Diastases Recti, What It Is and What To Do

Reader Fun Steve previously wrote with his success losing weight and getting in shape with Fitness Fixer. Then he moved from Thailand to Japan. What happened next?

Steve writes:

"I 'done did' something to my stomach. Without having visited any doctors here, my own diagnosis is/are hiatal hernia or tearing of the linea alba area of my stomach muscles.

"No 'pain' but constant discomfort. Constant but mild indigestion. Shortness of breath. Here is the real kicker... If I do leg lifts while doing 'slight' crunches, I have a 2-2.5 inch vertical band of 'something' that reaches from my xiphoid process down to below my belly button. Feels like a strip of weak muscle. I normally don't do full crunches. Perhaps I lift my shoulders 2-3 inches at most.

"My rectus abs are solid. Rock hard .. but the area between left and right side is soft now. This odd strip of 'something' doesn't protrude unless I do leg raises and crunches (so I'm not doing them!) but if I use my hands to press it inward, I can do the crunches or leg raises without that strip pressing up. It's as if the rectus abs, once contracted, hold it in.

"So... what have I done to myself? Besides not doing any crunches and leg lifts, what shall I do to heal myself?"

I answered that (using my e-mail x-ray machine) it sounded like a diastasis, full name Diastasis Recti.

The vertical muscle fibers pull apart, leaving an area between them. This is popular in pregnant women and men with bellies. The 'rock hard' belly is often the large amount of fat (or pregnancy) pushing against the covering muscle, stretching it tightly. Weight loss will let it rejoin and heal. It's not surgical, meaning it can heal if you lose the belly.

I reminded Steve that crunches are not functional exercises, meaning they do not use your abdominal muscles the way you need them to function during any real activity in your daily life. Crunches repeat the bent forward posture that people already spend too much daily time in, and that he already new I had developed a method called The Ab Revolution™ that solves the counterproductive nature of crunches and leg lifts. For the time needed to heal, he could stop belly stretches - back bends, yoga cobra, and updog, and stretching the belly with too much food and weight gain. Continuing to do crunches and leg raises using hands as manual splinting has turned out to make things worse - since the muscles atrophy more.

Steve replied:

"How could I be pregnant?!? Actually, I have 6-pack abs! (Well, really two 3-packs right now. Unfortunately there is a thick layer of blubber covering them.) Under them too.
">>Dr. Bookspan wrote: Sorry to hear.
"Yes... me too. I came back from Thailand having lost almost 20 kilos, and due to McDonald's introduction of the 'Double Quarter Pounder with Cheese' into Japan and a side of trans-fat potatoes, I put it all back on."

I reminded Steve that weight loss will let the split area rejoin and heal, and that a diastasis was not surgical, meaning it can heal if you lose the belly and stop pulling it open with Pilates style leg lifts and crunches.

Steve wrote:

"Lose the belly. Lose the belly. That's all anybody says. Lose the belly. Hey, Buddha had a big belly and he didn't have this problem!?! Humpty Dumpty had a big belly and all that happened to him was that he fell off a wall. Well I don't sit on no walls!!! No sir! Not me. I sit on a couch doing bicep curls with the TV remote! I do full presses with bags of Doritos! Pectoral presses crushing my beer cans! Lose the belly?!? Oh well... I guess I gotta..."

I had developed The Ab Revolution™ to solve one common source of lower back pain - a slouching posture of too much inward curve in the lower spine. The Ab Revolution™ retrains function. Conventional ab exercises are often mistakenly prescribed for back pain. Conventional strengthening does not make people stop the actual cause, the slouch. They are just stronger people who slouch. Doing crunches also perpetuates another cause of back pain. It is an irony of pop fitness that without understanding causes, counter productive exercises are prescribed, then repeated by reporters then repeated by trainers and so on. The same is true for hamstring stretches, covered separately. What was interesting was all the documentation I received from people with diastasis and hernias who could use The Ab Revolution™ without pain and with benefit to build abdominal wall strength without pushing things out further with crunches. It made sense. I am looking into it further.

Steve wrote again:

"I follow the the Ab Revolution™. That's what's made my back feel so much better. I haven't had so much as a twinge in my back in the past year or so! It's been your work that made the difference. I'm not worried... now :o) Just PO'd. Thanks for the info about my (larger than necessary) stomach."

Steve followed up that he was back to healthier eating and was easily losing weight by following the healthier traditional Japanese diet without fast food.


Related Fitness Fixer:

• Fun Steve Loses Weight With Fitness Fixer
• Reader Ivy shows why Good Life Works Better Than Bad Ab Exercise
• If Better Abdominal Muscles Are Your New Year's Resolution, Try This
• Innovation in Abdominal Muscles
• Back Pain in Pregnancy - and Why Men Can Get It
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
  

My Web Site information on how abdominal muscles work:

• DrBookspan.com/AbsArticle

Random Fitness Fixer:

• Extremes, Survival, Injuries, Faster Higher Stronger - Fitness Fixer

Labels: abdominal muscles, fix pain, injury, pregnancy, readers inspiring story, weight loss

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Supportive Hard Shoes Linked to Knee Loading and Arthritis

A Rush University Medical Center study has found that supportive, stable shoes increases the load on the knee joints compared with flat, flexible footwear or going barefoot.

