You're pregnant! Congratulations! Your body's changing-wondrously, marvelously. One unexpected and unwelcome change may be lower back pain. Recent studies suggest that two-thirds of pregnant women experience lower back pain.¹

These statistics seem reasonable. The weight of the growing baby, plus the weight of the placenta and amniotic fluid, create an unbalanced load in front of the lower back. The result is irritation of spinal ligaments, muscles, and tendons, causing pain, muscle spasm, and loss of mobility.

Of course, some cases of pregnancy-related back pain have specific medical causes. Uncommon conditions such as pregnancy-associated osteoporosis, septic arthritis, and inflammatory arthritis may need to be considered.²

That said, the vast majority of cases of back pain in pregnancy are mechanical in origin.

Your doctor of chiropractic will perform a complete examination and determine the correct course of treatment, if appropriate. Once you're feeling better, you can begin

stretching and doing safe, gentle exercises that will help prevent recurrences of lower back pain. The goal is to strengthen your lower back and minimize the mechanical effects of pregnancy.

The best method of preventing back pain in the first place is being fit. This includes healthy nutrition, gaining a moderate amount of weight, and regular exercise. Your obstetrician will likely recommend vitamin and iron supplements and will monitor your weight. The average healthy woman gains between 25 and 35 pounds during the course of her pregnancy.³

Let's fast forward a few years. Your newborn is now a toddler. Parents know that if you have kids, stuff happens. You bend over to place a bulky car seat in your car. Then you place your child in it. And then, you bend over to remove the car seat from your car. If you've gone to the mall, kids want Daddy or Mommy to carry them. Pick them up, cart them around, put them down again.

What's a parent to do? It's not like you can avoid any of these activities. Your kids are kids - it's up to you to do stuff for them. The answer lies in regular exercise. "But how will I find time to exercise, when there already isn't enough time to do the things I need to do?"

That's a tough question, but if you recognize the benefits, you'll make the effort to make the time. Forty-five minutes or an hour per workout, three or four times a week, will be plenty. And, once you're in the habit of exercising, you'll notice it's easier to lift your kids, easier to bend over, easier to carry them. It's easier because you're

fitter and stronger. And healthier. And, surprisingly, you're having more fun.

¹Pennick VE, Young G: Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev 18(2):CD001139, 2007.
²Sax TW, Rosenbaum RB: Neuromuscular disorders in pregnancy. Muscle Nerve 34(5):559-571, 2006.
³Jain NJ, et al: Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes? Am J Perinatol 24(5):291-298, 2007.

Windows and Mac users actually do have one thing in common - computer ergonomics issues, namely, pain.^1,2 Beyond the usual hardware and software gotchas we deal with on a daily basis, the real bottom-line question is, "how to play nice with my computer".

Doing computer work is a funny kind of work, a type of activity we're still getting used to. It's not physical work in the sense that there's no heavy lifting going on, no truck-driving, no emergency services heart-pounding decision-making.

But computer work is still an intensely physical activity, although the work is pretty subtle. In computer work it's the small muscles that are getting the workout, not the big muscles we're used to thinking about.

Wrist muscles, tendons, and ligaments. Finger muscles, tendons, and ligaments. Shoulder muscles, Neck muscles. All of these are involved in ongoing repetitive tasks when you sit at a computer and one hour turns into two, two hours turns into three, and suddenly half the day is gone and you notice you've got a killer stiff neck.

Or, one day the tendons on the back of your hand begin to hurt, feeling irritated and inflamed. Or your shoulders and upper back are tight and painful.

Your hands or shoulders feel better by the time you go to sleep. But the next day, as soon as you start to type they act up again.

This is all very uncomfortable, because you've got to do your work.

What's going on?

These various pain patterns in your hands, wrists, shoulders, and neck can be grouped together as a repetitive stress syndrome. Repetitive activities, done over a long period of time, can irritate and inflame the muscles, tendons, and ligaments that are involved in doing the work.

But computer work involves repetitive tasks. How can you avoid these painful problems?

