Avoid sitting on low surfaces, especially bleachers and low boat seats. As you can see in the photo, it is nearly impossible to keep your back straight when you are sitting on a low surface. This is often a concern for athletes who sit on benches when not in the game. It is also a concern for golfers who ride in carts. Golfers should take care to sit upright while riding. If you must sit on bleachers, try to get the upper row to make use of the wall for back support. To counter the effects of low sitting, perform frequent stands and frequent standing back extensions. If you can obtain the upper row, it will be easier for you to stand without drawing attention or blocking views. Take a walk between quarters or halves of sporting events. Stand as much as possible. It would be helpful if you could raise the surface with a firm cushion or folded blanket making it easier to keep good posture. Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2021. For the original video go to https://www.youtube.com/watch?v=ap6kn3DfmZw&t=414 Brad: Bob is not here today, but we have someone even better to help us out, Chris the pharmacist. Today we are going to talk about understanding diabetes head to toe, symptoms, treatments as well as blood sugars and how you measure those. This is pretty comprehensive. It's not very short. This is a very complicated disease and we want to cover all the aspects. So if you want to learn everything about diabetes, if you have been diagnosed or a family member has been recently diagnosed and you really want to get some good information, this is going to give you everything you need to know. So bear with us. If there is a part that you don't understand, I'm going to help Chris. He sometimes gets too complicated. I'm going to see if I can have him explain it so that everyone can understand it, including myself. So very good. Both physical therapists and pharmacists work with diabetics all the time. Chris: Correct. Brad: And there are things that therapists have to know about treating a diabetic so they maintain good health and we can help maintain, monitor, and have good results with the patients and problems. Chris: Absolutely. Brad: And with pharmacists, you are very acute to what's going on with them and how to talk to them and educate them. Am I correct on that? Chris: Quite correct, it's an unbelievably prevalent disease worldwide. You're talking about 480 million people on the planet. Within the United States, we're roughly around 35 million people. Brad: So that is about 10% of the United States population has diabetes. And then there's type one and type two? Chris: Correct. There is type one and there's type two. Within the bigger framework is diabetes mellitus. Within that framework, you've got type one and type two. Type one is what was usually recognized as what they call childhood onset. But that's not really true. It does occur in childhood often or in adolescents, but it can occur later in life as well, even into your 20s. And that's the type that is insulin-dependent diabetes exclusively. Brad: So that means they have to get a shot? Chris: Yep, without insulin being introduced into your body, you would die. Brad: So you can't treat that or change it with your diet? Chris: No, but diet and exercise are still very, very important. We'll talk about that between the two. But it's interesting with type one diabetics, they tend to be, they are thinner patients. They tend to be pretty lean in general. But it has a variety of complications that we can certainly get into. Brad: So the pancreas is what produces insulin and puts it in your digestive system. So those type one people, it doesn't produce insulin or just not enough? Chris: We don't really know fully why you become a type one diabetic. But what we do know is that whether it's a viral cause or just simply autoimmune, our immune systems attack our pancreas and you have alpha cells and beta cells and your beta cells are the ones that make insulin. So when we eat food, our body generates insulin so it can take up sugar and put it into our cells for further use for energy. When we're exercising, walking, doing life. Brad: So with that, with type one, that pancreas is not doing that sufficiently. Chris: Those specific cells die off. The immune system for whatever reason said "I don't like these things and I'm attacking it." And there's a lot of research going into that as to how we can fix this medically. So there are doctors doing research on transplants using stem cells and artificial pancreas. Brad: What about genetics, is type one genetic? If I have it, are my children likely to have it? Chris: There is a possibility. There's a strong genetic component with both type one and type two. So it's one of those things where, if you have a diabetic parent or parents, there's a higher likelihood that you will get it. I see it all the time, we see diabetic families. I've seen where one parent is type one and the other is type two and the kids are all type one. It just kind of depends. You can't always outrun that. It's very complicated and researchers are trying to figure it out. Brad: Sure. Chris: And they don't have the key, they're getting better and better at things, but it is not easy. Worldwide it's really interesting and in countries that don't have access to care as the United States does, sometimes it can actually be missed because sometimes it looks like other things. Time is everything because there's this thing called diabetic ketoacidosis, which actually can be fatal if not treated right away. And that's how a young diabetic or an adolescent, or just a type one approaches, they're really acidic, their sugars are through the roof. And so we want to make sure that we're looking at everything. Brad: Let's talk about type two. So type two, is that the kind that typically comes with older people, so the onset is because of lifestyle? Chris: That was the older framework. You can have a type two diabetic that's 10 years old. So I would say it's more lifestyle maintained. Brad: But usually is it 10-year-olds or is it in 30 or 60-year-olds? Chris: It is going to develop later in life but what we're finding, particularly with childhood obesity is that we're seeing more and more children being diagnosed with type two diabetes, which in previous generations was just not a thing. Brad: So type two is influenced heavily by lifestyle? Chris: Lifestyle and yep. So the thing that happens in type two, that's kind of a hallmark characteristic, we have plenty of insulin floating around in our bodies, but the cells that use it are resistant to it. So it's an insulin resistance category. And so when we don't exercise well enough, we don't eat properly and we are overweight, and if there's a genetic predisposition towards it, it's a high likelihood that type two could develop. Brad: So with type two, they typically are not taking insulin injections like type one? Chris: No. No, they won't start there typically. The first thing when you get your first diabetic diagnosis, if it's a type two, is they're going to talk to you about modification of lifestyle choices. So diet and exercise are the first two things. If you're going to be on medications, the first thing we're going to talk to you about, no matter what, is to exercise well and eat well. And they're going to probably put you together with a diabetic nutritionist, so a specialist. They'll probably have a nurse care specialist, you are going to have an endocrinologist, there's going to be a team. And then the pharmacist will come in when we're talking to you about your medication. Brad: So as far as exercise as a therapist, this doesn't mean that you need to start running 5K's, 10K's, and marathons. Chris: Absolutely not. Brad: We're talking about probably walking 30 minutes a day or work up to that. Chris: Yeah, basically the guidelines are, they want you to do 150 minutes a week. So five by 30 minutes. So things like walking, gardening, ballroom dancing, swimming, biking, and running. You actually need to be kind of be careful with exercise and diabetics too, because there are certain things like say weightlifting, where let's say there's maybe some diabetic retinopathy kind of issues, or with your kidneys, sometimes we're pushing really hard or straining on a big, heavy lift. They can cause some problems and obviously, in your arena Brad, we have to be super careful with that with diabetes. Brad: So the big picture is, exercise does not mean you have to become an all-out exercise geek. You're just going to go five days a week, 30 minutes, like we said, walking, being active with things around your house is good for that. As far as diet, I think there's no real special diet. There is a lot of getting rid of your processed foods or the high sugar. Chris: The processed foods. Yeah, and I mean especially in the Americanized diet, we've got fast food and we've got processed food and those are go-to because they're quick, they're easy and you get quick energy. Brad: Relatively inexpensive. Chris: Yep, and that's one of the things that I think makes it so dangerous is everything is so cheap. All the stuff that tastes good, that's not good for you, it's cheap. And so if we can stay away from things that are in boxes and bags, I think that's a big thing. You want to go to whole foods, lean proteins, fruits, and veggies. If you talk to a nutritionist or a diabetic educator, they're going to talk about what are good fruits and veggies versus bad ones, and veggies, not so much, but fruits, some have more sugar than others. And they talk about the glycemic index which can probably glaze everybody over if I start into that. Brad: For example, I know grapes have a high sugar content. So I don't eat many grapes. I like them, but I like to stick to the berries, that kind of a thing. Chris: Yeah, berries, blueberries, and bananas are a little bit lower on the glycemic index about 63. So I mean in the middle of the road. So it just kind of depends on the things that you choose. And again, a diabetic educator and, or a nutritionist, you will be talking with both when you get these diagnoses because it's so important to incorporate those lifestyle changes early. And Rome's not built in a day and diabetes is, like I said, it's one in four of all healthcare dollars in the United States are spent on diabetes. Brad: 25%. Chris: 25%. So you're talking about the average diabetic patient spends $9,000 a year annually out of pocket costs. So that's not the insurance guy, it's out of pocket. Brad: We just had an amputee in here. They were talking about dealing with the amputee and the prosthetist talked about the percentage of people that get amputated in the knee, arm, or whatever, typically the legs are highly oftentimes diabetic. Chris: Yeah, the number one, when we talk about peripheral artery disease. Brad: Yeah, we'll get into that. I do want to talk about typical symptoms before we get any farther because we are going to cover seven different topics that they're all kind of interrelated, but we tried to break them apart. Let's say that you are not type-one diabetic or whatever, you're type-two, what do you feel? What does a typical diabetic notice before they're diagnosed? Chris: It's kind of odd, whether it's one or two, they're somewhat similar. In diagnosis circles, they're going to talk about the three Ps. It's going to be polyphagia, which is you're hungry all the time. Polydipsia where you're thirsty all the time and polyuria where you go to the bathroom all the time. So the three Ps. Brad: So all three of them or just one of them? Chris: No, all three of them are kind of characteristically all together. You'll see those as kind of a hallmark thing. Then there will be subsequent fatigue and you just don't feel well and things aren't right, you're not thinking clearly. Brad: Is this consistent day to day to day to day? Or does it come and go where you feel you have it for a few days then you're fine? Chris: No, no, it's going to be, think of a crescendo. It's going to start here and it's going to keep getting worse and worse and worse. So if you think of a big wave developing, you know how it starts kind of small, and then when it comes into shore, it gets bigger and taller. Brad: Could it go up and down, depending on your diet? Chris: No, when you first get diagnosed with type one, there's this honeymoon phase where you can actually somewhat spontaneously recover, but that's very short and it's less than six months. Brad: You said again, type two is what percentage of diabetics? Chris: 95% are type two, and 5% are type one. The problems all remain the same with the complications that are associated with it. Leading up to a diagnosis, there'll be asking you questions about your family. They'll look at your age, they'll look at things that have been going on around you. Did you have an infection? So they'll look