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Facet Syndrome
By Dr. Eugene Lee

Most of us have heard of back pain as a result of a disc injury.    I’ve previously covered the signs and symptoms of disc herniations in previous articles.   Another common cause of neck or lower back pain is the less-discussed irritation of the facet joints.

Relevant basic anatomy:

The spinal segments in your back are stacked, one on top of the next, in a vertical orientation.   Each of these spinal segments are attached to the one below at three contacts.   The largest contact is towards the front and is the main spinal “disc”.   The other two contacts are the smaller joints called facets.   A simple analogy that I use to describe these joints is to compare them to a tricycle. The main spinal disc is the “big wheel” while the facet joints are the two smaller supporting wheels.   Facet syndrome occurs when these “supporting wheels” become irritated or injured.

What causes facet syndrome:

Facet irritation occurs by adding excess pressure to the joint.   This can occur though direct trauma or simply by sustaining longer term low pressure upon the joint. One of the most common presentations of facet irritation that I see in my office is a patient with a stiff neck and that occurred after sleeping in an akward position.   This akward position typically places the neck at the extreme of its natural range of motion.   Upon awakening the patient is unable to turn the head fully to one side without pain.    Outside of direct trauma, another process which may predispose a patient to facet syndrome is degeneration at the joint.

Conservative management and prevention:

In my experience, facet syndrome responds particularly well to manipulation (adjustment) of the joint. Often, the patient will see immediate relief of his symptoms following proper manipulation of the painful segment.

Poor posture can predispose a patient to facet problems.   Going back to our tricycle analogy, what would happen if you decided to place extra weight upon just one of those small supporting wheels?   That wheel would have a higher probability of wearing out earlier than the other wheels.    That wheel would also have a higher chance of being damaged if direct injury occurred to that wheel.   Years of poor posture and spinal misalignments can predispose a patient to facet irritation or injury.   I always encourage my patients to address postural problems and misalignments before pain becomes an issue.
-Dr. Lee

Preventing Golf Injuries-Part 2

By Dr Eugene Lee

I previously wrote about golf and the importance of proper mechanics in a previous article.    This is the time of year in which I regularly see a few patients who walk into my office with a golf related injury.   I’ve decided to add a few more tips to compliment my first article.

Strengthen Your Core:

        Your “core” is considered the area between your lower ribs and your pelvis. Among other muscles, your core includes your abdominals, obliques, and lower back muscles.    One of the major functions of your core is to provide power and stability during rotational movements.   With an unstable core, you will not be able to generate the proper power or stability required for a golf swing.    More importantly, your back will not be protected as it should with a strong core.   Describing a core exercise regimen will be covered in a future article.   It is important to note that the most important part of any type of core exercise routine should focus on balancing your muscles.    All aspects of the core muscles should be worked equally and symmetrically.    An imbalanced core can cause injuries as they promote improper mechanics and form.

Maintain a Symmetrical Swing/Avoid over swinging:

            We all want to drive the ball 300+ yards.   Some golfers attempt to accomplish this by “over-swinging” their golf club.   A typical golf swing already puts many of your muscles and ligaments at the extremes of motion.   Over-swinging pushes these limits and is a recipe for trouble.   Your power should be produced by strong/stable abdominal muscles during your power/forward swing phase.

            Your golf swing should also be symmetrical.   Now that you’ve shortened your back swing, you should also shorten your follow through.   It is also important that you maintain full balance throughout the swing, including the follow through.

Keep your feet parallel:

           Make sure that both feet stay pointed forward.   Many golfers tend to point their back foot diagonally outward to compensate a loss of flexibility in their hips and lower back.   This puts excess pressures in your lower back, hips, as well as your knees.   During the backswing, the body weight should be focused on the interior portion of the back foot and the back knee should bend straight forward (not laterally).

