Monday, September 26, 2016

When Is Back Pain More Than Back Pain?


Your First Chiropractic Office Visit
Your chiropractor's purpose on your first office visit is to make sure you're in the right place. He or she wants to make certain your back pain really is back pain - and treatable - rather than being a symptom of an underlying medical condition.

Your chiropractor will take a complete history, learning the facts about your problem. How long you've had the pain, the nature and quality of the pain itself, whether the pain is localized or radiating, and whether the pain wakes you up at night are key elements in solving the puzzle.

Following the history, your chiropractor will perform a complete orthopedic and neurologic exam, gathering all the information necessary to arrive at what's called a "working diagnosis".

If your chiropractor concludes that treatment is appropriate, she will outline the anticipated stages of improvement and recovery, noting that further evaluation will be done if you're not getting better in a timely manner.
Out of the blue, your back starts to hurt. At first, it's just an annoyance. You can live with it. You've had lower back pain before and it went away on its own.

Now it's a few weeks later. You've got a low-grade pain that's not getting any better. You're actually worse, in fact, because your back hurts most of the time.

What to do?

You don't want to run to a doctor. After all, it's just back pain. Everybody has back pain. So you begin to solicit advice from your friends. And, of course, your friends have plenty of advice. "Do these exercises my doctor gave me." "Do these stretches - they worked for me." "Go to yoga class." "I know a great Pilates instructor. She'll get you in shape and your back will stop hurting." "Take vitamins and drink more water." "Meditate."

Your friends mean well and it's all very good advice. But none of it seems to work. Another month goes by and now the pain is increasing. It's even affecting your sleep.

It's time to see a doctor. But which one? For the most part, medical physicians are not experts on back pain. Typical recommendations include rest, moist heat, and anti-inflammatory medication.1,2 But, really, you've done all that. You need more specific advice.

Choices might include doctors of chiropractic, orthopedic surgeons, and physical therapists.

Many orthopedic surgeons are spinal specialists, but what they do is surgery. This would be a last resort, typically, after other treatment options have failed.

Physical therapists are highly skilled practitioners who focus on exercise, rehabilitation, and re-training. They are not primary care providers, and typically patients are referred to physical therapists by family physicians, chiropractors, and orthopedic surgeons.

Doctors of chiropractic are spinal specialists, too, and what chiropractors have to offer is expert conservative therapy.3 Chiropractors treat back-related problems all day, every day, and are the right doctor to see first.

As spinal specialists, chiropractors receive extensive training in evaluating patients with back pain. Chiropractors consider all aspects of the problem, and develop sound treatment plans based on the facts. If a person does not respond as anticipated, their chiropractor has a "Plan B" in place for further evaluation and possible referral.

When choosing a doctor, you're allowed to ask questions and participate in the process. The strategy for follow-up is critically important.

First, if you're improving and doing well, how will can you help keep the problem from recurring? Will your chiropractor prescribe stretches, exercises, and other self-care action steps to help you keep yourself well?

And, what steps will be taken if your problem and pain are not improving? Where might you be referred for further tests and evaluation? Chiropractic treatment is a powerful tool in most cases of back pain. Symptoms should begin to improve quickly. Have your chiropractor outline the "Plan B" if you are, in fact, not getting better.

Your doctor of chiropractic will be able to answer these questions.
http://www.lakewoodchiropracticjax.com/

1Zuhosky JP, et al: Industrial medicine and acute musculoskeletal rehabilitation. Arch Phys Med Rehabil 88(3 Suppl 1):S34-39, 2007.
2Cayea D, et al: Chronic low back pain in older adults. What physicians know, what they think they know, and what they should be taught. J Am Geriatr Soc 54(11):1772-1777, 2006.
3DeVocht JW: History and overview of theories and methods of chiropractic. Clin Orthop Relat Res 444:243-249, 2006.

Friday, September 23, 2016

Pregnancy, Parenting, and Lower Back Pain


 How to Pick Up Your Kids
 We're not talking minivan here. Moms and Dads spend a lot of time bending and lifting. We want to do this right, as much as possible, and not have a lot of down time while our injured back is healing.

First, get as close to your child as possible. You want to have your arms right next to your body, not extended in front of you.

Next, always bend your knees. Never bend over with straight legs.

