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=x9c0MWX3x_4 Brad: Hi I’m Brad Heineck, physical therapist. Chris: Hi, I’m Chris, the pharmacist. Brad: We are here today to do a video on coffee! The good news, the bad news and how much is too much? All from recent research. We are very happy to have Chris the pharmacist here to take how caffeine and coffee and how it works with our bodies and give us the most updated recent research. You’ve done a lot of homework on this, haven’t you Chris? Chris: Little bit, little bit. Brad: Yeah, his little bit, believe me it’s complete. Bob is on a coffee break today. Ha-ha, just kidding. Chris: That guy. Brad: Coffee, first of all, it is one of the most widely consumed drinks throughout the whole world. It’s right up there in the top 5. Chris: It’s up there, everybody drinks it. 80% of the planet, so you got 7.8 billion times that by 80%, that’s a large number of people. About 60-65% of Americans drink it on a regular basis. Brad: If you haven’t noticed, Chris is a numbers person. He knows his stats. Which is also nice. Chris: It’s alright, I’m a nerd. Brad: The history of coffee, very briefly, has it been around for a couple hundred years? Chris: It’s been around for thousands of years. Basically, there’s a fancy cute little story about a goat herder, his name was Kaldi. The story goes that he was watching his goats and basically these goats were eating these berries and he observed that they just wouldn’t sleep at night. They were jumping around and all crazy. He figured out what they were eating, brought it home to his wife. His wife took some and was like, oh my gosh, this stuff really jacks me up. To the point, they were like, we should probably tell somebody. So, what do you do in Ethiopia in 850AD? You take it to the monastery, so they had a monk try it. Basically, at first, they kind of scoffed at it. Then they were like, well, maybe it’s not so bad. It kept me awake during my prayer session. This is a good thing. So, that’s the story of how they essentially came up with coffee. Realistically, the Persians, Ottoman Empire, Ethiopia, all those areas seem to have had all around the same time been trading coffee. Went to the 1500’s, and then it was more or less started to expand towards Europe. In the 1600’s, brought to the United States and here you go. Brad: We have Folgers and everything. Chris: The whole nine yards! Brad: We’re going to refer to one cup of coffee. We’re going to talk about the good news, and the bad news. Let’s start with the good news. When we refer to a cup, let’s define what that is, according to most studies. Chris: Yeah, coffee ranges all over the map. That’s one of the problems is nobody knows what they’re getting in a cup of coffee. So, to standardize it, we’ll assume that one cup of coffee, which we’ll call it eight ounces, contains 100-milligrams of caffeine. Brad: Okay, eight ounces, and I’m not even sure if this is exactly eight? Chris: That looks more like six, you know. If we pour it out, we could get a volumetric measure. Brad: We’ll hold on that. Chris: Yeah, I mean, so the average cup of coffee and again, it’s going to vary, we’ll just assume 100-milligrams. Brad: 100-milligrams of? Chris: Caffeine in the coffee. Caffeine in a lot of cases is the simulant that causes a lot of the effects. But not always. I mean, maybe we have to ask what’s in coffee. Coffee’s got a lot of good stuff in there. It’s going to have some essential vitamins, a few of your B vitamins, like B6, pantothenic acid/B5. It’s also going to have a little magnesium, potassium and of course the flavonoids, chlorogenic acids. There’s a lot of fancy stuff in coffee that does a lot of good things for a body. As we get into some of the health things that it helps, we’ll kind of break it down. Brad: So, the big thing everyone is aware of, the caffeine. So, caffeine has good effects and maybe some bad effects? Chris: Good and bad. That’s one of those things that you want to kind of be aware of with your doctor, guys. It’s one of those things where, if you have a heart condition, an anxiety condition, probably not the best thing to be taking. Because of what caffeine does, it’s got kind of an adrenergic effect, it’s kind of jacks you up a little bit. We do have to be kind of careful with that, for our friends that maybe shouldn’t be on it. Always check with your doctor. Brad: I think we were talking before, typically the symptoms that are bad are oftentimes, you’ll know it. You’re jumpy, you don’t feel right. If you’re that person, you just stay off of it. Or stay away from it. The other thing I was going to say is, now I can’t remember what I was going to say Chris! Chris: That’s okay. The interesting thing is there’s probably a genetic predisposition to people that actually drink coffee. Brad: That’s where I was going. Chris: It’s metabolized by a specific enzyme in our livers, so if you’re playing score at home it’s the C1A2, which will glaze everybody over. That particular pathway in our bodies and in our liver, when people drink coffee and aren’t really bothered by it; we all have those friends that can drink a cup of coffee and then go right to sleep. I’m not that guy. People don’t like me on caffeine. It’s a bad thing. So, there are other people that it metabolizes a lot longer. From that standpoint, they naturally tend to avoid it. They recognize the symptoms of taking too much coffee makes them jittery, makes them jumpy, raises the heart rate, makes them anxious. It’s one of those things where we want to try to avoid it. They know how to avoid it. Although there’s actually more and more accidental caffeine overdoses being seen in the ER’s. Brad: From coffee? Chris: Coffee and/or more likely energy drinks. We’ll sidebar that for another day. But if we’re sticking with coffee at hand, I mean, those are the negatives. Brad: Let’s get back to some of the good things. That’s what I wanted to get in to. I sidetracked things. So, we talked about fitness. People who are marathon runners, people who are doing some aggressive things. Chris: Yup, cyclers, swimmers, rowers. Brad: They are actually, taking caffeine in what form? Chris: Yeah, well usually just a cup of coffee. And basically, when coffee hits your lips, into the system, you’re going to start to feel the effects within about 15 minutes, maximum response, about 45 minutes to an hour, and then it lasts for about 4-5 hours in your system. Brad: We are talking about that rush, that buzz, from the caffeine? How does that relate to making you faster? Chris: Well, it’s kind of interesting. They’ve done a lot of studies on endurance athletes. Cyclists, marathon runners particular, but they’ve also look at swimmers and we’ll talk a little bit about team sports. Marathoners and cyclists in particular, caffeine when you take it before a race, tends to increase your metabolism. In fact, cyclists have been putting out more power, so they test their muscles. You could probably speak to that a lot more effectively than I could. They’re putting out about 17% more power on caffeine. Some of the studies show like 200 mg before, 400 mg before, 100 mg before. Brad: So that’s like, 1-4 cups of coffee? Chris: Yes. That’s kind of that safety range that we’ll talk as we get into the health benefits. It’s that range of 1-4. We aren’t really going to exceed that. Beyond that, it gets to be too much. To get the aerobic output, and for a swimmer, a bicyclist, or a marathoner, you’re definitely going to improve your times. They’ve done studies with guys that were trained, and they improved their mile time. They’ve improved their cycling times; they’ve improved their marathon times. Brad: You know what I’m thinking Chris? Chris: That we should take it before a race. Brad: Well, that but I’m thinking there’s going to have to be potty breaks because that’s an issue. Chris: Well, yeah, it is a mild diuretic. For a lot of people though, it’s kind of interesting, if you’re a seasoned coffee drinker, that effect tends to go away. Kind of looked at that a little bit, because you’re putting liquid in, but you’re also putting liquid out. The effect seems to negate itself. So, dehydration, what was once believed to be a big issue with coffee drinking, is not so much because coffee’s mostly water. It’s just beans, and filtered water. That’s how it works, it’s pretty slick. So, it’s not as bad as we think, but if you’re going to use it before a race, you want to save it for race days in most cases, because caffeine that’s in coffee, you develop a tolerance. You will lose some of the benefit from it if you’re doing it every day to train. Test it before you take a race. Some people, you go out and you could have a bad day if you miscalculate the dose or what have you. Find what works best for you but then save it for race day. It is going to help you to improve your performance. That’s almost guaranteed. Brad: Another thing I understand, coffee can actually compliment that caffeine can compliment some pharmaceutical meds. Is that accurate? Chris: Yes. There are actually several prescription medications that do get affected by coffee, so we have to be really careful with that. Your pharmacist certainly, if you’re a coffee drinker, you should let them know up front. Then they can kind of tailor make something. There’s certain muscle relaxant where all of a sudden, if you’re having coffee with that, it actually competes with how the drug is actually metabolized, raising the drug level and you’re just putty. Brad: So, you want to avoid caffeine with muscle relaxers? Chris: Yeah, the one that I’m talking about is tizanidine, so you would know if you were on it. You might have to be really careful with that. There’s certain antibiotics, it actually goes the other direction. So, the quinolones, things like Cipro. It’s used commonly for a lot of people. Brad: So, it’s good to combine that, or no it’s not? Chris: No, these are things that are bad. Basically, if you take Ciprofloxacin and you had a cup of coffee, it can really amplify the caffeine effects of the coffee itself. Brad: And these are antibiotics? Chris: Yes, for certain infections. Again, I think the biggest thing is when you’re talking to your doctor, you go in, you’re sick, you’re not doing well and you think you’re going to get something, let him know if you’re somebody that actually uses coffee or caffeine. Because certain drugs can affect how it is used. There are certain anti-depressants, certain medications used for arthritis, that we have to be careful with. Brad: What about the other side, are there some medications that are helped if you take coffee or caffeine? Chris: There’s disease states that are helped by having coffee. Because there’s the good things in coffee; they have the flavonoids, and the magnesium, the B vitamins and so it’s interesting that there’s a litany of different health conditions that can actually be improved. There’s a wide variety of studies, like almost half a million people study, much likely to analyze which shows coffee makes you live longer. Really, when we look at it for its overall health benefits. Most people when you look at diet aids, the number one ingredient in most diet aids is caffeine. Brad: You’re talking about diet pills? Chris: Yes. People can lose weight on coffee though. There’s a thermogenic effect from caffeine that’s in the coffee itself. Brad: So, thermogenic, you’re going to get hotter? Chris: Nope, not quite, it helps your body burn more calories. Basically, unlocks your ability to break down fat cells, and actually covert it to energy. Which conversely when we’re talking about improving our physical performance, they think that it’s carbohydrate sparing. What happens is you break down your fat cells for your energy first, and then your carbohydrates later. That’s why marathoners and cyclists seem to do better when they have caffeine, which is kind of the opposite of what a lot of us were taught a long time ago. We want to carbo-load before a race, because that’s our quick energy reserves. Well, it seems like caffeine seems to spare that. That’s why those endurance runners and endurance athletes tend to perform better when they have coffee before a race. Kind of interesting. Going back to the weight loss aspects. That one’s a little iffy, because what happens with a lot of us that drink coffee, is the tolerance does develop after about 90 days. It’s one of those kinds of a quick hitter. When they’re a quick hitter, basically what happens is the effect kind of loses itself after 90 days, and over the course of a year all of a sudden, those weight loss gains kind of gradually comes back. It’s not to say that you don’t still get some of that thermogenic effect, but if you’re not changing your diet and you’re not exercising the way you should, that weight loss balance kind of goes away. Brad: Now, before you mentioned there’s some disease processes that studies have shown it actually helps. Can we talk about a couple of those? Chris: Yeah, so diabetes type II, that’s the one that’s non-insulin dependent, although some people can use insulin with type II diabetes. Brad: Is that the one you get with age or you’re born with? Chris: That’s the one that we get with age. That’s the one we develop when we let things slide. We’re not eating as well as we should, we’re not exercising as well as we should. It’s one of those things where it shows pretty eloquently that it can reduce the risk by about 7% if you’re a regular coffee drinker. Again, what’s regular? 