Practice Guides

Centrum Vitamins: The Good, The Bad, & The Ugly

Great, you’re taking a multi-vitamin. Which one? Ahhh, Centrum. Let’s have a discussion.
I’ve had this conversation too many time with my patients over 50. The answer is often “Centrum Silver” or “Centrum Women’s 50+.”  I’ve had the conversation too many times, so I’m writing about it here.
Centrum has some great marketing, I’ll give that to them (The Good). Marketing supplements as healthy when there is a bunch of junk in there, is genius, if not downright wrong.
And I get why people buy them. It’s advertised to be this ultimate multi-vitamin with everything you could possibly need.
And why would we trust Wyeth, the company that […]

Can Stress Lead to Osteoporosis?


I find what is missing in information on osteoporosis is the effect of stress on bone health.

People talk and write about nutrition and exercise (though not in much specifics). But even in some yoga books, the element of stress reduction is not addressed.
Maintaining strong and healthy bones is a complex process.
And there are many factors at play: genetics, nutritional deficiencies (Vitamin D, phosphorus, calcium), medications (glucocorticoids like cortisone and prednisone), positive or negative stresses on the bones, our immune system, and hormones that are in disarray (thyroid, human growth hormone (IGF-1), estrogen, testosterone, cortisol, insulin).

Osteoporosis, meaning, “porous bone,” is a skeletal disorder characterized by compromised bone […]

Is jumping or hopping ok with osteoporosis or osteopenia?

I really started to investigate this information because I was curious how much force/pressure on the spine is produced by certain exercises. In particular, by someone that may have a compromised spinal column and wanting to exude the least amount of compression to the spine as possible.
One article1 with a small sample size demonstrated spinal loads given cycling, walking, standing or lifting 10kg. The smallest force on the spine was with unweighted standing, then with cycling, then with standing and then with lifting 10kg (see image). Not surprising. But it was nice to see some evidence (again with a small sample) that provides some […]

Pre-hab: Prepare Yourself for Surgery

You’ve heard of rehab, but have you heard of “pre-hab?”




Prehab is preparing your mind, body and spirit for surgery.
Recently, I’ve seen many of my patients and friends heading into surgery. But often times what I hear is that their care provider did not educate them on preparing for surgery. Prehab has been shown to reduce hospital stays and reduce the post-surgical pain experience.
A study by researchers at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School, based in Boston, found that knee and hip replacement surgery patients who had participated in water and land-based strength training, and aerobic and flexibility […]

Shoulder Series: Pain relief and strength using mind, body, breath awareness

Shoulder Series

Find pain relief and strength with yoga, breath and posture for rotator cuff injury

I created these a couple years ago but realized I never really posted them here. So here they are! There are certainly other aspects I would address, such as lifestyle, nutrition, sleep, etc. However, the emphasis of this post is on the physical.
What you will find:

Introduction to this Shoulder Series

Caution about these exercises

Posture and shoulder pain

Dolphin Glides for shoulder strength

Alternate Leg Lift with Strap for shoulder strength

Side Planks for shoulder strength

Sleeper Stretch at the wall

Sleeper Stretch sidelying

Shoulder Opener with strap

Neck Stretches for Shoulder Pain

Triceps Stretch

Posterior (back of) Shoulder Stretch–Eagle Arms

I […]

Hic-Hic-Hic…..A Method to Relieve Hiccups

Definition of a Hiccup: “A quick, involuntary inhalation that follows a spasm of the diaphragm and is suddenly checked by closure of the glottis, producing a short,relatively sharp sound.” (

So if the hiccup is a result of a spasming diaphragm, then I would hypothesize that performing a bit of massage or soft tissue work on the diaphragm during the spasming episode should help it to ease. In fact, WebMD lists massage as a way to ease muscle spasms. And on a search for “massage and spasm” on APTA’s (American Physical Therapy Association) Move Forward page, 39 results come up.

I don’t know why I didn’t think of this earlier, […]

4 Ways to Get Your “Yoga On-the-Go”


I’ve heard before. You’ve heard it before. Shoot, I’ve said it before. “I don’t have time for yoga.”  NOW I know this is true. There is always time for yoga. Or perhaps you might have thought, “I don’t know how to do yoga.”  Well, you’re in for a treat. And it doesn’t cost anything….just a little well-spent time.

