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So….. You made a NewYears resolution to get in shape and lose weight.  Did you keep it?  How far did you get?  Well, maybe you just made some easily fixed mistakes.  Since graduate school I’ve worked in numerous doctor’s offices, all of which provided some sort of general health and fitness counseling.  The two greatest mistakes people make when getting into an exercise or weight loss program are that they make it too hard or too complicated.  Now I know you have heard this before but I promise to provide real examples and real help before the end of this article. 

First, if your resolution was to get into shape, you need to decide what you want to be shapely! Are we talking about your general health or are we talking about your thighs?  For example, many of our patients want to be in “better shape” and by that they mean a healthy heart and better over-all endurance for their daily activities.  If you want to trim down, I’ll address that a little later. If health and fitness is your goal, you need to find an activity that will cause you to reach your target heart rate (pulse rate) for 20 minutes three times a week.  For the regular guy or gal that is all you need to do and your cardiovascular health will improve.  You will feel better and you will enjoy all the benefits of better health.   To figure out your target heart rate (beats per minute) you subtract your age from 220 and multiply it by 0.7.  Take your pulse as you exercise and see how close you get.  If you do not reach your target pulse/heart rate right away don’t worry about it.  The most important aspect of this exercise is that you do it.  Even if you don’t reach your target the first month, don’t worry about it.  I would even go so far as to say don’t schedule more than 20 minutes even if you reach your target heart rate and find it very easy.  The thing that makes us motivated to get into shape is many times fleeting.  It’s the person who sticks with the moderate activity for the longest time who will reap the greatest benefits. If the activity of your choice consumes too much time you will eventually have to reschedule it as life’s other priorities take over.  If you do too much your gonna hurt! And probably the most important aspect of doing any physical exercise --- you have to make your workout fun. What is enjoyable is different for everyone so think about what will work for you. Do something you like. Lets face it, if you wind up thinking of your workout as a chore you won’t stick with it very long. I personally enjoy jogging by picturesque bodies of water, but “to each their own”.  

Did that resolution include weight loss?  I’m going to give you a somewhat simple formula to design your own weight loss program.  Please forgive me for not referencing any celebrity testimonials or pushing any prepackaged foods.  If you want to lose body fat you simply have to expend more energy than you consume.  This is not an oversimplification, it’s a scientific fact. You use energy to breath, keep your heart beating, and blink, all of this is defined as your BMR (basal metabolic rate).  You use energy to walk, talk, and type as well and that’s referred to as your Voluntary Muscular Activity. The foods you consume are simply a fuel source and so are those love handles.  To figure out your BMR: (and I’m sorry about the math) 

Basal Metabolism:  Use the factor 1.0 kcalories per kilogram of  body weight per hour for men, or 0.9 for women. 

1.     Change pounds to kilograms:                                ________ lbs  (divided by) / 2.2lbs/kg  =  _______ kg. 

2.     Multiply weight in kilograms by the BMR factor:                 _______ kg (multiplied by) x 1 kcal/kg/hr =  _______ kcal/hr 

3.     Multiply the kcalories used in one hour by the hours in a day:                 _______kcal/hr  x  24 hr/day  =  __________ kcal/day = Energy needed for BMR. 

Then you need to decide about how much energy you burn off during a normal day.  Be honest! 

Voluntary Muscular Activity:  The following figures are crude approximation based on the amount of muscular work a person typically performs in a day.  To select the one appropriate for you, remember to think in terms of  the amount of muscular work performed; don’t confuse busy with being active. 

1.     For sedentary (mostly sitting) activity ( a Typist), add 40 to 50 percent of the BMR.

2.     For light activity ( a Teacher), add 55 to 65 percent.

3.     For moderate activity ( a Nurse), add 65 to 70 percent.

4.     For heavy work (a Roofer), add 75 to 100 percent or more. An Example:1,632 kcal/day  x  50% (Secretary) = 816 kcal/day  Then add this to the BMR.1,632 kcal/day + 816 kcal/day  =  2,448 kcal/day. _______ kcal/day x  _______%   =  __________kcal/day  +  _______ kcal/day = _________ kcal/day

Did you do this right? Example: 172lbs man (teacher) close to 3,095.99kcal/day
150lbs woman (typist) close to 2,209.09kcal/day       

