Common Muscle Imbalances: Upper Crossed Syndrome & Lower Crossed Syndrome


Maintaining poor posture for a prolonged period can lead to common muscle imbalances known as upper crossed syndrome and lower crossed syndrome, described first by Dr. Vladimir Janda. In these syndromes, there is a pattern of muscles that become relatively tight/short versus muscles that become weak/long. Unfortunately, with ageing, posture tends to decline. That being said, much improvement can be gained from posture retraining and rehabilitation exercises of the involved muscles.

Predisposing Activities Leading to Muscle Imbalance:

It appears that we are living in a flexion-addicted society. What this means, is that people tend to frequently stoop forward. This is seen in office workers and students who tend to sit at a desk for prolonged periods, slouching forward to see the computer screen. Students carrying heavy backpacks also tend to lean forward – the shoulders curve inwards and the head juts forward to counterbalance the load. Reclining on the sofa and driving in one’s car, people are frequently in a forward flexed position.

In the above examples, the muscle imbalances are seen between the front and back of the body. It is also possible to see muscle imbalance between left and right sides. Handedness contributes to this phenomenon because the dominant side is used more and becomes stronger. One-sided rotational sports (such as tennis, golf, hockey, baseball…) can also predispose an individual to this type of muscle imbalance.

Consequences of Poor Posture:

Most people don’t think about the impact that posture plays on overall health. Many people also don’t put two and two together and recognize that posture can be responsible for pain – yet they wonder why they have frequent headaches, neck pain, back pain and fatigue. Suboptimal posture inevitably leads to suboptimal loading of the spinal joints and stress and strain on muscles and ligaments which can contribute to pain and even arthritis over time. Below is a list of common negative consequences of poor posture.

  • pain in the neck, mid-back or low back

  • muscle spasm/tightness

  • decreased range of motion

  • fatigue

  • arthritis, due to uneven joint wear over time

  • increased risk for disc herniation (especially when poor posture is combined with exertion or repetitive flexion)

  • headaches (including migraines, tension headaches and cervicogenic headaches)

  • suboccipital pain

  • teeth clenching & TMJ problems

  • rib dysfunction

  • pinched nerves

  • reduced lung capacity

  • loss of overall height

  • poor appearance

  • reduced balance

  • reduced performance

  • poor digestion (due to compression of internal organs)

  • less energy, poor mood

As seen above, poor posture can impact one’s whole body and overall health. How do we correct this? The first step is awareness.

optimal postureOptimal Posture:

Optimal posture is the posture that minimizes joint compression and shearing forces and minimizes muscle contraction necessary to stand upright. The body can carry the weight of gravity comfortably and efficiently. In general, there are two gentle backward curves in the spine (the cervical lordosis and lumbar lordosis) and a gentle forward curve in the mid-back (thoracic kyphosis). Having these gentle curves aids in shock absorption between joint surfaces as you ambulate. Deviations from normal (either excessive curvature or reduced curvature) can lead to problems. When visualizing the body in the side view, ideally the following structures should line up: the ear, the shoulder, the hip, the knee and the front of the ankle.

Upper Crossed Syndrome:

Upper crossed syndrome is characterized by the following muscle pattern.

Tightness: upper trapezius, levator scapulae, sternocleidomastoid and pectoralis muscles

Weakness: deep neck flexors, serratus anterior, middle trapezius and lower trapezius muscles

upper crossed symdrome postureLower Crossed Syndrome:

Lower crossed syndrome is characterized by the following muscle pattern.

Tightness: erector spinae (thoraco-lumbar), rectus femoris and iliopsoas muscles

Weakness: abdominals and gluteal muscles

lower crossed syndromeCorrecting Upper and Lower Crossed Syndromes:

Correcting upper and lower crossed syndromes can be challenging especially if they’ve existed for a long time. Patience and dedication are required to ultimately correct posture. In some people, posture can’t be fully corrected but with the following tips, improvements can be made and further declines can be prevented.

**Note: Poor posture, especially when accompanied with pain can sometimes be a sign of a deeper underlying condition (such as osteoporosis or rheumatological conditions). The following is for information purposes only and does not apply to everyone. Consult with a health professional before beginning any exercise program.