1-4 cups a day. Know yourself because too much can be too much. Too little is not enough. We have to be careful with that. You never want to go over four cups. That’s that 400 mg threshold of caffeine, and that’s where it can get pretty jumpy for people’s hearts or anxiety levels. It does seem to help you to process sugars more efficiently, it helps with insulin resistance. It does seem to do a very good thing for diabetics, for the most part. So, talk to the doctor, but if you’re going to be using coffee, but it’s certainly something that could have a preventative effect on type II diabetes. Brad: So, the big thing is, again, I want to emphasize, if you are on meds, or you’re going to be put on meds, make sure you talk to your doctor. If you say, “Oh, I forgot to tell my doctor that I drink three cups of caffeine a day, is that going to affect things?” When you go to the pharmacist, make sure you mention it too, because that’s part of the pharmacist’s job to double check and make sure that there isn’t something missed. Chris: Yes, there’s lots of stuff that could get by the goalie, so to speak, if we’re not told. If you don’t tell us, we don’t know. Same thing with your doctor or your nurse practitioner. Anybody that sees you. Want to share, sharing is good. Brad: What about things like Alzheimer’s or Parkinson’s? Chris: They are two of the biggest neurological problems that people face. The studies show there’s coffee and decaffeinated coffee. In Alzheimer’s, which is the one where we kind of get forgetful and we kind of lose things. It’s a very sad, debilitating neurological disease. Drinking coffee, interestingly, seems to have a strongly preventative effect with Alzheimer’s. That 1-4 cups of coffee range, can lower the effects quite a bit. Brad: This is from studies? Chris: Studies over hundreds of thousands of people, retroactively. The proof is there. It does show it. So, it seems to unlock certain nerve pathways in the brain. With some of the neurotransmitters it involves. Brad: So, it’s a prevention thing, or once you have it, it lessens? Chris: It’s more preventative. I mean, I would say you probably would want to be starting to drink coffee at an earlier age. When we’re 70 and also, we start cranking down the cup of Joe to try and reverse our Alzheimer’s is probably not going to work. It seems like, these are people that have been lifelong studies and they’ve done studies from 30-50. That’s kind of where that sweet spot for a lot of these studies have been picked out which is why they end to look for diabetes, Alzheimer’s, Parkinson’s, liver disease. These are all things that coffee is very beneficial for. Jumping back to Alzheimer’s and Parkinson’s, Parkinson’s interestingly enough, you heard me say decaf and regular caffeinated coffee. In Alzheimer’s decaffeinated coffee will still actually help you. So, the flavonoids and other things that are in there seem to work with the brain chemistry to help to work with those pathways that are associated with memory. Whereas in Parkinson’s, which is kind of a motor disorder, where we can get those shakes where muscles don’t quite work the way we want them to. It’s contingent upon the caffeine to help with that. People that drink coffee, they will notice to a lesser degree that their symptoms will be alleviated when they have Parkinson’s. Usually at that point, its too far gone. Parkinson’s probably starts 30 years before you figure out you have it. Again, as a preventative measure, you’d want to be drinking coffee well before the problem starts. Without genetic testing, you really wouldn’t know that. Brad: I just do want to emphasize those people with personalities kind of like mine, well if 1 or 4 cups of coffee is good maybe 8 cups a day is even better! Chris: There’s a lot of us that subscribe if some is good, more is better. And that’s, again, the exact opposite. The upper limits of coffee or coffee intoxication, which is really caffeine intoxication, can be quite dangerous. It can put you in the hospital, ER visits. You’ll see them more with energy drinks, and usually kids, but it still can happen with adults. So, you do have to be mindful of that. Brad: And that’s because the energy drinks have a more concentrated … Chris: Much more concentrated across the board. So, I mean, the fatal dose of caffeine is 10 grams. So that’d be like drinking a hundred cups of coffee. You on your best day could never do that. That’s the interesting thing with coffee drinking, it’s generally self-limiting. At some point, you’re like, “ooh, I’ve had too much.” You just naturally tend to stop because it’s uncomfortable for your heart. That’s one of the first thing you notice. Your heart starts racing, really pounding and you get a little jumpy. Somebody comes through the door; you’re willing to jump. Be afraid or something to that effect so usually we’re going to back off. Brad: So, let’s say, because I notice that with myself, I can have one, two cups and then it doesn’t taste so good anymore and it’s like, why am I even drinking this anymore and I’m done with it for the day. But how long does that caffeine stay in your system? Chris: The law of averages unless you’re on certain medications, it’s going to be about 4 ½ to 5 hours. Then it starts to peter off. For a lot of people, insomnia is kind of a big thing. I mean, we have a sleep deprived nation. So probably cut off the coffee around two or three in the afternoon, if you’re trying to be in bed at a reasonable time. That’ll certainly help, so it’s kind of peters off and runs out of gas. Brad: Well, I know like my mother, she’s been drinking coffee all of her life and she’s 84 now. She could drink a cup of coffee at 10:00 o’clock at night and go to bed, “It doesn’t bother me a bit.” Again, that’s because she’s been drinking it for so long. Chris: There’s definitely a tolerance. She may just have the genetic structure that says that hey, I can handle this. Maybe she’s just used to it because she’s been drinking it for 50, 60 years. Brad: I’m hoping that that’s not a bad thing, for her. Chris: No, no it shouldn’t be. If anything, it might actually, you know you said 84, that’s some serious longevity, so it may be adding to it. Brad: 84 and ½ now. She’s doing well. All she takes is a little high blood pressure medication. She’s an incredible woman. Chris: Yes, she is, yup, I know June. I do think, and a lot of the other studies show, that actually helps you live longer. I think it’s pretty safe to say that unless your doctor directly tells you no, or if you’re on certain medications that could create a problem with caffeine, I think it’s okay to drink a cup or two a day. I think it’s pretty reasonable. Couple withstanding medical conditions, of course would have us avoid it. Brad: Well, boy, there isn’t too much bad news and if it is bad you should know it by your symptoms. Chris: You just naturally kind of quit. You’re just like, “Eh, it’s not for me.” Brad: What about people that have a-fib? Chris: A-fib, that’s actually a no-no. That’s going to be one of the ones that we do have to be careful with. That’s one of the cardiac conditions. Brad: So atrial fibrillation, we’re talking about. Chris: Atrial fib, tachycardia, I mean these are things that are heart problems. A lot of the heart problems I would tell you probably to avoid it. Although, it’s interesting, people that have mildly elevated blood pressure or hypertension, studies used to say, “Oh we have to avoid coffee at all costs.” We are actually finding that it only raises if you’re a tolerance coffee drinker. It only raises your blood pressure by about two to three points, which is really insignificant. Brad: So, that’s different, the blood pressure versus heart rate? Chris: Blood pressure versus yeah, so if you’re talking like A-fib, that’s an absolute hard pass. You are not going to do that. We’re going to put the breaks on that one. Brad: Alright, I’ll tell you what, I have to get a cup of coffee, we’re going to have to cut this off. Chris: Alright, drink up everyone! Brad: Thank you everyone and hope you learned something. Well, whatever, just get some coffee. 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Two reason for tapping your foot. You are thinking of trying an arch support insole, and you want to see if added support in the arch makes your foot feel better. Tape can provide added arch support. Good for individual who are loose jointed. See three quick tests (below) to see if you are loose jointed. You would prefer not to use an insole in your shoe- or can’t- but still want increased arch support. Materials needed: We suggest using two types of tape to avoid skin breakdown. First layer of tape against the skin should be a 2” wide CoverRoll Stretch. This tape will protect your skin from the second type of tape. The second type of tape can irritate and even tear your skin. We recommend a 1 ½ inch Leukotape. A link to amazon for these two types of tape is also provided below. Before taping your arch make certain it is acceptable to your physician or podiatrist. The advantage to this taping technique is in its simplicity. Watch the video for the technique. 3 Quick Tests to see if you are loose-jointed. Flex your hand toward your wrist. Then take your thumb and bend it toward your forearm. If able to touch you are hypermobile or loose jointed. Straighten your arms in from of you. Do they bend beyond straight? Do your knees bend beyond straight? If you are interested in the products mentioned above visit: 2’’ Wide Cover-roll Stretch: https://amzn.to/2Z3QW2A 1.5’’ Leukotape: https://amzn.to/3lPIA8f For more information on the Plantar Fasciitis Treatment Program visit: https://www.bobandbrad.com/plantar-fasciitis-treatment-program https://youtu.be/WTFUZR89zUc

FAQ’s with Dr. Anuja Mathew on Pre/Post-Natal Rehabiliation + General Women’s Health By: Dr. Anuja Mathew, DPT, MsPT, OCS - Orthopedic and Pelvic Floor Physical Therapist First, I would love to introduce myself. My name is Dr. Anuja Mathew and I am a licensed Physical Therapist in the states of New York and New Jersey. I am board-certified in Orthopaedics, with an Orthopedic Clinical Specialist certification (one that is earned by 5% of Physical Therapists across the country - not to toot my own horn), as well as trained in Women’s Health/Pelvic Floor. I’ve been in practice for over 10 years now, and am a strong promoter of manual therapy, therapeutic exercises, and biofeedback. I have been treating patients with orthopedic conditions such as sports injuries, tendonitis, arthritis, lumbar/cervical pain, and post-surgical rehabilitation. I also have experience in Women’s Health conditions such as Urinary Incontinence, pelvic pain, pubic symphysis dysfunction, diastasis recti, and prenatal and postnatal rehabilitation. Congrats on being pregnant! Many people struggle to get to where you are, so be proud! Motherhood is a fun and rewarding journey, but it can also be a tough one. Many soon-to-be and new mothers might experience pain in places they haven’t experienced before, and working through those pains can be a challenging journey. This rewarding chapter in your life may also come with some unwanted side effects like lower back pain, soreness, or pelvic pain. These often occur during prenatal carrying and postpartum delivery. Physical therapy can help with any pains that might’ve popped up during this time, but it can also help you have a smoother pregnancy and birth in general. A woman’s body is constantly changing during pregnancy. This increase in weight may cause an increased strain on the spine, along with the increased ligament laxity could cause pain and instability in the lumbar and thoracic spine and pelvis. The pelvic floor is a complexity of joints, ligaments, connective tissue, and muscles. All of which can be affected due to numerous reasons which cause tightness, weakness, and pain in your body. Some common questions we get are during one’s pre or postnatal journey include: 1) Is it normal to have back low back pain during pregnancy? How can I prevent sciatica? Some discomfort in your lower back is normal during pregnancy. In fact, the American Pregnancy Association reports that 50-70% of women experience back pain while pregnant. As your ligaments stretch and your pelvis widens, you will feel some discomfort in the first trimester. As your belly grows, the center of gravity shifts and this causes increased strain on your lower back. Anything more than just discomfort should be addressed right away. Sciatica is one of the more common diagnoses during pregnancy. A lot of times it could be pelvic girdle pain that is misinterpreted as sciatica. It would help to do some strengthening of your hip muscles to improve stabilization in your pelvis and reduce the pelvic girdle pain. 2) What exercises can be done during pregnancy to reduce low back pain? Do’s and Don'ts. Exercises done during pregnancy should focus on hip strengthening, and gentle stretches for the lumbar spine, hamstrings, adductors, and glutes. Prenatal yoga is usually safe to perform. Do not perform any abdominal exercises like crunches or sit-ups, as it might make your diastasis worse, and to be honest — there is a very little chance that you will get 6-pack abs while your belly is growing. If you have been a runner prior to pregnancy, you can continue running, but be careful in your 1st and 3rd trimester. A belly belt/support should be worn or Kinesio-taping should be done to prevent diastasis during your prenatal and postpartum journey. Other good measures to take are strengthening your upper body during breastfeeding, as you most likely will have poor posture that might lead to upper back and shoulder pain. Maintaining good posture during pregnancy with postural awareness, strengthening, and stretching is a MUST. Though the Kegel is a good exercise to start during pregnancy, it is not always advisable for all pregnant patients. People suffering from vulvodynia, dyspareunia, or pelvic pain should focus on reverse Kegels and relaxation more than performing regular Kegel exercises. 