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Ever notice how strength training and aerobic exercise go together? Aerobic exercise accentuates strength training because you have more endurance. Strength training makes aerobic exercise better, more fun, because you have more power. Like marshmallows and campfires or vanilla ice cream and hot apple pie, each one enhances the experience of the other.

Awareness of these possibilities helps you get more out of the valuable time you spend exercising.

Strength training by itself doesn't provide much of an aerobic benefit. Strength training by its very nature is an anaerobic activity. Some aerobic benefit can be gained by doing five- or six-exercise supersets. But that's not the main point of lifting weights.

Aerobic exercise by itself doesn't provide much of a strength benefit. Aerobic exercise by its very nature is a glucose-burning endurance activity. The main muscle that gets stronger is your heart, and that's why you're doing aerobic activities. You don't really increase lean muscle mass by doing aerobic exercise.

But when you do both activities on a regular, weekly basis, magical things happen. You notice you're getting stronger on your strength training days and getting faster and have more endurance on your aerobic training days because you're doing both consistently.

From the viewpoint of exercise physiology, focusing on things like VO2 max and oxygen-consumption rates, the combination of strength training and aerobic exercise generates a positive feedback loop of training effects. Done correctly, strength training not only strengthens the prime movers involved in the specific exercise, but also the accessory and stabilizing muscles. These latter muscles come into play during aerobics, too, and provide a strong base to support the prime movers of aerobic activity - the quadriceps, hamstrings, and calf muscles.

Aerobic exercise itself trains accessory and stabilizing muscles only minimally. So strength training is needed to complete the biomechanical picture and allow you to get the most out of your aerobic training.

Similarly, aerobic exercise strengthens your cardiovascular and pulmonary systems. Your cardiac stroke volume increases, meaning your heart is pumping more blood each time it contracts. Your lung capacity increases so you take in more air (and, therefore, more oxygen) with each breath. More air and more blood means more nutrients reaching hard-working muscles during your strength training sessions.

In effect, aerobic exercise and strength training complete each other. When you engage in both activities, consistently, week by week, you are maximizing your training benefits across the board.1,2,3 Together, these life-affirming activities help you paint a beautiful picture of vibrant health and well-being.

¹Field T: Exercise research on children and adolescents. Complement Ther Clin Pract 18(1):54-59, 2012

²Walsh NP, et al: Position statement. Part one: Immune function and exercise. Exerc Immunol Rev 17:6-63, 2011

³Sung J, et al: Prevalence of Coronary Atherosclerosis in Asymptomatic Middle-Age Men With High Aerobic Fitness. Am J Cardiol Dec 21 2011 (Epub ahead of print)

We're all familiar with the mechanism of action-and-reaction in the world of sports. Pitcher-and-batter is an action-reaction duo in baseball. A basketball guard driving to the hoop and a defender leaping to block the shot is another example. A racecar driver negotiating a tight turn at speed is executing a complex series of actions and reactions.

Actions and reactions may also refer to choices we make in our daily lives. Someone cuts you off as you're trying to get into the left-hand lane. That's an action. Yelling and shaking your fist in the direction of that driver who by now is long gone is one sort of reaction. Taking a deep breath and simply releasing your tension is another sort of reaction. We may also take action on our own behalf or be reactive to events as they unfold. These are personal choices and, of course, there's no "right" way to be. However, the outcomes and consequences of an active vs. a reactive approach may often be different. These differences are apparent when we consider our approaches to personal health.

For example, the numbers of people affected by chronic diseases such as cardiovascular disease, type 2 diabetes, and cancer continue to increase. In the United States one out of every three persons has a chronic disease, and most of these people have more than one chronic disease. It's also well-known that two-thirds of American adults are overweight or obese. The majority of these disorders are related to people being reactive when it comes to their health. For example, the majority of cancers are preventable.¹ Eating more food than your body needs for energy is a choice. Over time these extra calories accumulate in the body and one or more chronic diseases is the result. Finally, your doctor informs you that you have type 2 diabetes. You react to this news and declare you're going to cut down on junk food, lose weight, and really get serious about exercise. You're in reaction mode.

But there are consequences. Type 2 diabetes is associated with increased risk of developing cancer ² as well as cardiovascular disease. Once you have a diagnosis of type 2 diabetes it's certainly important to be reactive, but an active lifestyle approach could easily have prevented long-term consequences. Likewise with cardiovascular disease. You've never felt you needed to watch your weight, but as the years have gone by you've gradually gained weight and now you're concerned. Your doctor may inform you that both your blood pressure and your cholesterol levels are way too high and recommend several lifestyle changes that have been shown to be beneficial. Now you're in reactive mode and you eagerly desire to make a change.

