Physical well-being is vital for seniors, especially since their bones get brittle as they age. Seniors suffering from mobility issues or poor balance look for ways to assist them in addressing these problems. Depending on the severity of pain or ailment, here are a few ideas to help seniors restore their physical functions: 1. Light Exercise - movement doesn't have to be strenuous. A moderate amount should be helpful, like walking at a steady pace for a certain period. 2. Mobility Devices - moving around using assistive devices such as canes or walkers can keep them safer and more independent. 3. Physical Therapy - programs are usually designed to help increase flexibility and endurance, especially when seniors are recovering from illnesses or accidents. Bob and Brad have created a series of free programs designed to treat common therapy problems at home. Click here to find out more. 4. Nursing Homes - medical professionals provide the highest level of care for older adults to improve their overall wellness and quality of life. For seniors looking to move into a nursing home, Caring.com created this online directory to navigate the nearby facilities in Minnesota. Click here to learn more. Caring.com is the leading online destination for those seeking information and support as they care for aging parents, spouses, and other loved ones. We offer free expert help to families coping with the many challenges of caring for an aging loved one. To make that journey a little easier, we provide personal, one-on-one guidance with a Family Advisor, thousands of original articles, helpful tools, comprehensive Senior Living and Senior Care directories, and the collective wisdom of an involved community. Caring.com’s carefully researched and expert-reviewed content includes advice from a team of more than 50 trusted leaders in geriatric medicine, law, finance, housing, and other key areas of healthcare and eldercare. Caring.com’s seasoned management team, editors, and technical staff have decades of experience producing award-winning health and family media. But perhaps more importantly, nearly all of us have firsthand experience as caregivers. We know the role’s practical challenges, as well as its emotional ones, and we’re dedicated to guiding a fast-growing culture of new caregivers through both. *Update: Caring.com now has a Paying for Senior Care Guide available.

This article is a transcribed edited summary of a video Bob and Brad recorded in December of 2020. For the original video go to https://www.youtube.com/watch?v=MP3q9WbXuOs&t=3s Bob: Today, Brad, we're going to talk about how to know if you have a serious knee injury or problem. Now this could be after an injury or it could be just over time. Brad: Right, right. The aging process, which we know about, unfortunately. Bob: Right, we're well aware of. So let's go with number one, Brad, you see, you can't even bear weight on the leg. That's not a good sign. Brad: Right. Most people are going to figure that out, but there are some people, particularly some guys that may try to tough it out. It's like, “it's just a flesh wound. No big deal.” Bob: Right. Brad: Well, you might make it worse. Bob: That's an old saying, it's like flesh wound. Number two, it's really swollen. We're not talking about a little swollen around the kneecap or something like that. I mean, it really swelled up. Brad: It starts to look like a balloon, so to speak. Bob: Right. There you may have a ligament injury or the patella maybe slid out of place. Number three, you see an obvious deformity. Now this is one I think people would probably go in, if they see the knee's kind of off. Brad: Yeah, say your knee cap is over on the side. Bob: Right, or your bone is kind of hooked off to the side. Brad: Yeah, so pay attention to that. Bob: That's pretty obvious. Okay, number four, it feels like the knee buckles or gives way. Like a lot of times it may even feel like the shin bone is shifting. Like we have with an ACL injury. Brad: Or you have that thing where you’re walking and it just buckles. It's like, "What happened?” You know it just gives out. Bob: Right, exactly, the knee buckles. So number five, excessive bruising. You might have a quadriceps or hamstring tear down near the knee. Brad: Particularly if there's not an obvious reason, like you fell on the ice. That's one thing, but you know, you may strain a muscle and actually get some of that ecchymosis, or that bruising color from muscle being torn. Bob: Just generally as a rule of thumb, the more ecchymosis or black and blue that you see, usually the worse the injury was. Brad: Sure. Bob: Because you tore a lot of blood vessels. All right. Number six, you can't flatten the knee. You can't straighten it all the way out. It feels blocked. Brad: Yeah. It won't go down like it's supposed to, and it always used to. Oftentimes there may be pain associated with straightening the knee. Bob: Right. Sometimes it's swelling, but sometimes it could be your cartilage got tore and flipped a little bit. Brad: Yep, your meniscus injury. Bob: And it's blocking the movement. Number seven, you can't bend the knee. It would be the same thing. It could be cartilage, but you can compare your two knees. You can bend your one knee. Brad: One goes way up here, but the other one's stuck. Usually there is pain associated at the end range with both of those. Typical with a meniscus problem. Bob: Number eight, your knee gets stuck, or it kind of catches, when you're walking. Brad: Locks up. Bob: Number nine, you have pain in addition to redness and swelling in your knee. So this, we're worried about infection. So you have pain, but you have redness and swelling. Brad: Particularly if you've had a knee replacement, and there's no reason for it. Bob: Right, this happened with my mother-in-law. She went into the clinic three times before they diagnosed it. Brad: Really? Bob: NO, to a hospital three times, and they didn't even diagnose it there. They diagnosed it at another hospital and they diagnosed it within like 10 seconds. Brad: Oh, yeah. Bob: So I don't know. All right. Number 10, final one, the pain is just not getting better, or it's getting worse. Brad: So that constant ache that goes on for, you know, two or three weeks, and there's nothing that obviously makes it worse or better. And it's just hanging on there. Bob: And especially like night pain. You always want to get things like that checked out. Short one, Brad. I this may be a record for us. Brad: We could keep babbling for a while, see what happens. Bob: No, we'll stop for once. Remember Brad and I can fix just about anything- Brad: Except for- Bob: A broken heart Brad: But, we're working on it. Bob: All right. Brad: Absolutely, we continue to persevere. 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 Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad Steem It: 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: https://amzn.to/36pMekg​ Q2 Mini Massage Gun: https://amzn.to/3oSMBu9​ Handheld Massager: https://amzn.to/2TxZBqU​ 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​ Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi 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.

The Pros for buying the iReliev 5050 TEN: It is a TENS and EMS unit combined - See our video in the series entitled: What is the Difference between TENS (Transcutaneous Electrical Nerve Stimulation) and EMS (Electrical Muscle Stimulation)? Effective Powerful Compact Comes with Hard Carrying Case Comes with Belt Clip Holster Comes with 4 smaller self-adhesive electrode pads and 4 larger self-adhesive electrode pads Has two channels so it can run four smaller pads and two larger pads at once. It is rechargeable Display is back-lit Excellent instructions Two-year Warranty Get a sizeable Bob and Brad discount if you use this link below The Cons for buying the iReliev 5050 TENS unit: More expensive that other iReliev units Need to recharge the unit and the pods separately We are going to provide a step-by-step demonstration of how to use the 5050 TENS unit. If you purchase the 5050 TENS unit, the instructional book included with the purchase will provide the written instructions. 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.