3) Am I at risk for gestational diabetes? Doing regular, gentle exercises, and walking can prevent gestational diabetes. So just remember to stay active during your pregnancy, and you should be good to go! 4) How do I stop urine from leaking when I don’t want it to. And when should I go to the doctor/physical therapist? Performing pelvic floor strengthening is not just in the form of Kegels but other strengthening methods integrated with core strengthening can prevent leakage. If you notice any pressure in your vagina, any bulging from your vagina while passing urine or otherwise, you will need to consult your physical therapist or OBGYN to rule out pelvic organ prolapse. If the leakage of urine has prolonged for more than 6 weeks postpartum and is getting worse, then you need to see your physical therapist. 5) You guys can improve scar tissue? What benefits does that have besides aesthetic reasons? Physical therapy can help with scar tissue mobility for C-section scar, episiotomy scar, or scarring from a 1st-3rd degree tear. Scar tissue causes fascial restriction, which means it can adhere to the surrounding soft tissue and organs. This will often cause pain, poor extensibility, and decreased strength in the area. You should wait until 6 weeks postpartum to start massaging or mobilizing your scar tissue. 6) How can I get rid of this split down my ab muscles? That split or gap is known as Diastasis Recti, which is the separation of the abdominal muscle. During pregnancy, the uterus moves up into the abdomen and stretches between the rectus abdominis muscles to make room for the growing baby. Diastasis Recti can cause low back or pelvic pain but don’t worry, a physical therapist can help in reducing this separation through soft tissue mobilization in the abdomen, strengthening techniques, and even breathing techniques! Some things to remember during pregnancy to avoid diastasis are: do not perform abdominal crunches and use Kinesio tape or a belly support belt during your 2nd and 3rd trimesters. Here’s how to perform a self-test at home to see if you have Diastasis: Lay on your back, lift head off the ground, leaving your shoulders resting. Take your fingers and feel down the central abdomen, beginning at the sternum and travel all the way down while assessing that central line until you hit your pubic bone. While feeling down the midline, here’s what to look for: How wide is your separation? How deep is it? Can you feel the walls on either side of the separation? Is there any bulging in your central abdomen as you lift your head? (if you do see bulging, it is a sign that there is significant weakness in the deep layers of the abdomen) Postpartum Diastasis Self-Test Strengthening Exercises for Postpartum 7) Sex hurts. Will it always be like this? When does the pain go away? This is known as Dyspareunia, which is a recurrent pain that is often located in the genital area and may occur before, during, or after sexual activity. This pain might come on as a result of the way your body changes during pregnancy, infections/STIs, vaginal dryness, or just stress. But luckily there are things you can do at home, or we can do to help Dyspareunia. Simple stretches like child's pose, happy baby, along with diaphragmatic breathing and pelvic floor relaxation can go a long way. Pelvic floor massages and the trigger point release method using your finger, pelvic wand, or a miracle ball can help your symptoms as well. Pelvic wands and miracle balls are available online for purchase, however, we would not advise using these during pregnancy. Child's Pose Happy Baby Pose 8) What is Pubic Symphysis Dysfunction and how do I know if I have it or am at risk for it? What can help these symptoms? Pubic Symphysis Dysfunction is when your ligaments that normally keep your pelvic bone aligned during one’s pregnancy become too relaxed and stretchy after childbirth. This causes the pelvic joint - or symphysis pubis - to be unstable and which in turn, causes pelvic pain. Some symptoms include difficulty while walking and pain in your pelvis, typically focused in the pubic area but can also radiate towards the upper thighs and perineum. This doesn’t only happen while walking, but can happen while one is lifting heavy items, climbing stairs, getting dressed, getting into your car, or even while in bed. You can do many things to ease your discomfort. We would recommend Hip stabilization exercises during pregnancy and also using an SI loc belt. Avoiding triggers is also important, this includes keeping your knees together during transfers like getting out of a car or getting out of bed, sitting down while getting dressed, and avoiding heavy lifting. 9) Why do I need a Pelvic PT for my pre-natal/post-natal care when I already have an OB/GYN that I go to? An OBGYN is usually the first doctor people think of when it comes to prenatal care, delivery, and the postpartum journey. However, they usually aren’t trained to address the musculoskeletal implications like a Physical Therapist is. A Pelvic Floor Physical Therapist is even more apt to treat your pains and discomforts if you are pregnant, just gave birth, or just have any pelvic pains that might be also causing your abdomen, back or hip pain. However, not all OBGYNs will know when to refer their patient to a Pelvic Floor Physical Therapist, which is why often we encourage people to ask for a referral from their physician themselves. Some OBGYNs still may not give a referral, but you can always come straight to us and we can give you a free consultation! No one deserves to live in pain, and the best way to help it is to prevent any further complications from happening. We believe in Preventative health as much as Reactive health, which is why seeing a Pelvic Floor Physical Therapist is important, especially while pregnant, to prevent any pain or conditions from happening in the first place. Here’s to healthy pelvic floors, and tearing down the stigmas that often surround Women’s Health issues! Check out our socials: Website: http://nyppt.com/ Instagram: https://www.instagram.com/nypptdowntown/ Facebook: https://www.facebook.com/nyppt To book an Appointment for those in the NY/NJ area: https://msgsndr.com/widget/booking/b69MHrX35yz3eGK9hCG7 Zocdoc Link: https://www.zocdoc.com/professional/anuja-mathew-dpt-289265 Our Phone Number if you have any questions: (646)-886-8687

This article is a transcribed edited summary of a video Bob and Brad recorded in October of 2020. For the original video go to https://www.youtube.com/watch?v=39Vpffll5_s&t=1071s Brad: Hi, I’m Brad Heineck, physical therapist. Chris: I’m Chris, the pharmacist. Brad: Today’s title of this video is Opioid Pain Meds; How They Stop Pain, Why They’re So Addictive and we’re going to get into recovery as well. This is going to be made easy to understand. Chris is going to explain it to us in a technical way but he’s going to also back off on that and show us in a good way that they lay person can understand this. Opioids, man. No matter what, you hear a lot about opioids. As a therapist, we see them used for pain meds and they’re widely used. But, their is this big problem of opioid crisis, which we'll get into but it’s a big problem. We need to know how to use these or understand these, so that we’re not afraid of them but we respect them and use them well. Doctors are very well aware of this. So, first of all, opioids, what are we talking about. What are the common names that we hear? Chris: Well, there’s a whole bunch of them that can be used. The most common one’s are probably going to be oxycodone. Then we’re going to use hydrocodone with acetaminophen. You can use oxycodone with acetaminophen. You can use fentanyl patches and there’s actually sublingual lozenges. There’s a lot of different things. Most commonly, those are the ones you’re going to use the most, but you can use morphine. Morphine is a really common opioid as well. Brad: That’s an opioid? Chris: That’s an opioid as well. It’s kind of the grandfather one, soldier’s drug. So, it’s the first one that came out. Brad: So, all of these opioid drugs fall into this opioid category and they have these names, which are very common. I know the Oxycontin, oxycodone is very common with total knee replacements in the past. Chris: Very necessary. Brad: Right, exactly. So, as far as the names, why do these work? How do they work, can you explain it in a lay person’s way? Chris: Yeah, it’s kind of interesting. You have receptors that go through your brain, your spinal cord and even your gut. There’s actually, within those receptors, there’s a breakdown of those. Brad: So, receptors, we’re talking about the nervous system. Chris: Yeah, it’s just kind of like a little puzzle piece. You’ve got pain reliever up here, receptor down here. It locks in like a puzzle piece and the most important, there’s pretty much three receptors that are widely studied. The Mu is the one where it’s at. That’s the one that has most of the pain-relieving properties and then you have lesser ones that you would call Delta and also Kappa receptors. Brad: So, the puzzle thing, we’re talking about these things coming together and that tells, or gets pain to our brain? Chris: Yeah, so as soon as you take the medication, it goes into your gut, gets into your blood system, and in about 15-30 minutes, you’re going to start to get analgesia, which is pain relief. And you still have that pain. Let’s say you broke your wrist. It still hurts like crazy; you just don’t care about it. That’s what pain relievers do. Brad: You mean all are opioids? Chris: Yep, any opioid. I guess I’ll use opioids and pain relievers synonymously. Just to keep it as simple as possible, but the problem with opioids and where we have the crisis is pills can lead to addiction and can lead to seeking some of the street drugs like heroin. Brad: Okay let’s back up. Let’s go to knee replacement because they’re very common in my world. You’re on opioids, it hurts like crazy. You have to range it out, it hurts, but if you don’t get it moving, it’s going to contract, and scar tissue is going to be a problem. So, we have this connection of the puzzles come together, so that the pain goes in the knee, to the brain, it gets pain, the opioids, blunt that effect. So, that’s all good? Chris: Yes. Brad: So, we’re going to take those, we are going to get good therapy, you’re going to be walking again. So, where does the problem come from this less pain, or pain you don’t care about, into a problem, a crisis where you’re addicted to it? Chris: Yeah, you know it’s kind of funny when you talk about that because especially like if you take a total knee. That type of therapy is going to take time to go from A to B. I mean, how often do you see your patients? Brad: Typically, it’s a four-week regimen. It can go less than that and can easily go more than that, but we’ll use four to five weeks, whatever. Chris: Yeah, and so the newer studies are very interesting. We had maximum prescribing of opioids that hit the peak in 2012. We’ve seen a very dramatic decrease to where we are today. Brad: You’re talking about overall use? Chris: Overall prescribing of these opioid painkillers. And so, it’s been fascinating and they’re harder to come by. You don’t see the forgeries; you don’t see the seeking behaviors as you do. So, to treat your patients, what doctors are doing now is there’s the number three and the number five that are very important numbers. A lot of surgeries, when you get doctors are only prescribing these kind of FDA guidelines. You get three days of narcotic pain reliever and then the doctor will review you and see what they need to do next because it seems like going up to five days, there’s a lot more continuation of the use of those opioid pain medications. It’s interesting when you have somebody that’s on a total knee, you want to transition from using something like hydrocodone or oxycodone for pain relief to getting over to like Tylenol and something like ibuprofen more rapidly, if you can. Brad: Well, so where’s the problem? Why do people get addicted and why are people dying from it? How do they go from the prescription, medical use for it to this crisis of opioid addiction? Where does that happen? Chris: Remember when we were talking about that puzzle piece? There’s one main puzzle piece that I went over, I said that weird word, Mu, kind of like a cow. Well, it hits that, not only does it give you the analgesic, but it also gives you a euphoric response. Brad: So, you’re getting a buzz? Chris: You get a buzz, basically when you’re in pain, you don’t notice this. Actually 97% of patients don’t have a problem. It’s that 3% that can get hooked. Brad: Would that be like, an addictive personality? Chris: Yep, and there’s a lot of factors. I mean, are you in a transitional stage in your life? The younger you are to start pain medications, or is there a family history of genetics? There’s a lot of things that build into addiction science that make it very very challenging. I mean, for the scope of what we’re talking about is what can we do to keep ourselves safe? It’s using them as prescribed by your doctor, what your pharmacist recommended you take it as and using it for the shortest possible period that you can. Brad: So, if you’re on opioids for more than a month, that would be pushing the limit? Chris: That’s pushing the envelope. I mean, you get up to using