Research shows that both TENS and EMS help increase circulation to an area. Increased circulation can help with healing. In addition, if a TENS unit decreases your pain, it may enable you to perform exercises that can help with healing. For this reason, we decided to show you at least one exercise to perform when using a TENS unit on a specific pain problem. For example, when using a TENS unit for controlling wrist pain, we will also demonstrate how to perform wrist flexion, extension, and circumduction. 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 https://youtu.be/RrBCTydWlmY 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=o9TJZgMhiX0 Brad: Hi Folks, Brad Heineck, physical therapist. Chris: I'm Chris the pharmacist. Brad: Tonight, we’re going to be talking about, will vitamins boost your immune system and health. As well as this being science-based, we’re going to get this information from Chris, who is a pharmacist and he’s done a lot of research and recent research to get this covered properly. So, I need to talk about this, Chris. Just bear with me here, but today with all the highly processed foods, carbohydrates, that’s a big buzzword, now is the carbs and then sugars. Everything has got sugar in it from milk to anything, it amazing. Do we need supplements with all this garbage in our food? Do we get enough vitamins in our food because if you look at the cereal and you look at the ingredients, it’s like, my goodness, all these vitamins in here, really good. But, of course there’s a lot of sugar in there? That’s what we are going to talk about today. This is going to be a controversial subject. Some of the things that are brought up, there’s going to be people with strong feelings. Put them on the comment section! It’s nice to read them and then we get people talking back and forth. Chris: Yeah, I think it’s good to have that interaction. Brad: Absolutely. So, should we start with vitamins? Are they important for our system, our immune system particularly? Chris: Oh, yeah. In today’s world, we are a COVID pandemic society, so yeah, I mean all nutrients are good nutrients. At the end of the day, no matter what we do, your immune system is good health, it’s a 24/7 job, 365 days a year. What you need to do is make sure you’re eating well. So, getting things through your diet, make healthy food choices, and you want to make sure you’re exercising. That’s a huge driver of your immune system. You want to make sure you’re getting your sleep because that’s also a huge driver of our immune system. And you want to make sure you’re drinking plenty of water. That’s a huge driver of our immune system. There’s four things there that are very, very essential and critical. Brad: And the vitamins and minerals are just one part but without the other three? Chris: Just think of yourself like a pyramid. If you kick a leg or two out, it’s not going to stand very well. We live in an Americanized society or a lot of us do, where it’s not always conducive to get the most nutrition. I’ve been a victim of going through drive through, I’m sure you have too. Brad: Absolutely I have. You’re in a big hurry, you have things to do or you just don’t have time to get a proper diet. Chris: Even those foods though do have some of the nutrients that we need. If you go to Subway, I mean there’s going to have fruits and veggies and grains and everything else. They can be fortified with your folates and your B vitamins and all the stuff that you get from fruits and vegetables. Natural foods have other ingredients in there, which is why it’s always best to get your nutrients through food, but when it comes down to it, sometimes we just can’t do that. Maybe taking a daily multivitamin is a reasonable answer. We want to make sure that within that multivitamin, it’s got just certain ingredients to make sure it’s doing the job for you. Brad: Right. We aren’t going to get into this too much, but there are people with certain health conditions where you may need to take a lot of a certain specific vitamin. Do you know of some specifics? Chris: Oh yeah, if you have something like osteoporosis. You’re going to need vitamin D and you’re going to need calcium. And actually, magnesium and a little vitamin K too. These are all things that work synergistically together to help to improve bone health. Multivitamins are going to generally these days be fortified with vitamin D. It’s been a buzzword; we’ve known a lot about it for a lot of years. It’ll be D3, it’s going to be cholecalciferol. It’s one of those things where you just look at your labels and make sure you’re getting roughly anywhere from 600-800 IUs a day. Your doctor will tell you if you need to take more. Brad: IU’s? Chris: International units. Most multivitamins will be in IU’s. Some newer ones are going to micrograms but for the sake of simplicity, we’ll keep it at IU’s. Brad: So, we’re establishing already that obviously you need vitamins, you need minerals to stay healthy. You should be able to get them all from your diet, if you’re eating properly. If you have a health condition, maybe you need more of one or another, but let’s talk about particularly people who are generally healthy and they’re here to find out, I’m not sure I eat good enough. Instead, I’m one of those people, I’m always busy, I’m always running, doing fast food and I’m worried about having good health. I’m stressed a lot too. I think I should take a vitamin. So, a multivitamin is the way to go? Chris: I think so. Generally speaking, I mean, the supplement industry is a $31 billion industry. That’s a big number folks. Brad: Vitamins, supplemented? Chris: Yeah, when I came out of college 25 years ago, it was about a $2-$3 billion industry. It’s expanded in 25 years. It’s definitely grown and definitely got a market and a place. To market, that’s one of the things we have to be careful with vitamins, a lot of these are super doses when you’re looking at some of the individualized supplements. I think for the average person, that’s reasonably healthy, but sometimes can’t eat perfectly well, a multivitamin is going to be the way to go. You can just go to any health store, any pharmacy, any grocery store, Amazon, you name it. They’re all going to have good multivitamins. You want to look for something that’s at least USP certified because that’s the standardization and that stands for United States Pharmacopeia.Their the standard so you know what’s in that bottle is in that bottle. Brad: You said, USP. Chris: USP yes. Brad: So, if you look at the bottle it’ll say it somewhere on it? What does it say after that? Chris: Yep. Basically, it’s just going to tell you that the ingredients that are in that bottle are certified, so if you have, we’ll call it 600 IUs of vitamin D, you can bet your dollar that it’s 600 IUs of vitamin D or 15 milligrams of vitamin C or 18 milligrams of iron. Brad: So, there are supplemental vitamins or vitamins out there that may say they have so much of a vitamin but if it doesn’t say USP, it may or may not? Chris: Yeah, it could have some things that are maybe not as good as what they should be. They could have some things that shouldn’t be in there. They may not even have the exact amount of dosage that it says it does. You want to look for a high value, well-respected company, that’s going to be giving you the nutrition needs that you need. Brad: If we are looking at it and we know, let’s pick one vitamin, for example, vitamin B12 or something. Typically, what’s the range someone would need for that? Chris: Yeah, you don’t need a heck of a lot for B12, you’re talking about just two to three micrograms. So that’s a really teeny tiny amount, not milligrams, that’s a factor of 1000 less. Teeny tiny, for vegans and vegetarians, listen up, these are people that we probably do want them taking a straight up vitamin B12 supplement or a B complex, because how do you get B12? Through meat. Basically, it’s all through your animal products. For people that have that lifestyle choice, which by the way, they’re eating better than most. But sometimes you don’t get quite what you need, so for them a multivitamin is probably going to help, or they could supplement a B12, but I would prefer a B complex. They’re a little bit more realistic with the doses that they contain. Brad: So, now that’s kind of going back and forth here, because you said if you’re eating well then you probably don’t need a supplement. Chris: Yeah, you gave me a curveball there. There’s an exception to every rule. I’m trying to hit it. Brad: I’m thinking of all the vegans out there. Chris: Oh yeah, it’s huge. Very proud of themselves. And they should be. It’s excellent. You’re not going to have a problem with a vegan because they eat better than just about everybody. It’s a lifestyle that they choose, and they know how to extract nutrients better than most. They’re very well-educated group of people. Brad: One of the concerns is, and I don’t think some people are aware of this, if you’re taking a supplemental vitamin or just eating a healthy diet and your body already gets what it needs, then all of a sudden if you get an overload of a vitamin or mineral, what happens? Is it bad for you? Chris: Our bodies are pretty interesting things. Basically, in a lot of cases, but not every case, when we get too much, and the B vitamins are really easy to pick on because they are water soluble, you excrete them, you get expensive urine. From that standpoint, you’re throwing your money out the toilet. We do want to be kind of careful with that. When you’re looking for your vitamins, some of these things have mega doses. Actually, in my pharmacy yesterday, on the way out the door, I said, let’s see what’s in this B. I saw a B12 supplement that had 1000 micrograms, which is actually 16,000 times the recommended daily intake. Brad: So that’s just going in and most of it’s going right out. Chris: Your body is going to extract what it needs that, but the reason they dose it that way is for specific people that have issues like pernicious anemia and things, but that’s a sidebar. For the most part, if you’re going to use a B vitamin and you’re vegan or vegetarian lifestyle, I’d either go with a B Complex or a multi because it’s going to be reasonably balanced and properly dosed. Brad: The other thing is, I’m thinking, I’m not opposed to taking vitamin supplements. At the same time, I’ll forget to take it. Chris: That’s the case with many people. Compliance is key. Brad: I focus on my diet; I eat vegetables and I’ve really backed off on the carbs the last couple three years. It’s been very beneficial. Chris: No matter what you choose, food is best, but a good multivitamin is going to get us what we need to do. Whether you’re looking at vitamin D which has things that stimulate our immune system, helps to minimize the risk for upper respiratory infection, good for our bones. Good for our mood. It’s the sunshine vitamin, so ideally if we could get it through standing outside, but we live in Wisconsin, so it's not conducive at all times of year to getting outside and getting that 10-15 minutes direct exposure to the sun. Brad: That’s what I don’t get is 10-15 minutes of direct exposure and you say that, and I’ve heard that before, but it you’re out there and you have your gloves on and your coat and all covered up, so does your face. It seems like you’d need more than 10-15 minutes. Chris: As opposed to when you’re just wearing short sleeves, etc. And with skin cancer risk you still have to be wearing sunscreen even in winter. If you’re out there for longer than 15 minutes, you better be protecting that skin. Brad: Sunscreen doesn’t block the vitamin D benefits? Chris: You’re going to get a very small amount absorbed so it’s not enough. We’re already not getting enough in the northern climate. The multivitamin does have enough already in there. That’s at 600 to 800 IU level, like we were talking at the beginning. It’s very, very important and it does a lot of good things for the body. So, you want to make sure your vitamin contains that D and most do. Brad: Let’s say we have someone whose generally healthy, not taking any meds, normal lifestyle and they come onto a crisis in their life or something that lasts a number of weeks or months, putting unusual stress and/or physical demands on their body, say a new job, family changes or something that you’re just overloaded with. Are excess vitamins needed? Is that going to help you get through it? Chris: Yeah. There’s actually some really good studies specifically with the B vitamins and there’s 8 of them. 8 separate B vitamins. Actually, it’s funny when you look at B1 through 12, you look at them and they are B1, B2, B3, B5, B6, B7, B9 and B12. B’s are good for stress. Actually, a little bit of vitamin C too. A lot of the balanced B Complex’s, which is a type of multivitamin, the C enhances the absorption of the B vitamin so that’s why it’s important, if you’re looking for that one to get it, because if we’re working really long hours and with this COVID society, people are doing things that are probably far more unusual. They’re probably working two and three jobs. A lot of cases, just to make ends meet. That puts tax on your body, puts tax on your immune system. Those B vitamins do support that. As we’re going through all these stressors, our body tends to burn through those things. If we’re on the go like that, and we’re not being able to eat properly timed or properly nutritious meals. You’re probably going to need to supplement those. Most of the multivitamins again are going to address those needs to get you what you need. It’s just a one a day vitamin that you can handle. Like we were talking about earlier, more is better, I better take a B complex too, because I’m going through so much, you know, water soluble vitamins, you just excrete them out, so just pick one that you know you can stick with and be good with. Brad: I know we’ve been talking about the vitamins and supplements, how to take them, what to watch out for, but again, I want to go back to the four things you mentioned. First of all, if you’re eating good food, fruits, vegetables, and meats, all good quality food, and you’re eating it regularly, you probably don’t need any vitamins because again, you’re making expensive urine. So, you can certainly be healthy without a supplement. Chris: Yes, you don’t need it if you’re eating well. If you’re eating perfectly all the time, it’s a waste. Brad: Not just a diet, you know, I’m a physical therapist, we both understand you need to get some exercises; you don’t have to be a marathon runner. Get out and walk. Do exercise to get things moving, and what was the other thing you mentioned? Chris: Sleep. Brad: Sleep! How could I forget. So, sleep, exercise, nutrition and just be happy. Chris: Reducing your stress does have an effect on your immune system. There’s several other nutrients and other minerals that stimulate our immune system like zinc and magnesium. There’s a lot of stuff out there. When you get a complete multivitamin, a little bit of vitamin A, these are all things that work synergistically in our body. There’s thousands of little chemical actions and reactions that are going on that stimulate our immune system. But like I said, those four pillars that we talked about; the sleep, the rest, the good nutrition and exercise are huge. But vitamins can supplement that. If we’re not getting it through our diet, it’s certainly going to help us be healthier, especially in these extended really unusual times. Brad: I have more questions. Chris: Fire away. Brad: Ok, say you go into your store and like you had mentioned, there’s a whole wall full of vitamins, so, we’re not going to pick out certain brands but again, look for the USP on the label, look for exaggerated amounts