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Does Having Young Children Really Build Your Immune System?

Does Having Young Children Really Build Your Immune System?

Maybe it’s just wishful thinking, but many moms and dads believe that having a young child or two around the house boosts their immune system.  It’s easy to see why this idea has some popular appeal.  After all, young children typically have lots of contact with other young children, often in environments where lots of germs can be spread. They then bring these same germs home, where parents’ immune systems need to fight them off over a sustained period of time. The thinking goes that this, in turn, helps make parents more resistant to them.

But what does the science actually say about this? Although there is at least one strong study and a lot of related or anecdotal evidence that suggests that the idea may be sound, more research needs to be done to see if this theory is valid.

The “strong study” is from Norway, and was published in the journal Science & Medicine. It’s important to note that the study did not specifically evaluate the immune response of parents and non-parents. Rather, this particular research was aimed at understanding the relationship between parenthood and overall health. The investigators looked into detailed medical records of more than 1.5 million men and women born between 1935 and 1968, and found that there was a strong negative correlation between being a parent and the risk of developing cancer, heart disease, becoming an alcoholic, and even dying in a car crash. The study found that the people most at risk of dying from any of these causes were those who were childless. The researchers theorized that this may be because the individuals felt less of a need to take care of their health.

Fascinatingly, the study also found that the positive health benefits or parenthood seemed to depend on the numberof children. Having only one child or having more than three children actually slightly increased the risk of dying from any of these factors, whereas having two children was “just right.” As researcher Emily Grundy of the London School of Hygiene & Tropical Medicine, says: “Four-plus children might have adverse effects arising from stress, socio-economic disadvantages and lifestyles, off-setting, or even outweighing, social benefits of parenthood.”

In terms of other evidence, the strongest suggestions that having children might strengthen their parent’s immune system come from related studies that have consistently shown that having pets in the home strengthens and builds the children’s immune systems and helps to keep them healthy. For example, a 2012 study from the journal Pediatricsshowed that children who lived with dogs and cats during the first year of life tended to be significantly healthier than those who did not. The researchers theorized that the pets exposed children to a wide variety of “good germs,” some of which are beneficial for developing immunity to the “bad germs.” We may be able to infer that parents might also benefit from being exposed to a variety of germs, both from the pets and from their own children, as children pick them up at school and bring them home.

There is certainly anecdotal evidence of the latter to be found in the “common wisdom” imparted to people becoming new kindergarten and elementary school teachers. When one woman started teaching in California, her school board warned her that she should probably plan her finances for the first year of teaching based on being out sick more than her allotted number of “sick days,” and thus not being paid for them. The woman, who had always been remarkably healthy, laughed at this advice, but then spent 25% of her first year at home sick, because of all the germs she picked up from kids in the classroom.

However, this same schoolteacher rarely ever got sick again. Her exposure to a wide variety of germs transmitted by the kids did seem to boost her immune system over time, and enhanced her ability to be exposed to them in the future without getting sick herself. We can possibly infer that the same thing happens with small children in the home—they pick up germs at school and bring them home where the parents are exposed to them. This exposure then buildsimmunity over time rather than diminishing it. Dr. Jordan S. Orange, chief of immunology, allergy and rheumatology at Texas Children’s Hospital explains the simple mechanics of this “early exposure” process this way: “When you get it [immunity], you have it. So, if you get it earlier, you’re going to be immune earlier.”

Related studies have indicated that many people feel happier when they have kids. If this is actually true, then their positive mental state can also certainly contribute to staying healthy. Besides, as all parents know, there are so many other joys associated with having kids that even if there aren’t a huge number of studies proving that they keep parents healthier, they’ll feel healthier.

Drink Your Vegetables! Guide to the Best Vegetable Juice Options

Drink Your Vegetables! Guide to the Best Vegetable Juice Options

Experts recommend that we get 9 servings of fruit and vegetables each day in order to stay healthy and reduce our likelihood of a wide range of diseases, including heart disease, diabetes, stroke and cancer. An evaluation of long-term studies conducted in Europe and the US found that those who ate more than 5 servings of fruit and vegetables daily had a 20 percent lower risk of stroke and coronary heart disease than those who ate fewer than 3 servings per day.

