Reprinted from The Chart on CNN Health.

Written by: Lisa Shives, M.D., the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

Patients often come to me with symptoms they describe as "fatigue" or "tiredness." The first task is to tease out exactly what they mean. To a sleep doctor, fatigue and tiredness usually mean the body needs or wants to rest, whereas "sleepiness" suggests that the mind wants to rest.

Patients with any pain syndrome often come in complaining of fatigue or tiredness. Their bodies have trouble falling and staying asleep. Sleep and pain are both ultimately controlled by the central nervous system. Poor sleep and pain form a vicious cycle - uncontrolled pain makes sleep difficult (if not impossible) and, in turn, the resulting poor sleep makes it more difficult to adequately control the pain.

Most physicians know very well that poorly controlled pain will cause difficulty sleeping. But they often don’t think about the patient having a separate sleep disorder that may be fueling the pain.

For this reason, it is important for people with chronic pain to first have a thorough sleep evaluation in order to determine if there is an underlying cause. If a patient has something like sleep apnea or restless legs syndrome, then the diagnosis and treatment of these disorders can make a huge impact on  sleep and, as a result, on his or her quality of life.

Unfortunately, many times people with chronic pain syndromes do not have sleep disorders that are easily diagnosed, but they do have sleep disruptions of unknown origin.

They also tend to spend a lot of time in the light stage of sleep and have a characteristic, but non-specific, finding on their EEG (electroencephalogram, which measures the brain's electrical activity) during the sleep study. This finding is called "alpha intrusion." The cause of this particular brain wave pattern is not known, but it has been associated with different disorders that lead to chronic fatigue or chronic pain. There are no specific treatments that are aimed at alpha intrusions - we just try to treat the underlying pain syndrome and any primary sleep disorder that patients have.

The question remains whether sleep disturbances can actually lead to fatigue or pain syndromes. In fact, recent research has shown that people who complain that their sleep is disturbed or not refreshing have three times the risk of developing fibromyalgia. Fibromyalgia is poorly understood, but there is a specific pattern of musculoskeletal pain with the involvement of common anatomic sites, or trigger points, that can be tested on physical exam.

The persistent myalgia, or muscle pain, and the fatigue are thought to result from a disturbance in the functions of the central nervous system. Since sleep is a function of the central nervous system, it makes sense that the CNS dysfunction might start with sleep and then affect pain receptors and pain perception. And it is often the case that the healing can’t really begin until the patient can get the right amount of good quality sleep.

The take-home message here is this: If you have chronic pain, for whatever reason, and feel tired or sleepy in the daytime, get a sleep evaluation. Pain doesn't explain everything.

I find myself often trying to retell this story in clinic.  So here it is. Told much better than I tell it.

I recently had a client report about severe abdominal pain following work on his lower body, which provided him good relief in the local areas we were focusing on.  Turns out he was most likely experiencing something similar to Mr. Moseley as a response to a previous severe abdominal pathology.  After his brain figured out that he was not 'under attack', everything settled nicely.

I love the inter-webs! I mean, I truly feel blessed to live in a time where I can learn anything, anytime, anywhere. I spend huge amounts of time reading on my iPhone. Little hits of research, thoughts of gurus, opinions of not-so-gurus, tweets & timelines. Feed my brain. 

Side benefit: watching the trolls and flame throwers chase their tails and embarrass themselves. Speculation is what made wives tales and myths.  The internet has a way of revealing BS as much as it has a way of hiding it.  Snake-oil salesmen abound, living almost harmoniously next to the bitter skeptics who live to debunk them.

I meet people everyday who have this idea or that idea about their health, wellness and a myriad of other topics.  One of the best things about the two careers I have had is the incredible diversity of humanity I have been able to touch the lives of. But, I digress...

One question you can almost be certain of me asking when you come to clinic is about your activities that you do daily.  Job, sports, pets, sleeping, eating, etc. etc. Interestingly, many folks approach this differently than my main intention,which is to find out about your main movements, possible over use injuries, possible weaknesses and all that kinetic stuff.  However often I get response telling me about how the work for this company and they do this service or about this team they play on and the big game.

