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Does Bad Posture Cause Back Pain?

You have probably heard the claim that bad posture causes back pain, or that you should work on your posture to get rid of low back pain. You can find this claim all over the internet – from physical therapists, chiropractors and personal trainers. If you do a Google search for “posture and pain,” you get 4 million hits.

With so many posture police on patrol, you will almost certainly be told sooner or later by some authority that your posture needs work.

For example, if you have a relatively large curve in your upper back (kyphosis), you might be told that you have “upper cross syndrome.” This pattern involves rounded shoulders, a sunken chest, and a forward head. Common “corrections” are to stretch the chest muscles and strengthen the muscles between the shoulder blades.

Or, if you have a relatively large arch in your low back (lordosis), you may be told you have lower cross syndrome. In this pattern, the pelvis tips down in front (anterior pelvic tilt), and the stomach protrudes forward. To fix this, most people will tell you to strengthen your abs and glutes, stretch your hip flexors, and spend time during the day sucking in your gut and/or keeping your core active.

Another popular idea is that asymmetries cause pain. For example, a therapist may try to identify and correct a twist or tilt in the alignment of your pelvis, because they’re worried this will rotate or bend your spine. They may be interested in whether one of your legs is longer than the other, because this will tilt one side of your pelvis higher than the other.

These ideas have intuitive appeal, and are advocated by numerous experts. But are they supported by evidence? And should you spend time trying to analyze your own posture and correct deviations from what is considered optimal?

Let’s look at some evidence that might help us answer these questions. Although you wouldn’t know it from reading most books or articles, there are many studies looking for associations between pain and measures of postural alignment. And most of them find none. Let’s take a look.

What do studies find on the connection between posture and pain?

Research looking for correlations between back pain and posture typically involves one of several different study designs.

In cross sectional studies, researchers recruit people and divide them into groups — those with and without back pain. Then they use x-ray, radiograph, or some other means to measure pelvic or spinal alignment, such as leg length discrepancy, pelvic tilt, degrees of curvature in the low back, upper back, or neck. After these measurements are made, researchers determine whether there are significant differences in postural alignment between the groups with and without pain.

In prospective studies, researchers analyze the posture of a certain group of people without back pain, and then determine whether the subjects with a certain posture are more or less likely to have low back pain in the future.

Although the results from these studies aren’t completely clear, most do not support the claim that bad posture causes back pain. Here are some representative findings:

No association between leg length inequality and back pain.
No significant difference in lumbar lordosis or leg length inequality between three groups of 321 males with severe back pain, moderate pain, or no pain.
No association between measurements of neck curvature and neck pain.
No significant difference in lumbar lordosis, pelvic tilt, leg length discrepancy, and the length of abdominal, hamstring, and iliopsoas muscles in 600 people with and without back pain.
Teenagers with postural asymmetry, excessive thoracic kyphosis and/or lumbar lordosis were no more likely to develop back pain in adulthood than peers with “better” posture.
Pregnant women with greater increases in low back curve during pregnancy were no more likely to develop back pain.
People who work occupations involving frequent awkward postures do not have higher levels of back pain.
Although some studies have found a positive association between measurements of spinal alignment and pain, these are exceptions to the rule.

The weight of the evidence is probably best represented by a systematic review done in 2008, that analyzed more than fifty-four studies on the the link between pain and posture. Although the quality of the studies was generally poor, together they did not produce evidence supporting an association between measurements of sagittal (back to front) spinal alignment and pain.

The above research indicates that if any correlation exists between posture and pain, it is weak. These results are striking given that many studies have found other factors that correlate with low back pain, such as exercise, job satisfaction, educational level, stress, and smoking.

Even if a correlation between pain and posture does exist, this would not prove a causal relationship. It may be that pain causes bad posture, and not the other way around. This is very plausible. People who are injected with a solution causing back pain will spontaneously adopt different postural strategies.  Big surprise!

Moreover, even if bad posture does contribute to back pain, it is yet another leap to conclude that posture can be corrected. And yet another to prove that correcting “bad” posture will reduce back pain.

Why is there no association between pain and posture?

The above evidence is surprising and counterintuitive. Why is there no link between pain and posture? There are at least three plausible reasons why posture does not associate well with pain.

1. Tissues adapt to stress over time

The theory that bad posture causes pain is based on the idea that it places excess mechanical stress on certain areas, which causes micro damage that accumulates over time. Although this makes sense, it fails to consider that tissues have the capacity to adapt to stress.

Just as your muscles will get stronger when exposed to the stress of lifting weights, your joints, ligaments, and tendons will adapt to withstand the local stresses created by particular postures.

2. Tissue damage does not equal pain

The second reason that posture does not correlate with pain is that even if bad posture causes tissue damage, tissue damage does not equal pain.

