BLACK FRIDAY DEALS THAT MAY BE WORTH YOUR MONEY, PART 2

As we tackle part 2 of our list of Black Friday deals, I reiterate my disclaimer that this is not an exhaustive or static list, and that I have no personal financial connection to any of those products.

GROUNDING MATS

Probably not on the radar of many people, but nonetheless a very useful tool that's been around for a while now, grounding mats allow you to discharge some of the static electricity that can easily build up in a modern indoor tech heavy environment. Natural occurring electricity in nature flows in a direct current but our modern electricity grid is based on alternating current. In addition, modern humans lack the normal grounding mechanism which happens when electricity to which your body is exposed is naturally discharge to the ground through your feet (and incidentally the reason why so many people feel so rejuvenated and calm when they get to walk bare feet on natural ground like as earth or sand). It's beyond the scope of this brief blog to talk about some of the symptoms associated with static electricity overload, but there are many and you can look them up for yourself. Grounding mats plug into the ground part of your electrical outlet and will mimic the natural grounding mechanism that normally happens to your feet when any part of your skin touches the mat. A lot of people end up not using the mats because they assume that you need to have your bare feet on the mat which is not always feasible or comfortable in the home office setting especially in the winter months, however any part of your body can discharge and I personally have found it most useful to put my grounding mat underneath my keyboard on my desk, where my bare hands and wrists continuously touched the mat. At a price point below $100, and with the durability of several years, I definitely think it makes the top 10 list.

INSOLES

The debate is still raging out in the integrated space about barefoot walking versus supported foot walking and I'm not going to get into this debate in this blog. My experience after 30 years of practice is that there's a certain percentage of the population that still has the ability to mimick a more ancestral way of walking using minimal support by building up the natural musculature for that purpose, but I've also seen a lot of people whose structural damage and other health backdrop will simply not allow them to pursue that goal. For those people, especially for people who have to be on flat hard ground, which is not at all what our ancestral foot experience was designed for, having the right flexible full contact support is the next best option. I'm surprised by the number of people who walk along with chronic ankle and foot pain, estimated to be upwards of 20% of the population on any given year. Matching people with the correct insole, whether standard over-the-counter full-length or customized often results in profound improvement in people's pain level and their ability to stay physically active on their feet. It's a bit of a wild West experience for patients to lookup their own insoles, so I'm always willing to help my own patients pick what's right for them.

INDOOR AIR FILTRATION

A counterpart to the water filtration indoor air filtration is turning out to be a much bigger player in maintaining good health than we previously thought. When it comes to air pollution, most folks think about outdoor air pollution which is certainly not improving, but indoor air pollution over time is probably more impactful on your health because of the amount of time and exposure that most of us will have. Indoor air filtration is also a little easier for an individual to control than the outdoor air because you have so to speak the captive audience of your indoor space to manage. I have just completed a series of educational podcasts over the last 3 months all talking about long-term cognitive health and risks of neurodegenerative diseases like Alzheimer's. 1 of the surprising risk factors that is scoring very high on your overall risk tally is air pollution, both indoor and outdoor. Indoor air filters definitely come at a higher price point than some of the other items on the list, especially if you want to have a good durable option. I remember doing most of my research at the beginning of the Covid era when it became clear that we needed to improve our indoor air filter for the sake of infectious load management, but at the same time trying to capture common indoor household pollutants. For more details I would refer you again to the AHAM resourcde list

https://ahamverifide.org/directory-of-air-cleaners/

BLUETOOTH KEYBOARD AND MOUSE

I sometimes joke with people that laptop and other small electronic device pay my mortgage because of the amount of havoc they wreck on people's neck and shoulder. That is only a mild hyperbole. The basic concept in ergonomics is to ensure that reading material remains at eye level, while typing and writing material remains a trunk level, with your hands and wrists in line with your elbow. It's relatively easy to accommodate with a desktop computer, where your keyboard and your screen are independent, but because much more problematic with the air of laptops and tablets, where the keyboard is attached to the screen or even digitally on the screen. As a result, the average user ends up putting the laptop at wrist level to type, and spending hours with their neck in a forward flexed position. It's a huge problem for cervical and shoulder ergonomics, leading to chronic neck and shoulder pain, reverse cervical curve, and chronic headaches. There is a simple $20 solution to the problem called a Bluetooth keyboard. It's very easy to pair these device to your tablet or your laptop, while to use them like the desktop keyboard, while elevating and propping up your tablet or laptop to eye level and use it as a screen. I personally own 2 of them, one at my home office and the other one is the ultrathin floater that travels with me anytime I travel with my laptop. I recommend the USC rechargeable ones so you don't have to mess with the batteries.

