small, and the semi-spherical head, the pneumatic head offers the most give. These three are all in a similar category as they are the largest heads and, therefore, provide relief to larger surface areas. However, due to its design, the pneumatic head is the safest to use closer to bones or ligaments. It provides adequate pressure to aid in treating muscles. Meanwhile, its pneumatic folds better-adapt to the shape of the area it’s treating. Thus, while the other two round heads hold their firm shape, the pneumatic has the most flexibility and can provide pressure to both flat and non-flat areas. 4. Bullet (small and pointed) Unlike the round and pneumatic heads, the bullet head is designed for pin-point precision when treating muscles. This particular head can dig deeper into the muscle tissue. This can help target very specific areas where you may wish to go between top layer muscles for a deeper massage. As it is a more specialized tool, it likely won’t be the one you use most. When you do decide to go for a deep-tissue massage with this head, remember to use it for shorter periods of time. Targeting a muscle with this head for too long could lead to adverse effects. Make sure to give the area ample breaks between uses so as not to over-strain the muscle. 5. Flat (firm and flat) Completely flat top attachment heads can come in both large and small. These help stimulate the muscle while always maintaining a wide surface area. Unlike the targeted bullet head or flexible round tops, this head aims to give a wider firm massage to muscle groups. Massages with this head will have a slightly greater intensity with each hit. Do not use this massage head near bones or ligaments as there is less flexibility and a stronger impact. 6. The Fork (spinal head) This particular head is unique and is only recommended for targeting the muscles on either side of the spine simultaneously. Use this head with caution and assistance. Do not attempt to use this attachment head by yourself (if using it along the spine). It’s best to have someone help you to make sure the massage gun is always well-aligned with your spine. The fork can be used by placing its ends at either side of the spine and slowly working your way down. Be sure never to place it directly on the spine itself and don’t go too far up where you might start hitting the neck area. A good rule of thumb is to stop before the ball of the neck and focus most of the massage time on the areas in the middle and lower back. 7. Flat Aluminum Some massage guns offer a flat aluminum head attachment. This works almost exactly like the other flat top attachments. It provides a firmer percussion massage to the muscle group you wish to treat. The only difference is that because it’s aluminum you can alter its temperature. By placing the head in warm water or ice water you can control the temperature to help loosen stiff muscles or treat swollen muscles. This is a relatively new practice with massage guns and is therefore not an attachment head that is provided by all brands. What to look out for: Your comfort level - The classic “no pain, no gain” saying doesn’t apply here. When using a massage gun you shouldn’t feel pain or excessive discomfort. If you begin to feel pain it’s probably best to stop and let the muscle rest for a while. You could try using a larger head attachment to target a wider area. Alternatively, you could try using a warm towel to loosen up the muscles or use an ice pack to reduce swelling. Time on each muscle - Though it might seem as though more time working a muscle would provide quicker results, this is rarely the case. It’s much better to practice a technique that uses several attachment heads for short periods of time (1-2 minutes) then let the muscle rest and continue in a few hours or the next day. It’s important to use the massage gun to help the body perform its natural healing process, not as a replacement. Care for bones and tendons - The massage gun should only be massaging muscles. Be careful not to move too close to the edges and start hitting bones or tendons. Muscles have a natural bounciness to them that allows for them to absorb the percussion of the massage gun, bones and tendons do not. Adapt to each muscle group - All muscles are different. Thicker muscle groups like the calves and quadriceps will require a higher intensity than muscles on the hand and feet. Make sure you’re adapting your settings and head attachments to the specific group you’re working on. Build a routine - The best way to ensure you get optimum results from your personal therapy is to build it into your daily routine. Massaging the muscles and stretching before exercising can loosen them up to avoid injuries. Similarly, massaging the muscles in the evening can help stimulate the recovery process during sleep. Be a responsible guinea pig - Every