The Value of Health, Chiropractic Explanation

The Value of Health, Chiropractic Explanation

Get Healthy and Pain Free with Chiropractic Adjustments

Chiropractic is a health care profession that focuses on disorders of the musculoskeletal and nervous systems, and the effects of these disorders on general health. Doctors of chiropractic—often referred to as DCs, chiropractors or chiropractic physicians—practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. In addition to their expertise in spinal manipulation/adjustment, doctors of chiropractic have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.

For Acute and Chronic Pain Chiropractic Success and Research

Patients who saw a chiropractor as their initial provider for low back pain (LBP) had 90% decreased odds of both early and long-term opioid use.
Kazis et al. (2019), BMJ Open

“Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence).”
American College of Physicians (2017)

“For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence).”
American College of Physicians (2017)

“Many treatments are available for low back pain. Often exercises and physical therapy can help. Some people benefit from chiropractic therapy or acupuncture.”
Goodman et al. (2013), Journal of the American Medical Association

“Chiropractic Manipulative Therapy in conjunction with standard medical care offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute low back pain.”
Goertz et al. (2013), Spine

In Comparison to Other Treatments
Chiropractic users had 64% lower odds of receiving an opioid prescription than non users.
Corcoran et al. (2019) Pain Medicine

The results of a clinical trial showed that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone. The study, which featured 750 active-duty members of the military, is one of the largest comparative effectiveness trials between usual medical care and chiropractic care ever conducted.
Goertz et al. (2018) JAMA Open Network

“Manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain compared with usual medical care. 94% of the manual-thrust manipulation group achieved greater than 30% reduction in pain compared with 69% of usual medical care.”
Schneider et al (2015), Spine

“Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers with back injuries who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.”
Keeney et al (2012), Spine

Cost Effectiveness
Findings from a study utilizing data from the North Carolina State Health Plan collected between 2000-2009 show that care by a doctor of chiropractic (DC) alone or DC care in conjunction with care by a medical doctor (MD) incurred “appreciably fewer charges” for uncomplicated lower back pain than MD care with or without care by a physical therapist.
Hurwitz et al. (2016), Journal of Manipulative and Physiological Therapeutics

For Headaches
“Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with cervicogenic headache, and the effects were maintained at 3 months.”
Dunning et al. (2016) BMC Musculoskeletal Disorders

“There was a linear dose-response relationship between spinal manipulative therapy (SMT) visits and days with cervicogenic headache (CGH). For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.”
Haas et al. (2018) Spine

“On average, spinal manipulative therapy plus home exercise and advice (HEA) resulted in better clinical outcomes and lower total societal costs relative to supervised rehabilitative exercise plus HEA and HEA alone… .”
Leininger et. al. (2016) Spine

For Neck Pain
In a study funded by NIH’s National Center for Complementary and Alternative Medicine to test the effectiveness of different approaches for treating mechanical neck pain, 272 participants were divided into three groups that received either spinal manipulative therapy (SMT) from a doctor of chiropractic (DC), pain medication (over-the-counter pain relievers, narcotics and muscle relaxants) or exercise recommendations. After 12 weeks, about 57 percent of those who met with DCs and 48 percent who exercised reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group. After one year, approximately 53 percent of the drug-free groups continued to report at least a 75 percent reduction in pain; compared to just 38 percent pain reduction among those who took medication.
Bronfort et al. (2012), Annals of Internal Medicine

Care for Seniors
Older Medicare patients with chronic low back pain and other medical problems who received spinal manipulation from a chiropractic physician had lower costs of care and shorter episodes of back pain than patients in other treatment groups. Patients who received a combination of chiropractic and medical care had the next lowest Medicare costs, and patients who received medical care only incurred the highest costs.
Weeks et al (2016), Journal of Manipulative and Physiological Therapeutics

“This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.”
Weigel et. al. (2014) Journal of Manipulative and Physiological Therapeutics

Senior Care and Medicare
Older Medicare patients with chronic low back pain and other medical problems who received spinal manipulation from a chiropractic physician had lower costs of care and shorter episodes of back pain than patients in other treatment groups. Patients who received a combination of chiropractic and medical care had the next lowest Medicare costs, and patients who received medical care only incurred the highest costs.
Weeks et al (2016), Journal of Manipulative and Physiological Therapeutics

For Low Back Pain
Low back pain initiated with a doctor of chiropractic (DC) saves 20 to 40 percent on health care costs when compared with care initiated through a medical doctor (MD), according to a study that analyzed data from 85,000 Blue Cross Blue Shield (BCBS) beneficiaries in Tennessee over a two-year span. The study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays. Researchers estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee. They also concluded that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.
Liliedahl et al (2010), Journal of Manipulative and Physiological Therapeutics

Articles and Videos source:

The American Chiropractic Association and Palmer College of Chiropractic partnered to provide the following series of articles and videos that translate how the findings of research studies and other evidence can be applied in clinical practice.

Sensitization (Part 1): Characteristics and Implications
By Anna-Marie Schmidt, MM, DC, and Robert Vining, DC, DHSc

Sensitization (Part 2): Management Strategies
By Anna-Marie Schmidt, MM, DC, and Robert Vining, DC, DHSc

“Chronic Pain: Screening for Potential Psychological Factors”
By Anna-Marie Schmidt, MM, DC, and Robert Vining, DC, DHSc

“Best Practice Recommendations: Translating Evidence Into Action”
By Anna-Marie Schmidt, MM, DC, and Robert Vining, DC, DHSc

“Social Factors: A Sometimes-overlooked Opportunity”
By Anna-Marie Schmidt, MM, DC, and Robert Vining, DC, DHSc

“Developing Person-centeredness: A Continual Process”
By Anna-Marie Schmidt, MM, DC, and Robert D. Vining, DC, DHSc

“Choosing Outcomes Assessments for Back Pain”
By Kara Shannon, DC, and Zacariah Shannon, DC, MS

“Improving Interprofessional Communication”
By Heather Mai-Roecker, DC, ARNP, and Christopher B. Roecker, DC, MS

“Collaboration for Low Back Pain Treatment in Older Adults”
By Zacariah Shannon, DC, MS
> Listen to the author discuss the article in this video.

“Does Spinal Manipulation Affect Central Nervous System Pain Mechanisms?”
By Zacariah Shannon, DC, MS, Robert Vining, DC, and Stephen Onifer, PhD
> Listen to the author(s) discuss the article in this video.

“Enhancing a Biopsychosocial Approach”
By Robert Vining, DC, and Yasmeen Khan, DC

“Interpreting ‘Quality’ and ‘Strength’ in a Practice Guideline”
By Robert Vining, DC, and Zacariah Shannon, DC, MS

Chiropractic and Acupuncture

Doctors of chiropractic are experts in addressing musculoskeletal conditions without the use of drugs or surgery. While best known for spinal manipulation, chiropractors may use a variety of evidence-based therapies to help their patients. Some DCs are even trained in acupuncture or work in integrative clinics where acupuncture is provided, giving patients access to two of the most effective non-drug approaches to pain management.

If acupuncture is on the list of your doctor’s services, here’s what you should know—including what it entails, conditions it may help treat, and who should avoid this type of treatment.

What Is Acupuncture?

“Acupuncture is probably the closest thing we do as chiropractors,” says Dr. Gary Estadt, DC, DACRB, an American Chiropractic Association (ACA) member who started practicing chiropractic 42 years ago and now teaches and lectures on acupuncture and dry needling.

During acupuncture, hair-like needles are inserted into specific points in the body to achieve various therapeutic effects. One of its effects is the release of tight muscles, making it easier for patients to move. Acupuncture also stimulates the release of certain hormones in the brain, providing benefits for some medical conditions.

Conditions Acupuncture Can Treat

One of the conditions treated by acupuncture is pain. “Acupuncture has a profound effect on pain,” explains Dr. Estadt. “It causes the brain to release some of the body’s natural pain relievers.” That makes it a way to get pain relief without popping any pills. And it can be used for pain that exists in one area of the body (called local pain) or pain that is more widespread (systemic or chronic pain).

“For chronic pain, you get a beneficial effect because you’re altering the brain chemistry,” explains Dr. Estadt. This has been supported by research using MRI images. “When you induce pain, certain pain centers in the brain light up on functional MRIs,” says Dr. Estadt. “When you needle the patient, they turn off.”

In addition to traditional body acupuncture, there are specific microsystems utilized in acupuncture. These microsystems are very effective at controlling pain. Acupuncture administered to the head (called scalp acupuncture) can be beneficial for treating neurological and psychological conditions, even helping to resolve addictions. Acupuncture performed on the ear (auricular acupuncture) can help you stop smoking and ease withdrawal from drugs.

Dr. Estadt adds that acupuncture also “works very well” for people who experience post-chemotherapy neuropathy. In fact, most cancer institutes have incorporated acupuncture as part of their treatment programs.

Acupuncture vs. Dry Needling: What’s the Difference?

Sometimes acupuncture is confused with dry needling, but they aren’t the same thing. Dr. Estadt shares that in dry needling, the needles are longer and placed based on myofascial trigger points, which are the same trigger points targeted in some cases when patients get a cortisone shot, for instance.

“Dry needling is the exact same thing without shooting in the cortisone,” says Dr. Estadt. “You needle the trigger point to get the muscle to twitch and release. Studies have shown that results are similar between dry needling and injection, which shows that the benefits come from inserting the needle into the muscle.”

This makes dry needling good for musculoskeletal complaints that involve a restriction in movement, such as frozen shoulder. But it’s also helpful if you’ve experienced trauma to the muscle, whether through a sports injury, a car accident, or due to a medical condition like arthritis.

Who Should Avoid Acupuncture?

Despite acupuncture’s many benefits, this treatment isn’t right for everyone. Dr. Estadt stresses that a proper case history and examination must be performed to determine if the patient is a candidate for acupuncture. Taking blood thinners or having recent joint replacement surgery might be contraindications for treatment.

Electroacupuncture, which involves adding electrical current to the needles, should be avoided by patients with electrically implanted devices (cardiac pacemakers, spinal cord stimulators, etc.). Some medical conditions require you to avoid acupuncture over certain regions of the body, like lymphedema, complex regional pain (CPRS), or cancer.

Combining Acupuncture and Chiropractic

While acupuncture and chiropractic services are two different treatments, they can be used together to potentially provide greater benefit. Acupuncture may even help when progress with chiropractic has stalled.

“I’ll have patients that I treat with chiropractic, and I hit a plateau with them,” says Dr. Estadt. “You alter your treatment plan and do acupuncture on them, and it gets them over that hump. You’ve released something that allows you to get past the sticking point.”

What to Expect

One concern that many have is, “Does acupuncture hurt?” Not if it’s done properly, says Dr. Estadt. Ancient Chinese proverbs describe it as “less than a mosquito bite.” You might feel a little bit of discomfort, but most patients find the experience relaxing.

The needles used for acupuncture are much smaller than those used for injections—or about the thickness of a hair. That allows them to enter the body without causing the same discomfort you might experience when getting a shot.

Each acupuncture session generally lasts between 15 and 30 minutes and you should begin to feel its benefits after just a few treatments. Talk to your chiropractor to learn what options exist for your medical condition or concerns.

Potential Side Effects

The risks of acupuncture treatment are minimal. The most common side effects are drowsiness, minor bleeding or bruising, or a temporary increase in symptoms. Dr. Estadt notes that some people feel more energetic after an acupuncture session.

Serious adverse side effects are rare. Fainting is also a rare occurrence following needling. This is the same response that causes people to faint at the sight of blood and is due to an overactive nervous system (vasovagal response). “I’ve only seen this once in my career,” says Dr. Estadt.

The risk of infection is low if you are receiving acupuncture anywhere in the Western hemisphere. The sterile needles are used only once and then discarded, says Dr. Estadt. This helps ensure patient safety.

How to Pick an Acupuncture Practitioner

If your chiropractor offers acupuncture, this is a good place to start. Otherwise, Dr. Estadt suggests that you “look for a practitioner that is licensed in your state and has experience treating your type of problem.”

Christina DeBusk is a freelance contributor to Hands Down Better.