opioids regularly for a month, you’re going to have to have walk down because otherwise you’re going to go through withdrawal. At that point, you are at least physically addicted to the medication. Brad: Even the prescription? Chris: Yeah, even the prescription. So, if you’re taking, we’ll just, I’m going to pick on hydrocodone with acetaminophen. You’re taking, you know, one tablet four times a day, every six hours. If you do that for four weeks and I’ll send a note to say, “Brad, I’m not going to give you any more medication.” It’s going to be a bad day. Brad: Just one day or is that going to take a while? Chris: It takes about a week to flush out of your system. If we taper you off, going from four down to three tablets a day for a week and then maybe two tablets a day for a week and then finally one table a day and off, that exit is very clean. Brad: Then you’re probably not going to feel addicted? You’re not going to want it anymore. Unless maybe you’re in that 3%. Chris: Then there’s other stats that we can throw in too that make it even more confusing. I mean, for the most part, it’s that 3%. Brad: I’ve heard this too, from doctors as well as patients, that they’re less likely to prescribe opioids and it’s governed, regulated. Is this worldwide or is this just in the United States? Chris: The United States. It’s kind of funny, looking at the stats but right now in the United States, we use a thing called the PDMP, which is a website that helps us, The Prescription Monitoring Drug Program. When we get an opioid that comes in, we have to log on and look at that and then see what the prescribing history has been. Brad: Of that person? Chris: Of that drug and actually, prior to that, the doctor does the exact same thing. So, our stories will match each other. So, the doctor, before he can even prescribe it, and a lot of systems now around in our local healthcare area; they have to log on, look at the PDMP and then they can actually select the drug. If they don’t do that step, I believe the systems will not allow them to write for it anymore. It’s a safety check. Just to make sure they’re using it appropriately. There are cases: cancer, arthritis, I mean, you’re going to have people that may take these things forever. It’s tough and as long as they’re used the way the doctor intends it to; it’s not going to be a problem. When you use these long-term, you’re physically addicted to the medication but it’s not so much like a drug seeking behavior. If we remove it from you, you’re going to have withdrawal. That’s what I mean by addiction in that particular instance because there are also psychological addictions as well, where you just, the only way you’re going to feel comfortable is if you’re using the drug. It gets very confusing. Brad: Where does the crisis become involved? If people are just using it with their doctor, the things get out of the system, through their high school kid, isn’t there some stats on getting into the medicine cabinet and taking it because these pain meds work well. Chris: Yes, they do and that’s where the rush comes from. That’s what people want. When you finally go from using the medication for medicinal uses to using for recreational uses. That’s when we start to see this opioid epidemic taking place. You know, it’s a pretty easy problem to fall into. There are reasons why addiction occurs. Did you have a genetic predisposition to it? Were there family problems, did you have an alcoholic father or mother? Did you have a transitional period in your life where you start at a new school or you started a new job? Those things, just all of a sudden, you just want to try and escape and all of a sudden, taking the medication, you just feel a little bit better about everything and you just don’t care. That’s part of the problem with it. It’s very easy to slip into that. It becomes a very very ugly rabbit hole. Brad: So, did you have some stats on who is getting addicted? Is it the patients? Is it their family members who get to it somehow? Chris: It can be anything. That’s the thing. When you do the breakdown, if you look at across the board, the younger you start, and the longer you take the pain medication are strong predictors if you’re going to have a problem with opioids or even other substances in your life. We want to be really careful with that. We want to be upfront with our doctors. If there’s a problem, you want to talk to your doctor. When you look at some of the stats, high school, one in 12 high school seniors has tried opioids. Now, it could be heroin, which is a street drug, or it could be getting pills. When you look at the breakdown, it’s like, how did you get the opioid? It first comes from family members. So, they checked the medicine cabinet, somebody who said, “Oh, I’m done with these, you can have them.” Basically, they can get them from family members, 35% of them get them from the doctor but 53% get them from their family. Brad: Now, you said heroin,so there is a black market? Chris: There are black market opioids. Brad: So, what are those opioids? Heroin and? Chris: Well, heroin is the main one. It’s cheap, so that’s the problem. Back in the 90s, when I came out of college, we had a very different mindset for giving people pain relief. The dose was given to what they could tolerate. There’s no ceiling with opioids. Brad: Prescription wise? Chris: Yes. We started reigning things in after about 2012. Brad: So, there was 10, 20 years where there was a lot of opioid prescriptions, high doses? Chris: Wild Wild West. I can tell some pretty crazy stories about the involvement with the DEA and very particular uses for drug busts on bad doctors. It’s crazy. People will go to no end to get what they want once they are addicted to these things. The problem with heroin these days is, you start on pills, doctor won’t give you any more pills. I need something. I’ve just got this void in my body. I ignore my family, I ignore my job, I ignore my friends. I need to do something. Well, we find heroin. Heroin is cheap and it’s easy to use. You can snort it, or you can inject it, or you can smoke it. Brad: Is it readily available in the street? Chris: Unfortunately, it is readily available. It’s very dangerous stuff. One in four gets addicted to it right out of the gates. Why is it so addictive? It goes back to that Mu receptor again. It’s kind of creates this incredible intense pleasure for about one to two minutes after you ingest it. However, whether it’s in shooting, smoking, or snorting. After that two minutes rush, you have about four or five hours of just generalized contentment, kind of like you’re in a warm cocoon of happiness. For a lot of people, that’s very attractive. You just don’t care about anything else, you’re just kind of comfortable. The problem goes, after about that four hours, then you’re looking for your next fix. Eventually, the addictive psychology takes over and most people don’t even get the high. After that first high, on heroin specifically, or chopping up and shooting opioids of any sort, you never really get that initial high again. Now you’re just chasing it. You’re just trying to not feel like garbage. This is the withdrawal effect. Brad: Like the hangover? Chris: Yeah, so it’s a vicious cycle. It’s one of those things that you’re always chasing that. It affects the brain in such a way that when you go to rehab, they have to teach you how to think differently to break the cycle, so you can make the healthy choices, so you’re staying away from the people that can cause you to fall into these patterns, staying away from the situations that can cause it. It’s very complex and it’s very sad. Brad: Is there any stats on how many people maybe start from the medical field, the prescription and get into that illegal street drugs? Chris: You’ve got two million people right now, walking around in the United States alone, that are in what they call an opioid crisis. Basically, at that point, they’re hooked on it. Whether it’s pain medications or street drugs. That makes it really challenging to try and treat from that standpoint. There’s definitely avenues, you know, and the biggest thing is when you know you have a problem, you have to reach out to a doctor to get help. A lot of times family members will try to break through, and the addiction is just so strong that they don’t care. It’s tough stuff. Brad: So, this is the kind of thing that can lead to death. Chris: Absolutely and part of that problem is with some of the drugs that are available on the street. Heroin is cheap, pills are expensive. It’s $30-$80 for a prescription pill to be sold on the black market. Brad: You mean one? Chris: One tablet. Brad: One tablet that you could get from your doctor would go for $30-$80 on the street? Chris: Yes, versus a $10 bag of heroin. Brad: They’re both going to give the similar type of high. Chris: The advantage of the pills is you know what you’re getting. Things like heroin, you don’t know what you’re getting. They cut it with other things. One of the bigger dangers you have with drugs like heroin is what we’re seeing with the death rate rising so much. Last year alone, 67,000 people died. Brad: 67,000 people? Chris: 130 people a day die from opioids and heroin. Brad: Both street and prescription? Chris: Yes, they are kind of lumped together. The National Institute of Health has some real good graphs if you guys want to research it yourself. It shows, quite eloquently, the dangers of these drugs, but the big scary one right now, are the synthetics. Considering La Crosse, they just had a big fentanyl bust down by Gunderson. They’re cutting the heroin with fentanyl, which is an extremely potent; way more potent than heroin itself, and they mix it in with the heroin, so people that who melt it, shoot it or snort it or smoke it. Brad: Fentanyl, where do you get that from? Chris: You get it from your doctor, but this is a black-market fentanyl, so it’s coming from drug dealers. It’s a powder and you can’t really eat it. That’s why in prescription, you have a fentanyl patch or Duragesic patch, you wear it for three days: it’s great for cancer pain. It’s something where it’s a phenomenal painkiller but when you mix it with something deadly like heroin, the death rates get even higher. It’s actually outdoing straight up heroin death rates now. Brad: Wow. Chris: It’s scary stuff. Brad: So, if you’ve got a family member or yourself, and you know you have this problem, you want help. Obviously, it sounds to me like to get through the withdrawal, as something to do by yourself, is extremely challenging. Chris: You’re going to need help, yes. There’s a lot of different ways. Some of them are a little bit controversial. You can get a doctor, a medicated assist to get you off the drugs. You literally go to a hospital. They check you in. They give you special medications to help your body taper you down off the opioids until you’re clean. You’re basically in a medically induced coma to get to that. That’s the most controversial one, or they can try cold turkey but that’s 7-14 days of hell. Or you can get into a program. There’s lots of programs that doctors can lead you to and there’s things on the internet. Anywhere you want, help for the opiate addiction. You will see multiple sites come up. Basically, they want to keep you safe and healthy. A lot of those programs are incredibly successful. They have to place you on medications to help to get rid of the craving. Things like Suboxone is a drug that they use. It’s a special film that they dissolve in their mouth. It’s two drugs in one and one blocks the receptor, so that if you were accidently broke down and tried to use something like heroin, it doesn’t work. It doesn’t work at all and it gives another one to basically take the edge off so that you can function and feel normal. It’s amazing, when you see a functional addict. They can take a hit of heroin and you look at them and they’re talking to you and you wouldn’t even know it. It’s weird. Then there’s other ones that are all gorked out in left field. Brad: Right. I wasn’t really aware of that myself. People can function while they’re on opioids and you wouldn’t know it. Could this go on for days or years? Chris: Year. Brad: Years? People could be using this for years. Chris: Until they die. Brad: As they are using this, is their body and their brain slowly decaying? Chris: It causes brain damage. It’s just one of those things where, more than anything else, all your brain wants to do is seek that drug and nothing else exists. When you get to a doctor and you finally get to treatment, crisis management of all these things, they’re going to work with you psychologically to try and teach you behavioral patterns to help you to become safe and healthy again. Brad: Do you recover? Say, your mind, it gets beat up through all this use. I’m thinking like your lungs; after you’ve smoked for 20 years, they get beat up but after a few years, when you quit smoking, it does recover. Maybe not to 100%, but you get through it. Is it the same thing with this? Chris: You could say it is. I don’t think you’ll ever get back to 100% of yourself, but you might have to have medical help. As far as prescriptions go, they can try and help you. There can be chronic depression. There can be anxiety issues. There’s a lot of different things that have to be looked at. It’s a very complex medical condition that requires a doctor and regular check-in’s and visits. Sometimes, even weekly. Sometimes there are doctors in some of these programs that see people every other day. Brad: Once you get further and further away and you’ve been completely free of using