person is different. Treat your massage technique like an evolving process. Don’t assume something you watched or read online will work exactly the same way for you. Try a massage method and keep track of the head you used, the time you spent, and see how you feel the following day. By paying attention to these details you can develop a superior technique that suits your needs. Most importantly: don’t hurt yourself! If something feels uncomfortable or painful STOP and allow your muscles to rest before trying again. Often the muscle is too sore because the injury is fresh and it needs some time to repair from the inside. Try Them Out! Now that you have a good idea of how each attachment head works, you can start to carefully experiment on your muscles to see what works best. Remember that bigger attachment heads are better for larger areas and smaller attachment heads help you target smaller, more-specific areas. Never over-strain your muscles looking to heal them in one session. Give yourself time to recover and learn by listening to your body. The best times to use the massage gun and the best technique for your muscles depends on your needs. Be patient and soon you’ll be feeling more nimble and comfortable than ever!

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As we have mentioned in earlier videos there are hundreds of types of TENS units available on the market. We have tried dozens of them. Without a doubt, many of the TENS units available will do a great job for you. After reviewing multiple units, we have decided to endorse the iReliev units. The iReliev units are powerful, effective, simple to use, and they have excellent instructions. We have contacted iReliev, and they have agreed to allow us to provide their program summaries for three of their models: For example, look at the chart for the model 8080 unit. This unit has both TENS (Transcutaneous Neuromuscular Nerve Stimulation) and EMS (Electrical Muscle Stimulation). For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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 November of 2020. For the original video go to https://www.youtube.com/watch?v=POEifRungeo&t=199s Bob: Today we are going to talk about five simple tricks to stay motivated every single day. Brad: That's right. Bob: Life changing habits will change your life. Brad: Well, Bob, you know, I was thinking about this and everything going on these days. Life can be challenging enough and then you have all kinds of other things. Bob: Going on in the background. Brad: Right. The virus, there can be financial issues. In order to be successful, happy and have a satisfying life, you need to stay motivated. It's not always easy. Bob: No, very difficult. Brad: We are going to go through five different steps. We are going to take our time a little bit so you can get everything. Number one, and I think, Bob, you fully agree with, you need to avoid negative people. As well as negative information. Bob: I totally agree with this, yes. Brad: Sometimes you can't avoid negative people because you either live with them or you work with them. Bob: That's exactly right. Or they're family. Brad: So, you've got to work around that and see if you can turn the tide and get them to be a little more positive. Bob: I want to give you a compliment, Brad. That's one of the reasons I like being around you. You're a very positive person. Very good example. Brad: Well, that's what I was going to say about you, Bob. We're starting to rise up here. Bob: Yeah, boats are rising up on the tide. Brad: The next thing, this is good. During this time in our society, how things have evolved, is news can be so negative. Particularly because they dwell on being negative. It seems like in the music in the background. The good news is there's things like podcasts. You can pick out your own sources. Like, Bob and Brad has a podcast. Bob: Yes, we do have a podcast that we started. Brad: We just started that. Bob: I love driving in the car now because we always listen to a podcast. Brad: You can tune it in. There's no commercials. It's a whole different thing. There's a lot of good options coming up. Bob: They have every topic available possible. If you haven't started listening to podcasts; it took me a while before I grabbed onto the concept. You need to start because it is the best way to get information. There's something for everybody. Even on the most obscure topic. Brad: Number two, you've got to be an optimist. Is the glass half empty or is it half full? It all depends on how you look at it. This is one of those things that, like earlier, Bob and I just had a good example. Join the compliment club. Like Liz! We came in today, both Bob and I said to Liz, and keep in mind I saw Liz twenty minutes before Bob. I said, you got your hair done. It looks so nice. Then Bob came in and said the