Reviewed by the ACA Editorial Advisory Board. The information in this post is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional. If you have specific questions, contact your doctor of chiropractic. Credits:

Another Reason to Quit Smoking? Reduced Back Pain

Many people realize the damage that smoking can do to their lungs, with those who smoke being 15 to 30 times more likely to develop lung cancer or die from this disease than a non-smoker. But what is lesser known is the negative impact that cigarettes can have on the musculoskeletal system, giving you just one more reason to quit the habit.  

Smoking’s Impact on the Musculoskeletal System 

How does smoking hurt our muscles, bones, and other soft tissues? The answer lies, in part, in the way that it affects the circulatory system. 

“Generally, tobacco and the components within tobacco smoke damage the small arteries in the body first,” explains Will Evans, DC, PhD, an American Chiropractic Association (ACA) member who is the associate dean for academic affairs at the University of Southern Mississippi’s College of Nursing and Health Professions and immediate past-chair of the American Public Health Association’s Chiropractic Healthcare Section. “This is why it is so detrimental to the heart’s arteries. As it turns out, the spine’s smaller blood vessels are vulnerable to this damage as well, especially those that supply the endplates of the vertebra and tissue surrounding the disc.” 

This is why smoking and chronic pain in the spine often go hand in hand. A 2016 study of 34,525 American adults found that as exposure to smoking increased, so too did back pain. Specifically, while 23.5% of people who had never smoked reported having pain in their back, the number of current smokers experiencing back pain was 36.9%—an increase of 13.4%. Even former smokers had an elevated risk of back pain at 33.1%.  

Smoking’s damage to the blood vessels and their surrounding areas is also why a tobacco user is more prone to problems after spinal surgery. In fact, many spine orthopedists won’t operate on someone until they quit smoking as “the vast majority of complications and post-surgical infections are in tobacco users,” says Dr. Evans.  

Smoking can also worsen inflammatory conditions, such as rheumatic diseases that affect the joints. Quitting is even one of the main lifestyle recommendations for people with neck pain, tension headaches, osteoarthritis in the knee and hip, and fibromyalgia according to clinical practice guidelines for chiropractic patients with chronic musculoskeletal pain. 

How Important Is Quitting Smoking for Musculoskeletal Health?  

Many factors contribute to the health of the musculoskeletal system, some of which include getting regular exercise and eating a healthy diet. So, how much does quitting smoking contribute to this health? 

“For smokers, the single most important thing they can do for their health, regardless of whether we are talking about lung health, heart health, or musculoskeletal health, is to stop smoking,” says Dr. Evans. This includes not just smokers but also people engaged in any kind of tobacco use, such as chewing or vaping. “Make no mistake, tobacco users die sooner than non-users,” says Dr. Evans, “but with an added decade of disability or morbidity.” In other words, smoking doesn’t just lead to an earlier death but a poorer quality of life leading up to that untimely death, as well. 

Quitting smoking is helpful for people with both acute and chronic back pain. Acute back pain is pain that occurs suddenly and is generally short-lived while chronic back pain tends to come about slowly over time but is long lasting. In the case of acute back pain, smoking can make it harder to heal and may even contribute to the pain turning chronic. In short, if someone smokes, “it is complicating their ability to get well and stay well,” says Dr. Evans.  

If You’re Ready to Kick the Smoking Habit 

Quitting smoking isn’t easy. This is evidenced by research that reports that out of the 30% to 50% of smokers in the U.S. who will try to kick the habit this year, only 7.5% will succeed. But this same research also stresses that “the earlier a smoker quits, the better.” Therefore, if you’re ready to take the next step and stop smoking for good, numerous resources can help. 

One option is to call the Quitline at 1-800-QuitNOW. The Quitline is a joint effort led by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute and aims to connect smokers with counselors, local smoking cessation programs, and even free medication to help them quit.  

Other resources suggested by Dr. Evans include: 

  • Nicotine Anonymous. This nonprofit organization offers a 12-step program designed to help people quit all forms of tobacco and nicotine by attending local meetings with others who have the same goal. This provides support while quitting, also enabling you to learn from others who have been successful in stopping tobacco and nicotine use. 
  • American Cancer Society’s tips and tools. The American Cancer Society offers many valuable tips and tools for ceasing tobacco use. They include access to a “Guide to Quitting” which covers everything from making a plan to quit to dealing with the mental side of tobacco addiction, access to other smoking cessation resources, or even calling them directly at (800) 227-2345 to discuss your particular challenges and which resources may help most. 
  • American Heart Association’s quit smoking recommendations. Because smoking is harmful to the heart, the American Heart Association offers advice for quitting cigarettes as well—in addition to helping people quit a nicotine vaping habit. One of the recommendations includes following five steps for quitting, which involve setting a quit day, choosing how you’ll quit, and making a plan for your “Quit Day” and beyond. 
  • CDC’s quit smoking resources. CDC also provides helpful strategies for quitting smoking, like working with a quit-smoking counselor and talking with your healthcare provider to see if some type of medication can help. Other suggestions offered by the CDC include signing up for a free texting program such as SmokefreeTXT or using a mobile app such as quitSTART to stay motivated and inspired, both of which are services offered by 

It’s also helpful to talk to your chiropractor about your desire to quit smoking. They can help identify your options, also serving as an ally in your fight to become smoke-free.  Credits:

Chronic Pain and Depression

Pain serves an important function in our lives. When you suffer an acute injury, pain warns you to stop the activity that is causing the injury and tells you to take care of the affected body part.

Chronic pain, on the other hand, persists for weeks, months, or even years. Some people, often older adults, suffer from chronic pain without any definable past injury or signs of body damage. Common types of chronic pain include headaches, low back pain and arthritis. Unfortunately, there is scant objective evidence or physical findings to explain such pain.

Until recently, some doctors who could not find a physical cause for a person’s pain simply suggested that it was imaginary — “all in your head.” Now, emerging scientific evidence is demonstrating that the nerves in the spinal cord of patients with chronic pain undergo structural changes.

Psychological and social issues often amplify the effects of chronic pain. For example, people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment and anger for the pain patient, as well as stress and strain in family and other social relationships.

How is depression involved with chronic pain? Depression is thought to be three to four times more common in people with chronic pain than in the general population. In addition, 30 to 80 percent of people with chronic pain will experience some type of depression. The combination of chronic pain and depression is often associated with greater disability than either depression or chronic pain alone.

People with chronic pain and depression suffer dramatic changes in their physical, mental and social well-being—and in their quality of life. Such people often find it difficult to sleep, are easily agitated, cannot perform their normal activities of daily living, cannot concentrate, and are often unable to perform their duties at work. This constellation of disabilities starts a vicious cycle—pain leads to more depression, which leads to more chronic pain. In some cases, the depression occurs before the pain.

Depression associated with pain is powerful enough to have a substantial negative impact on the outcome of treatment, including surgery. It is important for your doctor to take into consideration not only biological, but also psychological and social issues that pain brings.

What is the treatment for chronic pain and depression?

The first step in coping with chronic pain is to determine its cause, if possible. Addressing the problem will help the pain subside. In other cases, especially when the pain is chronic, you should try to keep the chronic pain from being the entire focus of your life.

  • Stay active and do not avoid activities that cause pain simply because they cause pain. Avoiding performing activities that you believe will cause pain only makes the condition worse in many cases. The amount and type of activity should be directed by your doctor, so that activities that might actually cause more harm are avoided.
  • Relaxation training, hypnosis, biofeedback, and guided imagery can help you cope with chronic pain. Cognitive therapy can also help patients recognize destructive patterns of emotion and behavior and help them modify or replace such behaviors and thoughts with more reasonable or supportive ones.
  • Distraction (redirecting your attention away from chronic pain), imagery (going to your “happy place”), and dissociation (detaching yourself from the chronic pain) can be useful.
  • Involving your family with your recovery may be quite helpful, according to recent scientific evidence.

Feel free to discuss these or other techniques with your doctor of chiropractic. They can suggest some simple techniques that may work for you or refer you to another healthcare provider for more in-depth training in these techniques.

Signs and Symptoms

Some of the common signs and symptoms of chronic pain include:

  • Pain beyond six months after an injury
  • Allodynia—pain from stimuli which are not normally painful and/or pain that occurs other than in the stimulated area
  • Hyperpathia—increased pain from stimuli that are normally painful
  • Hypersensation—being overly sensitive to pain

Signs of major clinical depression will occur daily for two weeks or more, and often include many of the following:

  • A predominant feeling of sadness; feeling blue, hopeless or irritable, often with crying spells
  • Changes in appetite or weight (loss or gain) and/or sleep (too much or too little)
  • Poor concentration or memory
  • Feeling restless or fatigued
  • Loss of interest or pleasure in usual activities, including sex
  • Feeling of worthlessness and/or guilt

Written by Lawrence H. Wyatt, DC, DACBR, FICC, and reviewed by the ACA Editorial Advisory Board. Credits:

The information in this post is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional. 

Choosing a Doctor of Chiropractic

Choosing a Doctor of Chiropractic

You’ve got back pain — or shoulder or leg pain, or even a headache — and you’re looking for a doctor of chiropractic (DC) to help with your problem. How do you choose? Selecting the right healthcare provider for your needs is important. Consider the following suggestions to help you narrow the field:

What qualifications should my chiropractor have?

The first step is to ensure that your chiropractor graduated from a school accredited by the Council on Chiropractic Education (CCE). The CCE ( is the national agency that accredits chiropractic colleges in the United States. It is recognized by the U.S. Department of Education.

Second, make sure that the chiropractor that you’ve selected is licensed in your state. Find your state’s licensing board here. You can also contact the state board to see if any sanctions have been placed on a doctor for state law violations.

How do I choose the chiropractor that’s right for me?

The best source for finding a good chiropractor is often a referral from a relative or friend who has had good experiences with a doctor. Referral from another healthcare practitioner is also generally helpful. Just as you wouldn’t continue to see a medical doctor who refused to refer you to a good chiropractor for problems with your musculoskeletal system, you should also refrain from selecting a chiropractic doctor who refuses to send you to an MD when necessary.

A good chiropractor might offer you safer and more effective non-drug and/or nonsurgical approaches to your problems. The chiropractic profession believes in a conservative approach to health care (using non-drug, nonsurgical methods, when appropriate, as first-line therapies) and holism (considering the body as an interdependent whole, rather than focusing only on a single part that is causing pain). Remember that any good chiropractor will address the physical, social, and psychological aspects of your problems with conservative approaches, as appropriate.

What are the benefits of chiropractic care?

Research shows that proper maintenance of your musculoskeletal system is important to your health. We suspect that pain in the joints caused by a reduction of normal joint motion is a common reason for many nonsurgical musculoskeletal problems. Most chiropractors address these problems with spinal manipulation, exercise, and other types of active treatment.

Your chiropractor will focus on helping you prevent future episodes of pain and disability, rather than suggesting that periodic, ongoing adjustment of your spine alone will solve your health problems. Depending on your case, a chiropractor may teach you how to maintain your musculoskeletal system through exercise, good posture/adequate movement, and good lifting techniques. He or she may also describe good health habits, such as the elements of a healthy diet. A good chiropractor will evaluate your condition and inform you of your progress at each visit.

What diagnostic procedures are appropriate?

Your chiropractor has many well-documented diagnostic procedures to help evaluate your condition that include asking you questions about your health and giving you a physical examination. Chiropractors may use X-rays to help determine the health of your musculoskeletal system and to see if your body has developed any serious conditions that should be managed by another provider.

There are specific well documented reasons for performing X-rays. A reputable DC will X-ray only the patients who require it. Feel free to question your chiropractor about the need for X-rays in your case, about the percentage of patients who require such screening in his or her office, or about any other diagnostic or treatment procedure that is unclear to you. Remember that it is not a good idea to X-ray you periodically to see if changes in your vertebral misalignments have occurred.

Musculoskeletal problems can exist for many reasons and can occur in any part of the system. A good chiropractor will evaluate your overall health, in keeping with their holistic approach, and will formulate a diagnosis for your condition, as required by most state laws.

How long should my chiropractor treat me?

Any good healthcare provider will work hard to get you out of the office and functioning independently as quickly as possible. Joint manipulation is a wonderful noninvasive procedure in the hands of a skilled doctor of chiropractic. It has been repeatedly shown to reduce pain and help patients function better in daily life. However, it has not been shown to prevent problems. A good chiropractor can help you prevent musculoskeletal system problems by teaching you how to engage in regular exercise, maintain good posture/movement, and practice other healthy living habits.