Next, suck in your stomach muscles. When you activate your abdominal muscles, you're taking a lot of potential strain off the lower back muscles. Your abdominal muscles are designed to carry the weight.

Finally, straighten your legs, continuing to activate your stomach muscles, holding your child close to you.

With a little practice, safe lifting will become a habit.
You're pregnant! Congratulations! Your body's changing-wondrously, marvelously. One unexpected and unwelcome change may be lower back pain. Recent studies suggest that two-thirds of pregnant women experience lower back pain.1

These statistics seem reasonable. The weight of the growing baby, plus the weight of the placenta and amniotic fluid, create an unbalanced load in front of the lower back. The  result is irritation of spinal ligaments, muscles, and tendons, causing pain, muscle spasm, and loss of mobility.

Of course, some cases of pregnancy-related back pain have specific medical causes. Uncommon conditions such as pregnancy-associated osteoporosis, septic arthritis, and inflammatory arthritis may need to be considered.2

That said, the vast majority of cases of back pain in pregnancy are mechanical in origin.

Your doctor of chiropractic will perform a complete examination and determine the correct course of treatment, if appropriate. Once you're feeling better, you can begin

stretching and doing safe, gentle exercises that will help prevent recurrences of lower back pain. The goal is to strengthen your lower back and minimize the mechanical effects of pregnancy.

The best method of preventing back pain in the first place is being fit. This includes healthy nutrition, gaining a moderate amount of weight, and regular exercise. Your obstetrician will likely recommend vitamin and iron supplements and will monitor your weight. The average healthy woman gains between 25 and 35 pounds during the course of her pregnancy.3

Let's fast forward a few years. Your newborn is now a toddler. Parents know that if you have kids, stuff happens. You bend over to place a bulky car seat in your car. Then you place your child in it. And then, you bend over to remove the car seat from your car. If you've gone to the mall, kids want Daddy or Mommy to carry them. Pick them up, cart them around, put them down again.

What's a parent to do? It's not like you can avoid any of these activities. Your kids are kids - it's up to you to do stuff for them. The answer lies in regular exercise. "But how will I find time to exercise, when there already isn't enough time to do the things I need to do?"
That's a tough question, but if you recognize the benefits, you'll make the effort to make the time. Forty-five minutes or an hour per workout, three or four times a week, will be plenty. And, once you're in the habit of exercising, you'll notice it's easier to lift your kids, easier to bend over, easier to carry them. It's easier because you're

fitter and stronger. And healthier. And, surprisingly, you're having more fun.
http://www.lakewoodchiropracticjax.com/
1Pennick VE, Young G: Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev 18(2):CD001139, 2007.
2Sax TW, Rosenbaum RB: Neuromuscular disorders in pregnancy. Muscle Nerve 34(5):559-571, 2006.
3Jain NJ, et al: Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes? Am J Perinatol 24(5):291-298, 2007.

Tuesday, September 13, 2016

Carpal Tunnel Syndrome or Repetitive Stress?


Carpal Tunnel Syndrome or Repetitive Stress?
Relative rest will give overused muscles and tendons a chance to heal. What's next is to pay attention to your posture and do exercises designed to strengthen your shoulder
girdle, forearm, and wrist.

To restore good posture, let your shoulder girdles rest on your rib cage. Your shoulders tend to ride upward during the course of a workday. Gently remind yourself to let go

of these tight neck and upper back muscles, allowing the shoulders to assume a neutral position and rest on the upper rib cage.

Shoulder shrugs are a useful isometric exercise that will help relieve painful trigger points. Sitting comfortably, lift both shoulders as high as they can go. Not forcing

anything, just lifting. Hold at the highest position for a moment, then relax, gently returning the shoulders to a neutral position. Repeat three times.


You're getting ready to launch your new business. And, being a savvy entrepreneur, you've been spending a lot of time doing research on the Internet. Entering searches, following links, cutting-and-pasting, typing, mouse-clicking, dragging-and-dropping.

By the time you're ready to "go live" you've begun to notice a dull ache in your wrist (the one that does most of the mouse-ing). There's an annoying tingling sensation in your thumb and the tendons in your forearm hurt whenever you move your fingers.

"Oh, no," you think. "I've got carpal tunnel syndrome."

However, the news is probably not as bad as that. It's much more likely you've developed repetitive stress syndrome, which can be effectively treated by a chiropractor.

