Anton, Alberto (farioreo), and others have asked how many "sets and reps" of exercises and stretches will help. The answer is in a story my Mother told me when I was small:
A young boy in school always made the same mistake in English. Instead of the proper, "I have gone…" he said, "I have went." The teacher told him to stay after school and write 100 times on the chalkboard, "I have gone, I have gone, I have gone…" The boy wrote "I have gone" the required 100 times. When he finished writing, he saw the teacher had stepped outside. He left her a note, "Dear Teacher, I wrote "I have gone" 100 times, and now I have went home."
The answer is that repetitions are not the entire answer - you have to understand and use the result. I am asked the question so many times of how many "reps" (repetitions) of a rehabilitation or training exercise are needed, that it has become a "light bulb" joke - How many (whatever) does it take to change a light bulb?
Readers ask:
Q. How many sets and reps of upper back exercises does it take to straighten rounded forward posture? A. None, you just straighten up right then and hold it. A2. Or you can say one repetition is enough. Then use that one all the time. A3. Or until you actually use it - Note the person slouching (photo right) to measure posture.
Q. How many sets and reps of back exercises does it take before my disc pain stops that I got from bending over wrong to pick up things. A. None if you stop bending wrong to remove the cause. A2. A whole lot more than if you stopped bending wrong.
Q. How many sets and reps of good squats with heels down does it take to get enough stretch in the Achilles tendon to be able to squat well? A. Doesn't matter, if you use good bending in your ordinary day, you will get hundreds of Achilles tendon stretches throughout the day and it will be built in for you. You aren't supposed to stop your day to do a number of repetitions, then go back to heel up squatting, or bending over wrong.
Q. How many sets and reps of squats does it take before I can squat right to bend right? A. Until you do it right.
Q. How many sets and reps of your exercises on Fitness Fixer should I do? A. Until you remember them.
--- Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
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Photo of slouching while measuring posture by Neeta Lind
This weekend we will attend the Black Belt Hall of Fame event hosted by the Eastern USA Martial Arts Association. Paul and I are honored to be invited back this year, and receive awards for Instructor of the Year. I will teach a workshop on Stretching Smarter for Martial Artists.
Why stretch smarter? Many standard stretches work to increase flexibility but don't improve martial arts or other sports, and aren't good for the joints.
Martial artists and other athletes often develop injuries from years of bad stretches. It's understandable to put yourself in harm's way to carry children and elders from a burning building, or suffer cold and hypoxia rescuing a stranded mountaineer. It's silly to injure yourself doing stretches and exercises you think are for your health. In martial arts you can harden your body to withstand blows through difficult and uncomfortable training, but it isn't the point of martial arts or other sports and activities to beat up yourself. I cover the difference between toughening the body and injuring it in the seminar and in my book Healthy Martial Arts.
My workshop teaches functional flexibility - changing your body to work better in real ways needed for daily life and fighting arts.
The hall of Fame event is by invitation only. Contact:
Executive Director Soke Kanzler Eastern U.S.A. International Martial Arts Association 1 (800) 456-3872 EUSAIMAA@aol.com P.O. Box 9642 Pittsburgh Pennsylvania 15226 USA
Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer - Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Forward Air Head Syndrome - Doing Sets and Reps and Missing The Point of the Exercise
Thursday, October 22, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
After the article Help Yourself last Monday, I received many notes from readers. Almost a dozen the first few hours. Notes saying that that once they understood how my method changes "doing" exercises into stopping causes of injury, they tried to help their friends who had pain. The friends turned their generous help back into the party line of doing sets and reps of stretches and exercises, then returned to habits that recaused their injury. They missed the greater point of using the retraining after the reps stop - during actual real life.
One reader wrote how he explained to his friend about the cause of degenerating discs and vertebrae of the neck. His friend was constantly jutting the neck forward - a painful posture called a "forward head." The friend protested that he had a disease of the facets, the joints of the vertebrae. The reader explained that damage to the facets was caused by the bad posture called a forward head. The friend insisted he had disc deterioration and bulging. The reader explained the cause was simple bad posture called a forward head. The friend agreed to try my method, did a few stretches mentioned in part of one of my articles, then went back to their forward head posture, and complained that the method didn't work because pain returned. He wanted to know exactly how many and which other exercises to do and how long it would take for the exercises to work.
Check some of the comments to certain Fitness Fixer articles. Some commenters miss the point that the stretches or exercises may help you feel better for the moment (and if they don't then you are doing them wrong) but you must change injurious movement habits. Prevent tilting your hip and use neutral spine instead when you stand and walk, to prevent lower back and SI pain. Stop craning your neck. These are voluntary actions that need your brain to work.
Reader Paul J wrote this accurate assessment:
"The Department for Silly Syndromes has determined that Forward Air Head Syndrome is closely related to Cerebral Detachment Syndrome that occurs in patients that read the writings of Dr. Bookspan.
"The patient knows how to read and understands words; however after reading Dr. Bookspan’s writings, a detachment in the cerebral cortex seems to occur often affecting the patient’s ability to think and type. The patient exhibits some of the following symptoms:
Writing questions to answers already given in the original text,
Writing questions to answers already given in previous articles
Writing questions that are not congruent.
In mild forms, the patient will read some of the information, do some stretches, and expect complete results.
"The recommended treatment for those suffering from CDS is to watch the movie* ‘What About Bob?’ This may not cure CDS however it should temporally delay the effects of CDS."
(*In the movie, a psychiatrist gives his nice but overanxious patient a book, to understand and solve his own problems. Instead, the patient drives the psychiatrist insane with repeated unneeded questions (and did his previous doc in with the same).
Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Reps of Exercises Don't Fix Pain; Fixing Causes Does
Monday, October 19, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Monica from Montana bent over dogs daily in her dog boarding kennel. She spent the summer doing stretches, exercises and going to chiropractors for severe back pain. She did all her "sets and reps" (repetitions) of the exercises her various practitioners gave her. The pain kept coming back. What did she do differently that stopped this cycle?
I first heard from Monica through her short happy note:
"Thank You!! So much. I've had quite the drain of lower back pain the whole summer. Finally I got online and read your article and have now begun the fast road to recovery. The first day I did have relief. Now it's been three days and I can't stop talking about how good I feel. Today I drove six hours and was still comfortable! "Thank you again, "Monica "Montana"
I wrote to thank her for using my work as intended and taking time to tell me. She replied:
"Hi Dr. Bookspan, "The whole summer of 2009 was plagued with lower back pain, I thought due to raking pine cones. I did my usual routine. Going to the chiropractor. Doing stretches (the wrong stretches) all day long thinking they were giving me relief and come to find out by reading your website I was re-injuring my back over and over by doing these improper stretches of bending forward. When I found your website it all made sense so I immediately implemented your instruction and what do you know I immediately started feeling better.
"The pain did not all go away over night, it has taken time to heal, tolerable time thank you. At the end of August I wrote to you saying thank you. It is now the first part of October and the lower back pain is pretty much gone.
"When the pain makes an appearance I immediately pay attention to body position and it (the pain) goes away. I also suspect the chairs I use at work were a part of setting me up for this injury. The chairs are like saddles to "help with upright posture." The molded hard part of the back of the chair is protruding to where it was subtly pushing on my tail bone I've now realized. I think that's a part in why the injury was so low in my back. Plus I think the saddle part of the chair had been affecting my hips. This has taken some time to realize I was so used to these chairs. This whole combination has caused quite a bit of pain and discomfort but due to your website I started looking at all of these things and am reaping the benefits.
"Thank You Dr. Bookspan! You are a bright expression of this essence we all are. The essence of compassion, clarity and skillful means. "Much Love, "Monica
Thank you Monica, for lovely writing.
I wrote back to Monica to see what, specifically, she found helpful, and make sure that after time, she remained pain free, had her life back, and could do more than before she started using my work. To help readers, I make sure these reader inspiring stories are tutorials, not just testimonials. For new readers who have not previously heard of fixing causes rather than doing a few sets and reps of exercise and stretches, I ask success story writers to include specifics.
Monica continues with two commonly prescribed forward bending stretches that add to a common source of pain, rather than fix any problem:
"The main (wrong) exercise I kept repeating over and over was to sit in a chair, bend forward with arms between my legs to stretch as much as I could. This would make my spine move as if straightening - I thought. I also found that bending forward over the front knee created a stretch that would make my spine move. I realize now this was not a good thing."
She also described habitual body positioning that are classic contributors to pain. Even if you do all your sets and reps of exercise and stretches, if you don't prevent these causes of pain, you won't stop the resulting pain:
"My habits have been to let the bottom of my pelvis bend back at while sitting or standing. You know the "butt out" posture. While walking, my feet tend to face outward too. I've now been more conscious to keep my feet square and tilting the bottom of my pelvis forward to give my spine more support. Works like a charm.
"For real life bending... The first thing I do in the morning is go feed dogs in my dog boarding kennel, so in order to pick up bowls and put them back down I now bend my legs instead of bending over using my back. I try to keep my heels to the ground and come up easy while I'm still gaining strength to take care of my knees. My legs have adapted quickly. I bend using my legs all day long and really try to take care of my knees and back.
"I hope this helps someone. "Warm Regards, "Monica"
If You Have Questions How To Do This For Yourself:
Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Fast Fitness - Contest: What Does It Take To Sit Upright?
Friday, October 16, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - a Contest!
Conventional beliefs about posture include that you must do certain exercises or stretches or strengthening to change your posture. Is that true?
Look at photo 1 and 2 and answer the simple question below:
Photo 1
photo 2
Submit Your Answer:
What muscle strengthening or stretch is required to change from first (unhealthy rounded) to second (upright) sitting?
Name the muscle(s) and action needed - don't just name a muscle, say which way it needs to pull.
Explain why the same people (with the same tightness or weakness) who sit with the lower spine rounded forward (flexion) often stand with the lower back overly curved inward (hyperlordosis) - just the opposite.
Disregard the leg position in the two photos - the question is not how to move the leg, those were just the two photos I could find. Focus on describing how to change yourself to upright sitting without moving the leg (why? if you need to move the leg, then you are too tight for basic health. This question is how to restore that basic).
Use your brain. Partial credit applies. I will post answers, explanations, and winners.
Hint for success:
Sit and try it yourself, don't go only to anatomy books.
Read inspiring success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more (answer to this quiz too) in Dr. Bookspan's Books.
"It reminded me of a conversation I had yesterday with one of my neighbours. She is 71, very much overweight and is in a lot of pain. She has been receiving physical therapy for the last year. Not having much success she asked her doctor to refer her to a specialist. The results of her x-ray show that she has 2 herniated discs. She also has arthritis plus her lower spine has a curve.
"I mentioned your name and said that herniated disks can heal. I showed her how to stand with a neutral spine. She did not want to know. You have probably come across people like this time and time again. The way she spoke, she wants to have surgery. I was horrified.
"What could I do???? Sadly, I walked away.
"Over the years, she has complained about her weight. I have tried to help in a nice way. How can one help a lady who sits all day long watching TV, eating. So sad. One has to help oneself."
Mindset alone can't fix pain. You can want something until you are blue in the face, but that will not change what happens. You need to do the steps needed. It's also sometimes hard or impossible to do the steps on your own, and a little help is needed. A flame can't ignite on its own.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Fast Fitness - BIPOD Reader Prescription for Healthier Feet
Friday, October 09, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - BIPOD is a way to happier feet that you can do yourself at home. Reader Paul J sent in this gem in July. Other great work from him and other readers are still in the piles of mail.
For background: A shoe insert is any pad of any size, shape or quality that you put in your shoe for various reasons. Hard shoes are a common course of joint pain. Many shoes benefit from better cushioning and even a cheap soft insert for cushioning purpose can help that. Orthotics are different. Orthotics are hard shapes, specially fitted by a trained orthotist or sometimes a physical therapist with orthotic training. Orthotics usually cost a few hundreds of dollars. Orthotics are rigid forms to hold your feet in a specific position. There are also hard inserts with molded arch or other area advertised to change your foot posture. Sometimes orthotics and hard inserts make more pain or don't change the source of the problem. Most of the time, for non-paralyzed people, if the orthotic can make your foot change to a healthy position, you can do the same using your own muscles and sense of positioning. Using your own feet and ankle muscles is often healthier, more comfortable, and more likely to yield long term results.
Now Paul J's intelligent prescription:
"Bookspan Invisible Pain-free Orthotic Drops - BIPOD. Now you can walk, run, or stand without the pain of traditional hard orthotic inserts. BIPOD will revolutionize the way you stand. Read and follow product instructions, failure to do so will render this product ineffective. Attempts to walk, run, or stand without BIPOD is not recommended by our accountants.
"In order to reduce the burden on landfills, please follow the directions below to make BIPOD at home. You must use your brain and following all directions in order to get DHMO and CS (see above).
Ingredients: one tablespoon of cold tap water one tablespoon of tap water from hot tap, before it gets hot.
Mix for 4 seconds in a container that can hold 2 _ tablespoons of liquid.
"The left over mixture maybe placed in the refrigerator for later use or discarded in most plants."
Remember - get the point of healthy practices. Don't get bogged down on purchasing exercise machines and expensive devices that reduce your own body's involvement in your life, or trivial details of exercise "form." Get the big picture of easy healthier ways and enjoy improving your life.
Many readers' great stories are in the piles. Remember to read the instructions and concepts in articles on fixing pain first before asking what to do. Gain the benefits and better health and send in that story. Then we can all enjoy more instead of taking time plodding through and answering reader comments of, "I read your work on how to fix neck pain, will your stretches work?" and similar instances of missing the point. Would anyone help Hannah (or Cheryl?). She left the 36th comment asking if the stretches work on Fixing Upper Back and Neck Pain, which had already explained, along with the 35 questions and replies already there. Thanks!
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
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Image of helping feet with brains by "lapolab" via Flickr
Tracking problems have several names: Lateral Facet Syndrome, Chondromalacia, Anterior Patello-Femoral Pain Syndrome, Lateral Pressure Syndrome, Malalignment Syndrome, Maltracking Syndrome, Patello-femoral Degenerative Arthritis, and other scary names. It is not a disease or a syndrome or that you are doomed to arthritis, but usually a simple injury process that can be stopped.
Instead of surgery, you can stretch the tight side area and retrain the weak area, so the kneecap slides normally instead of grinding sideways in its channel. Stopping causes stops need for surgery, bracing and pain pills. The knees heal and you go back to all you want to do, using the new healthy mechanics.
What can you do when pain continues after physical retraining? Captain Scott wrote that he had been to physical therapy for his knees "for a few months without much success." He had previously endured ongoing treatments for back pain, then discovered Fitness Fixer methods and resolved the pain. He came back to see if he could do the same for his knees.
Kneecap tracking should begin normalizing within days of stopping causes - far sooner than "a few months." If not, one obvious thing to check is if you have the right re-tracking stretches, exercises, and functional retraining. After that, here are four common reasons when PT does not "work."
Tracking Exercises That Don't Fix Tracking. A common PT scenario is doing 10 (or however many) repetitions of straightening the knee against resistance of a stretchy band, called "terminal extensions," "setting" exercises such as squeezing things between the knees, stretching the lateral (side structures), and small leg lifts with ankle weights to strengthen inner thigh muscles (VMO)s. Without retraining gait and knee use during real life movement, the person often gets up from the PT session and walks away and goes back to their activities with the same poor tracking. PT needs to look at and fix specific use during real life activity - do you turn your knee inward or your feet outward, do you let your foot flatten, do you let your upper leg bone rotate. Also, weight or resistance used is often far less than what the knee encounters when the person stands up and uses their knees to walk away from their exercise session. Tracking angles should monitored during rehab. Not just during standing or during leg lifts, but during the patient's customary activities. If they are not changing, and they are the confirmed cause, then you may not be changing tracking.
Are You Sure It's a Tracking Problem. Knees can hurt for other reasons. You can go for the best re-tracking programs, but if your knee does not have an actual tracking problem, it is no mystery when tracking exercises do not help. You have not spent time fixing the cause. Make sure that tracking is the reason before treating for tracking. Tracking can be identified with specific patellar x-rays or other scans that can clearly include position during several points of motion. Tracking also can be visualized - look at kneecap path during quadriceps use during several kinds of movement. The kneecap slides up and down obviously under the skin at the knee during use. There is a variable degree of normal angle at the knee. Human legs are not straight from upper to lower leg. That angle at the knee allows us to walk upright on two legs in a smooth gait. The angled knee is one of many markers that tell forensic scientists and anatomists if the leg bones they are looking at are human. Sometimes a normally tilted kneecap slide is misidentified as a tracking problem when it is a normal angle in line with the joint.
Multiple Causes. Sometimes tracking mal-alignment is confirmed and rehab done. The patella tracks normally and stops wearing the area, but pain continues from other causes. No mystery. Check for other poor knee mechanics that cause injury. Check if your shoes are too hard. Many people paying for "good supportive shoes" get knee pain from the hard shoe. Often the pain from bad shoes is sharply outlined around the kneecap with deeper aching. Check your bending. If you have pain with knee bending (squatting), fix that. Fitness Fixer articles summarize and my books detail more.
Medicines that Cause Pain. Whether you have tracking problems or not, common prescription medicines cause pain that does not respond to PT. Look into stopping reasons you need the medicines in the first place, and save yourself time, money and pain.
My idea of health care is a quick, straightforward assessment of causes and intelligently addressing them. That beats having someone stick a knife in your knee and charging you for it.
Health&Fitness in Plain English THIRD edition - How to Be Healthy, Happy, and Fit for the Rest of Your Life. Both available from www.DrBookspan.com/books.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. LimitedClass spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Reader Robert Davis sent a well-written summary in last Thursday's Healthy Aging Starts Now. Here he adds about our view of aging, and improving physical skills as years pass rather than letting them slip away from lack of use:
"I forgot to mention to that this stuff has helped my instrument playing as well! Sitting straight up and relaxed makes execution of difficult passages so much easier. I used to unconsciously tense up sometimes and it made it harder for no reason. Things just seem so much easier relaxed =P
"I think aging in America is a plague the way it is viewed. I dunno if I made a good point or not (Thursday's Part I) but it seems to me that aging has a warped sense of reality to it in our country. Easy example is I was watching a clip from a dancer (pop dancer) who was in her 40s. Someone made an off the wall comment - "Well she does really good for being 45." But what does her age have to do with it.
"I just realized lately that you see this "plague" of thought that seems to be culturally conditioned that says by a certain age we should be degraded and unable to "do" things. This is how people think and it seems this is how the medical fields think. All I can think of when I see this plague is people in other countries going up and down mountains in flip flops or bare feet at all ages. Activities that would really poop out an average American, they do with ease.
"I get frustrated that we as a nation have the mentality that we must decline when you have shown me this is not true. I used to believe it, but when you turn your head slightly and see it from a better angle, it is not true. It is our lifestyle and habits that degrade. Not our age:) Change the habits, like you say and say over and over again. Why can't people see this?
"Ok I am all worked up lol.. This is why I have considered trying a different field more like yours! I am still considering it."
Mr. Davis has been making great gains in his weight lifting and healthy life using my work after first writing last year to learn how to fix a back injury from lifting. He previously sent in photos practicing various retraining drills by propping his cell phone set on timer against a paper clip and other impromptu devices. I asked if he had update photos of his progress. He replied that, "the phone that had the camera had decided to test gravity and never came out of it :( "
With his can-do ways, I think he will be sending more of his success stories. Click the label 'readers inspiring story' for many readers' stories of using my work to fix injuries and get their life back.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Robert Davis, frequent Fitness Fixer success story contributor, wrote to me with observations that will encourage, educate, and help many -
"I am beginning to see an almost "plague" in our society. That plague is auto-assumption that age automatically will start to equal degradation of your body."
Mr. Davis, a young lifter, had first left a comment to a Fitness Fixer article last year asking about fixing his back injury from weight lifting. His success stories came in frequently from there, telling how he gained better health and ability than before his injury. In a recent update letter to me, he sent these insights:
" I have not mailed in a few months. However I did not want to forget what got me back to what I love. I have had no issues with my back for months now. It went from dreadful to move, to better then ever.
" It is all so simple once it becomes ingrained. At first it does seem to be a chore learning to (bend right with a lunge and) squat and all the other things to correct bad habits. However these things, with conscious repetition, become habits. No longer do I have to think about healthy movement!
" This has been beneficial not only for my back, but for all areas that were troublesome. The more I loosed up, bent correctly, and used movement correctly, the more minor problems just seem to fade away!
" I have a new mantra when I workout with weight. It is called "on the muscle" chant. Every exercise I perform I say this in my mind and concentrate all weight on the muscles (instead of making it easier by shifting weight to joints). If I feel it is too heavy and I am doing some joint crushing, I back off the weight. I do not lose anything backing off. I gain something. More strength to do the same "on the muscle". In sum, I have really really chosen healthy movement over getting in an extra few pounds with "joint/arch or whatever" assistance. It is not worth it. You will get it eventually "on the muscle!"
" One sad thing I am noticing though lately after going thru stuff myself is this. I am beginning to see an almost "plague" in our society. That plague is auto assumption that age automatically will start to equal degradation of your body. I grew up as a pre-teen/teen in the late 80s and into the 90s. I never remembered regarding people who were much older as limited. I think this phenomenon is a cultural condition based on no facts, and the massive influx of pharmaceuticals. I could be wrong but that is what I see.
" I am amazed at all the people I run across in the gym who are told to "not do this or that". I often think of my grandfather and the time period he grew up in. He was very active and working under cars and whatnot till a few months before he passed away. No one told him his age would hamper that.
" I could go on and on about this but I think particularly in America, we are in a self created plague where age is a bad thing and something to postpone. What little do people know is that healthy movement, awareness, and lifestyle help one get thru all this without having to stop what they love.
" Look at me. From a debilitating back injury to returning to what I love to do - "lift weights in the gym." I was skeptical I would have ever made it back when I got hurt. However I am kinda glad now I did get hurt as sometimes there is a gem inside what otherwise would seem problematic. That Gem was learning (from you) how to do what I love to do without worry of age or injury ever detouring me from that. I am in my mid 30s now and plan to stay on top of myself with your methods for as long as I have a passion for this(and I feel that is a very long time). After all I see the body builders in the 70s and am truly inspired to keep going.
" Thank you! I also wanted to just check in and give a little insight of what I was doing and my thoughts on things =P "Robert Davis"
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Three years ago, Merlene's closest friend died. Merlene, who is 74, lost all motivation. Because she was not exercising, she gained a lot of weight. This is where Ivy came in...
Ivy from New Zealand, frequent success story contributor, wrote me in August about her neighbor Merlene:
"You will be pleased that I have a new lady under my wing so to speak. I lent her your book "How To Fix Your Own Pain Without Drugs Or Surgery." Along with giving her advice she tells me that it has changed her life which pleases me."
I wrote to Ivy to ask her if Merlene would be comfortable telling us more on what she did, so others could try it too. Ivy replied:
"I encouraged her to walk again. At first it was difficult, she had difficulty breathing. I noted that she was walking flat footed and taught her to lift her toes. She complained of back pain - I showed her how to lie on her stomach and lift herself up on her elbows before getting out of bed in the mornings. She has now learnt to put her spine into the neutral position. Re her breathing, I showed her how to breathe deeply. She told me that she rolled her neck every day in a circle - she now does the trapezius stretch plus pectoral stretch instead.
"Instead of bad bending, she does squats and lunges while making the bed, doing the vacuum cleaning, going to the fridge and the like, plus gardening.
I checked in with Ivy a while later to make sure all was still improving, and gave her questions to ask Merlene so I could make sure all was well. Ivy wrote again:
"Today I visited Merlene and asked her some questions. She is stronger, breathing has improved, she is more flexible, can walk further, the back pain has improved immensely. She hasn't weighed herself yet, however, is hoping that there will be a weight loss when she weighs herself next week.
"She finds your books "How to Fix Your Own Pain Without Drugs or Surgery" and your Stretching Smarter book very helpful so I left them with her so that she can refer to them.
"She also tells me that your books along with my help and advice has changed her life for the better. She has lost that negativity and feeling positive about life again.
"Merlene is a very quiet, private lady so I try to treat her in a gentle way. She comes from another country and I gather that life has been very hard. She is so enjoying what she is doing. Most important is the fact that she trusts me plus she is very happy you are doing this article.
"Merlene is happy for you to use her name. Re the photo and title (of the article) she would rather it was your choice. "Hugs Ivy "
How to Fix Your Own Pain Without Drugs or Surgery and Stretching SmarterStretching Healthier, and others, on www.DrBookspan.com/books.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Teachers, coaches, parents, babysitters, trainers, and others have asked me for retraining drills to do with their sports teams, exercisers, and regular school classes.
I will start a series of short articles, one topic per article.
Each will have short instructions that work for group training.
Teams can practice them before each training session, or incorporated into their other exercises.
These will be retraining exercises that school teams and athletes can use to reduce sprains, knee pain, back strain, and other common musculoskeletal issues that arise during the team season.
Each topic can be taught in a short lecture, hopefully within 1-5 minutes, then everyone can try the drill.
This new curriculum is part of the Academy of Functional Exercise Medicine (AFEM)'s Youth Division programming. If your team is changing to healthy ways, you can be a part of this program, which includes certification, awards, teacher training, and other fun - click Academy. There is no charge to participate. This is for health.
Send in your ideas for a name for this program. Trainers, send in your stories of how you use them in your program.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
"Thanks so much for your help. "I wanted to let you know that I have had a herniated disk in my lower back for eight months. Had physical therapy & injections, but still needed medications-pain pills, etc. I never experienced so much pain in my life. I came across your website & articles & starting doing what you recommended, & within days I have been feeling great & have reduced the pain medicine because I don't need it.
"I know now that I was doing the wrong exercises in the past- too much bending forward & back. Didn't really know that this exercising technique (bending, stretching forward, arching) is incorrect. It sure is!!!!
"I really like the hamstring stretch - putting your leg on the wall. This is terrific. I feel so MUCH BETTER....
"Also, when you get copies of the Abs book, please let me know. "Have a great day Dr. Bookspan!!!! Laraine"
A herniated disc is an injury, not a condition or disease. It can heal. You do not have to live with it. You can go on to being able to do more not less.
Discs are living parts of your body, not like a tooth that once broken cannot heal. Most of the time, injured areas can heal, if you let them. Bulging areas can reduce. Dried discs can rehydrate. Each night as you sleep, discs replenish fluid. They plump back up a bit. That is part of why you are taller each morning, than in the evening. They can do all this if you stop the causes that injured them.
Doing surgery, adjustments, treatments, massage or yoga does not stop the cause of disc injury. Common exercises add to injury. Not all exercise is medicine. Then it is no surprise when pain does not stop, or stops but returns, or the next disc herniates after fixing the first one.
Changing unhealthy movement habits that degenerate discs and push them out of place means moving in healthy ways for all you do, not just for sets and reps in a gym. You can do all the "reps" of back exercises in the world. If you return to bending and standing in injurious ways all day around the house and workplace, it is no surprise that the exercises and treatments did not fix the pain.
Click the following for simple ways to stop causes of disc injury. Get the overall concepts, don't bog down on details. I see people in gyms following trivial, exacting "proper form" for exercising, while missing the whole point of healthy bending and lifting or how to apply it to general motion all day.
--- Read success storiesand contribute your own of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Prescription Acid-Reducing Drugs Produce Heartburn and Dependency
Tuesday, September 08, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
In a study of acid-suppression drugs, healthy adults with no previous symptoms developed
"heartburn, acid regurgitation and dyspepsia" after a course of the drugs. Forty percent of 120 volunteers taking anti-heartburn drugs called proton pump inhibitors (PPIs) had a rebound increase in gastric acid secretion, resulting in acid levels above their starting levels.
Study - "Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy." Gastroenterology. 2009 Jul;137(1):80-7, 87.e1. Epub 2009 Apr 10.
Gastroenterology is the official journal of the American Gastroenterological Association (AGA) Institute. A comment appearing in the Journal stated, "Evidence that proton-pump inhibitor therapy induces the symptoms it is used to treat." Gastroenterology. 2009 Jul;137(1):80-7, 87. McColl KE, Gillen D.
PPI drugs for gastrointestinal symptoms is widely prescribed. Study authors stated, "This might lead to PPI dependency and thus have important implications."
In the previous Thank You to Grand Rounds, I noted that several prescriptions drugs are known to cause the problem of increased symptoms, rebound, or the original problem - Thank You Grand Rounds 5.50, Medicine & Technology.
It is becoming known that these drugs also do not target the source of the problem, so may not be needed. It does not seem necessary to start a course of drugs that perpetuates your symptoms. The Fitness Fixer article Stomach Acid Drugs Increase Osteoporosis and Hip Fractures explains more.
--- Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Read and contribute your own success stories of fixing life with Fitness Fixer methods. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Here is Friday Fast Fitness - Save your neck while biking, while drinking from a water bottle while biking, and get a needed upper back stretch at the same time:
Main concept - your neck is not a Pez dispenser. Don't tip and pinch back at the neck to look upward to drink or look forward while riding.
Notice if you jut your chin forward and upward to drink or ride.
Instead, extend upward through your entire upper back. Keep your chin fairly still and see how much upward range you can get from your upper back. Instead of rounding the upper back forward, you get a nice straightening stretch.
Craning the neck (pinching backward at one joint) and pushing the chin forward, pinches and compresses your discs, joints of the neck bones, the soft tissue, and nerves.
To help remember good biking form, I put a reminder on a healthy water bottle. Keep your exercise healthy. Click AcademyGifts or the image to order.
--- I make posts from fun mail and success stories. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
Wednesday, July 15, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Three years ago, I started a series of Fitness Fixer posts about the extensive phenomenon of muscle, joint, and body pain occurring from common prescription drugs. The editors at that time asked me to defer writing about it. I have been watching the medical reports grow, substantiating the numbers and secondary problems of chronic pain from common medicines. This is a short summary, with more coming this summer.
Major side effects of body and muscle pain from common prescription drugs are not rare as once thought. Misdiagnosis of this pain is common. Unnecessary treatments, surgeries, and more drugs are often given. Exercises and stretches do not stop body pain from drugs:
Statin drugs for cholesterol are a frequent cause of muscle and joint pain, and sometimes, numbness or tingling in the fingers or toes
Common prescription drugs for anxiety and depression. Even though this class of medicines may be prescribed for nerve pain, they can cause nerve and muscle pain as side effects
Ritalin (methylphenidate hydrochloride) and related drugs
Some prescription allergy medicines such as Allegra (Fexofenadine)
Prescription acid prevention medicines called PPIs - proton pump inhibitors (Nexium, Prilosec, Prevacid, Zoton, Inhibitol, and others). PPIs have also been shown to greatly increase risk of hip fracture
Erectile enhancing drugs
The calcium channel-blocker drug verapamil
The antibiotics erythromycin and clarithromycin
Some HIV medications
Prescription medicine for constipation like Zelnorm (Tegaserod), irritable bowel, and others digestive complaints.
Migraine and headache prescriptions
Medicines for fibromyalgia
Even many medicines for pain, sadly have pain both as direct side effects and rebound pain, increasing drug dependence and pain cycles
There are several more prescription drugs that cause more problems than they relieve. List your additions in the comments below.
Often the need for the original medicine can be stopped with simple healthy changes. Motivated people can address and change the original problem, making their life better and more active than before instead of paying for more medicines and the problems that come with them.
Two of my books teach how to fix pain and mention specific drugs and what to look for:
Fix Your Own Pain Without Drugs or Surgery. Each chapter on each kind of pain gives a list of drugs that are known to cause pain.
Health & Fitness THIRD ed - How to Be Healthy Happy and Fit For The Rest of Your Life. Several chapters include drug information pertinent to the condition covered, plus several chapters on general health, offering many ways to avoid needing the original medications.
--- Questions come in by hundreds. I'm bailing the ocean with a bucket. I make posts from fun mail. Before asking more, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
How Effective Are Medical Treatments For Back Pain?
Monday, July 13, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Many well-known conventional treatments for injured athletes and military personnel came from ways to keep wounded combatants able to continue fire, not to maximize their long-term survival or later health.
Years of my career laboratory research was improving physical training for athletes and military, and developing injury protocols that were healthy, not just a remedy for the moment. I also found that much good sports medicine for athletic motion was never applied to the more common body motions needed all day. Not only can the athletes benefit, but everyone else. Many patients and readers have success using my improved non-surgical methods, and write us their stories (click for reader stories). Many more have success without writing about it. Other readers asked about various medical (surgical/drug) treatments, and why don't I use them.
Thank you to my colleague Fabrice Czarnecki. M.D. emergency room physician, for sending me a report, recently published in a prestigious medical journal. The work was a systematic review of the "benefits and harms of nonsurgical interventional therapies for low back and radicular pain."
The medical methods they looked at were local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleolysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation.
Their results: "For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies.
What does all that mean? They summed it up in their conclusions: "Few nonsurgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials."
Report name: Nonsurgical interventional therapies for low back pain: a review of the evidence for an American pain society clinical practice guideline. Published in Spine. 2009 May 1;34(10):1078-93.
Medical reports on these methods (as well as general strengthening exercises) frequently show what is called a scattershot success - meaning if you try it on hundreds of people, it's bound to hit a few of them. Often these hits (moderate improvements) are about the same as chance or as time passing and the person heals on their own over the weeks of the treatment and recovery. Use those medical treatments if you believe in them and prefer them.
I prefer a direct approach:
Instead of shots to anesthetize the area, or surgery to remove or fuse an area, retrain movement to be healthy so that you no longer injure the area and it can heal.
Instead of medicines to mask the damage you cause, stop the damage.
Stopping damage does not mean stopping movement, activity or fun. Use healthy body mechanics to become able to do more than before.
Questions come in by hundreds. I make posts from fun mail. Before asking more, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
An old sports medicine joke says that if you pull a groin muscle, make sure it is someone else's. Here is less known info for Friday Fast Fitness - do you stretch in a way that groin pulls are more likely to happen to you?
When you lift one leg to kick, stretch, or step up, you can get the needed range from the upper leg muscles, or you can just round your back. Many people round the spine and roll the hip under (tuck too much) to make the stretch easier. They don't get the stretch from the muscles high in the leg, leaving the area tight.
In event of large or sudden kick, step, or slip, high forces pull on tight groin muscles. Varying degrees of injury can occur, or the tight area yanks the standing leg out from under and the person falls backward suddenly - seen in aerobics and martial arts classes, and funny video shows. Then the person hobbles around saying they don't understand it since they do their stretching, and articles get published that stretching doesn't work and no one know why.
Being so tight that your other leg comes forward with the lifted one, comes from bad stretching habits that allow hip and pelvis to round and tuck under too much:
When you stand on one leg and lift the other, don't bend at the knee and hip, pictured at left. Straighten your back with chin loosely in, not rounded forward. Hold pelvis upright without letting it tilt and round under you, pictured right.
Keep the standing leg normally straight (not locked straight, but not bent more than normal standing). Stand straight and relaxed (both at once). Don't force or strain. Breathe.
Feel more stretch in the front thigh and groin of the standing leg.
Check your stretching, kicking, and stepping. Check if you round your back and hip when taking the stairs, stretching while standing, and stretching lying on your back.
When lying on your back to stretch by lifting one leg, keep the other leg flat on the floor, not bent at the knee and hip. It is a myth that you must bend your knees when stretching legs to protect your back. If you must bend your knees to protect your back, how are you supposed to stand normally and move?
Prevent Stretch And Exercise Habits Promoting Tight Anterior Hip:
--- Questions come in by hundreds. I'm bailing the ocean with a bucket. I make posts from fun mail. Before asking for more, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not read and learn, then contribute! Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
Fast Fitness - Somebody Please Do My Personal Responsibility For Me!
Friday, June 26, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
A couple was buying a house. The real estate agent told them a problem with the house was that it was near the train, rumbling noisily by every night. It would take the first two weeks to be able to sleep through it. "No problem, said the couple, we'll spend the first two weeks in a hotel."
An opening line of last Friday's Fast Fitness was, "How long does it take to stop slouching, or stop herniating a disc, or stop paying money to eat food that is bad for your health? It takes as long as you want to continue injurious ways."
The letters came in. Some missed the whole point, hoping for magical externals to do it for them: " Can I use a posture brace until it works? … Is it until my shiatsu starts working? … My body worker says it takes 6 weeks for massage to make me aware of my body… My yoga teacher said the pain has to be worked through so I bend wrong to get used to it… OK, bending right does fix my pain, but every time I go back to bending wrong the pain comes back. I do the exercises 10 times. How long until the exercises work?... "
The "martyrs" blamed externals: " It is not possible to control how I stand or sit, I am fat/ weak/ large chested/ too thin to have muscles/ old/ young/ a person of privilege… You're wrong, the slouching just comes back by itself. … You're wrong I have gone to a chiropractor three times a week for years and I have to go or the pain comes back, that proves he is helping me and I can't change the pain…Another blog said to get a thousand dollar mattress and that will fix it… "
Some of the whining was comical: "You can't expect me to actually try to remember that… You're wrong, my body FORCES me to slouch… I have read all your posts and you didn't mention posture or answer readers when they asked (for new readers, you can fall over laughing at that)… Don't you know that it hurts my back to sit at a desk to read your book on fixing pain?..."
Excellent readers sent the brains: "You expect me to actually get free exercise using my muscles to make my own life better?? Congress will hear about this!… I can move my own body? Shocking!… Burn more calories, free, and be healthier and stop disc pain by sitting so that my back does not hurt? I won't, I won't, I WON'T!!!..."
The moment you bend right, you will stop injurious forces on the discs and knees. Keep good habits, and they can heal. Stop tensing your body and it will not be tight and tense any longer. Relax does not mean slouch. The moment you change to healthier sitting habits, you will be able to sit more comfortably.
No exercises, no séances, no pills, no mattresses make you bend right and stand in the kitchen preparing meals with healthful stance, breathing not grunting, shoulders back, not hunched, smiling and contented instead of poisoning your body with stress chemicals that you generate yourself through hurtful behaviors.
The method you choose to fix your injuries depends on your view. If you don't like to have it free, quickly, and in a way that uses your own body to get exercise as part of your life, then of course go to another method and comment there about your pain. It seems to be a 'sign of the times' to do pills and blame. Time for change to something healthier (if you want). This Fitness Fixer and all my other methods are for people who would be embarrassed to whine, and want direct, intelligent ways to get their own life back. Be prepared to have fun and use your brain.
Where to Start (if you want to, no one is making you):
www.DrBookspan.com/books. Read the descriptions if you want the right book for your injury or life goals. Up to you.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. LimitedClass spaces for personal evaluation. Top students may apply for certification -DrBookspan.com/Academy. Learn more with Dr. Bookspan's Books,
Weak Hips on Purpose? Running Injury and Hip Strengthening
Wednesday, June 03, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Who works their hips? Fitness Fixer success story Robert Davis wrote me several
notes that the weightlifters he knew didn't want to exercise their hip because they thought it would take away from the "V shape" they worked for.
Mr. Davis said that using my daily good bending and other functional exercise worked his hip greatly. He was pleased with reduction of stiffness and pain and increase in strength and mobility. No decrease in "V-shape."
The May/June 2009 issue of Sports Health: A Multidisciplinary Approach, published a study based on a literature review, concluding that running injuries to the lower leg may have more to do with weak hip muscles than how many miles run. Lead author Reed Ferber, Assistant Professor and Director of the Running Injury Clinic from the University of Calgary stated ”Hip muscle weakness especially appears to lead to atypical lower extremity mechanics and increases forces on knees and feet while running.” He also stated, "Based on a literature review, it appears that foot pronation (turning the arch and ankle flatter to the ground, and/or the knee inward) and inadequate hip muscle stabilization are the top categories for injury.”
From my own work in this area, I found that strengthening alone won't make you run with good mechanics, prevent pronating, or other injurious habits, you need to retrain them too. Not hard. Stopping your life to do rehab exercises then returning to bad daily movement also isn't so helpful. My work builds-in both strengthening and mechanics to daily life - functional exercise. Robert Davis has been sending in his successes fixing back and other injury using functional fitness.
Robert Davis writes:
"I had made a slight error in my story! I just wanted to let you know.. I had not ordered fix your own pain till only about 4 weeks ago cause I was looking at my expenses and the Amazon one came up!
"So to see how rapidly things change when you take up these habits is even more encouraging.
"Some things I noticed along the way (I did have some slight questions on this!). My hip muscles for one, started to get "sore". I believe this is because of over tightness and overall lack of use. My guess is like every other gym rat they avoid things to make obliques and lower back "too" big because it takes away from the V shape they are after. Everyone seems to fall for this but it is an un-healthy trap I now realize.
"Anyhow I had started to get really sore over the last few weeks in hip muscle areas and even upper buttocks from stretching these areas and working them (using your stuff). When I practiced going into full squats, this really seemed to stretch out areas that began to show signs of weakness/tightness. So it was like working out muscles and getting that "soreness" when your muscles start to adapt. I kinda figure it is as it is just as normal to workout a bicep and for it to "be sore" the next few days.
"The soreness goes away and with each passing week, it becomes more mild - kinda like the body getting used to biceps being sore and you don't get sore anymore.. They do not get sore like they did when I first started your stuff. I was just curious if you had seen this. I am sure it is normal, especially for a group of muscles not used to being used or stretched out.!
"Jeez I do not think most people realize just how tight and weak they can be in areas, mostly because they are never used or people are used to being tight there. People do not believe in the squat (I showed a few people to prove them wrong lol) because they are too tight. I realize how much I am glad I found this out early in life. I get stronger every day in the areas that were weak. I know I will have a much better core, lower back, complete back, and body then before I hurt myself :)
"I put together my "planche/pull up" setup for pictures and to start working on a full planche! That is difficult to do like you do it! Any suggestions? Just keeping trying? Heheh
"Thank you again! Thank you for posting my story."
Mr. Davis, thank you. You are well ahead of the fancy researchers :-)
Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from fun ones. Before asking more, see if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index.
The RSS feed may still be down. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
Fast Fitness - Built in Upper Body and Core Exercise Carrying Children
Friday, May 29, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - get better exercise and stop aching back and shoulders when carrying children (or anything else) in backpack carriers or by piggyback:
Put on the carrier (and baby for a fun practice ride or use groceries, etc). Look sideways in a mirror.
See if you round your upper and or lower back forward. See if you lean your upper body backward under the weight. Notice if you increase your lower spine inward curve, are tilting the hip out in back to hold up the carrier.
Straighten upper and lower body segments. You will feel a strong pull on your abdominal muscles when you reduce overarching in the lower spine and prevent leaning the upper body backward. You will feel an upper back workout when you don't lean or round forward.
Use straighter positioning all you can:
It may be "natural" to try to offset loads by hunching and contorting your body, but it still hurts.
Overarching the lower spine makes carrying feel easier because it shifts weight to the spine joints (facets) and surrounding soft tissue, and off the ab muscles. Rounding forward feels easier as it shifts weight to the discs and off the back muscles.
Get more exercise and less joint trauma with neutral posture.
Looking downward with good neck dynamics: Holding healthful position does not mean never look up or down to see where you are going. It means to get natural, built-in upper body exercise, burn calories, and enjoy your time going places with the kids - Tax Preparation Health
Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from fun ones. Before asking more, see if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index.
RSS feeds are still going down - Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
Knee Surgery - Arthroscopy Results No Better than Pretend Surgery
Wednesday, May 27, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
A study of arthroscopic knee surgery found that the surgery was no more successful than pretending to do the surgery.
Arthroscopic surgery for knee arthritis is performed in substantial numbers. Why? The patient's doctors said they needed it. Where did the doctors get that opinion? It is taught in medical school and repeated at medical conferences. Repeating things is not evidence-based medicine (which is key) but vehemence-based medicine. When highly paid people repeat things without even knowing if it is true, that is eminence-based medicine.
Studies are now following up the same patients who had the surgery. Numbers show that often the surgeries are not needed, and people can do as well without surgery, and with intelligent non-surgical rehab.
This is not new. In the 1930's, patients being prepared for the rigors of surgery through exercise, often found that by surgery time, they didn't need it. Other patients without receiving exercise went straight to surgery. They may have had continuing pain and damage after surgery or later in life, but patient tracking was not done. Doctors just reported that the surgery was done, the patient lived, and that was all, and on to the next paying job.
Then studies compared surgery to physical rehab without surgery. Improvement rates were found to be about the same.
Then came an even more interesting study in 2002 of 180 patients that compared knee arthroscopic surgery to cutting the patient but not doing the knee surgery. Sixty patients in the placebo group received skin incisions and underwent a simulated surgery without insertion of the arthroscope. Two other groups had one of two typical knee procedures: Sixty-one patients had arthroscopic lavage group, and 59 to had arthroscopic débridement.
Results showed, "At no point did either of the intervention groups report less pain or better function than the placebo group." Conclusions were, "In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure."
Source: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine. Volume 347:81-88. July 11, 2002. Number 2. NEJM.
This does not mean that surgery does not "work" but that you do not have to have it or be rushed into it, if it is not right for you. There are other ways, often as quick, and less expensive and painful and without the limitations following. Take your time. Don't let anyone push you into something not right for you. Medical claims that you will get worse if you do not have immediate surgery have not turned out to be factual.
Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index. For personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
Comments, A Medical Conference, New Findings on Discs
Monday, May 25, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
By the time this post comes out, we should be halfway out West to a medical conference. I'm presenting a study, which took years to do, and which found something unexpected.
I am a medical researcher. I find out the things that doctors (with any luck) then learn and put into practice. A research career has all (and more) of the medical schooling, but without the burden of the medical salary. In previous studies, I found that chronically overdoing the inward lower spine curve pinches the lower spine. It forces the spine joints, called facets, backward against each other, eventually wearing them out, and compresses surrounding soft tissue. After long periods of standing, exercise, and lifting with too much inward curve, lower back pain is not a big surprise or mysterious to fix. In the work I am presenting, I found that although it is known that the main factor to injure vertebral discs is too much bending forward, that overarching backward can hurt discs too. This is a new proposed mechanism of disc injury.
There is supposed to be a small inward curve to the lower spine. With the (very) small normal inward curve, spine bones line up on top of each other like stacks of cups so that there is equal pressure on discs from front to back. That is called normal lordosis (inward curve). Chronic bending forward manages to unequally load the discs so that they push out in back. Overarching also unequally loads the area. It seems to pinch already protruded discs, and may even factor in the herniation process. I will be presenting on years of my work that lead to this finding.
I made a diagram showing the disc injury coming from overarching/ hyperlordosis/ hyperextending the spine that is so common in pop fitness. The Healthline blog software is still not loading any new photos of my own. Stock photos or those from other people's sharing sites appear, but I the blogger is not letting us get my own diagrams and student photos to you, for now. I mailed the image to Healthline.com staffer Jerry, who said he could upload it for you. It should appear here, below this paragraph, so you can understand better why hyper-lordosis, although common, and often taught, it not neutral spine and can make unnecessary pain. The damage and pain can be quick to fix when you know how. Click the labels "facets" and "lordosis" for posts explaining this issue.
I have to pay the travel to get to the conference, pay the conference fee, essentially, pay to work. I have to bring a computer and projector to give my own presentation (or pay an AV fee to the conference) but won't have Internet access to see or answer questions. Leave fun comments but hold questions for the next two weeks.
Photo is me, taken on the way on the way to a previous medical conference, out for some barefoot climbing.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Pectoral (Chest) Stretch - The Most Common Mistake in the Best Shoulder Stretch
Tuesday, May 19, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Mike Benson has sent several Fitness Fixer inspiring stories. In response to reader requests, he made us this photo set showing, "The most common mistake in the best stretch - How to not get any stretch from the pectoral stretch." I asked him to demonstrate this, because I see this mistake so often. People often "do" a stretch without "getting" a stretch.
Why is this stretch so good? Round-shouldered posture is a main contributor to neck and upper body pain and rotator cuff injury. Round-shouldered posture feels comfortable and natural when the front chest muscles are tight. A common mistake is to stretch the shoulder joint, which does not address this problem.
The purpose of the pectoral stretch is to lengthen chest muscles so that healthier positioning feels natural and comfortable. If you merely hold your elbow to the side, little lengthening can occur - shown in first photo:
Second photo below - changing the position to get the purpose - lengthening anterior (front) muscles that go across the chest. One way is to use a wall to help you press your elbow back.
Turn your body and feet away from the wall.
Your elbow is behind you, no longer out to the side.
Raising the elbow higher or lower changes the stretch.
Experiment until you only feel a stretch in the front chest and no pain or pinching anywhere in the shoulder:
Keep shoulder down and relaxed
Do not make any pain anywhere. The idea is to make things healthier, not to strain, push, force, tighten, grunt, and call that a health promotion activity.
Understand the purpose first. The purpose of this stretch is to lengthen front chest muscles so that tightness does not pull you into feeling that round-shouldered position is the norm or that it is uncomfortable to straighten. Feel the stretch in the intended area.
Use a mirror to help you connect what the position looks like with what it feels like.
Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from fun ones. Before asking more, see if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index.
RSS feeds still down - Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
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Photos by and of Fitness Fixer reader success Mike Benson
Back pain from lifting and carrying babies and young children is common. Rehab and PT programs commonly have people spend time (away from their children and other important things they need to do) to lift weight to strengthen back muscles.
Here is an idea - if weight lifting helps, lift the kids. Just lift them right, so that you do not get the back pain in the first place. It is not the lifting that causes the pain.
Good Kid Lifting:
Prevents pain,
Strengthens your muscles,
Gives built in exercise (functional exercise the way your muscles work),
Increases contact with your young kids, important to their development,
Improves ability to keep time with your children fun, healthy, and happy.
Readers asked me to make reminders for them about how to lift and carry their young children.
I created several different reminders on good lifting, bending, carrying. Fun T-shirts for kids are available in several colors and fabrics. There are bibs, singlets, and shirts for babies, and fun Back and Neck Saver reminders for grownups too.
Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from fun ones. Before asking more, see if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
Certain headaches can be initiated or aggravated by tense facial muscles (squinting, scowling, furrowing brow), and by tight, tense, overstretched muscles in back of the head, neck, and shoulders, common with letting the upper body slouch forward. Headaches from tight muscles were formerly categorized as tension headaches. A growing theory includes upper body muscle use among triggers of a different kind of headache, the migraine, previously thought of as only a vascular event.
The wide range of kinds of headache is not my major field of study. I had previously had results with patients retraining upper body position to stop tension headache. I was not aware my own research would be useful to people with other kinds of headache, so I am learning from my patients who frequently report stories just like this one recently in from engineer Johannes Ernst:
Dr. Ernst writes:
"Some mindblowing ideas one might come across by accident instantly convert you into a new missionary because they are so clearly and obviously true, no further check required. Your particular religion ;-) of fitness is one of them.
"I would summarize it as follows: if our ancestors, over 10's of thousands of years, had had as many ailments as we have today, the human race would have died out a long time ago. No ergonomic chairs but only rocks and logs to sit on? No exercise equipment? Not even one pill a day? Just leaves and furs instead of expensive mattresses and beds? Humans clearly had no chance.
"Well, but here we are nevertheless. So given how many ailments we have, something that we are doing these days must be much worse than what our ancestors did in the forests. Jolie's mindbogglingly straightforward answer: instead of using ever-more complicated medical and fitness tools and regimens, whose benefits, never mind costs, often are marginal or doubtful, what about we use our bodies how they were meant to be used? Duh!!
"The shameful thing is that medicine, as a profession, does not necessarily nudge anybody in that direction. Often, its leading practitioners seem totally oblivious to what should be a "Duh".
"What is wrong with this picture?
"In my case, over the course of 25 years of headaches, healthcare professionals on two continents, etc. etc., nobody, never, not once, suggested, that I could improve my posture. I got all the drugs, regardless of how expensive, few of which would make much difference other than to put me out cold.
"Last week, for the first time, about 6 weeks since I got a few of Jolie's books, I managed to extinguish an immobilizing headache through some rather simple exercises, completely without drugs. I totally expect that I will be able to do it again. (I did! This morning!)
There is more to headache than muscles and posture. Many causes can be controlled without unhealthful pills. The book Health & Fitness in Plain English THIRD edition has an entire chapter devoted to known ways to prevent and end a headache.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Limited Class spaces for personal feedback. Top students may apply to get certifiedDrBookspan.com/Academy.
Readers, patients, and students have asked me for years to write down for them about good lifting and bending over babies and children. I wrote articles and books. I did experiments in the lab. They still said they couldn't remember. So I made something for all of you. You can give these to everyone in need for Mothers and Fathers days, coming up, and all year.
Here it is, quicker and easier than reading the books:
If the photo does not appear (blogger is having troubles) click this link.
I designed singlets and one-piece suits for infants, T-shirts for toddlers and children, various sizes and colors.
One student had asked me to write down and hang the information around her neck so she would have an easy way to remember all the time. So I made a bib too - for the baby - so she could see it each time she bent to feed and lift.
I was surprised people wouldn't just remember on their own to live in a way so important to their health. But they kept coming back asking for me to tell them again. I am drawing the various concepts and putting them on daily items as funny reminders. I will show them in future posts if readers are interested.
Click the photo or go to this site for all the educational gifts designed so far - http://www.cafepress.com/AcademyGifts. Send your requests for other ways to have fun health built in to daily memory.
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Read success stories of Fitness Fixer methods and send your own. Questions come in by hundreds. I make posts from fun ones. See if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index.
Subscribe to The Fitness Fixer, free. RSS feed currently not working, so click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
A news report published in several publications including The Wall Street Journal stated that anesthesiologist Scott S. Reuben faked data so that it would seem that benefits occurred from painkillers like Vioxx and Celebrex. The studies had been published in several anesthesiology journals between 1996 and 2008.
Dr. Reuben had been a paid speaker for Pfizer, a powerful pharmaceutical company, and Pfizer paid for some of the research.
The journal Anesthesiology has retracted three of Dr. Reuben's articles. The journal Anesthesia & Analgesia has retracted 10 of Dr. Reuben's studies and posted a list of 11 of his studies published in other journals.
Jacques E. Chelly, head of acute interventional postoperative pain service at the University of Pittsburgh Medical Center, said that the situation has prompted his hospital to review the protocols it uses to treat patients for pain, because Dr. Reuben's work was so influential in establishing them.
Editor James C. Eisenach warned in an editorial in the journal Anesthesiology, stating:
"these retractions clearly raise the possibility that we might be heading in wrong directions or toward blind ends in attempts to improve pain therapy."
Other Problematic Drugs. Vioxx and Celebrex are not the only highly prescribed drugs that have been found less effective than advertised. Several major drugs prescribed for pain/fibromyalgia and headache were later ordered by the FDA to carry a Suicide Risk Warning:
Healthy Ways To Stop Sources of Pain. Specific well-known medications and surgeries have found to be no more effective than less expensive and disruptive methods:
Questions come in by the hundreds. I make posts from selected ones. Before asking, see if your answers are already here by clicking labels under posts, links in posts, and archives at right.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right.
Fast Fitness - Better Legs and Pain Relief Comes From You Not The Exercise Ball
Friday, April 03, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - Be healthful when you do health activities. What a concept.
How fit is it to use fitness equipment in unhealthy ways?
When you pick up and put down an exercise ball, or any exercise equipment, how do you bend? Unhealthfully? During an activity you use to improve your health?
Robert Davis sent in this change of bad bending to good bending . Good bending shifts weight and leverage off lumbar discs and onto leg, hip, and back muscles.
Robert Davis wrote. "I had to use my cell phone on timer so the pictures are not the greatest quality."
Here is the ouchy
Here is the squat
Robert Davis was a weight lifter with a painful back injury from conventional lifting. He fixed his back pain with Fitness Fixer, intelligently applying principles of healthful movement for everything during exercise and also daily life. He wrote:
"I took a picture of what was causing "ouchy" because it is so normal in America *for adults!*.. (upper photo of forward bending). Then ouchy started to go away the more I did, 'ah much better' (squatting)... Pretty soon ouchy was gone from the bad forward bending.
"I am now doing a complete head to toe revision... Point was that my back stopped hurting, and as you said, heals when I let it, with better movement.
"I am glad there is someone out there like you who tells you how it is. It gives encouragement and hope. I have seen people my age already with a few surgeries (and they are in the 20s to 30s!). They were from injuries, and sadly they never had a chance to find that they didn't need it.
"I was encouraged by others' stories and with your statement, "don't let them scare you" because I was a bit scared. I have never been injured before with that much pain. But, I was more then willing to try this because I did not want limitation as I had seen in my friends who had surgery. Some multiple times. "
Mr. Davis has been sending in success stories one after then next. Here are some of his Inspiring Functional Fitness:
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Several studies have found that sunlight helped with depression and agitation in elderly people. It is likely that younger people benefit also.
Simple adjustments, not only in lighting, but scheduling daily outdoor activity and simple walks, may ease behavioral problems associated with dementia.
Click the label sunlight for ideas.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
Fast Fitness - Fixing Arches, Knock Knee, and Knee Pain Without Orthotics
Friday, January 23, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - Stop one major source of inward-turning knees (knock-knees). Click the movie arrow to run:
Look at your bare legs in a mirror with feet facing straight forward.
See if the knees turn inward to face more toward each other than forward.
Feel how the muscles can pull outward to gently move (not force) knee position. These muscles like to be used correctly, not left unused.
