The document discusses the poor performance of the U.S. healthcare system compared to other industrialized nations. It finds that while the U.S. ranks #1 in crisis care, it ranks #37 in overall healthcare and has the most expensive system. The U.S. spends the most on healthcare but ranks low in key health outcomes like life expectancy and infant mortality. Medical errors are a leading cause of death in the U.S., killing over 250,000 people annually. Proper spinal structure and function are discussed as being essential to overall health and longevity.
Falls are a major health issue for the elderly population. They are the leading cause of injury for those over 65 and increase mortality rates, with falls accounting for 70% of accidental deaths in those over 75. Falls result in millions of emergency room visits and hospitalizations each year. They negatively impact patients, families, and society through physical injuries, loss of independence, financial costs, and increased mortality. Preventative measures like home safety assessments, exercise programs, and care coordination can help reduce falls and their consequences.
Muscular dystrophy is a genetic disorder that causes progressive muscle weakness. It is characterized by defects in muscle proteins and affects skeletal, heart and smooth muscles. The main symptoms are muscle weakness and deterioration over time, leading to difficulties with movement. There are many types of muscular dystrophy but they all involve degeneration of muscle fibers. Currently there is no cure, but treatment focuses on managing symptoms and slowing disease progression through exercise, physical therapy and other means. Researchers are working on developing new treatments such as gene therapy.
This document discusses various types of sports injuries and how athletes cope with them. It notes that injuries can be short-term, long-term, or career-ending. While physical rehabilitation is important, psychological coping strategies can help athletes recover faster from injuries. Common injuries differ between male and female athletes due to anatomical differences. Career-ending injuries force early retirement, as illustrated by examples in football, basketball, and baseball.
This document summarizes a master's project that studied the effects of repetitive motion injuries in youth competitive sports during puberty. Specifically, it aimed to show a correlation between injuries and specializing in one sport from ages 10 to 16. The introduction discusses the rising trend of early sports specialization and notes injuries are often from repetitive motions straining joints and muscles. The literature review covers topics like parents' influence on children's sports, recommendations against specializing before age 12-13 due to injury risk, and studies finding overuse injuries in baseball pitchers and soccer players. The purpose is to encourage participating in multiple activities and sports to develop skills and prevent burnout or chronic injuries from specializing too early.
The document discusses falls prevention in the elderly population. It summarizes that falls are the main risk factor for fractures in older adults, not osteoporosis. Exercise interventions, particularly those focused on balance, strength and gait training, can effectively reduce falls rates. A multifactorial assessment of fall risks followed by tailored interventions is recommended approach to address modifiable risk factors and prevent falls.
This study examined muscle dysmorphia in male university athletes across different sports. It administered a modified Drive for Muscularity Scale questionnaire to 83 athletes from 6 sports: swimming, distance running, tennis, American football, rugby, and soccer. It was hypothesized that sports requiring more muscle mass like American football and rugby would score highest, while distance running would score lowest. It also predicted that team sports would score higher than individual sports. The results showed that team sports had a higher drive for muscularity and sports requiring more mass scored higher than others, suggesting muscle dysmorphia is present in some male university athletes.
Young throwing athletes are at risk of overuse injuries due to repetitive overloading of the shoulder and elbow from fatigue, poor recovery, lack of warm up, and inadequate strength and conditioning. Studies have shown losses in range of motion, particularly internal rotation, in the shoulders of adolescent pitchers. Maintaining scapular strength and mobility is important for injury prevention. Training the entire kinetic chain from the core and lower body to the throwing arm can help build strength while maintaining flexibility and proper mechanics. Prevention guidelines recommend limiting pitch counts and types of pitches for young athletes.
Falls are a major health issue for the elderly population. They are the leading cause of injury for those over 65 and increase mortality rates, with falls accounting for 70% of accidental deaths in those over 75. Falls result in millions of emergency room visits and hospitalizations each year. They negatively impact patients, families, and society through physical injuries, loss of independence, financial costs, and increased mortality. Preventative measures like home safety assessments, exercise programs, and care coordination can help reduce falls and their consequences.
Muscular dystrophy is a genetic disorder that causes progressive muscle weakness. It is characterized by defects in muscle proteins and affects skeletal, heart and smooth muscles. The main symptoms are muscle weakness and deterioration over time, leading to difficulties with movement. There are many types of muscular dystrophy but they all involve degeneration of muscle fibers. Currently there is no cure, but treatment focuses on managing symptoms and slowing disease progression through exercise, physical therapy and other means. Researchers are working on developing new treatments such as gene therapy.
This document discusses various types of sports injuries and how athletes cope with them. It notes that injuries can be short-term, long-term, or career-ending. While physical rehabilitation is important, psychological coping strategies can help athletes recover faster from injuries. Common injuries differ between male and female athletes due to anatomical differences. Career-ending injuries force early retirement, as illustrated by examples in football, basketball, and baseball.
This document summarizes a master's project that studied the effects of repetitive motion injuries in youth competitive sports during puberty. Specifically, it aimed to show a correlation between injuries and specializing in one sport from ages 10 to 16. The introduction discusses the rising trend of early sports specialization and notes injuries are often from repetitive motions straining joints and muscles. The literature review covers topics like parents' influence on children's sports, recommendations against specializing before age 12-13 due to injury risk, and studies finding overuse injuries in baseball pitchers and soccer players. The purpose is to encourage participating in multiple activities and sports to develop skills and prevent burnout or chronic injuries from specializing too early.
The document discusses falls prevention in the elderly population. It summarizes that falls are the main risk factor for fractures in older adults, not osteoporosis. Exercise interventions, particularly those focused on balance, strength and gait training, can effectively reduce falls rates. A multifactorial assessment of fall risks followed by tailored interventions is recommended approach to address modifiable risk factors and prevent falls.
This study examined muscle dysmorphia in male university athletes across different sports. It administered a modified Drive for Muscularity Scale questionnaire to 83 athletes from 6 sports: swimming, distance running, tennis, American football, rugby, and soccer. It was hypothesized that sports requiring more muscle mass like American football and rugby would score highest, while distance running would score lowest. It also predicted that team sports would score higher than individual sports. The results showed that team sports had a higher drive for muscularity and sports requiring more mass scored higher than others, suggesting muscle dysmorphia is present in some male university athletes.
