Manipulation under Anesthesia: What to Expect

Manipulation under anesthesia, or MUA, is getting a lot of attention from patients and doctors alike to help those who are suffering from chronic pain. This particular form of chiropractic manipulation was developed in the 1930’s, and is usually prescribed when more traditional forms of care (such as medication, physical therapy and/or surgery) aren’t working as effectively as they could be. But what, exactly, IS manipulation under anesthesia – and what should patients expect if they agree to this procedure?

In the case of manipulation under anesthesia, “manipulation” refers to the types of movements a chiropractor may perform. It could include stretching techniques, passive movements, forced movements or mobilization. The most common type of MUA is spinal manipulation, though the treatment can be used for joint pain in the shoulder or knee, too. The procedure, which can take up to three days depending on the level of chronic pain management needed, works like this: under the care of an anesthesiologist, the patient is consciously sedated. (This is sometimes referred to as “twilight sedation,” because the patient is asleep but his/her reflexes are still working.) This makes it easier (and safer) for the chiropractor to perform the necessary spinal manipulations, because it eliminates the possibility of muscle spasms and contractions.

Once the chiropractic manipulation is finished, patients “wake up” relatively quickly. Most patients notice an immediate change in mobility or reduction of pain. There is usually some soreness in the muscles, like the kind associated with a strenuous workout, but the chronic, nagging pain should be all but eliminated (depending on how many sessions an individual patient is supposed to have). The patient is usually scheduled for additional therapy for a number of weeks after the procedure, so that s/he can learn strength-building exercises and mobility-gaining stretches.

Chiropractic Manipulation Can Help

So why should you choose MUA for your chronic pain management? First and foremost, MUA is non-invasive: it’s not a surgical procedure, so the risks associated with it are far fewer. Secondly, this form of chiropractic manipulation has a recorded success rate of about 80-90%, so its track record is impressive. But most important of all, MUA works as a form of chronic pain management for a number of problems, which means that it’s a viable option for most chiropractic patients. Some of the conditions that can be treated by manipulation under anesthesia include:

  • Lowers and upper back pain
  • Fibromyalgia
  • Disc bulges, herniation and protrusions
  • Nerve entrapment
  • Acute and/or chronic muscle spasms
  • “Frozen” joints
  • Limited hip mobility
  • Tension headaches
  • Chronic whiplash

Spinal manipulation is especially effective for those who have had surgery on their lower back without any real change or benefit. This is because it allows the doctor to perform the necessary chiropractic manipulation treatment on your back without the risks associated with repeated surgeries. And because patients are sedated, there’s no risk of muscle “guarding” – a protective response by the muscles when a patient is afraid of pain or movement.

However, there are some forms of chronic pain that manipulation under anesthesia won’t correct. Patients with protracted pain caused by arthritis, acute fractures, gout or prior strokes won’t be able to get relief through MUA. That’s because joint and spinal manipulations only work on dysfunctional joints and spines – and since none of these conditions are a result of joint/spinal dysfunction, the technique would be useless. The best way to determine whether or not manipulation under anesthesia is an appropriate treatment for you is to set up an appointment with your chiropractor. Together, you can see if MUA might put an end to your pain once and for all.

What Are the Benefits of Kinesio Taping Techniques?

Kinesio taping techniques are all the rage in sports medicine right now, thanks to a popularity lift from world-wide Olympians. In fact, you’d be hard pressed to find a clinic specializing in sports injury treatment that isn’t adopting the practice. But if you’re new to the world of competitive sports, you may find yourself asking “What is Kinesio taping” or “How does Kinesio tape work?” Hopefully, this will answer your questions.

What is Kinesio Tape?

Kinesio tape is a cotton and acrylic tape applied to muscles for rehabilitation purposes. As opposed to more traditional tapes used in sports injury treatments, Kinesio tape allows for a full range of motion for your muscles while supporting them against strains and pulls.

How Does Kinesio Tape Work?

It’s the Kinesio taping techniques that get the most credit here, though the specialized tape itself certainly plays a part. It was designed as a muscle pain treatment for athletes. It helps to rehabilitate weak and overused muscles, stabilize the injured area, and decrease pressure caused by inflammation in the muscles and joints.  It also decreases the amount of time needed for sports injury treatments and recovery. The tape itself is porous, which allows for it to be used for longer periods of time, because it doesn’t come off in the shower or if you sweat.

How do You Use It?