Repetitive stress syndrome is often misdiagnosed as carpal tunnel syndrome by family physicians, internists, and even many orthopedists. The doctor thinks, "wrist pain and thumb pain, must be carpal tunnel". This path of least resistance leads to much unnecessary neurologic testing, needless medication, and unwarranted surgeries.

Real carpal tunnel syndrome (CTS) is actually uncommon, usually associated with pregnancy, rheumatoid arthritis, or decreased thyroid activity.1,2 Also, pain is more noticeable at night, rather than during activity. Finally, a quick test for CTS is to place the tips of your thumb and index finger together, forming a circle. Hold the circle closed while another person tries to pry your fingers apart. If your fingers are strong and can keep the circle closed, you probably don't have CTS.

The wrist, tendon, and forearm pain most of us experience after too much time at the computer is due to repetitive stress syndrome (RSS) - basically, too much of the same activity repeated frequently over too long a time. These new pains can be very uncomfortable and cause significant limitation and frustration.

The primary solution is rest and avoidance of the irritating activities. In practice, rest can mean relative rest.3 One key approach for computer-related repetitive stress is to begin using the opposite hand to do mouse or trackpad activities. This may take a while, but it's a highly effective method. And, once your non-dominant hand gets up to speed, you've got two hands that are smart, not only one!

What about chiropractic treatment? Several trouble spots may contribute to RSS, particularly tight shoulder and neck muscles. Your chiropractor will do a complete physical examination and determine the sources of the problem.

Treatment may include gentle chiropractic manipulation to improve the mobility of your neck and remove stress from that area of your spine. Trigger point therapy will relieve pain and relax tight muscular "knots" in your shoulder girdle and forearm.

Treatment combined with relative rest and rehabilitative exercises will likely result in rapid improvement - decreased pain, greater mobility, and a renewed focus on the work you want to get done, rather than the pain that is getting in your way!

Dr.’s Steven Warfield and Dr. Dave Edenfield offer the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident, Veterans and Workers Compensation injuries with state-of-the-art technologies.
http://www.lakewoodchiropracticjax.com/


1Source: National Institute of Neurological Disorders and Stroke - http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm.
2Piazzini DB, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil 21(4):299-314, 2007.
3Akuthota V, et al. Shoulder and elbow overuse injuries in sports. Arch Med Phys Rehabil 85(3 Suppl 1):S52-58, 2004.

Tuesday, August 30, 2016

Shoulder Pain - Heart Attack or Rotator Cuff Injury?




Rotator Cuff Rehabilitation
Basic rotator cuff rehabilitation addresses the loss of mobility. The two main activities are finger walking and pendulum swings.

In finger walking, stand about 18 inches away from a wall, positioned, so your torso is perpendicular to the wall. Reach your arm out to the side and touch the wall with the tips of your fingers. Your elbow should be bent slightly. Slowly walk your fingers up the wall as high as you can go. Walk your fingers slowly all the way down the wall and repeat ten times. As you continue the exercise over days and weeks, your range of motion will improve.

In pendulum swings, sit at the edge of a hard chair and bend your torso forward, supporting your weight by activating your stomach muscles and resting your non-working arm on the inner thigh. Let your working arm dangle to the side and, slowly and gently, begin to swing the arm in a small circle. The movement begins by a gentle swaying of your torso. Slowly increase the diameter of the circle to a maximum of about 18 inches. The whole routine should take about a minute. 
The great TV classic ER helps teach armchair physicians to become amateur diagnosticians. He's in shock! She's got kidney stones! Rule-out pheochromocytoma!

But sometimes a little knowledge can be a dangerous thing.

You've learned somewhere - on the network news, in the Science section of The New York Times, or in a CPR class at your job - that shoulder pain can mean you have a heart attack. Now, seemingly out of the blue, your shoulder begins to ache and throb. Very concerned, you rush to the local emergency room.

The resident's first question, of course, is "where does it hurt"? You point to your right shoulder and blurt out, "Am I having a heart attack?" The resident smiles, gently reassuring. "A heart attack might give you pain in your left shoulder," she says. "Have you been to the gym lately? This might indicate a rotator cuff strain."