But before I learned what yoga could be, I probably would have felt the same way. “If I can’t get to yoga class or get on my mat, then it’s not yoga.”  Again, not true. The yoga asana (postures) are just one way to “do” your yoga. […]

Non-grippers only!….4+1 Poses/Exercises for Awareness + Strengthening of the Pelvic Floor

Now that you’ve learned a bit more about where that pelvic floor is and most importantly, how to relax it, it’s time to venture into strengthening that baby up!—but not too much….then we’d back to square one. There should be balance. Just like the song (or the Book of Ecclesiastes, depending on your version), “To every thing there is a season, and a time to every purpose.” There is a time to contract, like when you’re doing something requiring more force, like lifting your child or kicking that soccer ball. And there is a time to relax, like when you’re going to the bathroom.

Think of […]

Ahhhh…..3 Simple Poses/Practices for Awareness and Relaxation of the Pelvic Floor

So you’ve been told to do Kegel’s. Why? Possibly because you’ve been told you have incontinence or overactive bladder syndrome. But what if there is more to the story? What if you have pain “down there?” Or what if you have low back pain (LBP) or sacroiliac joint (SIJ) pain? Kegel’s, or contracting and strengthening the pelvic floor may not be appropriate for you. Sometimes the muscles of the pelvic floor are overworked, or tense or hyperactive (you choose). And this imbalance between short/tight muscles may be at the source of your issue (pain, incontinence, etc).

Let’s put it this way: if you have a […]

Chronic Inflammation: Change your Lifestyle, Change your Genes. (Part II)

Let’s just start Part II by saying that the body is one amazing creation!  You do something, eat something, think something and there is an entire cascade of events that happen inside your body. The result is good/bad, necessary/unnecessary. Whether you like it or not, it’s happening.  But there are ways to alter the cascade. Part II will be looking more into empowering you–you just have to make a choice.

So last time (Part I) we looked a bit at the inflammatory process and where your medicines (NSAIDS, corticosteroids) come into play.  And how dietary nutrients can also alter the inflammatory process by halting the very enzymatic […]

Chronic Inflammation: Are you at risk? Where do NSAIDS fit in? (Part I)

We ultimately take medicine to get a result, right?–decreased pain, decreased inflammation, improve digestion because we’re taking medicine to decrease our pain and inflammation….you get the idea.  Over medicated and under nourished–it’s the world we live in. Don’t get me wrong, some medicines have stepped in and stopped epidemics and if I was faced with Ebola, I would definitely take the meds.

But the medicines that were designed in labs were created to step in at crucial pathways in the body to inhibit pain and inflammation. And they actually mimic natural dietary source, meaning they have an effect on the very same enzymatic pathways and genetic transcription.  So […]

Trust Your Gut, Heal Your Gut: A Personal Story


I just wanted to share my personal story of working through a case of systemic inflammation—because I didn’t think it could happen to me.  And perhaps you are feeling similar and it might help direct you towards some resources so you can start to feel better.

I consider myself to be healthy—a vegetarian since 1999, practice and teach yoga, a physical therapist, daily exercise and meditation.  I teach and talk about having an anti-inflammatory diet to my clients and suggest stress-relieving tools. Pretty healthy, right?

But then I started to not feel so good….just not like myself. And when you practice yoga and meditate, you can […]

Ouch, my jaw hurts!……must be my TMJ, or is it?

Jaw pain, you may have had it at some time, but that doesn’t necessarily mean it’s a larger problem. When it is ongoing and starts to interfere with eating or is causing headaches, then it’s time to seek help.

Several patients have come in, reporting, that they have a “TMJ.”  Well, that’s true, and its true for all people, we all have a TMJ. TMJ stands for temporomandibular joint—a long word for the joint of your jaw.  What they really meant to say was that they had “TMD,” which is temporomandibular disorder.  TMD is defined as disorders associated to the jaw, ie difficulty opening, pain […]

Find Resolve in Impermanence: A Look at Dancer’s Pose


Shiva Nataraja: Lord of the Dance
Inspired by a recent article in Yoga Journal with a combination of a grief relief workshop I took this past weekend—a look at this pose with a little more depth.