There are many good chiropractors available to help you manage your neuromusculoskeletal system with sound, well documented procedures. As with any other healthcare decision, remember that if it sounds too good to be true, it probably is. Choose a chiropractor you are comfortable with, who addresses your health concerns, and who uses sound principles of modern health care in helping you manage your problems.

Reviewed by the ACA Editorial Advisory Board.  Credits:

After the Storm: Yard Clean-Up Safety

Winter storms and other severe weather events have been sweeping the nation lately, leaving snow, leaves and debris in their wake. Yard clean-up is unavoidable after a storm, whether it’s shoveling snow, raking leaves or picking up fallen branches. And although you can’t avoid doing yard work, you can avoid injury by keeping these safety tips in mind.

Just as any athletic activity can injure your body, the twisting, turning, bending and reaching of shoveling and raking can also cause injury if your body is not prepared. Like an athlete, if you leap into something without warming up or knowing how to do it, the chances of injury increase. To prevent unnecessary strain and pain, consider these simple tips before you get started: 

  • Wear supportive shoes. Good foot and arch support can prevent some back strain.  
  • Stand as straight as possible and keep your head up as you rake or mow. 
  • When raking, use a “scissors” stance: right foot forward and left foot back for a few minutes, then reverse, putting your left foot forward and right foot back. 
  • Bend at the knees, not the waist, as you pick up yard equipment, piles of leaves or fallen branches. Make the piles small to decrease the possibility of back strain. 

Using Outdoor Equipment 

Equipment like leaf blowers, edgers and hedge trimmers can be helpful for getting a yard back in shape after a storm, but it’s important to exercise caution to avoid musculoskeletal pain. These tips can help you safely enjoy a productive day in the yard: 

  • Regardless of what piece of equipment you use, make sure it has a strap and that you use it. Place the strap over your head on the shoulder opposite the side of your body from the device. This will help normalize your center of gravity. 
  • Be sure to switch the side on which you operate the equipment as often as possible, and to balance the muscles being used, alternate your stance and motion frequently. 
  • Try ergonomic tools. They’re engineered to protect you when used properly. 
  • When mowing, use your whole body weight to push the mower, rather than just your arms and back. 
  • If your mower or edger has a pull cord, don’t twist at the waist or yank the cord. Instead, bend at the knees and pull in one smooth motion. 
  • Take frequent breaks from the activity of the day. Muscle fatigue may be felt when using any of these devices for an extended period. 

Shoveling Snow 

Shoveling snow without proper preparation can wreak havoc on the musculoskeletal system. Consider the following tips to help prevent injury:  

  • Layer clothing to keep your muscles warm and flexible. Shoveling can strain “deconditioned” muscles between your shoulders and in your upper back, lower back, buttocks and legs. Do some warm-up stretching before you grab the shovel. 
  • When you do shovel, push the snow straight ahead. Walk it to the snowbank–don’t try to throw it. Avoid sudden twisting and turning motions. 
  • Bend your knees to lift when shoveling. Let the muscles of your legs and arms take some of the strain of shoveling off your back.  
  • Take frequent rest breaks to take the strain off your muscles. A fatigued body asks for injury. 
  • Stop shoveling if you experience chest pain, shortness of breath, or get very tired. You may need emergency medical assistance. 

For more information on prevention and wellness, or to find a doctor of chiropractic near you, visit 

Reviewed by the ACA Editorial Advisory Board. Credits:

Water Exercises for Better Health

Whether you’re looking for a way to stay in shape or trying to recover from some type of injury, working out in the pool or another body of water can help. This is because water exercises support health in a variety of ways. And they can target the areas of your body that you want (or need) to work on the most.

How Swimming and Water Exercises Support Better Health

“Exercising in a pool of water has numerous benefits,” says Robert A. Hayden, DC, PhD, FICC, an American Chiropractic Association (ACA) member who practices in Griffin, Ga.—especially if performed consistently. Among these benefits are:

  • It doesn’t put as much pressure on the muscles and joints. The good thing about water is that it makes you more buoyant. This places less stress on the muscles and joints, which can be helpful if you have a chronic pain condition such as fibromyalgia, osteoporosis, or arthritis. It’s also better for people with muscle and joint injuries while being an effective option for those who may struggle with other forms of exercise, such as those with obesity.
  • Improved muscle strength and tone. Because water is thicker than air, it forces the muscles to work harder. “This kind of exercise increases muscle strength and tone,” says Dr. Hayden. At the same time, it also helps keep tendons more lubricated and makes them looser.
  • Better balance. Water not only forces muscles to work harder, but it also requires you to pay more attention to your coordination. “Over time, this improves balance and reduces the risk of falls,” says Dr. Hayden, “[which are] the number one cause of both fatal and nonfatal injury in people over 65 years of age.”
  • Greater flexibility. Water’s resistance may even increase range of motion in your arms and legs. This means that you can move them more freely, giving you greater flexibility.
  • Cardiovascular benefits. “As with any physical activity, particularly with the kind of resisted exercise experienced in a pool, there is significant cardiovascular effect,” says Dr. Hayden. “It will increase your heart rate and dilate blood vessels leading to your skeletal muscles. This will improve the strength of your heart as well as your peripheral circulation.”
  • It’s comfortable. “Many seniors in my patient population have access to a heated pool,” shares Dr. Hayden. “Not only does this add comfort, but it also lets people have access to the pool year-round, even in those cold months of winter.”

Simple Water-Based Exercises for Your Upper Body, Lower Body, and Core

If you’d like to enjoy these types of benefits, here’s a few exercises that Dr. Hayden suggests adding to your water workout.


Before you even get into the pool, it’s important to get your body ready. To start, stand with your feet about shoulder-width apart. Then turn your body to each side several times, touch your toes, lean backward, and do some deep knee bends. “If you have conditions that will not allow you to move this way, save them for when you were in the pool,” suggests Dr. Hayden.

You can also walk in shallow water that is no more than waist high. Go slow, keeping your hands at your side as you move. “This will begin increasing your heart rate and diverting blood flow to the muscles of the lower extremity and the postural muscles of your back,” says Dr. Hayden. Do this for five to 10 minutes.

Lower Body Exercises

To help strengthen or rehabilitate your lower body (legs, buttocks, and lower back), grip the edge of the pool and extend your arms to float. For flutter kicks, keep your legs straight out and kick them up and down separately, just as you do when swimming. A butterfly kick is similar to what a dolphin does and involves keeping your legs and feet together, kicking them up and down at the same time.

Start with 10 flutter kicks followed by 10 butterfly kicks. Add more of each type of kick until you can do three full sets.

Upper Body Exercises

Want to tone or rehab your arms, shoulders, and neck? For these exercises, you’ll need to get into water up to your shoulders. Standing with your hands at your sides, raise your arms with your palms up against the resistance of the water. When your arms are level with your shoulders, turn the palms down and push down toward your hips. Repeat this 10 times.

Next, with your arms level with your shoulders and outstretched, turn your palms straight ahead of you and move your arms forward and backward as though you were a bird flying. Repeat this 10 times. “You should feel the muscles in your chest, shoulders, and neck fully engaged,” says Dr. Hayden.

Core Exercises

To work your midsection, stand so the edge of the pool is behind you. Reach back and hold onto it, then draw your knees to your chest before pushing yourself backward into the water and floating on your back.

When you stop moving, draw your knees back to your chest, then extend your feet to the bottom of the pool and walk back to the wall.  Repeat this until you can do two or three sets of 10. “You will feel this in those muscles over your stomach that you would like to convert to a sixpack,” says Dr. Hayden.

Additional Tips for Pool Exercise Success

There are also a few things you can do to make your water-based exercise safer and more effective. They include:

  • Get approval first. Before beginning a new exercise regimen or increasing the intensity of your current program, talk with your healthcare provider to make sure it is safe for you.
  • Staying hydrated. “It is easy to forget that when we exercise, we sweat,” says Dr. Hayden. “So, stay hydrated. Drink plenty of water before, during, and after pool exercises.”
  • Make sure the water isn’t too warm. “If you are in a heated pool, make sure the temperature is under 90 degrees,” suggests Dr. Hayden. This is because water that is too warm may negatively affect your circulation.
  • Pay attention to your body. “If you feel lightheaded, dizzy, faint, weak, nauseated, or experience chest pain, get out of the water immediately and call for help,” stresses Dr. Hayden.
  • Practice pool safety. Have a flotation device on you—particularly if you are getting into water above your waist. “Falling onto the ground or floor is bad enough if you are prone to falling,” says Dr. Hayden, “but falling underwater is a different proposition altogether. And don’t get in the pool alone. Have someone close by while you are exercising.”

Adding Chiropractic for Greater Musculoskeletal Health

Doing these exercises can help you boost your musculoskeletal health. So too can engaging in regular chiropractic care.
By Christina DeBusk


Staying Fit As You Age

Exercise is often prescribed for patients of all ages to reduce complaints about pain in muscles and bones, but some feel it gets harder to exercise as they get older. “For seniors, exercise can also be an incredible way to be social,” says Scott Bautch, DC, president of the American Chiropractic Association’s Council on Occupational Health. “The social aspect of exercise is huge. Pilates is becoming more and more popular among older adults. Seniors can interact with each other while they exercise at their local gyms. Nowadays, many gyms have hours of operation that are friendly to seniors.”

Health and social benefits aside, many seniors still have questions about exercise: 

I’ve been inactive for so long. Won’t it hurt to exercise?  

You can always become as physically fit as possible, given your current health status and limitations. When you commit to a physical fitness program, you will move toward enjoying life more fully. 

First, pick an activity that you enjoy doing and perform it regularly. Make your exercise program as pleasant as possible. If you feel exercising is a chore, you will be uncomfortable with the program and will quit. If you can, ask a friend to exercise with you so you can support each other. 

Second, begin your exercise program gradually, starting with five minutes of exercise each day. As you become more comfortable with the routine and notice the positive effects of fitness, you may increase the exercise time. 

If you have been inactive for some time, you may feel some small aches and pains. They will fade with time. Be sure to tell your doctor if you experience any unusual pain or other symptoms during or after your exercises. Check with your doctor of chiropractic before starting any exercise or physical fitness program. While exercise is beneficial to your health, the type of exercises you perform can be affected by your health status. 

How do I start?  

Develop a plan for an exercise program and stick with it. Make your exercise program an integral part of your normal daily activities – or use normal daily activities to help your muscles and bones become as healthy as possible. 

  • Research shows that “functional exercises”— those that mimic actual daily activities, such as walking up and down stairs and getting in and out of a chair — can be quite effective.  
  • Some research suggests that people who live in two-story houses are less prone to certain types of heart disease. Repeatedly climbing a flight of stairs or rising from and returning to a seated position helps build leg strength and aerobic fitness. If you hold a weight during these exercises, you can increase your level of physical activity even further.  
  • Household chores, such as vacuuming, loading and emptying the dishwasher and moving wet laundry from the washer to the dryer can increase strength and flexibility. Lift with your legs, when necessary. 

I don’t feel as strong as I used to. Can I still exercise?  

As we age, we lose muscle mass. Some healthcare providers suggest that weight training will help prevent strength loss and keep patients feeling younger. Unfortunately, many seniors find they can’t lift the heavy weights necessary to actually build muscle mass, but don’t be discouraged. Recent studies show that while muscle strength diminishes with age, muscle endurance does not. It means that, as we get older, we may benefit from switching strength exercises to endurance exercises, working muscles with lighter weights for a longer period of time. 

Exercises that emphasize endurance, such as dancing, walking or bicycling, may be not only more beneficial but also more enjoyable. Many senior citizens have neighborhood areas where they can get together to walk. Walking with a family member or friend helps your physical fitness — and helps build relationships. These exercises are also aerobic and will benefit your heart health. For people who cannot walk or ride a bike, there are endurance- and flexibility-enhancing exercises that can be performed in a chair. Set goals for yourself that can be tracked and make exercise a part of your overall health plan. 

I have arthritis. How can I exercise safely?  

Physical activity actually decreases arthritic pain. Many people with rheumatic conditions are physically inactive. There is oftentimes a fear factor for seniors when it comes to activity and arthritic pain – a social fear, a fear of pain, a fear of falling, etc. However, for those with arthritis, the worst thing they can do is stop moving. In most cases, you can — and should — exercise. 