The resident knows that heart attack symptoms usually involve chest pain (in two-thirds of cases), and may include faintness, shortness of breath, sweating, and a feeling of impending doom.1   Chest pain may spread to the back, jaw, and arms. Left arm pain may radiate to the inside of the forearm and the ring and little fingers. So, shoulder pain by itself probably doesn't suggest a heart attack.

She orders an MRI which shows mild damage to the right rotator cuff. What's going on? What exactly is the rotator cuff?

The rotator cuff is a muscular sheath that surrounds the head of the arm bone (the humerus) and the entire shoulder joint (really, two joints - the acromioclavicular and glenohumeral joints). The four muscles that comprise the rotator cuff help raise the arm to the front and the side and help turn the shoulder inward and outward.

If you're a sports fan, you know that rotator cuff injuries affect baseball pitchers, tennis players, swimmers, and football players. Such injuries are due to repetitive motion, and may also result from falling on the shoulder or arm or lifting heavy weights.

Rotator cuff injuries may also be slowly developing and chronic, related to arthritic and degenerative changes in the rotator cuff tendon and the two shoulder joints. Low-grade pain may develop, and the pain may become aching, throbbing, and chronic. Raising the arm may cause pain, and there may be a loss of mobility.2

In the above-40 population, lack of exercise and chronically poor posture may contribute to rotator cuff problems. Sitting at a desk all day, with the neck jutting forward and slumped shoulders, places long-term mechanical stress on the rotator cuff.

Chiropractic treatment may be very useful in helping to rehabilitate chronic rotator cuff injuries. The chiropractic physician is an expert in evaluating postural problems and associated spinal conditions. By providing effective treatment, postural corrections, and rehabilitative exercise, chiropractors offer a comprehensive therapeutic program to reduce pain, improve shoulder mobility, and regain function. 

Dr.’s Steven Warfield and Dr. Dave Edenfield offer the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident, Veterans and Workers Compensation injuries with state-of-the-art technologies.
http://www.lakewoodchiropracticjax.com/

1Source: Cedars-Sinai www.cedars-sinai.edu
2Baring T, et al.: Management of rotator cuff disease. Best Pract Res Clin Rheumatol 21(2):279-294, 2007.

Tuesday, August 23, 2016

When Are Simple Headaches Not So Simple?



High Blood Pressure
High blood pressure (HBP) is a common unrecognized cause of headaches. And, HBP itself is very common - according to the American Heart Association, approximately one-third of American adults have HBP. And nearly one-third of these people don't know they have HBP. This is a big problem.

The National Heart, Lung, and Blood Institute of the National Institutes of Health has recommended the DASH diet (Dietary Approaches to Stop Hypertension). This diet has been shown to reduce high blood pressure within two weeks. Daily recommendations include

•  7 to 8 servings of grains
•  4 to 5 servings of vegetables
•  4 to 5 servings of fruit
•  2 to 3 servings of low-fat or non-fat dairy
•  2 to 3 servings of fats and oils
•  4 to 5 servings per week of nuts, seeds, and dry beans
Headaches are big business. For the drug companies, that is.

Approximately 10 million Americans suffer daily headaches, and 50 million have headaches often enough to seek medical care.  Approximately 23 million Americans suffer from migraines.  Billions of dollars are spent each year on Aleve and Motrin for tension headaches and Imitrex for migraines.

But all that money might just as well be poured down a hole in the ground, because the statistics haven't changed in almost 20 years.  Approximately one out of every six Americans suffers from headaches.

Tension headaches are most common, caused by muscle spasm in the neck and shoulders, stress, and even eye strain. The dull, pounding pain may be severe, and there may be nausea. Migraines are even more debilitating, and may be preceded by an "aura" - visual symptoms such as flashing lights or loss of portions of a visual field.

Headaches, although common, should never be taken for granted. People suffering headaches should, at some point, have a physical examination to rule out underlying problems such as high blood pressure.

Importantly, an unusual headache, accompanied by brand-new symptoms, should be evaluated by a physician immediately. A sudden, severe headache, "like nothing I ever had before", needs immediate attention. If you've never thrown up as a result of a headache, and suddenly you are, you need to see a physician. An unusual, unexpected level in the increase of headache pain needs immediate attention. Any of these situations could be caused by a serious underlying problem, and an MRI is usually necessary.