of volumes. Chris: Avoid the exaggerated amounts. The super vitamins are not going to help you. You’re just going to end up excreting them out. Even if we are eating a partially nutritious diet, a lot of the things are already supplemented in our cereals and breads and grain and folates and things of that nature. We want to be mindful of that because too much can be bad. In some cases. Brad: If you’re taking medications, make sure to talk to your doctor. Chris: Very specifically on that. There’s certain interactions, my favorite one is the blood thinner warfarin because of vitamin K but certain antibiotics with the minerals like magnesium and zinc and calcium can inhibit how certain antibiotics are absorbed. If you’re taking things like Tums or antacid, they slow down the thyroid medications and things like that. You want to be careful with the timing of nutrients. It’s one of those things that is certainly going to help. Iron is another big one that you want to be careful with, it’s best on an empty stomach. Brad: Outside of iron, I’m thinking most vitamins you mentioned before when we were talking, you need to have a diet or whatever’s in the food, so your body absorbs it, and you have a complete system working. It’s not like you can take vitamins without eating and be healthy. Chris: Correct. There’s no shortcuts, Brad. There just isn’t. So, what a multivitamin is going to do is to supplement what we’re not quite getting. It’s just going to provide a benefit, but you can’t just go on coffee, cigarettes, and water and vitamins. It’s just not going to work. We said some things pretty bad there. Brad: Alright, wow, so very good. I think there’s good news and bad news here. I mean, mostly good news. You don’t need to take a vitamin if you’re eating well and if you’re not and your concerned, go ahead. But make sure you take some good ones and not too much. I’m exhausted here. Chris: There’s a lot of nutritional facts that we kind of talked about. We probably have glossed over a few that maybe we could consider another program on. I think though at the end of the day, go out there and get your rest, try and get your exercise, eat well, get your sleep, drink your water, those are going to be the bigs. When you can’t do it, it’s really safe to say that a good multivitamin is going to help you. Brad: Sure, alright. Thanks for tuning into us and we’ll catch up next time. Chris: Sounds good guys. 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This article is a transcribed edited summary of a video Bob and Brad recorded in February of 2021. For the original video go to https://www.youtube.com/watch?v=zbAmE7HIxLQ Bob: Welcome, my friends. I’m joined by Chris, the pharmacist, smartest guy I know. Or at least in the top 5. I’ll give you that. Today we’re going to talk about the truth about sleeping pills, Ambien, Lunesta, Sonata. We might even talk about another one. Are they dangerous? We are going to get into this. Now these are called "Z-drugs." Chris: "Z-drugs," primarily just because they have the names, the z’s. Bob: The "Z" is the other name they have. Chris: Yep, zolpidem, eszopiclone, and zaleplon. Bob: So, they all have the Z’s in them. Chris: Yes, that’s why. Bob: I, unfortunately, have some experience with this. I was always a great sleeper. Like the best sleeper ever. Then I ran into some problems with sleeping and I didn’t have any coping mechanisms. I was already doing all the things that we recommend you try first, all the natural ways that can help you get to sleep. I know the most important suggestion is that you go to sleep at the same time every night. Chris: Yes, they talk about sleep hygiene. Let’s talk about these numbers, you’re talking about 50-70 million Americans at some point or regularly have difficulty sleeping. That’s a large amount of people in our population. Bob: And it affects your health greatly. Chris: Yes, top to bottom, there are so many things that sleep is restorative. When a lot of people that you see approach a pharmacy or talk to your doctor, 70-80% of those problems can be corrected with good sleep hygiene. Bob: Keeping the room cool, keep it dark. Chris: Same time every night, easing into the evening, relaxing activities. Bob: Turning your lights down at a certain time. Chris: Exactly. Darkness, it starts to bring those melatonin levels up. It’s really important for that. We are a busy society as a whole. As Americans, we are runnin' and gunnin' pretty much from the moment we wake up, running the kids to school, working on a project, working on a business project, I mean, we are just a busy society. Unfortunately, insomnia can encroach on that and a lot of times, sleep hygiene goes out the window. That’s the first place to attack it. So, if you can ease into your night, minimize caffeine, minimize alcohol, leading to your evening. Bob: Caffeine, it can stay in your system for quite a while. So really probably no caffeine after lunch, right? Chris: I mean, well lunch, or not much later than 3 or 4 in the afternoon. Some people have incredible tolerance to caffeine so it kind of depends on the person. We have to tailor it to the patient because it depends on their patterns and what they do. If you’re having a cup of coffee at 8pm, probably not going to help with the sleep scenario. Same thing with alcohol which is kind of interesting. If you’re like, “I’ll take a beer before bed and I’ll fall right to sleep.” Well, there’s a paradoxical excitation that can occur with a beer or a glass of wine, which you think is relaxing, but it’s actually stimulating. Then it affects your REM sleep, which is rapid eye movement which is that part of the sleep which is so important to us because it resets our brains. Bob: It restores us. Chris: Then we miss out on a lot of that. So that sleep hygiene is critical and watching out for certain drugs that can impact sleep. So, those are some of the non-drug things we can do before resorting to drugs. You do want to see your doctor too. Say you’re going thirty days in a row and you’re not sleeping well, that’s kind of the medical criteria. I tend to be, somewhat impatient. If you haven’t slept in like 2 weeks, you’re probably affecting your immune system. You’re definitely going to be affecting your work life, your social skills, because this can cause you to be short tempered. There’s a lot of things that absolutely affect you. So, we want to be super duper careful. What if it’s a thyroid issues that's not controlled? What if there’s something going on with your adrenal glands? What if there’s something else that’s triggering these types of things? As a pharmacist, there’s no way on earth I could possibly know and that’s why we have to go to the doctor so they can ask the certain questions and run the certain tests. To see if there’s maybe something else out there that’s maybe creating the problem that you just didn’t even know when you’re falling asleep, getting frustrated, beating your head against the wall because, “I can’t sleep.” It is such a frustrating scenario for patients all across the board. It’s awful. Bob: Right, because you can’t will it. The more you think about it, the worse it gets. Chris: Absolutely. Bob: One of the problems that I have, that a lot of people have, if you go on vacation or a conference, and one time I had trouble sleeping because there was road noise. I didn’t sleep all night, and then I had to go to a conference. I want to make sure that it’s well known here that we are not advocates of drugs. If we can, we try to go off prescriptions, we try to go natural ways, that’s the Bob and Brad Way. But there’s times where you may need to use them for a short period of time or maybe just when you go on vacation or a conference. Chris: Yeah, the whole invention of this "Z-drugs" in general, was based off of benzodiazepines. The benzos came into effect in the fifties and we thought they were a great drug so then, over time, we realized that there was tolerance and addiction, so in came the nineties. The first "Z-drug "on the market was Ambien or Zolpidem. Early in my career, 25 years ago, you mays well have put it in the water, as far as the prescribing habits at that time. It was so proper because it worked great and really the distinct advantage of the "Z-drugs" that they have over benzodiazepines and the false impression that they get, they are safer but there’s a caveat to that. Long term, whether it’s a benzo or if it’s a "Z-drug," they’re not designed for long term use. Yet, I’ve got patients that have been on it forever. There are newer studies that suggest that it could be affecting your memory. Bob: Dementia, right? Chris: Yes dementia, and some of those studies are conflicting too. It’s kind of tough. There’s an interesting doctor that had talked about a discussion that he had with a patient to try and get her off of one of her sleeping medication. It was met with a lot of animosity and it’s tough because when we don’t get our sleep, it’s kind of like taking away your best friend. It’s like, gosh, you can’t take that away from me because how am I going to get rest? Bob: If I don’t sleep well, the day is not going to go well. I mean, it can ruin vacations. Chris: Well yeah, it can ruin performance. You have to be focused at work or even just with family and friends. Having proper sleep fixes a lot of other ills. It’s restorative, it’s helpful to your immune system. It’s critical to get that sleep. It’s such a hard challenge and that’s why your doctor is so incredibly important in trying to find the right mix for you to keep you safe. Bob: Along with the end goal of trying to get off of them. It’s a temporary fix. Chris: If you look at like, you take Kaiser Permanente, which is a West Coast health system, which is about 12 million members strong, their optimum goal is to have everybody no matter what they are on, only two weeks of consistent use before we want them to either taper or discontinue. Going forward and then used only intermittently, like that occasional night where, “oh, I had a crazy day and I just can’t unwind.” Then it’s very appropriate to use. Within the three drugs, whether it’s Ambien, Lunesta or Sonata, which again would be the zolpidem, the eszopiclone, or the zaleplon, in that order for the generic names: the doctor’s going to be very critical about selecting which ones the right one for your particular situation. With the Ambien, it has an extended-release formulation, and Lunesta has a longer action. So, we have to be careful. Bob: Ambien has both forms right? Chris: It’s an interesting drug. It’s pretty cool. It works for four hours and then you get a burst four hours later that keeps you to sleep. It’s for people that actually can wake up. That’s the problem. We will pick on Ambien. When people use drugs, like this one, on a regular basis, over and over again, actually loses its effectiveness. Bob: That’s what I found, because I was on Ambien. It worked fantastic, ½ pill is what I’d take, and it took the hour to fall asleep. Then it went to the point where it only would work for three hours. Chris: Yep. You develop a tolerance to all these medications relatively quickly. The Sonata, or the Ziaplon, is interesting because it really only works for about an hour. It’s designed for people that just can’t fall asleep. Within the dosing guidelines for the FDA and actually the manufacturer says if you wake up within four hours and you have at least four hours more you have to sleep; you can repeat that dose. It’s so short acting but it’s interesting that all these "Z-drugs" can get this weird amnesia effects. When you take this drug, you want to go to bed right away. That is absolutely critical. Bob: You can feel it working. I could not sleep, and it put me to sleep. Chris: Absolutely. The thing is it can put you into a hypnotic state. Basically, you can sleep-eat, you can sleep-walk and say, “Man, I want to go to McDonald’s and get a shake,” and all of a sudden, you’re sleep driving and you drove through somebody’s front yard. Bob: They call that ambient zombie or "Z-drug" zombies. Chris: Yeah, it’s a powerful, powerful drug. So, when you take it, you go to bed right away. Bob: Yeah, people were found binge eating, cleaning their house, driving a car, having sex. Chris: Yeah, lots of strange things but also getting really weird things that show up from Amazon the next day. You’re like, “Oh my gosh, I got a $10,000 blender”. I mean, we can laugh about it, and it is kind of funny, but it’s not because you can not fight these drugs. They are very powerful. Bob: Roseanne Barr made that racist remark, she blamed it on Ambien, and the Ambien manufacturer. Chris: They backtracked it. Bob: They said no, they said racism is not a known side effect of Ambien. Chris: In today’s society, that’s not an excuse and that’s why she was fired. Rightfully so. Social exceptions, that’s not there, but the drugs do have these very powerful effects. We have to respect them. We have to use them effectively. It’s very, very critical for that. Bob: The thing I found out, Chris, as I started weaning off of it, the fact that it was just there; helped. Like, I’m going to go to sleep and if I can’t get to sleep then I can just take this and that calmed me down and it stopped my mind from spinning. Chris: Yeah, just knowing that it’s there, there’s a psychological aspect to it and there’s a physical aspect to it. Like I said before that tolerance does develop. I had a conversation with one of my patients yesterday, she said she tried everything, did the counseling, and so there’s still millions and millions upon Americans that these are a very requisite and very appropriate portion of their lives. Yes, we want people to use it as minimally as possible, but sometimes there’s just times for whatever reason, brain chemistry, psychological chemistry, history, I mean, there’s a lot of other things that are going on underneath the surface that the doctor needs to get to. They work exclusive with the patient to ensure that we are getting the best possible care and try and keep them safe as possible. But yeah, just have that psychological factor that just knowing that you can just go to that. Some people say, I can go three days and kind of wing it. But that fourth day, I’m going to have to take that medication. Sometimes that’s enough. That’s when we get you back in, we get you reset and you’re good to go. Exercise, minimizing caffeine, sleep hygiene. We put it all together in a complete package and then hey, we have a better quality of life. Bob: With the Ambien ER, obviously you can’t cut that in half. Chris: No, you cannot split that because what will happen, you’ll get a bolus dose, your stomach acid is going to degrade that. And it’s basically going to launch all that Ambien into your system. Bob: How would that be if you only took half of it? Chris: Well, you’re just going to churn through it. You’re going to take half the drug but you’re going to get all the drug that’s in that half table and it’s just going to elute out into your system. If it’s a compression matrix tablet, it’s actually kind of interesting. The manufacturer’s quite genius when they did this. Basically, they just found a way to get it around your stomach acid, get it into your gut. So, it has two parts. You have your immediate release and then, four hours later, boom, it’s absorbing again but it’s absorbing in the intestines rather than, well they all absorb in your intestines, but the first round passes the stomach acid that helps to get it going, gets in the intestines, absorbs in your system and then makes you tired. And it works within 20 minutes. Bob: So, I tried the Lunesta too. That seemed to keep me asleep longer. That was eight hours. Chris: Yes, it does. You have to give yourself, especially that constantly point for