at the autoimmune aspects for type ones if it's a younger diabetic patient. So there are a lot of things that are very, very complicated for a doctor or a clinician to try and figure out at the onset of this. You come in, something's not right. One of the first things we're going to do is take blood work to make sure that they see and the astute physician is going to look at your A1C, which is a diagnostic criteria. They're going to look at your glucose level and they say, "wow, it's 500. This is insane." And then they're going to immediately go into crisis mode and try to figure out how we can protect the body. And then they'll start to figure everything out. Brad: You don't go in to see a doctor in one visit and they say, "oh, you're diabetic." They're going to ask a lot of questions, do a lot of blood work, a lot of other tests and you're going to come back and they're going to analyze it. Chris: It can be really scary stuff, I mean, it can be a crisis situation. You could have a kid that's unconscious. You don't know why they're not arousable, in a type one particular case. Whereas an adult type two, the onset is much slower. If we weren't eating well, we're not exercising well and we're gaining weight, it builds up. I mean, they hypothesize that there's at least 8 million people in the United States walking around that don't even know they have diabetes, but they're diabetic. Again, that's going to be a type two. Type one it's medical crisis. You don't get that treated, you're dead. I mean, it's that serious? Brad: As far as symptoms, a typical symptom that I've worked with patients, is they get lightheaded. It's like, oh, they're diabetic and then we come down and the nurses come down or whoever, or we get something like orange juice or something. Chris: Yeah, when their sugar is low, it's called hypoglycemia or low blood sugar. Brad: Yeah, and that's when you get that lightheaded feeling. Chris: Yeah, they can almost behave drunk. So yeah, there are a lot of things to be aware of. Let's say that you weren't feeling well that morning and they brought you down for treatment and maybe you didn't eat breakfast that day, but you took your insulin, or you took your meds, and all of a sudden you're crashing. And so you can be unstable, almost drunk like, just talking about things that don't make sense. I mean, they can present in a variety of different ways. And so, yeah, a little bit of orange juice, sometimes they'll tell you to chew on lifesavers. We have glucose tablets in the pharmacy or glucose gels. There's a variety of different ways. If it's really serious, they're going to give you a shot of glucagon to stimulate blood sugar production. Brad: And what if it goes high, if it spikes, what are the symptoms? Chris: Well, if it spikes high, that's where you're not going to feel right, you're going to be fatigued, lethargic, and cloudy thinking. They sound kind of similar, don't they. So it makes it kind of tricky. They'll probably give you a bolus of insulin, so they will treat you specifically with insulin. When you have blood sugars over the marking would be 240 and that's milligrams per deciliter. Brad: What's normal, what's normal blood sugar, 120? Chris: For healthy people, it's going to be 80 to 120. Brad: So what numbers are high? Chris: After 120, but I mean, if you have what they call postprandial FTE after you eat, our sugar's going to go up, so it wouldn't be uncommon for you or me to be like a 200 if we had a really starchy meal. So let's say we had some pineapple and I don't know some coconut and some rice and some chicken. I mean, it's going to go up. Brad: That's normal. Chris: Yeah, it's got to be variable with what you eat, but it's going to come down right away because your body's going to uptake those sugars, put them in the cells, and then it'll be expunged when you have energy needs. So with somebody that's well, whether one or two and their blood sugar is way high, we have to watch out for that risk of diabetic ketoacidosis. And that can be actually fatal if not treated properly. The blood becomes acidic, the sugars are super high, so the clinician is going to recognize this. Brad: So if you're at home and you're diabetic, and you get these symptoms, it's probably time to go to the ER. Chris: Yes. Yeah, and with new diabetics, most doctors coach them, but you should have a kind of a diabetic rescue plan. And your family members and friends should know about it. Diabetes can be a long-term, frustrating situation for people to deal with. It's a big blow when you say "Brad, I'm sorry, but you're a diabetic." I mean people think, oh my God, am I going to die? And no, the answer is absolutely not. It's a very treatable disease state that you can live a great life. You can still have all your hopes and dreams can come true. It's not the end of the world. It's going to require work. And so we have to be willing to put the time in and make some of those changes if it's a type two. Type one, you make your peace with using your insulin and doing all the things that are necessary. Brad: Can we go onto our list of seven here, it's circulation, neuropathy, vision, internal organs, heart disease, mouth, and age-related issues. So let's start with number one, circulation. That's a big one. Chris: Yep, I mean our cardiovascular system, when you are a diabetic, whether it's one or two, and this will be a standard thing, the longer you have diabetes, the more these risks become more prevalent. So whether you're, let's say a 30-year-old type two diagnosis or a 15-year-old type one diagnosis, it's not as advanced, but when we're 65 and we've had diabetes for a number of years, the cardiovascular disease becomes a very real risk. And I mean, it can affect you in your 40's, your 50's, your 60's. Brad: So cardiovascular, we're talking about the heart then? Chris: Yep, the heart because basically with sugar, every single problem that we have in diabetes is a circulatory issue. So cardiovascular disease is much higher, I mean, you've got a much higher risk for heart attack, much higher risk for stroke. Part of those changes are because of the sugars in our blood, it causes the breakdown of vessels, and causes fatty deposits to develop. So it can cause atherosclerosis, which is the hardening of your arteries and clogging of your veins. It can lead to peripheral vascular disease in your extremities, which can cause circulatory issues. It can cause issues in our kidneys. Obviously issues around the heart. You can get just fatty deposits in your arteries. And then basically that can break off and become a stroke. So we have lots and lots of risks and they actually talk about vascular issues and for microvascular and macrovascular. So macro think of bigger, micro is in smaller, smaller at the capillary level. So it becomes unbelievably complex as a clinician because the diabetic umbrella is so encompassing. So you list off those seven things. And one of the things too, with respect to that is so what do you do? What do you do to protect yourself? Well, there's going to be medication therapy, for sure. So whether you're going to be put on a statin, is going to be absolutely critical to protect you. Obviously, hypertension, managing your blood pressure issues. Brad: This isn't all diabetics, this is where it can lead to this, but if you change your lifestyle? Chris: No, it's going to be all diabetics. You're going to have those lifestyle changes but if you don't make those lifestyle changes, this is your future. It's going to be managed with chemistry. We still want you to exercise. We still want you to eat well. I mean, that should be number one, "A" number one no matter what you do. Brad: What about neuropathy? Now that's a term that I think a lot of my patients will say "oh I have neuropathy." But with diabetics and neuropathy and the physical therapy world, we're always concerned about people's feet. Chris: Feet, feet, feet. Brad: Circulation is not good down there, and then you become numb and tingly and you don't have good sensation. Let's say you put your shoe on too tight or you have a wrinkle in your sock and it pushes into the skin and the skin breaks open. Chris: You've got the ulcer. Brad: Then you've got an ulcer that will not heal very well with a diabetic. And it can lead to an amputation. I've worked with a number of amputees as a result of a fold in their sock, or they stubbed their toe, broke something open and it will not heal as a result of circulation and the other effects of diabetes. So boy, keep your feet and your footwear properly fitting. Chris: Proper fitting shoes. Wearing wicking socks that are not like loose and droopy, I guess. Brad: Yeah, we can't have the folds on the socks. Chris: No, no, you want to make sure that everything's well-fitting. I mean, from the toolbox in your shoes, probably like what I'm wearing today would not be probably good diabetic footwear. Brad: You are not going to wear the pumps of the high heels where they're pointy. Chris: No, no, because you're going to be cramping your toes. That's one of the things with neuropathy, it's a progressive issue too. It starts out in a lot of cases, as pins and needles or burning, and then eventually, it's just numbness. It can affect their gates, it can actually affect the bone structure of their foot. And sometimes people just can't see their feet. And yet the ball of the foot is where most of those ulcers start or your toes. And so again, it's the footwear issue. So we want to make sure we're taking care of that. You want to make sure you have regular doctor visits. You should inspect your feet daily. After you dry off, you should put a moisturizer on them. Vaseline is a very simple way to help to maintain that, but you don't want to put it between the toes because that's where sweat collects. Then, you can get a variety of different skin infections too. So we'll talk about some of that as well. Brad: This is sounding pretty gloomy, but I do want to give some bright sides. I personally know a diabetic, she wears a pump so she has insulin in her system from a pump. You would never know it, she's got a very good job, she's very active, she's athletic, which helps. And she deals with it well. So again, I just want to say, if you choose to do your lifestyle changes, do whatever you have to do, what your doctor and whatnot coaches you. Chris: Absolutely. Brad: It's not all doom and gloom, but again, it potentially could go that way. Chris: But you have to work at it. And you have to realize that there are days when patients feel frustrated. Let's say you just went to a wedding last weekend. Well, I mean, there's always great food and there are always things that we're maybe not thinking about. Do I have the piece of wedding cake? Do I not have the piece of wedding cake? What kind of ramifications are we going to do? Did I do enough dancing at the wedding to kind of burn off some of those calories? Or am I going to have to take an extra walk or what's going to happen to me tomorrow? There are so many things with diabetes that makes it so incredibly complex to treat. And as a patient, it can be frustrating, but realize that if you can take a team, have a family member or a friend that can help support you, and have a plan to work on things. These are things that will help to minimize that. Most people on a pump are type one diabetic, but that's not always the case. You can have people on pumps with type two. And those pumps are incredible. It's kind of like having a fake pancreas. It's just put into you and it literally gives you a basal level of insulin. That's that baseline level. And then when you eat, you can program it for your meals, what you are going to eat. So they're incredible these days. So your endocrinologist is certainly going to be paramount in doing this. It's certainly something you don't see at the pharmacy level, other than the people coming in to pick up their insulin for their pumps. But it's certainly something that has been life-changing for many people. Brad: Good. Chris: And again, diabetes is a very livable disease. There's no reason why it's the kiss of death. If you don't take care of yourself, you can end up with an early grave. So I don't like to scare people, but it's certainly something that we have to be an active participant in managing our own disease states. So if we move to the neuropathy, I mean, it's circulatory at the end of the day, those nerves are not being bathed properly. But again, so we move on to vision where we start talking about diabetic retinopathy. That's the leading cause of blindness in working-class people throughout the world. Brad: So that means that as a result of the diabetic issues in your system, your retina becomes damaged. Chris: Yeah, damaged, and so it becomes part of the microvascular portion of diabetes. So this is the small blood cells. And so in our eye, it