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=hCAjFfd_cgo&t=80s. Brad: Today we are fortunate enough to have Bob off and Chris the Pharmacist on, we've got a very serious subject to cover. The title is “Fibromyalgia, (Have Pain, Fatigue, Brain Fog, Memory Loss)”, those are all typical symptoms. We're going to go through four steps to success to help manage and overcome these problems associated with this syndrome. Chris: There we go. Brad: Fibromyalgia is a very painful, debilitating condition and if you have it, you've been diagnosed, you're very well aware of this. It's oftentimes in some specific parts of the body, across, I'm not going to go through the points because I do have them mapped out, the most common locations in the body, but typically the upper back and the chest, around the hips and waist, and I may be missing some that you may be suffering from but it's a chronic condition, it goes on and its really life-changing. So, we have done research on it, we've both had patients over the years that have this and we came up with a four step guide that you can vary from, because everyone does not treat fibromyalgia in the same manners, it's not a cookie cutter thing. Chris, do you want to step in so I can quit talking so much? Chris: Yeah, fibromyalgia, it's not even really a disease state, it's much more of syndrome. So, when we think about it, it's many, many, different things and oftentimes, when patients have the diagnosis of fibromyalgia, it's arrived almost backhandedly like a process of exclusion. It takes an average of five years just to hit the diagnosis in most cases. And you're talking about, two to three percent of the population, about 70-90% women. Some unique facts about fibromyalgia, oftentimes when they come in they present with pain and they just don't know why, but you know, the doctors try. And, there's not a set test for it either, which makes it so darn frustrating to diagnose as a clinician and it makes it really, really hard on the patient, because they're just waiting for an answer! I think, so many times when we get an answer it's nice to start to turn the page and work on the healing process, and that's what's so darn hard. So, your doctor will rule out other arthritis form conditions, you'll see strange things that pop up like IBS, inflammatory bowel syndrome. Brad: IBS? Chris: Inflammatory bowel syndrome. So, basically, constipation, diarrhea-type dominant side effects with a lot of pain in the tummy and with that respect, you know, you're like, “well, are we treating one thing?” I mean, are we looking for an elephant and it should be a giraffe kind of thing, and they just don't know where it goes. Well, I still have these symptoms, but you know, I'm hurting here, hurting there, I'm in pain for every second of the day from the moment I wake up to the point where I go to bed. Your friends and family will be like why are you always hurting all the time? So ultimately when they get the diagnosis, then I think the healing can begin and then I think we have lots of things that we can kind of start to share to try. It's not a hopeless condition, it's something that can go into remission, and we can move forward and have very happy effective lives so there's lots of good things that we can do to help people. Brad: Right, and that can be the challenging part. I did want to mention, as far as from a therapy standpoint, when I look at it with people, is part of the explanation of the pain is, these muscles will tighten up in these painful areas and when a muscle tightens up, there's less circulation because the muscle's tightened up like a ball, a real knotted area and blood cannot circulate in that near as well as a relaxed muscle, it's like a sponge, it can absorb the blood and the nutrients and the oxygen that fresh blood provides and we want to get rid of the waste products. You may not have heard that term, thinking of in your muscles but the waste products being carbon dioxide, lactic acid, and these things when they build up create that pain in there, so, getting to be able to relax can be a big part of this. We're going to talk about that a little bit more, so again, oh, the point I wanted to bring up, Chris, is this is kind of like back pain, although it's different, in the way that you look normal. I mean, it's not like you have a broken arm, you look healthy, but you've got this pain that the average person is not familiar with it, who's ignorant of fibromyalgia. They don't understand. Chris: No, and that's one of the biggest, I think one of the biggest tragedies of fibromyalgia is we all look perfectly normal if we're suffering from it, except for the fact that we're not, because we're feeling so miserable. What we think is that it was probably brought on by a stress event, a traumatic event, so whether it's a car accident, stress, an infection, so we don't really know that nexus event that caused it. We know that it runs in families so we don't really know. But what we think we understand right now is it seems to be nerve transmission is the problem. So, if you think of your nervous system as a series of highways, something's not right with that. When we talk about the pain points, and there's at least 18 of them that they look at pretty routinely but I think there may be others as you alluded to. But what happens is that, let's say we're listening to the radio and we like it loud, we're rocking out, we're driving, it's on ten, well, your pain, if you have fibromyalgia, is easily an 11 or higher, so it goes beyond that and just simple things like if you went in for a massage or you know, you just hit your arm on a door in one of those tender spots, it puts you through the roof. So it's not a normal response, like, for anybody else it's just a little slap and you're like, why did you almost want to drop to your knees or actually have tears in your eyes. You know, and it's a very real pain. I mean, just because it doesn't look bad, it's bad. Brad: Right. Chris: And so you know we go through a lot of different things to treat these and we'll jump into those as we go forward. Brad: I'm not a fibro specialist, so I went to Adriaan Louw. He's a physical therapist, he's got his PhD in pain, he treats people with fibromyalgia on a regular basis and he does research and he has dedicated his life to pain, people with chronic pain. We've had him on our show actually, he lives in Iowa not too far from here. Chris: Yeah, right down the way. Brad: Yeah, and he's just a heck of a nice guy, you can just tell he is, life is, you know, this is his passion. So he does have a book specifically for fibromyalgia, he has them for other chronic ailments as well, painful ailments. The name of his book is "Your Fibromyalgia Workbook", it's made for the layperson. Chris: Yeah, it's made for everybody! Brad: But one of the things I wanted to bring it down to, and I heard this from him, break it down to the simplest areas to address for pain and so there was sleep. Chris: Critical. Brad: Yeah, as opposed to going after this painful condition as a whole, break it down into four. One is sleep, the next one is understand your pain, try to get a better understanding of why it is. People come out after they see the doctor, maybe someone else, they say,” well, they think it's just all in my head,” which is the farthest from the truth. You're not going to progress if you don't understand it a little bit better and he does a really good job of explaining. I've watched some of his videos and talking to him, his way to communicate that to the patient is really good, as opposed to coming across in a real technical manner. He comes across in a personal manner so you can relate to it. And then exercise or motion. I'm going to show you a little, a way to work into movement because most people with fibromyalgia don't want to move because it hurts. Chris: No, the pain is so extreme. Brad: Right, exactly, so it's like, “I know I should be moving but it hurts worse,” so there's some ways to work through that. Then we are going to touch also on some diet at the end. We're not dieticians but we can give some good general rules for that. Chris: Absolutely. Brad: Did I miss one? Chris: No, I think, I think we'll start with sleep. Brad: Yeah, and that's what Dr. Louw said, if you can get your sleep under control that's half the battle right there. And it's not easy, because we have people having problems with sleep without pain because of other issues. Do you want to talk about sleep? Chris: Well, we can. One of the hallmarks of fibromyalgia is the fatigue. Not only are they in pain all the time but they're always exhausted, I mean, we're talking like just bone weary tiredness. So you're just dragging tail every moment of every day and so how do you fix that when you're sore, painful, tired? It's just a very frustrating point, so one of the things that we can do to try and gravitate towards better sleep, I always call it sleep hygiene, but there's other ways of looking at it. But some basics with sleep, whether you have fibromyalgia or anything else, are just keys to getting a better night's rest. Everything follows through from sleep in a lot of cases, so if we can get the rest, our bodies begin to heal, things calm down, your nervous system seems to settle out, so we'll kind of see that as we talk. The reality of it is to go to bed, you want to have a nice, quiet setting. You want a dark, dark room. You want to be putting away your iPhones, your iPads, your laptops, you probably don't even want to be watching TV. Your phones and your iPads and computers reflect that blue light and that's stimulating to the brain and that keeps us awake to begin. It is kind of strange, because a lot of people, think, “oh, I'm just relaxing, playing a little, you know, keyboard Sudoku or words with friends or whatever.” Brad: Even on your cell phone, there's enough blue light to affect you? Chris: Correct, and some of them now have recognized that. I know that with Apple they do have a dimming setting, so it's certainly something that I would encourage to take advantage of even as you're approaching bedtime. But I would still encourage putting all the things away so that you're heading into bed in a quiet, relaxed manner. We want to have same set times. You want to have the same bedtime and you want to try and establish the same wake up time, too. Brad: Sure, some consistency. Chris: So that you're getting a nice, round-the-clock chronologically, you just want to have that same set time. Ideally seven or eight hours. Some people need a little bit more. You know your body and you know what you need. But you want that quiet time. I think white noise is actually important for a lot of people. What is white noise, well it's not a color, but it's like a fan. A gentle whooshing. Brad: That's what we use, we just use a fan. Chris: There's lots of studies outside of this, what we're talking about, that actually shows that white noise just relaxes the brain and when you look at the brain waves and the delta waves and all the things that they're looking at with sleep, specifically, you just get a deeper level of sleep. So it does help to promote that healthier sleep. And you know, you want kind of a cool room, you don't want it real hot, so your body, as the temperature slows down, heart rate slows down, you promote deeper sleep so we head into REM, which is actually one of the restorative parts for our brain but also our body, we're learning. So, there's a lot of fascinating things with sleep that oftentimes we take for granted. Brad: I just want to say, I just read a book a few months ago by Sean Stevenson, and it's about sleep. If you look up the author, Shawn Stevenson, it’s called “Sleep Smarter.” The whole book talks about things, one of the things, he was so specific on having a dark room is if you need light to be able to see your time, get it in red, if you need a nightlight, get a red nightlight so you don't trip over. There's something about red that does not produce the same, is it the melatonin in the brain? Chris: Blue is stimulating and red, red actually doesn't throw off a lot of effect, so if your partner is there too it doesn't annoy them. It just doesn't reflect, so that's why the military uses to read their maps and things. Lots of studies on those wavelengths. Brad: Ah, I want to get to the next number, understanding, some understanding of the pain, but before we do that, medication for sleep, that's your specialty? Chris: I dispense it, it's not my specialty, but I can tell you a lot about them. The reality of it is, is that sleep does not come easily to millions and millions of Americans and when you're talking about three to five million Americans with fibromyalgia, sleep is one of the things that's a challenge to achieve. So there's a lot of different ways that we can approach falling asleep. We've talked about some of the basic mechanistic things that we can do but sometimes we need pharmaceutical help. Not always, I mean, sometimes it can be something as simple as melatonin. For some people, you can get it through foods like raspberries or pineapple or cherries. Some people like that because it also gives you other healthful nutrients, and it also helps to stimulate that sleep about 30 minutes before you want to lay down. Otherwise, we have to use medication so something like trazadone which is an old-school anti-depressant, which isn't much of an anti-depressant, but interesting with fibromyalgia, it has unique capabilities because it works on some of those neurotransmitters which we talk about fibromyalgia as being a kind of a highway disorder where the nerves are firing improperly, it raises serotonin and some dopamine and norepinephrine levels to try and help to improve transmission. The benefit for people who can't sleep is that it just makes you doggone tired. So it helps you to sleep and get more fitful sleep. But there's other drugs that we can use, like the Z drugs, which we did a video about awhile back, so you talk about zolpidem is probably one of the more common ones, but also zopiclone. Brad: So, the big picture, pharmaceuticals for sleep is not going to be a long-term fix. Chris: No, we hope that you can naturally do it on your own because there's really no substitute for it. When it comes down to pharmaceuticals, yeah, America is a society of better living through chemistry, but if we can do it without, it's best. And I'm telling you that as a pharmacist. But if you can, you can, but if you can't, you can't, and those of you that know that you just can't sleep, you understand it and you realize the need for these medications, obviously your doctors do and they do a very good job of trying to diagnose and they'll try and mitigate where they can. It depends on the circumstance; everybody's case of fibromyalgia specifically is different. So, if you had it and I had it, we'd have two totally different stories. Brad: Yeah, I should have said that if sleep quality is not one of your biggest problems, you could probably skip this section, but it's probably part of it. Chris: No, but everything stems from that well, fitful night of rest. And that's one of the things that is hard to achieve. That's why you want to go into a pattern and that's why it's so important going forward, that if we have this diagnosis of fibromyalgia that we learn to make some of these lifestyle changes so that we can go forward. Brad: Sure, yep. Okay, so let's go on to the next topic, understanding why you hurt. I know, from my point of view, my understanding as far as the physical part where I talked about tight muscles, we need to get them relaxed, so we get the blood flow, I'm going to show you an exercise warm-up that actually you could do before you go to bed. It may help you relax so you can sleep better. But I think my best advice is to go to an author like Adriaan Louw, read some of his information. Search YouTube for his name, see and listen to how they talk about these experts that have studied it and dedicated their life to it. I know one of the analogies he talks about is, and it's a lot better coming from him, but he talks about pain, you know it's there and it's so painful and he relates that to a lion coming into the room. Like if you get tapped and you have that pain, he says, there's that big lion and there's that fear response and if you can work it out so that that big lion coming in and getting that fight or flight response, if you can get that big lion down into a little cub. So that that fight or flight response settles down as well, and that's one of those things that is easier said than done. Again, that's why from an expert