Chiropractic treatment may be of benefit for many people suffering with tension headaches and even migraines. A chiropractic physician will perform a complete physical examination, which may include x-rays. Underlying causes of headaches are ruled out. If a medical condition is suspected, the patient may be referred to the appropriate specialist.

Chiropractic spinal manipulation is a gentle procedure that reduces muscle tension and increases spinal mobility. Neck and shoulder muscles are freed from being held in fixed positions, resulting in increased circulation, improved nutrition, and more efficient muscle activity. The frequency and intensity of tension headaches may improve noticeably. Migraine headaches may improve as well.

Regular exercise and a balanced diet are very important in the treatment of headaches. Exercise improves all aspects of muscle function and improves circulation. Improved cardiovascular function means more blood is flowing to neck and shoulder muscles, bringing oxygen and nutrients and removing irritants such as lactic acid.

A balanced diet ensures that neck and shoulder muscles are getting the energy sources, vitamins, and minerals they need to work properly. A balanced diet in combination with regular exercise also results in weight loss, removing unnecessary mechanical stress in the form of excess pounds.

Headaches are usually a symptom of being out-of-balance. Exercise, balanced nutrition, and chiropractic care can help restore balance to our highly stressed lives.
http://www.lakewoodchiropracticjax.com/

1"Hospital Treats Headache Suffers". The New York Times, 12/25/88.
2Source: National Headache Foundation - www.headaches.org
3Source: Yale Medical Group - www.ymghealthinfo.org

Thursday, August 4, 2016

Dealing with Arthritis


Arthritis Prehabilitation
The best way to deal with arthritis is not to get it in the first place. Osteoarthritis (OA) is not really a disease, it's much more of a condition. And in many cases, OA is a lifestyle-related condition. It is associated both with a long-term lack of activity and with being overweight.

In the sense of "use it or lose it", people who spend most of their day sitting at a desk and/or working on a computer are at risk for developing OA of the neck, lower back, hips, and knees. These same people are at even increased risk if they're overweight.

Supple joints that go through an entire range of motion are doing what they're designed to do. Given the structure of modern life, we need to intentionally work our bodies to keep them healthy and well. This means regular exercise and it means eating smart to maintain our weight at a healthy level.

What kind of exercise? Do what you like, do what you're interested in doing. Just be consistent and exercise three, four, or five days every week. And, every so often, vary what you're doing. Your body will let you know when it's getting bored.
We've all seen the TV ads ─ nice-looking woman in her fifties, sitting on a nice sofa in a nice living room, rubbing her hands, in obvious pain. Of course, she's not Lady Macbeth, trying to rub off the imagined blood of her murdered husband. She's a woman with arthritis.

According to the Center for Disease Control, arthritis is the leading cause of disability in the United States.1  Approximately 47 million people have doctor-diagnosed arthritis and 17 million have arthritis-attributable activity limitations.

Osteoarthritis, the most common form, is a degenerative condition affecting the joints and the soft tissues around the joints ─ the associated cartilage, ligaments, and tendons. The most commonly affected areas are the spine, the hands, and the shoulders, hips, and knees. The pain of arthritis, the reduced mobility, and the lifestyle accommodations needed for pain avoidance are discouraging and may even lead to depression.

Many anti-inflammatory drugs are available for the treatment of arthritis, and in recent years many of these have been found to cause severe side effects. Vioxx is the most notorious of these ─ cardiovascular complications caused a worldwide recall of the drug. Celebrex, another well-known arthritis medication, was also found to increase the risk of heart attack and stroke at high doses.

The very good news is there are several wellness-based treatment alternatives to long-term medication. These include exercise, diet, and in many cases, chiropractic treatment.

Exercise is critical in restoring mobility and, over time, in reducing pain.2,3  Persons with osteoarthritis often experience a vicious cycle of deteriorating symptoms. Pain causes reduced mobility (pain avoidance), which (paradoxically) actually causes more pain, which causes further reductions of mobility . . . . Activities of daily living ─ getting out of a chair, opening a jar, bending and lifting ─ become a real challenge as the person struggles to avoid further pain.