Again, there are consequences. High blood pressure and elevated cholesterol levels are important risk factors for heart attack and stroke. ³ Engaging in healthful actions in the first place helps to reduce these risks.
Regular chiropractic care is an important component of a healthy lifestyle. Chiropractic care can be reactive, helping you to recover from an injury to your back or neck. Chiropractic care can be of even greater benefit from an active perspective. Chiropractic care helps to ensure that all of your body systems are working efficiently and working in harmony. Chiropractic helps you maximize the benefits from your lifestyle actions of a healthy diet, regular exercise, and sufficient rest.

¹ American Cancer Society: Cancer Prevention and Early Detection. Facts and Figures. Atlanta, GA, ACS, 2008
² Currie CJ, et al: The influence of glucose-lowering therapies on cancer risk in type 2 diabetes. Diabetologia 52(9):1766-1777, 2009
³Robinson JG, et al: Atherosclerosis profile and incidence of cardiovascular events. A population-based survey. BMC Cardiovasc Disord 9(1):46, 2009

Chronic diseases such as hypertension and diabetes have increasingly high prevalence in world populations.¹ Such prevalence is rising despite extensive use of prescription medications. Problematically, many people have two or more concurrent chronic disorders and are taking multiple medications. But frequently the various physicians are not in contact and are not aware of the patient's complete list of current prescriptions. No single physician or nurse is managing the patient's array of medications. As a result, potentially harmful drug interactions are a common occurrence.^2,3 Mistakes are made and patients may suffer serious side effects. In such adverse circumstances, the cure in fact may be worse than the disease.

In today's health care systems, people as patients need to be good custodians of their own care. In many health systems, a patient is lucky if he or she is able to spend more than five uninterrupted minutes with their doctor. Physicians are rushed and harried by numerous responsibilities related to management of their offices, all of which take precious time away from patient interactions. In such an environment, patients need to be proactive to do their best to ensure that recommended treatment is actually going to be helpful, rather than potentially harmful. This is a very difficult task, as most people do not have backgrounds that will help facilitate understanding of such decision-making. But especially for those with a chronic disease, it's critically important to master at least a basic level of information regarding their condition and various types of treatment.

In addition to expanding one's knowledge base, an important long-term strategy is to begin to make lifestyle choices that will support good health. Appropriate and effective lifestyle choices include regular exercise, a healthy diet, and sufficient rest. All three of these key components of good health can be started right now. An exercise program should consist of five 30-minute sessions of vigorous exercise every week. A healthy diet consists of daily selections from all five major food groups: fruits, vegetables, grains, proteins, and dairy. A daily diet should include at least five servings of fresh fruit and vegetables every day. Regarding sufficient rest, 7-8 hours of sleep per night is a good average for most people. If you're not waking up feeling rested and refreshed, you're probably not getting enough sleep.

Ultimately, each of us is responsible for our own health and well-being. Prescription medication may be necessary, but of course such treatment is primarily directed toward the effects of a person's disease or disorder. Changes in lifestyle are required to address the underlying causes of such conditions. Beginning to institute and maintaining healthful lifestyle choices will provide long-term benefit for the welfare and well-being of our families and ourselves.

¹Bauer UE, et al: Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 384(9937):42-52, 2014
²Rotermann M, et al: Prescription medication use by Canadians aged 6 to 79. Health Rep 25(6):3-9, 2014
³Marengoni A, et al: Understanding adverse drug reactions in older adults through drug-drug interactions. Eur J Intern Med 2014 Oct 10. pii: S0953-6205(14)00282-9. doi: 10.1016/j.ejim.2014.10.001. [Epub ahead of print]

Headaches are big business. For the drug companies, that is.

Approximately 10 million Americans suffer daily headaches, and 50 million have headaches often enough to seek medical care. Approximately 23 million Americans suffer from migraines. Billions of dollars are spent each year on Aleve and Motrin for tension headaches and Imitrex for migraines.

But all that money might just as well be poured down a hole in the ground, because the statistics haven't changed in almost 20 years. Approximately one out of every six Americans suffers from headaches.

Tension headaches are most common, caused by muscle spasm in the neck and shoulders, stress, and even eye strain. The dull, pounding pain may be severe, and there may be nausea. Migraines are even more debilitating, and may be preceded by an "aura" - visual symptoms such as flashing lights or loss of portions of a visual field.