can affect our lens, it can increase the risk for glaucoma, and it affects the retina and the macula. I mean, there are all parts of the eye that are all in tune so we can see clearly. And what happens is that because it becomes a circulatory issue, it breaks down the little capillaries in the eye that feed the retina and the macula and the optic nerve and everything else. Just think of blood as your lifeline. When those vessels are broken down because sugar has basically screwed up the whole mechanism for delivering nutrients and oxygen in the blood, problems occur. And so in the simplest fashion, I mean you can get floaties, your retina can become detached, so your eye checkups are very critical. Brad: So again, with this same thing, the maintenance, your lifestyle changes and get things under control and actively manage it persistently. Chris: Every single solution that we have comes down to lifestyle modification, eating well, and using your medications appropriately. I mean, there is no in-between, there's no negotiating at this point. It's kind of like playing monopoly where you go to jail. It's like, do not pass, you go directly to jail. If you don't treat your blood sugars well and with respect, it's going to create a cavalcade of problems. Brad: Let's see, anything else? Like what about the mouth? Are there some issues with the teeth? Chris: Yeah, so again, circulatory. So, if we aren't getting good oral circulation in our gums, it can cause gum disease, and it can cause periodontal disease. And we're a diabetic too, so we don't heal as fast. So when we were talking about the neuropathy of the foot, diabetic foot ulcer, we don't have that rich source of blood to come and just try and oxygenate and help that foot heal. And so there are a variety of different things that doctors do with that, but the same thing with the dentist. You see how this adds up with the healthcare costs. So you've seen your eye doctor, you're seeing a kidney doctor, maybe, you're seeing your foot doctor, you're seeing your endocrinologist, you're seeing your regular GP. So it's a team-wise approach. And then you go into the pharmacy to get your stuff, and maybe you're paying your physical therapist to help you to improve your lifestyle. Which a lot of cases, physical therapists are paramount in developing exercise programs, how to do things properly, warn the patients what to look for. So, I mean, they are so paramount in treating and actually a lot of cases like with peripheral artery disease, which is circulatory again, physical therapy is better than drugs. So it's huge. Brad: Yeah, so appropriate exercise. Chris: Correct. And so going back to the mouth, because I just digressed, I'm sorry, I do that. Again, it's circulatory, keeping your sugars in check and making sure that your dentist is looking at those teeth. Because actually one of the things is, when you have a bad dental disease, you're not eating properly because you can't chew the right foods. So what do you go to? All the easy mushy sugary stuff. Worldwide, sometimes nutrition is hard to come by or at least good nutrition is hard to come by. And so with the mouth, it's very important. Our internal organs when we're talking about our kidneys, our livers, our hearts. So you talk about diabetic nephropathy as one of the leading causes of kidney damage. And so we have a little filter called the glomerulus and those fatty deposits into those little microvascular changes can cause damage. Brad: So you're compromised throughout your gut if you will. Chris: Everything, the average adult has basically 100 million miles of blood vessels. If you lay them end to end, that would wrap around the planet a few times. So that's what they theorize. The child has 60 million. So it's an incredible amount. And so circulation is key and to manage it, it all comes down to blood sugar management. Brad: So let's get to that. How do you measure? Because that's going to be a key thing. Once you're diagnosed, you are going to be responsible to measure your blood sugars on a daily basis. Chris: Every day it should be done. Brad: And that's where you poke your finger and you get a little drop of blood. Chris: That's one way. Brad: Okay, how many ways are there that you can measure? Chris: Well, it's going to be a finger prick or it can be through constant glucose monitoring. And that's one of the newer things that we have, they're wearable, implantable devices. Brad: Put on your arm. Chris: Yep, so they just have a special mechanism and it has a little capillary that if you could picture, would go in right below the surface of the skin. Brad: So something pokes into your skin. Chris: Yep and you'll wear it for 10 to 14 days, depending upon the manufacturer that you choose. And you have a little unit and actually, it's even integrated with cell phones, but you just wave it right over the sensor and it'll give you a real-time picture of what your blood sugar is at that moment in time. Brad: Wow, otherwise you're poking your finger, blah, blah, put it in the little machine and it takes some time. It's not a big deal, but yours is easy. Chris: It's not a big deal. But when you talk to patients, the one thing with the finger prick is it's a little sting, so they get frustrated with it. It can cause thickening of the skin. So we're talking about diabetics when they come in and actually checking, you want to use the side of your finger, not the tip of your fingers, a lot more nerve endings here. So it hurts more if you use the tip. So you want to use the side. Some people their circulation's not great, so they can run their hands under warm water to kind of work that up. Or you can actually rub your hands together and create a little friction, so you get a better sample. So sometimes it can get hard, especially for lifelong diabetics that are checking it three to eight times a day. Brad: Oh really that often? Chris: It can be, so that's why the constant glucose monitoring is a bit easier and a lot of the pumps now are integrated with that too. So like Medtronic and a variety of different companies. Brad: So they put the pump on that monitor? Chris: Yeah. Brad: And that goes for more than 14 days, as long as the pump is in? Chris: Yeah, and the pump to pump, they have different varieties because they're going to load it with their insulin. And then also it also integrates with their blood sugar. Brad: That gets pretty specific per patient. Chris: Yes, yes, yes, yes. But in so far as just self-monitoring, I mean the money's in the strips. When we talked about one in $4, I mean, test strips, I mean just an average box of 100 test strips is 180 bucks. Brad: Oh, really? Chris: Most insurance companies cover those. But if you take the new diabetic, the constant glucose monitoring, so there's the Freestyle Libre, Libre 2 and then there's Dexcom, which are the three units I'm most familiar with. They all, like the Dexcom are 10 days sensors and the Libres are 14 days sensors. They're a little bit cheaper than the strips, but interestingly, most insurance companies don't cover the constant glucose monitoring, which is strange because it's the most cutting edge, best possible information you can get to give yourself. And plus you don't have to prick your finger. So it's getting more comfortable. I mean, there are people like the Freestyle Libre product, you can swim with it. Brad: Oh really? Chris: Yeah, yeah, they stay right on, you can bathe, I mean, you don't take it off, you wear it for 14 days. Brad: Yeah, that information is documented, so if you can refer back to it for future reference possibly. Chris: Yeah, yeah. Like I said, you heard me say the test strip is about 180 bucks for 100 strips, for a sensor it's about 60 bucks. So it's cheaper. But for some strange reason, many insurance plans don't seem to cover those sensors. And I don't fully grasp why as a pharmacist. To me, when I talk to patients that use these devices, they love them. Their sugars improve. It tells them real-time, they're like, oh my gosh, I'm low, it's time for me to grab a quick snack or I'm way too high of, gosh, I'm going to have to go out and take a walk. Brad: You get to learn your body. Chris: You learn much more effectively, all of a sudden, wow, I went on this and I lost 11 pounds, my sugars are great, I'm feeling better, I'm more active, more energetic. I mean, they really are an incredible tool because of all these things that we talk about, as complications. It's the simplest thing that we can do to help ourselves on a day-to-day basis. And a doctor uses a different tool called an A1C, which has done about every 90 days. And that's a snapshot of how well you've been doing. And that's what the clinicians use. But if you're using your blood glucose, your self-home monitoring devices, hopefully, it will mirror what the physician sees every 90 days or six months, or whenever you come in for your checkups. So it is a critical, critical step in us helping to conquer the disease state itself, is just being in the know. Brad: I wanted to cover this earlier and I should have brought it up earlier, I feel bad, but people with type two, if you catch it early enough and you're not too far off, is that the point where your lifestyle changes could reverse it? Chris: Yes. Brad: But not cure it, but at least make it very manageable without medication. Chris: Yeah, absolutely, 100% yes. So I mean, and you can be a type two for five years and then you just find religion and say, I'm done with all this stuff. You exercise, you eat well, you do everything, your nutritionist says, your doctor says, you can get off the meds. It is a goal that I talk about with many of my patients, like, "Hey, if you can work at this and you commit to yourself." Because I think you're your own best asset. And so if you treat yourself as a billion-dollar commodity, you're a billion-dollar corporation, and it's like, well, I want to make this corporation last for a long, long time because I want kids, I want grandkids or I want to write a book. Brad: I want to live. Chris: You want to live. I mean, whatever your goals and dreams are, it should not crush them, is my point. This is very livable. And if you're active, if you pursue it actively yourself, you can beat the disease is not quite the right word because it's always going to be there in an underlying fashion, but you can reverse it and to the point where you don't need medications. Brad: Sure. Chris: This is a little bit of a side note, but like there are patients that are candidates for bariatric bypass, which is the special stomach procedure that doctors reduce the surface area and you're going to reduce caloric diet and very, it's very regimen and very difficult, and you have to be psychologically ready for something like that. But a lot of people lose 100 pounds and all of a sudden they're off all their diabetic meds, all their blood pressure meds. Brad: Oh, really? Chris: So it's an option for people that just can't quite get it done. Sometimes we just need a little help. Brad: It's a select group of people. Chris: A very select group, but it's something that's out there. And when you see all of a sudden, they're like, I am no longer classified as a type two diabetic because I've made these changes. But they're also exercising and eating well. A lot of times too they can clip a nerve that turns off the ability to even sense hunger. So there's a lot. It's pretty amazing stuff. Brad: Is that something that's pretty new? Chris: Newer. Well, I don't know, I guess you'd have to talk to a gastroenterologist that specializes in bariatrics. Probably, it's not new to them, but it's newer I think to us in the real world. Brad: I don't want to give people the idea that everybody should have it done. Get the nerve slipped for hunger and they're okay. Chris: No, it's not that simple. And there's a cost to those things too because people can forget to eat. They have to set an alarm to be sure you eat at this time. So again, that's a sidebar. It's not the end all be all. I guess the point being is that if you can commit to those lifestyle changes, you will see improvement, you will see your blood sugars under better control, and you will see overall better health. The one thing with all these things that we're talking about with complications is, that the longer we're diabetic and the less well-controlled we are, the more severe and the more frequent these complications can become. And so that's that diabetic umbrella. That's everything that's under there. I mean, it's the heart, it's the mouth, it's the nerves. I mean, it's everything, it's stroke, it's vascular disease, it's your circulatory, it's your eyesight, it's kidneys, it's the amputations. When we talk about all these things, it sounds pretty dire. But if we are willing to put in the work, we can live with it and we can manage it and we can manage it very effectively. Brad: And prosper it sounds like. Chris: Exactly! Brad: So that puts you in control of it, which is a big relief. And I know when I have my patients with pain, particularly back pain, if I can show them some exercises or some things not to do, and it puts them in control, it's like, oh, I can control this pain. Their whole life changes. They just have to realize and accept what they need to do and you do it. Chris: Yeah, you have to almost treat it like a job. I mean, and it's just like, all right, I'm packing my lunch box with healthy food and I'm going to work. It's one of the things that, cured, no, treated, yes. And I think if we're willing to commit to it, you can have a great life, an even better life. And I mean, there are athletes, there are movie stars, there are presidents. Brad: Everyday people that you may not even know. Chris: That you don't even know. They just don't talk about it. Brad: Yep, all right, very good. Hopefully, we've covered it. I think we covered it quite well. Maybe too well, I don't know. But good luck with it. It can be a problem, but you can certainly overcome and live well with it. So take care and thank you, Chris, for coming on and sharing all your knowledge. Chris: Absolutely. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2017. For the original video go to https://www.youtube.com/watch?v=01W9RCXKgys&t=614s Bob: Today we're going to talk about the big lie about trigger points, which you might know as knots, and how to get rid of them. This is a big topic for a lot of people. Brad: Right and we're talking seriously, we're using the three-letter word 'lie' so we have some attention here. Bob: Right, we need to back this up. Brad: There is a great bit of truth to this, so we're going to get into it. Bob: Trigger points are also sometimes known as myofascial trigger points. It's very controversial as to what causes them. That's been the issue for like a century. Generally what it is, is a hyperirritable spot and a common spot is like in the upper trapezius. You're going to find a nodule and you push on that and it really is sore. It just feels like a knot right in the area. You can get them all over different spots here, you can even get them in the low back, in the buttock, so that's what we're going to be talking about. Brad: Right and there's always a trigger point right about there on pretty much everyone. Bob: Yeah you can feel a little bit normally there and that's because a lot of people have bad posture. So for years, people thought, and this is back in the early 1900s or 1900-1950. They thought it was in the muscle itself and they called it fibrositis. That was a common diagnosis. That kind of went away and now what we believe in our opinion, in most cases, even though you're having trouble in the muscle, is it's coming from the neck or the spine. Brad: Right, another irritated tissue is causing the muscle to spasm or tighten up. A referral type of pain. Bob: Yeah it's being referred from the neck and it goes into the muscle. There are three signs that you can look at to figure out if it is really muscle or if it is coming from the spine. So we'll talk about those. Number one, if it is in the muscle when you test the muscle or put resistance on the muscle, it'll hurt. Brad: If it is a muscle issue, so this is not a good example but, if it's at the bicep and to stress that muscle you put it at mid-range. Bob: And I push on it and if it doesn't hurt there's no lesion in the muscle. That nodule you're feeling is not for the muscle itself it's from somewhere else. Brad: Right because we're stressing the irritated point if that's irritated the stress should cause more irritation. Bob: Let's talk about a muscle that most people do have trouble with, the upper trapezius. Now a simple way to test it, if you want to be a purist you actually have to bring your head back to the side, turn away, and then bring it up. Then you push on it. Brad: Okay so we're looking at this muscle, so this muscle is working to maintain that posture. I’m going to push here and that's going to make that muscle work even more and I’m pushing pretty hard. Bob: There's no pain. Now a simple way to do it is just to bring it up. I mean you're probably getting mostly upper trapezius. If you bring it up like this and again someone pushes on it and there's no pain. Same way, you can test the other side. Bob: You can test some of the lower trapezius and stuff like that by laying down. If I bring the arm up like this and you push on it. Brad: If I put pressure here with your arms up, so we're working that lower trap right here. Thumb up by the way. Or if I go out to the side, I’m getting the middle trap. Bob: So if none of those bother you, it's not the muscle. It's not hurting in the muscle so let's go to the next thing. Are the trigger points jumping around? I see this quite often in patients that at one moment it's over on the right, it's really pretty bad, and then you'll do a couple of things, you move around and it's on the left now. If that's the truth then obviously it can't be in the muscle. Brad: Right and that’s very common with upper back or lower back pain. One day it hurts in one spot and the next it's somewhere else. The muscle is not going to move around. Bob: The third thing is, can you create these trigger points by doing a movement? For example, if moving my neck makes one of the trigger points worse. That by far is probably the biggest indicator. Generally, if you find a movement that makes it worse, you can find a movement that makes it better. Let's talk about a few of those. So if you're getting trigger points up in the upper traps, one of the first things quite often you want to try is chin tucks. A lot of times people sit with a forward-head and rounded shoulders. This often brings on those trigger points because the neck's in this position. Bob: So you want to do a chin tuck where you're not bringing your chin down, you're not bringing your chin up, you're just going straight back. Bob: See if that makes things any better at all. Generally, that won't, but a lot of times what will start helping is if we start working on neck extension. Brad: One thing that I do, is I may have someone with a problem over in the left shoulder blade, and I'll start them doing a chin tuck and it changes the trigger point pain or that knot pain. If doing a chin tuck changes how that feels or moves the location of it, it's telling me I’ve got to look at the neck. It's not in the muscle it's in the neck. The neck is causing that muscle pain. Bob: So we're going to work on neck extension. Bob: If this is painful when you do this, one again it probably is the cause of it, but two just try shorter arcs if it hurts. If it still hurts you may want to try the towel trick which Brad and I have done many times. So, the Bradley Heineck technique is to actually just put the towel down low, pull down, and then you can lean back and work on doing some extensions. Quite often that takes a lot of the stress off the neck. Brad: I didn't have the other towel but the stretch strap works better than using the, what do they call it, the "selvage" of the towel. Bob: Right, a lot of times there's a little edge on the towel, and a different way to do it is actually taking that edge and putting it up underneath your ears and you're going to pull up now and work on extending back. Do you see how my arms are moving along with my neck? With this selvage or stretch strap, you can go lower too and work on different levels. Again see if that changes the trigger points. Brad: Now you're only going to do these if it helps and makes it feel better. If this irritates it you're just going to stop and you need to go approach it differently. Bob: Right. One last neck exercise that often works is the chin tuck and the side bend. So if the pain or trigger point is on the right, a lot of times if you chin tuck and bend to that side it helps. Again, you can do these every hour as long as it's making things better and not worse. Eventually, people get to this point and then they give even a little stretch. Brad: A light stretch, don't pull hard on it, it's just a gentle stretch. Bob: One of the problems I see with trigger points, especially in the upper trap and the traps is I think they're coming from right here. I don't think they're coming from the neck per se unless it's really low neck or maybe a little bit of what we call the upper mid-back. That thoracic area is really hard to treat. That's why a lot of times people go "well the neck is not affecting my trigger points at all." They need to get into this area and it's really hard to do so. Bob: I’m going to show you a couple of ways to try. One thing you can do is you can take a couple of tennis balls, I actually have two lacrosse balls, in a sock and you're going to roll on them. I want to show you on Brad where they are. So you put one tennis ball on each side of the spine and when you roll on this it'll help extend that part of the lower neck and upper mid-back. It can get some movement in there. Doing that every so often helps get that movement and takes away the trigger points. Brad: Right and you can do this on the table but you can also do it against the wall. Bob: I can tell you, my son was having trouble with this area and I worked on it manually. I mean, as a therapist I know how, but it's really hard to treat yourself sometimes and that's why these things stick around. Again all I have to do is take the two balls, and put one on each side of the spine and this actually works pretty well. I can roll onto it and I'm really working on that area. I'm not having to move too much. Brad: The sock is there to hold the balls in the general right location. If you don't use that they're rolling all over the place. Bob: We'll show the mid-back one and then we can go over to the wall real quick. The mid-back one, again if it's maybe even a little bit lower, it's good to get a ball like this and you can move it in different spots of the mid-back. Then you can do stretches up over the ball like this. Brad: A little spongy of a ball, not like a basketball or something that would be too hard. You need a little give in it. Bob: You can move it up and down and you can try to get that higher spot and it works. I can actually feel that it's going right into that upper area. Brad: I'll have patients, if they respond well to this, I'll give a little overpressure. As long as it feels good and they'll say "oh that feels like a good stretch." Bob: It does feel good. All right last thing, did you want to show it against the wall? Brad: Absolutely, so this is actually kind of hard to do by yourself until you get used to it. You're going to get the balls behind you and lean against them. I've got one a little higher than the other, but I'll have to work that out. Bob: It was easy to do it on the table, you just put a lot more weight on it then. Brad: Right, now that I've got it lined up this is wonderful. You could do it on the floor, a tight carpet even a hard floor. So another good use for lacrosse balls or tennis balls. You know, you just have to have some fun with this stuff. Bob: Remember folks we're not just pretty. Brad: Yeah we're pretty ugly. Bob: No, we're pretty helpful and handy. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

