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We know that exercise is good for us to keep our bodies functioning well. Most of us initially learn to exercise informally through play as children. Some forms of exercise, like running and walking, come naturally. Other forms of exercise are learned in a more formal setting like a physical education class or sports team practice. By the time we reach adulthood, most of us have some concept of what cardiovascular exercise, strength training, and stretching are. Sadly, however, we often overlook one of the major body systems until there is a problem. The nervous system doesn't get much attention in the exercise world. Perhaps, because it is one of the systems we understand the least about. It is also, however, the system most responsible for processing pain and other information in the body. In a world where one in five people experience some type of chronic pain ( 1 ), a closer look at how to exercise your nerves is long overdue. Our nervous system is a series of flexible wires that communicate with tiny electrical impulses. While our understanding of how this works is in its infancy, we do have some ideas about how nerves work. (See How Nerves Work: Simplifying Complex Neuroscience ) When it comes to exercising our nerves, there are a few different approaches we can take. Similar to other kinds of exercise, we can stretch them, we can move them, we can try to get them better blood flow, and we can use them to send messages. Let's take a look at some of the different kinds of nerve exercise. Nerve Stretching (Tensioners) Nerve Movements (Gliding/Flossing) Nerve Targeted Blood Flow Nerve Messaging (Up & Down) Nerve Stretching Stretching your nerves is often called "tensioning". This type of exercise should be used cautiously. Some nerves, especially ones that are already painful, may not like being pulled on. Some people who perform nerve tensioning exercises will say that it "hurts good" while other people will feel like it is painful in a harmful way that doesn't make them feel good afterwards. Unfortunately, there aren't good, standardized tests at this point to help us know in advance who will respond well, and who will find the tension to be unpleasantly painful. To some extent, this is determined by trial and error. When tensioning a nerve, we intentionally pull on both ends. This requires some knowledge of anatomy and is best done under the care of a licensed physical therapist. Most of us, however, have had the unpleasant experience of tensioning a nerve without even realizing what we are doing. Many children in physical education classes do something called the presidential fitness test. If you grew up thinking that you had tight hamstrings based on the presidential fitness test, you may want to reconsider. The hamstring attaches to the pelvis (ischial tuberosity), and the bones just below the knee (the tibia, and fibula). To stretch the hamstring, a person has to straighten/extend their knee, and tip the pelvis (usually accomplished by leaning forward). The presidential fitness test, however, requires that a person flexes their feet, and reaches forward towards their toes with the head down. This places added tension on the sciatic nerve chain down at the ankle, and in the neck. (Coming Soon: Mastering Mobility: The Sciatic Nerve). Nerve Movements The goal with these exercises is to move your nerve, without pulling on both ends. Nerve glides are sometimes called "flossing", because the idea is that you pull on one end of the nerve, while reducing tension on the other, similar to the way you move a piece of floss back and forth between your teeth. Ideally, during this process your nerve moves comfortably, which helps to teach your brain that movement isn't painful and dangerous. It has also been suggested that if there is any "scar tissue", or fascial tissue adhesions, that moving the nerve can help to break them up. As an additional benefit, nerve movements help signal your body to generate better blood flow in the area around the nerve. This is because all the tissues need blood and oxygen to supply them energy to actively move. Nerve Targeted Blood Flow While gliding the nerves is a great way to try and facilitate blood flow on the whole, by moving and using all the muscles around the nerve, there are other strategies we can try. A physical therapist may suggest targeted stretches for the muscles that the nerve passes through. As you pull on these muscles, you naturally compress all the veins and arteries that flow in and out of the muscles. This can help to squish the blood out and pump it along. If tissue adhesions, or "scar tissue" is present, stretching can also help to pull on this tissue and make it more flexible. If the tissue is rigid, blood flow can get trapped within it. Stretching the tissues can help to free up the blood flow in this way as well. Nerve Messaging Our nerves are busy places. They are like highways for information sending sensory information up to the brain, and then carrying commands from the brain for how to respond to our environment back down. (See: Nervous System Highways ) We can exercise our nerves in a unique way, by various types of stimulation. A physical therapist might prescribe the use of TENS units, hot/cold packs, vibration/percussion, two-point discrimination training, or positional awareness/sensory mapping, to stimulate your nerves and send messages to your brain. A therapist may also recommend graded motor imagery techniques such as laterality training, mirror therapy, or guided visualization to encourage the brain to send signals back down. Closing Thoughts In a world where neurological disorders like Parkinson's, Alzheimer's, neuropathy, migraines, and chronic pain are increasingly common, we may be able to prevent or delay the onset of these conditions if we start to re-evaluate how we care for our nervous system. With a little bit of intentionality, we may be able to reduce the severity of pain with some of these conditions. We are just beginning to understand the ways in which nerve exercise effects the body. This is true even for chronic pain conditions that we don't think of as neurological. A 2017 pilot study found that patients with rheumatoid arthritis reported improved pain with addition of nerve glides to their exercise routine ( 2 ). If you aren't sure where to start and nerve exercise feels new to you, you aren't alone. Most people have very little exposure to how to exercise their nerves. Physical therapists are trained to dose exercise in the same way a medical doctor learns to dose medication. The right type, and the right amount, is important for the medicine to be effective. This article is intended for educational purposes as a starting point for a conversation with your healthcare team. It is not intended as a replacement for individual medical advice from a licensed healthcare provider. If you are interested in an evaluation and recommendations for your personal situation, click to Book Online and set up an appointment with one of our physical therapists. References: (1) NIH study finds high rates of persistent chronic pain among U.S. adults | National Institutes of Health (NIH) (2) The effect of nerve mobilization exercise in patients with rheumatoid arthritis: a pilot study - PubMed ( nih.gov )

While body scanning might sound basic, the truth is that our bodies are continually doing a lot of things to keep us alive that we don't notice. If you're a typical person sitting and reading this article, in the last 60 seconds, your heart beat 60-80 times, you took 12-18 breaths, you blinked 15-20 times, and you swallowed saliva at least once. More likely than not, you barely noticed it and that is only a fraction of what your body is doing minute to minute. Our bodies are constantly sensing their environment and responding to it. In the fast-paced environment of modern life where multi-tasking is seen as an expectation rather than an occasional necessity, our bodies can be overwhelmed. Living in the "Information Age" is great for a lot of reasons, but we are often so busy obtaining information, that we seldom take time to process it. This information overload can create a processing back log for our bodies. The brain simply can't keep up, so it begins to prioritize what it thinks is the most important and tucks the rest away to be processed later. The place many people run into trouble is that "later" never comes. Taking even 5 minutes of your day to check in with your body can help to ground you and let your brain catch up. The goal is to gain better understanding of what is happening in your body. This brief slow down frequently helps us to respond to our body's needs better in the long run. In this article we'll cover: Getting Started : How to do a body scan. Sample Questions : Sensations to notice during body scans. Who Should Use Body scans and Why ? Reviewing the research. Getting Started Plan a time to do your body scan when you can minimize distractions and interruptions. When you're ready, find a comfortable place where you can focus. Close your eyes and take a few deep breaths to bring your focus onto your body. Choose an area of your body to start with. Most people prefer to start at the top or the bottom, but you can choose to start wherever you'd like. As you bring your attention to and "scan" each part of your body, take note of how it feels. There are no right or wrong answers. For now, we are just observing the sensations that come to mind in the moment. If you notice yourself beginning to judge and interpret the feelings, take a couple of deep breaths and return to your scan. If you start thinking about how to avoid a feeling that you don't like, know that this is normal. Try to set aside your desire to fix the feeling for a few moments. It may help to remind yourself that it is difficult to address a problem that you do not yet fully understand. Scanning is an investment in better understanding the body. Move from one part of the body to the next. Take time to scan your head, neck, shoulders, arms, hands, chest, back, abdomen, pelvis, hips, and legs down to your feet. Sample Questions If you've never done a body scan before and have a hard time checking in with your body, try choosing just one body region and going through this list of questions. Is there pain present? Do you notice tension? Is there a sense of weight such as feeling heavy, or light? Do you notice pressure or touch contact? How does the temperature feel? Is there a swollen feeling? Does it feel dry, or wet? Is it itchy, or inflamed? Does it feel weak, or strong? How is the energy level in this area? Do you sense any particular emotion in that area? Do you feel disconnected from that part of your body? Keep in mind that you may not feel all of these sensations in an area all the time. This is just a list to get you thinking about types of sensations you may notice while doing your scan. Many people have a natural tendency to avoid unpleasant feelings and sensations. This is especially true if pain is present, or you have experienced some kind of traumatic event. While the ability to ignore our body's signals until an appropriate time is helpful and important, we also need to check in from time to time. If you have a lot of different symptoms, it can also help you to be less overwhelmed by giving you a chance to process them. Who Should Use Body Scans, and Why? The research on body scans is still forthcoming. While some studies suggest potential benefits like improving sleep quality ( 1 ), reducing anxiety ( 2 ), and reducing pain ( 3 ), more study is needed. Another recent systematic review suggests that body scans alone may not produce significant health outcomes ( 4 ). This is common for many medical interventions, however, that work better when used in combination with other interventions. For example, most commercials for medications that lower cholesterol encourage you that the medication works best when combined with diet and exercise. After you're done scanning, some research suggests that it's what you do with your body scan that counts ( 5 ). While performing the body scan, meditation experts discourage you from judging the sensation you experience as good, or bad. The goal is simply to increase awareness and allow yourself to accept what you are presently experiencing. They don't want you to worry about acting on the sensations while doing the scan. Taking a brief period of time to allow your brain to process information can be good and teach your body to delay judging sensations long enough to get the rational part of your brain involved. This can make you less likely to react emotionally out of fear, panic, or in avoidance of a sensation. If you don't return to thinking about and processing the sensations at some point, however, it may leave some people feeling a loss of control. Gaining information that you can't act on can create helplessness or a feeling of anxiety for some people. After you finish the body scan, taking time to judge the sensations you experienced may be helpful. This lets you decide which sensations are important for you to pay attention to, and which ones can be safely ignored. (See: Hurt vs. Harm & Car Alarms: Interpreting Chronic Pain ) For people who are prone to ignoring their symptoms, and sometimes miss signs of illness that they should have sought medical attention for, or for those whose lack of awareness of their symptoms prevents them from getting treatment, the scans can be helpful. If your hope is to use the body scan to better direct your treatment choices, it may help to look for trends in your symptoms. Recording the results of your body scan on a diagram page to track the results gives you information you can use. It can be a starting point for a discussion with your doctor. Using a chronic pain self-care journal like one of these can help you track your progress. For others who already think about their symptoms frequently (ruminating), and experience thoughts that focus on overly negative scenarios about their symptoms (catastrophizing), drawing attention to their symptoms can sometimes be unhelpful. The brain works on a "use it or lose it" basis, and this can actually wire the brain to experience more pain over time. (See: Hurt vs. Harm: Reprogramming The Pain Alarm ). The value in body scanning for these individuals may be in the scan itself and the ability to think about their body without negative judgements, and then stop thinking about it when not doing the scan. If you're unsure about if body scanning is right for you, discuss it with a mental health provider. This article is intended for educational purposes and is not a replacement for individual medical advice. You are encouraged to seek evaluation of your specific mental health needs from a licensed provider before adding new elements to your self-care routine. (1) The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials - PubMed ( nih.gov ) (2) Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program - PubMed ( nih.gov ) (3) Immediate effects of a brief mindfulness-based body scan on patients with chronic pain - PubMed ( nih.gov ) (4) The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials - PubMed ( nih.gov ) (5) Do body-related sensations make feel us better? Subjective well-being is associated only with the subjective aspect of interoception - PubMed ( nih.gov )

