On the wall in my office, there is a photo of a woman running across the desert. The word DETERMINATION is written at the top, and the quote below reads: “A journey of a thousand miles begins with a single step.” - Lao Tzu. Although these words shared by Lao Tzu, ancient Chinese philosopher and poet, were spoken many years ago, the message still rings true.

The thought of beginning an exercise program may still seem unreachable in today’s busy world. However, please know that getting back to the gym or beginning an exercise routine doesn’t have to be overwhelming. Remember to start slowly – begin with a single step.

If you are ready to start a physical activity program, here are some strategies to help you get moving!

Set specific, manageable goals. You don’t have to begin by running a mile. Instead, you could try going for a walk on your lunch break each day for 20 minutes.

Tell someone about your goals. Your loved ones can help motivate you and help you hold yourself accountable for sticking to your plan. If you have a friend or family member who also wants to get healthy, invite him or her to exercise with you.

Switch it up. To keep boredom at bay, try multiple types of exercise. One day, go for a bike ride – the next time, try swimming.

Reward yourself, but not with food. Once you’ve reached a goal, reward yourself – you’ve earned it! Because rewarding yourself with food can derail your healthy momentum, instead, treat yourself to a nonfood item such as new clothes or a massage once you’ve reached your goal.

What is one of the first things a runner does when he or she is injured? More often than not, the runner performs an online search before seeking care. This search is performed in hopes of learning what is wrong and what can be done to get rid of symptoms. The one thing that is missing from this approach is that the internet typically cannot tell someone why he or she was injured. Sometimes, similar injuries can be caused by very different factors, and seemingly different injuries can be caused by similar circumstances. The internet might be able to tell runners about their injuries, but there is no way of helping them figure out why they were injured in the first place.

Many injuries heal with appropriate rest and care — however they may recur in the future. Research shows the biggest risk factor for injuries is having prior injuries. Even when these injuries occur on different parts of the body, it is likely these injuries were caused by very similar factors if the root of the original problem was never addressed. For example, tight heel cords can lead to injuries in other locations of the body. A person who has tight heel cords may finally get over a case of plantar fasciitis (pain and inflammation of the tissue that runs across the bottom of the foot, connecting the heel bone to the toes) only to develop knee pain several months later.

The question that should always be asked first is, “Why was the runner injured?” In physical therapy, we use movement to help determine this. Many runners often come to our clinic with a variety of different movement problems. Some have too much movement at certain areas of the body, while others don’t have enough. Some have specific muscle groups that are underactive, while others have certain muscle groups that are overactive.

One of the best ways to know if you have a movement problem is to be assessed by a physical therapist. A typical physical therapy evaluation takes about an hour. The evaluation usually involves a full body assessment that looks at overall global movement (e.g., how well someone squats, lunges and balances on one leg) as well as local movement (e.g., how well specific joints move and the strength and flexibility of certain muscle groups).

Video running analysis is another useful assessment that can be performed during a physical therapy examination. Movement problems, which often affect how a person runs, can be detected in a video analysis. This analysis helps your physical therapist get a better understanding of all the factors that might contribute to your injury. Knowing a diagnosis is one thing, and knowing what caused it is another. Looking beyond that initial internet search might just be the key to preventing future injuries caused by the same underlying problems!

Word Pictures

Posted by Dr. Kimberly Fielding

From my earliest memories, I have been an “explainer.” Some people called it long winded and others referred it as a teaching ability. This trait has not decreased as I’ve gotten older. All the earlier descriptions about me can still be true sometimes, and I’ve gained a few additional labels — not all bad. My favorite compliment is from a friend who says I’m the “queen of metaphors.” For myself, I think in pictures and then use words to help communicate my thoughts so others can see what I’m thinking — I call them “word pictures.”

Specializing in children’s mental health, all those metaphors come in handy in my work with children and child-serving professionals. Embarking on the series of blog posts ahead, my plan is to inform and perhaps entertain through these word pictures. Most importantly, I hope you will remember the teaching points and be encouraged to apply them in life — especially to benefit the children in our community. The reason I’m so passionate about helping children can be explained by providing my first blogging word picture: the five-gallon jug!