We hope to convey to you one of the key points with all forms of sitting and back pain is the benefit of movement and change of position. The most important tactic you can use to combat back pain while sitting is to intermix sitting with walking and movement. The person who attempts to sit with the perfect posture should still intermix change of back positions, movement, and walking. I (“Bob”) hurt my back when moving furniture to a new apartment in 1985. I began to experience sciatica type symptoms. Over the next month I avoided sitting. I did all my notes for treating patients standing at a counter. Eventually the sciatica pain subsided, and I have not had any symptoms since. If I were to injure my back now, I would use a height adjustable standing desk (photo A) or desk converter (photo B). In fact, I am typing this document while standing at a desk converter. A B There are many great desk companies out there, but we have found the quality of our Flexispot desks and converters to be excellent. Adjusting your computer workstation Many of you work at computer workstations. This is why we thought it would be beneficial to discuss how your station should be set up correctly in order to lessen stress on your back. Adjusting your computer workstation Many of you work at computer workstations. This is why we thought it would be beneficial to discuss how your station should be set up correctly in order to lessen stress on your back. Computer Station Working on the computer has become a common source of back and neck pain. Note the “C” posture of the woman in the photo. Many individuals who work at the computer do so for hours on end without any breaks. As a result, the back muscles and joints do not get any movement (remember they need movement). As a result, we see many people who develop pain. Recommendations for your Computer Work Station: Always adjust your workstation in the following order: A. Chair B. Keyboard C. Mouse D. Screen E. Documents A. Chair - Your feet should be firmly on the ground. If they do not reach the ground, you may need a footrest. Ideally the footrest should be horizontal (not sloped) and as wide and deep as space permits. A large footrest surface encourages movement of your legs and feet while sitting. Use a chair with a firm and upright backrest. If necessary, use a back cushion to provide support to your lower back. Avoid chairs with flexible backrests. The flexible backrest will usually encourage your back to settle into a “C” position. Avoid crossing your legs. Crossing your legs places your back in an awkward position, which can result in more pain. If need be, you may cross your legs at the ankles. B. Keyboard - Your upper arms should be vertical (straight up and down) and your forearms should be level (if you need to look at the keyboard quite often). If able, type without looking at the keyboard, the keyboard may then be slightly sloped below level. This allows your wrists to be as straight as possible. C. Mouse - If you tend to use your mouse more than the keyboard, you may want to position the mouse in front of you, instead of off to the side. The placement of the mouse should be level with the keyboard. D. Screen - Position the screen approximately 25-40 inches from your eyes. The further you can sit from the screen, the less fatiguing it is for your eyes. To find your ideal eye-to-screen distance, keep moving your screen further back until it is difficult to view. Then, slowly move the screen closer until it is the most comfortable distance from your eyes. Most screens are placed too low. Use books or a stand to raise your screen up. The top of the screen should be at least a few inches above your eyes when your back, neck, and head are in good posture. If you are using a laptop computer, it is essential for you to obtain a separate wireless keyboard. If you wear bifocals or trifocals you should purchase a pair of reading glasses designed to be used with your computer screen. Sit so you can comfortably view your screen 30-40 inches away. If you don’t, you will be constantly putting your head forward and tipped back to see through your bifocals. It is impossible to obtain good posture in that position and it can cause neck pain and headaches. To avoid a glare, tilt your screen slightly. Don’t forget to blink. Dry eyes are a frequent problem for computer use, due to the tendency to stare at the screen. This can be especially bothersome to contact users. E. Documents - Use a document holder to reduce stress to your neck and upper back. The document holder is generally best positioned directly below your screen or to the side of it. Remember to move. Get up every twenty minutes and do some standing back rotations or back bends. Walk whenever possible. While you are at the computer you can perform shoulder shrugs, neck extensions, and tap your feet and your heels. Products: 1) Flexispot Desks: (Discount of $15 off Included in link ) 2) McKenzie SlimLine Lumbar Support 3) Kebado Lumbar Pillow 4) McKenzie Lumbar Roll Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

Image via Pexels Regardless of what advertisers tell you, healthy living does not have to be expensive. With a little planning and preparation, you can improve your health without spending a fortune. The following outlines how to do so. Fitness Data shows that less than 25% of American adults get the recommended amounts of aerobic and strength-training exercise. There are low-cost exercises that you can do at home or outdoors. Many routines can be performed without equipment, but there is a variety of budget exercise equipment that you can purchase, including: • Resistance bands • Jump rope • Yoga mat Bigger equipment can often be found on sale or purchased secondhand. Check out yard sales and social media market pages. If you want to join a gym, there are a few ways to save money. Compare membership prices at gyms near your home and work. Many employers offer a stipend for gym membership as part of a wellness program, so check your employee benefits. If you aren’t sure how often you will actually be able to make it to the gym, offer to pay per visit rather than a monthly fee. If you have a condition, such as sciatica, that makes it more difficult for you to exercise, check out free physical therapy videos from Bob and Brad, and remember to always speak with your doctor before starting a new fitness regimen. Nutrition Another area where many individuals pursuing a healthy lifestyle worry about expense is nutrition. Although it is possible to spend hundreds of dollars every month on healthy food, a little planning can save you a lot. Swap fresh produce for canned and frozen alternatives. Not only are they cheaper, but they also last longer and are less likely to go to waste. Depending on the size of your household, there are many items that you may be able to buy in bulk to save money. When buying large quantities, purchase things you know you like and will consume before the expiration date. Packaged foods and prepared meals are generally more expensive than raw ingredients. Find healthy recipes that you can cook yourself. If you appreciate the convenience of microwavable meals, prepare meals in bulk and freeze them in single-serve containers. Finances For many individuals, physical and financial health are interconnected in a variety of ways. When money is tight, you may be more anxious and not sleep well. When your financial situation improves, you have more money to spend on your health. Fortunately, it is possible to stick to a budget while making healthier choices. In some cases, it may also be possible to monetize your healthy lifestyle. A wellness blog may supplement your income. If you want wellness to be a larger focus of your work life, consider opening a health-focused business. These are very trendy, so be sure to do thorough market research before investing much money. Find a niche that has not been overdone but is not so specialized that the customer base will be too small for success. A strong logo can solidify your brand identity. There are many online logo makers that can help you quickly and easily design the right image for your business; check into this online logo maker if you’re looking for one with great features. The wellness industry is growing, and prices are rising for specialized food and fitness classes. However, if you stick to the basics and focus on your needs, you can save money while improving your overall health.

This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2022. For the original video go to https://www.youtube.com/watch?v=ULx0TJorq_Y&t=438s. Brad: We've talked about this before, but this is the mother of them all. We're talking about leg cramps. Because they're the most common. Hamstrings and calves are probably prevalent. But, you know, you get toe cramps or thigh cramps as well. Typical causes of cramps, number one, night cramps. That's not a cause, but that's when they occur for a lot of people. And I don't know about you, Bob, would you say that's more in elderly people? Maybe 50 and over? Bob: I would guess. Absolutely. I know myself, I get cramps when I stretch a certain way. Brad: Ah, yeah, yeah. I've had a number of patients, in the middle of the night, they are awakened by this painful cramps in their legs. And of course we taught them how to get through that. Bob: Right. Brad: Also athletes, people who exercise a lot, maybe they exercise too much, too much intensity. We can have some ways to deal with that. And cramps associated with fatigue. This is like when you're maybe exercising or walking and all of a sudden you start to feel pain associated with that. But there's something you have to know that it may not be a cramp, and people get this confused. This pain, they think it's a cramp, and it's actually a circulation problem. Bob: There is even a test, we could show you, that you could try. Brad: Yep, absolutely. So we're going to start with number one. Now, this number one, I've kind of put a few of them together and I'm calling it under one. First of all, medications. If you're on medications or you started a new medication or you've changed something, that could lead to cramps. Bob: There is always those side effects, Brad. Bob: Yeah, exactly. So you need to check with your doctor to make sure that's not a problem. Bob: Right. Brad: Dehydration. How many glasses of water a day, Bob? Bob: Right. Well, they say eight a day. But you might have to do more than that. Brad: Right. It depends how big your glass is. I think it's eight, eight ounce glasses, right? Bob: Right, it depends, how much you sweat that day and other factors. Brad: There's a lot of variables. But many people, I know my mother she's in her eighties and she does not drink near enough. And you know, we're working on that. Bob: As you get older, I think you have less thirst. Brad: Yeah. I don't know? She's still drinks a lot of coffee, though. Bob: Yeah, she does. That helps. Brad: Yeah. There's some water in there. Electrolytes, your diet. Make sure you're getting enough vegetables, fruits, good things like that. Or what do you use? Bob: Nuun tablets. I actually take them before I go out and golf. Because I often will get an imbalance. And so it helps. Brad: A lot of perspiration. Bob: Right. Brad: Anything like that. That's always an option. There are a lot of other products out there that offer that electrolyte in tablet form. So, and again, blood flow issues in a little more detail, if you are walking and you get cramps in your calf or your feet. My father had this, he always felt like his feet were cramping up. It was a matter of blood flow circulation. They weren't cramping. Bob: Claudication. Brad: There you go. That could happen in the calf. And possibly even a DVT, deep vein thrombosis. Or blood clot. Bob: So if you dorsiflex your ankle, or bring your foot up and squeeze on the calf and if there's pain that could be a blood clot. It could be a DVT. Brad: It may not. That's not the best test. It's still something you should get checked out. Bob: Right. Brad: Exactly. All right. Let's go to number two. Let's look at those night cramps. Now, if you get a night cramp you need to stretch the muscle to stop it. So in other words, if I'm lying here and I get a cramp in my calf, what's going to happen is my toes are going to point down and it gets painful. So either just pull your toes up, sometimes you can. If it's a bad cramp, you actually have to get out of bed, point it down and then put weight down, and stretch, stretch, stretch. Bob: It's not fun. Brad: No. These things are very uncomfortable. Painful, uncomfortable doesn't even describe it. Bob: It feels like you're going to tear the muscle. Brad: Oh, gosh. Or if you get a hamstring cramp then your knee is going to want to bend. Then you have to try and straighten it out. And if you cannot do it in bed or even if your partner in bed can grab your leg and help straighten that out. Ah! There you go. Brad: Or if you're by yourself and you get up and you try to go forward, when you flex forward that'll stretch that out. Brad: So I've had a number of people, if they have calf cramps, I'll show them the wall stretch. Before you go to bed. Bob: Yes. Brad: Some gentle stretching, it doesn't need to be too aggressive but stretch that muscle out, get relaxed. Do this one, the hamstring stretch you can do in bed, lying down. Bob: Grab at the knee and try to straighten your leg. You really pull the heel toward forward. Brad: And you'll feel those hamstrings stretch and loosen up. And hold that, that one's kind of hard to hold for 30 seconds, but try to get five to 15 seconds on each leg. Bob, do you want to talk about if you heat up the muscle to get circulation? Bob: Before going to bed I think it's a great time, while you watch TV, to go ahead and put heat on. The Thermotex is what we prefer because it's deep heat. Brad: Far-infrared heat. Bob: Right. So, how deep? Brad: 2.3 six inches, according to the studies. Versus if you just get a regular hot pack, they're going to just heat up the skin, essentially, but not get into the muscle. You can use a regular one, because these are quite a bit more expensive. But they do work well. So one way or another, get some heat on you. Bob: Right. Good for your back, good for your legs. Brad: Whatever muscle is the guilty one, if it's your hamstring, or the calf muscle, or maybe the quads, you're going to have it on there. If it's far infrared