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Locus of Control as a Bridge Between Mindfulness and Basic Health Education

Posted By Rich Morris, Thursday, January 17, 2019
Updated: Thursday, January 17, 2019

My academic background is in exercise physiology, and I have taught Health continuously at the college level since 1979 at four different institutions. My primary title during those years, however, was NCAA swimming coach. Coaching swimming is an extremely technical endeavor. Biomechanical analysis of technique, combined with a thorough understanding of anatomy, kinesiology, and physiology help a coach prepare athletes for amazing feats. But no matter how well trained an athlete is, the mind can help or hurt their performance. One of the all-time great coaches, Dr. James Councilman, said:

“Give similar top swimmers to three different coaches. One, an expert in the physiology of training, another in the biomechanics of stroke, and the last one an expert in sport psychology, the third coach’s athlete will win every time.”

And so, coaches such as myself schooled in the physical, studied even harder how to motivate and sustain an athlete’s spirit. What kept me in the sport for so long was the ever-changing science of performance. Years ago, we all learned that yoga and mindfulness can help an athlete. Some coaches ignored the studies, some embraced them, but most of us tried to work it into our schedule like so much weight lifting.

Swim team practicing yoga and mindfulness before practice.Here is a picture of my team practicing yoga and mindfulness techniques before practice. The yoga instructor was thrilled by the response, all the athletes seemed to love it. But let’s dig into that a bit. Some of the athletes loved the fact that yoga was taking away pool time. Others appreciated the opportunity to center themselves and relieve the day’s stress. Out of the nearly 40 athletes, maybe 3 or 4 actually improved as an athlete by really using the skills they were learning.

And so my journey continued. From a physiologist’s standpoint, I understood clearly how increasing circulation cleared the stress hormones and benefited any training. From a fledgling psychological standpoint, I could see and feel the benefits of self-monitoring emotions and accepting them, moving into seeking alternative perspectives without judgment, allowing for changing attitudes. But I couldn’t teach it by sticking to the curriculum or practice schedule, there seemed to be a big piece missing.

For over twenty years I have given a clinical survey on Locus of Control as a pre-test to all of my classes. Julian Rotter’s research into how we perceive the control in our lives, be it external such as fate, divine intervention or luck, vs internal through mindful choices, understanding and accepting the consequences before deciding, intrigued me, so I studied it further. The fascinating thing about this was no matter where you fall in the continuum, you truly accept that as reality. If you are worried about a test or project next week, there can be a huge paradigm change caused by a very subtle shift in perception. A more external person gives the test power and control over their life. The date of the test, the professor’s demeanor, the amount of material covered, all are cause for concern. The more internal person sees the test as a thing and is more concerned with their own attitude towards that thing. Studying the material, of course, is paramount, but the truly internal person has been studying all along, talking to the professor after class when clarification was needed, doing the readings and participating in class. For them, the control comes from personal preparation. Not just the material covered, but also eating correctly, taking study breaks to clear their mind, getting rest and exercise to keep circulation going, a holistic approach to success.

From a physiological perspective, stress is the release of hormones causing predictable changes in the body as a result of reacting to a stressor. For the more external person, the test is stress. It causes the release of the hormones, therefore the reaction is predictable. To the more internal person, mindful of alternative perspectives, the test is a stressor. Assess the difficulty, plan your response, control the level of hormones released. Take time and effort to clear the hormones as you prepare. As Viktor Frankl wrote,

“Between stimulus and response, there lies a space. In that space is a choice. In that choice lies our growth and our freedom.”

Does the test represent stress or a stressor to you? That, to me, is where mindfulness training has to start. Behavioral psychology has always reinforced the behavior after the action. And the fact is it works, people can be manipulated by reinforcing desired behavior. In my classes, I try to get students to experience that moment of clarity brought on by a mindful decision. Take that extra beat before reacting, breath, seek alternatives without judgment. Then make a decision understanding the reinforcement will come as a result of your choice; not luck, chance or powerful others. You chose the consequence. Subtle, but so powerful.