Although fruit is very healthy (it provides lots of vitamins and fiber), it contains a lot of sugar in the form of fructose. This is why experts say that about three-fifths of those 9 servings of fruit and vegetables should be comprised of vegetables. But it’s not easy for a lot of people to get those all-important servings each day, given our increasingly busy schedules. Luckily, it’s relatively simple to get your daily veggies from drinking juice.

Just to be crystal clear on this point—it is generally better for you to eat whole vegetables either raw or very lightly cooked as often as possible. Vegetable juices are generally pretty low in fiber, depending on the juice (or juicer) you get. Fiber is important for digestive health, reducing the risk of constipation and keeping your cholesterol at a healthy level. Nevertheless, drinking vegetable juice is far better than getting little or no vegetables at all!

Juicing can be a particularly useful option for people who have digestive issues. To get the most nutritional value from your vegetables (or from any other food you eat, for that matter), your body must first break them down during digestion. Generally speaking, the simple act of chewing and swallowing our food so that it can be dissolved elsewhere along the digestive tract should be sufficient to release the nutrients in whatever we eat. However, some people (including the elderly, whose digestive enzymes may not be as powerful as they once were) have digestive problems that interfere with the absorption of nutrients. Since juice has had most of the vegetables’ cellulose removed or broken down, it’s easier for the digestive system to absorb all those important nutrients.

For veggie juices with the highest nutritional content, consider juices featuring some of the following vegetables:

  • Tomatoes – Possibly the best vegetable to juice, tomatoes contain lycopene, which has been shown to lower the risk of prostate cancer and is supportive of heart health.
  • Kale – Chock full of vitamins and minerals, including vitamins B, C and K, calcium, copper and magnesium, kale also is high in cancer-fighting phytonutrients.
  • Cabbage – Helps protect against ulcers, and its indoles help to regulate metabolism and the balance of estrogen.
  • Peppers – Red bell peppers in particular are high in vitamin C and antioxidants. Adds a refreshing flavor to any vegetable juice.
  • Celery – High in potassium, celery helps to regulate blood pressure. It also reduces uric acid in the blood, which is good news for anyone with gout.
  • Spinach – High in the cancer-fighting antioxidant lutein, spinach is also high in vitamins A, C and E, and is a good source of calcium, folic acid, iron and potassium.
  • Carrots – These contain large amounts of beta carotene, good for the skin, eyes, brain and arteries. They blend well with other vegetables as well. Just be sure to use them somewhat sparingly, as they are also quite high in sugar.
  • Parsley – Cleanses the liver and kidneys and is supportive of heart health. It is also high in vitamin C.

So drink up, and enjoy the health benefits you can gain from these wonderful vegetables!

  • Special Note: Using a high-powered blender such as a Blendtec or Vitamix Blender allows you to get your juice and fiber as well! Not everyone can afford one but for those that can, it can be a wonderful investment!

 

Opiates Ineffective for Chronic Back or Hip Pain

Opiates Ineffective for Chronic Back or Hip Pain

A new study just published in the Journal of the American Medical Association finds that opioids are not an effective solution for chronic pain.

In this article, researchers from the University of Minnesota studied 240 patients who had chronic back, hip, or knee arthritis pain. Half of the study subjects received opiates; the other half received non-opiate pain medications. Patient progress was evaluated at 3-months, 6-months, 9-months, and one year.

The study found:

  • There was no difference in pain-related function between the two groups.
  • At 12 months, the nonopioid patients had less pain than did those who received opiates.
  • “The opioid group had significantly more medication-related symptoms over 12 months than the nonopioid group”

The study authors write:

“Among patients with chronic back pain or hip or knee osteoarthritis pain, treatment with opioids compared with nonopioid medications did not result in significantly better pain-related function over 12 months. Nonopioid treatment was associated with significantly better pain intensity, but the clinical importance of this finding is unclear.”

Previous research has found that about 20% of patients with musculoskeletal pain are prescribed narcotic pain medications for their symptoms, and another recent study found that 36% of people who overdosed from opiates had their first opioid prescription for back pain.