Of course, if you experience any pain during your rounds, consult with a health care professional.    Have a fun and safe season!
-Dr Lee

Acupuncture and Pain Control
By Dr. Eugene Lee

As a physical medicine practitioner, one of the most common complaints that presents to my office is that of pain.   I’m often asked if and how acupuncture can be helpful in the management of pain.   The following are summaries of a few recent trials studying the effectiveness of acupuncture and pain control.

  The Annals of Internal Medicine recently published the results of the largest and longest randomized controlled clinical acupuncture trial.     Funded by the National Institutes of Health, this study enrolled 570 patients with complaints of osteoarthritis of the knee.   The trial divided the participants into three groups which received either traditional acupuncture, “sham” acupuncture, or a self help arthritis educational course.   Compared to baseline, the results showed that the traditional acupuncture patients had a 40% decrease in pain and nearly a 40% improvement in the overall function of their knees.

The Archives of Internal Medicine published the results of a 2007 trial regarding the effectiveness of acupuncture for lower back pain.   The participants of the study received either acupuncture or conventional medical care for their back pain.   After 6 months of therapy, the results of this large trial showed that 47% of the acupuncture patients improved with care.     The study also showed that only 27% of patients improved with conventional medical treatment.

A 2006 trial conducted by the Mayo Clinic studied the effectiveness of acupuncture in the control of pain and other symptoms associated with Fibromyalgia.   The results of the randomized, controlled study showed that patients who received acupuncture significantly improved compared to the control group.

In my clinical experience, acupuncture can be highly effective in the management of pain conditions.   I often compliment the practice of needle acupuncture with other manual acupuncture techniques as well as modern modalities in order to reduce pain and stabilize the condition.    To answer the question asked at the beginning of this article, acupuncture can be a powerful and safe tool in the management of pain.

-Dr Lee

Sciatica
By Dr Eugene Lee

Often accompanying lower back pain, sciatica is a common complaint that presents to my office.   There is some confusion about the symptoms and causes of sciatica.   This article will cover some basics for this condition.

  Relevant basic anatomy:

  Your spine is composed of small cylindrical pieces stacked in a vertical fashion from your pelvic area to the base of your skull.   This alignment forms a protective structure which allows the nerves from your brain to safely travel to different parts of your body. The sciatic nerve, which is the largest and longest nerve in your body, is composed of 5 separate nerve roots which originate from your lower back.   The sciatic nerve combines the 5 nerve roots and travels from your lower back all the way to your feet.

  Definition:

Sciatica is a set of symptoms that may be caused by irritation of the lower back nerve roots or by irritation of the sciatic nerve itself.   It is important to note that sciatica is not a diagnosis but rather a symptom of a problem.   The treatment for the cause of sciatica will vary depending on the actual diagnosis.

The causes of sciatica:

  Lumbar disc herniations:

           If you’ve been following my articles, I previously covered this condition    My website has a log of my previous articles at drelee.com.   Disc herniations often cause a pressure at the exiting location of the nerve root from the spine. The majority of disc herniations occur at L4-L5 and L5-S1 nerve roots.   Disc herniations can be cared for conservatively by flexion distraction technique as well as with select acupuncture points.

Spinal stenosis:

      Spinal stenosis is the narrowing of the column inside the spine before the nerves exit.   Spinal stenosis can be caused by various conditions including spinal dislocations, bone spurs, and specific types of disc herniations. Conservative management of spinal stenosis can be effective depending on the actual cause of the condition.

Piriformis Syndrome:

            The piriformis muscle is a relatively small muscle located deeper within your gluteal region.    Typically, the sciatic nerve travels below this muscle.   In 15% of the population, the sciatic nerve travels through this muscle.   When this muscle becomes hypertonic (too stiff), it can cause compression on the actual sciatic nerve and cause numbness/pain into the legs.   Proper stretching of the involved muscle along with modalities to relax the muscle are necessary for the proper conservative management of this condition.