Richard MorrisRichard Morris has a degree in Exercise Physiology from UCF and a Masters from UTC in health and Physical Education. Richard has served as a floor exercise leader and adult fitness director at private clubs. In 1990 he served as Orange County, Florida's first wellness coordinator and developed "Wellworks" wellness programming for over 7,000 employees. He currently serves as Director of Health Education at Rollins College, where he has taught and coached for nearly 30 years. He and his wife Lisa have two children and three grandchildren.

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What to Consider Before Consulting a Physical Therapist

Posted By Dr. Brent Wells, D.C., Thursday, January 10, 2019
Updated: Thursday, January 10, 2019

x-ray of hand making OK symbol

Photo: Owen Beard on Unsplash

The American Physical Therapy Association (APTA) boasts more than 95,000 members in the United States alone. Although many of those members are not licensed physical therapists, a majority of them are chiropractors, podiatrists, rheumatologists, neurologists and other respected medical professionals who take an active interest in their client’s overall wellbeing.


For patients who willingly participate in it, well-managed physical therapy has countless benefits, including:(APTA) boasts more than 95,000 members in the United States alone. Although many of those members are not licensed physical therapists, a majority of them are chiropractors, podiatrists, rheumatologists, neurologists and other respected medical professionals who take an active interest in their client’s overall wellbeing.

  • Increased range of motion
  • Decreased pain
  • Enhanced pain tolerance
  • Reduced swelling
  • Improved muscle tone
  • Revitalized mental health

Despite the increased availability, however, it can be difficult for a patient to feel confident when choosing a physical therapist. To make matters seem more complicated than they need to be, the Bureau of Labor Statistics reported more than 200,000 physical therapists working on American soil as of 2016, with a steep increase of about 28% since then.

What Is A Physical Therapist?

According to the World Confederation for Physical Therapy, a physical therapist goes by many names: physiotherapist, kinesiologist, and chiropractors just to name a few. Regardless of the title, physical therapists provide a variety of essential services. Typically, their carefully cultivated techniques help patients restore, develop, or maintain function and mobility in any part of the body.


Patients seek help from physical therapists for numerous reasons, including but certainly not limited to the following:

  • Injury
  • Injury prevention
  • Rehabilitation
  • Physical promotion
  • Illness
  • Disease
  • Age
  • Environmental conditions
  • Professional goals

woman getting physical therapy


In short, physical therapists work diligently to help patients improve the quality of their life, whether that be simply regaining the ability to walk or competing in a marathon. It’s important to consider your needs and expectations before scheduling an appointment with a physical therapist.


What to Expect During Routine Physical Therapy

Although every patient is unique and all physical therapists use different methods, the average PT session involves a series of required activities and exercises. Especially if the therapist is legitimately qualified and professional, you can expect the following things to take place during most routine physical therapy appointments:

  • A comprehensive examination to analyze the patient’s physical limitations and therapeutic requirements
  • An evaluation of data from the initial analysis to make clinical decisions regarding the patient in question
  • Development a diagnosis and prognosis
  • Formulation of an effective treatment or intervention plan
  • A consultation about any potentially helpful referrals to outside healthcare professionals
  • Implementation of the aforementioned treatment plan
  • Gather data during each session to determine the expected outcome of treatments
  • Recommendations regarding self-care

If you experience anything that diverges from what’s listed above, be sure to communicate your concern with the therapist as soon as possible. It may be that you’re simply participating in innovative treatments. However, too many deviations should raise red flags.


doctor examining x-ray

Photo: rawpixel on Unsplash

How Does Physical Therapy Work?

Physical therapy is effective at helping patients in numerous ways, and the reasons for that are quite clear according to the experts. However, patients are always urged to consider their current physical fitness level and general health when formulating a treatment plan. Although physical therapists are specially trained to coax the body into regaining range of motion, strength or flexibility, they are not miracle workers.