Content warning: This article discusses, in medical language, a variety of things that can occur during birthing experiences and the topic of sexual assault. Parental discretion is advised for readers under the age of 13. When working with pelvic health patients, you have to ask some pretty personal questions. While asking if a patient has a history of sexual trauma or abuse is part of the standard intake process, I often find that some women are trauma survivors and don't even recognize it. Instead of discovering this trauma on an intake form, I sometimes uncover it when I ask women about their pregnancy and delivery. There are types of trauma that have become so normalized by society that we don't realize just how significant of an impact they have on our lives. Some women who develop problems with pain during intercourse after having a baby are left wondering why. They don't realize just how similar to a sexual trauma experience giving birth can be. It bears mentioning the cliche: "Expectation is the root of all heartache." Culturally we come to labor with expectations of what birth will look like. Our experience of birthing is usually based on high school health classes, watching movies, or pictures of the newborn photo-shoots that people post on social media platforms. Most of us don't develop our mental picture of labor by witnessing actual births. This is anxiety producing for many mothers because their first experience in the labor and delivery room is when they are the one having the baby. As a disclaimer to expecting mothers, not every birth experience goes awry. There are many deliveries that go smoothly as planned. You should not read through the situations below and assume that a terrible birth experience awaits. This article is intended to validate the experiences of women who have already had traumatic deliveries. It will discuss the things that can happen; that does not mean that they will happen. Even in the best of circumstances, giving birth is anxiety producing for moms-to-be, and reasonably so. Some of this is normal, and healthy. It is a healthy attitude to not be eager for experiences we expect to be painful. After all, we consider masochism, where people intentionally seek to inflict pain on themselves, to be a mental health disorder that warrants treatment by a trained professional. Pain is typically the body's alarm system. It's meant to protect us from harm. Pain sends us a message to quickly move our hand if we put it on a hot stovetop in hopes of minimizing the burn damage to our skin. So when it comes to having a baby, while pain during labor is "normal", it is understandably a complicated experience for women. They have to be willing to set aside everything their body has known and been programmed to think about pain. Your body's entire life it's been taught to avoid pain, and now, you are intentionally asking it to embrace it. The idea that this pain will lead to a joyous occasion, the birth of a child, may be "normal", but it is still a neurological paradox for your nervous system to wrestle with. There is a reason that birthing classes and maternal education regarding what to expect in labor are recommended. Unfortunately, however, they can't prepare you for everything, and some lessons in life are learned by experience. Birth trauma can take many forms: 1.) Being Seen Someone came into your delivery room against your wishes (i.e. a mother-in-law). Your doctor wasn't available, and although you had signed something saying you'd accept care from whoever in the practice was on call, the person you ended up overseeing your delivery was someone you didn't want to work with. Students were allowed in to participate in your care, and you felt pressured to accept, but didn't feel comfortable working with them. The reality is, that during the labor and delivery process, women are vulnerable, and their bodies are often exposed to multiple people. They are anxious, exhausted, and often lose a lot of blood. They are dependent on doctors that they may or may not know and trust to make decisions to balance their own health and that of their baby. In any other context, strangers walking in on us naked would be seen as a violation of our privacy, but in a labor and delivery room, it seems like anything goes. Different nurses, doctors, medical assistants and family members are often in and out. While this may be different than a sexual assault in that it isn't being perpetrated maliciously, we have to admit that there are some similarities to the experience. 2.) Being Touched Maybe you really wanted a vaginal birth, but developed complications at the last minute and needed an emergency C-section that you didn't want. An episiotomy was done without your knowing it (or without your consent). The baby went into fetal distress and the doctors had to make quick decisions about what to do to your body that they didn't have time to explain. You may have been repositioned, forceps may have been used, etc. In some instances, the doctor may have done these things for the right reasons, but it is still confusing to your body. Ideally, as human beings we grow up with a healthy sense of boundaries around our own bodies. We have a right to decide if someone is allowed to touch us or not. We have also spent our lives signing consent forms to give permission for any medical treatment we receive, so naturally, we believe we have rights to decide what kind of medical touch we receive also. In a labor and delivery room however, this gets complicated. When having a baby, because two lives hang in the balance, these boundary lines can become blurred. What is necessary to protect the baby can be at the mother's expense. In the heat of the moment, doctors assume that the mother's desire for her baby to live is consent. They make quick decisions and often don't have time to communicate empathetically that they are sorry it has to be this way. While the insertion of forceps to quickly get your baby out may have been necessary, and rationally, you probably would have agreed if asked, in the moment, it is shocking. It is still penetration that you didn't have time to process was going to occur to your body and agree to. Again, while it was not maliciously intended, there are some definite similarities to the idea of penetrative sexual assault. C-sections and episiotomies are surgical procedures that you may not have wanted, but been helpless to prevent. They are touch to your body which may have been necessary, but this also brings us to the third issue of consent. While you may have given consent out of necessity, it may not have been with a full desirous agreement. In reality, for many women, it comes more often in the form of not having said anything at all. It bears mentioning, that in a court of law when it comes to sexual assaults, if a person freezes during an assault, their inability to communicate does not grant consent. Labor is different, because in emergency situations, doctors are given legal protection to make the decisions they believe to be in the best interest of their patients. However, understanding the similarities to an assault can help us to understand why some women experience pelvic pain and problems after having a baby. 3.) Loss of Control You tried to tell your doctor something that was happening in your body and they didn't listen (i.e. that you were further along in the process and needed a room to deliver NOW and they didn't believe you, or that the pain medicine didn't work, and they didn't believe you). In the fatigue and anxiety of a long labor, you didn't understand what you were being asked to consent to and ended up with an episiotomy scar. The doctors did things they didn't explain to you because they were worried about stressing you out and jeopardizing your health more if you knew what was happening and they needed you to remain calm. You passed out from exhaustion or a medical complication during labor and woke up not knowing what happened. You wanted an epidural for pain control, but the epidural didn't take, and you felt everything. You may have heard it said that rape and sexual assault are crimes about power, not about sex. With this in mind, (though again, it isn't malicious) it's important to recognize the loss of control that women can experience during the labor and delivery process. This is especially true for women who have experiences they didn't anticipate. Birthing classes center around trying to prepare women for potential outcomes. They help women to know their options in advance, and therefore help them feel more in control. Unfortunately, however, it's just not possible to prepare them for every situation. Their doctors spend over a decade in school studying to be doctors, and even then, they learn and gain experience on the job. Most good providers are humble enough to tell you that even when you work in labor and delivery every day, you've never seen it all. Sometimes there is little choice but to deal with the consequences of the situation afterwards as they come. 4.) Pain: Your labor was longer than expected. The pain management strategies weren't effective. The pain management strategies were effective temporarily. Everything was fine until they wore off and your body was in shock, not understanding why it was in so much pain and hadn't been able to protect itself. Labor is different than our other short-lived pain experiences in the medical field. It's true that we have asked our bodies to endure brief episodes of pain in the past for medical benefit. For example, most women by the time they are having children, have submitted to blood tests, vaccines, pap smears, and other medical interventions that involved some level of pain and discomfort. This, however, is wholly different than a 30-hour labor experience. The difficulty of a long labor is especially true if your pain management strategies don't work as planned. Continually asking your nervous system to submit itself to a prolonged pain experience forces you to engage in that neurological paradox we mentioned earlier. Pain is the body's way to tell you about danger, so you are essentially asking your body to live in a state of feeling threatened, and anxious for a long time. To make matters worse, you can't control just how long that will be. Despite your best efforts to give them the eviction notice and push them out into the world, babies come on their own time. The one that often surprises people, especially first-time mothers, is that you aren't off the hook just because the pain management strategies work during labor. Consider for a moment what anesthesia does to your nervous system. It pleasantly keeps your pain alarm system from sounding, but we are using it to cheat the system. During labor, changes are happening to the body that should be painful; there are demands placed on your pelvic muscles far beyond the everyday. As a result, when the alarm system comes back on, your body feels cheated. Pain was robbed of its ability to do its job and protect itself. This can be confusing to your body. Something "dangerous" happened to your body, and pain missed it. It can cause our pain system to overzealously attempt to protect us. If your body experiences pain and it knows the source, you learn to avoid it. In the hot stove example, by the time you've reached adulthood, you've learned to be careful to avoid touching hot stoves. This is true even if you've never touched one, simply because you know that if you did, it would hurt. The trouble with numbing the body to the labor experience is that sometimes, because it seemed like you weren't doing anything in particular, the pain system doesn't know what to blame. As a result, in some cases, it decides that it needs to be on a higher alert level all the time. Any touch to the pelvis can become painful, and in some cases, the pain can be present even when nothing is touching the pelvis, and you aren't doing anything at all. What Can I Do About It? The good news is that you've already taken the first step to healing if you've experienced some of these things. The first step to addressing the problem, is recognizing what the problem is. Identifying the elements of your story that are traumatic can help you gain valuable insight and understanding. This can help to re-establish a sense of control. You may still want to process through your experience with a trained counselor. They can often help to draw you out and ask questions to help you better understand your experience, as well as suggesting potential treatment strategies to help you heal psychologically. If you are still having physical symptoms, pelvic floor physical therapy may be able to help. If your gynecologist says that everything looks good, but you're still having problems, it may not be a structural problem. The way your muscles are functioning may be to blame. Physical therapists are movement specialists; they are experts in function. If you are experiencing problems with bowel or bladder function like pain or incontinence, or if you're experiencing pain during sex after having a baby, you are not alone. While this article is intended for educational purposes and is not a replacement for individual medical advice from a licensed healthcare provider, it can be the start of your journey. If you are interested in learning more about pelvic floor physical therapy or scheduling an evaluation with a pelvic floor physical therapist, click to book online , or contact our office to schedule an appointment.

