Sore feet?  Painful arches?  Plantar Fascitis?!

Are you waking up in the morning hobbling out of bed?  Finding walking, running and doing stairs painful?  Are you trying to stay healthier, lose weight and get fit only to be frustrated by not being able to because of pain on the bottom of your feet?  You may have plantar fascitits or fasciosis.

Plantar fascitis (PF) is a condition of inflammation on the bottom of the foot, in particular the plantar fascia, which is the fascia or fibrous, connective tissue that attaches from the bottom of the heel or calcaneus to the phalanges or toes of the foot.  The PF has a protective function for the underlying muscles, blood vessels and nerves of the foot.  It also has a supportive role making up the three weight bearing arches of the foot:  the medial longitudinal arch, the lateral longitudinal arch and the transverse arch.  You may have heard the term “dropped arches”.  This is referring to failed integrity of these arches.  Dropped arches can lead to the formation of inflammation on the bottom of the foot via a stress effect or pulling of the plantar fascia.

Patient is seated.  Integrity of medial arch is seen (above).

       Patient is weight bearing.  Notice loss of medial longitudinal arch.

Patient is weight bearing.  Pronation and valgus bowing of Achilles tendon is seen (left).

PF usually presents as pain on the bottom of the foot especially near the inside edge of the bottom of the heel and along the medial or inside arch.  Commonly the pain can be worse upon getting out of bed in the morning but improves with subsequent steps.  The problem will often present more with standing on one’s feet for prolonged periods, walking for extended periods,  compressive activities or sports, such as volleyball, running, and with wearing non supportive shoes or sandals, e.g. flip flops, sandals and high heeled shoes.

Many now believe a chronic state of plantar fascitis eventually becomes plantar fasciosis, or degeneration of the plantar fascia tissue.  This most likely occurs due to an ongoing inflammation causing eventual degradation of the tissues on the bottom of the foot¹.

So what causes PF?  When one studies the anatomy of the foot and posterior line of the lower leg, the attachments of both the plantar fascia to the inferior aspect of the calcaneus (heel) and the Achilles tendon (the conjoined tendon of the gastrocnemius and soleus muscles of the calf) to the superior, posterior aspect of the calcaneus – it is apparent that these two tissues/areas would influence each other.  It is no wonder that tightness in the calf muscles could then create a pulling effect on the plantar fascia below via the common bony attachment site of the calcaneus.  Commonly, runners and bikers as well as office workers who sit a lot will often have very tight calf muscles.  Dropped or failed medial longitudinal arches will obviously create an elongation and stretching of the PF.  Combine this with shoes with poor arch support and an irritation of the PF can easily develop.

Obesity has been identified as a contributing factor to the development of PF, especially of chronic heel pain ² .  The feet are the base or the foundation of our structure, supporting our entire frame especially with weight bearing postures or standing.  Added weight to our frame will have a multiplying effect on the demand of the plantar fascia for supporting the integrity of our arches.  The more weight our arches support the more likely the PF will be tractioned and stretched.  Subsequent inflammation will likely develop in between and above the fibers of the PF connective tissue.

My primary doctor friend always used to say to me “the apple never falls far from the tree”.  I find this is the often the case with inheriting our parent’s system, organ or tissue weaknesses.  One can inherit our parent’s low arches, flat feet or overpronated feet or even their high instep or supinated feet.  If one or both of your parents have dropped arches, you may be headed for the same especially as age has its “drooping” effect on our bodies.

Finally, it is commonly believed by many different medical authorities (medical orthopedists, podiatrists, chiropractors, physical therapists, osteopaths, etc.) that overpronation and abnormal motion of the foot is the major instigator for development of plantar fascitis or fasciosis³.

Now that we understand more about the beast of plantar fascitis and its causes, what can we do to tame this beast?  Stay tuned for a follow-up  article on just this subject!

References:

1.  www.northcoastfootcareblog.com/plantar-fascia-tear.

2.  Irving DB, Cook JL, Young MA, Menz HB.  Obesity and pronated foot type may increase the risk of chronic heel pain:  a matched case-control study.  BMC Musculoskeletal Disord.  2007 May 17; 8 (1): 41.