Often, knees turned inward are a simple case of letting body weight sag downward onto the inside of the leg and arch of the foot, not a case of unchanging anatomy. Pain often comes from letting the knees and ankles twist, rotate, and sag. Restoring neutral position can stop this source of pain.
Orthotics are hard inserts that hold your foot in a certain position. Orthotics are different from cushion inserts that make a softer landing for each step. You can control leg and foot position without orthotics. That doesn't mean orthotics don't work, just that you can do it without them. It's cheaper and you get a free leg muscle stability workout at the same time.
Remember, don't force. If it hurts, it's wrong. Creating new strain instead of restoring function is not health or good thinking. All you are doing is restoring muscle length and using that to learn how to stand neutral, not tilted so much that you compress your joints.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own. Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column. Find fun topics on the Fitness Fixer Index.
Your Muscles Are Your Orthotics for Arches, Knock Knee, and Knee Pain
Thursday, January 22, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
David from Belgium has been a success story and valuable contributor. He frequently makes us photos and movies showing how to fix pain and unhealthful fitness using Fitness Fixer techniques. He first left a comment on a post in 2007:
"I'm training to be a yoga teacher and I'd love to teach the right things to my pupils such as good posture. Your insights are very inspirational. After struggling with minor but persistent knee pain for some years, I was diagnosed with seriously fallen arches recently. I'm not really flat-footed, but ankles that drop inwards too much. (I could clearly see that on the video my podiatrist made of me walking on bare feet). In a week I'll be getting new orthotics. Though, after reading a patient's testimony on your site I decided to try and use my feet differently. So now on my walks to and from my day job I'm trying to walk 'right'. Rolling on the entire foot, heel to toes, leaning more on the sides and using all five toes. It feels awkward though and I notice that I often forget it. I wonder if this will 'fix' my feet eventually? Anyway, thanks for sharing your knowledge!"
I replied that it "fixes" arch positioning as soon as you do it. It is natural to control how you stand and move - the whole intent of functioning in a healthy way in life, and the intent of yoga (supposedly). It seems at odds to say that yoga teaches body awareness, strength, or positioning, then let ankles slump without control, and purchase devices to do it for you. Once you understand the purpose, it will not be awkward. It is the same as any other good posture.
Since then, David has consistently made good use of these materials, and shared many success stories. He has fixed various pain producing habits for himself and his students, fixed his mother's herniated lumbar disc by showing her healthy bending around the house - Bending Right is Fitness as a Lifestyle, and developed a new yoga system of healthier movement - Getting the Right Yoga Medicine.
Orthotics are rigid shaped devices, fitted by prescription, that specifically move and hold your foot in a certain position.
Orthotics are different from over-the-counter shoe pads that can help by cushioning impact.
Orthotics do not do anything you cannot do yourself using your own muscles and sense of positioning (kinesthetics).
It is a myth that only a device can move your foot and leg leg. Click the label "myth" under this post for all Fitness Fixer posts on fitness myths.
Try these in relaxed way:
Stand and see that you can raise your own arches back to normal, taught in the post Arch Support Is Not From Shoes. It takes only seconds.
Make sure you are also not pronating from higher up - Healthy Knees.
Remember, don't force. If it hurts, it's wrong. All you are doing is learning how to stand neutral, not tilted so much that you compress the joints.
The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
During walking and running, a brief and small inward drop (slight pronation) occurs right after foot contact that creates part of the "spring" and propulsion. The idea is not to prevent all foot motion, but to not let the knee twist inward. You can do that with your own brain and muscles.
See if your answers are already here by clicking links, labels under posts, archives, and the Fitness Fixer Index. Read success stories of these methods and send your own. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer - Click "updates via e-mail" - (trumpet icon) upper right. Find fun topics on See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Surgery for Knee Arthritis, Meniscus, Not Needed To Stop Pain, Restore Function
Monday, January 19, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Good news. If you don't like or want knee surgery for most arthritis or meniscus injury, you don't have to have it. Lack of need for surgery has been demonstrated over many years in rehabilitation populations, and in a mostly ignored older clinical study. Recent studies confirm you can stop most pain and restore function just as well without surgery through good physical rehab.
Millions of Americans undergo arthroscopic surgery for knee pain every year. Over the last 30 years, arthroscopic surgery has been routinely accepted and prescribed for knee pain without undergoing rigorous evaluation.
Even when a 2002 study published in the New England Journal of Medicine (NEJM) found that results of arthroscopic surgery for knee osteoarthritis were no higher than medicine and physical therapy alone, the surgical community "remained unswayed."
Dr. Brian Feagan, co-author of a study in the Sept. 11 2008 issue of the NEJM stated, "It really didn't change practice that much. That's why this second [study] was really important."
Feagan's randomized, controlled trial involved 178 patients, average age 60. All had moderate-to-severe osteoarthritis of the knee. Half underwent arthroscopic surgery plus medical and physical therapy. The other half used medical and physical therapy alone. After two years, both groups' scores on a measure of arthritis severity were about the same.
A second study also published in the same journal issue, found that meniscal tears are common in the general population and, "may not, in fact, be responsible for painful symptoms." That means that if you have knee pain, and have scans and imaging which show a meniscus tear, it may not even be the tear that is causing the pain.
"There's going to be a swing in practice," said Dr. Feagan.
Study authors stated that meniscal tears detected on MRI may confuse matters and lead to unnecessary therapy. This is a similar finding to back pain where patients with pain are shown to have a herniated disc, stenosis, or other finding, but the pain is not from the anatomical finding, but the same bad movement habits, slouching, and lack of good movement that make anyone hurt. Discs also often appear herniated, and spines compressed by stenosis on scans of people with no back pain. Don't base your treatment and future on a picture. Scans are not tea leaves.
Poor knee stability increases risk of developing arthritis, and increases wear on the meniscus. Studies tracking results for years following surgery are finding that surgery "adds no benefit over rehabilitative training alone." That means you don't need the surgery to fix or prevent possible future arthritis.
--- I make posts from fun mail and success stories. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
Fast Fitness - Hip Stretch and Spine Stability Training When Stretching Legs
Friday, January 16, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - Retrain your standing leg stretches to hold your spine and hip in healthful position, get more stretch to the front of the hip, use your back muscles, practice balance, and learn functional stretching - the way your body needs to move in real life in a healthy way.
When you raise one leg to stretch when standing:
Keep your standing leg straight. Don't bend at the knee and hip, as pictured.
Don't round your back or let your pelvis and hip round under you, as pictured.
Stand straight. Relaxed. Don't force or strain. Breathe.
When stretching, remember function. Why practice a position that is rounded, tight, and detrimental to how you move in real life when you lift your legs. It would look silly and unhealthy to stand up that way. Why stretch that way?
Get functional stretch by lengthening your body enough to be able to straighten out. That is the purpose of the stretch.
Use the new length and your brain to stand straight. Transfer the positioning to real life when you are standing and lift one leg to take stairs, kick, dance, play sports, climb over things, and other life activities. Standing without being so tight that you round your body forward, or just round from habit, is healthier, better looking, burns more calories, and stops many sources of chronic aches and pains.
Send me your photos of fixing this stretch. Doing is the best learning. I will post the photos in a reader success story.
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking labels below posts, and links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
The International Academy of Functional Sports Medicine was formed to provide:
Evidence-based education in functional physical medicine, training, sports medicine including diving medicine, and rehabilitation,
Internationally attended sports medicine congresses,
Certifications for physicians, allied health, physical therapists, fitness instructors, massage professionals, and the public,
Fellow advancement opportunities for physicians and researchers.
We are non-sectarian and dedicated to peace and health of all. We accept no advertising from unhealthful "health and sports" products. Part of course tuitions go to medical research, charity, and elderly help.
We are holding a contest to design the Academy logo. Winning logo will be seen internationally with credit to the designer. Logo designs should be simple, incorporate the concepts of brains and functional strength. Other concepts and ideas welcome.
If you are interested to help through your logo design submission, or other good ideas and talents, or be part of this organization, let me know. Be prepared to have fun and use your brain. To see how, the new Academy web site is www.DrBookspan.com/Academy.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links,labels under posts, and archives. Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer - Click "updates via e-mail" (trumpet icon) upper right.
Overhead Lifting, Reaching, and Throwing Part II - Lower Back
Wednesday, January 07, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Part I of this three part series, showed a major hidden cause of rotator cuff injury - jutting the neck and chin forward while raising arms. This post shows a major hidden cause of "mystery lower back pain."
Letting the head and neck hang forward is called a "forward head." The forward head puts the shoulder at a position of compression when the arm is raised, even when using a computer, a common cause of pain and numbness that radiates down the arm.
The forward head is a bad posture. It causes much upper back and neck pain. Usually people have a forward head because they do not know it is bad posture and do not prevent it. Occasionally they have used a forward position for so long that the muscles get tight and it feels familiar to jut forward and strange to hold the neck and head in upright healthier position. Click links below to Fitness Fixer articles that show how to spot and prevent the cause of the injurious positioning.
The photographer (red shirt) in the photo at left, several of the people in blue shirts, are leaning the upper body backward to raise the arms. Leaning back increases the inward arch of the lower back.
The resulting posture is called swayback, overarching, and hyperlordosis.
Hyperlordosis is a major cause of mystery lower back pain. The sharp angle presses on the lower spine, making it ache. Over time, the compression can injure the facet joints which are the joints of the vertebrae, discs, and soft tissue.
Reader David from Belgium has made us several helpful training videos. In the one below:
Click the arrow to watch as he reaches upward.
He first allows the beltline to tip downward, then mostly corrects it.
David left some of the arch to show readers.
I thank David for all his continuing great work. We are in the process of making more of these helpful topic segments.
Coming on Friday Fast Fitness - How Abdominal Muscles Prevent Hyperlordosis When Carrying.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own. Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column. Find fun topics on the Fitness Fixer Index.
David of Belgium developed and teaches an improved new yoga system. He presented it at a world yoga congress. His system corrects for the widespread pain syndromes from flexion overuse, and reduces the cause instead of adhering to set ritual pose sequences - Getting the Right Yoga Medicine. He continues to translate my work into Dutch, create links for posts to reach world audiences, and make dozens of photos and videos for Fitness Fixer posts.
Dr. Clara Hsu teaches Fitness Fixer methods to patients in her practice, prescribes my website, gives my books as presents around the world, and has offered her office space to hold workshops for our new International Academy - How Doctors Help Patients With Fitness Fixer and How Doctors Use The Wall Stand.
An anonymous reader took time to find a neighborhood association with volunteers to shop and deliver a food order at no extra charge to the blind diabetic widow in - Thank You To Readers - Simple Gifts
Thank you everyone for using my methods for Good. Thank you for writing your stories for others to benefit. Congratulations on your great work.
Thank you readers Mim, Kate, Al, Kathy, Julia, PhatMac, Eddie, Carol, Dave, Tony, Anton, Terry Lee, Airchild, Teresa, Nina, Marina, Wondering Oriental, 9Volt Terry, Alberto (farioreo), Kip, Lee, Ness, Jayakrishnan, Michael LMT CNMT who gives his massage clients the Fitness Fixer and my professional website DrBookspan.com as their homework, and all the others who wrote their success stories in the comments of various posts.
Hundreds more, too shy to have their story online, mailed me the best thanks - that because of these methods, they had their lives back.
Happy New Year
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Be in the Fitness Fixer Hall of Fame. Send me your success story of using these methods for good. Subscribe to The Fitness Fixer, free. Click "updates via e-mail" - (trumpet icon) upper right. Find your topics on the Fitness Fixer Index.
A reader wrote in that he tried the "wall test" done by standing with your back against a wall. The wall test is a quick general assessment to see if you can comfortably stand up straight, and if not, where the tightness exists that prevents it. The reader said the test hurt. He was angry and wanted me to warn everyone not to do the wall test.
The point of the wall test is to see if you are generally standing upright, or have tightness preventing healthy stance, not to cause pain by forcing it. If you can't comfortably stand straight, it is likely that you are going about your day in a tight, crooked position that contributes to pain syndromes and gradual spine and disc damage. That is the point of doing the test - to determine the source of the problem right then. Then, see if it is just a bad habit of how you stand, if you don't know how to stand well, or if tightness prevents it. Specific functional stretches easily restore resting length to the area. Then you use the new ability to stand and move in healthy ways.
In the photo, Dr. Clara Hsu stands well while checking a patient. In the photo, the patient looks tight, both at the hip and the front of the shoulder. The patient seems to be straining to pull in her chin. She is lifting her ribs and overarching the lower back to try to get the upper body to the wall. These two compensatory moves are things to check for. Instead, pull neck and chin back loosely. Bring upper body upright by unroundng the upper back, not by leaning back, increasing the angle at the lower spine.
The wall test is a general test, not an exercise. It shows three things:
How you are standing at the moment, and perhaps as general habit
Where bad habit or tightness may be that prevents standing in healthy positioning, for example a forward head, bent or tight front hip where it meets the leg, or overarched lower back
The wall test is done a second time as immediate feedback after doing specific retraining stretches, to see how well you have achieved the purpose of the stretches to restore normal length of these areas.
The wall test is a general, not absolute measure. The assessment works for most body types. Many people who think that larger lower body prevents upright stance, may actually be standing bent forward at the hip.
Straining to stand straight is not healthy straight standing. Making it possible to be healthy is the point. Causing more pain would be silly, and counter to the point. Often it is just a matter of identifying what is straight stance using the wall test, and standing better from then on. If the wall stand is uncomfortable, or not possible, check your standing habits. If there is tightness, then stretch the hip, shoulder or wherever else is holding you in tight bent position.
To stretch front chest and hip to make straight standing comfortable:
Coming soon, Dr. Clara Hsu asked me to tell the story of, "Class is always in session."
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
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Anterior Cruciate Ligament (ACL) Surgery Unnecessary
Monday, December 22, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
After injury to the anterior cruciate ligament of the knee (ACL) it is common to be told that surgery is the only way to restore function. Is it?
Ninety percent of ACL injuries in the U.S. are treated with surgical reconstruction. A study reported in the Dec. 15 issue of Arthritis & Rheumatism found that, "Two to five years after treatment, patients had similar muscle strength and function whether they had training alone or with surgery." The study concludes, "Reconstructive surgery is not a prerequisite for restoring muscle function." That means you can have good results with good rehab and without surgery.
A second question is development of ostoarthritis following ACL injury. Poor knee stability increases risk of developing arthritis. Studies tracking results for years following the surgery are finding that surgery "adds no benefit over rehabilitative training alone" and that surgery is done, "despite an absence of evidence to suggest that reconstruction of the ACL prevents or reduces the rate of early-onset osteoarthritis." That means you don't need the surgery to prevent possible future arthritis.
Another common myth is that knee injury comes from "muscle imbalance" in the thigh from too much strength in the quadriceps muscles over the hamstring muscles. The strength of a muscle does not make you move it. That means you control whether you overstraighten a knee or not. It is a use issue, not a strength ratio. Future posts will cover the issue of quadriceps to hamstring ratios and injury to the ACL and other knee structures.
You don't have to have ACL surgery to rehab a knee injury.
Fitness Fixer Posts on Fixing Knee Pain Without Surgery:
Health&Fitness - How To Be Healthy Happy and Fit For The Rest of Your Life. THIRD edition.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking labels below posts, links in the posts, and archives. Read success stories of these methods and send your own.
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After being told he'd have to retire, have surgery, and live with pain forever, Coast Guard Lieutenant Bill S. attended my workshops and went to on return to marathon biking and new work flying cargo 747's around the world - with Captain's bars. Bill has contributed three previous success stories (links below). He keeps in touch and signs his updates "Free Man."
Bill wrote me two notes of thanks over Thanksgiving:
"Hi Dr. Jolie, " I just wanted to say "thanks" for all the help. I would not be able to do my job or enjoy my strenuous activities if we had not done something about the pain. I have much to be thankful for. I cannot start the day without remembering you as I healthfully stretch on my elbows before rising from bed. I am well though my family thinks I'm nuts as I continue to enjoy my 10km runs, 50km hikes and 100km bike rides. The activity is healthy and gives me much to look forward to. I do something everyday I can as it clears the cobwebs from my head and chases the blues away!
" Still flying as 747 captain. I could not do it without the fitness I am maintaining. I am enjoying the job more than initially. My confidence is back.
" Hot new subject: teaching myself to weld and braze so I can design and build bicycles. I am no longer happy with buying frames made by others. Wish me luck. I hope I don't burn down my garage!
" Hope you are well and enjoying all things. Your blog is a frequent inspiration." Take care, safe journeys, your friend, Freeman(really!)
We are still having trouble uploading photos, so imagine the photo of a happy fit Captain Bill standing at the: top of the steps in Liege, Belgium.
Questions come in by the hundreds. I make posts from fun ones. See if your answers are already here by clicking links in posts and labels under each article for more Fitness Fixer on each topic. Find topics on the Fitness Fixer Index.
Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free - Click "updates via e-mail" (trumpet icon) upper right. Take classes with Dr. Bookspan - www.DrBookspan.com/classes.
FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others
Tuesday, December 16, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
The FDA issued a public health alert today based on their review of 199 clinical trials. Specific drugs for epilepsy and psychiatric disorders are often prescribed to patients with migraine, back and body pain. The FDA review was released last January, and showed that patients taking those drugs had "almost twice the risk of suicidal behavior or thoughts than patients taking a placebo."
One of the drugs on the warning list is Neurontin (Gabapentin). Patients with back and various nerve and diabetic pain are commonly prescribed this drug. More drugs on the list are frequently prescribed for fibromyalgia and other pain: Lyrica (Pregabalin), Topamax (Topiramate), Celontin (Methosuximide), Felbatol (Felbamate), Zarontin (Ethosuximide) and others.
Here is a list of the medications required to add the warning:
* Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR) * Clonazepam (marketed as Klonopin) * Clorazepate (marketed as Tranxene) * Divalproex sodium (marketed as Depakote, Depakote ER, Depakene) * Ethosuximide (marketed as Zarontin) * Ethotoin (marketed as Peganone) * Felbamate (marketed as Felbatol) * Gabapentin (marketed as Neurontin) * Lamotrigine (marketed as Lamictal) * Lacosamide (marketed as Vimpat) * Levetiracetam (marketed as Keppra) * Mephenytoin (marketed as Mesantoin) * Methosuximide (marketed as Celontin) * Oxcarbazepine (marketed as Trileptal) * Phenytoin (marketed as Dilantin Suspension) * Pregabalin (marketed as Lyrica) * Primidone (marketed as Mysoline) * Tiagabine (marketed as Gabitril) * Topiramate (marketed as Topamax) * Trimethadione (marketed as Tridione) * Zonisamide (marketed as Zonegran) Some of these drugs are also sold generically.
I will be covering migraine and other headache in the future. Instead of drugs to mask back pain, neck pain and various musculoskeletal and nerve pain, fixing the cause is healthier than drugs. By no longer injuring the area, the pain will stop and the area can heal. It is not matter of choosing between pain and often worse problems from the treatment.
To stop common causes of pain, and the need for drugs, start with these:
Health&Fitness - How To Be Healthy Happy and Fit For The Rest of Your Life. THIRD edition.
The Ab Revolution - No More Crunches No More Back Pain THIRD edition.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own. Find fun topics on the Fitness Fixer Index.
New studies have been making big health news. These studies conclude that knee surgery is not needed to rehabilitate after several kinds of knee injuries, and that "question the benefits of the surgery." This information is not new. How do I know this? Because of years of previous studies concluding that surgery "worked." Here is what those previous studies often meant:
About 10 years ago, I attended a sports medicine conference. A new line of knee surgeries had come out, and the surgeons and manufacturers of the products used were anxious to have their surgery accepted and endorsed. One of the clinical presentations of the conference was the results of a study that compared patient outcome after knee surgery to the outcome of physical rehabilitation without surgery.
The patient group receiving physical therapy had improvement of function and reduced pain over time. The sample undergoing surgery went through the risks of anesthesia and surgery, lost work and wages, pain controlling narcotics during surgery and recovery, reduced activity for a minimum of 2 months following surgery, and pain from the surgical area. They then underwent months of physical therapy to regain function lost from the surgery. Many had permanent reduction of knee range of motion, considered "standard and acceptable" for that surgery. The loss of range can reduce function of the area, and reduce ability to stretch the hip, which can cascade years later into further restrictions. The physical therapy group had improvements that started soon after beginning treatment. The surgical group initially had decreases in all measures of strength and function, then months of painful recovery, and further months of reduced physical condition while they worked to "get back in shape."
Patient outcomes of muscle strength and pain levels were compared after two years and found roughly equal. The conclusions of the study were that surgery was effective, since two years afterwards, patents in the surgical group had made gains equal to the therapy group. I raised the question to the presenters about the initial painful recovery, then months of recovery, which the therapy group never had to experience. They were angry that I could not see that the outcome measures were equal, so "all's well that ends well." They pointed out that their surgical patients often thank them because they, "wake up and the pain is gone." They omitted that post-surgical patients are on pain relieving drugs, often narcotics.
I do not judge my own patients to be fine, or a method to be worthwhile, if they have to endure loss of mobility and physical levels at all, let alone over two years.
What works better than knee surgery?
Physical retraining of how you use your knees in daily life when walking, running, and other activities.
It is common to do exercises to strengthen the legs, then walk away from those same exercises allowing the knees to sag inward, slide, or twist in directions different from the line of the joint. The chronic unequal loading grinds, stretches, and wears at various bands of cartilage that connect upper and lower leg bone (ACL and PCL), meniscus cartilage, can grind the inside of the kneecap causing pattelo-femoral pain, and can even wear away at the shiny smooth cartilage covering bone ends (the articular surfaces), predisposing to arthritis.
This is why much supposed knee rehab isn't " working" - it is being undone the rest of the day by continuing the causes of the problem. Physical retraining is for all real life, not just a bunch of "sets and reps."
You don't have to have surgery to stop pain. Here are Fitness Fixer posts on fixing knee pain without surgery:
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Vertebral Artery Compression, Dizziness, Discs, and the Forward Head
Tuesday, December 02, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
I received an e-mail from Serbia. Miroslav had suffered eight years of dizziness from compression of the vasculature and nerves of his neck. Then he found how to prevent the bad position called "forward head" using my methods. Miroslav had previously read various sources promoting the often-repeated bad advice to bend the neck forward as a the way to make space for the nerves that exit the back of spine. A little knowledge is a dangerous thing. That kind of forward bending is not a healthy way over the long term.
Bending the spine forward pinches vertebrae closer in front and farther apart in back, creating unequal pressure that over time, wedges and squeezes discs rearward and outward, like squeezing a tube of toothpaste. A disc nearly always bulges (herniates/moves/slips/migrates/extrudes) toward the back of the spine out the enlarged space, from years of the bad posture of sitting and standing with a rounded/bent forward spine.
Sitting and standing straight would make more space for the nerves without the herniating force. Miroslav also had a forward head as a regular posture, also called "straightening the cervical lordosis." He had been flexing his neck (bending forward) trying to fix his various numbness and pain, and wound up compressing verves, blood vessels and other structures.
Miroslav wrote in one of his blog posts that he was practicing Alexander technique for the previous few weeks, "as specified in Richard Brennan's book /head up and forward." After getting worse and trying various doctors and cures, Miroslav found my web site. He wrote:
"Dear Dr Bookspan, "I have found Your articles online and they have been extremely helpful. I just wanted to say that I appreciate Your work immensely. Few last articles I wrote on http://cvelee.blogspot.com/2008/11/quick-solutions.html regarding my problem and how You have helped me. If You have time, you can catch a glimpse of them. "With respects, "Miroslav Cvetinov"
Here is the post from his blog:
"Q u i c k s o l u t i o n s
"I am strong opponent to quick solutions to many of our everyday problem, whether money or health related. In such manner, I didn't expect my dizziness to disappear over night without trace.
"I had it since 2000. So 8 years before, they did everything necessary to rule out other diseases : EEG, Dopler, Blink reflexes, Evoked potentials... everything clean.
"In 2007. dizziness worsened so neurologist sent me to do endocranium MRI/MRA. Totally clean: no lesions whether white MS or atherosclerotic, balanced blood flow...
"2008. I have found article from Dr Jolie Bookspan, describing forward head posture and neurological deficits. I did have extremely straightened cervical lordosis, so I qualify for FHP. I started practicing healthy head postures : head back and FLEXION.
"I always thought that neck flexion was the key to healthy disc, because it opens neuroforamen, and that that degree of neck flexion wasn't possible without FHP. But, guys, I am physics scientist, I do not know how did it miss me : head-neck system has 5 degrees of freedom. I could pull it back, yet keep healthy degree of flexion. Just think of extending back of the neck while shortening front portion of it. That compulsive strengthening of SCM muscles I did, didn't do me any good, but...
"Anyway, MY TREMENDOUS DIZZINESS DISAPPEARED IN A MOMENT!! MOMENT, not day, not week, immediately. How? I do not know! I do not care! Thanks Dr Jolie.
"I can look over my shoulder while walking now. Easily without dizziness, loss of balance and lightheadedness. This it totally new.
"I have to give credit to 2 doctors more: 1. Dear ENT Vukoja Novak - he was the first one out of many doctors to tell me that if I consider it real, organic disease and not anxiety/panic related, I should check out carotid arteries on Doppler and cervical spine on roentgen. Latter revealed disk degeneration and straightened lordosis. He was the first to point to the spine. 2. Dr Mijanović - While doing EMG, he told me that tongue is clear except huge amount of hyperexcitability and asked me to check out something serious and real. I suggested left arm, with disesthesia running in C6 dermatome. He asked me about dizziness, I told him " I do have it, a lot of it, but dear doctor, I have panic disorder and somatoform disorder. It is due to this.". After poked me with a needle in left deltoid he immediately said "I can assure you, your dizziness are due to your spine."
"So, now I know. Not that it was spine, it can be cured in a moment:)"
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
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14,000 Miles on a Bike - Herniating and Fixing Discs
Monday, November 24, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Kristin S was run over by a hit-and-run driver while biking home from work. The car's trailer hitch crushed her face, nose, jaw, cheekbones, and eye sockets inward to her sinus cavities. After Kristin's reconstructive surgery, her step-mother, a student in my martial arts classes, asked me to make a house call to get Kristin back to physical activity. When I met Kristin, she had just had the wiring removed from her jaw, was moving slowly and painfully, and could barely open her mouth when she greeted me at the door.
We had a good session. I showed Kristin several of my rehab methods. She was a good listener and applied everything well. She rehabbed quickly and went back to biking, her socially conscious work, and her active life.
Kristin soon designed a bike trip called The EarthCycle Campaign to raise public awareness of ways to reduce common practices that waste and destroy world resources. Her trip extended 14,000 miles (22,530 kilometers) from Fairbanks, Alaska USA to Tierra Del Fuego, Antártida e islas del Atlántico Sur, Argentina.
I donated some of my books to Kristin to raffle along with her other fund raising activity for the trip, then off she went.
Along the 14,000 mile ride, Kristin stopped in villages and cities to exchange information about simple ways that we all can lower our impact on Earth's environment.
Months of biking passed. Kristin's back pain began.
Pain worsened as she rode mile after mile, through villages, open roads, and cities. She tried exercises she found on various web sites and doctors visited in cities she passed through. She did yoga. She stretched. The pain worsened. After one medical evaluation, the doctors told her results showed several herniated discs in her lower back. From there, she was told by every doctor that it was permanent and she had to stop biking. The rehab they gave her didn't help.
I received a short e-mail from somewhere on the road - "Help me, how do I fix this, they said I have to live with pain and have to stop the tour."
I chided her good-naturedly, "Kristin you should have read my books before selling them :-)" I e-mailed her back explaining the uncomplicated way that discs can be injured and also healed.
A herniated disc nearly always bulges (herniates/moves/slips/migrates/extrudes) toward the back of the spine, not the front. What pushes it to the back? You do.
Sitting with a rounded back physically angles the spine bones (vertebrae) closer in front and farther apart in back. The "opening" in back is often mistakenly written about as a positive way to make space for the nerves, but what is missed is that the bones pinching closer in front make unequal pressure, like squeezing a tube of toothpaste from one end. A little knowledge is a dangerous thing. Contents are squeezed outward to the other side. The discs are mashed and degenerated in front and pushed outward (herniated), little bit by bit, in back. At left (hopefully since we're still having graphics problems) is a graphic of the process from the post: Disc Pain - Not a Mystery, Easy to Fix. Two vertebrae are shown from a side view, as if you are sitting facing right. The right-hand drawing shows how sitting bent forward physically pushes discs (herniates them).
Sitting and standing straight would make space in a healthier way for the nerves.
Disc herniation is a process taking a few years, just like the damage of smoking or eating junk food accumulates until the heart is damaged enough to hurt.