A licensed medical professional who focuses on muscle pain treatment, such as a doctor who specializes in sports medicine, a physical therapist or a chiropractor, places the tape over the affected areas of the body, from one end of the stretched muscle to the other. Then, depending on the muscle and the injury, the tape is placed in specific patterns on the skin. The tape then “pulls” on the skin, which creates some space between the muscle and the skin, allowing for increased blood flow.

A New Kind of Sports Injury Treatment

The current trend in chiropractic care to use Kinesio taping techniques has garnered a tremendous amount of positive feedback. Seven-time Tour de France winner Lance Armstrong even credits the technique as beneficial in one of his books.

The space created by the “pull” of the tape works effectively as a muscle pain treatment because it relieves pressure on nerves. When an athlete’s nerves are too compressed, the impulses sent to your muscles from your brain are overtaxed. Kinesio taping techniques ease that pressure, which means that your muscles receive the right signals – in the right amount – from your brain. This cuts down the pain, stress, and recovery time needed for more traditional sports injury treatments.

It’s also possible that Kinesio taping techniques affect the deeper tissues in your body, because they allow for increased fluid flow in the muscles. The muscles perform better, resulting in less strain and fatigue – which means that deeper tissues are under less pressure. Less pressure and greater fluidity means less aches and pains deep in the tissues of the body. These same techniques have been used for sports injury treatments for joints, too, as the methods work in the same way.

If you’re looking for non-invasive form of medical pain treatment, this is a great way to go. Kinesio taping techniques vary from injury to injury, so it’s best to outline a plan with a medical professional about what will work best for you.

Staying in Shape This Summer

Staying in shape during the summer months can be hard, especially if you’re on vacation. (Because who doesn’t “cheat” a little on a diet during vacation, right?) But there are a lot of fun summer activities you can participate in that have all the benefits of traditional exercise without feeling like exercise at all. As long as you’re smart, you can have fun in the sun while avoiding common summer injuries.

Jump In: Staying in shape is a lot easier in water. The water’s buoyancy makes exercises like water aerobics easier on joints, and you can use something as simple (and as inexpensive) as a beach ball to add a little oomph to your workout. Besides: what list of outdoor summer activities DOESN’T include swimming? Swimming is perfect for staying in shape during the summer because it works every muscle in your body. If you’re not much of a swimmer, you can try “water jogging,” which gives you the benefits of jogging with less impact on your knees, hips and ankles.

Hit the Beach: Even if you’re not a water person, a day at the beach is a must for fun summer activities. Walking or jogging on sand adds resistance, which allows for a better workout. Not a runner? Try grabbing some friends for a game of Frisbee: it has all the benefits of aerobic exercise, but you’ll be too busy having fun to notice. Just make sure that you liberally apply sunscreen throughout the day to avoid the worst of all summer injuries – sunburn. And stay hydrated! Nothing ruins outdoor summer activities like a trip to the ER.

Pedal On: Looking for ideas for fun summer activities the whole family can enjoy? Bike rides are the way to go. If you’re new to working out, pick a place that’s closer to your home, or find a park with bike trails, so that you don’t overextend yourself. A number of summer injuries come from people who give themselves too difficult of a ride, ending in muscle strains, muscle fatigue and dehydration. If you have kids, make sure that you have regulation-sized helmets for you and your children, and that little ones are strapped in correctly to a carrier seat.

Keep Climbing: There are ways of staying in shape AND feeding your brain, and a nature hike is one of them. Try contacting your local, county or state park to see what kinds of fun summer activities they have. Many offer nature hikes that range in difficulty, as well as summer-only programs for kids and adults alike. You can save some money by packing your own picnic lunch (and plenty of water), and many places have only small entrances fees, if they have any at all. They may even supply a map or “scavenger” list for particular plants and wildlife indigenous to the area, so you’ll learn something while you’re there. This can also help you avoid poisonous plants (like ivy and sumac). Make sure to wear appropriate clothing, to avoid bugs like lice that feed in the summer. Injuries can also occur with the wrong footwear, so make sure you’re wearing shoes that can handle hills or uneven terrain.

Stay Safe during Fun Summer Activities

Staying in shape this summer doesn’t have to be a drag – not when there are so many things you can do outside! It’s imperative, though, that you remain vigilant when it comes to your health. Certain precautions should be taken to avoid getting hurt or sick.