Inevitably the conversation turns to ether yoga, stretching muscles or both.  When comes to yoga, I like to listen.  I have just recently started my yoga journey and feel I have only limited info to add to the conversation with experienced yogis. With those who are inexperienced or expressing interest in starting/learning yoga, I tell them about finding an instructor who is in it for the right reasons. This is why I love going to the Iyengar Yoga Centre, a non-profit society here in Victoria. (Find one near you here.)

But I digress once more... I plan more topics about my journey with yoga of many types in the near future.

So stretching - to stretch or not to stretch.  
Before activity or after? Heat? 
Static? What hell is static? I feel pretty dynamic...

So much confusion, changes & conflict and everywhere I turn there is another Doctor or otherwise so-called expert telling me (and my clients) something different.

This week some pretty respectable educators forwarded this link from Dr. Stephan Gangemi, DC for reading:

10 Reasons Not to Stretch: Don’t Stretch: January 25, 2012 By Sock Doc 
Here’s some fun reasons not to stretch; some more serious than others. If you’re overly sensitive about stretching, (noted in #2), you can catch-up on the Sock Doc “Stop Stretching!” – or continue to stretch.

1. Stretching is exercise for the muscles like sea water is hydration for the body. When you’re desperate for relief, it feels so right but it’s just so wrong.
2. All athletes, especially runners, are so passionate about stretching. They defend it like their political association, religion, or family. I think many of them may have pictures of their kids in their wallets doing all types of cool stretches that they show their co-workers every day at the water cooler. “Look at my little one sitting on both his elbows!”
3. Runners will follow any trend they think will make them run faster. Whether it’s a new supplement, pair of socks, pair or shoes, custom orthotics, or stretching. They’re the first in line for Kool-Aid.
4. Stretching is a conditioned behaviour, not one we are innately born with. I see my kids run, jump, climb, throw things, and carry objects of all sizes. They move well, and efficiently. I’ve never seen them stretch. Their developing nervous systems know better.
5. The day I see my dog holding a static stretch is the day I’ll start stretching too.
6. Flexibility is a reflection of overall health and fitness. Stretching does absolutely nothing for health or fitness. It’s not exercise. It’s not a warm-up or a cool-down. And it definitely doesn’t substitute for restful sleep or a wholesome diet which will lead to natural flexibility.
7. Yoga is not stretching. Stretching is not yoga. Enough of that claim.
8. Make sure you stretch if you want to weaken muscles, promote injuries, decrease performance, delay tissue healing, and have absolutely way too much free time.
9. Stretching reduces injuries and improves endurance performance just like certain shoes will make you run or jump faster. Neither claim is true.
10. I enjoy watching runners stretch. They must stretch because they think they will run faster. I bet they believe in Sasquatch too.

Wow, that is some pretty provocative stuff. 
Might just challenge a few things you had in your brain for a long time. 
But there are some problems with what he has to say.  And boy oh boy, did the inter-webs ever let him (and anyone else who posted it) know exactly what they thought.

The good: It stirred up some great debate and educated many people because it went viral.

The bad: There are no obvious facts or citations to back up his information.  He could have made this up after a few glasses of a lovely Cabernet for all we know.

The ugly: A lot of people who are not aware of how to read research will take this at face value and stop stretching.

The truth of the matter is the good doctor of chiropractic (yes, that is what DC after his name means) wrote a much better article with references and a few decent studies and this really is just his summary.  If you go back to the title of the article you will notice a passive statement that if this article bugs you, you should go read the real one. Follow that link, there we have some much better thoughts and a link back to this short blurb which he further describes as: "10 Reasons Not To Stretch – Some funny and true, some funny and not all that true." Probably a better title for his post. To the same point, the bigger (better) article should probably be called "Stop Static Stretching"

Consider this: Be careful what you read about your health (or anything else for that matter) on the inter-webs. There is a whole lot of crazy out there.  I suspect the above example was much more poor judgement in picking article titles than anything else, but there many people who misrepresent themselves for a lot of different reasons.  Look for articles and posts with references or citations from reputable articles and authors.