I e-mailed Kristin telling her that a herniated disc is a simple injury, not a condition. It can heal if you understand and stop the bad postures that push the disc outward. In her case, it was sitting bent rounded over her bike, and unhealthful stretching and yoga. Here is what she did to understand and fix it all:
So was her yoga. If you already spend time bent forward and have the usually result of a flexion injury, you don't need more forward bending stretches - Getting the Right Yoga Medicine.
Questions come in by the hundreds. I make posts from fun ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
How Much Inward Curve Space Should There Be In The Lower Back?
Wednesday, November 19, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Reader Carina asked a good question on the post Prevent Back Surgery about how much space there should be in the lower back inward curve. Comments were not accepted by the Blogger software for several weeks, and I could not reply in the comments. Her question is so good, it was chosen for this Fitness Fixer post.
Carina writes:
"Hello Jolie, "Your information is so wonderful. Thanks for this stuff it's priceless.
I have been using the wall trick during the day when my back hurts (How to Feel Change to Neutral Spine). Wow it feels great. Only thing I can't STAY and walk like this. My knees are STUCK bent (or I go back to the big arch). I'd seriously look very odd walking around with bent knees. So here are my questions
"1) How much of my hand should go through when I am standing against the wall??? When I stand at the wall and do it naturally I can stick my whole arm to my elbow behind the arch.
"2) Besides these links you provided from a previous question Fast Fitness - Quick Relaxing Hip and http://windowsxp-privacy.net/?id=198760105 " (Note - the above link didn't come through in Carina's comment; I don't know which it is.)
"is there anything that helps me walk in neutral spine and not looking silly? "Thanks for caring about our backs, Carina"
Carina, great work. You have found that simply changing spinal angle (wall "trick") to reduce overarching works right away to reduce cause of pain. Next, here is how to retrain neutral spine into a normal natural stance:
1) Don't worry about "How much hand fits." It doesn't indicate amount of overarching. Lower spinal angle is what matters. Body proportions change the distance from wall - independent of spinal angle.
If you have too much tilt to the pelvis or you lean the upper body backward, lower spinal angle increases. To reduce an arch that is large, press the lower back closer to the wall.
The post Neutral Spine or Not? shows how to tell if your hip (pelvis) is tilted or straight, and/or if overarching (hyperlordosis/swayback) is coming from the upper body (leaning back). The wall maneuver shows you how to reduce the overarch. Don't press flat against the wall or you'll round like a beetle :-)
While standing at the wall, see if you can do a small "crunch" movement without rounding your upper body forward, to reduce the overly large arch. Movement is just from the hip and mid-torso. Hopefully, you will feel that you easily move the body without bending your knees. That should produce reduced lower back arch. Send some photos if you like and I will take a look.
2) Next, you need to make it possible and comfortable:
Check how you are standing. Don't try to touch the back of the legs to the wall. Just heels, backside, upper back, back of head.
Thank you for already checking the other links and finding the relaxing-hip-stretch. I couldn't tell which other stretch you wrote, but most stretches that lengthen a tight front hip can help. One that is functional for daily bending that you need to do anyway is Hip Stretch While You Strengthen Legs.
Hope to hear more about your successes. Send photos and I can post your continuing success in Readers Inspiring Stories.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
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This weekend, we will be at the International Black Belt Hall of Fame. Top martial artists and their students attend from all over the world.
I will teach a seminar on Stretching Smarter. Research is increasingly showing that conventional stretching is often not preventing or helping heal injuries. My seminar covers state of the art changes to stretch methods to restore function rather than doing artificial movements for arbitrary range of motion. Stretching Smarter workshops for the general public and medical personnel are planned for the Spring of 2009. Through cooperation of the International Academy of Functional Fitness, we hope to have certifications in place. See information on workshops on my website CLASS page.
Grandmaster Kanzler and Kim Harper and staff work tirelessly all year to make each year's Hall of Fame event. Photos are still not posting to show Hall of Fame training and the seminars. Hopefully will follow. For now, it's a martial arts visualization exercise. Paul and I were inducted into the Black Belt Hall of Fame several years ago and have been invited back each year as teachers. I am back in a white do-gi (karate training uniform). I left karate years ago to compete, train, and teach in other styles. This year, Paul reopened our karate dojo (training hall) after many years. I have returned to karate as his student. Check the CLASS page if you want to study karate with Paul at the new center. Scroll down to the karate class description.
I won't have e-mail for a few days to answer questions. Several posts are having technical trouble posting my replies to comments anyway, as part of overall temporary difficulties with the Blogger. Blogger needs a rest too, why not. I am preparing some of the reader questions as posts to come.
The Hall of Fame event is by invitation only. To attend or stop by and say hello this weekend, contact the International Headquarters of the International USA Martial Arts Association, 1-800-456-3872. Tell them I referred you.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
Which Stretch Stops Back Pain by Making Neutral Spine Possible?
Monday, November 10, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
What can you do if you're too tight to stand and move in neutral spine? A common lower back pain occurs after long standing, walking, and upright activity. The most common cause is exaggerated inward curve in the lower spine - a bad posture called hyperlordosis or overarching which pinches the joints called facets and the surrounding soft tissue. An obvious treatment is to simply stop the cause, and restore neutral spine.
Which specific stretches relieve the tight muscles that make neutral spine difficult?
Usually the tight muscles are in the front of the hip (anterior hip muscles) called hip flexors. Several specific easy stretches restore resting length to the front hip. Several of my patients and readers find that posterior hip stretches also help quickly. Liz first wrote in with her success story, How a Reader Stopped Recurring Pain, Got Stronger, and Said Aha!
Liz continues her story:
"Dear Dr Bookspan, "Just a few days ago I checked back to read your blog…since I posted my "Short history" which turned out to not be so short. I was particularly trying to share one thing that had happened to me, for which I couldn't find any specific help until I read your blog, which was back pain after bike riding.
"Even short walks hurt my back before I discovered your work, let alone the way my back felt after a bike ride, a future of pain, getting fat and depressed from lack of activity.
(trouble persists with getting photos to load - Liz' photo should be here and hopefully will soon)
"I thought I'd send at least one photo of me on my bike (I think I have mastered the dorky cyclist look) after a 12 km ride home from work and 12 kms to work that morning. If it hadn't been for you I would not have been able to do this, I would have not experienced the joy it gives me to use my muscles, feel my body doing what it was meant to do.
"I like being able to look after myself and not rely on an external source, like a chiropractor, to keep me well. Whenever I take out your book (Fix Your Own Pain) to refer to, my husband says, 'oh oh, what's wrong?' Mostly now it's just to refresh my memory of an exercise or principle you have written or to check I'm not doing something terrible to my knees. What a marvelous reference book it is.
"After I hurt my back during my first trial cycling to work, I read so many books and articles and web pages on back pain, and many on cycling and back pain. Mostly they were about pain caused by the racing position or impact injuries from bumps in the road. Then I read one of your blog entries where a readers/patient explained he had to give up cycling because of the pain he experienced in his lower back a while after he had been on a ride.
"This is what happened to me, in that blog you explained that a few specific stretches were useful for specific muscles. I checked many pictures of anatomy, which named the muscles that I seemed to be having trouble with, I went back to your book and read more about hips and how tight muscles in the hip area can cause lower back pain. It seems, sitting at a computer all day, then using my leg and hip muscles to propel myself up really steep hills was causing the muscles in my hips to tighten a great deal. That's why I tried your figure 4 stretch.
"It did precisely what I needed it to do, now if I don't do it regularly, I can feel my pelvis is tilting the wrong way, all by itself and my lower back starts to hurt. And when I lie on my back my front hip/pelvic bones (iliac crest) stick way out because of the extreme tilt. Then I do the lying figure 4 stretch and they go back into the right place. Now I know exactly what to do to end the pain and I wanted to make sure, should anyone be searching for help, that they will know there is an answer and your work is the source.
"Thank you for helping me find my joy." Liz.
Neutral spine is pictured at left. Too much inward curve (hyperlordosis) is pictured in the middle and right drawings. Abs are too long, lower spine is pinched in back.
Habitually keeping too much inward curve (hyperlordosis) shortens and tightens lower back muscles. Tight lower back muscles pull the back of the pelvis upward, tilting it outward in back and forward in front. The tight area feels normal when held shortened (hyperlordotic) and resists lengthening enough to stand in neutral spine. Stretching the lower back allows neutral spine to become possible and feel normal.
I wrote back to Liz asking if she was using anterior hip (hip flexor) stretches too and if she felt the posterior hip stretches working to let her restore straight hip instead of tilting forward.
Liz replied:
"Yes, being a mostly sitting worker I do the hip flexor (anterior front hip) stretch too, I'm sure it helps my ability to voluntarily keep my hips tilted correctly all the time, I can feel with my hands when they 'flatten'. I do this stretch everyday, sometimes twice a day and it's very helpful. I have on occasion skipped this stretch and only done the posterior hip stretch and I've found I have had no trouble achieving neutral spine. But I do it anyway, it's got to be good for me!
"This is my description of the reason I do the posterior hip stretch, mostly on my bike ride days (though it's so good for me, now I do it twice a day) - Even though I am tilting my hips voluntarily to the best of my ability, if I have not done the posterior hip stretch I feel a sharp pinching in my lower back, where the 'dimples' are, sometimes only one side sometimes both. I feel my front hip bones with my hands and can tell my pelvis is not correctly angled, I can't tilt it correctly any further without starting to use muscle force. Not the gentle neutral spine you describe.
"When I lie down and try to gently straighten my spine to neutral, I find I can't and my front hip bones stick out quite a bit. It feels like a muscle somewhere is holding on to my pelvic bone so firmly I can't move it without force. So then I do the posterior hip stretch on both sides for 30 seconds or more if it's feeling wonderful. Often I feel one side is far tighter than the other. Then I test again by lying straight, feeling my front hip bones with my hands and gently moving into neutral spine and I find they are nice and flat, and stay that way. Also the pinching pain goes quite rapidly. Occasionally the pain doesn't go away for a few hours, a hot bath helps. If this happens I do the posterior hip stretch a few times over an hour or two and that also helps. I expect this means I may have done a wee bit of damage to the soft tissue, amazing how the body heals.
"I have discovered that even on non-biking days, if I do this stretch regularly, I rarely feel any pain in my back at all. I'm not 100% certain if it's the combination of stretches that I do, including the hip flexor stretch, but I feel this one is critical for the correction of some kind of internal postural muscle, that is not behaving in a natural way, through some unconscious action of mine."
Usually, no special exercises are needed to have neutral spine. Worse, a common scenario is someone doing exercises then walking away with the spine still arched, never applying the exercise to real life. They become stronger people with the same bad posture - the exercise was not used for function. Instead, just stop the bad position and deliberately move your spine to neutral. However, when the area is too tight to move to neutral, here are stretches. The stretches don't change your voluntary posture, you do that. They just can make it possible:
First, Don't Tighten:
First make sure you don't tighten or clench abdominal or posterior hip and leg muscles. Tightening does not change posture, inhibits movement, and makes it hard to move to neutral spine.
Then, check if you just need a guide to help feel how to reduce the lower spine arch without pushing the hip forward, leaning back, or moving everything else:
If you find you are still too tight, stretch the front of the hip (anterior) and back (posterior):
Anterior Hip Stretches:
Until I make a post for this one, a relaxing start to stretch the front of the hip is to lie face up with knees bent and ankles crossed. Let knees separate to each side as far as comfortable. Keep lower legs next to each other, not one on top of the other. Do this without shoes, to fit your feet side by side without resting the lower leg on the foot. Experiment with pressing your lower back toward the floor. This stretches front and back at the same time, as needed for straighter standing. If this stretch is too much at first, start lying on your back with only one knee bent to the side, the other leg straight. Rest bottom of the foot of the bent leg at the knee of the straight leg.
A nice stretch over a bed or bench - Quick Relaxing Hip Stretch. If this one is too much, try it lying flat with a pillow under your hips. Gradually use a bigger pillow. Finally, lie with legs stretching down from the edge of the bed and no pillow.
A big stretch - Relaxing Hip, Leg, and Groin Stretch. If the Relaxing Hip, Leg, and Groin Stretch is too much to start with, do it face up instead of face down (see the first stretch above).
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
When is "quick fix" not a bad thing? When something is not right, there are times to make it right, then and there.
The health, injury prevention, and physical rehabilitation methods I developed are designed to quickly identify and stop sources of injury and poor health. The idea is to begin the benefits right then. It doesn't mean to substitute another problem, but put good practices to work intelligently and quickly.
Ivy from New Zealand first found The Fitness Fixer a few years ago when looking for information to fix serious sciatica and drop foot. Click Inspirational Ivy to see how she quickly stopped the pain, and how her neighbor took the photos used for that post and the updates Ivy has been sending since then. She wrote:
" You can imagine my joy when after 2 days I was free of pain. I was so excited that I contacted Dr Jolie, who in turn, took time out from her busy schedule to e-mail me giving me further advice and exercises which I might add, I follow religiously"
In a recent e-mail to me, Ivy brought up the idea of people wanting quick fixes. I am all for it. If something is wrong or bad, don't leave it that way. Mistakes become habit over time. It is quick to stop much pain and poor health by simple actions.
If something is causing injury or poor health, it makes no sense to allow it to linger. When medicine and fitness aren't healthy, fix it.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. LimitedClass spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. See Dr. Bookspan's Books.
For someone with "foot drop," the front lower leg muscles are too weak to lift the foot upward at the ankle. The foot hangs downward instead of lifting upward to take each step. Gait is altered and the front of the foot may slap the ground with each step. Fixing foot drop involves fixing three things - stopping the original cause, strengthening the (several) secondary effects of the weakened and tightened muscles, and retraining gait to normal. Common treatment options of braces to hold the foot up, canes or walkers to steady walking, drugs for the pain of whatever is causing it, reductions in activity, and certain surgeries, may all interfere with recovery and create new, and even more serious problems. Healthy treatment can be done without surgery, drugs, inactivity, or bracing.
One common surgery fuses the ankle so that the foot can't hang down. The foot can't move any other way either, causing new gait disturbance, and limitations in moving for health or fun. When foot drop comes from a herniated disc reducing nerve conduction, surgeries may remove the disc. However, discs are needed for healthy spine dynamics. Surgical spine fusion, even more drastically limits healthful movement, and ultimately health itself.
Interchangeably called drop foot, it is not a disease by itself, but the result of something else. Foot drop can follow a herniated disc that presses on nerves that exit the lower spine. It may also come from an injury directly to the peroneal nerve behind the knee. Certain diseases of the nervous system such as multiple sclerosis, Parkinson's, and amyotrophic lateral sclerosis (ALS) may reduce signals to various nerves.
A disturbing and increasing number of foot drop cases come from back and knee surgery. Someone undergoing surgery for a herniated disc or a knee replacement may wake with foot drop when nearby nerves were damaged or accidentally cut during the surgery. Such "side effects" are regularly called unavoidable surgical risks. It is important to change understanding of medical practice so that it is understood that adding new problems is not healthy and so, isn't "health care." Tragically, surgery itself for disc trouble is nearly always unnecessary.
As foot drop continues, lack of stretching in back of the leg that would have naturally come with each step from lifting the foot results in Achilles tendon and other structural tightness. Tightness can increase until that alone restricts lifting the foot.
Reader Sylvia wrote me several notes of her success reversing the components of foot drop. She first wrote in August, after finding the post of Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier. Her photos walking with a cane and needing to ride in a golf cart are above, left.
In Sylvia's case, her physician told her that a herniated disc was preventing the nerve down the leg from conducting enough to the front lower leg muscles (usually the tibialis anterior), which lifts the foot. Sylvia wrote,
"The specialist orthopedic surgeon I was referred to fortunately said he would not operate and my subsequent follow up visit has resulted in him telling me to go away as I am no longer in pain although I still have no dorsiflexion (upward lift of the foot). If in a year I still have drop foot I should discuss again with my doctor. Not very helpful…Thankyou for the wonderful work you have done putting this web-site together Best Wishes from England.
Sylvia"
When a disc is involved, the first thing to do is to stop the reasons for discs pressing outward, such as bad bending and sitting, and use good bending and sitting instead. If it is slouching so that you have too much inward curve of the lower spine, and that is pressing on the nerve, or it pushes the disc which then pushes the nerve, then you stop that habit, so it can heal. Stop the source. Surgery is not necessary. This is explained more in the post Cauda Equina - Result Not Cause. Then you exercise the shin muscles that have weakened, and stretch the calf and Achilles and bottom of the foot, which has tightened. You also need to practice balance and gait.
Reader Ivy began corresponding in the comments of the post to tell Sylvia her specific events to first stop the disc herniation, which was pressing and constricting nerve conduction.
By October, Sylvia has done much to reserve several causes and results. She was walking without a cane (right) and wrote,
"Hi Jolie and Ivy "I really appreciate your support and enthusiasm. My badly herniated disc obviously impinged on the nerve causing the nerve damage. I know this is from years of bad posture. I have come a long way already but not too far in the lunging and balance areas yet.
"At the weekend I was seen to be dancing at my son's wedding and I realised that non-one would believe I am usually slapping along.
"Instead of wearing my usual flat shoes or bare feet I had some new ankle strap 2 inch heel sandals for the event. The strap helps to keep the shoe on and the height of the heel was just right to keep me on my toes ! So I have decided to find a dance class to supplement my pool and land exercises as I have rediscovered I love dancing !
"I am going to Florida for a couple of months and should be able to find some dance action there. I'm going to try and toe walk on the sandy beach too.
"In the meantime I will keep on trying to change my bad postural habits! Best wishes. Sylvia"
Sylvia and I also corresponded. She send a photo of her happy and healthy at her son's wedding (below, right), with this update:
"Dear Dr Jolie, "I have received the books today... Now I have no excuse for not stretching and correctly at that !
"I can't wait to get back in the water and see how my ankles are - they are probably quite stiff so will need some work.
"I have printed the Inspirational Ivy page with the pictures of her exercising and keep it in my purse as a constant reminder that my condition will improve. Everyone here whom I haven't seen for two months whilst in the UK, is telling me how much better I'm walking. I tell them what I'm doing and if they have any problems refer them to your web page. Best wishes for now." Sylvia
We will be hearing more wonderful things from Sylvia.
Disc Pain - Not a Mystery, Easy to Fix - When you stop bending wrong many times each day, which pushes discs outward many times each day, damaging forces will stop, and can heal.
Read success stories of these methods and send your own. Questions come in by hundreds. I make posts from fun ones. See if your answers are already here by clicking links and archives, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Have The Fitness Fixer e-mailed to you, free. Click updates via e-mail "Health Expert Updates" (trumpet icon) upper right column. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
This morning, the United States Department of Health and Human Services (HHS) released "The Physical Activity Guidelines for Americans." The guidelines describe, "the types and amounts of physical activity that offer substantial health benefits." In summary, adults need 30 minutes of moderate-intensity daily physical activity five days a week, and children should run and play at least an hour every day.
Regular exercise lowers the risk of heart disease, many cancers, osteoporosis, diabetes, Alzheimer's disease, depression, and other diseases. Health and Human Services Secretary Michael Leavitt said in a telephone interview, "More than 59 percent of adults don't get enough physical activity and a quarter of adults aren't active at all in their leisure time."
Guidelines for ages 6–17:
1 hour (60 minutes) or more of physical activity every day.
Most of the 1 hour or more a day should be either moderate- or vigorous-intensity aerobic physical activity.
Vigorous-intensity activity on at least 3 days per week.
Muscle-strengthening and bone-strengthening activity at least 3 days per week.
Guidelines for over age 18:
2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week.
Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderate-intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both.
Muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.
Barry A. Franklin, PhD, national American Heart Association spokesperson and Director of Cardiac Rehabilitation and Exercise Laboratories at William Beaumont Hospital in Michigan, stated, "Numerous studies now suggest that if we can simply move people out of the lowest levels of cardiorespiratory fitness, it can have a profound (and beneficial) impact on public health." More information and downloads of federal guidelines - www.health.gov/PAGuidelines.
Use this Fitness Fixer column to see how to get healthful activity as part of daily life. You don't need a gym, a trainer, or equipment. Click the articles and archives in the list at right, use the search box at top right, and the Fitness Fixer Index. Read success stories of these methods and send your own.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. For personal evaluation take a Class. Top students may apply to certify throughDrBookspan.com/Academy.
---
Photo - Family meets guidelines on Morro Strand State Beach by mikebaird
Readers Count - Second Missed Cause of Back Pain With Golf
Monday, September 15, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Although twisting during the golf swing is often thought to be part of spine injury, two far more injurious movements are the most ignored.
Reader Jean Christophe wrote asking about the second factor - how many times do you bend wrong, instead of bending right using the leg and back muscles. This is a largely missed cause of back pain both in every day life and in golf. I asked readers to count how many times every day they bent badly. Jean Christophe wrote:
"Dear Dr Jolie Bookspan, "One year ago, I wrote you about golf and you gently answered. I could not play then because of the season and just wanted to share with you that we have to bend and reach the floor a lot of times: We tee the ball 18 times, and pick up the tee from the ground 18 times, we take the ball from the hole 18 times, we repair pitches on the green 10 to 15 times, we putt 36 times, we go to the bunker 4 times so we have to take the rake on the ground, we make divots that we take from the ground 18 times, and we have to take the flag from the ground 6 to 12 times; this means that we bend in a golf course around 115 times in a round of 18 holes. If you add the practice session where we put a ball on the ground 60 times or the putting practice, this means that we bend 200 times each time we go to play golf.
"Now, all of us bend the wrong way. But frankly, I tried to squat but it is not practical to tee the ball (it is not nice looking either but let's forget that) or to pick up the ball from the hole (ie under the ground).
"So I tried to stand on one leg and make the kind of stretch you spoke of ones putting the trunk and the other leg horizontal. This is more nice looking but not really the solution.
At the end, I reverted to bend badly like all the other players, unhappy because there must be a way.
"Last but not least, I made a swing more on my whole feet (instead of on the balls of my feet) and played solid. So the swing doesn't lose with good posture. But these 200 bendings need some work. "Dear Jolie, thank you for all you help. "Jean Christophe"
1. The reader captured the problem with this summary: "All of us bend the wrong way. But frankly, I tried to squat but it is not practical to tee the ball (it is not nice looking either but let's forget that)." To solve this problem, the first thing to do is to make good bending, using a squat (also called crouch) or lunge (drawing at right), practical to tee and pick up the ball:
2. Standing on one leg, lifting the other keeping the back straight and upper body uplifted, rather than bent over is a useful way to bend for objects on the ground. It is often called the "golf pick-up."
3. Reader Jean Christophe counted 200 bad bends in a single game of golf. No wonder it hurts. He reminds that bad bending is not the answer and wants to know how to get out of the habit: "At the end, I reverted to bend badly like all the other players, unhappy because there must be a way." One good way is to realize that bending right as an isolated strange action will not build the brain and body habit. This is bending you want the day when not golfing:
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy. ---
"Short history, I have hurt my lower back and neck several times previously through poor lifting technique and bad posture. My chiropractor did help, but it kept happening. I used to sit at a computer most of the day at work, then drive home, then go for a 30min walk with minimum stretching.
"Last year, when my back was ok, I decided to try riding my bike to work, three days a week, for the environment, the money, and for my fitness and weight. Each way is 12 kms, very hilly too in Auckland (New Zealand). After one week, my lower back was very badly hurt. I thought I'd never be able to ride to work again, that I'd have to get dressed sitting down for the rest of my life and I could barely walk. I felt like an old arthritic lady and I was only 38.
"I searched every book and website I could find, I had the idea it was my posture but I didn't know what to do about it. I found some information, but often what they recommended I couldn't do, they were too extreme or hurt me more or made no difference.
"Then I found your website www.drbookspan.com. Aha! I thought-this sounds good. And it was.
"I bought your book "Fix your own pain" and learn't more and got stronger and healthier, following your advice.
"But still my back hurt a bit, I would forget to tuck my pelvis, then it hurt and I'd remember. I would get up and move around more, I adjusted my chair and computer to help my posture at my desk, but would forget and slump and my back or neck would hurt and I'd then I'd remember.
"I can't believe how long it took me to "Click." When you say it's for every time you bend, you mean Every Single Time! Keep your pelvis gently tucked All The Time. Keep your back straight, heels down and knees over your ankles Every Single Time you bend.
"Then I started to remember alot more, and my back only hurt a little bit. Then just recently I decided to try cycling again.
"And my lower back hurt again. I went back to your book and read some more and thought. I read about the hip stretches and read your blog and thought.
"And I tried two stretches I hadn't tried before, the sitting figure-4 stretch and the stretch on your blog where you lay on your back to do the figure-4 stretch and gently lean to the side your foot is facing.
"What a difference they have made. I have to tell you just those two stretches have changed my life. Now I walk (pelvis gently tucked) with no pain, I sit (small lower back arch, chin in, relaxed) with no pain. Any little twinge and I do the seated figure-4 stretch and it's gone. After my bike ride I get down on the ground (in the changing rooms!) and do the stretch on my back.
"I found that I needed to lift my foot well up from the floor, keeping my hips level, and move both legs, still in the figure-4, over to the side my foot was facing, helped by holding my crossed ankle with my hands and keeping this stretch for about 30 seconds. This increased the stretch and felt sooooo gooood. And continued to feel good after the stretch.
"This is the first time I've added a comment to a blog, but I just had to let you know how grateful I am to you and your generosity in sharing your knowledge and I wanted to share with your readers about the increased stretch, I've learnt so much from reading their stories and your replies, I wanted to contribute a little bit too."
Many many thanks, Liz Auckland, New Zealand"
Liz, thank you for great work applying the concepts, rather than just doing treatments and exercises, and taking time to write to inspire and teach other readers. Send updates and photos when you can.
Going to a chiropractor does not solve the cause of the pain. Something may be tight or "out" but that is the result, not the cause. Save a lot of money and time by spotting the cause and making simple changes to stop it from happening again, yourself:
When Liz says "tuck the hip" it means straighten the lower spine to neutral position, not to round the back. Rounding is tucking too much. There is a difference. Here is a post with descriptions and drawings - Prevent Main Factor in Back Pain After Running and Walking
In A Whole Big Fix Mike fixed several injuries and made the interesting statement, "I stopped cycling to improve my health."
Back in December, I asked Mike if he wanted to get back to cycling and about his shoulder. While we were working on his story, reader requests piled in by the hundreds. Stay with us and questions will be answered. If I only answer them in order, it will be hundreds more posts before I get to questions arriving today, so make your questions fun and helpful.
Mike wrote his update:
"The cycling didn't cause pain at the time, but created bad posture habits and muscle tightness (shoulder rounded forward after separating collarbone in a crash, tight psoas muscles and hamstrings) which led to pain later. I'm walking more human-like now. Also, the air and traffic around here has gotten worse because of the housing and population boom, so I was having horrible coughing fits. Now I don't, without the aid of any medicine and, I believe, by following your diet recommendations.
"Shoulder: The physical therapist had me doing the trench coat type exercises you've described in your books as not as effective or needed, in many different ways (pictured at right), especially the "closing of the trench coat" which didn't make sense to me because they said I was overly tight in the front and too flexible and weak in the back. The visits there didn't work.
"Instead, I used the two stretches shown by your husband - right angle elbow with hand in air in Fixing Upper Back and Neck Pain, and the hand in the opposite pocket behind the back while leaning sideways, in Nice Neck Stretch."
Standard physical therapy exercise for rotator cuff consists of keeping the elbow close to the waist and rotating the forearm inward and outward, like a flasher opening and closing a trench coat (photo). There are almost no daily activities that need this specific motion, not even opening a door. No one uses their muscles this way (unless you are a flasher I guess). People do these exercises then go back to daily bad overhead reaching and re-injure their shoulder, or wonder why it never heals.
The rationale for doing the trench coat exercise is that strengthening the rotator cuff will heal the injury. Strengthening is not the main issue in most shoulder injuries that I see. Misuse of the shoulder is the root cause. A common counterproductive scene is people "doing shoulder exercises" with their head and neck slouching forward, upper body rounded, which injures the shoulder with each arm lift.
Slouching the upper body forward when raising arms for any daily activity, stretch, yoga, or weightlifting will continue to injure the shoulder. What improvement are you making to your shoulder to do exercises in a way that will injure?
Mike wrote:
"I'm also concentrating on keeping my thumbs facing forward when arms are down in order to help prevent my shoulders from rolling forward. I'm feeling more upright and balanced when doing everyday activities."
I told Mike that the idea is not to hold thumbs forward. The idea is to get the purpose of the stretch so that the chest muscles lengthen enough so that the arm bone is not pulled into inward rotation. The post on this topic is listed at the end.
Mike was also "doing" one of the key stretches but not getting the stretch needed, so no benefit was occurring. He was going through a set of motions to achieve the set of motions instead of to achieve the purpose, which was to restore resting length to the chest muscles. Mike made us some photos of how he was originally doing the pectoral stretch and how he fixed the motion to get the purpose. I will post them soon so everyone can see the difference.