Electrolyte supplements originally gained interest with the advent of Gatorade in 1965 as a supplement to improve athletic recovery and performance. Since then, a wide variety of products have become available. There are a lot of reasons people choose to supplement their electrolytes beyond athletics. The first step in choosing the right supplement, is knowing why you are using it in the first place. Some reasons you might choose to supplement electrolytes include: Participating in athletics Working outdoors in warm environments Hyperhidrosis (excessive sweating) Heart conditions like Dysautonomia, and POTS Kidney problems Colonoscopy preparation Poor dietary intake of fruits and vegetables Prolonged illnesses, especially with vomiting Gastrointestinal issues like Chron's disease or IBS that lead to diarrhea Things to consider when choosing a supplement: 1.) Which electrolytes do you need? 2.) How much of the electrolytes do you need? 3.) Sugar content (and alternative sweeteners) 4.) Dyes and additives 5.) What a supplement leaves out 6.) Flavor 7.) Packaging 8.) Cost Which electrolytes do you need? Electrolytes are more than just "salt". While sodium is an electrolyte, there are others. Potassium, magnesium, calcium, phosphate, chloride, and bicarbonate are all considered electrolytes. The majority of electrolyte supplements contain sodium, and many include potassium. Depending on your unique health history and situation, you may want a supplement that includes others like magnesium or calcium if you know you have deficiencies in those electrolytes. This may depend on your family health history as well. People with a family history of osteoporosis for example, might want to supplement calcium in their diets to promote bone health. If you aren't sure which ones you need, the most accurate methods are to have testing such as bloodwork to check your levels of each electrolyte. If you want to avoid medical testing, you have a few options. Some people choose the electrolytes they believe they need based on symptoms they experience. A word of caution if you plan to use this approach: correlation and causation are not the same thing. Low magnesium levels are associated with muscle cramping, but there are many other things that can cause muscle cramping. This is not the most accurate method to determine which electrolytes are low. Other individuals who want to avoid medical testing attempt to determine what is lacking in their diet. Diet calorie counting apps can be helpful to track nutrient intake, but there is some work involved. You have to commit to entering everything you eat for a few weeks to get a sense of your usual diet. It's important to recognize that while this gives us a sense of your dietary intake, it doesn't tell us how much of those nutrients are being absorbed. The gastrointestinal system is highly variable between individuals. It is not uncommon that some people have difficulty absorbing one vitamin or another. While national recommendations exist for the daily dietary intake values of each vitamin, some people need a higher amount in order to absorb what they need. How much of the electrolytes do you need? This is the question that is trickiest to answer. How much you need is based on your medical conditions, how low your levels are, how good your system is at absorbing the electrolytes, your physical activity level, and even the weather. For people with dysautonomia, the most commonly diagnosed form being POTS (Postural Orthostatic Tachycardia Syndrome), some doctors might recommend drinking electrolytes with all of their fluid intake in a day if they usually have low blood pressure. For an otherwise healthy athlete however, it may only be appropriate to drink electrolytes when they are exercising outside in warm weather. As another example, a person with kidney function problems may require ongoing monitoring of their levels of electrolytes by a nephrologist to determine the right amount they should consume. In short, the answer to this question is going to be unique and variable from person to person. While this article is intended for educational purposes, it is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in evaluation of your personal situation, you can schedule an evaluation by clicking book online . Sugar content (and alternative sweeteners) The original Gatorade was designed with collegiate level athletes in mind. It was intended for people who engaged in high levels daily of physical activity. Most people do not need added sugar in their electrolyte supplements, and for some it can be harmful. For a person who is diabetic, liquid sugar makes it into the blood stream quickly and can cause the blood sugar to spike. Many electrolyte supplements on the market offer low calorie, or sugar free versions. It's important to be aware however, that just because it is low calorie doesn't mean it's the right choice for you. Many people have food sensitivities to artificial sweeteners which are often used to make the drinks more flavorful. Dyes and additives The coloring dyes used in electrolyte supplements are another potential irritant for people with food sensitivities. They can also cause problems with some medical testing. Instructions for colonoscopy preparation often ask patients to avoid red and purple dyes due to concern the coloring is too similar to blood and residual dye may cloud the accuracy of your testing. It's also important to note that many electrolyte supplements will add in other supplements as well. Be careful to read the labels to make sure you know what you are getting. You may find vitamins, caffeine, amino acids and other additives when you read the label. Almost every electrolyte drink supplement will contain citric acid. This can be a problem for individuals with citrus sensitivities and some medical conditions. Citrus is considered a bladder irritant and may cause problems for people with incontinence and conditions like interstitial cystitis. (See: Bladder Irritants ) The other important consideration for consumption of high quantities of citric acid, is that it may not be the best thing for your teeth. People with weak tooth enamel are often counselled by dentists to avoid consuming acidic foods and drinks. What a supplement leaves out Some supplements will claim to be gluten free, vegan friendly, have no artificial sweeteners, are kosher or are non-GMO. You may find options that are keto friendly, make climate friendly pledges or are fair trade certified. It's best to check the ingredients on a supplement and make sure they represent your dietary needs and are consistent with your personal beliefs. Flavors Of course, the supplement you're most likely to actually use is one that you like the flavor of. Fortunately, the flavor choices available on the market are pretty diverse. Most flavors are fruit related, but flavor free varieties do exist. Some companies even offer dessert flavored options like rainbow sherbert for those with a sweet tooth. Packaging Some supplements come in the form of a drink bottle already mixed, while others come in a container of powder you have to measure/scoop out and mix in your drink. The single serving powder packets are convenient for people who want to take their drink mix on the go. Another popular choice to skip the potential mess of powders and decrease the amount of individual packaging required, are dissolvable tablets. Packaging is relevant for those who prefer to avoid plastic bottles. Concern regarding BPA and the prevalence of microplastics in the environment has increased in recent years. Most pre-mixed drinks come in plastic bottles which may not be your first choice. Different packaging options may also influence portability and shelf life of the product. Consider how you will be consuming your supplement. The most common method is to mix it into a glass/bottle of water, but there are other options. Some choose to add electrolytes to their morning smoothie, and salty hot cocoa isn't a bad idea. Chocolate and sea salt is generally hailed as a good combination after all. For the purist who prefers their water to be just water, electrolyte tablets are available in pill form. If you are using this method, just be aware that it pushes a lot of electrolytes into your system all at once, and you need to consume fluids accordingly. It's also possible that your body may not absorb as well when you give it a lot of one nutrient at a time. It's as if the body says "I already have plenty of that right now, and there is a lot of it around, so I'll take it in later." If you struggle with absorption problems, it may be better to choose a drink that you sip on over several hours. Cost It goes without saying that we all have a budget to work within. Most people would rather spend their money on fun things like vacations, concerts, and nicer houses, than on electrolyte drinks. Just like anything else you buy at the grocery store, figuring out the cost per serving will help you make wise decisions as you compare products. Another part of cost calculation is the time it takes you to obtain the product, and shipping costs. Your time has value, and for some people it might make more sense to pick up the supplement that is available at your regular grocery store, while others may prefer to shop online. Closing thoughts As you consider which electrolyte supplement is best for you, make sure to talk with your healthcare team. When doctors' offices ask you about any medications and supplements you are taking, be sure to let them know which electrolyte supplement is on your list.

The idea of pacing isn't a topic that makes most people excited. Most people don't like to be told that they can't accomplish something as quickly as they want to. The word "no" is one that we develop enmity with from our toddler years. The idea of accepting any kind of limits on our abilities is difficult for everyone. Eventually however, everyone will reach some kind of limit in life. Whether in time, athletic performance, academic achievements, the glass ceiling at work, or a basic physical need for food/water/sleep, we all have limits. This is true regardless of if you have a chronic illness or not. The better question is not if we have limits, but what each of our individual limits are. If we know that, then we are better able to make choices to work within our limits, compensate for our short comings and eventually increase the limit of what we can do. Let's take a look at: 1.) The Rollercoaster Rider: Understanding the Problem 2.) Growing Grass: Pacing for Success 3.) Clearing hurdles: Addressing the Elephant in the Room 4.) Mountain Climbers: Striving for Progress, not Perfection 5.) Pacing Activity: Spending your Spoons The Rollercoaster Rider: Understanding the Problem When your energy supply is limited by pain or chronic fatigue, it can be challenging to get everything done in life. It is a familiar story to hear patients say "I had a good day and so, ______________" The blank space is often filled to the brim with a slew of activity. They work overtime hours, clean the whole house, do all the Christmas shopping, and/or go run errands all around town. Unfortunately, the next part of the story is fairly predictable "Then I was so tired and in so much pain that I spent the next day(s) in bed and couldn't do anything." This is one roller coaster you don't want to be on. People go up the hill, just to go plummeting down the slope and as soon as they recover, the cycle continues. In light of the fact they haven't been able to get anything done for the past few days, when a good day comes around again, they seize the opportunity to catch up on what they've missed. This mentality makes sense when you live in it day to day. Understandably, life doesn't stop, and everyone has things they need and want to accomplish. When we take a moment to zoom out and observe from a bird's eye view however, the dysfunction is obvious. We would never apply this logic to a diabetic trying to manage their blood sugar. No one would say it's healthy for a diabetic to eat an entire cake, and then not eat for three days. The goal is to maintain a fairly steady blood sugar by eating a balanced diet of multiple small meals a day. Growing Grass: Pacing for Success When we apply this concept to physical activity, it is a tough sell for people with chronic pain and fatigue. They are often fearful that if they don't take advantage of the good day they will lose their opportunity. In reality, if they pace themselves to do smaller amounts of activity each day, they will typically find they start to have more good days. Often, they are able to accomplish the same number of tasks over multiple days that they were previously cramming into one day. Exercise and activity are a lot like watering when trying to grow grass. If a person throws grass seed down on a dirt lot and never waters the grass, it probably won't grow well. On the flip side, if they flood their lawn with water, the grass seed will wash out into the street. They'll end up with a mud pit and will have to let it dry out for a couple of days before they can put down new grass seed and try again. The secret to growing grass is patience. You water it for a few minutes each day or sometimes twice a day in the morning and the evening. While it is slow going at first, in a few weeks, the grass will start to grow. After 4-6 weeks, your grass will be full grown and tall enough to withstand a flood when it comes. There will come a day when you are able to manage a busy day filled with activity without being wiped out and having to start over. Clearing Hurdles: Addressing the Elephant in the Room It is incredibly difficult to be patient when a person struggles with chronic pain or fatigue. It is true that life does not stop. Taking 4-6 weeks to invest in slowly increasing your activity tolerance will mean saying no to some activities in the short term. The goal however is that you are making an investment in the long term. It's just like setting aside money to save for retirement, a vacation, or a home remodel. A person sacrifices some things in the present, to attain a larger goal in the future. Physical therapy, losing weight, and other lifestyle changes are similar. It often takes 4-6 weeks to really see change. As much as we love the idea of a magic pill, or a winning lottery ticket, they generally don't exist and aren't good for us anyways. Unfortunately, we know that the "get rich quick" schemes in life rarely end well. Statistics say that the majority of lottery winners end up bankrupt. The pain medications that work quickly in 20-30 minutes, often wears off in a matter of hours. Even if the medication works in the short term, many medications have potential risks and negative side effects. The long-term fixes in life that last, rarely work quickly. The timeless children's stories like the tortoise and the hare generally prove themselves true. The slow and steady person wins the race. When we take it slow and divide big tasks into manageable pieces we are more likely to be successful. History is filled with sayings such as "How do you eat an elephant? One bite at a time." Mountain Climbers: Striving for Progress, not Perfection The goal with pacing activity is to be a mountain climber, not a roller coaster rider. Ideally, we want to lay a foundation that we can stand on and take the next step up the mountain. It's true that climbing a mountain sometimes involves some ups and downs, and isn't a straight path to the top. As you start trying to make wise choices about pacing your activity level, there are bound to be a few missteps. To keep climbing the mountain, you may have to continually remind yourself to focus on progress rather than perfection. While we often use phrases like "two steps forward and one step back" to express our frustration at the obstacles in life, in the end, you still took one step forward. While climbing the mountain can be slow, there are several things that can help you to keep your eyes on the prize. Motivation and gratitude are key factors to success. Many people find it helpful to know their "why". Understanding your motivation can give you something to refer back to and lean on when times are tough. Keeping a meaningful goal in mind can help us handle setbacks better. A technique called motivational interviewing has recently gained popularity in medicine to help patients with making big lifestyle changes like quitting smoking and losing weight. (Coming soon, See: Making Changes that Stick) Knowing your why, can also help make it easier to say no to using our energy on the things that don't matter to us most. Let's say your dream is to go on a vacation to Italy. If you're trying not to spend so much money eating out so you can save for your trip, putting a picture of beach in Italy as the home screen on your phone may make you think twice before you call in your to go order for take-out. Gratitude is another key factor to help you climb the mountain towards your goals. When a person is hiking up a mountain and gets tired, they often stop and turn around to look at the view. Taking time to look back and see how far you've come can encourage you to keep going. When living with chronic illness, it is easy to focus on the negative things that your illness prevents you from doing. While it is ok to grieve the negative ways that an illness impacts your life, taking time to appreciate positive things in your life can help. It can be as simple as appreciating a new pair of cozy socks, or the taste of piece of chocolate. If you're ready to confront and reframe some of the losses from your illness, targeted gratitude can help reframe negative things into more neutral ones. For example, a person who suffers from chronic pain, might take time to appreciate the good things about having pain. If we truly evaluate the opposite claim, a person who doesn't feel pain is actually at a huge disadvantage. Congenital Insensitivity to Pain is a real condition some people are born with. Other people lose their ability to feel pain (or anything at all) in certain parts of their bodies from spinal cord injuries, or diseases like leprosy. Philip Yancey was so moved by his experiences working with people who had leprosy that he wrote an entire book called " The Gift of Pain ". (Coming soon, See: Why Pain is a Good Thing) A final suggestion for how to deal with setbacks as you climb the mountain is to learn from your mistakes. For people with chronic pain and fatigue, one of the most common helpful metaphors is learning to count your spoons. Pacing Activity: Spending your Spoons Spoon Theory originated in an essay written by Christine Miserandino. The basic concept is that a person only gets so many spoons to use in a day. Some people may start the day with 10 spoons, other people might only start with 6 spoons. The activities that you do each day cost you a certain number of spoons. Taking a shower might cost one spoon. Folding the laundry might cost 2 spoons. The spoons are simply a unit of currency to represent how much energy is expended on a given task. While many people living with chronic illness understand that they have a limited amount of energy in a day, the concept of spoon theory can help friends and families to better understand your struggle. If you know that you only have 6 spoons to spend in a day, and you have already spent one taking a shower, and two spoons folding the laundry, then you are down to 3 spoons. If cooking dinner will cost you another two spoons, then you only have one left for the day. Letting your family know that you only have one spoon left to share with them in the evening might make it easier to understand why you cannot be responsible for both walking the dog and taking out the trash that evening. It may help to create a list for yourself, and your family of what the costs are in your spoon energy economy. Then you can begin to have a conversation with your family or yourself about what it is reasonable for you to accomplish in a given day. Laying it out on paper, can help everyone in your family to understand what they can expect. This provides a consistent framework and lets the family plan for their week. Your kids may realize, that if they want you to make them dinner and help with their science project, they are going to have to take on the responsibility of loading the dishwasher after dinner. Your spouse might realize that if they want you to have the energy for a date night in the evening, they may need to help out with an extra household chore during the day. As you make your list, keep in mind that even enjoyable things cost spoons too. You might love to go for a walk with your spouse after dinner, but it still requires energy and costs a spoon. In closing, pacing activity levels takes intentionality and planning. We'd encourage you to take some time to think about some of the concepts discussed here, and share them with your social support system. This article is intended for educational purposes and to stimulate healthy conversation around the topic of pacing. It is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in scheduling an appointment to evaluate your unique situation, call or click here to book online .