  • Stay Hydrated: This can help you avoid muscle fatigue, unwanted strain on your joints, and damage to your internal organs.
  • Wear the Right Clothing: Jogging in a sweat suit in the dead of summer is a silly idea at best, and a potentially fatal one at worst. Make sure your clothing is light-weight, and that it covers your skin completely if you’re exposed to too much sunlight. Dress according to whatever outdoor summer activities you have planned for the day.
  • Use Sunscreen: No tan is worth cancer.
  • Pace yourself: Don’t take on too much if you’re not accustomed to a lot of strenuous exercise. Getting and staying in shape during the summer time can be fun, but you’ll risk sunstroke, dehydration and muscle strain if you take on too much at once.

Remember to have fun! Summer activities like water sports and beach volleyball should be enjoyed. So as long as you’re careful, there’s no reason why you can’t avoid the most common summer injuries while having the time of your life.

Allergies in Spring

If you live in New Jersey, allergy season is probably one for concern. Whether you sneeze because of tree pollen or itch from blooming ragweed, your spring allergy symptoms can make spending time outdoors very uncomfortable. New Jersey allergy sufferers can lose out on time spent with family and friends in their backyards or at local parks and playgrounds, all because of airborne allergies. That’s why more and more patients are seeking out the help of a chiropractor for allergies and nervous system relief.

A chiropractor?  Really?  Absolutely.

While you think you’re suffering only because of allergies in spring and summer, you might actually be suffering from a stressed nervous or immune system. When you have an allergic reaction, it’s your immune system that’s overreacting to the allergen – the cause of your discomfort. In New Jersey, allergy attacks can be caused by particular indigenous flowerer, bee stings, even the chemicals used by lawn care services. So it’s possible that your allergies in spring and summer months are being exacerbated by things beyond your control.

This overreaction of the immune system to allergens can be dangerous if left untreated.  A compromised immune system can’t fight less severe infections (like the common cold, for example) which results in you being stuck in bed for longer than you should be.  In rare cases, the immune system is so taxed that it becomes unable to work properly at all.  Cancer cells, which replicate abnormally and quickly, may go unrecognized in your body altogether.

Luckily, spring allergy symptoms are fairly easy to recognize, and usually encompass one or more of the following:

  • Sneezing
  • Itching
  • Watery Eyes
  • Achy Joints
  • Hives
  • Difficulty Breathing
  • Difficulty Swallowing
  • “Stuffed” Nose or Ears


You can sometimes get short-term relief from your spring allergy symptoms by taking over-the-counter allergy medications or by seeing an allergist, but that doesn’t always get to the root of the problem. New Jersey allergy experts agree that the average number of Americans who suffer from mild to severe allergies is around 50 million. But not all patients who suffer from allergies in the spring find relief through medication, and so homeopathic remedies can be used to help.

The End of Spring Allergy Symptoms

So how can seeing a chiropractor for allergies help? A chiropractor is trained to ease the stress on your nervous system. And since the nervous system directly affects the immune system, your spring allergy symptoms can be lessened or even eliminated by first working to restore your nervous system to full capacity.  A chiropractor will realign your vertebrae to relieve any pinched nerves you might have. Once the spine is realigned, your immune can concentrate on the substances that cause your allergies in spring and summer months. Plus, seeing a chiropractor for allergies may have the unintended benefit of eliminating other, less acute problems with your spine, muscles or joints.

If you live or work in New Jersey, allergy attacks are bound to happen: experiencing all four seasons means living with plants that flower at different times of the year.  Next to cat dander, outdoor allergens are the most common cause for spring allergy symptoms. Seeing a chiropractor for your allergies can alleviate the underlying causes of a compromised immune system – so you can enjoy the great outdoors for the whole year.

Helping Those with Running Injuries

Soft tissue injuries can be devastating to runners. Months or even years of training can seemingly vanish when running injuries start cropping up.  This is why the Active Release Technique might be the most important form of therapy out there for runners.  Active Release Techniques have been proven to help athletes with soft tissue injuries, muscles pulls – even simple headaches.

What is Active Release Technique therapy?

ART is a form of systemized massage and pressure designed to loosen “locked” muscles, tendons and ligaments, making it easier to repair soft tissue injuries. Over time, repetitive injuries lead to a build-up of scar tissue.  This scar tissue can put pressure on healthy tissue, which limits your range of motion, puts tension on your tendons, and disrupts your nerves’ ability to transmit signals to the rest of your body, which can lead to pain or even (in a worst case scenario) decreased mobility.  When this happens, athletes need to see a medical professional to help repair the damage done by repetitive injuries and scar tissue.  The patented ART system has hundreds of precise, specific movements designed to lessen the impact that scar tissue has on your body. Medical professionals must be licensed to perform Active Release Therapy, so if you have a chiropractor in NJ, make sure s/he has completed the training.