Headaches, although common, should never be taken for granted. People suffering headaches should, at some point, have a physical examination to rule out underlying problems such as high blood pressure.

Importantly, an unusual headache, accompanied by brand-new symptoms, should be evaluated by a physician immediately. A sudden, severe headache, "like nothing I ever had before", needs immediate attention. If you've never thrown up as a result of a headache, and suddenly you are, you need to see a physician. An unusual, unexpected level in the increase of headache pain needs immediate attention. Any of these situations could be caused by a serious underlying problem, and an MRI is usually necessary.

Chiropractic treatment may be of benefit for many people suffering with tension headaches and even migraines. A chiropractic physician will perform a complete physical examination, which may include x-rays. Underlying causes of headaches are ruled out. If a medical condition is suspected, the patient may be referred to the appropriate specialist.

Chiropractic spinal manipulation is a gentle procedure that reduces muscle tension and increases spinal mobility. Neck and shoulder muscles are freed from being held in fixed positions, resulting in increased circulation, improved nutrition, and more efficient muscle activity. The frequency and intensity of tension headaches may improve noticeably. Migraine headaches may improve as well.

Regular exercise and a balanced diet are very important in the treatment of headaches. Exercise improves all aspects of muscle function and improves circulation. Improved cardiovascular function means more blood is flowing to neck and shoulder muscles, bringing oxygen and nutrients and removing irritants such as lactic acid.

A balanced diet ensures that neck and shoulder muscles are getting the energy sources, vitamins, and minerals they need to work properly. A balanced diet in combination with regular exercise also results in weight loss, removing unnecessary mechanical stress in the form of excess pounds.

Headaches are usually a symptom of being out-of-balance. Exercise, balanced nutrition, and chiropractic care can help restore balance to our highly stressed lives.

¹"Hospital Treats Headache Suffers". The New York Times, 12/25/88.
²Source: National Headache Foundation - www.headaches.org
³Source: Yale Medical Group - www.ymghealthinfo.org

Many of us think of depression as a psychological condition. The causes of depression are sought in the person's childhood or in her personal circumstances as an adult. But within the last 10 or 20 years depression is increasingly being evaluated within a physiological context. Various disease states and physical disorders are being recognized as important contributors to depression. This viewpoint is empowering to persons with depression and often provides a way forward when progress has been minimal or absent.

Those with depression experience both physical and psychological pain. It is well-documented that chronic physical pain can lead to depression. Also, it is well-known that depressive states can cause physical pain. A feedback loop (vicious circle) is often created in which physical pain makes a person's depression worse and the person's depression makes the physical pain worse.

In addition, changes in brain physiology may cause a person to be depressed. In other words, abnormal electrical activity in the brain - which, of course, is not under the person's conscious control - may result in depression. The brain's electrical activity is evaluated by a method known as quantitative EEG (QEEG).1 For those with clinical depression, the QEEG often demonstrates too much slow-wave activity in the left front brain (prefrontal cortex) and too much fast-wave activity in the right prefrontal cortex.

For those with clinical depression, the light of the world is considerably dimmed. The mood of a depressed person is low and he loses interest in normally pleasurable activities. Depressive disorders interfere with a person's work and/or school activities, family life and social life, and overall health. Lack of energy, lack of appetite, and decreased physical activity are all associated with clinical depression.

An access to relieving chronic depression may be found in encouraging the person to begin to engage in physical activity.2,3 Such activity may be difficult for those who are severely depressed, and yet all persons with depression should be presented with this form of therapy.

Additionally, chiropractic care may be of great benefit for those with clinical depression. The pain relief and improved musculoskeletal function afforded by chiropractic care may help reduce the physical component of ongoing depression.

¹Hargrove JB, et al: Quantitative electroencephalographic abnormalities in fibromyalgia patients. Clin EEG Neurosci 41(3):132-139, 2010

²Gill A, et al: Clinical Inquiries: Does exercise alleviate symptoms of depression? J Fam Pract 59(9):530-531, 2010

³Uebelacker LA, et al: Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. J Psychiatr Pract 16(1):22-33, 2010

We all want to get the most we can out of life. Whether we want to find a loving partner, work at a meaningful career, gather an abundance of financial resources, or have enough leisure time to pursue favored interests, the usual bottom line is that we want to be happy. Throughout thousands of years of history, the great philosophers have pointed to happiness as the worthwhile goal of all human activities. In the Nicomachean Ethics, Aristotle (384 B.C. - 322 B.C.) suggested that eudaimonia - happiness - is our best good.