  1. Posture Education: You must understand the importance of good posture and be conscious of your posture as you carry about daily activities. Actively correct yourself.

  2. Avoid Prolonged Postures: If your work requires prolonged sitting, remember to get up frequently and walk around. In other words, take posture breaks at regular intervals. Sit up tall and do the Brugger’s stretch.

  3. Stay Physically Active: Overall fitness and endurance helps improve posture and prevent declines. It is also good for overall health.

  4. Corrective Exercises: Specific exercises to target the involved muscles are important. In general, tight/short muscles must be stretched and weak/long muscles must be strengthened. Endurance is just as important as strength.

corrective stretches
CORRECTIVE STRETCHES A) Brugger’s stretch: Sitting tall with chin tucked back, lift chest and externally rotate arms back. B) Chin tuck: Tuck chin straight back and hold for several seconds. C) Forward lunge: With hands on hips and torso tall, lean forward to feel a stretch in the psoas. D) Pectoralis stretch: Staying tall, rotate shoulders and extend arms back. E) Quadriceps stretch: Pull heel to buttocks.
corrective strengthening
CORRECTIVE STRENGTHENING A) Deep neck flexor exercise: Tuck your chin straight back and lift head 1 inch off floor. B) Bridge: Squeeze gluteal muscles then lift pelvis of floor to make a straight line. C) Plank: Resting on elbows, lift body off floor in straight line to strengthen abdominals. D) Scap T: Lying prone with pillow under forehead, lift arms up in ‘T’ position with thumbs pointed to ceiling to strengthen middle traps. E) Reverse fly: This is an alternative to D. Keep spine neutral, only bending at hips and knees. Holding light weights, bring arms back in ‘T’ position.

How Chiropractic Helps with Posture Syndromes:

Chiropractic care plays an important role in diagnosing and correcting postural problems. Chiropractic care helps relieve pain, improve flexibility, improve joint function and improve muscle balance. Chronic poor posture can lead to pain and arthritis. Muscle imbalance can lead to joint dysfunction and poor spinal alignment. Chiropractic care involves manual therapies to help put the body into better balance both mechanically and neurologically. Chiropractors can also prescribe exercises to balance the muscles and facilitate recovery and provide other holistic advice. Postural problems and related joint dysfunction do not appear overnight and will not disappear overnight. These issues require a program of care and dedication on the patient’s part too. Combining passive chiropractic treatment with home exercises leads to the best results.

Preventing Spinal Injuries:

Having good posture as you carry about your daily activities plays a critical role in prevention of spinal injuries. Having a strong core is also important.

Dr. Elisabeth Miron

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Tips to Boost Your Immunity

Boost Immunity with ChiropracticDo you want to take charge of your health, to feel great, heal faster and prevent sickness? If this sounds like you, then read on! There are many ways to boost your natural immunity, prevent health conditions and heal faster.

Before I share the multitude of things that you can do for your immunity, I want to share some of the exciting new research about how chiropractic helps immunity. For years, chiropractors have observed that patients often demonstrate improvements of immune problems such as reduced allergy symptoms and fewer and faster recovery from colds, other respiratory infections and other maladies. However, scientific research into this area has been relatively scarce until more recently.

An early study by Brennan et al (1992) showed that a single adjustment to the thoracic spine primes activity in immune cells including neutrophils and mononuclear cells. Research by Teodorczyk-Injeyan, et al (2006) describes neural immunoregulation – the communication between the nervous system and the immune system. Their study showed that a single adjustment to the thoracic spine reduces inflammatory cytokines (including TNF-alpha and IL-1beta) compared to both the sham and control group. Another study by the same group (2008) showed that T-lymphocyte activity (measured by IL-2 production) increases after spinal adjustment which was shown in their later study (2010) to increase antibody production.

Yikes! What does all that mean? The bottom line is that spinal adjustments reduce inflammation and increase antibody production which has great clinical relevance! Thus, it appears that the nervous system and immune system function together to create optimal responses for the body to adapt and heal. Beyond the well known physical and mechanical benefits of chiropractic care, adjustments boost immunity! How often should you see a chiropractor? For maintenance and wellness, once or twice per month is recommended. A higher frequency of care is recommended if you have a specific problem that needs to be corrected.