In fact, recent research has shown that older people with arthritis gain modest improvements in physical function, pain, general mobility and flexibility, when participating in long-term exercise programs. Water-based exercises, such as swimming or “water walking,” can work on joints without putting them through the stress of weight bearing. If necessary, your doctor can show you how to use a cane, a walker or other assistive devices to help prevent falls and injuries while you are physically active. 

Which fitness program will help me most?  

The best exercise program should be tailored to your individual health status. Your doctor of chiropractic can help you plan the fitness program that is right for you. Typically, low-impact activities that keep joints moving and minimize pain, such as walking, swimming and water-based exercise, are effective. Research has shown that exercise can reduce joint stiffness, pain and inflammation associated with arthritic conditions, which affect most of us as we age. 

Doctors of chiropractic can not only help restore muscle and joint function that have been affected by injury, illness and age-related conditions, but they can also maintain the health and flexibility of your muscles and bones. They often prescribe exercise to prevent and treat many of these conditions, helping older patients to remain active and independent. 

For more information on prevention and wellness, or to find a doctor of chiropractic near you, visit 

Reviewed by the ACA Editorial Advisory Board. The information in this post is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional. If you have specific questions, contact your doctor of chiropractic. Credits:

Healthy Holiday Shopping

The day after Thanksgiving is a milestone of sorts in America. It reminds us of just how quickly the year has gone by and how close we are to the holiday season. This realization—coupled with the fabulous sales at major department stores and malls everywhere—helps make the day after Thanksgiving our biggest shopping day of the year. And until we flip the calendar over to a new year, the chaos just doesn’t let up.

“Our bodies have the capacity to do a little more than we normally do,” says Dr. Scott Bautch, president of the American Chiropractic Association’s (ACA) Council on Occupational Health. “But our bodies do not adapt very well to doing a lot more than we normally do. Since the added demands of this season can stress the capacity of our bodies, we need to do everything we can to help ourselves. Eat right, drink plenty of water, stretch, exercise and take a few minutes to slow down and reflect on what the season is all about.”

Relax and enjoy the holidays! Dr. Bautch and  ACA encourage you to consider the following tips to help keep you and your loved ones healthy, happy and safe this season.

Treat Holiday Shopping as an Athletic Event

  • Wear shoes with plenty of cushioning in the soles to absorb the impact of walking on hard shopping mall floors.
  • Make sure the clothing you wear is as comfortable as possible. It’s a good idea to wear layers, because you may be going from a cold environment (outdoors) to a warm environment (indoors).
  • Leave your purse at home. Keep your belongings in a zippered-up coat pocket or in a light backpack, packing only items that are absolutely essential (driver’s license, credit card, etc.).
  • Ask for help if you’re purchasing an item that’s heavy, oddly-shaped, or hard to reach. Be patient, ask for help, and don’t try to do it yourself.

Plan Frequent Breaks 

During a day of heavy shopping, most people should take a break every 45 minutes. Those who lead a sedentary lifestyle may need to take a break every 20-30 minutes, while those who are physically active may get away with taking less frequent breaks.
  • If your mall or shopping center doesn’t offer lockers, try to plan trips to your car where you can drop off excess bags and continue shopping without the extra weight. Don’t carry around more than is absolutely necessary at one time.
  • When taking breaks, try to eat light foods. A salad and some fruit is a much better option than a burger and fries.

“We actually need to eat better than normal during the holiday season,” explains Dr. Bautch. “Heart attacks occur more often during the holidays. Eating a heavy meal and then running out on an exhausting shopping trip can be dangerous.”

Shopping With Children

If at all possible, do not bring children along on a holiday shopping trip.  Most children simply do not have the stamina for such an event, and you and your child will only become frustrated with one another. Avoid adding this type of stress to an already stressful situation. Instead, try to split up “child duty” with a spouse or another parent. They can watch your kids while you shop, and vice-versa.

“Shopping with children is just a bad idea,” says Dr. Bautch. “If your hands are loaded with shopping bags, you may not be able to hold your child’s hand, which could increase the chances he or she might wander away from you. Take whatever steps necessary to avoid bringing your child along.”

Wrapping Gifts

Since there is no “ideal” position for wrapping gifts, the most important thing to remember is to vary your positions. For example, try standing at a table or counter top for one package, sitting on a bed for another, sitting in a comfortable chair for another, and so on. Do not wrap packages while sitting on the floor. Wrapping packages while sitting on a hard floor can wreak havoc on your posture, and should be avoided.

Always remember to stretch before and after you wrap gifts. “When wrapping presents, it’s a good idea to ‘stretch the opposites,’” recommends Dr. Bautch. “In other words, if you are leaning forward when wrapping your gifts, stretch backward when you are done.”


Fall Yard Clean Up

Before you rev up the lawnmower or reach for your rake this fall, the American Chiropractic Association (ACA) cautions you to consider the possible consequences: upper or lower back strain, neck strain and/or pain in the shoulders.

Just as playing football or golf can injure your body, the twisting, turning, bending and reaching of yard work can also cause injury if your body is unprepared. Like an athlete, if you leap into something without warming up or knowing how to do it properly, the chances of injury increase. To prevent unnecessary strain and pain, consider these simple tips before you get started:

  • Wear supportive shoes. Good foot and arch support can help prevent back strain.
  • Stand as straight as possible, and keep your head up as you rake or mow.
  • When it’s still warm outside, avoid the heat. If you’re a morning person, get the work done before 10 a.m. Otherwise, do your chores after 6 p.m.
  • When raking, use a “scissors” stance: right foot forward and left foot back for a few minutes, then reverse, putting your left foot forward and right foot back.
  • Bend at the knees, not the waist, as you pick up yard equipment or piles of leaves or grass. Make the piles small to decrease the possibility of back strain.
  • Wear a hat, shoes and protective glasses. To avoid blisters, try wearing gloves. If you have asthma or allergies, wear a mask.
  • Drink lots of water before and after your work.

Tips on Using Outdoor Equipment

The equipment available today for lawn and leaf management can turn the average homeowner into a lawn specialist overnight. But the use of weed trimmers, leaf blowers and hedge clippers also has sent many aspiring landscapers to the office of their local doctor of chiropractic.

ACA cautions that using this equipment can result in back and neck pain, as well as more serious muscular strains and tears. The repetitive motion that your body undergoes when using such equipment can create a host of mechanical problems within the body. It is essential to operate your equipment properly. The following tips can help you safely enjoy a productive day in the yard:

  • Regardless of what piece of equipment you use, make sure it has a strap and that you use it. Place the strap over your head on the shoulder opposite the side of your body from the device. This will help normalize your center of gravity.
  • Be sure to switch the side on which you operate the equipment as often as possible, and to balance the muscles being used, alternate your stance and motion frequently.
  • Try ergonomic tools. They’re engineered to protect you when used properly.
  • When mowing, use your whole body weight to push the mower, rather than just your arms and back.
  • If your mower has a pull cord, don’t twist at the waist or yank the cord. Instead, bend at the knees and pull in one smooth motion.
  • Take frequent breaks from the activity of the day. Muscle fatigue may be felt when using any of these devices for an extended period of time.
  • If your equipment is loud, wear hearing protection.

Simple Stretches 

While it is critical to operate yard equipment safely, it is equally important to prepare your body for the work you are about to do. To help avoid injury, be sure to include a warm-up/cool-down period that involves stretching. Breathe in and out slowly throughout each stretching exercise until the muscle is stretched to its furthest point. At that point, hold your breath in; when you relax, breathe out. Stretch gently and smoothly. Do not bounce or jerk your body in any way and stretch as far as you can comfortably. You should not feel pain. Get the most out of the time you spend in the yard with these stretches:

  • Stand up and prop your heel on a back door step or stool with your knee slightly bent. Bend forward until you feel a slight pull at the back of the thigh, called the hamstring. You may need to stabilize yourself by holding on to a garage door handle or sturdy tree branch. Hold the position for 20 seconds, then relax. Do it once more, and then repeat with the other leg.
  • Stand up and put your right hand against a wall or other stable surface. Bend your left knee and grab your ankle with your left hand. Pull your heel toward your buttocks to stretch your quadriceps muscles at the front of your thigh. Hold that position for 20 seconds, relax and do it again. Repeat with the other leg.
  • Weave your fingers together above your head with your palms up. Lean to one side for 10 seconds to stretch the side of your upper body, then reverse. Repeat two or three times.
  • “Hug your best friend”- Wrap your arms around yourself after letting your breath out and rotate to one side as far as you can go. Hold for 10 seconds; then reverse. Repeat two or three times.


Bike-fitting Basics

Distanced and outdoors: Rediscover the fun and benefits of cycling.

While COVID-19 has hit many industries hard, bike sales have been booming since the beginning of the pandemic as people avoid gyms and look for ways to exercise more safely outdoors. Whether you ride on-road or off, pedal casually or competitively, it is important to pay close attention to how your bicycle fits your body. A properly fitted bike will allow you to ride comfortably and safely, avoid injury, and produce more power so you can go faster with the same or less effort.

In general, when choosing a bicycle, there are five basic components to consider:

  1. Frame size
  2. Saddle (seat) height
  3. Saddle position
  4. Saddle tilt
  5. Handlebar position

Frame Size

Frame size is perhaps the most important of all measurements because once you purchase the bike, there are very few—if any—minor adjustments that can affect the overall frame. Frame size is not necessarily dependent on your height; rather, it is more a matter of leg length. Simply, the frame should be easily straddled with both feet flat on the ground, and with perhaps an inch or two of clearance.

  • For a road or hybrid bike, you should have an inch or two of clearance between your crotch and the top tube.
  • For a mountain bike, clearance should be about four inches—especially if you plan to ride in rugged terrain where an unplanned dismount is likely.

Note that frame sizes come in inches or centimeters, depending on the manufacturer. Also, a 21-inch frame from one company may fit very differently from the same size made by another manufacturer. Lastly, frame size is not the same as wheel size, which is commonly used in sizing kids’ bikes.

Saddle Height

A saddle (seat) set too high or too low can cause pain and lead to injuries of the back and knees, and will also affect the efficiency of each pedal stroke. As a starting point, set the saddle height so that your knee is slightly bent when the pedal is at its lowest position and the ball of your foot is on the pedal. It is recommended to make adjustments in very small increments and, if applicable, to wear your cycling shoes during the adjustment process.

Saddle Position

To check the saddle position, sit on your bicycle, using a friend or a stationary object to keep yourself balanced, and rotate your pedals until they are horizontal (at the 3 o’clock and 9 o’clock positions). If your saddle is positioned properly, your forward knee should be directly over the respective pedal axle (with the ball of your foot on the pedal). For precise measurement, use a plumb-bob to help you visualize the alignment. If adjustments are needed, loosen the seat post and slide the seat saddle forward or backward, keeping the seat level.

Saddle Tilt and Design

Generally speaking, your saddle should be level. Check this adjustment by using a carpenter’s level balanced on the saddle while the bike is on level ground. If your saddle tips too much in either direction, pressure will be placed on your arms, shoulders and lower back. (Note: The type of bike you ride can influence the proper positioning and tilt of the saddle, so it is best to consult a bike shop for specific recommendations.)

Saddle selection is a matter of personal preference. Saddles come in gender-specific, comfort, and performance models. For example, women-specific saddles are wider at the back, have a shorter nose and usually have a soft or cut-out section in the middle.

Handlebar Position

Handlebar setup is a matter of personal preference because it will affect shoulder, neck and back comfort. Generally, handlebars are positioned higher for comfort (a more upright riding position) and lower for improved aerodynamics.

Bicycle Types

  • Road bikes are designed for speed. They have lightweight frames, dropped handlebars, multiple gears, and narrow, high-pressure tires. Road bikes do not possess the stability or traction to be ridden off-road.
  • Mountain bikes are designed for off-road cycling. Mountain bicycles feature sturdy, highly durable frames and wheels, along with wide, treaded tires to help the rider resist sudden jolts. Mountain bikes can also be used on the road, just not as efficiently as other bikes.
  • Hybrid bikes are a compromise between mountain bikes and road bikes. Hybrids offer a more upright, comfortable riding position and have wider tires than road bikes. In comparison to mountain bikes, hybrids offer a smoother ride. Hybrids are great for fitness riding, riding with the family and light touring.