It should be completely obvious by now that when it comes to creating content, I am a complete amateur. I rely on the network of good authors and publishers to keep me in the loop.  But I do read a reasonable amount and I do treat a fairly diverse group of humans and am able to draw a few conclusions about my own body as well. This blog is about my written opinion with links to articles I value.

So here goes: My humble observations

1. Move it or lose it. Atrophy (the diminishing of muscle cells) occurs after about 10 days if you don't move.  Cells get smaller, metabolism slows, circulation and joint range of motion may become restricted. The newest research is saying 30 minutes a day/3.5 hours a week, is sufficient as a starting point.  Even if it is broken into 10 minute segments. Dance, walk, swim, fly - it really doesn't matter. Just start today.
2. Over stretching of muscles may result in 'guarding' or tightness based on how much you irritated the 'load sensors' in your tendons, muscle bellies and/or fascia, etc. After all that is the job of those sensors - to protect you from hurting yourself further.  
   This why we encourage runners to do movement inside the natural range of motion before their activity.  
   STOP! - go back and read those words again...
   Light warm up and cool down inside the usual range, treat it nice. Strain it and it will protect itself, wouldn't you?
3. Stay balanced. If we only work one side of our bodies (we are prone to overworking the anterior upper body for example) then the opposite side is prone to be inhibited, shut off, weakened (hunched shoulders and upper back for example). The fascia must strengthen in order to support the spinal frame. This cycle will continue until you interrupt it (yoga, manual therapy, heat).  Remember things like your job and sleeping posture are akin to going to the gym several hours a day and working only that side of your body.  The more laborious your job, the better chance your movements are dynamic and better for your, save over use injuries. Desks are poison and should be treated as such.
4. Using the body's natural physiology is very helpful with allowing tight muscles to seemingly gain length and/or decrease the pain tension cycle.  My favourite example is to point out how the Triceps muscle rarely experiences pain with ordinary activity, but often experiences absolutely ignorant pain with even slight over use.
   Basically, we all know that the Biceps curls the arm.  Its' big and bossy and does most of the work in the upper arm. Basically, because both muscles cannot be contracting at the same time if we expect movement and the Biceps is more frequently doing the work, then Triceps is being constantly 'inhibited' and thus stretched.  
   The same appears to be true of all the primary movers and their antagonists. Quads. vs. Hams. Pecs. vs. Rhomboids. The various neck muscles... etc. etc.
   This shows up in the effective work of Muscle Energy, contract/relax, AIS, Yoga and a ton of other movement based therapies. 
5. Drink water and eat real food.

I find my clients really enjoy learning about what they can do to help themselves in the easiest and simplest ways. I try to find realistic and 'do-able' movements for people (mostly because I am the least compliant patient ever).  I get very strong feedback on the fact that many therapists are not sharing this info with their clients. One of my clients recently referred someone to me by saying "He is just like Wikipedia!"  I was thrilled.  What good is this education if it stays in my head? How can I support them in advocating for their own healthcare, if they don't get how to learn about it?

Every once in while I am faced with someone who is just learning the bad news.  This thing that they are experiencing is not going to go away.  It's chronic; a lifetime of battling pain and tension or what ever it is. So we learn together, we learn to learn and we discuss.  This way they can advocate for their future, what ever it may bring.

I wonder why the rest of us wait until we get the bad news.

For a very good review of research around the science of stretching, please visit Paul over at SaveYourself.ca He is not always right, he is a science writer though and as such, he looks forward to being wrong and learning something new.

Mild dehydration can be the cause of:

• headaches
• fatigue
• dry mouth
• low blood pressure
• dizziness
• constipation
• dry skin
• nausea
• shortness of breath
• rapid heart rate
• hot flashes
• AND of course Myofascial PAIN!

What's Myofascial Pain? 
Myo = muscle, 
Fascia = the connective tissue between the muscle, nerves, arteries and veins. 
Pain = owie!