Most of us are dependent on a GPS for directions to tell us where to go. The human brain works similarly, pulling up maps at lightning speed for each movement you want to make. Sometimes, however, we don't already have the right maps. This is especially true when performing a new movement. We are often clumsy when learning something new. When a baby is learning to walk for the first time, they often wobble, fall on their bottoms, and have to use their arms to balance. As adults, we experience this if we are learning to play an instrument, taking a dance class for the first time, or any other new activity that requires our brains to create new movement maps. Ideally, we create the maps right the first time and get ourselves into good habits, but that isn't always the case. If you make a mistake enough times, it tends to become your default movement pattern. Most coaches and music teachers will tell you that it is better to stop and slow down and get the desired movement right, than to rush through it and repeatedly do it incorrectly. The problem is that there are many things in life that we don't have coaches for. Many of us go through life without someone telling us the correct way to move. Unless you grew up with a physical therapist for a parent, you probably went through life not being taught that there is a right way to roll over in bed, push a vacuum, and lift a box. We often don't think about those things until there is a problem. Rolling over in bed, pushing a vacuum, and lifting a box aren't things we think about, until we've thrown our back out. Prior to that, we just did the task. As long as the goal was accomplished, we didn't pay much attention to how we did it. When pain enters the picture, sometimes it's a sign that our maps need to change. For specifics on breaking down individual movements, see the Moving Well blog section (coming soon) When we have chronic pain however, re-working the maps can help reduce pain signals that shouldn't be there. Sometimes the pain is present because our body is trying to tell us that we are damaging our tissues and harming our bodies. Other times, the pain is persistent and there is seemingly no good reason for it. Training our brains to pay attention to movement instead of pain can be valuable in decreasing the amount of pain we feel over time. Correcting the movement can eliminate the repeated tissue damage we are subjecting our bodies to. However, it can also help for the unexplained pains that persist when we can't see any tissue damage at all. When your body can rationally recognize that the movements it just performed are safe and should not be causing new tissue damage, it can help you to ignore pain signals that shouldn't be there. While the pain is real, and it hurts, if it isn't harming you, it's safe to ignore (See Hurt Vs. Harm & Car Alarms: Interpreting Chronic Pain ) So how can we train our brains to sharpen their maps? By increasing our sensory awareness. There are several ways to do this, including laterality training, two point discrimination training, perfecting proprioception, stereognosis, and sensory mapping. Sensory Mapping Simple sensory mapping can be done with a partner at home. It can even be made into a game to play with your kids. All you need is some paper and pencils. Have your child hold the piece of paper against your back and start to draw a picture. Let's say your child starts to draw a house. As your child draws square on your back, your job is to draw a square on a piece of paper in front of you that is about the same size as what they drew on your back. Next they might draw a triangle for the roof, and you would follow suit. The goal is for your picture to look as similar to your child's as possible. If you have multiple kids, this can even be turned into a game of Telephone Pictionary on family game night. If you have kids who struggle with chronic pain, or are just clumsy and uncoordinated, this can help with their coordination and motor development. If that seems a little too challenging and artistic for you, a simpler version of sensory mapping is Clock Mapping. Again, if you have young kids, this can even be an educational game to help them learn to tell time. This time, you'll draw a clock on your paper. It is easiest to label the numbers at 12, 3, 6, and 9 o'clock for beginners. This time you will tap your partners' back over one if the numbers. They have to guess which time you touched. As this gets easier, you can add the other hour marks onto your clock. As you get better at differentiating the hours, you can draw a smaller circle in the middle of your clock. Now you can tap on the outer circle for the big hand of the clock, or the smaller circle for the little hand of the clock. That will make your brain work harder to know exactly what time it is. Both of these methods involve training the sensory system on your back. You can work on your upper back or your lower back with these methods, but they tend to work best for people with back pain. If you have a smaller child, you could also have them stand facing you and draw on your stomach. Even if lower back or abdominal pain isn't your particular area of struggle, there can still be some value in sensory mapping. As you try and reproduce the image being drawn on your back, your arms and hands are active as well, so the nervous system that controls your upper body is engaged in the process. If you're looking for a whole-body sensory mapping experience, feel free to get creative. Try having someone trace letters on your leg or the back of your hand to spell a word. You can do this on any part of the body that is painful or hard for you to coordinate using. If you're looking to use these skills for kids, to keep them engaged, this option can become a race game of deciphering secret codewords that you are spelling out to your partner. Whether your nerves are trying to sense a picture being drawn, a location of time being tapped on your back, or letters being traced, they are working to fine tune their awareness of what is happening to your body, and where it is happening. Stereognosis Stereognosis is a medical term for your body's ability to identify the shape and form of three-dimensional objects. If we have healthy nervous systems, if we hold a nail in our hand, we can recognize it as being different than a screw. While we may traditionally think of this as being difficult for someone with neuropathy, they aren't the only ones. For many people with chronic pain (of many kinds) this ability becomes dulled. The brain is so busy processing pain, that it has trouble focusing on identifying the objects. Because the brain works on a "use it or lose it" basis, if we use it to process pain all the time, that is what it gets good at doing. On the other hand, if you consciously tell your brain to focus on other things, it can teach it to prioritize something else over pain and over time the pain experience becomes less consuming and less severe. If you've ever learned something in school (such as a foreign language) and then not used it for years, your memory of it fades over time. The same neurological principles can help us to dull chronic pain in our nervous system. The most basic form of stereognosis training is to reach into the bag, take an object in your hand and move it around with your fingers in your palm until you can identify what it is. The more similar the objects are that you place in your bag, the trickier it will be. A ChapStick tube and a AA battery for example will be harder to tell apart than a toothpick and a Lego. Stereognosis training can be done inexpensively at home. All you need are some small household objects and a bag to place them in. You can get creative using miscellaneous objects from around the house like office supplies, kids toys, hardware items, personal care items, etc. Some common items you might have at home could include: Office supplies: paper clips, binder clips, pen caps, erasers, rubber bands, or ear pods Kids toys: Legos, crayons, dice, marbles, dominoes, puzzle pieces, or board game pieces Personal care items: ChapStick, bobby pins, hair clips, hair ties, toothpicks, floss picks, toothbrush head caps, earrings, rings, makeup containers, cotton balls, or Q-Tip's Hardware items: batteries, screws, nails, washers, nuts, bolts, keys, or allen wrenches Miscellaneous items: coins, buttons, bobbins, thread spools, beads, bottle caps, wine corks, wrapped candies, or clothes pins. As you assemble your kit, keep in mind, safety first. Avoid using objects that are sharp and could cause injury to your hands. While paperclips and binder clips are fine to include, thumbtacks are not advised. If you feel like identifying objects out of the bag is getting easy, the next step is to be able to find the object amongst others. Instead of using a bag, try a bucket of dried beans. Mix your objects into the bucket, and search for them in the beans. This can add another layer of challenge without too much expense. If you're looking for more ideas on how to train your brain, don't forget to check out the related posts for more information on laterality training, two point discrimination, and proprioception training. This article is intended for educational purposes and is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in personalized recommendations for your specific situation, call or click book online to request an appointment for a physical therapy evaluation.