it's going to make more sense than from me. Chris: Well, I think that's why his workbook is so important for a lot of people. I think it gives nice easy-to-read steps that are going to allow them to relate to their day-to-day activities. One of the things that they talk about also is cognitive behavioral therapy, and it’s kind of an understanding of the condition and I think the more we know, the more we can cope with things more effectively. Whether it's more of a CBT kind of, cognitive behavioral therapy thing where we reach out and we get that understanding for why we're hurting, when we understand the why, and whether it's writing down some things within what Adriaan has done with the workbook, it definitely helps us. When we have that understanding it allows us to accept it, make it become part of us and so we can face it more easily without the fear and the frustration that is associated with it. Brad: I do want to also mention, you said there was a patient of yours that had chronic low back pain. Chris: This was a chronic pain, but yes. Brad: But he used one of Adriaan’s books. Chris: One of his workbooks, specifically, and he completely is opioid free close to eight years now. Then he was a strong, strong opioid user and he just knew that he was to a point in his life where he couldn’t keep doing that, and he was actually having other subsequent side effects as a result of that. Brad: Sure. Chris: Which, you know, just to briefly touch on for fibromyalgia, there's a lot of drug therapies that we do. Over my career, I've been doing this for 26 years, fibromyalgia just kind of came out in the mid-90s when I started coming out of school and one of the things doctors just figured out, well, we got this thing, let's put this label on it, it's fibromyalgia and its pain, it's chronic pain, so what do we do? Well, we treat them with opioids. Well, we found out that that is the last thing on Earth you want to do simply because they're addictive and the reality of it is, is what do pain medications do, they just make you not care about the pain. The pain is still there. So when we're treating FM patients, a lot of it's going to come down to sleeping well, we're going to talk about exercise and things like that shortly, but the medications that we rely on are going to be anti-depressants and maybe muscle relaxants. So those are the things that help to bridge and improve neuronal transmission, that highway, so things like pre-gabalin, things like Sevala, which is menilsopram, any of the antidepressants but duloxetine, or Cymbalta, specifically, are indicated directly for FM. Brad: Should we jump right into the exercises? Chris: Yeah, let's go to the exercises. Brad: So, exercise, and Chris, we've talked about this, as a pharmacist, you're saying exercise seems to be the way to go versus drugs. Chris: Absolutely. Brad: And again, we talked about the pain gets worse with exercise, so why do I want to exercise? So I want to show you, this is from a fibromyalgia patient, she was actually a doctor, and I kind of modified it a little bit for my therapist background. Before you exercise, and I'm talking about exercise as simple as a mild walk, which, that can really be uncomfortable, do the warm-up. This is one thing I do with my back in the morning, I’ve got spondylosthesis. If I try to warm up in a standing, weight-bearing position, it is uncomfortable, it's not fun at all. So I lie down on my back, your muscles are much more relaxed. Chris: You don’t have to fight gravity. Brad: Yep, exactly. So, you're going to lie down, you can do this on your bed. It might be better on a carpeted floor; it depends on how you feel about getting down onto the floor or not. You're going to start out with a deep breath, everything should be quiet, you're not going to have your dog licking your face or the kids running around. Chris: That's going to make a problem. Brad: Yeah, just take a deep breath; two or three deep breaths, in your nose and out your mouth. They talk about meditation, if you can meditate, anything to allow the nervous system to settle down and relax. We're going to start with the feet and probably shoes off, I'm not going to take mine off, you can do it with your shoes on. You're going to do, five to ten ankle pumps. You can do more if you'd like. Allow your feet to relax, get that circulation going. Everything is relaxed, you're going to take your time and we're going to go to single knee-to-chest. Brad: Everything is just in slow motion, I'm going to go down to two or three motions for the video, you do as many repetitions as you'd like to and let it go down slow. Go to the other knee, and you may find one leg or one arm, when we get to the arms is more painful than the other, just take your time with it, read your body, get used to it. Brad: Then we're going to go both knees up and bring them up, help it out, stretch here, get that low back and those hips. In the back, you'll feel those muscles, just take your time with it. If it's too uncomfortable, skip that stretch and go to the next one as we go on here. And then in this position, relaxing again and I call them windshield wipers every time I have a patient. I say windshield wipers because I say hip rotations and it doesn't make much sense, but it's like windshield wipers going back and forth. Brad: If it's painful one direction, don't go that way. Go the other direction a few times and then bump in to the other painful direction, and it may get better as a result of going the other direction. Do it as appropriate, as your body allows. The next thing we're going to do is we're going to go up to the arms, and here we're just going to do shoulder flexion as tolerated, if you want to bring both hands together, if that helps, that may be a thing to do if one arm is weaker or has more pain let the other one help, so it relaxes it more, whatever works out best for you. Brad: These are the nice kind of a pushup you can do with fibromyalgia is just, I call them air pushups. I used to do these when I was in karate just as part of a warm-up, and it was kind of a fun way to do pushups. Chris: Get those shoulders going. Brad: Yeah. Okay, and then I’ll do like, snow angels, just bring your arms out to the side and bring them up as far as you feel comfortable. Brad: Okay, and then we're going to go into the shoulder squeezes, squeeze the shoulder blades back and down and then you can make your circles. Brad: If you don't feel comfortable doing it this way you'll find out, we're going to get up and oftentimes people find it better in a seated or standing position. Again, because a lot of the pain is going to be up in those shoulders and you need to relax you shoulder and neck muscles. Brad: Throughout this whole thing we're always thinking about relaxed, deep breathing. This might be a good warm up for either getting ready for bed or for going out and doing your walk or whatever your exercise program is. What kind of exercise programs are there that you have found in your research? Chris: Well, it comes down to what you can commit to and what you enjoy, what makes you happy. When we have fibromyalgia and we're in that much pain, you know, we want to do something simple. It might just be a walk to the mailbox for your first go-round. Then we just progressively add to it and it's not to say that you can't go out and enjoy weight lifting, aerobics, kayaking, biking, swimming, hiking. There's just so many things that you can do but we have to realize that we have to know thyself. You have to know when you're overdoing it. So, you might find early on, particularly, you might not know what you can get away with and what you can't and it might set you back a few days. It might be something where, we have a little bit of mild soreness or stiffness from exercise like we've all kind of experienced. For the FM patients it can be much more severe, really. “I can't get out of bed, that just smoked me.” And so we want to ease into it, so short walks, gradually building up, maybe gradually building in intensity. But when we start those workouts, like, your warm up that you just showed, I think could be done with just about anything. I think that would probably apply to that, and then when we start, you don't want to start out sprinting right away, you start walking. Maybe add a slight little jog if that's something that motivates you but maybe it's mailbox to mailbox. Brad: And that impact, I have a feeling, a lot of people, most people don't like to jog. Chris: No, and it doesn't have to be, I mean, it can be yoga, it can be tai chi, and it's actually, they've done very extensive studies on things like yoga and tai chi, and Pilates, specifically. Brad: With fibro patients? Chris: With fibro patients, specifically. They actually show, like yoga in particular, you have these poses that we hold and such. They also work on the flexibility, which does a phenomenal job for those muscles. Again, I’m preaching more in your church than I am mine. Brad: That's all right! Chris: But at the same time, they've shown to be very, very, effective. I think a lot of times, too, you always hear the phrase misery loves company. I think that, you know, look out for groups. A lot of places now, we belong to the YMCA locally, where we go, and actually within those organizations they have groups for fibromyalgia patients. I would encourage you whether that's, let's say you're going to Mike's Gym or whatever, see if they've got a fibro board where they have other people with like problems where you can talk to people. See what worked for them, how did they start, what helps them, maybe you can share your experiences and a lot of times when we talk about things, all of the sudden it's like okay, well, this worked really well for Mike and I'm going to try it. You know, and I think there's some positivity in there. Brad: Put some light at the end of the tunnel! Chris: Yeah, put some positivity on there and I think the one thing that we have to know is, if you accidentally overdid it, just realize that this is baby steps and we have to work towards a goal. And that goal is getting back out there and not letting the syndrome control our life. We're going to take control and one of the biggest things that we can do, number one, in my opinion after sleep. I guess we'd call it number two, would be getting that proper exercise. Because we need to help make those nerves and muscles work together and when you're stronger by even just simple things as walking or just, yoga, Pilates, tai chi, swimming, biking, whatever you choose, I think goes a long way to helping improve those symptoms. Not only that, but when we fatigue the body, we sleep better at night, so it all kind of falls back to sleep anyway. Brad: And we did segue actually into the, number four, on the four steps is motivation, a reason for you to get up in the morning. Whether it's your job, I know there's one woman, she was a farmer, and she had to get her work done and that worked out good for her because she kept moving throughout the day to keep the farm going and she said it really helped manage her pain. She was still working on at the end of the day because it would come back to get her, so that was part of her next step was to get that aspect of it so it's a 24-hour relief but still, it was a whole point. I like what you're talking about is, to be around positive people, support groups, what you read, you know, from books like Adriaan Louw and other people who are experts or people who have written their success stories if they've had it. You know, if someone else did it, maybe I can too. It gives you that light at the end of the tunnel, so critical. Should we go onto the, now this is number five, we put this in because we wanted to just touch on it, and that's diet. Chris: Diet. Brad: We're not dieticians or nutrition experts but we have some general information. Chris: Yes, nutrition is a critical component of any health aspects anyways but actually eating well, one of the things with fibromyalgia is maintaining a healthy body weight. We can get vitamin D through food, obviously it's going to be your sunshine vitamin, too, magnesium is an interesting element but it seems to help with muscle functioning and so it's going to be your leafy green foods. Brad: It's like spinach. Chris: Spinach and kale and lettuce, romaine lettuce, because it's darker. Brad: The darker greens, yep. Chris: Yeah, your darker greens, broccoli, nuts, almonds. There's lots of things, you know, legumes of any type unless you have like certain allergies to things but we want to be mindful of that. Lean protein, so you want to find things that will help because that helps with muscle restoration and building and bone health. A lot of times, and I didn't touch on it heavily, but most people with fibromyalgia have multiple other syndromes or issues or disease states whether it's osteoarthritis, osteopenia, rheumatoid arthritis, IBS we had talked about, so, nutrition comes into play with all of those and so for helping, whether we're going like a gluten-free diet for some people seems to be a very effective choice, so taking the wheat out of the equation, basically, so if we can do that, that seems to be very beneficial, the lean proteins, whether fishes, lean beef, grass-fed beef, that type of thing. Brad: And I think this next part we're talking about what we should eat and what we shouldn't eat. Everyone is hearing this now, stay away from those highly processed sugars. Chris: Oh, yeah, nothing in a box. It's just bad, they have lots of other chemicals in there that just aren't going to really support what your body needs and so when we give the body the right fuel, I think a lot of other good things happen from that. It gives us the energy to sustain and be able to do the exercise programs. So, all these things are very holistic and kind of work together kind of like a big circle. You take something out, and all of the sudden you have a leak in your circle, so to speak, if it was holding water it'd have a leak. So they're all very, very important aspects of treating fibromyalgia. So I think it's just critical to, and its baby steps guys, I mean, this is not easy for anyone and for the people that are naïve to fibromyalgia patients, just do what you can to support them because they need your help. They need your understanding, and sometimes it's just, it's hard to relate when you don't walk in somebody else's shoes. It's really difficult to see from another point of view but when they tell you, I hurt, don't just go “ah, you're being a Sally.” No offense to people named Sally, but, you know, at the same time, we need to be respectful of that and support them and say, well, how can I help? Brad: Sure, exactly. Chris: And so maybe you can pick up the grocery bag for them, or maybe you can grab the milk from the grocery store. Just little things, it helps out quite a bit and I think there's a lot of good things that we can learn. Brad: All right, so one step at a time, don't try and tackle everything at once. Look for everything you can, you're going to find ways and all of the sudden, someone will say, “oh, that's helping.” You get to that point and we're going to go to the next step and we really wish your success and progress one step at a time to get through this. So, very good, from Brad and Chris and Bob is also along with you on this journey as well, thank you. Chris: Thanks guys! Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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. 