pharmacists is, you want eight hours and even realistically, probably 10 hours out of your system because if you’re driving and all of a sudden you get into a car accident. You say, “I took my Lunesta last night.” Well, that’s operating while intoxicated so that is a risk. That’s something that we have to be careful with. As we age, that’s another big risk because unfortunately as we age, our metabolisms slow down, drug stays in the system higher and longer. Bob: Also, when you age, sleep becomes more difficult for a lot of people. Chris: It does, for a lot of different reasons. We talk about our sleep cycles. It’s very important as we age. Like, a newborn, they sleep 16 hours a day. If you’re a new parent, five minutes at a time. Bob: As a teenager, I could sleep 12 hours. Chris: Yeah, but you had a lot of growth changes going on. I think we all could. It’s interesting, sleep cycles themselves, by the time a child is 5 years old, it mimics an adult. It’s just a longer period of time in the four phases of sleep. It’s kind of interesting when you look at it from that response. More importantly, with respect to these medications, and you use the example of Ambien ER, and also your Lunesta. You want to make sure that you have that 8-hour gap, minimum, before you consider thinking about things that require more thought or focus like work or business or driving. If you’re going to do a workout, it could actually affect your coordination. Bob: We were going to mention this too, Chris. I actually had a fall and what had happened, one, I didn’t have the lights on in the room. But I got up and it’s in the middle of the night and I was on Ambien and I was trying to get to the bathroom, and I was all over the place. I was tired. Chris: It absolutely messes with you. From a coordination standpoint and again, as we age, that’s why the importance of these things is we have to be exceedingly careful with the prescribing of them. You’re a very coordinated person and it took you for a loop. As we age or maybe some of our muscles aren’t firing the way we want it to, let’s say we’re 75 years old. You take that fall, you hit your head on the counter, you could break a hip. Bob: You could kill yourself even. It can be a downward slide after that. Chris: It’s that serious. That’s why we have to be cautious with that. We don’t need as much sleep as we age but that’s not to say that you still need sleep. It’s very, very critical. It’s funny when you look at different species. Like a giraffe only sleeps 30 minutes a day. Which I thought was really kind of interesting. It’s funny. Bob: Humans are the only ones that are not following the sleep cycle of sunlight, because we can artificially create light so we can work longer hours, a bad thing for humans actually. Chris: Yeah, you know or shift work makes it very challenging; people that travel for a living. Like you said, you have trouble in hotels. I mean, there’s a lot of appropriate uses for these "Z-drugs," but you know, again, you want to use it with a level of caution. Bob: Now, what would you recommend as far as length of time? Chris: Well, the guidelines that are kind of being placed in now, currently, they really say two weeks of consecutive use and then to taper and/or try and find another mechanism. And even when you’re using the "Z-drugs," asleep hygiene still has to be a mainstay of everything that we do. It’s getting actually adequate sunlight during the day if we can, which, if we work at a 9-5 position, we’re in the Northern Hemisphere for us here, sun’s gone by the time we get out of work. It doesn’t always work to our advantage. If we can though, we’d like to get some outdoor activity, if it’s at all possible, even though it’s cold. Because daylight is important so hopefully there’s a window or something that we can at least get some of that. The reality of it is, you still want to fall into that sleep hygiene pattern. Try it and use it. Bob: I want to warn against this, and I’m sure you’ll back me up on this 100%. Taking melatonin and if you keep taking it, your body stops manufacturing it, am I correct? Chris: Yeah, some of the studies suggest if we repeatedly take the over-the-counter supplement melatonin, that it can actually shut down our natural system. Basically, when it gets dark out, melatonin goes up, makes us tired, and when it’s light out, it drops, and we wake up. That’s our circadian rhythm. It’s critical for our functioning and you know, we have so many people now that work third shifts. There are physicians, there’s nurses, there’s manufacturers, there’s just people that are night owls. It’s still so critical for us to make sure we get that adequate amount of sleep. When we use these drugs longer than that, the studies actually show that if beyond two weeks, you actually revert back to the same sleep patterns you had pre-drug. So, you really want to use it for a short period of time, get your body caught up so that you’re functioning cognitively and feeling well, because sleep also affects our immune systems, the way we feel, our behavior, I mean, it’s everything. Once we can get reset, we want to try and rely on our own natural methods to try and sleep. Then for the occasional use or difficulty sleeping, it’s there for you. For some people, though, I mean, you have people that have PTSD and a lot of other things that are out there and there’s a multitude of other medications that the doctors will certainly try and/or encourage. Sometimes it just doesn’t work that way. Bob: You might be someone that’s having difficulty with pain too and having trouble sleeping because of that. Chris: There’s a multitude of reasons why doctors have people on these things long-term. The guidelines are one thing, but each situation is individual. We’ve got, what, 340 million Americans? So, there’s, you know, we’ll call 70 million Americans that have each individual different sleep issues on a given day. And so, we have to treat them each as individuals and what’s best for them. What works for Bob might not work well for Chris. It just kind of depends on the person and what we can do to try and keep ourselves going forward in the healthiest way possible. Bob: I’m really happy that I’m completely off it now. And you only get by on what, 4 hours a sleep a night? Chris: I’ve got problems, ha-ha. Bob: Thanks everybody and check us out on all our channels. 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 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 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. * More info on Chris the Pharmacist can be found on his Bob and Brad's Experts Page here

It is safe for most people to use a TENS unit and most will not usually experience any side effects. Serious side effects from TENS units are rare. Some people may be allergic to the adhesive pads and experience some mild skin irritation. Anyone who experiences skin redness and irritation can switch to using hypoallergenic pads instead. The electrical impulses that a TENS unit produces cause a buzzing, tingling, or prickling sensation, which some people may find uncomfortable. Obtain clearance from your healthcare professional before you use a TENS unit and always follow the directions provided by the manufacturer. The following are warnings for the iReliev TENS units. While most units contain similar warnings, make sure to read the precautions and contraindications for your unit. WARNINGS If you are in the care of a physician, consult with your physician before using this device. If you have had medical or physical treatment for your pain, consult with your physician before using this device. If your pain does not improve, becomes more than mild, or continues for more than five days, stop using the device and consult with your physician. Do not apply stimulation over your neck because this could cause severe muscle spasms resulting in closure of your airway, difficulty in breathing, or adverse effects on heart rhythm or blood pressure. Do not apply stimulation across your chest because the introduction of electrical currents into the chest may cause rhythmic disturbances to your heart, which could be lethal. Do not apply stimulation over open wounds or rashes, or over swollen, red, infected, or inflamed areas or skin eruptions (i.e. phlebitis, thrombophlebitis, varicose veins). Do not apply stimulation over, or in proximity to, cancerous lesions. Do not apply stimulation in the presence of electronic monitoring equipment (e.g., cardiac monitors, ECG alarms), which may not operate properly when the electrical stimulation device is in use. Do not apply stimulation when in the bath or shower. Do not apply stimulation while sleeping. Do not apply stimulation while driving, operating machinery, or during any activity in which electrical stimulation can put you at risk of injury. Do not use the device on children, if it has not been evaluated for pediatric use. We also recommend the following: Consult with your physician before using this device, because the device may cause lethal rhythmic disturbances to the heart in susceptible individuals. Apply stimulation only to normal, intact, clean, healthy skin. PRECAUTIONS We also advise users of the following: TENS is not effective for pain of central origin including headaches. TENS is not a substitute for pain medications and other pain management therapies. TENS devices have no curative value. TENS is a symptomatic treatment and, as such, suppresses the sensation of pain that would otherwise serve as a protective mechanism. Effectiveness is highly dependent upon the individual using the device. Results may vary. Additionally, the long-term effects of electrical stimulation are unknown. Since the effects of stimulation of the brain are unknown, stimulation should not be applied across your head and electrodes should not be placed on opposite sides of your head. The safety of electrical stimulation during pregnancy has not been established. You may experience skin irritation or hypersensitivity due to the electrical stimulation or electrical conductive medium (gel). If you have suspected or diagnosed heart disease, you should follow precautions recommended by your physician. If you have suspected or diagnosed epilepsy, you should follow precautions recommended by your physician. We also recommend the following: Use caution if you tend to bleed internally, such as following an injury or fracture. Consult with your physician prior to using the device after a recent surgical procedure, because stimulation may disrupt the healing process. Use caution if stimulation is applied over the menstruating or pregnant uterus. Use caution if stimulation is applied over areas of skin that lack normal sensation. Keep this device out of the reach of children. Use this device only with the electrodes and accessories recommended by the manufacturer to avoid adverse reactions. Please be aware of adverse reactions and precautions below: You may experience skin irritation and burns beneath the stimulation electrodes applied to your skin. You may experience headaches and other painful sensations during or following the application of electric stimulation near your eyes and to your head and face. You should stop using the device and should consult with your physician if you experience adverse reactions from the device. 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 https://www.youtube.com/watch?v=Y5SEH8iK3mw&feature=emb_logo 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 May of 2020. For the original video go to https://www.youtube.com/watch?v=fmLxHjk1n4o&t=254s Bob: Hi folks I’m Bob Schrupp, physical therapist. Brad: Brad Heineck, physical therapist. Bob: This sounds a little bit crazy Brad, but we’re going to show you how to add two inches to your height in one day. Brad: Bob! Bob: That sounds a little suspicious to me. Brad: Yeah, but Bob, you’re going to find out, you can do it. We’re going to prove it. Bob: Alright, Brad, snake oil salesman. How does this work? Brad: Actually, Bob, there’s no magic here. But it’s really important and it’s really critical, and it’s going to help your daily life. First of all, now this is the one most people aren’t aware of. You’re going to gain approximately one centimeter in height, from when you go to bed to when you wake up in the morning. Know what that is from? Imbibition. Imbibition is a term, that used to describe what happens to your discs. If we look at the discs, the discs are between the vertebrae. Each disc has fluid in it, and when you lay down at night, Bob: When you lie down. Brad: Lie down, thank you Bob. The discs imbibe, or actually they absorb fluid from your body. Then in the daytime, when you stand, the body weight squishes down, and each disc pushes that fluid out. There’s a very good functional reason for that. It keeps the discs alive and healthy. The nutrients are in the bodily fluid around the disc, it sucks that in, there’s nutrients are used for the discs to stay healthy. Then the waste products in that fluid, during the day, they push out. So every day you go up and down approximately one centimeter. It depends on how tall. Bob maybe goes a little more than a centimeter. Bob: That’s right, I have a lot of discs. No, we all have the same amount of discs normally. Brad: But, you know, I had to say something, ha-ha. Bob: Large discs, yeah. Brad: So, the next thing now, this is something everyone can do easily. What dominates your height? Posture. So many of us, including Bob and I, find ourselves with poor posture. Bob: We have to work on this all the time. Brad: So, what we have here is on our nice, white wall, is a mark and the first mark to the top of this line, is where Bob stands. Bob, can you demonstrate? Bob: Sure. It’s funny, when we started doing videos, we started realizing how bad our posture was. Brad: Yeah, ha-ha. Here, Bob’s got head-forward posture. He’s rounded in the spine. He’s got this posterior pelvic tilt that’s making things drop. Bob: I’m locking my knees actually; I’m not bending them because that could make me shorter. Brad: Yeah, yeah, but that would be cheating. Everything else is going on with the spine, and that puts a lot of pressure on the spine, the neck, it causes pain, it causes knots. Bob: I don’t look good either. Brad: No, you don’t look good, Bob. Okay, here we go. So, right there, you can see it lines up with the top of that mark. Now, Bob, can you correct your posture? There we go. Two inches!! We did it! Bob: We made it! Brad: Bob, you look better now. You’re taller. Bob: I look better, I look more confident. I’m going to get that job interview. Brad: We just did the video on power posing. Bob: And as you might well suspect, if you have poor posture over time, you’re going to end up with neck pain. Upper back, shoulder pain, lower back problems. Brad: Breathing problems. There’s just nothing good from poor posture. Bob: No, there really isn’t. So, we want you to correct your posture. We will show a couple ways to do that. Brad: Yeah, they’re easy. All you need is a wall. You simply go back up against the wall, take your shoulders, bring them back. Make sure your buttocks are touching the wall. Shoulders back, chin in, but don’t look up, keep the chin down here, that’s what we call a chin tuck. You can just do scapular retractions and hands up against the wall is one option. Then you’re going to do that five times, do that every hour for one day. Put it on your cell phone. We should have a posture app. Bob: That’s right. That’s a good idea! Now, what you may find also is some of you probably can’t get your head back even yet. Brad: That’s very true. Bob: You’re going to want to work your way back there and you’ll be able to note your progress. By seeing how far you are from the wall the first day and then continue to work on