Most people have seen those big blue water cooler jugs — either at the office or at the water-filling stations in the front of the local supermarket. I see a connection between these water jugs and the way that adults can invest in the lives of children, who start out so empty and dependent. Adults are like a full five-gallon jug, full of resources such as time management, emotional stability, physical energy, spiritual connection, financial potential and ethics. Then, as they invest, or “pour,” into children, adults act as a resource to fill children with the capacity to reach adulthood as five-gallon jugs of happy, safe and healthy citizens in the community.

My blog posts in the near future will elaborate on this metaphor to explore it from various perspectives, all in hopes of equipping adults to better invest in the lives of children. Some examples I have planned involve enhancing the “pour.” Some have to do with clarifying what it is that we are pouring. I prefer to think in “can do” ways, so we can even approach the uncomfortable perspectives of the jug from an encouraging point of view. (By the way, the “can do” is a hint that there is a related metaphor in the wings — the traffic light of words!)

In the meantime, explore one of those five-gallon jugs. Take a look. Reflect. I invite you to check back to see what discoveries may emerge in this metaphor. Our word picture has some explaining to do…

Many have heard the old adage, “You are what you eat,” and perhaps the response, “Then I want to eat a skinny person!” While this is a humorous sentiment, the facts surrounding the joke’s punch line aren’t so funny:

• 65% of Missourians are overweight, which is consistent with the national average
• Employers spend an estimated $73.1 billion among full-time employees on healthcare costs
• Heart attack, diabetes and high blood pressure are health conditions that employers spend the most dollars on and are all directly linked back to obesity

Many people know the basics of proper nutrition: choose lean protein, eat plenty of fruits and vegetables and minimize or eliminate consumption of processed foods. The best way to determine the nutritional value of a food is to educate yourself by reading the product’s nutrition label. Reading and understanding nutrition labels can help you make healthy decisions about what and how much to eat.

Freeman OccuMed clinics performed more than 8,000 physicals in 2013. As part of the physical, we spend time educating the patient on the importance of a healthy diet and how that affects his or her overall well-being. In doing so, we hope to play a part in bringing Missouri’s obesity statistic below the national average.

Let’s decode a nutrition label to help you make more informed food choices that contribute to a healthful diet.

Cooking Flavorful Meals Without Adding Calories

Published: 06/25/2014

Posted by Kris Drake, RN, CHPD

I ran across this quote from Andy Rooney that you may relate to, “The biggest seller is cookbooks and the second is diet books – how not to eat what you've just learned how to cook.”

It may not seem possible to prepare a great tasting meal without adding a lot of extra calories, but healthy meals don’t have to lack flavor. With local farmers markets open, now is a great time to prepare meals with locally grown, fresh produce, which adds both flavor and interest to your meals.

Healthy meals include a variety of fruits and vegetables, which are readily available at a farmers market and naturally low in calories. Choose from a rainbow of food colors to ensure that your family gets the nutrients they need – for example, try tomatoes, beets, carrots, lettuce, spinach, green onions, Swiss chard, radishes, strawberries, broccoli and cauliflower.

You could also try adding a new herb to your recipes to spice things up without adding calories. Culinary herbs such as rosemary, parsley, basil, sage, mint, oregano, lemongrass, mint, fennel and chives are popular herb choices at farmers markets.

Freeman offers a farmers market on Wednesdays and Thursdays during the summer. I hope you will stop by and check out the locally-grown produce.

Summertime brings barbeques, parties and trips, but it can also bring unhealthy foods and habits. The good news is that you can enjoy summer fun and stay on track with your healthy living goals. Try these tips!

Lose excess body weight. Every pound of excess body weight lost improves your overall health. A modest weight loss of 7% can improve your blood sugar and reduce your risk of developing diabetes by 60%.