Each year, nearly 2 million Americans seek medical attention for a painful heel. In the US alone, the annual economic cost for managing this common condition is in excess of $300 million (1). While the majority of patients with painful heels respond favorably within 3 months, nearly 10% of patients with painful heels become chronic, experiencing pain and limited function for more than 2 years after the initial diagnosis. Until recently, it was believed the most common cause of heel pain was an over-pronated foot. The logical assumption was lowering of the arch increased tensile strain on the plantar fascia causing chronic pain at the attachment of the plantar fascial to the calcaneus (Fig. 1). Because excessive lowering of the arch is so often managed with arch supports, orthotic intervention eventually became one of the most popular methods of managing chronic heel pain. Fig.1. Until recently, excessive lowering of the arch (A) was believed to increase tension in the plantar fascia (arrow B), producing heel pain by pulling on the plantar fascia’s attachment (star). While orthotic intervention is effective for reducing pain in a wide range of conditions (2), recent research shows that orthotics are not that effective for managing heel pain. In a comprehensive 2018 meta-analysis by Whittaker et al. (3), both over-the-counter and custom orthotics produced insignificant reductions in plantar heel pain when compared to sham orthotics. The reason for the surprising outcome is that excessive lowering of the arch and the development of heel pain are not that strongly correlated (4-6). To determine which biomechanical and activity-related factors might be associated with heel pain, Sullivan et al. (4) took 202 people with plantar heel pain and compared them to 70 asymptomatic control participants. The authors evaluated a wide range of causes for heel pain, including body mass index, foot and ankle muscle strength, calf endurance, ankle and first metatarsophalangeal joint dorsiflexion, foot alignment, occupational standing time, exercise level, and generalized hypermobility. As with other studies, Sullivan et al. (4) found that a more pronated foot was in no way correlated with the development of plantar heel pain. Additionally, chronic heel pain was not associated with tibialis posterior weakness, rearfoot eversion range of motion, dorsiflexion of the first metatarsophalangeal joint, generalized hypermobility, occupational standing time or even exercise level. The only factors that correlated with the development of heel pain were limited ankle dorsiflexion (measured both with knee straight and bent), weakness of the toe flexors, and weakness of the peroneal musculature. The authors of the study emphasize that because these 3 factors are modifiable, they should be targeted in the management of plantar heel pain. The observation by Sullivan et al. (4) that limited ankle dorsiflexion correlated with the development of heel pain was not surprising. Numerous studies have demonstrated that calf tightness correlates with the development of heel pain and that stretching is an effective form of managing chronic heel pain (7,8). It was also not surprising that heel pain patients also had weakness of their toe flexors. Wearing et al. (5) identified toe weakness as a possible cause/effect of chronic heel pain almost 15 years ago. Because flexor digitorum brevis can unload the plantar fascia during propulsion (Fig. 2), strengthening the toe muscles should be an integral part in the management of heel pain. The big surprise of the study was that peroneal strength so strongly correlated with heel pain. In fact, heel pain patients had eversion strength differences more than twice the effect size of any other strength deficit. Until this paper came out in 2015, no other paper had ever evaluated peroneal strength in heel pain patients. It is likely that peroneus longus plays the key role of plantarflexing the first metatarsal (Fig. 3), thereby unloading the medial band of the plantar fascia. The reduced strain placed on the plantar fascia associated with a strong peroneus longus contraction may limit the tensile strain transferred into the calcaneus. Fig. 2. Tension created in the FDB muscle can absorb force that would otherwise be placed on the plantar fascia strain. Since toe flexor and peroneal weakness are so strongly correlated with the development of heel pain, it is important to identify which exercises most effectively strengthen these 2 key muscle groups. Unfortunately, popular exercises such as the short foot exercise, marble pickups, and various elastic band exercises have been proven to produce negligible increases in toe flexor strength (9,10). In contrast, Goldmann et al. (11) recently demonstrated that exercising the toe muscles while they are in a stretched position produces dramatic increases in toe flexor strength. These authors had 15 subjects perform 4 sets of 5 isometric contractions (3-second contractions performed at 90% full effort with the toes dorsiflexed 25 degrees), 4 times per week for 7 weeks. At the end of the study, the subjects had toe flexor strength increases of nearly 40%, along with appreciable improvements in their horizontal jump distance. The authors theorized that maintaining the toe muscles in a stretched position during the isometric contractions created an “optimal overlap of the contractile elements” thereby allowing for enhanced muscle hypertrophy. Prior research has also shown that exercising muscles in their lengthened positions produces significantly greater strength gains than exercising the same muscles while they are in their midline or shortened positions (12). One option for strengthening both the toe flexors and peroneal muscles is to have the patient stand with an AirEx balance pad beneath each foot with their hips abducted 45° and their knees flexed. This position effectively inverts the rearfoot relative to the leg thereby stressing the peroneal muscles. Another very effective way to strengthen both the toe flexors and peroneals in their lengthened positions is with the ToePro exercise platform. This platform has a built-in elevation beneath the toes to duplicate the dorsiflexion angles used in the study by Goldmann et al. (9). The device also has a negative lateral slant that places the peroneal muscles in their lengthened positions (Fig. 4). Performing 4 sets of 25 repetitions 3 times per week very effectively strengthens the 2 muscle groups associated with chronic heel pain. Regardless of which strengthening Fig. 3. Concentric contraction of the intervention is chosen, the latest peroneus longus muscle (A) plantarflexes research shows that evaluating and the first metatarsal during propulsion (B), increasing strength in the toe flexors and thereby reducing strain on the medial band peroneal muscles increasing strength in of the plantar fascia. the toe flexors and peroneal muscles should be an important part in the management of every patient presenting with heel pain. Fig. 4. The ToePro Exercise Platform. The platform angles down on each side to exercise the peroneal muscles in their lengthened positions (arrows in A). Also, the forward crest places the toe flexors in their lengthened positions, allowing for improved strength gains (B). If you are interested in Tom's book Injury Free Running visit: https://amzn.to/2TLzEas References: 1. Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop. 2010;39(5):227-231 2. Malkin K, et al. A year of foot and ankle orthotic provision for adults: Prospective consultations data, with patient satisfaction survey. The Foot. 2008;18:75-83. 3. Whittaker GA, Munteanu SE, Menz HB, et al. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med 2018;52:322–8. 4. Sullivan J, et al. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot & Ankle International. 2015, Vol. 36(1) 37 –45. 5. Wearing SC, Smeathers JE, Yates B, et al. Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis. Med Sci Sports Exerc. 2004;36:1761-1767 6. Allen RH, Gross MT. Toe flexors strength and passive extension range of motion of the first metatarsophalangeal joint in individuals with plantar fasciitis. J Orthop Sports Phys Ther. 2003;33:468-478. 7. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85A(5):872-877. 8. DiGiovanni B, Nawoczenski D, Lintal M, et al. Tissue specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg. 2003;85- A:1270–1277. 9. Houck J, Seidl L, Montgomery A. Can foot exercises alter foot posture, strength, and walking foot pressure patterns in people with severe flat foot? Foot & Ankle Orthopaedics. September 18, 2017. 10. Spink, M.J., et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomized controlled trial. BMJ, 2011; 342:d3411. 11. Goldmann J, Maximilian Sanno, Steffen Willwacher, et al. The potential of toe flexor muscles to enhance performance, Journal of Sports Sciences. 2012;31:424-433. 12. Noorkoiv M, Kazunori K, Blazevich A. Neuromuscular adaptations associated with knee joint angle-specific force change. Med Sci Sports Exerc. 2014;46:1525–1537.