Researchers compared gait and knee joint loading of 31 patients with osteoarthritis while walking in flip-flops, barefoot, and wearing several types of popularly prescribed shoes. Clogs and stability shoes increased loads on the knee joints up to 15 percent over flat walking shoes, flip-flops or barefoot. Knee loading was roughly the same whether the subject wore flips-flops or walked barefoot.

Dr. Najia Shakoor, rheumatologist and lead author stated, "Stiffness is also a factor. We've shown in earlier studies that barefoot walking is associated with lower knee loads than walking with conventional footwear. It may be that the flexible movement of the bare foot is mechanically advantageous. The natural flex of the foot when it contacts the ground probably attenuates the impact on the joint, compared to the artificial 'stomping' movement created by a stiff-soled shoe."

"Clogs and stability shoes, conventionally believed to provide appropriate cushioning and support, actually increased the loading on the knee joints, as opposed to shoes with less 'support,' flatter heels and more flexibility."

The article stated, "A higher-than-normal load on the knees during walking is a hallmark of the disease, associated with both the severity of osteoarthritis and its progression."



Study authors felt they had to also issue a caution that people who will trip if they wear flip flops or have poor balance not to wear them, however it seems better to do simple function to improve balance and reduce cause of the falls rather than wrap people in shoe "straight-jackets" that are not good for them.

When I was small, I remember worrying that horses had to wear iron shoes. I asked the teachers in school if it hurt the horses' feet, and was told their feet don't feel anything (a myth). I asked if the metal increased the hard impact against paved streets and why didn't horses wear sneakers instead. I was told that sneakers were bad for you because they don't "support" (another myth). I asked why you needed anything to hold your own body up and why you couldn't have healthy feet without them. I asked if cavemen wore support shoes and incredibly, the teachers said that support shoes were important and barefoot was wrong and cavemen had to wear shoes or they would not be able to walk. Later I found that arthritis, lameness, and gait changes were higher in metal shod horses, and that new horseshoes were being made in urethane and other soft composites.

When I tell patients that hard supportive shoes are known to increase pain and problems, they say they wear them because their doctor told them to, their trainer, their aerobics instructor, and their physical therapist said they must. When I remind that hard shoes may be part of their knee and foot pain, they say that they got the shoes from their podiatrist or orthopedic shoe place. Doctors used to recommend smoking cigarettes for the several benefits they gave - calming nerves, better digestion. The two bad side effects (illness and death) were left out. It may be commonly repeated that you need hard supportive shoes however, untrue stories are common.


Related Fitness Fixer:

• Which Shoes Help Exercise, Fall Prevention, and Ankles?
• Healthy Knees
• Your Muscles Are Your Orthotics for Arches, Knock Knee, and Knee Pain
• How To Treat Ankle Sprains and Prevent Them
• Better Balance by Christmas
  

Random Fitness Fixer:

• Do Fun, Not Exercise

Labels: arthritis, feet, fix pain, injury, knee, shoes

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Functional Fitness as a Lifestyle By Mail Room Workers

Peggy Santamaria wrote me that she was using my work, and my illustration Backman!™ to teach healthy movement to workers for a good day's work without injury and repetitive strain:

"Hi Dr. Bookspan,
"Very excited to report that I met with the Appalachian Crossroads staff and the trainees of the Mail Room Service Unit. The goal is to connect developmentally disabled adults with a paycheck for good work done well.


"I had created some Backman!™ flash cards illustrating some of the daily work in the mail room. These were distributed to the trainees with explanations for the staff about our new program. Then I met with the trainees and talked more about functional fitness.

"We then practiced some of the healthy movements needed for their work day. We took pictures to document their great understanding of what we are working toward. I will make these photos into small posters that can hang in their workspace.

"They are all excited about what we are doing and are proud to be part of the Academy.
"Peggy"

Here is Ms. Santamaria's update with the successful outcome plus great photos. I personally congratulate and thank each participant:

"Hi Dr. Bookspan:

"Here is an update on Academy activity. As you know, I am working with staff and trainees at Appalachian Crossroads, a private nonprofit human service agency that primarily serves developmentally disabled adults in Garrett County, Maryland.


"One of the Appalachian Crossroads work units provides a "mail room" service to local businesses. The trainees in the mailroom provide support, expertise, and manpower to process everything from daily statements to sales catalogs to monthly newsletters. More than 1.2 million pieces of mail go through the hands of 18 employees each year.


"As the Academy’s director of Developmental Abilities I set about creating a program using your work and Fitness Fixer to help the trainees work in a healthy way and be functionally fit. I met with staff and trainees of the unit to hand out instructional flash cards featuring Backman!™ going through the daily functions required in the mail room.


"The Appalachian Crossroads folks were super. They got right to it. With the help of staff they were ready to work and demonstrate their functional fitness skills. I took pictures that I am making into small posters for their work area.


"I will continue to work with these men and women as well as others in the custodial service unit, the grounds crew, supported employment, and the day program. It is a privilege to be working for the Academy and sharing your fitness message.
"Peggy Santamaria"

This is a shining example of getting things done well, simply, and intelligently. Thank you Peggy! Thank you Appalachian Crossroads staff and mail room!

Readers, The Mail Room is teaching us how to keep things healthy and smart. They are role models and generous guides for all of us. Use what they have done, and send your stories of using this work for Good.

