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Preventing Sciatica

Preventing Sciatica

Learning the risk factors of sciatica can help you minimize your risk of developing it. A recent study sheds light onto what makes you more likely to develop sciatica.

The study evaluated 5261 participants aged 40-60. Researchers collected data on participants’ occupational class, physical and psychosocial working conditions, body mass index, smoking, leisure-time physical activity, and history of neck and back pain.

Risk factors for sciatica varied based on gender. Women were more likely to have sciatica if they worked in manual occupational class, were overweight, smoked, lived a sedentary lifestyle, and had previous neck and back pain. Among men participants, those employed in semi-professional and manual occupational classes had higher risk levels. Researchers concluded that occupational class, unhealthy lifestyle and a personal history of back and neck pain made patients more likely to develop sciatica.

Chiropractors have been successfully treating sciatica patients for years. If you are having sciatic pain, be sure to call our office to schedule an appointment with Dr. Oblander to assess your risk factors for sciatica and/or receiving effective treatment.

Kaaria S, Leino-Arjas P, Rahkonen O, Lahti J, Lahelma E, Laaksonen M. Risk factors of sciatic pain: A prospective study among middle-aged employees. European Journal of Pain. 2010 Dec 14.

Written by: Michael Melton 
Shared from www.chironexus.net
Risk Factors for Spinal Degeneration

Risk Factors for Spinal Degeneration

As we age, the discs in our spine start to naturally break down due to normal, everyday living . This is commonly referred to as disc degeneration and can result in pain in the neck and/or back area–pain that is felt by almost half of the population 40 years of age or older . For those over 80, this rate doubles to a whopping 80 percent, which makes understanding what factors promote this particular condition critical to raising the quality of life as we enter our later years. Fortunately, recent research provides some very important information in this area.

Disc Degeneration Risk Factors Revealed In Recent Study

On November 9, 2015, a study conducted by health experts from Mie University Graduate School of Medicine in Japan, Osaka University (also in Japan), and Rush University Medical Center in Chicago, Illinois was published in BMC Musculoskeletal Disorders. In this research, these experts followed 197 individuals living in Miyagawa, Japan who were over the age of 65 for a 10-year period, measuring their disc height at two year intervals to determine what factors, if any, contributed to their spinal discs degenerating at a faster rate.

What they discovered was that, over the time span of the study, the participants’ disc height gradually reduced an average of 5.8 percent, with roughly 55 percent experiencing degeneration in one or two of their discs. Furthermore, there were three factors that they identified that increased the likelihood of disc degeneration. They were: 1) being female, 2) having radiographic knee osteoarthritis, and 3) the presence of low back pain when the study began.

Based on these results, women should take extra care to protect the discs in their spinal column, potentially saving themselves from experiencing neck or back pain later in life. Some options for doing this include maintaining a healthy weight, avoiding repeated lifting of heavy objects, and not smoking as studies have found that smokers tend to experience disc degeneration at greater rates than non-smokers . Chiropractic can help with the other two factors.

For instance, in one study published in The Journal of the Canadian Chiropractic Association, researchers looked at 43 different individuals between the ages of 47 and 70 who were experiencing osteoarthritic knee pain. Some participants received treatment three times a week for two weeks and others served as a control. The subjects who engaged in treatment reported more positive results than those who did not, citing that, after the treatments they experienced fewer osteoarthritic symptoms, had greater knee mobility, and felt that it was easier to “perform general activities.” And this was after just two weeks of care.

Chiropractic can also help lower back pain, further reducing the likelihood that your discs will degenerate at a faster rate when you age. That makes this specific remedy beneficial both now and well into the future–ultimately raising your quality of life. If you need to see Dr. Oblander for an adjustment, please be sure to give our office a call at 406-652-3553!

 

 

  • Akeda K, Yamada T, Inoue N, et al. Risk factors for lumbar intervertebral disc height narrowing: a population-based longitudinal study in the elderly. BMC Musculoskeletal Disorders 2015;16(1):344.
  • Fogelholm RR, Alho AV. Smoking and intervertebral disc degeneration. Medical Hypotheses; 56(4):537-9.
  • Pollard H, Ward G, Hoskins W, Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. Journal of the Canadian Chiropractic Associations 2008;52(4):229-42.