It is common to stretch in ways that does not achieve the purpose, or are done in injurious ways. Then news stories report on studies that stretching doesn't improve physical performance or help prevent injuries, and no one knows why. It is not difficult to see why: What Does Stretching Do?
Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury
Monday, August 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
The photo at right shows one main contributor to shoulder and rotator cuff pain, and one for lower back pain. Can you see them? Can you see why the person in red is not getting as much stretch in the shoulder as they think?
I see patients for shoulder pain all the time. Their chart says, "normal range of motion at the shoulder," or the chart reads with a number of angle degrees corresponding to directly overhead reach. I ask the person, "Reach up for me please." They lean their upper body backward, increase the inward curve of the lower back, and their hand points directly overhead. Often they do this while tilting their neck and head forward, which puts the shoulder at a position of compression when the arm is raised. I show them how to straighten the upper body upright, reduce the lower back over-arch, and return to neutral spine. I ask them to reach up again. They can't. They shoulder is too tight to reach directly overhead. They were never stretching their shoulder when they thought they were. They were getting the motion from their lower back, not shoulder. They were only leaning backward, adding compressive load to their lower spine joints, called facets. This will be covered next in Part II.
In the photo, note that the head is forward, a major contributor to rotator cuff injury during overhead arm motion. Lifting your arm with the neck and head tilted forward mashes the upper arm bone against the shoulder bones. This compresses the soft tissue between them, including the rotator cuff and nerves that go down the arm. Each small pinch can eventually saw at the area until a rotator cuff tear begins.
Rotator cuff injury is common, even in people who do no overhead athletics, like pitching, martial arts, or kayaking. Reaching upward is common around the house and for exercise. Starting in the morning, you wash or comb hair (or polish a bald head). You pull clothing on and off overhead. You reach in cabinets, wave goodbye, shield your eyes from the sun, open car trunks and hatches, put things up on racks, shop for groceries and put them away in cabinets, lift children, clean curtains and tub walls, put work in overhead shelves - many reaches, all day, every day. At the gym there are overhead lifts, stretches, and arm motions.
Compressing the nerves that pass through the area and go down the arm sets is called impingement. Impingement is not a disease. Someone with a diagnosis of impingement does not have a real diagnosis. Impingement is not a cause of pain, it is a result. If you stop the mechanical cause, then you can stop the resulting impingement. No drugs or surgery or repeated therapies are needed:
Notice your neck and head position when lifting overhead and don't let your head and neck sag or jut or tilt forward. To see if you have the health and flexibility just to stand straight, try seeing of you can stand comfortably with your back and back of your head against a wall. If not, try some posts on upper body flexibility, such as Fixing Upper Back and Neck Pain. Don't force. Breathe. Smile. Relax. It's all for health.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Readers Carol, Don, Teresa, AJ, and others asked about strength, and knee pain and placement when descending stairs.
Physical trainer Teresa wrote:
"Hello Dr. Bookspan, "The post on "Better Exercise on the Stairs" from July 2007 contains the following statement: 'When descending stairs or hills, bend your knees when landing for soft shock absorption. Don't step down on a straight, locked, knee.'
"Some clients I work with have the habit of descending stairs on one leg because they can land straight-legged on the "weak" leg. Pain or fear of pain keep them from having the confidence to bend that "weak" leg sufficiently to support themselves for a soft landing on the other leg, but the "strong" leg will let them land softly on the "weak" one. When I get them to practice it, they find the proper motor pattern that is pain-free, but end up falling back on the old motor pattern that creates pain.
"Do you have any ideas on this one since descending usually requires more use of the toes than climbing the stairs does?
"I keep recommending your site to loads of people because you are sooo right. It's about motor patterns of moving our bodies, not just "exercise." Thank you for your time and assistance!" Teresa Merrick, M.A. ACSM HFI, NSCA-CPT/CSCS, NASM CPT Master Trainer
Climbing stairs is a functional (real life) skill. Not having the strength to support your own body weight is serious weakness:
It is not healthy to land straight-legged with a locked knee on either a weak or strong leg. The functional life skill needed to descend the stairs is similar to what is needed for simple daily healthy bending (right drawing). Bending knees to retrieve and reach is something everyone needs to do many times a day. How many times a day do you think you bend for ordinary actions? Click How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
Use the simple built-in life activity of healthy bending using the half squat (right drawing) to train your legs for the strength and mobility needed to descend stairs in a healthful way.
When you bend in the half squat, keep both heels down and your weight shifted back over the whole foot (right drawing), not just the toes (left-hand drawing). Pull back more to the heels if you slide forward.
No need to increase the inward curve, called hyperlordosis, or overarch (left). Hyperlordosis pinches the spine and can cause impingement and mystery back pain (Prevent Back Surgery). Overarching is sometimes taught to weightlifters because it shifts some of the effort onto the lower spine joints called facets, making the lift easier. It is healthier to keep the weight on the muscles and not overarch. Keep neutral spine (right drawing).
Keep heels down for bending using the half-squat, instead of lifting the heel. Keeping heels down shifts weight to the thigh and hip muscles and off the knee joint. Enjoy the free, built-in Achilles stretch with each bend. Specifics on this in the post Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.
Descending the stairs should not be a toe-intensive maneuver. Your body weight belongs on the strong muscles of the thigh and hip.
Once you have the idea of the healthy bending you need for daily life bending, transfer that healthy movement to the stairs:
Keep more weight on the leg on the upper stair, instead of flopping and stomping all weight down on the foot that is stepping down.
Keep your weight back more toward the heel on the upper leg.
Keep heel down longer on the upper leg, instead of lifting the heel right away. Get the free, built-in, functional Achilles stretch.
Bend knee slightly upon stepping down instead of landing straight-kneed. Remember this is the same strength and skill that you need and have been developing (or should have) for ordinary daily bending, which totals many dozens every day.
Use good shock absorption from the thigh muscles of the leg stepping down.
Instead of dong artificial leg exercises like leg raises, use legs for real life to get automatic built in exercise in the way you need to move. The movement gives built-in strengthening and stretch and movement patterns. The built-in strengthening and stretch and movement patterns directly improve daily function.
More will come in future posts. Have a real life of activity and fun, and enjoy.
Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from fun ones. Before asking more in the comments, see if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index.
Subscribe, free by using "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
A widespread myth is that to fix posture you must strengthen sets of muscles.
After spending time and money on strengthening exercises, people often wind up as stronger people with the same poor body position. The fallacy is that strengthening does not create movement. You do that yourself.
A physician wrote me that he has hyperlordosis from surfing, and is "working" to fix it. He had spent much time waiting for the exercises to "work." What he missed is that surfing does not cause it, and how you stand can be fixed there and then by deliberately, volitionally changing how you stand. How? Try Friday Fast Fitness - Neutral Spine in 5 Seconds.
"Thank you. I am a D1 athlete and have been struggling with back pain/extreme tightness when lifting and playing in the same day. I have known I had bad posture while running/walking for about 4 years, went to physical therapy for it, and still haven't changed it. I kept waiting for a certain exercise to suddenly "fix" me. Duh, what fixes me is ME CHANGING IT. Shocking."
When certain muscles are tight, it can feel normal to stand badly. Even though it is popular to talk about tight hamstrings changing posture, that is mostly an issue when sitting. When standing, two tight areas are most common, chest and front hip:
Tight front chest muscles make round-shouldered position feel normal. Round-shouldered positioning keeps the front muscles shortened, in a cycle of shortening and tightening. The upper back muscles over-lengthen. This is why the most common stretch of pulling an arm over the front of the body is usually counterproductive. To fix anterior (front) tightness start with understanding and doing the pectoral stretch, described in Fixing Upper Back and Neck Pain and stop promoting an already overstretched posterior shoulder with The Stretch You Need The Least.
Tight front hip muscles make standing badly feel normal. The front of the hip is pulled downward, tipping the backside outward in back. The lower back increases in inward curve in a painful posture called swayback or hyperlordosis. Many people stand this way without knowing it because they think standing with the hip tilted forward in front is normal or "cute." Much of modern conventional "fitness" encourages this unhealthy, unattractive bad posture.
Hyperlordosis is a major hidden factor in lower back pain. People may undergo months, even years of treatments, adjustments, shots, medicines, therapies for discs, sciatica, facet pain, and other pain without knowing or changing the cause - allowing a too large an inward curve to the lower back.
The photo at right demonstrates an over-arch in the lower spine, the hip tilted forward in front, and a forward head while doing an activity supposed to be for health.
It seems impractical to do "fitness" in unfit ways - practicing unhealthy positioning, shown in the photo ->
Moreover, tilting the hip forward reduces the Achilles stretch and reinforces bad movement habits. For a more functional Achilles stretch try Better Achilles Tendon Stretch.
Hyperlordosis is not a medical condition or unchangeable anatomy. It is simple bad posture that you can allow or change right as you stand. Neutral spine is not pushing the hip forward, just moving it enough to make it level. See a short movie in the post Friday Fast Fitness - Neutral Spine in 5 Seconds. To stretch the front hip, try these:
Remember that stretching the hip and shoulder, and anywhere else, will not automatically make you stand right. You do that yourself using your own muscles and brain. Free exercise. Free fix.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Fast Fitness - NoCost Hand Strength and Rehab Equipment
Friday, June 20, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness -hand exercise without rehabilitation equipment.
One of the exercises against repetitive strain syndrome is to exercise the muscles that open the hands. There are expensive commercial devices you can buy for this. One consists of a special glove with weights and pulleys to resist your ability to open your hand. Or you can:
Hold the fingers of one hand closed with your other hand
Open the hand against the resistance of the hand holding it closed
Do as many as comfortable. Repeat with the other hand. Vary intensity and number.
If you want to go high-tech, put a rubber band around the fingers instead of using your other hand. Push each finger in a variety of ways.
Fast Fitness - Fixing Yoga Warrior and Lunge Exercise to Neutral Spine
Friday, June 13, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - quickly change your posture to change your luck on Friday the 13th. Hyperlordosis (swayback posture) seems to be unlucky - it causes lower back pain. You can do this in seconds to make a certain change to healthier spine for yoga or practicing the lunge. If you don't believe in luck, you're lucky. It's just good posture and simple anatomy.
Reader David from Belgium demonstrates in this 20 second movie that he made for us:
First ten seconds - he steps into a yoga pose called Warrior pose, but allows overly arched lower spine. He also demonstrates leaning more weight forward of center line, which is a different issue.
Note how the belt line tips downward in front and the lower spine overly curves inward - more than a normal curve.
At second 11 he levels the hip to bring the posture to neutral spine. Then he kindly demonstrates overarching when raising the arms further. Instead, hold neutral spine and raise the arms from the shoulder, not the lower back.
To prevent shoulder impingement when raising arms, keep shoulders down and back, don't just chin and neck forward, keep them gently in. A forward head posture compresses the rotator cuff when lifting arms. See Safer Overhead Military Press.
I never expected repeated requests to see how to do neutral spine in different activities. It is the same. Just apply the same neutral spine and that’s all. I thought one post would do it, but will post each activity readers ask about. I am aware that there are yoga and fitness places which teach to overarch the spine as part of the move. Teaching swayback does not seem to be as helpful as teaching neutral spine. Changing lunge and Warrior pose to neutral also improves the stretch to the front hip muscles of the back leg. Lucky.
Simulation Suit To Feel the Pain of Osteoarthritis
Monday, June 09, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
A BBC news article reported on a suit that gives wearers a "real life" insight into the pain and impaired quality-of-life associated with osteoarthritis (OA). The suit costs £20,000 and was developed by Loughborough University. They wrote: "The JOINT Osteoarthritis Education Programme will be made available to GPs throughout the UK, providing advanced training on the diagnosis and management of the condition, including both drug-based and lifestyle approaches to help improve mobility and minimise pain."
How does this suit work? The specs for this particular suit are proprietary to the company (that means they are not telling). Similarly marketed suits to simulate arthritis use a simple principle to produce the painful feeling - they use straps and other restrictive designs to hold the body in bent positions that cause the rubbing and strain.
The suit would be useful for the kind of health care worker who tells people to live with their pain instead of fixing the cause to stop the pain. Most other people don't need an expensive suit to show them how to hunch over and hurt all over:
The post Disc Pain - Not a Mystery, Easy to Fix shows how to understand the simple mechanics that damage discs. In my work, I have found it is one of the same mechanisms that increases wear and tear on the vertebrae contributing to spinal arthritis.
The second main wear and tear injury adding to spinal arthritis is standing with the lower spine arched inward too much (lordosis) - Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine. The muscles you would use to simply move your spine to a less arched position and restore neutral spine are your abdominal muscles.
Discs and vertebrae are living parts of your body. They can heal, when you stop hurting them, usually starting within days by stopping the harmful movements that aren't good for you anyway, and using healthy movement during daily life that gives you free exercise. Discs can heal without surgery, just like a sprained ankle. More on how to stop recurring ankle sprains is in How To Treat Ankle Sprains and Prevent Them and No More Ankle Sprains Part II.
Post on changing bad positioning that increases wear and tear and risk of osteoarthritis on knees: You Can Fix Your Own Knees.
Post on changing positioning that increases wear and tear and risk of osteoarthritis of the lower back: Prevent Back Surgery.
Use all the various articles on fixing injuries in The Fitness Fixer to see how to move in healthful positioning so that your exercise is healthy rather than injurious. You don't need to get treatments, or adjustments, or surgery, or shots, or medicines. It is a win-win situation where you do not have to give up favorite activities, and can become healthier than before. Just use healthy movement as part of normal daily life and get free exercise, better physical abilities, and stop the processes that cause injury, all at the same time.
For books, try Fix Your Own Pain Without Drugs or Surgery and Health & Fitness in Plain English Third Edition. The Fix Pain book concentrates on how to stop injury process in each area, with patient stories in each chapter. The Health & Fitness new third edition covers back and neck pain, plus living and exercising in healthy ways, nutrition, and health issues including measuring body fat tests, bone health, heart health, and other topics. Descriptions on my books page.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Exercise and Aging - Don't Limit the Patient to Limit the Pain
Wednesday, June 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
A Reuters news item last week reports that "baby boomers" are accumulating wear and tear injuries, and they should consider cutting back on amount and type of exercise they get.
The article points out that contributors to injuries are biomechanics, poor flexibility, and "pounding" or stomping down unnecessarily hard when running, jumping, walking, etc. Even with that knowledge, the news report goes on to say the answer to reduce injuries is to cut back activity. In Sunday's Fitness Fixer post, Forearm, Upper Body and Hand Exercise, I wrote that it is not a healthful or useful solution to "limit the patient to limit the pain."
The Reuters article quoted a foot and ankle podiatrist saying, "It is really important that people continue to be physically active, but they need to think logically about how to remain active as they age… Probably when you start getting into your 40s and 50s, the half marathon is a great alternative (to full marathons). Or, if you did two or three marathons a year, cut it back to one a year or opt for 10K or 5K runs." The podiatrist himself is a marathoner. He stated, "Having run 25 marathons, it was hard for me to cut back."
I would suggest looking at biomechanics, poor flexibility, and "pounding" first, before telling someone to stop doing what they love:
I have some exciting developments about getting you information on Exercise and Aging. Will announce soon.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
"Hello, I'm writing as someone who has incurred a training-related lower back injury and who has great interest in your words on hyperlordosis. I am hoping that you might shed some insight on how to achieve a neutral spine while doing "kettlebell swings." This is the exercise that has caused me back pain, and I would love to return to working out with kettlebells, but am not sure how to do so without creating too much lordosis. Any ideas? I appreciate any assistance you can provide and thank you for your contributions! Take care, Dan L"
Kettle bells (also called kettle balls and many other names) are usually ball-shaped weights with a handle. A variety of sizes is shown in the photo below, along with a medicine ball for comparison. Kettle bells were long used in various martial arts and cultural festivals and contests before being rediscovered for modern weight lifting. In general, you lift, swing, and move them to do various weight lifting exercises.
When lifting and swinging kettlebells (and any weights) overhead, don't lean your upper body backward (photo below left). Leaning backward is often mistakenly done to "balance the weight" and make the lift easier. Another common body movement to make lifting overhead easier is changing the tilt of the pelvis (hip) so that it juts forward in front and outward in back (same photo below left). Leaning the upper body back and tilting the pelvis are not necessary to balance a load - your own muscles can hold the load, and in fact, that is the point of lifting the weights. Not only are they not necessary, they increase the inward curve of the lower spine. Increasing the small normal small inward curve (lordosis) to a large curve (hyperlordosis) increases compression on the joints (facets) and soft tissue of the lower spine. The same overarching is the hidden cause of back pain in women who lean back and/or tilt the hip trying to offset the load of a pregnancy - Back Pain in Pregnancy - and Why Men Can Get It.
The photos of spine position swinging the heavy medicine ball are from the book Healthy Martial Arts. My black belt student Christopher demonstrates. This is a similar overhead motion as swinging kettle bells by the handle. In the left photo, Christopher allows the hip to tilt forward in front (and out in back) and his upper body is tilting backward relative to the lower spine. In the right photo, he holds neutral spine. In the right hand photo you can see the change to reduce the overarching to neutral spine. The belt line changes from tipped downward in front to level.
Leaning backward and overarching are not helpful adaptations as sometime thought, are not unavoidable, and are not limited to pregnant women. Overarching (hyperlordosis) is a common bad posture, and an often missed source of back pain. It can be easily prevented by using your muscles to hold neutral spine. The post Prevent Back Surgery shows photos of hyperlordosis compared to neutral spine during many activities.
Neutral spine while exercising with kettle bells is the same as neutral spine during anything else - just hold your spine position. Holding neutral spine is the same as not slouching your shoulders or not letting your mouth hang open. You just voluntarily move to and hold desired position.
Neutral spine is not done by tightening or clenching any muscles. It is done by moving your hip and lower spine the same way you move your arm to scratch your nose - without tightening, just moving it to where you want it.
Helpful posts to see and learn neutral spine while swinging kettlebells, babies, and all other fun weightlifting:
The book Healthy Martial Arts (www.DrBookspan.com/books) has a section on lifting and swinging kettlebells, medicine balls, and other weights. Keep breathing, smiling, and have fun. You can swing weights to be stronger and healthier, without injury.
"Thanks for yet another great post. I am an ER nurse and see the horror of chronic back pain on a daily basis -- the disability, depression, and addiction that eliminates any quality of life for the sufferer and their family. Even after surgeries and pain clinic visits, I've yet to meet a patient who has managed to rehab well. Last year at age 52, after years of moving patients, some over 700 pounds, I injured my back while installing a patio and I couldn't breathe, let alone move without pain. If I hadn't been a devoted follower of yours, my career would have been over. I got your book, Fix Your Own Pain, did the exercises and went back to work four days later. I took a muscle relaxer to help me sleep the first three nights but have never taken any pain medication. The exercises actually relieved pain for me. I can't thank you enough.
Just a quick question, can you suggest proper form for climbing stairs, to prevent back and knee problems? I'm in a 3-story condo and don't want daily routine to do any harm to the old joints. Thanks so much Jolie!"
Barb, you have the intelligence, quick thinking, interest in learning, and empowerment that makes a quality ER nurse. Try Better Exercise on the Stairs.
Click this books link for the book Fix Your Own Pain and other resources.
Fixing Pain and Golf Easier With Real Life Movement Than Isolated Exercises
Monday, May 12, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Jeff is a Silicon Valley executive, and coach of Next Stage. He found that a lifestyle of unhealthy exercise habits can accumulate, until one day of golf becomes "the Camel's Last Straw."
Jeff writes:
"There is life after back pain – even the kind where you can’t walk, sit, lie down, or sleep.
"The weekend before Thanksgiving (2007), I was out golfing, and I made a pretty bad swing at a ball that was buried in deep rough. My club got stopped by the deep grass, my back and arms kept going. I immediately felt a sharp pain in my lower back – so much in fact that I could no longer make a normal swing or even get down into a putting stance.
"I had to give it up after 6 holes and head home. I could still walk, but I couldn’t crouch and I had a hard time getting up out of a chair.
"Three days later feeling a little better, I headed out to the fitness center to do some treadmill running - NOT a good decision. After about 10 minutes, as I was cranking up the speed to a fast jog, I felt a searing pain in my lower back and down through my left thigh. From then on, I was toast.
"By the next morning I could barely walk. I had so much pain in my lower back and left leg I needed to support myself with a cane. I could barely walk or stand with the cane. There was no comfortable position for me, and I couldn’t sleep more than an hour at a time – even on pain killers and over the counter sleeping pills. Two trips to the chiropractor changed nothing.
"I did a web search, found Dr. Bookspan's web site, bought "Fix Your Own Pain Without Drugs or Surgery" and then even sent her an email telling what had happened. To my amazement, I got a personal answer (then another then another as I wrote with more questions and my progress). Dr. Bookspan referred me to the lower back pain part of her site, and I started doing the retraining exercises daily – and more importantly I started “living” the exercises, i.e., using them to get good body positioning and healthy movement into my day.
"In the beginning I could barely do the exercises, my pain was so extreme I couldn’t lie flat on my stomach or back without pain, not to mention doing upper or lower back extensions. (I wrote to Dr. Bookspan who found that I was overarching the lower back, when I was thinking I was straight. Wow! Consciously tucking the hip more reduced the pain significantly.)
"After a few days, things improved so I could perform the exercises better. I started to walk again – albeit with discomfort. (I wrote again and once again got the encouragement I needed, and realized the specific things I was not yet getting right. I was still overarching the lower back and that was preventing healthful motion.)
"Today, it is 5 weeks since worst of the pain. Thanks so much for your support. I am orders of magnitude better! I am walking without a limp – pretty much normal gait. I played 9 holes of golf this morning, walking a very hilly course, carrying my clubs. Yesterday I was on the treadmill doing some light jogging. All signs of discomfort are gone and I am gradually working myself back into shape. I am not taking any medications of any kind, and I am doing just great.
"I am working hard to incorporate the things I learned from Dr. Bookspan about movement, posture, and exercise into my daily life. It makes total sense to me that the positions you are in for most of the day have far more impact than 10 minutes of exercise. I feel like I have been to hell and back, and I definitely don’t want to make another visit."
Dr. Auerbach of the Wilderness Medicine blog wrote an important post for the many requests we get for personalized medical replies. Internet articles are not intended as a substitute for care from your own providers. We don't diagnose, treat, make medical claims, persuade or dissuade anyone about seeking medical attention. Dr. Auerbach's post was so well said, I echo it here for readers of Fitness Fixer: A fair number of comments from readers of this blog come in the form of clinical questions, in which someone asks for a response to a personal medical question. While I would like to be able to answer most of these, it is difficult to do that without more complete information, and in the absence of being able to examine the patient(s).
When a question or comment raises an issue or point of interest that is important for everyone, then I will try to address the topic in a separate post, rather than as an isolated answer to a question. In this way, more people can benefit.
Thanks for being a reader, and for your understanding.
When you stretch and exercise, especially if you stretch and exercise to improve your health, remember that the purpose is not to recreate unhealthy movement habits.
Two similar letters came in recently.
Reader Tina wrote:
"Thanks so much for your posts on stopping upper back pain. I have stopped my upper back pain. But, when I pull my neck and shoulders back, I get pain in my lower back. Which stretches should I do to stop this pain?"
Alicia wrote:
"I recently stumbled upon your articles on the Internet about how to reduce back pain. Thanks so much for providing this information! I am experiencing less pain for sure already… but I have a question. When I am keeping my neck back and shoulders back and correcting the lower back arch, I get a pinching sensation in the middle of my back. What am I doing wrong?"
Tina was doing a common unhealthy movement habit. She didn't need stretches to fix the pain; she needed to stop old injurious movement habits. Tina was leaning her upper body backward thinking she was pulling her shoulders back. Leaning backward is not correcting rounded forward shoulders, even if it seems to move the shoulders rearward. The shoulders have not moved at all just stayed rounded while the upper body pinched backward at the lower spine.
The photo at left is a performer who had just finished a trapeze performance. All the exercise and stretching she did every day didn't change her bad positioning habits.
Leaning the upper body backward (shown in the photo, left) increases the inward curve of the lower back, making a sharper angle between the pelvis and the lower spine. That increases the normal lordosis (inward lumbar curve) to hyperlordosis (too much inward curve as in the photo), which put painful pinching compression on the area. Look at the strip on her leotard. It tilts forward at the front hip and back at the back of the hip. It should be straight up and down, which is part of holding neutral spine.
The photo also shows shoulders and upper back rounded forward, and the neck and head jutting forward.
Slipping into familiar unhealthy ways of moving may be habits that occur without thinking. You need to think a bit.
Alicia was just pulling back so tightly that she pinched the area between the shoulder blades. There are sources that say that you should squeeze shoulder blades as if holding a penny between them to fix posture, but of course, that is painful and too tight.
Alicia wrote back:
"Thanks! That helps actually. The pinching was in my upper back, but it's gone now! Thanks so much for responding to me. I look forward to your class in July. Alicia"
Pinching back does not fix posture or stop upper back pain. Instead, stop the causes of the rounded shoulders and the pain.
These three posts help understand and fix the causes:
The post Prevent Back Surgery shows several photos of how people learn the upper body back or tilt the hip out in back during several common exercises, stretches, and daily activities. Both increase the pinching compression on the lumbar spine.
Remember to think and watch for causes instead of just *doing* exercises and stretches.
Last year, reader Ted fixed back pain by learning to use neutral spine during running and daily life. This week he checked in to say the back is still fine, and that he went on to fix other painful sites.
Fixing pain and injuries by doing some exercises may temporarily ease symptoms. Instead, you can stop the source of injury by making movement habits healthy while exercising and moving through daily life, so that you can get exercise at the same time that the area can heal, and the pain not return.
Ted writes:
"Dr Bookspan, last summer, you helped me return to running, and did an article on me and how the neutral spine fixed my back problem with running.
"The back is a NON ISSUE. Thank you so much.
"Currently, I am working on hip/hammy/knee issues (probably due to over-training). Just thought I would share a thought on the ''Duck Foot'' issue you had talked about (I read the Fitness Fixer religiously). While running on the padded infield of the Stadium Football Field, I was still noticing pains in my hip (caught my foot on the ''upswing'' during a run, hip has hurt off and on since October).
"I focused on my feet, specifically, how I pushed off after the foot-strike (very soft, I often scare other runners because they can't hear me coming up on them). A straight push off after the foot-strike made the pain go away (probably because it aligned my foot/knee/hip during the movement). Also, when the knee pain flared, tensing my quads made it go away.
"I have enjoyed reading your ''Running Articles' please keep 'em coming. AND Thank you for fixing my Back. Much Appreciated, Ted H"
To fix the source of pain, it works best to understand healthful movement retraining and not just "do" a series of rules. One important example is keeping feet parallel or facing forward. The idea is to understand that a straight push-off comes from keeping all the joints in the kinetic chain from feet to hip and spine from twisting in unhealthful ways, not just straighten one segment by twisting another. Yanking or forcing the feet straight is not the point of good positioning.
Ted has more helpful stories to come in future posts. Click these posts for more:
Raina and several other readers asked about plantar fasciitis.
On a house, a fascia is a flat horizontal surface just under the roof. In your body, a fascia is flat fibrous tissue that wraps your muscles and soft structures. You have fascia in several places. One is across the bottom of your feet. "Plantar” means the bottom of your foot that you "plant" on the ground. Your plantar fascia is the fascia on the bottom of your foot. Plantar fasciitis is an inflammation (-itis) of the fascia on the bottom of your foot.
Normal Plantar Fascia Action When you walk or run with your feet facing straight ahead, the line of bending of the foot is straight from front to back. Each step gives you a nice, built-in small stretch across the bottom of your foot. As you walk, run, jump, and move, your plantar fascia transmits body weight across your foot. It is part of shock absorption for your entire leg.
How Bad Movement Mechanics Hurts Several things can make the fascia tighten and hurt. Here are three. More to come in future posts:
1. When you walk or run with feet facing outward, the fascia loses the normal stretch. Over years of not getting its normal stretch, it becomes tight. Walking with feet facing outward also puts sideways forces on the fascia with each step instead of the needed stretch. Walking with poor shock absorption, banging down heavily with each step can amplify strain forces on a tight fascia. Every step you take on a tight fascia yanks on the heel where it attaches. Eventually the heel and bottom of the foot get irritated from the yanking and start to hurt. Irritation can eventually cause the bone to thicken to protect itself - a heel spur.
The tighter your Achilles and foot fascia, the more "normal" it feels to walk toe-out. In a circular problem, walking toe-outward is a common fascial tightener. It may be "natural" with tightness, but can increase tightness over time.
2. Letting ankles constantly sag into pronation (flattened arches) is another fascial strain. Keeping body weight more evenly around the sole of your foot, not pressing and downward on your arches, lifts the weight off the arch. Reader David from Belgium made us a great short video of easily changing from rolling in on the arches to holding straight in Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches.