Fascia surrounds all the organs, bones, individual muscles and various other tissues in the body, extending from the top of your head to the tip of your toes, from the skin to the bones, in one three dimensional piece.  Think of it as your internal skin; it is made up of very similar tissue.  It is normally very gelatinous, pliable and stretchy.  

As various stresses (good or bad; physical and/or emotional) act on our body this tissue may react by tightening and strengthening itself, laying down layers of collagen and elastin proteins in irregular patterns; creating a 'scar tissue', a thickening. Almost exactly in the same way the cut on your finger heals.

The other change we see in Fascia tissue is the gelatinous base will change to a sol.  That is, it becomes less pliable and stretchy. Not solid, but very strong and much tighter.  It is here that I find a palpable difference in my regular clients over short periods of time as their hydration changes.

At this time of year I find myself reminding folks that even though the air is much cooler, our need to hydrate can even be more important than the warmer seasons. Here is why...

1. We simply drink less water than the summer when we often provoke our thirst with hot temperatures and more activity.
2. Many of us stop eating as much in the way of fresh fruits and vegetables.  We return to the comfort foods; greasy, fatty and warming and all too often out of a box or heat and serve container.
3. Out here on the West Coast it feels like everything is damp and humid, but in fact it has not rained much until recently and the humidity has been relatively low. In the interior the air is drying and extreme cold is on the way.
4. Add to that the fact that as the temperatures drop we force ourselves into manufactured heated environments; in the house, in the office and a big one is, in the car.  Blowing warm, DRY air all over ourselves, sucking the moisture out of our skin. (Remember how I said the Fascia is like your internal skin??)
5. Colder season = increased hot beverages including coffee, tea and hot toddies, all of which are diuretics, sucking yet more water out of us.

It has been a common theme in the clinic over the past month that many of my clients who were making good progress or on maintenance programs have had a set back.  For no particular reason they are tighter, pain has returned or in some cases completely new and different postural concerns have shown up.  My massage cream is being soaked into the skin at an unbelievable rate.

Common theme means common answer.  Movement and diet.  

Myofascial Release is a fabulously effective modality for resetting this tissue into it's proper postural alignment.  If you have not experienced it before, I will tell you that it is different then your average massage.  This tissue is very strong, takes a relatively long time to engage and respond and can leave some soreness with the initial treatments.  It is done without cream or oil, often holding tissues in stretch for several minutes.  However the results can be spectacular. See my modality page of some more info.

More movement in the forms of walking, swimming and yoga are great.  Actively moving tissues before strenuous activities such as running, sports or even dancing at the club is wise.  Watch for future posts on Stretching vs. Active Range of Motion.

And then make that effort to hydrate our bodies through our diet.  I learned a lot about this from my pets.  When I switched my dogs from kibble and processed foods to real raw meats and bones, they drank significantly less water from the bowl.  Especially in the summer when they were outside more, they would just eat/lick the grass to supplement.  Now, inside the dry house they are taking a fresh bowl daily. Hmmm.

The lizards are interesting, in that both the Iguana and the dessert lizards I keep are vegetarians (no worms or crickets for us, yeah!).  Neither takes fresh water at all.  They gain all their water needs through metabolism of their food.  In the case of the dessert lizards they can metabolize seed into H2O. I know we are mammals and not reptiles, but surely we can learn something from the creatures that have been walking this planet the longest, no?

Some rules around water intake....

1. Drink before you are thirsty. It is reported that once your are thirsty you are as much as 25% behind the starting line. keep water beside your bed if you wake up thirsty.
2. Alternate diuretic drinks and salty foods with water.  Alternating H2O at the Christmas Party may reduce post party dehydration headache (hangover).
3. Keep up the fresh fruits and succulent vegetables.
4. Watch your external skin and lips for the first signs of what's happening on the inside.
5. Fruit juice can be added to water total but watch out for sugar content, especially in concentrates and packaged products.  Soda pop counts against you.
6. Your urine color can help you to determine whether or not you're hydrating well enough. Generally, your urine should be very light or clear. However, if you're taking vitamins, your urine may be bright yellow or darker after you've taken them.
   