Always Wear a Helmet!

A bicycle crash can happen at any time, however, according to the National Highway Safety Traffic

Administration, a properly fitted bicycle helmet reduces the risk of head injury by as much as 85 percent and the risk of brain injury by as much as 88 percent. The following are tips to help ensure the correct helmet fit:

  • The helmet should be level on the head, and it must cover the forehead.
  • The Y of the side straps should meet just below the ears.
  • The chin strap should be snug against the chin so that when you open your mouth very wide, the helmet pulls down a little.
  • Put your palm on the front of the helmet, and push up and back. If it moves more than an inch, more fitting is required.
  • Shake your head around. If the helmet dislodges, work on the strap adjustments.
  • Do not wear a hat under the helmet.
  • All helmets sold in bike shops must be approved by the U.S. Consumer Product Safety Commission (CPSC) and should carry a CPSC sticker.

Consult a Professional

The suggestions above are general guidelines only. A quality bike shop should make the necessary adjustments for you or offer to help you fine-tune the fit of your bike, which is crucial to reduce wear and tear on the body, as well as minimize injuries.

Visit the website of the National Bicycle Dealers Association at to locate a nearby retailer. Professional bicycle retailers can fit you properly to a bike, assemble it professionally, and give you the advice and continuing service you need to ride safely and comfortably.

Reviewed by the ACA Editorial Advisory Board. Credits:

Avoiding Tennis Injuries

Tennis, Anyone? Injury-Prevention Tips

When it comes to tennis, the combination of both high and low-exertion levels of the game can bring not only a unique exercise experience, but also tremendous health benefits. In the age of COVID-19, tennis offers other important benefits: it is an outdoor sport and games involve only two to four players. Plus, with standard tennis courts measuring 78ft. in length, players are more than adequately distanced for safety.

Tennis is also convenient. In fact, if you can find a tennis facility that has a tennis wall, or a wall with a horizontal line that simulates a tennis net, you can get a great tennis workout all by yourself. In addition to enhancing your cardiovascular health, playing tennis can tone the muscles of your upper and lower body, burn calories, and improve your balance, hand-eye coordination and agility.

The American Chiropractic Association (ACA) suggests the simple measures below to help you avoid tennis injuries and improve your game.

Clothes, Shoes and Socks

  • Avoid wearing tight clothes that pinch any part of your body. These “pinch points” can inhibit circulation, causing you to tire more quickly. They can also cause uncomfortable blisters and rashes.
  • Because of the constant pounding on your feet, it is critical to select a true tennis shoe. Don’t purchase shoes designed for basketball, running or cross-training. The tennis shoe should be low to the ground, yet be able to absorb shock to minimize stress on your feet.
  • Keep your feet dry by wearing socks. Use foot powder to prevent blisters.
  • Choose socks and clothes made from fabrics that absorb perspiration, allowing the skin to “breathe.” Some synthetic fabrics are engineered to “wick” the perspiration away from the body. Good old cotton and acrylic also work well.

Choosing a Racket

  • The grip of your racket should be thick enough for your hand to fit around it without having your thumb and fingers overlap one another.
  • The racket should be comfortably cushioned to absorb the shock that comes from hitting a tennis ball.
  • Don’t pick out a bigger racket to give you a better chance at hitting the ball. With an oversized racket, you tend to catch the ball on the extreme edges of the racket, which can twist your hands and wrists beyond their normal range of motion. Instead, look for a normal-sized racket, with a hitting area of 105 square inches or smaller.

Avoiding Tennis Injuries

Select a tennis court with a safe playing surface. Because your knees, hips and feet will take a pounding, surfaces that have some give—such as cushioned surfaces or even grass—are better than concrete for avoiding tennis injuries.

  • Check the tennis court for trash, sand or other objects that can make it easy for you to lose your footing when practicing or playing.
  • If you are a beginning player, take tennis lessons. There is value in learning good tennis habits and proper form, which will help take pressure off your wrists, spine and hips. If taking lessons is not an option, books and videos can be very helpful in familiarizing your mind and body with the game.
  • Warm up before practicing or playing. Rotate your legs, shoulders, hands and elbows in a slow, circular motion. Also, move forward and back, then left and right, across your end of the tennis court, simulating the movements you would make when actually playing, but do it more slowly and deliberately.
  • Drink water. When playing tennis, you lose a lot of fluids. Avoid sodas because your body must use more water to push them out of your system than they put into your body.

Even with the best preventive measures, pain and injury can be a fact of life with any sport. If you experience pain or injury beyond simple muscle soreness, visit your doctor of chiropractic. Chiropractors are uniquely trained to treat common tennis injuries, such as tennis elbow, shoulder injuries, low back injuries, sprained ankles and knees. They can also help you choose proper rehabilitation exercises and prevention techniques to get you back on the court and reduce the likelihood of future injuries.

Reviewed by the ACA Editorial Advisory Board. Credits:

Walking: One Step at a Time

While some fitness enthusiasts relentlessly seek out the latest exercise trends, others—especially those who are avoiding gyms and health clubs because of COVID-19—are returning to good, old-fashioned walking to help them feel great and get into shape. Whether enjoying the wonder of nature or the company of a friend (at a safe distance), walking can be a healthy, invigorating experience.

Thanks to its convenience and simplicity, walking just might be right for you, too. And except for a good pair of walking shoes, it requires virtually no equipment. The Center for Disease Control and Prevention (CDC) notes that a sedentary lifestyle has a debilitating effect on our health as we age, therefore physical activity is imperative. According to CDC, walking accomplishes all of the following and more:

  • Improves cardiovascular endurance
  • Tones muscles in the lower body
  • Burns calories
  • Reduces risk of heart disease
  • Reduces anxiety and enhances sleep

Selecting Shoes

Too many people choose fashion over function when purchasing running shoes, not realizing that ill-fitting shoes can do more than hurt their stride; they can also lead to pain throughout the body.

  • Make sure the shoes you purchase fit properly. The balls of your feet should rest exactly at the point where the toe end of the shoe bends during walking.
  • Shop for sneakers at the end of the day or after a workout when your feet are generally at their largest.
  • Wear the type of socks you usually wear during exercise. When trying on shoes, be sure to wear them for at least 10 minutes at the store.

Once you have purchased a pair of shoes, don’t walk them into the ground. While estimates vary as to when the best time to replace old shoes is, podiatric experts suggest between 350 and 500 miles is a good benchmark.

Getting Started

CDC recommends adults get 150 minutes per week of moderate physical activity (or 75 minutes of vigorous activity), and walking is a great option. The following tips can help you get started on your walking regimen:

  • Move your arms freely, in coordination with the opposite leg.
  • Don’t stoop your head or look down as you walk. This will challenge the normal forward curve of your neck, which, in turn, will cause you to carry your weight improperly.
  • Don’t carry weights or dumbbells while walking. They’re better used as a separate part of your exercise regimen.
  • Expect a little soreness in the thighs and calves for the first week or two. If you experience more than soreness, consult your doctor of chiropractic.
  • Walk briskly, with “purpose.” Simply sauntering, while relaxing, is not an effective form of cardiovascular exercise.
  • Stay hydrated.

Walking Surfaces

Some walking surfaces may be better than others on your musculoskeletal system.

  • Walking on a cushioned or rubberized track is generally better because the cushioning of this type of track absorbs most of the impact of your walking. Many recreation centers offer this type of track free of charge.
  • Grass is another good surface, but watch out for hidden dips or holes in the ground.
  • Walking on a surface with no give, such as concrete or a mall floor, is not your best choice, because this type of surface will not absorb much of the impact your body will experience. If you do choose to walk on such a surface, be sure to select adequately cushioned shoes.
  • Alternate the days that you walk at a slant. For example, Monday, Wednesday and Friday, walk on slanted terrain. On Tuesday and Thursday, switch to flat terrain. This keeps your spine symmetrical.

Pain and Injury

While you may experience pain or injury in a particular area (such as a knee or a hip), the root of the problem may lie elsewhere. A problem in the foot or ankle can create an imbalance in every step, leading to discomfort or injury that moves to the knees, hips, low back or other regions of the body.

If you suffer from pain beyond typical muscle soreness, your doctor of chiropractic can diagnose and treat your pain or injury and get you back on track. Your chiropractor can also customize a wellness program that is right for you and has the expertise to help keep you feeling and functioning your best.

Reviewed by the ACA Editorial Advisory Board. Credits:

Stretches for Back Pain

Stretching and an active lifestyle are often recommended to help reduce back pain and speed up the recovery process following an injury. Depending on one’s individual injury and level of pain, the exercise and rehabilitation program may vary. Therefore, the key is to start slowly and increase the repetitions as you feel stronger.

Consult with your doctor of chiropractic prior to starting a new exercise program, especially when associated with low back pain. Your chiropractor can help develop an individualized program and provide instruction on proper stretching techniques, which can be modified for your specific needs. Following are some general suggestions.

Stretching Tips

To get the maximum benefit from stretching, proper technique is essential:

  • Warm up your muscles before stretching by walking or doing other gentle movements for 10 to 15 minutes.
  • Slowly increase your stretch as you feel your muscles relax. Don’t bounce.
  • Stretch slowly and gently, only to the point of mild tension, not to the point of pain.
  • Don’t hold your breath. Inhale deeply before each stretch and exhale during the stretch.
  • As your flexibility increases, consider increasing the number of repetitions.
  • Stop immediately if you feel any severe pain.

Passive Stretches

Passive stretches help facilitate movement in the affected muscle or joint. Because muscles should be allowed to gradually relax and strengthen, stretches should be held for 15 to 30 seconds. Stretches should never cause pain nor should you feel tingling in the extremities. These stretches may be performed several times per day. However, you should stop immediately if you experience any discomfort.

  • Hamstring Stretch: Lie on your back with both legs straight. Bend one leg at the knee and extend one leg straight up in the air. Loop a towel over the arch of the lifted foot, and gently pull on the towel as you push against it with your foot; you should feel a stretch in the back of the thigh. Hold for 30 seconds. Relax. Repeat 3 times per leg.
  • Piriformis Stretch: The piriformis muscle runs through the buttock and can contribute to back and leg pain. To stretch this muscle, lie on the back and cross one leg over the other; gently pull the knee toward the chest until a stretch is felt in the buttock area. Hold for 30 seconds. Relax. Repeat 3 times.
  • Back Stretch: Lie on your stomach. Use your arms to push your upper body off the floor. Hold for 30 seconds. Let your back relax and sag. Repeat.

Active Stretches

Active stretches facilitate movement and improve strength. Stretches should never cause pain, nor should you feel tingling in the extremities. These exercises may be performed several times per day. However, you should stop immediately if you experience any discomfort.

  • Leg Raises: Lie on your stomach. Tighten the muscles in one leg and raise it 1 to 2 inches from the floor. Do the same with the other leg. Repeat 20 times with each leg.
  • Bridges: Lie on your back with your knees flexed and your feet flat on the floor. Keep the knees together. Tighten the muscles of the lower abdomen and buttocks; slowly raise your hips from the floor and lower your back to the resting position. Repeat this exercise 20 times.
  • The Pointer: Kneel on a mat with your weight on your hands and knees. Palms should be directly under your shoulders and knees hip-width apart. Slowly raise your right arm, and extend it forward parallel to the floor. Balance by contracting your abdominal muscles. Keep your right palm parallel to the floor, then lift your left leg and straighten it behind you. Hold the opposing limbs off the ground for 30 to 60 seconds without arching your back. Then switch sides. Repeat 3 to 6 times.

Getting Started

The Center for Disease Control and Prevention (CDC) recommends adults get 150 minutes per week of moderate physical activity (or 75 minutes of vigorous activity). Until you’ve recovered from back pain, select low-impact activities that burn calories. For instance, stationary recumbent bikes, walking, ellipticals, and water therapy won’t place undue stress on your joints. Before beginning a vigorous exercise program, check with your doctor to rule out any possible cardiovascular health risks.

Doctors of chiropractic are uniquely trained to treat common injuries, including low back pain. In addition, they can help you choose proper rehabilitation exercises and prevention techniques to get you back on your feet and reduce the likelihood of future injuries.