3.  Kwong PK, Kay D, Vover RT, White MW.  Plantar Fascitis:  Mechanics and pathomechanics of treatment.  Clin Sports Med.  1988: 7: 119-26.

The ideal way to get vitamin D is when our body converts it to the activated form after exposure to UVB rays in sunshine.  We also gain vitamin D from dietary sources and from vitamin supplements.  Even by obtaining the vitamin from three potential sources, Vitamin D deficiency is common today in children and adults.  In fact, more than 50% of women and men ages 65 and older in North America are vitamin D deficient, according to a consensus workshop held in 2007.  People who have trouble absorbing dietary fat, such as those with Crohn’s disease or celiac disease, can’t get enough vitamin D from diet no matter how much they eat (vitamin D requires some dietary fat in the gut for absorption).  People with liver and kidney disease are often deficient in vitamin D because these organs are required to make the active form of the vitamin, whether it comes from the sun or from food.

The discovery that most tissues and cells in the body have a vitamin D receptor and possess multiple effects on gene-regulation has provided new insights into the function of this vitamin.  So far, scientists have found approximately 3,000 genes that are affected by vitamin D.  Of great interest is the role it can play in decreasing many chronic illnesses including common cancers, autoimmune diseases; rheumatoid arthritis, multiple sclerosis, diabetes, infectious diseases; colds and flu, cardiovascular disease and high blood pressure.

Vitamin D deficiency can cause growth retardation, skeletal deformities and may increase the risk of hip fracture later in life.  Another symptom is pain and weakness in the muscles and bones.  Based on this fact, it has been suggested that some disorders diagnosed as fibromyalgia may actually be vitamin D deficiency.

A study published in the Archives of Internal Medicine in June 2008 showed low levels of vitamin D doubled the risk of death from cardiovascular causes in men and women (average age 62) referred to a cardiac center for coronary angiography.  Postmenopausal women who took 1,100 international units (IU) of vitamin D plus 1,400 to 1,500 milligrams of calcium per day reduced their risk of developing non-skin cancers by 77% after four years, compared with a placebo and the same dose of calcium. The 1,100 IU dose – nearly three times the 400 IU per day recommended in federal and other expert guidelines – was correlated with a 35% higher blood level of vitamin D, on average. A large study of aging in the Netherlands published in the May 2008 issue of Archives of General Psychiatry found a relationship between vitamin D deficiency and depression in women and men ages 65 to 95.

Vitamin D Dose Recommendations

So, how much Vitamin D is enough?  Based upon most recent research, the current recommendation for healthy vitamin D levels is 35 IU’s of vitamin D per pound of body weight.

For a child weighing 40 pounds, the recommended average dose would be 1,400 IU’s daily, and for a 170-pound adult, the dose would be nearly 6,000 IU’s.  However, it’s important to realize that vitamin D requirements are highly individual, as your vitamin D status is dependent on numerous factors, such as the color of your skin, your location, and how much sunshine you’re exposed to on a regular basis.

It is recommended you monitor your blood vitamin D levels regularly when taking oral vitamin D supplements to make sure you’re staying within the optimal range.  Your vitamin D level should never be below 32 nanograms per milliliter, or 32 ng/ml, and any levels below 20 ng/ml are considered serious deficiency.

The OPTIMAL value that you’re looking for is 50-65 ng/ml.  This range applies for everyone; children, adolescents, adults and seniors, and are based on healthy people in tropical or subtropical parts of the world, where they are receiving healthy sun exposures.

There are two blood tests that closely resemble each other: 1,25(OH)D and 25(OH)D.  25(OH)D, also called 25-hydroxyvitamin D, is the better marker of overall D status. It measures the precursor produced by the skin and converted in the body to vitamin D.  This marker is most strongly associated with overall health.   Please realize, however, that the “normal” lab range for 25-hydroxyvitamin D is between 20-56 ng/ml.  This conventional range is really a sign of deficiency and is too broad to be ideal.