BIKE TRAINERS

After 30 years of practice I am a little burned out on seeing the cycle of deconditioning that so many people go through in the winter because they don't have a good exercise outlet. Some people find it difficult to incorporate formal exercise outside of the home due to scheduling constraints, and low motivation to get out in the dark and cold to a facility in the winter months. They have limited options to do any sort of cardiovascular endurance exercise at home. Incidentally, many of these people have a good outdoor bike they enjoy writing around during the summer months. The solution is a bike trainer. It's a relatively simple and low-cost device (you can find a good used one around 100 and no decent new one a little over 200), that allows you to convert your regular outdoor bike into an indoor stationary bike by propping the front tire on a riser and connecting the back wheel to the trainer. I have to admit I'm not particularly handy with these kinds of things but my neighbor was able to do that for me in 15 minutes in exchange for a good hot meal. Unless you're planning to do competitive racing, you do not need any of the complicated to work you bike. I do recommend using online free exercise bike training sessions to leverage getting a good half hour 3 or 4 times a week in the winter.

BLACK FRIDAY DEALS THAT MAY BE WORTH YOUR MONEY, PART 1

With Black Friday right around the corner and many folks wondering how to stretch out their hard earned dollar on which rockin' deal, I thought about sharing my top 10 list of self-care items I am willing to spend my hard earned dollars on. (Which is saying a lot being I am Swiss and we are historically frugal). Finding the top 10 cut off was really really really hard since there are so many options out there, and many more than 10 that could be beneficial, especially depending upon your individual needs. However I think that as a whole those are items that will stand the test of time in their cost-benefit ratio in improving your long-term health and well-being. As with all things health and wellness, it's going to be a dynamic list subject to change in a rapidly changing consumer market, some already putting myself a note to do a 2026 update.

Please note: I have no personal connection with any of these products and will derive no financial benefit from recommending any of these products

WALKING PADS

We spent the last 20 years trying to mitigate the damage done by the sedentary lifestyle of our deskbound workforce. The 1st step was to move people from 8 hours of sitting into alternating sitting to standing, which was no doubt a huge benefit. The next frontier is to get people actually moving at a normal physiological speed during their workday. The walking pads are a form of very rudimentary treadmill which are motion activated by the movement of the worker. They take little room, are very simple machines with less opportunities to break down, and have significantly come down in cost over the last 2 years. The walking pad is associated with a standing desk set up. You walk on them at approximately 1 mile per hour, which feels like a very leisurely stroll. It may not feel like much but after an 8 hour workday you could have basically walked 8 miles. The benefits are huge. There's a great deal of attention placed on NEAT (non-exercise activity thermogenesis), the energy expenditure associated with day to day light normal movement in the context of metabolic health and weight management. Using a walking pad during your regular 8 hour workday brings out more energy than engaging in your average 45 minute workout at the end of your 8 hour sitting workday. So it's a bit of a no-brainer and doesn't take any extra time out of your day. It takes a little bit to get your brain used to slow walking while you're doing other tasks, most patients tell me about 2 weeks. The other enormous benefit is improvement in peripheral circulation, and surprisingly brain health. Slow walking continuously stimulates the cross crawl pattern in the brain, which improves firing of the frontal cortex for complex tasks and memory retention.