So, restoring mobility is key. Exercise ─ very gently at first ─ is the answer. Range-of-motion activities to get the joints moving again are very beneficial, including
•    Arm circles
•    Wrist circles
•    Shoulder shrugs
•    Side-to-side bending for the lower back
•    Gentle knee bends
•    Ankle circles
•    Flexing and pointing the feet

Walking is a perfect exercise for treatment of arthritis. Begin by walking one block, then two, then around the block. Walk five minutes daily for a week, then increase by a minute or two each day. Get up to 15 minutes of gentle walking, then begin to gradually increase your pace. The increased mobility will not only reduce pain, but also provide a cardiovascular benefit and improve one's ability to perform activities of daily living.

Chiropractic treatment, in combination with an exercise program, may assist in restoring joint mobility and reducing pain. Gentle chiropractic manipulative therapy is designed to improve mobility of spinal joints. As spinal joint motion improves, pain lessens, and a positive cycle of return-to-function begins.
http://www.lakewoodchiropracticjax.com/

1"Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation." CDC Morbidity and Mortality Weekly Report  55(40);1089-1092, 2006.
2Huang MH, et al: A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Semin Arthritis Rheum 32(6):398-406, 2003.
3Suomi R, Collier, D: Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Arch Phys Med Rehabil 84(11):1589-94, 2003.

Tuesday, July 26, 2016

Senior Fitness


SAMPLE WORKOUT ROUTINES
UPPER BODY
  • Bench Press (Chest)
  • Lat Pulldown (Back)
  • Seated Shoulder Press (Deltoids)
  • Incline Dumbbell Curls (Biceps)
  • Triceps Pressdown
Lower Body
  • Machine Leg Press (Quadriceps)
  • Hamstring Curls
  • Standing Calf Raise
CORE
  • Abdominal Press
  • Prone cross-raise (opposite arm/leg)
  • Plank (2 x 15 sec)
  • Lunges (50-foot course)
Bob Barker, beloved host of The Price Is Right, recently made headlines by announcing his retirement after 35 years. "Barker irreplaceable!" blared the entertainment tabloids. And yet, Mr. Barker celebrated his 82nd birthday a few months ago.

Eighty-two! Who really are the "seniors" among us? And what does "senior" mean in today's world? Certainly, America's population is aging by the minute. Baby boomers are rapidly closing in on their 60th birthdays. But most of those in this huge group (more than 76 million)1 are resisting the concept of "getting older" and searching for ways to stay healthy and fit and well.

Fitness programs provide a major answer to these challenges. Yet, there are many questions. What to do? How to get started? What if I have health issues - can I still get fit?

Before we dive in, some special concerns need attention. Baby boomers and those even older must address decreased flexibility and possibly - temporarily - decreased stamina. Medical issues, including osteoporosis2, high blood pressure3, and diabetes, as well as overweight/obesity, must be considered when beginning a new fitness plan.

The bottom line - have a complete physical exam with your chiropractic physician and/or family physician, and make sure you're good to go. Start slowly and easily, making gradual progress, and adding intensity and duration over the first several months.

Begin a walking-for-fitness program. Walking is fantastic exercise! Do 10 minutes at an easy pace the first day, build up to walking around the block, gradually building up over a 12-week period to a brisk 30-minute walk.

Also, begin lifting weights. Many helpful books are available, or ask a friend who knows what they're doing to show you the ropes. Start slowly, carefully, gradually. Train your upper body and lower body on separate days. Make sure you're focusing, paying attention, and working within yourself!

Nutrition is just as important as exercise in regaining the level of fitness we need to live healthy, long lives. Eating right requires some mental toughness, and it may take a while to build new habits. The payoff comes quickly, though, and is tremendously empowering.

We want to be fit for the rest of our lives. How to keep it all going? Here are a few tips from the fitness front lines -
•    Writing down a weekly plan. This keeps your workout and nutritional goals fresh. They're right there, on your desk or refrigerator, where you see them every day.
•    Vary your routines. Change your workouts every few weeks. Ride a bike if you've been walking. Use dumbbells instead of machines. Vary your fruits and vegetables, and vary your sources of protein.
•    Set up a buddy system or join a fitness club. The support of a group of friends who share your lifestyle goals, can make a big difference.

And, most importantly, have fun!
http://www.lakewoodchiropracticjax.com/
  1MetLife Mature Market Institute Analysis, U.S. Census Bureau, 2000.
  2Carter ND, et al: Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal 67(9): 997-1004, 2002.
  3Staessen JA et al: Life style as a blood pressure determinant. Journal of the Royal Society of Medicine 89(9): 484-489, 1996.