This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2021. For the original video go to https://www.youtube.com/watch?v=iI2PSkuDCvg&t=478s Bob: Today we are going to talk about how to get your stomach slim. Brad: SLIM! Tighten it up, Bob. Bob: Slim and tight. I almost said slim and trim. Brad: Well, it could be that too. Bob: In 3 weeks, you’re not going to need to do sit-ups and you’re not going to need to go to the floor. You can do this in your chair? Brad: Yeah, seated position, Bob. It’s very convenient. You have to do it properly though. We want to get that tight tummy, you know, and get it slim and trim. We need to get those muscles toned up. There’s a lot of people who really just do not want to go down on the floor. Bob: Or they can’t get on the floor. Brad: Exactly. Now this can be done at work or at home. You’re not going to do this in a recliner or one of those soft chairs. You need a firm chair. Something that offers good posture. I’m going to use this as a desk. We are going to use a desk an option for resistance. What we are going to do is isometrics to the three primary muscle groups that we are going to address. One is the transverse abdominus, and they are a deep flat muscle. I always think of it like a pancake. It’s a lot of posture and we use that to tighten up and it supports the back and helps with your breathing. There’s a number of things that these abdominal muscles do. Bob: I think you just mentioned to me earlier that it’s like a corset. Brad: Yeah, it wraps around, and goes from the sides to the middle. We are going to address that one first, but we also then will do what everyone knows about, the rectus. The six-pack muscle group which goes up and down. Bob: Rectus damn near killed us. That’s an old joke LOL. Brad: Why, Bob, why? I’m in the middle of a roll here. Bob: Alright, alright, go ahead, keep going. Brad: Then the oblique, the fibers that go kind of at that angle. We are going to hit all three of those. Bob: As Brad alluded to, these all go around and attach into the fascia of the back so if you improve these, you can protect your back. Brad: Back pain, exactly. That’s another benefit to this as well. We are going to look at that first one, that transverse. If you go to your ASIS’s there’s those bones sticking out right about at the beltline. You’re going to go in a little bit, not too far, an inch in, and a little bit down and just feel there. Then what I want you to do, you’re going to feel those muscles contract. You feel them, Bob? Bob: Well, I’m just thinking you could probably kind of just go from the belly button out a little bit, right? Brad: Yeah, we want to get past the rectus. Bob: Oh sure, out a little farther. Brad: Yeah, a little bit. Bob: So, go from the belly button and go out. Brad: The visual cue I want you to think about is taking your belly button and sink it in and push it into your spine. In and up. You don’t have to put your fingers there it just gives you some feedback. Bob: For the first time. Brad: Right. Then you’re going to take your phone, put it right on the desk or somewhere where you can see it. Set it for 10 seconds with a little ringer on there, or just watch a clock or you can count as well. For ten seconds you’re going to hold an isometric. So, it’s in and hold. I’m just looking at the clock here. We still have an old analog clock. You’ll feel those muscles get tight and then relax. Bob: It’s nice, you can actually be working, Brad while doing this. Just tighten without your hands touching it. Brad: Yeah, but if you’re reading, you’re not focusing enough. You’re going to have to take a break to do it right. Bob: They’ll find muscles tighten up or strengthen a lot better if you are focused right on the muscle. Brad: Exactly. You really couldn’t do your work and read and do it properly to get the benefits. Bob: You could make it look like you’re working, ha-ha. Brad: You can do that again, 10 seconds, 3 sets. Take a little break in between. We are going to do each of those and as you get stronger, because if you’re being completely sedentary, you’ll get sore stomach muscles the next day from this. Bob: Surprisingly enough. Brad: Yeah! Especially if you’re really working them hard; the way you should be. Let’s go to the next one. So, you’ll do that 3 times, 10 seconds, little break in between. Next one is the rectus. You don’t have to do them in this order, but I picked this order. The six pack or the 12 pack. In Wisconsin we called it a 12 pack. Bob: You would. Brad: Whatever. It’s a Wisconsin joke. Sorry about that. Anyways, rectus, now this one, I want you to think about bringing your knees up so that gets them going and then you’re going to flex forward. If you have a desk, I’m going to use the desk for resistance. I’m not going to round forward, nice upright posture. Bob: Yeah, keep the back straight. Brad: Lean forward, bring the knees up. You could also do it with your hands right on your knees as well. I’m going to show you one other option which is better than this, but you need a ball for it. So, we’re going to push and again we are going to hold for 10 seconds and then you’re going to relax. Do that three times. If you’ve already got a toned muscle to a certain degree, you can go up to 20 seconds. Bob: So, are you trying to lift the legs up too? Brad: Yeah. Bob: So, you are kind of pushing up with your legs and lifting your heels off the floor. Brad: Exactly, good point, make that clear. If you happen to have a squishy ball. You could use a pillow too. The nice thing about using this ball is it gives you some feedback. It just seems like you feel like you’re doing more if you have some feedback. You can see, I’m squishing the ball. Bob: And lifting the knees up. Brad: Yeah, exactly. You could put the ball under the desk and push it into there and that works too. Just an idea. It makes the exercise work better. Three sets of those and finally we need those oblique muscles that come in at an angle. I just have the desk here because I think you can do it at work. You can do these two or three times a day. You’re going to take the right hand over the left knee. Then bring the left knee up and to the right and push into it at the same time and rotate. Rotate and kind of push down. Bob: Oh man, you really do feel that. Brad: Oh, absolutely. I like the ball if you want to get the ball in there. Bob: If you do rotate, still try to keep your back straight. Brad: Yes, don't hunch over. It isolates pretty well. These are good exercises. Bob: I’m surprised. Brad: Now on this one, you have to go 10 seconds to the right, and then 10 seconds to the left. So, you have twice as many to do. You can’t just do 3 sets of 10. Go one direction and then the other. So, you’re going to do those all 3 x 10 secs, do it once. See if you get sore the next day. As things go on, try to do this at least three times a day. In the morning, afternoon and the evening. It’s going to get those muscles to pull in, but there’s one big thing that is not going to happen. If you do this, that fat that’s around those muscles isn’t going to fall off by just doing this. Bob: It’s not going to tighten up. Brad: This is not a big calorie-burner. It’s going to burn calories. It’s going to tone muscle. You’re going to have to change your diet, but that’s okay. Bob: Yes, diet is number one if you want to lose fat. Brad: Yes. I hate to say this, there are channels out there that say you’re going to burn off these calories by this simple way or drink their little magic juice and it’ll fall off in a week. We can’t promote that kind of stuff because it’s simply not true. Bob: One of the conspiracy theories is that food companies came up with the idea that you can exercise to get the fat off because they didn’t want you blaming their food. Seriously, I’ve read that a couple of times. So, let’s name some of the foods, Brad, that you should try to cut down. You really want to cut down on sugar drinks. Brad: Absolutely. I say just cut them out. Bob is saying, “No,” but I’m saying you get one cheat day. You have three weeks to do this. This is not a big deal. You can do it. Cut the sugar drinks out. No juice. Orange juice, I used to think was so healthy. It has a ton of sugar in it. Bob: Actually, oranges are fine, but orange juice really concentrates the sugar. Brad: You have to look at the ingredients. I’m just saying, eat an orange if you want the vitamins out of it instead of the juice. It’s not processed. Now, this is big for some people. It wasn’t big for me to stop but I quit eating bread. Well, I didn’t quit, but 90%. I’ll still have it occasionally. No pizza. Bob: There’s a lot of carbs in pizza. I’m not saying you can’t, but it’s going to help you if you want to lose weight, to cut them out. Both Brad and I cut down carbs, and we both lost a lot of weight. Brad: You’d be amazed. Then no sugar, no candy, all that garbage stuff. You’ve got to get the real food. It’s going to work, and if you happen to have this in your diet on a regular basis and you cut it out, you’re going to be amazed after the first week. You won’t notice it the first few days and you’re thinking, “Oh, where it is going?” But by that third week you’re going to say, “Oh.” You’re going to be able to eat volume. You’re going to be able to fill up eating good food. Not this stuff, but vegetables, meats, fish. Bob: You didn’t mention the pasta or ice cream. Brad: I was going to save that for you. Bob: You have to cut down on those too. I was a pasta fiend. Brad: I never was. That was easy for me to cut it out, but the ice cream was hard. Bob: There are healthy pastas you can get now though. They are made out of something else. Brad: Yeah, then you got a lot of fiber. It’s easier for me to just ignore it but, if you like pasta there are options for it. You’re going to slim and get tighter doing these exercises and you’re really focused on that diet. You’re going to be amazed how much better you look and feel. 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 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: COMING SOON! 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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 the TENS Unit for Elbow Pain (Tennis Elbow, Golfer’s Elbow, General Elbow Pain): 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, or click the link below. Under the series look for the videos with the 1313, 5050, and 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 a Small Area of Elbow Pain (Tennis Elbow or Golfer’s Elbow): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or 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. General Guidelines for a Large Area of Pain: In our examples channel one has yellow pads and channel two has green pads. See Photo for Elbow Example 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 upper left corner of the pain and one pad in lower right corner of the pain. This arrangement forms an X pattern. General Guidelines for Pain Referred from Another Area: An example would be elbow pain that is coming (referred) from the neck. Using channel one, place the two pads along the nerve pathway. 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. One treatment recommendation: Cross-fiber friction massage 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.