Trigger points/spinal dysfunction:

            Years of poor posture and improper biomechanics can cause the problems with the movement of the joints in your lower back as well as muscular imbalances.   Spinal dysfunction, most commonly in the sacroiliac joint, can replicate symptoms of sciatica.   The formation of trigger points (a type of muscle knot) within select shortened/hypertonic muscles, can also replicate symptoms of sciatica.    Chiropractic manipulation of the fixated joints in combination of appropriate stretches is often effective for these types of patients.   Acupuncture can also be very effective at releasing pain causing trigger points.

Dr Lee

Conservative Care for Headaches
By Dr Eugene Lee

  Headaches are a common complaint that most patients have experienced at one time or another.   The frequency, intensity, and location of pain varies depending on the source of the headache.   The more common types of headaches that present to my office include tension, cervicogenic, and migraines.   Other headaches, including cluster and secondary causes (ex. trauma) will not be covered in this article.

Migraine Headaches:

         Although I’ve seen migraine headaches in patients from all walks of life, the majority of migraine patients tend to be female.   Migraine headaches are recurrent headaches that commonly present a unilateral pain distribution.   Nausea and/or vomiting may accompany the patient’s symptoms.   Migraine headaches are categorized into two groups, differentiated by the presence of an “aura”.


     Migraine with aura sufferers experience visual disturbances which may include flashing lights and/or blind spots followed by a disabling headache.   These headaches can last from several hours up to three days.   These headaches are believed to have a neurogenic origin (caused by a nerve problem). Triggers for these headaches include caffeine, wine, cheese, nitrates, and hormonal fluctuations.


Migraines without aura are, as you guessed, migraine headaches without the visual disturbances described above.   These headaches can also last for a few days but tend to be slightly less disabling than migraines with aura.   These headaches account for the vast majority of migraine headaches.   It is believed that these headaches have a vascular origin (blood flow/blood volume).

            In my clinical experience, migraine headaches tend to be more difficult to manage than other types of headaches due to their chronic nature and the multiple factors that may trigger these headaches.   Conservative treatment is aimed at decreasing the patient’s reliance of medications and obviously decreasing the frequency/intensity of the headaches experienced.    I often find that migraine patients are responsive to acupuncture therapy.   Patients often experience a decrease in frequency, as well as intensity of their headaches with acupuncture care.   A study in the British Medical Journal involving chronic headache sufferers treated with acupuncture showed overall improvements in the short and longer term management of their condition.   One year after the acupuncture treatments were administered, the acupuncture patients in the study, compared to the untreated group, had 22 fewer headaches per year, used 15% less medications, made 25% fewer visits to general practitioners, and took 15% fewer sick days off (Vickers AJ, et al. BMJ Epub 2004 Mar 15).

Tension Headaches/ Cervicogenic Headaches:

            Tension headache sufferers tend to have headaches in the afternoon or early evening.   The pain experienced by these patients is usually bilateral with a distribution around the back of the upper neck and/or around the forehead region.   The pain can last for a few days and are often responsive to over-the-counter NSAIDS (aspirin, Tylenol, etc.).

Cervicogenic headache are caused by a dysfunction of the cervical spine(neck).   Cervicogenic headaches sufferers present with symptoms which often overlap other types of headaches, including those described above.   Cervicogenic headache sufferers tend to have pain/discomfort of the upper posterior neck (suboccipital region) upon palpation.   These patients often show restrictions in proper movement of their neck.

            Cervicogenic headaches are the most common type of headache that presents to my office.   Both tension and cervicogenic headaches often respond well to conservative care.   Stretching of select overused/overdominant neck musculature is necessary to begin the restoration of proper balance/movement of the neck region.   These headaches respond well to chiropractic adjustments, which help remove restrictions within the neck. Adjustments are key to the proper conservative management of both types of headaches, particularly cervicogenic headaches.   Finally, education on proper posture/ergonomics is vital to long term management of both tension and cervicogenic headache sufferers.