WIDE TOE BOX SHOES

Those should really be called anatomically correct shoes. Take a look at your feet for for a few seconds then take a look at your shoe. The shape of the front of your foot rarely matches that of the front of your shoe. As a result, you're having to take these complex orthopedic sensory structure of your midfoot and toes and compress them into a space that doesn't allow them to move normally, much less transmit appropriate sensory information to your brain about your position movement and balance. Transitioning to shoes that correctly encapsulate the normally positioned front foot is totally no-brainer for me. But for most people it's a matter of aesthetics. We are just not used to seeing shoes with a wider toe box and we've been conditioned to think of narrow front shoes as being sexy and aesthetically pleasing. (Much in the way that 19th century Chinese viewed tortured bandaged feet as aesthetically desirable). Time to revolutionize your thinking and let your feet operate the way they are designed. People are always surprised by how little foot discomfort they experience when transitioning to anatomically correct toe box, that their balance improves, that the rest of the lower extremity feels better, and that in general they feel more alert. (For more sensory input from your foot, something that is especially important for children). As a bonus they are becoming more popular and available from a wide variety of routine no-name vendors, after being once the exclusive offering from specialty expensive brands.

OURA RING

I really hesitated adding the oura ring to this list because as a rule I do not recommend a single brand product. However while the competition is getting close, it is still a pretty unique product in many ways. It falls under the category of wearable device that measure a variety of health metrics (heart rate, proxy blood pressure, pulse oximetry, sleep efficiency, temperature, etc.). 2 of the things that in my opinion make it stand out from the rest of the device is its size for the amount of data that it captures, as well as the accuracy of its HRV or heart rate variability. The latter is emerging as are really useful real-time metric of "stress", as measured by the autonomic response to a variety of outside factors. Once a baseline has been established, HRV can be a real good monitoring tool for how you fare under various circumstances as well as the responses to new health oriented interventions you may be trying: for example what is your ideal fasting window, what is your ideal exercise intensity, how well do you respond to a particular dietary change etc. The other feature that stands out for women is the surprisingly accurate cyclical temperature reading for those who are looking to to use basal body temperature for fertility monitoring, especially when it comes to spotting ovulation timing.

THERAPEUTIC INFRARED DEVICE

Red light therapy is a tried and true method of improving soft tissue recovery in a variety of settings from acute injuries to chronic degenerative changes. It's mostly safe although you always should consult with your healthcare provider to make sure you don't have any of the few contraindications (vascular insufficiency being 1 of them as well as some cases of diabetes). The mechanism of action has to do with improving energy production in the tissues, so it's pretty versatile for a variety of tissues from muscle tendon and nerves. I still recall the 1st unit I purchased in the early 2000, for thousands of dollars, which served me well at the time. The current technology is around the hundred dollar and many times over the power of my original unit. You have to make sure you get the right specs, which have to do with the right mix of wavelength producing diodes between 660 and 880 ideally. You also need to have sufficient density of diodes in your infrared pad to get the most benefit for the shortest treatment time. When patients asked me what they can do to speed up the recovery during a new injury or the flareup of a chronic condition, I'm always thrilled when I find out they have an infrared device at home that they can add to the mix.

WATER FILTER

Environmental pollution affecting air and water is unfortunately not going away, and if anything going in the wrong direction. Ideally we should have better policies to limit exposures for everyone but until that elusive goal is achieved, you can take some steps to mitigate your personal exposure in a few simple ways. Total elimination is not a realistic gold, however reduction definitely is and the technology has continuously become cheaper and better. Unless you have the budget for a whole house unit which is going to be somewhere in the thousands of dollars, you can get a really solid handheld picture product for something around a hundred. Always remember that the filter is only going to be as good as the frequency at which you replace the cartridges, so put yourself a calendar reminder and ideally put your replacement cartridges on auto fill. I have been relying on the recommendation from the Environmental Working Group (our household recently upgraded to Epic when our old pitcher died and we've been extremely happy.)

https://www.ewg.org/tapwater/water-filter-guide.php

Posture and weighted vests

Novelties in physical fitness come and go at a surprisingly rapid pace. Although not totally novel, the discussion regarding weighted vests came up during a recent osteoporosis update webinar and I thought we should give it a little nod and attention.

Weighted vests are basically just that, vests that can be weighted with different levels of weights, typically between five and 30 pounds. They are typically worn over athletic garments. The concept is to increase loading on the body during physical activity, with three primary goals in mind: increased bone loading for bone mass recovery in the context of osteopenia and osteoporosis, enhancing muscular endurance and bulk during a set activity, such as a walking, and increasing calorie expenditure for the same workout.