There are many studies on the prevalence of various kinds of tissue damage in people without pain. These consistently show that large percentages (e.g. 20-50%) of people with pain-free backs, shoulders or knees have bulging discs, tears in the rotator cuff, or torn menisci.  The fact is that almost no matter where you point an MRI on a person over 30, you have a very strong chance of finding significant damage there, even in places without pain.

The reason? Pain is complex, and tissue damage is only one contributor to pain. Thus, to the extent that posture is causing some form of long-term tissue damage, it will not necessarily result in pain.

3. Different people are different

The third reason that seemingly “bad” postures do not correlate with pain is that everyone has a unique structure. If you look at skeletons from real people, you will see substantial differences in the shape of the bones and spinal curves. Asymmetry and irregularity are the rule, not the exception.

The size and shape of the bones will to some extent dictate the most efficient and comfortable way to stand, sit or move. Therefore, what is “dysfunctional” alignment for one person might be optimal for another.

Because of these individual differences, comparing your posture to some ideal model and trying to make corrections is inherently problematic.

What to do instead of worrying about posture

The above evidence suggests that it may be a waste of time to try to identify defects in your static posture according to some ideal model, and correct them as a way to treat or prevent pain.

So if posture doesn’t matter so much, does that mean we shouldn’t worry at all about the alignment of the body during rest or exercise? I think the answer is no.

1. Ensure good alignment when high forces are involved

Don’t misinterpret the research on posture to mean that biomechanics and good form don’t matter at all. Vigorous exercise is different than just sitting or standing around, and it may require more attention to proper alignment.

During static standing or sitting, the mechanical stresses on your joints are very small. Your body has experienced these exact stresses thousands of times per day for many years, and is well adapted to handling them.

By contrast, during strenuous exercise, such as a heavy deadlift, the mechanical stress is far greater, and your body has had less opportunity to adapt to those specific stresses.

So your posture and alignment matters in a heavy deadlift. It matters when you land a jump. It matters when you sprint, lift weights, or engage in any activity involving a great deal of mechanical stress. In these cases, it is a good idea to use conscious effort or coaching to ensure that your biomechanics and spinal alignment are optimized to distribute stress, reduce risk of injury and increase performance.

2. Work on your movement

The way you move is more important than how you look standing or sitting. So don’t worry if your chest slumps while sitting at work. But make sure you preserve your ability to fully extend the chest to allow functional activities like overhead reaching, rotating, or pressing weight overhead.

3. Vary your posture

Many people need to sit or stand in the same basic posture for many hours at a stretch. If this is causing stress and pain, subtle variations in posture are a better strategy for comfort than maintaining one “perfect” posture the whole time. Variation will distribute the stress of supporting your body weight to many areas as opposed to concentrating that stress in the same places. Take frequent breaks and keep moving. And if a particular position aggravates back pain, experiment with alternatives.

Forget good posture: think good movement

To sum up, don’t worry too much about trying to change your static posture to conform to some ideal. It is not a likely contributor to back pain. Instead, stay comfortable, keep moving, work to improve your function, and make sure to use good alignment and form when engaged in strenuous exercise.

Whiplash Injury Exercises

Whiplash injuries can result in significant amounts of lost work productivity, medical care, and legal services, making it one of the most costly musculoskeletal conditions to treat in the United States at roughly $29 billion dollars per year.

Dr. Curtis wrote this great article highlighting several key points. We can help with your pain – and you can reach out to us using the form to the right- One of our doctors will get right back to you!

Symptoms of Whiplash include:

  • Neck pain or stiffness with a loss of active range of motion
  • Headache
  • Radicular symptoms
  • Cognitive impairments
  • Sensorimotor symptoms:
    • Altered patters of muscle recruitment
    • Altered postural control mechanisms:
      • Kinesthetic sense
      • Balance
      • Eye movement control

Structures in the neck that can be injured with a Whiplash injury:

  • Facet joints
  • Nerve roots
  • Ligaments
  • Cervical discs
  • Muscles

Trigger points in the muscles of the neck and shoulders likely contribute to your pain16 following a Whiplash injury. A trigger point is a hypersensitive spot within a taut band of muscle that refers pain to a distant location17. We have an amazing way to calm these down immediately, and you can read about it here. 

Studies find that patients with Whiplash have more trigger points in the neck and shoulder muscles than normal subjects.

The specific muscles with a higher prevalence of trigger points are:

  • Upper Trapezius
  • Suboccipitals
  • Levator Scapulae
  • Sternocleidomastoid
  • Scalenes

The greater the number of trigger points in these patients, the greater their intensity of neck pain and higher self-reported disability. These findings suggest that active trigger points may be an important pain generator in patients with acute Whiplash20.

How Long Does Whiplash Last?

Many Whiplash patients get better with time – usually within 2 to 3 weeks of the injury. Current research, however, is showing that about 50% of people still complain of neck pain even one year after the injury. One study even found that 58% of patients report having symptoms 30 months after.