Another recent study found that chiropractic patients are less likely to use opiates for their pain than are medical patients.

From this research, it seems clear that it’s risky to prescribe opiates for musculoskeletal pain. Chiropractic care is a proven safe and effective approach for both chronic and acute back pain.

Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018 Mar 6;319(9):872-882. doi: 10.1001/jama.2018.0899.

Fitness Standards for Adults: Here’s What They’re Good For

Fitness Standards for Adults: Here’s What They’re Good For

President John F. Kennedy once said, “Physical fitness is not only one of the most important keys to a healthy body, it is the basis of dynamic and creative intellectual activity.” Since July 16, 1955, the American government has shown at least a political interest in the health of Americans. Under President Eisenhower, the President’s Council on Youth Fitness established a beachhead against the lagging health of American youth compared with citizens of other countries. Military officers in World War 2 complained that their recruits were out of shape. Perhaps Eisenhower’s program was meant to help reverse that condition. However, it wasn’t until President Kennedy that the Commander-in-Chief took an active role in promoting standards and committing resources to them.

After nearly 60 years, the presidential council has expanded its role in a number of directions, including sports, nutrition and—most relevant to this article—adult fitness. The president’s council has had an established standard for nominal health since 2008 and benchmarks have been created for regular, moderate and vigorous activity. In addition, the council has established an online Adult Fitness Test that allows you to compare your scores with those of fellow Americans. The test can be found at http://www.adultfitnesstest.org/dataEntry.aspx.

The areas tested include the following:

  • Aerobic fitness—Preparing for the test, you should work up to moderate exercise (e.g. brisk walking) for 30 minutes, 5+ days per week; and vigorous exercise (e.g. running) for 20–30 minutes, 3–4 days per week.
  • Muscular strength and endurance—3+ days per week, work up to 3 sets each of 25 half sit-ups and 10–20 push-ups. Between each set, include a short rest.
  • Flexibility—Static stretches should be taken to the point of tension, but never to pain. Hold each for 10–30 seconds. Repeat 1–2 additional times.
  • Body composition—Your body mass index (BMI) is a measure of height related to weight, with your waist measurement as a health indicator. This should be kept between 18.5–24.9. BMI calculators can be found online.

These sorts of tests can do a lot to raise public awareness and to help focus people on activities that will make a difference. But they will only be effective is they’re used the right way. And using them the right way starts with understanding what these tests are actually measuring and what the results mean. In some ways, measuring your performance in specific exercises relative to a national average may be less helpful than measuring your improvement over time and setting new goals based on your own progress.

When taking on any exercise program or fitness testing, especially when you have not engaged in rigorous physical activity regularly for several years, you should consult with a doctor or physical trainer. Proper preparation, good technique and consistency are the keys to staying healthy and avoiding injury. Regular chiropractic care can also play an important role in helping to speed recovery, prevent future injuries and improve performance. As musculoskeletal system specialists, chiropractors have unique insight into how patients can safely increase their strength, stamina, flexibility and balance. If you want to learn more, just call or visit our office! You can reach us at Oblander Chiropractic at 406-652-3553.

Exercise, Chiropractic More Effective Than Medicine

Exercise, Chiropractic More Effective Than Medicine

You may remember your grammar school gym class where the PE teacher would lead you in jumping jacks, push-ups, sit-ups and arm circles. If you’re like a lot of baby boomers, you probably look back and assume it really didn’t do much for the health of the students — just kept the class busy for an hour.

Elementary school days may be way behind you, but exercise carries many benefits now that it couldn’t offer a younger you, especially if you’re battling pain from an injury or chronic condition.

The Journal of Manipulative and Physiological Therapeutics published a report on randomized controlled trials, or RCTs, looking at the result of exercise as treatment for patients experiencing intense pain from soft tissue injuries in the hip, thigh or knee. Success was measured by the following factors:

  • Intensity of pain
  • Recovery
  • Quality of life
  • Psychological outcomes
  • Adverse events

“One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a ‘wait and see’ approach for patellofemoral (anterior knee) pain syndrome,” the study says. “Patients with patellofemoral pain syndrome or groin pain had the best results with clinic-based exercise programs.”

