My dad was a government servant and we moved quite a bit during my childhood. We cousins always had a blast during the summer holidays. A few days ago my youngest cousin announced his marriage. As expected all of us got into a flurry of activities. After one such long call, I couldn’t help feeling relaxed, at ease, at peace. I love the role of Epigenetics in being pain-free and healthy.
Oxytocin is a neurotransmitter and hormone. It is lovingly called the Cuddle or love hormone. It strengthens empathy and reduces stress and anxiety. This improves clinical outcomes in treating pain and being pain-free. In this world of virtual vs. real interactions here are a few things that help
Listening to music with loved ones
Aromatherapy especially lavender and vanilla
Sharing a good laugh
Physical relaxation techniques like deep breathing, aerobic or group exercise.
Genes play 4% role in any disease 96% is what we tell the genes to do and how we live.
An otherwise routine Saturday afternoon turned out quite insightful thanks to my dear friend. We had decided to catch up over coffee. Delicious coffee and delightful company filled me with joy. An otherwise cheerful person she seemed quite worried. She was a fitness freak and super motivated and yet she complained that her energy levels were dipping and waistline increasing. Thinking that these were typical perimenopause symptoms she was dieting and gymming harder to no avail. Seeing her the clinician in me got curious. I ran a blood work. HbA1c was more than 6, Fasting insulin more than 8, LDL and triglycerides elevated, and a waist-hip ratio was more than 1. She was clearly Pre diabetic Aka insulin insulin-resistant.
It is a metabolic condition where the cells downregulate insulin receptors. so there is more insulin in the blood and less in the cells. This signals the brain to store fat in case of starvation. Fat is tucked away and stored in the cells. This fat is not available as a fuel even in high-intensity workouts. So we burn the carbs causing energy slumps and unrelenting waistline. Time for actionable
Focus on form and CAR( Controlled Articular Rotations)
Stroll for 20 -30 min after each meal
Keep the majority of exercises in a Moderate, aerobic zone.
Support liver and pancreatic health with cruciferous veggies, sleep, low glycemic and fiber-rich foods.
Balance cortisol with 2-3 rounds of belly breathing every hour.
Coming back to my friend she has lost a couple of inches and is her old cheerful self again
A healthy gut leads to healthy hormones and a healthy weight.
It was a regular Wednesday afternoon till my regular auto driver stood me out and I had to pick my kids up. Standing on the street corner, my eye caught sight of an auto with heavy Ferrari stickering. The driver a chirpy young lad in his early 20’s got talking about his love for fast cars and why his auto had become his Ferrari. I laughed it off little did I know that he had meant it literally.
A middle-aged person with no appetite for speed I felt my heart flutter every time we negotiated a bend. After the initial shock, the movement nerd in me took over and wanted to note my physical response.
This is what I found
Anticipatory core bracing
As we neared any vehicle I would involuntarily tuck my abdomen in, lift my diaphragm up, and push all the air out of my lungs. Lift my chest, shoulders, and neck up. This reduced the blood supply to my brain making me feel more nervous and lightheaded. My ramrod rigid back was amplifying the sensation of the shock making me feel like a brick being thrown around. A few rounds of this and I had had enough and now it was time for the correctives.
When under stress, free up the belly. Allow the breath to flow in and out-of the belly, this will loosen your back and allow efficient shock absorption.
when under stress, free up the breath to free up the brain
As my journey came to an end I learnt that we may not be able to change the circumstances of our lives but can surely choose our response which will change the effect the circumstance has on us.
Hormone reset is a method of weight loss that focuses on the hormones that regulate our metabolism, hunger and cravings. In this article, we’ll be looking at how hormone reset can help you lose weight in three different ways:
Boosting your metabolism by reducing insulin resistance and increasing thyroid function (the “engine” of your body)
Reducing hunger and cravings with leptin resistance reduction (the “brakes” on your appetite)
Balancing the sex hormones estrogen, progesterone, and testosterone
Technique 1: Eating Habits
The first technique is to optimize your macronutrient intake. This means eating more protein and healthy fats while reducing sugar and processed foods.