How can we predict the likelihood of your recovery?

Early identification and getting the right resources for yourself can help.

Whiplash Clinical Prediction Rule (CPR) was created based on a tremendous amount of collected data from patients with Whiplash injuries and their recovery timelines. This CPR predicts 2 recovery pathways following injury:

  1. Long-term moderate to severe pain and disability is predicted in individuals with:
    • A high level of self-reported disability
      • Baseline NDI (Neck Disability Index) score of 40% or greater
    • Age of 35 years or older
    • A high level of post-traumatic stress
      • Hyperarousal subscale symptoms score on the PDS (Posttraumatic Diagnostic scale) of 6 or greater
  2. Full recovery is predicted in individuals with:
    • Age of less than 35 years
    • A low level of self-reported disability
      • Baseline NDI score of 32% or less

The greatest predictor of your outcome is how you rate your baseline pain intensity – greater than 55/100 predicts a poor outcome

Other predictors of a poor outcome worth mentioning are:

  • The presence of low back pain
  • Psychological factors such as :
    • Negative expectations
    • Catastrophizing (making things a bigger deal than they are)
    • A Passive coping style (expecting something or someone other than you to make things better)

To me, these last 3 are the most important, because they are factors that YOU can control – you’ll see how next…

What Are the Best Treatment Options for Whiplash?

If all of this talk of poor outcomes wasn’t bad enough, I’ll get the rest of the bad news out of the way now, then we can talk about the bright side…

Once a Whiplash injury becomes chronic, >3 months or so, most treatments have little to no effect.

That’s why, as I stated before, it’s best to identify the problem early on and get to work.

The Best Treatment Options for Whiplash:

  1. Exercise

Rather than having a passive coping style, you need to be active in your recovery. Being active with gentle exercise leads to better outcomes. And, the higher your pain and disability levels, the more effective exercise is. Good news: the exercise doesn’t have to be intense, and it doesn’t have to be sophisticated…

I usually give my Whiplash patients these few simple exercises to do regularly throughout the day:

  • Walk frequently
  • Active cervical rotations
    • Sit up straight
    • Gently and slowly rotate the head side to side in a pain-free range
  • Deep Neck Flexor endurance and coordination exercises
    • Chin tuck and hold in sitting, supine, and prone
    • Chin tuck with rotations
  • Wall Slides
    • Stand facing a wall
    • Slide both arms up and down the wall (with a towel) slowly and in a pain-free range

2. Psychological counseling

Remember I shared with you earlier that negative expectations as well as catastrophizing tend to lead to poor outcomes following a Whiplash injury, right? You also saw that Post-traumatic stress leads to poor outcomes.For these reasons, even simple advice to improve cognitive-behavioral components can have a huge positive impact on your recovery – even equal to that of a comprehensive exercise program.

Here are some important pieces of advice I usually share with my Whiplash patients:

  • Try to get back to your normal activities early on
  • Perform relaxation techniques
    • Deep, slow breathing
  • Stress management
  • Challenge irrational beliefs
    • Remember that 50% of Whiplash injuries improve within a few weeks. Other than age, the only differences between those who get better and those who don’t is related to self-reported disability and self-reported stress

So, What ARE Humans Supposed To Eat??

What foods ARE we supposed to eat??  There are over 20 million different species that we share this plant with….and each of them have a specific menu they eat from!  Seems that only humans are still at a quandary as to what they should be eating!  I’m certainly not an advocate for something like the “blood type” diets….after all, do you really think that a species would vary its diet based on what kind of blood type they have!?  Of course not.  That’s silly.  There are over 16 different families of primates, and literally hundreds of subfamilies, and guess what, they all pretty much eat the same thing: a diet based on fruits, veggies and some nuts and seeds.  When in doubt; look to nature.  Why are humans so darn confused about what they should, or should not, be eating!?

If you look at the media today; views are literally bombarded with information from all directions 24/7.  It used to be simply from radio, TV, newspapers and magazine would supply more than enough confusion.  Not today.  Now, with the thanks of modern online social media, websites, blogs (kind of like this one!?), Facebook, YouTube, websites, podcasts, snapchat and tweets….we are thoroughly confused.  How can we not be?

And, don’t forget, when you see your physician, he or she is listening to the same garbage that you are.  Couple that with the fact that most United States medical schools do not even require more than a few hours in Nutrition coursework!  So, asking your doctor, may not yield the vital info you seek…and deserve.