-Dr Lee

Computer Use/Desk work and Neck Pain
By Dr Eugene Lee


    How many times have you returned from a long day at work with stiffness in your neck region?   It’s a very common complaint that has become more prevalent as our dependence on computers has increased over the last few years.

        Most of us are unaware how to sit properly in order to minimize the negative effects of chronic computer usage and desk work.   Ideally, one’s body should be in or as close to a neutral position when sitting behind a desk.

Neutral position:

             A neutral position is achieved when three front to back curves are maintained within the spine in proper proportions.   In the neck area (also with the lower back), this curvature should form a concave “C” shape.   While seated, the shoulders should be dropped directly to the side of the torso.   The “C” curve of the neck should be maintained while the center of the shoulder should line up with your ear.

What most of us do:

              Computer usage as well as general desk work forces us to reach forward in order to write or use items like a keyboard or mouse.   This leads to rounded forward shoulders which can be a common cause of shoulder pain and stiffness.   The neck follows the shoulders forward leading to the neck straightening away from the neutral “C” curvature. In order to compensate for this loss of curvature, most desk workers will increase the curvature at the very top of their neck.   This abnormal position can be a source of headaches that often accompany neck pain after desk work.   Now repeating these activities over months or even years can lead to chronic imbalances in one’s structure and musculature.   These imbalances can be a source of various pains throughout the region.

What can you do?:

            Prevention is key.   I always tell my patients that if you’re going to stare at a computer or sit at a desk for hours on a daily basis, you need to stretch your overused muscles.   I recommend taking a break every 15 to 20 minutes for a walk or stretch while working at your desk.   Stretch your chest muscles out by extending your arms out to your side and slowly moving your arms backwards.   Stretch your neck muscles out by turning your head 45 deg to the right and slowly tilting your head the opposite way (to the left). Repeat this procedure on the left as well. These should obviously be done only in a pain free range of motion.   If these basic stretches are not enough to help your condition, a consultation with a health care professional is advisable.
-Dr Lee

Lower Back Pain-Disk Herniations
By Dr Eugene Lee

Lower back pain is a common complains that patients present with to my office. Though lower back pain can have various causes,   a common source of pain is due to a disk herniation.

The Anatomy:

             The spine consists of 26 bones called “vertebrae”.   These vertebrae are aligned in a vertical column, one on top of the other. In between each of these vertebrae are soft structures called disks.   You can imagine a disk as a jelly donut.   A disk has a soft gelatinous substance contained within a fibrous sack.   These disks allow the spine to bend and twist, which gives our bodies the flexibility it needs to perform many of our daily tasks.

  What is a Disk Herniation?

             Using our jelly donut example, what would happen to this donut if we started to add pressure to the top of it?   The jelly inside would pop and leak outside the donut.   A disk herniation occurs when excess pressure is loaded onto the disk, causing the “jelly filling” to leak outside the containing sack.

   What Causes Disk Herniations?

             As stated above, disc herniations occur when excess pressure is applied to the disk. The fibrous sack is unable to contain the jelly substance inside and the disk herniates.   Accidents such as a slip and fall or an automobile accident are common causes of disk herniations.   Bending forward while twisting under load is also a common cause of these herniations.   A classic example of this is show shoveling.

  What are the Symptoms?

             The symptoms associated with disk herniations vary from patient to patient.   When the jelly like substance that is pushed out of the disk contacts a nerve, patients classically feel numbness and tingling which shoots into their legs.   Without nerve involvement, some patients may experience more localized back pains which are typically position dependant.   In my clinical experience, some patients may feel minimal symptoms from herniation at the time of the accident.    Symptoms may occur at a later time when an activity irritates the back and induces the onset of pain.

  Can Disc Herniations be Treated?