Physical therapy works best when a patient is ready for a challenge. Licensed therapists can teach various exercises and stretches or introduce patients to specialized equipment to use independently but they cannot force patients to comply. Since effective physical therapy typically requires several weeks, individual self-care is an important part of the process and should never be underestimated.

During most therapeutic sessions, therapists will work with the patient to achieve pre-set goals. Throughout the process, but depending on the physical requirements of the patient, the following treatment techniques will likely be used:


Muscles and joints can become stiff and tight, especially after long periods of inactivity. Physical therapists assist patients with deep stretches to loosen muscles and tendons and improve overall functionality.

Strengthening Exercises

By improving the strength of the muscles in the body, patients thereby enjoy enhanced balance and increased range of motion. Physical therapists use graduated weights to boost the patient’s forte as much as possible.

Core Strengthening

The strength of the body’s core is perhaps the most important part of physical fitness. Therapists work on stability by guiding patients during various workouts that target the abdominal and thoracic muscles.

Application of Ice or Heat

Introducing heat and/or cold to muscles and joints can decrease pain, increase range of motion, and promote better blood flow throughout the body. Physical therapists use heat and/or ice treatments at the beginning or end of most sessions, especially with patients who have sustained an injury.

Acupressure or Chiropractic Massage

Targeted massage, also known as chiropractic massage or acupressure, is perhaps the most enjoyable part of most physical therapy sessions. Experts providing chiropractic massage use state-of-the-art procedures to relieve pain, make necessary adjustments to the musculoskeletal system and boost circulation.

Electrical Stimulation (E-Stim)

Used primarily as a tool for physical therapists, e-stim treatments send waves of dense electrical currents to certain parts of the body. Physical therapists will subject various muscles or nerves to controlled stimulation for the purposes to encouraging movement, sensation and blood flow.

NOTE: In some cases, a physical therapist may utilize ultrasounds or x-rays to determine the extent of an injury or monitor improvements. Ultrasounds may also be used to stimulate blood flow post-therapy.

When Is Physical Therapy Better than Medication?

Properly monitored and responsibly used prescription medication has its merits. However, physical therapy may be a better option for some people. Pharmaceuticals are often laden with potentially harmful chemicals and can present dangerous side effects. On the contrary, physical therapy tends to lean toward a more natural, holistic approach to healthcare.

Therefore, physical therapy may be better than medication when patients are experiencing adverse side effects. However, one should err on the side of caution and consult with a doctor before abruptly stopping any medicinal regimen. Often, routine physical therapy can serve as supplemental rehabilitation when used alongside the proper medication.

Who Can Benefit from Physical Therapy?

children playing outdoors

Photo: Mi Pham on Unsplash

Fortunately, physical therapy is safe, effective and appropriate for people of all ages, genders, and backgrounds. In fact, there’s an entire PT specialization that focused exclusively on children and another for the elderly. Expect the treatment options to be tailored around each patient’s unique needs and characteristics.


Sabrina WalesekDr. Brent Wells, D.C. is graduate of the University of Nevada and Western States Chiropractic College in Portland, Oregon. As the founder of Better Health Chiropractic in Wasilla, Dr. Wells is highly respected in his field as one of the premier chiropractors in Alaska. He specializes in rehabilitative therapies which include acupressure, chiropractic massage, adjustments and natural pain relief at his multi-disciplinary clinic.

He enthusiastically continues his education with ongoing research on spinal conditions, neurology, physical therapy, biomechanics, and trauma. As an active member of the American Chiropractic Association and the American Academy of Spine Physicians, Dr. Wells also supports numerous studies and volunteers at the Reflex Sympathetic Dystrophy Foundation.


Photo by rawpixel on Unsplash

Tags:  chiropractic  physical therapy  wellness 

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NWI Member Spotlight - January 2019

Posted By NWI, Friday, January 4, 2019
Updated: Friday, January 4, 2019

Nicole AkparewaNicole Akparewa, RN, MPH, MSN

Creative Director of “Transform Nursing”

John Hopkins University, Bloomberg School of Public Health

John Hopkins University, School of Nursing

My mission is to train nurses globally with the tools they need to confidently address health policy, patient advocacy, and patient engagement in both clinical and non-clinical settings. Transformative nursing means that every nurse in every country has the knowledge, the training, and the ability to be effective leaders who will combat health disparities through empowerment, awareness, and education. I am a nurse entrepreneur and coach who teaches online courses for nurses to delve deeply into health and social challenges, and empower the global community of nurses to take the lead on health system change.