 

Written by: Christina DeBusk
Article shared from Chironexus.net
Why Chiropractic is Superior for Musculoskeletal Pain

Why Chiropractic is Superior for Musculoskeletal Pain

Countless studies have demonstrated that chiropractic care is a safe and effective way to treat musculoskeletal complaints like back pain, neck pain, or sciatica. Now a new study from Switzerland has looked at the relative benefits of chiropractic compared to medical care for the most common types of pain issues.

In this study, the authors examined data from people who reported spinal, hip, or shoulder pain. 403 patients saw a medical doctor for relief; 316 people saw a chiropractor. Four months after treatment, the patients were asked to fill out a survey reporting on their recovery.

The authors found that:

  • “Patients initially consulting MDs had significantly less reduction in their numerical pain rating score…”
  • Patients who saw MDs  were significantly less satisfied with the care they received and the outcome of that care.
  • Patients who saw a chiropractor had significantly lower healthcare costs for their treatment.

The authors conclude that patients should first be sent to a chiropractor for musculoskeletal problems, rather than a medical doctor:

“The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions. Restrictive models of care in which patients are required to contact a medical provider before consulting a chiropractic provider may be counterproductive for patients experiencing the musculoskeletal conditions investigated and possibly others. In addition to potentially reducing health care costs, direct access to chiropractic care may ease the workload on MDs, particularly in areas with poor medical coverage and hence enabling them to focus on complex cases. The minority of patients with complex health problems initially consulting a chiropractic provider would be referred to, or comanaged with, a medical provider to provide optimal care.”

Houweling TAW, Braga AV, Hausheer T, et al. First-Contact Care With a Medical vs Chiropractic Provider After Consultation With a Swiss Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoulder Pain Patients. Journal of Manipulative and Physiological Therapeutics 2015;38(7):477-83.

Written by: Michael Melton and shared from ChiroNexus.net
Chiropractic Patients Recover Faster, Spend Less Money

Chiropractic Patients Recover Faster, Spend Less Money

Back pain is an expensive health problem for both patients and businesses. A 2012 study reported that we spend about $635 billion on pain every year, with a significant amount of that spent on back pain. Over the years, quite a few studies have shown that chiropractic care is more effective for back pain than medical care, plus chiropractic patients spend less money on their care than medical patients do.

Because back pain is such a common problem, a group of Canadian researchers recently investigated the role that the type of primary caregiver has on financial compensation.

This was a large study of 5,511 patients who experienced a work-related back injury in Ontario, Canada. The patients saw the following providers for their first visit:

  • 85.3% saw a medical doctor
  • 11.4% saw a chiropractor
  • 3.2% saw a physical therapist

The authors set out to “compare the duration of financial compensation for back pain” among patients from each care group.

The study found that chiropractic patients had the shortest amount of time receiving compensation for their pain and also were less likely to have a recurrence.

In addition, chiropractic patients didn’t need to see other healthcare providers for their pain. 75% of chiropractic patients saw no other provider, while 58.6% of physical therapy patients also saw a medical doctor.

The authors conclude:

“The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest.”

Blanchette M, Rivard M, Dionne CE, et al. Association between the type of first healthcare provider and the duration of financial compensation for occupational back pain. Journal of Occupational Rehabilitation 2016 Sep 17.

Written by: Michael Melton on September 19, 2016.
Today’s chiropractic news shared from the following website: https://www.chironexus.net/2016/09/chiropractic-patients-recover-faster-spend-less-money/
What Are “Manual Therapies” and How Are They Used?

What Are “Manual Therapies” and How Are They Used?

Manual therapies have been used to treat musculoskeletal disorders for thousands of years. Practitioners around the world—in countries with many different cultural influences and diverse medical traditions—have used their hands to manipulate various parts of the body to stimulate healing. “Manual” literally means “by hand.” Thus, manual therapies consist of healing techniques that use the hands. There are more than two dozen techniques used worldwide. Among the most commonly known are acupressure, chiropractic, massage therapy, physiotherapy, reflexology, Rolfing and shiatsu.