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This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2021. For the original video go to https://www.youtube.com/watch?v=F6CxDNE9hKA&t=1s Bob: Today I'm joined again by Chris the pharmacist. One of the smartest guys I know. That's my tagline with him. And he's going to talk about understanding the pharmacology of benzodiazepines and how to reduce anxiety, and it also can help us sleep, correct? Chris: It sure can. Bob: All right, so let's get started. What role does this drug play? We had another video where we talked about the SSRIs. You maybe want to tell what that is really quick, and what the benzodiazepines are. Chris: When we're dealing with anxiety specifically, anxiety is an awful, awful feeling. And there are several different forms of anxiety, but most commonly is general anxiety disorder. But the reality of it is when people feel like garbage, you're talking about one in five Americans, so that is a lot of people, upwards of 50 million Americans experience anxiety. And it's horrible. Bob: And worse this year. Chris: Yup, it seems to be a lot worse this year, 2020 has been a highly unique year for that. And then at least my pharmacy, I'm seeing more of these drugs going out left and right. Bob: Than ever, would you say? Chris: Yeah, I would say so. I mean, it's not scientific, but my staff and I have kind of talked and are like “wow, we're really kicking these out.” But the reality of it is, when we have anxiety, the mainstay of therapy is first talking with your doctor. Well, first seeing your doctor, because we need to know if there's a physical underlying cause. You know, certain medications can cause it, thyroid condition can cause it, cardiac conditions. There's a lot of things. So once we’ve established it's nothing physical that's causing it and it is anxiety, and you're having these horrible thoughts, what they say most days of the week for six months, which again, in my opinion is way too long. You know, they would start you on either cognitive behavioral therapy or the SSRIs, which are the serotonin, selective serotonin re-uptake inhibitors. Bob: Do they start the cognitive behavior therapy right away, or do they wait until the medication has started to kick in? Chris: No, I think, the patient drives the bus. I mean the therapy is centered around what the patient's willing to do. So if you're willing to go through therapy, I think it is one of the best things out there, because it's non-drug. Cognitive behavioral therapy basically teaches you, and they have very skilled clinicians that are going to help you to teach you to replace the negative, horrible thoughts with positive ones, to help you to kind of balance things out and understand why those feelings occur when you're having those negative thoughts, so that we can kind of come to a better place where you can control it more naturally. Bob: I've seen the studies where you take one, drugs, or you take the therapy. They both can help, but together they’re more effective. Chris: They're far more effective. And I think it's a widely underutilized aspect of our healthcare community. I think counselors have a lot to offer. Unfortunately, there's been a stigma with mental illness and people are like, “well, I don't need that kind of help.” Bob: The stigma seems much less, but it seems like yeah, it's still there. Chris: Yeah, and we have to crash that door down. I mean, it's something that, that people need to take advantage of because it's there for them and it's helpful. It leaves lasting beneficial results for the rest of your lives. Bob: What about like meditation? Does that fall in that same category? Chris: Yep. Mindfulness and meditation actually are all within that. And you know, it's interesting there's books about it. You can go to group talks about it. Sometimes there's apps on your phone that you can actually utilize. And for some people, they're wonderful opportunities to help you to help mitigate and manage anxiety. But, sometimes we just need the medications. And so, and it's just, sometimes that's the easier choice. Maybe you've got three small kids that are running in five different directions, although with COVID, it's a little bit different these days. But you know, it might not be optimal for you to go in and see a counselor. So medications certainly help. And a lot of times they'll start you on the SSRIs or even the SNRIs but that point, those take time to work. Like four to six weeks. Bob: They take a long time to work. Chris: So that's where the benzodiazepines kick in. And so those are the ones that work immediately, but they have a strong, negative connotation. They are addictive. We have to be careful with them. Tolerance develops, and there's lots of side effects that are associated with them, so they're just a small stopgap. Bob: How quickly, typically, could a dependence occur? Chris: Within a couple of weeks. So it doesn't take long. Bob: So if you took it every day for a couple of weeks, you mean? Chris: Yeah, I mean if they need to, and again, it's kind of intermittent. There's a phrase that doctors put on prescriptions called PRN. It stands for as needed. It's actually just a derivative of Latin, but a lot of times these drugs, depending upon which one, whether it's lorazepam, clonazepam, diazepam, alprazolam, those are the ones that are the most, those are the four most commonly used ones. And there are others, many others actually, and they all have different potencies and lengths of action. So a doctor is going to certainly listen to you and make sure that there's something appropriate. And if it's something that's like, “I am just so panicky, I'm about just explode”, I think sometimes clinicians will say, you know, I think it is reasonable for you to consider taking a benzo. Bob: Make that bridge. Chris: And let's get you something so that we can help you to relax, get you the sleep, so that your brain can recover, so that we can wait for the other drugs to kick in. Or your therapy to begin to help you. So it's a short term thing. Bob: Yeah I have a family member, I’m not going to mention her name, but she had cancer and so they actually let her be on the clonazepam the entire time. Chris: Sure. Bob: And it's funny, you know, she, she got off it fairly easy. She did pretty well with it. She said, "I really don't like how I feel on it, so it was easy for me to get off", but apparently she didn't get dependent upon it. Chris: Yeah, and you know, the things drive addiction, are, you know, there's a genetic predisposition to a lot of these things. And again, your clinician is very skilled at looking for these cues. And so they have to assess you every time you come in. So you're meeting with a doctor, you know, in some cases monthly, three months, six months, depending upon the circumstances that they deem appropriate for your particular situation. And so they're going to be looking for those cues and seeing what's appropriate, what's not appropriate. The generalized guidelines are, you only want to take it for a couple, two to four weeks. And actually if you take it for as long as four weeks, then you have to actually taper off it at about a rate 25% per week to step down safely, because you could have withdrawal effects. And that can be very, very serious even to the point where a severe withdrawal with benzo could actually create a cardiac type of emergency. Bob: Oh my gosh, yeah. Chris: So it's things that clinicians are very, very careful with when they're treating their patients. Us as pharmacists in the community, we're kind of looking at to see refill patterns, how they're doing. We want to make sure that they're safe with their medication of use, making sure they're tolerating everything okay. Not having problems with dizziness, drowsiness, falling asleep at work. You know, those are the mainstay. That's why they work, is they make you tired, but they can make you dizzy and they can make you drowsy. Bob: How long are they in your system? Chris: Well, and again, that kind of depends. Bob: On which one you use. Chris: Yeah. So clonazepam, much longer, diazepam even longer. Things like lorazepam and alprazolam much shorter, but the problem with the shorter acting potent benzos is they can cause rebound anxiety. So these things are not designed to be used, they're just a stop gap until hopefully other measures will take place and really help to the patient to safely manage their anxiety symptoms. Bob: Yeah, the same girl would use it when she'd fly, because she had a fear of flying. Chris: Yep, very reasonable, fear. That's a phobia, so that's an anxiety. Bob: And she would use it for that alone now, and always worked quite well. Chris: Yeah. And so that's a onetime thing, unless she's flying for a living, I mean, obviously pilots don't get to take it. But it's one of those things where yeah. People that travel, some people do not like sitting in a tube that's 44,000 feet in the air. It's not a comfortable feeling for some people. Bob: Same storage advice with these? Chris: Yeah, any medication really, it comes down to, unless we tell you specifically. Bob: Avoid the moisture. Chris: Yeah. So it's not in the kitchen, not in the bathroom because those are the two most moisture prevalent rooms in the house. So you want it to be out of reach of children and really somewhere that's cool and dry. So usually it's a bedroom high up where little kids and pets can't get at it. Bob: Sure. Now, I saw, when I was doing some research, there's people that actually had to go to rehab for the addiction. Chris: Benzos are absolutely dangerous medications when used inappropriately. And that's the key. Bob: And again, you talked about the genetic portion of it can really weigh heavily. Chris: Yeah, I mean, the science of addiction, is fascinating and scary all at once. And I mean there's books and books and programs to help people to try and avoid those perils, but it happens and it happens much more commonly. And right now with COVID, we're seeing even higher addiction rates, with other drugs too. And a lot of times benzos are mixed with other products like alcohol or other drugs. That's where the real dangers can set in, you know, an overdose on a benzo can cause respiratory depression and stop your heart from working, and that's it. Bob: I know she talked about alcohol that you just don't want to do that. You don't even want to have a glass. Chris: You don't want to go anywhere near mixing and matching with these types of medications. It can be devastating. I mean, you may not wake up depending upon how much you've imbibed. So we have to be exceedingly careful. And it's something that, as pharmacists, we're kind of looking for that too. We all want to be safe and sometimes it's an accident too. I mean, and some of these drugs affect how you think. Bob: Yeah, you're not even thinking correctly. Chris: Yeah. And so all of a sudden it's like, well, I don't remember if I took one a couple hours ago, I'm going to take another one because I feel panicky. Well, all of a sudden now we've taken three or four doses and all of a sudden it can have some devastating consequences. You know, and so as we age, I mean, it can definitely affect your memory and your cognition, so it's certainly something that clinicians, again, they look very, very carefully at their patients. Sometimes some more than others, it just kind of depends. I mean, there's, we run into clinical inertia all the time. We see, you know, an 80-year-old lady taking these medications, and is this really the safest thing for you to do? Sometimes that's a very hard conversation to have because these people have taken these medications for a number of years, which again, you heard me say earlier, only a couple of weeks, and you heard me just now say a couple of years. And so, it's the clinician's responsibility to make sure that the patient's using it in a responsible way without the side effects. But sometimes, you know, doctors can be busy and also, it's like a quick visit. And it's like, that one just got by the goalie. Bob: Oh yeah, you maybe have so many medical issues to address. Chris: There were seven other things on the docket that you wanted to talk about. And that one just got, it just slid under the rug, so to speak. Bob: I was talking to a doctor friend who has all these little old ladies and they're on Ambien and, they don't want to be off. Chris: They don't want to be off, nope. Bob: It gets them to sleep, they don't want to get off it. Chris: Exactly. And that's one of the hard things, it's very hard. I actually was reading an article last night about a doctor suggesting how do people stop these things? And it's like, they try. Bob: It's difficult. Chris: And it is, long-term, it's just not a good solution. And so we don't want people on them indefinitely. Bob: Do you have to take these with food or not? Chris: No, in a lot of cases, it's not. The biggest thing, just stay away from alcohol and some other substances while you're on it. But you know, it can be with, without food. Kind of depends on your stomach and you know, what your GI tolerances are. So if it's something that you got a little bit of a touchy tummy, you have piece of toast, some crackers with that. And always, you know, full glass of water is ideal from that regard. But for the most part, there's not a lot of GI side effects. The biggest things that we watch for are central. So it's going to be the dizziness, the drowsiness, the impaired driving of an automobile. I mean, and that's a big thing with benzos, take it with a panic attack and let's say you're at work. All of a sudden, now you have to get home. Taking these types of drugs, if you got in a car accident and the police are like, “were are you on any medications?” Well, I just had some little alprazolam at work. That's now a DUI at that point, driving under the influence. Bob: If somebody got hurt, you'd be… Chris: It's devastating. And I mean, their responses you know, I mean, it can go on forever, depending on how bad the scenario is. So these are things that you don't want to drive on because they do affect your coordination. I mean, you wouldn't go out and play baseball or golf on these things because you wouldn't be able to control, you just don't have the coordination physically because of how they work with the polarization in your cells and why it relaxes you. It's also why it works so effectively is because it allows the communication in those nerves to work a little bit more efficiently so that they tell the cells to kind of calm down. Bob: These, I imagine there's over the counter meds you don't want to take with this, too. Chris: Correct, there's actually several, a lot of the herbal products like kava, dangerous. Bob: Well maybe, some that make you sleepy. Chris: Antihistamines. So, I mean, if you look at, let's say Benadryl. Benadryl is kind of the granddaddy of all antihistamines, what is the number one side effect? Well, it's sedation, because it binds the histamine receptor and it makes you sleepy. It's also why you don't itch or have allergy symptoms. Well, when we take something that makes you sedated by itself, and then we add another ingredient that, we'll just pick on alprazolam today, that makes you tired. We take them both together, you see a synergistic response. And so what would be maybe somewhat tolerable or okay, now all of a sudden becomes, “wow, I am really knocked out.” Bob: So it's not one plus one equals two, it might be one plus one equals three? Chris: Six. Bob: Or six, wow. Chris: Yeah. I mean, it just depends on your metabolism and the doses of what you've taken. So there's a lot of factors, your genetics. So there's a lot of factors that go into these things and, these are the things that pharmacists talk to you about, your doctor talks to you about. But you know, there's certain things that, yeah, we can't just indiscriminately, just medicate with other stuff when we're on certain things. And so that's why I like to think I have a job. I encourage everybody, if there's a question, please call. I am happy to take any phone call, anytime, anyplace, anywhere. Bob: Yep, he does a great job. Chris: If they have a question on something. So we're going to try and minimize those effects, just because at the end of the day, we have to keep you safe. Number one. Bob: Awesome. Well, I think we'll wrap it up there. If you got questions, put them in the comments below and we'll maybe address them in a future video, if we see the same one popping up a lot. So that we know what people are thinking. Chris: All right. Sounds great, Bob. Bob: Thanks. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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. For more information on Chris the Pharmacist check out our experts page.