Reviewed by the ACA Editorial Advisory Board. Credits:

Kids and Sports

In today’s age of health and fitness, more and more kids are involved in sporting activities. Although being part of a football, soccer or Little League team is an important rite of passage for many children, parents and their children could be overlooking the importance of proper nutrition and body-conditioning needed for preventing injuries on and off the playing field.

Without proper preparation, playing any sport can turn into a bad experience. There are structural and physical developmental issues that need to be taken into consideration before children undertake certain sports.

Highly competitive sports such as football, gymnastics and wrestling follow rigorous training schedules that can be potentially dangerous to an adolescent or teenager. The best advice for parents who have young athletes in the family is to help them prepare their bodies and to learn to protect themselves from sports related injuries before they happen.

“Proper warm up, stretching and weight-lifting exercises are essential for kids involved in sports, but many kids learn improper stretching or weight-lifting techniques, making them more susceptible to injury,” says Dr. Steve Horwitz, an ACA member from Silver Spring, Maryland, and former member of the U.S. Summer Olympic medical team. “Young athletes should begin with a slow jog as a general warm-up, followed by a sport-specific warm-up. They should then stretch all the major muscle groups.”

Proper nutrition and hydration are also extremely vital. While an ordinary person may need to drink eight to ten 8-ounce glasses of water each day, athletes need to drink even more than that for proper absorption. Breakfast should be the most important meal of the day. Also, eating a healthy meal two to four hours before a practice or a game and another within one to two hours after a game or practice allows for proper replenishment and refuels the body.

The following tips can help ensure your child does not miss a step when it comes to proper fitness, stretching, training and rest that the body needs to engage in sporting activities.

Encourage your child to:

  • Wear the proper equipment. Certain contact sports, such as football and hockey, can be dangerous if the equipment is not properly fitted. Make sure all equipment, including helmets, pads and shoes fit your child or adolescent. Talk to your child’s coach or trainer if the equipment is damaged.
  • Eat healthy meals. Make sure your young athlete is eating a well-balanced diet and does not skip meals. Avoid high-fat foods, such as candy bars and fast food. At home, provide fruit rather than cookies, and vegetables rather than potato chips.
  • Maintain a healthy weight. Certain sports, such as gymnastics, wrestling and figure skating, may require your young athlete to follow strict dietary rules. Be sure your child does not feel pressured into being too thin and that he/she understands that proper nutrition and caloric intake is needed for optimal performance and endurance.
  • Drink water. Hydration is a key element to optimal fitness. Teenage athletes should drink at least eight 8-ounce glasses of water a day. Younger athletes should drink five to eight 8-ounce glasses of water.
  • Avoid sugar-loaded, caffeinated and carbonated drinks. Sports drinks are a good source of replenishment for those kids engaged in long duration sports, such as track and field.
  • Follow a warm-up routine. Be sure your child or his/her coach includes a warm-up and stretching session before every practice, game or meet. A slow jog, jumping rope and/or lifting small weights reduces the risk of torn or ripped muscles. Flexibility is key when pushing to score that extra goal or make that critical play.
  • Take vitamins daily. A multi-vitamin and Vitamin C are good choices for the young athlete. Vitamin B and amino acids may help reduce the pain from contact sports. Thiamine can help promote healing. Also consider Vitamin A to strengthen scar tissue.
  • Avoid trendy supplements. Kids under the age of 18 should avoid the use of performance-enhancing supplements, such as creatine. Instead, they should ask their coach or trainer to include weekly weight training and body-conditioning sessions in their workout.
  • Get plenty of rest. Eight hours of sleep is ideal for the young athlete. Lack of sleep and rest can decrease performance. Sluggishness, irritability and loss of interest could indicate that your child is fatigued.

Chiropractic Care Can Help

Doctors of chiropractic are trained and licensed to treat the entire neuromusculoskeletal system and can provide advice on sports training, nutrition and injury prevention to young athletes.


Strategies for Fall Prevention

Every September on the first day of fall, the National Council on Aging’s Falls Free Initiative promotes National Falls Prevention Awareness Week. Their goal is to raise awareness about the impact of falls among older adults and offer practical falls prevention solutions. This Falls Prevention Awareness Week, learn what you can do to keep yourself and your loved ones safe from falling. The American Chiropractic Association (ACA) offers the following information to help keep you standing strong:

With aging, bodily systems that keep us balanced and standing upright require more awareness. You may no longer see or hear as well, for example, which can affect your coordination. Nerves that carry information from your brain to your muscles may deteriorate, slowing your reaction time and making it more difficult to move away from oncoming pedestrians or adjust to icy patches on a sidewalk. Normal declines in muscle strength and joint flexibility can hinder your ability to stand, walk and rise from chairs.

Do not let the fear of falling rule your life, as many falls and fall-related injuries are preventable. Through scientific studies, researchers have identified a number of modifiable risk factors that increase the likelihood of a fall, including medication side effects, loss of limb sensation, poor eyesight, tripping hazards within the home and lack of physical activity.

Consider the following strategies to reduce the risk of falling:

Perform a Home Safety Check

At least one-third of all falls involve hazards within the home. The most common falls occur when people trip over objects on the floor. Work with a family member or healthcare provider to evaluate your home for potential hazards and minimize your risk of injury.

All living spaces:

  • Remove throw rugs.
  • Secure carpet edges.
  • Remove low furniture and objects on the floor.
  • Reduce clutter.
  • Remove cords and wires on the floor.
  • Check for adequate lighting at night (especially along the path to the bathroom).
  • Secure carpet or treads on stairs.
  • Install handrails on staircases.
  • Eliminate chairs that are too low to sit in and get out of easily.
  • Do not wax your floors—or use nonskid wax.
  • Ensure the telephone can be reached from the floor.


  • Install grab bars in the bathtub/shower and by the toilet.
  • Use rubber mats in the bathtub/shower.
  • Pick up floor mats when you are not using the bathtub/shower to avoid tripping over them.
  • Install a raised toilet seat.


  • Repair cracked sidewalks.
  • Install handrails on stairs and steps.
  • Trim shrubbery along the pathway to the home.
  • Install adequate lighting by doorways and along walkways leading to doors.

Begin a Regular Exercise Program

Consider a general exercise program that includes strength training, balance training and activities such as walking, water workouts or tai chi, which is a gentle exercise that involves slow and graceful dance-like movements. Exercise reduces your risk of falls by improving your strength, balance, coordination and flexibility.

Review Your Medications

Your risk of falling may increase if you take certain prescription medications. Many medications have side effects that can affect your brain function and lead to dizziness or lightheadedness. Taking multiple medications magnifies the risk, as does combining prescription drugs with alcohol, over-the-counter allergy or sleeping medications, painkillers or cough suppressants. Medications that can increase your risk of falling include psychotropics, antiarrhythmics, diuretics and sedatives.

Also, taking four or more types of medications contributes to increased fall risk. Ask your prescribing physician to review your medications and reduce your chances of falling by using the lowest effective dosage. Also, discuss the need for walking aids or supports while taking medications that can affect balance.

Have Your Vision Checked

Reduced vision increases risk of falls. Age-related vision diseases, including cataracts and glaucoma, can alter your depth perception, visual acuity and susceptibility to glare. These limitations hinder your ability to move safely. It is important to have regular check-ups with your eye doctor. Also, regularly clean your glasses to improve visibility.

Nutritional Considerations

Osteoporosis makes bones less resistant to stress and more likely to fracture. Caused by hormonal changes, calcium and vitamin D deficiencies and a decrease in physical activity, osteoporosis is a chief cause of fractures in older adults, especially women.

To help limit the effects of osteoporosis, be sure to eat or drink sufficient calcium. Calcium-rich foods include milk, yogurt, cheese, fish and shellfish, broccoli, soybeans, collards and turnip greens, tofu and almonds. In addition, consume enough vitamin D to enhance the absorption of calcium into the bloodstream. Vitamin D is formed naturally in the body after exposure to sunlight, but most adults need a supplement.

Falls don’t have to be a part of getting older. You have the power to stay securely on your feet. A physical activity program, lifestyle changes and home improvements may further reduce your risk. Also, be aware that dehydration contributes to falls, and make sure you drink adequate amounts of water every day.

If you do find yourself falling, you can try to reduce your risk of serious injury. If possible, fall forward on your hands or land on your buttocks—try to protect your head from striking furniture or the floor. If you live alone and are afraid no one will help you if you fall, ask someone to check on you once a day or consider paying for an emergency monitoring company that responds to your call for help 24 hours a day.


Preventing Text Neck

Some 83 percent of American adults own cell phones, and three-quarters of them send and receive text messages. Text messaging users send or receive an average of 41.5 messages per day, with the median user sending or receiving 10 texts daily. As technology advances, allowing us to do more tasks on smaller equipment, our bodies often pay the price. With a growing potential for injuries from tools we rely on, it’s a good time to learn how to minimize the risks. One problem that is becoming more and more prevalent is neck strain from the overuse of these mobile devices, or “text neck.”

What Causes Text Neck?
Text neck is caused by poor posture when using a mobile device. It’s all too common to become hunched over with your head drooping forward and your shoulders rounded as you become engrossed in messaging, games and social media.

How to Avoid Text Neck

  • Sit up straight with your chest out and your shoulders back.
  • Bring your arms up in front of your eyes so that you don’t need to look down to see the screen.
  • Tuck your chin into your chest to look down rather than dropping your head forward.
  • If you must use your mobile device for lengthy typing, invest in an external keyboard.
  • Rest your forearms on a pillow while typing to help minimize neck tension.
  • Avoid using mobile devices while in bright sunlight. Straining to see the screen leads to jutting the chin forward, shifting work from the
    spine to the muscles that hold up the head.
  • Avoid looking at your phone for long periods of time while traveling in the car.

The best way to avoid text neck is to limit the use of your mobile device. If you need to send an e-mail, wait until you have access to a computer. If you need to share some information, call the person rather than texting them.

See Your Chiropractic Physician
If you find yourself aching despite your best efforts, your doctor of chiropractic can treat your pain and teach you ways to improve your posture.


Exercise, the Easy Way

Many years ago, Americans walked regularly throughout their day. Today, we are lucky if we can reach 3,000 steps in one day. As a country, we are not getting enough movement in our daily lives. Fortunately, it doesn’t have to take a lot of time or effort to incorporate exercise into your schedule.

Start Small

If all you can manage is a five-minute walk, do it. Five minutes are better than none. Eventually, you will be able to work your way up to 30 minutes or more, and you will be taking a big step toward maintaining the flexibility and mobility of your joints.

For those in a time crunch, consider taking small breaks from work. Simply getting up from your desk and walking around the office or the parking lot, or going up and down the stairs a few times, is enough to get your blood flowing and to trigger feel-good endorphins to get you through the rest of your day.

You can also think about incorporating exercise into the activities that you enjoy, such as shopping. Next time you take a trip to the mall, walk around the entire perimeter before going into a store. Or you can turn household chores and yard work into exercise. Consider washing your car by hand rather than using a drive-through car wash. Next time you have to mow the lawn, don’t groan and put it off. Instead, think of it as an opportunity to get in some exercise and work up a sweat. The same is true of raking leaves and vacuuming the living room—anything that gets you on your feet and moving around is going to be beneficial to your health.

What’s My Motivation?

With busy schedules and the rising cost of gym memberships, it’s easy to make excuses for not exercising. The important thing is to remember what motivated you to start working out in the first place. Do you want to be able to keep up with your grandkids? Play 18 holes of golf? Run a marathon one day? Avoid the diabetes that runs in your family? Wear a new outfit hanging in your closet? Whatever it is, keep your goal in mind to keep your body moving toward it.

Vary Routines

If you already have a workout routine that you enjoy, think about how you can tweak that plan to get the greatest health benefit. Regardless of how you choose to exercise, experts agree that it is important to vary your routine at least every few weeks to avoid plateaus and see maximum results.

Variety can be as simple as changing the machines on your weight-lifting circuit or switching from a treadmill to an elliptical. If you’d prefer to continue with the same activity, such as running, consider altering how far or how fast you run. Switch from interval training to hill training, or from one-mile sprints to three-mile jogs.