The best approach is to prevent them in the first place.³ If such a syndrome does develop, relative rest is indicated. Reduced computer activity, in smaller intervals, is a good solution. A very useful work-around for right- or left-arm pain is to teach your non-dominant hand to use the mouse or touchpad. This training may take a few weeks - the valuable result is the ability to switch hands whenever you like, distributing the workload between the two sides. Much better.

The most important aspect of prevention is to take a quick, refreshing break once an hour. This is a critical habit to develop. Get out of your chair, walk around, get some fresh air if possible. Change your environment for a few minutes - talk to a co-worker for a moment, get a drink from the water-cooler down the hall, seek out a picture, wall-covering, or landscape you've never seen before.

These activities refresh your body AND your brain, and you're ready to do another hour of productive, creative, healthy work. You'll feel much better, you'll be avoiding repetitive injuries, and your workday will be more enjoyable.

¹Keyserling WM, Chaffin DB: Occupational ergonomics - methods to evaluate physical stress on the job. Annu Rev Public Health 7:77-104, 1986.
²Computer Workstation Ergonomics. Centers for Disease Control and Prevention, 2000. http://www.cdc.gov/od/ohs/Ergonomics/compergo.htm
³Robertson MM, et al: Effects of a participatory ergonomics intervention computer workshop for university students. Work 18(3):305-314, 2002.

Kids get hurt all the time. They're running, they're jumping, they're crashing into things. Kids want to have fun, and when they play, they play full-out.

So, when kids play real sports, stuff happens.1,2 Whether your kid plays soccer, baseball, football, or studies karate, a broken bone, sprained ankle, or twisted knee is just the natural fallout of learning new skills and having a good time.

The treatment for most childhood sports injuries is straightforward and standard.3 For strains and sprains that involve only mild to moderate swelling and pain, the time-honored RICE protocol is followed - rest, ice, compression, and elevation.

Pediatric orthopedists get involved when the injury is more severe or when an arm or leg bone is broken.

But there are other issues, and every parent needs to be aware of these possibilities. In one of the unusual chains of circumstances that make the practice of medicine and the practice of chiropractic so interesting, a physical trauma (like a sports injury) can reveal an underlying serious problem.

In other words, various disorders of bone may not show themselves in terms of symptoms until a physical trauma makes them apparent. Such problems include metabolic disorders, growth and development problems, and even benign and malignant tumors.

What would make a parent suspect such an issue? First, if the child's pain seems out-of-proportion to the degree of injury. A mild knee sprain - for example, caused by tripping over second base while trying to stretch a double into a triple - should not be causing significant pain.

Also, mild-to-moderate injuries should not be warm to the touch. A parent can evaluate this. And, a child should not be running a fever after an activity-related injury.

It would also be suspicious if the pain did not improve daily. For the majority of injuries, pain that lingers beyond several days suggests an underlying problem. Children are resilient. Healthy kids heal quickly. They want to shrug off an injury, forget it happened, and get back to playing.

If your child isn't getting better in a few days, seems lethargic, or feels ill following an injury, warning bells should go off.

Your family chiropractor is familiar with all such conditions and scenarios. He or she is always alert to unusual situations and will recommend the appropriate steps to take, including a complete physical and x-ray examination. If necessary, your chiropractor will be able to recommend appropriate specialists for follow-up, including hematologists, endocrinologists, and pediatric orthopedists.

These more serious problems are uncommon. And, of course, well-informed parents help their kids grow up healthy and strong.

¹Caine D, et al: Incidence and distribution of pediatric sports-related injuries. Clin J Sport Med 16(6):500-513, 2006
²Emery CA: Risk factors for injury in child and adolescent sport: a systematic review of the literature. Clin J Sport Med 13(4):256-268, 2003
³Demorest RA, Landry GL: Prevention of pediatric sports injuries. Curr Sports Med Rep 2(6):337-343, 2003

Kids can get checked, too. Do kids need regular blood pressure check-ups or regular tests of their blood glucose levels? Probably not - these simple procedures can be done during a child's annual physical. But kids are very active and more frequent chiropractic check-ups are usually a good idea. Most of us were introduced to chiropractic care when we were adults - and we had to play catch-up for however long a period of time before we really began to feel healthy again. If we began chiropractic care as a younger adult, it probably didn't take too long to restore good health. If we were older - well, the process probably took more time.