this. See if you can get to the point where your head is back without you head tilting up. Brad: Right. What I’ve done this with patients is, I’ll measure how far they cannot get their head to the wall. Say it might be an inch the first day. After a week of doing that, maybe they can get a half inch from the wall. Bob: It’s very motivating. Brad: So, that’s one exercise, the wall angel. You want to show the wall angel, Bob? Bob: Sure. Basically, it’s the same thing. You get in position here, chin tuck, if you can get the head up against the wall, do it. Now you’re going to put the hands out, palms forward and you’re just going to do some angels. Just like you used to do in the yellow snow. Brad: Not the yellow snow. Bob: The white snow. Brad: You probably went to the yellow snow. Bob: What you’re going to find is that as you get up overhead, it gets harder and harder. I’m starting to hit the ceiling, but I can’t keep my elbows back. I’m just stretching the front of the shoulders; my upper back is not as stretched out as it should be. You want to go as far as you can, keeping those elbows up against the wall. This is where you really feel it, Brad. Where you really feel the stretch. Brad: You may start with your elbows coming off the wall down farther like mine, but as you work on it, it is should get better. Bob’s much more flexible, I have tight shoulders. I get to shoulder height, and once I get above there, (grunts), the arms come off the wall. There’s so many options for good posture. Bob: We just thought we’d show you that. You can actually take a tennis ball, do we have one nearby, Brad, or not? We probably don’t. Brad: No, not today. Bob: So, take a lacrosse ball or tennis ball, and this one, I think is a great one, Brad, the lacrosse ball, because a lot of your posture problems, you mind coming over here? Brad: Oh, sure. Bob: A lot of posture problem are right here, that’s where the roundness occurs. So, if you put a ball on the side of the spine. Don’t put it on the spine, put it on the side of the spine, and you can work like this, six different spots here, all the way up and down the spine, off the spine but just to the side of it. You can roll on it, you can start up against the wall first, because it ends up being a little intense for you, especially just starting. Then, eventually, if you can, you can lie on the floor – and roll on the ball. I do something similar to this every day. I think this has been the number one thing that’s helped my posture. Brad: Plus, it gets those knots out of those muscles. Feels good. Bob: Yup, it feels good. Whenever I get done, I go for a run. I feel like I’m running really straight up and down. Well I probably am. Brad: Well, you’re two inches taller now. Bob: Yeah, I’m two inches taller now! Brad: The neighbors notice that. Bob: Yeah, the neighbors, by the way, they make fun of me on my bike because my bike is so tall, so I look so stupid. Brad: Ha-ha. They probably make fun of you for other reasons. Bob: Yeah, there’s a whole host of reasons they could make fun of me for. Brad: Bob’s coming! Ha-ha Bob: Ha-ha. Anything else you want to include Brad? Brad: Well, I did, if you have the booyah stik. You don’t have to have a Booyah, you can use any five-foot-long stick, usually works well. Bob: Or a broomstick. Brad: We are going to put that so my head touches on the top. Bob: Yes, we have three points of contact. We have the head, the mid-back and the low back or the pelvis. Brad: Then you’re in good posture. Bring your shoulders back, and then you can do some exercises, getting used to some body movement while you’re doing that. It’s good muscle memory for body mechanics for bending to lift things up. It’s a win-win. Bob: Brad, you mind giving me the Booyah stik? If I’ve found anything out that you’re going to realize that a lot of times, your posture was a lot worse than you thought it was. Sometimes people film you, like we said when we first started filming ourselves, that’s when we realized it. I had a friend that was at work and a security camera picked him up, and he goes, “Who’s that old man?” It was him. So, another stretch I like, I like just taking the Booyah Stik, Brad and taking it up and then going back like this and squeezing the shoulder blades together. This is just a great stretch here. Brad: Show from a profile once. If you do this, just make sure your head doesn't go forward because you’re trying to get away from the stick. Bob: Right. You want to make sure you’re keeping your head back. And if you’re hitting your head, you don’t have the posture right yet. You’re not getting the arms back far enough. Brad: Until you get stretched out, you may not be able to do it. I’m a little tighter, I like this one though. Especially when I can get down here across the shoulder blades, I can work that. It’s just amazing what a little thing like this can really work. Bob: Yes, you can use a broom handle for so many things. If that’s what you have around. Brad: Right. Bob: Just give it a try. Remember, Brad and I can fix just about anything, Brad: Except for Bob: A broken heart. Brad: But, Bob: We’re working on it. 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 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 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.

This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2021. For the original video go to https://www.youtube.com/watch?v=gwjKG_QTpAs&t=642s Bob: So today's topic is going to be anxiety medications. We're going to talk about the SSRIs, and we'll explain to you what that is. You know, what do you do? How do you choose one? We're going to go through all that. And Chris has a plethora of knowledge on this. So, you want to start by talking about what the SSRIs are? Chris: Yeah, basically what an SSRI is, it stands for selective serotonin re-uptake inhibitors. So it's kind of a mouthful. Bob: That’s what I thought. Chris: It’s definitely kind of hard to process, but there's several drugs in that category. I mean, you can go with, Celexa which would be citalopram. There's Lexapro, which is escitalopram. There's Zoloft, which is sertraline. There's Prozac, which is fluoxetine, and Paxil is paroxetine. So those are the main ones that are in that family. Bob: The big question I have is, what is it exactly doing? It's improving your serotonin levels? Chris: Yeah, so basically what happens is, to understand when we're treating anxiety, basically, when we put people on these types of medications, is its communication between two nerve cells. And so what serotonin does is it kind of carries signal A to signal B. And when we have anxiety, some of those nerves are hyper polarized and you're not getting really good transmission. And serotonin is kind of looked at as kind of a feel good or a relaxing type of neurotransmitter. When that message is interrupted, or maybe just not sent properly, it's going off into the other areas of the brain and bloodstream, what have you, you're finding that these cells are hyper charged and you're getting things known as anxiety. When we take medications, like the aforementioned SSRIs, what it does, it doesn't have your body make more, but what it does, it blocks the uptake of it. So it's a selective serotonin re-uptake inhibitor. So inhibit- think of it as blocking. And so it's going to allow more serotonins to kind of bathe that cell gap, so that it transmits more of that information to hopefully help you to feel a little bit more calm. Bob: So when you go off the medication, eventually, is that going to affect your body's ability to produce the serotonin, or, do you know what I mean? Chris: Yeah, that’s an interesting question. And it's debatable. So basically, we know for a fact that anxiety is a biochemical driven condition. Is it brought on by life circumstance? Is it bought on by something else? There's a lot of mitigating factors that lead to it. Bob: Sure. Chris: And there's different forms of anxiety within that group as well. You and your doctor are part of this team to determine when it's ready for you to go off of these types of medications, you have that discussion and you'll want to taper off, because if you go off of these medications abruptly, you're going to have some very serious problems. It’s not so much that you're physically addicted to the medication, but you can have, kind of this, withdrawal syndrome kind of thing, where you go off the medication and you feel yucky, you get rebound anxiety… Bob: Can't you get like electrical shocks? Chris: Yeah, basically the term that kind of floats around in my circle is brains zaps. Bob: Yeah, that's it. Chris: And so, basically people feel like just little electrical stimulation kind of going through the brain, they can't stay focused, they feel agitated. They don't sleep well. They can be short with their tempers, feel achy. I mean, it's actually, it's a multitude of side effects that are associated with that. And even just one of the things that's very important in my arena, as well as adherence to the drug. Meaning you have to take it consistently. Drugs don't work if you don't use them consistently. In these it's paramount that you take them on a daily basis as your doctor directs. Bob: So, let's bring up this question. What if you miss a dose? Chris: Well, that's a very good question, actually, Bob. What we do when you miss a dose, we try and tell the patient, it kind of depends on the time of the day that you recognize it. We use the kind of half a day so if it's within 12 hours, take it for sure right away when you remember it. If you're getting to let's say it's the next morning, and you're like, "Oh my gosh, I forgot my dose yesterday. No wonder, I felt horrible." We don't want you to double up. You just take your normal scheduled dose, and get back on track. Bob: And you'll obviously feel maybe a little bit of the effects of that. Chris: Yeah. You're going to notice that. With the exception of the drug fluoxetine or Prozac, that's the only one that people can kind of get away with skipping. All the other ones have shorter half-life’s and you know it when you skip a dose. All of a sudden, let's say you just take your normal dose at six in the morning every morning after you have breakfast. All of a sudden it's noon, and you're like, "I just don't feel right. I can't focus. I'm kind of ornery." And you're like, "Oh, I forgot my medication." So, and then at that point it's like, man. Bob: That probably creates some anxiety in itself. Chris: Sure, and it can, so, I mean at that point we'd instruct you, if it's possible, I mean, if you're in the middle of your work day I don’t know if you can just leave work and go back home and take your medication, or somebody can bring it to you. We want to try and come up with some sort of solution because it will definitely affect the remainder of your day. Bob: Sure, now you talked about, a lot of people out there are questioning whether or not they should be on drugs. They don't want to be, because people don't like to take drugs if they don't have to. I mean, you know, when we talk about the stigma...And you talked about the three things that are important. Chris: With anxiety, I mean to understand it, the mainstays of therapy are really, it's going to either be medicine, or chemical, and then also there is therapy, cognitive behavioral therapy. Those are really the big two, and you're a big proponent of that. And across the board, when doctors are choosing what's best for the patient, the patient is driving the bus in this case, because if somebody is not saying, "Oh gosh, I don't know that I feel comfortable going to counseling. You know, I just, I don't have the time I can't leave work." Bob: Imagine the stigma. Chris: There sometimes can be considered a stigma, which is the absolute wrong thing. We have to smash that stigma, because it's not a stigma. Bob: Right. Chris: I mean, you're talking about 50 million people, one in five. Bob: You also mentioned when we were talking about this at one point that you said that you've seen more this year, then ever. Chris: Yeah, you know. It's been stressful year, 2020, thank goodness this is the last day of the year. know, it's one of these things where, it has been rough. As a pharmacist, when I dispensed the medications that doctors are prescribing I've seen a tremendous increase in both the SSRIs, and other drugs used for anxiety as well. So it's definitely there. It's definitely prevalent, and again it's so important to just kind of circle back that the patient kind of drives the bus for the treatment. You know, if you think, "Well, I can take a tablet every day and it's going to work for me." And you're going to make it work. I think it's important that that's probably your choice. And your doctor will go through a series of questions that are going to determine maybe what's the best choice for you, and ask would you be amenable to considering counseling, you know cognitive behavioral therapies. Bob: So yeah, you had mentioned the five drugs and these are the main five? Correct? And some of them have been around a lot longer than others. And so they have a long history of them and how they affect people. So they can feel comfortable with what you can propose the side effects are. Chris: Absolutely, and actually all of these drugs now are old. I mean, I've been a pharmacist for over 25 years. These drugs are all older medications. Bob: So you probably don't need to make a choice based upon that. Chris: No, but from a scientific standpoint, it's kind of interesting that with brain imaging we're seeing that these drugs, they work. And if you think of a stream, actually when we take the SSRI drugs as a class, there's a lot of things going on upstream probably that are much more significant as far as what we're seeing with brain chemistry. And then using the medication certainly helps, but it's kind of more downstream meaning the things that are probably to come with medicinal science are probably going to be much improved therapies as they learn which systems to trigger or what trigger points that we need to hit. So there's other things going on above stream. So I think, I don't want to say it's crude or rudimentary, because they're excellent medications that safely help people to manage anxiety conditions every day. But I think there's things that we can do better. And I think that's the wonderful thing about science is we're always pushing that envelope. We're always trying to learn; we're always trying to go forward. Bob: It's a miracle what they're able to do now, even, if you ask me. Chris: Yeah. Oh, the doctors are very, very adept at helping patients these days. I mean, and it's not even always drugs, like I said. Therapy for some people is a wonderful opportunity. Bob: Now, the side effects, you had mentioned that they are fairly similar, among the five. Chris: Yeah, they really are. It’s kind of interesting that all of the drugs have a different chemical structure but they act on the same area, which is the serotonin re-uptake. And they're just really in that synapse. So from that standpoint, it kind of comes down to the clinician's ability to select something for your needs, you know, maybe your body type, and they might even ask some questions about family members. Because you know, genetics play a big part in all of the things that we drive and they do kind of drive the bus. So let's say, you know, your mother your father, aunt, uncle, brother, sister took something like, hey, that drug worked well. Well, you know what, why don't we try, maybe sertraline is going to be the best choice for you or maybe fluoxetine is the best choice for him. Or maybe paroxetine is the best choice for me. It just kind of depends on what your clinician decides. And keeping in mind, these drugs do take