Eat more protein: Protein helps you feel full for longer, so you’ll be less likely to overeat later in the day. It also helps build muscle mass, which can help you burn calories even when you’re not exercising!
Eat healthy fats: Healthy fats are an important part of any balanced diet–they help keep your hormones balanced too! You should aim for a minimum of 25 grams per day (about 2 tablespoons). Some good sources include avocado, olive oil (make sure it’s extra virgin), nuts/seeds like cashews or almonds (try them with some dark chocolate!), and coconut milk/creamer instead of dairy milk if possible…
Technique 2: Exercise
The second technique to weight loss is exercise. Exercise can be a great way to lose weight, but it’s important to focus on strength training and incorporate HIIT (high-intensity interval training) and cardio into your routine. When it comes to strength training, focus on compound lifts like squats, deadlifts, bench presses, and rows. These exercises use more than one muscle group at once so they’re more efficient at burning calories than isolation exercises like bicep curls or triceps kickbacks. Additionally, these movements require more energy from your body which means that you’ll burn more calories during the workout itself as well as after it’s done! HIIT workouts are another great way of burning fat because they’re short bursts of high intensity followed by periods of rest–so even though they only last 15 minutes or so per session (compared with 45+ minutes for traditional cardio), they still provide an excellent calorie burn!
Technique 3: Stress Management
Stress is a major factor in weight gain, and it can be hard to manage. If you’re feeling stressed out, try these techniques:
Reduce your stress levels as much as possible. This may mean getting more sleep or practicing mindfulness and meditation.
Get adequate sleep every night so that your body has time to recover from the day’s stresses before going to bed (and not eating late at night).
A hormone reset is a great way to lose weight.
It’s an easy way to get started on your journey to a healthier lifestyle.
You can do it at home, with minimal equipment and no special training required!
Hi in this blog ,I will talk about blood sugar management from a movement science and a functional medicine perspective. Before we dive into the action items let’s briefly see what is the root cause for the glucose levels to vary
The Spectrum of blood glucose dysregulation
Wake up When we are about to wake up the liver is signaled to release more blood glucose to give us energy to start the day
Post MealSpike in the levels of blood glucose and insulin to move the glucose inside the cells to provide energy
StressIt has the same effects as a meal. There is a spike in both glucose and insulin levels. The brain is tricked into believing that you have had a meal.
In diabetic patients as there is low insulin secretion the early morning glucose levels rise up causing hyperglycemia .. This lasts from 3 am to 8 am and is called the Dawn effect. This spike in blood sugar can wake you up from sleep
Similarly if you have had a very low carb dinner or have skipped it then the sugar levels drop till 2 am and then hormones are released to stop insulin secretion and this will cause rebound hyperglycemia.. aka Somyogi effect
As you can see that our blood sugar levels are not static but quite responsive to what we do, what we eat, and how we feel and when we have too many fluctuations for too long it becomes a blood glucose dysregulation which is seen as increased
Estimated average glucose
Lets talk about insulin resistance
Image source shutter stock
A great image to show what happens in insulin resistance…As you can see the glucose from the food is not able to get into the cells as they don’t respond to the insulin secreted. So cells cant utilize glucose our biggest energy source
In my pain and functional medicine practice I have listed a few most common complaints reported
Low energy levels mainly in the morning even after sleeping for 7 to 9 hours
Delayed recovery from a workout session of moderate intensity. Persistent soreness or low energy even 2 -3 days post-session.
Unable to lose belly fat even with dedicated workouts
Difficulty in building muscle
More exercise injuries which relapse or have delayed healing. I had a patient who had a groin injury that had never really healed even after 3 years and had taken multiple manual therapies and fascial work in physiotherapy before coming to me. When I did a metabolic work-up on him he had an elevated hba1c of 6.3 and fasting insulin. He reported 3 out of 5 above-mentioned symptoms and was confused as to why he was unable to break the injury cycle and tame his expanding waistline even with dedicated hours in the gym. Chronic pain management is all about getting to the root cause of the problem.