New Research Shows the Best Way to Warm Up May be to Lengthen and Strengthen Your Tendons. Twenty years ago, when a group of runners got together for a workout, a few would casually be stretching either their hamstrings or calves, but the stretches seemed pretty random and inconsistent. It was almost as if the runners knew they were supposed to stretch, but didn’t really want to. Now, it’s not uncommon to see runners performing elaborate stretches with special straps and/or splayed out moving back and forth over oddly-shaped foam rollers. The question is, are the new pre-exercise warm-ups actually worth the time and energy spent performing them? And if so, should the stretches and/or foam rolling be performed before or after a workout? In February of 2019, Smith et al. (1) evaluated the acute and long-term changes in calf flexibility following six weeks of static stretching, foam rolling, or combination of static stretching and foam rolling. At the end of the study, all three training groups had increased their calf flexibility by nearly 20%, with no differences between the three groups. The authors reference additional studies showing that foam rolling in particular can significantly increase range of motion, especially when it is performed more vigorously (2). The important question is: does increasing your muscles’ range of motion reduce injury rates? Without doubt, the overwhelming body of research says absolutely not (3,4). The one exception to this is a study by Daniel Pereles (5), who had almost 3000 recreational runners assigned to either a stretch or non-stretching pre-run routine. Not surprisingly, there was no significant difference in injury rates between the runners who stretched versus the runners who didn’t stretch (which is typical of all studies on stretching). However, if a runner who routinely stretched was assigned to the non-stretch protocol, he/she was nearly twice as likely to sustain a running injury. Because of the number of participants, this single study proves that if you feel that stretching reduces your risk of injury, you should continue to stretch in spite of what experts tell you. The same is true for foam rolling: if you feel it helps you avoid injuries, you’re probably right. While foam rolling immediately before exercise has been shown to produce a temporary reduction in muscle stiffness that may reduce the risk of injury (6), other experts recommend foam rolling after a workout (7), as the vigorous massage associated with foam rolling can raise cortisol levels, which acts as a natural anti-inflammatory to accelerate recovery. In my opinion, if a runner really wants to decrease his or her injury rate, they would be better off ignoring the flexibility of their muscles and do everything they can to improve the strength and flexibility of their tendons. Until recently, it was believed that muscles lengthen then suddenly shorten to generate the force necessary to propel you forward while running. To prove otherwise, researchers from Brown University placed special sensors in the calf muscles and Achilles tendons of turkeys and forced them to run on treadmills (8). The sensors revealed that just before the calf muscles generated peak force while running, they isometrically tensed forcing the Achilles tendon to rapidly lengthen and snap back to return energy. The lengthening Achilles tendon essentially acted as a rubber band, storing energy from the forward motion of the leg only to return it to improve efficiency while running. The Achilles tendon is especially well suited for storing and returning energy as it rotates nearly 90° before attaching, so it can store energy like a spring. In young athletes, tendons are so efficient they are able to return 93% of the force needed to stretch them. Interestingly, the capacity of tendons to store and return energy decreases with age (i.e. running economy is significantly reduced in older runners because muscles are unable to compensate for the stiffer tendons) and in immature tendons (explaining why kids are so bad at sprinting). The reduced elasticity present in older tendons explains why the perceived effort associated with running increases as we age, and why we slow down so much as we get older. Resilient tendons also protect muscles from injury as a flexible tendon acts as a buffer to store energy that would otherwise go into the neighboring muscle. The good news is that researchers are coming up with ways to specifically improve tendon flexibility. Using ultrasonography to evaluate muscle and tendon flexibility, Anthony Kay and his colleagues from the UK had 17 volunteers perform a variety of different stretches, including conventional static stretches and the more complicated contract/relax stretches, while observing real-time changes in muscle and tendon resiliency (9). Not surprisingly, conventional static stretches slightly improved muscle flexibility but had no effect on tendon resiliency. In contrast, stretches using muscle contractions prior to initiating a stretch improved muscle flexibility about the same amount as static stretching, but also increased tendon flexibility by nearly 20%. The authors claim the most effective way to improve tendon flexibility is to place a muscle in a midline position and isometrically tense it for 5 seconds. This is immediately followed with a 10-second stretch. You then return to the original starting position, tense the muscle again for 5 seconds, and repeat the stretch for another 10 seconds (see Fig. 1). When performed 3 times, the entire stretching routine takes less than a minute and results in substantial improvements in both muscle and tendon resiliency. Although the illustration depicts the stretch being performed on the Achilles tendon, it can be modified to be done on any tendon. Because the muscle is always tensed while in a midline position, I refer to this stretching technique as “neutral position stretching.” Figure 1. Using a belt or strap, place your ankle at a 90° angle to your leg and isometrically tense your calf for 5 seconds (isometric contractions involve tensing a muscle with no movement of the joint). Follow the 5-second contraction with a 10-second stretch by pulling with your hands (arrows). When repeated 3 times, this routine will improve tendon flexibility by 20% (9). While neutral position stretching is good for improving tendon flexibility, several papers have shown you can significantly increase tendon strength by performing isometric contractions with the muscle maintained in its lengthened position (10,11). Using the Achilles tendon as an example, stand on the stairway while holding a weight in one hand (or wearing a weighted backpack) and lower your heel so it is positioned slightly below horizontal (Fig. 2). You should use enough weight so you are fatigued after 15 seconds. Repeat this maneuver 6 times on each leg. In just a few months, this exercise routine has been proven to markedly increase tendon resiliency and strength (11). While neutral position stretching is good for improving tendon flexibility, several papers have shown you can significantly increase tendon strength by performing isometric contractions with the muscle maintained in its lengthened position (10,11). Using the Achilles tendon as an example, stand on the stairway while holding a weight in one hand (or wearing a weighted backpack) and lower your heel so it is positioned slightly below horizontal (Fig. 2). You should use enough weight so you are fatigued after 15 seconds. Repeat this maneuver 6 times on each leg. In just a few months, this exercise routine has been proven to markedly increase tendon resiliency and strength (11). Figure 2. While wearing a weighted backpack or holding a weight in your hand, make yourself stable by holding onto a nearby wall or handrail (A), and slowly lower your heel off the edge of a stair step so it is slightly lower than horizontal (B). Hold this position for 15 seconds and repeat 6 times on each leg. There should be enough weight so you are fatigued after each repetition. Another option is to perform the exercise on a ToePro platform (C), which works the tendons of the toes, calves, and peroneals while they are all in their lengthened positions (arrow). If you are interested in Tom's book Injury Free Running visit: https://amzn.to/2TLzEas References: 1. Smith J, Washell B, Aini M, et al. Effects of static stretching and foam rolling on ankle dorsiflexion range of motion. Med Sci Sports Exerc. Feb 23, 2019. 2. Škarabot J, Beardsley C, Štirn I. Comparing the effects of self-myofascial release with static stretching on ankle rangeof-motion in adolescent athletes. Int J Sports Phys Ther. 2015;10:203–12. 3. Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ, Davis IS, Lopes AD. What are the main risk factors for running-related injuries? Sports Med. 2014;44:1153-1163. 4. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469-480. 5. Pereles D, Roth A, Thompson D. A large, randomized, prospective study of the impact of a pre-run stretch on the risk of injury on teenage and older runners. USATF Press Release 2012. 6. Morales-Artacho A, Lacourpaille L, Guilhem G. Effects of warm-up on hamstring muscles stiffness: cycling vs foam rolling. Scand J Med Sci Sports. 2017; 1-11. 7. Macdonald G, Button D, Drinkwater E, Behm D. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46:131–142. 8. Roberts, T, Marsh, R, Weyand, P, et al. Muscular force in running turkeys: the economy of minimizing work. Science. 1997;275:1113–1115. 9. Kay A, Husbands-Beasley J, Blazevich A. Effects of PNF, static stretch, and isometric contractions on muscle-tendon mechanics. Med Sci Sports Exerc. 2015,47:2181-2190. 10. Oranchuk D, Storey A, Nelson A, Cronin J. Isometric training and long-term adaptations: Effects of muscle length, intensity, and intent: A systematic review. Scand J Med Sci Sports. Dec 2018. 11. Kubo K, Ohgo K, Takeishi R, et al. Effects of isometric training at different knee angles on the muscle–tendon complex in vivo. Scand J Med Sci Sports. 2006;16:159-167.