Academy Web Site of This and Related Work:

• www.DrBookspan.com/AcademyStudents

Related Fitness Fixer:

• How Ms. Peggy Santamaria started - New Healthy Employment Programs for Developmentally Disabled
• Mr. Stuart Wood uses this work to make programs for his city of Tucson - StuartShip - How To Start Healthy Movement Programs
  Mr. Georges Nakhlé helped me start the whole Academy - New International Academy Using Jolie Bookspan's Methods
  
• Fast Fitness - Better Back and Leg Exercise When Vacuuming
• Household Fitness in the New Year

Random Unrelated:

• Fast Fitness - Strengthen Character

Labels: disability/ability, fix pain, International Academy of Functional Sports Medicine, readers inspiring story, repetitive strain

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Fast Fitness - Stop Common Source of Elbow Pain

Here is Fast Friday Fitness - Strengthen your arms while learning to change a movement habit that is a common source of elbow pain:

1. Hold a pushup or plank position, handstand, or just lean on one or both arms.
2. Notice your elbows. Check if you lock them straight, or let them hyperextend (bend slightly backwards) shown in the photo below.
   
3. Instead, keep elbows slightly flexed (bent forward). You will feel an increase in arm muscle use.

The elbow joint is called a hinge joint. It is shaped to open and close like a door. Because of the shape of the bones, opening wider than a certain point - usually close to a straight line - is stopped by the bones, not muscle flexibility. You can try it yourself now, and feel the bony end point. Like a door, if you force the elbow joint open past maximum straight range, it yanks one side of the hinge and squashes the other. Don't try that yourself. That is a common injury in yoga because some forms of yoga teach to hyperextend the elbow under body weight.

People with flexible elbows, both men and women, have bones shaped to open slightly wider. They can hyper-extend the elbow so that it bends slightly backwards. That is not a disease or cause of pain by itself and does not preclude them from sports like archery as often repeated (will be covered separately). You can easily control elbow angle using your brain and muscles.

For leaning against a counter, bike handlebars, doing pushups, plank, yoga, and other leaning or arm balancing. Keep elbows slightly flexed instead of letting the joint open to or past maximum range.

Related Fitness Fixer:

• Making Thai Massage Healthier Part II - Avoid Snapping Elbows or Knees Backward
• Fast Fitness - Prevent Wrist Pain During Pushups and Cooking
• Fast Fitness - Plyometric Partner Bench Press for Valentine's Week
  

Random Fitness Fixer:

• Muay Thai Monks on Horseback

Labels: elbow, fix pain, pushup

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Ivy Fixes Neighbors Fitness - Making Results Last

Ivy from New Zealand continues making her community healthier, one neighbor at a time. What does she do that helps so many? Here are just a few stories from her many updates:

In December 2009, Inspirational Ivy wrote me:

"Thought I would share this amusing little story.

"Yesterday, I was talking to a 64 year old woman who is a new resident to this country and she told me that she was experiencing back pain. I told her that I could help her - she was most insistent that she hated exercise so I promised that I would not have her exercising that what I would show her would be what she could do as she went about her daily life. I showed her how to lie on the floor and lift herself up on her elbows. She marveled at the instant relief. I then showed her how to squat and do lunges which she was most receptive to. I showed her how to sit up straight, shoulders back and suggested that she lift her ribs (to learn to unround the upper back instead of forcing the straightening from the shoulders or neck). I was most amused she put her hands over her rather ample breasts and lifted them up. It looked so funny. It is the first time I have had someone do that to lift her ribs."

In January 2010, this update came:

"Just the other day when I spoke to Jean she remarked how young I look. (Jean is the lady who I helped re back pain) She said that she felt envious when she compared herself at 62 with me at 73. I remarked that I could not help but be surprised as all I see are the wrinkles when I look in the mirror. No, she replied, we all get wrinkles, it is your slim, fit body plus the fact that you walk so fast. So........., there is hope for me yet!!!!! Smile,
"Hugs to you both
"Ivy"

In January, Ivy sent me a happy e-mail. The large-chested neighbor who thought pain was due to her size was able to stop upper back pain with healthy techniques, and holding her weight in healthy positioning on her muscle, rather than letting shoulders round and slouch in painful position:

"Jean tells me that she is now free of back pain. She is lying down on her stomach lifting herself up on her elbows on a daily basis. Needless to say she is very happy with the results.

"Re the trapezius and pectoral stretch - she will be visiting me over the next few days (to check good positioning learned from it).

"Re: Merlene (Strengthen a Neighbor, Strengthen a Community) - I did not have to telephone Merlene, she called me to ask if I could vist her. She showed me how well she was doing re her balance. Also, she was delighted re her weight loss. I checked her posture and it was perfect. No longer any back pain.

"She asked if I could help re strengthening her legs. I showed her how to do lunges.

"Merlene is always a pleasure to work with. She is a delightful lady. Love and hugs to you both
Ivy"

At the end of January Ivy wrote again:

"Jean: I visited her at home this morning to show her both the Pectoral and Trapezius stretch. She tells me that she no longer has any pain in her back and hip. She also tells me that she has shown her daughter the back stretch and she, too, no longer has any back pain. So.........two very happy women.

"Merlene: I also contacted Merlene this morning to see how her lunges are going. She, too, is happy with her progress.

"Jean did make a comment as to how much I could help people here in the village. I replied that I do try, however, the request has to come from them personally. It is all a matter of choices. Some choose to take medicines, others do not (and use healthy ways to fix the pain without needing medicines).