Head to Head to Head

An ABC News blog posted study results comparing the outcome of three different forms of treatment for pain. Results show that patients treated by chiropractic professionals and the individuals who received home exercise advice, referred to as HEA, had higher rates of success than those who turned to medication for relief. Just 13 percent of the patients who took medication reported a satisfactory reduction in pain, whereas, about two-thirds of those who were treated through either chiropractic care (32 percent) or HEA (30 percent) said they were pain-free.

A total of 272 patients, ages 18-65, who were suffering from recent-onset neck pain took part in the study, which the National Institutes of Health spearheaded.

“I always prescribe exercises and/or physical therapy for neck pain,” wrote Dr. John Messmer from Penn State College of Medicine. “I also tell patients that the exercises are the treatment and the drugs are for the symptoms.”

Dr. Lee Green, professor of family medicine at the University of Michigan, also talked to ABC News. “Doesn’t surprise me a bit,” Dr. Green said. “Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.”

The study, which was published in the Annals of Internal Medicine, singles out the effectiveness of spinal manipulation therapy, or SMT, to provide relief for patients with neck pain. Researchers found that in both the short-term and long-term statistics, SMT had the most effective outcome. The report adds that HEA proved equally effective at some points in the study.

Participants rated their pain at several intervals: 2, 4, 8, 26, and 52 weeks. This enabled scientists to draw specific conclusions, such as the evidence showing that 12 weeks of SMT provided greater pain relief than up to one year of medication.

Chiropractic Benefits

Your chiropractor can not only provide pain releif and preventatiive therapies, they can also guide you in choosing exercises that target the areas you need treating. Chiropractic visits, in addition to home exercise practices, are a way to double down on your odds of successful treatment.

The Mayo Clinic website says there are multiple benefits to using exercise in addition to chiropractic care for your joints, as well as improving general wellness. In combination they serve to:

  • Strengthen the muscles around your joints
  • Help you maintain bone strength
  • Give you more energy to get through the day
  • Make it easier to get a good night’s sleep
  • Improve your balance

We’re not talking about the kind of punishing calisthenics that win you the Presidential Physical Fitness Award, but something to just curb your symptoms and add some range of motion. Consulting with a chiropractor and incorporating some exercise seems to be the best way to get a passing grade in pain relief.

This article was written by Martha Michael and is shared from the following website: exercise-chiropractic-more-effective-than-medicine

Where Does Good Balance and Coordination Come From? Introduction to Your Proprioceptive System

Where Does Good Balance and Coordination Come From? Introduction to Your Proprioceptive System

balancing-on-fence

Proprioception is a complex system of anatomical checks and balances, neural impulses, and brain functions that controls our sense of balance, coordination, and agility. Put most simply, proprioception is the “sixth sense” that enables you to scratch your head without looking in a mirror or climb a flight of stairs without having to look at each step.

Most of us are so accustomed to proprioception that we take it for granted. Its development starts soon after we are born and is observed in infants as soon as they gain control of their neck muscles. When the infant’s body tilts in any direction, its head also tilts in the opposite direction to level its eyes with the horizon. This “righting reflex” is the beginning of our sense of balance.

More technically, proprioception is your body’s ability to transmit a sense of its position in space, analyze that information, and react—either consciously or unconsciously—to stimuli with the proper movement and force. Proprioceptors are a specialized type of motor and sensory nerve that transmits impulses to the central nervous system (in particular, the area of the brain known as the cerebellum) from stimuli felt by the muscles, tendons, joints, and skin. The impulses transmitted by proprioceptors contain vital information, such as the amount of tension in a particular muscle and the relative position of a body part when it is moving.

, Proprioception is what enables you to reach for a glass and actually find it in space. It is also what allows you to pick up the glass with just the right amount of force, neither dropping it nor breaking it by squeezing too hard. Proprioception is what enables you to keep your balance when walking on uneven surfaces or when riding a bicycle. The impulses from proprioception combine with input received from the vestibular system (the fluid-filled network in the inner ear that enables us to feel the pull of gravity and know which direction is “up”) and with input from the visual system to create our sense of balance.

