Topical treatment for pain and inflammation

It's a question that comes up frequently and I realized recently that I don't have a good written resource material to direct patients to and I find myself repeating the same thing over and over in the middle of a busy day. Unlike some of my colleagues, who tend to downplay their value in an overall treatment plan, I feel that topical's can have huge benefits to direct therapeutic activity to a local local area, and can overall minimize the patient's need for more toxic oral medications.

Understand that this is a generic list, and that you will probably need to figure out with your own individual healthcare provider which 1 of these may be the best, and understand that you may need different topical treatments at different times. Also understand that while mostly safe, a few of them do have some potential contraindication related to other medications and comorbidities that you should be aware of.

Topical treatments full in different broad categories matching their mode of action: counter irritant, vasodilators, anti-inflammatory, analgesics, and some of them crossover into more than one category.

COUNTER IRRITANTS: those agents tend to create a local receptor response that competes with pain receptors, thus tricking the body in perceiving sensation rather than pain. Menthol is probably the most common one. It's found as a base in the majority of topical treatments. It's usually quite safe, short acting and reversible. There's a huge variety of products available, and ultimately it boils down to preferring water-based versus oil-based, and how much of an overlying sent or not you want to have.

VASODILATORS: those agents tend to increase local blood flow by increasing vasodilation of smaller blood vessels. The main benefit is to improve circulation to a particular area, especially in the periphery of the body. The main ingredient is capsaicin, derived from hot peppers. On the tail end of the activity, they tend to have a mild analgesic effects. The benefits are to improve blood flow to deliver soft tissue repair nutrients, especially oxygen, in areas that are having a hard time healing or are somewhat avascular because of previous trauma or general health issue with blood circulation. You have to be quite careful with them, since they can create great irritation to the skin, and they are more medical contraindications to using them, especially with peripheral vascular disease and diabetes. It comes in different potencies, and you also have to be extremely careful not to rub your eyes after applying them.

ANTI-INFLAMMATORIES: it's a relatively broad category, with many agents having a secondary anti-inflammatory effect in addition to another primary effect. The effect pathways of information in peripheral tissue. This includes both pharmacological over-the-counter substances as well as naturally occurring substances.

- salicylate and dicofenac are topical versions of pharmacological oral equivalents, which are available over-the-counter. (Aspercream or generic equivalent is the most common version). They are quite effective, have a moderate acting range, but have to be used very carefully especially if it's used consistently in the long term because it does eventually reach your bloodstream. I think there is definitely a time and a place for short-term use during acute trauma recovery, to minimize the need for oral pain medication. There are some definite contraindications, so best to check with your provider before using.

-Essential oils like frankincense: should be used in small amounts in a carrier oil because of their potency, but can be a very nice long-term alternative because in smaller doses they really quite safe.

- Arnica: increasing in popularity in the US, I grew up with Arnica as a mainstay in our pharmacy box. It's a little bit of an atypical anti-inflammatory, which is used mostly for acute trauma and contusions. It has virtually no side effects so that one is safe for just about everyone to try.

- CBD: an oil-based extract from the hemp plant, CBD alone has no psychotropic effect and is relatively easy to use in the long term quite safely. I find that CBD takes a little bit to kick in, and I think it's best used for long-term management of chronic joint or soft tissue inflammation rather than as an acute aid.

- MSM: a sulfur based compound, it has a great safety profile when used topically. It has a mild anti-inflammatory effect, but is primarily used to support chronically injured collagen, such as osteoarthritis of joints, and chronic ligamentous or tendon injuries.

ANALGESICS: it's a little bit of a difficult category to pain, since analgesics means pain reducer. The mechanism of pain can vary in different patients, so all of the above can act as analgesics in a particular patient. However technically only very few compounds are considered true analgesics and they are relatively uncommon. The most commonly available over-the-counter is a pharmacological compound called lidocaine usually applied in transdermal patches. Lidocaine is powerful, short to moderate acting, but it has a fair amount of side effects and many medications adverse interactions for a lot of people so I would use that one was a lot of caution and with the green light of your provider. There are very few nonpharmacological true analgesics, such as California Poppy.

This is not an exhaustive list, with several other less commonly used compounds such as homeopathic's, and many bundled products. But this should at least be enough of a background for patients to start asking the right questions to select the right topical for their personal use.

First trimester pregnancy and low back pain: caught off guard ?

I have recently completed an online review of pregnancy related neuromuscular skeletal common issues. Quite a bit of it was just that, a review of things that I already knew and practiced for 3 decades, but there are always a couple new nuggets of information that are worth savoring.