heat 30 minutes at least, maybe 45. Bob: Well it takes 10 minutes to warm up. It's even heat, though. Brad: Number four. Now this one's interesting, use apple cider vinegar. Now, this is a home remedy for the old fashioned type, but actually we have a video on this. Bob: With Chris the pharmacist. Brad: Yep. And he did extensive research on updated information. And if you go to our YouTube channel, the title is "Apple Cider Vinegar: Used for Leg Cramps, and More." And we not only have information from that, but also anecdotal evidence. Now, Chris cramps on a regular basis and he finds this to be useful. He was the last person to use it, you know, coming from a pharmacist and he starts using it and it works. So anyways, there's also other products that have apple cider vinegar as the base that claim they'll stop leg cramps or cramps. Bob: And do they work? Brad: Yeah! Actually, when he gets a cramp, as a matter of fact just last week he was getting leg cramps and he has to get out of bed and start to stretch it, then he takes one tablespoon of the apple cider vinegar in four ounces of water. You know, the pharmacist, you have to be exact. And he drinks it. He says, within a minute, it'll make that cramp relax. So, yeah, he's got it figured out. There's a whole thing with the nerve connection between the taste and how the cramp mechanism goes on. And it's a theory, but he swears by it. It works well for him. Again, that video will go through in detail. And number five, the last one. Bob, now, you actually found this originally. Bob: Right, it was sent to us, actually. It comes over the counter. It's called Theraworx. And, you want to talk about the reviews? Brad: Yeah. Over 3000 reviews. Four and a half stars, and it's for cramp relief or stopping cramps! I think it's Theraworx Relief. Bob: It's helping a lot of people. Brad: Yeah. So it seems to be working. We have not actually tried it Bob, you had it. Bob: Oh, I had. But I don't have cramps. Brad: Right. We should have given it to Chris but Chris wasn't with us at the time. But anyways, it's worth a try, I think, you know? It's got good reviews. It's a foam, you spray it on. You rub it in before you go to bed and there you go. I don't know, does it smell good? Bob: It's all right. Brad: So it's not going to be like one of those things that is going to be a problem. Bob: Your wife will still lay by you. Brad: All right, well, good luck with those cramps. They're very painful and we need to, as our motto says, help you feel healthy, fit, pain-free. Is that what is it? Bob: Healthy, fit and pain-free.. Brad: Got it, after 10 years, you'd think I remember that. Take care! Bob: Good luck. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

Battery If the battery will not charge and the lights is off: Please charge your massage gun with only a USB-A to USB-C cable. The use of USB-C to USB-C cable will not charge it. Press and hold the power button for 8-10 seconds to start. Massage gun won‘t start. The lights are off: Please charge with only USB-A to USB-C cable. The use of USB-C to USB-C cable will not work to charge it. The indicator light is still on: Please contact customer services team for replacement. USB-C USB-A *The battery issue: This occurs after the guns battery was almost fully drained after use. When the charger was plugged in the battery level indicator should be flickering in every scenario. *Will not start: First make sure it is not plugged into the charger. It will not start if it’s plugged in. Hold the button in until it starts, usually between 8-10 seconds. If it’s still not starting, it’s most likely that the motor is seized because of the high pressure. The restart to this is actually very easy and requires you to charge the massage gun with USB-A to USB-C cable until you see the light flickering. *Every Bob and Brad product is backed by a 1-year warranty and award-winning customer service team. We want you to be completely satisfied with every purchase you make. If you are in any way dissatisfied with a product you ordered, we’ll exchange it, replace it or refund your money within the warranty period. Simply email us the problem, and we’ll take care of it. If your massage gun is still not working, contact our Customer Services team at +1 (612) 567-3035 or email us at support@bobandbrad.com for assistance.

We hope to convey to you that in order to reduce back pain while sitting, you must increase your movement and position changes. The most important tactic you can use to combat back pain while sitting is to intermix sitting with walking and movement. Even the person who attempts to sit with the perfect posture should still intermix back position changes, movement, and walking. Foam Back Supports We believe it is important to use back supports to help avoid the “C” position and to obtain a good sitting posture when in the car. Driving in a vehicle is generally very hard on your back. This is especially true if you are driving with a slumped posture. Vibration and road shock will place even further stress on your back. In this picture one can see a foam roll is being used to keep the spine from slumping into the “C” position. Proper placement of a foam support 1. The foam roll should be placed approximately at the level of your belt (either a little higher or lower depending on what’s comfortable). 2. Your bottom should be slid all the way back in the seat. 3. Lean back against the roll and attempt to keep your body in straight alignment. Your body type and specific back problem will dictate the size of back support you need. A larger person with greater curves is more likely to require a thicker back support. If the roll feels like it is too much, you may want to try a thinner support. Before you purchase a foam back support, we recommend you try the following: Take a towel and roll it into a tube shape. Place it behind your back when sitting and gauge your comfort level. We have also generally found our patients who are suffering from back pain want a thicker support (or a thicker towel). Those who are not currently having back pain generally desire a thinner roll. Experiment and decide what works for you. If you decide to use the rolled towel for a longer trial period, you may want to duct tape the ends to prevent it from unraveling. Once you have decided on a thickness, you have the option of purchasing a back support with a similar feel. We also recommend using a support to help prevent back pain from occurring or reoccurring. It is important to follow these rules when driving or after driving: 1. Avoid long trips when recovering from sciatica or a back injury. 2. If you need to drive, stop every half hour and walk a bit. Perform standing back extensions if allowed by your therapist. 3. Do not slump. Use a back support or rolled towel as already suggested. 4. Use your left foot to prevent your bottom from sliding forward on your seat (which can cause your back to slump). Use the stationary inclined footrest located to the left side of the brake pedal if this feature is available in your car. 5. Try moving your car seat slightly forward. When your knees are too straight, the tendency will be for your bottom to slip forward on the seat and cause you to slump. 6. Lower your hands on the steering wheel. The least stressful and fatiguing position for the arms, neck, and back when driving is with your arms hanging nearly vertical. This is accomplished by placing your hands on the steering wheel in the nine o’clock - three o’clock position or the eight o’clock - four o’clock position. Placing your hands on the steering wheel in the ten o’clock - two o’clock position will cause your upper back and shoulders to round forward. 7. Excessive back inclination will also cause your back to slump forward. 8. Avoid reaching to the back seat. This will cause your back to bend and twist. 9. Use the proper technique for getting into and out of your car. When getting out of the car, pivot your whole body as a unit on the seat while you bring one leg out of the car at a time. For support, grasp the doorframe or steering wheel. When both legs are out of the car, scoot forward on the seat. Move your feet back and under you as far as possible. Then, lean forward from your hips, keeping your back straight. Finally stand with assistance from the doorframe or steering wheel. 10. Do not lift any heavy objects immediately after a long car ride. A long drive leads to fatigue of your lower back muscles, increased pressure on your discs, and stretching of your back ligaments. You are at a higher risk for developing low back pain and sciatica when involving yourself with lifting activities after long car rides. Remember, your goal is to keep your back in proper alignment. By keeping your back in proper alignment, you are STOPPING THE CAUSE OF YOUR BACK PAIN. Products: 1) McKenzie SlimLine Lumbar Support 2) Kebado Lumbar Pillow 3) McKenzie Lumbar Roll Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2021. For the original video go to https://www.youtube.com/watch?v=Kby8kvUpKvg. Brad: Hi folks, Brad Heineck Physical Therapist. Chris: Hey, I'm Chris the Pharmacist. Brad: Bob's not with us today, I think he's out golfing, having some fun somewhere else. Chris: Atta boy. Brad: But today we are going to talk about neuropathy, causes, and symptoms, with at-home treatment and medications. We're going to talk about what you can do yourself and the medications, how they work, and some good information on that. Chris will give us his expertise. Chris: All right. Brad: I do want to mention that with neuropathy, you're going to go through some of the details on it. You can explain it much better than I do, but for this channel, we're related to physical therapy and almost always in my experience, and I think most PT's would agree, that neuropathy is associated with diabetics, in our field. You could have neuropathy from r diagnoses as well. We're going to talk about it. Chris: I mean, there's a lot of things out there. Brad: Say a few of them. Chris: Post-herpetic neuralgia. I mean, you could have just an injury, a spinal injury. There are a lot of things that can cause it. Brad: Okay. So there are some neurologic things that could cause it. MS. So the treatments are going to be similar for those, but we will kind of relate to diabetes because it is so prevalent in that diagnosis and that's our experience. So what is neuropathy? Can you explain that? Chris: I hate to say it, it's not a real long flowery explanation, but basically neuropathy is that burning, stinging, pain, numbness that you get. How does it develop? With diabetes in mind, if our blood sugars are high and a lot of times our sugars are high, that means our cholesterol is high. So, circulation doesn't bid the nerve real well due to high blood sugars and probably cholesterol. As a result, the nutrients and oxygen that your blood flow carries, do not bid those nerve cells and they are not healthy. And as a result of that, they kind of die-off. So for lack of anything better to say, you just don't get what they call better neuronal transmission. So just think of it as a highway in your body and just the signal is interrupted. And so you don't get that good, nice confluent signal going back and forth as a nerve would. Brad: So what, what are the most common locations in the body? Chris: Well, a lot of cases with diabetic neuropathy, a lot of times it's going to be below the knee. So you're going to see a lot of problems in the feet and lower leg, which is why foot care is so important for diabetics. And we'll touch on that as we go forward. But I mean, you can have problems in your gut, particularly with a diabetic, but you can also have problems in your legs. You can have it in your arms and hands. So it just kind of depends on where it is on you, but the treatments in most cases are going to be similar, which is going to be pharmacological and physical therapy related. Brad: Okay. And in my experience, and I've talked to Bob about this too. Usually, it's below the knees, on both sides typically. Chris: Well, that's why we worry about, especially the diabetic foot. Brad: Yeah. What kind of symptoms do these people typically complain of? Chris: Symptoms kind of manifest themselves over time. So, I mean, the longer you're a diabetic, the more opportunity you have to become a patient that has neuropathy. So the less well-controlled your blood sugars are, and the longer you have diabetes, the more likely you are to get neuropathy. But they come in and they're going to complain about tingling, burning, pain, numbness. Even to the point where a diabetic with bad diabetic neuropathy could literally have a rock in their shoe, they could be walking around all day long and they won't even know it. So they lose that sensation and they might have like some very vague feeling, or it could have been one of my feet felt that