             Flexion-distraction technique is one therapy that I apply to my disk patients. This technique is administered using a table which allows for gentle spinal distraction.   This stretch helps to decrease the pain causing pressure caused by the disk herniation.   Flexion-distraction therapy is applies in combination with various other physical modalities in order to decrease pain and increase flexibility.   In addition, I often combine acupuncture points during my therapy.   Acupuncture helps to relieve pain which is obviously key to the acute patient.   Many patients can be and have been helped with this conservative therapy.   Unresponsive patients may be referred for more invasive therapies.

I will cover other common caused of lower back pain in future articles.
-Dr Lee

Back Friendly School Luggage
By Dr Eugene Lee

As summer comes to an end, the yearly “back to school” ritual begins.   While shopping for your children’s new school gear, make sure to keep proper ergonomics in mind.   I’ve decided to discuss backpacks and their impact on spinal health in this article.

     Though times have changed since most of us have been in students, the use of textbooks seems to be here to stay.   Unfortunately, children are often required to lug these heavy textbooks back and forth to/from school. There have been many studies demonstrating the link between backpack use and start/aggravation of back pain in children.   Alarmingly, almost 60 percent of children in their teen years will experience an episode of back pain.

         I’ve often seen students bent over struggling to carry carrying overloaded backpacks. To make matters worse, children commonly carry backpacks on one shoulder.   This imbalanced weight distribution forces the spine to twist and bend towards the opposite direction. Sustaining this improper posture is bad enough for the back.   Placing a heavy load while in this poor posture can be a dangerous situation for the spine.   The cause for concern becomes more obvious as growing children repeat this activity on a daily basis.

         Health problems that can stem from overloaded backpacks include back pain, neck pain, and headaches.   Chronic problems can also develop including an increased chance of developing osteoarthritis and disc problems.   Carrying overloaded backpacks can also increase your child’s chance of falling do to the difficulty in balancing the increased weight.

        Using both straps of the backpack does help, but does not fully solve the problem.   Though the side to side weight imbalance can be minimized, there is still weight imbalance from the back to the front of the body.   This can cause your child to lean forward which puts your child’s neck, among other structures, in an unfavorable position.

So what can we do to minimize the risks of developing back problems?

1.      Decrease the weight of the backpack.   There is a strong link between the development of back pain and the load placed on it.   It’s common for today’s backpacks to weigh 25% of your child’s bodyweight.   I recommend keeping this percentage at 10-15% maximum.

2.      Purchase a backpack that is properly fitted for your child.   Make sure the straps are well padded and the appropriate width for your child’s shoulders.   “S” shaped straps are better than straight straps. Adjust the straps so the backpack falls just below the waist. The backpack should be as light as possible and should have a waist strap which locks in the front.   A backpack with a lumbar support pillow built in helps to keep the lower back from hunching too far forward. Now, even the best backpack will not help if your children do not use them properly.   Instruct your children to wear both straps at all times.

3.      Even with a 10-15% load, caution should be used when bending forward and/or lifting objects.   Have your children bend at the knees while keeping the back straight. This is a practice that should be done even when your child is not wearing a backpack.

4.      Consult with a healthcare professional if your child starts experiencing pains which are related to the use of backpacks.

Good luck in the new school year!
-Dr Lee

Back Pain and Golf
By Dr Eugene Lee

  Golf has been gaining popularity over the last few years.   It’s a great mental sport that can also keep you fit, especially if you’re walking the course (vs riding).   As with any fitness activity, there are risks of injuries that can be sustained while playing the sport.   Lower back pain is one of the most common complaints that I hear from my golfing patients.

  Approximately half of all golfers will eventually sustain an injury while playing golf.    Many of these injuries are due to improper swing biomechanics.    One of the best tips I can give my golfing patients is to maintain proper backwards curvature of the lower back.   Lumbar lordosis is the technical term for this curvature. Proper lumbar lordosis can be achieved by maintaining a concave curvature between your gluts and your middle back.   Basically, stick your bottom out an inch or two more during your stance and though your swing. This curvature is an important source of mechanical leverage for properly rotating the hips though the golf swing.   Without this curvature, your losing power as well as placing added stresses to the structures in the lower back.