The common thought about the 1st trimester of pregnancy from a neuromuscular skeletal standpoint is that is pretty routine because you have not started growing a lot of weight in the front of your lumbar spine and pelvis yet, and that most of the problems will start as your pregnancy advances. Nothing could be further from the truth and reality. Here are some facts that explain why some women are caught off guard and feeling quite silly about the amount of problems they are encountering before showing off a baby bump

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• The key hormone associated with softening of soft tissues and especially ligaments, called relaxin, actually peaks in the 1st trimester, and has a 2nd smaller peak in the 3rd trimester. This hormone creates a softening of the ligaments that are beneficial to prepare a wider pelvis during labor, but also indiscriminately affect all the thoracic lumbar and pelvis ligaments. During the 1st pregnancy, this means that practically you start developing a slightly hyper mobile pelvis and increased lumbar lordosis (anterior curve or sway back) very early on, sometimes even before you may know for sure that you're pregnant. Increased nonspecific lower back pain associated with hyperextension and facet syndrome is extremely common, as well as reactive discomfort in the gluteal and anterior hip area. Even the rib cage can feel like it's easily strained with normal activities. A whopping 25% of women will have a major fall during the 1st trimester of pregnancy because the center of gravity has already started shifting and the brain has not quite caught up with that.

• Women are not expected to significantly curb the activities during the 1st trimester of pregnancy because their body looks un-pregnant yet. Women need to understand that on the outside their body may still look the same but from a functional standpoint the stability of many of the thoracic lumbar and pelvic joints is already altered, and may require more care and stability during activities and exercise. This is especially true with subsequent pregnancies after baby number 1. It's okay for women to give themselves permission to curb back a little bit on the household chores when they find out they are pregnant even if they're not showing yet.

• Seeking chiropractic care during the 1st trimester of pregnancy can be really beneficial for variety of reasons. Not the least of which is to address some of the more immediate discomfort, but also to get a better baseline of any long-term structural issues that will require some time and intervention including a fair amount of home care to optimize women's body for labor and delivery.

• From a functional standpoint every woman can start working on a little better lower abdominal strength, making sure to center the trunk over their pelvis as it's naturally wanting to shift more anterior, be little more aware of fall prevention by limiting tripping hazards in your environment. Incorporating deep decompression flexion stretches as part of your wellness routine is also remarkably comfortable during the 1st trimester.

Tips on winter oral health

A little bit off the chiropractic path but worth a mention because of the number of questions that are starting to come up. Integrative dentistry and oral health somehow has been bubbling up on several of my health podcasts, that I listen to during my daily commute. The oral cavity is unique in that it ties into our respiratory system, and in this matter very much connected to our immunity to airborne pathogens, as well as the beginning of our digestive tract, and in that matter very much connected to our overall digestive health.

While oral health is a year-round issue obviously, underlying problems tend to be accentuated during the winter months because our indoor air quality and dryness.

Before I dive into a few specifics, I obviously want to remind everyone that basic care when it comes to proper nutrition and basic oral cleaning should be your foundation. You do not want to be snacking on starchy or sugary foods and drinks, and you want to make sure you brush your teeth at least twice a day and floss appropriately.

Beyond that, there are a few practical approaches to chronic oral problems, which involve gum irritation, cold sores, poor breath etc.

As a backdrop: the oral cavity is its own very micro biome rich environment under optimal circumstances, very much like the rest of you digestive tract, although the optimal microbial distribution is somewhat different than the lower digestive tract. Some of the same factors that tend to suppress digestive micro biome tend to suppress oral micro biome: unbalanced diet with high process foods especially sugars, food preservatives; carbonated beverages which disrupt the oral pH; artificial sweeteners of any kind that tend to kill of good bacteria (all the sugar alcohols are major problem in that regard and often overlooked, especially in things like gum). Additional factors that are unique to the oral cavity include chronic mouth breathing, which creates abnormal dryness of the oral mucosa and selectively allows non-beneficial gram-negative strains to dominate. Harsh anti-septic such as alcohol-based oral rinses will compound the problems, since they will indiscriminately kill all bacteria including the beneficial ones.

Here are some practical tips to improve your oral health this winter:

– recognize and address mouth breathing. It's a broad category and it sometimes complicated. Practice nose breathing multiple times a day, to break the habit of painting through your mouth. Obviously nasal congestion that prevents or limits nasal breathing can be a difficult and challenging problem over time if you dealing with chronic infections or allergies, but you can still start working on improving the amount of time you breathe through your nose rather than your mouth. You may need to work with a healthcare provider for some underlying root causes including myo functional oral therapist.