Become more physically active. Regular exercise is an important component of diabetes management. Your exercise plan should include both aerobic and strength training. Examples of aerobic exercise include brisk walking, bicycling, jogging and dancing; examples of strength training include free weights, resistance bands, pushups, sit ups, squats and lunges.

Watch for added calories and carbohydrates. Pay attention to condiments when eating summer meals. Just two tablespoons of ketchup or relish can add an additional 10 grams of carbohydrates each – for a healthier option, try adding mustard instead. Also, include low-carbohydrate vegetables such as asparagus, summer squash, tomatoes, onions or zucchini in your grilled meals.

Keep carbohydrates under control. Carbohydrate counting is a very effective way to control blood glucose levels and manage weight. Use the diabetes plate method to help plan your meals:

• Place an imaginary line down the middle of a nine-inch dinner plate.
• Divide one side in half again so you have three sections on your plate.

• Fill the largest section of the plate with non-starchy vegetables such as broccoli, cauliflower, spinach, carrots, tomatoes, green beans or cucumbers.
• Add lean protein such as skinless chicken, turkey, beef, fish, eggs, tofu or low-fat cheese to one of the smaller sections of the plate.
• Add starchy foods such as pasta, rice, potatoes, peas, squash, beans/lentils, grits or tortillas to the other smaller section.
• Add a serving of fruit or dairy and a low-calorie drink to complete your delicious and healthy meal.

In school, I imagined that being a physical therapist would be similar to being an auto mechanic for the human body. “My body is pulling to the left; it must be out of balance.” I could see myself looking at the deep connections and finding the one part to correct, “Ah, yes, well… if you were to just stretch this and move that here while you walk it would fix your problem.” Some days and some problems are simple like that, but usually problems are much more complex. Pain can be a sign of poor overall health and may not get better until the person improves his or her overall health.

Pain is the body’s alarm system, signaling any threats to survival. The body produces pain to move us to action when there is a threat to our health and then get us to change our behavior. For example, if I have been sitting too long, my back and legs will begin to hurt. The pain compels me to stand up and move.

Pain is a vital sign of health, similar to blood pressure or heart rate. It is the result of complex interactions with more than one cause. Persistent or chronic pain can be resistant to change until overall health is improved. When healthy, the body will heal most tissue damage without any special treatment.

New studies on pain have taught us the importance of sleep, nutrition and activity; improving those health factors are essential to reducing persistent pain. Effective pain management strategies may include:

• Sleeping 7 - 8 hours every night
• Exercising 30-60 minutes each day (set a goal of walking 10,000 steps over the course of a day)
• Eating more whole foods, fruits, vegetables
• Consuming less sugar and saturated/trans fats
• Adopting these healthy habits can make a difference in reducing chronic pain and pain that has been resistant to medical treatment.

Chronic and severe pain is a sign that something in the body is out of balance – however, remember that it may not be just a muscle or joint that is out of balance. Sometimes, there are structural or medical issues causing the pain that require treatment.

However, staying healthy does make a difference when it comes to pain; our bodies are marvelously adept at taking care of themselves when we are healthy. Making healthy choices is not always easy, but small changes can make a big difference in your health and pain. It is always helpful to set and track goals, ask for support from friends and family or ask a health care provider about more ways to make the healthy choice easier for you.

Reviewing the previous five-gallon jug metaphor, I think the jug in my last blog post symbolized parents investing in the lives of children, who start out empty and dependent. Parents are like a full five-gallon jug, filled with resources (such as time management, emotional stability, spiritual connection, financial potential, ethics, and so on). Parents act as a resource, “pouring” resources into their children to help them reach adulthood as five-gallon jugs of happy, safe and healthy humans on the planet.

Today, I will be discussing the five-gallon jug and how it relates to time management. Understanding and managing time is a human need. In the past, time motivated people to learn about the Earth’s rotation around the sun, and with that knowledge, that rotation was replicated through the motion of a clock. Understanding time is about more than reciting hour and minute. Before sundials and hourglasses, understanding time helped support human connection. This need drives people to reflect on history, be present in the moment and have a good outlook to the future. Parents “pour” into children a sense of belonging by connecting time to ancestry and pride of “where we came from.” Parents also contribute to a child’s ability to focus and sustain attention by being aware of the current surroundings. They also tip their jug as a way to encourage hope and resiliency for tomorrow. When a child misses this important pour into his or her life, he or she may experience challenges in developing a sense of self, engaging in satisfying interpersonal relationships, planning and making decisions.

Parents can help their children understand time by telling stories that help the child learn about previous generations. Traditions are a fantastic way to underscore this essential principle by bringing the past to the present. To complete the circuit, the parent can guide the child in reflecting on the experience of participating in an activity that has been passed down through the family’s history.

Face time with parents is essential to understanding time and how to be “in the moment.” Simple activities, such as playing “I Spy” and or going on a “discovery” nature walk provide opportunities for children to notice their surroundings.

As children mature and fill their jugs, one of the crucial elements of understanding time includes having a hopeful outlook for the future. While younger children may consider shorter time spans as the future, this early skill leads to planning and decision making later in life. Parents can promote forward thinking through:

• Tracking positive behaviors via behavior charts
• Counting down to an exciting event using a calendar
• Asking the child questions that will help plan a future activity

Time management is about more than being “on time.” Understanding the complexity of time is crucial for good mental health. Understanding time helps us appreciate the past, be mindful and present and anticipate good outcomes for the actions of today.

“If you don’t like the road you’re walking, start paving another one.” This quote by Dolly Parton reminds me that we all have the opportunity to make changes in our lives. Sometimes it’s hard to decide where to start. Let’s begin by looking at the concept of well-being. Achieving wellness requires balancing the various aspects of our physical, emotional, mental and spiritual health. If one or more of these aspects are out of sync, then you can start looking at ways to bring them back in balance.

Physical wellness is probably the aspect that comes to mind first when we think of wellness. According to the 2008 Physical Activity Guidelines for Americans, you need to two types of exercise each week to improve your health–aerobic and muscle-strengthening. Adults need at least 2 hours and 30 minutes of moderate-intensity aerobic exercise (such as brisk walking every week) and muscle strengthening exercises on 2 more days a week that work all major muscle groups (legs, back, abdomen, chest, shoulders, and arms.)

Emotional wellness is the aspect that involves your personal thoughts and feelings. How you handle stress is a big part of your emotional well-being. Improving your emotional wellness involves getting comfortable with who you are by building positive self-esteem and practicing emotional self-care.

Mental wellness can be defined as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. Mental wellness can be influenced by medications, illnesses, family history, losses and traumatic events. You can improve mental wellness through healthy habits such as regular physical activity, nutritional meals, adequate sleep, stress reduction and more.

Spiritual wellness deals with how we find meaning and purpose in life, a connection to the universe and a relationship with a higher power. It involves clarifying your beliefs and values so that you can truly live by them. Some questions to ask yourself relating to spiritual wellness include: “Do I make time for relaxation in my day?”, “Do my values guide my decisions and actions?” and “Am I accepting of the views of others?”

If you find that any of the aspects of your wellness are out of sync, look for ways in your daily routine to make improving them a priority. Oftentimes, making an appointment with yourself to walk or return to the moment by turning off distractions such as your cell phone, computer or the TV can be helpful in the process. Remember: if you don’t like the road you’re walking, start paving another one.

Reviewing my previous five-gallon jug metaphor, I think the jug in my last blog post symbolized parents investing in the lives of children, who start out empty and dependent. Parents are like a full five-gallon jug, filled with resources (such as time management, emotional stability, spiritual connection, financial potential, ethics, and so on). Parents act as a resource, “pouring” resources into their children to help them reach adulthood as five-gallon jugs of happy, safe and healthy humans on the planet.

Today, I will be discussing the five-gallon jug and how it relates to emotional stability. Emotions originate in the brain, which is an organ in the body just like the heart and lungs. This biological component is the most tangible part of the process of emotions. However, emotions also involve thoughts and behavior choices, which are social, cultural and spiritual in nature – these last two parts are less specific in location of the brain. For this reason, human emotions are as unique the individual who is experiencing them. At birth, children’s brain functions are mature for bodily functions such as keeping the heart beating and lungs breathing. However, a child’s brain functions are immature with regard to emotions; these social, cultural and spiritual processes have to be experienced in order to promote maturity. Hence, a return to my five-gallon jug metaphor.

Emotions = Thinking + Feeling + Doing

Imagine a large, empty jug – as you pour water into it, it echoes and rumbles as the water hits the bottom and you hear high pitches and swirling. The same is true with an infant. Every new experience is “big” and consumes the child’s entire being. (Think of a baby. When the baby is happy, his or her whole body smiles. When the child is hungry, his or her whole body lets us know!) An explanation for this observation is that the brain is experience-dependent, meaning each event in a child’s life helps form a network, or web, of connections in the brain. Yet, other portions of this web of experiences is determining what events are safe. This is where the parent comes in.

As a child experiences new events, parents can help provide a sense of safety because a child will be determining whether “new” events are okay or not. If the parent provides safety, a child will approach life to experience it. For example, the child will want to try new foods and crawl to reach for a toy. If safety is not provided, a child will avoid experiencing life. A younger child’s brain rewards the body for new experiences that include exploration, curiosity, imagination and discovery. These rewards encourage the child to keep approaching throughout life. This reward matures the brain’s ability to manage emotions.

Present adult safety = child approaches = reward
Absent adult safety = child avoids = no reward

As children grow, their five-gallon jugs may not echo as much, because previous pours absorb the new sounds as water pours in. When children have new learning experiences that are positive, their brains mature and they learn how to manage “bigger” new experiences. Children can learn to manage their emotions when it comes to ongoing change – however, without parental guidance, the echoing in the pour can signal alarm defenses. Without guidance from parents, a school-aged child may feel anxiety and frustration. The child may be reluctant to explore and imagine. Going into adolescence, the result of a low number of positive new learning experiences leads to fewer rewards and thus fewer opportunities to learn how to manage complex emotions and situations in life.

Parents can help their young children prepare for positive new experiences by clearly stating a plan, including start and end times. For example, when going into a car seat, the parent should mention the word “car seat” so that a child can begin to identify the beginning of the process. The adult then says “ready” as the straps and buckling starts. When everything is in place, the adult lets the child know it is “all done.” A child can then begin to predict what will happen with the car seat, approach the process and manage the possible feelings of annoyance at the process. Remember that protest is okay; defiance is not.

Parents can help their school-age children prepare for positive new experiences by sharing control through choices and negotiating a plan. For example, when it is time to review homework, ask “what would work best for you: review homework before dinner or before riding your bike?” Consistency and following through will help a child predict what will happen, approach the process and manage the possible feelings of annoyance. Once again, protest is okay; defiance is not.

Finally, parents can help their adolescent children prepare for positive new experiences by explaining the importance accountability, correcting/building on mistakes and showing fairness. For example, as youths often begin identifying different groups (to belong or not belong to), an adult could “wonder” about various topics to help facilitate conversation. Without making a conclusion, the parent can help the child think about social, cultural and spiritual processes. For example, the parent could ask, “I wonder why it’s important to get a high school diploma?”, “I wonder what would help you get better at being on time for class?” or “I wonder what the outcome might be for such behavior?” These questions help the adolescent prepare for adulthood by helping him or her predict what behavior society expects. Such “pouring” from an adult can help youths approach life and learn to manage the ups and downs in life. Always remember that protest is okay; defiance is not.

With help from parents, children can enjoy learning to experience emotions and all the components of thinking, feeling and doing along the way. While the brain will go through its physical processes, parents have the opportunity to help foster emotional growth through the unique experiences that shape each individual for life. Each “pour” helps a child to reach his or her full five-gallon potential as a happy, healthy and safe adult.