Golfers also should ease into the season by playing only a limited amount of holes the first day.   In other words, don’t play all 36 holes during your first time out in the field. The typical golf swing places your body at the upper limits of your normal range of motion.   If you haven’t maintained your stretching and/or golf related strength training, your body is more prone to injuries the first few times out on the field.   As a safe guideline, I recommend going at 50% of your normal golf routine your first few times back at the course.


Golf is a sport where proper posture and biomechanics is essential to avoiding injuries and optimizing one’s game.    Along with muscular flexibility, spinal flexibility is equally as important to avoiding injuries.   Your muscles can only compensate so much for an improperly moving spine.   Chiropractic adjustments can help reestablish proper spinal flexibility which can be a limiting factor to one’s performance.

Finally, stay cool out there and make sure you keep hydrated.
-Dr Lee

Pain in the Neck
By Dr Eugene Lee

Neck pain is one of the most common complaints that that patients present with in my office.

The anatomy:
    In the simplest terms, the main function of the neck is to allow the head to function. In the most ideal terms, this design works very well. Neck problems begin when the orientation of the head on top of the cervical spine (aka the neck) allows for the head to perceive.
    At worst, the arrangement of the head and neck can become a dangerous lever arm in acute injuries.

    Another common cause of neck pain occurs with years of poor posture and the following misalignments that this can cause. Much of what we do during the day is forward flexion dominant. What I mean by that is most of our daily activities require our bodies to reach forward. Computer usage, working behind a desk, and driving are all common activities that most of us do on a daily basis. They are also classic examples of forward flexion dominant activities. These activities require us to reach forward, leading to the shoulders rounding forward along with the arm. The neck often follows forward to have a better view of the task at hand. This forward flexion positioning of the head and neck puts increased load on the back portion of your neck. Now repeat this activity daily for hours upon hours each day. It becomes obvious why neck pain is such a common complaint in today’s environment.

   What I’m often surprised about is how long some patients wait to find help for their condition. It’s not uncommon to hear stories about how a patient has had neck pain for the last 10 years but just recently it’s become unbearable to the patient decided to finally take care of the problem. I often wonder why these patients wait so long to seek a solution.

Acupuncture Basics
By Dr Eugene Lee

   I’m often asked in my practice what Acupuncture is and how it works. There has been a growing interest in this form on medicine over the last few years. I thought it would be a good idea to explain some basics of Acupuncture.

What is Acupuncture?

   Although relatively new to most western cultures, Acupuncture is one of the oldest and most widely used medical practices in the world. The first record of Acupuncture dates back almost 5000 years with the first writing of “The Yellow Emperor’s Classic of Internal Medicine”. Over time, the theory of Yin/Yang energy was developed and became a central philosophy within Acupuncture. Yin/Yang theory is about balance. For every day, there must be a night. One can not be independent of the other as they are a part of a cylindrical pattern. This theory is also applied to one’s health. Disease, in the view of an Acupuncturist, is an imbalance within the body thought which energy travels. There are many causes for the development of these imbalances including improper diet, lack of exercise, stress, as well as physical injuries. These energy imbalances can be manipulated with the insertion of fine needles at distinct points on the body. Acupuncture, in essence, brings the body back into balance, allowing the body to heal itself.

The Science behind Acupuncture:

Though there has been an increase in the study of Acupuncture over the last few years, scientists still have no solid answer why or how Acupuncture works. There are a few leading theories on how Acupuncture may be helping certain conditions.

Gate Control Theory: Developed in the early 60’s by Ronald Melzack and Patrick Wall, this theory explains how we perceive pain. Nerve fibers that transmit signals from a pain area back to your brain are carried on either large nerve fibers or small nerve fibers. Chronic pain, for example, is carried on the smaller ones. When one stimulates the larger nerve fibers, this signal overrides the smaller pain fibers which would “block” pain from being perceived. Acupuncture may block these smaller pain fibers explaining why Acupuncture can be effective in alleviating pain symptoms.