Most parents know that the secret to managing toddlers is distraction. If your child is misbehaving, sometimes the problem is that you haven't given them something better to do. While adult brains have grown and matured, some of the strategies of managing undesirable experiences and behaviors aren't different from children to adults. Even our adult brains are only capable of doing so many things at a time. The best multi-taskers have their limits, and our brain is no exception. While we don't consciously think about it, our brain is constantly managing our breathing, heart rate, blood pressure, and a number of other things that keep us alive. Then we pile on the added demands of daily life, like eating while driving and listening to music or sitting at work talking on the phone and answering emails simultaneously. For most of us, our daily lives are pretty full. As much as we live in a society that glorifies busyness, (perhaps sometimes in part because we already know that it lets us distract ourselves from some of the unpleasant things we'd rather not dwell on), the limited capacity of our brains to multi-task is actually a gift we can use to our advantage. If your brain is busy processing information for one sensation, it has a harder time processing information for a second sensation at the same time. This means it will have to choose where to invest its resources. For example, when you place a hot or cold pack on an area that is painful, it seemingly helps alleviate the pain. The feeling only lasts, however, for as long as the hot or cold is still affecting the nerves. If you take the hot/cold pack off, as the skin and nerves return to normal temperature, you begin to feel the pain again like you did before. The truth is that the pain was never really cured; your nervous system was just distracted from feeling the pain because it was focused on feeling something else. While the form of distraction may be different for an adult than a toddler, it's value is the same. When the brain is stuck on something undesirable, whether that is chronically spending all it's energy processing pain signals, anxious thoughts racing through our neural circuits, or that embarrassing memory you just can't seem to stop thinking about, we have to find a way to break the cycle. Distracting your system with something else can be the perfect solution if you can't get your mind off of the pain. It can also help you to re-wire your nervous system over time so that you have less pain. For more on how this rewiring works based on the "use it or lose it" principle, see Hurt Vs. Harm: Re-programming the Pain Alarm . When it comes to making distraction work best for you, here are a few tips to keep in mind: How much do you like it? What's your preferred learning style? Do you prefer to be in control or to escape responsibility? What intensity of stimulation is best? How do you feel when it's over? How much do you like it? The more you like the thing you're using to distract yourself, the better. The brain is prone to choosing pain and the well worn nerve paths it's developed over years because they are familiar. In fairness, if pain is supposed to tell you about danger, it makes sense that the brain sees this as a top priority and chooses to process pain over most other things. What's your preferred learning style? In light of the fact our brains prefer to choose processing pain over almost anything else, it may also help to consider your learning style to decide which methods of distraction work best for you. If your brain is wired to be a visual learner, your brain already has a preference for experiencing and paying attention to sensory information presented visually. Visually distracting things may work better for you. Do you prefer to be in control or to escape responsibility? Some of us have a tendency to want to be in control while others would rather escape and take a break from having to always be doing things and making decisions. For example, a person who wants to feel empowered by being able to do something for themselves may not find a massage relaxing. Instead, it could feel like just one more thing to have to spend money on and generate a feeling of helplessness because it's just one more thing in which they need help from someone else. The idea of continually requiring ongoing treatment may not be a positive distraction. That person may prefer engaging in activities themselves to self-treat. The idea of physical therapy may be more attractive. If you can learn some exercises to manage your symptoms, it would give you the control to manage your health more independently after a few visits. This person might prefer distraction techniques like doing sudoku puzzles that engage their minds, over something like watching a movie where they are just observing something being presented to them. For other people, they find themselves exhausted and tired of doing things all the time. It can seem like everyone at work and in their family is dependent on them to make things happen constantly. Making decisions is overwhelming to them as their brain sorts through all the possible outcome scenarios. For this person, the idea of a passive escape from their symptoms may sound more attractive. The idea of relying on a healthcare provider, like a massage therapist that they trust to take care of them, might feel easier. It's important to remember that just like having a learning style preference for auditory learning as opposed to visual learning isn't wrong, neither is having a preference for active or passive treatment approaches. You just have to keep in mind that both have their downfalls. The person who prefers control and active treatment is at risk of becoming an over-doer and not accepting help when they need it. The person who prefers escape and passive treatments is at risk of developing a costly dependence on someone or something that can be problematic if that person or thing is no longer available. There is a fine balance in life between resting and laziness, and between being active and having a control problem. What intensity of stimulation is best? Also consider your body's preferences for stimulation. Some of us love going to rock concerts with flashing lights, heavy vibrating bass, loud music, and people jumping up and down around us. Others find that to be overwhelming and would rather focus on just the sound of an orchestra in a dark auditorium where it is easy to forget the other people who sit in still silence around us. What is therapeutic for one person may not be for another. Some people love the casino with its' bright lights, the shows, the smells of the buffet, and the thrill of the potential to win money. There are many people, however, who prefer a quiet familiar environment at home where they know what to expect, and they can keep the level of light and sound at lower levels. How do you feel when it's over? It bears mentioning, that you may think that a high degree of stimulation is your preference, but this can be abused. It's important to ask yourself how you feel after the stimulation is gone. If you feel better while distracted, but returning to being aware of your symptoms leaves you in agony, and worse off than you were before, you may have to re-evaluate if this is helping. This can be a warning sign that you are actually doing things that are harming you while you're distracted. Distraction techniques should help you to get a vacation from your pain, and when you stop being distracted, you should feel recharged, like you have more energy to cope with and handle the pain that you still have. Need Some Ideas? Here are some ideas about things you can use to distract your system categorized by sensory system and learning style. Keep in mind that having a hybrid of different options is generally the best strategy. We all know that too much of a good thing, isn't a good thing and moderation in life is important (e.g. if food is your primary distraction technique, it may start to have negative health consequences). Sound / Auditory Learners Listening to music Listening to the radio Listening to podcasts Listening to audiobooks Listening to the TV Listening to the sound effects of a video game Listening to nature sounds/white noise machines Guided meditations Talking with other people and listening to them Playing an instrument Learning a language Talking to yourself in the mirror Journaling/writing - giving words to your thoughts Sight / Visual Learners Watching television Viewing social media sites like Pinterest or YouTube Watching a play/performance Creating/viewing visual artwork Playing video games People watching at the mall Reading - making associated mental images in your head Graded motor imagery and guided imagery meditations Looking at yourself in the mirror Touch / Kinesthetic Learners Exercising in general - walking, swimming, yoga, dancing etc. Transcutaneous Electrical Nerve Stimulation (TENS) Getting a massage Physical intimate touch with a partner Applying hot/cold Vibration from music, percussion/massage guns, or vibration plates Journaling and writing out your thoughts - through the movement of your hands A repetitive movement-oriented hobby, like knitting Playing an instrument Learning sign language Smell Aroma therapy – using candles, essential oils, or other scented objects Cooking/Baking Brewing coffee Gardening Spending time outdoors Taste Eating Drinking Wine tastings Sampling foods at grocery stores Sucking on hard candy Chewing gum General/multisensory: Pet therapy - engaging with animals Volunteering - getting the focus off of yourself and onto others Socially engaging with friends/family Doing puzzles – being intellectually engaged in completing tasks Art therapy - creating something Reading - encourages auditory engagement with words, and visual engagement as you conjure images of what you've read Working – draws your focus onto something other than your pain Hobbies – focus on something enjoyable rather than pain Keep in mind some activities use multiple systems. We traditionally think of watching television, but you are also usually listening to it at the same time. We may think of reading as being auditory because it involves words, but in actuality, your eyes are the thing moving along the page, and your mind is creating images of what you are reading, and/or a word picture in your head. Lastly, it's important to keep in mind that the results from reprogramming take time. We are creatures of habit, and we don't learn new skills overnight. Your brain has to essentially learn a new sensory processing language. It may take some practice before teaching it to speak like this feels like your native language. This is especially true if you've been using the old language for a long time. If you've had chronic pain for 20 years, it's important to be patient with yourself. What did not start yesterday, won't likely be gone tomorrow. Disclaimer: This article is intended for educational purposes and is not a replacement for individual medical advice from a licensed healthcare provider. If you would like to schedule an evaluation for personalized healthcare recommendations, call or click to book online today.

If you struggle with your sense of direction and you have chronic pain, you're not alone. While some may be inclined to blame it on growing up in the "GPS Generation", there may be more to it than that. People living with chronic pain have been shown to struggle with their ability to differentiate right from left (also called laterality). This is true for people with a wide variety of pain conditions in different body regions including the arm, wrist, hand, leg, knee, and even the face ( 1 ). While being directionally challenged can be inconvenient, most people are able to compensate for this by using the GPS technology on their phones. Being able to tell right from left, however, may have an impact on your body's pain processing and be worth training. If your body doesn't know the difference between the right shoulder and the left shoulder, you may start to feel that pain you had on the right is now also on the left side. In short, if you can't tell the difference between right and left, it's possible the same effect is happening in your brain, adding the sensations together and making life more painful. It makes matters complicated that your nerves are pretty good at addition and not very good at subtraction. If your body can't tell the difference between two points on a pair of tweezers touching your skin because they are close together, it will add the pressure of both points together and you'll feel it as one. This is a problem for people with pain. It can mean the nervous system is amplifying a pain signal and making it more intense because it can't clearly differentiate what it's feeling. Fine tuning our sensation can help to decrease the intensity of chronic pain by simply helping recalibrate the nervous system to better interpret what we're feeling more accurately. The best part is, you can do this at home for minimal cost by doing what's called laterality training , and two point discrimination training . What is laterality training? Laterality training is challenging your body to differentiate right from left in a variety of situations to help improve it's accuracy. This will help sharpen your brain's map for the right and left side of your body. As an added perk, it may also help you to be better at navigation and directions. If you prefer the more guided approach, there are apps that will take you through a laterality program, like the Recognise App or the Orientate App . Unfortunately, Recognise requires you to pay for each body part which can get pricy at $6.50 per app if you have widespread pain. Orientate offers the first few levels free, but in-app purchases are involved after that. There are some advantages to the app, in that the images are specifically selected and the program is able to give you feedback. If you aren't ready to spend the money when you aren't sure if it works for you yet, there is another way. If you prefer the more economical version, you can practice laterality training with a magazine, or scrolling through images on Pinterest on your phone or tablet. First you'll choose a body part to search for. It is generally easier to start with hands (the side of the hand the thumb is on tips you off to which direction the hand is facing.) You may have chronic pain specifically in your shoulder, however, or your knee. Once you get the hang of the laterality training searching for hands, you'll eventually want to work on practicing for the part of your body that is painful. Get your magazine ready and start with all of the images face up; it will be easiest this way. As you turn the pages of your magazine, try and find every right hand (or whatever body part you chose to work on). This may be somewhat challenging at first, but you will get better with practice. As you make mistakes and realize them, redirect your attention to the correct hand in the picture. When you get to about 80% accuracy in selecting the correct hand consistently, it's time to increase the level of difficulty. Turn your magazine 90 degrees counterclockwise. Now your brain will have to work harder in differentiating the right and left hands because the position of the image has changed. This will further hone your body's skill to tell right from left regardless of position. When you reach an accuracy level of 80% or better, simply turn your magazine another 90 degrees so that it is now upside down and repeat the process. When that gets too easy? You guessed it, turn it another 90 degrees. If you don't have magazines lying around, you can use a feed of images on your phone or tablet. Just place the tablet on a flat table top so that it doesn't automatically adjust the screen to your position as you turn the tablet in the 90 degree turns. What is two point discrimination training? Just like the title implies, the goal is to help your body differentiate between two points touching you at the same time at as close of a distance as possible. Different parts of your body are more capable of doing this than others. For example, the palm of the hand is more sensitive than the skin on your lower back. While you can buy two point discrimination testing devices that are at set distances apart, the more economical version is to use a large paperclip. The advantage to a paperclip is that the metal is fairly flexible, and you can bend it to different widths between the two points. This is convenient for training because you can easily make changes depending on where on the body you're training. First you want to assess how far apart you are able to tell the difference between one and two points. Have another person quiz you while your eyes are closed. The person quizzing you will tap you with either one of the two points on the paperclip, or both points. Your job is to tell them whether you are feeling one or two points. If you are consistently accurate in answering correctly (about 80% of the time or more), then the person doing the quizzing can bend the paperclip to make the two points a little closer together. Eventually the points will be close enough that you can't tell the difference between them consistently. Measure how far apart your paperclip points are when you first reach a distance that becomes difficult. This is what you want to set your paperclip to when you work on yourself. If you are practicing with someone consistently and they can quiz you all the time, that is great. If not, you can do this yourself and it's ok for training. In fact, if your body is having a hard time feeling the difference between the two points, when you can see that you are touching your skin with both, the visual feedback helps your brain learn what it should be feeling and can help it to interpret the information more accurately. Likewise, if you are controlling the paper clip, and you know that you intend to touch yourself with both points, your brain will tell your nerves to expect touch in two places. This can also help fine tune the nervous system to feel what it is supposed to be feeling. As you practice alternating between touching yourself with one, or both points of the paperclip and feeling the difference, you may notice that you feel like it becomes easier. You may be able to close your eyes now, and still feel the difference between one and two points consistently. If so, it's time to retest; have someone else check. Having another person check means that your brain won't produce the right sensation because you know it should be there. Our brains and our nervous systems rely heavily on expectations, so it's easy for them to do this. Our brains are excellent at finishing other people's sentences, predicting where the ball will bounce next, and anticipating all kinds of different things. If you test well, at the previous level of distance between the two points, your tester can move them closer together until you begin to struggle again. Then you can repeat the process and train at the new level. So what is the goal? To help give you a sense of "normal", there is some data out there on what distance a typical person can differentiate between two points. If you need some direction, here is some data for a few different body regions: Citation credit for this research article and the associated image can be found here: ( 2 ) The typical person was able to tell the difference between two points until about 10.4mm on the palm of the hand, 20.9mm on the sole of the foot, 55.5mm on the lower back, and 45.9mm on the neck. ( 2 ) You'll notice that some areas are more sensitive than others. The hands that we use to interact with our environment and engage with most objects are the most sensitive, followed by our feet. Our lower back, which isn't as heavily involved in sensing our interaction with things in the world, on the other hand has a much larger distance between two points. The ultimate goal of these types of sensory training is to sharpen the maps that your brain has for your body's sensory system. Bringing clarity and focus to sensation in the brain can help people have less pain that shouldn't be there. If you're interested in more ways to train your brain and your sensory system, see Train Your Brain: Sensory Mapping and Stereognosis . This post is intended for educational purposes only and is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in an evaluation of your specific case, call or click to request an appointment . Resource Citations: (1) Ravat S PT, MSc, Olivier B PT, PhD, Gillion N PT, MSc, Lewis F PT, MSc. Laterality judgment performance between people with chronic pain and pain-free individuals. A systematic review and meta-analysis. Physiother Theory Pract. 2020 Dec;36(12):1279-1299. doi: 10.1080/09593985.2019.1570575. Epub 2019 Jan 27. PMID: 30686110. (2) Catley MJ, Tabor A, Wand BM, Moseley GL. Assessing tactile acuity in rheumatology and musculoskeletal medicine--how reliable are two-point discrimination tests at the neck, hand, back and foot? Rheumatology (Oxford). 2013 Aug;52(8):1454-61. doi: 10.1093/rheumatology/ket140. Epub 2013 Apr 22. PMID: 23611918.