3. Hard sole shoes and some fasciitis braces stop the sole from getting the normal lengthening while walking, stopping the pain from the stretch, giving the false impression that the injury is lessening. A negative cycle continues of shortening and continuing the source of the injury. Injections briefly make the area more prone to injury. Pain pills allow you to continue the injury process without pain telling you that it is wrong. Several kinds of anti-inflammatory and pain medicines interfere with healing. Wearing high heeled shoes raises the heel, shortening the length of the Achilles tendon, putting less stretch on the tendon, the lower leg muscles, and the fascia of the foot.
Fasciitis can be quickly stopped. It does not have to be chronic. "Doing" a few stretches does not undo a lifestyle of shortening, tightening, and straining. Forcing tight, artificially straight position instead of creating the length and use of the area that allows healthful motion, can create more pain in other segments. Use your brain and learn good body movement to allow it to heal and be functional.
Helpful links to move in healthy ways to stop plantar fasciitis:
The book Fix Your Own Pain Without Drugs or Surgery has a section on fasciitis, the many unhealthful lifestyle contributors, and simple lifestyle fixes to build into daily life and your exercise classes.
We live part of each year in Asia. For a few months, I was posting articles for you from various villages. The town shower of one is pictured at right - not the hut, the outdoor green post with hose. Imagine what the Internet café was like.
On the flights over, our only bag was lost. US transportation security required us to check our sole knapsack, since it had a small gift for friends containing liquid. It never reappeared. We don't need "things" and it was just as easy to make our own soap, comb, and toothbrushes as carry them.
In Western stores, I am astonished by the number of "personal care items." Not just shelves full, but aisles. Each promising better hair, skin, nails, and other parts, but with ingredients that are not healthy for your body, produced in ways that pollute the world, and packaged in plastics that are unhealthy to produce, pollute when discarded, and which apparently leak chemicals into the product that can be absorbed through your skin - see Green Water. A study commissioned by the Organic Consumers Association found that even shampoos, body washes, and lotions labeled "natural" and "organic" can contain unhealthful, even carcinogenic compounds.
I feel high maintenance just carrying a toothbrush. Then we arrived without even that. What freedom.
We made simple hand sanitizer from coarse salt, rubbed between the palms.
For body, face, and hair, we picked aloe leaves, squeezed out the gel inside, and rubbed directly on - see Fast Fitness - Aloe Inside and Out. It dries non-sticky, and makes your hair shiny, clean, and healthy. We used the rest of the gel in food and drink for healthy digestion.
Bamboo is easily made into cooking pots (photo above left). We also visit our favorite bean sprout PadThai restaurant - an outdoor wok on wheels run by a friend. Paul is always popular when we travel (photo at right). The others are not sitting; Paul is really that tall, and has to duck those umbrellas, doorways, and ceilings.
Baking soda and salt makes clean toothpaste. Even without them, a short branch called a neem stick with one end mashed until fibrous, makes a soft, effective bristled toothbrush. Neem extract is said to be a good antiseptic, and effective against various health ills and germs.
After a long day at work and after hard training, instead of hand lotion, you can rub sesame or other light healthy cooking oil onto your hands and feet. You can scent it with mint leaves, citrus peels, spices, and flowers. More ideas in Healthy Mother's Day.
I don't use sunblock, even in the tropics. I do use something to stop some of the unwanted effects of too much sun, but I do not want to block the Vitamin D and other helpful effects of sunlight. Vitamin D deficiency can lead to osteoporosis (thin, brittle bones) and osteomalacia (rubbery, demineralized bones). Vitamin D deficiency is associated with increased risk of a few types of cancer, including lung cancer. Studies find that people with low blood levels of vitamin D were more likely to have high blood pressure, cardiovascular disease, cystic ovary, and type 2 diabetes. Another study found that a number of patients with aches and weakness were vitamin D deficient and concluded, "A lot of 'fibromyalgia' may be D deficiency."
Instead of blocking or deflecting UV rays using chemical sunblocks that may contain chemicals that I am not sure are healthy, I mix my own, that I hope stops the oxidizing effects and makes my own body better able to stop skin cancer mechanisms. I mash together fresh coconut pulp, green tea, vegetable sprouts, mashed turmeric root, and aloe gel.
A study by Johns Hopkins researchers, reported in the Proceedings of the National Academy of Sciences (October 30, 2007, vol. 104, no. 44, 17500-17505) found that rubbing an extract made from broccoli sprouts on your skin may help prevent skin cancer from high levels of ultraviolet (UV) radiation. Broccoli, and the sprouts in particular, contain a chemical called sulphoraphane, which is found to activate cancer-fighting enzymes in your own cells throughout your body, not only skin cells.
Instead of chemical anti-mosquito products, we try various things. Marigold flowers rubbed on the skin seem to work for us. I don't seem to be "sweet," and mosquitoes often ignore me while going after Paul. We have heard various theories from locals. One is that he eats sweet rice while I eat more garlic. Various grasses rubbed on the skin also work well for us. There are vines growing in Thailand with beautiful purple flowers. When you rub them on wet hair, it leaves your hair soft and shiny and sweet smelling, but the bugs do not like it. There are other vines that, when mashed with water made effective gentle soap and mosquito control combined.
In Asia, martial arts training is often more rigorous and disciplined than is common in the states. After hard evenings of training, I would sit by a candle made from oil and tightly wrapped bamboo leaves, and rub salt and oil into my, and Paul's, tired feet. Bliss.
Fast Fitness - Sprain Prevention and Rehab Training
Friday, April 18, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - feel how your own muscles work to hold ankle position, so that you can have stable ankles without artificial shoe supports or bracing, which weaken the supporting muscles from disuse:
Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
Rise to toe and hold
Keep body weight over big and second toe with straight ankle position as you remain on tip-toe. Don't let your weight shift over the small toes, allowing ankle to bend outward.
Click the arrow to see this short movie of my student Diana's feet, as she first allows rolling the ankle outward when rising to toe, then at second 3 in the movie, she uses ankle, foot and leg muscles to pull to straight neutral ankle position. She prevents outward rolling as she again rises to toes three more times.
Prevent rolling outward whenever you rise on toe or push off or land from a jump or step.
Developing positioning sense in the receptors of your ankles prevents the sprain-promoting position called inversion, and gains built-in foot and ankle muscle strength and stability. Nice foot stretch too. Practice balancing on tip-toe, and rising up and down without rolling outward every day.
Feeling Better Than She Ever Has Part II - Fixing Herniated Disk and Reclaiming Active Life
Tuesday, April 15, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Barbara lives in a little town of 300 people in Yukon Canada - map at right. Part I of Barbara's story last Wednesday described why it didn't take six weeks to fix Barbara's herniated discs and severe sciatic pain and numbness, but it was six weeks until the "light went on" and she did the things to stop the cause of the injury, so it could stop hurting and start to heal.
Here is an insider's peek behind the scenes week-by-week:
"Dear Dr. Bookspan, "This is a bit of a long one, and probably reaffirms everything you've ever received in hundred and hundreds of emails and stories, but I wanted to share this with you anyway. I can’t thank you enough for working hard and sharing all your knowledge. I am almost completely pain free!
"After 6 weeks of severe sciatic pain and numbness and weakness of my left leg and foot, something just clicked on Thursday night and I became more determined than ever that I could get rid of the pain. Through your website, the Fitness Fixer, and reading lots of personal stories (on your web site and book), I realized that I had to fix (the) causes. I know this might sound dramatic, but you’ve changed my way of life.
"Pre-sciatica lifestyle: "A cycle of: 1) a few months, everyday, of "power" exercising with all the unhealthful postures and movement habits you talk about, then sitting at the computer in all the unhealthy ways you talk about and drinking coffee and smoking, feeling like I’d accomplished something in my day; 2) followed by a few months of complete laziness (not even power exercising). Power exercising consisted of running (without stretching at all) with bad form, and Hatha Yoga (forcing myself into the stretches and tons of forward bending).
"Sciatica struck.
"First two weeks: "I did absolutely nothing about it. I read stuff on the internet and was convinced from the stories that I had some debilitating disease that would affect the rest of my life. I thought the cause was that I didn’t keep up with my "power" exercising. But, I continued to sit bent forward in a chair, hunched over, bending wrong, doing yoga forward bends, smoking and drinking coffee. I know, how sad."
How to avoid herniating forces on the lower back discs during yoga and fitness stretches for the hamstring:Healthier Hamstring Stretching
"Third week: "Had to go back to work in the morning, teaching 4 and 5 year olds in a kindergarten class; in the afternoon, teaching reading strategies to Grade 1 and 2's - sitting in a chair all afternoon. No longer could I hobble around the house holding my backside and leg - full on activity - and pain, tingling, numbness in my left foot, and total weakness in my left leg. Felt like I was walking around all day with a Charlie horse going down my entire left side. Amidst all my continued Internet searches, stumbled upon your website when a friend said that slight forward bending doing dishes and getting ready in the morning leaning over the sink might be a cause. Your website made so much sense to me - if a slight forward bend is a bad thing, how much more unhealthy would my Hatha yoga program be, with all its constant forward bends. I might add here that the two people at work who talk about slight forward bending being a bad thing continually hunch forward while sitting and exercise using forward bends. Just something I’ve begun to notice."
Major news stories quote physicians saying that back pain is often a mystery and that no one knows why stretching isn't working. My readers regularly report that once they understand the simple principles, they see the unhealthful positioning that causes pain frequently - at the gym, in fitness magazines, and in exercise videos and classes:
"I started with lying on the floor propped up, upper and lower back extensions, pec and trapezius stretches, isometric abs, being continually aware of my posture and not doing ANY bad forward bending. Tried to do the lunges and squats for daily good bending, but my muscles were so weak and I practiced them half-heartedly. I tried to apply them in daily life but life seemed so fast-paced at work and I was in so much pain constantly, that I would get _ way into it and then just try to lean to the side to pick things up - result, I was contorting my body in very odd ways! I ordered a support brace and special support backrest (now I know why I never needed them) and seat cushion for my chair from other web sites, but also ordered your book Fix Your Own Pain, along with a few of your other books."
"Fourth Week: "Limping and terrible pain, my boss told me to visit the nurses station -living in a town of 300 in the far north, we have one general store and a health centre, doctor visits once every two weeks - and take every afternoon off during this week to rest up. He still needed me at work in the mornings. Taking my new prescription of Naproxen and trying the lunges and squats and some stretches but not really trying to apply them to the rest of how I was moving and bending and sitting. I would be in quite a bit of pain coming home from my mornings at work. In the afternoons I would basically throw in some stretches, but generally read (sitting badly) and nap for an hour. A lot of the pain would dissipate after my stretches and a good nap - only to be set into full force the next morning at work.
"Your book came in on the Friday and I was very excited. I read through it and practiced the retraining stretches that show how to restore straighter positioning throughout the day. I felt much better by Sunday night with the stretching. Still only half-hearted attempts at lunges and squats."
"Fifth Week: "Decided to start my morning off by doing my full range of stretches instead of sitting in the computer chair smoking and drinking coffee. I felt pretty good when I left for work. People at work were starting to call me "feisty" saying that I seemed to be walking better (that was probably because of my better posture from applying your method instead of just doing stretches!) Sitting in a chair almost killed me - after 25 minutes in a chair the pain was almost unrecoverable - to be endured for the next hour and a half at work."
Barbara was getting the idea about healthy movement, but was sitting in the same way that causes discs to be pressured. She thought it was "taken care of" because she used a commercial lumbar support she purchased the first week. However she was still sitting in unhealthy ways, right over the support:
"I could manage the pain better with frequent relaxing on my stomach propped up on arms and stretching, but I never felt complete relief until I got home at night. I still didn't realize it was bad sitting position, so decided to get rid of my chair and stand to teach. This was better, but the pain still kicked in(especially in my left buttock!). Once my left buttock got hit with pain it went downhill - down my whole leg, followed by the numbness and severe tingling. Midway through the week I went to see our visiting doctor - quick visit and the prognosis that I had a herniated disc L5-S1. He said it would heal. I was feeling pretty positive about this, as it seemed to coincide with what you say about herniated discs. Meanwhile, the sciatica was taking it out of me. I felt I was always either in pain, or awaiting a painful episode. I made it through, relieved that the weekend was underway. I decided to trying walking - every couple of hours I'd walk on my treadmill for 20 minutes and then do my stretches. I did this two times in the day, and then went for a walk outside in the evening (-35 degree weather so I bundled up really well). My dog and I headed out for what was to be the most agonizing walk for me. Half hour into the walk I started to get that butt pain but I was only half way home. By the time I got home after an hour walk, I wanted to hit the roof and I although I could alleviate some of the pain through lying on my stomach propped up, and stretches, I could still barely sleep. I was also completely consumed by whether or not I had slacked in my posture somewhere along the line while I was walking, or whether I was too tight or loose (still missing the big picture)."
"Sixth Week: "Still determined. Began the week at an all-day staff meeting where I lay on a gym mat on my stomach, propped up on my elbows- all day. Stretching at lunch and a couple of other times I walked out of the meeting to stretch. It almost floored me to do a 20 minute standing stint that we had to do during our meeting. Followed by a 2 hour course via video-conferencing where I did the same thing. When I got home the pain was less and I didn’t want to "over-do" it again, so I gently did my stretches throughout the evening- I didn’t try to walk. Next day at work, the pain was pretty bad from the beginning, but it was -60 degrees F outside and not many kids came to school - more time out to stretch when I needed to. Wednesday - more of the same. I tried to walk at night but got discouraged when I couldn’t walk for more than about 10 minutes without pain. Thursday - same thing, but I almost ran out of the school at the end of the morning to go to the nurses station. (We both wrongly assumed that I had overdone walking, not just walked in injurious ways.) She prescribed more Naproxen and told me to make sure that I walked but more frequent intervals. She also told me to keep stretching, but that lunges and squats were simply out - don’t do them. I kept wondering about this advice as I reread Ivy’s story and looked at the pictures of her doing those amazing squats and lunges. I spent most of my evening on the internet reading and rereading stories."
Barbara was lying face down propped up on elbows for long periods in a way that hurt instead of help. Instead of letting the entire spine gently extend backward so that the upper back "unrounded," she was "folding" a crease at the lower back, increasing pinching in the lower back.
"Friday of the Sixth Week: True Awakening! "I took Friday off work and first thing in the morning while I was doing my usual morning stretch routine, it just hit me! I became so obsessed with my posture, thinking that stretches should magically make my pain disappear, but I wasn’t viewing my body as how I used it during regular activity; I was also very guilty of giving up on certain things when they got "too hard" (lunges, squats). My balance was bad (despite trying to practice it while putting on my socks and shoes), my walking gait was horrible, I wasn’t really trying to do anything that required some effort, and I was continuing my bad habits of resting for hours before I tried to get back up and stretch again. Having reread some of the personal stories, I worked on my walking: feet straight ahead, feet hip-distance apart, heel to ball of foot, using my whole foot to walk - I was so focused on posture that I was holding myself stiff while walking instead of walking naturally with a bit of rotation at the waist). When I thought I was using my muscles, I was really just tensing them right up instead of truly using them. Reading posts and walking also made me realize how tight my Achilles tendon, hamstrings, and hips are. I decided to work on this through my stretches too. Next hour I was back up and walking, and stretching those areas after (using a counter to hold onto while doing a full squat, doorway hamstring stretch, and stretching my hip sitting on a chair rather than lying on the floor). Every hour I walked and stretched, and every walking session was longer, every stretching session I could actually stretch farther! Halfway through the day - now it was time to really engage myself in those lunges and half-squats - just do them and do them properly - no excuses - I need them for everyday life and unless I go beyond what I think I can do, I’ll never get to that point. They’re definitely not just part of an exercise routine, but unless I could do them with strength and stability in my living room, I knew I couldn’t do them in a fast-paced setting when I needed them.
"Time to stop making excuses. I was up and about constantly all day, walking, lunges and squats, stretching. By the end of the day, I can’t even describe my feeling of elation when I went to bed completely pain free, with my left leg hardly stiff at all, and some of the numbness in my left foot gone! Actually having been rather lazy, and in fear of lunges and squats doing more damage, they turned out to be the best stretches and strengtheners...now why wouldn’t I want to use these in all situations to get a beautiful natural stretch during my day! The confidence and calmness that all using your principles, and truly using my muscles to engage in activities is giving me give is fabulous. Not to mention all the energy! This is a new way of life for me. And quitting smoking is not a different story...it’s the same story...and my next step is to look into my eating habits and to quit smoking. It’s my life and my body is a temple...I’m sick of mistreating this temple with lethargy and apathy. No more unhealthy exercises in "power" work-outs and yoga for me...strength, balance and flexibility will is every moment, every day. Now I'm ready for your Healthy Martial Arts book...
"Thank you! Thank you! You (and Ivy) are my inspiration! Wishing for you all joy and true happiness in life (which I know you already have :) ). "Fondly, Barbara
"I'm truly thankful for your hard work and great insight into pain and how to live healthy in every day life!!
"PS I was frightened when I was told I had a herniated disk at L5-S1, and this was great news to me as I know I'm healing and I won't need any physiotherapists, etc. to help me through this! Your book Fix Your Own Pain is amazing - I think I've almost memorized it; two people at work have borrowed it already (including my boss) - I think they're seeing how much it has helped me. I'm thinking about giving your book to people for Christmas."
Summary "take-home" message - Barbara found that she doesn't have to "do" any exercises. That is the difference with this method and others. Moving for daily activities using the retrained healthful positioning stops the source of the injury. At the same time, it just happens to give much built in functional healthful movement. That is how exercise is supposed to be - a natural part of your human life.
There is more good news to Barbara's story, but that's enough for now.
Taxes are due April 15th. Piles of papers, forms, schedules, receipts. Readers have asked how to be healthier while working at the desk, and how to keep their cool during tax preparation.
Several readers asked how to stop neck pain when looking down over deskwork. Reader John M, specifically asked "How do you suggest someone look down (to look at a chart etc at work) without pushing the (herniated neck) disc out more (or aggravating symptoms)?
Three photos above show tilting the neck forward and/or jutting the chin forward. Holding the head forward of the neck and body is a major source of upper back and neck pain. The "forward head" is hard on the soft tissues, the joints of the vertebrae called facets, and the discs of the neck, and is a major overlooked cause of "upper crossed syndrome." The forward head is just a bad posture, and easy to stop. It is not necessary to jut the neck or chin forward to look downward.
Check how you are sitting right now. Are you letting your neck hang forward, are you jutting your chin forward, or are you pushing or rounding your neck and upper body forward? Instead, keep chin in, loosely and gently. If needed, bring your chair closer in closer to the desk and lean the upper body back instead of rounding your lower back against the chair back and leaning the upper body forwad.
To look down comfortably - tip chin down in relaxed straight position instead of jutting the head and neck forward. That is healthy positioning for everyone - injured or not. No need to lean or hang the head or neck forward, or round your upper back to look downward.
More Fitness Fixer with quick techniques to feel better during desk work:
Read inspiring success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
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Forward head photo 1 by Kevin K. Luu Forward head silhouette photo 2 by äÁǻǵ Forward head writing at desk photo 3 by My Hobo Soul Straight good cooking posture photo by Presta
Feeling Better Than She Ever Has Part I - Fixing Herniated Disk and Reclaiming Active Life
Wednesday, April 09, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Barbara's story came in over several weeks. Barbara thought she was healthy and active, and had done years of yoga. She had years of lower back pain, then a sudden onset of severe pain, leg weakness, and numbness. She couldn't push off effectively with her left foot, or stand on tiptoe. The heel of her left foot was completely numb, as well as the left side of that foot.
Barbara lives six hours from the nearest big town (there are 300 people in her little town in the Yukon and one general store).
Her doctor found that she had a herniated disc in her lower back, put her on anti-inflammatories. She was in continuing pain, and fearful of her future of pain and reduced activity, which would mean getting more out of shape and feeling worse. She was frightened that she had some "debilitating disease."
Barbara found my web site and this Fitness Fixer column with free information of how discs become pushed outward (herniated) through bad sitting and bending habits, and began trying some of the information. She wrote me excitedly the first week,
"I decided, after reading one of the many great patient stories you included in your book showing what to do, to lie on the floor on my stomach propped on my elbows to read your book. This felt amazing and when I got up again I could walk straight!"
Another e-mail followed that she was feeling worse again after that. I asked if she had gone back to all the injurious habits that cause the pain. She was surprised to realize that she had. Bad forward bending puts outward and eventually herniating forces on the discs. Barbara was bending badly all day at work when she need to pick things up, bending badly at home over the sink, counters, and while doing housework, then going to yoga class and spending much time bending over forward. Even in a yoga class, herniating forces occur from chronic forward bending, both sitting and standing bent over. It isn't magically good for the discs by calling it a stretch. Barbara also had been told by her health care providers not to do any lunges or squats. She later realized they were just the healthy bending she needed to do normal daily reaching and bending at work and around the house. Without them, she would only be doing the same bad bending that was contributing to the original problem.
Barbara wrote,
"I realized that part of my problem all week was that I had been half-heartedly doing "exercises" then going back to wrong bending while getting completely frustrated because it would seem things would start to feel better in the morning, but I'd feel like garbage by night. I wouldn't do all the things you recommended first thing in the morning, and I would get halfway through a lunge or squat to bend or pick something up and then bend forward out of frustration. So, I pampered myself yesterday - really, truly practicing and applying how to move in real life, especially concentrating on those lunges and squats when I needed to get something. It also finally clicked with me that while I was trying to concentrate on tucking the hip to neutral spine to walk, I was totally ignoring the forward bend of my upper back while standing and walking all week. I was walking all stooped over and feeling like an invalid."
I wish I could write that Barbara followed everything I said and was better the first day. What actually occurred was that it was six weeks until the "light bulb went on" and Barbara realized that "doing" a stretch or exercise doesn't magically erase the injury. Stopping the injurious bad movement habits that harms the disc is needed to let it heal. Using healthy movement in daily life for daily bending and reaching would improve strength and balance. Barbara said that reading the Fitness Fixer stories from Ivy sparked her "turning point" to understand. She then started feeling relief.
Barbara wrote.
"In short, I’ve come from having pain, and muscles completely unaccustomed to healthy movement lifestyle, to feeling stronger, more flexible and agile, pain free, along with a new attitude to everyday life and health, with fresh energy and a renewal of love of life. I know this might sound dramatic, but you’ve changed my way of life.
"Your website has been a godsend actually; especially when I surf the net and see "surgery" splattered everywhere.
"PS My principal just ordered your book - he borrowed Fix Your Own Pain for a week (I didn't think I'd get it back) and would like his own copy. That's saying a lot - he's doesn't take well to other people's advice."
It was six weeks of half-way recovery and recurring pain until Barbara got the idea that "doing exercises" doesn't heal an injury if you go back to bad movement habits the rest of the day. She also noticed how some of the most common exercises contribute to the original problem. Here are links to the information Barbara used:
Barbara generously wrote up her story to help readers see that they can fix pain sooner, rather than waiting six weeks. Coming next, Feeling Better Than She Ever Has Part II - a look behind the scenes.
--- Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy. ---
Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches
Friday, April 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - feel how your own muscles work to hold arch support, so that you can have healthy arches without artificial shoe arch supports or orthotics, which weaken the supporting muscles from disuse:
Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
Pull outward (straighten) until your arches rise and restore to neutral position, and your ankles are straight.
Learn to feel neutral position. Don't hold rigidly or roll outward. You gain built-in muscle strength and arch stability with each step you take.
Click the > arrow to see the short movie made for us by reader David from Belgium:
First he allows his weight to shirt inward, pushing his arch flatter toward the floor. At seconds 3 to 4 in the movie, he uses the outer muscles to pull to straight neutral ankle position. At seconds 8 to 9 he allows the arch to sag again, then restores and holds healthy arch from second 13 onward. The "exercise" is not to roll back and forth. It is just to learn to feel what allowing sagging too much feels like, and how to restore neutral position.
During walking and running, there is a small natural inward drop (slight pronation) that is part of the spring and propulsion. Allowing exaggerated sagging is like rounding your shoulders too much. Legs and feet have posture that you can control yourself. Use your own muscles and get free built-in exercise and arch support all day, and stop painful poor positioning.
Some people with existing abnormality or growths in the ball of the foot will roll inward (or outward) to get the pressure off the deformed area because standing straight hurts. See your doctor first. Remember, don't force. If it hurts, it's wrong. All you are doing is learning how to stand neutral, not tilted so much that you compress the joints. The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy. ---
Not long after, I saw Dennis running by at a fast clip, with beautiful neutral spine, good leg and foot alignment, and a light landing with each foot-fall. I asked him why he had asked about running lightly. He said he changed to running lightly after I worked with him on it. I asked if it made a difference and he laughed, "Of course. It used to hurt."
Dennis is muscular and squarely built. He used to leave an impression on the floor when he walked, and had knee, neck, and lower back pain after running.
Landing without jarring reduced pain. Dennis also did several things to stop injuring his joints during movement:
Stopped letting his arches flatten downward. Using his own leg and ankle muscles, Dennis held neutral foot position maintaining a good arch without needing any inserts or special running shoe - Arch Support Is Not From Shoes.
Stopped letting the knees bend inward toward each other when running, and held neutral foot position - Healthy Knees.
Using the information in my classes, Dennis fixed recurring ankle injuries, and various back neck and other joint pain and went on to win medals in wrestling. His stories and photos will follow in posts to come.
The post Spotting Back Pain During Running and Walking - What Do Abs Have To Do With It? showed the common and painful bad posture of standing with too much inward curve in the lower back, called swayback and hyperlordosis. A reader mailed me an article about gluteal muscles and asked what gluteal muscles have to do with it. The article shows one kind of hyperlordosis, with the hip pushed forward. The drawing at right shows that hip-forward hyperlordosis position (right figure) compared to neutral spine (left figure). The article stated that the hip-forward posture was due to weak gluteal muscles, and that strengthening the muscles would fix the bad posture. The article gave a strengthening exercise of lying on your back and squeezing the "cheeks" of the backside together as if squeezing a coin between them.
Knowing muscle action will help you know why it doesn't work that way:
Your gluteal muscles are muscles of your backside. One function is to pull your upper leg backward, for example, when walking, to pull each leg behind you. The distance between the back of your hip and the back of your upper leg shortens.
If you use your gluteal muscles while standing (not tighten them, just use them to bring about movement) your hip will push forward. That is the opposite of correcting a hip that is forward in bad posture.
Squeezing the "cheeks" of the gluteal muscles together is training a different movement direction than either pushing your hip and leg forward or back.
Another fallacy is that tight gluteal muscles pull the hip so that it pushes forward into bad posture. It is true that tight hip muscles in front will change the tilt of your hip. People with anterior tightness cannot easily bring the leg behind them, which hurts stance and gait. Gluteal muscles cannot get that tight unless you have tetanus. Gluteal tight enough to push the hip forward a few inches would be so tight that you would not be able to sit down. You would tear your backside like splitting your pants.
The key point is that strengthening a muscle does not make it move your body or change your position. If you strengthen your arm, for example, your arm does not automatically wave around or raise over your head. Your arm only moves when you make it move. Strengthening your gluteal muscles will not move your hip for you. Even if strengthening did make any body part move on its own, gluteal muscles would cause a forward hip, not correct it.
Think of asking a dog to shake hands with you. If you want the dog to move his paw up to shake your hand, you do not strengthen his leg and paw. You train the movement and the voluntary desire to bring about the action.
Standing, walking, and running in hyperlordosis is a major cause of lower back pain. Some people stick the backside out in back and others tilt the upper body back with the hip thrust forward. Both increase the inward curve of the lower back and painfully pinch the lower back structures. Although some fitness information and advertisements represent overarching as attractive, even something to deliberately do, it is an unhealthy and weak posture, making it unattractive and undesirable.
Strengthening muscles is good and helpful and fun and healthy, and so on. Strengthening gluteal muscles or any other muscles will not automatically make you stand in healthful position. Stronger muscles do not make you move. You can change to healthful position right now without strengthening. These posts show how:
When you hear that you need various strengthening exercises to correct posture, think of shaking a dog's paw.
--- Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
Spotting Back Pain During Running and Walking - What Do Abs Have To Do With It?
Thursday, March 13, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
The post Innovation in Abdominal Muscles showed one of the most common, yet most overlooked cause of lower back pain during long standing walking, and running.
Readers sent excited letters stating they could finally see and feel why they had back pain, and could immediately feel the difference when they stopped standing with too much inward curve in the lower spine, and began standing and moving in neutral spine.
Neutral spine at left. The line from the top of the leg up to the middle of the hip is vertical. The beltline (line from front to back through the crest of the hipbone) is horizontal.