However, just as our eyes become weaker with age, so can the proprioceptive system, leading to a loss of proper balance. This is one of the reasons that falling is the number one cause of hospital admissions for people over 60. Something has gone wrong with the complex processing of information needed to maintain their balance, so older people are more likely to slip and fall on stairs or on slippery sidewalks and injure themselves.

Fortunately, you can strengthen your proprioceptive system by practicing simple balance exercises, thus keeping keep your sense of balance from weakening as you grow older. There are many forms of inexpensive exercise equipment (such as BOSU or Bongo Boards) that enable you to stand on a platform that is designed to be wobbly. This instability forces your muscles and your proprioceptive system to work more, and thus become stronger. So if you are over the age of 50, you should consider speaking to your chiropractor about exercises to improve your proprioception. They are very simple but can greatly improve your overall sense of balance, therefore significantly reducing your risk of injury from falls as you grow older. To schedule an appointment with Dr. Oblander, call 406-652-3553.

The New Science of Slips and Falls: What the Research Tells Us

The New Science of Slips and Falls: What the Research Tells Us

While we’ve all seen the old banana peel skit, slips and trips in the real world are no laughing matter. Simply falling to the floor or pavement from an upright position causes a great many serious injuries—and even deaths—each year. No one really knows for certain how many falls could actually be prevented, but the topic is of growing interest to a wide variety of people, from public health officials, designers, architects and community planners to business owners, workplace supervisors and employees. Senior citizens are perhaps the most at risk. The U.S. Centers for Disease Control and Prevention (CDC) presents several statistics that highlight this point:

  • One out of three older adults (those aged 65 or older) falls each year, but less than half talk to their healthcare providers about it.
  • Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Among older adults, falls are the leading cause of both fatal and nonfatal injuries. In 2010, about 21,700 older adults died from unintentional fall injuries. Over 95% of hip fractures are caused by falls. In 2010, there were 258,000 hip fractures.
  • Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.
  • In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized. In 2010, the direct medical cost of falls, adjusted for inflation, was $30 billion.

Walking is a very complex activity, and science has only recently begun to understand the biomechanics involved. Shirley Wang wrote in a recent Wall Street Journal article, “Scientists are finding that maintaining stability and balance with each step we take requires complex coordination of foot placement, arm movement, trunk angle and neck and head motion.” At the same time, researchers are also learning how other factors like sloping, uneven or slippery surfaces and obstructions come into play. There are many variables to consider. Even when the body’s movements are perfectly coordinated, small things about environment can still foil our best efforts to remain upright.

We know from nervous system studies that the body is capable of reacting within milliseconds. Science has shown that a person’s balance is maintained by simultaneous feedback from the body’s visual system, proprioceptive system and inner ear. If one of these systems becomes less efficient or fails altogether, then the other two can usually compensate to keep us balanced. If two fail, then balance becomes far more difficult. Aging frequently leads to poorer eyesight and troubles with the inner ear, so it’s small wonder that seniors are more likely to fall.

Canadian researchers at Simon Fraser University used video cameras in a long-term care facility to see if seniors were right about “tripping” or “slipping” being the reasons for their falls. What they found was surprising. Tripping actually accounted for only 20% of events. The nearly 3-year study of 227 falls involving 130 people showed that the single largest cause (41%) was from improper weight shifting, such as leaning over too far. This seems to indicate a failure in the seniors’ proprioceptive system.

There are a few ways you can help to prevent slips and falls. Be sure to keep walkways clear of clutter, and consider adding non-skid material to flooring—especially to floors that are more likely to become wet. Maintaining your strength helps too. Upper body strength is particularly important for catching yourself before or during a fall. Even when there’s nothing to grab onto, having the sort of upper body strength that helps you to do push-ups can soften the blow to more sensitive parts of the body. Reaching out with hands and flexing elbows upon impact can slow the fall or stop it altogether. The late Jack LaLanne, fitness guru, was still doing fingertip pushups at age 93. Don’t say it can’t be done!

Balance requires that every part of the body works well together. Dr. Oblander can help you maintain this balance by ensuring you have a healthy spine and nervous system.  He can also recommend specific exercises that maintain or increase your upper body strength.  So if you or someone you care about is interested in avoiding slips and falls, we can help you take advantage of the latest research!  Just call or visit our office today: 406-652-3553!