The most common response we get to the question: “why do you think you are overweight?” is one of two reasons:

  1. I need to eat less
  2. I need to exercise more

Both are actually incorrect answers.  You see, humans are NOT designed to ‘eat less’.  Hunger is a signal created in the brain to KEEP YOU ALIVE.  We are not supposed to skimp on food, it’s simply not natural.  However, we are NOT supposed to gorge ourselves on ‘fake foods’.  You know the kinds; refined sugars and fats.  Yes, even fats.  By the way, everyone will respond quickly that refined white sugar is bad and unhealthy.  After all, it has nothing good in it.  That’s correct; all the good things like vitamins, minerals, fiber, fats, proteins, enzymes, antioxidants have been ‘refined’ or processed out to leave a nice, pure white sugar.  There is nothing left in it, except FOR the actual sugar.  BUT, there is a disconnect.  When it comes to asking the SAME question about oil, people get confused.  They actually have been duped into thinking that oil Is healthy!  Let’s take ‘extra cold pressed, virgin olive oil’ as an example.  9 people out of 10 will respond that Olive oil is ‘healthy’.  “Why do you think it’s healthy?”, I ask them.  “well, I don’t know….I’ve heard on the news that its ‘heart healthy’”  Or they will mention something about the ‘Mediterranean diet’, but not really know much more.  That is pure advertising dollars hard at work.  They have shaped the way you think, without giving you much information on WHY you are thinking about it.

The Truth is, Olive Oil has the very same ‘good things’ refined out of the sugar beet or sugar cane plant.  All the good proteins, carbohydrates, vitamins, minerals, fiber, enzymes, antioxidants….have ALL been refined or processed out.  And, we are left with nothing but pure liquid plant fat, called ‘oil’.  And the oil industry is happy to take your money for its ‘health food’.  It’s a lie.  Plain and simply.  You have been lied to.

The real truth is that there is a mountain of nutritional scientific evidence that shows that oils, of ANY kind are harmful to the heart and blood vessels.  The lining of our vascular system is made up of delicate endothelial cells and they have the ability to expand when needed in order to help the flow of blood not just to the heart but to all areas of the body.  After eating just ONE meal that is high in fat and oil, that ability to expand and relax is lost, and can take several hours to normalize!  Usually just as long til the next meal rolls around, and then we reinjure ourselves all over again.

The fact is, most Americans eat a diet that is way too high in fats and proteins.  Close to 40-50% of the standard American diet consists of calories coming from fat.  And, in our clinic our heaviest patients who stand to benefit the most from a healthy lifestyle and weight loss, find themselves approximately, wait for it….40-50% body fat!  Folks, YOU ARE WHAT YOU EAT!    Forget about ‘low carbs’…..that is NOT based on science.  What works is eating a diet that is HIGH in CARBS!  Really?  Yes, really.  Ever hear of a ‘fruit’ or a ‘veggie’?  Yes? Well, did you know that they are made up of usually OVER 90% ‘Carbs’!!?  They also have fats and proteins, but a small amount.

We are DESIGNED to eat HIGH CARBS…and LOW FATS and LOW PROTEINS.  That is the most natural human diet.  That is what we seek, that is what satisfies our needs, and fuels our cells.  Look to nature. You will see what we are designed to eat.  Those foods that are brilliant in color, textures, fragrance.  We have COLOR vision for a reason.  We can SEE when a fruit tastes good before we even pick it.  We can SMELL the fruit, veggies and herbs.  They tempt us, and we salivate when thinking of eating them.  They provide us with all of the needed vitamins, minerals, water content, enzymes, fiber, antioxidants etc.  They are the highest food nutritionally for us.

According to science, and nature, the choice is quite simple.  You do not have to be confused any longer.  Eat a diet high in whole food, plant based items, and your body….and waistline, will thank you!

Dr. Melmed’s 70 Calorie Vegan Broccoli Casserole

Important: Buy from your supermarket, fresh whole broccoli which still have their stalks attached. Packaged broccoli will not have the stalks attached and you will need these for this recipe. If you prefer to make an asparagus casserole, buy whole fresh asparagus.

Carefully cut the branching stalks from the florets and separate them. Place the florets onto the bottom of a casserole dish and the stalks into a blending device. If using asparagus, cut off the last 2 cm of the very hard base of each stalk and discard. then cut off the bottom 1/3 of each asparagus stalk and place into a blending device

Buy enough broccoli (or asparagus) so that you have about 3 cups of broccoli florets (or 3 cups of asparagus) in the casserole dish and 1 cup of the stalks in the blender. If using asparagus, save the softer top 2/3 of each asparagus stalk for the casserole dish


3 cups broccoli florets       93 calories        OR substitute 3 cups of asparagus = 81 calories

1 stalk celery                        6 calories

1 medium carrot                 25 calories

2 medium onions               88 calories

1/4 cup vegan cheddar

cheese such as Daiya        90 calories


1 cup organic unsweetened almond milk         30 calories

1 cup low sodium vegetable broth                      20 calories

1 cup broccoli stalks                                              31 calories           OR 1 cup asparagus bases = 27 calories

1 TBSP potato starch                                            30 calories

1/2 tsp paprika                                                         3 calories

1/2 tsp garlic garlic powder                                   5 calories

1/4 tsp ginger powder                                             2 calories

Add 1/2 tsp salt to taste (but note that the cheese and vegetable broth both contain sodium).