How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific correct way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for Back of Hand: Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly below the other pad (at least a pad’s width apart). See Photo for Example Use one channel and two pads. Place one pad on each side of the pain (at least a pad’s width apart). General Guidelines for Pain Referred from Another Area: An example would be hand pain that is coming (referred) from the neck. Use of two channels and four pads. Using channel one (yellow pads), place the two pads along the nerve pathway. Using channel two (green pads), place one pad on the pain and one below the pain (at least a pad’s width apart). Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Hand Treatment: Hand Range of Motion (6 pack) (Do 5 Repetitions) 1. Finger abduction (spreading apart) 2. Tabletop 3. Claw 4. Full curl into fist 5. Touch each finger with thumb 6. Touch tip of thumb to base of fifth finger For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 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 2021. For the original video go to https://www.youtube.com/watch?v=22NHTTkQtr4&t=52s Bob: I'm Bob and this is Mike, who's joining me today. He's going to help me out here because we both have had experience with this title today, Gassy, bloated, constipated, how to treat. And we both, individually went on the FODMAP diet. Let's just say right at the start here, Mike, we're not dieticians, or nutritionists. Mike: I'm a PT assistant who's worked with Bob, so that's how we know each other. Bob: And I'm a physical therapist. So we're not experts on this but we're here to tell our personal experiences, and our approach about using the FODMAP diet, and I think it could be very helpful to you in the end. Mike: Yeah. Bob: So, Mike, what do you want to talk first about? I want you to tell me what your symptoms were and why you even looked at the FODMAP diet. Mike: So for me personally, it was a lot of uncomfortable amount of bloating and gas, and it would get worse throughout the day. So I've done different eating styles over the years. When I was young I didn't really know what caused it. It wasn't terrible, I just thought I was a gassy person. Bob: You've had it a long time. Mike: Yeah, and then when I got older, I was eating more cleaner foods, but still getting a lot of gas. And the joke is, you know, when you're eating more protein, it's protein farts, when you're a kid. But honestly, it's not that at all, when you start to look into it. Bob: No its not. Mike: It's carbohydrates fermenting in your stomach. So for me, it was never like IBS symptoms or anything terrible like that, or like I don't coeliac disease or anything. But for me it was just, it gets uncomfortable. And if you live with someone they really don't want to be around you, you know, if you're having all this gas basically. Bob: Yeah, and I think this is a good time to say here, Mike too, this isn't about eating healthy versus non-healthy. There's a lot of healthy, almost all our FODMAPs are healthy foods. Mike: Yeah, there's a wide range of foods which are good to eat or not good to eat. And then everyone's going to be different, which foods they can and can't eat. Bob: Now, my symptoms came on like over a period of like two or three months, and just recently. Mike: Yeah. Bob: So it was a way different situation than Mike's. But it would like every day around two o'clock, it seems like it would start picking up. Mike: You had a time? Bob: Well I did, and I don't know if my mind started creating that time but it would go until almost till bedtime. I thought it was miserable, Mike. I mean, it's the same symptoms you had, But I mean, I was like, who can live like this? I couldn't lie on my stomach, like when I would read, I couldn't really concentrate really very well either. Mike: Yeah, it's very distracting. Bob: It is. Mike: And it's like, you almost have to plan not to be around people as the day goes on, if you're having gastrointestinal issues like that. Bob: It definitely can increase anxiety and stress. Like, I would start getting stressed out around two o'clock, that's true, because I knew what's coming on. Mike: Yeah, and this can happen from like people that are eating, you know a standard American diet can have it, people eating you know, any style that you want, low carb, high carb, it doesn't matter. Some of these FODMAP foods are in every genre. It's not just like, only this does it, only that does it, like there's a list of foods. You can do numerous diets and do FODMAPs, I should say. Bob: Yeah, so you could be a vegetarian and do FODMAP, a little more difficult, but you certainly can do it. Let's talk about what FODMAP is. First off, it's basically your body is not processing carbs very well. Mike: Yep, they're fermenting in your stomach essentially. Do you want me to read what it is? Bob: Yeah, why don't you read that. Mike: So this is from Monash university. They are basically the university in Melbourne Australia that coined the term FODMAP. You can go to their site, they also have an app. According to their site, FODMAPs are a group of sugars that are not completely digested or absorbed in our intestines. So when FODMAPs reach the small intestine, which is right after the stomach, it goes into the small intestine, they move slowly attracting water. When they bypass into the large intestine, which is also known as your colon, if you're curious. FODMAPs are fermented by gut bacteria producing gas as a result. So the extra gas and the water cause the intestinal wall to stretch and expand. So this is known as bloating for us. Because people with IBS have a highly sensitive gut, stretching the intestinal wall causes exaggerated sensations of pain and discomfort. So this is commonly used for people with IBS. Bob: What you should say is Irritable bowel syndrome. Mike: Yeah, which we're not diagnosed with IBS. Bob: It's hard to be diagnosed with it actually. Sometimes it’s by omission, you know that it wasn’t another things, so they call it IBS. So, and inflammatory bowel disease, same thing. Mike: Yeah, there's a lot of these stomach issues, FODMAP come help. Like I know people with Crones have also looked at it, SIBO. Bob: S-I-B-O. Mike: It's another one. Bob: Gastro intestinal sensitivity. Mike: Yeah. Bob: Just like what you kind of alluded to. Well right now we should tell you though, the studies had showed that it helped like 85% of the ones with IBS. So I mean, there's a good chance this is going to help you. It definitely helped us two. And my daughter had stomach issues for years I actually was thankful that I got this because I passed it onto her. And she's finally, she says, it's the best it's felt in years. It's finally getting over it, so. Mike: They do say like 15% of the world's population has IBS. Bob: That's one out of seven, yeah. Mike: And then like they said, you know typically three out of four people have success. So, you know, there is like a small percentage of people that don't find a lot of benefit, but it helps most people. Bob: So obviously there's different numbers out there because I had said 85% and I also saw three out of four too. Mike: Oh yeah, I mean, 75, 80% of that. Bob: Right, I think part of it is that, all people that have IBS don't even know it sometimes. Mike: Yeah, I mean, I didn't know what it was called. I just thought I was a gassy person. Bob: I mean, you know, it's miserable. It really is. I can't say that enough. I just thought it really affects your life. It affects whether you go out, it affects your anxiety levels. So, why don't we talk about what FODMAP stands for? F-O-D-M-A-P, I can start with the F. It's the fermentation. So you're fermenting the carbs and they give off carbon dioxide, methane and hydrogen, which is gas, gas, gas. Mike: Yeah. Bob: So, yeah, again, for me, I felt like I always had to go, have a bowel movement. Mike: Oh really? Bob: Yeah. Mike: Mine didn't feel like that. Bob: And I never would. You know, I'd go on to the toilet and it would just be gas. Mike: Yeah. Bob: So, all right. How about the O? Mike: So the O stands for oligosaccharides. Oligosaccharides are known as fructans or galactans. So these are typically found in wheat, rye, legumes, various fruits and vegetables, such as garlic and onions. So all these saccharides, they're going to be numerous of them. Oglio means there's a few. The next one is disaccharides. Di Means two. So disaccharides is the D, that is lactose. Bob: Yeah, that's mainly lactose, I think they kind of talked about, was this sucrose too, was that? Mike: That's a different one. Bob: That's a different one, okay. There was one other thing that really wasn't a problem though. Mike: Yeah, lactose, you know, that's in your milk, your yogurt, your soft cheese, most people know that's lactose intolerant. This is technically part of FODMAP. Next would be monosaccharides. So this is fructose, found in various fruits including figs, mangoes, sweeteners, such as honey, Agave Nectar, where fructose is your main carb source. Bob: The other one is high fructose corn syrup which is, I'd be honest, you shouldn't be eating any way. I mean, that's one ingredient you should avoid all the time from a health standpoint. But, yeah, that's the one you'll have to look for in the ingredients. Mike: So now we're on letter A, that just for and. Bob: And there we go. Mike: P is polyols. So this is known as sorbitol or mannitol. Those you often see ingredients in like sugar-free gum or mints like that. They're also found in stone fruits or they're also known as drupes. But they include stuff like avocados, peaches. A stone fruit is typically a fruit that has a large pit, essentially, if you want to look into that. Bob: So yeah, polyols are sugar alcohols, but it's basically any ingredient with the itol. You know, mannitol, xylitol, sorbitol, right. So, you know, we should say right now like, well, all these foods, how am I going to know what to do? Now, you put down in the comments a list, I mean, you can Google it too. You're going to find a list. Mike: Yeah, you just look up low FODMAP, is what you want to eat if you have these problems and high FODMAP are the foods you typically want to avoid. So what they recommend is sticking to the low FODMAP foods for four to six weeks, roughly and then try to add certain high FODMAP foods back in that you like and see how your body reacts because some of those high FODMAP foods aren't going to affect everyone the same. So it's like, it's an elimination at first. And then you put back in what doesn't cause these symptoms, essentially. Bob: Yeah, and you have to watch portion control too. That's very difficult. And I want to say right here, Mike, that a lot of times you're going to find discrepancies and people saying how much they should use and should not use. I always relied on Monash as the reliable authority. They are they're the ones that had done the testing on it. They actually have an app, you just look up Monash in the app. And I got the app. It was definitely worth it. My daughter got it. It's on your phone then no matter where you're at you can just push on it, it has fruits, vegetables, everything in there you can find it really. It's got recipes in there. It tells you exactly how much you can have. Like almonds is a good example. There are galactans and you can have 10 almonds. Mike: Yeah, some of them are limited. So like, for me, I primarily eat keto now. So there's not as many options on keto, so that just naturally helped a lot of these FODMAP issues. But there are some foods I eat that are high FODMAP. Like I eat almonds and cashews and stuff. I eat nuts. They don't really bother me. Avocado is technically a high FODMAP, and that is a pretty big staple in my diet. So all I do is I like half or one at a time. I may get a little bloating, but it's not like I'm uncomfortable. It's like a natural amount. And even if I produce gas from it, it doesn't have like an odor. Bob: The methane. Mike: Yeah, the methane odor is what happens with FODMAP. Bob: When you really have a smell and it's likely the methane, a byproduct that's not getting absorbed. And so, you know, one thing you should know about this too is that relief is fairly rapid. If you start this, you're going to be motivated to continue on it. Because I started getting some relief within a day or two, and then I wasn't being really strict. And it was same with my daughter, she wasn't being really strict. And so it was like just kind of hanging in there yet. And then I got really strict and then it went away. I mean, you know I don't know you're going to be 100% better in seven days, but you're going to be so much better. Mike: Yeah, I believe on their site on Monash site, it said typically within two weeks, people will notice a lot of change. And when you do reintroduce foods, they say, just do one. Don't like try to add three things, because you're not going to know which one causes the problem. Bob: And you also, this is one thing I found out and this kind of messed with my daughter, is that, if the food is affecting you, it's not going to affect you like right after the meal. It's going to take like four to six hours. So it's something that you ate four to six hours ago or even a day before. If it's affecting you right after the meal, that's not FODMAP, that's something else. You might have some type of sensitivity or something, some issue going on but it's definitely not FODMAP. So again, you can also go online make a copy of the foods, or you can get the app. Mike: Yeah, and they're broken down into every category, so it'll be, you know, fruits, vegetables, grains, oils, meats, whatever, milk and stuff. And they'll have like alternatives to say you have something you really like, it'll give you alternative options as well. Bob: Yeah, now like we said, it's a two phase thing, the elimination phase. I had a book, Mike, that actually talked about just doing the elimination phase for like seven days even. So, I mean, you don't necessarily have to go the six to eight weeks, but you know you can experiment. I think I went like three to four. Mike: And those recommendations are based off people that have pretty bad IBS. Some people with IBS, like I had a friend that had it bad and he would like have to go, like all of a sudden we'd be driving, he'd have to pull over. He would have to run. I mean, he was taking Imodium, you know at times to control it basically. But he's since cleaned up his diet a lot he doesn't have these issues either anymore. Bob: Sure, the other thing is, some of these in addition to the foods, you have to look for ingredients too. Like when you're getting certain foods you have to look for onion powder. Mike: Yeah. Bob: Garlic powder. Mike: You're going to have more troubles with processed foods. If we're being honest. Like a lot of those you don't always know what it is because if the ingredient list is this huge, you can't pronounce half of it. Yeah, you're probably better off just staying away from it unless, you know, it doesn't bother you. Bob: Yeah, “itals” are going to be one to skip away from. And also if you look at the ingredients, the ones that are the highest concentration are the first ingredients. Mike: Yeah. Bob: So like, if it's listed way down the list, you might be able to get away with it. You know, if there's onion powder and it's the last ingredient of 30, it would be very little in there. So, I want to point out this to Mike, I had trouble getting enough fiber when I first started on this diet, because suddenly I switched to eggs and meat and you know what I mean? And so it was a little bit difficult for me. I actually got constipated at first, which is not fun either. Mike: Yeah, I mean, I guess I didn't have that issue as much. I mean, when I went to keto I guess I get less fiber in general but that's more like my body was getting used to the increase of fat intake. So that kind of led to like loose stool for me. But that corrects itself very, very fast. Bob: Yeah, I agree with you Mike. I just started eating a little more fiber as far as... I ate actually a lot of peanuts, which you can eat almost unlimited. Mike: Yeah. Bob: And there's a lot of fiber in peanuts. Mike: Yeah, you could find ways around it. Like everyone's fiber intake's going to be different. Like mine's pretty low, like I'm typically 20 grams or less a day of fiber. Bob: See, I'm way higher. Mike: I know if I eat too much fiber I tend to get a little more bloated and stuff. Bob: And I can eat 50 a day. I think I have to actually watch it how much I'm taking in because you can overdo fiber without your knowledge. Mike: Yeah, you can. Bob: The other thing is I found out Mike, right away, I was hungrier than usual. My gosh, especially after breakfast, and I was eating a fair amount, but it's just, I don't know if it wasn't because it wasn't carbs or what? Mike: Yeah, I mean, a lot of these foods, like, breads are, especially with like whole wheat ones, they're pretty fibrous dense. Or like if you have, lower glycemic index carbohydrates it takes longer to break down. And for me, like that was an issue, like when I was eating carbs. So, going from Brown rice to white rice, white rice was just better for me because it digests so easily and fast, but it does leave you hungrier faster if you're used to that full feeling. That was my biggest issue is I could have no bloating and gas running off carbohydrates for my fuel source, but my energy sways were greater. And then I was just like, well I know keto keeps my energy real consistent