  Endorphin Theory: Acupuncture is believed to stimulate the release of endorphins, often referred to as the body’s natural pain killers. This chemical is also responsible for relaxing muscles and reducing anxiety. Among other conditions, this theory has been used to explain how Acupuncture may positively influence cardiovascular conditions and blood pressure.

  The Circulatory Theory/Neurotransmitter Theory: Acupuncture may have an affect on either constricting or dilating blood vessels. This may be caused by the release of the body’s vasodilators such as Histamine during the Acupuncture treatment. Acupuncture may also positively influence neurotransmitters such as Serotonin and Noradrenalin.

In my personal opinion, these theories help to explain some of Acupuncture’s benefits but much research is still necessary to fully explain why and how Acupuncture truly works.

Can acupuncture help your condition?

   For thousands of years, Acupuncture and a system of medicine often referred to as Traditional Chinese Medicine, was the only medical system used in the east. As such, the scope of what was treated with acupuncture included most ailments. In my clinical experience, acupuncture can be effective for a wide range of conditions. I’ll cover different disorders that can be helped by Acupuncture more specifically in future articles.
-Dr Lee

Are You Having a Healthier New Year?
By Dr Eugene Lee

    Another year has come and gone. It’s clear that time never stands still. In today’s busy world filled with Blackberrys and cell phones, it’s easy to forget that life is a journey, and not a destination. So, considering it is a new year, how has your life changed compared to last year? Are you more financially stable? Are you getting more comfortable with work? Are you better at chasing after the kids? A more important question; how does your health compare today to your health last year?
   I’ve often participated in the tradition of the new year's resolution. It's a great way to make changes in one's life for the better. Though I’ve fallen short of some of my goals, even the attempt at change is often a positive experience. Here are two examples of the more common resolutions.

Weight loss
   One of the most common resolutions made. The solution seems simple enough, eat healthier and exercise more. Unfortunately, changing one’s lifestyle is often more difficult than it may seem. If you have the motivation, here are a few tips that you may find helpful.

Portion your foods
   With today's supersized portions, it's difficult to gauge how much we should actually be eating. You should limit your meals to foods that measure to approximately the size of a closed fist. Smaller portions spread out over 5 meals is recommended over larger portions and fewer meals.

Eat foods in their most unaltered state.
   Foods are usually better before companies get a chance to process and package them. Eating foods in their purest state will ensure you get the nutrients contained within the food. As a good frame of reference, if a food has an ingredients label, avoid the product. This also makes it easier to actually know what your eating which takes some of the confusion out of making those healthy choices.

Avoid bad fats and increase your intake of “good fats”
   Studies are showing that the total amount of fat in the diet is not nearly as important in the development of disease or obesity as the type of fats consumed. Saturated fats and trans fats should be avoided. You should ensure you're getting enough Omega 3 fatty acids in your diet. Omega 3's can be found in larger quantities in fatty fishes and flaxseeds.

Address those aches and pains
   Getting into the gym is easier said than done, especially if your one of the millions of Americans that have aches and pains which limit their physical activity. The principle behind exercise is to take your body beyond its normal "comfort zone". How can you expect to reach this point when even daily activities can aggravate your pains? Pain can often snowball into a bigger problem if not addressed or corrected properly early on. As we all know, lack of physical activity can lead to various health conditions, one of which is weight gain. Addressing your “tolerable” aches and pains properly can prevent them from being an excuse to avoid the gym.

Remember that healthy weight loss is best accomplished by making the right choices over the long term.

Quitting smoking
The link between smoking and the development of lung cancer, hypertension, emphysema, and various other conditions is well established within the medical community. Smoking is the most preventable cause of disease and excess mortality in the United States. The good news is that the health benefits of quitting smoking today are long lasting and immediate. If you're ready to quit, here a few tips on quitting successfully.