time to work. So it's not quick. It's a four to six-week endeavor to start to get relief, which is frustrating. Bob: That's the thing, right. Because if you have anxiety that seems like for a lifetime. Chris: Yeah, I mean, it is, it is a lifetime. Bob: You're counting off the days. So we understand that. If this is something you're considering, you probably want to get it started. Chris: You want to get started. You know, just even the definition of anxiety is kind of interesting, but you know they want you to, most days of the week you should have a thought that's just not sitting well with you for six months. I mean, that's kind of DSM five guidelines. Bob: To put up with for six months. Chris: If you have anxiety, you want it gone yesterday. Bob: Yes. Chris: It is an awful feeling. It's an overwhelming sense of dread, and it's just something that we really don't want to delve into because it's just such an awful uncomfortable feeling. And until you've been in those shoes, it's really hard to understand that perspective. And again, it's just like, well I don't know why he feels that way. He seemed just fine yesterday. It doesn't work like that at all. Bob: They can't understand it. Chris: And that's the other thing, as a pharmacist and I'm sure as a doctor, if we had one sitting here, too, and you tell a patient, “it's going to take about four to six weeks before this is going to help you feel better.” I mean, you're like what? Bob: What, yeah, exactly. Chris: And I mean, it just, it's somewhat deflating but, the thing is, is that we get your body used to it. We minimize the side effects. We keep you on track. Bob: You ramp up slowly. Chris: We do ramp up slowly because if I give you too much too fast, in all likelihood, you're going to feel yucky. You can feel yucky. You can have an upset stomach. You can be nauseated. Your appetite can be shot. You don't sleep well. Bob: That’s going to compound this. Chris: So we start basically baby steps and the appropriate dose based on body type, weight, again, genetic factors what have you, other medications that you take. So your clinician is going to look at a lot of different things that go into the prescribing of the choice that they provide. Bob: Are the doses fairly similar for the five? Chris: No, I mean, you look, let's see, we'll pick on citalopram, you've got a 10 and 20 and 40 milligram tablets, sertraline got a 25 to 50, a hundred milligram tablet. Fluoxetine is a 20 milligram and also a 40 milligram dose. So paroxetine, it's got the 10 and the 20 and the 40. Bob: So the typical where they end up at, those tend to be different? Chris: They do, but it's interesting. I mean, these drugs are also used for depression, but for anxiety, you'll see a little bit different dosing level for each of them. Sometimes it's a little bit higher. Bob: For anxiety? Chris: Yeah, it can be. So yeah, it's kind of funny how that works. And even within the classes themselves, Paroxetine tends to have a little bit higher dose for OCD, obsessive compulsive disorder, and things like that, or other types of anxiety. So, and then whether you're using it for social phobia or agoraphobia, I mean there's other anxiety conditions under that big umbrella too. So it just kind of depends. Your doctor is going to drive the bus on that. And really what they do is like we were talking about, you start slow and you gradually build up. They're going to ask you; you're going to come back for an appointment about four weeks. And then there's either going to be a phone call or another appointment after that discussing how well you're tolerating it. Bob: That brings up the point. So you have five drugs here. What can you see as a difference between, let's say the best performing one and the worst performing one for you? Could you have one that this does nothing for you? Chris: Well, well you can, and that's why these other choices exist. I mean, way back when Prozac came out on the market, and then all of a sudden Zoloft was number two. I think the drug industry itself, they see something, and Prozac at the time when it came out, I mean, there was a book Prozac nation. There's a lot of things out there that came out when these drugs were first available and they all, I guess the fondest form of flattery is imitation, right? So they come up with drugs, you know and they think, well, hey, as the manufacturer of Zoloft I'm going to one up, you know, the manufacturer of another brand. Then that's not necessarily true, but they come up with a way to get into that market, and they do want to constantly improve. I mean, when you look at the molecules, they all look functionally different. And so let's say we started you on something that didn't work well, we have other options available for you. Bob: How soon would you know that? Chris: You're going to know... Bob: In a couple of weeks? Chris: I would say you're going to have a solid answer probably within four weeks. And that's why that first appointment back to the doctor is so critically important. And they are going to ask you those questions. How are you doing today? You know, Bill or Bob or Gene. Bob: So is that common, that you might not have any help from it? Chris: I wouldn't call it common, but it can certainly happen. And so that's why it's important to keep that next appointment with your provider, because they have to gauge how well you're performing. If we're giving you a drug that doesn't work or you're not buying into the fact that you have to take it every day, we've got some serious issues that, as a pharmacist, we want to make sure that you stay adherent on the medication and that you're tolerating it well, and you're not experiencing the side effects that could create problems for you. And so, we always say, please give us a call. We'll try and help you out any way we can. Oftentimes I spend a lot of phone conversations with patients just saying, well, and we actually the other thing that we do with the company that I worked for is we make what we call adherence calls. So we'll call you in about five or six days, to make sure that you're actually doing well and comfortable on the medication. Bob: See, that's what I was wondering because doctors have a feedback loop. They're seeing the patient and they come back. And I wasn't sure if that you had that. So apparently you do. You have a good sense of what all of these drugs work and what side effects. Chris: Yeah, we do. Exactly, and it really does make a difference. And I think patients really like to hear from us too. Bob: Oh, absolutely. Chris: It's like, "Oh really, thanks for calling." And to me, it's very gratifying. It's worthwhile. And if, heck, if I can even just help somebody an inkling I feel like it's definitely made a difference, and I'm hoping we can keep things going forward so that they can continue to get the help that they need. Bob: You know, when you're ramping somebody up, now let's say they end up being at 100 milligrams or something like that. They're not going to feel the full effect of that until they're at the hundred and for another four weeks after that, right? Chris: It can be because there is a change. So you got the first four weeks where I guess honeymoon period is probably the wrong word. Bob: You're at 25 to 50 maybe. Chris: Yeah, if we pick on sertraline for instance, you know, a lot of times we'll recommend start at 25 milligrams because of the side effects, GI are most common. So it can cause nausea or it can cause, loose stool, pain. So, I mean, we want to try and avoid that. So to say a little food first. Bob: Those will go away? Chris: Those will go away. And usually within about five to seven days, they're gone. And then at that point, depending on your clinician's wishes, that might be the point where we jump you up a little bit. And then we kind of have you sit there until that four-week appointment. Then we see how you are doing, and your doctor will determine how you're tolerating it. And if it's beginning to see the benefits. So, in this case since we're talking about anxiety, to say are you feeling a little bit more calm a little bit more relaxed? Are you sleeping a little bit better? Are things a little bit better through your day-to-day? And hopefully the answer will be, yes. I think things are getting better. And then at that point, or if it's, you know if the answer is no, they're not doing well, I still feel like garbage. Well, do you feel like you've gained some benefit? Yeah. Well then maybe we are going to ramp you up to the next level dose. So on sertraline let's say we were at 50 milligrams for four weeks. Maybe we're going to try at 75 or even a hundred milligrams to see. And then we're going to re-engage in about a month to see how you're doing at that point. Bob: How long does someone typically stay on the drug? And if they have the idea they'd like to get off. Chris: Yeah, and that's an interesting question, Bob. There's not a simple answer. When these drugs all first came out they were thought you just needed to take them for six months and everything was all was well. We've found that over the years, that is not the case. I mean, there are people that have been taking it for years. You get to a point, too, where sometimes the drug just kind of runs its course and it doesn't seem to be as effective as it used to be. Or you just feel like, I'm in a really good place. I think it's time for me to have an engaging conversation with my physician and see if it's time for me to taper off. Bob: Would that be six months minimum? Chris: Well, I would tell you it's probably going to be longer. The problem is when we come off of these medications too quickly you get kind of almost a rebound effect. So you have to taper off of them very slowly. And even if we come up too soon, oftentimes you end up back on them three, four months after you're off of it because you've rebounded back to the same situation. So, when you look at it, at least in prescribing circles, pharmacy circles, we kind of look at, people are on these things for the long haul. And I would say a year plus, and maybe even longer yet, depending upon your tolerance. Bob: I imagine it might even be the time of year. Chris: It can be. Bob: Like, you'd probably rather go off in Spring in Minnesota or Wisconsin, you know what I mean? Chris: There are people that do benefit from short courses like that. So there's seasonal effective disorder. It depends. There are lots of other ways that you can treat with that. You know, the holidays can be tough for people. COVID has not made it easy for people. So we're going back earlier. I mean, I'm just seeing a lot more of these drugs being prescribed for anxiety than ever before. Bob: All right. How are these drugs stored? Are they stored any differently? Chris: A cool dry place in the house. So basically the worst two places storing any medication would be, if you're keeping score at home, guys. Don't keep them in the kitchen. Don't keep them in the bathroom. Moisture destabilizes these medications rather quickly. And so, you're spending good money on these medications. We want to make sure that they work for you. So, a bedroom, a drawer away from, out of reach of children, obviously, you want to use your safety caps if you have small kids or pets around the house. So keep it high, like on a shelf or just somewhere where kids can't reach, or maybe even out of eye sight, but where you know you're going to remember to be able to get at it every day. Bob: Can you become dependent on these drugs? Chris: Not physically dependent. Bob: You've talked about tapering off. Chris: Yeah, you taper off, but it's not like an addiction per se, that you're going to be like you're shooting heroin and you need to get your next fix. It’s nothing like that. But if you skip a dose, your body, like we talked about a little bit earlier, your body lets you know so there is a bit of a physical dependency just because your body is used to, and I always liken it when patients go, why does that happen? It's kind of like if you were standing on a rug, Bob and I just pulled the rug out from underneath your feet and you fell, that's an awful feeling. And it's much the same thing clinically. We accidentally skip a dose, your body lets you know, it's a bad time. It's a bad day and you definitely don't feel like it's effective and things are going sideways on ya. Bob: Do you want to just talk about, we'll finish up with this. Maybe, do you want to talk about some of the side-effects that are common that you see? They list a lot of common side effects. Chris: Yeah. If any consumer were to look at what I read on a daily basis or what a physician reads on a daily basis most people would probably be less inclined to take some medications that they do. And a lot of the studies that are done and I guess, to compare like with the vaccines out in warp speed, I mean we've done some really quick research. The research that went into these drugs is always ever evolving. Doctors are constantly publishing studies about what is safe, you know, is it okay to use during pregnancies, is it okay to use in pediatric patients? Is it okay long-term, short term, with certain different medications? So we'll come back to, we'll circle back to side effects. And so it's like what's best tolerated? Across the board, these drugs all have kind of the same side effect profile. And so it can be usually it's GI's the first thing most people discover. So we want you to take it with food. Bob: Short term. I mean you should take it with food all the time. Chris: Sometimes it's just kind of, a lot of the serotonin is in your gut. So it stimulates those receptors first. And so as a result, you get tummy side effects. So food, then drug helps to eliminate that. So that's the primary one that I always discuss with patients. Kind of an odd one that happens is in about 10% of the patients almost across the board with these drugs particularly, is some people can actually get tired. So there's one in 10 that's just like, man, I am just dragging tail. And so you feel like, man I need five cups of coffee just to get through my morning. Then all of a sudden I took five cups of coffee and now I'm more anxious than ever. Well, that's not the way we want to go. So that one in 10, we actually want you to take it at bedtime. Because you'll sleep through that side effect. Then by morning, everything's right. You kind of get your dose patterns established and it seems to work a little bit better. But for some people, you know that 90% of us that take these medications, you can get kind of an activating effect. It's not so much like you had a cup of coffee, but it's just got a little bit of a spark to kind of get you moving. And so it's something that obviously could interrupt sleep. And one of the side effects is of course insomnia. So we don't want to be promoting something that's going to keep you up all night when sleep is so paramount with actually treating anxiety. And that's again, we could probably almost do another video on all non-drug things to use, to treat anxiety. Bob: Well, I think we'll cut off there since we're at a quite a long time here and we'll pick up this topic with another video where we're actually going to tell you a drug you can take to kind of help you make it through that four to six-week period. Chris: Yeah, there's a couple out there that definitely work in addition to this and again, up to the doctor but I think there's a lot of good things that we can do to help people with anxiety. Bob: Thanks. Chris: Have a great day. * More info on Chris the Pharmacist can be found on his Bob and Brad's Experts Page here 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 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 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.