"Love and hugs to you both
Ivy"

February brought this:

"Over the weekend, I received an e-mail from a friend who lives in Australia, telling me that she had back ache. She had had it for a week and had decided that once the weekend was over, she would go to the doctor to get some pain relief.

"I wrote back and told her to lie on the floor or bed and lift herself up on elbows. I have just received a reply saying that the pain has gone.

"Today while shopping in my local organic shop I got talking to a lady who had decided that she would shop for healthy foods instead of the usual junk food. She explained that her family had minor health problems and thought that perhaps if she changed their diet, the health of the family would improve. She noticed what I had in my shopping trolley so asked if I would mind helping her. Actually, I must admit that I did enjoy doing so. She could not believe the knowledge that I was able to pass on and was most grateful. One of the things she asked was how to make sprouts. Not a problem I replied and explained how I, personally, do sprouts. I hope I see her again soon so I can catch up on their progress.

"My shopping which usually takes 20-30 minutes took more like an hour and a half. I assure you, it was time not wasted.

"Hugs
Ivy"

Does Ivy meet people who work against themselves? Last October she wrote me about one:

"Thank you for the post re helping oneself. I must have missed your post "Somebody Please Do My Personal Responsibility For Me." (my computer would have been out of action) To be honest, I could not help but burst out laughing at some of the excuses, as I, too, hear these same words time and time again.

"As an example, about 3 years ago, a lady approached me for help re her weight. I might add that she was morbidly obese.

"I wrote her out what I believed to be a balanced diet with plenty of food so that she would not feel hungry. She was thrilled to see that she had lost 16 lbs when I weighed her the following week. For the next few weeks there were no weight losses at all. I asked her if she was following the diet. No, was her reply, you allow me too much food, so I cut down on the quantities. I then get hungry and eat what I shouldn't. This went on for 6 weeks.

"Needless to say, I gave up on her.

"This same lady now lies in bed all day. She does no exercise what so ever. Her husband does everything for her. Once in awhile I see her go out with her husband in the car.

"It is so sad. I did but try. No doubt you can tell many similar stories.

"Have a great day
"Hugs,
Ivy"

Wisely, Ivy has focused her energy on others since.

Fitness Fixers Ivy Taught Neighbors:

• Face down, slightly propped - Fast Fitness - First Morning Stretch
• Leg Exercise That Helps Your Back - Why The Lunge?
• Pectoral (Chest) Stretch - The Most Common Mistake in the Best Shoulder Stretch
• Trapezius stretch - Nice Neck Stretch
• Fast Fitness - Sprouts Inside and Out
• Ivy helps Merlene - Strengthen a Neighbor, Strengthen a Community
• Inspirational Ivy
• Is Healthy Living Less Expensive?
  
• Fast Fitness - Somebody Please Do My Personal Responsibility For Me!

Labels: fix pain, lower back, readers inspiring story, upper back

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New Healthy Employment Programs for Developmentally Disabled

Another reader has Fixed the Fitness for a community program so beneficial and potentially far-reaching that I have given her an Academy Appointment.

Peggy Santamaria is bringing my healthy daily life techniques to developmentally disabled adults. She has made a new program to transition developmental disability to Developmental Ability.

After her success story appeared - Shoveling Snow - Reader Wins Mother Nature's Fitness Challenge with Fitness Fixer, Peggy wrote:

"Thanks. Cool to find that this morning on Fitness Fixer. I would like to work with job coaches at a local agency that trains and finds employment for developmentally disabled adults. Snow removal is one of their big programs. I hope I would have your permission to use Fitness Fixer techniques to help prevent injuries for these trainees. I am on the board of directors for the agency and really support the program.
Thanks again.
you rock!!!"
peggy

I wrote back asking if she could start before the snow season ends, which was soon, and that when the snow season ends, what activities and healthy movement retraining could she bring to them?

Peggy replied:

"Just spoke with program director at Appalachian Crossroads. I will meet with his job coaches and staff on Monday afternoon to talk about healthier movements while on the job shoveling snow, landscaping, vacuuming, etc. This is their website if you want to check them out, www.appalachiancrossroads.com/"

I am pleased to announce her appointment through the Academy of Functional Exercise Medicine (AFEM) as Director of Developmental Ability. We are working on better names - write in your ideas in the comments for a good title for this program for the disabled to develop their abilities. Peggy has been working hard developing the program. She drew the shovels for me for the Backman!™ illustration, and has been drawing and developing more teaching tools.

Our plan is for participants to gain skills and healthy work, reduce injury and pain risk, and be proud role models. The community gains important improvements in ways that are healthy for all. We hope our program with Appalachian Crossroads becomes a model for programs all over the nation like it.

Peggy wrote back:

"WOW!!! That's all I can say. Off to teach a class. I have read a gazillion of your fitness fixers (they are like peanuts, you know). I just don't get any housework done. But I will be well-armed to begin this task.

"My daughters and grandchildren are very proud. (They) said it was "awesome" and "Go Grandma Peggy!""

Related:

• Peggy first appeared in Shoveling Snow - Reader Wins Mother Nature's Fitness Challenge with Fitness Fixer
• Stuart Wood is my Community Programs guy for healthier Watershed, Youth, and Elder exercise programs - StuartShip - How To Start Healthy Movement Programs
• Here is how Stuart started - Reader Gains Academy Appointment for Making Community Projects Healthy,
  
• and continues with Natural Hard Exercise - Stuart's Community Health Stewardship Continues
• Join The Fun - Join in this work, and do the same for your own local world. Send in your own ideas and stories. See my Academy page - www.DrBookspan.com/Academy.
  