the drug, then you don’t have to go as often. Chris: Exactly. Once we get to a point and your stable on the medication and then the goal after you get to a good point, hopefully then we try and pull you off of some of these things. Then you just check in counseling. You keep working on re-evaluating life choices and keeping in mind, a lot of folk’s relapse. It’s something that you have to realize that they can succumb to it. They can’t look at it like a failure. It’s just a disease. Brad: They could be off of it Chris: But then fall off the wagon, so to speak. But they can get help. They just have to re-evaluate and retrain the brain to try and avoid those and make better lifestyle decisions. Whether it’s going into an exercise program, where you’ve got to find something to fill that void. What happens is, when you get into that, you burn out all the receptors that help you feel normal. Then you have to retrain your brain. You have to come up with activities that are going to help you get back to that normal. What is your “new normal”. Brad: Wow, we really went through a full cycle, through the whole idea of how does it work to get through that total knee with that painful rehab, medically, into the illegal drug portion, which it could lead to and then you have to get out of it. Chris: It’s heavy. Brad: Yep, and there’s help out there if you are in crisis mode. If you are taking it for a medical reason, a total knee replacement, shoulder problem, whatever it may be, you can do it safely. Be attentive to your doctors. Chris: Work with your doctor. If you have a question to ask your pharmacist, we’re going to funnel you to the right people to try and help you to do whatever we can to keep you healthy and safe. Again, for most of us, it’s not a big deal. But there’s a small portion, it’s a huge deal to and it can kill you. Brad: Again, the younger you start, the worse it is. So, pay attention to what your kids are doing. Chris: Yes, and don’t be shy. Ask questions. If you’re a parent, you can’t be a buddy, you have to be a parent. Sometimes it’s not nice and those conversations are very unpleasant. But at the end of the day, it’s about the people you love, and you want to kind of help them as much as you can. There’s always help. Brad: Outstanding job, Chris. I’m learning here. We talked about this before and I feel like I’ve learned something. I feel uplifted, so very good. I hope you feel the same way and good luck. 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: Grip and Forearm Strengthener: https://store.bobandbrad.com 15% off with code BLOG15 Wall Anchor: https://store.bobandbrad.com 15% off with code BLOG15 Booyah Stik: https://store.bobandbrad.com 15% off with code BLOG15 Knee Glide: https://store.bobandbrad.com 15% off with code BLOG15 Fit Glide: https://store.bobandbrad.com 15% off with code BLOG15 Massage Gun:https://amzn.to/36pMekg Hanging Handles: https://amzn.to/2RXLVFF Bob and Brad Resistance Bands Set: https://amzn.to/36uqnbr 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 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. 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After you determine your arch, choose a shoe that is suitable for your arch. • To minimize the risk, try to only buy shoes that are immediately comfortable, not that you will need to “break in”. If you need the added support of arch supports or plantar fascia inserts, it’s usually best to replace them with your new shoes. If you don’t yet have a new pair, swap your old inserts into your new shoes until you are able to replace them to ensure you always have proper support. • While trying out shoes wear the socks you will normally be wearing. • Try on shoes at the end of the day in case your feet swell during the day. • Length of shoe. The shoe should be about a quarter inch longer than your longest toe. • Width of shoe. Depends on your overall comfort. Too narrow and your feet may go numb. Too wide and your feet may slip. • Heel to arch length. The widest part of your foot should line up with the widest part of the shoe. • The heel counter: Simply the back part of the shoe that cradles your heel. Tighten the laces of the shoe to a comfortable level and the heel should not slip. • If you have plantar fasciitis you may want to wear a shoe with a little more heel which will decrease the pull from your heel cord. Heel height can be anywhere from 1/3 inch up to ½ inch depending on comfort. • Rotating footwear between at least two different types of shoes decreased the incidence of plantar fasciitis by 72 percent. (study by Werner et. al 2010). The time allows the soft material in the footwear to rebound and provide better cushioning. • Dress Shoes for Men: Leather shoes are not very cushioning and don’t absorb shock very well. If possible, opt for a softer soled casual dress shoe. Just search for soft soled dress shoe. • Dress Shoes for Women: Women and high heels. If you can wear proper good supporting footwear 90 percent of the time- you need not worry about the ten percent of the time with high heels. If you are wearing high heels at work and sitting most of the day- this is also not a problem. • Work Shoes: Work shoes were designed for safety and not for comfort. You may want to remove the sock liner. Replace it with an insert that is thick, supportive, and comfortable. • Hiking boots: Hiking boots tend to be great footwear for people with plantar fasciitis. They have great arch support. However, if you are seeking more “cushioning” in your footwear you may need to look elsewhere. • Replace your footwear when you begin to see wear patterns that are more than half of the treads in once area. • Change positions often if on hard surfaces For more information on the Plantar Fasciitis Treatment Program visit: https://www.bobandbrad.com/plantar-fasciitis-treatment-program https://youtu.be/PZDxyck_QPw

This article is a transcribed edited summary of a video Bob and Brad recorded October in of 2019 . For the original video go to https://www.youtube.com/watch?v=oMIf-CFS7Qs&t=301s Bob: Once again, we are joined by someone, Brad, do you want to introduce him? Brad: Chris the pharmacist. I’ve known Chris for about 25 or 30 years now. He is the man we go to to get some real good scientific information about this topic we’re going to go over. Bob: We want some authority, and this is the guy. I would say, semi-genius? Or full genius. Brad: Yeah, I would say he’s right up there. Chris: Let’s lower the bar. Bob: Alright, we’re going to talk about the harms of marijuana/THC on the young brain. This is a very important topic obviously as things become legalized and we want to make sure we explore it fully. Brad: Right. And all three of us have adult children. Chris still has a high schooler. Chris: I still have a teenager at home. Brad: So, we can relate to this at a personal level as well. I guess growing up when I was younger, I didn't use or at least I didn’t inhale, older joke. But anyway, does it really hurt a teenager if they smoke some marijuana? It’s been around back in the 60’s, it seems like it really got popular and exposed to the public and also in the media especially. Also, at the same time, there’s the question about can you justify it as it's becoming medically legitimate. They’re saying it’s legal medically in some states now. It’s a good pain killer. There’s some research being done with cancer and that kind of thing, but we need to get this all cleared up. Chris: Well, at the end of the day, I mean, people smoke marijuana to get high. I mean, it’s recreational use. I think that’s probably the area that we’ll focus on because that’s where the danger really lies. And kids are going to be kids. I think it’s something that, as parents, we give them the best possible information we can. As far as marijuana, THC, which is the active component which gives you that high effect, is actually probably something that is very, very dangerous to a developing brain. There are actually some pretty decent studies that show pretty eloquently why it’s a bad thing. The brain doesn’t stop developing until about 25 years old. So, I guess, even alcohol use, which is also dangerous for a lot of reasons, but we won’t side bar that too much. But probably shouldn’t even drink until you’re 25. When we take something like marijuana, THC, it really does affect the teenager’s brain. There’s a lot that happens between 12 and 17 and continues to happen until about 25. There’s that magic spot right in there where there’s just lots happening in the brain. When you smoke marijuana, what happens is, you get these chemicals, it makes you feel funny and high and all these silly kinds of things, but it actually really stunts brain development. Those risks that happen are just really traumatic. The high rates for depression and anxiety are huge, off the Richter scale. We’re talking, on the normal population, it’s between anywhere from, depending on the study, 15 maybe 20% of people will suffer from it without adding any risks. I mean it’s not; you’re walking by without a net. You add marijuana into the frame in a young developing brain and it increases that risk fivefold. So, it’s a much higher risk. Not just little bits of depression and anxiety, but lots where actually it’s very clinically significant. It’s requiring prescriptions, it’s requiring watching out for things as dangerous as suicide. It’s something that we have to be very careful with. Bob: A friend of my son’s, smokes marijuana and it just happens to be that he does have huge issues with anxiety and depression now. I mean, I know that’s a one case of one. It’s just interesting to observe up front. Brad: But you’re talking about studies that reveal this clearly. Chris: Yeah, there’s study after study that shows it very clearly. Actually, the things that are really the most damaging, so the younger and the frequency of use dictate the amount of damage later down the road. So, that’s the take home. So, if you have a 12, 13, 14, 15 year old kid that’s using this and using it habitually, it’s something that we have to be super careful with. Their risk for anxiety and depression, what they show, is permanent, and you’re going to have problems. Just to kind of jump it around; there’s a study in Norway that actually had a twin study, which was kind of interesting. It was a small study, so I don’t know that you could necessarily hang your hat on it, but it’s certainly something that brought it up. There’s two separate kids, one that did and one that didn’t. They were twins. So, you’ve got good matches. That’s what’s so interesting about his study. It showed that the one that didn’t, seemed to be well adjusted and fine but there was a much higher incidence of suicidal ideation in the twin that used. It wasn’t really clear on how much marijuana was consumed, at what ages, but they showed that suicidal ideation and depression and anxiety were very very high in the ones that did compared to the twin. So, even though the study was very small, I think at least it gives a window on what we have to be prepared for. It’s something as a parent, none of us want our children to be exposed to those types of things. Life is hard enough as it is. I don’t think we need to do anything to make it more challenging. Bob: What about that thing you often see in marijuana use in movies that’s the lack of ambition. Is there anything to that? Chris: Oh, there’s a lot to that. That goes with a lot of things that occur with the smoking of marijuana when you’re talking about the developing brain you have the frontal cortex where all the thinking goes on, but you have other areas, your hippocampus, where all your memories are processed, so there’s lots of really complex things happening in that brain. That chemical, for whatever reason, seems to slow down your ability to, you’re apathetic, you’re impulsive, so you’re more likely to just say, hey that sounds like a good idea. So, we’re going to do that. We have problems with memory and recall. Spatial orientation. That’s just directions to the local quick mart. It’s like, alright, you’re going to take two stop lights, you’re going to take a right and then a left. You know, we all got it. Two stop lights, a right and a left. Well, all of a sudden, they’ve gone left and then two stop lights. So, I mean it’s something that does affect how the brain works, and it’s interesting. Some of the studies actually show after periods of absence or not using the product, what happens is, it recovers a little bit, but not great, and it seems like those effects are probably permanent. Bob: Especially used at a young age. Chris: Yes. I mean, you have kids that are in school, they’re learning. They talk about things like verbal fluency, so when you’re learning to use your vocabulary and different words, you kind of get stuck on one word. It’s easy to make fun of because we see it in the movies. We see the comical aspects of it. There’s a lot of truth to it and there’s a lot of very real issues that occur. I think what these kids do not realize, and I think we can call it, they’re children, our children. They don’t realize the damage that they are doing. They’re stunting their development; they’re stunting their intelligence. They’re opening up their lives to possible, really sadness, misery and anxiety. Just for the short-term gains because maybe societal pressures, peer pressure. Hey, I’m doing it, so you have to do it. See, now you’re cool, now you’re not. There’s a lot of things. It’s very hard to be a teenager. I think in this day and age, it’s probably harder than it was when we were kids. There’s so many more options and choices that are available