A transcutaneous electrical nerve stimulation (TENS) unit is a small battery-operated device that can be used to treat pain. The TENS unit creates electrical impulses that can do two things to help lessen your pain: 1. The electrical pulses can flood your nervous system and reduce the ability for pain signals to reach your brain. 2. The electrical impulses can stimulate your body to produce natural pain relievers called endorphins. Studies show TENS can be very helpful with acute and post-operative pain. Acute pain is pain that develops abruptly and is usually short lived. Post-operative pain is pain that occurs after surgery. Research is mixed on whether TENS is helpful with chronic pain. However, using a TENS unit is much safer, less expensive, and less invasive than using opioids for pain control. Those who experience some pain relief from TENS may be able to reduce their intake of pain medications (some of which may be addictive or have adverse side effects). Also, a TENS unit may provide you with enough pain relief to allow you to perform helpful exercises and stretches. These exercises can assist in the healing process. TENS units are small, portable, and provide easy access to pain relief throughout the day. The TENS units can be carried in your pocket or clipped to a belt. There are hundreds of TENS units on the market. The vast majority will serve you well. However, our only warning is that many of the TENS units have horrible instruction manuals or inserts. Many also have confusing buttons with strange images accompanying them. Often the instructions are incomplete and hard to understand. After having tried dozens of units we (Bob and Brad) decided to use the TENS/EMS units by iReliev with our patients. The iReliev units work very well, are powerful, and are simple to use. iReliev provides in-depth, easy to understand instructions and videos on how to use their products. In addition, iReliev products are: · FDA Cleared · Medical Grade · Clinically Supported · All Natural We will provide you with step-by-step videos on how to properly use their TENS units. iReliev has agreed to provide you with a sizeable discount to their products, if you use the purchase link we have listed on our website or in the description of our videos. Having said all that, do your research and purchase the TENS unit you are most comfortable with. What do most TENS units look like? Most units have a small battery-operated plastic box with wires coming out of it. The wires are called leads and one set of leads connects to two adhesive pads (or electrodes). The electrodes deliver the electrical current or impulses from the unit into the skin. Most TENS units have two sets of leads and are therefore able to connect to four adhesive pads or electrodes at once. Each set of leads has its own intensity button- so two of the pads will be controlled by one dial and the remaining two pads will be controlled by another dial. 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 https://youtu.be/pbJNd7TZUhk 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.

is 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=sG8p0wykCsY Bob: Today we're going to discuss should you buy a massage gun? We're going to give you 10 pros but we're always going to give 10 cons. Brad: There you go, Bob. Bob: Okay. So we have three massagers. Bob: There's the C2 Massage Gun, which is kind of our big massager, our most popular massager. Brad: The most powerful one. Bob: It’s probably the higher end model. Then, we have the Q2 mini massager. This is really cool because this one can fit in your purse, or your handbag, or your murse. Brad: Yeah. And it still has a lot of power. Bob: Then we have the economical model, I would call it. It’s the handheld massager. These all come with five attachments. Brad: Five heads. Bob: The handheld massager is a little easier to get your back. Brad: This one is really nice, particularly if you’re an older person and you don’t want an aggressive massage. Bob: Yeah, we’ll discuss that actually. Okay so, let's start off with a con. I hate to be negative, but…. These massagers are not good for neck pain per se. Especially if you get up directly on the neck or near the spine. Brad: The back of the neck, particularly back by the base of the skull around on the head. The low base of the neck, upper shoulder might be okay. Bob: Yeah, upper traps. Perfect for that. But anything higher is just going to rattle your cage. Try it once, you’ll find out. Brad: It's not a pleasant thing. Bob: Alright. A pro now. It's terrific for muscle strains, pulls or tears. I don't know what else you'd do that would be better. I've had several tears, muscle strains. Brad: Well, to be honest with you I think the only thing better than this is actually go to a professional masseuse. You know, pay them their money. Unless you have someone in the household that would do it. Bob: But when you're able to do it and also could they do it long enough and you know, the whole bit. Brad: Right, right. Bob: Another con, it's not good for headaches. I, again, up on the head, it's just going to thump away. It's going to probably hear a hollow sound if it went on my head, huh? Brad: Say no more, Bob. Bob: All right. Another pro. It's terrific for many types of tendonitis, Brad, I have found. So like, tennis elbow which is a lateral epicondylitis. It's good if you start in the muscle part of it first and then you just kind of gradually move into the where the tendonitis is, right? It worked well on my quadriceps tendonitis too. Terrific, in fact, for that. It took it away. Brad: Yeah, they're great for any, where the muscle belly is, where it goes into that tendon that juncture's a really good place to get at it with these. Bob: And again, you're using the different heads. All right. Another con, it's not good for a pinched nerve in the neck. The pinched nerve is often up in the neck itself. It could be the hole where it's coming out or it could be a disc. And this is just not going to affect that. If the pain is going down in the arm it's certainly not going to help that. So, we just want to be honest with people. Brad: Right. It's not good for everything. Bob: All right another pro. It's a really, just a one-time cost, then there's no ongoing fee. Like you would pay a massage therapist. Now a massage therapist might be better. You can carry it with you. You have your own massage therapist with you. All the time, basically. All right. It's not good, just as we said, it's not good for a pinched nerve in the neck. It's also not good for sciatica which is the pinched nerve basically in the back. Brad: You're not going to massage a nerve, not like this. You know, you're not going to get on that nerve and beat on it. Not like a muscle belly where you're trying to get that muscle to relax. Bob: Well, the exception would be then if you have actually what we call false sciatica or, piriformis syndrome. That's a small muscle in your buttock that often gets, I think often it gets pulled and torn too, we've decided. And sometimes there's scar tissue on it. And this works really well for that. That's actually one of the better treatments for it. Brad: So you're massaging the muscle. Not necessarily the nerve itself. We don't want to hammer on a nerve. Bob: Right. Another con. It is portable, especially the mini one here. This one, is this not cute, Brad? Brad: It is cute. Bob. Bob: But like you said, it's powerful. Brad: It is. Bob: But you could slip that almost into anything. You could probably take that into a concert or something. Brad: You probably couldn’t get it in your back pocket. You could with some of those big back pockets, or cargo pants. Bob: There we go. They still have those? Brad: I do. Bob: Let’s go on. Another con. It's not good for arthritis per se. I mean, it's not good, like if the pain is coming from the joint itself. The thing with arthritis though, quite often, a lot of the tissues have tightened up around it. Brad: Right. So you can massage those. Bob: You can massage the tissue around it. So it makes your arthritis feel better. Brad: Right. But you're not going to go right on that joint. Bob: Right. It's just not going to help with that. So number five for the pros. It's great for warming up muscles. I like to use these. I have a couple of muscles that can give me trouble when I'm running and these help keep me out of trouble when I'm running. Brad: It all has to do with that whole concept of pliability, keeping the muscle soft. And so that circulation. Bob: Good circulation Brad: Exactly. Get the fresh blood in, get the old blood out. And it's a healthy tissue that way. Bob: Another con might be if you're elderly or of a slight build, you know, where you're not a big muscular person the massagers, these massage guns might be too much. Brad: Yes. You get too aggressive. And who was telling me their grandmother, Mike's, yeah, actually. She uses the handheld massager. It's not near as powerful. And it works out really well. Bob: Not as much translation either. Brad: Right, exactly. It's a different type and you know so there's something for most people. Bob: For everyone. But again, you may keep that in mind. Brad: Or if they have fragile skin, then you're not going to use them. Bob: Yeah, if your skin tears really easy, which we find a lot of times in the elderly. Another pro, it's good for muscle recovery. So like if you've been lifting a lot or like an athletic event and you're sore, this can help ease some of that soreness and get you back running again or moving again. Brad: That relates to our previous point of circulation. Getting the nutrients in and the old blood out. Bob: One of the cons too, with some of these, not so much ours, but some of them, guns are really quite bulky. They're big and hard to handle. Brad: In general, the older ones are. Like anything, they get smaller and smaller but there are still some, you can see by the size of my hand, it's still not too big. And that's the big one. Bob: Right. And then we got the mini of course. Another pro is that some patients actually prefer this. Some of our patients actually prefer this over actual regular massage. Brad: Someone's hands on them. Bob: Yeah. I would say around 50%, Brad. I mean, I would say, do you want Tim to give you a massage or do you want the massage gun? And they're like, we'll take the massage gun. Brad: Yeah. But one way or another, we've had good positive results. And personally myself, I would definitely go to a masseuse before one of these, if the price was the same. Bob: Sure. Because they can tell what spots and stuff. Brad: Yeah, they definitely have their skills that are unmatched by this. Bob: But then you have to go there and then you have to drive there. And then you have to wear a mask now and all that. All right, another con. Some of them can be pretty expensive. Actually when they first came out, we did not support many of them because they were way too pricey. They were $400-500, and we just said, that's too much for people. There was an expensive version out there. They're coming down now. Like this one's around $90-$100, depending on the day and how much they're giving you back on it. Brad: With promotions and such. Bob: Another pro is that they all come with the five heads, like we said. You can, almost every situation that you can think of, you can deal with it. Brad: They hit different parts of your body, depending on how much muscle you have that you want to get into, location, so. And we did a video on all of that. Bob: The air-filled head is really popular because it actually feels quite good overall on the surface, even the bones when you go over it. Another con is if you don't spend enough money on these, this has happened to my nephew, he bought an inexpensive massage gun. He called me and said, it's a piece of junk. He said it just doesn't work well. So you want to buy one from a reputable person. Not on the street. The last pro is that it's easy on your hands and fingers. Like if you're the person giving the massage, you know, that's one of the things they're taught is to try to protect their hands because they become strained over a while and it can even stretch the ligaments out. Brad: Oh yeah, you could really could. Bob: That's why a lot of them use their elbows and stuff like that. Brad: Yeah, they have a lot of hand tools. It would be interesting to know if many masseuses actually used these. I know they have hand tools. And again, they're very skilled and they do a very good job, but they also use things to avoid their hand from falling apart over the years. Bob: Right, right. Another con, the final con is that certain places can be hard to reach. Like you're back, you know, you can get there if you've got pretty good shoulder range of motion, but. Brad: It's just still hard to get the right angle all the time. Bob: The handheld massager works a little better for that. You know, it's got the handle. But still. Brad: If you're doing your low back or your mid back, someone else pretty much needs to be doing this. Bob: That would be good. Right. Be friends with somebody. All right. So those are the pros and the cons. If you guys have any pros and cons yourself that you want to add, just put them in the comments below. We always love to hear your feedback. Brad: That's right. Bob: And remember Brad and I can fix just about anything. Brad: Except for... Bob: A broken heart. Brad: And these aren't going to work. Bob: No, that's not going to help that. So that's a con. To purchase the individual massagers featured visit: 1) Bob & Brad Massage Gun: https://amzn.to/36pMekg​ 2) Bob & Brad Handheld Massager: https://amzn.to/2TxZBqU​ 3) Bob & Brad Mini Massage Gun: https://amzn.to/3oSMBu9 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 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 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.