There are also dozens of other, lesser-known manual therapies, including the Bowen technique, cranio-sacral therapy, the Dorn method, manual lymphatic drainage, muscle energy technique, myofascial release, myotherapy, naprapathy and zero balancing. We examine the most common therapies here:

Acupressure

Using the hand, the elbow or various devices, an acupressure practitioner applies a light force on various parts of the body following the patterns found in traditional Chinese medicine and acupuncture. More than half of the scientific studies on acupressure showed that this technique was effective, but some critics have claimed “a significant likelihood of bias.”

Chiropractic

Most chiropractic work involves manipulation of the spine to achieve better vertebral alignment. Lower back pain is perhaps the primary complaint which leads patients to a chiropractor. Chiropractors are expert at treating musculoskeletal conditions without the use of drugs or surgery. Among others, many top athletes swear by their chiropractor’s hands to keep them performing at their best and help them avoid injuries.

Massage Therapy

This is perhaps the oldest of the manual therapies. Massage was (and still is) used in ancient Egypt, China, Mesopotamia, and other parts of the world that gave rise to early civilizations. Massage practitioners chiefly use their hands, but also other parts of their body to apply pressure, rolling motions and other techniques to muscles and joints, to stimulate circulation and relax the patient. In today’s high-stress world, massage is proving ever more popular.

Physiotherapy

Physiotherapy has been used for years as standard treatment for patients suffering from musculoskeletal conditions. A physical therapist uses a variety of techniques to help their patients regain function—particularly mobility. Repetitive, assisted motion can help the patient strengthen muscles that have been damaged through injury or disease. Assisting the patient in the performance of targeted exercises can help a patient regain greater range of motion.

Reflexology

A trained reflexologist applies pressure to various parts of the feet, hands or ears to stimulate organs within the body associated with the part to which pressure is being applied. It is a Chinese therapy with a philosophy that is similar to acupuncture—using points on the body to restore energy flow. Although there is not yet much scientific evidence to support its effectiveness, anecdotal evidence shows that patients are happier and more relaxed after treatment.

Rolfing Structural Integration

Rolfing specifically targets the body’s connective tissue to release tension, realign and balance the body. Rolfing techniques involve deep-tissue massage to achieve therapeutic benefits such as better posture and greater freedom of movement, including reducing stress and relieving pain.

Shiatsu

A traditional Japanese therapy, the term Shiatsu means “finger pressure,” but can include palm pressure and other approaches to massage. A Shiatsu practitioner uses touch, comfortable pressure and manipulative techniques on specific points of the body (similar to the meridians of Traditional Chinese Medicine) to adjust the body’s physical structure and balance its energy flow. Anecdotal evidence shows it to relieve patients of stress, nausea, muscle pain, depression and anxiety.

 

Most Common Auto Injuries Explained

Most Common Auto Injuries Explained

Perhaps the most frequent injury involving automobiles comes from closing the door. Nearly 150,000 times a year, someone is injured in this fashion, and that’s with the car parked or stationary. This includes doors closing on fingers. Another 10,000 are injured by using a jack and 74,000 have been injured by a car or car part falling on them.

But cars also move. Roughly one third of auto-related injuries occur due to an automobile striking someone, particularly pedestrians and bicyclists. Injuries can include anything from simple scrapes to multiple broken bones, dislocated vertebrae and damaged internal organs.

A Forbes magazine article noted that researchers from the US Department of Transportation “estimated an annual total of 1,747 fatalities and 841,000 injuries due to non-traffic crashes and non-crash incidents.” These included back-overs and single-car collisions not on a highway.

During a collision, passengers can be thrown about within the car, or be ejected from the vehicle (particularly if not wearing a seatbelt), causing significant injuries. One of the most serious of these is called traumatic brain injury (TBI). This is when the brain becomes bruised or otherwise injured. This can happen when the head is forced into rapid acceleration and/or deceleration from impact with other objects, such as a windshield, the body of the car or objects outside of the car. Such brain injuries can result in brain function impairment or even death.

Neck injuries include whiplash and vertebrae disk damage. These can result in a range of effects from persistent, long-term discomfort to debilitating pain and even immobility. Whiplash is perhaps the most common malady, which happens when the neck snaps quickly backward (during acceleration), then forward (during deceleration), causing hyperflexion and hyperextension of the cervical vertebrae. After an accident, the victim may be unaware of any damage, but may experience headaches or neck stiffness hours or days later.