TOTAL CALORIES: 423 for broccoli casserole and 407 for asparagus casserole.

Into a blending device, put the almond milk and vegetable broth. Chop the broccoli stalks (or asparagus stalks) into pieces that your blender can handle. Place these into your blending device with the potato starch and spices. Blend until completely liquefied.

Sauté the 2 onions and celery (chopped) and sliced carrot in water in a frying pan until soft. If you are brave, let the water cook away for a few seconds so that the onions brown (caramelize) lightly. Repeat this process if you want more browning.

Preheat oven on bake to 350 degrees F.

Into the casserole dish, place the broccoli florets (or asparagus) which you should first cut up into bite size pieces. Spread these evenly on bottom of dish. Spread evenly on the broccoli (or asparagus) the sautéed onion, celery and carrot.

Pour onto this the liquid from the blender.

Spread evenly onto the top of this shredded vegan cheddar cheese.

Cover with foil to prevent spillage.

Place casserole dish onto bottom shelf of oven and bake for about 90 minutes (1 1/2 hours for those of you in Australia because of time difference).

The added liquid should be nice and creamy thick when done.

Makes about 6 one cup servings, each only 70 calories (68 calories for asparagus casserole) containing no fat but there is 1 1/2 grams of vegetable oil. For you dieters, that means plenty of leeway for a second helping making 140 calories (136 for asparagus). For dessert try one cup of watermelon (46 calories) and your total meal consumption will be only 186 calories (182 for asparagus).


The Best Way to Wash Fruit and Vegetables

How might we reduce our exposure to pesticide residues on fruits and vegetables? What about staying away from imported produce? Well, it turns out domestic produce may be even worse, dispelling the notion that imported fruits and vegetables pose greater potential health risks to consumers.

Buying organic dramatically reduces dietary exposure to pesticides, but it does not eliminate the potential risk. Pesticide residues are detectable in about one in ten organic crop samples, due to cross-contamination from neighboring fields, the continued presence of very persistent pesticides like DDT in the soil, and accidental or fraudulent use.

By choosing organic, one hopes to shift exposures from a range of uncertain risk to more of a range of negligible risk, but even if all we had to eat were the most pesticide-laden of conventional produce, there is a clear consensus in the scientific community that the health benefits from consuming fruits and vegetables outweigh any potential risks from pesticide residues. And, we can easily reduce whatever risk there is by rinsing our fruits and vegetables under running water.

There is, however, a plethora of products alleged by advertisers to reduce fruit and produce pesticide residues more effectively than water and touted to concerned consumers. For example, Procter & Gamble introduced a fruit and vegetable wash. As part of the introduction, T.G.I. Friday’s jumped on board bragging on their menus that the cheese and bacon puddles they call potato skins were first washed with the new product. After all, it was proclaimed proven to be 98% more effective than water in removing pesticides.

So researchers put it to the test, and it did no better than plain tap water.

Shortly thereafter, Procter & Gamble discontinued the product, but numerous others took its place claiming their vegetable washes are three, four, five, or even ten times more effective than water, to which a researcher replied, “That’s mathematically impossible.” If water removes 50%, you can’t take off ten times more than 50%. They actually found water removed up to 80% of pesticide residues like the fungicide, Captan, for example. So, for veggie washes to brag they are three, four, five, ten times better than water is indeed mathematically questionable.

Other fruit and vegetable washes have since been put to the test. Researchers compared FIT Fruit & Vegetable Wash, Organiclean, Vegi-Clean, and dishwashing soap to just rinsing in plain tap water. 196 samples of lettuce, strawberries, and tomatoes were tested, and researchers found little or no difference between just rinsing with tap water compared to any of the veggie washes (or the dish soap). They all just seemed like a waste of money. The researchers concluded that just the mechanical action of rubbing the produce under tap water seemed to do it, and that using detergents or fruit and vegetable washes do not enhance the removal of pesticide residues from produce above that of just rinsing with tap water alone.

That may not be saying much, though. Captan appears to be the exception. When plain water was tried against a half dozen other pesticides, less than half the residues were removed.

Fingernail polish works better, but the goal is to end up with a less toxic, not a more toxic tomato.

We need a straightforward, plausible, and safe method for enhanced pesticide removal. Is there anything we can add to the water to boost its pesticide-stripping abilities? Check out my video, How to Make Your Own Fruit & Vegetable Wash.

If you soak potatoes in water, between about 2% to 13% of the pesticides are removed, but a 5% acetic acid solution removes up to 100%. What’s that? Plain white vinegar. But 5% is full strength.

What about diluted vinegar? Diluted vinegar only seemed marginally better than tap water for removing pesticide residues. Using full strength vinegar would get expensive, though. Thankfully there’s something cheaper that works even better: salt water.

