Monday, September 15, 2014

Getting healthy? It's 80% diet 100% culture..

A Very Wise Sage Once Told Me Fitness is 80% Diet. 
Having worked in and around gym's for the last 16 years I have have worked with fitness professionals, body builders and athletes. I have also  endured my own journey towards fitness and seen many patients change their physique. It's no secret diet and exercise are the cornerstones of fitness.  For me the holy grail of fit was more raw foods and high intensity interval training or metabolic training. Real changes are those that transcend your schedule and lifestyle, which brings  me to my next statement.

You MUST Change How You View Food.
Our ancestors must have gotten a completely different palate, keeping in mind that spices were reserved for the privileged. Food was most likely bland and it was most certainly sparse, my parents grew up in German occupied Greece and even one generation ago, there were people starving to death.  The take home point is that it's only until recently that our culture has put so much emphasis on eating as a social event. Historically food has been viewed as fuel.

Dinner and Drinks?
I have many patients and friends who ask how to improve their body composition(less fat or more muscle), and inevitably the conversation moves to dinning. Going out to dinner has become a common pastime and a weekly occurrence. The individual looses control of the preparation of the food and seldom asks for nutritional information, since they're going out, one may figure "where's the fun in that?" The problem is that just an appetizer alone can account for all of your daily allowance of fat and calories as explained in this Good Morning America post. Add a few beers or glasses of wine at around 150 calories each and you can see even a modest meal turns into a  4000 calorie event. 
Convenient, but obese kids make obese adults.

The Good News? We're Not the Fattest Country Anymore!
Mexico has surpassed the U.S. as the fattest country in the world, perhaps due to the infiltration of Starbucks. All kidding aside, our super-sized portions and Mocha-chino Grande (600 calories) have consistently ranked us among the fattest in the world. A simple way to lose excess weight is to steer clear of drinking calories. 

Prepare for the End - the Bottom End of Course.
Food preparation sounds like a big task, but it doesn't need to be. Baking 5 or 10 chicken breasts at the beginning of the week can give you all of the salad with chicken all week. Boiling 2 dozen eggs, also an excellent protein rich and calorie poor option for breakfast or snack. Put some broccoli florets in a zip-lock and grab some hummus for a balanced, low calorie filling snack!  Greek yogurt is one of the packaged foods that you can eat and feel great about.  There are tons of great ideas in magazines and online, but the sooner you appreciate the power of preparing your meals the faster you'll be feeling and looking great.

Diets Don't Work--You Need a Lifestyle Change
Understanding this is a total shift in how to live and not a diet.  Gradual changes are ones that cause less stress and will be more sustainable.  Limiting half of the starchy carbohydrate that you typically eat at a sitting will be a great stepping stone to eventually eliminating them altogether.  Gluten and sugar have a major impact on inflammation, insulin levels and cardiovascular health. Dr. Seaman did an interview that can be found here explaining how our diet is killing us slowly.

It's better to look good than to feel good
Looking good and feeling good are very much intertwined, in explaining the way to a fitter physique we also extoll the benefits of good health. Not everyone wants a beach body and by following some of the guidelines we have set forth, will not only get you looking better but also improve your cholesterol and triglyceride counts. It's important to keep in mind why we would want to change, it's not all about aesthetics.
You look marvelous darling
Everything in Moderation
We all enjoy a night out and if you're active and practicing good eating habits most of the time you can enjoy a nice restaurant, but overall, most may want to develop other forms of entertainment.  Active hobbies would have a definite impact, increasing activity levels as well as limiting outside meals. Personally, my wife and I have shed our inhibitions and frequently dance like no one is watching in a club full of people way younger(at least chronologically).

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our facebook page.

Tuesday, September 9, 2014



Comprehensive Strategies For Addressing Plantar Fasciitis
In today’s clinical environment, plantar fasciitis is a common and debilitating condition. “Plantar fasciitis is the most frequent cause of heel pain in adults, accounting for 15% of visits to podiatrists and approximately 9% of running injuries”(1).   The purpose of this article is to discuss comprehensive strategies that include instrument assisted soft tissue mobilization (IASTM) and functional evaluation techniques. Irritation to the plantar fascia is widely treated with immobilization and injections. Unfortunately these interventions are incomplete and short sighted.  When faced with these types of complex injuries, each provider should ask; is the treatment we are rendering comprehensive?  Many of the patients I have treated have most likely seen other types of providers before seeking our care as a last alternative. Chiropractic is touted as treating the root of the issue, but if we seek to only provide short term relief, how can we hold ourselves to that higher standard.
Form & Function;
Static analysis and Orthotic correction (shoe inserts)  is a common treatment for plantar pain. Traditional approaches to heel pain have come up short fully addressing plantar pain. It’s been brought to my attention that much of the chiropractic (and physical therapy) profession is unaware of the rehab renaissance occurring. Functional movement analysis has allowed those who utilize it to find faulty movement patterns as well as muscle imbalances that are the underlying causes of dysfunction. The work of Janda, Liebenson, and Cook have provided us with screening tests that gauge the “quality” of movement and identify areas of overuse; thereby identifying underlying causes of injury(2).
A staple of the functional testing is the squat, in its performance we sometimes note the subject’s heels lifting off as the squat gets deeper.  This would be indicative of calf/ankle hypo-mobility. Having the patient repeat the squat with the heels in the elevated position and having them perform it with greater competency would further validate calf and foot shortening.  If you cannot deep squat, it may be because of your ankle mobility and that in turn is a major underlying reason your heel hurts!
Plantar fasciitis is surely a musculo-skeletal issue. Let’s investigate the work of Tom Myers “Anatomy Trains” to see what else may be associated with the chain of soft tissue(muscle/ ligament/ tendon) known as the plantar aponeurosis.

As we can see from the illustration above, there is a long track of fibrous tissue that runs contiguously from the plantar aspect of the foot to the top of the skull; therefore shortening  the muscle along the superficial back line would shorten the continuous chain of connective tissue-in other words not only are bones connected to bones, but muscles are connected to muscles. Tightness in one muscle can and will affect other muscles along the same line.  In my own clinical experience as well as medical literature, shortened calf/ heel chords are commonly noted in cases of plantar fasciitis (3). While almost everyone knows how to isolate the Gastrocs calf group, affecting the Soleus calf group seems to elude both patient and doctor.  Most patients that present to my office with a plantar pain issue have NOT been shown this simple and ultimately effective move. Feel free to contact us for assistance in performing the Soleus mobility drill.

When treating movement related conditions it's best to use everything available. Massage, Release technique, avoidance strategies, mobility drills and strengthening rehab procedures. Restoring the amount the ankle can bend upwards (dorsiflexion) is a primary goal.  Muscle energy techniques (contract/relax stretching) should also play an integral role in the muscles situated along the superficial back line as well as any tight/ overactive muscle groups. Restoring ankle Dorsiflexion through joint mobilization (Cook’s tall half kneel) of the ankle in addition to manipulation of the ankle joint will also aid in restoring proper biomechanics. Finally we need to address foot stability, as Boyle’s joint by joint approach(4) tells us, it’s an area designed for that role. 
Self care and long range goals should include activities that would affect the superficial back line (Yoga). Finally, sparing strategies cannot be ignored, as self care will move the patient towards independence in their favorite activities. There is a wealth of tools and techniques available to us, and as my father the carpenter often told me “the right tool at the right time results in the best job”.
Correct form for the tall half kneel.

1. Ranawat, Chitranjan S., and Rock G. Positano. Disorders of the Heel, Rearfoot, and Ankle. New York: Churchill Livingstone, 1999. Print.

2. Page, Phillip. "3; Chain Reaction." Assessment and Treatment of Muscle Imbalance The Janda Approach. N.p.: n.p., n.d. N. pag. Print.

3. Garrett, T., and Pj Neibert. "The Effectiveness of a Gastrocnemius-soleus Stretching Program as a Therapeutic Treatment of Plantar Fasciitis." Journal of Sports Rehabilitation 12th ser. 22.308 (2013): n. pag. Web.

4. Boyle, Michael, Mark Verstegen, and Alwyn Cosgrove. Advanced in Functional Training: Training Techniques for Coaches, Personal Trainers and Athletes. Santa Cruz, CA: On Target Publications, 2010. Print.