Semi-Related Fitness Fixer:

• Want Weightlifting? Plant A Food Garden

Random Unrelated Fitness Fixer:

• Secret To Get Better and Fitter

Labels: disability/ability, fix pain, International Academy of Functional Sports Medicine, mind, readers inspiring story, shoveling/digging, spirit

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Shoveling Snow - Reader Wins Mother Nature's Fitness Challenge with Fitness Fixer

Reader Peg S. put healthy bending to work in real life, wrote in with this success story, sent a title for it, took photos and sent them with captions. Thank you Peggy for great work:

"Dr. Bookspan, your emphasis on squats and lunges in place of unhealthy bending has saved my back during long hours of snow shoveling.

"Lots of snow has fallen in far western Maryland - over 265 inches so far this season - with three back-to-back blizzards (22 feet of snow, or 673.1 centimeters).

"All that snow needed to be moved. I avoided unhealthy bending and had no back discomfort after hours of lifting snow-laden shovels.

"When I took a break, I emailed my yoga class students reminding them of the healthy movements such as squat and lunge in their snow removal efforts. They later thanked me for the reminder.

"Thank you for the information on back health!!!"
Peggy S

Peggy is teaching these and other healthy movement techniques to developmentally disabled adults to train useful work skills and prevent injuries. See the first results in Functional Fitness as a Lifestyle By Mail Room Workers

Peggy, her colleague Patty, Reader Paul J, and I have been working on Peg and Patty's project of using human powered devices like bicycles, to make electricity. More on this to come. Contact me if you can offer real input to design or build.

Related:

• Reader Success - Using Good Bending For Shoveling Snow
• How to teach this to your groups - Fast Fitness - The First Group Functional Training Exercise, Good Bending for Back and Knees
• How to do this for yourself during all daily life - which means Fitness as a Lifestyle - Bending Right is Fitness as a Lifestyle
• How often should you use this technique? - How Often Should You Be Healthy?

Labels: fix pain, lower back, readers inspiring story, shoveling/digging, squat, yoga

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Fast Fitness - Hip and Quadriceps Stretch Lying Down

Here is Fast Friday Fitness - The front of the leg and hip are helpful places to stretch. Here is another nice stretch for the front of your hip and thigh.

People often "do" a quadriceps stretch without getting a stretch. They keep the front of their hip bent forward at the crease where it meets the body, meaning the area is being shortened not stretched. This is opposite of the point of the stretch. To get the stretch and the idea of lengthening and extending at the hip:

1. Lie on one side with both knees bent in front of you. It is ok to round your body a bit. The spine is not rounding under compression. It's a nice stretch. Prop your head comfortably.
2. Keep the bottom knee still bent in front of your body.
3. Bring the upper leg back, behind your body.
   

Notice different stretch with raised and lowered top knee placement. Stretch the other leg too.

Prevent these reasons the top knee may hurt:

• Don't pull back so hard that it pulls painfully at the knee.
• Tight quads can feel like knee pain when they tightly pull where they attach at the knee. It is not a problem with the knee, but with tight thigh and quadriceps muscles. Tight people may feel sharp pulling or yanking around the knee when trying to put weight on a knee stretched behind them, as when ruining or lunging. The problem is tightness, so stretch gently and intelligently. The idea is to stretch the quads so you don't hurt, not yank so that you do.
• Check that you are not twisting at the knee - generally you can tell this if your foot is facing a different direction than the front of your knee. One commonly missed reason for knee pain felt during running and walking is twisted stretching, including yoga poses like lotus and hero if you don't turn from the hip, and others, covered in Knee Pain When Running - Check Your Yoga.

Related Fun Fitness Fixer:

• Instantly Better Hip and Quadriceps Stretch
• Hamstring to Quadriceps Ratios Not the Answer in Knee Injury

Random Fun Fitness Fixer

• Surgery for Knee Arthritis, Meniscus, Unnecessary

Labels: fast fitness, fix pain, hip strength, knee, leg strength, yoga

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Doctors Don't Prescribe Effective Back and Neck Pain Therapy - Exercise

Studies have confirmed that directed exercise is beneficial for chronic low back and neck pain. Is it being used? In a survey reported in Arthritis Care & Research, of 684 patients with chronic low back or neck pain, only 14.4% were prescribed exercise by their physicians. By contrast, 63.8% of those seeing a physical therapist and 33.1% of those who saw a chiropractor were prescribed exercise.

Other significant predictors of an exercise prescription were being female, having greater than a high school education, and being on workers' compensation.



My colleague, family medicine physician Dr. Fabrice Czarnecki sent me this:

A study did a review "prospective controlled trials of interventions." These are studies that evaluated effectiveness of various interventions to prevent back pain (BP) in working age adults. In short, after all the math and big words were sifted through, they found that, "only exercise was found effective for preventing self-reported BPs in seven of eight trials. Other interventions were not found to reduce either incidence or severity of BP episodes compared with controls. Negative trials included five trials of education, four of lumbar supports, two of shoe inserts, and four of reduced lifting programs."