The science is a little bit all over the map yet because it’s a relatively new product, but there are some pretty strong data emerging as follows:

• Weighted vests are raising a lot of concern among musculoskeletal providers because they tend to enhance poor posture and common abnormal posture changes, such as increased thoracic kyphosis, lumbar lordosis, and especially anterior head posture and rounded shoulders. So before considering using a weighted vest, you need to address chronic postural changes first.

• Weighted vests seem to be potentially beneficial for certain activities, but not others. They seem to give you more benefit when used for short term, strength workouts, and much less for lower intensity cardiovascular workouts. They may be best used to slightly increase loading when doing large muscle activities, such as step ups, squats , but they do not appear to be beneficial when doing walking or light cardio.In that regard they function a little bit like added free weights, bypassing the limitations of having to hang onto weights with your arms, for example when you're trying to add 40 pounds of loading doing squats. One area where I find them remarkably useful is when a patient is trying to increase weight loading to progress with lower extremity and core strength but they can only hang onto so much weight with their arms, especially for patients who have permanent limitations and injuries in the wrist shoulders or elbows. (I remember wishing I had one of those when I fractured my wrist 10 years ago and I was trying to to do a relatively normal core and lower extremity workout in the gym with my arm in a full cast.) They may also free up the upper extremity to do other activities such as range of motion and helping with balance when someone is for example doing in line lunges.

• As with many fitness interventions, more is not better. And starting gradually is very important. I have seen plenty of people with really hideous spinal and shoulder strains who decided to suddenly pop a 30 pound weighted vest when starting to work out after break.They may not be indicated for people who have certain types of orthopedic underlying issues, especially lower lumbar stenosis or active disc herniations, as well as osteoporosis with micro compression fractures. As always, best to run that question pastor treating provider.

Thoughts on the Ultraprocessed Nation

I recently returned from a short caregiving trip in Finland and was catching up on my weekly research digest on the plane. This particular research article caught my eye because of what I had just experienced the cafeteria of my father‘s senior facility.

https://www.amjmed.com/article/S0002-9343(25)00549-2/abstract?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%27s%20Friday%20Favorites&utm_term=recent%20study&utm_content=recent%20study&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

In the US, as in some other developed nations, which are unfortunately catching up with US standards in terms of the over abundance of ultra processed foods in that daily plate, ultra processed foods are starting to make up a whopping 70% of our total food consumption. While most people understand on some level that processed food is bad for them, we have a long way to educate people to make them understand what in their grocery basket is a real food versus a highly processed food. And understanding doesn’t necessarily translate into better consistent food choices either.

Moving away from ultra processed foods back to whole foods shouldn’t feel like this insurmountable task. But it takes a lot of communal goodwill, and a lot of structural changes in how a country supports food growing, distribution and pricing. Which would be an entirely different complex and lengthy discussion that is not appropriate for this blog entry.

Back to my trip to the senior care cafeteria. I was having lunch with my family and was so delighted to realize that most of the food offerings were so simple and essentially healthy even in the context of mass production (after 20 years of visiting my father in Helsinki I can assure you this is the norm and not the exception). So much so that I decided to immortalize it with my phone. The soup is a simple chicken and carrot soup in a creamy broth, made from scratch, the main course is ground beef and cabbage, the sides are lingonberry sauce, roasted zucchinis and roasted root vegetables, plain mixed vegetable salad with a dash of sauce and some pickled fish. Totaling close to 90% of unprocessed foods. Pretty tasty too, especially if you are used to eating these sorts of whole foods dishes. The bottom line is that it’s possible, but it’s going to take some personal and collective dedication to reverse the trend and make this cafeteria tray the norm and not the exception.

WHAT IS THORACIC OUTLET SYNDROME

Another overdue blog about a very common problem that lands a lot of people in our office who have often been worked up medically and released with no good explanation or treatment plan.

The term thoracic outlet syndrome is an umbrella term encompassing several clinical syndromes, which all have to do with compression of nerve and/or vascular structures between the neck and shoulder.