Most of us would agree that the life we want to live involves achieving the greatest degree of happiness. Even if we haven't spent much time studying the works of Aristotle, we intuitively seek our greatest happiness. But such joy often escapes us, even at times when we think to ourselves that we ought to be happy. Various obstacles stand in our way, not the least of which is physical pain.

Physical pain can overshadow our various paths to personal happiness. We can tolerate acute pain for a while in the hope that it will go away soon, within a week or two at the most. But chronic pain is another matter. Often, extraordinary resources need to be utilized to maintain a positive attitude in the face of ongoing pain.

Many people experiencing chronic pain may find it difficult to imagine really living the life they want to live. Pain seems to influence everything. But there are many tools and techniques for diminishing the impact of chronic pain. The practice of yoga^1,2 has consistently been shown to provide benefits, as has developing the habit of doing regular exercise³, such as walking or swimming. Engaging in enriching activities such as learning a new language, studying a musical instrument, and learning how to draw or paint with watercolors can shift one's focus away from pain and toward personal growth and development.

Also, chronic pain, at least that involving the musculoskeletal system, may benefit from chiropractic care. For example, chiropractic care can often help with chronic headaches, chronic neck pain, and chronic low back pain. For many people the benefit may be substantial. Your chiropractor is experienced in the care of many chronic conditions and will let you know whether chiropractic care is right for you.

¹Michalson A, et al: Yoga for chronic neck pain: a pilot randomized controlled clinical trial. J Pain 13(11):1122-1130, 2012

²Tilbrook HE, et al: Yoga for chronic low back pain: a randomized trial. Ann Intern Med 155(9):569-578, 2011

³Sullivan AB, et al: The role of exercise and types of exercise in the rehabilitation of chronic pain: specific or nonspecific benefits. Curr Pain Headache Rep 16(2):153-161, 2012

Cancer is a health issue for many families. It's important to understand that there are different kinds of cancers. Not all cancers are life-threatening. Some types may be very serious and some may be dealt with relatively easily.

First, it's important to distinguish between benign and malignant tumors. The words "tumor" and "cancer" are usually interchangeable.

Tumors (or cancers) affect how cells reproduce. Normal cellular reproduction is tightly regulated. Normally, cells reproduce at regular intervals. In a tumor, cell reproduction is unregulated - cells reproduce on their own schedule, rather than based on the needs of the body. The result is a mass of cells that is growing unchecked. The tumor mass "doesn't belong" - it's like it exists within its own world. But the tumor uses the body's precious resources to maintain its own existence.

Benign tumors are usually slowly growing. The benign tumor mass is surrounded by a membrane and is "well-encapsulated". A benign tumor may cause health problems when it reaches a size big enough to create pressure effects on the surrounding tissues. Such a tumor mass may create pressure on an important blood vessel, or it may kill nearby cells and tissues by the pressure it's exerting on them. Basically, the tumor isn't supposed to be there. There's no room for anything "extra" in the body.

Malignant tumors have more dangerous characteristics. In general, malignant tumors are more rapidly growing than benign tumors. Malignant tumor cells have the ability to make their way into the capillaries, traveling through the bloodstream until reaching suitable locations for new growth.^1,2 A metastasis is a new malignant mass developing in a new location from that of the original tumor.

Also, malignant tumors have the unique ability to cause the body to build an individualized, extensive blood supply for the tumor. This process is called angiogenesis. This complex network of blood vessels supplies the malignant tumor with extra oxygen and nutrients to fuel its rapid growth. So, essentially, malignant tumors highjack the body's resources for the tumor's own benefit. Malignant cells are highly adaptive and deadly.

Medical treatment for malignant cancers includes

Chemotherapy
Radiation
Surgery

Where does chiropractic treatment come in? Chiropractic care may be an important component of supportive care in cancer treatment. Your body needs to use all its available resources and energy to help fight cancer and assist in recovery. Gentle chiropractic treatment helps your body work more efficiently, improving overall mechanical function and easing stress on muscles and joints.³ These chiropractic benefits help make more energy available to assist your body in returning to a healthier state.

Chiropractic treatment helps support the process of recovery and the transition back to maximum health.