Here are some other ways to boost immunity naturally…

1) Stay Hydrated

All of your body’s biochemical processes take place in the fluid that makes up your body. 60% of the human body is composed of water. Every system in the body depends on water for flushing out toxin and carrying nutrients into cells. A moist environment is also necessary for ear, nose and throat tissues. Lack of hydration will hinder normal biological processes and drain your energy making you tired. How much is enough? It is often recommended to drink at least 8 glasses of water per day but need will obviously increase depending on environmental conditions and how much you exercise and sweat.

2) Use a Humidifier

Using a humidifier especially during winter months can help prevent colds and flues by preventing excess dryness that can irritate mucous membranes making them more susceptible to infection. You can also add tea tree oil, eucalyptus and/or cinnamon for extra defence.

3) Sleep Well

Sleep is essential for health. During sleep, there is growth and rejuvenation of the immune system, nervous system and musculoskeletal system. Sleep is also important for memory formation. How much is enough? For an adult 7-8hrs per night should do the trick but being consistent with time of sleep and wakefulness is also crucial. Sleep deprivation increases the risk for fibromyalgia, diabetes, irritability, depression, memory loss, headaches, malaise, obesity and symptoms similar to ADHD.

4) Exercise Regularly

Get up and move it! Exercise is quite possibility the best thing you can do for your health. How exercise boosts immunity is not fully understood but it may be related to better circulation, enhanced sleep, temporary rise in body temperature or the reduced release of stress-related hormones. Aim for at least 30 minutes of moderate intensity exercise daily.

5) Reduce Stress

Stress is an unavoidable part of life. In some ways, stress is a good thing. Consider this: stress and life demands bring about accomplishment, ingenuity and change. It challenges us to get things done, to be our best, to leave a legacy and with this comes about achievement and pride. However, when most people talk about stress, it’s about the negative consequences of it. Certainly, too much stress is not good for you. People need a balance between life’s demands and doing things for the sole purpose of enjoyment. We need a balance between work and play. The good news is stress can be relieved by some of the other items on this list of tips, like exercising and sleeping well. Other ideas are going for walks, reading, socializing, meditation, yoga and chiropractic care.

6) Laugh Out Loud

We’ve all heard that laughter is the best medicine and it’s true! Hearty laughter enhances immunity, reduces stress hormones, lowers blood pressure, triggers endorphin release (which makes you feel good and reduces pain) and much more. Best of all, it’s fun and free! So, lighten up – it’s great for both your emotional and physical health. Need some ideas? You can watch a funny movie, share funny stories with friends, go to a comedy club, spend time with kids…

7) Cut Out Sugar

Why is sugar so bad? Sugar suppresses the immune system. Sugar also promotes inflammation which when excessive promotes ageing and disease. When sugar is in excess in the bloodstream, it binds to proteins preventing them from functioning normally. This process is known as glycation. Glycated proteins produce free radicals which damage surrounding tissues. Avoid simple sugars found in muffins, cakes, candies, white bread and junk foods. Instead, choose complex carbohydrates found in vegetables, fruits, whole grains, brown rice, oatmeal and nuts. This will prevent spikes in your blood sugar level and the associated health consequences.

8) Have a Healthy Diet

A healthy diet is important for optimal immune system function. Be sure to include plenty of fresh fruits and vegetables, whole grains and healthy fats (such as omega-3 fats found in fish, flaxseeds and walnuts). Garlic and onion are great infection fighting foods and the spice, turmeric has anti-inflammatory properties.

9) Consume Probiotics & Prebiotics

An unhealthy colon is associated with various immunological problems including allergies, asthma, frequent infections, autoimmune conditions and inflammatory diseases of the colon (such as Crohn’s disease and ulcerative colitis). Probiotics are live microorganisms that confer a health benefit to the host, including the digestive tract. This is done by improving the digestive system’s microbial balance which helps digestion and overall immune system function. Studies show that probiotics down-regulate pro-inflammatory cytokines thus reducing overall inflammation in the body. Examples of probiotics include lactic acid bacteria such as Lactobacillus. On the other hand, prebiotics are non-digestible food ingredients that stimulate growth of healthy bacteria in the digestive system. These include soluble fibers. Some sources of prebiotics include soybeans, inulin sources (such as onions), raw oats, unrefined barley and wheat.