and I don't have the bloating and gas. So that's basically why I just switch back to going with it. Bob: But also understand this, if you're thinking, well, I'm going to go on a FODMAP dive and choose to stay on it. Which first off, you're going to miss certain foods. But secondly, FODMAPs are really important. They're rich in vitamins, minerals, fiber, antioxidants. So really, to help keep a healthy bacteria in your gut, you need some FODMAPs. So you have to try to reincorporate them. In talking to Mike, it sounds like you really had something from every category. Mike: Yeah, I mean like lactose to me, I can have lactose free milk fine. I can have yogurt fine, bread causes issues. Bob: You had nuts, that were some trouble with you, weren't you? Or wheat, bread. Mike: Wheat and bread caused problems with me. Lactose causes some issues with me. Bob: Apples. Mike: Yep, apples, so fruits, a lot of these fruits cause issues with me. I have something from each category I need to avoid. Bob: Well, I think mine is mostly fructans, which is the oligosaccharides. And I think this is, if I read it right, that's probably the one of the most common ones is fructan. Mike: Fructans are in a lot of different things too. Bob: They're in a lot, they're in a lot of fiber foods. Mike: Yeah, and everyone's going to vary. I just know, yeah. I'm much happier eliminating this stuff and eating more strictly and feeling better. Than like trying to add some of these things in just to not feel good later, basically. Bob: Right, no, I mean you can get very motivated to get rid of this, and you feel good, And you're like, gosh I kind of forgot what it felt like to feel good anymore. So, I would also say that it's a lot easier to prepare meals ahead of time. I don't know if you do that Mike, at all, we put together like I'll make salmon ahead of time. You're less likely to run into problems, like, what am I going to eat tonight? And just to grab some food that you're not supposed to eat. Mike: I mean, I'm pretty content with having like six staple meals and just rotating. Like I'm a pretty simple person. Bob: That's the same with me. I’m a person of routine. So this was easy for me to do it once I got the routine. Mike: Yeah. Bob: But if you like variety, you're going to have to work a little harder. Mike: Yeah, you have to pay attention. I mean, the app might be more beneficial to you then. So you can kind of suddenly just look, if you want to be more creative with what you eat or what you make. Bob: But I mean, even as being consistent as I am, I use that app a lot. I used it this morning. I'm always looking at it like how much, what is the thing that I want to reintroduce, what food group is it? You know, what carbohydrate is it? Mike: Yeah, like for me, I used to like apples. I still think they taste good, but they just, yeah, they're just don't agree with me. Like when I was eating carbs, I switched to citrus fruits. Citrus fruit didn't bother me, like pineapple, oranges, stuff like that. Bob: Now pineapple's low FODMAP, I found out. Mike: Yep, and so even on keto I have like some berries they're pretty low FODMAP. I think blueberries you have to watch. Bob: Blueberries, you have to watch, blackberries can be bad. Mike: Okay. Bob: Yeah. Mike: Oh yeah, they're in one of the groups. Bob: Okay, well anything else Mike, you want to add? I think I covered all the points that I would today. Mike: Yeah, I think I'm all right. Bob: I really like to encourage you to give it a try. I mean, what would it hurt? If it doesn't work, it doesn't work. Mike: And if you need help, a lot of registered dieticians know this stuff, and they're taught this, and they can definitely work with you, and you can work with it, with your doctor. You know, if you're unsure or you can ask them. Bob: I mentioned it to my doctor and she said that she had a lot of patients that were helped by it. I mean, I already had been helped by it. Mike and I were both self-taught on this. Which with our own reading on it, there's a ton of information online. So, give it a try and put your comments below, if you're not listening to the podcast. Mike: Yeah. Bob: Put your comments below, and tell what has helped you and what has not helped you. Mike: Yeah, and down below I'll link the university's website on FODMAP. I'll link some high FODMAP, low FODMAP list sites. And then the other ones just kind of like the history of the FODMAPs, if you're nerdy and you want to read about that? Bob: There we go. All right, thanks everybody. Mike: Thanks. Resources on FODMAP: High/Low FODMAP Food Chart https://www.ibsdiets.org/fodmap-diet/fodmap-food-list/ Origins of FODMAP: https://onlinelibrary.wiley.com/doi/full/10.1111/jgh.13685 Monash University FODMAP Page: https://www.monashfodmap.com/about-fodmap-and-ibs/ Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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. 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This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2021. For the original video go to https://www.youtube.com/watch?v=2EcimMpcaGI&t=496s Bob: We're going to talk about, why you should not buy a massage gun, and but we're also going to tell you why you should. Brad: Sure. Yup. Bob: And let's get right into it. Brad: Put it right out there. Bob: Number one, if you have hard to reach places, you might need a partner if you're using a massage gun. Brad: Right. Right. Bob: Obviously your back and upper traps. Brad: You just cannot reach. Bob: Yeah, you can't get the leverage on it. So yeah. Brad: Are we going to talk about that now? Bob: Yeah, this one would work better for that, the handheld massager. But this doesn't have the power as much as a massage gun. HANDHELD MASSAGE GUN Brad: Yup. Bob: It's fine. It's going to be fine for someone who is maybe a slighter build or not as muscular. Brad: Yeah. You may want to get one and have a massage gun too. These are not too expensive and they have their place. Bob: All right, next one, for disc herniation or sciatica, this is not going to heal a disc herniation or sciatica. Brad: No. Bob: You might feel better for some secondary reasons, like the muscles have tightened up because they're, sore from the sciatica, but really don't buy one of these if you think it's going to heal your sciatica. Brad: Right. Again, you may feel better, but the nerve is still pinched. Bob: Brad, do you want to talk about neck pain and headaches? Brad: All the time. Yeah. If you have neck pain, we're talking like base of neck up. You're not going to use a massage gun on the neck here. The muscles are there, but you cannot do it without hitting the bone, the spine. And that spine is very delicate if you will. Bob: Yeah. Brad: When you're hammering on it, because that's what's going on, the gun is traversing back and forth. You could hurt your spine, as a matter of fact, you could cause a problem. I made a mistake years ago, with one of these. Bob: I did the same. Brad: I was massaging a patient's shoulder, and then I went up to the neck and I saw by the look on his face, I was doing the wrong thing. And I felt really bad as a therapist. Bob: Right. Brad: I said, “what am I doing?” And anyways, it worked out fine. Bob: You try it on yourself, and you’re like, “Oh my God.” Brad: Don't go directly on the spine either. Bob: And the same with the head. You wouldn't be doing it for a headache. It's just not good. Brad: Oh! You're not going to do it to your temples. Your head, you can do it with your hands. Bob: Right. And that leads us kind of to the next one, Brad. You really want to avoid bony surfaces. There might be some exceptions like when you have quadriceps tendonitis or you have the suprapatellar pouch, sometimes you hit the knee cap a little bit and you use the air-filled one. Brad: Yup. They're soft and squishy. If you hit the edge of the bone, it's not so bad. Bob: Yeah. Even tendonitis. Like, if you have a tennis elbow or golfer's elbow. Brad: You'll know if you get too close, it's going to hurt. Bob: Yeah, it's going to hurt. Brad: You don't massage that kind of, in that fashion. Bob: Next, you shouldn't go over a pulse. Brad: The arteries in the neck, or the brachial artery in your arm. Bob: Right. On the back of the knee, a lot of nerve, artery, veins there. I won't go over your heart either. It's never a good idea. Brad: Yeah. The other thing, I don't know if you had this on the list, but don't go over lymph nodes. Bob: No! I don't. That's a great one. That’s a good point. Brad: Particularly, in your femoral crease right here. Bob: Right in the groin. Brad: They're very superficial, right under the skin. Bob: Well, obviously right under the armpit too. Brad: The axillary, yup. Because if you hit those lymph nodes, I mean you could cause some problems. If not anything, you just irritate them. And I know I had some lymph node issues and the doctor, I thought it may be cancer, well, he ruled that out. He says, “if it's bothering, you just stay away from them. Cause this is going to make them worse.” So when you irritate a lymph node, it just gets worse and it's no good. Bob: Gotcha. All right. During pregnancy, obviously don't go over the fetus. I mean, we always want to say that. Brad: Yeah, obvious. Bob: Generally, you wouldn't do it over a bursa if it's inflamed. And a bursa is a fluid-filled sac. Brad: It'll be tender. Bob: Right. It'll be tender and I wouldn't go over that. Brad: And you have bursas in almost every joint in your body. Bob: All the joints. So you have to be careful. Brad: Yeah. You go over the muscle belly there not the joint or you'll feel it. Bursas hurt. Bob: If it makes pain worse, and the pain hurts afterwards yet, you shouldn't do it. Brad: Right. Bob: All right, if you have a bleeding disorder or bruise easily, obviously you're not going to want to do the massage gun. It is pounding, I mean, it's percussion. Brad: Yeah, if you're one of those people, when you bump into a piece of furniture, you got a bruise there, you're going to bruise from this if you're getting aggressive particularly. Bob: Yeah. Brad: So, yeah. Don't even think about it if you're really a bruiser, you know, easily bruised. Bob: Now, if you've had surgery, I want to make sure you have it approved by your physician or medical provider before you do massage because after surgery, you're actually at higher risk for developing blood clots. Brad: Sure. Bob: Let's say you do a massage in your calf, you loosen a blood clot and send it up to your lungs and it kills you. So, we obviously don't want that. Brad: Right. Bob: So we want to avoid that. This is, I would say again, you want to get it approved by your doctor. If you have some type of nerve disorder, like if you have multiple sclerosis or epilepsy, unless it's approved, I wouldn't do it then either. Brad: Right. Bob: Open sores, obviously, skin tears, you don't want to go over. This is very obvious to us, Brad, you would think everybody would know this but it's not. I guess people have done this before. They've had a broken bone or a healing fracture and they start massaging all over it. Brad: Oh! Bob: So, they want to make it feel better. Brad: I mean, that could be well after it's healed, and you've been walking on it or many weeks after. Then you may want to have scar tissue break up but not during the healing process. Bob: All right. Well now, why would you buy one? And there actually are very good reasons why. Brad: Yeah. Indeed, a lot of them. Bob: One, it's very easy to use. You don't have to get on the floor like a foam roller. So, if you can't get on the floor, and you want to massage an area. Brad: Foam rollers work well but, it takes more effort. Bob: Yes, they do. And you know what? The cost actually, like, if you use one of the less expensive ones, like the handheld, is almost comparable to a foam roller. Brad: Yeah. Or even one of these smaller ones, like the Q2 mini, that really do a heck of a job. Bob: Yup. Many people believe it or not, Brad, and I have used this in our clinics for years and, I found 50% of the people actually prefer the gun over our hands, or our assistant’s hands. Brad: Again, we're not professional massage people. Bob: Right. Brad: So we can't talk. But we know what we're doing as far as the muscle groups. We're trained. But it's not like we're masseuses. Bob: Right, right. Brad: So keep that in mind. Bob: All right, it never gets tired and never says no to you. (chuckles) Brad: Well, unless you run the battery down. Bob: Yeah. Brad: You have to keep them charged up but they hold a charge for quite some time. Bob: Yeah. What's nice about it is you can also use it with the whole family, generally. Yeah. I mean, seriously. Brad and I gave away some of these massage guns to some teachers. Brad, I am still getting great compliments from them. Brad: Yeah. Bob: And the principal, he uses it every day. His kids say “you're in love with this thing.” I mean, it's just been funny. And another principal, she said her whole family uses it. Instead of going on vacation, they went and used the massage gun. Brad: So did the principals hogging these things from the teachers? Bob: Yeah, apparently so. You know, if you're a principal you could do what you want. So, it's great, these are really great. I use them in this manner to warm up the muscles before I run. Brad: Yeah. I should probably do that. That may help me. Bob: Problematic muscles at least. I mean, I don't do all of them, by any means. But seriously, I hit my calf muscles before I run. It’s just a great way to stretch them out and get them warmed up before you go out. Brad: Sure. Bob: So you can also use it for cooling down. So, I mean, they're really great for that too. And that's what I'm talking about with muscle recovery. But it's also good for muscle strains or scar tissue or tendonitis. It really works well for that because one thing, your hands are going to get tired if you're doing a self-massage. And the massage gun, you can apply for 10 to 15 minutes, like just like you should. Brad: I'm telling you, for most people, I think I can speak across the board. If, you've got a massage gun or you're going to massage by hand, chances are if you're going to do it by hand, you might just skip it. With the massage gun, you look forward to it. It's so much easier, it feels good. And it just feels good when you're done. And if you get that feeling for the next 15 minutes or so, it's worth it. I mean, these are popular for good reasons. Bob: Yeah, there's a reason. And the last thing, I've given so many of these away, Brad, it's honestly one of the best gifts you can give. Brad: It is, yeah. Bob: It is! There's not anybody, hardly anybody that's going to say, "No, I don't want a massage gun." I mean, most of them find out they really like it a lot more than they thought. Brad: Sure. Bob: They're surprised at how much they like it. Brad: Just make sure you get the right one for the right person. I think like Mike's grandmother, she had one of the massage guns, and it was way too aggressive. And then she went for one of the handheld massagers. And it was, much more appropriate. Bob: It was appropriate, yup. So this video is a part of a series of videos on massage. If you want to check out the entire series, go to https://www.bobandbrad.com/programs ! And in that section, you're going to find a whole bunch of topics like we have a program on plantar fasciitis. We've got a program on sciatica. Brad: TENS. Bob: TENS. And shoulder, and some of the other ones are coming out. Brad: Right. Bob: Find the program on massage, check it out, figure out which videos you want to watch. There’s going to be like 20 of them, or 30 or 40. Brad: There'll be a bunch. Oh! There is a PDF printout so that you can look through a review of the whole video you just looked at, print it out and keep it handy until you basically memorized it. Bob: And how much are charging people? Brad: Absolutely, Bob. It's astonishing. Zero. Big zero! Bob: It's our gift to you. Brad: Not even an email. Bob: Nope, just come on and use it. Thanks for watching. Interested in learning about the Bob and Brad's Massage Gun products: US: C2 Massage Gun: https://amzn.to/36pMekg Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 X6 PRO Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv Handheld Massager: https://amzn.to/2TxZBqU T2 Massage Gun: https://amzn.to/3GfflX1! Canada: C2 Massage Gun: http://amzla.com/t4qn7uniltfb Q2 Massage Gun: http://amzla.com/s506onkyq2cm UK: C2 Massage Gun: http://amzla.com/rhdco5f8zprk Q2 Massage Gun: http://amzla.com/qe4bmn3puczb EU: C2 Massage Gun: http://amzla.com/skpiccayp2rc Q2 Massage Gun: http://amzla.com/rhdco5f8zprk AU: C2 Massage Gun: https://amzn.to/38JLxSv Q2 Massage Gun: https://amzn.to/3nb9pa Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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.