What can Active Release Techniques help fix?

ART is designed to help people with running injuries, carpal tunnel, back pain, tennis elbow – you name it.  The technique is designed to help ease the pain by working on scar tissue caused by repetitive injuries, such as tears, pulls or lack of oxygen.  ART practitioners often work with:

  • Muscles
  • Ligaments
  • Soft tissue
  • Tendons
  • Plantar fasciitis

Why is Active Release Technique therapy beneficial to runners?

Those who incur running injuries have the most to gain from ART.  Soft tissue injuries in the legs affect more than just a runner’s ability to compete.  Long-term effects of running injuries could lead to decreased mobility as the runner ages, problems with balance, and increased back pain.  The repetitive motions employed by cross-country and track runners can stress particular muscle groups and tendons. Even non-competitive runners can stress these parts of the body if they’re not careful. The Active Release Technique is designed to work with running injuries caused by all different terrains, thus ensuring that the therapies are both specific to you AND effective.

Getting You up to Speed

The most important thing to remember about ART is that it is a process – NOT a quick fix. Chiropractors in NJ who are schooled in ART therapy will require you to undergo a number of sessions to help ease the pain and strain of your running injuries.  The length of the session, as well as the amount of sessions you need, is determined by how severe your soft tissue injuries are. Pilot studies are showing improvements in athletes who undergo ART therapy, and it has been used by Olympic and Ironman competitors all over the world.

The Mystery Illness: Causes of Fibromyalgia

There is a lot of mystery surrounding the causes of fibromyalgia.  The illness can occur on its own, for no immediately apparent reason, but it has also been linked to repetitive injuries, traumatic experiences, and certain diseases.  In other words, the symptoms of fibromyalgia may be related to a previous accident or illness, or may have manifested on their own with no health-related starting point.  Because of this, it’s easy for doctors to misdiagnose fibromyalgia as something else. Over 12 million people suffer from the unknown causes of fibromyalgia, and women are 10 times more likely to develop symptoms than men. Doctors diagnose most patients between the ages of 25 and 60, and treatments can be as varied as the patients themselves.

So how do you know if you’re suffering with the symptoms of fibromyalgia? Most patients present with a combination of the following signs:

  • Overall achiness in the joints or muscles
  • Sleep deprivation
  • Overwhelming fatigue
  • Difficulty concentrating (also known as “fibro fog”)
  • Abdominal or menstrual pain
  • Headaches
  • “Tingling” or numbness in hands and feet
  • Incontinence

More than anything else, patients want a break from the pain from their fibromyalgia treatments.  The pain can be incapacitating, causing patients to feel powerless over their own bodies.  This loss of control can lead to anxiety, depression, and loneliness.  In extreme cases, patients are unable to perform ordinary, everyday tasks such as getting the mail, walking a dog – even getting out of bed. In the most extreme cases, the lack of identifiable causes of fibromyalgia may lead patients to feel hopeless about leading a normal life.  These far-reaching effects can devastate not only patients, but also friends, families and loved ones.

Fibromyalgia Pain Relief

Luckily, fibromyalgia pain relief is both possible and obtainable.  Fibromyalgia treatments may require a team effort between you, your GP, and a specialist, such as a neurologist or chiropractor.

The first step to helping yourself on the road to recovery involves eating well, attempting exercise when possible, and getting enough sleep.  Since most sufferers of fibromyalgia present with fatigue, it’s important to set up a specific sleeping schedule.  The structure may help you control the fatigue by regaining power over the symptom.

If these simple steps don’t afford you the relief you crave, make an appointment with your doctor to see if your fatigue or pain is caused by fibromyalgia.  Discussing the symptoms of fibromyalgia with your doctor may help him/her determine the individual factors contributing to your illness.  S/he may order a series of tests to rule out other diseases.  Once diagnosed, your doctor may prescribe medication for fibromyalgia pain relief.  Current research indicates that there are non-drug related therapies being developed to help ease the causes of fibromyalgia, so you should consult a specialist if you want a more holistic, natural approach to pain management.  Because indications of the illness may be brought on – or exacerbated – by stress, fibromyalgia pain relief may be obtained through the services of a licensed chiropractor or massage therapist, who could help you realign your body without the use of medication.

Osteoporosis And Seeing A Chiropractor

Osteoporosis is difficult to spell and pronounce but an even tougher condition to endure. Osteoporosis is the weakening and thinning of bones and can drastically reduce the quality of life for sufferers, who are more prone to fractures thanks to the compromised nature of their bones.