If chiropractic care is valuable for you, imagine how valuable it is for your children. Kids are natural explorers - they run, jump, climb things, fall down, and bounce around. And, kids are resilient - this ability to recover quickly is one of the great benefits of being very young. Occasionally, one of these activity-related injuries impacts a child's spine. Nothing obvious has happened and nothing hurts. But there may be subtle injuries to spinal muscles and spinal ligaments that have a long-term effect on spinal nerve function.

Spinal nerve function depends on mechanical integrity of the spine itself. If spinal muscles and ligaments are inflamed or irritated, spinal nerve function is compromised to a greater or lesser extent. In a child, the short- and long-term results may include muscle pain and stiffness, loss of full range of motion in the neck or lower back, frequent colds, headaches, gastrointestinal problems, allergies, and asthma. Of course, when it comes to good health for you and your family, preventing a problem is much easier than treating a problem. In the long run, prevention also costs much less. We all want our kids to be healthy and well. We want them to play full-out, to engage in all kinds of sports, and to have a lot of fun. In order for children to continue to enjoy optimal health, regular spinal check-ups are as important as an annual physical exam. Your local chiropractor is the spinal health expert in your community. She will be glad to help you ensure your child's continued good health.

¹Barkley JE, et al: Reinforcing value of interval and continuous physical activities in children. Physiol Behav April 16, 2009
²Fecteau D, et al: The effect of concentrating periods of physical activity on the risk of injury in organized sports in a pediatric population. Clin J Sport Med 18(5):410-414, 2008
³Spinks AB, McClure RJ: Quantifying the risk of sports injury: a systematic review of activity-specific rates for children under 16 years of age. Br J Sports Med 41(9):548-557, 2007

American kids are under tremendous pressure to perform well in school. Every year they're required to take more and more standardized tests, and every year they fall further behind children around the world, particularly in science and mathematics.More is required to do well in school beyond sitting in the classroom and managing to stay awake throughout the day.

Kids by nature want to learn, but somehow this love of new knowledge and new experiences is sucked out of them early on. Many teachers no longer teach to broaden the skills and abilities of their students. Instead they teach to the standardized tests. There's no longer much room for exploring new territory, and kids get bored easily and stay bored if they're not challenged.

How can we help our children when the educational system does not provide the formula to engage many kids? Making sure our kids are healthy and well is a very good start. One of the most interesting developments in cognitive science (how people learn) in the last ten years is the importance of physical activity in relation to human performance. The results are in - research proves that physical activity is highly correlated to learning and academic achievement. Active kids are explorers. Active kids are alert and interested in what's going on around them. Active kids have an instinctive desire to grow and develop.

What kinds of exercise should our kids be doing? The great news is that the specific type of exercise doesn't matter. It's all good, whether a kid is playing soccer, running track, or riding around the neighborhood on her bike. It's the amount of exercise that counts, not the format of the exercise. Federal agencies recommend that every child get an hour of physical activity each day. This hour can be broken up into small segments or done all at once. What matters is the amount and consistency of the exercise.

Chiropractic care can play a big role in a child's development. Periodic chiropractic treatment can improve the functioning of a child's musculoskeletal system, and thus help improve their physical performance. And, chiropractic care can help a child recover quickly from activity- and sports-related injuries.

By helping a child continue with fun, enjoyable, and rewarding physical activities, chiropractic care is also helping them improve their academic performance. The result is a much more well-rounded young person, one whose interests may extend from the ball field to the science lab to the music room.