The way I have created social impact, which is the effect I want to have on the well-being of the communities I serve, is through blogging and podcasting to build awareness of social justice. I use Facebook Live to speak to the issues that nurses are facing. I also have a course that is focused on social justice and influential leadership called the “Nurse's Influential Leadership Lab” that is all about creating nurse leaders in inclusive practices.  

I lead with passion, bold enthusiasm, and most importantly by example. When it comes to approaching uncomfortable topics in nursing, I don’t ask my students do something that I don’t have the courage to do. I share my stories about nursing, even the times where I felt slighted or shamed, or just fell flat on my face. My relationship with nursing has endured many iterations from infatuation, to bittersweet, to verging on resignation because I didn’t feel comfortable speaking out about issues that made me or my patients unsafe. I finally realized that I have a distinct purpose in nursing — to create a safe space for nurses to have a deeper awareness of how their individual practice can improve the lives of their patients beyond the hospital room, and transcend into their lives and communities.

What makes me who I am is my dedication to my purpose and the atmosphere of support that I provide the students in my courses. I am often termed the “eternal cheerleader” because I champion for nurses to take the lead on health policy and education while being involved in civic engagement. I help nurses make subtle shifts that can bring profound changes, and reflections that yield those “aha” moments as they awaken to new insights. It’s really quite special to watch. My authentic desire is to co-create, collaborate, and build strength in the nursing community through a transformative process that will help you find yet undiscovered joys and new challenges in your profession.

I am originally from Seattle, WA. I graduated from the University of Washington School of Nursing with a BSN and then the Johns Hopkins University School of Nursing with a dual Masters in Nursing and Public Health. I knew nursing was my passion when I met a Native American nursing student who worked with pregnant teenagers in her tribe. Until then I never knew that nurses worked in the community.

When I’m not working I like to spend time with my little boy Gabriel, read books, and watch the Golden Girls.

To learn more about Nicole and her work contact her at:

Phone: 443.388.6345

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The Best Gift Is Presence

Posted By Sabrina Walasek, Friday, December 21, 2018

The unfolding of a conversation is like unwrapping a present.

As someone who works remotely, I have come to value face-to-face conversation. 
The unfolding of a conversation is like unwrapping a present. It sets a vibe and pace to the ritual. While some people have a knack for being really present when conversing, many of us have to work at it. So let’s uncover what it takes to create a real gift of gab.

First, it’s best to share a real space together so you pick up on the full energy of the other person. The nonverbal connection between people has real power. It can cause people to subconsciously adjust their positions, movements, and breathing. When face-to-face, the brain's ‘mirror neurons’ mimic subtleties of the other person. 

While physically showing up is important, the real gift lies in our intention. It not only impacts what is communicated; it also establishes the balance of power. Let’s illustrate with a gift analogy. 

Scenario #1: Envision someone attacking a carefully wrapped giftbox with reckless abandon, snapping off ribbons and shredding paper in pursuit of its contents. No eye contact, no pause to relish the moment. In this scenario, the intent is to self-serve and own the experience.

Scenario #2: Now imagine someone admiring a giftbox, gingerly slipping off the ribbon, massaging the tape loose to preserve the paper. A pause allows for eye contact and a deep breath. Tissue paper is peeled back for the reveal. In this case, the intent is to build rapport and share the experience.

Intent exists in every conversation and it’s often buried deep in our subconscious. It lives in our words, pace, volume, tone, and body language. When we are present, we start to recognize and adjust intent before talking. 