Unfortunately, osteoporosis is a fact of life for many older citizens. An estimated 75 million people will suffer from it in the United States, Europe and Japan alone. In addition, 1 in 6 women will suffer a hip fracture related at least somewhat to osteoporosis while 30 percent of men 50 years of age and older will endure a osteoporosis-caused hip fracture.

For those who do not suffer fractures, the symptoms of osteoporosis can linger and result in long-lasting and frustrating pain. Osteoporosis sufferers grow further annoyed by the difficulty in finding reliable osteopenia treatment. Too much of the traditional treatment for osteoporosis is trial and error and results in little to no long-term relief.

However, one treatment for osteoporosis that can yield positive results for patients is chiropractic care. In addition to relieving the symptoms of osteoporosis, chiropractors can help identify the causes of osteoporosis and help sufferers manage the pain moving forward. Here are some commonly asked questions about chiropractic treatment and osteoporosis.

—Can chiropractic care cure osteoporosis? Unfortunately, there is no cure for osteoporosis, which is a degenerative disease that can begin affecting a patient beyond his or her 35th birthday. Prior to that point, the human body regularly makes new bone while breaking down old bone. As we get older, though, that process begins to decelerate and the body makes less bone than it loses. Unfortunately for most people, osteoporosis does not appear until a serious injury or fracture is suffered. It is with that in mind that you must ask…

—…is it safe? Chiropractic care for treatment of osteoporosis is much safer when there is not a fracture involved. Therefore, it is essential that a chiropractor administer bone scans, X-rays and/or MDTs (mineral density tests) to a new patient who suspects he or she has osteoporosis. If the results come back revealing “only” osteoporosis, then chiropractic treatment is advisable. But patients who have fractures or bone diseases may not be strong enough to endure chiropractic treatment and we can discuss other options.

—For those who can handle it, what are the benefits of chiropractic treatment for osteoporosis? Chiropractors can address the symptoms of osteoporosis in a number of ways, including ice therapy, electro-muscle stimulation, orthopedic support and physical therapy that strengthens ligaments and muscles around the spine. Our treatment can relieve the pain generated by osteoporosis while also protecting patients from possible fractures by improving balance, muscle tone, range of motion and joint mobility.

—Further treatment for osteoporosis includes setting up a diet that will improve bone density via specific foods and vitamin supplements as well as recommending exercises that will strengthen the affected areas while avoiding the type of stress and strains that can further weaken or fracture the bones.

Tips for Shoveling Snow Safely

What is physical therapy?

Physical therapy focuses on relieving pain, restoring movement, function and strength. Physical therapy also educates people on ergonomic fitness and wellness issues.

Being a licensed physical therapist I look at this time of year where the incidence of back pain tends to increase because of issues related to slip and falls. It may also be due to everyone’s not so favorite thing. .. SHOVELING SNOW. According to the Surgeon General’s Report, 15 minutes of shoveling counts as moderate activity, making it good exercise for most people.  However, MOST shoveling is done incorrectly and can put increased stress on your heart and back.

Some physical therapy exercises before and during a snowstorm:

  • It is recommended to spend 5-10 minutes in this warm-up.
    The purpose is to get the blood flowing to your muscles to help reduce pulling a muscle.  Here is an example of a flexibility warm-up:
    – Neck rolls                  – Trunk rotations
    – Arm circles                – Body weight squats
    – Hamstring Stretches (place foot on step or chair and reach toward toe with back straight)

or when shoveling, just remember doing more to go faster isn’t necessarily better.  My recommendation is to find an ergonomically correct shovel with a curved handle.  The jumbo sized shovels that lift twice as much, just increase the stresses onto your back, and these types of shovels should be avoided.

The use of proper body mechanics along with proper equipment will help reduce the forces on the back and decrease the likelihood of injury.  The most common mistake is bending over with your back rounded and tossing snow across the body.  Here are a few tips for protecting yourself when you shovel snow:

  • Make sure you have warmed up before hand with some stretching to get the blood pumping
  • If you have a history of heart trouble, do not shovel without a doctor’s permission.
  • It is easier to push snow than to lift it, therefore, push the snow as you shovel. It’s easier on your back than lifting the snow out of the way. Should you have to throw snow, do so in front of your body- avoid throwing snow over your shoulder.
  • Lift with your legs bent, not your back. Keep your back straight. By bending your knees and “sitting” into the movement, you’ll keep your spine upright and less stressed. Let your shoulders, torso and thighs can do the work for you.