to them. Bob: Now that it’s being legalized in a lot of areas, I mean is society saying, yeah, it’s okay now. Chris: It sends mixed messages. I think, again, everybody is free to choose, but I think at least until that brain is 25, and even after 25, there’s still studies that show it’s not a good thing either. But there’s also aspects of marijuana use that can be good as far as pain relief and cancer relief, seizure control. I mean, it’s a slippery slope and we have to very careful with what we’re doing. But in the case of our kids. Bob: Now what you’re talking about though, is basically, again, choosing your poison to some extent. It’s going to be a lot better to use marijuana than maybe some of the opioids. Chris: Oh, yeah, yeah. They are lesser evils. We’re not going to tell you to go out and find some meth or find some heroin. It’s all very bad. Let’s face it, they’re all bad. At some point or another, people use it recreationally, but you know, I’ve been guilty of having a beer at a local tavern. It’s certainly something that my friends can attest to how many beers I’ve had. So, it’s certainly something to be aware of. Bob: That’s the argument quite often that they make. Well, they legalized alcohol. The thing is, that alcohol is bad. So is marijuana. So is if we legalize another drug. They’re all bad. We’re just adding to the mix there basically. Brad: We were talking earlier; Chris and you had mentioned there was a study on was it your IQ or something about your cognition? Without the use of marijuana and with it, or the THC. Chris: Yeah, so there are some good studies that actually show that your IQ could drop as much as 8 points. Bob: I don’t have 8 points to lose. I don’t know about you. Chris: Exactly. Now, if there were a drug that would give me 8-10 points of intelligence, I’m all about it. But I mean, when you’re going backwards, and you’re old and it’s one of those things where, I don’t want to lose those 8 points. When you’re in a developing mind, it’s even more serious because the damage that you do then, is probably more permanent. So, we are going to have problems down the road. It’s like, we want these kids to emerge and flourish. The last thing we want them doing is going backwards. We just can’t do that. Brad: Especially when it sounds like it’s a permanent thing. The damage is done. It’s not going to correct itself like the lungs. If you’re smoking and you quit smoking, your lungs do regenerate. Not the case here. Chris: I mean, there is an extent with abstinence where it does get better, but it never seems to get where that baseline is. You’ll never really get that what you once had. It’s kind of one of those things that these kids for the most part come out and they’re perfect, for the most part, unless there’s other mitigating factors, and every day you live is a little bit closer day to death. So, why would we do anything that’s going to make that path from A to B more difficult? I think, unfortunately, with a developing brain, it can. Photo by Robina Weermeijer on Unsplash Bob: Now, you’re mentioning too, that some of the doses now of marijuana are much more potent now than what people may remember when they tried it as a kid. Chris: Oh yes. I think what happened in the 60s and 70s and 80s, we’ve had some very smart botanists out there that really know how to manipulate plant genes. They can structure the types of highs that they can manufacture. It’s interesting because I think there is some medical aspects that it can be certainly researched and hopefully moved forward with some of these scientists. At the same time, I think we have to be careful again, with the age of things and the exposure. We just have to be so careful because of the damage that we can do to the brain. It’s just something that we have to care to care. Brad: You know, we were talking just a little bit ago about that they’re changing genetically the plant. I can relate to that because my nephew just got his PhD in agronomy and he’s been literally, he tells me about it in the stories that he’s growing grass, actually, grass seed. They want to make a grass seed better, like in your lawn. It’s amazing what they’ve done with what they can do. There’s a Bill Murray reference in there. Someone with his knowledge had decided, well, if I can do this with grass seed, I’ll do it with marijuana plants. I can just imagine that they can really change it. In other words, one joint from the 60s versus one joint today, modified, the level of THC could be doubled or tripled? Chris: I don’t know if we have a straight percentage. I think what you can say is that the level of THC produces a more potent high. I think you can take that to the bank. From that standpoint, they just understand, like I said, how to manipulate the plant genes. In the case of your nephew, it’s just another plant that we can manipulate genes. You see it all over the place. It’s the genetically modified organisms. It’s something that they’re going to continue to do it and maybe even make a better plant. I mean, heaven knows what’s going to happen out there in the future, but I think there’s so much research that we need to do for the safety of everybody that’s involved. What are the dangers will be, obviously? There’s respiratory illness, there’s going to be cardiac issues. Obviously, the mind is what I typically focus on. It’s certainly something we have to be very careful with. There’s emerging evidence. There’s this cannabinoid hyperemesis syndrome and it’s something that ER doctors have kind of reported. It’s an interesting article. Bob: And hyperemesis is what? Chris: Throwing up a lot. Brad: Profusely. Chris: To the point where they actually dehydrate, and all these other really bad things happen in the body to the point where it can actually cause death. I think that’s the thing we have to take away from. Bob: And not recognizing it in the ER for being caused by marijuana. Chris: It’s being recognized now because it’s becoming more of a hot topic. It’s been misdiagnosed. The problem is that there’s a very casual thought that marijuana’s not that big of a deal. I think it is a big deal, and it should be treated that way. Alcohol, I think is actually worse than marijuana. If you were going to pick the two poisons. If you look at the addictive scale, alcohol comes in well ahead of marijuana. But it’s certainly something that has its own emerging set of problems. I think over the next 20 years, we’re going to see more and more of those. Going back to that hyperemesis, the throwing up, there was an example of a young lady that, she was 27 years old and she knew she had this. She figured, well one more night’s not going to kill me. So, she went out on, I guess for lack of anything else to say, a marijuana bender. She partook of various different foods and types of smoking. Brad: And this was at a restaurant? Chris: Yeah, just a restaurant. It’s something that’s kind of a fad thing out west. I mean, I think you’ll see a lot in California for sure. They have clever chefs that try and add this to make things at least get people through the door. So, she went through but the takeaway is that she ingested tons and tons of marijuana that night, and it landed her in the ER. It ultimately put her in the hospital for days. The study, I believe said three days. She nearly died. There’s a really tragic story, same article, of a 17-year-old boy that had the same thing. He was vomiting so profusely and dehydrating and everything else that went with it, it shut down all his organs and he passed away at 17 years old. What these physicians are noticing is that they didn’t realize that it was probably from marijuana use and so it was being treated as stomach ailments or maybe a virus. Now your astute physicians, and they’re all sharp. I mean, I think for the most part, so now they’re becoming more and more aware of this particular condition. I think as it becomes more decriminalized and more people use more of it, it’s simply a small example of the dangers yet to come. I think that’s the take home. As parents, as friends, you just want to make sure that your friends and loved ones are being taken care of. We don’t want anybody to go down that route. Bob: You may have just saved someone, Chris, because we’ve all seen it more then once on our channel where we’ve warned people of something and they’ve emailed us later and said that because of you, we figured this out. This is why we’re vomiting. Chris: Maybe. It’s just a dramatic example for sure. And I chose that simply because it is a dramatic example. But I mean, it is something, a real possibility. We’re seeing many many more people affected by it. Another friend of mine is a physician and he’s like, just you wait. You’re going to see an eruption of problems associated with marijuana. Respiratory, cardiac, obviously the mind, which we kind of gravitated to through this program. It’s something that I think we have to take with a grain of salt with our youth, in particular, but even as choices as adults, we have to be careful with it. Bob: I think if some of the states wait long enough, they’ll watch some of these other states that have legalized it and start to see the issues cropping up there unfold. Chris: It’s hard to deny the money unfortunately. That’s where the problem is. Schools and bridges, I mean it’s crazy. Brad: Another conundrum that our society is going to have to face. We’ll get through it with people like Chris. Our channel can educate some people and help it out. Bob: Thanks again to Chris for coming. Well done, well done. Brad: Excellent job, Chris. Chris: Thanks guys. Bob: Thanks for watching. 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: Grip and Forearm Strengthener: https://store.bobandbrad.com 15% off with code BLOG15 Wall Anchor: https://store.bobandbrad.com 15% off with code BLOG15 Booyah Stik: https://store.bobandbrad.com 15% off with code BLOG15 Knee Glide: https://store.bobandbrad.com 15% off with code BLOG15 Fit Glide: https://store.bobandbrad.com 15% off with code BLOG15 Massage Gun:https://amzn.to/36pMekg Hanging Handles: https://amzn.to/2RXLVFF Bob and Brad Resistance Bands Set: https://amzn.to/36uqnbr 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 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 October of 2020 . For the original video go to https://www.youtube.com/watch?v=sKio9c3sGZI Brad: Hi, Brad Heineck, physical therapist. Mike: Mike Kenitz, Physical Therapist Assistant. Brad: Together, we are the most famous physical therapist on the internet. Mike: In our opinion, of course. Brad: There you go, Mike. Today’s episode is understanding spinal decompression using an inversion table. And will it work for you? You’re going to understand it and you get some answers for this. So, understanding why this can take care or delete or does it actually work? Or take care of your back pain. We’re going to cover that. How it works, is traction or decompression which really is the same thing. We’re going to look at that closer using the spine. If we look at the spine, often times particularly with sciatica, we’re going to be dealing with a bulging disc. Now if you have tight muscles, this also can be helpful just for relaxing the muscles, but we’re going to look at the bulging disc. Here we have, L3 and L4 and there’s a bulging disc here pushing on the nerve causing back pain and sciatica all the way down the leg. Now, that bulge, if we can centralize it or reduce it, medically speaking. We want to get it to go back in. If we actually could pull the vertebra apart, allowing space for the bulge to go back in, that is good. Mike: Typically, reduces the pain you are experiencing from sciatica or wherever it may be causing. Brad: Now, what used to happen back in the day, when I was early in the therapy, there wasn’t inversion tables. They had traction machines where you would lay down. I should call them devices. Machines sound a little industrial. Mike: They still have them. Brad: They would have a device where they connect up your waist and connect up your trunk or your torso. Mike: You laid on a big table and it would pull and would get relief. Brad: If you got relief, you’re doing the right thing. You typically lay there for 15-20 minutes on a certain protocol prescribed by the therapist or the doctor. So, how do we do this without an expensive device? We found out the inversion table can work out very well. These have come more popular over the last 5-10 years. Mike: Yes. This is a Teeter table. They have different versions. We have one of the higher end models here. This one just has a bigger base of support. It also comes with a few adjustable features compared to the other ones. But, they all work well. Brad: I used to have an inversion table. It worked well on my spine for about two and a half years with spondylolisthesis, then it stopped working and I actually sold it on the used market. That worked out well, but these are very top quality. You’re going to be happy with how it’s built mechanics and the how it works. Before we get into that, I did do a little research Mike, I want to share this with people. There’s a nice research study done, people who had a sciatica, a bulging disc, according to the MRI. And they split it into two groups. One group had therapy exercises alone. The other groups had the same therapy exercises with the inversion table treatment. What they found out was that people who had the inversion table, by the way, all of these people were cited for surgery. There was a significant difference and people who used the inversion table did not have the surgery, evidence that it works. Mayo Clinic, I looked at