Aerobic exercise, or really anything that requires physical exertion can be exhausting for people with POTS. While the research suggests that regular aerobic exercise helps people with POTS feel better because it encourages their bodies to make and store more blood volume, most patients will quickly interject "I want to, but I can't tolerate exercising." The reality is that getting started with exercise has extra challenges for people with POTS. Their bodies have a hard time getting blood the right places at the right times. (See: POTS University ) The additional blood supply required by the muscles to exercise puts even more stress on their cardiovascular system. For a person with POTS, their cardiovascular system was struggling to begin with. The demands of exercise can lead to headaches, light headedness, a racing heart rate, and extreme fatigue. Many who attempt cardiovascular exercise will stop within a few minutes because their symptoms make them feel like they just can't continue. For most people who haven't exercised in a while (whether they have POTS or not), the hardest part is just getting started. In order to be successful in doing aerobic exercise with POTS, we have to start with tackling 1.) Reframing Our Idea of exercise. 2.) Warming up with POTS 3.) Progress with POTS: A Percentage Perspective 4.) Sealing the Deal: Cool Downs Matter Reframing Our Idea of Exercise Physical therapists go to graduate school for a doctorate degree to learn to dose exercise like your medical doctor goes to school to learn how to dose medication. When it comes to any treatment, the right kind of medicine and the right amount of it are important. The appropriate amount of activity we consider to be exercise depends on the fitness level of the person doing the exercise. Exercise looks different for a marathon runner than for a person who has been hospitalized and in bed for a week. The first physical therapy session for the person who's been hospitalized might only involve an exercise prescription of walking to the bathroom and returning back to bed. In some cases, just being able to sit up on the edge of the bed is as much as exercise as they can tolerate. To be successful, the exercise prescription has to match the starting level of the person doing the exercise. Warming Up with POTS When building a good exercise routine, it should have a warm-up. Even the idea of warming up can sound daunting to a POTS patient in all senses of the phrase. Many people with POTS are symptomatic when they get too hot. Temperature control is a struggle for people with POTS because the body directs blood flow to help regulate our body temperature. Exercise warm-ups not only affect their body temperature, but exercise increases blood flow demands to the muscles and can stress their cardiovascular system to the max. When a typical person exercises, as their body senses an increase in demand for energy to the muscles, the cardiovascular system kicks into gear. The heart begins to pump more quickly and our blood pressure elevates so that the supply of oxygen and nutrient rich blood is pressurized to move through our blood vessels at faster speeds. For a person with POTS however, their body struggles to figure out where to send blood and at what time. The system may not realize you've started exercising, and your heart rate may stay flat and even. This creates a problem because it leaves your muscles hungry for blood and oxygen and unable to produce energy to keep you moving. In some cases, not only does the heart rate not increase, but it dips even lower and slows down. When this happens, a person will most likely experience extreme fatigue and a feeling that they have to stop exercising. This is where most people with POTS get stuck. If you think about your body like a car, POTS bodies struggle to go from zero to sixty in 3 seconds. They may be able to get up to sixty, over several minutes. A common mistake when trying to exercise with POTS is doing too much too soon. Patience is something most of us aren't naturally good at, but we're going to need it to be successful long term. The secret is to "Start low, and go slow." A warm-up should be slightly more activity than you were doing at rest. If your goal is to go for a hike, it isn't best to just start working your way up the hill. Taking some time to walk slowly on a flat surface, or stand in place and kicking your bottom alternating gently and slowly one foot at a time gives your body a chance to realize you're starting to move. This may take several minutes. To know how your body is responding, use a heart rate monitor or a smart watch. These devices let you track your pulse in real time. If you have a sense of what your typical resting heart rate is, you can monitor for changes. If your resting heart rate is usually 70 beats per minute, and while you are doing your warm-up, it hasn't changed, you may need to warm up longer. If your heart rate starts to increase slightly, test out increasing your activity level a little and see how you feel. If your heart rate decreases from your resting level of 70 down to 60 beats per minute, don't panic. Just keep moving slow and steady. This sometimes happens to people with POTS. Your body may just need a little extra time to realize what is happening and adjust your heart rate. If you are symptomatic, it's ok to slow down the pace of your activity, during this phase. Your warm-up speed may have been a little too fast. If safely possible, don't stop moving entirely. This may mean moving at a snail's pace for a minute or two, to give your body time to catch up. If given enough time, the body usually gets the message and the heart rate will begin to climb. Once your heart rate is climbing, you're ready to start climbing too. Hiking the hill won't feel as difficult once your muscles are getting the blood flow that they need. Progress with POTS: A Percentage Perspective When it comes to exercise progression, we have to start to think in terms of percentages rather than amounts. For example, if a weightlifter was exercising in the gym, and they were able to squat 200lbs without difficulty, you wouldn't advise them to go back the following day and attempt to squat 400lbs. Typically, a weightlifter might only increase their weights by increments of 10 or 20lbs at a time. We wouldn't say that makes them weak or a wimp. For those who don't love math, that would mean an increase of 5-10% from one workout to the next. This concept has to come into play when we think about progressing exercise for a person with POTS. If your current exercise tolerance is to walk for 5 minutes, while walking for 10 minutes doesn't sound like that long, it is a 100% increase in your activity level. If we followed the rules of our weightlifter, a 10% increase from your 5 minute walk is actually 30 seconds. The problem in our ability to be patient in the early phases of exercise is in our perception. When we are able to do a smaller amount of activity to begin with, the increase in activity has to be smaller. If we think about exercise increases in percentages rather than solid numbers, it helps us to be less upset about the "slowness" of progress, and more successful in the end. When we fail to do this, we end up riding the chronic illness roller coaster instead of steadily climbing the mountain. (See, Pacing Activity: Mountain Climbers and Rollercoaster Riders ) Sealing the Deal: Cool Downs Matter After the first successful exercise attempt, it's tempting in the excitement to skip the cool-down and celebrate. Unfortunately, people with POTS aren't quite out of the woods yet. In POTS, the cardiovascular system doesn't handle rapid changes well, and that applies to when a person stops exercising too. As a general rule of thumb, the amount of time it takes you to warm up, is about the same amount of time it will take to cool-down. The goal is to gradually decrease your activity level and your heart rate back to it's typical resting level. If you don't give your body time to recognize the activity level change, your heart rate may stay elevated for a while after you stop exercising unnecessarily. If your heart is still exercising even when you're not, it causes the body to expend extra energy. This can leave people with POTS feeling unwell after exercise. They are often all too familiar with the discomfort of a racing heart rate, and the struggles of chronic fatigue. Cool-downs should look similar to warm-ups. Slowed, gentle activity levels can look different depending on the type of exercise you were doing. If you aren't sure what kind of movements are the right ones for your warm-up or cool-down, consult with your physical therapist for help. This article is intended for educational purposes and is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in an evaluation of your unique situation, you can call or book online to schedule an appointment.

When it comes to the muscles in our pelvis, most of us don't know what they're called or what they do. Fortunately, you don't need to be an anatomy expert to understand the basics. While there are similarities between the pelvic floor muscles in men and women, this article will focus on the pelvic floor muscles in people whose biological sex assigned at birth is female. In this series, we'll take a look at the pelvic floor muscles, what they do, and why they matter. 1.) Pelvic Floor Muscles: Layer 1 2.) The Gate Keeper: Bowel & Bladder Control 3.) Sexual Function 4.) Orthopedic Function (and back pain) Pelvic Floor Muscles: Layer 1 There are three layers of muscles in the pelvic floor. The first layer of muscles are the ones closest to the surface of your skin. Because they are superficially located, evaluating these muscles is minimally invasive. Some of their function can be evaluated by visually observing the pelvic floor while a patient performs certain movements such as a cough, bearing down, or attempting a Kegel. If doing an internal assessment of this layer for women, the therapist typically inserts one gloved finger into the vaginal canal to the depth of approximately the first knuckle (anatomically called the distal interphalangeal joint (DIP)). A speculum is not needed assess these muscles. The Gate Keeper: Bowel & Bladder Control The first layer's primary job is to be the gate keeper. These muscles are tasked with controlling when we allow things to pass in or out of the pelvis. While you may not actively think about contracting these muscles, they are actually "on" or contracted most of the time. Our default is for our pelvic floor muscles to be slightly contracted. This is important because we want to control when we go to the bathroom. We don't want to be leaking urine or stool all the time, so the first layer of pelvic floor muscles contract to constrict the opening of the urethra and the rectum. When it's time to go to the bathroom, these muscles relax and allow us to empty. At least they should relax to allow us to empty. For people having trouble with emptying their bladder, who have to strain to have a bowel movement, or who have pain with initial penetration during sex (called entry pain), this is often where the problems start. Because these muscles are "on" all the time, relaxing them can feel like work. Relaxing the muscles is the opposite of how they are usually positioned. This can be a bit of a paradox for our brains. We typically think of the "resting" state of a muscles as being the one that the muscle is in most of the time, unless we tell it to do something else. For our pelvic muscles however, the default setting is "on", not "off". Muscles however, can contract at varying degrees of strength. Rather than a simple on/off switch, think about your muscles contracting on a continuum more like a dimmable light switch. Let's take a more familiar muscle like your biceps for example. You might slightly contract your biceps to bend your elbow while carrying a water bottle in your hand rather than letting your arm swing loosely at your side. That same bicep muscle can also contract with more force to curl a 20lbs dumbbell and raise it up to your shoulder. The pelvic muscles work similarly, but the source of the resistance isn't a dumbbell or a water bottle. Instead, pelvic muscles have to adapt the strength of their contraction to the internal weight of the fluid in the bladder, or the stool in the colon. They're also responsible for resisting the downward abdominal pressure created by a cough, sneeze, or laugh. They even resist the pressure of your own body weight that sits on top of them. Because of their role in managing internal pressures as air moves in and out of our lungs, they can even affect things like voice production, singing, and playing woodwind instruments. Singers are often taught to breathe deep down into their bellies. If a person is experiencing flatulence or incontinence problems with laughing, coughing or sneezing, these are all signs that the pelvic floor muscles are having a hard time managing the downward pressure placed on them with forceful airflow out of the body. It's best to think of the pelvic floor muscles like a hammock that carry the weight of the bladder, and the colon. This particular hammock, however, has a release valve. If the weight it's carrying gets to be too heavy, it has the option to release some of the weight from the bowels or the bladder. If this release happens involuntarily, we call it incontinence, leaking, or having an accident. Incontinence can happen in varying degrees. Sometimes the leakage is a couple of drops of urine, and other times it is significant enough that we need to change clothes. Bowel/fecal incontinence could include finding small stool pellets or streaking in the underwear, up to passage of a full bowel movement or having diarrhea. It can also take the form of unintended loss of gas. Sexual Function In regard to sexual function, the first layer of pelvic muscles have to relax to allow for penetration. If the muscles don't relax, pressing against the tightened muscles can feel forced and painful. For many people who experience "entry pain" with initial penetration during sex, the pain resolves when the muscles relax. Women's bodies in particular often take some time to be able to relax their pelvic muscles to accommodate penetration comfortably. Increased duration of foreplay prior to penetration, tends to improve the relaxation of the muscles. Many people are also sensitive to external life stressors. Similar to the way people develop tight and tense shoulders or clench their jaws when they are stressed, the pelvic muscles are also prone to carrying stress. Learning to relax the pelvic muscles is often part of pelvic floor physical therapy. In terms of vaginal function, in order to experience a vaginal orgasm, the muscles surrounding the vaginal wall have to be able to rhythmically contract and relax. The first layer of pelvic muscles are a part of that lining around the vaginal wall. For some women who have difficulty with reaching an orgasm, pain, tension and coordination problems the pelvic floor muscles are the limiting factor. Orthopedic Function Aside from being a gate keeper, because this layer of pelvic muscles is the most superficial, it also serves as the foundation for your back and your pelvic organs above it. For individuals with persistent lower back pain that has been unresponsive to other treatments, pelvic muscle function is sometimes the culprit. For those who prefer a metaphorical explanation: The Leaning Tower of Piza could not simply be fixed by moving the top floor over. To straighten out the tower and keep it from falling over, the foundation had to be addressed for it to be structurally sound. Sadly, when talking to patients about chronic back pain, many doctors don't ask patients about pelvic health. Although many doctors are quick to comment on a person's weight as a source of their back pain, your pelvic function may actually be more important. There is a stronger correlation between low back pain and urinary incontinence than there is between low back pain and BMI (body mass index). Interestingly, there is also a stronger correlation between allergies and low back pain than low back pain and BMI. Because of the role that the pelvic floor muscles play in managing air pressure, pelvic floor treatment often involves conversations about breathing. (Coming soon, See: Breathing: Why Laughter Really is Medicine) Closing Thoughts Pelvic health is often an under-discussed topic. Many people, even doctors, feel uncomfortable discussing it. It's important to recognize however that pelvic floor problems are incredibly common. It's estimated that urinary incontinence affects approximately 60% of adult women ( 1 ). Pain during sexual intercourse, also called dyspareunia, is believed to affect 10-20% of women ( 2 ), and is likely under-reported. 