A chiropractor can recognize this kind of damage using a variety of diagnostic tests with and can treat it with multiple adjustments, massage therapy and repetitive exercises performed by the patient at home. The chiropractor may even recommend a traction weight bag to help the neck return to its natural curve. Sometimes the damage is permanent, but treatment can reduce the discomfort and decrease in range of motion that might otherwise plague the patient.

Damage anywhere along the spine can occur during a car accident. This type of injury can range from mild to life-threatening. Dislocated vertebrae can result in excruciating pain that can lead to tight back muscles which intensify the problem. Physical therapy and chiropractic adjustments can help return the patient to health. Rehabilitative therapy can also include hot packs, massage, cold packs, traction, ultrasound, electrical stimulation and other methods.

When the spine is injured, symptoms can include difficulty breathing, tingling, numbness, paralysis, arm weakness, leg weakness, and unusual bladder or bowel control. If you are experiencing these or other unusual symptoms, seek proper care from a chiropractor or other health professional immediately.

What is a “Pinched Nerve”?

What is a “Pinched Nerve”?

‘Tearing her hair out’ Metaphor or bad hair day

A “pinched nerve” refers to a condition in which a nerve is compressed by surrounding tissue, such as ligament, cartilage, tendon or bone. The term “pinched nerve” is not a standard medical expression, but it’s an intuitive expression that almost anyone will understand.

Nerves radiate from your brain, down your spine and to all other parts of the body. Signals are sent from and to the brain along the nerves, and if a nerve is compressed (“pinched”), it will interfere with proper signal transmission. Usually, this will manifest as pain, not only at the site of compression, but sometimes radiating from that point to surrounding parts of the body. Misalignment of the spine can result in pinched nerves that can give you back pain and even a deadening ache or sensitivity along your arms (cervical radiculopathy) or legs (sciatica).

Any pain of this sort is a warning signal that there is a problem that should be treated right away. Left untreated, pinched nerves can lead to a loss of the protective barrier around the nerves which could generate fluid buildup. And this fluid would create swelling, more pressure, more pain, and possibly scarring. When nerves have been scarred, they may no longer function properly.

Pain isn’t the only indication of a pinched nerve. Sometimes a compressed nerve will generate numbness or tingling, a burning or “pins and needles” sensation, or even weakness during certain activities.

Pinched nerves can occur more often when the following risk factors are involved:

  • Overuse—Repetitive actions such as movements during work or while involved in a hobby or sport.
  • Posture—Bad posture creates more pressure on the spine and the nerves traveling through it.
  • Gender—Women’s carpal tunnels are smaller and are at greater risk for carpal tunnel syndrome.
  • Rheumatoid arthritis—Inflammation of any kind can compress nerves, especially at the joints.
  • Obesity—Increased body weight can increase pressure on nerves throughout the body.
  • Bone spurs—Bone thickening (from conditions such as osteoarthritis) or trauma can lead to bone spurs that stiffen the spine and narrow the space through which the nerves pass.

Mainstream medicine frequently recommends drugs, including NSAIDs, oral corticosteroids, narcotics (for emergency, short-term pain relief) and steroid injections to treat the symptoms of a pinched nerve. The Mayo Clinic suggests that patients can sometimes recover within a few days or weeks from pinched nerves with rest and additional “conservative treatments.” Other mainstream medical treatments may include physical therapy, a splint to immobilize a limb to give it a bit of rest, or surgery.

A chiropractor specializes in nerve health and non-invasive methods of reducing pain and restoring proper function, including spinal adjustments and other treatments that take the pressure off the nerves without the need for drugs or surgery. Sometimes a single adjustment can lead to immediate relief. In other cases, repeat visits may be required for full recovery. If you or someone you care about is suffering from a pinched nerve, you should know that there are alternatives to drugs and surgery and that chiropractic care has proven effective in treating the source of the problem so it is less likely to recur in the future.

If you would like to be seen by Dr. Oblander for treatment of a pinched nerve or any other ailment, please call our office at 406-652-3553 to schedule an appointment.