And lastly: Use proper breathing techniques: inhale when you pick up the snow and exhale when you unload it. Never hold your breathe while shoveling.

Even if you follow these tips and exercises you may still experience some discomfort after shoveling. I would urge you to speak to your local physical therapist to discuss any questions and concerns. We will monitor your accomplishments and make adjustments appropriately.

Carpal Tunnel Syndrome?

Are you one of the millions of people that have numbness or tingling into your hands? Do you get the feeling that your hands are falling asleep? Then you might have Carpal Tunnel Syndrome. Carpal Tunnel Syndrome is a condition where the Median Nerve is being compressed at the carpal tunnel which is located at the wrist. This can happen from a number of reasons which include trauma to the wrist, repetitive motion (such as compression with typing or repetitive twisting at the wrist).

Carpal Tunnel Syndrome commonly presents with symptoms (numbness/ tingling from the wrist into the thumb, pointer finger and middle finger. The symptoms must be in these fingers only. If all of the fingers or the ring and pinky fingers have symptoms, you do not have Carpal Tunnel Syndrome. The nerve entrapment is likely somewhere other than the carpal tunnel. If you have symptoms in the arm or forearm the problem might be coming from you neck or elbow.

The treatment for Carpal Tunnel Syndrome varies depending on severity of the injury. Conservative care can range from muscle work at the wrist to release the pressure off the nerve, ultrasound to the involved area, strengthening and stretching the area to help release the nerve  compression and manipulation of the wrist to increase mobility to the joint. Most cases respond well with conservative treatment, however, more severe cases might require surgical intervention.

Could you have carpal tunnel?

Symptoms include:

  • A pain caused by compression of a key nerve in the wrist, the median nerve, becomes pressed or squeezed at the wrist.
  • The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm.
  • Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent.
  • You might feel decreased grip strength making it difficult to form a fist.
  • In extreme cases some people are unable to tell between hot and cold by touch.


Carpal Tunnel points

  • It is estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome.
  • Early diagnosis and treatment are important to avoid permanent damage to the median nerve.
  • Women are three times more likely than men to develop carpal tunnel syndrome.
  • Persons with diabetes or other metabolic disorders that directly affect the body’s nerves make them more susceptible and are at high risk.
  • Carpal tunnel syndrome usually occurs only in adults.

Getting Back in the Game

One lament that is shared by people of all ages is an inability to get into the kind of shape they were in a decade or two (or more) ago. Who doesn’t want to look like he or she did as a teenager or young adult? And who doesn’t wonder how it all went so wrong so fast? Why did we seem to stop exercising right at the moment our metabolism slowed to a crawl?

Being out of shape is exacerbated by the discouragement we all feel upon realizing just how long a road it is back to the shape we once enjoyed. It seems easier to just continue down the path we’re headed on than to embark upon the lifestyle changes, diet and exercise plans necessary to get back into shape.

Of course, that’s no solution at all. Nobody’s ever lost weight and built a physique to be proud of by doing nothing. So the question facing everyone looking to get back into shape is how to start exercising? A common mistake—and one that can end a fitness program almost as soon as it begins—is to try and do too much, too soon, and wind up exhausted.

When figuring out how to start exercising again, the last thing anyone should do is try and pick up where they left off way back when. If you used to run cross country, don’t roll out of bed and run five miles. The same goes for anyone who once was a star athlete on the swim team or baseball team. Don’t expect to swim a mile or play nine innings—pardon the pun—right off the bat. You’ll pay the price for days to come and will be doubly reluctant to resume exercising once you feel better.

The best advice for those looking to start exercising again is to begin slowly—very slowly. Rome wasn’t built in a day, and you won’t get in prime shape in a day either. Begin by simply walking around the block or taking the bike for a ride around the neighborhood. If you must run, make it a VERY short distance.

The most important thing anyone can do as he or she figures out how to start exercising again is to stretch. If you want a reminder of how long gone the old days are, just try exercising without trying at least a couple types of stretching beforehand! The benefits of stretching are two-fold: it helps prepare your muscles for what’s to come and prevents muscle pulls and tears while also getting your blood flowing.

Regardless of the types of stretching you choose—such as leaning against a wall and stretching hamstrings or stretching the calves and other lower leg muscles with a variety of sitting stretches—these are essential answers to the question of how to start exercising again. You can’t run before you walk and you can’t get on the road to fitness without engaging in some types of stretching. So don’t skip this crucial step!