1 in 12 adults (8%) are estimated to have fecal incontinence ( 3 ) While this article is intended for educational purposes, it should be a conversation starter, and is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in advice for your unique situation, click to book online and schedule an evaluation appointment with a pelvic floor physical therapist. If you don't live in our area and need help finding a provider, the national provider directory for pelvic floor physical therapists can be found here . References (1) Updated Prevalence of Urinary Incontinence in Women: 2015-2018 National Population-Based Survey Data - PubMed ( nih.gov ) (2) Dyspareunia in Women | AAFP (3) Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis - PubMed ( nih.gov )

When it comes to dizziness, the healthcare system can be difficult to navigate. It's hard to know who to seek care from, in order to get the right diagnosis and treatment. Furthermore, the English language often fails us when it comes to describing dizziness which can make it hard to communicate with doctors. The fact is that the word "dizzy", can mean a lot of different things. A person might say they feel: like the room is spinning lightheaded like they're seasick on a boat motion sick from reading in the car like they're tipsy/drunk as if they're falling in a certain direction like they're seeing double. like their vision tunnels/goes dark All of those sensations can be described as "dizzy". The problem is that they don't all suggest the same kind of problem is causing a persons' dizziness. Room spinning dizziness is more commonly associated with vestibular problems, often called "vertigo". Lightheadedness on the other hand might suggest a circulatory problem where the brain isn't getting enough blood flow. Debunking dizzy and getting to the heart of the problem is important. To demystify the dizziness that can get in the way of life, we have to sort through: 1.) What does it take for the body to be well balanced? 2.) Who should I see for my dizziness? 3.) What causes each type of dizziness? 4.) What can I do to treat dizziness? While it is tempting to jump right to treatment, in order to prescribe a treatment that works, we have to address the root cause of the symptoms. To do that, we have to understand why a person gets dizzy in the first place. What does it take for the body to be well balanced? In order for us to feel well balanced, essentially the brain needs three things to add up. The equation balances if the information the eyes send to the brain, matches the information that the vestibular system in the inner ear sends the brain, and they both match the information all the position sensing nerves in the body (called proprioceptors) send the brain. Lastly, the brain has to be able to function to put all the information together. This presents a bit of a problem for getting an accurate diagnosis because most healthcare providers don't specialize in all of those things. Who should I see for my dizziness? When a person is feeling dizzy, they can seek care in different places. Primary care doctors Emergency rooms Eye doctors ENTs (Ear, Nose, & Throat doctors, also called Otolaryngologists) Neurologists Physical Therapists Primary care doctors by nature are expected to know a little bit about a lot of things. Their job is to treat common conditions, and to know which specialists to direct you to for care. The typical tools they use to address dizziness include medications that help to reduce nausea and dampen the nervous systems sensitivity to make you more comfortable. Emergency rooms are set up to evaluate and treat certain kinds of dizziness. They are used to seeing people who have dizziness related to brain injuries like strokes and concussions. When it comes to the vestibular system however, their training is limited. They may sometimes diagnose Benign Paroxysmal Positional Vertigo (BPPV), which is the most common vestibular system disorder. The nature of an ER however is not to provide long term care. They stabilize patients, and then refer them to other specialists. Eye doctors primarily focus on dizziness related to visual acuity problems. They can adjust prescriptions of glasses and contacts to help your visual system function better. An eye doctor may also screen your cranial nerves to see if your brain is involved, but they get very little training in the proprioceptive nerves in your body that sense position, and the finer points of the vestibular system. Otolaryngologists, more commonly referred to as Ear Nose and Throat doctors, or ENTs for short, have more experience in the vestibular system. As the nickname suggests, the ear is part of their specialty. They are also acquainted with screening cranial nerves to check if the brain is partly to blame for your symptoms. Speaking of the brain, the neurologists are the experts there. If damage to the brain is preventing it from putting all the information together that your ears, eyes and proprioceptive nerves are sending, the neurologist looks for causes and solutions. The last person you might think of on your dizziness team is your physical therapist. In reality however, primary care doctors, ENTs, neurologists, and ER doctors all write referrals to PTs to evaluate patients for dizziness. Physical therapists are the movement experts. Neurological problems, vestibular issues and balance training are all part of their standard education. While you may think of physical therapists as working on muscles and exercise, this actually allows them to provide a unique perspective on visual aspects of dizziness because they are experts in the way the eye muscles work to move the eye. What causes each type of dizziness? Now that we've covered who evaluates and treats dizziness, as well as what needs to happen to prevent it, let's talk about why people get dizzy. 1.) Vestibular Dizziness 2.) Visual Dizziness 3.) Proprioceptive Dizziness 4.) Central/Brain Dizziness Vestibular Dizziness Most commonly, people refer to their dizziness as "vertigo". True vertigo is a disorder in the vestibular system. The classic complaints of people experiencing vestibular dizziness are that it comes on when they go to lay down or are rolling over in bed. They will complain that the room starts spinning as though they are on a playground ride that they can't get off. The primary cause of this type of dizziness is movement of the crystals in the inner ear, called otoliths or otoconia. Our bodies use the movement of these tiny calcium crystals to sense the position of our head and body as they shift in the fluid in the labyrinth in the inner ear. Like the name suggests the labyrinth is a bit like a maze with several complex twists and turns. There are many different problems that can occur in the vestibular system. Visual Dizziness When the visual system is causing dizziness, several factors can be at play. The first major factor is visual acuity; how clearly your eyes can see objects. This is what the eye doctor tests when they are determining if you need prescription corrective lenses. The second major factor is eye movements. We are able to look different directions without moving our heads. That means that the eye itself moves to direct or pupils where to look. In order to take in information effectively, your eyes have to be able to track an object as it moves. This might mean smoothly tracking an object like an airplane as it moves across the sky, or the doctor asking you to follow their finger back and forth. It can also mean the ability of your eye muscles to accurately jump between two objects. For example, when reading this article, your eyes repeatedly jump from the last word in one line of text, back over to the first word in the next line of text as you work your way down the page. These muscles can have coordination problems just like any other muscle. This can lead to the eyes having difficulty supplying the correct visual balance information to our brains. Third is eye stabilization. It is just as important to be able to move your eyes to the desired location, as it is to be able to hold them still. When you are watching a movie, you want to keep your eyes focused on the TV, not bouncing around between the TV, the floor and the ceiling. Your eyes have to be able to stabilize your gaze on things both when you are sitting still watching TV, and when you are moving. When driving for example, the eyes have to be able to stabilize on a traffic light up ahead even if the car is moving towards the light and simultaneously moving sideways while changing lanes. This forces multiple systems to work together. (Coming soon: Why Driving Makes You Dizzy) When the visual system and the vestibular system have to coordinate with one another, it gets even trickier. In order for you to fix your gaze on an object while you are moving your head, your brain has to be able to perceive the speed and direction that you are moving your head, and then adjust the direction your eye muscles pull your eyeball in a fraction of a second. Keep in mind this isn't an exhaustive list. There are other less common visual factors like problems with pupil dilation, eye dryness, traumatic eye injuries, and strabismus that can contribute to dizziness. Proprioceptive Dizziness When the proprioceptive system is causing problems, the nerves are to blame. Proprioceptors are nerves that sense position in our bodies. If the proprioceptive nerves are not sending the right messages, we often think of people with this problem as being "clumsy". This can be related to genetic predispositions, as well as lifestyle and environmental factors. Some people like those with connective tissue disorders like Ehlers Danlos that affect the ligaments can also struggle with proprioception. While these nerves are spread throughout the body, many of them are concentrated in the ligaments near your joints. The ligaments are a strategic location to house these nerves because they support the joints, which serve as the pivot points where our bodies change position. For people who are born with a typical, healthy proprioceptive nervous system, it still needs to be trained. Children are all clumsy when first learning to walk. As we use our bodies throughout our lifetimes, they become more skilled at the activities we practice. A concert pianist may have incredible coordination and dexterity in their hands and be able to play Mozart blindfolded. That same pianist however may not have the position sense in their feet to walk across a balance beam with their eyes closed. The proprioceptive nerves can become damaged in a variety of ways including: Chemical agents like chemotherapy medications or environmental toxins. Long term exposure to poorly controlled blood sugar levels Chronically poor circulation/blood flow which limits oxygen/nutrient supply Traumatic injuries like ligament tears or surgeries. Conditions/habits associated with these types of problems might include neuropathy, diabetes, smoking, peripheral vascular disease, and traumatic injuries. Central/Brain Dizziness Assuming that the eyes, the vestibular system, and the proprioceptive nerves are functioning correctly the final hurdle to cross is in the brain. Your brain has to be able to synthesize all of this information correctly. While the nerves from the eyes and the vestibular system connect to the brain directly, it bears mentioning that proprioceptive nerves have to communicate with the spinal cord first on their way up to the brain. Nerve root problems in the spine and injuries to the spinal cord can cause sensory processing problems on their own. Once the information gets to the brain, it has to be able to put it all together. This means that the brain has to have what it needs to function. Some people describe their dizziness as feeling "lightheaded" which can be a sign that the brain isn't quite getting what it needs. Circulatory conditions like dysautonomia (the most commonly diagnosed form being POTS) can cause periods of slightly decreased blood flow to the brain which can cause a person to feel lightheaded. If the loss of blood flow is significant enough, the person may experience tunnel vision and "black out", or faint. The brain structures also have to be connected and communicating well. Some dizziness is caused by damage to the brain such as from a stroke or a concussion. There are also many neurological disorders that can affect the brain such as Multiple Sclerosis (MS), or Parkinson's disease. What can I do to treat dizziness? Vestibular Dizziness In terms of short-term symptom management, if the vestibular system is to blame for your dizziness, closing your eyes often makes the problem worse. People whose vestibular system is sending the wrong information, often feel most comfortable when the other systems are still sending the right information to the brain. They will commonly prefer to fix their eyes on something to try and stabilize their gaze. They also tend to prefer having a lot of touch contact. They might spread their arms out and press them into the bed to maximize the amount of tactile contact they have so that the proprioceptive nerves can send signals to the brain saying that the body is stable. The most common problem diagnosed in this area is called BPPV, or benign paroxysmal positional vertigo. Some patients are diagnosed and sent home to do what's called an Epley Maneuver to self-treat the problem. It