7. If you are using hot baths or heat pads to soothe aching muscles and fascia, remember you are sweating in there.  Hydrate before, during and after.

And one more interesting fact.  My friends, Adrian and the Mysterious D. are DJs from San Francisco who have participated in the famous Burning Man festival in the dessert outside Reno Nevada for the past 19 years. Adrian has long written, compiled and distributed that Black Rock City's main newspaper, Piss Clear.  The quote on his website is: 
From 1995 to 2007, the alternative newspaper PISS CLEAR was a fixture at Nevada's annual Burning Man arts festival, its cheeky name deriving from the Black Rock Desert's #1 survival tip: "drink enough water so that you piss clear."
As always questions and comments are welcome, feel free to share and repost.May your myofascial tissue be supple and your pee clear!Take care & be well ~d.

So when we say go outside and play, where do we start?  What is the one single exercise that we can do anywhere, with anyone, anytime, with no equipment other than a good pair of shoes. Walk.

It's not just for beginners, either: Even the very fit can get a good workout from walking. From a simple walk of the dog around the block to hiking in the hills of Peru, walking is perhaps the easiest of the movement exercises to build into your daily routine.

As always begin slowly if you haven't had movement in your life for a while, whether through illness or sitting still at home or at work. Start with as few as 10 minutes; five out and five back, daily.  But here is the key - walk fast enough that you can still talk to your friend but couldn't sing a song. Brisk. Daily. Walk.

"Doing a brisk walk can burn up to 500 calories per hour," says Robert Gotlin, DO, director of orthopedic and sports rehabilitation at Beth Israel Medical Center in New York. Since it takes 3,500 calories to lose a pound, you could expect to lose a pound for every seven hours you walk, if you did nothing else. 

If you do not experience stiffness, soreness or straight up pain after your first few walks, then gradually add five minute increments until you find up to 1 hour each day for your walks.  Remember as well that you can build walking into your daily routine easily.

Park at the far end of the parking lot when getting your shopping done and then remember to pick up the pace getting to and from that car to the building.  Take the stairs when you can.  

I have a very distinct memory of not being allowed to use the elevator at the doctor's office as a child.  We always had to walk the three floors up.  Now admittedly, I grew up in a small town and I probably only remember this because it was the only tall office building I went to with my mother regularly.  Just last week my children heard this story for the umpteenth time as we ran up the stairs to get our flu shots. (Okay, the 17 yr. old didn't exactly run)

The point is, if you are looking for a place to start then, walk. Head up, breathing deep with your tummy, shoulders back. And don't forget to smile while you walk, you will enjoy it even more.

Now the puppy is giving me the stare. Time to practice what I preach.

So - getting closer to going live with this new site.  Exciting.  I love my work more than ever. It amazes me every day.  To have seen so many of my dreams come true at this point in my life is a real testament to persevering through the roller-coaster  of life. I am truly a late-bloomer and with out a doubt, and only a few exceptions, my life has never been so grand as it is right now.

Then comes the sobering reality. I may be faced with a cancer battle. Biopsy is scheduled and possible treatment plans are being formed.

Admittedly it is early in the process and all may be well, but we all know that the public funded health system doesn't go here with out good reason to spend the $$$.  I am prepared either way and look forward to resolving this situation, however my path to get there.

As I work toward my family, career, and personal goals, I am struck by the irony of trying to find an equilibrium in my life while working in a clinic of the same name.

When I look at my values of integrity, growth and living life to it's potential, I reflect on times when I have not achieved that balance.  It is in there that I find the missing key ingredient. Movement.  
Get up and be active. 
Go outside and play.

I learn at work just how many of life's little aches and pains (and the big ones too!) relate to the human bi-ped sitting still.  I always enjoy working with my athletic clients, but the truth is that they come in a lot less often.  Mostly with activity injuries or training imbalances (there is that word again).  Much of my treatments are based on well documented cross spinal column weakness vs. tightness. aka Poor Posture.

This will be what this blog is about - finding balance together through caring movement of our human temples.  

Now it is the end of the hour of sitting, time to go outside and play!