¹Hillman CH, et al: The effect of acute treadmill walking on cognitive control and academic achievement in preadolescent chiildren. Neuroscience 159(3):1044-1054, 2009
²Ploughman M: Exercise is brain food. The effects of physical activity on cognitive function. Dev Neurorehabil 11(3):236-240, 2008
³Davis CL, et al: Effects of aerobic exercise on overweight children's cognitive functioning. Res Q Exerc Sport 78(5):510-519, 2007

The worldwide type 2 diabetes epidemic has been thoroughly documented.^1,2 Yet despite extensive study and analysis, there has been little actual progress in slowing the spread of this chronic disease. Numerous medications such as metformin and glyburide are available to help counter the severe problems that result from unchecked diabetes. But if the person with diabetes doesn't assist in the process of getting well, the disease will continue on its unrelenting course. There are many important steps a diabetic patient can take to improve his or her health status. Better still, these same steps may be implemented by healthy persons to ward off type 2 diabetes in the first place.

In type 2 diabetes, the cells of your body become resistant to the effects of insulin. Normally, the hormone insulin promotes the absorption of glucose from the blood by muscle cells and fat cells. With insulin resistance, glucose fails to be properly absorbed by these cells and blood levels of glucose rise. Over time, some of this excess glucose is converted into fat, increasing the person's weight, causing high blood pressure, and placing undue stress on the heart. Further, prolonged exposure to excess glucose damages small blood vessels and nerve fibers, leading to significant pain along large nerve tracts (neuropathies), loss of circulation to and even amputation of a lower limb, kidney disease, kidney failure, eye disease, and blindness.

Thus, diabetes can be devastating for both patients and their families. The annual public health costs related to diabetes treatment are huge. Diabetes costs in the U.S. were $245 billion in 2012, representing $176 billion in direct medical costs and $69 billion in lost productivity. Worse, in 2012, 9.3% (29.1 million) of Americans had diabetes, up from 8.3% (25.8 million persons) in 2010. Costs of diabetes to patients, families, and society continue to rise.

The only feasible method of combating the worldwide diabetes epidemic focuses on individual initiative. Medical treatment, by definition, arrives after the fact, typically years after the diabetes process has been set in motion. Prevention is the best strategy. Adopting a lifestyle that, indirectly, leads to appropriate utilization of insulin rather than insulin resistance offers a real, effective solution to diabetes prevention. More than 20 years of research has demonstrated that 30 minutes of vigorous exercise a day, combined with a healthy diet and sufficient rest, will substantially assist a person in avoiding chronic diseases such as diabetes.³ Personal accountability and personal responsibility are called for. It is up to each of us to make such choices in the best interest of ourselves and our families.

¹Vollenweider P, et al: HDLs, Diabetes, and Metabolic Syndrome. Handb Exp Pharmacol 224:405-421, 2015
²Skrha J: Diabetes mellitus--a global pandemic. Keynote lecture presented at the Wonca conference in Prague in June 2013. Eur J Gen Pract 20(1):65-68, 2014
³Orio F, et al: Lifestyle changes in the management of adulthood and childhood obesity. Minerva Endocrinol 2014 Dec 17. [Epub ahead of print]

What is your lifestyle? Not whether you are married or where you live, but rather, how are you choosing to live your life? What choices are you making to keep yourself and your family healthy and well?

It is startling to learn that some of the most prevalent causes of illness, disease, and death - including cancer, heart disease, and diabetes - are all heavily influenced by lifestyle. For example, we don't usually think of cancer as a lifestyle disease. We think a person is unlucky if they have cancer, and often we have a fatalistic outlook toward news that someone has developed cancer. "It's in their genes," we say. Or "stuff happens - the luck of the draw."

Like Scylla and Charybdis, the twin sea monsters of Greek mythology, diabetes and obesity are the twin medical monsters confronting America's children. Diabetes and obesity have even been featured as the story line in a recent episode of Law & Order, a show well-known for focusing on issues that matter.

What's going on? Diabetes and obesity are twin raging epidemics endangering the health and welfare of our nation's young people. In New York City, by the age of 4, there is a one in three chance that the child will be obese. More than 40% of children are at an unhealthy weight at ages 2 and 3.¹ National statistics are similar.

Type II diabetes, long known as "adult-onset diabetes", is now being recognized as a significant juvenile disorder. Up to 45% of the children diagnosed with diabetes have the type II form.² And the numbers keep increasing.