way yesterday too. So it's so important as a diabetic, number one is to check your feet daily to make sure there are no little nicks, cuts, or blisters. Brad: Sure. Chris: Those are the things that can lead to infection and other problems. Brad: So with that, say there is a little stone in there and you walk on it. You did not feel it as a result of the neuropathy, and that stone may break the skin open. Then you have an open sore. And because of the lack of circulation, that can get infected and it's slow healing because of the diabetic side effects and it can actually lead to an amputation. Chris: Yeah. That is the worst worst-case scenario. So the things that we're going to talk about today guys, are we want to make sure that we're controlling our blood sugars, we're exercising well, we're eating well, and we're using our medications appropriately. And those are the things that will help to stave it off. Brad: So I do want to mention one other thing as a therapist, one thing that we deal with a lot with people with neuropathy, if they have numbness in their feet or their legs, you cannot feel the ground or the surface that you're on. That dramatically increases your risk for falls because your balance is heavily dependent on the feedback back from your proprioception, back from your feet where they're touching the ground. And it just really makes a big difference on your balance and a fall risk goes way up. So we do deal with that, we're not going to talk about that too much, that's probably all we're going to mention for now. We have balance videos out there. Can we go right to diet? How can these people with neuropathy change or manage their symptoms? Chris: Yeah, absolutely. I mean we know neuropathy has no cure. That seems kind of damning for a lot of people, but at the same time, we can make it better. And so one of the simple tools that we have is just eating well. And so if you're a diabetic, that means going to the leaner proteins, your fibrous fruits, and veggies, those types of things. Brad: Some examples of leaner proteins, we're talking about meats and fish? Chris: Yep. So we're going to go with poultry like chicken, we'll go with fish, lean beef like grass-fed beef, very lean protein, and eggs. For our vegan folks, it's going to be your nuts and legumes. Those are going to be good protein sources. So you're going to want your leafy green vegetables. That's going to help with the B vitamins, that's going to help with nervous system development. Brad: Spinach. Chris: Spinach, kale, broccoli. So all the things your mother loves. Brussels sprouts, there's another one. Alfalfa sprouts. There is a lot of good stuff out there. Brad: Sure okay. Chris: Just eating well, helps our body with the nutrients that it provides it. So it's going to actually help with the circulatory system. It's going to help keep our weight at a better level. If we're going to McDonald's and just eating fries and chips, I mean, that's going to create problems from a circulatory standpoint. It's going to cause problems from a blood sugar standpoint. So like we always say, we don't want anything in a box. Whole foods are ideal. Brad: Right. In the grocery store, down the aisles, we got all these quick-make things. You know, open it up, open up the rapper and just eat that. Those health food bar things that usually are not healthy. Chris: They're not as healthy as what they were advertised to be. Unfortunately, there's a lot of sugar and other processed things in there. Particularly for the diabetic too, and that's one of the things with advertising that makes it so challenging is, oh, well I'm having this particular bar and it seems like it's going to be a nutritious choice. Brad: A health bar, it says health bar right on it. Chris: Yeah they show people climbing mountains and everything else. And you think it's going to be a good thing to have, and all of a sudden it's made with tons of sugar or high fructose corn syrup and things of that nature. Brad: A big one that I always look for now is yogurt. I used to just think yogurt was yogurt. And I started looking at the sugar content, and there's as much sugar in a thing of yogurt as there is in a can of Pepsi. And it's like, whoa! Chris: There's a ton. It's kind of like the better it tastes, the worse it is. Brad: Exactly. So be careful, look at your labels. Chris: But you know, let's talk about yogurt. Yogurt is great, to me, it's kind of a power food you know. If you get plain yogurt. So what can you do? Add blueberries, add raspberries, or add some walnuts. You know, you can add the sweetness yourself. Brad: Yeah. That's my recipe. I do blueberries, blackberries, walnuts, flax seed, and chia seed. Chris: Yeah and all those products, nutritionally have actually kind of nutraceutical properties that will help your body. You have the flavonoids in those dark berries, those help with your circulation and with anti-inflammatory action. So there are a lot of nutrient-dense things in that. And then the yogurt it's got the protein, it keeps you full. So it's good for your muscles, it's good for your bones cause it's got calcium and vitamin D. Brad: So I do want to mention it, because a lot of times people say, "oh, stick to your genre." So, you know, he's a pharmacist, I'm a therapist, but we're talking about pretty basic health. I think we're covering the basis pretty safely. Chris: Oh yeah. I don't think we're too far out of our lane. Brad: Yep. Should we go on to the next thing? Exercise. Why do you need to exercise? If you're got neuropathy, how's that going to help? Chris: Well there are a lot of different reasons, but specifically, what happens when we exercise? Our heart rate comes up. So if our heart rate comes up, we're challenging our circulatory systems. That helps to bade those nerves and the muscles and it gives them some oxygenated blood that also is carrying nutrients from the good foods we've just eaten. And so that will help the body to develop and hopefully get stronger and more endurance and hopefully improve some circulation and moderate some of those neuropathy symptoms. So when you have better circulation, you have better strength, better coordination, and better proprioception as a result of exercising because these things all kind of build on one another. We hopefully help to minimize some of those diabetic neuropathy symptoms. So it's never going to be a cure guys, but it certainly could make them better and make your life a lot safer, more effective, longer, happier, and healthier. Brad: Let's move on to medications in regard to neuropathy and the diabetic. Can you briefly go over some of the most common ones and some information? Chris: Yeah, your physician is going to take into account, what's going to be best for you when you have neuropathy. But, what I see most often in my world, the big three are probably going to be pregabalin (generic Lyrica), Gabapentin (generic Neurontin), and then duloxetine (generic Cymbalta.) So those three are all widely recognized and used for the treatment of neuropathy. I mean, Lyrica or pregabalin is actually known for treating neuropathy. The advantage of pregabalin over Gabapentin they work similarly to kind of like Coke and Pepsi. So they have similar properties and they do similar things in the body, which is to actually improve neurotransmission and minimize pain. So basically that's what they believe is how it works. And so with that, if we can diminish the pain and discomfort, a drug like pregabalin, takes a lower dose, so it is less side effect prone. It acts faster than Gabapentin. The difference between those two drugs is pregabalin, a lower dose creates a nice effect. So we have to be careful because there is some addictive potential. So we have to be mindful of that. Caution with driving, because of dizziness and drowsiness are two primary side effects. And you'll see that with Gabapentin as well, but where they delineate, the pregabalin works better in a lot of cases. Whereas Gabapentin you keep having to take a bigger and bigger dose to get the same type of effects. And when we go to those bigger and bigger doses, what happens? Well, we have more side effects, so more dizziness, more drowsiness, and a little bit of forgetfulness. So things that we have to be careful with and, your doctor is taking that into account and your pharmacist is going to be talking to you about watching for things. Brad: Sure. Chris: So we do want you to be mindful. And the other one that I didn't really touch on was the antidepressant Cymbalta or duloxetine. And that actually works by raising serotonin, it raises norepinephrine or noradrenaline. So those are two different neurotransmitters. They actually work with the body's nervous system to minimize pain and also to help improve neuronal transmission, is what they believe happens with the medications. Brad: Okay. Chris: So, well-tolerated, generally not a lot of side effects associated with that either, so it's safe. Because there can be pain with neuropathy, it certainly is a great alternative to using opioids, which also is something that has its own series of bad. That's kind of where the utility came from. Brad: That's a whole other video there. Chris: Yup. Long video but I mean, those are kind of the main three. Any antidepressant and any antiseizure medication, just to kind of envelope them in, will have benefits for neuropathy. And sometimes if one, let's say pregabalin, Gabapentin, or duloxetine doesn't work for you, your doctor can try some of the more atypical things like maybe an old-school antidepressant, like a tricyclic amitriptyline or something to that effect. But, those are the things that your doctor would do based on your conversations, your appointments, and your follow-up. Brad: That's pretty individual. Chris: Exactly. Brad: All right good luck on this. Chris: All right. Bye guys. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

1 – The Bob and Brad Foot Massager isn’t switching on or not working A) Make sure the massager is plugged in. Try to unplug the AC power adapter from the massager and plug it back in. B) If you have been using the massager for a long time, overheat protection may have activated. Turn the massager off and allow it to cool for at least 40 minutes. C) An unknown error occurred. Unplug the AC power adapter from the massager and plug it back in. D) The massager is making an unusual noise or emitting a strange smell. Turn off and stop using the massager immediately. Contact customer support team via support@bobandbrad.com or call us at +1 (612) 567-3035 (Mon-Fri 9:00 AM-4:30 PM CST) 2 – The foot massager doesn't heat up or you don’t feel the heat. A) Make sure that the heat option you are using is turned on. Because of the structure of the heating function, the heat massage heads will feel warm after 5 minutes due to the residual heat. Continuing to massage on level 3 in the same area even after turning off the “HEAT” may increase the temperature felt. B) If you don’t feel the heat even after 5 minutes with the heat on level 3, please contact the customer support team via support@bobandbrad.com or call us at +1 (612) 567-3035 (Mon-Fri 9:00 AM-4:30 PM CST) 3 – Remote control not operating properly or not responding at all. Make sure there are no obstructions between the Bob and Brad foot massager and the remote itself. The foot massager remote controls use infrared (IR) technology, which means they need to be aimed directly at the device you want to control. If there is an obstruction between the remote and the foot massager you're trying to control, your commands will not work. 4 – The massage intensity is too strong or too weak. Change the mode and intensity settings of the massager to match your preferences. There are four levels of air intensity. By selecting the manual settings of knead intensity, air intensity, or air mode you can experience a more relaxing massage. Our Guarantee. Today’s busy professionals need high-quality products and solutions that perform in real-world settings. We deliver innovative, high-quality, and durable health care products that improve physical activity. We stand behind all our products with a 100% Satisfaction Guarantee. This guarantee means that if you are not satisfied with any Bob and Brad purchase for any reason, contact us and we will replace the product, credit your account, or refund your purchase price. No hassles. No restocking fees. No kidding. With Bob and Brad, you will always be satisfied. We guarantee it! Why do customers continue to choose Bob and Brad? 100% Satisfaction Guarantee 100% Honest with our followers 60 Years of Combined Experience in Physical Therapy (We know what product works) Unmatched Product Selection If any of your Bob and Brad products are still not working, contact our Customer Services team at +1 (612) 567-3035 or email us at support@bobandbrad.com for assistance.