¹Gavert N, Ben-Ze'ev A: Epithelial-mesenchymal transition and the invasive potential of tumors. Trends Mol Med 2008 (in press)
²Guarino M, et al: The role of epithelial-mesenchymal transition in cancer pathology. Pathology 39(3):305-318, 2007
³Demark-Wahnefried W, Jones LW: Promoting a healthy lifestyle among cancer survivors. Hematol Oncol Clin North Am 22(2):319-342, 2008

We all know someone with high blood pressure (HBP), possibly a beloved family member or a lifelong friend. This common problem affects one in four American adults.¹ An alarming 75% of patients with type 2 diabetes also have HBP.²

High blood pressure is particularly dangerous because, for the most part, there are no symptoms until severe damage occurs. Heart disease, stroke, kidney disease, atherosclerosis, and eye disease are some of the serious problems that may result from untreated HBP.

Normal blood pressure is in the range of 120/80 ("120 over 80"). The first number represents the systolic pressure, the pressure at which your heart pumps blood into your arteries. The second number represents the diastolic pressure, the pressure in your arteries between heart beats (the resting pressure). The systolic pressure can increase, in the short term, in response to stress or physical activity. Systolic pressures over 140 and diastolic pressures over 90 suggest the possibility of HBP. Blood pressure readings should be repeated several times, over a period of several days, before a diagnosis of HBP is considered.

Medical treatment for HBP consists of blood pressure-lowering medications (antihypertensives). This group of drugs is typically effective in reducing pressure, but getting the dosages right may be tricky and there may be unwelcome side effects.

Lifestyle strategies and activities (complementary medicine, lifestyle medicine) offer significant, well-documented benefits in reducing blood pressure levels. Regular, frequent exercise is an important part of all lifestyle programs targeted toward lowering blood pressure and reducing the risk of cardiovascular disease and stroke.^3,4 Regular exercise makes your heart stronger, and a stronger heart pumps blood more easily and efficiently. Over time, regular exercise may reduce blood pressure levels by an average of 10mm.

Meditation is another key reducer of blood pressure levels.⁵ Much more than a New Age fad, meditation has consistently demonstrated benefits related to several health issues. And, meditation is easy to do. All you need is a comfortable chair or cushion that allows you to sit in a straight posture without any tension. There's no special breathing to do and you don't have to do any chanting.

To meditate, sit facing a blank wall (if possible) and let your hands relax in your lap. Tilt your head slightly downward, and let your eyes achieve a soft focus at that slightly downward angle. Breathe easily and gently. Breathe in and visualize energy going up your spine in the back. Breathe out and visualize the energy going down your spine in the front. Silently say "one". Continue up to "ten" cycles, and begin again at "one". That's it!

How long? This is completely up to you. Start with five minutes twice a day, and gradually build up to 20 minutes twice a day. You'll probably notice you're feeling much more at ease, more relaxed, with more energy during the day than before you started meditating. The benefits are powerful, and again, there is a profound effect on high blood pressure.

Your doctor of chiropractic can help participate in a complementary approach, assisting your body and you nervous system to function at peak performance.

¹Undiagnosed hypertension is common among urban emergency room patients. Medscape Medical News, Sept 2, 2005 - http://www.medscape.com/viewarticle/538785.
²Schutta MH: Diabetes and hypertension. Epidemiology of the relationship and pathophysiology of factors associated with these comorbid conditions. J Cardiometab Syndr 2(2):124-130, 2007.
³High blood pressure and exercise: Why activity is key. August 11th, 2006 - http://www.mayoclinic.com/health/high-blood-pressure/HI00024.
⁴Zanabria E, Welch GL: Hypertension and exercise. American Fitness March-April 2003.
⁵Walton KG, et al. Psychosocial stress and cardiovascular disease. Effectiveness of the Transcendental Meditation program in treatment and prevention. Behav Med 28(3):106-123, 2002.

According to a recent report, cardiovascular disease claims more lives worldwide than any other disorder.¹ Diseases of the heart and blood vessels, including coronary artery disease, are responsible for more than 4 million deaths in Europe each year² and almost one-third of all deaths worldwide. In the United States, coronary artery disease is responsible for nearly 20% of all disease-related deaths. Each year approximately 1.5 million Americans suffer a heart attack. Despite decades-long public health campaigns conducted across the globe, heart disease remains a powerful, formidable foe.

A large part of this problem is related to three classical risk factors for heart disease: high blood pressure, high cholesterol levels in the blood, and diabetes. As worldwide epidemics of obesity and diabetes continue to worsen, it is easy to understand why heart disease remains a number one killer. Obesity is strongly linked to high cholesterol levels, and the combination of diabetes and overweight/obesity is strongly linked to high blood pressure. As the epidemics persist, so does the prevalence of heart disease risk factors. No public health issue exists in isolation, and this is especially true for heart disease.