This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2017. For the original video go to https://www.youtube.com/watch?v=xORPFVXv6_M&t=187s Bob: Okay, Brad, we are going to talk about big toe pain and stiffness. It’s also known as hallux rigidus. We are going to show you 10 steps to cure this. Brad: Exactly. Bob, we should be correct in our terminology. The big toe is really not the big toe. It’s called the great toe. Bob: The great toe! Like the great Brad Heineck. Brad: Oh, wow. It’s good to be compared to the toe. Bob: The captain. He’s the captain of the foot. Brad: Anatomically, it is the great toe. Most people call it the big toe though, so we will say that. So, the first MPT joint; metatarsal phalanges. This is the phalanges; your toes are the phalange and the metatarsal is this long bone right here and this black line represents the joint with the motion. That’s the joint that gets the pain, the stiffness, the arthritis and worst-case scenario, which happened to a friend of mine, they actually fused the joint together. So she has no more range of motion. Bob: Surgically they fused it? Brad: Yes. Bob: Because she was having so much pain? Brad: Yep. Bob: Not a minor thing because you can’t take a step without that flexing. Brad: It really changes how you walk, your balance; everything. It’s the last thing you want to do, so, we’re going to show you some of the things you’re going to do to prevent the surgery. The earlier you get at this, the better off you are. So as soon as your toe is getting stiff, we are going to talk about some things to do. One is, what is causing the pain in the joint? There could be a number of things, but one of the big things is footwear. If you have a shoe, and they come in at a tight angle, or a narrow toe, and your big toe is being pushed inward. Also with high heels, that’s even a double whammy because you have the pointed shoes and the weight of your body pushing down. This is just one of the problems. There are other problems that can go along with this, but we are going to stick to the subject. Bob: It’s a real problem with fashion. My wife worked as a manager at a hotel, and she wore high heels every night with the narrow toe base and now she’s got bunions. That’s all in the same family, wouldn't you say, Brad. Brad: The other thing that happens is it takes the joint out of alignment but also there’s tendons that make your toe push down which is important for walking and balance. The tendons have two little bones, on the bottom of the foot, and there’s grooves that those bones need to go into to work properly and when the toe gets pushed over, they go out of alignment so that kind of compounds the problem. Bob: So, everything is out of alignment. The ligament, the tendon and bones. Brad: The joint itself. So, get a shoe with a wide toe box. And don’t get high heels; you have to stay away from that if you happened to wear those in the past. Also, if you’re walking and you’re to the point where every time you walk, that joint bends and it’s painful and it’s really interrupting your life, you’re going to want to get a shoe that’s really stiff. If you pick a shoe up and you put your one finger at the end and you can bend it easily, that’s not very stiff. If you get a shoe that is stiff, or a motion control shoe. If you talk to a salesperson that knows their shoes, they’ll know exactly what you’re talking about. They are typically walking shoes. Otherwise, you want to put an insert inside to stiffen up the shoe, you can get a carbon fiber insert. That you’re going to have to look around for. I don’t know if you are going to find that at any old store. But it’s an insert that slips in and it makes the shoe base more rigid. Bob: So, wide toe box, rigid insert, no heels. Brad: Right, exactly. The next thing is getting that joint moving again. What happens is, the joint will become sore and irritated and since it’s sore when you’re moving it, you move it less. Anytime you move a joint less, it becomes more arthritic, more painful and tighter. It’s a compounding thing and eventually you get to the point where you can hardly touch it and just laying in bed and having the covers touching it will make it painful and then it’s hard to sleep. We want to get that joint moving. First thing, if the toe is going laterally or toward the other toes, we want to pull that toe back in line and do some stretches on it. There are some muscles and connected connective tissue between the toes you want to get and stretch it out. Do it within reason. If it’s really sharp pain, you’re going to have to be gentle. This isn’t going to just take one treatment. It may take a number of days or weeks to get this feeling better. Bob: Is this a bad time to bring this up, where you may put gauze in place? Brad: It’s a perfect time! You can just take some gauze and roll it up and you can put that in between your toes. You can buy this gauze at any pharmacy. Bob: Dr. Scholl’s has these little rubbery type things that you can stick in between your toes. Brad: That’ll hold the toe in place. Bob: You want to get that toe realigned again. Brad: Exactly. You'd have your wide toe shoe and this can be used in addition. It should feel better as a result of it. Bob: That’s going to work on it all day long, as opposed to the short time your during the stretch now. Brad: Exactly. Now the next one is how to mobilize this. Now this is where therapists are trained to do joint mobilization. However, I think this is simple enough that you can do this at home. Bob: You certainly can try some of these. Brad: You have the tarsal bone, it’s a solid bone. You can grab it and feel it. Get a hold of that bone. Thumb on top, fingers on bottom. It’s right by the big toe. Bob: Lined up with the big toe. Along the same line. Brad: So that stabilizes it. Imagine that’s like a vice and I'm just going to hold it steady. Now we are going to work this joint where the black line is. Now, you don’t have to do these in this order, but the first thing I do is relax this foot and pull the toe. Pull your toe up and give it some traction. Hold that for 10-20 seconds. You can do it longer if you can tolerate it and don’t get cramps in your fingers. Brad: The next one I’m going to do, and you can combine it with some of these, I’m going to do some rotations. Rotate to the right and rotate to the left. I’m going to turn my foot this way. This is like if you imagine a nut on a screw that is all rusted and you have to work it back and forth to loosen it. That’s kind of what you are doing with your toe joint. Bob: Now, if it really hurts in one direction, I would probably work it the other way more. Brad: Good point, Bob, exactly. That’s why it’s nice to have two people doing this. One person forgets to say something but the other usually remembers. If I go in one direction and it’s really painful but going the opposite way I get more range of motion, I’ll go that way more. Then I’ll go back to the other direction and see if it loosened up. Bob: It often does too. Brad: The next thing I’m going to do is called inferior superior motion. The foot stays stationary and the toe goes up and down. It’s going to be very limited, not a lot of motion there. But you get that joint moving. Again, if it really hurts one way, work the other way more. Then you go back and assess the sore direction again and eventually it’ll get looser. Bob: It’s amazing how much this helps. It shocks me sometimes. You just start moving that joint around a little bit and it helps. Brad: Then we go to the major motions. The dorsiflexion or extension and the plantar flexion. I’ll go up and stabilize here and then stretch it. You should be able to get about 90 degrees on a normal toe. If you’re only going up 10-20 degrees you’ve got some work to do. Bob: By the way, this is something we also do with plantar fasciitis. If you have plantar fasciitis you often find that your toe is tight and will not go up into that extension. It’s a good one to go ahead and stretch it, pressure on, pressure off. Brad: After that, you may get flared up a little bit. You may need to take some ibuprofen. Bob: You can ice it too. Brad: Yes. That may take a week or two and by the time you get the toe moving again where you can actively move it, it’s getting closer to that 90 degree or at least halfway there. Then we want to start strengthening it again. Then we go to our favorite, stretch band, TheraBand; whatever you want to call it. Get just around that big toe, this is kind of cute. Bob: The great toe. Brad: The great toe! You should get the yellow band. This red one is a little aggressive. Bob: If this hurts, you can’t do it. Brad: Right right. There’s another technique where you put a towel on the floor and try to take all your toes and scrunch the towel. Put wrinkles in the towel with your toes. Another one you can do, get something under your toe (like shaking dice) and you try and squeeze it. Pick it up with your toes. You can go over there and put it down. If you have four or five dice, you pick them up and move them. Just for something to do and it’s working those muscles. Brad: Remember, that downward motion on that toe is really important for balance. The upward motion is important when you walk. The toe needs that normal range of motion, so you have a normal walking pattern, or gait. If you have the great toe pain, hallux rigidus, that’s the whole treatment method to get through. Good luck with it! We want you out there walking smoothly. 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 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: COMING SOON! 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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 the TENS Unit for Shoulder Pain (Impingement, Rotator Cuff Injury, Arthritis): 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, or click the link below. Under the series look for the videos with the 1313, 5050, and 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 a Small Area of Shoulder Pain: Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or directly below the pad (at least a pad’s width apart). See Photo for Shoulder Example 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. See Photo for Shoulder Example General Guidelines for a Large Area of Pain: In our examples, channel one has yellow pads and channel two has green pads. Option one: one pad from channel one placed above the area of pain and one pad placed below the area. One pad from channel two placed in front of the area of pain and another pad from channel two placed behind the area of pain. This arrangement forms a cross pattern. Option two: one pad from channel one in the upper right corner of the area of pain and one pad from channel one in the 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. Exercise: Statue of Liberty or hanging. 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 If you are interested in the Booyah Stik visit: https://store.bobandbrad.com/collections/products/products/bob-brad-booyah-stik 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.