New Exercise Options

Tired of running on a treadmill? Check out these exercise options to spice up your workout routine:

  • Practice yoga. With a variety of styles and poses, yoga can fit into many different lifestyles and address a variety of health and fitness needs. The physical benefits of yoga, such as increased flexibility, strength, endurance and balance make it an excellent option for athletes to complement the often repetitive motions of training. The same benefits are valuable to less active people looking for a way to add more movement to their days.
  • Diving in for a few laps is a great workout option because it provides cardio and resistance training without any added stress on your joints. You can also “run” in the water for even more variation. Either strap on a flotation device and hit the deep end for minimal resistance while running, or try the shallow end (with the water level hitting about mid thigh) for much stronger resistance.
  • Do weight training. You can use free weights or grab those soup cans from the cupboard and fill an old gallon milk jug with water to create your own. Start small—with light weights and only a few repetitions—and work your way up to more sets with heavier weights.
  • Go for a bike ride. Biking is good for your body because it provides a great cardio workout without putting extra stress on your joints. You can hit the trails for an outdoor ride or try a spin class at your local gym for a more structured workout.
  • Take a dance class. Dance classes are fun, so you won’t realize you are exercising and you can make the workouts as high impact as you’d like.

Reviewed by the ACA Editorial Advisory Board. Credits:

Prevent Aches & Pains on Your Next Road Trip

Traveling can be rough on the body. Due to the COVID-19 pandemic, many people are opting out of traveling on crowded airplanes and choosing instead to drive to their desired destinations. Whether you are traveling alone, on business or are on your way to a sunny resort with your family, long hours in a car can leave you stressed, tired, stiff and sore. 

No matter how comfortable your car seat is, sitting for long periods of time can wreak havoc on your body, placing strains on your muscles, restricting blood flow, and making you feel stiff once you stand up. The solution? Do some simple stretches to “warm up” before settling into a car and “cool down” once you reach your destination. If you are taking a very long trip, take breaks to move around and stretch your muscles. Do some upper- and lower-body stretches or take a brisk walk to stretch your hamstring and calf muscles.  

If you are the driver, try the following tips to stay ache and pain free: 

  • Adjust your seat so you are as close to the steering wheel as comfortably possible. Place four fingers behind the back of your thigh close to your knee. If you cannot easily slide your fingers in and out of that space, try re-adjusting your seat. (Check your car manual to ensure you are at a safe distance from the steering wheel in case the air bag is deployed.) 
  • Consider purchasing a back support. Using a support may reduce the incidence of low back pain and strain. The widest part of the support should be between the bottom of your rib cage and your waistline. (Check your car manual to ensure using a back support does not interfere with the safety features of your vehicle.) 
  • Exercise your legs while driving to reduce the risk of any swelling, fatigue or discomfort. Open your toes as wide as you can, and count to ten. Count to five while you tighten your calf muscles, then your thigh muscles, then your gluteal muscles.  
  • Roll your shoulders forward and back, making sure to keep your hands on the steering wheel and your eyes on the road. 
  • Tighten and loosen your grip on the steering wheel in order to improve hand circulation and decrease muscle fatigue in the arms, wrists and hands. 
  • While being careful to keep your eyes on the road, vary your focal point while driving to reduce the risk of eye fatigue and tension headaches. 
  • Take rest breaks. Never underestimate the potential consequences of fatigue to yourself, your passengers and other drivers. 

Reviewed by the ACA Editorial Advisory Board. 


Put On Your Dancing Shoes

Exercise is important for everyone, but it’s not a one-size-fits-all practice. There are countless fun and interesting ways to add physical activity into your routine. If you’re not a fan of the gym or don’t feel like going for a run, maybe it’s time to try a new form of exercise: dance. When done safely, dance can provide a lot of benefits and be an enjoyable way to get in your regular aerobic activity. 

“Dance is a great workout,” says James Walters, DC, an American Chiropractic Association (ACA) member whose career as a professional dancer led him to a career in chiropractic. One of the biggest health benefits he sees in dance is that it exercises the whole body. “No matter what you’re doing, every part of your body is generally doing something,” he says. 

This kind of whole-body exercise can have a number of physical and mental health benefits. Dance gets your heart pumping, making it a great cardio workout. It can also help with balance and strength, using muscles that might not be activated in other kinds of physical activity. Dr. Walters also recommends dance for the sense of discipline and multitasking ability it instills. “There’s that physical benefit of using your whole body during exercise, and there’s also that mental gymnastics you’re doing,” he says.  

First Steps 

If you’re interested in getting into dance as a form of exercise, look at dance studios in your area and find a class that’s right for you. 

“Anyone can get into dance,” Dr. Walters says. “There’s a lot of studios out there that’ll offer adult dance classes, classes specifically designed with the idea of integrating people who have never taken a dance class before but who want to use it as a form of exercise.”  

One of the things that makes dance such an appealing form of exercise is its variety. There are countless styles of dance, as well as other forms of fitness that can go hand in hand with dance classes. “They’ll incorporate things like Pilates, yoga — often it’s a ballet and jazz class, but I’ve even seen adult tap classes,” Dr. Walters says. Though ballet and jazz are probably the most commonly available classes, there are plenty of options out there. Dr. Walters suggests a ballroom dance class for a fun date night, or even a pole dancing or aerial silks class for a new form of exercise. “The world of dance is probably equally as big as the world of sports. There are so many cool things. Find something you like.” 

Safety Tips 

As with any new physical activity, it’s important to be aware of safety recommendations and the potential for injury if you’re starting dance for the first time. One of the important things to be aware of in dance is positioning. Many dance positions involve moving your body in a way that may not feel natural or comfortable at first. 

“If you’re not used to dance and you’re going in and taking a ballet class, it’s really important to hit those basic mechanics,” Dr. Walters explains. “For anyone getting into dance for the first time, I’d tell them to go slow and take it at their own pace.” 

Because dance is a whole-body exercise, you’re likely to feel sore after your first dance classes, especially in your hips and knees. These, along with the ankles, are what Dr. Walters considers the most important joints in dancers’ bodies. This also makes them the most vulnerable to injury. 

“The single most common injury in all of dance is an ankle sprain,” Dr. Walters says. “A lot of that is because dance happens up on the balls of your feet, and when you’re in that position your ankle’s actually the least stable. When you have a professional dancer who’s been doing this for decades, that ankle is rock-solid. But especially older people getting into dance more as an exercise form, take it slow and really focus on your positioning. Rolling out your ankles is really easy to do when you’re not a master of that technique.” 

In addition to sprains, dancers of all levels should be aware of the potential for repetitive use injuries. Dance involves doing many of the same movements over and over, which can cause damage that builds up over time.  

“Dancers get the same types of injuries that football players get,” Dr. Walters explains. “The exception is, football players get these injuries because they have people colliding into their body, whereas dancers are doing really tiny microdamage over and over again. Fast forward ten years of their career, all of a sudden they do something they’ve done a million times before and their meniscus tears, or their hip labrum tears.” 

Chiropractic and Dance 

Whether you have been training for years or just took your first dance class, talk to your chiropractor about how to make sure that dance is a healthy activity for you. “It’s important to have a team of providers that you can rely on for different things,” Dr. Walters says. “Be comfortable with having that relationship of talking to them about what you do and how you do it.”  

For more health and wellness information, or to find a chiropractor near you, visit ACA online at 


Lindberg S. Benefits of dance: 8 benefits for adults and kids. Healthline.

Better Sleep: 7 Mindful Practices to Improve Your Rest

By Jamie Benjamin

If you struggle to fall asleep at night, endlessly toss and turn, or wake up stiff and tired, practicing mindfulness may help. The practice of being mindful means dedicating your full attention to something. To truly be mindful, you need to slow down, take a breather, and focus entirely on what you’re doing.

When you relate mindful practices to sleep, there are specific ways you can shift your focus and ensure you improve your quality of rest.

These methods include:

Creating the ideal sleep environment 

Your bedroom should be a sanctuary dedicated to relaxing. Too often, our bedrooms are multi-purpose rooms that include televisions, computers, gym equipment and other items that don’t promote rest. It’s almost impossible to sleep properly when there’s so much going on in the room. Try to turn your bedroom into a space with just one focus—sleep.

A good sleeping environment has soft colors and minimal visual distractions. It’s also important for it to be quiet. Even devices with fans that run when they’re on standby can be noisy. Light from devices inside and from streetlights or cars outside can prevent you from sleeping, too. Use heavy curtains to block out external light and take all devices out of the room.

Eliminating distractions

It seems that people’s attention spans are getting shorter, and it is very easy to get distracted. Scrolling through social media on your phone or messaging friends just before you try to go to sleep can keep your mind awake.

Blinking lights from your computer or television can distract your body and prevent it from relaxing. All these distractions need to go, and you should discipline yourself to ignore the temptation of your phone.

Focusing on your breathing

There’s nothing quite like taking a moment to focus on your breathing to calm down and relax your body. If your breathing is relaxed, sleep becomes the next natural state.

When you want to go to sleep, this technique works incredibly well. Climb into bed and get comfortable, then bring all of your thoughts and attention to your breathing patterns. Start inhaling and exhaling in slow, measured breaths.

The physical act of measured, controlled breathing will calm your body and slow your heart rate, getting you into a state ready for sleep. When you focus your mind on your breathing, you cut out thoughts about your day, stress from work, or anything else that may distract you and keep you awake.

Stretching or mild exercising

The temptation to do intense cardio exercise before bed can be quite high because you think that tiring out your body will make you fall asleep quickly. This is not the case. Endorphins are running high after a run or a cycle or an aerobics class, making your body alert. Gentle exercise that allows your body to relax can help you fall asleep more easily. Consider doing some stretching to release tight muscles just before you hop into bed.

If your lifestyle only allows time to exercise in the evenings, you can do workouts like walking, swimming or even light resistance training in the four hours before you go to bed. Just try not to raise your body temperature or your heart rate too much. It’s best to finish your workout at least 90 minutes before you plan to go to sleep.

Scheduling meals correctly

Eating a large, heavy meal just before trying to fall asleep is not conducive to good rest. Your body will still be trying to digest the food while you’re trying to turn most of your internal systems into standby mode. Research shows you should eat your last meal for the day around three hours before you want to go to sleep. This will give your body enough time to digest the food so that it isn’t still in your stomach when you get into bed.

If you find that you’re hungry before you go to bed, you can have a small snack in that three-hour window. It’s best to eat something like fruit or vegetables or a small portion of protein. These are nutritious and will add value to your body, rather than breaking down into sugar that will turn into fat while you sleep.

Learning to quiet your mind 

A racing mind is one of the major complaints that people have when they’re unable to fall asleep. They’re too busy thinking about the past and future and not paying enough attention to being mindful of the present. An internal monologue that dwells on what’s already happened or fixates on what’s to come will keep you awake for hours.

It’s important to learn how to quiet your mind and let thoughts that keep you awake drift away at night. You can do this by reading a book, thinking about places or people you love, or simply observing and enjoying the quiet space you’re in. These activities will get you out of your own head and keep your mind from churning.

Using relaxation techniques 

If your body is tense, it’s alert and wide awake. Whether the tension comes from stress, worry, or a physical ailment, it’s important to learn how to relax.

Practicing mindfulness means paying attention to the here and now and focusing on a singular idea. Mental exercises that methodically take you away from thoughts of whatever is causing tension are an excellent way to do this.

Visualization techniques help your mind become calm and focus on relaxing your body, preventing you from thinking about things that stress you out. Try imagining a warm liquid filling your body, starting at your toes and slowly moving up to your head.

Another great relaxation technique is to run through the muscle groups in your body as you lie in bed. Tense up your calves and then relax them. Then move onto your quadriceps, your glutes, your abdominal muscles and so on. Hold the tension for about five seconds in each section before releasing and then repeat after about 30 seconds.

Your lifestyle plays a role in sleep patterns, and improving the way you unwind will benefit you.

It may take time to create a new mindfulness routine, but regularly getting a good night’s rest goes a long way to keeping you happy, healthy, and revitalized.

Jamie Benjamin is a freelance contributor to Hands Down Better. With a passion for writing, she loves to get creative on topics covering health and wellness, self-care, mindfulness, and fitness. For Jamie, self-care means going on a hike with a friend, reading a good book by John Irving, or having a huge slice of apple pie (with a scoop of ice cream).