Young throwing athletes are at risk of overuse injuries due to repetitive overloading of the shoulder and elbow from fatigue, poor recovery, lack of warm up, and inadequate strength and conditioning. Studies have shown losses in range of motion, particularly internal rotation, in the shoulders of adolescent pitchers. Maintaining scapular strength and mobility is important for injury prevention. Training the entire kinetic chain from the core and lower body to the throwing arm can help build strength while maintaining flexibility and proper mechanics. Prevention guidelines recommend limiting pitch counts and types of pitches for young athletes.
The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. It can tear when the knee is twisted or hyperextended, often during sports. ACL injuries have increased as sports have grown in popularity. While initial treatment focuses on reducing swelling and pain, many patients require reconstructive surgery followed by months of rehabilitation. Females are particularly at risk of ACL tears due to anatomical and hormonal factors. Prevention programs aim to strengthen muscles to reduce this risk.
The document discusses epidemiology and risk factors related to athletic injuries. It provides an overview of sports injury surveillance systems and defines reportable injuries. Several high-risk sports are identified along with common injury sites. Intrinsic risk factors like age, gender, and medical conditions are examined. Adolescent growth-related risks and gender-specific concerns are also outlined.
The Relationship between Implementation of Discharge Plan and Mobilizing of A...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
The Relationship of Hip and Trunk Muscle Function to Single Leg Step-Down Per...Jeremy Burnham
The Single Leg Step-Down Test (SLSD) is a screening test used to identify athletes with hip and trunk strength deficits who may be at risk for lower extremity injury such as anterior cruciate ligament (ACL) tear.
This document summarizes research on mobility impairment in the elderly and discusses challenges it presents for biomechanics research. The population of elderly is growing rapidly and mobility impairment is common. Biomechanics research is needed to more precisely assess impairments, design more effective therapies, and understand prevention. Factors like joint range of motion, muscle strength, and reaction time decline with age and affect mobility. Further research could identify critical impairment factors and inform targeted interventions to restore function and independence for the elderly.
Intralink-Spine is introducing NEXT, an injectable collagen crosslinking agent, as a non-surgical treatment for degenerative disc disease (DDD). NEXT aims to revitalize discs through chemical crosslinking to augment the native collagen matrix. Over a decade of testing in animal and human models demonstrated reductions in disc bulge and instability, as well as increased nutritional flow and strength. NEXT has the potential to be superior to surgery as a primary DDD treatment and as an adjunct to spine surgeries like discectomy. The company is pursuing FDA approval and plans non-surgical applications in spinal deformity correction and meniscal regeneration as well.
This literature review examines overuse injuries in young athletes. It discusses how increased sports participation rates among youth have led to higher injury rates, as young athletes have immature musculoskeletal systems. Overuse injuries result from repetitive sub-maximal loading without adequate rest and commonly involve bones, bursae, tendons, and neurovascular structures. Risk factors include both intrinsic factors like age, prior injury, and gender as well as extrinsic factors like the type of exercise, equipment used, environment, and societal pressure. While early sport specialization may lead to overuse injuries and burnout, delayed specialization may provide benefits. More evidence-based research is still needed on topics like the relationship between sport specialization and injury risk as
Cheerleading where non contact sports can lead to severe injuriesGavin_Randall
Cheerleaders spread school spirit during games and other school activities but cheerleading itself has become a competitive sport. In the United States, there are around 4 million cheerleaders, including 400,000 high schoolers.
Due to its prevalence worldwide, osteoporosis is considered a serious public health concern. Currently it is estimated that over 200 million people worldwide suffer from this disease.
This document discusses musculoskeletal trauma and its management. It notes that musculoskeletal trauma presents special considerations and challenges, including open and complicated fractures, injuries involving joints or bones losses, and medical comorbidities. Effective management requires thorough assessment, careful treatment planning depending on the injury type, and consideration of reduction, immobilization, rehabilitation, and prevention of further damage and recurrence of injury. It concludes that prevention of accidents and establishing trauma centers are important for improving outcomes of musculoskeletal injuries.
The document discusses the classification and management of musculo-skeletal trauma. It prioritizes injuries from highest to lowest priority, listing cervical spine injury, respiratory impairment, and severe external hemorrhage as highest priority. It also discusses several trauma scoring systems used to assess injury severity, including the Injury Severity Score (ISS) and Glasgow Coma Scale. Advanced trauma centers with multi-specialty care are important for managing polytraumatized patients with multiple injuries.
This document discusses musculo-skeletal trauma. It defines trauma and lists common causes including road traffic accidents, falls, sports injuries, and war or natural disasters. It describes priorities in trauma management and classifications systems used to assess injury severity. Supportive care needs for trauma patients are outlined. The challenges of treating musculoskeletal injuries are also discussed.
The Draganflyer is a remotely controlled unmanned aerial vehicle designed for wildlife photography and videography. It carries wireless cameras and is operated by a handheld controller that allows the operator to view footage in real-time. The drone detects wildlife in designated areas and captures images which are stored on an SD card. It must meet FAA regulations regarding flight ceiling, visual line of sight, and notification of flights. The system aims to help monitor wildlife populations through aerial imaging.
Chloe Whittle booked media equipment from the Salford Community College media department for a shoot on May 23rd, 2013 in the canteen from 9am to 10am. The equipment booked included one HD SLR camera, one lapel microphone, one digital video camera, one shotgun microphone, one mini DV digital video camera, one boom pole, one compact digital stills camera, one SD card, one sound recording pack, one mini DV tape, and one tripod.
Information literacy and graduate employabilityInformAll
The document discusses the relationship between information literacy and graduate employability. It provides background on employability, noting that it involves lifelong learning, self-awareness, and adapting to changing work environments. Employers value soft skills like teamwork, communication, and problem-solving over technical skills. The document also examines how information literacy relates to employability competencies sought by employers, such as business awareness, coping with complex workplace information needs, analytical and problem-solving skills, networking, and career management. While information literacy is not explicitly listed as a key skill, it contributes to developing many competencies important for employability.
This document provides details for two recipe card ideas - one focused on organic meals and one on indulgent desserts.
For the organic card, it will feature light, quick recipes like salads and bread taking 5-25 minutes to prepare/cook. Greens and a handwritten font will communicate the organic theme. High quality photos will show on a light green background.