Their conclusions: "Twenty high-quality controlled trials found strong, consistent evidence to guide prevention of BP episodes in working-age adults. Trials found exercise interventions effective and other interventions not effective, including stress management, shoe inserts, back supports, ergonomic/back education, and reduced lifting programs. The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals."



Not all exercise fixes pain. Many exercises cause lower back pain, even those commonly used in rehab and PT programs. Prescribing random exercise is not effective.

Top Methods That I Have Found Effective:

• Leg Exercise That Helps Your Back - Why The Lunge?
• No More Crunches No More Back Pain

Options To Stop Causes of Pain In The First Place:

• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
• The Cause of Disc and Back Pain
• Back Pain in Pregnancy - and Why Men Can Get It
• Fix Disc Pain Without Surgery
• Prevent Back Surgery
• Prevent Neck Pain and Get Upper Back Exercise Carrying Backpacks
• Fast Fitness - Stop Neck Pain From Biking

Related Fun Fitness Fixer:

• How Effective Are Medical Treatments For Back Pain?
• Prevent Back Surgery
• Studies Say Back Surgery Not Needed
• Quick fix?
• Trainers Don't Exercise Enough?

Random Fun Fitness Fixer:

• Secret To Get Better and Fitter

Labels: fix pain, lower back, practice of medicine

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Knee Pain When Running - Check Your Yoga

If your knee pain from running isn't getting better with fixing bad gait, physical therapy, and medical care, check your yoga. Several poses directly twist, overstretch, or pinch knee cartilage. Over time, injury builds that does not show much in people who do yoga and little else, until their knees encounter resisted motion for running and sports, or from a trip or fall.

Not long ago, people in yoga or sports did not intersect much. Now, the previously more sedentary yoga populations try running, aerobics, and sports. Athletes are being told that yoga will give them magic benefits. Knee injuries bloom when they go back to sports, making the staunch yoga camps claim sports are the culprit, when it was the knee damaging motions in yoga and other stretches.

The knee is a primarily a hinge joint, like the hinge on a door that only can open and close. The door swings toward you and away. If you lift up on the door, it twists the hinge and eventually loosens it. The door begins to creak and rub and make noise.

Think of sitting cross-legged (tailor style). Your knees are out to the side and your lower legs bend toward you. All is fine at that point. Now picture, as with lifting upward on a door, you lift the foot and lower leg to rest it on your thigh in Lotus position or lifting it in some pigeon poses as in the photo, at right. Unless you outwardly rotate the upper leg fully at the hip, the knee twists, overstretching the lateral (outside) ligament and pinching the medial meniscus and soft tissue.

Often people bend the ankle upwards too, also pictured at right, a separate problem - see Unhealthy Yoga Ankles.

How to picture rotation at the hip? Think of a stapler. Like the door just mentioned, the stapler has a hinge or knee joining two sections, like your upper and lower leg. It opens and closes on the hinge. If you pull the upper or lower part sideways, it twists or shears the hinge. To turn to staple sideways, you need to rotate the whole thing.

Hero pose, (Supta Virasana) begins sitting on bent knees, meditation style (left-hand photo below), which often is fine. The knee hinge closes, like closing a door, normal bending. Then the pose continues by pulling the feet outside of the upper legs, like pulling upward on the door hinge. If you do not inwardly rotate both upper legs at the hip fully, your knee twists at the hinge, overstretching the medial (inside- facing the other knee) ligament, pinching the lateral (outer) meniscus and soft tissue. Lying back, as in the right-hand photo adds prying of the joint to the rotation damage (often people overarch the lower spine too instead of stretch the muscles, an additonal problem). In "W" sitting, both feet face outward. Not a problem for the knee unless the hips do not fully rotate (whether relentless W sitting is eventually is too much at the hip is a separate question). Runner's hurdler stretch is the same issue, one leg at a time.

Even though yoga may call for "doing both sides" and following each motion in one direction with one in the other, twisting both the medial and lateral sides of the knee cartilage by doing both Lotus and Hero will not cancel each other, but can overstretch and degenerate both sides.


Warrior poses 1 and 2 are like a lunge. Check your front knee:
- Is it inside the line of your foot?
- Do your foot and knee face the same direction?

Sagging inward unequally loads the knee and when the foot and knee face differently, the knee twists under body weight (blue center model, photo at right).

Keep your knee above your foot, both facing directly forward.



Mighty Chair pose - watch for, and change overly-stylized artificial position, not valuable for any functional motion (photo right and lower drawing left).

For chair pose, use outer thigh muscles to hold straight and prevent knees from sinking inward. Use neutral spine instead of overly-arched to practice movement the way it is needed all day for real life. Right-hand drawing below shows fixing.

Make yoga something that benefits your real life movement habits, not trains artificial, damaging, motion you don't even need.

Check that you don't crane the neck while raising arms, impinging rotator cuff and shearing neck vertebrae and greatly overarch (hyperlordose) the lower spine, see Prevent Back Surgery.

For a functional exercise, instead of straining in chair pose a few moments a week, use healthy half squats (right figure on drawing at left) for daily bending and get hundreds of healthy bends - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.


Hindu squats and one-legged heel-up deep bends may not twist the knee as much as pry it. Picture a tool to crack nuts - two handles joined at a hinge, like your upper and lower leg joined at the knee. Imagine putting an object (for example, a soccer ball) between the upper and lower leg and try to close the heel toward the upper leg - if the ball does not compress, the hinge (knee) pries open. That happens with low squats on the toes (heels up) if you have large or heavy legs. If you have slender legs, the heels can come closely, like bending your elbow so that your lower arm rests along your upper arm. Slender legs do this, while muscular athletes may destabilize their knees, leaving them venerable to future injury.