exact same thing. Bob: Those little things can make a difference. It makes Liz feel better, but it also makes you feel better. It's just an all-around positive thing. There's always something good to say about everybody. You might have to work a little harder for some people, but you can come up with something. Brad: You might have to get that book out. Bob: So, this is a book that I had read. I've seen it recommended a lot. It's called The Obstacle is the Way by Ryan Holiday. Basically, it goes throughout history and gives you examples of people that run into really huge obstacles. I mean obstacles that would crush many people and they flip it around to their positive. I'm not going to give any examples because I'm not very good at that, but this book is a good example of taking the negative and turning it into something positive. Brad: Right. What is that saying? You can take lemons and turn it into iced tea, or? Bob: Into lemonade. Brad: LEMONADE! That old memory thing; I'm still working on that. I know, Bob and I are fans of Zig Ziglar. One of his quotes that I remember to this day is you can have everything you want in life if you help enough other people to get what they want. Bob: I love that one too. It's so true. It's amazing how the karma seems to almost work that way. With this channel, that's our goal, to help as many people as we can in the world. Brad: That's exactly right. Bob: It's really brought us a lot of satisfaction in doing so. Brad: Just this morning I was reading those comments and there's happy faces and people thanking us and it's like, it's working, Bob. Bob is the one who spearheaded this, and he's brought this out. Initially I thought it wasn't going to work. But it's going! Bob: Right, it's going. Brad: It's one of those situations, give and take and it'll always work out for the better. Bob: You give, you get back. Brad: Number three. This is right up our alley as physical therapists. Get physically active. If you stay sedentary, you can exercise your mind but the mind and the body work together. You have to get up. You have to get moving, like at the beginning of the video. This W stretch is one of my favorite stretches because it works posture. It works your shoulders. It stretches. The W is for? Bob: I'm not sure what you always say. Brad: It's for winning! It reminds me of that song by Santana back in the 80s. Remember that? Bob: No, I don't. Brad: Steve Winwood. Winning. That's the name of that song. Bob: Oh. Brad: "I'm winning", (singing). I better not sing. But if you go to Steve Winwood on YouTube and put "Winning", it'll come up. If you look at the lyrics of the songs, it's about someone being lifted up and winning. The whole video shows pictures. It's not a video. It just shows pictures of mostly sports people but other people very successful in that time era. So, if you're 50 years old, you'll know, it's a great way to start. Bob: From that time period. Brad: Yes, but even older, younger people, you'll know. Bob: They'll appreciate it too. Brad: It's a good uplifting song. Turn some music on that gets you going. Bob: Yeah, if you're really down and you're in bed, or whatever, just give yourself some small goal. Like, today, I'm going to walk back and forth on the floor. Brad: We didn't get to number five. Bob: Oh, did I really? Brad: It all fits together. There's no number order here. So, get active, do some stretching, get out and walk. If you can't walk, do some exercises. Bob: Yeah, just do something that you can do in bed and start with that. The next day you do a little bit more. Brad: Boy, the mind just really turns on and responds to the body. Sometimes you have to take control and force yourself. For me, it's almost that way every day. It's not that bad, but you know. Bob: I think when you combine the physically active if you can go outdoors. You're getting a double bang for your buck there. Especially if the weather is nice. My wife and I, we like to get out running in the winter and especially when the roads are fine. There's nothing like it. You get that fresh air, and you feel a real sense of accomplishment. When you run out in the 20 degree below weather. Brad: You're from Minnesota. Bob: I am from Minnesota, yeah. Brad: This next one is, number four, having a mentor figure or friend or a family member that you look up to because they give you inspiration. Inspiration when you're down, is important. I'll give you an example of one. It's actually a movie I watched. Have you ever watched Rudy? Bob: Oh, of course. Brad: He's the little guy that just everything's against him and he keeps chugging along and keeps chugging along. Bob: Never gives up. Brad: He never did play football. He never played in college; he played one play. And it was a victory. Bob: And he got carried off the field. Brad: Yeah, the only person. Bob: To ever be