If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for Small Area of Wrist Pain: Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad directly below the pad (at least a pad’s width apart) or above the pad. Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain or place one pad on each side of the pain. General Guidelines for Larger Area of Wrist Pain (Back or Front): In our examples channel one has yellow pads and channel two has green pads. Back of Wrist One pad from channel one is placed above the area of pain and one pad is placed below the area. One pad from channel two is placed in front of the area of pain and another pad from channel two is placed behind the area of pain. This arrangement forms a cross pattern. Front of Wrist One pad from channel one is placed above the area of pain and one pad placed below the area. One pad from channel two is placed in front of the area of pain and another pad from channel two is placed behind the area of pain. This arrangement forms a cross pattern. Reminder: Do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Wrist Treatment: With your opposite hand grab the side with the painful wrist and apply some traction. While applying traction rotate your forearm back and forth. Do this for 20 to 30 seconds only if this can be done pain-free. For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 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 June in of 2020. For the original video go to https://youtu.be/00wo6t4lPqw Bob: You want to burn away body fat? For the millionth time, spot reduction is a myth, do this instead! We've all seen the videos, Brad, "How To Get Rid Of Belly Fat", "Burn Away Belly Fat", "How To Get Rid Of Arm Fat", right? Brad: Yeah! Bob: Under the arm. Brad: Yep. Double chin. Bob: Yeah, how to get rid of the thigh fat. No, you can't do it through spot reduction. It just does not work. It's been proven beyond a shadow of a doubt; you can't spot reduce. So if you're working on your abdominal muscles and your core, that's not going to reduce the body fat in your stomach. Brad: Right! The body is going to take the reduction in fat where it wants to. Bob: Right. Brad: There's some genetics involved. There's a number of things but if you think you're going to reduce the fat in your stomach by doing sit ups, no. You're going to definitely tone up the muscles. Bob: Yeah. You'll have tone muscles underneath the fat. Brad: Right. Bob: It's basically what you're going to have. Brad: Right. Bob: Same with triceps. If you're working triceps, you want to get rid of the arm flab? You'll have strong muscles underneath the fat. Brad: Right! Bob: Same with thighs and muscles in the inner thigh there, you can strengthen them but you're not going to get rid of the fat. Brad: By no means are we saying you should not exercise or exercise these muscle groups but just don't think that because you exercise that muscle group, you're going to lose weight right there. Your diet is going to be the big key. Brad: Exactly. Bob: And it's a combination diet and exercise is great. Brad: Yeah! And we'll talk about that. Now you can build muscles site specific. Bob: Sure. Brad: We all know that, right? You can build your chest muscles. You can build your biceps, triceps, glutes, quads, calves. All those, you can work on a specific area. Bob: Right. Brad: You just can't reduce fat. Kind of as a general rule of thumb again, fat reduction occurs at the dinner table. Strengthening occurs at the gym. Bob: Right. Brad: That's a general phrase you might hear once in a while. So you need to burn more calories at the gym if you want to reduce fat. Bob: Right. Bob: Now we're not dieticians, Brad and I obviously, but I think we can make three statements about things if you want to reduce fat intake and reduce the fat output basically in your body. Basically, number one, you have to decrease the amount of sugary drinks that you drink. Especially those fruit juices, they're terrible. Brad: Right. Bob: Just full of sugar. Brad: Sport drinks, oftentimes have a lot of sugar. Bob: Good point Brad! Brad: And it doesn't really matter. I just look at the sugars on what you're eating. Not only just drinks but the food you eat, all these carbohydrates. We've done a lot of studies on this over the last couple of years and had great success ourselves in losing weight without cutting down. Bob: Around, the abdomen too. Brad: Yeah absolutely! Bob: Look at our old videos. You can see our puffy shirts. Brad: Oh my God! I’ve got a video from four years ago, swimming, I don't even like to look at it anymore. Bob: Actually, Brad, you did a video that showed the sports drink was similar in sugar or had more sugar than a can of pop. Brad: Yeah. Pepsi or Coke, with all the sugar, you might as well just drink pop because they had the similar amount of sugar, just that it was carbonated. Bob: And as Brad alluded to you, you don't want to eliminate your carbs but you want to watch the refined sugars. Brad: Right. Bob: The white bread and of course candy. Brad: Right. Bob: And again, the sugary drinks. The carbs. Definitely, big difference in my life just decreasing the carbs. Even if you just get rid of the bread in your life, that alone can make a big difference. Brad: Right. I cut down 90% of the breads, all ice cream, although I still really like it, and no pastas. I'm not a big pasta eater anyways. But like for oatmeal, I'll eat, organic steel cut oatmeal. Bob: Sure! Brad: And it's wonders for me and it's a carbohydrate but it's not refined. Bob: Well pasta's Brad, I've been eating a lot of the whole grain pasta. Brad: Sure. Bob: You have to look at the ingredients to make sure they really are whole grain. But that made a big difference. You still can get your pasta fix and decrease your carbs. Brad: Exactly. Bob: Eat more fiber too. Fiber fills you up and it keeps you regular and it's going to help with the body fat too. Brad: Right. Bob: Now, in addition to that, you do want to do some resistance training. Because when you do resistance training, not only are you burning calories while you're doing it but you continue to burn calories after you're done. Brad: Right. Bob: That's why we always want you to do some weight training. And usually we work on separate body parts depending on the day of the week because you always want to give a day of rest at least after you've done a body part. Brad: And I do want to clarify it Bob, weight training and resistance training are the same thing. I do a lot of resistance training but I do no weight training. Bob: Sure! Brad: All mine is with bands because I really like it and there's a lot of benefits to it. Bob: It’s easy on the joints. Brad: Right. So whatever works best for you. I never used to do resistance training, all I did was aerobic, bike, swim and running. I changed in the last three years. I started doing resistance training and I realized that over the next day I'm burning more calories. It's amazing. I got to eat more and not gain any weight. Bob: The muscles are basically trying to recover, and that's why they're burning a little more calories while they're going through that. Brad: Right. And then I started bulking up too. Bob: Well he started bulking up. But also as you get older, you start to becoming weaker and so you have to make up for that. If you don't do anything differently, you can lose like 5% of your strength a year. And that doesn't take long before you're down to zero. Brad: Right. And then more chance for falls and all these other problems that come along with it. Bob: So you can do cardio too but with cardio, we recommend a High Intensity Interval Training, the HIIT. Basically quite often, you're doing really high intensity for like a minute and then you're resting for a minute. There's a lot of variations on that. Brad: There is, really can do a lot. I still like to do the long duration exercising because it's gives me a chance to air my head out. But yeah. Bob: I do both. Very stress reducing. Brad: The HIIT is less time consuming. If you have the time issue, you'll get the cardiovascular benefit. Bob: Again I like to do a little bit of both. Almost even both most days. All right, now we're going to bring in that new product that we're talking about, Brad, that we're all excited about. So this is actually made by the Teeter Company which actually makes inversion tables. Brad: Which we really do like, because they're high quality. They are. I really like 'em. Bob: So I found it very interesting that, Teeter, a man named Teeter, made an inversion table like a teeter totter. Brad: Right. I wonder if he changed his name? Bob: I don't know? Brad: I think we looked that up. I don't think he did. Bob: We've got to find that out. So this is called the FreeStep LT1. And they're trying to compete a little bit with the NuStep. I'm not sure if you're familiar with the NuStep, more of a commercial model. But this is a model that you can use at your home. It is a little more expensive maybe than some home equipment, I don't know. It's $750. Brad: Right. Bob: It seems to be pretty reasonable to me. Brad: Compared to the NuStep or other models like the NuStep, those are in the thousands. Bob: Right, NuStep's stripped down version, is at least $4,000. Brad: Yep. I think it's more than that actually. Bob: Yeah, I think it actually could go up to $7,000 very rapidly. So this has different resistance and as you can see, despite me being very tall, it fits me quite well. Brad: What are you? Six foot? Bob: I'm six foot six. Brad: Right, I'm five foot 10 and I had that adjusted for me and it just easily adjusted for Bob. Bob: What I want to show you on this is I'm not using my arms here because you can really get humming on this thing. And so you can get high intensity interval training on this where you can work it hard for a minute and then you can calm down and rest take your cardio down a little bit. Brad: And you certainly can use arms with that as well to get more muscle groups involved. Bob: And there's resistance so you can actually get some leg resistance once you’ve got it set up at the highest setting. Brad: Right, if you want to get that resistance training without so much cardio. And it's just a little knob that you turn. Bob: It's in the back of the seat. Brad: Right. Bob: We'll do a full review on this thing. I like the fact too that, like I said, it adjusts for me and it fits for me. And I also like the fact that, it has a great seat. Brad: The lumbar support is adjustable. Bob: Yeah, I like biking but this thing, really gives a good seat. Unless you have a recumbent bike, you're not going to get this kind of support while you're working out here. Brad: And it's extremely quiet, which is a big advantage for the home. Bob: Exactly, this thing is whisper quiet. You can watch TV. Brad: You've never seen anything that quiet. Bob: I've never heard anything that quiet. Brad: Had to get that one. Bob: And it is easily movable. Brad: Yeah. Bob: Yep even Brad can move it. Brad: Yep I'm not afraid of it. Bob: We'll see you later. Brad: Goodbye! Bob: Remember Brad and I can fix just about anything. Brad: Oh yeah that's right, except for-- Bob: A broken heart but no, we might have the answer right here. Brad: Well, it's part of the puzzle, Bob. Once again, we continue to be-- Bob: Amazing! Brad: Wow! Bob: Thanks. Interested in learning about the products mentioned in today's video: 1) Teeter FreeStep:https://shrsl.com/2e6mm Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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 March of 2021. For the original video go to https://youtu.be/jd7J0PiTcRk. Bob: Today we're going to talk about neck pain, pinched nerve, when do you need to see a doctor immediately? Brad, we're going to actually break this down into two categories. The first category is not as urgent, but you should schedule an office visit. You should see a doctor. But two is when you probably should seek emergency medical care right away. So let's start off with the first one, Brad, for an office visit, if your neck pain just keeps worsening, despite your self-care, it's probably time to go in and see a doctor and make sure something serious isn't going on. Brad: Right, right. Bob: You may need physical therapy, so you need to see the doctor. Brad: If it's restricting your sleep, and it's getting no better, or getting worse after two or three nights. You can't sleep. I mean, you've got to get sleep, things don't heal well if you don't sleep. Bob: That's right. Brad: It's just a bad situation. Bob: It landslides, in the wrong direction. If the pain is radiating down your arm or legs, especially your legs, that means that could be really serious, and it seems to be from your neck, I would definitely go in and see a doctor then. Brad: To be clear, pain could be numbness, tingling, burning, feels like cold water's running down your arm. All those things are associated with a nerve being irritated. Bob: Those weird sensations. It's amazing, if want a variety of different sensations, get a nerve involved. Brad: Right, yup. Bob: If neck pain it's accompanied by headache, numbness and tingling, I would probably go in too. Especially if it comes on suddenly and it's the first time you had it, then it might be an emergency. So if you're one that normally doesn't get headaches, and all of a sudden you get a headache, and a numbness and tingling, yeah. Brad: Especially if you look up and that gets you a headache, or dizziness associated with some head movement. Bob: Sure, sure. If the pain is so bad, like Brad kind of indicated before, it's just affecting your normal activities and your sleep, it's time to go in. You know, you’re sick of it. Brad: Like, I had that pretty severe bout a couple of weeks ago, but it happened on a Sunday night, Monday night, Tuesday night were very uncomfortable, but by Wednesday it started getting better. Bob: Well, you know what you're doing, too. And you knew what caused it, too. Brad: Right, right. But probably if it's not better within a week, you have to get it checked out. Bob: Yeah, that's the next one, Brad. Brad: Oh! Bob: If it lasts for weeks, it's time to go in and check it out. We talked about tingling, if there's any tingling in any part of your body, emanating, it seems to be, from your neck, check it out. If it comes with urinary or bowel incontinence. Now this is actually an emergency. I don't know why I've got that in office, I would say that's more of an emergency. Brad: Right, yeah if you cannot control your bowel movements, or your bladder control is clearly thrown off, and you have these other symptoms, that is an emergency. I've only had two people over 20 some years that actually went in and they didn't need surgery. Bob: I had one person and it was the same thing, he went in and it wasn't that. I've treated people after the fact, though, that had it and became paralyzed. Brad: Yeah, so that is something obviously we'd want to get at immediately. Bob: This one too, you know, could be an emergency if it comes on real suddenly, if you have weakness in your arm or leg. If it's a gradual thing, comes on slowly, then you can probably set an office visit. But, we're always worried about whether or not it's a stroke, or something like that, so you want to make sure. Brad: Yeah, if you can't pick something up that you normally could, and you've got numbness and weakness. Yeah, you have to go in. Bob: It's time to go in. These are definitely emergency medical care situations, and we'll go into these now. One, if you've had a traumatic injury, like a diving accident, or you're in a car crash. Don't mess around with it because you could have a fracture and not even realize it. You could have what is called a hangman's fracture and your neck is unstable and you could actually become paralyzed. So you really don't want to mess around with it. If you have a high fever, along with your neck pain, then we're worried about meningitis. And the membrane covering your spinal cord and brain can get an infection and you don't want to mess with that. Brad: It builds up pressure. Bob: You want to go in and have that treated, obviously. If you have a severe, persistent headache accompanied by nausea and weakness, it's time to go in right away. Brad: Right. Particular if you're one that doesn't have headaches, or headaches like that. Bob: Yes. Yeah, if you have migraines and you're used to it, I mean, that's a different story. Yeah, nausea or vomiting, that is probably beyond the neck pain. If you have a rash, if you have sensitivity to light, if you have a racing or irregular heartbeat, along with the neck pain. Difficulty breathing, like we said before pain or numbness radiating down the arm that just started suddenly, and pain in your chest, or jaw. Then we're obviously worried about a heart attack, so you want to make sure you check that out. Brad: And I think if you had all of a sudden pain or numbness down both arms at the same time, then get in, because that's more unusual too. So get that figured out, it very well could be something that's not serious but definitely get that checked out. Bob: You always want to be on the safe side here. Thanks everybody for watching. Brad: Very glad, oh! What about our PDF, we'll skip it? Bob: Oh, sure, well this program by the way is part of a series of videos on neck pain. If you want to check out the whole program, go to https://www.bobandbrad.com/programs, look for the neck series. There's about 30 videos, you pick out the ones you want to watch. You don't have to watch each one. They're all free, we don't require an email, or anything of you, you can just check them out. Brad: And they have a PDF printout, a little review of exercises and what we've talked about on the video. It's all free, there's no email or anything, it's just our gift to you and would hope that you improve and become healthy, fit and pain free. Bob: Well, like this one now, on this video you can look at the list, see what symptoms you have and what you should be doing. Brad: Sure, right, yep. Bob: So you don't have to write them all down. Brad: Yeah, that's a good deal. Bob: All right, take care. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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.