 

Tips for a Healthy Spine

Tips for a Healthy Spine


A healthy spine is an often overlooked and essential part of a healthy lifestyle. People who suffer from back pain, particularly if it is long-term, are generally less healthy than those who do not. In fact, back pain costs are staggering not only financially, but also in terms of lost time from work and because of psychosocial problems that arise during the healing process associated with long-term back pain.

Unfortunately, approximately 80-90% of the population suffers from spinal pain at some point. People who are overweight or obese, and who smoke, lift heavy objects, or had a previous episode of back pain, are more likely to experience back pain.

Because so many people suffer from spine pain, it’s important for you to try to keep your spine as healthy as possible. Following simple posture, lifting, and healthy lifestyle guidelines can help you keep your back in good shape. One of the best things you can do for your spine is to get regularly adjusted. If you are in need of an adjustment, be sure to call our office at 406-652-3553 and schedule an appointment with Dr. Oblander. In the meantime, here are some good ways to take care of your spine:

The American Chiropractic Association recommends the following spinal health tips:

Standing

• When standing, keep one foot slightly in front of the other, with your knees slightly bent. This position helps to take the pressure off your low back.

• Do not stand bent forward at the waist for prolonged periods of time. The muscles in your low back become deconditioned in this position, which may lead to pain.

Lifting

• At all times, avoid twisting while lifting. Twisting is one of the most dangerous movements for your —spine, especially while lifting.

• If the item is too heavy to lift, pushing it is easier on your back than pulling it. Whenever possible, use your legs, not your back or upper body, to push the item.

• If you must lift a heavy item, get someone to help you.

Sitting

• Keep your knees slightly higher than your hips, with your head up and back straight.

• Avoid rolling your shoulders forward (slouching).

• Try to maintain the natural curve in your low back.

Reaching and Bending

• When reaching for something above shoulder level, stand on a stool. Straining to reach such objects may

not only hurt your mid-back and neck, but it can also bring on shoulder problems.

• Do NOT bend over at the waist to pick up items from the floor or a table.

• Instead, kneel down on one knee, as close as possible to the item you are lifting, with the other foot flat on the floor and pick the item up.

• Or bend at the knees, keep the item close to your body, and lift with your legs, not your back.

Carrying

• When carrying objects, particularly if they are heavy, keep them as close to your body as possible.

• Carrying two small objects—one in each hand—is often easier to handle than one large one.

Healthy Diet and Exercise

• While the proverbial jury is still out, we suspect that extra weight puts undue strain on your spine. Keep within 10 lbs. of your ideal weight for a healthier back.

• “Beer belly” is likely the worst culprit, as it puts unwanted pressure on the muscles, ligaments and ten- dons in your low back.

• The most efficient and effective way to reduce weight is by eating a sensible diet and exercising regularly.

• Consult with your doctor before beginning any exercise program, particularly if you have a health condition.

Sleeping

• Sleeping on your back puts approximately 50 pounds of pressure on your spine. Other positions may be better

.
• Placing a pillow under your knees while lying on your

back cuts the pressure on your spine roughly in half.

• Lying on your side with a pillow between your ——– knees may also reduce the pressure on your back.

• Never sleep in a position that causes a portion of —- your spine to hurt. Most often, your body will tell you what position is best.

Quit Smoking

Smokers have more spine pain than nonsmokers, and they also heal more slowly when they have an episode of back pain because the chemicals in tobacco smoke restrict the flow of blood to the tissues in and around your spine.

While following these instructions is no guarantee that you’ll be free from back pain for your entire life, it can certainly reduce your risk of developing it. These simple steps will help you keep your spine in good shape, making you a healthier, happier person.

Lawrence H. Wyatt, DC, DACBR, FICC, Professor, Division Of Clinical Sciences, Texas Chiropractic College, Writer

Nataliya Schetchikova, PHD, Editor

This health article was shared from the following website: http://www.chiroworkscarecenter.com/documents/Articles/ACA_healthy_spine.pdf