Shiva derives from the Sanskrit root, meaning “liberation.”  “He cannot stop the passage of time or the fire that surrounds him, but he can find bliss amid the chaos.”1 In one image, it combines Shiva’s roles as creator, preserver, and destroyer of the universe. It conveys the conception of the never-ending cycle of time.

Shiva’s dance is set within a flaming wheel. The god holds in his upper right hand the […]

Cup Therapy (Cupping) for Pain Relief & Rehabilitation

Cupping, Myofascial Release, Myofascial Decompression

Myofascial decompression or cup therapy is a form of myofascial release. To understand release of the fascia we must understand fascia and it’s role in the body.


We have extensive information about the myofascial tracks or trains (Anatomy Trains1) by the work of Thomas Myers.  His definition of fascia is “ all the collagenous-based soft tissues in the body, and the cells that create and maintain that network.” 1  This includes all the fascia that is in and around the muscles (endomysium, perimysium and epimysium), ligaments, and tendons. It also includes the fascia in and around the organs, the chest cavity and […]

Find Balance: From Your Yoga Practice to Daily Life (Part II: Mental Balance)

Ever feel out of sorts? Stressed? Anxious?  You wouldn’t be human if you haven’t.  What happens? Heart races, stomach tightens up, perspiration, shallow breath. Suddenly you’re in the thralls of a physiological “stress response” regulated by the autonomic nervous system (sympathetic in this case).

If you remember from Part I, Merriam-Webster’s definition of Balance included not only physical equilibrium but also, mental and emotional steadiness.1

To consider how to achieve mental and emotional balance, we should reflect on the forces, which might teeter us into a state of unsteadiness.  Some things that can throw us off are:

Stress (including unintended life circumstances)
Daily habits (including taking on more than we can handle)

I’ll […]

Find Balance: From Your Yoga Practice to Daily Life (Part I: Physical Balance)

In my physical therapy practice I often get referrals for balance disorders. Difficulty in balance usually stem from a combination of sources. Some patients come in with vestibular (inner ear) dysfunction, Parkinson’s or Parkinson-like features, cerebellar insults, post-traumatic accidents such as motor vehicle accidents or falls, post-chemotherapy (“chemo-fog”) and poor balance without any known diagnosis.  And usually the diagnosis is not so specific, sometimes just reading, “Balance, Evaluate and Treat.”  As an integrative rehab professional, I have to differentially diagnose from their signs and symptoms, gathering subjective and objective findings to determine a hypothesis or a “physical therapy diagnosis.”

I have tried to keep it somewhat […]

Posture: Looking for Patterns

During my physical therapy graduate education, postural assessment was a key factor in all evaluations. And we were taught that the shoulder of dominant hand was often lower than the opposite side. And that was it. No true explanation for why and no recommendation that it could possibly altered. Just merely, a nice party trick to tell people you knew something about them just by looking at them. They are amazed that you could tell.  Wouldn’t it be more amazing if you could actually alter that posturing?

It wasn’t until someone pointed out that my Right shoulder was lower than my Left that I began to really […]

Letter To the Editor of Physical Therapy Journal: Stress Management as an Adjunct to Physical Therapy for Chronic Neck Pain

Self photo, catching some blissful breath on the foam roller
Late last year I wrote a response to the Physical Therapy Journal article, “Stress Management as an Adjunct to Physical Therapy for Chronic Neck Pain.”  My response is posted here:

“Initially, it was a pleasure to finally see an article in PTJ that approached the psychosocial aspects of pain. We know that pain is a sensation that may be brought on by sensing pressure, chemical irritant, or temperature. But what that pain means to us and how it escalates into a chain of mental and physiological processes, can be stoked by psychosocial aspects. So, I thank the authors1 for […]

Chronic Inflammation: Could it be making you depressed?

Updated 10-3-14: Please see additional information in a more recent blog, Trust Your Gut, Heal Your Gut: A Personal Story. 