This final figure will tell you what you can consume calorie wise to break even and maintain your particular weight.  If you consume a little less you should loose weight, you consume a little more you should gain.  In a practical sense any diet will have to include some calorie counting.  You are going to have to read a lot of labels, which can be tedious at first. However, you will be much better off knowing what you’re really eating! The choice of foods should be roughly 30 percent or less calories from fat,  35 percent of calories from carbohydrates, and 35 percent of calories from proteins.  This is what the experts suggest as a healthy balance.  Fad diets are great but if you actually read the books almost all of them suggest a healthy balanced diet when you reach your target weight. I suggest you start off the right way and stick with it. The best way to get started is eat to maintain your current weight by the formula and see if you feel satisfied. If you are hungry all the time, you estimated your activity level wrong or your math is off. And remember, you are setting yourself up for failure if you try to loose too much too fast.  When you shed a lot of weight fast your body thinks your starving and you will rebound if you slip up. It is my experience that if patients try to start an exercise program and a diet at the same time they also fail. It takes a lot of discipline for either and most of us can’t do it for very long, myself included.  When you increase your activity level your gonna get hungry, hungry, hungry.  Do I think it is a good idea to shed those extra pounds and exercise regularly? Yes. I am just saying it is very hard to start both when you have been doing neither.  

This brings us back to the original question I had of your resolution.  What did you want to be shapely? Unfortunately, you can do sit-ups until you have the abdominal muscles of Arnold but if you are not expending enough energy to reduce your fat stores you will still have a gut.  What you will have is strong tone abs under a layer of soft tissue fat. Which is completely normal, its how our bodies are designed. The principle is the same no matter what part of the body we’re talking about. So figure out your real goal and proceed with a passion.  If something doesn’t feel right or you have any hesitations go see your doctor.  Physicians and therapists are impressed by people who want to take charge of their own health.  If you have any physical ailments, if your no spring chicken, or if you are more than 30lbs over weight, you should consult your doctor before starting any weight loss or exercise program.  

Dr. Kevin S. Steele, D.C.

If you’re looking for a safe bet, bet that at some time in your life you’re going to have a least one episode of debilitating back pain. Back pain is actually as common as headaches in the adult population. It is estimated that 80% of the adult population in our country will experience some form of low back pain in their life time (Tribune media services, 91-92-93). Would you believe that nearly half of the people reading this article have back pain right now? The prevalence of low back pain in the USA in any given month, is 41.7% in females, and 34.5% in males (Spine 1995;20:1889-1894).  It is a huge problem that costs us millions of dollars in lost wages and endless personal grief. Even our federal government has issued guidelines to the healthcare community for the treatment of this “epidemic!”  But as I see it, all these back aches are not the real problem. In fact, the majority of people who experience one episode of uncomplicated low back pain heal completely on their own.  That’s right, the pain just goes away like a headache. The real problem is getting out the information people need to avoid serious back problems. But how do you know when your one episode of back pain is more than just a passing annoyance? A Quick easy reference is as follows:

Acute low back pain can be generally divided into three practical categories. The first, is low back pain that starts after a recognizable incident, is not severe, goes away after only a few days, and does not preclude you from doing your normal daily activities.  What’s severe? Well, as a general guideline you can say that anything over a 6 on a 0 to 10 scale is severe (0 being no pain at all, and 10 being the worst pain imaginable). If you have back pain that falls into the first category it will likely be self-limiting and not require a trip to the doctor.  The second category, is comprised of any back pain that does not fit into the first category.  Any back pain that you would deem severe, does not go away in a few days, keeps you from your normal routine, or that comes on for what seems like no reason, warrants a trip to a health care provider. In addition, any back pain that comes with radiating/shooting pain or numbness down a leg should be added to this category.  In many cases this second type of low back pain is also self-limiting, but it is generally recommended that your health care provider eliminate any serious underlining medical problems with a good physical examination. The third category is comprised of any low back pain that is associated with an inability to control your bowel or bladder, or comes with extreme leg weakness, a high fever, abdominal pain, or numbness in the groin or rectal area. If you have any of these symptoms with your back pain you should go to the emergency room right away!

If you do end up having to go see your health care provider what can you expect?  What will happen at the doctor’s office? Your health care provider will ask you about your symptoms in detail.  He or she will ask you about the history of the injury and your general health history.  They will also give you a physical exam. It is important to check out if any other more serious medical illness is causing your back pain. Assuming there is not any serious medical problems to worry about, there are a variety of treatments that help relieve low back pain! Medicine: Medicine often helps low back symptoms.  The type depends on the severity of the symptoms, your allergies, the strength of your stomach lining, and so on.  But generally, over-the-counter strength medicines such as acetaminophen, aspirin, or ibuprofen are prescribed.  Stronger medications are prescribed for more severe symptoms. Heat & Ice: Low back injuries can be treated just like sports injuries when it comes to the application of heat or ice. The first 48 to 72 hours after the symptoms start one should apply ice for 5 to 10 minutes at a time repeatedly.  (Never apply ice directly to the skin) After 48 to 72 hours one can apply heat (hot packs/warm showers/hot tub) in the same manor.  Spinal Manipulation: This treatment (using the hands to apply force to the back to mobilize poorly aligned or “locked up” vertebrae) has been shown to help elevate low back pain. It should only be preformed by a professional with experience in manipulation. Physiotherapy:  Physiotherapy is the term used to describe treatments from a variety of machines designed to reduce pain and swelling in joints or muscles.  Some examples include, TENS (transcutaneous electrical nerve stimulation), Low volt current, Interferential current, and Ultrasound.  These treatments should only be applied by a professional, with training in physiotherapy modalities. Massage: Massage has been shown to help reduce the muscle spasms that come with low back pain. Exercise: Most health care professionals suggest you avoid any strenuous exercise when you have acute low back pain. Although, mild stretching can also help reduce the muscle spasms that come with low back pain.

What kinds of things can I do to help my back pain? There are many little tricks you can employ to help alleviate your back pain! * Wear comfortable, low-heeled shoes. * Make sure your work surface is at a comfortable height for you. * Use a chair with a good lower back support that may recline slightly. * If you must sit for long periods of time, try resting your feet on the floor or on a low stool, whichever is more comfortable. * If you must stand for long periods of time, try resting one foot on a low stool. * If you must drive long distances, try using a pillow or rolled-up towel behind the small of your back.  Also, be sure to stop often and walk around for a few minutes. * If you have trouble sleeping, try sleeping on your back with a pillow under your knees, or sleep on your side with your knees bent and a pillow between your knees. * And, the single best thing you can do for your back, is stay in shape! Healthy backs heal faster!

Dr. Kevin S. Steele, D.C.

Running, like walking, seems like a series of simple movements at first glance. Yet a careful analysis reveals the act of running to be a very complex task.  A trained eye can break down the simple act of running into nine definable parts, and that’s just for one leg. Then adding all the sequenced muscle actions and joint movements together demonstrate the coordinated teamwork required for any speedy locomotion. When any one of the parts that comprise the whole process becomes off balance, injuries can and do happen.

Runner's knee, also known as Chondromalacia, is a common condition causing knee pain. The pain can develop close to the kneecap, under the kneecap, at the front of the knee, or on the side of the knee.  The pain tends to be gradual in its onset, increasing over weeks or months.  The problem arises when the cartilage under the kneecap starts to wear away.  The inner surfaces of the knee joint becomes rough, and tell tale signs may include a grinding sound when the knee is bent.  Why does this happen?  There are quite a few possible scenarios. More common causes of Runner’s knee include the following: 1. not warming up properly before you begin to run, 2. lack of flexibility in your quadriceps and or hamstrings, 3. weakness in your quadriceps, 4. running on a sloping road or hill, 5. poor initial contact of your foot on to the ground, 6. running to much early in your training sessions, and 7. running to hard early in your training sessions.

Prevention of Runner’s knee can be simple. First, address the following:  Stay flexible.  Begin and end each exercise session with slow static stretching of the quadriceps, hamstrings, groin, calf, and low back muscles.  Press slowly into your stretch, never bounce when stretching! Maintain a well-balanced exercise program that focuses on strength and endurance.  Don’t be a weekend warrior. Start out slowly and work up your endurance or distance. Train your whole body, not just your legs.  You can’t  forget about your belly and your back muscles. Muscles above your waist help provide stability for your hips and pelvis. Your hips determine how your whole lower extremity will hit the ground and so on. Avoid deep knee bends and bicycling against a heavy resistance.  This can just be tremendously hard on your knees. Be fitted with a running shoe that fits your foot correctly.  Shoes are a runner’s most important piece of equipment and should be chosen wisely. There are several running shoes on the market that focus on different aspects of ones foot and the way it makes initial contact with the running surface.  Each runner has his or her own unique stride and I recommend that each runner be fitted by a professional for a proper fit.  Avoid running on sloped or camber surfaces.  This will avoid putting too much stress or strain on to lateral aspects of the knee and lower leg.  Avoid running on cement.  Cement is a hard surface that will increase the impact shock on the knee joint. It is best to pick a softer surface.  Running in the sand or on the beach is also not recommended because it can cause excessive pronation, ankle turning over, or stretching of the Achilles tendon. Pronation or a loose Achilles tendon can lead to ankle sprains.  Experts recommend running on a track or a firm gravel surface.

Again, Runner’s knee can be prevented if you take some simple precautions.  Nevertheless, if symptoms arise or persist, seek help from a professional.  Use your body as a guide.  If you feel pain, it is your body’s way of telling you that something is wrong.  “Listen to your body - work with it, not against it”. If you catch the problem early, you can prevent further damage from occurring.  The earlier you diagnosis Chondromalacia or Runner’s knee the easier it is to rehabilitate.  A licensed physical therapist can lead you to recovery.  A physical therapist can develop an exercise specific program focusing on your deficits and problem areas.