is a series of movements that aims to move the crystals through the labyrinth back into the right position. It doesn't work for everyone, however, because it assumes the crystals are in the most common position. If an Epley maneuver isn't working for you, it's best to consult a vestibular physical therapist for further evaluation to make sure you are treating the right problem. They can also help you to perform the maneuver correctly, as some people struggle to get in the right positions for the multiple step maneuver. It's also common that when performing an Epley maneuver at home, patients don't hold the positions long enough to obtain benefit. Consulting a vestibular physical therapist can help you trouble shoot why the maneuver isn't working for you. Visual Dizziness As a general tip for symptom management, if the visual system is giving the brain incorrect information, closing your eyes usually helps to reduce the symptoms at least temporarily. If you find your dizziness is better with your eyes closed, it's a good indicator that the visual system is contributing to the problem. If the visual acuity in the eyes isn't adequate, you might need corrective lenses in order to see things that are near or far away. If you aren't sure and want to test yourself before making a trip to the eye doctor, you can screen yourself at home. Eye charts can be printed off from online in the standard sizes used at the eye doctor's office. You can then stand the designated distance away and try to read the chart with each eye. It isn't as precise as going to the eye doctor, but it can give you a rough idea of your visual acuity. For dizziness that stems from an eye movement problem, a physical therapist can teach you eye exercises to train your eyes to move more effectively. There are multiple eye exercises depending on the types of movements that your eyes are struggling to perform correctly. Working on these exercises and gradually increasing their difficulty level will often resolve these issues. Proprioceptive Dizziness As with the other forms of dizziness, increasing the level of correct input your brain receives is helpful. Keeping your eyes open to ensure good visual feedback often improves your sense of balance if the proprioceptors aren't functioning well. While current medical understanding cannot reverse all types of nerve damage (i.e. from some chemotherapies), some types of proprioceptive problems are treatable. If some sensory nerves are still working, those nerves can be trained to be more efficient. Balance exercises that emphasize controlled/intentional movement can improve coordination and balance. This often means slowing down while performing the exercise to give the nerves more time to sense what you are doing. This type of training can also be helpful for people with connective tissue disorders like Ehlers Danlos. They can also help people who are just generally a little "clumsy" from lack of practice training their nervous system. Your therapist may ask you to perform very specific movements to improve your balance and the posture/technique matters. Many people with proprioceptive limitations struggle to know if they are performing an exercise correctly or not. This may mean they need help from an outside observer like a physical therapist to coach them through performing the movements correctly. It can also be helpful to work on balance exercises while receiving input from the other systems. Your physical therapist may encourage you to perform balance exercises in front of a mirror in order to help your nerves orient themselves to where your body is in space with the visual feedback from your eyes. Central/Brain Dizziness When it comes to treating the central nervous system, the best treatment is very dependent on the type of disorder causing the problem. Neurologists are often the most skilled provider to help with medication management for disorders like Multiple Sclerosis and Parkinson's Disease. Strokes and concussions that have caused some degree of damage to the brain tissue are typically treated with structured exercise protocols by physical therapists, occupational therapists, speech therapists, and athletic trainers. Because the brain is a highly individual organ, it's important to work with a trained clinician who can tailor the exercise program to the area of the brain that has been damaged. If a circulatory problem like dysautonomia is to blame, working with a cardiologist to manage medications, and a physical therapist to train the cardiovascular system to better support brain function are the preferred treatments. In closing, when it comes to dizziness, remember to put safety first. If you're dizzy, you shouldn't drive or operate heavy machinery. You are also at an increased risk of falling when you are walking and moving around. It may be best to have someone there to help you maintain your balance when you are trying to move around and/or use assistive devices. While this article is intended for educational purposes, it is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in scheduling an evaluation to have a physical therapist review your unique situation, we encourage you to call or book online to schedule an appointment.

For many people living with chronic pain, it's a natural response to make the assumption that the pain they are experiencing doesn't indicate any real danger. After all, if you've been to the doctor (over and over) and been told that nothing is wrong (again and again), it makes sense that your trust in your body's pain alarm system is shaken. Your body is telling you that something is wrong, but all the doctors and medical tests say that there isn't anything to justify that pain response. They may have even told you that "it's all in your head" or accused you of "attention seeking" or "drug seeking" behaviors. Even if your doctor validated your experience, was compassionate and apologetic that they couldn't identify a reason for your pain, you still learn quickly that they can't help you. Furthermore, you will still get a bill for their time, even if there is no treatment that fixes the problem. So, in the end, it sometimes doesn't make sense to keep going. When the pain is chronic, and doesn't have a clear cause or remedy, you will frequently have heard phrases like "suck it up buttercup", "it's all in your head, you're fine", don't be such a drama queen" or "no pain, no gain", especially if the pain started as a child when adults were less likely to take you seriously. It becomes a very practical coping mechanism to simply ignore the pain signals and stop talking about them. For people who experience pain constantly, if they stopped every time something hurt, they'd never get anything done and would spend most of their lives in bed. Many will therefore make the choice to keep doing things regardless of the pain. It will hurt whether they do things or not, so they might as well live life. If we ignore all the pains and just continue to do whatever we please, we risk becoming over-doers and running ourselves into the ground. The fact is that pain does have a job in our bodies. We need it to tell us about legitimate danger. For these individuals, hurt vs. harm matters, because of the old proverbial story about the boy who cried wolf. The boy cried wolf several times when there was in fact no wolf threatening him. As a result, when there really was a wolf, and the boy cried wolf, no one believed him to come to his aid. The fact is that ignoring pain can be dangerous. You would not say "no pain, no gain" to a child who cries because their hand is on a hot stovetop. The reality is, that leaving their hand on the stovetop is only going to cause more severe burns and make it hurt more. The truth is that not all pain leads to gain, and like most cliches, you can't apply it to all situations. That's why it is important to be able to differentiate pains that are hurting and pains that are harming us. While the hurt is very real, not all chronic pain indicates new tissue damage. (See Hurt Vs. Harm & Car Alarms: Interpreting Chronic Pain ). It's rational to ignore the chronic pain signals that are "hurting" for many reasons. It can even be a useful strategy for improving chronic pain when paired with distraction techniques for "hurt pains". It doesn't help us, however, if we ignore a "harm pain". When we ignore "harm pains", our bodies will get frustrated with us. If the higher brain that does the cognitive processing in humans ignores the needs of the lower brain, eventually the lower brain will revolt. For example, most people cannot forcibly drown themselves. Even a person who is experiencing significant suicidal ideation, won't be able to bring themselves to hold themselves under the water. Their lower brain will take over and force their head above the surface to gasp for air. (We value all our readers as human beings, and living with chronic illness is hard. If you are experiencing suicidal thoughts, help is available. Please reach out to the national mental health hotline by calling 988.) Our pain system works similarly, though in a more passive-aggressive way. Let's say your body gives you a pain signal, at a 3/10 intensity after you walk for 30 minutes and your body wanted you to sit down and rest. If you ignore your body, and keep walking for 60 minutes, the pain signal will escalate, perhaps to a 7/10 intensity. Eventually, it will become painful enough for you to listen to your body and sit and rest. If this is a habit, your body will start to learn from the experience. If you could hear your nervous system talking to itself, the lower brain might be saying "Hmmm, she can't hear me...I must need to make my warning louder." If, over time, the body realizes that you sit down at a 7/10 intensity, you may find that the 7/10 intensity starts to occur earlier and earlier. You might experience it at 45 minutes instead of 60 minutes, then at 30 minutes, or even sooner. Ignoring "harm pains" over a prolonged period of time, may actually be sensitizing the body to pain more. If this is a pattern that has been learned for years, it may take some time for the lower brain to learn to trust the higher brain (you) again. This is one reason that chronic pain is so common amongst professional/high level athletes, military veterans, and abuse survivors. These individuals lived a significant period of time in their lives where they did not or could not allow themselves to really process pain. For people in the military, this is a survival skill. There are times in military combat when stopping to attend to an injury would mean losing your life, and pushing through the injury can get you to safety where the injury can be attended to later. In fairness, running on a sprained ankle, or even a gunshot wound to the leg, is worth it if you are running for your life. This is a mindset that is specifically cultivated in military training, along with other habits like strict obedience to following orders from commanding officers. While it may keep you alive in a war zone, that way of thinking can often overflow into everyday civilian life for years afterwards. In the absence of a commanding officer barking orders at you, when the lower brain is finally left to it's own devices, it can take back control with a vengeance. It can then insist that you process all the pain you have ignored for years, and give you overzealous signals about new injuries to make up for lost time. For high level athletes, it may not have been life or death, but there are other things that motivate us. Professional football players play through all kinds of injuries because they decide that the paycheck, the fame, or just the love of the game are worth the price they are paying. They often also have access to high level medical treatments to cover up the pain for a while. Team doctors, athletic trainers, physical therapists, and other health care providers offer them a whole array of treatments to try and keep them in the game. While the doctors are usually well intentioned, and trying to provide relief in the short term, sometimes they and the athlete lose sight of the long term negative consequences that can follow. Pain medication may cover up the pain, but playing on the injury may make it worse. Furthermore, the athlete is often set up for psychological failure. When everything centers around the sport, and then eventually they retire, or are injured to the point they can no longer perform, not only are they left with a broken body, but an identity crisis. The compounding physical and mental health struggles, in addition to access to money can lead athletes to dark places. It's not an uncommon story to hear of professional athletes who end up addicted to drugs and alcohol. Lastly, let's consider survivors of abuse. Sadly, many abuse victims are children who have a limited ability to both recognize the abuse, and to know how to get help. They develop survival skills specific to their situation and the type of abuse. Some may attempt to rationalize the abuse as something they deserved. Others brains may respond by refusing to acknowledge or process the abuse entirely and repress the memory of it. The victim of the abuse is often just trying to make the best of a difficult situation that they have a limited ability to control or influence. When these coping mechanisms are applied to pain processing however, it can muddy the waters. In addition to working with medical providers, professional counselling is often needed to help the individual heal. Medical providers will help to rule out any actual tissue damage and treat it when present. Professional counsellors who specialize in the type of trauma/abuse the person experienced and/or pain psychology can help heal the emotional damage and aid in rewiring the brain. If you believe that adverse childhood experiences may be affecting your pain processing, consider reviewing resources available from the Centers for Disease Control on the Adverse Childhood Experiences (ACE) Study. The ACE Questionnaire may serve as a starting point for you to evaluate if you have experienced childhood trauma that would benefit from professional counselling services. The ACE study also provides data on the prevalence of chronic illness and diseases later in life for people based on the number of adverse childhood experiences they had. For the body's pain processing system to be healthy, we require balance. There is a right time to ignore pains that are legitimately hurting, but not harming us in order to help reprogram our nervous system. (See Hurt vs. Harm: Reprogramming the Pain Alarm ) There is also a time to recognize that some pain is legitimately harming us and to take steps to respond accordingly. If you need help taking the next steps and aren't sure where to start, talk to your healthcare provider to connect you with local resources. This article is intended for educational purposes and is not a replacement for individual medical or psychological advice. If you are interested in seeking individualized medical care for personal recommendations, call or book online to request an appointment.