them. They also said they’re very consistent with reducing back pain. Then they’re saying not for long-term, in other words, you might need to use it for maintenance. I’ve had patients own one. They say they love it because they invert, they decrease the pain. It lasts but not forever. Mike: Yeah, it’s not a long-term solution. Brad: Should I let you talk? I’ve just been babbling on. Mike: Go ahead. Brad: LOL, so, why don’t we demo? Mike: Okay. So, to get into these, you have to first step in. Obviously, if your back is hurting, you might have to have someone bend down to push this closed. You want it tight. You don’t want it so tight your ankles are uncomfortable. So, I’m just going to snap it in. That feels tight for me, it’s adjustable. We have this preset to my height. We also have it strapped in here, so it will not fully invert. Mike: You can full invert. We do not recommend it. Full inversion is honestly used more for exercises, which we’ve showed in previous videos in the past, but this is set up so all I’m going to do is lean back. As soon as I lean back, I’m going to get to a neutral position. This is set up for me, for my height, my weight. You’re going to have to mess with it. Brad and I are the same height but I’m a little more top heavy than him. So, I have to set it up a little different than him. As you can see, if I bend my knees, I start to come back down. If I straighten and go back this way. I’ll go neutral, start in neutral. And then to actually invert, I’m going to start raising my arms up above my head. And down I go. Brad: And at this point, as the weight of his arms, head and trunk offer that traction and Mike, as the person using it, or the patient if you will, needs to learn to relax the abdominal muscles and the core muscles. And that allows that traction to occur. If you’ve got that bulging disk allow that to centralize go back in or if it’s just a relaxing of the muscles. You have to kind of learn how to relax here and focus on your breathing. Are you feeling okay, Mike? Mike: Yep. Brad: Also, if you have arthritis in your back, in the facet joints that can gap those and allow that synovial fluid to get in reducing the pain and Mike’s going to come back up. Mike: Also, if you had any type of back surgery, you probably should not do an inversion table, check with your doctor. And some people's pain is so bad, getting into this is uncomfortable. So, it’s not for everybody. Brad: There are a few instances that you’re not going to be a candidate for the inversion table with some medical issues. Number one, if you have glaucoma. The pressure in your eyes goes up when you invert. And if you have any eye problem, make sure you check with your eye doctor or your eye doctor. Glaucoma’s uh, what are you laughing at Mike? Mike: The eye doctor or the eye doctor. Brad: Did I say that? Mike: Yeah. Optometrists, is that what they’re called? Brad: There you go. Heart conditions. If you have blood pressure problems, any cardiac problems, make sure you check with that doctor. If you recently, or in the past, had a stroke, a hiatal hernia, because you don’t want the pressure and that to change and irritate that. Or, if you’re pregnant. Mike: Or high blood pressure. Hypertension is also precautious. Brad: Didn’t I say that? Mike: I think you skipped that one. Brad: All right. So, what I did was, I went to a store that had them and I tried it. You’re only going to, in my recommendation, you’re only going to use these if they offer relief while you’re doing it as well as after you get off and walk around and for the next few hours. In other words, it could feel good while you’re inverting, and then when you get up and walk around, oh man, that was not the right thing to do. That’s the problem. You’re not going to use one. If you invert and you’re going to not invert too long the first time. The first time I did it, I was inverted for about five minutes. I thought if one minute is good, five is better. Well, my back was feeling good, but I got a headache for the rest of the night. And I inverted too steep. I recommend 60 degrees, at the most and this is about 60, maybe a little less. Mike: The strap is adjustable. It’ll allow them to go further back or less. Brad: What if I can’t find a store, particularly now with COVID going on. You can buy one of these from Teeter. You have a 60-day trial. If you’re not happy with them in 60 days, full money back guarantee. Mike: Yes, if you go through the link we put in the description, you do get a bit of a discount as well. Brad: So, there we go. Understanding spinal decompression or traction as it is described here. I've used them. They are vaild and they're useful and I really hope that we helped straighten this out in your head. Mike: And your back. Thanks. Interested in learning about the products mentioned: 1) Teeter FitSpine Inversion Table: https://shrsl.com/2e6mo 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: Grip and Forearm Strengthener: https://store.bobandbrad.com 15% off with code BLOG15 Wall Anchor: https://store.bobandbrad.com 15% off with code BLOG15 Booyah Stik: https://store.bobandbrad.com 15% off with code BLOG15 Knee Glide: https://store.bobandbrad.com 15% off with code BLOG15 Fit Glide: https://store.bobandbrad.com 15% off with code BLOG15 Massage Gun:https://amzn.to/36pMekg Hanging Handles: https://amzn.to/2RXLVFF Bob and Brad Resistance Bands Set: https://amzn.to/36uqnbr 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 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.

You should plan on purchasing shoes with good arch support and cushion. You may want to purchase a good pair of walking or running shoes (even if you do not run) You should purchase shoes based upon the type of arch that you have. To determine your type of arch, do the following: Put the water on the bottom of your bare feet and walk over a paper bag or vanilla envelope has been taped to the floor. Compare your footprint to the photos below. High Arch (first foot in photo) is a supinator and generally is very rigid. It does not absorb shock very well. Tends to take more pressure on the outer side of the bottom of the foot. Normal arch (middle foot) is neutral. It does not pronate much or supinate much. Foot pressure with a normal arch tends to spread out even between the inner side and outer side of the bottom of the foot. Low arch (last foot in photo) is a pronator and generally has a lot of mobility- can absorb shock well. This type of foot is referred to as a flat foot. Pressure tends to be on the inner side of the bottom of the foot. Running or walking shoe categories: Even though these are classified as running shoes, they are designed to help the average person with their daily walking Cushioning Shoes: generally good for a normal arch to a high arch. Provides increased cushioning but not a lot of support. Stable Neutral Shoes: generally good for a normal to low arched foot. Have a lot of cushioning AND more support for the arch of your foot. Stability Shoes: Generally good for a low arch or pronator. It has more support inside part of the shoe and material is stiffer in the arch. Motion Control Shoes: Have firm support on inside and outside of shoe. Stiffest and heaviest shoes you can get. Generally designed for people who severely over-pronate their feet. 3 Tests to tell what type of shoe you have: Grab the heel and forefoot of the shoe and twist it or wring it like a washcloth. If you can completely twist so that the heel ends up facing one way and forefoot the opposite. It is most likely a cushioning shoe. Grab the heel and forefoot and bend the shoe. If it bends at the forefoot and not the arch. it is more likely a stability or motion control type shoe. If it bends at the arch, it is a cushioning type shoe. Take your finger and poke into the base of the midsole. If it is soft and cushiony all the way around the shoe with no plastic bars or posts it is a cushioning shoe. If there is a hard or form plastic support, it is a stability or motion control type shoe. For more information on the Plantar Fasciitis Treatment Program visit: https://www.bobandbrad.com/plantar-fasciitis-treatment-program https://youtu.be/RXzk7OdZ0Hs

This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2019. For the original video go to https://www.youtube.com/watch?v=y1ZmxlmJnAQ&t=10s Bob: Today Brad, we actually have an interesting topic. It’s called horns on your skull caused by your cell phone and how to stop it. That’s intriguing isn’t it? Brad: Yeah. Bob: So what are we talking about, Brad, horns on your skull? What we’re talking about here is actually a bone spur that can occur on the back of your skull. We kind of created one here. So, we have Napoleon Bone-apart here, we took his head off. And you can actually see the little bone spur coming out. That’s probably a fairly large one. Brad: Sure. Bob: There are probably a lot smaller ones. Brad: But, you said you saw x-rays and it looked very similar to this. Bob: Yes. Now the thing is, why this is not surprising to us, is because you can get bone spurs in your shoulder, you get bone spurs in your back, you can get bone spurs on your heel. So, why couldn’t you get bone spurs on your skull? Brad: Right, because all we need typically, is a ligament or a tendon that attaches to a bone, overstress it, calcium deposits form, and it creates a bone over time. Bob: And we’ll show you what ligament causes that on the skull. Brad: There you go. Bob: So this is based on research. It was from the University of Sunshine Coast. What a name right? Brad: I’d like to visit. Bob: Yeah this is in Australia. You probably want to go to Australia, don’t you? Brad: I do. Bob: It’s in Queensland and they did 1200 x-rays. They did it on a wide variety of ages. One-third, Brad, that would be 400 people, showed bone spurs. Brad: At this location on the skull. Bob: Yes, at that location. And, the frequency decreased with increased age. It was more in the younger people that had it. Isn’t that a little frightening? Brad: Well, it kind of makes sense as we go into the research here. Bob: Yeah, we’re going to talk about this. So, first off where does this occur? It actually occurs right at the back, and actually, if you want to tell right now whether or not you have one, you can feel on anybody here. There is actually a bump on the back. It’s the occipital protuberance there. The first bump you will feel right in the back of your head. Brad: And that’s normal. Bob: That’s normal to have the bump there, but run your finger down a little bit down towards your neck. Now if you start to feel the bone continues and forms something like the protrusion on the skull. Then, you probably have a little bone spur. But not to worry. That’s not really going to give you any problems or any pain. Brad: I guess if it was large enough and you extended you head up and it starts to physically bump into something, then it might be painful or uncomfortable. Bob: It could. It’s like heel spurs, a lot of heel spurs don’t give you pain, either. But, why does this bone spur occur? So, we’ve got Sam our other skeleton here. And this is a great demonstration here because attached to that bony protuberance there, is a ligament. It’s called a ligamentum nuchae. I always remember that from college and PT school because, it’s an interesting name to me. But that ligamentum nuchae attaches to that bone and then it attaches to the bony bumps on the back of your neck all the way down to C7. Brad: Those are the spinous processes. Bob: And it looks similar to this. It’s really wide, but it’s very narrow if you look at it from the back. Brad: It’s probably not blue. Bob: It’s probably not blue. But what happens is, every time you bend your neck forward, you can see that stretching, don’t you Brad. Brad: Yeah, so you can see this tape is flexible, and it’s literally stretching. And that’s what happens when you bend forward. For example, to look at your cell phone. We’re looking like this, stretching that particular ligament out causing stress on that bone. Which causes the calcium deposits to form, causing bone spurs. Bob: Ergo, bone spurs. So this doesn’t happen overnight. This is generally from prolonged posture. So you have your head down for a long time. It could also be a laptop, if your head is down. So again, the bone spur generally is not a problem in itself. But the other things that are going on could be a huge problem on your neck. With your neck down like this all the time, now you can start to get some deterioration in the neck itself. And you could get, what we call degenerative disc disease. Brad: So the disc between the vertebrae are starting to fail or break down. Bob: Right. So we talked again about how posture, where for every inch your head is forward that puts 10 pounds more stress on your neck. So, if you’re way forward you’ve probably got about 40 or 50 pounds more stress on your neck. And so, how do we get away from this? Very simple. Don’t look down on your phone like that. Brad’s going to show you. Bring your phone up to you, we call it Tyrannosaurus arms. You have short little arms, bring it up to you and look at your phone that way. Brad: Or, you know, the other thing you could do is kind of compensate with your eyes. Instead of looking down with your head, look down with your eyes. And you can do this, but it is a little bit harder if you have bifocals, of course. But with healthy eyes, you can do it. That’s a habitual change, though, and it’s not going to be easy. But I’m thinking probably going to make a device, a harness that goes around the neck and you put the cell phone there and you go. You could just walk around with this thing bobbling around. Bob: Well, Brad, I think they tried it with glasses, you know. They had the google like glasses, where you could see things on there. I think they’ll probably implant something in our eyes is what they’ll do. Brad: Yeah, I see. Well one way or another it’ll get taken care of. Bob: But the thing is, it’s also what we talk about with laptops, you don’t want to have your head way down with laptops either. Down looking at your keyboard or laptop for long periods of time, I think may be the culprit more than anything. Brad: We have some videos on really nice ways to alleviate that, particularly people at work or at home. Bob: So, basically get rid of the horns, Brad right? Brad: Why, Brad, why? That’s exactly what I’m talking about. Bob: Alright, thanks for watching. 