KINESIOLOGY TAPING IS THE CURRENT BUZZWORD IN THE FIELD OF SPORTS MEDICINE, WRITES REGISTERED OSTEOPATH JOHN GIBBONS Brightly coloured tape is now a common sight at most major sporting events and anyone that is involved with assessing, treating and rehabilitating sports-related injuries, or even back and neck pain will need to have the skill of taping. Castro-Sanchez et al (2012) studied the effects of kinesiology taping in reducing disability and pain in chronic non-specific low-back pain. They found that individuals experienced significant improvements, immediately after the application of kinesiology taping in the following categories: disability, pain, and isometric endurance of the trunk muscles. Origins of kinesiology taping In the 1970s, a Japanese chiropractor called Dr Kenzo Kase brought the technique to the international arena. He was the first person to have the idea of applying a new type of taping method, which subsequently led to a new form of sports tape. Kase wanted to develop a taping system that would naturally assist in the healing of damaged tissue by encouraging lymphatic drainage and at the same time providing support to the joints and muscles without causing a restriction to the range of motion. How does it work? Kinesiology taping has been clinically shown to help with the natural response to inflammation as it targets different receptors within the somatosensory system (sensory systems associated with the body – includes skin senses and proprioception and the internal organs). Correct application of the kinesiology tape will help alleviate pain and encourage the facilitation of lymphatic drainage by microscopically lifting the skin. This lifting effect helps create distortions in the skin, thus allowing for a decrease in the inflammatory process for the affected areas. Additionally, kinesiology taping helps with the following: • Provides support for weak or injured muscles without affecting the normal range of motion. This allows full participation in therapeutic exercises and sports training and minimises the risk of developing compensatory imbalances or injuries • Stabilises the area without restricting the movement like conventional athletics tape • The athlete can remain active during the sport or activity • Relaxes, and can offload, overused and overstrained muscles • Accelerates blood flow to the injured area to speed up the healing process • Helps to reduce pain • Reduces oedema – a form of swelling – by removal of lymphatic fluid • Can enhance performance and endurance • Helps prevent injury General rules Before application • Always check for a history of allergies to tape adhesives • Cleanse skin from any oil, cream and massage wax and trim hair if needed • Measure and cut the tape into the size and shape required • Round off the corners at the end of each tape to prevent it from lifting or peeling • Never stretch the ends of the tape and always leave around 2–3cm of tape at each end that will remain unstretched. Leaving no stretch at the ends of the kinesiology tape will avoid a “shearing” type of tension to the skin and will limit any potential for irritation as the tape is normally kept on for at least a few days. Pre-stretch and tape application Before the kinesiology tape is applied to the area that is injured, guide and place the soft tissue of your patient, such as the muscle, into a position that will cause the tissue to be naturally stretched. Prior to applying the kinesiology tape, expose the adhesive side of the tape so that it can be attached to the specific body area. It is natural to want to peel off the backing from the tape – however, this process is not needed as the tape can simply be torn across one of the squares on the back. This tearing will not damage the kinesiology tape, as only the backing will be removed. Apply a prepared ‘I’ or ‘Y’ strip to the pre-stretched tissue of the body, with little to no stretch of the tape on first application. This technique will help stabilise the area. Two injuries fairly common to athletes include medial tibial stress syndrome (shin splints) and patellofemoral pain syndrome (PFPS). Treating shin splints Athletes can often have pain that can be localised to the lower medial aspect of the tibia, especially straight after or during sporting activity. The condition starts as an irritation of the outer lining of the bone called the periosteum and can lead to periostitis. The muscles that are normally responsible for this type of pain at the medial aspect of the tibia are the tibialis posterior, flexor digitorum longus and flexor hallucis longus, as shown in figure 1. Figure 1: Periostitis/shin splints of the medial border of the tibia as well as the associated muscles If left untreated, the medial tibia can stress the bone and eventually lead to a stress fracture. In the worst case, if this injury is neglected, a posterior compartment syndrome can develop and a surgical fasciotomy to reduce the pressure within the myofascial compartment might be recommended. The patient adopts a long sitting position and is instructed to dorsiflex their ankle and evert their foot to place the tibialis posterior on stretch. Apply an ‘I’ strip from just below the medial malleolus and ideally attach the tape from the navicular bone. Apply the tape with little to no stretch. Follow the medial shin so that the area of pain is covered as shown in figure 2. Figure 2: first application of the tape starting from the navicular bone to the medial tibia Apply a ‘Y’ strip and start posterior to the pain with a 75% stretch to each tail of the tape. Apply across the hotspot of the painful area as shown in figure 3. You can activate the stickiness of the glue, by rubbing and warming the tape briskly. Figure 3: second application of the tape starting slightly posterior to the pain Treating patellofemoral pain syndrome (PFPS) Patellofemoral pain syndrome (PFPS) is a painful condition that can relate to a type of mal-tracking of the kneecap (when the muscles pull the patella tendon in different directions) (see figure 4). This condition has many causes, such as an overpronation of the subtalar joint (STJ) of the ankle and poor foot biomechanics. Weakness of the inner quadriceps muscle can also contribute to PFPS, especially the vastus medialis oblique (VMO) fibres, which are thought to atrophy due to pain and minimal swelling. In addition, weak gluteus medius and gluteus maximus can cause this type of knee pain. The knee joint is therefore what I refer to as “a weak link in the kinetic chain” and typically the presentation of the pain is not where the problem lies. Figure 4: patellofemoral pain syndrome is one of the most commonly treated conditions with some form of strapping and taping The patient is asked to adopt a long sitting position with their knee at 90° of flexion. Next attach a ‘Y’ strip from the superior aspect of the patella and apply the tape, with no stretch, to the medial and lateral sides of the patella. Finish by crossing over the tibial tuberosity as in figure 5. Figure 5: first application of the ‘Y’ strip starting from the superior aspect of the patella and finishing at the tibial tuberosity Apply a ‘Y’ strip from the tibial tuberosity and lay the tape medially and laterally around the patella so that it overlaps the first ‘Y’ application. Apply with little to no stretch and finish near the quadriceps tendon - see figure 6. Heat to activate the glue and once the glue has been heat-activated lower the limb back down to the couch and observe the “wrinkling” of the tape. Figure 6: the second application of the ‘Y’ strip starts from the tibial tuberosity and finishing at the starting point of the first application This illustrates the effect the kinesiology tape is having on the underlying soft tissues through its unique lifting motion. John Gibbons is a registered osteopath, author and lecturer for the Bodymaster Method®. He specialises in the assessment, treatment, and rehabilitation of sports injuries and supports over 75 sports teams in his busy clinic at the prestigious University of Oxford, as well as teaching his acclaimed Bodymaster Method® to physical therapists throughout the UK and internationally. Gibbons is also the author of: A Practical Guide to Kinesiology Taping for Injury Prevention and Common Medical Conditions as well as Muscle Energy Techniques, The Vital Glutes, The Vital Shoulder Complex, The Vital Nerves, and Functional Anatomy of the Pelvis and the Sacroiliac Joint. John has over 400 instructional videos on YouTube: https://www.youtube.com/user/Jgibbo246 For John's book A Practical Guide to Kinesiology Taping for Injury Prevention and Common Medical Conditions as well as Muscle Energy Techniques visit: 1) https://amzn.to/3sEEq6w

1. Manually with your own hands- circular and splaying 2. Golf ball, Lacrosse ball, etc. Good for under the desk. 3. Renpho cordless massager 4. Renpho foot massager. If you are interested in the products mentioned visit: Renpho cordless massager- https://amzn.to/2LJ0EDo Renpho foot massager- https://amzn.to/2YgrPa3 For more information on the Plantar Fasciitis Treatment Program visit: https://www.bobandbrad.com/plantar-fasciitis-treatment-program https://www.youtube.com/watch?v=KnuyeV3aBr0&feature=emb_logo

This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2017. For the original video go to https://www.youtube.com/watch?v=KFTI2PHgRIA&t=429s Bob: Howdy folks, I’m Bob Schrupp, physical therapist, Brad: Brad Heineck, physical therapist, Bob: Together, we are the most famous physical therapists on the internet, Brad: In our opinion, of course Bob. Bob: We’re going to talk about eight everyday habits that are harming your spine, maybe your neck and back and you don’t even know it. We’re going to help you get through this, so you know to stop doing that. Brad: So, if they don’t stop doing that and these are things we know are happening and you just don’t know because it happens over a period of years. It’s largely because of posture, keeping the spine where it needs to be. Were you just reading something about teenagers? Bob: Yes! We just found out that a lot of teenagers are getting their necks examined and looking at the x-rays they found out that the deterioration is equivalent to somebody that’s been working at a job for around 20 years. Like a dentist or somebody who is bent down all the time. Their necks have deteriorated equal to that. Brad: That’s because they’re studying so hard? Bob: Oh no, no. That’s because they are looking down at their phones all the time. I’m not being negative, because we are all on our phones all the time. When you use your phone, you’re going to want to bring it up to your face so you’re not looking down. They talk about the Tyrannosaurus Rex arms, the real short arms, you keep your elbows against your body and bring the phone up to your face. Brad: We should tape your arms to your body, so they stay in the right spot. Bob: Yeah, that’s a good idea. Brad: We’ll come up with something. We’ll come up with that later. Bob: Alright, 8 habits, and maybe we’ll throw in a bonus if we have time, Brad. Let’s start off right away in the morning when you’re getting out of bed. Your back is very vulnerable in the mornings because what happens at night is your discs fill up with fluid during the night so you’re actually taller in the morning than you are during the day because during the day you start squishing that fluid out and you’re actually getting shorter. Brad: That’s how they survive, overnight they get fluids and nutrients and then during the day it squishes out the old fluids and waste products go out, and it’s called imbibition. Bob: Wow, that’s quite impressive. So, you’re starting off, you wake up in the morning and the first thing a lot of people do is lay on their backs and pull up to sitting. This is a really hard maneuver on your back, especially in the mornings. Brad: In your back, you’re all rounded out which puts a lot of pressure on the back side of the disc; if you do have a start of a herniation, which you would not know yet, or a bulging disc, that will help make it worse, pulling yourself up with a rounded back. Bob: So, we want you to get out of bed one of two ways. One, you can roll over onto your side. We say, “roll over like a log.” So, you’re rolling your upper body and lower body together and you’re going to push your legs off the edge of the bed and now you’re going to use the elbow and the hand and you’re going to push up like this. You’re also keeping the back straight the whole time. Bob: An alternative would be, if you’re having a lot of pain in your back already, you can go ahead and slide over on your stomach and now you bring the foot off. That way you can keep your back straight. This is a lifesaver if you’re having back pain. Those are the two ways to get out of bed without having pain. Bob: That was number one, now number two, Brad. Number two is using too many pillows for your neck. If you’re on your couch or bed watching TV or whatever you're doing, but I have too many pillows and my neck is flexed forward. Brad: Your spine is straight in your back but then it takes about a 45-degree angle in the neck. You can see the TV easier or your cell phone but your neck is really taking a beating. Bob: What you can try to do is get the pillows so you’re a little bit more level by putting a pillow under my back as well as my head. But one of these wedge things works out quite nice. If you tend to be in the habit of watching TV in bed or maybe even read in bed, this wedge is a really nice alternative. And these things aren’t that expensive. Brad: No, I think they are around $20-$30. Bob: So, now I can read and watch my phone. It's really a nice alternative. Brad: Really, the bed is made for sleeping, not for all this other stuff. Bob: We’re sticking with the head here, let’s say you get up in the morning and you get to