Middle drawing shows tilting the hip forward in front and out in back.
Right drawing shows tilting the hip forward, and also leaning the upper body backward.
Readers asked for more photos so that they can see the difference between overarching (hyperlordosis) and neutral spine (normal lordosis) during running and walking. They wanted to see the overarch in action and what running in neutral spine looked like.
The two photos above show allowing hyperlordosis, or too much inward curve (arch) in the lower spine. It is not a normal curve. The angle increases where the back of the vertebrae come together. It does not look fit or healthy.
In both photos, the hip tilts forward in front (and out in back) instead of holding vertical. The abdomen rounds outward.
Note the red stripe on the runner's pants in the photo at left. The stripe tilts forward from the top of the leg to the middle of the hip. Compare to the red vertical line in the middle and right-hand drawing. The beltline tips downward in front. Compare to the red lines tilting downward in the drawings.
The walker in the photo at right tilts the hip forward in front (and out in back), beltline tips downward. The upper body leans and sags backward.
Neutral spine.
The muscles that shorten to prevent the upper body tilting back and the hip tilting forward are your abdominal muscles. The abdominal muscles are too long when you allow overarching. Keep this in mind when you hear about exercise programs that claim to lengthen your abs.
Moving your spine to neutral spine for all daily life is how abdominal muscles help prevent back pain. It is not strengthening them that does this, and it is not tightening. Crunches and other forward bending exercises do not train you how to use your abs to hold neutral spine and they increase herniating pressure on your discs - click Good Life Works Better Than Bad Ab Exercise. Use your abdominal muscles, without tightening them, to position your lower spine during all you do, just like using any other muscles to move any other part the way you want. It is a free ab workout all day, and you will stop a major cause of back pain during standing, walking, and running.
Click Prevent Back Surgery to see why overarching can be so damaging to the joints of the vertebrae.
Click my web site books page www.DrBookspan.com/books to see the training manual The Ab Revolution™. It shows several techniques to learn neutral spine as a normal habit, and how to use it to stop back pain from hyperlordosis, even if you don't exercise (Part 1) and how to use it for better core training if you want to incorporate it into exercises (Part 2), from simple to the hardest you can get.
How many of you caught that the photo in the Fast Fitness post - Fix Positioning by Watching Others is of terrible body positioning that is a common source of upper body pain and injury?
I received letters asking about the photo. Several readers did not catch that the reason for the photo was that both people were standing in terrible rounded forward posture. Some readers thought the photo was not of bad posture, but showed people with interest in the game or that they way they were standing was a needed position to see the ball.
It is a harmful body position called forward head and round shoulders.
The rounded and tilted forward position of the upper back, neck and head is a bad positioning that is a major cause of:
Upper back pain sometimes called Upper crossed syndrome
Look in your fitness magazines and videos and look around during fitness classes and the gym to see if you can see the forward head and a rounded upper body. It's a handy reminder that it is not healthy, and to exercise in better, healthier ways.
A Reader Asks About Osteoporosis and Walking Lightly
Tuesday, March 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
One good question launched many answers. The post Walk Lightly - Shock Absorption for Happier Joints explained a light step prevents joint, soft tissue, and plantar fasciitis pain. In the comments, Carol asked if there were, "a connection between walking lightly and oesteopenia?" This is interesting, since osteopenia is lower than normal bone density, lack of enough pulling or tension on the bones reduces bone density, and a certain amount of vibration may help bones. The simple answer seems to be, that walking lightly should not be enough to reduce bone density, by itself.
Walking, running, and jumping lightly is good exercise to load the bones, while being better for your ankles, knees, hips, and spine than jarring with each step. The post Why So Many Aerobics Injuries? cited news accounts attributing joint pain and injury to high impact activities, with examples of popular aerobics personalities of the 1980s who now say they are too crippled to exercise. Their injuries were avoidable, but not by avoiding impact exercises. Impact activities can be done safely by not stomping down hard. Even repeated jumps from a height can be done with soft landings. Good athletes run, jump, and box with far less impact than most people walk, and have good strong bones. Exercise, done right, is crucial for your bones - Exercise is More Important Than Calcium Supplements for Bones.
When muscles pull your bones during walking, running, and other exercise, the pulling increases bone density. Adding external weight loads bones further. That is a major way weight-bearing and weight lifting exercise increases bone density. The effect of muscles contracting to provide good shock absorption when moving also pulls on the bones,which should be good. The post Forensic Anthropology and Bone Density looked at influencing the shape of our bones by how we move.
The reader went on to comment, "I have always been very light on my feet, and now in my 50s I have found out I have low bone density. I have a cousin who shakes the house when she walks who has been told that she doesn't ever have to worry about her bone mass." Walking lightly alone should not have caused the osteopenia. Questions would be, what other exercise the reader does, and what things might be decreasing her bone density? For the cousin, "shaking the house" by itself may not be enough bone stimulus that anyone could tell her that she "doesn't ever have to worry." Has the cousin taken a bone density test and was found to be high (for whatever reason)? Then you can say there is lowered risk of fracture. Is this cousin is very heavy, which helps load bone? Does this cousin do regular exercise to increase her bone density? It is not likely to be a valid prediction that someone never has to worry about bone density just because they walk badly.
The reader went on to ask, "I went to a bones for life class and was taught to do heel bouncing to stimulate bone growth. i.e. dropping repeatedly from toes onto heels while standing in proper alignment. Do you agree with that exercise?" I did a few searches on the bones for life class and found that the class uses many exercises, not bouncing on the heels alone. Bouncing for a few minutes would not be enough to undo sedentary life style, and the various things people do that actively take away from bone density. You need to do all the other exercises. How much the shock wave of the impact may additionally load or stimulate the bone is still an open question.
There are studies looking at effects of vibration and tapping on bone building. Mechanisms have been studied from the effect on cat bones of their purring, to various machines that bang or vibrate. Some advertising for vibration machines goes as far as making claims that they will increase bone density. So far, none have been found to have as much bone building effect as muscular activity (exercise). Too much occupational vibration, like jack-hammer, helicopter and similar environments produces joint pain, injuries to the spine, eyes, ear, nervous, and other systems. That was one of the topics I was looking into when I did aviation medicine research, explained in Indiana Jones Rocket Sled. A news article that came out on last year's fitness fad of vibration plates promising weight loss and fitness building, mentioned a few of the problems with too much vibration, and, ironically had an accompanying photograph showing severely hyperlordotic (overarched) lower spine positioning by a person listed as the trainer. Hyperlordotic spine posture, by itself, damages the facet joints of the spine over time. It seems safe to say that the jolting of the vertebral joints against each other in this overly arched position would only be worsened by vibration. The post Prevent Back Surgery shows examples of overarched lower spine and why it causes so many injuries in fitness.
It would be interesting to know if low levels of vibration, through tap dancing, Flamenco dancing, pogo stick jumping, and similar activities, would change bone compared to the same amount of exercise without the impact. Some studies claim that swimmers or cyclists do not have as high bone density as runners, while others do not find that when they control for the direct muscle work applied to the area. There are even studies showing that Tai Chi, a most mild form movement with almost no foot-falls at all, can increase bone density in older people, just from the movement.
Along with walking or running, and weight lifting to build bone density, and using your muscles to stop stomping which can hurt the joints, you can prevent bone loss by avoiding things that reduce bone density:
Smoking
Drugs that are known to greatly increase risk of bone fracture: stomach acid drugs and steroid anti-inflammatory drugs, regular use of SSRI antidepressants such as Prozac and Paxil. Numerous medications used to treat different cancers may produce osteopenia (bone shortage) and osteoporosis in long-term cancer survivors. See Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
Lack of sunlight. Calcium cannot be absorbed or do its job without enough sunlight
High consumption of meat and dairy products
Drinking alcohol too often
Lack of fruit and vegetables, and vegetable calcium sources
Eating wheat and related grains by people with celiac
Osteoporosis and osteopenia cause major problems for men, not only women. More on this to come. Move, walk, lift weights, stand on your hands, and jump for fun, exercise, and bone building. You do not need to ooze around on tiptoe to avoid impact injuries. Jump and dance and stamp your feet for fun, without jarring your joints and retinas loose. Have fun.
Carol ended her comment to me with, "Thanks for your site - I've learned a lot about alignment, which has helped in many ways." Thank you Carol for writing so many helpful questions for our benefit.
Part II of Bernie's story looked behind the scenes of how we fixed the source of the pain, step-by-step.
The promised dance is at right.
The point of the two posts was that the key is to fix the source of pain and injury, not just have surgery, take medications, and do some exercises. The posts also showed things to do to fix the causes so that readers could do it too.
A reader wrote an opinion in the comments of Part II, that Bernie's signs and symptoms were of Cauda Equina Syndrome (CES), and felt cauda equina was important for readers to know about.
The problem is that cauda equina is not the cause of the collection of back and leg pain and numbness problems, but the result. The cauda equina is a group of nerve roots of your lower spine that go down toward your feet. The bundle of stringy nerves looks like the tail (cauda) of a horse (equina). If something hurts or presses on the area, pain and numbness can result. It is just saying something wrong has resulted in that location. The key is finding and stopping the cause of what is hurting or pressing on the area, not taking medicines or having treatments.
It is like saying someone has stomach pain, and prescribing pain medicines and support groups. The pain could be worms, a pregnancy, a lack of enough stomach acid to digest food. You need to know the cause to do the right treatment.
For example, if a herniated disc is compressing the cauda equina, you need to stop pushing your disc out of place, described in Disc Pain - Not a Mystery, Easy to Fix and use daily simple good body mechanics instead of the bad bending that gradually push discs outward - The Cause of Disc and Back Pain. Then the disc and nerves can heal and the pain will stop without drugs or back surgery.
The reader asked me to review a web site. The web site they recommended lists treatments of drugs such as narcotics and antidepressants, and epidural injections. It mentions exercise to maintaining muscle strength in leg areas that have weakness from nerves that are compressed. This is like trying to catch blood loss in a bucket instead of stopping the blood loss at the source. The web site says sufferers with foot drop can use a brace. Instead of using a brace, which can cause more atrophy, it is better to stop the cause of the foot drop, where possible.
Fitness Fixer reader Ivy from New Zealand had foot drop from nerve compression. She stopped the cause, detailed in Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier. By stopping the cause of the nerve compression, Ivy did not need the brace or cane. It is not healthy to allow nerve compression to continue. Muscles and nerves become more damaged over time. A brace or cane does not restore function. They can further cause bad gait and body mechanics.
Bernie had many injuries from the surgeries he had undergone for the purpose of relieving back pain. In addition, the back surgery deliberately resulted in some reduced movement of the spine. Many back surgeries do this on the premise that reducing movement will reduce pain. The reduced movement meant reduced function and mobility, resulting in more pain.
The cauda equina web site says, "We live with CES every day." The approach of The Fitness Fixer is not to live with an injury or take unhealthful drugs, but to find the cause and stop the cause so that you do not have to live with pain and drugs.
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Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from fun ones. Before asking, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. SeeDr. Bookspan's books and Academy.
We have been traveling for the past 2 months in Asia and are on the way to the chilly Smokey Mountains of Tennessee USA to teach medical students for a week during their rotation elective in Wilderness Medicine. This is the third year I will teach there.
I will teach the entire curriculum of diving medicine and physiology, plus a workshop on why commonly prescribed stretches are not healthful, and what to do instead. Several members of the Knox County Sheriff's Office from Knoxville TN have requested to attend my lectures, and several readers made the effort to find the class information on my web site and make arrangements to travel to the camp to attend.
As a physiologist, I design the techniques that physicians use. I spent many years as a military and university researcher in environmental physiology, which is how the body functions in the heat and cold, at altitude and underwater, breathing different mixtures of gases, doing different forms and intensities of exercise. It's important to understand why things work. If you don't understand, then you can't think for yourself, and all you can do is repeat the mistakes of the generation before you, who also were just repeating what they learned in a book from teachers who just were repeating what they had heard.
This problem occurs with some of the exercises and stretches given as physical therapy. An introduction to the problem is in the post What Does Stretching Do? In the past two years teaching at the camp, we encountered young students who were not interested to change bad stretches, and made a point of showing me after my lectures that they will keep doing their rounded bent forward toe touches, since "everyone knows" that is how it is done. However, Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch.
The problem can occur with medical treatments that are in the books, even though wrong. In my diving physiology lectures, I try to show that if you understand the physiology, you will know why certain treatments do not work or are not needed. Immersion in water, for example, creates many interesting effects such as distributing blood volume more out of the limbs to the body. This is similar to the effect that occurs in space, described in Collapsing Astronaut Gives Healthy Reminder. Recently, during our travels, Paul wound up in the hospital with a swollen leg. The doctor who was Chief of Medicine of the hospital, announced that the treatment was bed rest. Paul was told he must lie flat in bed for at least three to fours days with the leg elevated to drain the fluid. We understand that bed rest is often listed in books as a treatment for this, but it is wrong. I asked the doctor if going in the water could help. The doctor said that standing in the water meant the leg would be "hanging down" and the leg needed to be elevated to drain. If you understand immersion, then you know why immersion can more effectively treat limb edema and water retention than medicines and lying in bed. Extended bed rest is unhealthy, and reduces muscle and bone health so much that it is used to study the damage to the body from floating around during space travel. We escaped the medical care and went into the water. I will post more on immersion, edema, and health soon.
I will not have Internet access for the next week to read or reply to comments. Enjoy the posts. Start taking and sending in fun photos of your successes using all the fun techniques.
Important festivals of new beginnings fall around this time of year. The Lunar New Year began this week. It is a big festival. It is New Year to many people. Lent began for Latin rite followers, and the Triodion that marks the Lenten start for Eastern Orthodox will fall on Feb 17 this year. This past week was marked by wearing ashes in several cultures. Ash is deeply symbolic of endings, transience, and transformation.
Ash begins black with substance and turns white with formlessness, a symbol explained last year in The Story of the Black Belt. Ashes are used to clean bodies and spirits. They symbolize wisdom that remains when all else is burned away. All things eventually become ash. Catholics wore ashes last Wednesday. Hindus used bhasma, the sacred ash, at the recent festival we attended to learn more about wound healing, told in this post - Thaipusam - Exercise of Body and Spirit.
In the North, February is a harsh month. Through the cold and dark, the first plants begin to bud and animals show growing signs of spring births to come. The first signs of returning life inspired the February 1st Imbolc festival of Brigid (the Bride) a Celtic goddess. The Church later replaced this festival with Candlemas on February 2, dedicated to the Virgin Mother Mary. Both festivals are marked by candles and fire, a mark of the coming end of winter and the return of crops. Shinto followers celebrate this as Setsubun Sai.
To help your New Years resolutions (or remind you to start) here is a link to a post with labels that will give all posts on the label topic: New Year's Resolutions Made Easy.
Fast Fitness - Prevent Wrist Pain During Pushups and Cooking
Friday, February 08, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - Learn to use strength and good joint positioning instead of compressing the wrist joint during activities that put weight on a bent wrist.
Good positioning and strength is more effective than splinting wrists straight and restricting activity:
While sitting or standing, press your right wrist and hand backward strongly using your left hand. Feel the right wrist compress under the weight of the other hand.
Now use your right hand and forearm muscles to press forward against the left hand. You should feel the compression come off the right wrist.
Hold a pushup position. Use this technique so that, regardless of your weight, instead of letting your weight compress your wrists, you use your hand and forearm muscles. Keep weight distributed across your hand, not just on the heel of the hand.
Use this whenever you use your wrists - for weightlifting, for standing on your hands, for typing, driving, biking, playing piano, and during cooking and cleaning.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Lower back pain is a common problem for golf players. Pain is sometimes attributed to twisting the torso during the swing. The "twisting theory" seemed reasonable, since that is when many people feel the pain. However, the main problem is not twisting. Beside the bad forward bending that is common for picking up golf shots and equipment, a major overlooked source of lower back pain is overarching the spine during the swing.
If you increase the inward curve in the lower back, you increase normal lordosis to hyperlordosis. When you do this during the swing while letting your upper body weight press down on the area, it compresses the facet joints and surrounding soft tissue. It is the same pain that occurs from overarching during walking and running.
A golf pro attended my last workshop on fixing back, neck, and hip pain. I was able to check with her to make sure that what I found to stop lower back pain with golf would not interfere with a good swing.
She stated:
"I do not think arching is essential, but I can imagine the older golfers and what their swings might look like...there are some ugly ones that would arch WAY too much and that is the source of many problems on the score card, as well as the back!"
In the following photo examples, look for too much inward curve in the lower back. Too much curve is not a normal lordosis, it is overarching, called hyperlordosis. Overarching is the reason for much unidentified pain during standing activities.
In the next two drawings, the lower spine is overarched (hyperlordotic) on the left and neutral on the right. Neutral spine keeps a small inward curve, but not a large one:
In these photos, see how the lower back is overarched:
These photos show the lower spine from the back:
In these three photos, see how the lower back is held in neutral spine: Preventing overarching and holding neutral spine does not mean that you do not get a full or strong swing. It is not the case that the only way to get full range of motion is by pivoting from the lower spine joints. By holding neutral spine you will shift the effort of the swing onto your abdominal muscles, giving you a more powerful swing.
To understand how bad forward bending (opposite problem from hyperlordosis) contributes to back pain click The Cause of Disc and Back Pain.
Golf cartoons by subscription to Clipart.com Golf arched 1 photo by jarrod job Golf arched 2 photo by subscription to ClipArt.com Golf arched 3 photo by MattFM Arched swing from the back photo by digital_image_fan Neutral swing from the back photo by mahalie Golf neutral 1 photo by dospaz Golf neutral 2 photo by minds-eye Golf neutral 3 photo by Jayel Aheram
Here is Friday Fast Fitness - make rowing good exercise, not bad sitting:
Don't round your spine forward (left). Rounding pushes discs outward. Left drawing shows disc pushing outward by bending the vertebrae to that they open in back. Rounded sitting with chin forward shown in 1st and 3rd rower in left photo.
Chin in.
Stay straight during the pull (right drawing and photo).
--- Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
"I would like to take this opportunity to tell you that after suffering for many years from back (scoliosis) and neck (arthritis) pain, it was my good fortune to happen upon your website. I read every word, tried the movements and postures and found an immediate measure of relief from the pain that no doctor, chiropractor, physical therapist or massage therapist has been able to help (I am 56). I immediately ordered a number of your books, read them from cover to cover, gave them to my daughter and son-in-law and then ordered more for my son.
"I took your books with me to New Orleans, where I worked for 10 days as a volunteer building houses, and am happy to report the exercises and stretches allowed me to climb ladders, wield heavy loads and hammer nails without further consequence to my back and neck.
"As mentioned by most people, I found instant relief upon simply correcting the positions of my neck and back. I took the books to New Orleans with me and did most of the stretches, especially the side bending, back extension, hip and hamstring ones. I also took great care with my positioning with the construction work and lifting. "Before I found you, because I was in so much pain, I had stepped up my go-to stretching routine gleaned from years of aerobics and some yoga, which always included toe touching with straight knees and plow and all those exercises you say not to do. I thought it was good that I could touch my toes on the floor behind my head in a plow or my palms to the floor bending forward. Ouch!
"I've also been doing many of the strength-building exercises, trying to work up from the elementary to the more difficult. It's fun stuff and it feels SO GOOD!
"Thank you for putting so much information out there for the long-suffering public! Sincerely, Marla Black"
"PS - my daughter is a triathlete and she and her husband have been doing all the bad stretching and wrong postures. Her neck and back were starting to hurt. I gave them the books and they are already onboard and feeling the difference!"
Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
Thursday, January 17, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
In Part I of this post on Monday, photographer Bernie tells of fixing years of pain that doctors told him only surgery would fix, even after three surgeries. Here is a look "behind the scenes."
10 March 2005, Bernie e-mailed me:
"I've had this persistent paresthesias for 4+ years. I just learned about you yesterday. Where are your back & spine classes held. Tomorrow, I'm having lumbar myelogram & CT at (top name deleted here) Hospital. Before I consider anything else, I want to learn about your methods."
I wrote back with class information. I had two classes coming up. One was the next month. The second would be in early May and only a few blocks from where he lived. I told how we work to see change in pain right in class. I asked him to let me know the test results and that I hoped to see him in class.
20 March 2005 he wrote back:
"Thanks for asking, I never expected you to keep in touch. The myelogram and CT showed moderate central spinal stenosis at L4-L5. Severe facet joint arthropy & hypertrophy of ligamentum flaxa causing compression of the lateral recesses stenosis of L5 on both sides, kinking of L5 nerve root sleeves on both sides. I have a copy of the xray, showing the "hourglass" at L4-L5
"(name deleted) is the attending, 3-B Orthopaedics. He said the next step is surgery, by ( ), at ( ) Hosp. I asked if strengthening of my upper body would help support my spine. He said "try it" so I'll be at physical therapy next week to start.
"I have a commitment for the weekend of April 2-3 so can't attend that class, much as I'd like to. Since I live at (close to) your class at Temple CC is my best chance of attending. Cordially, Bernie Cleff"
I checked back in to make sure he was signed up for the May class and to ask what he was doing in Physical therapy. He wrote:
29March 2005 "The phys therapy that I'm getting concentrates on my core muscles. Thanks for getting in touch...very kind of you."
I wrote back saying that conventional core exercises were not the best thing. Usually they are forward bending actions that will further compress the discs, the nerves, and also do not retrain the abdominal muscles in the way they work when you go about daily life. Strengthening does not automatically support the spine. I wanted to make sure that he had my Ab Revolution book, which was then out in a training manual version. He said he had it with him for PT. (I found out two years later that they had the book, but they were not using it, and were doing traditional forward bending abdominal exercises.)
10 May 2005, the day after the Fix Your Own Back Pain workshop was held, Bernie wrote me,
"Hello, I did sign-up for your class at TUCC on Monday 5/9, but I was too tired to attend. On top of that, I am scheduled for spine surgery at ( ) on Wed 5/11/05, with ( ). After having 2 epidurals and physical therapy I decided to go for the surgery. My nerve that is pinched is in the shape of an hourglass (at L4- L5) and (the doctors told him) that no body position or exercise changes are going to help at this time. Both legs are numb and I am walking like a drunk. It is kind of you to keep in touch. I hope to meet you at your fall class."
Days later, Bernie had the surgery. He tells about it, and his next two years, in Part I of this story. The doctors all considered his surgery a "complete success." They said the surgery went completely according to plan, with no complications. His recovery was in line with expected results. The fact that his pain returned, was worse, and complicated by limited movement from his plates and screws and other surgical hardware not a factor to them. They felt the limited movement was beneficial and a goal of the surgery. The commonly held idea is to stop motion in the area to stop the pain.
In late October of 2007 arrived to teach the Fix Your Own Back and Neck Pain Workshop. I had 16 people waiting for me. One was Mr. Bernie Cleff, a funny white-haired muscular man of 80, who was in much pain.
We had a fun, energetic class. One of the students was a young man from India. He sat unsmiling as I mentioned various yoga poses that can injure discs in the neck. I explained that I am not against all yoga, and studied years to become a teacher myself. He sat unsmiling. We did three specific techniques to stop the neck pain process and a beautiful smile radiated from the young man from India. He had three herniated discs in his neck from his yoga practice of the specific moves I had mentioned, together with sitting badly at a computer for his work. He already knew those yoga moves hurt his neck. He had just been worried the pain would never stop. When the pain stopped right there in class, he smiled.
Another of the students was a golf pro. Who I consulted with afterward to test out my work on lower back pain and golf. More on this to come.
Mr. Cleff did great in the first class. This class was done over two weeks. I gave the students things to try during the week before the second (last) class.
Oct 25 2007 he wrote me:
"Today (Thursday) is my class day at The Clay Studio, working over the wheel for 5 hours. I felt good with very little noticeable pain. Usually after walking the 5 blocks from my home to the studio both my legs would tingle badly and I would stop to rest halfway. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to check-up. You are one hellova person and I'm thankful that I've met you.
"I've had my spine problems with the pinched nerves for a long time - roughly 4-5 years - and I'm slowly getting better since you came into my life. There is no other way to say it. Thanks Jolie."
He was improved in one class, and he felt that he was "slowly" getting better. I like an empowered student who does not want to dawdle to get better. The day after the second of the two sessions, Bernie wrote:
28 Oct 2007
"Last night, I walked about 7 blocks to restaurant AQUA (great value, low cost & delicious) and back home another 7 blocks.
"Upper back extension causes no pain, lower back does. I can do plank on elbows, holding for 60 seconds now, no pain.
"If you want to make photos of a geriatric doing your things, it's OK with me. as you've seen, I'm not bashful or delicate. I will work at getting better, my daughter is getting married January 5 and I want to be able to dance with her and my wife."
Bernie went back to his doctors to ask about a small amount of remaining pain. They told him he should have more surgery and gave him prescriptions. He wrote to ask me:
"On Nov. 2 I have a follow up with the spine surgeon (same guy) and on Nov 14 a consult with a Neurologist ( ). Do you have any suggestions about a pain med FENTANYL, which was suggested by a doc at the V.A."
I wrote back that Fentanyl is a surgical grade narcotic. It is used "off-label" for back pain and there have been deaths. I asked him to tell me more about what hurt, and when, so we could stop it without any harmful medicine, and also what the neurologist said.
14 Nov 2007, he wrote:
"I had an office visit with the neurologist at ( ), he said my twisted nerve at L5 will never get better and I will always have pain."
They told him to have another spine surgery and take the Fentanyl. (Then why did they put him though all that surgery??)
He wrote:
"Hello, I still have some tingling in both knees...but much better than 2 weeks ago! There has always been pain in my left flank between spine & hip, never told you because the knees were my greatest problem… The lower back pain persists, but only left side. When I do the trap stretch leaning to left--puts much pressure on that pain. Leaning to the right feels like a good stretch. Any additional suggestions?"
I found that that he was still doing "their" exercises. Conventional exercises of bending forward to stretch the hamstrings are often prescribed for back pain. The assumption is that tight hamstrings have something to do with back pain. However, bending forward is one major contributor of this kind of back pain. I changed how he stretched his hamstrings to one of the ways we did in class.
He was also continuing to overarch his lower back when walking, which was a large source of the tingling pain. When he used the Trapezius stretch, he was also overarching, which makes pain when bending to that side. This kind of pain is often confused for spinal stenosis. One classic sign of stenosis is pain when bending toward one side. However, the narrowing is not true stenosis, but just overarching which narrows and pinches the area. For someone who has stenosis, not pinching the area further with overarching is frequently enough to stop pain.
What was complicating everything was his surgeries. They were considered "completely successful." The two knee replacements were "completely rehabbed" meaning he could bend his knees enough to sit in a chair. He could no longer stretch the front of his hip enough to prevent the kind of tightness that encourages standing and moving in overarched position. The back surgery put a plate in his back to prevent much movement. That meant that even small overarching movements were enough to pressure the newly immovable area. The back hurt, and the tight back and hip were compressing nerves going down both legs.
After we fixed these issues he wrote two mails:
"Jolie You hit on the spot. I will keep at it gently."
and
"Jolie, a quick note to tell you today I walked 12 blocks, stopping to stretch hamstrings.. often on steps or fireplug....as you suggested...also lunge stretch. I will dance at my daughter's wedding. Much thanks.
"There will not ever be more surgery on my body."
For the flank pain, he had been for many tests, and was even scheduled for a kidney evaluation. The muscles in the area were so tight, that I biked over to his home to do a sports medicine technique to stretch it out for him, and checked his other stretches. I went over how to stretch the front of the hip without overarching his lower back. His sweet funny wife made me lunch. We got some fun photos of things as gifts for you, of fun stretches and activities.
He wrote:
"I've had x-rays, MRI, bloodwork, surgery, injections, no Dr. had any solution. YOU HAD THE ANSWER. No wonder so many people have thanked you."
He did the work and gave me the credit. That's a good man.
Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I
Tuesday, January 15, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
In this post, Bernie, an 80 year old retired photographer tells how he was signed up to take my "fix your back pain" workshop in 2005, but was convinced by his doctors that nothing but surgery would help. After "completely successful" surgery, his pain returned and worsened. He returned two years later to me. December 2007, Bernie wrote:
"I was a professional photographer for over 53 years-freelance-meaning go any place, any where- for many varied clients and I am now 80 years old and retired from photography.
"Much of the time I carried a 40-pound camera bag on my shoulder when climbing a 75 ft radio tower, walking on railroad construction sites or climbing The Great Wall in China.
"When I was at my vacation home, I climbed ladders to paint, replace cedar shingles and install new windows.
"Both my knee joints were replaced (5/93 & 6/01). Sometime in 2003 I was aware of tingling in both of my lower limbs from the knees downward. That started my medical testing with EMG’s, MRI, CT Scan and X-rays. The diagnosis was spinal stenosis caused by age-related changes in my spine. Physical therapy was started and I had an epidural, which helped for about a year. Then a second epidural lasted for only 3 months.