After his blood glucose was stabilized not only did his energy levels improve so did his injury susceptibility.
Why are these happening?
This is science simplified …
Cells are starved of glucose
Can’t produce enough energy due to the body and poor mitochondrial function
CELLS GET TIRED and We feel tired even after a meal
POOR MUSCULAR CONTROL AND EFFICIENCY DURING EXERCISE aka Poor exercise form and poor recovery
MORE EXERCISE CAUSED MICROTRAUMA
After exercise injuries and soreness increases and this makes more injuries.
Why does my belly fat not reduce?
Increase blood glucose
High insulin production
Cells have become insulin resistant because of constantly high blood insulin
High insulin levels in the blood
Prevents breakdown of fats aka LIPOLYSIS
Increases fat accumulation in the body around the organs ie the abdomen
If any of the above resonates with you read on for some of the strategies which I use regularly
The food you eat talks to your gut microbiome and decides your health.
Eat whole, natively sourced and a variety of grains.
Go gluten free
Do not skip dinner.
Add more veggies to your diet. A simple ratio of 2:1:1 with 2 of veggies and 1 of grain and 1of protein is great.
Relax , do a few belly breaths and eat slowly and mindfully
Our body has an internal clock and a cicardian rhythm. Our hormones are released as per this clock. So sleep and wake at roughly the same time everyday. Again keep your meal times consistent
Image credit Cleveland center of medicine
A great picture to show why should you exercise and move more
Do atleast 2 to 3 sessions of strength training per week.
Make sure to recruit more muscles during exercises.
Recruit large groups more like core and gluts.
Focus more on the form and not the number.
Keep your breathing synchronized with the movements.
If you are doing weights follow a scientific protocol like SAID or OXFORD.
Look out for signs of overtraining.
I hope you enjoyed reading this as much as I enjoyed putting it down…. Take care
All of us know that pain is an unpleasant sensation and can happen with or even without tissue damage. In this blog let us look at how our gut health or lack of it will determine how much and how long the pain remains with us and what to do about it.
Pain simply put is an immune response to an antigen ( injury, threat of injury). This leads to activation of our immune system just like forces are primed before a war our immune system is in a state of alert.
When the pain is chronic ( more than 3 months), it can alter the gene function of the immune system. This will affect how the T cells, a group that is very important to regulate immune functions, respond. This in turn will release Proinflammatory cells aka Cytokines. This will keep the inflammation and the pain drive alive and thus you are stuck with pain that either comes back every now and then or remains with you even after the tissue damage is over.
It is the communication between the nerve cells in the gut and the microbiota with the brain and the spinal cord. If the gut microbiome is diverse and healthy it gives accurate signals to the brain to turn down the pain stimulus and that’s the ideal situation.
When for any reason the gut health is poor ( medications, stress, leaky gut, nutrient-deficient foods) the microbes release chemicals which sensitize the nervous system, increase the cortisol ( stress hormone) levels in the blood, and put us in a state of alarm. This can increase the pain and prevent full recovery.
In short, a happy gut makes a happy brain and a pain-free life.
Hi, this blog is for those of you who have knee pain and have stairs in your house which you have to negotiate on a daily basis. Here I am going to share a few tips which would help you to do this activity pain-free and safe.
Before we move on to the actionable let us look at what happens when we climb up
If the step is high we bend the hip and knee to 90 degrees and if low less than that.
With patellofemoral pain aka front of knee pain
The front of the thigh muscles or Quadriceps lengthen eccentrically and the back of the thigh muscles aka Hamstrings shorten. The calf muscles shorten to help bend the knee and place the foot on the step. All of these try to push the knee cap out of the groove in which it sits aka Patellar groove. To prevent this displacement the ligaments tighten and put pressure on the knee cap and the cartilage behind it causing pain and burning.
With medial osteoarthritis
In a normal joint both the lower bulb like ends of the thigh bone femur or medically known as femoral condyles glide and roll forward smoothly on table top of the tibia or the shin bone. This bends the knee painlessly. In case of any degeneration or tear the gliding is uneven and painful. When such a knee is loaded more while climbing up it increases the pain.