10) Be an Optimist

Optimists live longer than pessimists! Studies show that those who are negative, moody, nervous and easily stressed have a weaker immune response. A 2004 study published in Archives of General Psychiatry found that those with high levels of optimism had 45% lower risk of death from any cause and 77% lower risk of death from heart disease over the study period. Want an interesting book to read? Try Bruce Lipton’s “Biology of Belief.” It talks about how your thought processes can alter the expression of your DNA.

11) Spend Time Outside

In other words, get some natural light! Vitamin D is synthesized by the skin upon exposure to sunlight.

Vitamin D has a role in bone health as well as immune system function. Some exposure to sunshine is good. Keep in mind that sunscreen will reduce synthesis of vitamin D by 95%.

1) Brennan PC, et al. Enhanced Neutrophil Respiratory Burst as a Biological Marker for Manipulation Forces: Duration of the Effect and Association with Substance P and Tumor Necrosis Factor. J Manipulative Physiol Ther 1992 (Feb); 15 (2): 83–89.

2) Teodorczyk-Injeyan JA, et al. Spinal Manipulative Therapy Reduces Inflammatory Cytokines but Not Substance P Production in Normal Subjects. J Manipulative Physiol Ther 2006 (Jan); 29 (1): 14–21.

3) Teodorczyk-Injeyan JA, Injeyan HS, McGregor M, et al. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat, 2008;16:5.

4) Teodorczyk-Injeyan JA, et al. Interleukin-2 regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropr Osteopat, 2010;18:26.

5) Borchers, A, Selmi, C, Meyers, F, Keen, C & Gershwin, E. (2008). Probiotics and Immunity. Journal of Gastroenterology; 44:26-46.

6) Zitmam, FG et al. Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly Dutch men and women. Archives of General Psychology, 2004;61:1126-35.

Dr. Elisabeth Miron

Poor Desk Posture

Why Prolonged Sitting Sucks – How to Save Your Spine

Poor Desk PostureA common misconception is that you won’t be injured from sitting. The fact of the matter is that you don’t need a forceful physical trauma to sustain an injury. Injuries can indeed occur form mere sitting! These are commonly understood as postural strain type disorders in which there is repetitive and cumulative microtrauma to the tissues of the body. The sad truth is that the majority of people sit for most of the day. An average day consists of sitting at a desk for hours staring at a computer screen, sitting when driving to and from work, sitting during meals and more sitting in front of the TV. That’s quite a lot of sitting! Some of the worst culprits are students, office workers and people who drive for a living.

So what is wrong with prolonged sitting? With prolonged sitting, there is a tendency to slouch forward (or you may have poor posture to begin with). Ultimately with sustained postures, you end up consistently loading the same tissues in the same way (ie: your muscles, ligaments and joints). Over time, this leads to a phenomenon known as creep. This is similar to the mechanism by which dentists use braces to repair crooked teeth. The braces impart a constant force to the teeth such that over time, the tissues surrounding the teeth deform to allow the teeth to move into better alignment. Similarly, in your back and neck, prolonged postures can result in structural changes (affecting joint position and alignment), postural strain to the muscles and sprain to the ligaments. Common complaints include neck and shoulder pain, upper back pain, low back pain and headaches. These problems can become chronic if nothing is done. Soft tissue creep from prolonged slouching also impairs the reflex contraction of back muscles which normally act to protect the underlying spine from injury1. Thus, a person is more likely to sustain an injury immediately following prolonged sitting.


1) Move around!

Don’t sit for more than 40 minutes straight. Get up, go for a walk, move around or stretch. Range of motion exercises and spinal extension exercises are good. Make sure to change your position frequently (ie: take micro-breaks!) as this will help redistribute the forces acting on your body. Did you know that fidgeting is actually good for you? Besides burning extra calories, it helps to redistribute the forces acting on your body. Another good tip is to drink plenty of water. Besides hydrating the body and flushing out toxins, drinking plenty of water forces you to get up frequently to go to the bathroom!

2) Don’t slouch!

The unfortunate tendency for desk workers is to slouch. The head juts forward, the shoulders and upper back curl forward and the normal backward curve of the low back is reduced. Over time, this leads to a postural problem known as “upper crossed syndrome.” Upper crossed syndrome describes a pattern of muscles which are either chronically tight/shortened or weak/lengthened that develops over time2. Instead, sit erect maintaining the natural curves of your back. You may consider purchasing a lumbar support.