When you sit incorrectly, you are likely to settle into the C position (slouching, slumped, or flexed) with the accompanying stress to the parts of your back. For many of us, the sitting stress continues throughout most of the day. We sit when we eat, drive, work, watch TV and when we are in the bathroom. Many researchers believe the significant increase in cases of back pain and sciatica over the past few decades have much to do with the fact that more and more of us are spending our workdays in chairs. Improper sitting is a common contributing factor to back pain, sciatica, and the delay of healing. Yes, at the root of all back pain, one can generally find a chair. Even more distressing is that the poor slumped sitting posture begins to shape your standing posture. Your body remembers the sitting position and attempts to continue the posture when standing. Instead of having erect and correct posture like a marine soldier, you begin to stand slouched and slumped. Therefore, it is important for you to understand proper sitting and sitting postures. We recommend that our patients in pain avoid sitting as much as possible. We advise lying down or standing up whenever possible. Avoid sitting on overstuffed furniture, easy chairs, and recliners when you are experiencing back pain. If you feel that you must sit on such furniture, use a throw pillow behind your back to prop yourself up as straight as possible. Toilet sitting: one possibility is to sit on the toilet backwards, gaining support from the back part of the toilet. A bed pan is another option. We want to convey to you that one of the key points about all forms of sitting and back pain is the benefit of movement and position changes. The most important tactic you can use to combat back pain while sitting is to mix sitting with walking and movement. If attempting to sit with perfect posture, you should still mix in changing your back positions as well as increasing movement and walking. The following are some general rules or strategies for reducing the stress on your back while sitting at home: A. Lie on the couch with low back support using throw pillows. B. When sitting on a couch or recliner, vary the amount of recline in the recliner. Keep a throw pillow in your low back. C. Lie on the floor on your back with your feet up on the coffee table or couch. D. Lie on the floor on your stomach. E. Get up and walk around the room on a regular basis. F. Change positions every 20-30 minutes or so. Products: 1) Elevating Leg Rest Pillow 2) McKenzie SlimLine Lumbar Support 3) Kebado Lumbar Pillow Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in February of 2022. For the original video go to https://youtu.be/wdymXr2b0H4 Bob: What are we going to talk about today, Brad? Brad: We are going to talk about the shoulder, separation versus dislocation. There’s a clear difference between the two and you need to know what you actually have. Bob: I think it’s often mixed up. I think people think separated is dislocated. Brad: Right, but not so! What we’re going to talk about is first a separated shoulder. We are going to use Sam (the skeleton). Here you’ve got your clavicle or your collarbone. Same thing. It comes over and there’s ligaments connecting the end of your collarbone to your scapula or shoulder blade. The bone on the end is called the acromion. There’s a ligament here from the clavicle to the acromion. There’s also another ligament that goes underneath and connects to the coracoid process. You don’t need to know these names. And a third ligament, the Conoid ligament. They all stabilize the clavicle, which is a really important part of your shoulder movement. Bob: Really, when we are talking about separation, we’re talking about the clavicle. It’s that bone right here, you can feel it easily on yourself. Brad: So, what happens if you have a separation, it’s the clavicle literally separating from the acromion and the coracoid process. These two bones. So, the line represents if you have a separation. There are three grades of separation: one, two and three. First grade is the acromioclavicular ligament is torn. If you have a second degree, it’s a little worse, the acromioclavicular ligament and the trapezoid ligament are torn. If you have a third degree, that’s the worst. All three of these ligaments are torn and this clavicle just pops right up. I had this happen to me and my wife has it right now after ten years but hers is not very noticeable. When it happens, the collarbone sticks up pretty high, it can, and it looks obvious. Bob: And it’s called? Brad: This is called the piano keys syndrome. Bob: I didn’t understand that at first but if you push down on it, it pops back up. So, like a piano key. Brad: Yup, you’ll see a bump there. I remember mine was dislocated and I moved around, and it really popped up. It hurt; it was no fun. I looked in the mirror and it was like; I didn’t think about piano key, but you can push down on it because there’s nothing holding it. You can push down, and it pops back up. After it’s happened for a while, for a few days, it typically settles down: it’s not so painful. Then you can push it up and down. Bob: What’s amazing about it is, quite often the body will heal it. Brad: Yes, it rarely has surgery. Unless it’s really severe or if you’re a high-level athlete and you need it, they may do something or if it’s an aesthetic, or an appearance thing, like if you’re a model and you have bare shoulders. Bob: You don’t have to worry about that, Brad. Brad: No, I have no problem with that! So, that’s a separated shoulder. Xray’s will show you don’t need an MRI. Same with a dislocated shoulder. Bob: You probably could almost see it manually. Brad: Right. You’ll get an X-ray to confirm things though. If you look at this side, here we have the shoulder joint. Bob: We have the humerus and the ball, and it fits into the socket right here. Brad: A dislocated shoulder has nothing to do with a separated shoulder. Everything is intact on the clavicle, but the head of the humerus pops out of the socket. Bob: If I remember right, like 95% go forward. They don’t go back like this. Brad: Yeah, probably the rest will go down or down and forward. It really doesn’t matter, it hurts! Bob: The mechanism for doing so is it needs to be understood. By turning your arm out, like this, that causes the head to move forward. Brad: Or if you have an outstretched arm and you fall and there’s a lot of leverage, it causes that same dislocation. Again, no MRIs are needed, just an x-ray. Usually, you can see it. Then, hopefully, it pops back in. Sometimes you have to go into the ER. Bob: The surgeon has to do it. Brad: It’s very painful. Hopefully they can get it done. My mother, she fell on the ice and hers dislocated. Actually, I saw the x-rays and it went down on the rib cage. She went to the ER, and they pushed it back in and then she was much happier. After that, typically no surgery. You need to do some strengthening. Let it settle down for a few days, and then get into some strengthening exercises. Bob: Let’s make this point, Brad. If you are younger and you keep dislocating your shoulder, then they might do surgery. You’re more susceptible to this if you are younger. The ligaments have more stretch. Brad: You might be considered hypermobile, maybe your joints are all a little lax. Bob: But, if you’re older, this is one of the few advantages of being older is they probably won’t do surgery. Brad: Sure, ha-ha. That does make me feel better. I’ve never dislocated a shoulder. Bob: Me either. Brad: There’s one thing I did want to mention here. Should we show them the sulcus sign? Bob: Sure Brad: So, if you have a dislocated shoulder, this bone, you pull down and you’ll see a bump right there. I’m going to see if I can relax, you can't see it very well. My ligaments aren’t loose. Some people are loose enough where you can see a gap here between the acromion and the humeral head. If you have a stroke and all these muscles are lax, that’s pretty common on a stroke patient. Brad: There’s rehab for this. We aren’t going to get into the dislocated shoulder, but I’ll just get it back into place, that’s the next step. We’re going to talk a little bit about the separated shoulder. We’re not going to get too detailed in this. Bob: Right, just give you some basics. Brad: So, you’re going to give it a break. Ice it, ibuprofen, all that stuff, when it initially happens. You may find yourself being suggested to wear a brace. When I had mine, I had what they called a Figure 8 Brace. I don’t have one here and I’m not even sure if they use them anymore. Bob: I don’t know if they do anymore. I don’t think so. Brad: I actually liked mine. I had to wear it for a few weeks, and it pulled my shoulders back and it supported it. Bob: You just liked it because it got you attention. Brad: No, I actually wore it underneath. Bob: You probably had it outside your suit. Brad: I would have, a blaze orange one. So, that may happen, it depends on your doctor or your surgeon if they want you to brace it or not. Also, avoid sleeping on it. It’s really easy to avoid it because if you roll over on a separated shoulder, in my experience, it woke me up screaming because it hurt like crazy, especially the first week. Bob: It’ll let you know. Brad: You get really good at sleeping on your back or the other shoulder. Once it's feeling better you can start moving it more. I was a therapist at the time and my surgeon said once it’s feeling better, do your PNF exercises and I just did it on my own and it worked very well. Basically, you might start with Codman exercises just to get it moving, in the flex position. Bob: When you’re doing that, you’re really relaxing. Brad: Right. From there you can do assisted flexion, just raise it up as far as tolerated. You’ll get so far and then it’ll start to pull and hurt. Then you go back down. Bob: The work is being done by the left arm. Brad: Right. I like using the ball actually. If this is my sore shoulder, you can just roll it out. Watch my shoulder, I roll it out and back. Brad: Then I can roll it out to the side. When that feels better, then you can go to the wall. Bob: Which adds a little gravity to it. Brad: Yup. Then you can assist it, roll it up and down. Ten repetitions. Turn sideways. It is going to be a little more challenging this way. Use a hand here and roll it that way. After about a week or two of that, it’s going to get stronger. Then you’re going to start strengthening it. But you’re not going to strengthen it until you can raise it up, pretty much all the way. You might need a little help with that. You have some favorite ones you want to talk about, Bob? Bob: Probably just external rotation, that’s probably the big one. Brad: Sure. We’ll take a band here. You want to start strengthening the rotator cuff to help stabilize things. You can do this one, scapular retraction. You’re going to want to do this one for sure, using both hands. Ten of that one. Brad: I do want to talk about resisted flexion. I like bands, I’m a band person. You can use weights, dumbbells, if that’s what you have. You’re just going to go up as far as you can. Bob: You can use a soup can if you want, to start. Brad: How about chowder? Bob: Whatever. Beans work too. Brad: It actually works good because you’re not going to need much weight or resistance. Out to the side. Make sure you go across your body because that’s a real functional motion. It’s going to pinch a little bit more at first, so be careful with that. Bob: Avoid pain. Brad: For the people that are not athletic or don’t do over head work, you can rehab this pretty easily. As long as you can reach up into the cupboard. I’m thinking maybe for people that aren’t that active or if you’re older, you know. Bob: That shows how the body is so amazing that it heals itself. Brad: I remember the doctor told me it’s going to heal up fine. Just keep working it and sure enough, it did. They said you’re going to notice it when you get older and I’m noticing it, but it’s not bad. Very good, good luck with your separated shoulder and we do have some dislocated shoulder exercises. Bob: Look for those on our YouTube channel. Thanks! Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.