Front of knee pain
The quads or the front of the thigh muscles shorten actively to straighten the knee to allow the foot to be placed on the step-down. The hamstrings and the calf lengthen. Both these force the knee cap into the groove loading the patella and its joint more. This makes climbing down more painful for those of us who have this kind of pain.
Inner knee pain
As the gliding is not smooth and there is instability there is pain with loading but much lesser than climbing up.
By now you have a brief understanding of what happens and why does it pain lets get to how to do it painfree
1.Always hinge or bend from the hips
Most of us unknowingly curl the spine and flatten the low back while climbing. Be mindful to bend the hips and keep the chest relaxed and down. Keep the weight on the heels.
2. Tighten the buttock muscles or the gluts
To engage the core and the gluts breathe out and gently pull the navel to the spine without rounding the back. Try to tighten the buttock on the side which is lower. Again there should not be any turning of your chest. As you alternate steps you will alternate the contractions
It is overuse and degenerative injury of the cartilage behind the kneecap or the patella. Cartilage is a soft tissue that acts as a shock absorber and makes the patellar movements smooth and efficient. When the knee is overloaded it puts a lot of stress on this small area and causes the cartilage to break down. As with any injury, inflammation follows with pain and loss of function.
Our bodies respond to our habitual postures… here are few and their effects on our knees
Image courtesy Dawn.com Aug 12 2021
Forward head, flattening of the low back makes the hamstrings overactive and inhibits the gluts activity. This does not allow the knees to straighten fully and over a period of time puts excessive loads on the front of the knee aka the Patellofemoral Joint and causes degeneration.
Weak core and makes the pelvis moves forwards. Now the knee is locked in an abnormal straightened out position aka HyperextensionThis causes overactivity of the quadriceps which pushes the knee caps into the knee joint causing the patellar cartilage to wear out.
Improve torso stability and alignment so that the lower back and hips are free enough to support the knees
The increased hip extension helps to engage the big gluteal muscles and offload the knees
Improve core muscle control to improve the position of the pelvis and free up the knees for walking painfree.
Movements which help
Standing core tuck in with toes extension
Stand with feet shoulder-width distance against the wall such that the psis touch the wall. Your weight must be on the heels. Now breathe out and pull the navel to the spine keeping the low back in neutral. Count to 4 . Simultaneously lift only the toes keeping the balls of the toes on the ground up. Hold for 4 counts and relax counting to 8.
Single leg standing and hip hiking in the unsupported side
Stand with feet shoulder-width distance and the outer border as parallel to each other as possible. Bend one knee to 90 degrees. Breathe out, engage the core counting to 4 and hike the hip on the unsupported side without leaning over with the torso. Hold for 4 counts Relax counting to 8.
Standing and heel strike
Stand as above. Engage the core counting to 4. Place a cushion in front of you. Take a step forward such that the heel is placed on the cushion. Try to contact your gluteus maximus without altering your position. Keep the knee cap facing forwards. Hold the contraction for 4 counts and release counting to 8.
Lying single leg lift
Lie on the back. Place a small towel under the left hip. Now place your fingers on the front of the hips on both sides and check that they must be in the same line. Bend one knee to 90 degrees and place the foot flat on the bed. Straighten the left knee such that the toes point towards the ceiling. Engage the core counting to 4 and simultaneously lift the left heel up by 3 to 5cms. Hold for 4 counts and relax counting to 8.
Each movement can be repeated 3 to 5 times each hour. One movement per hour.
Pain is the biggest driver to determine how we move, how much we move, and how we feel about ourselves.. I am signing off by wishing all of us pain-free bodies and movement rich lives.
It had started when a 26-year-old female who had recovered fully from a mild covid infection 4 months ago came to meet me. After complete recovery, she started getting back to her pre covid life and that’s when she realized that all was not the same.
Post covid syndrome
These are the residual effects of covid 19 infections. Even though one is tested negative and technically covid free these symptoms either persist or even occur new. So if you or your loved one has had covid this blog is for you…
A mild shortness of breath is noticed during exertional activities like stair climbing, playing with the child or pet, doing things in a hurry, or even brisk walking. She would feel that the breath stops at the upper chest level and would want to pause to take a deep breath.