How to Use a TENS Unit with Neck Pain. Correct Pad Placement. If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for One Sided Neck Pain: Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad directly below the pad (at least a pad’s width apart) or above the pad. Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain. General Guidelines for Neck Pain (Both Sides): In our examples, channel one has yellow pads and channel two has green pads. Place one pad from channel one in the upper right corner of the area of pain and one pad from channel one in lower left corner of the area of pain. Place one pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. Reminder: Do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Do not place pads over the carotid arteries! Neck Pain Treatment: Neck extensions with towel. For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 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 June of 2021. For the original video go to https://www.youtube.com/watch?v=me9Ufp_idBY&t=222s Bob: Today we're going to talk about knee pain. 12 signs that you should see a doctor immediately. Brad: How about a dozen? Bob: Sure. Brad: There you go. Bob: Cheaper by the dozen. So if your knee pain was caused by an injury, so sports, a fall, work, and so on, you should seek out medical advice or attention, if any of the following conditions exist. Brad: Right, let's do it. Bob: Number one must be the most obvious, if you have a deformity, like you have a bone sticking out. Brad: An obvious deformity, yeah. Bob: Right, if you compare the one knee to the other knee, and there's something just not right, visually. You may have broken something or dislocated something. Brad: And you have to look around the knee, around the joint, like just below the kneecap. You might see a little, if the meniscus is actually torn, popped up, but there's probably going to be some pain associated. Bob: Well, the kneecap could be over. Brad: It usually doesn't happen without notable pain. Bob: Number two, if you have significant bruising or swelling. Bruising generally means you've had some artery damage. You know, it's strain on the arteries. The more bruising, the more swelling, the more likely you've experienced a serious injury. Brad: Sure. Bob: So get it checked out. Brad: And typically with that, the range of motion is going to be painful too. But not always. Bob: Number three, let's say you have difficulty walking after an injury. So it's causing you to limp. The intense pain can could indicate a bone fracture or a torn muscle or ligament. Brad: Right. So, in other words sitting, it's not too bad, and maybe you can range it out but as soon as you put some weight on it, it makes you jump. Bob: Yeah, and number four fits right along with that. Let’s say we're walking and your knee won't hold the weight. Like you actually, step and it gives way. Brad: Yeah. Obvious. Bob: That's an obvious sign that you should go see the doctor. Brad: Yeah. You don't probably don't want to wait and see if it gets better for a couple of days. Bob: Let's say it's not that severe, but it feels unstable or instable, you know, that can often be ligament damage too or even the cartilage damage. You know, it's just not holding it in place like it should. Brad: Yeah, you can walk, but it just feels like it's going to give out at any time. It's that really queasy feeling. Bob: And this is interesting how often this happens, the next one, you actually hear a popping noise and you hear a lot of people that say that well, like they especially have, they tore their ACL or something. Brad: Oh, you mean when, at the time it happens. Bob: Yeah, at the time it happens. I remember even sometimes people would say they heard it in the crowd. That they heard a popping noise. Brad: Yeah. I've always wondered. Because I always think that sometimes the person who's having the knee thing they hear a pop, but nobody else can be because, you know, you can feel it. Bob: It's a vibrational thing. Brad: Yeah. You don’t even associate that, but when they say they hear it from the audience. Then you know it's the real thing. Bob: If you have reduced range of motion. So if your knee is not straightening all the way or not bending all the way, again, there's a lot of things going on there that could cause that. One is a torn meniscus. Brad: Sure. Bob: Or torn cartilage. Brad: So bending just means all the way like this, you know and all the way straight. Bob: It might be swelling. Just plain, old, swollen. Brad: Right. Yeah. Bob: That's stopping it, but, if there's that much swelling, you probably should have checked out. Brad: Sure. Bob: So if there's less sensation in the knees, so you can't feel part of the knee or around the knee anywhere, then it could be even sciatica or some non-knee condition. But you want to get checked out. Brad: So you touch it and it just feels numb. There's a numb area in the knee. Bob: Now, if, if you didn’t have an injury, like a sports injury or fall, but you've had long-term pain or discomfort in your knee you know, and it's chronic, it's ongoing, you may want to check out a doctor and just see where you're at. Brad: Right. So you injure it. Yeah, you can walk on it. It's not too bad, not much swelling, but it doesn't feel a hundred percent, but it goes on for a week or two weeks. I would think after two weeks you should have it checked out. Bob: Yeah. Especially if it's new. Brad: Right, it's not improving. It's just kind of hanging out there. Bob: But if it's a gradual onset. You know, you might, you might go several months before you go to check it out. Brad: Yeah. Some people are that way. Bob: Yeah, like some people, (laughs) you and I are both that way. Brad: Well, well that's a different story. Bob: Well we diagnose ourselves is all. If the knee pain is affecting your daily activities, so you're having trouble doing the things that you've wanted to do in the past, obviously have it checked out. If it's affecting your sleep that’s usually a sign that it's pretty serious. I mean, not serious, but you need to get it checked out. Brad: Yeah. If it feels comfortable throughout the day and then, or not too bad throughout the day, but then at night is it really gets sore and it hurts in bed, get it. Get it checked out and make sure that you don't have something unusual going on. Bob: Yeah. Sometimes what that means is it could be as simple as that you overworked it during the day and that the swelling goes into the knee at night. Brad: Yeah. Bob: But again, pain at night is always kind of a red flag. You always want to pay attention to it. So number 11, redness or swelling around the joint. This is something obviously not to mess around with it. If you think you might have an infection, and you're tender to touch. Brad: It's warm. Bob: It's warm, very good, yes. You experience a high fever along with it. Brad: Yeah, you have to get that taken care of. Bob: Fast! That's not one you don’t mess around with, that's when you go in and have it checked out. And the final one if you have really high intensity knee pain. I'm sure that's going to cause you to want to go in any way. But don't tough it out. There's something wrong if it's really hurting quite seriously. Brad: You know, the other thing I don't think we mentioned with that redness or swelling, particularly if you had a knee replacement. Bob: Right. Brad: Definitely, because infections migrate to that artificial components in there. And that's really important. Bob: We've seen this quite often in our patients. And unfortunately I've seen it in my family. My mother-in-law, she had an infected knee. Bob: Oh yeah. She had a replacement? Brad: Yeah. She had a replacement. They had to take it out. Brad: Yeah. I've seen that too, over the years. Bob: It's more and more common unfortunately. Brad: I wonder why. There's more knee replacments? Bob: Well the bugs are getting stronger. Brad: Oh, sure. Bob: We're not able to fight them as much. Well, that's it folks. This video, by the way, is part of a series of videos on knee pain. If you want to check out the whole series, go to https://www.bobandbrad.com/programs You'll find our videos on knee pain. Now, if this is early on, they all might not be there yet. We're uploading. Brad: Yeah, because there's going to be, I don't know, 20 of these or more. Bob: 20, 30, 40, 50, probably. Brad: Depends on how ambitious Bob gets. Bob: Yeah, yeah, yeah exactly. Brad: But anyways, yeah, it'll say they're not ready yet. You'll just have to come back. And this is not a two or three-day process. Bob: Yeah, this takes a long time. Brad: Yeah, it takes a number of weeks. Bob: What else comes up with the video, Brad? Brad: Well, Bob, this is a great thing. You have a printout, PDF printout. Click the button print it out on your printer. You'll be able to read it and know exactly what the video says. You don't have to go over and look at it over and over and over and see our faces more than once. So it's a benefit. Bob: Again, no charge. Brad: Absolutely. Not even an email. Bob: Yeah. We don't ask for anything from you. Brad: That's right. Bob: All right. Just ask for your forgiveness. Brad: Be careful. Bob: Be careful. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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 2021. For the original video go to https://www.youtube.com/watch?v=H6HpK2OHPPc&t=146s Brad: Hi folks, Brad Heineck, physical therapist. Chris: Hi, I'm Chris the Pharmacist. Brad: And today we're going to talk about, lowering your high blood pressure naturally, recently supported by science. Chris has done a lot of homework on this. Blood pressure is a big deal, you want to keep it intact, keep yourself healthy from now until you're 101 years old. So, what is high blood pressure? And we've got a nice chart here from the American Heart Association. So, should we start out with normal? Hopefully we're there. Chris: Yeah. So, basically the generalized number is going to be 120 over 80. So, that's considered normal blood pressure. And it can be a little bit lower, some people like me, my blood pressure is constantly like 100 over 60. That's still considered normal. So, even though it's lower than the norm, that's something that's very comfortable. Unless you're getting lightheaded or dizzy that's when your doctor begins to address those issues. Brad: Sure Chris: But for the purposes of today's conversation, we'll just deal these numbers. Brad: Yeah. Now, we're looking at elevated, it's like you're in the borderline, starting to get the high blood pressure, but you don't need meds yet. It’s a good place to change your diet, change your exercises. Chris: Exercise and diet. Brad: And that's exactly what I did about 20 years ago, I was in this range and with running consistently and other activities, I was able to drop it down within a few months. Chris: Yup. Now, that's huge. So, this elevated range (120-129/80-89) is where you're going to really focus on those lifestyle changes. And when you come to the doctor, they're going to start to talk to you about: how are you eating? what are you doing for your activities? And the key with activities, and that's probably the simplest natural way to, is to increase your aerobic output. It’s not to say that just aerobic is the only way to get exercise, weightlifting can be something that can be done. So, there's swimming, there's biking, there's dancing, there's gardening. Brad: Now, if you're not familiar with the term aerobic, that doesn't mean you have to go to aerobics class, where people are wearing everything and doing the jumping, and having fun. It's a good way to do it, but you may not feel comfortable, you can go for a walk. Chris: Yup a walk. A brisk walk, 30 minutes, five days a week. Brad: There you go. So, that's not a big deal. Well, if you're a sedentary person, that is a big deal. Chris: It is a big deal. Brad: You may want to start out walking five minutes. Chris: Yup, Rome was not built in a day. So, if you have a sedentary lifestyle, but you're ready to make these lifestyle changes so that hopefully we can keep you off from medication, it's just a little bit at a time. Baby steps, I think it's a real approach, because actually the last thing we want is an injury. And you always want to do this in accordance with what your doctor feels is safe for you. So, we can't stress that enough. Brad: Right. You don't want to overdo it. And that can be a big thing. If you've been diagnosed, you're maybe at stage one, you're at that borderline stage and your doctor has talked to you about it, it's like, I better get after this. You might think, well, my father died from high hypertension. Chris: Yeah. And he was 56 years old or something like that. Brad: Exactly. And I know this one guy, he wanted to run a half marathon and he started at age 60, hadn't run before. But he did it appropriately. He actually hired a trainer. Chris: All right. Brad: And it took him six to eight months, more like eight months. And he did it. Chris: That's a phenomenal goal. Brad: That's an option. He didn't have high blood pressure problems, but he knew that if he went after it too aggressively he's going to hurt himself. Chris: Yeah. And that's the last thing you want to do is put you back on the couch. I mean, other than they'll have to come and see you, or they’d have to come and see me for something for pain but I mean, from that standpoint. But basically when we get to those levels (130-139/80-89) up to stage one, and that's about when your doctor is going to start to say, "all right, how are we doing on the diet?" Brad: Sure Chris: So, we want to look at that too. So, they talk exercise and diet. So, one of the biggest guilty causes of blood pressure and a lot of us don't know about it, is just the amount of sodium we eat. Brad: Salt Chris: Salt. Yeah. So, we want to read packages. There’s your favorite saying, “don't buy anything out of the middle of the store,” and I say, “don't buy anything out of boxes.” For the most part, it's one of those things where that's a lot of the foods that are not natural, are packaged and prefabricated, and they're processed, highly processed. Processed food, they add salt in there and sugar for flavor. And so it's those dead calories and that sodium. And that sodium can make you retain water, which when you retain water that makes your heart work a little bit harder, more vascular resistance, higher blood pressure. Brad: I always think of it like a balloon, you know, you put more water or air in the balloon and it just gets more and more pressure built up. And that's really what's going on in your system, your vessels are taking in all that water and it's blowing up those vessels and the pressure goes up, heart has to work harder. And then also we have some arthrosclerosis. Chris: Yeah. So, the hardening of the arteries. We