The dessert card will feature rich ice creams with alcohol. Deep reds, purples and creams will convey luxury. A fancy font and portrait layout with borders matching the dessert photo color will be used. High quality images and a logo will make it professional.
The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. It can tear when the knee is twisted or hyperextended, often during sports. ACL injuries have increased as sports have grown in popularity. While initial treatment focuses on reducing swelling and pain, many patients require reconstructive surgery followed by months of rehabilitation. Females are particularly at risk of ACL tears due to anatomical and hormonal factors. Prevention programs aim to strengthen muscles to reduce this risk.
The document discusses epidemiology and risk factors related to athletic injuries. It provides an overview of sports injury surveillance systems and defines reportable injuries. Several high-risk sports are identified along with common injury sites. Intrinsic risk factors like age, gender, and medical conditions are examined. Adolescent growth-related risks and gender-specific concerns are also outlined.
The Relationship between Implementation of Discharge Plan and Mobilizing of A...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
The Relationship of Hip and Trunk Muscle Function to Single Leg Step-Down Per...Jeremy Burnham
The Single Leg Step-Down Test (SLSD) is a screening test used to identify athletes with hip and trunk strength deficits who may be at risk for lower extremity injury such as anterior cruciate ligament (ACL) tear.
This document summarizes research on mobility impairment in the elderly and discusses challenges it presents for biomechanics research. The population of elderly is growing rapidly and mobility impairment is common. Biomechanics research is needed to more precisely assess impairments, design more effective therapies, and understand prevention. Factors like joint range of motion, muscle strength, and reaction time decline with age and affect mobility. Further research could identify critical impairment factors and inform targeted interventions to restore function and independence for the elderly.
Intralink-Spine is introducing NEXT, an injectable collagen crosslinking agent, as a non-surgical treatment for degenerative disc disease (DDD). NEXT aims to revitalize discs through chemical crosslinking to augment the native collagen matrix. Over a decade of testing in animal and human models demonstrated reductions in disc bulge and instability, as well as increased nutritional flow and strength. NEXT has the potential to be superior to surgery as a primary DDD treatment and as an adjunct to spine surgeries like discectomy. The company is pursuing FDA approval and plans non-surgical applications in spinal deformity correction and meniscal regeneration as well.
This literature review examines overuse injuries in young athletes. It discusses how increased sports participation rates among youth have led to higher injury rates, as young athletes have immature musculoskeletal systems. Overuse injuries result from repetitive sub-maximal loading without adequate rest and commonly involve bones, bursae, tendons, and neurovascular structures. Risk factors include both intrinsic factors like age, prior injury, and gender as well as extrinsic factors like the type of exercise, equipment used, environment, and societal pressure. While early sport specialization may lead to overuse injuries and burnout, delayed specialization may provide benefits. More evidence-based research is still needed on topics like the relationship between sport specialization and injury risk as
Cheerleading where non contact sports can lead to severe injuriesGavin_Randall
Cheerleaders spread school spirit during games and other school activities but cheerleading itself has become a competitive sport. In the United States, there are around 4 million cheerleaders, including 400,000 high schoolers.
Due to its prevalence worldwide, osteoporosis is considered a serious public health concern. Currently it is estimated that over 200 million people worldwide suffer from this disease.
This document discusses musculoskeletal trauma and its management. It notes that musculoskeletal trauma presents special considerations and challenges, including open and complicated fractures, injuries involving joints or bones losses, and medical comorbidities. Effective management requires thorough assessment, careful treatment planning depending on the injury type, and consideration of reduction, immobilization, rehabilitation, and prevention of further damage and recurrence of injury. It concludes that prevention of accidents and establishing trauma centers are important for improving outcomes of musculoskeletal injuries.
The document discusses the classification and management of musculo-skeletal trauma. It prioritizes injuries from highest to lowest priority, listing cervical spine injury, respiratory impairment, and severe external hemorrhage as highest priority. It also discusses several trauma scoring systems used to assess injury severity, including the Injury Severity Score (ISS) and Glasgow Coma Scale. Advanced trauma centers with multi-specialty care are important for managing polytraumatized patients with multiple injuries.
This document discusses musculo-skeletal trauma. It defines trauma and lists common causes including road traffic accidents, falls, sports injuries, and war or natural disasters. It describes priorities in trauma management and classifications systems used to assess injury severity. Supportive care needs for trauma patients are outlined. The challenges of treating musculoskeletal injuries are also discussed.
The Draganflyer is a remotely controlled unmanned aerial vehicle designed for wildlife photography and videography. It carries wireless cameras and is operated by a handheld controller that allows the operator to view footage in real-time. The drone detects wildlife in designated areas and captures images which are stored on an SD card. It must meet FAA regulations regarding flight ceiling, visual line of sight, and notification of flights. The system aims to help monitor wildlife populations through aerial imaging.
Chloe Whittle booked media equipment from the Salford Community College media department for a shoot on May 23rd, 2013 in the canteen from 9am to 10am. The equipment booked included one HD SLR camera, one lapel microphone, one digital video camera, one shotgun microphone, one mini DV digital video camera, one boom pole, one compact digital stills camera, one SD card, one sound recording pack, one mini DV tape, and one tripod.
Information literacy and graduate employabilityInformAll
The document discusses the relationship between information literacy and graduate employability. It provides background on employability, noting that it involves lifelong learning, self-awareness, and adapting to changing work environments. Employers value soft skills like teamwork, communication, and problem-solving over technical skills. The document also examines how information literacy relates to employability competencies sought by employers, such as business awareness, coping with complex workplace information needs, analytical and problem-solving skills, networking, and career management. While information literacy is not explicitly listed as a key skill, it contributes to developing many competencies important for employability.
This document provides details for two recipe card ideas - one focused on organic meals and one on indulgent desserts.
For the organic card, it will feature light, quick recipes like salads and bread taking 5-25 minutes to prepare/cook. Greens and a handwritten font will communicate the organic theme. High quality photos will show on a light green background.
The dessert card will feature rich ice creams with alcohol. Deep reds, purples and creams will convey luxury. A fancy font and portrait layout with borders matching the dessert photo color will be used. High quality images and a logo will make it professional.
La pandemia de COVID-19 ha tenido un impacto significativo en la economía mundial y las vidas de las personas. Muchos países han impuesto medidas de confinamiento que han cerrado negocios y escuelas. A medida que los países comienzan a reabrir gradualmente, existen desafíos significativos para restaurar la confianza de los consumidores y revivir las economías.
The document outlines a new swimming lesson curriculum for Village Club with 4 sessions (Aqua Tots 1-4). It details the age groups, materials needed, skills to be taught for each session, as well as sample songs and activities to teach each skill. Helpful tips are provided for swim instructors, such as introducing themselves, using routines, demonstrating skills, and specific praise statements.
Periscope is a live streaming app that gives businesses an innovative and entertaining way to engage with their target audience.
Who does use Periscope? What is so special about this platform? How to measure success? When should you broadcast? Find answers on these and many more other questions in my presentation.
- The document discusses transverse and longitudinal waves. Transverse waves have a disturbance perpendicular to the direction of propagation, while longitudinal waves have a disturbance parallel to the direction of propagation.
- It provides examples of different types of waves - ocean water waves are a combination of transverse and longitudinal waves, while waves on guitar strings are transverse. Sound waves in air and water are longitudinal.
- Differentiating between longitudinal and transverse waves is important because the energy and motion propagate in different directions for each type of wave. This affects how the waves behave and transfer energy.
Primary Programs Framework - Curriculum Integration: Making ConnectionsSarah Sue Calbio
Alberta Education,. (2007). Primary Programs Framework - Curriculum Integration: Making Connections. Alberta, Canada: Alberta Education. Retrieved from https://education.alberta.ca/media/563581/guidingprinc_curr2007.pdf
La auditoría de cumplimiento evalúa si las operaciones financieras, administrativas y otras actividades de una entidad se realizan de acuerdo con las leyes y normas aplicables. Revisa documentos, analiza procesos administrativos y contables, e inspecciona controles internos para verificar el cumplimiento normativo y mejorar la eficiencia. El objetivo es asegurar que la entidad opera legalmente y sigue procedimientos adecuados.
The U.S. spends more on healthcare than any other country but ranks poorly on overall health outcomes. While emergency and crisis care is excellent, 99% of healthcare spending goes to chronic conditions like heart disease and diabetes. The current model focuses on eliminating symptoms rather than achieving optimal health and function. Vertebral subluxations can reduce nervous system function and healing potential, yet are often not caused by pain or symptoms. Chiropractic aims to detect and correct subluxations through spinal adjustments to improve overall health and homeostasis.
The Mental and Physical Health Outcomes of Green Exercise
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For more information, Please see websites below:
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Organic Edible Schoolyards & Gardening with Children
http://scribd.com/doc/239851214
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Double Food Production from your School Garden with Organic Tech
http://scribd.com/doc/239851079
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Free School Gardening Art Posters
http://scribd.com/doc/239851159`
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Increase Food Production with Companion Planting in your School Garden
http://scribd.com/doc/239851159
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Healthy Foods Dramatically Improves Student Academic Success
http://scribd.com/doc/239851348
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City Chickens for your Organic School Garden
http://scribd.com/doc/239850440
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Simple Square Foot Gardening for Schools - Teacher Guide
http://scribd.com/doc/239851110
This document discusses low back pain and sciatica. It notes that low back problems are the most common cause of doctor visits each year, with 8 out of 10 people experiencing low back pain at some point. Low back pain results in more lost work days than any other physical affliction for those under 45. While back pain affects both adults and children, there are several potential causes and treatments discussed, including lifestyle factors, injuries, stress, chiropractic care, exercise and surgery. Chiropractic care is presented as a drug-free and effective treatment option.
This document discusses low back pain and sciatica. It notes that low back problems are the most common cause of doctor visits each year, with 8 out of 10 people experiencing low back pain at some point. Low back pain results in more lost work days than any other physical affliction for those under 45. While back pain affects adults, 51% of school children also report suffering from low back pain. The primary causes of back pain are misalignments of the spine putting pressure on nerves, as well as bulging discs. Sciatica, a condition causing leg pain, weakness, or numbness, is often caused by low back problems irritating the sciatic nerve. Common treatments for back pain include drugs, surgery, or physical
The document discusses aging and fitness for older adults over 50. Some key points:
1) As people age, they naturally experience declines in muscle mass, bone density, and cognitive function, but physical activity can help offset many aging effects and improve health outcomes.
2) The population of older adults is growing rapidly worldwide, and physical inactivity increases with age, contributing to chronic conditions.
3) Resistance training studies show that even very old adults, such as those over 80 on average, can safely gain muscle and improve strength, mobility, and independence through regular low-intensity exercise.
This document discusses the overmedication problem in America. It argues that Americans are overly reliant on pharmaceutical medications when their bodies are capable of healing themselves. While medications can be appropriate and helpful in some cases, such as for cancer patients, they are being prescribed too frequently and for conditions that do not require them. This overprescription of medications is costly and can have harmful side effects while delaying the natural healing process. The document advocates for alternative approaches like physical therapy and lifestyle changes to allow the body to heal itself without relying so heavily on medications.
God, evolution, global warming and heart diseaseMike Rayner
This document discusses population health and related concepts. It defines population health as "the science and art of preventing disease and promoting health through the organized efforts of society, organizations, communities, families and individuals." It also notes that a population's health is more than just the sum of individual health states. Additionally, it discusses how population health aims to promote the health of groups, not just individuals.
The document discusses the benefits of chiropractic care and correcting vertebral subluxations. It explains that subluxations can develop from physical, chemical, or emotional stresses and interfere with nerve function, compromising health. Left uncorrected, subluxations can progress through phases of degeneration over decades. However, chiropractic adjustments can correct subluxations and improve mobility, function, and quality of life. Research shows chiropractic effective for both acute and chronic back pain and can reduce costs compared to other treatments.
Traditionally, those considered in society to have a disability have been stigmatised, often kept out of view. Despite considerable efforts by the disability rights movement over the last decades, there are still many stereotypes in existence concerning the disabled, stereotypes which are also classed, raced and gendered in different ways. Disability has been described as ‘fluid’ and, contrary to general opinion, may not be a permanent state. With the increasing medicalisation of society, conditions that may not have been considered disabilities in the past – for example certain learning disabilities – may now lead to early labelling. There are differences of opinion as to whether these are liberating or debilitating labels. As more and more people are living with a disability of some kind, this class will consider what living with disability in everyday life can be understood sociologically and politically.
Mechanical low back pain team 4 (aguilar barradas-guevara-luque)School RN BCPS
This document discusses mechanical low back pain (LBP) and is presented in four sections by four student authors. It provides an overview of LBP, including that it is the second most common reason for physician visits in the US. It also discusses the anatomy and pathophysiology of the back, causes and risk factors for LBP, the impact of LBP on both society and family, and strategies for preventing and educating patients about LBP.
1) Falls are common among older adults, especially those over 80 years old, and can threaten their independence and quality of life. They often result from deficiencies in multiple domains like senses, muscle strength, cognition, chronic conditions, and medications.
2) Epidemiological studies show that 30-40% of older adults fall each year in the community, with higher rates in long-term care facilities. Injurious falls can result in fractures, hospitalization, admission to long-term care, and even death in some cases.
3) Risk factor assessment, physical and cognitive evaluation, and targeted interventions including exercise, medication review, and fall prevention programs can help reduce falls among older adults.
The document discusses how aging is not solely determined by genetics or the passage of time, but rather is influenced by lifestyle choices and environmental factors that can accelerate or decelerate the aging process. While lifespans have increased, quality of life in older years is not assured without steps to promote health. Factors discussed as impacting aging include inactivity, chemical pollution from medications, neurological stress from poor posture or injuries, and vertebral subluxations which can interfere with the nervous system. Maintaining activity, avoiding excessive medications, and addressing spinal issues can help support healthy aging.
This document discusses chronic illness management. It defines a chronic illness as a condition lasting 3 months or longer that can be unpredictable. Common chronic illnesses include heart disease, cancer, diabetes and arthritis. Risk factors include behaviors like smoking, poor diet and lack of exercise, as well as genetic predisposition. Chronic diseases account for most American deaths each year. Health psychology examines the biological, psychological and social factors related to illness and health. Clinical health psychologists help patients manage chronic conditions through cognitive and behavioral therapies.
The document discusses various health statistics in the United States, including cancer rates, heart attack rates, and deaths from medical errors. It also discusses the importance of the spine and nervous system for overall health, noting that trauma or stress on the spine can disrupt nerve function and lead to health issues. Chiropractic care is presented as an alternative to traditional medical care that aims to correct spinal misalignments and restore overall health and posture.
This document discusses various health and fitness topics that affect physical aging, including nutrition, exercise, substance abuse, sexuality, and psychological stress. It notes that overweight and obesity are widespread problems in the U.S. due to environmental pressures and sedentary lifestyles. Regular exercise is recommended to promote cardiovascular health, reduce risks of disease, and improve mental health. Substance abuse like smoking and heavy drinking can damage the body and increase health risks over time. Psychological stress is linked to various health issues and low-income individuals often face greater stress exposure.
The document summarizes key findings from a survey on musculoskeletal health in Britain conducted by the Simplyhealth Advisory Research Panel (ShARP). Some of the main findings include:
- Back pain is the most common musculoskeletal issue, affecting 70% of respondents.
- Women experience more back and knee pain than men and are more likely to rest instead of exercising to relieve pain.
- Musculoskeletal issues increase with age, with over 50s most likely to experience daily pain and seek medical advice.
- Obesity is strongly linked to increased rates of back and knee pain. Nearly all respondents weighing over 14 stone reported back pain issues.
- Height can also impact musculoskeletal health, with taller individuals more likely to experience neck, shoulder
The document discusses startling statistics about chronic disease in America, despite advances in medicine and healthcare spending. While the U.S. has the most advanced healthcare system, the WHO and AMA said in 1985 that America is experiencing the worst epidemic of chronic disease ever. Two out of three Americans will die from heart disease, cancer, stroke, lung disease or diabetes. Since then, rates of obesity and diabetes have doubled or tripled. Nitric oxide was discovered to play a key role in cardiovascular health, and Dr. Prendergast found that supplementing with L-arginine successfully reduced plaque and reversed disease in his patients.
Restraints and Seclusion: Challenge the AssumptionsJLundholm
The document discusses several assumptions about the use of restraints and seclusion in treatment facilities. However, the realities outlined show that restraints and seclusion have frequently resulted in injury and death. Numerous cases describe people, including children, who suffered fatal consequences from the misuse of these interventions. Research also indicates a lack of evidence for the therapeutic benefits of restraints and seclusion and suggests they are often used punitively rather than as a last resort for safety. Cultural biases may also influence their disproportionate use on certain groups.
CHAPTER CONTENTSCultural Differences in the Definition of Health.docxchristinemaritza
CHAPTER CONTENTS
Cultural Differences in the Definition of Health
Comparison Across Cultures
Comparison Within Cultures
Three Indicators of Health World Wide
Life Expectancy
Infant Mortality
Subjective Well-Being
Genetic Influences on Physical Health and Disease
Psychosocial Influences on Physical Health and Disease
Social Isolation and Mortality
Sociocultural Influences on Physical Health and Disease
Cultural Dimensions and Diseases
Cultural Discrepancies and Physical Health
Culture, Body Shape, and Eating Disorders
Culture and Obesity
Culture and Suicide
Acculturation and the Immigrant Paradox
Summary
Differences in Health Care and Medical Delivery Systems
A Model of Cultural Influences on Physical Health: Putting It All Together
Exploration and Discovery
Why Does This Matter to Me?
Suggestions for Further Exploration
Glossary
One major role of psychology is to improve the lives of the people we touch. Whether through research, service, or provision of primary or secondary health care, we look forward to the day when we can adequately prevent, diagnose, and treat diseases, and foster positive states of being in balance with others and the environment. This is not an easy task; a multitude of forces influences our health and the development of diseases.
As we strive to meet this challenge, the important role of culture in contributing to the maintenance of health and the etiology and treatment of disease has become increasingly clear. Although our goals of maintaining health and preventing and treating diseases may be the same across cultures, cultures vary in their perceptions of illness and their definitions of what is considered healthy and what is considered a disease. From anthropological and sociological perspectives, disease refers to a “malfunctioning or maladaptation of biologic and psychophysiologic processes in the individual” and illness refers to the “personal, interpersonal, and cultural reactions to disease or discomfort” (Kleinman, Eisenberg, & Good, 2006; p. 141). Thus, how we view health, disease, and illness, is strongly shaped by culture.
This chapter explores how cultural factors sway physical health and disease processes, and investigates our attempts to treat both psychological and sociological influences. We begin with an examination of cultural differences in the definition of health and present three indicators of health worldwide: life expectancy, infant mortality, and subjective well-being. We will then review the considerable amount of research concerning the relationship between culture and heart disease, other physical disease processes, eating disorders, obesity, and suicide. Next, we will explore differences in health care systems across countries. Finally, we will summarize the research in the form of a model of cultural influences on health.
CULTURAL DIFFERENCES IN THE DEFINITION OF HEALTH
Comparison Across Cultures
Before we look at how culture influences health and disease processes, we need to examine ex ...
CHAPTER CONTENTSCultural Differences in the Definition of Health.docx
Youth&vitality v1
1.
2. In a study of over 191 healthcare
systems of all the major industrialized
countries in the world, the U.S…
…ranked #1 in crisis care
…ranked #37 in healthcare
…had the most-expensive healthcare system in the world
—World Health Organization, The World Health Report 2000 – Health Systems: Improving Performance (Geneva: WHO, 2000)
3. In 2005, the US…
…spent $2 trillion on healthcare
…was ranked 34th in life
expectancy
…was ranked 26th in infant mortality
…had 20-30% of patients receive
contraindicated care
—Medical Industrial Complex, Myths and Truths, Feb. 28th, 2009
4. “As grim as they are, these statistics are likely to be
seriously underestimated as only about 5%-20% of
iatrogenic incidences are even recorded.”
—Park A. America’s Health Check Up. 11/20/2008. Time Magazine Online
5.
6. “Perhaps the word „healthcare‟ has given us the illusion
that medicine is about health.”
—Medical Industrial Complex,
Myths and Truths, February 28, 2009.
7. “Out of 13 countries in a recent comparison, the United
States ranks an average of 12th (second from the
bottom) for 16 available health indicators.”
—Starfield B. M.D. Primary Care: Balancing Health Needs, Services and Technology. New York, NY. Oxford
University Press, 1998. published by JAMA
“The poor performance of the US was recently confirmed
by a World Health Organization study which used different
data and ranked the United States as 15th among
25 industrialized countries.”
—World Health Report 2000. Accessed June 28, 2000. Mercola.com, 2001.
8. Today in this country the majority of people die of only
three major diseases.
Can you name them?
9. Leading cause of death in the U.S.:
Heart Disease
• 831,272 deaths from heart disease in 2006
• 34.3% of all deaths in the US
• 1 of every 2.9 deaths
This year an estimated 1.26 million Americans will
have a new or recurrent coronary attack.
—American Heart Association, January 8, 2010
10. 2nd Leading cause of death in the U.S.:
Cancer
• 565,650 die every year
• 1 of every 4 deaths
• Expected to get worse
In 2008, an average of 1,500 Americans died per
day. Research shows this number is expected to
increase.
—Articlesbase.com, February 11, 2009
11. 3rd Leading cause of death in the U.S.:
Medical Care
• 250,000 die every year
• 20%-30% receive inappropriate or
contraindicated care
• 106,000 die from negative effects of drugs
(right drug, wrong effect)
• 80,000 die from infections contracted in hospitals
• 12,000 die due to unnecessary surgeries
• 7,000 die from medicine errors (wrong drug)
• 20,000 die due to other medical care errors
—B. Starfield, M.D., July 26, 2000. JAMA 284(4). pp483-485.
12. These kinds of deaths are preventable! These three
„diseases‟ are curable!
How?
13. What is the life source and
health of our body?
14. The power that made the body, heals the body. We are all
born with life energy!
18. Energy / Life starts in the brain.
One cubic inch of the brain‟s
cortex contains 10,000 miles
of nerve tissues.
Nerve energy travels
at the rate of 270 mph.
19. Abundant Health begins in the spine.
Optimal Spine = Optimal Health
Out of 9 systems in the
body, only one is cased
in bone, why?
21. Optimal spinal structure and posture, front
and side views.
The spine and posture should be
straight and balanced from the
front (i.e. glabella over public
symphasis, over middle of feet.)
Three curves from the side (i.e.
the ear should be over the
shoulder, hip, and ankle).
22. “If we regard posture as the result of the dynamic
interaction of two factors, the environmental force of
gravity on one hand, and the strength of the
individual on the other, then posture is but the formal
expression of the balance of power existing at any time
between the two groups of forces. Thus, any
deterioration of the posture indicates that the
individual is losing ground in the contest with the
environmental forces of gravity.”
—Martin Jungmann, MD “Backaches, Postural Decline, Aging and Gravity-Stain,” ca 1963.
23. Subluxation (sub-lux-a-shun)
df. Trauma or stress to the body
that causes the vertebrae or spinal
curvatures to shift out of place
from their optimal form and function.
24. Subluxations of the individual vertebrae or whole curves, especially those
complicated by soft tissue injury, accelerate degeneration, lead to
disability, and are known causes of morbidity.
Side view of neck x-rays
Normal Abnormal
25. Distorted Spine = Poor Nerve Function
Normal – Healthy Neck Curve
Healthy, relaxed spinal cord (open
nerves and blood vessels). Acts like
a fire hose of life energy.
26. Distorted Spine = Poor Nerve Function
Abnormal – Loss of Neck Curve
Stretched and narrowed nerves
and blood vessels. Acts like a small
garden hose of limited life energy.
What if this nerve went to your heart,
lungs, or other vital organs affecting
your metabolism or immune system?
27. “Head and neck posture
is a major factor in the
fatigue and immune
function in patients
suffering from fibromyalgia
(FMS), CFIDS, chronic
fatigue, and immune
dysfunction syndrome.”
—Dr. Herbert Gordon, 1997 Seattle Fibromyalgia
International Team Conference
28. “Cervical kyphosis
(segmental or total) leads
to total spinal
malalignment,
rounding of the shoulders,
headache, neck pain,
scapular pain, and possibly
even lower back
pain.”
—Kai Y, et al. Traumatic thoracic outlet syndrome.
Orthop Traumatol 1998;47: 1169-1171
29.
30. “Patients with relative kyphosis in the lumbar region had
significantly more disability than patients with normal
Sagittal Cobb-angle measurements.”
—Glassman et al. “The impact of positive sagittal balance in adult spinal deformity.” Spine. 2005 Sep 15;30(18): 2024-9
32. Freeman, was published in the Journal of American Medical
Association in 1957 stating that “aging in the spinal discs
caused postural deviations leading to intestinal
diverticula, hemorrhoids, varicosities of the legs,
osteoporosis, hip and foot deformities, overall poor
quality of health and life, as well as a shortened life
span.”
33. “The abnormal trunk
deformity groups tended to
score lower than the normal
group with regard to subjective
healthiness and life satisfaction
measures, including subjective
health condition, every day
feeling, satisfaction with human
relationship, satisfaction with
economic condition, and
satisfaction with present life.”
—Takahashi T. Osteoporosis Int. 2005:16 273-279
35. Right Truck Shift of the Lumbar Spine (low back)
“The average life expectancy
of individuals with scoliosis
is decreased by 14 years”
(Idiopathic scoliosis; long-
term follow-up and prognosis
in untreated patients, J Bone
Joint Surg Am 1981
Jun;63(5):702-12).
36. "Posture affects and moderates every physiologic function from breathing to hormonal production.
Spinal pain, headache, mood, blood pressure, pulse and lung capacity are among the functions most
easily influenced by posture.“ AJPM 1994
Right Lateral Trunk Shift and Spine X-ray of the Low
Back. Posture is the window to spinal structure.
This weakened
spinal structure
may lead to disc
bulges, nerve
injury into the
legs and
disability, as well
as health
problems in the
organs of the
pelvis, like
digestive
difficulties, sexual
dysfunction,
urinary
conditions, etc.
37. Subluxations / Postural Distortions
There are three major causes of subluxations leading to
overall postural weakness. They include:
1. Emotional Stress
2. Chemical Stress
3. Physical Stress
38. Emotional Causes of Postural Weakness
Raise your hand if you experience and of the following…
1. Marriage/personal relationships
2. Raising a family
3. Work
4. Financial obligations
5. Driving in traffic
6. Economic concerns
39. Chemical Causes of Postural Weakness
Raise your hand if you experience and of the following…
1. Being outside, breathing pollutants
2. Being inside, breathing cleaning and other solutions
3. Drinking water
4. Showering
5. Using alcohol or tobacco
6. Take prescription or over-the-counter drugs
40. Physical Causes of Postural Weakness
Raise your hand if you experience and of the following…
1. Auto accident (Crash)
2. Athletic activities/injuries
3. Exercise (in bad form)
4. Repetitive lifting or motion
5. Yard work
6. Sitting in a forward-flexed position for 20 minutes or
more (i.e. desk job, driving, airplanes, etc.)
41. What‟s the constant physical stress we endure that we don‟t
ever think about?
Gravity!
42. “In general, there is a correlation in body structure, health, and span of
survival.” —Freeman JT. “Posture in the aging and aged body.” JAMA 1957, Oct. 19: 843-846
How you age is a choice.
43.
44. Headaches Fatigue
Thyroid conditions Heart attacks
High/Low Blood Pressure Shortness of Breath
Numbness in arms/legs Menstrual Irregularities
Poor Circulation Swelling in feet/ankles
Weakness in Extremities Depression
Asthma/Allergies Visual Disturbances
Heartburn/Indigestion Hearing disturbances
Cancer Bladder Incontinence
Parkinson‟s Skin Conditions
Alzheimer‟s Carpal Tunnel
Mental sluggishness Fibromyalgia
Which is the most common sign of nerve stress / weakness?
Conditions of Postural Weakness
45. What is the first and most common cause of
subluxation leading to weakened posture and health?
Birth.
46. Medical studies show that trauma to the upper cervical spine
during delivery causes two major problems:
1. Lowers immune resistance
2. Causes the spine to grow abnormally
Proper development of the spinals curves is essential for life-
long optimal health.
47. Baby delivered by C-Section. Mother brought her baby boy at
eight weeks old with extreme colic. A severe subluxation was found on
the left side of his upper neck. He required two weeks of daily adjustments
before he could sleep through the night and resolve his colic.
48. Gutmann, a German medical doctor, studied 1000 infants
and discovered that trauma to the upper cervical spine
caused many health problems beginning in childhood
due to lowered resistance to disease. By realigning the
neck “they were able to eliminate these conditions of
lowered resistance.”
50. “Research indicates that the major cause of spinal
subluxation in infants is childbirth stressing the need for
correction from birth so that irreversible
degeneration does not occur. Nerve system injury
through cervical spine trauma at birth causes abnormal
function, abnormal behavior, and early death (SIDS).”
— Abraham Towbin, M.D., Harvard Medical School
51. Effects on the vertebrae from poor alignment and posture over time.
Side neck x-ray simulation of spinal degeneration.
52.
53. Medical Rehab Programs
• Range from $20,000 to $60,000
• Rarely covered by insurance
• Ineffective in eliminating pain or resolving issue
• Do not focus on structural or postural correction of the
spine where many injuries occur and systems stem from.
54. Vital Questions
• Where do you want your health to be in the next 20-
50 years?
• What do you want your life to feel like?
• What do you want your activity levels to be like?
• What‟s the most important aspect of your life?
55. Spinal and Postural Regeneration Program
It is possible to regenerate your spine through our state-of-
the-art systems to offer you life-changing results.
56. Stress Test and Postural Exam
We begin with a stress test. This will determine the exact
rehab protocols for you to recover your health as quickly as
possible; as well as uncover an complicating conditions.
We then do an adjustment followed by a head-weighting,
Denneroll Orthotic use, or mirror-image posture x-rays.
We‟ll share the results with you immediately following.
59. Example of how we fix loss of cervical curve
Evaluation Traction Adjustments Head Weights
60. Example of how we fix abnormal posture
Evaluation Rehab Adjustments Body Weights
61. Home Rehabilitation Kit
One of the key aspects of our highly effective treatment is
the work you will do at home. Your home-health
rehabilitation kit will provide you with all you need.
Blocks for posture mirror with image posture exercises
including cervical, thoracic, lumbar Dennerolls, etc.
63. Get your
body out of
the crisis.
Reconnect
the brain to
the organs.
Reduce
inflammation
and calm
down the
symptoms.
3x/week. Re-
Xray at 6
weeks
Intensive Care
64. Once function is
restored, reduce
frequency to
2x/week..
Re-x-ray every 6
weeks to monitor
structural
change.
Research shows that
a minimum of 90- 180
days of rehab must
be performed to
attain permanent
correction of spinal
biomechanical
change.
Home rehab
MUST be
performed every
day
Corrective Care
65. We will monitor the
strength and
stability of your new
posture while we
monitor your
progression toward
optimal health.
1x/week for 12
months for full
rehabilitation
Includes home
rehab exercises at
least 5x/week
Stabilization Care
One cubic inch of brain cortex contains 10,000 miles of nerve tissue.Nerve energy travels at a rate of 270 miles/hour!So that energy starts in the brain, goes down through the spinal cord. Spinal cords like a river; it carries energy from the brain through all those nerves to animate and bring life to all the cells in the body. If I cut this nerve to your heart, what's going to happen to your heart? It's going to die. Why? Because it's getting no energy.
Marchiori DM, Henderson CNR, A cross-section study correlating cervical radiographic degenerative findings to pain and disability. Spine 1996;21:2747-26752Norris SH, Watt I. the prognosis of neck injuries resulting from rear-end collisions. J House and Joint Surgery 1983;65-B:608-611
I want you to write down where you want your health to be in the next twenty to fifty years. Write down where you want your health to be, what you want your life to look like, what you want your activity levels to be like. So write that down. "Now I want you to sign it.“ Write their goal, sign it, discuss it, have a couple testimonials. Now that takes a few minutes, but this is hugely emotional right here. Now, I'm going to get into the program:
I want you to write down where you want your health to be in the next twenty to fifty years. Write down where you want your health to be, what you want your life to look like, what you want your activity levels to be like. So write that down. "Now I want you to sign it.“ Write their goal, sign it, discuss it, have a couple testimonials. Now that takes a few minutes, but this is hugely emotional right here. Now, I'm going to get into the program:
I want you to write down where you want your health to be in the next twenty to fifty years. Write down where you want your health to be, what you want your life to look like, what you want your activity levels to be like. So write that down. "Now I want you to sign it.“ Write their goal, sign it, discuss it, have a couple testimonials. Now that takes a few minutes, but this is hugely emotional right here. Now, I'm going to get into the program:
I want you to write down where you want your health to be in the next twenty to fifty years. Write down where you want your health to be, what you want your life to look like, what you want your activity levels to be like. So write that down. "Now I want you to sign it.“ Write their goal, sign it, discuss it, have a couple testimonials. Now that takes a few minutes, but this is hugely emotional right here. Now, I'm going to get into the program:
I want you to write down where you want your health to be in the next twenty to fifty years. Write down where you want your health to be, what you want your life to look like, what you want your activity levels to be like. So write that down. "Now I want you to sign it.“ Write their goal, sign it, discuss it, have a couple testimonials. Now that takes a few minutes, but this is hugely emotional right here. Now, I'm going to get into the program:
Now here's the three phases of care: Initial intensive care. Get your body out of crisis, reconnect the brain to the organs, restore function back to 100%. Get your body out of crisis. What's the crisis? The brain is not connecting to the body. The crisis is your organs aren't getting energy right now. Why? Got not curve in the neck. So our first goal is we got to start putting curves in your spine.
Corrective care once function is restored. Reduce the frequency to three times a week: Monday, Wednesday, Friday. Why is it Monday, Wednesday, Friday? Because initially in intensive care you can't even hold your adjustments or maintain that energy flow for twenty-four hours. Not until we get a curve in your neck. So once you can maintain your adjustments, and energy can get into your body for at least twenty-four hours, then we're going to go to every other day. Monday, Wednesday, Friday is well spaced through the week, but guess what? We have the weekends don't we? So what two days do you think are the most important? Mondays and Fridays, why? It's before and after the weekend. Mondays and Fridays are the most important adjustments; they are not an option. If you miss a day, you have to make it up within twenty-four hours. Okay? We schedule at the same time each day, if possible. In order for us to monitor the progress of how your nervous system is responding in the same time works the best. (Associate it with an event.) So what you'd say is, "Every day after you go to yoga. Every day after you drop your kids off from school. Everyday when you pick your kids up; then you can bring them in with you. So right at 3 o' clock when you pick your kids up, just take the whole family to the chiropractor right there. Or when your family comes together at night, you know, right before you have dinner, or right after dinner, then bring your whole family in. And that way you get into a routine. We re-exam every thirty days to monitor your nerve progress. We re-x-ray every 90 to monitor structural change. Research on muscle-physiology show that it takes a minimum of 90 to 180 days rehabilitation for permanent correction. Okay, so right there you're telling them 3-6 months. Now what I'm going to say, "If your like that woman in 1961 and that's what your x-rays look like, you'll probably be about 90 days. If you're like the woman in 1968 where we have to regenerate a disk, you're going to be about 90 days, maybe 120 days. If you're like that person in 1978-or 1975, you have advanced degeneration, advanced forward head, you're going to be more like 180 days of corrective care.” Right now what I want you to do is this. Right now, as I give you those parameters, what I want you to think about right now before you go into that room, "Is your health enough of a priority that you're willing to commit to a program like this?" (Now notice what I do innately. I'm walking towards you right. I'm walking towards the crowd because I‘m like, "Here's what I want you to think about right now." I'm coming towards you because I'm like, "This is serious. I want you to think about this. Is your health enough of a priority that you're willing to go through a program like this.) Are you willing to change your lifestyle for you and your family so that you can ensure and empower yourself that you'll have the life that you want, the life that God created you for? I want you to have that answer and what time of day that you feel you can come in most consistently when we go in this room. When we go in there, it's not about personal stuff, exercises, stuff like that. This is simply a "yes" or "no" and what time. Okay, and it's your decision to make." You have to do the home rehab twice a day.
Research on muscle ligament physiology shows it takes 12-18 months for the muscles to become functional, ligaments to become functional. So once you're through corrective care, it'd be once a week for about 12 months depending on your condition. Okay? Includes the home rehab once a week. After you first stabilization program we can help you develop….keep you healthy for the rest of your life.