Emerging evidence demonstrates that there is a connection between inflammation and depression.  It’s no wonder that when your body is always in a state of inflammation, you may feel sad.  And the science shows that it may not be just the fact that you are sad because you are experiencing limited function……it might just be the ongoing physiology in your body. Other disease processes may be caused by inflammation, as well…..cardiovascular disease, diabetes, and obesity, to name a few.

A review article presents the science of […]

Conservative Treatment for Plantar Fascitis: It isn’t all just stretching

You may have experienced this before: pain on the heel or sole of your foot upon rising from bed in the morning, burning sensation along the arch of the foot, or pain along the arch of the foot, under the big toe and perhaps into the heel, after you’ve walked for a bit. I’m not a doctor, and can’t diagnose you, but it’s likely that you experienced plantar fascitis.  I’ve experienced it, and I know it’s not fun, nor does it “go away” quickly. Below is a description of plantar fascia, how it functions, why it might become irritated and how do we help […]

Chronic Pain: Changing Your Brain

I was just looking through an old book I have on Repetitive Strain Injury (RSI). They go over the usual tips of relaxation, posture, and strengthening.  In 2006, I thought it to be a pretty comprehensive book to treat the RSI that I was dealing with at the time. But nothing in there approaches the science behind the pain and therefore, how we can make lasting changes.
The emerging science out there shows that with chronic and even acute […]

Headaches: Help without Medication

Headaches can come from many different sources.  Some things that influence headaches are: dietary contributions, stress and anxiety leading to tension, and musculoskeletal issues.
Musculoskeletal Sources of Headache:

Cervicogenic (cervical instability or stiffness): usually pertains to the upper cervical region

Thoracic (upper back) stiffness

Myofascial (tissue) restrictions

Psychosocial and Stress leading to tension-holding habits

The list below looks at sources of  irritation, inflammation and tension to the muscles around the neck.  This tension can impinge on the nerves that come from the cervical spine and travel up to the scalp, temples, and around the eyes.

Car accidents: In my experience, patients usually had a tendency towards the stiffness/instability in the cervicothoracic region […]

Holiday De-stress: Your Mind & Body will Thank You!

Holiday De-stress:
Take the time to PAUSE, your Mind & Body will thank you
As much as we try to stay balanced and breath through it….we just can’t deny that this time of year brings added stress. A little inkling of stress and your mind-body knows just what to do: increase your blood pressure, build tension in the muscles, createa short/rapid breath cycle and ramp up production of your body’s stress hormones (cortisol). And maybe you can handle this for a short time, but continue this cycle and you feel out of control by the end of the week. So when you’ve tried to find […]

Learn to be Still: Understanding Fatigue

I went to a great class this last week, “Understanding Fatigue: Focus on Stress, Habits and the Brain,” by William Sieber, PhD. I wanted to share some key points that I learned.  If you want to know more about anything, please contact me and I will do my best.

Common conditions with “fatigue” as a symptom:

Allergic rhinitis
Food allergies/intolerance
Heart and lung disease
Rheumatoid arthritis, Fibromyalgia, persistent pain syndromes, Chronic Fatigue Syndrome (CFS)
Sleep apnea
Type I or II Diabetes
Medication: analgesics, psychotropics, anti-hypertensives, anti-histamines

Interesting to note:

On a cellular level, mitochondria are our energy sources, producing ATP.  It has been shown that when we expend more energy (ie exercise, activity), our […]

Breath of Fresh Air


The pollen count is up and this may leave you scratching, coughing, and sneezing.  Allergies are flaring up. You may even have a heavy head or headache.  Once your airways become irritated, mucus begins to form. Mucus is just our body’s response to increased inflammation.  The key is to reduce the irritant and also the inflammation. So, following an anti-inflammatory diet is a good idea, particularly, staying away from dairy, sugars and alcohol. Adding natural anti-inflammatories to your diet may be helpful.  Turmeric and ginger are natural anti-inflammatories.

You can also try using a Neti-pot or Sinus-Wash bottle (by NeilMed) on a regular basis to keep your […]

%d bloggers like this: