We are getting to that time of year again. Some folks are preparing to make resolutions and goals for 2023. It’s a yearly tradition for many folks to conjure up various New Year’s Resolutions for health and other aspects of their lives. It sounds great initially coming up with inspiring things on a “To-Do List for My Life Beginning Next Year”. But the success rate of following through is not great.
According to a 2016 study, of the 41% of Americans who make New Year’s resolutions, by the end of the year, only 9% feel they are successful in keeping them. An earlier study in 2007 showed that only 12% of people who set resolutions are successful even though 52% of the participants were confident of success at the beginning1. The reasons cited for failing include the goals needing to be more realistic; forgetting about making the resolutions and having too many resolutions to follow.
As Chiropractors, we tend to be sources of motivation for our patients. We want to help them not only feel better but achieve optimal health. We are part of the healthcare movement that encourages patients to get and stay active. We have witnessed today’s society where lifestyle and everyday habits reflect sedentary activities. COVID-19 measures really kept people indoors in front of the computer or their desks. Breaking away from this “trapped” model of daily existence is important for many aspects of our lives.
I want to be supportive of my patient’s health resolutions as we head to the New Year. In an effort to encourage and nurture those goals, I look to stack the deck in our favor. Instead of having the patient come up with too many resolutions or those that are too difficult to attain, let’s look at some of the aspects of their daily lives that are easily identified and modified. These will help set the stage for larger accomplishments that can come sequentially with time.
In an effort to help your patients begin 2023 on a high note, we can analyze some specific Activities of Daily Living (ADLs) that create stress on their bodies that they may not be aware of. Interestingly enough, many healthcare practitioners that our patients seek care from fail to identify and analyze ADLs effectively. These stresses confound your Chiropractic treatment plan and destabilize the patient’s body. These negatively affect the spinal/extremity adjustments, exercises, and home care you are so carefully providing.
Sitting is the new smoking, the age-old enemy of the body and is a necessary evil to some degree. Many jobs and ADLs demand we sit down. I always encourage people to limit the amount of sitting to 30–45-minute increments so they can get up and move around. The problem is when an average person gets engrossed in what they are doing, has a meeting, or is under a deadline, the idea of standing up is forgotten. It’s not uncommon for patients to indicate many hours will go by before they stand up.
Many of you have been suggesting your patients get a stand-up desk. In many cases, desks come with the ability to be low for sitting and then convert to a higher level for standing. This encourages and allows the patient to mix in standing with sitting, easing the stress on their bodies.
Please help teach your patients to make good choices when they do sit. Have them use the right kind of chair. A fully adjustable chair (armrests, seat height/tilt, etc.) for their desk would be preferable. For casual settings, have the patients avoid the sofa or couch. Most of these furniture pieces are unsupportive and put the pelvis, hips, and lower to mid back under mechanical stress. Even a dining room chair or the floor can be better choices to sit on than a softer surface.
By the same token, we don’t want someone standing all day. That is too much pressure on the body over time, even with a great pair of Foot Levelers custom flexible orthotics underneath their feet. I encourage 1-hour blocks of sitting and standing when someone has a convertible desk.
It may not surprise you to learn that 54.1% of people sleep on their side (fetal position), 37.5% sleep on their back and 8.4% sleep on their stomach2. The sleeping position has significant effects on our bodies and how well our adjustments are supported or thwarted. Sleeping on the back puts the least amount of stress on the body. Side sleeping puts strain on the TMJ, neck, shoulders, ribs, hips, and knees. Sleeping on the stomach is rough because the person tends to turn their head to the same side every night in order to breathe. Also, add in the strain on the lumbosacral spine.
I often joke with my patients that “It’s easier to change your religion than change your sleep position”. In all seriousness, it is very difficult to take someone from sleeping on their side to their back. Try your best to convert them. It is so much healthier for them to sleep on their back. The problem is people who snore. Snoring is amplified on their back which is why so many sleep on their side. If they have to sleep on their side, then it’s time to talk about the pillow.
Pillows are one of the most important things I discuss with a patient who has headaches, or neck, upper back or shoulder pain. So many pillows are sold that are garbage. The patients don’t know how to look for a good pillow because no one has taught them. They are susceptible to marketing from these companies and they are all easy pickings. As a Chiropractor, you are an expert in alignment and posture so have your patients bring in their pillow for you to assess.
With the patient lying on their pillow on my massage table, I can see exactly how the pillow is supporting or not supporting them. An appropriate pillow for the patient will cradle their neck in neutral while on their back and keep their shoulders and cervical spine at a right angle (90 degrees) while on their side.
What I am really after in this section is identifying if your patient is engaging in the proper exercises. Often, we find patients performing exercises, sports, or activities at unhealthy levels because they think this is how they will get the best benefits and results. Some patients force themselves to keep doing certain activities even past the point of pain.
When it comes to exercising or getting back to being active as they get out of pain, I ask the patient what activity they would love to do first. I know that if the patient enjoys that activity, there will be greater success in following through. Whether it is yoga, swimming, walking/jogging, or pickleball is purely patient-specific. We will start with that activity whenever possible and get the patient excited and motivated. Keep in mind, I also want to make sure that the activity is appropriate and safe for their condition.
As a Chiropractor, you are well versed in how you want them to start and advance with the activity. If someone is coming off of a bout of lower back pain, going right back to running 10 miles at a stretch is not safe. Have them build up their walking before running or modify the activities to get them where they want to be.
Obviously, if you can make their exercising and activities fun, the likelihood of them continuing and making it habitual is higher. If you feel they need stretching and strengthening, wherever possible make it fun for them. Tailor the exercises to that patient’s motivation and they are less likely to make up excuses for not doing it.
Wearing Proper Foot Support:
Please take the time to check the various shoes your patients wear. I am not saying you have to examine 30 pairs of shoes on the next visit. But have the patient bring in 1-2 pairs of athletic shoes and 1-2 pairs of dress shoes (if they even wear dress shoes). Many people just wear athletic shoes now since they work from home so that is even easier for you.
There are really no shoes made in any category that have proper, 3-arch support. If you look into the shoe and remove the insole (if possible), you will see it’s essentially a flat pad. Your patients are pronating and supinating excessively inside their shoes. It’s up to you to look at this and show them they need to have better arch support that you can provide.
Flexible, custom, 3-arch orthotics are critical in keeping the patient’s overall foundation stable. Including these for patients as part of their activity program and long-term goals will help their overall health and your practice.
Remember when we talked about shifting patients to a standing workstation earlier in the blog post? Don’t forget to remind the patient to wear their Foot Levelers orthotics in whatever shoes they are wearing. This is really more of an issue when people are working from home as they are often barefoot, in socks, or wearing slippers.
Patients are excessively pronating while standing inside their houses as much as they are when they are out in the world. So put those orthotics in their slippers or a clean pair of house shoes. This is equally important for people who cook, clean or do any weight-bearing activities in their house. No more unsupported feet inside your house!
This is also a great time for you to check the state of their orthotics and examine or reexamine the athletic and dress shoes they wear most often. Orthotics wear out for patients in different timelines. Some patients are so hard on their orthotics that they need to be replaced after one year. Remember, patients will not get the maximum benefit from orthotics that are worn out or damaged. Is it time for a re-order or a new scan?
Some patients cram the orthotics into the wrong shoes so which affects how long the orthotics will last. Be sure to encourage patients to get the right custom orthotics for all their activities for the best outcomes. Round-the-clock alignment supports chiropractic care and makes them feel their best. Also, patients often wear shoes for too long. A worn-out shoe will reduce the effectiveness of the orthotic for the patient. Aside from using your eyes to identify shoe wear and tear, you can do a standing muscle test using the patient’s arms or a squat test with the patient wearing the orthotics/shoes. It might just be time to throw out those old shoes and replace them with new, better supportive ones.
Examining these various ADLs for our patients will provide tangible action steps to take that will enhance their overall health. Making the appropriate changes sets the foundation for other goals or resolutions for their health that they will make. As Chiropractors, we have the opportunity to help our patients become more active and healthy. Our work will enable them to formulate goals and resolutions that will be achievable and attainable. Have fun out there!
Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.
As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at footlevelers.com/seminars. Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.