The beginning of one of the pigeon poses is pictured at right. The person pictured is sitting to the side, instead of keeping the back knee and leg rotated to face straight downward. Sitting to the side greatly reduces the stretch, especially to the rear hip's front muscles that need the stretch, but usually no big problem to the knee. When the pose continues to lift the back foot for King Pigeon, if you lift the foot up without facing the knee downward, you twist the knee joint. By turning the whole leg downward, you get a better anterior hip stretch, and when you lift the foot, the knee can bend like a hinge, not twist.

One Legged King Pigeon kneels on the rear knee with that knee bent so only the kneecap bears your weight. To reduce compression, and get a better stretch for your hip, move your back leg further back so that your weight rests on the thigh, not kneecap.

I have taken several yoga teacher certifications. Each gives different, plausible-sounding rationale why knee twist poses help, but the anatomy is just off enough to come to wrong conclusions. In one, they taught to deliberately twist the lower leg on the upper "to protect the meniscus." Twisting does not protect, but twist in a damaging way. There are two bones in the lower leg, allowing some rotation, but twisting injures other structures. Another teacher training stressed extreme knee twisting as a stretch in itself, stating that any increase in motion is beneficial, especially from joints. Knee laxity results. Without much muscle and positioning training, you predispose yourself to instability when giving the knee challenge, like going back to sports, or from a fall or blow. Another certification teacher training taught that knee twisting is beneficial since it allows great range of motion in case you fall down with your knee twisted backward. Sounds plausible for that one fall (unless you fall differently), but for every other day in your life, so much extra space can result that the joint 'rattles' and wears prematurely. In another class we were made to sit in Lotus, then, still folded in Lotus, rise to knees and swivel from knee to knee to waddle around the room, compounding damage with body weight on the twisted strained joints.

In each yoga teacher training and class I take, I hear teachers tell about their knee pain and surgeries. They don't know why. They think they need more yoga and do more injurious poses, getting relief or distraction for the moment, then pain comes back. Movement in general often relieves pain for the moment. No need to repeatedly add injury to get temporary relief. Stop the causes and the pain stops.

There are assertions that many people do these stretches and not everyone gets knee pain, so they must be fine. Smoking and unsafe sex also do not have a one-to-one association with immediately bad consequences every time. Some stretches and movements twist the knee and overstretch cartilage. If you do these stretches and have pain, or just sit or stand with your knees hyper-extended (locked back) even if you think it is unrelated, it is one place to think about.

There is more. For another time.

Related Fun Fitness Fixer:

• Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
• Hamstring to Quadriceps Ratios Not the Answer in Knee Injury
• Surgery for Knee Arthritis, Meniscus, Unnecessary
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
• Prevent Knee Pain When Rowing
• Strengthen Legs Without Knee Pain - Standing Lunge
• Daughter's Love Saves Parent's Knees
• See all Fitness Fixer articles about yoga by clicking the label yoga, below
  

Random Fun Fitness Fixer:

• Trainers Don't Exercise Enough?

Labels: fix pain, injury, knee, running, stretch, walking, yoga

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Fast Fitness - New Understanding of Hyperlordosis and Disc Injury

Here is Friday Fast Fitness - a new possible contributor to vertebral disc injury, and how to avoid it:

1. In my previous studies, I found that overdoing the inward lower spine curve (hyperlordosis) pinches the lower spine like a soda straw. It forces the spine joints, called facets, backward against each other, eventually wearing them, 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.


2. Hyperlordosis was not previously thought of as a direct herniating force on discs. The major factor was and still is too much forward bending. Weighted flexion (bending forward bearing your body weight) opens the space between vertebrae in back, and over years of slouched sitting and bad bending and lifting forward, presses discs outward through that space creating herniated discs (an injury, not a disease). In my previous work I found that for someone with a disc already herniated, hyperlordosis pinches it, adding pain to the separate problem of the disc. Showing people how to stop standing in hyperlordosis greatly reduced their disc pain. In recent work, I found that hyperlordosis exacerbates, and possibly initiates disc herniation itself.


3. My new work is showing that hyperlordosis is a probable mechanism to directly shift disc position. I made a diagram showing the disc injury coming from overarching/ hyperlordosis/ hyperextending the spine that is so common in pop fitness.

Hyperlordosis (overarching the lower spine) is a spine damaging posture. Hyperlordosis and the pain from it can be changed as easily as moving your spine to a smaller, healthier degree of arch (neutral spine). It is not tightening your abs, just moving your spine, as simply as bending your elbow. Links below tell more.

Related Fun Fitness Fixer:

• I wrote of this in May 2009 when I was on the way to present my work at a medical conference - Comments, A Medical Conference, New Findings on Discs
• How To Spot and Stop Damage from Hyperlordosis - Prevent Back Surgery
• Damage from the opposite problem of injuriously done forward bending - The Cause of Disc and Back Pain and Disc Pain - Not a Mystery, Easy to Fix

Random Fun Fitness Fixer:

• Down the Stairs

Labels: disc, facet joints, facets, fast fitness, fix pain, injury, lordosis, lower back, posture

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Knee Tracking Surgery - Tracking Outcomes

In the article Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better, I listed common reasons knee pain doesn't resolve, including common bad stretches, bad shoes, treating the wrong thing, treating the right thing but returning to pronated, duckfoot or pigeon-toe gait (letting arches flatten or knees sag inward, and/or walking toe out or in), and omitting functional exercise and use. Fancy "supportive" running shoes, no matter how expensive or engineered often add to knee pain. I wrote that surgery for a tight lateral area isn't needed when you can stretch it. Readers wrote asking why stretch when you can just have surgery and cut it?