Once the cervical nerves exit the inter-vertebral foramen, a.k.a. the space or hole between two adjacent vertebrae, they will join and repackaged themselves in three branches that will then travel downward into the upper arm and give rise to the three major peripheral nerves: radial, median, and ulnar. Shortly after their redistribution from cervical nerve roots into peripheral branches, they are joined by nerves and arteries exiting from the thoracic cavity, to form the neurovascular bundle. You will often see the abbreviation NAV, to describe respectively nerve artery and vein, that travel together. As a result, any of these thoracic outlet compression syndrome subtypes will almost always include a combination of symptoms due to compression or irritation of the nerve as well as compression of vascular structures. As a result, the symptoms can include not only pain, numbness, but also change in blood flow into the upper extremity that can manifest as sensation of cold and discoloration.

The most common causes of thoracic outlet syndrome is that I find myself treating in the today practices are as follow:

– the scalene muscles are really a big player. They respond to cervical injuries by going into spasm, or developing scar tissue from things like hyperextension whiplash injuries. The soft tissue injury to the scalenes will often result in strangling or adhesions to the neurovascular bundle and brachial plexus. It's relatively easily to palpate the problem if you know where to look and how much pressure to apply. If the scalenes are causing the thoracic outlet symptoms, you can reproduce it by lightly compressing the muscle into the neurovascular bundle. A normal interface of the scalenes with the brachial plexus will move out of the way and cause no symptoms with light to moderate pressure.

– Improper alignment of the anterior first rib to the posterior clavicle. This is often the result of upper thoracic sprains and or shoulder girdle sprains, especially a chronic clavicular and sternal clavicular injuries. After the neurovascular bundle and brachial plexus exit the scalenes they have to "dive" posterior and underneath the clavicle to enter the anterior axillary area.

– Deep pectoralis minor and coracoclavicular injuries or repetitive strain injuries. There's a pretty narrow space behind the pectoralis minor for the neurovascular bundle to travel. Most modern humans are very predisposed to compression in that area because of our poor posture, with our shoulders hunched forward and constantly internally rotated. As a result there is not a lot of margin for an additional minor injury to the shoulder such as falls, heavy pushing, and certain athletic injuries from trying to do push-ups or presses. I should say that seatbelt injuries from motor vehicle accidents are notorious for triggering new thoracic outlet symptoms and a lot of patients.

– Last but not least, the subscapularis muscle deep in the anterior superior armpit is also a common culprit. As the largest of the four rotator cuff muscles and a significant shoulder stabilizers, it sits just below and very close to the neurovascular bundle deep in the armpit. It's very easily triggered with falls and throwing injuries, as well as repetitive strain injuries.

Treatment of thoracic outlet syndrome needs to start with specific identification of the area of compression, and the structures causing the compression. For the most part the treatment plan is going to consist of a combination of cervical and thoracic alignments, a lot of very specific soft tissue releases to separate nerves and vascular structures from the compressing soft tissue, and addressing some of the chronic postural distortion patterns that predispose to the compression in the first place. But treating thoracic outlet syndrome can be surprisingly rewarding, since many cases do respond pretty quickly within a few treatments, partially because many of the structures are not usually associated with more complex long-term degenerative changes that are slower to respond to conservative care.

PSOAS 101: what is it, what does it do, when does it hurt ???

Many people are getting familiar with the name of this sometimes hidden and obscure muscle, because of its importance and clinical relevance.

The psoas muscle, or more accurately the iliopsoas muscle group, is part of a broader group of muscle known as the hip flexors. As their name would indicate, their function is to flex the hip. But in reality the iliopsoas muscle group is involved in many more functions and clinical conditions that I would like to briefly highlight below.

– The iliopsoas is a very deep muscle group that is in the anterior part of the lumbar spine. As such it's difficult to palpate part of it. It's also a surprisingly large muscle group. For those among our readers who may be hunters, or butchered their own meat, it's the tenderloin muscle. The circumference of the muscle is larger than that of the spine itself which highlights its importance in the stabilization of the lumbar spine.

– In addition to being a hip flexor, the iliopsoas is a very strong lateral stabilizer of the lumbar spine. Which is why it's important to have a strong healthy and fully lengthened psoas in any persistent lumbar pain.

– The iliopsoas is important for a variety of clinical presentations. We always need to check it in persistent lumbar pain.