Latitude and vitamin D production in the skin

Except during the summer months, the skin makes little if any vitamin D from the sun at latitudes above 37 degrees north (in the United States, the shaded region in the map) or below 37 degrees south of the equator. People who live in these areas are at relatively greater risk for vitamin D deficiency.

Dietary Sources of Vitamin D

Vitamin D can be found in foods like milk, eggs, fish and fortified orange juice, but you only get an average of 250 to 300 international units (IU) of vitamin D per day from dietary factors alone, which is rarely enough to maintain optimal levels.

If you take a vitamin D supplement, you want to take the natural D3 (cholecalciferol), which is the same vitamin D your body makes when exposed to sunshine.

You may want to consider booking that tropical vacation.  It might be exactly what your body needs!

Yours in health,

Marion M. Fraser, D.C.

Sources:

N Engl J Med 2007;357:266-81, Michael F. Holick, M.D., Ph.D., Vitamin D Deficiency

Harvard Women’s Health Watch, “Time for more Vitamin D”, September 2008 issue.  http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch

http://www.mercolaa.com/nutritionplan/ beginner_supplements.htm

The New York Times, “A Second Opinion on Sunshine: It Can Be Good Medicine After All”, June 17, 2003

Weight Loss Program Offered Through Onion River Chiropractic

Dr. Marion Fraser is here to assist those looking to reach their weight loss goals.

Are you feeling overweight, tired, or simply unhealthy? Have you tried to lose weight and failed?  You are not alone.  Millions of Americans are caught in this world plagued with fast food options around every corner, poor eating habits, a general lack of activity, high stress environments, insufficient sleep, and a “sick-care” health system.  In this unsupportive environment, it is no wonder that two-thirds of adult Americans are overweight, and the predicted health of future generations is even more uncertain.

Take Shape For Life offers a simple solution: high-quality, medically formulated meal replacements combined with free coaching support to help you lose weight and keep it off.  The Take Shape For Life plan is a two-phased approach for weight loss and maintenance.

In the first phase, you will use Medifast portion-controlled meal replacements to lose up to two to five pounds a week, without surgery or medications.  As your Health Coach, I am a free resource that will guide you through the program and provide on-going personal coaching.  I will help you build up the knowledge, skills, and support you need to realize health and help keep you focused on your long-term goals and dreams.

Once you achieve your desired weight loss, you will transition into the Maintenance plan, which will allow you to put your healthy habits to work to support lasting weight maintenance. Small actions, such as building exercise into your day and eating breakfast, add up to make a significant impact on your overall health. Throughout this process, I will serve as your mentor, educator, coach, and friend.

Before you know it, friends, family, colleagues, and your doctor will want to know your secret to looking and feeling good. There is no greater feeling than when I am able to introduce optimal health to a Client, find out that, due to weight loss, they have reduced certain weight-related medications or discover the new aspects of life that he or she can now more fully experience.

I can offer you a safe, effective, and non-intrusive option for weight loss and long-term health.   Are you ready to choose health?  Please call the office today to schedule a free weight-loss consultation with me.  802-655-0354

Marion M. Fraser, D.C.

The old saying “the weight of the world on your shoulders” well picturizes what it is like for someone with a shoulder issue.  The precise incidence of symptomatic rotator cuff injuries is not known.  Cadaver studies of elderly persons have estimated full-thickness tears as high as 30%.^[2]   An estimated 4% of cuff ruptures develop a cuff arthropathy. Various authors report a rate of success with conservative treatment ranging from 33-90%, with longer recovery time in older patients.^{[3, 4, 5]}   Rotator cuff injuries and tears usually do not occur in persons younger than 40 years (5-30%). The great majority is found in persons aged 55-85 years. Approximately 15% of patients with shoulder pain who are older than 70 years have rotator cuff injuries.^[2]   Prevalence increases with age.^[2]  Younger patients are more likely to have rotator cuff dysfunction because of overuse, subtle instability, and muscle imbalance.  Older patients tend to have chronic shoulder pain and degeneration. 