However, there is good news. Heart disease, hypertension, diabetes, high serum cholesterol levels, and overweight/obesity are all lifestyle disorders. This means that we can take meaningful action on our own behalf and begin to do things that will positively impact our long-term health and well-being. Such lifestyle changes are important for everyone, as people of all ages, races, and genders may be affected by lifestyle diseases.

Lifestyle changes primarily involve modifications to diet, engaging in consistent vigorous exercise,³ and getting sufficient rest. For example, it is well-known that many people in the developed world consume more calories than they need on a daily basis. The excess calories are stored primarily as fat. Reducing daily food consumption, while adhering to the basic principle of eating from a wide variety of food groups, including fresh fruits and vegetables, will likely result in weight loss and a normalization of high cholesterol levels. Assisting in this process is the practice of engaging in regular vigorous exercise. A proven method is to exercise for 30 minutes five times per week. Such exercise can include walking, cycling, running, swimming, and strength training. The specific choice of exercise is less important than the consistency. The payoff for your commitment to a healthy diet and regular exercise is significant. Research shows that prevention strategies such as lifestyle modifications account for a 50% reduction in mortality from heart disease. This is a huge return on investment.

But in order to reap these rewards, a commitment of time and effort is required. In today's world, good health doesn't just happen. We have to work at it. It's up to us to choose whether we're worth it, whether we want to continue to enjoy a full range of relationships and activities, whether we want to be healthy and well for many years to come. If the answer to these questions is affirmative, lifestyle changes become very important.

¹Carmon B: Biochemistry to behaviour. Nature 493:S2-S3, 2013

²Perk J: The power of disease prevention. Nature 493:S6, 2013

³Winter KH, et al: Hypertension Prim Care 40(1):179-194, 2013

As we get older, years and decades of mechanical stress may lead to deterioration of joints, ligaments, and tendons. This degenerative process, commonly known as arthritis, primarily affects weight-bearing joints such as the hips and knees and those found in the lumbar spine. The shoulder, too, is especially prone to undergo arthritic changes owing to its extreme mobility. The extensive range of motion at the shoulder is built-in to the design of this structure, but the tradeoff is instability. The design of the shoulder sacrifices stability for mobility.

Degenerative disorders of the shoulder typically involve the rotator cuff. This broad, flat structure is composed of the muscle-tendon units of the four rotator cuff muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. The thick covering of the rotator cuff surrounds the head of the arm bone and supports and strengthens the shoulder joint. But owing to the shoulder's inherent instability contrasted with its great mobility, the soft tissues of the rotator cuff undergo repetitive stress and strain. Ultimately, degenerative changes may occur, leading to the two prominent symptoms of pain and restricted range of motion.

An entire orthopedic sub-specialty focuses on treatment of chronic shoulder pain and includes long-term use of anti-inflammatory medication, corticosteroid injections when medications do not provide sufficient relief, and eventually surgery to repair tears in the various rotator cuff tendons. "Revision" surgery is commonly performed when the benefits of prior surgery are exhausted.¹

The good news is that in many cases, a more optimal approach is available, one that utilizes the body's own natural recuperative powers. For many people, chronic shoulder pain can be reduced and chronic loss of mobility can be improved by engaging in specific activities and performing specific rehabilitative exercises. The goals of rehabilitation are to increase shoulder range of motion and build up shoulder strength. As these goals are accomplished, the likely result is reduction of intensity and frequency of occurrence of shoulder pain.

Engaging in an overall strength training program is an important general approach to managing chronic shoulder pain.^2,3 Strength training should be done progressively, starting with light weights and building up over time. Exercises specific to the shoulder include seated dumbbell or barbell presses, dumbbell or cable lateral raises, seated bent-over rows, and internal and external rotation exercises done with very light dumbbells on a flat bench. If one has experienced an acute shoulder injury, early rehabilitation should precede rehabilitative strength training. Early rehabilitation includes pendulum exercises and finger-walking up a wall in both forward-facing and side positions.

Your chiropractor is experienced in injury rehabilitation and will be able to help you design an effective flexibility and strengthening program for improved shoulder function.

¹Keener JD: Revision rotator cuff repair. Clin Sports Med 31(4):713-725, 2012

²Lewis JS: A specific exercise program for patients with subacromial impingement syndrome can improve function and reduce the need for surgery. J Physiother 58(2):127, 2012

³Andersen LL, et al: Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain 152(2):440-446, 2011

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