– Due to the modern lifestyle associated with frequent and prolonged sitting, the iliopsoas muscle will spend a large amount of daytime in the shortened position. This will create a lot of issues, most notoriously some anterior pelvic tilt of the lumbar spine and compression of the lumbar spine and lumbar discs. It's important if you have a sedentary job to offset this issue with frequent anterior hip extension stretches and gluteal activation.

– The iliopsoas has fascial connections into the thoracic diaphragm, as well as into the quads, and this latter connection can easily influence the function of the quads and normal alignment and tracking of the patella. When people have persistent patella pain, it's worth making sure that the psoas is firing and lengthening normally.

– The psoas influences pelvic tilt, and is an important muscle group to assess when patients have lumbar postural distortion such as a very anterior pelvic tilt.

– Several important peripheral nerves have to make their path through the psoas when exiting the lumbar spine and entering the leg. This would include the main femoral nerve, as well as some continuous nerves which only provides sensory input to the upper thigh such as the lateral femoral cutaneous nerve. Assessing the iliopsoas is absolutely crucial for any anterior leg pain and tingling presentations.

– Manually treating the iliopsoas requires a fair amount of training and experience on behalf of the practitioner due to the location of the muscle group within the abdomen, and close correlation to internal organs as well as traversing nerves.

BAKER'S CYST

It is a question that comes up quite often at the office and I thought I should give it its own blog entry. A Baker's cyst is almost a common household term but it's often very misunderstood.

Most patients think of a cyst as some sort of standalone lesion. A Baker's cyst is actually more so an outpouching of the synovial capsule of the entire knee joint. It is a non-specific finding associated with a variety of mechanical problems with the knee joint: aggravated osteoarthritis, recent sprain, meniscal tear, severe misalignment. All of these will cause some increased fluid production in the joint which will escape in the weakest part of the joint capsule, which happens to be in the back of the knee. Think of it as the "storm pond" of the knee. In some people the outpouching from the increased fluid pressure will result in a distinct round mass that often will extend downward into the upper portion of the posterior calf. It will prevent comfortable flexing of the knee especially.

In addition to the more traditional compression and icing recommendations, sometimes needle draining the Baker's cyst will be performed to relieve an acute situation. It will bring about some much welcome temporary relief, but that will be short-lived. The reason is that a Baker's cyst is caused by something else. It will recur at a high incidence if the reason for the cyst is not recognized and addressed.

In our chiropractic practices, we have found that a Baker's cyst highlights the need to look more closely at what's going on in the knee, and the entire lower extremity. Intrinsic subluxations of the knees, especially misalignment of the lateral tibia posterior, is excessively common especially with osteoarthritis of the lateral compartment of the knee. Something as simple as a posterior adjustment of the tibia can make a big difference in the amount of pressure building up in the posterior knee joint. However we also need to zoom out and look at the bigger picture, looking at the alignment of the lumbar spine, pelvis, foot and ankle, as to how much it's loading up the knee incorrectly, and address that as well.

The bottom line: a posterior swelling in the back of the knee is often categorized as a Baker's cyst, but you need to understand that this nomenclature refers to the end result of a variety of mechanical, postural, muscular imbalance, and alignment issues associated with the entire pelvis and lower extremity that are best understood and treated together.

Iliotibial band cupping

https://www.youtube.com/watch?v=6v6McHqoV08

What this gorgeous fall weather people are putting in their last long runs and marathons before packing their shoes for the winter month. As a result I seen a few more cases of lateral knee pain that are iliotibial band related among our runners and avid walkers. Iliotibial band overload is usually associated with some faulty mechanics in the pelvis and lower extremity as well is some muscular imbalances, so those obviously need to be addressed as the root cause. However once that's all said and done, you still often have to deal with the residual problem of the adhesions between the lateral quad and the distal iliotibial band tendon. One of the most effective ways to do so is using cupping. It has to be done multiple times other two or three day interval for maximal results, so I usually will teach the patient how to do it on themselves. The cupping will allow for the separation of the overlying flat tendinous band from the underlying quads during active flexion and extension range of motion of the quad. It's quite gentle and effective, without the pitfalls of some of the micro bruising and tenderness associated with deep tissue work which is best suited for less superficial structures.