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: Grip and Forearm Strengthener: https://store.bobandbrad.com 15% off with code BLOG15 Wall Anchor: https://store.bobandbrad.com 15% off with code BLOG15 Booyah Stik: https://store.bobandbrad.com 15% off with code BLOG15 Knee Glide: https://store.bobandbrad.com 15% off with code BLOG15 Fit Glide: https://store.bobandbrad.com 15% off with code BLOG15 Massage Gun:https://amzn.to/36pMekg Hanging Handles: https://amzn.to/2RXLVFF Bob and Brad Resistance Bands Set: https://amzn.to/36uqnbr 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 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 September of 2020 . For the original video go to https://www.youtube.com/watch?v=5Ru9h0NuBgg&t=1s Bob: Today we’re going to show you the one exercise that will improve your life forever including physical appearance, health and career. Brad: Absolutely. Bob: My gosh, Brad, anything else you want to throw in there? Will it make you rich? Brad: Bob, you know, some people say this may be clickbait but I am passionate about this subject. I think you are too. There’s no doubt about it. 30 seconds, do this daily. It’s going to change your life. We’ll talk about it in a little bit of detail. Bob: Multiple times daily is benefitial, by the way. Brad: So, why is this one exercise going to change our lives, Bob? We’re talking about the big P, posture. Bob: Right. Brad: I just read a study on posture and how it affects your breathing. They did it scientifically, measuring the amount of air you bring in and go out, goes up significantly. Okay? Posture as far as shoulder mechanics. We know that shoulder mechanics work much better. If you’re slouched, you can reach minimally. If you’ve got good posture, you can easily reach up overhead. Bob: You can swallow better. If your head’s forward, you can’t swallow very well. Brad: Back and neck pain, which can lead into arm and leg pain. Bob: By the way, I just was told about this study. I did not see it, but someone was telling me about it. If you have poor posture, you can actually, tighten up your abdomen. You can put pressure on the vagus nerve. That can actually increase your heart rate. So like, I always stress this with our runners in cross country. Is really good posture when you run, because your diaphragm’s in the right spot. Brad: Right, right. And lastly, people talk about it socially or professionally, what does that have to do with it? If you go into an interview and we were just discussing, the studies show that interview is determined within the first few seconds. Bob: They look at you and they probably already know if they’re going to hire you or not. Brad: And if you’re coming in slouched, you’re not a winner. You’re not going to help the company out. You come in here looking positive, posture up tall. You’re going to take over things. It’s all shown right there as well as your outfit. Bob: It shows confidence. Brad: How you dress is important too, obviously. Bob: We used to do a class on protection, right? Brad: Yes, self defense. Absolutely, Bob: That’s what I was trying to come up with. I remember reading an article about this criminal, and he said they would pick on people that were doing what they call the “Vic walk.” The victim walk. Brad: Oh. Bob: So they’d be slouched down. They’re the ones that they’d pick on. Brad: They look like a loser, Bob. Bob: Well they don’t look confident. So they think, well, I want to take that guy on. Brad: They look like a winner. Bob: A winner, that’s where he’s going! Brad: Which all leads to the exercise. I’m sorry to keep you going, but I really wanted to tell you why I’m so passionate about this. So the exercise is our Ws. We’ve talked about this many times. The reason this works is because you have to bring your head back, chin back, arms back, squeeze your shoulder blades together, which puts you in good posture. Bob: What you’re doing, by the way, is stretching the chest muscles, at the same time strengthening the muscles between the shoulder blades. Brad: So you’re doing both at the same time. So, in 30 seconds, you can do this between 5-10 of these. You’re not going to do them quickly, like this. It’s going to be, hold and relax. Hold. Do the chin tuck, don’t go forward. Chin back in and you’ll feel those muscle tighten up. You’ll feel a stretch in the front. And that’s exactly what you want. Bob: The key to this though is that you do it throughout the day. Brad: Right. You don’t have to do it for for five minutes. Again, 30 seconds is plenty. So, in bed, before you get up. Bob: Why don’t you show us Brad? Brad: Absolutely. You don’t have to lay down on the floor, but you could if you wanted. You need to take the pillow out, so you can do your chin tuck. Then back, like this. And you can do those. I even think if you’re doing 15 seconds, that may be adequate. 30 seconds is good. You can do them standing while you’re making your eggs. Do your chin tucks, you know? Bob: I’d love to be at Brad’s house in the morning. Brad: I put some turmeric on eggs, for anti-inflammatory. Bob: LOL, very good. Brad: At work, if you happen to have a job where you’re seated, boy you can just throw these in. Bob: Yeah, lots of these. Brad: Remember the "W." You’re going to win with this. It’s a reminder that you’re going to keep this good posture as opposed to this, poor posture, as well as all those other negative things that go along with it. Bob: Alright, become winners folks. I was worried when Brad was going to that loser thing. I mean, we don’t call people losers. Brad: Absolutely not, Bob, but we’re going to show them how to become "W" Winners. And "W" is for Wisconsin too, Bob. Bob: I knew that was coming. Brad: Yeah, that’s that state over there. Bob: How about Minnesota? Thanks everybody. Brad: Take Care. 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: Grip and Forearm Strengthener: https://store.bobandbrad.com 15% off with code BLOG15 Wall Anchor: https://store.bobandbrad.com 15% off with code BLOG15 Booyah Stik: https://store.bobandbrad.com 15% off with code BLOG15 Knee Glide: https://store.bobandbrad.com 15% off with code BLOG15 Fit Glide: https://store.bobandbrad.com 15% off with code BLOG15 Massage Gun:https://amzn.to/36pMekg Hanging Handles: https://amzn.to/2RXLVFF Bob and Brad Resistance Bands Set: https://amzn.to/36uqnbr 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 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.

The following is a list of the 12 things that can prevent plantar fasciitis from healing or getting better. If done to excess, they can also cause plantar fasciitis. 1. Standing or walking on hard surfaces over a long period of time. 2. Anything that overextends the plantar fascia such as kneeling and digging your toes into the ground. Anything that puts stress on the bottom of the foot. Anything that puts your toes in an extended position. Including exercises that place your toes in an extended position- planks, lunges, or calf raises. 3. Acute trauma- landing on your foot the wrong way during a sport or work. 4. Tight calf muscles and/or tight hamstrings. 5. Any leg injury that causes you to compensate and limp or taking greater weight on one foot can cause plantar fasciitis. For example, hopping on one foot because you are not allowed to place weight on the opposite foot. 6. Doing too much too fast. Changing the intensity in activities: Sprinting when you normally jog. Jogging when you normally walk. Jumping when you normally do not jump. Too big of increase in running, or walking. Too many planks. Doing too much too fast is common in January when you restart a fitness program. You should plan on ramping up workouts slowly. 7. Weight gain is a common cause of plantar fasciitis. Whether you are gaining fat, or muscle, the added pounds put additional strain on your feet. This can cause plantar fasciitis or trigger a new onset if you have already healed. 8. Poorly fitting shoes and old shoes: If your shoes are showing noticeable wear on the bottom tread, it is time to toss them out. A new style of shoe can cause plantar fasciitis if it does not fit properly or provide the proper support that you need. 9. Running, jogging, long fast walks, dancing, and/or aerobic type exercises. 10.Poor running or walking technique. 11.Leg length discrepancy: If the length of your legs differs significantly one from the other, you have a greater risk of developing plantar fasciitis. This is due to the increased stress placed on the longer limb. You can put a heel wedge or cup under the shorter leg to compensate. 12.Walking with bare feet or stocking footed. 3 additional things that may contribute to Plantar Fasciitis. 1. People with diabetes – less blood flow to the fascia (which has poor blood flow to start) and possibly balance problems which affects the way on walks. 2. Your age. As you age the plantar fascia becomes brittle and easy to injure. 3. Pregnancy- pregnant women- hormone Relaxin relaxes the ligaments of the pelvis and allows the pelvis to open for childbirth. Relaxin, along with the extra weight of pregnancy can result in plantar fasciitis. For more information on the Plantar Fasciitis Treatment Program visit: https://www.bobandbrad.com/plantar-fasciitis-treatment-program https://youtu.be/I7X9UTRdFIQ

We spend the vast majority of our adult lives telling children and grandchildren that they can do anything. But we often forget that that same advice applies to us, as well. If you are looking to make changes, you should know that it’s never too late. Here are a few healthy habits you can adopt starting today, no matter how many birthdays you’ve seen. Ease pain associated with aging. Many seniors struggle with chronic pain. This often stems from issues, such as arthritis, that can’t be cured. Fortunately, there are treatments. Bob & Brad recommends TENS treatment, which the Arthritis Foundation also suggests for arthritis pain. TENS units are not overly expensive and can reduce pain intensity by up to 50%. In addition to electrical stimulation, stretching and exercising can help reduce the perception of pain. Talk to your doctor before beginning a new exercise routine. Clear negativity from your life. Negativity stems from many different causes. One is living in a home full of tension. If you have adult children or grandchildren living with you, you may find that your space feels small and cramped. To combat this, open windows and spend a day cleaning and decluttering. Having a fresh environment can reduce complaining and create a happier home for everyone. When negativity comes from within, think about your situation differently, have a cup of tea in a quiet room, or simply write your feelings down and rip them up. These simple actions can help you reframe your thoughts and opinions and may lead to a more positive mindset. Manage your medications. If you take prescriptions or supplements, ask your physician or pharmacist to evaluate your current lineup for potential interactions. Many benign medications can have unintentional side effects. Antihistamines, for example, can cause grogginess, which might exacerbate developing mobility issues. Even the ibuprofen you take for a headache may put you at risk of a stroke or heart attack, according to Harvard University. Stay social. There are so many reasons to maintain an active social life in your older years, which may be the reason why there are so many senior centers across the country. A lack of socialization will bolster cognitive decline and can lead to depression. Having a strong network of peers, however, will lead to a better quality of life and may also keep you more active as you engage in physical hobbies, such as walking or exercising, together. See the dentist. A great smile is something to be proud of, but your oral health is much more than aesthetics. As we get older, we may experience issues, such as dry mouth, gum disease, or tooth sensitivity — all of which can make it more difficult to care for our teeth. Sadly, these issues can have an impact on your emotional and physical health. See your dentist regularly, and, if you wear dentures, have these evaluated at each visit for fit and integrity. Make plans to see your dentist at least twice each year for a cleaning and checkup. Reaching your Golden Years is an accomplishment to be proud of. What it is not, however, is an excuse to give up on your physical and emotional health. The above can help you maintain both of these so that you can live the life you deserve during your retirement. And remember, if you want to instill healthy values in your children and grandchildren, you have to model healthy habits for as long as they are watching. Bob & Brad strive to be the most famous physical therapists on the internet, but they’ll settle for knowing their information helps visitors to the site. Bookmark the blog today.