One of the most common shoulder conditions is rotator cuff syndrome.  The term “rotator cuff” actually refers to a group of muscles which stabilize and control primarily abduction, internal and external rotation of the shoulder.  Often referred to as the “SITS” muscles:  S= supraspinatus, I= infraspinatus, T= teres minor, S= subscapularis.  They attach around the upper part of the humerus or arm bone and form a “cuff” around the ball and socket of the shoulder joint.  These muscles are responsible for stability to the inherently unstable shoulder joint.

Within the category of rotator cuff problems are:  rotator cuff syndrome or rotator cuff myofascial syndrome, rotator cuff tendonitis, and rotator cuff tendon tears or frays.  Of the three, rotator cuff tendon tears are the most severe.  This is when one of the tendons of the rotator cuff muscles has become stretched, torn or severed, either due to chronic overuse, arthritic spurs at the acromioclavicular joint pushing down and fraying the supraspinatus tendon or a sporadic, traumatic event causing damage to the tendon. Unless the tendon has been completely severed, therapy or treatment such as cross friction massage, trigger point therapy, ultrasound, laser therapy or interferential current and specific shoulder strengthening exercises can usually significantly improve or heal the problem.  If the tendon has been completely torn, the only option for reasonable recovery is surgical intervention.

Rotator cuff tendonitis usually occurs due to repetitive and/or overuse of the shoulder and arm in certain positions which cause low grade strain to the muscle and specific tendons, and hence, an inflammatory process settles around the tendon in question and therefore a “tendonitis is born”.  Tendonitis of the shoulders is often very reluctant to resolve and frequently eschew even consistent therapy, partly because of our constant use of our shoulder and arm throughout the day.  Everyday tasks such as lifting a jug of milk, putting a plate up into the cupboard and sleeping at night on that side are all possible aggravators to an injured shoulder.  The best treatments again include interferential stimulation, ultrasound, laser therapy (to decrease the inflammation and promote cell regeneration), specific Active Release therapy to tightened rotator cuff muscles and cross fiber massage across the rotator cuff tendons, as well as rehabilitation exercises to strengthen the rotator cuff and surrounding parascapular/shoulder blade supportive muscles. 

Rotator cuff myofascial pain syndrome is, quite simply, a condition in which there is chronic inflammation and myofascial trigger points throughout the rotator cuff muscle especially in the belly of the muscles.  Probably one of the most common problems of the shoulder, this condition causes a progressive tightening of the rotator cuff muscles.  Symptoms include achy, burning pain in the local area of the shoulder and sometimes with referral into a specific trigger point pattern i.e. down the arm, into the shoulder blade, or into the front of the shoulder.  This condition will be negative for abnormality on x-ray and MRI and will not necessarily respond very positively initially to strengthening exercises.  Although orthopedists generally very easily diagnose shoulder pathology as osteoarthritis, rotator cuff tendon tears, etc., this condition often eludes even the very knowledgeable shoulder specialists (especially if they are not familiar with Dr. Janet Travell’s extensive research and documentation of myofascial trigger point conditions).  This condition is very successfully treated with specific myofascial release, trigger point therapy or Active Release techniques to rid the area of fibrous feeling “knots” (or trigger points) in the specific muscles.  A tell-tale signal of a rotator cuff myofascial pain syndrome is when one pushes on a big knot in a rotator cuff muscle and pain refers to another area of the body, (typical trigger point patterns of referral).  In order to successfully treat this condition a highly skilled therapist (chiropractor or massage therapist who is specifically experienced with trigger point syndromes) will be best able to resolve this condition.  Swedish type massage generally will not resolve this type of condition. 

With all of these conditions, after successfully reducing the muscular tightness and offending trigger points and reducing the inflammation in the tendons and/or muscles, shoulder stretching, rotator cuff strengthening, as well as parascapular stabilization exercises are important in full recovery.  Postural retraining and ergonomic evaluation of home and work station are often vital to prevent return of the condition.

With this information and the skill of an experienced doctor and therapist you soon may experience a greater “swing” of your shoulder and arm….”Batter up!”