 

How To Choose a Chiropractor

How To Choose a Chiropractor

We are sharing an article today that was first run in the Billings Gazette in 2014. We think it has some good information and we have added a few tips of our own at the conclusion of the article:

Chiropractors are a great resource for people with back, head or neck pain. These professionals believe that realigning your spine will help relieve pain and discomfort in the body.

People often find relief by seeking help from a chiropractor. They report having improvements in their muscles, joints, bones and ligaments.

It will often improve your general health as well. Headaches and sinus pain can also be healed with treatments.

Whether you are experiencing pain or simply want to enhance your overall well-being, you may benefit from seeing a chiropractor.

Thinking about the following factors can help you find the right chiropractor for your needs.

Quality

Chiropractors have some of the most stringent educational requirements in the health care industry. According to the American Chiropractic Association, accredited chiropractors go through at total of at least 4,200 hours of classroom, laboratory and clinical training time combined.

Students must spend four years in a pre-medical program, in addition to four or five years of professional training.

It is vital that the student understand different aspects of the body.

Prior to selecting a chiropractor, inquire about training and credentials. Make sure he or she is properly qualified.

Insurance Coverage

Many insurance carriers include chiropractic care as part of their regular coverage.

Verify that your care will be covered. You might be offered a discount for choosing an “in-network” professional.

But if you don’t have insurance, many chiropractors offer low cash rates or affordable plans to help patients. Even without health insurance, you can still find chiropractor offering quality, cost-effective care.

Get Referrals

Someone in your social or professional network has likely received excellent care from a chiropractor. Ask family, friends and co-workers for referrals.

Inquire specifically about his or her demeanor and schedule. Is it easy to make an appointment? You should also find out about the chiropractor’s philosophy about health and other wellness issues. Some practitioners will suggest complementary forms of care, including massage.

Given the results it can provide, chiropractic care is still affordable and well worth the money. With time and effort, you are likely to find a quality chiropractor in your area.

Our Own Comments:

We believe that it is a good idea to find a chiropractor that will listen to you. The doctor should be interested in understanding what issues you are seeking treatment for and resolving those issues. A doctor that is interested in getting you in and out of the adjusting room as quickly as possible is often more interested in his/her pocketbook than in your care. Also, a doctor that educates his/her patients is invaluable.

We are grateful that Dr. Oblander is the kind of doctor that genuinely cares for his patients and who seeks to give his patients the care they need, want and deserve!

For our current patients who read this, we would appreciate your online reviews for our office and Dr. Oblander. We have provided links below to make it easier for you!:

https://www.yelp.com/biz/oblander-chiropractic-billings-2

https://drive.google.com/open?id=1vTNoEI3dW-g4oqa_ifZLJmFhZL0&usp=sharing

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Car Accidents and Delayed Symptoms: What You Need to Know

Car Accidents and Delayed Symptoms: What You Need to Know

Even if your recent fender bender didn’t seem too serious, there’s still a very real chance that you or your passengers may have been hurt. That’s because even the most minor car accidents can cause hidden injuries and delayed symptoms. And while damage to your car is likely obvious and easy to assess, evaluating damage to your body may be far more difficult. In fact, it’s not unusual for a driver or passenger to walk away from a collision with potentially serious musculoskeletal injuries (such as a concussion or whiplash), without knowing it.

Because of the stress response, right after an accident the body’s defenses are on high alert. Any pain may be masked by endorphins produced by the body during and shortly after this kind of traumatic event. Endorphins help the body manage pain and stress and can create a temporary euphoria or “high” feeling. When the threat of the accident is gone, endorphin production slowly disappears, allowing you to feel pain that may have remained hidden earlier.

Perhaps the most common delayed symptom is that of whiplash. Whiplash consists of soft tissue damage in the neck from the sudden acceleration and deceleration of the head, creating hyperflexion and hyperextension of the neck. This can not only cause damage to the muscles, tendons and ligaments of your neck, it can also occasionally fracture or dislocate vertebrae and cause any of the following symptoms to show up later:

  • Headaches
  • Reduced range of motion or difficulty moving
  • Slowed reflexes
  • Vertigo
  • Muscle spasms
  • Localized weakness or numbness
  • Stiffness in shoulders and arms

 