A small-talker is congenial. A great storyteller is compelling. A conversation horder is neither and is likely too wrapped up in his- or herself to notice. We all need to share at length from time to time. However, when taking center stage is habitual, listeners are likely tortured or tuned out. 

Entering conversation to connect is not only about how much talking time you own, but the nature of your speech as well. In the dharma world, there are four common questions suggested to test potential words:

  • Is it true?
  • Is it kind?
  • Is it necessary?
  • Is it the right time?

Passing thoughts through these gates before the words leap off your tongue requires slowing down. This gives time to course-correct. 

Of course, the gift of conversation isn’t just about what you say—it’s also about truly being present for the words, emotions, and subtle communications of your conversational partner.

We all want to be heard, really heard. “Listeners” who are distracted (listening but not engaged) or who reroute the conversation back to themselves are not listening. Active listeners approach a conversation (and a person) with curiosity and the goal of deeper understanding.

According to the Korn Ferry Institute’s The Science of Listening:

“Our listening brain is wired to do exactly what active listening discourages: evaluate input, predict outcomes, make judgments and perform triage, all on a moment-to-moment basis. That mode of functioning, according to recent thinking in cognitive neuroscience, evolved as the brain’s strategy to use its finite neural capacity efficiently. As we take in the stimuli of the speaker’s words, the prefrontal cortex, which enables organizing and prioritizing, lights up with activity as we continually vet the incoming information against what we know, our past experiences and our theoretical construct of the future.”

According to our brain, being fully present all the time would waste enormous time and energy. That’s what makes active listening such a gift! It takes dedication and signals to the other person, “You’re worth it!” 


How to Test Your Active Listening Skills

  • Notice your urge to speak and see if you can “bite your tongue” until a natural pause is created by the other person.
  • Fully engage with your eyes and body.
  • Put down your phone or items that may lure you away.
  • Try not to connect what the person is saying with your own experiences.
  • Try not to anticipate what you are going to say next. 
  • Incorporate parts of what the person said in a response back.
  • Ask questions to go deeper without the intent to judge or compete.
  • Approach with curiosity; find out something new.

As you gather for the holidays, it’s likely you will be catching up with folks you don’t see on a regular basis. Now is the perfect time to practice spreading words of kindness and making connections that go a little deeper. Set an intention as a speaker and a listener, to share the space and enhance the quality of your conversations, a gift to yourself and the world.

Sabrina WalesekSabrina Walasek is a long-time educator and lover of exploration and learning. She has traveled to more than 50 countries, embracing humanity and nurturing her sense of curiosity. She facilitates a monthly mindful women's circle and is a contributor to Whole Life Challenge's blog. Her website is

Tags:  Active Listening  Conversation  Mindfulness  Presence 

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Improvements to Social Health Insurance

Posted By David Dallas-Orr, MBA, Monday, December 17, 2018

doctors looking at patient on operating tableDo we want to optimize health insurance for the individual given her/his willingness to pay? Do we want to reduce poverty and inequity by prioritizing reduction of inequity in health? These are two questions that face the medical system within every country no matter how developed the country may be. The development of social health insurance, to provide medical care to those that cannot afford it at the expense of tax payers, needs to be controlled by value-based care and increased transparency, while only paying for treatments that have proven to be cost-effective.

As compared to the healthcare system in Mexico before and after Seguro Popular, the US government is not subsidizing medical care unequally. To put it more simply, the rich in the US may be receiving much more healthcare, but they are not receiving more government money to do so. Although healthcare subsidies are not favoring people who can more easily afford it, there is still a great need to improve the way healthcare is funded. One of the ways to further increase the equity within health insurance is through value-based insurance design. This does not create all medical treatment coverage as equal, and instead covers the care that produces the best results. The value of care greatly depends on who provides it, who receives it, and where it is received.