carried off the field, right? Brad: Well, yeah, up to that point. That was at Notre Dame. Anyway, watch the movie, Rudy. It will inspire you. I've got another one. Agnus. I think I've told you about Agnus. Bob: No, I don't think so. Is she the older lady? Brad: Yeah. I was 39 years old, and I did a triathlon for the first time. Here's this woman, who I found out later was 72 years old. I was like, wow, she's doing this. I couldn't believe it. And she beat me by a half an hour. Maybe it wasn't a half hour, but it was substantial. Bob: Wow! Brad: I was like, I want to be like that. I want to do triathlons until I'm 72, but this COVID year screwed me. They cancelled them all! Bob: Be positive about it. Brad: Right. I'm going to put a checkmark that that was okay. Agnus would understand. So, I want to go until 72. She kept doing them until she was 76. That was the last time I saw her. I'm not sure what happened after that. Bob: Awesome. Brad: Do you have any mentors? Bob: A lot of times they aren't even ones you meet in life. Sometimes they are ones you meet through books. I like to read a lot of biographies and stuff like that. I try to take something from everybody. The good portions of it. Brad: See how it fits into your life. It's all a piece of the puzzle. We're complicated people. Bob: Humans. Brad: A little sense of humor is always good. And number five, is to set goals that are realistic that you can accomplish. That works for me. If I can set a goal, I just decide, I glue into it and sometimes too much, but my wife helps me with that. Make sure that the goal is a good healthy goal. Bob: The thing is too, we kind of alluded to it before, it may be the smallest accomplishment the first couple of days. That's how it works. That's how it builds up. Brad: Yes. Bob: If you do something you can do it's better. If you make it too big right away, it's just going to deflate you. You're not going to be able to move forward. Brad: Exactly. It's like this channel. When we started out, we had a goal of 10,000 subscribers and we were getting 200 views a day. Bob: We were thrilled. Brad: Yeah, we were happy! It was like, YES! We are moving in the right direction. Bob: When our first video ended up with a hundred viewers over time, it took like weeks and weeks. We just thought that was amazing. A hundred people have watched us. Brad: We were, what do they call it? Hitting it? We were doing good. Bob: Yeah. I don't know what that means, but ok. Brad: There's some popular thing that kids use now or whatever. We're doing good, anyways. So, make sure your goals are appropriate. They involve yourself, your family. Often times your community. Bob: Start! I'm not the kind of person that likes to give the goals out in public and use that as a motivation but sometimes they recommend that. You tell everybody that I'm going to do this. Brad: Yeah, I'm going to lose weight. I'm going to lose 10 pounds and you give it to the whole public. It gives you a little motivation. "Well, I have to do it because I said it to everyone." But everyone has their own different little tricks. Bob: It works differently for different people. Brad: So, there you go. Five things I think that will fit into everyone's life. Bob: Oh, I just want to mention these books. I didn't mention this book, it's by Gary Vaynerchuk. He's actually the reason why we got into videos. It was not only his books, but it was also his videos himself. Very dynamic guy. Brad: He curses too much for me. Bob: A little bit of cursing. A lot a bit of cursing. Brad: He must be going through a little bit of personal evolution too then. Bob: LOL, maybe so. Brad: But we got the Dale Carnegie one. He's kind of like the father. Bob: I didn't mention that one either, did I? Brad: He's like the father of personal growth; motivational thing. He's passed but he started in the 30s, wasn't it? 40s? Bob: Yeah, he was the guy that came up with this genre. Brad: Yeah, absolutely. So, there it is. Bob: Go Dale. Brad: Very good. Enjoy and stay motivated. Bob: Thanks for watching; (listening/reading!) Interested in learning about the products mentioned in today's video: 1) "The Obstacle Is the Way" by Ryan Holiday :https://amzn.to/2UJFZR7 2) "Crushing It!: How Great Entrepreneurs Build Their Business and Influence-and How You Can, Too" By Gary Vaynerchuk :https://amzn.to/2KuWWNv 3) "How to Develop Self-Confidence and Influence People by Public Speaking" by Dale Carnegie: https://amzn.to/3kNUMF3 Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad Steem It: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun: https://amzn.to/36pMekg​ Q2 Mini Massage Gun: https://amzn.to/3oSMBu9​ Handheld Massager: https://amzn.to/2TxZBqU​ Knee Glide: https://store.bobandbrad.com​ Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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.