A 10% salt solution appears to work as good or better than full-strength vinegar. To make a 10% salt solution, you just have to mix up about one-part salt to nine-parts water (though make sure to rinse all of the salt off before eating!).

There’s not much you can do for the pesticides in animal products, though. The top sources of some pesticides are fruits and vegetables; but for other pesticides, it’s dairy, eggs, and meat because the chemicals build up in fat. What do you do about pesticides in animal products? Hard boiling eggs appears to destroy more pesticides than scrambling, but for the pesticides that build up in the fat of fishes and chickens, cooking can sometimes increase pesticide levels that obviously can’t just wash off. In fact, washing meat, poultry, or eggs is considered one of the top ten dangerous food safety mistakes.

Breakthrough Migraine Treatment

Listen to Dr. Melmed take a few minutes and explain our revolutionary headache treatment! Its fast, easy and painless. Why suffer!?

Why Are Americans Fat?

Twisted Prayers – Do It!

Thanks to Dr. Dooley for this.

The Prayer Twist

The prayer twist increases mobility of the spine and hips while improving global stability. It also teaches you to maintain a quality breath during strenuous activity.

From a half kneeling position (bottom of a lunge) walk your leading foot forward a few inches or so depending on your level of stretch. Bring your elbow outside your opposite knee connecting your hands together in prayer. Pull your shoulders down and thumbs to the middle of your chest. You should maintain one continuous line from elbow to elbow.

Lift the back knee off the ground and squeeze the glute. The leading shin should be vertical. Drive your elbow into your knee increasing rotation in your spine. Gaze over your fingertips. Hold for a minimum of 5 breaths. Breath into areas of restriction.

Let the pose be challenging but not strenuous. Your breaths should be long and deep with a second pause in between. It’s optional to go in and out of the pose, before the hold, as a warm up. Now go get strong!

In-Office Challenge- Can You Make It Across?

Dr. Melmed made it across the two 1/2 foam rolls…and retrieved all 4 water bottles.

Come give it a try… and check out this great video on how to strengthen your legs!

Make it across and you’ll get a goodie bag, and entry for our weekly raffle.

Snow Contributes To Accidents

Did you know if you are in a car accident and have whiplash, neck or back pain, headaches, or any other problem caused by or exacerbated by the accident you can get treated for it?…usually with NO money out of your pocket! This is not determined by full coverage or liability only. Everyone has it. Do not wait for the “pain” to go away. Get checked and prevent your future chronic problems and pain. Studies show it takes 2 years for that to set in after the accident. Dr. Melmed, MD and our team of Physical Therapists, and assistants are ready to help you get back to 100%!

Eat What You Want… Just Mostly Plants

Over the past few months, I’ve written a number of times on how nutrition recommendations are seldom supported by science. I’ve argued that what many people are telling you may be inaccurate. In response, many of you have asked me what nutrition recommendations should say.
It’s much easier, unfortunately, to tell you what not to do. But here at The Upshot, we don’t avoid the hard questions. So I’m going to put myself on the line. Below are the general rules I live by. They’re the ones I share with patients, with friends and with family. They’re the ones I support as a pediatrician and a health services researcher. But I acknowledge up front that they may apply only to healthy people without metabolic disorders (me, for instance, as far as I know).

These suggestions are also not supported by the scientific weight of rigorous randomized controlled trials, because little in nutrition is. I’ve inserted links to back them up with the available evidence. They are not “laws” and should not be treated as such. No specific nutrients will be demonized, and none will be held up as miracles. But these recommendations make sense to me, and they’ve helped me immensely.
Full disclosure: I did not invent most of these. I’ve developed them from reading the work of others, including what may be the most impressive “official” nutritional guidelines, those of Brazil, as well as from earlier suggestions from readers, as in this great NYT interactive graphic. It captures readers’ responses to food rules by Michael Pollan. He is, of course, the promulgator of the well-known advice: “Eat food. Not too much. Mostly plants.”