Dynamic warm-up drills may be the single best way to prevent injuries and improve performance. As a rule, runners tend to be well informed when it comes to understanding the best ways to stay healthy and avoid injury. Most runners pay close attention to their diet, monitor their weekly mileage, and replace their running shoes at regular intervals. Yet, when a group of nearly 100 experienced recreational runners were re­cently asked to name the most common cause for running-related injuries, the overwhelming majority of them cited “failure to stretch regularly” as the most common cause of running injuries(1). The authors of this study were concerned because the runners seemed to be unaware of the overwhelming body of research showing that stretching does not alter injury rates(2,3). To make matters worse, the belief that stretching protects you from injury is becoming even more prevalent(4). So, with dozens of studies proving that stretching is a waste of time, why do so many experienced runners con­tinue to stretch? To begin with, they may be right. While researchers are quick to point out that conventional static stretching is useless, Daniel Pereles and colleagues recently proved that runners intuitively know whether or not they should stretch5. These authors randomly assigned 2,729 recreational runners to either a stretching or a non-stretching pre-run routine. Not surprisingly, there was no significant difference in injury rates between the runners who stretched versus the runners who didn’t stretch (which is typical of all studies on stretching). However, if a runner who routinely stretched was assigned to the non-stretch protocol, he/she was nearly twice as likely to sustain a running injury. Because of the number of participants, this single study proves that if you feel that stretching reduces your risk of injury, you should continue to stretch in spite of what experts tell you. The somewhat surprising outcome associated with Daniel Pereles’s stretching study may have something to do with an inherent flaw in the way studies evaluating stretching and injury prevention are designed. Because of time constraints and compliance issues, almost every study on stretching has evaluated outcomes over a short period of time (usually less than 12 weeks). While research has shown that flexible people are less prone to ex­ercise-induced muscle damage6, other studies suggest that stretching for less than 3 months does not convert a stiff muscle into a flexible muscle. In fact, some great research proves that when stretched for just a few weeks, muscles respond by temporarily lengthening with no change in the muscle’s architecture(7). In order to physically lengthen muscles, some experts suggest it is necessary to stretch for four to six months. In theory, when a muscle is repeatedly stretched for several months, cellular changes take place within the muscle allowing for a permanent increase in flexibility. Animal studies have shown that the increased flexibility associ­ated with repeat stretching results from a lengthening of the connective tissue envelope surrounding the muscle fibers (the perimysium) and/or an increased number of sarcomeres being added to the ends of the muscle fibers(8) (Fig. 1). Apparently, converting a stiff muscle to a loose muscle is a long-term commitment. Rather than spending months attempting to convert your stiff muscles into flexible muscles (with no guarantee that this will actually change your potential for being injured), the easiest way to avoid injury is to increase your body temperature prior to running9. One of the few sports to take advantage of this research is professional football. Look at the sidelines of any NFL game and you’ll see players riding stationary bicycles prior to going out on the field. Because most runners do not have access to a stationary bike before they begin their routine run, the simplest way to increase your body temperature is to initially run with a slow jog. Slow running with a high cadence and a short stride length significantly decreases impact forces while your muscles gradually warm up. Since older runners tend to be stiffer, the length of time you spend warming up is age-dependent: 30 to 40-year-old runners should consider warming up for 5 to 10 minutes, while the 50 and older group should run slowly for up to 15 minutes. Another way to increase your body temperature is with active dynamic running drills (Fig. 2). Popular with elite and sub-elite runners, these drills allow you to slowly warm up your muscles and can even improve performance. A recent study found that compared to a control group, runners who performed 14 repetitions of each of the exercises listed in figure 2 had a 6% improvement in running endurance and a 3% increase in 3 km race perfor­mance (10). This research suggests that regardless of whether or not you incorporate static stretching, dynamic warm-up drills may be the single best way to prevent injuries and improve performance. Fig. 1. The components of a muscle. Reproduced from Injury-Free Running by Tom Michaud. Fig. 2. Dynamic stretching drills10.The abductor, or grapevine drills, were not part of the study but they are important for warming up the hip abductors so I’ve included them in the illustration. Reproduced from Injury-Free Running by Tom Michaud References: 1. Saragiotto B , Yamato TP, Lopes AD. What do recreational runners think about risk factors for running inju­ries? A descriptive study of their beliefs and opinions. J Orthop Sports Phys Ther. 2014;10:733-738. 2. Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ, Davis IS, Lopes AD. What are the main risk factors for running-related injuries? Sports Med. 2014;44:1153-1163. 3. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and deter­minants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469-480. 4. Herbert RD, de Noronha M. Stretching to pre vent or reduce muscle soreness after exercise. Cochrane Data­base Syst Rev. 2007: CD004577. http: //dx.doi.org/10.1002/14651858.CD004577. pub2. 5. Pereles D, Roth A, Thompson D. A large, randomized, prospective study of the impact of a pre-run stretch on the risk of in jury on teenage and older runners. USATF Press Release 2012. 6. Malachy P, McHugh M, Connolly D, et al. The role of passive muscle stiffness in symptoms of exercise-in­duced muscle damage. Am J Sports Med. 1999;27:594. 7. La Roche D, Connolly D. Effects of stretching on passive muscle tension and response to eccentric exercise. Am J Sports Med. 2006;34:1000-1007. 8. Kubo K, Kanehisa H, Kawakami Y, Fukunaga T. Influence of static stretching on viscoelas tic properties of human tendon structures in vivo. J Appl Physiol. 2001;90:520-527. 9. Fradkin AJ, Gabbe BJ, Cameron PA. Does warming up prevent injury in sport? The evidence from ran­domised controlled trials? J Sci Med Sport. 2006;9:214-220. 10. Turki O, Chaouachi D, Behm D et al. The effect of warm-ups incorporating different volumes of dynamic stretching on 10-and 20-M sprint performance in highly trained male athletes. J Strength Cond. 2012;26: 63­71. If you are interested in Tom's book Injury Free Running visit: https://amzn.to/2TLzEas

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, or click the link below. Under the series look for the videos with the 1313, 5050, and 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 a Small Area of Knee Pain (Medial or Inner, Lateral or Outer, Back of Knee, Patellar Tendonitis): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or 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. General Guidelines for a Large Area of Pain: In our examples channel one has yellow pads and channel two has green pads. Option one: one pad from channel one placed above the area of pain and one pad placed below the area. One pad from channel two placed in front of the area of pain and another pad from channel one placed behind the area of pain. This arrangement forms a cross pattern. Option two: 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. General Guidelines for Pain Referred from Another Area: An example would be knee pain that is coming (referred) from the back. Using channel one, place the two pads along the nerve pathway. 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. Knee Exercise: Stretching into extension- internal rotation, external rotation, straight 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 December of 2020. For the original video go to https://www.youtube.com/watch?v=9FTn8JWH-6I&t=583s Brad: Today we're going to talk about blood pressure. How high is too high, possibly life-threatening, and top three options to correct it safely. This is a serious topic. I've dealt with a borderline of blood pressure myself and been able to successfully treat it without medications, but we need to know the big thing, blood pressure, what is too high and what's not too high, but let's go back. There's two numbers with blood pressure. Let's kind of clarify this, systolic, diastolic? Chris: Systolic, diastolic, top and bottom, whatever way is easier for you to remember. But basically the systolic is the first number that we see up here, that 120/80, that's a normal blood pressure, but that one is when the heart beats. So think of your heart as a pump, as soon as it presses that pressure that they feel in the vessels, that's what that top number is measuring. Brad: So that's the big push. Chris: Yep, that's the big push of the heart. And then when the heart is relaxed and it's filling back up with blood, that's what the diastolic number is measuring. So that's what that 80 is. Brad: We don't need to know this, but it's in millimeters, that's a technical measurement. Chris: Millimeters of mercury is how they recognize it. Brad: I always remember diastolic, D for down. So that's the lower number. Chris: Yeah, that's an easy way to remember it. Brad: But you really don't need to know that, but you do need to know the numbers and where you're safe and where you need to be concerned, and then of course the extreme. Chris: Absolutely, absolutely. Brad: So we've got the chart here. Chris made this really nice chart. Let's start out with the normal blood pressure that is acceptable and you're safe. Chris: Absolutely. We'd like to see that 120/80 with everybody. I think that's just a reasonable standard number that the American Heart Association, American Cardiology Associates, they all kind of recognize that. And it can be lower, it can be a little bit higher. As we progress through the whole chain here, that's where we want to strive for. And when people are healthy, that's what we see. Brad: Now we're talking about high blood pressure and sometimes it's called hypertension. Are there any other terms you might hear? Chris: No, I think high blood pressure and hypertension are used interchangeably. So I think that most physicians and nurse practitioners and PAs would probably say hypertension, but for you and me, high blood pressure. Brad: Okay, so let's start out. We've got normal and then these are actual classifications that I recognized and the first one says elevated. So that's, if you're just a little over normal. Chris: A little bit over normal. Brad: But it's not dangerous yet? Chris: Not dangerous yet, but it's a sign of things to come. So we do want to make sure that we're paying attention. When you go into your doctor's office and all of a sudden these type of numbers pop up, doctors will do a couple different things. They're going to measure it in a couple of different occasions. They might measure both arms just to kind of see what's going on because there's a thing called lab coat syndrome which suddenly or white coat syndrome. Basically when somebody walks in the room and they're in a very formal looking doctor and I say, "Oh my gosh he's going to figure out that something's wrong with me." People do get tense and it does raise your blood pressure. It's a known fact unfortunately. Brad: Sure, it's just a natural feeling. Chris: Yep, it's natural. A lot of us experienced that. So they want to take a couple of different readings and they'll eve n maybe at the end of the appointment they'll strap you up on a cuff again, kind of catch you off guard, so you're more relaxed. Because you've been talking about some things and I'll say, "Oh, look at that, it's normal." So sometimes it's just due to the stress. Maybe you walked up a couple flights of stairs to get the office. Brad: Sure. Then we'll go to the stage one. Chris: Stage one. Brad: So that's another step in the wrong direction. Chris: Yep, another step in the wrong direction. And you know I guess what I should mention is that in 2017, they changed all these numbers. It used to be the old norm before stage one. It used to be just 140/90, was like, "Okay, that's bad." Well, they decided to add this designation, this 130-139/80-89. That's stage one hypertension or a stage one blood pressure. And so it's kind of that first stage that when your doctor gets a couple of measurements, because they aren't going to put you on blood medication right away. They're going to look at it and observe it. They might have you come back in three or four weeks and do it again and all of a sudden, oh it's still there. So at this point, the doctor's in a lot of times they probably would have had this discussion about your lifestyle changes and things of that nature. What can we do to affect this? We'll move on to that. Brad: Okay, we'll talk about what you can do without, so you can avoid medication. Chris: Yes, yes. This group I think is a really good one to focus on and then we're in that point. And that's kind of the hallmark what most cardiologists and physicians are going to talk to the patients about. Brad: But you could come in maybe you have progressed to stage two or maybe you came in before that and all of a sudden you see these numbers 140/90. Okay, so things are starting to open your or at least the doctors. Chris: Oh yeah, you got 24 million Americans in this group right here, stage two. Brad: So what percentage is that? Chris: Probably right in that 30% range. Brad: Okay, are touching up into that? Chris: All adults. Yep, so it's something. And this is definitely going to require medication, at stage two. So this is the one we're still going to stress lifestyle changes but there's definitely going to be medications added. And they might even add medication depending upon your circumstances, genetics, cardiac risk factors. So there's a lot of other things that go into this. Brad: Individual factors. Chris: Yeah, but for the ease of simplicity, this is something that your doctor will probably at one point, you're going to be on medication to try and help to control that and keep you safe. Brad: Right, because you might say, "Well can I do this with diet and exercise?" But you're saying maybe you can but you're putting yourself at risk. Chris: Yeah, I mean, your doctor's going to have to be on board with your exercise plan and keep in mind exercise can be something as simple as a 30-minute walk. So I mean, that's enough, you got to raise your breath a little bit and get that heart rate pumping. And I think that's going to do a nice job of helping and it's exercise and diet are pillars of treating hypertension at any one of these ranges. So we have to make sure that when we're using that and then your doctor is going to be paramount. He's, like I've said before in other videos, he's your quarterback. So you're the team, he's the quarterback. And basically you're going to work together to try and make sure that we can bring it back towards this level. Brad: Right, right. So let's say, because a lot of people may be living at this. They don't even know it. And if that goes on for a number of years, that's actually causing problems with your arteries which can lead into strokes, other cardiac issues. Chris: You name it, stroke, heart attack, vascular dementia, kidney problems, organ failure, vision problems. I mean, it's a big umbrella that hypertension all of a sudden, you hear hypertension and everything underneath that umbrella kind of fills in. So there's lots of other things that can happen. Brad: All these diagnosis is that you're associated with it. And so if you can correct that higher blood pressure early that doesn't eliminate, but reduces your risk for all these other problems that can come down the road. Chris: Correct, and yeah, just to kind of put that in perspective. I mean you get 3 million Americans each year are getting diagnosed with high blood pressure or hypertension. So that's a lot of people. Brad: So that means they're at stage two. Chris: Not necessarily, it could be one, two. But they're going to call it hypertension one and two. So there's 3 million patients a year. We lose 500,000 to hypertension related conditions. Brad: So you're saying 500,000 people, half a million. Half a million people die every year worldwide or in the United States? Chris: United States of America. Brad: So a half a million people die as a result of hypertension or associated causes. Chris: Correct. Yep, hypertension with associated causes. Brad: Okay, so that could be a stroke. It could be vascular problems, heart attack. Chris: Exactly, exactly. So it's all encompassing. We have to be careful. Brad: So now we're getting to that part of the title, life-threatening. So we got it in red, Hypertensive crisis. Chris: Yup, that's the big word that they use, and it's nothing to sneeze at. This is a big deal. So if you are testing your blood pressure at home and you're caught popping in with a 180/120, it's kind of like monopoly, you go directly to jail or you go directly to the hospital. So you should certainly call your doctor if you feel it's necessary. Brad: Would that mean that an emergency room or urgent care? Chris: I would say an emergency room probably at this point, because they're going to be the ones that are going to decide. I mean, you got here for a reason. We don't know why. And if it goes sideways, stroke, heart attack could be eminent. So it's something that we just don't want to mess around with. Brad: I always think of this as a therapist, I've worked with a lot of people with strokes. I don't work with people with heart attacks except for after the fact, if the rehabbing, but a stroke I see them very quickly after the event. It makes so much sense because what happened is the pressure is getting so high it bursts through the arteries, the vessels, the blood vessels in the brain, starving the brain of blood and oxygen, and then you have a stroke and it's a life changing issue. And it could be fatal. Chris: Yup exactly. Brad: So there's no joke about high blood pressure when you get this high Oftentimes people are feeling symptoms like headaches. There are some other things. Chris: Well actually the scary thing about all of this, more often than not people don't feel anything. And that's the scariest part about this aspect. That's why they call blood pressure the silent killer. So when you have high blood pressure, it's something that you just may not even notice. People go for years and let's say they had an appointment in their twenties and you're healthy as a horse and you're feeling good. All of a sudden they haven't been to a doctor in years which is oftentimes the case. All of a sudden their 45 years old, they go in and see the doctor and they're like, "Oh my gosh you're 170/98." "What's going on?" "I don't know, I feel great." And all of a sudden it becomes this type of issue, and there's lots of long discussions at that appointment to how can we get this better and keep you safe? Brad: And so I think