"I had been volunteering in an E.R. for 7 years helping patients and I had to stop as it was impossible to walk or stand on my feet because of the strong tingling in both limbs. Then I was told that spine surgery was the answer, but continue P.T. with some changes of the therapy. So, two years later, with some relief… but not enough to continue, I stopped the P.T., had an MRI scan which showed further degeneration of L4 & L5 with kinking of nerve roots. All along there was a pain in my left flank, but that was overshadowed by the strong tingling in the knees. There had been suspicion of kidney stones or liver function but x-rays & all blood work proved negative. I was hurting more in both knees.
"The spring passed at my vacation home near Barnegat Bay with much pain and with me looking at my kayak that had remained in storage. I called for surgery to be scheduled.
"The lumbar myelogram & CT was done at Pennsylvania Hospital and surgery date was set.
"On March 10,2005 I found the website of Jolie Bookspan and e-mailed her with my “story” of pain. Her class to fix back pain was going to be held soon a few blocks from where I lived. She asked me to try the class first, (it was being held a week before the schedule surgery) but I told her that both legs are numb and I am walking like a drunk, the doctors said no amount of exercise or body mechanics would fix such structural problems, and am going thru with the surgery on May 11, 2005.
"Post-op recovery was hell. The summer was hell with pain killers and sleeping pills. At the follow-up exams, I was told “the surgery went well, no infection, you’ll be better in 6 to 8 months”. The laminectomy used a metal plate & 4 screws and a bone graft from my hip for the fusion of L4 & L5. The pain in my left flank remained throughout 77 physical therapy treatments. The surgeon prescribed Elavil and when I took it, I felt like a zombie. After I told him, I was told to try a half tablet. That made me feel like a half-zombie.
"No doctor had a solution except “try Tylenol, Advil, Fentanyl, and more”…a consult with a neurologist said that my twisted nerve would never get better. (So why all the surgery?) The pain in my left flank remained.
"Then I took Jolie's class on October 20, 2007 and she had the answer. My left flank pain was not a medical condition (I was put through every test including kidney function), but a muscle in spasm. I was doing the wrong exercises that I had learned in PT and they were making it worse. She taught me to do the exercises the correct way as shown in her books and articles in her websites.
"Five days later I reported to Jolie that I had been working at The Clay Studio, throwing clay on a wheel making pottery for 4 hours and felt good. Usually after walking the 5 blocks from my home to the studio both legs would tingle badly and I had to stop halfway to rest. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to checkup. You are one hellova person and I’m thankful that I’ve met you.
"I’ve had my back problems with the muscle spasm and damaged nerve for a long time…roughly 4-5 years…and I’m getting better since you came into my life. There is no other way to say it. Thanks Dr. Jolie for your passion for helping others.
"On your questionnaire in the first class I wrote that I wanted to be able to dance with my daughter at her wedding in January 2008. You have made it happen for me.
The International Academy Of Functional Sports Medicine was formed to provide:
Evidence-based education in functional physical medicine, training, sports medicine including diving medicine, and rehabilitation,
Internationally attended sports medicine congresses,
Certifications for physicians, allied health, physical therapists, fitness instructors, massage professionals, and the public,
Fellow advancement opportunities for physicians and researchers.
We are non-sectarian and dedicated to peace and health of all. We accept no advertising from unhealthful "health and sports" products. Part of course tuitions go to medical research, charity, and elderly help.
We are holding a contest to design the Academy logo. Winning logo will be seen internationally with credit to the designer. Logo designs should be simple, incorporate the concepts of brains and functional strength. Other concepts and ideas welcome.
If you are interested to help through your logo design submission, or other good ideas and talents, or be part of this organization, let me know. Be prepared to have fun and use your brain. To see how, the new Academy web site is www.DrBookspan.com/Academy.
As you read this, we will have been on several days of flights and trains.
Sitting for long periods does not have to be uncomfortable, whether at the desk, on a flight, when driving. Most lists of instructions for sitting without hurting your back tell you to sit in exact ways at exact angles. This is not needed. Instead, it's better to understand the concepts of how and why strain and injury occur when sitting. Then you can sit in healthy ways that are comfortable, easy, and healthy.
Commercial airline, bus, and train seats often have a concave seat back, encouraging prolonged, enforced rounding. So do many car seat backs, even those saying they have lumbar support.
If your seat back is too concave, pad the space with a small cushion.
Use a pad about the size of your own forearm.
Place the pad in the small inward curve of your lower back.
Don't remain sitting rounding forward against the lumbar pad out of habit. A lumbar roll will not make you sit right.
Lean your upper back against the chair. Don't press your lower back against the pad.
If your lumbar roll hurts, it is not right. It should not be a hard material that hurts you. See if you have it positioned in the right place.
At a desk, move your seat in closer so that you do not round or lean forward to reach or see the computer.
Future posts will cover more about lumbar roll use and misuse.
If the seat is very concave, you may need two pillows, one for the small inward curve of your low back, and the second above that one for your upper back, in the space still left by the rounded seat. The upper back has a small outward curve, however sitting with a large outward curve creates upper back pain.
Like a Bonsai Tree Your terrible posture at My dinner table
The photo above shows an injurious positioning called "a forward head." A forward head position presses cervical (neck) discs outward, causes upper back and neck pain often called "upper crossed" syndrome, and can press the nerve going down the arm, leading to arm pain and hand/finger numbness. Jutting the chin upward with the neck forward can, over time, create a spondylolisthesis (vertebral shifting). Raising the arm with the shoulder rounded and the neck forward adds to shoulder and rotator cuff injury.
Check yourself for a forward head position when eating and drinking (and on the phone):
Corner of the jaw is far forward of the shoulder
Neck tilts forward
Jaw juts forward
Neck pinches backward, with high compressive force
Shoulder rounded
Don't round your back or jut your chin forward. Instead, keep chin in when you eat and drink and talk on the phone. To look upward, get the upward motion more from straightening your upper back, and not from one joint in your neck. The neck is not a hinge joint.
Don't rely on, "Keep ear over shoulder" thinking that is straight posture. You can see in the photo that the ear is over the shoulder, but the neck is craned badly.
Use healthful positioning for built-in upper body muscle exercise and easy pain prevention. Check yourself sideways in a mirror. Watch other people eating and drinking for an easy reminder. Happy Holidays.
Studies first started to report the benefit of exercise to reduce incidence of colds when looking at recreational exercisers, who reported fewer colds once they began regular running. Later research on exercise, intensity, and the number of colds, found that people who exercised moderate on most days averaged one cold, while the less active group reported over four colds in the year. Related work shows that being a regular exerciser is also associated with quicker recovery from colds.
Moderate exercise also enhances immune function during the exercise and for a few hours following it. Specific research into mechanisms has found that moderate exercise speeds various immune-function cells through the body, and increases levels of the type of white blood cell called leukocytes that work to fight infection.
A 2006 randomized clinical trial found that "postmenopausal women who exercised regularly for a year had about half the risk of colds compared to those who did not work out routinely." The women in the exercise group also reduced body weight, body fat, and intra-abdominal fat from increasing their exercise level.
Too much intense exercise may lower immune function and predispose to some infectious illness shortly after the time of the exercise. The decrease seems to be temporary, similar to the increase seen around the time of moderate exercise. There is some concern that continual, intense exercise lowers immune function for longer periods. An example often offered for this is that during the Winter and Summer Olympic Games, clinicians report that "upper respiratory infections abound" and that "the most irksome troubles with athletes are infections." The situation may be more that high numbers of young people are concentrated in close quarters. Their high general health may mean that they are unlikely have other health disorders during the short period of the Games.
It is more likely that poor nutrition and insufficient rest, added to harsh, ongoing, strenuous work or exercise, decreases immune function, not just strenuous exercise alone.
Although cold and flu germs are reported to live better in the cool dry weather of fall and winter, if you are cold, caught in the rain or snow, or out in a draft, that does not make you more likely to fall prey to them. Immunology is not my field so I can only repeat what I've read. My understanding is that these germs are all around us most of the time. They are on surfaces all over our home, and workplace. Your immune system keeps them out or eats them if they try to invade (pictured to my level of understanding at right). They don't cause problems unless their number is too high and your immune system cannot deter them. I call germs the jerks of the world - they are always there and are harmless unless conditions let them under your skin with your defenses down.
Much attention is given to disinfecting yoga mats. Give attention to cleaning up your own strength against disease:
We need to start a new trend that Health is Contagious - Make Health Catching! Stand up and stretch. Do good deeds. Go now.
--- For more, click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute. Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy. ---
Photo of cold microbe toy by dantc Photo of AntiViral cat by surekat
In Monday's post, Katharine, an Ironman Triathlete, told of having pulmonary edema of swimming twice this year and asked if warm up or fluids were involved. US Open Water Swimming also interviewed me about pulmonary edema. Here are some things they asked.
1. What is pulmonary edema and why should swimmers know or be concerned about it?
Edema means too much fluid accumulation. Fluid suddenly fills the lungs. The left side of the heart is not pumping properly. It can cause you to have to stop a race. It can sometimes cause serious illness and death.
2. Is it more likely to occur in cold water?
It seems to be more likely in cold water. It has occurred in surface swimmers and scuba divers in both cold and warm water. Cold is only one of the several proposed causes.
Causes or contributors seem to be things that increase cardiac preload and afterload, including immersion in water, cold water, heavy exercise, negative pressure breathing (like breathing with a snorkel, and swimming with the chest below the surface and even the slight elevation of the head to breathe in), and drinking too much water or other fluids before swimming. Don't drink lots of water before swimming.
3. What are the signs and symptoms?
Unusually shortness of breath (not just fatigue) and coughing bloody froth. No chest pain.
With a stethoscope you can hear rales, an abnormal rattling breathing sound. Chest x-rays show the classic pattern of pulmonary edema. When blood oxygen in the arteries is checked, arterial O2 may be lowered.
4. Do wet suits provide any measure of protection against PE?
Difficult to say since it has occurred in people with and without wet suits. I haven't seen charts where the numbers of each predisposing possibility, like protective garments and temperature, were compared.
5. Can medical personnel easily detect PE?
Pulmonary edema is not subtle. The person is usually gasping and spitting pink froth, and asking for help with a worried look.
A swimmer who develops shortness of breath and cough in a race may have something else like exercise induced asthma.
6. What is the first aid if PE is suspected?
Get them out of the water. Sit them up to elevate the head, if conscious. Give them 100% oxygen by mask, and get them to the emergency facility.
7. If PE is untreated and the athlete continues to the race/swim, what could happen?
Depends how serious. Symptoms can resolve on their own or they can get worse. I wish I knew the future for them, but it's like other injuries. There have been deaths. We wonder how many people who suddenly went under were not drowning but developed pulmonary edema. We have no way yet to tell. Drowning also produces pulmonary edema (after the fact). Repeat cases of pulmonary edema can occur in the same person.
Interestingly, the frothing pulmonary edema occurs in racehorses after hard races. They are blowing bloody nose froth all over, but veterinarians have reassured me that the horses are fine. Any readers who are veterinarians, please tell me more. If a person is frothing, get help.
Here is Friday Fast Fitness - aloe vera fresher and cheaper, and probably more effective than bottled, to help cell repair.
Cut a one or two inch chunk from a whole aloe leaf. Ethnic markets may be more likely to have some.
Remove the side spines
Peel the skin and scoop the cool gel. Be careful cutting the slippery insides.
Add a chunk when making fitness water and sports shakes, and rub the inside of the peel on your face and hands, or apply to cuts and small wounds. Dries without stickiness.
Aloe is promoted as aiding cell growth and repair, as an anti-inflammatory, and helps move slow digestion on through. Promotes fitness inside and out.
Here is Friday Fast Fitness - fix your plank (hold pushup position) to strengthen core and wrists, and train standing neutral spine posture. In yoga the plank is done in high and low positions called chaturunga.
A sagging inward curve to the lower back is not the normal curve, it is too much curve - pictured at the start of the MPEG movie below. Holding a plank with a sagging (overarched, hyperlordotic) lower spine "hammocks" body weight onto your spine joints called facets, adding to lower back pain, and does not use your core muscles. It is counterproductive as an exercise. Instead:
Hold a pushup position
Change sagging lower back to neutral by tucking the hip. Head up, neck as straight as standing.
Don't flop all weight on wrists. Press with hand and fingers, and use forearm muscles to reduce wrist compression and shift weight to surrounding muscles - see Stronger Pain-Free Wrists When Biking for ideas.
Reader David D. from Belgium sent this excellent movie. He pushes up into plank. You can also can start on hands and feet without pushing up. He first demonstrates badly overarched lower back, then changes to neutral spine in seconds 8-11 of the movie, then holds. When you do this you will immediately feel the effort shift to your abs. Use this instead of crunches for functional core training. If you push up from the floor, hold tucked neutral spine, not lifting upper body first.
(The exercise is not to do overarching and change to neutral - it is to hold neutral throughout.)
Thank you for the many e-mails. I am sorting through the piles. Readers are sending success stories, long and short, of improving their lives and fixing injuries and the moves that produced them. They changed their mindset so that exercise is not something you change clothes and go "do" - if you can make time - but all the ways you sit, bend, reach, lift, and move all day in real life, using muscles to hold the positioning that prevents body aches and joint wear and tear, and comfortable easy movement. They are now getting fresh air, sunshine, balance, and real exercise going to work or grocery shopping on a real bike or walking on real ground, instead of driving then rushing home or to the gym to "do" exercise, illogically spending money on an artificial machine, exercise cycle, or treadmill. Instead of thinking they have to lose weight first to try things, they are using daily movement to be able to exercise for the first time without injury. They are saving money and health, eating real food instead of processed unhealthful "sports food."
Yoga instructor David from Belgium first asked about fixing knee pain and fallen arches in the comments of the post Thank You Grand Rounds 3.51. Since then, he quickly applied the posts I recommended and fixed his pain, no longer needed shoe orthotics, sent photos of new progress, asked about other injuries from yoga, changed how he teaches yoga, given his students my techniques, started making short mpeg movies for us (see the first here), and is translating my work into Dutch for his web site and students. I look forward to more collaboration. Watch for wonderful posts to come.
There have been a small number of e-mails from readers applying techniques in ways so "unclear on the concept," that some posts may turn out to be Readers Inspiring Stories of What Not To Do. All for the greater good, learning, and health.
If I can't get to everything in the comments I will make posts for you, don't worry. I read and want to get to them all. The top number of requests for posts, so far, are how to stop shoulder injury from swimming, baseball and weight lifting; low back pain from swimming, baseball, and golf; separating truth from advertising in orthotics and shoe inserts; more healthy sports food; rowing; sports drugs; hamstring injuries (often from the usual bad stretches); plantar fasciitis; knee pain from rowing, yoga, and walking; wrist pain from pushups and handstands; healthy sitting; and many requests for martial arts and self defense for body and mind. If you have other requests, let me know. Until I post each specifically, start with:
Shoulder - use for all overhead reaching and lifting
Lower back - learn the concept and apply to all sports
Fitness has become unhealthy. Healthful natural, comfortable body movement has become foreign as more people think that exercise means artificial sets of repetitions on a machine or using equipment. How are you sitting right now reading this? Pull chin comfortably in, instead of jutting forward or down. Stand up, breathe a grateful breath, and walk away from the computer for a few minutes contemplating a new, healthy fun life of natural movement. Print out a post of something that will make your own situation happier. Lie face down on a comfortable surface, propped slightly on elbows to read it. If you can't lie comfortably that way, that signals tightness that makes daily movement unhealthy and uncomfortable. I will post about that too.
A special story came in. I had been answering inquiries from a reader who wrote me to ask how to stop her mother's knee pain, and after her mother was better, to help her father. I was charmed by this good daughter who wanted to help her parents. She faithfully taught her mother everything I wrote her, and she wrote back with results. I didn't know where she was from, and didn't ask. In the weeks of letters back and forth, she caringly scanned and e-mailed me copies of lab reports and pharmacy prescriptions. She asked good questions about the medicines and tests and how they could help her parents. The tests and prescriptions had notes in Arabic and distinctive generic names. I wondered if I might wind up on a watch list of people who correspond with people from certain countries. In one reply that I wrote, I headed the instructions on knee pain with, "To whoever else may read this, please use it to stop your knee pain too, for more peace and less pain in the world."
Here is the story of Katayon:
"I belong to Afghanistan and I am very grateful to Dr. Jolie Bookspan. My mother’s knees pain was my biggest concern for a long time. She went to more than six best doctors here in Pakistan. But all she got was medicine for relieving her pain which not always helped her. She was also told not to walk a lot and rather sit on the chair most of the time. My mom is young and still it’s very soon for her to spend her life just sitting. Doctors said the cartilage inside her kneecap has dried and can never be recovered and she will always have the pain. And that the only way is to always use those tablets. This really bothered me to think of her feeling pain all her life.
"After trying the doctors in the city, I selected the option of getting support through the internet. That is where I fortunately found Dr Jolie Bookspan who always keeps telling me that medicine is not the only option. But rather we have to adopt healthy movements. In the first stage, this knowing this thing encouraged and cheered me a lot. She also introduced me to the free articles- exercises related to knee pain and back pain, on her website. I have checked almost a lot of those useful links and currently I am following a lot of those helpful movements, exercises and directions mostly for knee pain. Currently I am also suffering from knee pain which is due to weakness of my muscles as the doctors here have told me. Dr Jolie has been a great help for me and my mother.
"And now I and my mother are feeling much better. I learned not to use knee-bands (bracing) because it further weakens the joints instead of strengthening them. I have shared all what I leaned with my whole family. So we are all blessed with an opportunity of adopting healthy joints movements. Besides a lot of other very useful guidance, I learned these important things: climbing the stairs putting full flat foot on the ground avoiding knees coming forward, so overall moving the knees in a healthy way which should not create pain while walking – I am practically doing this and I really see how useful and pain free it is; while picking something from the ground, trying to avoid knees coming forward and instead making it like sitting on a chair. So all in all, we are following all of the guidance and tips which really are pain free and help my knee joints get strengthened. I and my mother regularly every morning and anytime during the day we find time do the squat and lunge exercise which are very much helpful. Not only this, but I have also shared this exercise and all of the other healthy tips with my office colleagues who are suffering from knee pain.
"I never thought of a way out but only as the doctor said that the only option is to have medicine for whole life, whereas Dr. Jolie changed the whole thing for me encouraging me to have fun and keep walking pain free. I feel very fortunate to have found her. And I appreciate all of her time and efforts that she makes to help the world live without pain. I and my mother are deeply inspired by what she is doing to help the people. And we wish her best of luck and lots of energy to keep on her good job." Katayon Q – Afghanistan
Why is there a picture of a flower with this story? A personal photo was not the right thing. I asked Katayon what photo she thought would represent her story and country. She wrote:
"With this email I am sending a picture to go with my story. I was thinking of something to show relief and happiness as a result of being healthy. And I came up with the idea of selecting flower picture for my story. To me, a flower presents every positive thing."
Prevent Main Factor in Back Pain After Running and Walking
Thursday, October 11, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
One of our readers, Nick, wrote me that he had had slowly increasing lower back pain despite exercising regularly. He ran, he stretched, he did abdominal exercises. Nick's doctor told Nick to give up running and take up low impact activity. Giving up running made Nick miserable but he did it. The pain came and went, but overall did not change. One day during a walk, his pain had spread into the back of his hip and was unendurable. He didn't feel able to make it back home, and wound up in the emergency room.
His x-rays were inconclusive and he was sent home with anti-inflammatory medicines, instructions to stretch his hamstrings, and rest or try other non-impact activity. This is a common story that readers mail me. It is unfortunate because:
The real cause of the pain was missed.
You do not need to give up running.
This kind of back pain is not inflammatory so does not benefit by anti-inflammatory medicine, which often causes its own problems.
Impact is not the problem. With a little common sense you can see if you clomp instead of walking or running lightly. Use leg muscles to step lightly instead of bashing down with no control. You should be able to run and jump with little impact. Many people walk with higher impact than a good runner lands during running. Future posts will cover this.
Most important was the missed cause - lower back pain during and following running, walking, lifting, and other upright activity is usually from allowing the lower spine to over arch. This hyperlordosis is not caused by an anatomic problem "condition." It is a bad posture, which is easily correctable. Hyperlordosis is one of the most commonly missed causes of lower back pain. Left drawing shows neutral spine. Right drawing shows one kind of hyperlordosis.
In the left neutral spine figure, the hip is level and horizontal from front (ASIS) to back (PSIS). The hip is also vertical from the top of the leg (greater trochanter) to the center crest of the hip. The right drawing shows allowing the front of the hip (pelvis) to tilt forward, which increases the lower spine angle. A small inward curve in the lower back is necessary for disc health and shock absorption. A high angle is as painful as any other pinching and pressuring of an area.
This is what I had Nick do. You can try it too. Check yourself these two ways to see if you stand in hyperlordosis:
Stand up and look sideways in a mirror. Your belt should be level-green line in left neutral drawing. The side seam in dress or trousers should be vertical from leg to waist - black arrow in left drawing, not tilted forward at the hip
Back up slowly and gently into a wall. If your backside touches first, it may be an indicator that you lean forward at the hip. If your upper back touches first it is usually a good indicator that you lean the upper body backward, which increases a second kind of hyperlordosis. See Neutral Spine or Not? for more.
Here is how to reduce an overly large arch:
Stand with your back against a wall, with heels, hips, upper back and back of your head touching.
Put your hands on your hips, thumbs facing the back.
Roll your hip under so that your thumbs come downward in back.
Feel the large space between lower back and the wall become a smaller space.
Keep your heels, hips, upper back and the back of your head touching the wall and stand tall and straight. Lower back pain that is caused by hyperlordosis should ease right away.
Keep the good new neutral spine when you walkaway from the wall, and all the time.
More step-by-step instructions and photos in the Ab Revolution manual.
Check back often. I am working on the next part of this post: Another Common Cause of Back Pain With Running.
Nick was quickly able to return to running by stopping hyperlordosis. So was Ted - Back Pain From Running. Recognize hyperlordosis. It will save office visits, even emergency room visits, tests, time, money, stress, and worry. Reduce hyperlordosis to neutral spine with a simple repositioning technique to stop and prevent much pain.
--- Questions come in by the hundreds. I make posts from fun ones. Before asking more, see if your answers are already here in the several replies to questions already here under this post. Get all posts on this topic by licking labels under posts and links in posts. Also check archives at right, the Fitness Fixer Index, and all the success stories of Fitness Fixer methods.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. See class schedules, get certified - DrBookspan.com/Academy. ---
On Oct 20 and 27th 2007, Temple University Center City (TUCC) Campus in downtown Philadelphia will hold a fun, fast moving workshop, "Fix Your Own Back Pain - Medical Breakthroughs in Non-Surgical Treatment."
The class is a combination of fun and fast-moving audiovisual lecture and non-strenuous physical practice.
You will learn how to fix and prevent the causes of neck pain, back pain, sciatica, herniated and degenerating discs, stenosis, lordosis, facet pain and other problems right in class. You will learn how to not get stiff and sore in the first place:
The class will be held over two Saturdays Oct 20 and 27, 2007, each class 9am-11:30am. This is one 5 hour class divided over two sessions. Plan to attend both days.
Information about this class and others is on my web site page for CLASSES along with links to free readings. To register e-mail Kevin Wood Director, or call (215) 204-6565. The class is suitable for the out-of-shape as well as the athlete.
One of my areas of injury research for both Army and Navy aeromedical systems was preventing back pain from running. Disease Non-Battle Injuries (DNBI) from exercising in the gym and doing PT is a huge military issue - grounding far more personnel than combat casualty.
I ran several studies and found that overarching (hyperlordosis) is a major overlooked cause of lower back pain - some examples are shown in the post Prevent Back Surgery.
I developed a simple method for people with this kind of back pain to understand and reverse the cause of pain themselves, with simple repositioning to neutral spine instead of overarching. It was unexpected news to some groups who have been taught to overarch, and who deliberately tilt the backside far out in back for exercise. But it was welcome relief for my guys who liked to joke that they were my STRACguys - combat slang for 'stupid troops running around in circles.'
I wrote a little training manual that went through several improvements to become the book, The Ab Revolution™ No More Crunches No More Back Pain. The book has two parts. The first shows how to stop back pain during various standing activity in daily life, both non-active and active, including running. The second part gives ways to exercise core muscles in healthier ways.
Reader Ted found the book and put it to immediate use to stop years of disabling back pain and return to running. Ted wrote:
"I am 57 years old and have weighed 175-lbs for the last 10-years (which drives my doctor nuts). I discovered running in 1969, after gaining weight when I entered college. The track at the University was fenced in, so we'd slide under the fence to run it. I jogged for six years, then raced for another ten years. I wasn't a fast runner, but I hit the legendary ''Second Wind'' on many occasions - you feel like you could Run Forever.......No Time....No Distance.....Just You and the Road.........it is a Mystical Experience....
"I tore out my ankle ligaments in 1980, and had to rehab for a year 'til I could start running again. I have run carrying 2 1/2-lb hand weights for the last 22 years. In 1989, I tore my back. It hurt, then the pain subsided, but flared up every so often."
The only way Ted had then to "cure the pain" was to stop running. Ted continued:
"In 2005 I REALLY hurt it, went into spasms (my wife had taken me shopping for eight hours, and I still blame this on being taken shopping), and the pain made me look back fondly on the Ligament Tear of 1980. After that, it was an All the Time Thing. Running dropped to twice a week (if that) and the slightest thing would trigger a back spasm. I accidentally came upon Dr Bookspan's ''Ab Revolution'' and 'mistakenly' bought it as an exercise book. It's more of a Way of Life, just like running.
"I have been pain-free (amazing) for 12-weeks and counting. I have increased my running to 4-5 days a week. Not having my back killing me is more than I could have hoped for. I thought my running days were over, and I would have missed them.......A LOT.
"The funny part was, I had gotten so used to the pain, it took about three DAYS for me to realize it WASN'T hurting. I cannot recommend the techniques in this book enough to other runners, If you can do The Thing You Love, why WOULDN'T you try this?"
What specifically did Ted do to fix the pain? He writes:
"The two techniques (in the book) I got the results from were the Standing Beginning Crunch with the hands facing each other, and the Where is My Belt Pointing? technique."
I will ask Ted what's going on with his knee in the photo he sent for this post, and what we can do to fix that up next. I will cover more on back pain after running, and also hope to post some other interesting work I did on the military running chants called jody calls or jodies, and their effect on perceived exertion during running. Check back often.
"Vegetarians have the best diet. They have the lowest rates of coronary disease of any group in the country. [T]hey have a fraction of our heart attack rate and they have only 40 percent of our cancer rate." —William Castelli, M.D., Director, Framingham Heart Study, the longest-running epidemiological study in medical history
From my work in sports medicine, I will add to Dr. Castelli's work that I see fairly consistent reduction in joint pain and other pain syndromes when patients stop known "inflammatory foods" including meat and dairy.
October 1 is World Vegetarian Day (www.WorldVegetarianDay.org). The month of October is Vegetarian Awareness Month. The purpose is for a happier, more aware and respectful, and healthier society.
Hurting animals is unhealthy for all involved. In the spirit of healthy body and mind, this post gives four ideas:
Build your own health and benefit your exercise: food and recipes for better exercise training (regardless of your sport), and preventing disease and pain syndromes. Get the book Healthy Martial Arts
Free vegetarian starter kit, free newsletter, with materials in Spanish, to avoid cruelty to yourself, animals, and the Earth, one meal at a time - TryVeg.com
Reduce global warming: GoVeg.org reports on work published in NewScientist.com - It's Better to Green Your Diet Than Your Car (17 Dec. 2005). "You could exchange your "regular" car for a hybrid Toyota Prius and, by doing so, prevent about 1 ton of carbon dioxide from entering the atmosphere each year, but according to the University of Chicago, being vegan is more effective in the fight against global warming; a vegan prevents approximately 1.5 fewer tons of carbon dioxide from entering the atmosphere each year than a meat-eater does. The math is simple: You could spend more than $20,000 on a Prius and still emit 50 percent more carbon dioxide than you would if you just gave up eating meat and other animal products."
Feel encouraged. Being vegetarian or making occasional vegetarian meals does not have to involve any strange or expensive foods from specialty stores. You do not need any special pots or food processing equipment. It is a myth that vitamin supplements are necessary. Grocery bills can also be also far less expensive when you don't purchase meat (and don't substitute other expensive food that you do not need).
More Good Stuff:
I will post easy-to-make healthful (real) food for athletes and exercisers, during October vegetarian month, and for Vegan month in November.
Click the label "nutrition" under this article for all Fitness Fixer on healthy smart nutrition, and other labels for all posts on each topic. NonVegetarians are welcome.
--- Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy. ---
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