have to be careful, there's a lot of other things that once we get that word hypertension, there's a lot of other things can go sideways. So, it can affect our organs, like our kidneys, it can affect our eyes, obviously it's our heart, it's our circulation. So, there's a lot of things going on because there could be strokes, there can be heart attacks, vascular dementia, memory issues. So, there's lots of things that we have to be extremely cautious with, when we start to hear this and why we're going to make this commitment to ourselves, to help to naturally lower our blood pressure. Brad: Sure. So, and yeah, the thing is these problems you talked about, the vascular problems, well, the stroke too, but all these things kind of accumulate, over time. Chris: Over time. Exactly. Brad: So, and you could be up to 140 over 90, and feel perfectly healthy. And maybe you haven't seen a doctor for 5 or 10 years. It's like my grandmother, she never saw the doctor until she went into a nursing home. Luckily she was healthy, she didn't need to, but she wasn't going to anyways. She was stubborn, you know. Chris: Yup. Exactly. There's a lot of us like that though. Brad: If you have a problem like stage 2 (140+/90+), and then you find out after you've had it for 10 years, maybe your vessels are already hardened and you're having serious problems. Chris: Yeah think of your blood vessels as kind of like supple spaghetti. They're just kind of a very flexible tissue. And so basically when something's pushing hard against it, in a case of like an aneurysm it's stretches, in the case of just hardening the arteries, you've got all this resistance force, pounding against it because that pump is working so hard, that they just kind of harden. They aren't quite so supple. There's some debris building up in there. Brad: Which actually makes the blood pressure go up more. Chris: Go up more because it narrows the arteries and vessels. And that's what we have to be so careful with. Brad: So it's a compounding effect? Chris: Yes. It's not just one simple thing. Hypertension or high blood pressure is the word, but there's so many other things going on. And you know, for every 10 points in blood pressure, your risk for cardiovascular problems goes up like 20%, each time. And so many of us, because again it's the silent killer, we don't feel blood pressure, we just generally don't. Some people say they'll have a headache or they get a nosebleed. I guess they're the fortunate ones, not that it's fortunate to have a headache or a nosebleed but they actually have a symptom. It's a symptom that shows you that, hey I need to figure out what the heck's going on. But for those of us that are just walking around for 10, 15, 20 years, you know, are healthy as a horse, feel great, and all the sudden you go in for that doctor appointment because maybe it was an insurance thing or maybe your wife made you go or your husband or whatever. And all the sudden you get this number, like, oh my gosh what am I going to do? This is why we have to be careful a lot. Brad: So, it might not be a bad idea if you're going to a store, some have a blood pressure machine were you sit and put your arm in there and takes it that way. Chris: Absolutely. They're regulated, they're always very accurate. So, I think you can feel comfortable with that. We'll give you at least a good guideline or thumbnail sketch of where it is. But again, when we're taking our blood pressure even in a store or even at home, we want to make sure we're sitting in that proper posture. Both feet on the floor, relaxed. You want to give yourself about five minutes of sitting before you actually hit the trigger if you're in a store. Brad: So, you relax? Chris: Yup, because you want to get an accurate reading. Because if you just rush in and, boy, I don't feel really good, you get it set. You know, you'll just jump in all of a sudden, yeah, oh my gosh, I'm 170 over 110, oh my goodness, what am I going to do? Well, then all of a sudden if you rest for five minutes, and it comes down to somewhere like, 120 over 80. So, that’s not very accurate. You were in a hurry, driving and traffic, had a cup of coffee, I mean, there's a lot of factors. Brad: And then, you may want to take it a few times. Because there's a little red flag there. Well it's pretty high does it jump up there often? Chris: Yup, you want to wait another couple of minutes and repeat it. Brad: Yeah. So, let's say you've been diagnosed, you've know you've got high blood pressure or you know you're in the elevated stage, stage one, you're going to work with exercise and diet. We are not nutritionists, we're not dieticians, but we can give you some good, solid, basic introductory. And we talked about the salt already. Any other things besides looking at making sure there's not much salt? Chris: Yeah, you're going to want to go with lots of fruits and veggies, lean protein. You just don't want tons and tons of basically animal fat or if you're a vegetarian or vegan, obviously you want to get your protein sources through nuts and things of that nature, soy. So, there's a lot of good things that are actually heart-healthy in that. And like I said, vegetarians, I always kind of liked because you know, they generally are eating a lot of the right things. It's hard to meet somebody that's having a lot of health problems when they're vegetarian. Not that you can't have lean meats and protein. To me, I couldn't live without it. I need to have meat. I would not feel right. Maybe even be a crabby person. Brad: And that's a personal thing, Chris: Exactly. Brad: You can work around that. As far as exercise, we did mention walking. But start out slow. I mean, there are some people, they may be overweight already, very sedentary and they'll go of for a 10-minute walk, could just literally be exhaustive. So, you might start out with a two or three-minute walk. Chris: Exactly. Brad: And build it up week to week. My typical rule of thumb for people who are starting out exercising like that, is not more than 10% increase per week. Chris: Correct. Brad: So, if you walked, let's make it easy, 10 blocks week one, week two you're going to go 11 blocks. Chris: 11 blocks. Brad: That's 10%. And so it's like a slow and you know, you don't have to do the math, it doesn't need to be perfect. Chris: No. But you know its mental math, it might stimulate the brain too. So, that's always good. Brad: Well, there you go, exactly. So, start out slow, it can be walking, if you want to get into jogging, stationary bike, things of that nature, you can do inside the house are all acceptable. Chris: Yard work. I mean, raking leaves. This time of the year eventually we're going to be shoveling because we're up here in Wisconsin, or Minnesota. It's one of those things where anything that you find an activity that you can gravitate to, that you enjoy, I think that's really the most important thing. Brad: There you go. Chris: You can repeat it and do it day in and day out where you're not thinking it's a chore. You want to just say, hey I really look forward to getting my daily walk, hey, I look forward to getting out in the garden or I look forward to pushing my lawn mower. There's lots of things that people can do and it can be resistance training, it can be Pilates, it can be Yoga. I mean, there's a lot of good things that happen with different forms of exercise. Brad: So, you say resistance training, it can be weights, but you don't have to have weights, you can use stretch bands in your house. You don't have to go and spend a lot of money. It's just a matter of doing it. There's a lot of YouTube videos, just go to Bob and Brad we've got a lot of exercises. Chris: A couple of videos. Brad: Yeah. Mostly with stretch bands. We don't do much with weights. Just not what Bob and I have a history of doing personally as well as clinically. It's a great way to exercise with your balance, strength, a number of things there. I do want to talk a little bit more about because we didn't touch on like diet and far as specialty foods, not specialty, but flaxseed. We actually did a video. Bob's wife did some flaxseed diet; you can watch that video. They both say, boy, her blood pressure came down as a result of it. What's the science or what does the research say about things like that? Chris: Yeah, you know, it’s a little bit of a mixed review, but I think more positive than negative. I do think that with flaxseed and flaxseed oil, both products may be used, it's got Alpha-linolenic acid, that's the active ingredient and it's the big fancy term for your Omega-3s, the healthy fatty acids that kind of help to maybe keep blood vessels more supple. They may help to lower cholesterol. They may help to kind of lower your blood pressure. So, with these ingredients, there's a couple of different ways you can attack it. Some people like the oil, some people like capsules, some people can grind up the seeds and put it in their food. You can bake it; you can throw it in your oatmeal. So, there's a lot of healthy ways that you can add flax to your diet and actually get some really good positive benefits. With consistent use, that's where I think you might see the blood pressure lowering effects occur. Brad: And this is one of the things, if I understand this right, there's really no negative effect. Maybe the research shows it doesn't do anything, but is it going to do any bad thing, bad side effect? Chris: Generally, it sometimes can cause a little bit of GI side effects but that is so rare and so remote. And I mean you'd probably have to be throwing too much flax, you'd be taking a quarter of a cup. Brad: Shoveling it in. Chris: Yeah. So, a little too much. Brad: So, flaxseed is a healthy thing. Chris: I would call it a thumbs up. I don't think it can do anything wrong. It's no different than adding fish to our diets. So, if you're eating fish two to three days a week, that's another really good healthy protein to put in your diet, particularly fatty fish like salmon and mackerel. Those types of things actually have those good essential fatty acids, which are very cardio protective. Brad: Sure. Chris: And when you see diets around the world, the Americanized diet doesn't have fish as a staple, maybe on the East coast and West coast where it's a little bit easier to get to it. But when you go to some of the Island nations or Japan in particular, they have some of the lowest incidences of blood pressure as a whole because of their diet. Brad: Japan? Chris: Japan. Brad: But they say it's from diet? Chris: Diet. They’ve done some studies, these are older studies, but when they've come to the United States and they've moved here for a while and they get acclimated to our Americanized diet, blood pressure goes up. So, a lot of that's from the salt and things that we eat so. Although there's kind of an interesting study in Northern Japan, that actually when we talk about essential hypertension, which is when we get to this stage one, we don't know why it's caused, but it is. But the Northern region of Japan, eats the saltiest diet per capita in the world. And that's just a small population of people, but they have so much salt in their diet, and there's a large increase in blood pressure. And then when they studied the people that just don't like salt, none of those guys have the blood pressure issues like the people that are on the high salt diets. Brad: Oh, so, they do? They're in Japan but they love salt and their blood pressure is higher? Chris: Yup. So, even though they're eating the fish and the protein, that salt or sodium just seems to be that limiting factor. So, it's something to be real mindful of. And when you're actually looking for levels, as we talk about food, a lot of people like flavor, so, salt is an easy thing to put in there. The standardized measure that they say is about 2300 milligrams is what we want. And a low salt diet is considered 1500 milligrams. Brad: But what does that mean? Chris: Yeah. So, it's kind of hard to figure that out. So, basically a level teaspoon full, if you took a measuring spoon and you filled it with those white crystals of table salt, and you scrape it off the top, that's about 2300 milligrams. So, that's your daily allotment for salt. So, when we talk about reading boxes and food stores and what the sodium content is in say cereal and bread, bread is like a sneaky ingredient that has a lot of sodium in it to make it taste good. Brad: Ah! Chris: Yeah. You want to look for low sodium options, especially when we're starting to get up into these higher levels. So, look for low sodium on your packaging. We want to get used to reading stuff in the grocery store before you buy it. Brad: So, bread's got a lot of salt in it? Chris: Yeah, it does it's kind of tricky. And you know, things like lean meats like turkey and ham even they have a lot of sodium in there. So, you want to be careful. Brad: As part of the processing? Chris: Yeah, that's the deli meats, so you want to be really careful with that. So, you'd be probably better off, you know, bake some chicken and use that for your sandwiches and things. Brad: Then you control what you put into your diet. Chris: When you're controlling it, exactly. Brad: Yeah. So, there's a lot of things diet wise that you can do just by being observant and reading the labels, and you may be reading a book or doing a little research, watching some YouTube videos. It can go a long way to getting that blood pressure down in a nice, relaxed manner. And I'm feeling very relaxed now, Chris. Chris: Yeah. Well, there you go. That's the other thing, stress is actually one of the other contributing factors of hypertension and blood pressure. So, it's something that's a lifestyle change. So, it's something that we do want to be mindful of. So, whether it's meditation, reading, taking a walk which again is more on the exercise, but you want to find some time to relax. If you have a stressful job, stressful lifestyle, a lot of us with this COVID situation, our lifestyles are very different these days, and maybe we can't be as active as we want or we're trying to work the job, trying to get the kids through their virtual learning modules. I mean, so there's stress on people that may not necessarily recognize that they're approaching some of these levels. So, just taking a few minutes to try and relax is actually still very important. It goes a long way with trying to help to keep that blood pressure under control. Brad: Right, yeah. That's from the neck up mostly. -Chris: It is, but there's so many things that, in our Americanized society and actually I would say worldwide, I think everybody is tending to get busier and busier based on things that I read. Taking a little bit of me time is important. Even though maybe as a busy parent or a single parent, it's not always that easy. You know, if you can find 15 minutes for yourself just to relax. Whether it's finding a book, doing a puzzle, just something. Staying relaxed, seems to have a very positive effect on blood pressure. Brad: Makes sense to me. All right. Well, I'm feeling relaxed now, I'm feeling much better, my blood pressure is down a little bit, I think I'm going to relax for the rest of the afternoon. Chris: All right, well sounds good. Brad: All right. Well, thank you for watching. And once again, we can fix anything except for- Chris: A broken heart, but we're trying. Brad: Yeah this fits right in. We're going to put it in the archives and into that category. Chris: Yeah, well hopefully we'll help a couple of people. Brad: Yeah. It's nothing to joke around about seriously, but we're doing a little bit of it here. Chris: Absolutely. Brad: All right, take care. Chris: Have a great day guys. 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How to Use a TENS Unit with Upper Back Pain. Correct Pad Placement. How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for Upper Back Pain (One Sided): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad directly below the pad (at least a pad’s width apart). Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain or place one pad on each side of the pain. General Guidelines for Mid-Back Pain (Both Sides): In our examples channel one has yellow pads and channel two has green pads. One pad from channel one in the upper right corner of the area of pain and one pad from channel one in lower left corner of the area of pain. One pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Upper Back Treatment: Use a tennis ball in a sock on the wall or on the floor. For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 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.