your computer, your head is forward. That’s something we’re going to want to correct too and we’ve always said that one of the first things you should do is take your screen and you’re going to want to raise it up. Most people, the screen is too low. When it’s too low, it brings their head down. Brad: Especially if they’re using a laptop, almost always these people have this problem. We’ve got some good videos on how to make those modifications. Bob: With a laptop, you’re going to want to raise it up onto a stand or a couple books. Then you want a separate keyboard for it. Brad: Really thick books work well, but it depends on if you have a cordless keyboard. I just bought a keyboard and mouse cordless for my laptop for $20. Bob: Yeah, cheap. They are going to save you a lifetime of pain. We’ve got a desk coming out. A little portable desk that we’re probably going to do in October. Somebody from Australia made it. It’s for laptops. You can carry it with you. Brad: Oh, something to look forward to. Bob: Next one Brad is, let’s say someone is just picking up their keys from the floor and they bend over at the waste with their legs straight, and it’s called a straight leg lift. They aren’t bending their knees at all. Brad: Then the hamstrings tighten up which puts even more force on the back. It’s a double whammy. Bob: People think, I’m only picking up something light, it doesn’t matter. If you keep doing this repeatedly and repeatedly, over time it’s going to be the straw that breaks the camel’s back. Brad: Not only the camel’s back but your back. Bob: You see a lot of people pulling weeds this way. This is even worse because when you’re pulling the weed, now you’re adding a force on your back as you pull. Brad: As a therapist, we know that’s a long lever arm, so it multiplies quite a bit of force. Bob: Can you hand me my 'mock' vacuum? Brad: This is a nice vacuum. Bob: Thanks. Now, what you also don’t want to do, is bending and twisting at the same time. This is very harmful to the back. If you want to hurt your back or if there’s someone you don’t like, and you want them to hurt their back, tell them to bend and twist. Brad: And then pull on something. Like a lawn mower. Bob: That would do it. What you’re doing is you’re bending and you’re twisting to pull the mower to get it started. Also, when you are shoveling and then you throw it off to the side. What we teach people is get one of those long handle ones and you push it if it’s snow. If it’s dirt, you shovel and you toss it forward. Keep your back straight. Vacuuming is another problem. They are pushing and twisting and pushing again without moving their feet. A lot of people who are vacuuming and they are cutting corners and they are having back issues; they literally can’t do it. Brad: I’ll ask patients, what things are you having problems with at home and vacuuming is almost always one of the first things they say. Bob: I tell people to put the vacuum handle on their hip and then move your body along with the vacuum. Have you ever seen a vacuum before Brad? I don’t even know what they look like. Brad: Nope! Actually, they make vacuum cleaners now, Kirby does, it’s powered so when you push it it just goes along and when you stop, it stops, when you pull back, it goes back. Those are kind of spendy, though .Bob: We’ve got the little round Roby that goes around the house and vacuums. Brad: A robot one. Bob: Yeah. We call it Roby. Brad: It’ll suck up your cat and dog and everything else. Bob: You don’t want to have your cat puke because it’ll spread it all the way around the house. Brad: Bob knows. Bob: We found that out. Okay, next one, if you’re stanging in an unsupported forward bent position. Let’s say I’m going over to work with a patient, and they are sleeping right here, and they wake up and I’m going to give them some medicine. So I'm hunched forward leaning toward them. Or let’s say, you’re brushing your teeth bend forward over the sink, it’s really hard on your back. Whenever you can, put a hand down for support to take pressure off the back. Brad: Well, if you’re brushing your teeth, you might want to just stand up straight. Bob: Stand up straight or sometimes you open the cupboard and you put your foot in there and it just gets you a little bit closer to the sink so that you don’t have to worry about hurting your spine. Brad: If you are remodeling your bathroom, make sure that you get the taller vanity. They make them taller now and they make a big difference. I have one upstairs that is tall and an old one downstairs and it clearly feels better on the tall one. Bob: I used to wash my hair in the sink. I don’t know if people still do that but, in the morning I would wash my hair in the sink, bent over, and that’s a terrible thing on your back. It’s better to put your hand out for support so you can wash your hair with one hand. Brad: That’s how you got that bald spot. Bob: Yeah, don’t show that! Brad: Too many bumps into the faucet. Bob: I was going to get the sprayed to fit that spot. Next one is a simple one, but we all do it all day long, sitting with a slump posture. This is very common with a couch that is soft. You sit down and you just sink right into it. Here you are, rounded forward all night long, watching your favorite TV show. Brad: I was just on a couch last week where we rented a cabin, and the couch was terrible. Lucky it had a lot of throw pillows. I was stuffing them behind my back and under my legs and all over to get good posture. Bob: Yup, and Brad just mentioned it. First thing you want to do is get some throw pillows and get yourself upright so that you’re in a good position. Brad: Right in your lower back is very commonly the part that’s going to make you feel better. Bob: If you’re in a car, you’re going to have to go ahead and purchase something to help your back. We start people off with a rolled towel to see what it feels like. There is the a McKenzie support pillow, but there’s a lot of different ones out there. Then there’s a memory foam one, Brad really likes this one. Brad: Yeah, this one has memory foam and gives you good support because it goes all the way up. If you need it more in a specific place, you’re going to want to go with the roll instead. Bob: The memory foam I like in my office chair, but I don’t like it in the car. It pushes me forward nicely so when I work, I’m leaning forward a little bit which I like, but I don’t like it in my car. Brad: Everyone’s a little bit different. My one car it works fantastic. My other car that has a lumbar support, this is a little too thick, so you know, every car, everybody is a little bit different. Bob: Okay, so we’re up to number 8, Brad. Going back to lifting, a lot of people say, “well, I’m lifting right, I'm bending with my knees.” But then they bend their back and they round it out so do you want to show the three-point system here, Brad? If I’m lifting wrong, there’s just going to be one point of contact. Brad: See, his back is all rounded out with a lot of force on it. Bob: So, if I’m lifting right, I’m keeping my back straight, now there’s three points of contact. Brad: Yes, you’ll have the sacrum, the mid back and the head. Bob: So, you’ve got to hire a person to walk around with you and put this pole on you to make sure you’re lifting correctly. Brad: Doesn’t your wife do that for you? Bob: She does this all day long, (waving the stick), now keep working. Keep doing the honey do list. Brad: Good thing she doesn’t watch you very often. Bob: Yeah. Thanks everybody for watching. Brad: Take Care. 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Strength training has come a long way in the last 30 years. Unfortunately, flexibility training has not progressed at the same pace. There are still a lot of myths, misconceptions, and confusion around how to stretch properly and how to get the most out of a flexibility training program. Although this article cannot cover all the mistakes people make when it comes to stretching, this article will focus on one of the most common, and dangerous mistakes people make when designing a flexibility training program, and that is the Full-Body Stretch Routine. What is a Full-Body Stretch Routine? I am often asked to design flexibility training programs for many different people and many different purposes, and one of the most common requests I receive is for a full-body stretch routine. This is a stretching routine that targets all the major muscle groups of the body equally. At first glance this sounds like a good idea and makes a lot of sense. So, why would you not want to improve the flexibility of all your major muscle groups? Why is a Full-Body Stretch Routine a bad idea? Every muscle group in your body has an opposing muscle group. They are called an agonist and an antagonist, and it is important to create a balance of tension between the two groups. A classic example of the agonist-antagonist relationship is the quadriceps in the front of your legs, which are opposed by the hamstrings in the back of your legs. These two muscle groups create a balance between each other, and when there is equal tension between the two, everything is fine. Another way of looking at it is to imagine the spokes in a bicycle wheel. The spokes on one side of the wheel represent the agonist, or the quadriceps in the example above. While the spokes on the other side of the wheel represent the antagonist, or the hamstrings. When they are in balance, or there is equal tension between the two, the wheel runs smoothly. But what happens if you have tight quadriceps, for example? Having tight quadriceps (or tight spokes on only one side of the wheel) will pull the wheel down to one side and create a wobble in the wheel, and then the wheel runs out of alignment or out of balance. The goal is always to create a balance between each opposing muscle group. In fact, it is better to have both muscle groups equally tight, than one muscle group tight and one loose, because this pulls the agonist-antagonist relationship out of balance. If you do have an imbalance somewhere (and we all do), and you do a full-body stretch routine, or just stretch everything equally, those muscle groups may get more flexible, but the imbalance remains. So, for example, if you do have very tight quadriceps and relatively loose hamstrings, if you stretch both muscle groups equally, you will not fix the imbalance. What should you be doing instead? Imbalances and tight spots cause more injuries, aches, and pains than being tight all over. So, the goal of any stretching program is not only to improve flexibility, but to create an even balance of flexibility between all opposing muscle groups. The same is true with strength training. If you only work on your chest and shoulders, and neglect the muscles in your back, you create an imbalance between the front of your body and the back of your body. It is this imbalance that can lead to all sorts of injuries, aches, and pains. As a rule, if it is not tight and it is not causing you any problems, you do not need to stretch it. There are a few exceptions to this, such as athletes that require increased flexibility for their chosen sport, but for most people this is a wise rule to follow. So, if you perform a stretch and you do not feel any tension in the target muscle group, this indicates that you are not tight in that area. As you start to notice which muscle groups are tight and which are not, aim to create a balance of flexibility between the front of your body and the back of your body, and the left side of your body and the right side of your body. For example, if you notice that your right hamstring muscles are tighter than your left hamstring muscles, work on the right hamstring muscles until you have even flexibility in both. What type of stretching should you do? Once you have identified your imbalances and those areas that are most tight for you, it is time to start stretching. While there are several different types and technique of stretching, static stretching is by far the best form of stretching for improving your flexibility and range of motion. In particular, long-hold static stretching (stretches held for longer than 30 seconds) and PNF stretching. Static stretches are stretching exercises that are performed without movement. In other words, you get into the stretch position, relax, and then hold the stretch for a specific amount of time. Stretching is NOT a quick fix. When someone starts a diet, they understand that it is going to take time before they see results. Likewise, when someone starts going to the gym, they understand that it takes time before they start getting stronger. And the same is true with stretching. Doing a few stretches before playing your sport or going to the gym is not going to make you any more flexible. If you want to see improvements in your flexibility, there are no shortcuts, you need to engage in regular, consistent flexibility training over the long term. --------------------------------------------------- Brad Walker – AKA the Stretch Coach Brad is a Health Science graduate of the University of New England and has postgraduate accreditations in athletics, swimming, and triathlon coaching. He has coached elite level and world champion athletes from sports as diverse as triathlon, motorcycle racing, roller skating, squash, and baseball, and has lectured extensively on stretching, flexibility and sports injury management. His stretching and sports injury articles have been published in numerous health and fitness magazines and extensively online at sites like the Washington Post and the New York Times, and Amazon has listed his books on five of their best-sellers lists both in the US and the UK. If interested in other works by Brad Walker visit: 1) The Anatomy of Stretching, Second Edition: Your Illustrated Guide to Flexibility and Injury Rehabilitation- https://amzn.to/3v6uaoT