 

1.Roy Stephen, Irvin Richard: Sports Medicine: Prevention, evaluation, management, and rehabilitation. Englewood Cliffs NJ, Prentice Hall, 1993. 

2. Holt D: Running Dialogue. Chondromalacia (Runners Knee) and Iliotibial Band Syndrome…Knee injury advice. 2000. 

Dr. Kevin S. Steele, D.C. 

Want to have FUN and do something good for your back?  There’s lots of good evidence now-a-days that we, as practitioners, have been pushing the wrong kinds of exercise!  It used to be the goal of rehabilitation to get the Patient to increase their range of motion and strength, and let’em go. Patients and training clients went home with lots of stretching and repetitious exercises. We all know how long it takes until you loose interest in that kind of exercise. Newer research is indicating that although range of motion and strength is good, something called Proprioception is also extremely important. Our Proprioceptive ability is the ability of our muscles, tendons, and joints to transmit information about their position to our brains.  In English, its our ability to be coordinated and balanced. Exercise for coordinating your back can be fun and easy. But, let me give you an example of why it is so important.  Let’s say you’re a lawyer.  The majority of your day is spent in front of a computer or at a desk.  Your functional range of motion is small.  It is not all that important for you to be able to touch the bottoms of your feet to the back of your head! The amount of stretching and bending you do is minimal and you can accomplish it easily. So why would it be that simply bending over to pick up a pen would “throw your back out”?  Simple, poor Proprioception and balance! Backs with coordinated muscles rarely “go out”!  Balanced joints surrounded by coordinated muscle do not catch wrong and cause pain. They react quicker when we take a wrong step or try to rapidly move beyond our normal activities. What I’m getting at here, is that a coordinated back is more important than one with a huge range of motion, for people who do normal activities. One of the easiest ways to coordinate your back is doing simple exercises on an Exercise Ball.  There are very easy exercises for beginners and challenging exercises for the more adventurous.     

Salters Creek is offering Exercise Ball (Proprioceptive) training.  The exercises are great for toning up as well!  Dr. Kevin S. Steele, D.C.

Help, "I've fallen and I can't get up", a phrase made humorous by poorly acted TV commercials, but it happens for real more often than you think.  As most medical professionals know, the probability that you will experience a bout of low back pain is extremely high.  For example, the prevalence of low back pain in the USA in any given month, is 41.7% in females, and 34.5% in males (Spine 1995;20:1889-1894).  These statistics taken as they are, produce a certain anxiety in most, myself included.  And lets face it, the percentage given for males is probably conservative as men are notorious for denying any pain they can't successfully treat themselves.   

It is estimated that 80% of the adult population in our country will experience some form of low back pain in their life time (Tribune media services, 91-92-93).  So odds being what they are, what's to be done when it happens to you?  First and foremost, many bouts of low back pain resolve on their own.  Simple muscle pain can be treated with over-the-counter medications which include aspirin and ibuprofen, please always take as directed.  In addition, basic first-aid such as cold compresses or ice packs are indicated for the first 48 hours. It is generally recommended that if you experience any pain or unusual stiffness after this 48 hour period you should seek an appointment with a medical professional.  Should you have any symptoms that include pain, numbness, or tingling into an extremity you should seek professional help despite being within the first 48 hours or after.  Any bowl or bladder incontinence constitutes a medical emergency and requires a trip to the emergency room.

Danger signs aside, if you do end up having to go to the doctor what can you expect?  What should you look for?  Any Physical therapist, Chiropractic physician, or Medical doctor should and will perform a through examination. They should give you a diagnosis and set up a treatment plan. This plan will include some therapy aimed at controlling the acute aspects of pain and inflammation in your spine.  These treatments might be anti-inflammatory medications, physiotherapy (electrical machines or ultrasound), or ice to name but a few.  When pain and inflammation are under control some form of rehabilitation should be undertaken.  It is now widely accepted that simply killing the pain so that an individual feels comfortable enough to re-injure themselves does them a disservice.  Even though we all avoid it, rehabilitation exercises to restore flexibility, coordination, and strength is always prudent.  If a conservative course of  treatment does not sufficiently improve the symptoms of your injury a referral to a specialist such as a orthopedist may be made.   

If you have any questions concerning a low back problem or any musculoskeletal ailment please do not hesitate to call. My partner, Dr. Karyn Lewis, or I would be happy to speak with you.  

Dr. Kevin S. Steele, D.C.

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