Choose a deadline to break your habit
   Though some have success going “cold-turkey”, having a “to quit by” date often makes the process easier and more realistic. Before this deadline, try to gradually decrease your smoking. You should also start eliminating reminders of smoking from your possession, including those lighters and ash trays.

Stay busy
   Besides the physical addiction to smoking is the mental one. Breaking your daily habits that involved smoking is vital to your success. Try to keep your mind occupied during the quitting process. Picking up a new hobby or activivity can be enjoyable and help to keep your mind of ciggarettes.

   To patients that need more assistance, I often recommend acupuncture. Acupuncture is not the “cure” for smoking, but it is effective at calming the cravings and the withdrawl symptoms from nicotine.

   Good luck to keeping all your new year's resolutions!
-Dr Lee

Shoveling Snow- The Safe Way
By Dr Eugene Lee

Winter always brings warm images of family gatherings, holidays by the fireplace, and of course, the beauty of winter’s first snowfall. Unfortunately, along with snow comes the task of cleaning it up to make driving and walking safe. I’ve outlined a few tips to help keep you and your back happy this winter season.

Make sure your healthy enough to take on the task yourself:

Shoveling snow can be hard on your back and heart, especially if done incorrectly. Check with your healthcare professional to make sure your healthy enough to take on the task.

Equip yourself properly:

As with most tasks, having the proper equipment can make shoveling snow easier and safer.

   THE SHOVEL: You won’t get very far without this piece of equipment. Considering that you’ll be carrying and picking this shovel up throughout the entire task, you want to choose the lightest shovel you can find. Plastic shovels tend to be lighter than their steel/aluminum counterparts. Also, choose a shovel with a smaller blade. Obviously this will make the shovel lighter, but it will also prevent you from trying to lift more than you can or should handle. Finally, choose a shovel with a curved handle. This helps to keep your spine straighter which is key to protecting your back.

   DRESS APPROPRIATELY: Cold weather can tighten up muscles and ligaments, which is something you don’t want to happen while performing strenuous activity. Make sure your dressed warm enough. Try using layers as this allows you to remove some clothing if you get too warm. Also, make sure your shoes are sturdy and have good tread. This will allow you to avoid slips/falls and give you more traction at your “base”.

The Warm-up:

Often the most overlooked part of any workout, the warm-up is key to keeping your back healthy. I recommend trying to shovel mid afternoon rather than in the morning. Muscles and ligaments tend to be tighter upon arising from bed. Giving them a few hours to loosen up is a good idea. Warm up for 5-10 minutes with light activity. A few examples could be walking up stairs or taking a walk around the block. Once you have some blood flowing, stretch the muscles of the back. Lie down and bring your knees to your chest to help stretch your lower back. From a seated position with your legs straight, bend forward stretching your back and hamstring muscles.

Shoveling the Safe way:

Keeping the spine straight is key to avoiding back injuries. Bending and twisting of the spine are common causes of ligament and disc injuries. First, if possible, push the snow instead of picking it up. The motion of lifting the snow is often the hardest part of shoveling. Pushing snow avoids this motion all together. If you must pick the snow up, ease the load on your back by using your legs and arms. Bend at your knees while keeping your spine straight. Keep your arms as close to your body as possible. To avoid the dangerous “twisting” motion in your spine, make sure that your snow pile is straight in front of you rather than towards your side.

Lighten your Load:

Don’t let the snow pile up all weekend and take one day to conquer the task. Shoveling smaller amounts more frequently will make the overall task easier and safer. Also, make sure you take breaks every 10-15 minutes. With both hands on your lower back, gently stretch backwards during this time.

If you feel pain of any kind, stop immediately and seek assistance.

Finally, for those who are able bodied, take a few moments and make sure your neighbors are up to the task of clearing their snow. A little of your time and effort will be appreciated and make you a good neighbor!