3) Stretch those muscles!

The muscles that are most important to stretch are those which are being chronically activated or shortened. These most typically include the pectoralis muscles, SCM, upper trapezium and levator scapula.

4) Focus on ergonomics!

Having an ergonomic office setup is important. For example, your computer screen is ideally placed straight in front and should be at a level that is directly in line with your eyes when you look forward. Make sure you have a comfortable chair that is adjustable. Make sure your keyboard and other equipment are placed close enough to avoid excessive/prolonged reaching and slouching.

5) Workout!

It is good to have an exercise routing during the workday. Exercise is good for the cardiovascular system and overall health. Doing core strengthening exercises is also good because the muscles of the core help protect the spine from injury.

6) Visit your chiropractor!

Your chiropractor will assist you in determining the best course of action for your problem and the best exercises for your case. Chiropractors use spinal adjustments to help restore proper alignment and mobility and keep you functioning optimally.

Remember: Have some faith and patience! Postural problems don’t develop over night and rarely go away over night. You need to change your bad habits into good habits and over time, your back (and overall health) will thank you.

  1. Sanchez-Zuriaga, D, Adams, MA & Dolan, P. (2010). Is activation of the back muscles impaired by creep or muscle fatigue? Spine. 35(5):517-25.

  2. Page, P. (2005). Muscle imbalances in older adults: improving posture and decreasing pain. The Journal on Active Aging. March April 2005; 30-39.

Dr. Elisabeth Miron

Looking for a chiropractor in North York? Visit my chiropractic website!

Why Posture Matters

It always amazes me how many people have postural imbalances and don’t even realize it! Many of them wonder why they have neck pain, back pain, headaches or general soreness without having any form of injury or trauma. A lot of the time, these problems are a direct result of irritation to muscles, joints or nerves from chronic, uncorrected imbalances in the body. Allow me to explain…

Some of the most common postural imbalances that I see are forward head carriage, excessive spinal curves, uneven shoulders or pelvis and scoliosis. These imbalances can arise from many different things such as daily activities, slips/falls, inactivity, daily stress, one-sided activities (such as golf or tennis) or poor posture habits (such as slouching). Posture imbalances can also sometimes originate at the feet which serve as one’s base of support. For example, if one or both arches collapse, it sets up an imbalance that will affect the alignment of related joints (like the knees, hips and pelvis). Everything is connected! In any event, body asymmetry over time can lead to uneven wear and tear to the body which can contribute to arthritis, muscle tension and tightness/restriction in spinal joints.posture types

It simply makes sense that a body in balance will feel better, heal better and function better!

A Healthy Spine = A Healthy Body.

Standing posture, sitting posture and dynamic postures are all important. Inappropriate body posture/position while lifting, for example, can result in injuries.

Posture is a like a window to the spine. If your posture is off, so too is your spinal alignment.

Regardless of pain or symptoms it is important to have your posture imbalances and alignment corrected as a form of spinal health maintenance and overall wellness. You don’t have to have pain to have a problem and a lot of the time these asymmetries can be corrected before chronic uneven wear and tear results in pain. You only have one spine! So take care of the one you have! Regular chiropractic checkups can prevent problems before they start just like how regular dental cleanings can prevent cavities.

The great news is that many posture problems can be corrected or drastically improved with chiropractic care. Chiropractors use hands-on adjustments to correct the alignment and mobility of the spine, pelvis and related joints such that your body regains its mechanical and neurological balance. Soft tissue therapies and home exercises may also be incorporated into your care plan depending on individual needs.

Achieving mechanical balance is only half of the chiropractic story. Chiropractic care also helps to balance nervous system function. Spinal health is so important because it protects the nervous system which controls and co-ordinates every system and process in the body. For optimal health, we need optimal communication in the nervous system. This can be achieved by optimizing alignment of the spine.

Regardless of pain or symptoms, everyone should have their spine checked. Chiropractic works.

The doctor of the future will give no medicine but will interest his patients int he care of the human frame, in diet, and in the cause and prevention of disease.” ~ Thomas Edison

Health is a lifestyle choice. Choose it. Make Chiropractic care a part of your healthy lifestyle.

