Black Belt Hall of Fame 2009

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.

Functional exercise and medicine is an exciting change in fitness and health. My Academy page explains more - Academy of Functional Exercise Medicine AFEM.

I won't have Internet or mail for the week.

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

If you can't attend the lecture, get the book:

• Stretching Smarter Stretching Healthier

Related Fitness Fixer:

• Black Belt Hall of Fame 2008
• Black Belt Hall of Fame
• Black Belt Hall of Fame - Black Belts and Black Tie
• International Martial Arts Association - Weekend Event Nov 10-12
• What Does Stretching Do?
• Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique

Random Fun Article:

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

Labels: fix pain, injury, International Academy of Functional Sports Medicine, martial arts, stretch

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Healthy Aging Starts Now

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"

Related Fitness Fixer:

• Exercise and Aging - Don't Limit the Patient to Limit the Pain
• Autumn Yard Work - Limiting the Person Instead of the Injury Again?
• What I Learned at the Aging Conference
• 91 Year Old Decides to Run and Sets Record
• Are You Stronger Than A 67 Year Old Lady?
  
• Mr. America Urges Goodness and Responsibility
• Secret To Get Better and Fitter
• All the More Reason To Try - Exercise to Overcome Each Difficulty

Some of Mr. