The Smith Clinic April Newsletter
Despite the confusing weather, Spring has Sprung! It’s a time of renewal, freshness, opportunity and transition. A time of readying for what comes next (summer), and a time where, if you pay close attention, you will see something new – blooming, budding, building, growing – around you at any given moment. Maybe even you!

Spring is the perfect time to focus on and renewing you. In spring, we see that all things are possible and we want to do them all! Do you see and feel the hope and opportunity and renewal around you as the seasons change? How is it manifesting itself within you and your life? What, if anything, is holding you back? And if you were to make a commitment today to renew you, what would that look like?

We encourage you to take a moment to appreciate all you have been given and the joy of living in the moment this spring. We are grateful for each and every one of you, and we can't wait to see how you blossom and grow... not only this spring, but all year long!
APRIL IS STRESS AWARENESS MONTH
Stress happens. Sometimes it's unavoidable, at times it's unbearable. That's why taking time for yourself is invaluable. It's healthy to relax, renew, and rejuvenate.

Stress does not merely afflict your mind; it can also affect you on a cellular level. In fact, long-term stress can lead to a wide range of illnesses—from headaches to stomach disorders to depression—and can even increase the risk of serious conditions like stroke and heart disease. Understanding the mind/stress/health connection can help you better manage stress and improve your health and well-being.

The Fight or Flight Response
The sympathetic stress response is a survival mechanism that is hardwired into our nervous systems. This automatic response is necessary for mobilizing quick reflexes when there is imminent danger, suc as swerving to avoid a car crash. When you perceive a threat, stress hormones rush into your bloodstream—increasing heart rate, blood pressure, and glucose levels. Other hormones also suppress functions like digestion and the immune system, which is one of the reasons why chronic stress can leave you more vulnerable to illness.

Danger triggers the stress response. Unfortunately, so can work conflicts, concerns over debt, bad memories, or anxiety in general. Although one bad day at work won't compromise your health, weeks or months of stress can dampen your immune response and raise your risk for disease. 

Combat Your Stress
If you suffer from chronic stress and can't influence or change the situation, then you'll need to change your approach. Be willing to be flexible. Remember, you have the ability to choose your response to stressors, and you may have to try various options. 
  • Recognize when you don't have control, and let it go. 
  • Don't get anxious about situations that you cannot change. 
  • Take control of your own reactions and focus your mind on something that makes you feel calm and in control. This may take some practice, but it pays off in peace of mind. 
  • Develop a vision for healthy living, wellness, and personal growth, and set realistic goals to help you realize your vision. 
Relax and Recharge
Be sure to carve out some time to relax and take care of yourself each day—even just 10 to 15 minutes per day can improve your ability to handle life's stressors. Also, remember that exercise is an excellent stress reliever.
Everyone has different ways they like to relax and unwind. Here are a few ideas to get you started:
  • Take a walk
  • Read a book
  • Go for a run
  • Have a cup of tea
  • Play a sport
  • Spend time with a friend or loved one
  • Meditate (learn how in the sidebar)
  • Do yoga
While you can't avoid stress, you can minimize it by changing how you choose to respond to it. The ultimate reward for your efforts is a healthy, balanced life, with time for work, relationships, relaxation, and fun.
Golf: How PT Can Help
Did viewing Augusta National and the Masters motivate you to get back out on the golf course? If so, here’s something you should know...Golf may aggravate the lower back. The good news is physical therapy can help!

Click HERE to read more about how LPGA professional, Natalie Gulbis relied on physical therapy to keep her in the game.
It’s that time of year again. Time to exchange your snow shovel and winter boots with gardening tools and watering cans. While the warmer weather brings on a sense of renewal and energy, we need to remember to use proper body mechanics and follow general safety to avoid muscle aches and potential serious injuries. The number one injury associated with gardening is low back pain.

Below are a few tips to make gardening experience more enjoyable and less painful.

LIFTING:
Lifting heavy objects such as bags of soil, planters and mulch improperly can lead to low back strains and/or sciatic pain. Alternative options include moving half of the soil/mulch to a separate pot before lifting the bag or planting in to smaller pots that are easier to maneuver. Using a garden cart or wheelbarrow can also assist with moving heavy gardening materials.

PLANTING:
Prepping the soil can also be a difficult and tedious task requiring prolonged forward bending and frequent changes in position. Try prepping the planting bed by using long-handled gardening tools. Once the soil is ready, plant from a kneeling position using either a kneeling stool or a cushion. Remember to avoid twisting at the spine. Those with known chronic low back pain may want to consider planting in to pots, flower boxes or raised flower beds to avoid further injury.

WEEDING:
Most people dislike weeding their gardens and flower beds. Options to reduce the need to do so include using plants as ground cover or using mulch in your flower beds to minimize weed growth. If using a weed spray, look for bottles that have a sprayer hose to allow you to stand upright while treating your problem areas.

MOWING THE LAWN:
Another task that most people find tedious. The action of pulling a cord to start your mower is the most common cause of low back injuries. If you must use a pull start mower, remember to bend at your knees and maintain the natural curve of your spine while reaching for the cord. Make sure you tighten your abdominal muscles just before pulling the cord in order to support your spine. If using a push mower, remember to maintain proper upright posture and take breaks as needed.

Listen to your body. Take frequent breaks and change positions when you start to experience aching, cramping or fatigue. Stay hydrated and wear sunscreen. If you do happen to experience low back pain or any other injury, remember to contact your physical therapist. They can help alleviate your symptoms as well as educate you on proper body mechanics.

GARDENING STRETCHES
Stretching before you start gardening can help you from experiencing pain later. Here are some stretching techniques to help get you started!
1.) Fold your hands together and turn your palms away from your body, but this time extend your arms overhead. You should feel the stretch in your upper torso and shoulders to hand. Hold for 10 seconds and repeat eight times.
2.) Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder. This is a stretch for the upper back and shoulder. Stretch both the right and left arms. Hold for 10 seconds and repeat eight times.
3.) Raise one arm overhead. Bend the elbow. Place the opposite hand on the bent elbow and gently push the elbow back further. This is a stretch for the triceps. Stretch both the right and left arms. Hold for 10 seconds and repeat eight times.
4.) Extend an arm in front of you, making sure the elbow is completely straight. With your palm down, take the opposite hand and bend in the wrist downward. Then turn the palm up, and stretch the wrist backwards. This stretches the forearm and wrist muscles. Hold for 10 seconds and repeat eight times.

The warm-up exercises were developed by professional hand therapists who are occupational and physical therapists specializing in the treatment of the hands, arms and shoulders. These exercises and tips have been designed to supplement more commonly known gardening safety practices that concentrate only on preventing back injuries. For more information visit:  www.asht.org
VITAMIN D: ARE YOU GETTING ENOUGH?
It’s been several months since most of us have really had any significant amount of sun exposure (unless you’ve been traveling!). Seasonal depression and lack of energy are 2 of the most common signs that you may have a Vitamin D deficiency, but other signs include aches and pains (very similar to fibromyalgia), frequent infections and malaise (not feeling well in general).

So what is Vitamin D, and why is it so important? Vitamin D is a fat-soluble vitamin that your body produces when you expose your skin to the sun, specifically to UVB rays. It has several functions in the body that have been well researched, including: regulation of mineral absorption (calcium and magnesium for example), immune system modulation, and anti-inflammatory and anti-carcinogenic effects. Although this vitamin is very well known, it’s estimated that up to 75% of Americans are deficient.

Here are the top 3 ways to get your full amount of Vitamin D:

1. Safe Sun Exposure: getting a good dose of healthy sunshine each day is the best way to get your fill of Vitamin D. 20 minutes/day of direct exposure on your face and arms is estimated to be all you need (but, of course, try to avoid burning!).

2. Diet: your body can absorb small amounts of Vitamin D from certain foods, such as cold-water fish (sardines, anchovies, herring), as well as beef and pork liver. Yum!

3. Supplementation: high-quality supplementation may be needed for those of us who just don’t get enough regular sun exposure. Make sure you choose a D3 supplement, preferably one without extra additives.

If you suspect that your levels are low, the only way to truly know is to get a blood test. Most sources recommend 40-70, but we recommend checking with your physician.
Now that Spring is officially here, I hope you’re able to get as much Vitamin D as
you need by getting outside!
LET'S BE SOCIAL!!