nowadays, and this has been going on for years actually, people are taking their own blood pressure at home but it's easier now. I remember years ago with my father, he had high blood pressure and he'd be pumping that thing up around his arm and measuring his own at home to monitor. But now you just put the cuff on, push the button. Chris: Push the button, it's really easy. So, and you always want to make sure too when you're getting a blood pressure cuff, unless you have an absolute problem where you can't get the cuff around your arm, you never want to do the wrist one. The wrist one, basically these two bones in your arm, you have one over here and one over here, it does not allow it to squeeze properly to give you a good accurate measure of blood pressure. But when you get it around the arm, you get that good, accurate measure. I mean, same way in the doctor's office, they don't measure your wrist, they always measured around your arm. Brad: And if we're talking about this will minimize be comprehensive with this video. If you are taking your own, the same thing my dad had one of the wrists and the numbers weren't good. We ended up going back to the arm. And this was later on, just within the last 10 years, but you should take it in a consistent posture. Chris: Perfect posture. Brad: So you should be sitting with your knees bent at 90, with good posture and take it on the same arm, write it down or sometimes the digital ones have a history but if you're not comfortable with that, write it down. That's me, write it on paper so it's there and do it in the same location or same atmosphere. Chris: Yeah, I always want to be consistent with it. So you always want to sit for five minutes. So maybe a walk, you had some breakfast and then you're like, "Oh it’s time for me to do my blood pressure." So you want to sit again with both feet on the floor, like you said, perfect posture, just kind of sit and relax. Brad: Relax. Chris: And then wait five minutes and then put your cuff on your arm. And it's actually important to make sure your cuff is on your own properly too. So depending upon the unit that you use and I will tell you what consumer reports the most widely recommend one is made by Omron. So it's a fantastic machine. So it's the one that I recommend routinely at work because I just can trust their accuracy. So it's excellent, it rates well, they're reasonable in cost. You can get it anywhere, pharmacies, online, wherever you want to shop for something like that. The nice thing about the Omron product actually is they show you nice little pictures on how to use it. So you have your arm palm up resting on a table. You’re going to have your cuff round your upper arm and there's a little line, that's the tube that goes to the unit. And so you just want to make sure it falls down the center of your arm. And then while you're relaxed, you hit the button and basically about 35, 40 seconds, you're going to get your pressure and your heart rate. Brad: All right, so we know where that really high blood pressure is, get to the doctor right away. Let's go back in here and let's look at the second part of our title. What are the three options? Chris: Well basically, number one that, depending upon where you fall, it's always going to be exercise and diet, which are under that lifestyle changes. And sometimes if you use that exercise and diet as one and two, medications are probably number three. So from that standpoint, but medications you can easily become the primary course of treatment depending upon what your doctor and you decided is best for you and your particular case. Brad: Do you know how many people are on blood pressure medications in the United States right now? Chris: Yeah, roughly about 30 million people are on blood pressure medications right now or at least should be. And about many of those are actually falling in that 140 over 90 range. So, it's a large number. Brad: And success rate with blood pressure medications? Chris: 25 percent of people on blood pressure issues are well controlled. So everybody else is not. Brad: So they have to monitor it? Chris: They need to monitor it, and so that home monitoring, I think it's a very invaluable tool for us to utilize at home so that we kind of know where you are and you can always fill in the gaps with your doctor and just say, "Hey, I did really well." And you go to the office when it's up 10 points, so maybe it was you're just stressed out about seeing the doctor, but it helps them. Brad: So, you were talking top three, diet and exercise but really that's kind of they're two separate topics, but they fit together. Chris: They do, they do, and exercise is so critical because we want to get that heart rate up as long as your doctor approves you to do exercises. So that's one of the first things that we have to clear that hurdle before we just. I mean, it's always good to exercise, you and I are firm proponents of that. But I mean, it's something that if there's something cardiovascular in nature you want to make sure that what you're doing is safe for you, because if we're maybe somewhere between stage 2 and hypertensive crisis or really super high, your doctor might want you to ease into an exercise program because too much, too soon, too fast could have some very serious consequence. Brad: So you could escalate or even cause a problem? Chris: Cause some serious problems. Brad: Right, if you have not if you're not an exercise person historically, and you don't want to go on meds and you think, "Oh, I'm just going to get after this right now. You better think again and you're going to gradually. You're not going to go out and start running a marathon, you're going to start by walking. Chris: You're going to walk. Walking is great. I mean, 30 minutes, five days a week, just so that you're breathing a little bit harder than usual. It's probably the easiest way to kind of determine how hard am I really working? Well, if I'm kind of taking some deep breaths, you know you're working hard enough. So if you're not, you know. If it's too easy to have a conversation, I mean, you could exercise and have a perfectly good conversation, and that's probably the training range you want, but you're going to want that heart rate bumping a little bit too. Brad: Not a casual, stop and look at the birds walk. Chris: No, a brisk walk where you're moving. Something that if it's a nice, cool morning, it helps you warm up. Brad: I want to mention, we're going to do another video, follow up on this probably in a couple of weeks. And we're going to go into more detail about diet and exercise and the medications I do want to come up with the good news is I looked at mine in my twenties and I was always in this range, the elevated range. Chris: Back then it wasn't a big deal. It changed that 2017. Brad: But actually at that point because my dad had it, I was looking at it and it was a little red flag for me. So I started back when I was about 30 years old, I started running. I didn't like running because boring. I was in karate at the time punching and kicking people is a lot more fun. Chris: Its always more fun. Brad: But it wasn't a rollback enough necessarily a lot of times. So I started running, went back to college. I needed something (indistinct) desk board anyways, started running and I dropped down 10 to 15 points at both ends. Dropped it down since I started running and actually my heart rate dropped way down too which is another benefit of cardiovascular exercise, you know, aerobics. Chris: Yeah, exactly. Brad: So, and I haven't had a problem since. So I think if you catch it in here and you're motivated to change your lifestyle, and then recently I've changed my diet, which probably has helped, but I haven't had a problem anyways. So get in early, get in that normal range and you don't have to get to the medication. I'd forget to take them, that's a problem. Chris: Well, and that's a big thing in my world. Brad: Is it really? Chris: Oh yeah huge, 60% of people don't take the medications properly. Brad: They don't take them daily or they forget. Chris: Just forget, taking them the wrong time, maybe not consistently. Actually we do things called adherence calls and things of that nature. So it's actually how insurance companies reimburse pharmacies now. So it's a big deal. Brad: If people don't take their meds on time then- Chris: We don't get paid. Brad: Insurance doesn't pay the pharmacy as well. Chris: Not as well. Brad: Yeah, that interesting. Chris: It's a big deal. Brad: Yeah, do you have to make sure you call people and see if they are taking them on time? Chris: Yeah we do. And it's actually more with Medicare part D patients. So this is a long sideways sidebar, but it probably puts people to sleep. Brad: We're getting at the end of the video anyways but there's a lot of things that revolve around this, so stay tuned, we're going to have another video on details of diet, exercise, and some more on meds as well. You know, what people that view this I think are hoping to stay away from the medication like most people are. Brad: Well, you know and exercise and diet are a huge component of that. And if we work at it, if you treat yourself like your own best investment, I think it can be very doable, but you got to work at it. It's not just something you're just going to hop off the couch and run a marathon and I'm good. I mean, once you stop exercising, all those good benefits that you received go away. So it's a lifestyle change, means forever. Brad: Now, I don't know if this fits right in, we can fix just about anything- Chris: Except a broken heart. Brad: But we're right on there. Chris: We're working on it, we're working. Brad: All right, very good. Take care. Chris: Thanks everyone. 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