– Practice good meal timing habits by trying to have 4-5 hours between meals, wash your mouth or clean your teeth after meals, and limit your intake to water between meals or any unsweetened beverage such as tea or coffee. This will allow you oral micro biome to restore itself between eating.

– Limit or eliminate your use of gums. People do not realize how many of them have artificial sweeteners or other chemicals that kill off normal oral bacteria.

– Use gentle non-alcohol-based oral rinses if needed, but simple salt and water rinsing and gargling may be all you need.

– The acidity of your saliva can be a big contributing factor to problems with gums, lips, and especially canker sores. Ideally you saliva should be at a pH between 6.2 and 7.5. Over acidic saliva is mostly related to dietary imbalances with too much fast acting sugars, however some people are much more predisposed to acidic saliva than others, as evidenced with increased gumline cavities. You can test your saliva away from meals, using over-the-counter pH strips. If you find yourself constantly closer to 6, you can also use baking soda oral rinses to raise the pH. Those can easily be made at home using the following recipe:1 tsp (5 g) of salt and 1 tsp (5 g ) of baking soda in 4 c (1 L) of water

– If dealing with chronic gum or oral infections, supplement your dental care with anti-infectious natural agents. You may need to work with a provider on how to select the right agent, but typically you want to start with something a little stronger, such as anti-infectious essential oil rinses for 2 or 3 weeks, then transition to gentle immune maintenance agents. Some examples would be essential oils of clove, tea tree, oregano for an initial antibacterial treatment, then transitioning to more immune support therapies such as propolis, echinacea etc. There are a lot of over-the-counter available products that target natural oral health that you can leverage. If you are dealing with more chronic viral overgrowth such as cold sores, HSV6, you will spend less time trying to kill off and more time trying to restore your normal oral immunity.

– Oil pulling is a great way to help root out chronic pockets of nonbeneficial bacteria are an infection. You can use something as simple as coconut oil by itself to start out, with an oil pulling time of a minute while you work up the patience and endurance to swish your mouth longer. You should not rinse out your mouth after oil pulling, simply spit out what you have in your mouth and let the rest coat you oral cavity to prevent dryness. If you're concerned about a severe infection to start out, rinse your mouth and then take 1/2 teaspoon of coconut oil in your mouth and let it dissolve in your mouth without spitting it out. You can also add 1 or 2 drops of your essential oil to your coconut oil.

– Oral probiotics are becoming readily available over-the-counter. They are the equivalent for the oral cavity of what a traditional digestive probiotic is for your lower intestines. They target strains that are more prevalent in the mouth. Once you have cleaned out infections and pathogenic bacteria, it's a great way to prevent a reinfection and re-colonize your mouth with a stable oral micro biome. You probably only need to do them once a day initially for 6 weeks, then twice a week for maintenance.

– For some people with unique oral challenges (certain immune modulating medications that we can soft tissue such as autoimmune Biologics, certain long-term chemotherapy agents, post radiation etc.), you may need to consider oral red light therapy. There are some over-the-counter device at a very affordable price point nowadays, which you can purchase with your HSA, which offer red and blue light therapy known to control surface infections as well as increase soft tissue repair.

BLUETOOTH KEYBOARD FOR LESS NECK PAIN WHEN USING LAPTOP

When it comes to writing blogs and recording videos, my source of inspiration is often the things I hear myself repeating the most. How this topic did not make it to publishing sooner is beyond me because it certainly one of my pet peeves and a simple hack that is not getting enough traction with the average technology using folk, which is all of us.

Limiting strain on the neck and shoulders with technology has a lot to do with keeping reading material at eye level, while keeping elbows at trunk level for typing, mousing and writing. The fact that keyboard and screen are linked in our smaller technology like laptops and tablets means that you're usually going to sacrifice the neck by looking down while keeping the hand at elbow level. Over time, your 10 pound head becomes a 50 pound head on your neck and shoulder, with all the associated misery of neck and shoulder pain, chronic muscle tightness and headaches just to name a few.

Detachable keyboards come in a variety of options. USB dongles are still a good option for older laptops, but the ultralight Bluetooth keyboard is really the way to go. They are rechargeable via USBc cables, and more recently have become so thin and lightweight that they are easy to drop into a backpack or laptop bag to transport while going to the office, on the road or 2 meetings. The price point around $20, there 1 of the best ergonomic hacks you can treat yourself to.

( never mind Milou photobombing our session)

https://www.youtube.com/shorts/BKcYT9Soq1w

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.