One common surgical procedures is an arthroscopic lateral release - surgical cutting of the lateral muscles from the patella (kneecap). The idea of the surgery is to decrease pull and pressure on the underside of the patella.

Studies following up people undergoing the surgery show, "The results are not always predictable or successful and in some cases, the surgery may have no effect on the patient's problem." http://www.arthroscopy.com/sp05032.htm

Another study from the Netherlands confirmed previous studies showing exercise therapy for patellofemoral pain was more effective to reduce pain and increase function than the often used "rest, wait and see." Science Daily.

Surgery often is made to sound like a quick way to get ahead, but numbers now confirm that you are restricted from full activity for enough time that your physical conditioning, flexibility, bone density, aerobic capacity, strength, and enthusiasm diminish. You will often be further behind, rather than quickly fixing a cause and going forward. Often, as much physical therapy is needed for full recovery after surgery as if you didn't go for the surgery. Stories are told of someone who had the surgery then went right back to skiing. I am the one who many of these people come to a year later. They say they are fine, but they still use pain medicine, still can't bend their knee enough to stretch enough to get relief of other tight areas and so on, and often haven't gotten back to previous benchmarks. To me, that is not "fine" enough. They slowly diminish in key areas of their life. They get new pain they don't recognize as related to compensating movement from the old ones. By the time they see me, they are often on several pain medicines, anti-depression medicines, and others that make new problems.

Surgical risks are also becoming better reported. Blood clot incidence is far higher after surgery than previous released. A study of nearly 1 million women tracked for an average of 6.2 years after surgery, showed risk continues for 12 weeks and includes minimally invasive procedures.

Not all patellofemoral pain is a tracking problem. Tracking pain is in the patellorfemoral area (where kneecap and top leg bone meet). However, other conditions besides tracking make patellofemoral pain. People with patellofemoral knee pain may be sent for tracking therapy even surgery, without needing it. Standing and moving allowing the knee to sag or rotate inward can also make rubbing. Surgery and tracking exercises do not address this. They may be done but yield no result. It is not a mystery.


Check For Reasons For Pain And Address Them:

• Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
• What Works Better Than Knee Surgery?
• Arch Support Is Not From Shoes
  

Related Fitness Fixer On Knee Surgery:

• Knee Surgery - Arthroscopy Results No Better than Pretend Surgery
• Surgery for Knee Arthritis, Meniscus, Unnecessary
• Anterior Cruciate Ligament (ACL) Surgery Unnecessary
• Another Reason to Avoid Surgery - Catching Fire "A Bigger Risk Than Thought"

Random Fun Fitness Fixer:

• All the More Reason To Try - Exercise to Overcome Each Difficulty

Labels: fix pain, gait, injury, knee, practice of medicine, shoes, surgery

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Good Bending Strengthens Legs and Lifting Ability

BikaBill, one of the winners of the How To Sit Up Straight Contest, writes,

"Ahhh, so good to be a winna!!!

"Another recent success:

"I'd bought a steel fire pit that weighs about 50 lbs, and when I got it last November I could barely move it more than a few feet and that was with some pain. I was going to ask someone to help me move it for use on New Years Eve. But I've been really watching and correcting my posture for the last couple months, and when I picked it up New Years Eve, it seemed really light. I just whisked it out to the front yard like it weighed nothing, and there was no pain!!!

Left drawing shows neutral spine and hip. Center and Right show two kinds of swayback (hyperlordosis) a slouching posture you can easily change to stop pain.

"I was amazed. I would never have guessed that good posture makes one so much stronger, but it does! I've also noticed a difference in my poise -- like forcing yourself to smile makes you feel happier, so does good posture make you feel more self confident. No surgeon could ever have given me that!

"Thanks, Dr. J.

"Happy 2010!
-Bill"

Good Bending:

• Fast Fitness - The First Group Functional Training Exercise, Good Bending for Back and Knees
• A short video with mostly good bending - Good Deeds With Good Bending
• Bending Right is Fitness as a Lifestyle
• Do you do good bending? Fast Fitness - Count How Many Times You Help Or Hurt Your Body Daily
• Examples of good bending in daily life - Household Fitness in the New Year

Lifting Overhead:

• Overhead Lifting, Reaching, and Throwing - More Part I

Better Ergonomics for Carrying Loads:

• Fast Fitness - How Abdominal Muscles Prevent Hyperlordosis When Carrying
• Healthier Carrying - Get Free Ab Exercise and Stop Pain

Great Technique for Pushing and Punching

Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique

What Is Neutral Spine?

• Neutral Spine or Not?

Another Reader Applies Good Bending:

• Reader Success - Using Good Bending For Shoveling Snow

Random Fun Fitness Fixer:

• Another Way Exercise Helps Rheumatoid Arthritis

Labels: fix pain, posture, readers inspiring story, strength

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