Reviewed by the ACA Editorial Advisory Board. Credits:

Preparing Fore(!) Golf

Preventing Golf Injuries

After shutting down in the spring due to COVID-19, many golf courses have since reopened to a boom in activity. It is easy to understand why: golf is an outdoor sport where social distancing comes fairly easy. However, the usual “traps” remain: many avid golfers contort their bodies into oddly twisted postures, generating a great deal of torque. Couple this motion with a bent-over stance, repeat 120 times over three or four hours, add the fatigue that comes with several miles of walking, and you’ve got a good workout—and a recipe for potential low back pain.

As America’s fondness for the game of golf increases, the American Chiropractic Association (ACA) suggests the simple measures below to help you avoid back pain or injury:

Purchase the right equipment:

  • Purchase equipment that fits. Don’t try to adapt your swing to the wrong clubs: Someone who is six feet tall playing with irons designed for someone five inches shorter is begging for back trouble. You may have been given an old set of “starter” clubs by someone, but unless their frame is similar to yours it might not be worth the risk of injury.
  • For senior golfers: If you show some signs of arthritis in the hands, consider a larger, more specialized grip for added safety and performance.
  • For some, scores may not be as important as enjoying the social benefits of the game. Having clubs that are comfortable will increase the chances of playing for a long time without significant physical limitations.

Prepare your body:

  • Take lessons. Learning proper swing technique is critical for avoiding golf injuries. At the end of the swing, you want to be standing up straight. The back should not be twisted.
  • Choose soft shoes or soft spikes, which allow for greater motion. Old golf shoes with metal spikes were not only harder to walk in and tore up the greens, but also increased stress on the back.
  • Warm up before each round. Take a brisk walk to get blood flowing to the muscles, then do a set of stretches. To set up a stretching and/or exercise routine, see a doctor of chiropractic or golf pro who can evaluate what will work best for you.

Make good choices:

  • Pull, do not carry, your golf bag. Carrying a heavy bag for 18 holes can cause the spine to shrink, leading to disk problems and nerve irritation. If you prefer to ride in a cart, alternate riding and walking every other hole, as bouncing around in a cart can also be hard on the spine.
  • Keep your entire body involved. Every third hole take a few practice swings with the opposite hand to keep your muscles balanced and even out stress on the back.
  • Drink lots of water. Dehydration causes early fatigue, leading you to compensate by adjusting your swing, thus increasing the risk of injury. Do not smoke or drink alcoholic beverages while golfing, as both cause loss of fluid.
  • Take the “drop.” One bad swing—striking a root or a rock with your club—can damage a wrist. If you’re unsure whether you can get a clean swing, take the drop.

Reviewed by the ACA Editorial Advisory Board. Credits:

Stress-Relief Strategies

Although occasional stress can help improve our focus and performance, living with chronic stress can backfire by causing anxiety, depression and other problems. Months into the global COVID-19 pandemic, it’s clear that many of us are experiencing higher levels of stress on a regular basis. However, we can better manage our stress by understanding who we are, recognizing our struggles, putting them in perspective, and taking action where possible.

Following are basic strategies that can improve stress tolerance and help lessen the effects of stress on our health.

Think Positively

When optimism is hard to muster, cognitive-behavioral therapy, which trains people to recognize negative thinking patterns and replace them with more constructive ones, can also help reduce the risk of chronic stress and depression.

Get Out and Enjoy Nature

While modern civilization has made our lives more convenient, it has deprived us of an essential source of stress relief—connection with nature. Studies show that interacting with nature can help lessen the effects of stress on the nervous system, reduce attention deficits, decrease aggression, and enhance spiritual well-being.

Use Humor to Find Perspective

Humor relieves stress and anxiety and prevents depression, helping put our troubles in perspective. Laughter can help increase pain tolerance, enhance mood and creativity, and lower blood pressure, potentially improving treatment outcomes for a number of health problems.

Build a Support System

Relationships are key to health and happiness in both men and women, and loneliness may contribute to stress. Building a social support system helps people maintain a higher quality of life. Today’s technologies, such as email, texting and Zoom calls, make it easier than ever to stay connected.

Employ the Relaxing Power of Music

Music, especially classical, can serve as a powerful stress-relief tool. Listening to relaxing music can help us avoid anxiety and an increased heart rate and blood pressure. Singing and listening to music can also reduce anxiety and depression. A dose of calming music may lower stress and anxiety.

Give Exercise a Shot

To get the best of both worlds, a calmer mind and improved physical condition, try exercise. Tai chi, which works for people of all ages, can reduce stress, while also improving balance and posture.

No matter which stress-relief methods you choose, make it a habit to use them—especially if you feel too stressed out to do it. As someone once said, the time to relax is when you don’t have time for it!

Reviewed by the ACA Editorial Advisory Board. Credits:

Summer Fitness for Children and Families

As weather gets warmer and the school year ends, many families are thinking about scheduling summer activities. For kids of all ages, this might include summer camps, family travel, learning a new hobby or playing a sport. While summer activities can be a great way for children to stay physically active, summer fitness doesn’t have to be scheduled.

“One of the roadblocks for families is always this idea that fitness has to come from a class or a sport or something that is structured and scheduled,” says Jennifer Brocker, DC, DICCP, president of the ACA Council on Chiropractic Pediatrics. “That’s not true. Sports and activities are great if your kids are super engaged in that stuff, but that’s not available to everybody. It’s really about helping them build good habits of going outside and creative play.”

There are plenty of activities that families and children of all ages can do around the house or the neighborhood to stay physically active during the summer. “Simple things like just going to the park together are a great way to keep kids active, especially if you can walk or ride a bike to the park,” Dr. Brocker says. Here are a few of her favorite summer fitness ideas for families:

Go for a Walk — And Make It Fun!

Walking around the neighborhood is a great way to exercise as a family, and making the walk engaging can be fun for everyone. Turn your neighborhood stroll into an adventure walk by adding a scavenger hunt component. Have kids look for a certain number or type of objects or point out things in the neighborhood that start with each letter of the alphabet. You can also work together as a family to learn more about the world around you by identifying plants and animals. “Any time that you can make just taking a walk really creative, it’s great fitness: the whole family’s out walking together, and most of the time the kids won’t notice how far they’ve walked because they’re paying attention to something else, so it’s a nice way to get them to walk farther, also,” Dr. Brocker says.

Build a Home Obstacle Course

Home obstacles courses, like adventure walks, are a mix of fitness and family fun. Using objects from around the house, work together to design an obstacle course in the yard, and then take turns attempting to complete the course. Try out different combinations, difficulty levels, or instructions. “It’s super fun to see how creative kids can be in designing obstacles, it gets everybody working together, and then you have this way to spend time together and do something creative that’s also fitness-based,” Dr. Brocker explains. “It keeps kids super engaged, and a lot of times they can build hard courses that are a challenge for parents to get through. It’s a way to be creative and fun with no rules.”

Rainy Day Fitness

For those days when the summer sun isn’t shining, there are plenty of things children and families can do to stay active indoors. A home obstacle course is still possible with some adaptations. “One of my favorite indoor obstacle courses for my kids was to take yarn and spread it between different points in a hallway,” Dr. Brocker says. “It’s like a laser field that they have to climb through like spies.”

Yoga is also an option for indoor exercise. YouTube channels like Cosmic Yoga offer story-based yoga practices designed for kids. “It’s one of my favorite things to recommend for kids who are anywhere from kindergarten to about 10, 11 years old,” Dr. Brocker says. “Yoga is such a great activity for kids. It promotes a lot of connection to your body, it provides a lot of calm, a lot of stretching and strengthening, so it’s a great all-around activity. And parents can absolutely do it, too.”

Family Fitness: Benefits and Safety Tips

In addition to physical health benefits for everyone involved, exercise can have mental health benefits for children and adults. Getting kids up and active, especially outside, gives them a break from screens, which can be good for them both physically and mentally. Staying active has been shown to benefit mental health, and family fitness can strengthen bonds between family members of all ages.

“Any time that you’re doing things as a family, it helps that attachment and bonding, even when your kids are older,” Dr. Brocker says. “It’s a way to stay connected where you can continue to build the attachment and bond that you have as a family. When you’re doing physical things together, it boosts everybody’s mental health at the same time, everybody feels connected, and that really helps support development for kids.”

Safety is always an important consideration when doing physical activity, and there are certain things to keep in mind when exercising with children.

  • Choose age-appropriate activities and items. A home obstacle course for a two-year-old is going to look different from a home obstacle course for a 10-year-old. Don’t put kids in a position to do things outside of their physical skill levels.
  • Pay attention to children’s limits. Kids are attuned to their bodies’ limits. Take breaks from strenuous activities like swimming or jumping on a trampoline, and listen if your child says they’re ready to stop exercising.
  • Stay alert. If you’re walking in the neighborhood, have smaller children hold your hand so they can’t wander into the street. During any sort of water activity, don’t ever put children into a situation where they could be over their heads. “If they can’t touch the bottom, they need to be with you, even if they have a flotation device on or with them,” Dr. Brocker says.

Additional water safety tips include walking instead of running on pool decks and ensuring that backyard pools have fences or other safety guards around them. Dr. Brocker recommends survival swim lessons, which are available in some places for children as young as six months old.

For more health and wellness information, or to find a chiropractor near you, visit ACA online at

Reviewed by the ACA Editorial Advisory Board. The information in this post is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional. Credits:

Make Your Home Workstation Work

As a result of the COVID-19 pandemic, many people are finding themselves working from home–with very little notice to prepare. Some without a dedicated home office are using coffee tables, recliners, kitchen tables and counters, and any number of other surfaces and locations as makeshift workspaces. All can potentially lead to aches and pain.

Scott Donkin, DC, DACBOH, and Scott Bautch, DC, DACBOH, ergonomics specialists and members of the American Chiropractic Association (ACA) Council on Occupational Health, are accustomed to making recommendations for their patients’ traditional workspaces, but they also understand that in times of unexpected change people must find ways to adapt quickly.

At the start of the pandemic, the two doctors noticed that many of the workers forced to go remote were working on laptops, which was contributing to their musculoskeletal issues. Here are their suggestions for making a home workstation work with your laptop:

  • Pick a spot. If you do not have a regular desk at home, working at a kitchen table is generally much better than sitting on a couch with your laptop on your lap.
  • Adjust your seat. For those without an ergonomic chair, use a seat wedge to help maintain better posture. Sitting on the wedge makes you tilt your thighs forward and down, which causes you to arch your back and sit up straighter. You can purchase seat wedges online, or you can make your own by folding a bed pillow in half to form a wedge.
  • Adjust your monitor. The kitchen table is often too low for the laptop screen. Try placing large coffee table books or reams of paper underneath to raise the laptop in a stable way so that you do not have to raise your hands up uncomfortably, or bend your head down uncomfortably. Consider purchasing a wireless keyboard, which enables you to raise the laptop screen higher—to eye level—and place the keyboard on the table top, which will encourage better posture.
  • Create a DIY sit/stand station. The popularity of standing desks has increased significantly over the past several years. You can create your own standing desk at home by simply working at a raised counter (such as in a kitchen) but be sure that the height of the counter does not cause you to bend your elbows too much. You should be able to comfortably reach your keyboard with elbows bent at about a 90-degree angle. While you’re at it, consider using a wireless keyboard and boosting the height of your laptop screen to eye level with books, reams of paper, or a stand, which in turn will prevent neck strain (see photo).

Below, Dr. Scott Donkin demonstrates working at a raised counter. Elbows should be bent about 90 degrees and monitors should be raised to eye level, which prevents neck strain caused by looking down at the screen.

Don’t Forget to Stretch and Move!

Drs. Donkin and Bautch note that every seated workstation, even a makeshift one, can also be a sit/stand station. All you need to do is stand up every 20 minutes or so and take a break that includes some stretching and movement. They offer this example:

  1. Stand up and move your legs up and down as if you are walking in place.
  2. Look at an object that is more than 20 feet away for about 20 seconds.
  3. Gently shake your hands wrists and elbows for a few seconds while you are also gently rolling your shoulders up, back, and down.
  4. Take a slow, deep breath in to improve your posture and smile, then slowly exhale.
  5. Sit down, refreshed, in a good posture. You are ready to get back to work!

Reviewed by the ACA Editorial Advisory Board