Dr. Elisabeth Miron

Headaches – Tips for Management & Prevention

headache tips

Headaches are a complicated subject because there are many different headache types and there are often many factors involved in their development (often, there is not one single identifiable cause). This article serves as an introduction to the topic of headaches with some tips about management and prevention. More information about headache classification can be found on the International Headache Society website.

The most common type of headache, responsible for ~90% of all headaches, is a tension type headache (TTH). Pain quality is described as a tensor band squeezing the head, bilateral across the temples and/or around the base of the skull. TTHs, along with a few other headache types have musculoskeletal components to their etiology. For example, tight muscles in the neck and shoulders and the joints of the neck and jaw can refer pain to the head. Overall posture and especially head carriage can be responsible for the development of joint irritation and muscle tension that results in headache development.

Management and Prevention Tips:

  1. Have a proper evaluation:

    Most headaches are benign in origin but having a proper diagnosis is important because the management may differ. In addition, certain “red flags” may indicate a pathology that must be taken seriously. Make sure to consult with a healthcare professional if the headache is severe, different from your typical headache has an abrupt onset or is associated with trauma, neurological signs, fever, other unusual symptoms or if you have concerns.

  1. Create a headache diary:

    If you have headaches frequently, creating a headache diary may be beneficial. This will help identify your possible triggers such that you can avoid them. Jot down what you were doing, eating, drinking, feeling, the type of environment you were in, the quality of your sleep, and amount of stress you felt during the 24 hours prior to headache onset. When you see a health professional about your headaches, you can also discuss your headache diary.

  1. Avoid headache triggers:

    Once you establish your headache triggers, you can try avoiding them. Some common triggers are food sensitivity / allergy, coffee, alcohol, stress, dehydration, loud sounds, bright lights, hunger and poor sleep. Wear sunglasses if bright light triggers your headache.

  1. Improve your posture:

Headaches are often associated with posture – especially head carriage. Having optimal posture reduces the stress on muscles, joints and ligaments that can otherwise refer pain to the head resulting in a headache. The biggest culprit is the forward head carriage where the chin and head jut forward relative to the shoulders. The muscles of the neck must work harder and tense to counterbalance the weight of the head (which is like a bowling ball sitting on your neck). Forward head carriage is common in students and office workers who slump forward at a computer for hours each day. Loss of the normal curve of the neck may also be associated with headaches due to joint irritation. A chiropractor can provide you with specific exercises for improving posture and advice regarding office ergonomics.

  1. Exercise regularly:

Regular cardiovascular exercise is good for overall health and stress relief.

  1. Stop smoking:

Smoke may be an allergen that triggers headaches. In addition, nicotine has an effect on the vascular system and the vascular system is thought to trigger certain types of headaches – especially migraines.

  1. Reduce stress:

Overall stress reduction may help headache sufferers. Take some time to enjoy hobbies, socialize and exercise so that there is balance between work and play. Some stress relieving activities include yoga, thai chi and meditation.

  1. Regular sleep pattern:

Getting enough sleep is just as important as maintaining a regular sleep-wake cycle. There are natural fluctuations in the body – for hormone levels, sugar levels and enzyme levels – which are influenced by sleep-wake cycle. These are know as circadian rhythms. Disruption of circadian rhythms may be responsible for headaches in some people. As far as quantity of sleep goes, the typical recommendation is 8 hrs of uninterrupted sleep per night. The best sleep positions for the back and neck are on your back or side (never sleep on your stomach).

  1. Find a cool dark place to nap:

Sometimes when a headache hits, the best thing to do is to lay down and let the headache run its course.

  1. Apply cold or heat

Applying a cool, moist cloth across the forehead or base of the skull can be especially good for relieving headache pain.

  1. Visit your chiropractor:

As previously mentioned, headaches are often associated with tight muscles and dysfunction of joints of the neck or jaw. Regular spinal check-ups and adjustments as part of a wellness plan help keep headaches at bay in many people. Chiropractors are also trained to identify red flags associated with headaches and to refer accordingly if necessary.

  1. Other:

Other natural methods for headache relief include acupuncture and massage therapy.

Headaches can be significantly disruptive to everyday life. I hope these tips have been helpful.