Type II diabetes and obesity are closely related - being overweight is one of the two major risk factors for developing type II diabetes. The other major risk factor, not surprisingly, is lack of exercise - not being physically active.

Why be concerned? Both diabetes and obesity contribute to additional severe health issues. Obesity is the leading cause of pediatric high blood pressure and increases the risk of coronary heart disease. Uncontrolled diabetes, over time, can lead to heart disease, kidney disease, neurologic disorders, and blindness.

So we are very concerned for our children's well-being. The good news - and it is very good news - is both conditions are lifestyle-related. Bad diet and lack of exercise cause both conditions. This is well-known. It is also well-known that maintaining a healthy diet and getting regular exercise prevents obesity and prevents or delays type II diabetes.^3,4

As parents, it's up to us to set the standards. If we're eating healthy, balanced meals, our kids will do the same. If we exercise regularly and keep ourselves fit and trim, our kids will exercise regularly, too.

¹"Child obesity picture grim among New York City poor", The New York Times, April 6, 2006.

²Fagot-Campagna A: Emergence of type 2 diabetes mellitus in children: Epidemiological evidence. Journal of Pediatric Endocrinology and Metabolism 13(Suppl 6): S1395-S1402, 2000.

³Hamman RF, et al: Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 29:2102-2107, 2006.

⁴Knowler WC, et al: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 346(6):393-403, 2002.

We all know some people who get sick all the time. They're just getting over one thing when here comes the next round of illness. We also know people who just seem to be full of energy. Those people never get sick or so it seems. What are the key differences between these North and South Poles of health? One key difference is healthy behavior.

On the North Pole side, people who frequently get sick think this is something that happens to them. In other words, their health problems are related to fate. "I catch whatever's going around the office", they say. "I catch whatever my kids pick up at school" is another common refrain. These individuals - and they represent most of us - don't seem to realize it's their behaviors, actions, and choices that lead to their continual state of unwellness. For example, two-thirds of all American adults are either overweight or obese. Is this fate? Or something else?

On the South Pole side, people who are rarely sick are usually very clear about what's going on. These individuals have trained themselves to take control of their health and well-being by making active choices. These choices, known as healthy behaviors, result in: a stronger immune system,lower serum cholesterol, lower blood pressure, improved cardiovascular health, weight loss, more restful sleep, and a positive mental attitude.

Healthy behaviors have been shown to reduce blood glucose (good news for diabetics) and reduce the occurrence of life-changing disorders such as stroke. What are these action steps? Everybody knows them, even North Pole people. Healthy behaviors include: regular vigorous exercise (the Federal Department of Health and Human Services recommends 30 minutes of exercise five times per week) - 30 minutes of walking fulfills your daily exercise requirement. Eat plenty of fresh fruits and vegetables (the Federal Department of Health and Human Services recommends at least five portions per day) Also, eat a balanced diet including high quality protein, complex carbohydrates, and mono- and polyunsaturated fats. Make sure to get the rest that you need (seven hours of sleep per night is the recommended average).

Healthy behaviors do require discipline and effort. In the 21st Century, good health does not come for free. To be healthy and well, we need to do the planning, make our schedules, and put in the time. Of course, there's a very big payoff. How great would it be to have a healthy height/weight ratio, normal levels of blood glucose, and a normal-for-age blood pressure? It would be very great.

The payoff is not only adding years to life, but also adding life to years. It's much more fun to have good health. We all know how not-fun it is when we're sick. Your local chiropractor can be an important part of your plan for good family health, and is an expert in all aspects of healthy behaviors. We will be glad to help you design plans and programs that will work for your needs and those of your family.

¹ Hamman RF, et al: Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 29:2102-2107, 2006
² Forman JP, et al: Life style as a blood pressure determinant. JAMA 302(4): 437-439, 2009
³ KKhan LK, et al: Recommended community strategies and measurements to prevent obesity in the U.S. MMWR Recomm Rep 58(RR-7):1-26, 2009