1. Get as much of your nutrition as possible from a variety of completely unprocessed foods. These include fruits and vegetables. But they also include meat, fish, poultry and eggs that haven’t been processed. In other words, when buying food at the market, focus on things that have not been been cooked, prepared or altered in any way. Brown rice over white rice. Whole grains over refined grains. You’re far better off eating two apples than drinking the same 27 grams of sugar in an eight-ounce glass of apple juice.
1b. Eat lightly processed foods less often. You’re not going to make everything yourself. Pasta, for instance, is going to be bought already prepared. You’re not going to grind your own flour or extract your own oil. These are meant to be eaten along with unprocessed foods, but try to eat less of them.
1c. Eat heavily processed foods even less often. There’s little high-quality evidence that even the most processed foods are dangerous. But keep your consumption of them to a minimum, because they can make it too easy to stuff in calories. Such foods include bread, chips, cookies and cereals. In epidemiologic studies, heavily processed meats are often associated with worse health outcomes, but that evidence should be taken with a grain of salt (not literally), as I’ve written about before.
2. Eat as much home-cooked food as possible, which should be prepared according to Rule 1. Eating at home allows you to avoid processed ingredients more easily. It allows you full control over what you eat, and allows you to choose the flavors you prefer. You’re much less likely to stuff yourself silly if you eat home-cooked food. I’m not saying this is easy. Behavioral change takes repetition and practice. It also, unfortunately, takes time.
3. Use salt and fats, including butter and oil, as needed in food preparation. Things like salt and fat aren’t the enemy. They are often necessary in the preparation of tasty, satisfying food. The key here is moderation. Use what you need. Seasoning is often what makes vegetables taste good. Don’t be afraid of them, but don’t go crazy with them either.
4. When you do eat out, try to eat at restaurants that follow the same rules. Ideally, you should eat at restaurants that are creating all of their items from completely unprocessed foods. Lots and lots of restaurants do. Follow Rule 1 even while out to dinner. Some processing is going to be fine, but try to keep it to a minimum.
5. Drink mostly water, but some alcohol, coffee and other beverages are fine. As I’ve pointed out before, you can find a study to show that everything either prevents or causes cancer — alcohol and coffee included. But my take is that the preponderance of evidence supports the inclusion of a moderate consumption of most beverages.
6. Treat all beverages with calories in them as you would alcohol. This includes every drink with calories, including milk. They’re fine in moderation, but keep them to a minimum. You can have them because you like them, but you shouldn’t consume them as if you need them.
7. Eat with other people, especially people you care about, as often as possible. This has benefits even outside those of nutrition. It will make you more likely to cook. It will most likely make you eat more slowly. It will also make you happy.
I’ve avoided treating any food like the devil. Many nutrition experts do, and it may turn out they’re right, but at this point I think the jury is still out. I’ve therefore tried not to tell you to avoid anything completely. My experience tells me that total abstinence rarely works, although anecdotes exist to support that practice. I think you’ll find that many other diets and recommendations work under these rules. These are much more flexible and, I hope, reasonable than what some might prescribe.
All of these rules are subtly trying to get you to be more conscious of what you’re eating. It’s far too easy these days to consume more than you think you are, or more than you really need, especially when eating out. I’ve found that it’s impossible to tell any one person how much they should be eating. People have varying requirements, and it’s important for all of them to listen to their bodies to know when they should eat, and when they should stop.
One other thing: Don’t judge what others eat. One of my closest friends has been avoiding carbohydrates for months, and has seen remarkable results. Another was a pescatarian — a person whose only meat dishes are fish — for a year and was very happy with that. I, on the other hand, avoid no food groups in particular.
People are very different. Some may have real problems consuming even the smallest amount of carbohydrates. Others may be intolerant of certain foods because of allergies or sensitivities. It will most likely take a bit of experimentation, on an individual level, to find the actual diet within these recommendations that works for you. But the above rules should allow for a wide variety of foods and for remaining healthy. At least, I hope so.

Adapted from Aaron E. Carroll

Dr. Melmed’s Salad Dressing

A lot of patients are disappointed when I tell them they should not use salad dressings available in supermarkets because they either contain fat, oil or sugar, containing a whopping 140 to 150 calories per serving. Even the “low calorie” options contain 70 – 90 calories per serving. AND…its non fat!

Here is a simple but delicious recipe containing just 14 to 17 calories (about one tenth of the calories in store-bought dressings) depending on the choice of ingredients you use below.

1 tablespoon red wine vinegar (0 calories)

1 tablespoon cranberry juice (9 calories) OR 1 tablespoon pomegranate juice (11 calories)

5 blueberries (5 calories) OR 3 raspberries (6 calories)

Place ingredients in a blender and blend for 3 or 4 seconds so that the berries are not totally liquefied. If the dressing is too vinegary for you, try halving the amount of red wine vinegar or add extra cranberry or pomegranate juice.

Note that the above recipe is for 1 serving. For additional servings or if you want to make additional servings for a future meal, multiply the amount of ingredients by the number of servings you want to make.

It’s Safe And Easy To Lose Weight

There are countless individuals all over the world wondering about quick and effective ways on how to lose weight. Because there are so many suggestions and recommendations by so-called fitness experts, it is quite confusing which one would actually work. If you are way over your recommended weight and you need to lose a whole lot of pounds, it would be best to consult with a fitness instructor. You can go to a doctor or just about any gym in your area, and an expert will be able to give you advice. However, you can also try out these tips below and if you are consistent about it, you will slowly but surely lose all the excess weight. These are also great tips if you just need to lose a few pounds in time for a special event such as a wedding or a trip to the beach.

If you have always thought about how to lose weight, you must know by now that it’s not easy. There are pills, diets, exercises and even surgery that can help you out, but it’s really still your choice what you want to do. These tips on how to lose weight are guaranteed safe, effective and quick for as long as you religiously do it.