References:

1. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I.       Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453-460. [PubMed: 18326164]
2. Moosmayer S, Smith HJ, Tariq R, Larmo A. Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. J Bone Joint Surg Br. Feb 2009;91(2):196-200. [Medline].
3. Ecklund KJ, Lee TQ, Tibone J, Gupta R. Rotator cuff tear arthropathy. J Am Acad Orthop Surg. Jun 2007;15(6):340-9. [Medline].
4. Fongemie AE, Buss DD, Rolnick SJ. Management of shoulder impingement syndrome and rotator cuff tears. Am Fam Physician. Feb 15 1998;57(4):667-74, 680-2. [Medline].
5. Hayes K, Ginn KA, Walton JR, Szomor ZL, Murrell GA. A randomised clinical trial evaluating the efficacy of physiotherapy after rotator cuff repair. Aust J Physiother. 2004;50(2):77-83. [Medline].
6. Greiwe RM, Ahmad CS. Management of the throwing shoulder: cuff, labrum and internal impingement. Orthop Clin North Am. 2010 Jul;41(3):309-23.
7. Matsen III FA, Fehringer EV, Lippitt SB, Wirth MA, Rockwood Jr. CA. Rotator cuff. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, eds. The Shoulder. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17.
8. Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, Tjosvold L, Sheps DM. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010 Aug 17;153(4):246-55.

What are the physiological affects of stress?

Stress triggers the body’s response to a perceived danger or threat, activating the sympathetic, or “fight or flight” nervous system.  This results in temporary changes to our body, including increase in heart rate and blood pressure and release of glucose into the system.  Coupled with this is a decrease in digestive process, immune system response and suppression of reproductive and growth processes.  While our bodies are built to recover from the occasional “fight or flight” response, chronic and unrelenting stress can cause major damage to our bodies through the overproduction of cortisol and adrenaline.

Chronic stress can cause the following deleterious effects on our bodies:

-Increased agitation

-Chronic headaches

-Increased susceptibility to colds and the flu

-Depression and anxiety

-High blood pressure, possibly leading to heart disease and strokes

-Diabetes (due to the increased release of glucose in the system)

-Weight gain (due to an increase of cortisol in the system)

-Insomnia and sleep disorders

-Chronic muscle and joint problems

Stress always goes to the weakest link in our system.  As a chiropractor, I see people in my office all the time with stress related exacerbations of their neck, back or shoulder problems. As wonderful as technology is, our “plugged” in society leaves us with more and more to do and less available time to do it in.  Our ability to interact constantly with the entire worlds leaves us less and less likely to interact with our natural environment.  However, it is interaction with our natural environment that can inevitably bring our stress levels down and bring more joy and fulfillment into our lives.

Here are some suggestions for how to reduce stress levels:

Spend time outside appreciating nature.

Exercise! Numerous studies have correlated exercise to a positive mental outlook and a decrease in depression.  Exercise also seems to have a link to increased mental clarity.  One explanation is that that exercise releases endorphins and enkephalins-natural antidepressants.

Journaling and prayer are considered meditative and cleansing for the soul.  These practices bring one inward and allow for reflection, improving coping strategies and allowing for analysis of the effects of our stressors.

Eat a healthy diet: Increasing the consumption of vegetables, fruits and whole grains, and decreasing consumption of sugars and other refined and processed foods can decrease inflammation in the body, leaving the body better able to fight stress that comes your way.  Remember the old saying –“You are what you eat!”

Use positive imagery: One popular recent book “The Secret” talk about how our thoughts influence our reality.  You are what you eat, but you also are what you think and believe.  Believe “life is good” and things will get better.

Meditation: many studies have shown link between a regular meditation practice and reduced stress levels.  Meditation reverses the effects of the sympathetic nervous system by decreasing heart rate, blood pressure, and respiratory rate.  It also provides the body with time to clear the mind of negative or stressful thoughts.

Breath work:  When we become stressed out, our breathing naturally becomes shallow. Training ourselves to breathe deeply in times of stress will reverse this natural tendency, reducing our stress at the same time!

All in all, the attitude we take towards the stressors in our life had a strong impact on how these events affect us.   Maintaining perspective and our sense of humor can go a long way in helping to cope with stressful events, eventually lessening their impact on us and our lives.

Piriformis syndrome occurs when a the sciatic nerve is affected in the area of the piriformis muscle, resulting in neurologic symproms of pain down the leg and weakness.  These symptoms can mimic those of a disc herniation or nerve impingement at the vertebrae, making diagnosis difficult.  For this reason, piriformis syndrom is an often missed diagnosis.

Anatomy of the piriformis:

The piriformis one of the muscles found in the buttock area.  It lies with a group of small muscles beneath the large gluteus maximus.  The piriformis muscle attaches to the front of the sacrum and the greater trochanter of the femur, and works as an external rotator of the leg.  Because the piriformis attachment is so close to the spine, many nerve and arteries pass both over and under this muscle.  In fact, it has been found that the sciatic nerve, the largest nerve of the leg, passes through the piriformis muscle or tendon in 22% of the population. Therefore, the sciatic nerve is easily affected by this muscle.

Mechanism of injury:

There is no one clear mechanism behind the development of piriformis syndrome.  Often, adhesions on the piriformis muscle can be caused by an initial fall to the buttock area, resulting in entrapment of the nerve.   The sciatic nerve may be more easily compressed if the nerve passes through rather than around the muscle, causing nerve injury.  Other possible causes of piriformis syndrome include prolonged sitting, increased muscle tone and muscle shortness of the piriformis, pregnancy, leg length discrepancy, inflammation of the piriformis, and weakness of the gluteus maximus and hip abductors.

What does piriformis syndrome feel like?

Those who are diagnosed with piriformis syndrome often complain of pain in the low back and/or buttock area.  This pain might be neurologic in type- traveling or shooting down the back or side of the thigh or calf.  Because the sciatic nerve is primarily affected, sensory changes in the leg may be felt.  Symptoms might be increased by prolonged sitting or stretching of the deep gluteal muscles.

What treatment is available for piriformis syndrome

Once piriformis syndrome is properly diagnosed, there are many treatment options. Myofascial release and trigger point therapy can break up connective tissue adhesions causing entrapment or compression of the nerve.  Stretching of the piriformis can also be beneficial to reduce compression and entrapment.  Chiropractic manipulations or adjustments can correct abnormal biomechanics, such as a leg length discrepancy and pelvic rotation or malalignment.  Modalities such as ultrasound and laser therapy can reduce inflammation and increase tissue healing to the foreshortened piriformis and gluteal muscles.  With proper diagnosis and treatment, the debilitating symptoms felt with piriformis syndrome can be reduced or eliminated and you can be on your way to a carefree, free striding walk.

There has been some recent talk in the news about Biophosphonates actually causing fractures in older women, including an article in Good Housekeeping magazine’s July 2011 edition.  Biophosphonates work by inhibiting the ability of osteoclast cells to break down bone. In healthy bone, osteoclast cells work in conjunction with other cells to continuously remodel our bones, ensuring healthy bone tissue.  While inhibiting osteoclast activity helps to keep bone density high, it may not improve the overall strength of the bone.  Because Biophosphonates reduce bone remodeling, they may “freeze” the skeleton, allowing for accumulation of minerals in the bone.  Increased mineral in the bone may lead to bone brittleness.  It is thought that the bone loses the ability to repair microfractures, and becomes more fragile in general.   This might lead to an increased risk of fracture.

Two recent studies have examined this relationship.  Women in Sweden who had sustained the kind of fracture (a subtrochanteric or femoral shaft fracture) thought to be caused by Biophophonates were examined.  It was found that 78% of patients who had this kind of fracture were taking Biophosphonates.  It was concluded that the risk of subtrochanteric or femoral shaft fracture was 10 times as high after 2 years of drug use and 5 times as high after two years.  This risk diminished 70% for every year after the women stopped using the drug.  A study conducted in Toronto, Canada made similar conclusions.  Park-Wyllie et al. found that long-term Biophosphonate treatment was associated with increased risk of these fractures after 5 or more years of use.  Therefore, these drugs may increase the risk for certain types of fractures– the very condition the drugs were supposed to be preventing!

While these studies show a clear connection between the use of biophosphonaes and atypical femoral fracture, their use still reduces the occurrence of osteoporotic fractures.  For this reason these authors concluded that the benefits of taking this medication still outweigh the risks.  However, according to Good Housekeeping magazine, in April the FDA issued a warning to physicians and patients about the possible risks of taking biophosphonates.  Here at ORC will keep our eyes pealed for more information about this important topic!

In the meantime, there are a few things you can do to keep your bones healthy!

Everyone knows about the importance of calcium rich foods, and yet determining whether or not you get enough calcium can be confusing.  The RDA (Recommended Daily Allowance) for calcium is 1,000 mg for most people and 1,200 mg for post menopausal women.  Many nutritionists and health experts believe even this amount is too low.  The best way to get your RDA of calcium is to eat calcium-rich foods.  Dietary calcium, or the calcium you get from food, is more easily absorbed than that from a supplement.  Here is a list of calcium rich foods and estimated calcium they contain. Be sure to check the label on your food container if you’re keeping track of your calcium as it can vary from product to product.

However, if you don’t get the proper amount of calcium from the food you eat, taking supplements is a good option.  The body best absorbs 500 mg of calcium at a time. Therefore, spacing out when you take your calcium supplements throughout the day insures the best absorption.  In order to be absorbed into the body, increased Calcium intake should be accompanied by Vitamin D and Magnesium. The National Osteoporosis Foundation recommends individuals under age 50 get 400-800 IU of Vitamin D every day and 800-1,000 for individuals over 50.  Often, you can find calcium accompanied by vitamin D and magnesium in the same supplement.  Here at Onion River Chiropractic we recommend and stock calcium by DaVinci Laboratories and Douglas Laboratories (two highly reputable, quality controlled supplement companies. Here are a links to their website with many options for calcium supplements.

http://www.davincilabs.com/vitamins_supplements/vitamins-supplements.php#minerals

http://www.douglaslabs.com/product_listing.cfm?products

Consult your doctor or chiropractor about which supplement is best for you.  In the meantime, have another cup of that delicious lowfat greek yogurt!

References:

Ince, Susan. (2011) Fractured. Good Housekeeping. July

Schilcher J, Michaelsson K, Aspenberg P. (2011) Biophosphonate use and atypical fractures of the femoral shaft. New England Journal of Medicine. 364:1728-37

Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, Whelan DB, Weiler PJ, Laupacies A. (2011) Biophosphonate use and the risk of subtrochanteric or femoral shaft fracture in older women.  Journal of the American Medical Association Vol 305, No.8

www.nof.org/ (website to National Osteoporosis Foundation)

http://www.uptodate.com/contents/pharmacology-of-bisphosphonates

In this day and age, it can be challenging and expensive to limit our exposure to pesticides.  Organic fruits and vegetables cost more than those grown with pesticides, making a pesticide-free diet out of reach for most Americans. Considering these findings, it is very important to limit pesticide exposure wherever we can.  Luckily, the Environmental Working Group has helped us by creating a shopper’s guide that shows which fruits and vegetables are exposed to the most pesticides (called the “Dirty Dozen”), and which are exposed to the fewest (called the “Clean 15”).

You can download the shopping guide and have it handy in for trips to the supermarket here http://www.ewg.org/foodnews/

A great way to support your health and the local economy is to buy local and organic produce.  Summer is here and soon the farmers markets will be overflowing with beautiful and healthy fruits and vegetables.  Buying local food means there is less time between when the food is harvested and eaten, making the nutritional content higher.  Less energy is spent shipping the food around the country (or world!), so it’s better for the environment.  Buying local food also supports the local economy, which works for everyone! For more information on how to buy local, organic food in Vermont go to www.nofavt.org.

References:

Pesticide Explosure in Womb Affects I.Q. New York Times. 4/21/2011

http://www.cnn.com/2010/HEALTH/05/17/pesticides.adhd/

The Framingham study, performed in 2006, investigated the relationship between carbonated beverage consumption and bone mineral density.  They found that drinking cola every day resulted in a significant increase in bone fractures in girls younger than 17.  A positive relationship between reduced bone mineral content and carbonated beverage consumption in teenage girls has also been found, especially if the girls are physically active.  Other studies have found a similar relationship between cola consumption and bone density in young men.

While these studies have focused on the consumption of all carbonated beverages, cola beverages have been the most implicated.  It is believed that drinking high amounts of cola may limit calcium absorption because of its high phosphorous content.  This may not be the case for other carbonated beverages that do not contain high levels of phosphorous (all non-cola flavored sodas, as well as carbonated flavored waters).  The consumption of caffeine has also been associated with the reduction of bone mineral density, and may contribute to these findings.  Caffeine can be found in Coke, Diet Coke, Pepsi, Diet Pepsi, Tab, Mountain Dew, Dr. Pepper, and Sunkist.  If you’d like to know the amount of caffeine in your soft drink, check the nutritional label.

It is also possible that consumption of carbonated soft drinks replaces the consumption of milk, limiting calcium intake.  This might be a problem especially for children and teenagers, for we build 85-90% of our bone before the age of 20.  Maximizing peak bone mass during childhood and adolescence is important for preventing osteoporosis.  Replacing milk with soft drinks of any kind might interfere with this.

Considering this evidence, it is important to reduce or eliminate the number of carbonated beverages we drink on a daily basis, especially if we drink lots of cola.  Be sure to encourage the consumption of milk and water in children and adolescents in place of soda whenever possible.

References:

Kinney MA. (2002) Does consumption of cola beverages cause bone fractures in children? Mayo Clin Proc; 77:1005-1006

Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA and Kiel DP.(2006) Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: the Framingham Osteoporosis Study.  Am J Clin Nutr. 84;936-42

Kristensen M, Jensen M, Kudsk J, Henriksen M and Mulgaard C. (2005) Short-term effects on bone turnover of replacing milk with cola beverages: a 10-day interventional study in young men.  Osteoporosis Int 16: 1803-1808

These curves allow for smooth articulation of the joints of the spine , called facet joints. If the facet joints are aligned properly, we will have biomechanically appropriate movement. When we sit with good posture, our weight is distributed through our spine rather than through our muscles and ligaments.  This allows our muscles to stay relaxed and the stress on the ligaments to be minimal.  When the spine moves the way it was meant to, it provides natural support to the discs, ensuring healthy discs throughout life.

When the curves are reduced or exaggerated due to the way we carry ourselves every day, many problems result. Unnecessary stress will be placed on muscles, resulting in chronic back or neck pain.  Pressure placed on the discs that cushion the spine might result in degenerated or herniated discs.  Some of the more typical postural deformities include standing with too much or not enough low back curve, accentuating the thoracic curve, leading to a stooped over posture,  or standing with the head forward from the body, creating strain on the neck muscles.

Standing postural exercise

Stand with your feet under your pelvis, and rock back and forth on your feet.  Find the center of the arch of your foot and place your weight there.  Rock your pelvis back and forth on your legs, and notice how the movements of the pelvis affect the curves of the low back. Find the center of your pelvis and hold it there.  Exhale and drop your ribs slightly, making sure your sternum is perpendicular with the floor.  Bring your shoulders slightly up towards your ears and rotate your arms out, bringing your shoulder blades on your back.  Relax your arms and shoulders.  Bring your ears  in line with your shoulders and relax your neck.

Seated postural exercise

Place both feet directly on the floor under your knees. Rock your pelvis forward and back on your chair, feeling for the “sit bones” of your pelvis.  First, place your weight on your sit bones (the bones you feel at the bottom of your buttocks). Lean slightly forward on the sit bones so that your weight rests on your pelvic floor. Exhale and drop your sternum and ribs slightly, making sure your sternum is perpendicular with the floor. Bring your shoulders slightly up towards your ears and rotate your arms out, bringing your shoulder blades on your back.  Relax your arms and shoulders.  Bring your ears so that they are in line with your shoulders and relax your neck.

While a more correct alignment may feel strange at first, over time it will become more natural, and healthier habits will be developed.  This will result in a healthier, pain free spine for years to come!