Every bit as serious as any broken bones or lacerations, a concussion can prove to be a grave threat to your health. Quite simply, a concussion is the result of the brain colliding with the inside of the skull from a rapid acceleration or deceleration. Not all concussions occur because of bumping the head. If the head is restrained in any way and the restraint suddenly stops or suddenly jerks into motion, a concussion may occur. Symptoms of concussion include the following:

  • Headaches
  • Bad temper
  • Nausea
  • Spasms
  • Loss of balance
  • Blurred or double vision
  • Disorientation
  • Confusion
  • Amnesia
  • Ringing in the ears
  • Difficulty concentrating or reasoning
  • Anxiety or depression
  • Tiredness, sleeplessness, or other problems with your ability to sleep

 

The key point with any of these symptoms is to know whether or not you had them before the accident. Someone who knows you or lives with you can help identify any changes in your behavior that may indicate a possible concussion. If you didn’t have a symptom that you’re now experiencing, see your doctor right away.

In addition to the health consequences of car accidents with delayed symptoms, there is also the insurance aspect to consider. Because many accident-related injuries don’t show up immediately, you may have to pay out-of-pocket for the medical expenses from any delayed symptoms if you settle with your insurance company right away. Therefore, consider waiting a few days before signing any release of liability so that any delayed symptoms have an opportunity to reveal themselves. Seeing a chiropractor for a medical evaluation as soon as possible after an accident is also a good idea, since he or she can help identify injuries and start treatment promptly. In many cases, seeking appropriate medical care soon after an accident can improve your chances of a more complete and more rapid recovery.

If you have been in an accident, you can call Oblander Chiropractic at 406-652-3553 to schedule an exam with Dr. Oblander.

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Top 7 Exercises for More Core Muscle Strength

Top 7 Exercises for More Core Muscle Strength

Top 7 Exercises for More Core Muscle Strength
Top 7 Exercises for More Core Muscle Strength

Sitting for long periods of time has a detrimental effect on our “core” muscles. These are the muscles responsible for keeping us upright and allowing us to twist and bend without falling over. It is important to keep these muscles strengthened in order to avoid chronic low back pain and injuries that may result from lifting heavy objects. The stronger your core, the less prone you are to injury. The following seven core muscle exercises are particularly good for strengthening these muscles. Hold each pose (except for the bicycle ab crunch) for at least 10 seconds and repeat 5 to 10 times.

Superman – Lie face-down on the floor with your arms straight out in front of you and your knees together. Simultaneously lift your arms, upper chest and legs off the floor, balancing on your pelvis.

Bridge ­– Lie on your back with your knees bent and your feet flat on the floor, as close to your buttocks as possible, with your arms close to your sides. Contracting your abdominal muscles, raise your hips toward the ceiling until a straight line is formed between your knees and neck.

Modified V-sit – Start while seated on the floor with your knees bent in front of you and feet flat on the floor. Lean back slightly on your hands and lift your feet off the floor so you are balanced on your buttocks (making a sort of square root symbol), then hold your arms straight out in front of you, on each side of your knees. Once you have gained some experience, you can work up to straightening your legs so you form a “V.”

Plank – Lie on your stomach with your elbows close to your sides and directly under the shoulders, with palms down and hands facing forward. Keeping your legs straight, lift your entire torso and hips off the floor, balancing on your toes and forearms. Your head should be parallel with your spine, looking at the floor.

Side plank – Start by lying on your side, resting on your forearm and on the outside of your foot, with one foot on the other. Placing your elbow directly beneath your shoulder, align your head with your spine while keeping your hips and knee in contact with the floor. Lift your hips and knees off the floor, keeping your upper arm flat against your side and balancing on your forearm and foot. For a greater challenge, raise up onto your hand and stretch your upper arm out, forming a leaning “T.”

Bird dog – On your hands and knees, place your hands directly below your shoulders, while aligning your head and neck with your back. Stretch your left arm out in front of you, parallel to the floor, while extending your right leg straight out behind you, being sure not to arch your lower back. Repeat with opposite arm and leg.

Bicycle ab crunch – Lie flat on your back with your hands behind your head. Curl your body forward, like performing a crunch, bringing your left knee towards your right elbow while extending your right leg out, lifted slightly off the floor. Keeping your shoulders off the floor, switch your crunch to right knee and left elbow, while extending the left leg. Keep alternating from left to right for about a minute.