Drink Lots of Water
This is not even a new tip on how to lose weight. Water therapy is definitely the number 1 way to lose those excess pounds. Get rid of sweet beverages that you are used to having every single day such as sodas and juices and replace those with water instead. Add a couple of slices of lemon to your water too to get its antioxidant and cleansing benefits.

There are many forms of exercise that you can do, and it’s really up to you to find out which one would be perfect for you. Running or jogging is definitely on top of the list on how to lose weight; however, going to the gym is great too. Not only will you have a variety of exercises to do to keep you from getting bored, you will also be given guidance and encouragement by your instructor.

Green Tea
Have a couple of cups of green tea per day to improve your metabolism. Many of those who have struggled with how to lose weight actually have problems with their bowel movement. Green tea is the answer you are looking for.

Proper Diet
Stay away from sweets and junk. Find a diet that would be suitable for you according to your taste because forcing food that you don’t like will just make you unhappy; hence, it is not really as effective when trying to lose weight. Focus instead on how to lose weight by lessening food intake. Eat the usual meals you have but in less proportions.

Good Posture

When your frame is aligned — meaning your heels, knees, pelvis and neck are stacked on top of each other — it moves more efficiently, can carry heavier loads, tires less easily and is less susceptible to strain or injury.

But the minute you sit down to update your Facebook page or drive to the store, you’ll likely drop your chin, tilt your head forward and round or hunch your shoulders. This pulls your muscles and ligaments out of balance — some muscles grow tight while others become weak — leading to back and neck pain, headaches, fatigue and other problems.

Still, it takes years to develop slouched shoulder syndrome and vulture neck, conditions that can’t be reversed overnight. Simply increasing physical activity doesn’t necessarily help; when a person with bad posture becomes more active it’s “like driving around with a crooked axle and hoping that the driving will straighten it out,” said Esther Gokhale, founder of the Gokhale Method, which treats chronic pain through postural adjustments.

These moves can help you stand up straight

If you’re having pain, get your posture assessed by a physical or occupational therapist who can test muscle strength and flexibility, and can make adjustments to your work station if you have a sedentary job. The following exercises can also help strengthen the muscles that grow overused and tight.

The OJ squeeze

When shoulders hunch, the muscles that stabilize the shoulder — the rhomboids and mid-trapezius muscles — become weak.

Try it: Pretend you’re holding an orange between your shoulder blades and try to squeeze it to make juice by bringing the shoulder blades (scapula) down and together, said physical therapist Paul Drew, the author of the book “Red Carpet Posture.” Hold for 10 seconds. You’ll also stretch out the front of your shoulders, which may be tight from slouchy desk posture.

The shoulder roll

Hunching the back forward compresses the front section of certain spinal discs and squeezes the contents backward, similar to squeezing one side of a s’more, said Gokhale, author of “8 Steps to a Pain-Free Back.” “Over time, this action wears and tears the fibrous exterior at the back of the disc,” she said.

Try it: Move one shoulder forward, upward and as far backward as you comfortably can without significantly moving your body. Gently slide your shoulder blade down along your spine. Your shoulder may settle further back than usual. Repeat on the other side.

The 5-minute rest

The eyes are often overlooked when it comes to posture. Once they’re overused or fatigue, the head moves forward, taking us out of alignment, said Donna Eshelman, a Los Angeles-based Feldenkrais practitioner who teaches posture improvement to desk workers.

Try it: Lie on your back for five minutes. “Cup” your eyes by interlacing your fingers and placing the heels of your hands on your cheekbones and outer eyes to block out the light. This will help “oxygenate your fatigued muscles, improve breathing and restore your alignment,” said Eshelman. Repeat once an hour.

Towel chest stretch

To keep the shoulders from rounding forward, stretch out the chest muscles and strengthen the mid-upper back, said fitness expert Tracey Mallett, a Pilates instructor and personal trainer.

Try it: Stand tall with your legs shoulder-width apart, holding a rolled-up bath towel — one end in each hand, said Mallett. Keeping the bath towel taut, reach the arms forward at shoulder height. Exhale and pull the arms up and as far back as you can; you should feel a stretch in the pectoral muscles. Hold for two breath cycles and then return the arms back to shoulder height. Repeat five more times.


Strong transversus abdominus muscles, which are the deep back and abdominal muscles closest to your spine, protect your discs and nerves from impact, said Gokhale.

Try it: Begin in push-up position, with your arms straight. Imagine a straight line from your legs through your torso to your neck. Don’t sag or lift your butt. If your shoulders are tensed toward your neck, roll them open, Gokhale said. Hold for up to a minute. This will “strengthen the muscles that keep your spine happy and lengthened,” she said.

Excerpts from: Julie Deardorff | Tribune Newspapers