In a survey done by the Kaiser Family Foundation, it was shown that a majority of the public believe that it is very important that future healthcare policy includes aspects of the Affordable Care Act that gave protections for people with pre-existing conditions (Kirzinger). However, given that people in the United States spend disproportionately more on healthcare expenditures as compared two other countries, it is clear that the money available needs to be spent more effectively. Healthcare plans in developing countries have become increasingly comprehensive due to the availability of new technologies, now covering a breadth of services ranging from obesity counseling to the morning-after pill. Do all of these healthcare services offer the same amount of benefit to patients? Because healthcare costs are shared amongst everyone in the system, patients do not have to pay the true cost of each medical treatment, creating an incentive to use more of the services available even though they may not be necessary. This has led to many doctors cashing in on the system, favoring volume over value, and offering patients unnecessary treatments and procedures for their own financial gain. An example of a procedure that is commonly overused is the laser ablation of varicose veins. Many times, this is done through embellishing medical records with symptoms that are more extreme in order to justify treatment. A recently published study in the journal Value Health showed that laser ablation for varicose veins showed the third highest cost effectiveness as one of 7 treatments available.


compassionate doctor comforting patient

In the same survey by the Kaiser Family Foundation, four in ten insured adults ages 18-64 say there has been a time in the past 12 months when they received an unexpected medical bill and one in ten say they received a “surprise” medical bill from an out-of-network provider in the past year (Kirzinger). This shows the need for the US healthcare system to be more transparent about the costs of care. Transparency is another way to combat the moral hazard that faces a social insurance system. If patients are not being surprised by the already insurance-subsidized medical bills, they will be less likely to seek medical care when they do not need it.

There are many ways to increase transparency. One of the best methods can be borrowed from our neighbors to the North. In Canada, there are many ways to view the costs of medical care, one of the easiest to use being the Alberta Medical Association Fee Navigator. On the site, it can be seen that varicose vein injections have reached their cap for the year and the amount that physicians are able to bill is not even available. This means that the AMA will not pay for this treatment for the rest of the benefit year… which ends on June 30th, 2019.

The AMA Fee Navigator can also give information on cost-effective treatment options. This tool allows us to very easily see what physicians are being paid and clearly shows what services they are incentivized to perform.


We are in the midst of election season and it is important that we advocate for legislation that leads to the most cost-effective treatments being delivered to patients. One of the metrics that is commonly used to evaluate the cost effectiveness of medical treatments and help control which procedures are covered by insurance is the cost per quality adjusted life year (QALY). One QALY is the equivalent of one lost year of healthy life. If someone had a disease that put them at 50% of their health for the last 5 years of their life and a drug could remove their symptoms and improve their quality of life for those years, the drug would add 2.5 QALYs. If the treatment cost $100,000 over those 5 years, then the cost per QALY is $40,000. In the United Kingdom, the National Institute for Health and Care Excellence sets a limit on average of $25,000, so this treatment would not be available in the UK. In the US, the drug Irinotecan has a cost per QALY of $50,000, yet it is still used for the treatment of metastatic colon cancer (Cohen). In conclusion, our social insurance can be improved and even expanded if the healthcare system moves to value-based care that focused on outcomes as opposed to treatments, transparency to prevent moral hazard and over treatment, and implementation of more strict reimbursement that removes coverage for treatments that are not cost-effective.


AMA, “Fee Navigator®.” Alberta Medical Association: Fee Navigator™ | Health Service Code 48.12: Aortocoronary Bypass of One Coronary Artery, 2018,

Cohen, J, et al. “Clinical and Economic Challenges Facing Pharmacogenomics.” Nature News, Nature Publishing Group, 10 Jan. 2012,

Kirzinger, Ashley, et al. “Kaiser Health Tracking Poll – Late Summer 2018: The Election, Pre-Existing Conditions, and Surprises on Medical Bills.” The Henry J. Kaiser Family Foundation, 12 Sept. 2018,

David Dallas-OrrDavid Dallas-Orr, MBA, has a background in wet lab biochemistry research and medical device commercialization experience in the areas of orthopedic surgery and cardiology. He is currently pursuing a Master's in Translational Medicine at UC San Francisco and UC Berkeley in order to learn more about bringing drugs and medical devices from the research stage to making an impact in the lives of patients.

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