Persistent irritation of the throat– A feeling that the throat was getting dry frequently and scratchy. It was more at night when she rested her head on the pillow.
Reduced appetite – A general lack of hunger drive and a feeling of bloating.
Restless nights- She felt that she was not sleeping deep and was getting up frequently.
Lethargy and fatigue– Lack of restful sleep made her feel more tired and irritable towards the evening. This had started to impact her personal and professional life.
What did we do
We set SMART GOALS
SHORT TERM GOALS (0-12 weeks)
Improve lung functions and overall aerobic capacity.
It’s not always about how much we do it’s also about how much time we give for repair and regeneration. This is where a good sleep routine is required. Sharing my short post on 5 useful tips to sleep like a baby
Regular walks 45-60 min at 60 -70%of the HR maximum
Breath work 3-5 times each hour and do 1 movement at a time. Exhale double of inhale.
Structured strength work as shared above ( reps 15 and 3 sets)
10 belly breathing before sleep.
Currently she is in month 1 of long term goals and she is able to manage moderate exertion in her day to day activities with ease. Mood and fatigue have improved greatly. Sleep is longer 6-6.5 hours and fairly restful. And the work continues…
In the words of Thomas Edison” The Doctor of the future will give no medicine but will instruct his patients in care of the human frame,in diet and in the cause and prevention of disease”
Hi sharing an interesting case of forward neck and continual back pain.A 35year old software professional presented with repeated episodes of low back pain and stiffness making sitting, standing or even lying down painful . His first episode was 3 years ago and have been repeating since then ,each time with increasing severity every 4-6 weeks. He had consulted many doctors and physios . He would feel better with prescription 10 day courses of anti inflammatory and muscle relaxants with physical therapy till the next episode hit and the cycle started again.Multiple MRI scans had shown that the lumbar architecture was fine and the lordosis aka the curve in the low back had flattened out.
A detailed history and observation showed that he was a workaholic in long periods of chair sitting and screen time. Both of these had not been kind to the back. He had a visible Forward head position, rounded shoulders and flattened out low back
Pic courtesy physioqinesis.com
Chain of events
His habitual positioning had caused a weakening of the spinal muscles. This was made worse with the weak neck musculature.All of these had lead to poor core strength and a flat back. A flattened back is like a stretched out rubber band with poor shock absorption and flexibility. This caused repetitive microtrauma to the structures and tissue damage over a period of time. At this stage the body would respond to pain meds and passive pain management techniques like IFT and TENs but as the original faulty pattern was not addressed the tissues had never healed fully . Their ability to bear the loads in day to day life had come down and thus started another pain spasm episode. Repeated pain cycles had caused the brain to freeze or inhibit the painful part even now without actual tissue damage. This explained the constant stiffness without pain.
Phase 1( Repositioning forward head and strengthen upper back)
Once he was comfortable repeating each movement 30 times per day painless we moved on to phase 2
Phase 2( Functional core muscle activation and improving hip flexibility)
Chair squat- stand facing the back of a sturdy chair. Place your palms on the back of the chair . Keeping the knee caps forward and bend the knee 5-8 cms keeping the weight on the heels . Breathe in as you go down and out as you come up. Repeat 3 to 5 times each hour. Make sure to keep the ribs in line with the hips .
Stand with the feet shoulder width distance and the outer border parallel to each other. Breathe in and lift yourself up on the toes. Breathe out engaging the core and come down without touching the heels to the ground . Repeat this movement 3- 5 times each hour.
Over a period of 8 weeks he reported no pain flare up. His pain at rest had gone down by 50 percent of the original reported and he had started walking at a comfortable pace outdoors for 60 min everyday.
To sum it all I’m quoting one of the foremost pain clinicians Dr Greg Lehman BKin ,Msc,DC,MscPT
The body is more of an Ecosystem and less of a car that needs aligning. Our treatment should reflect this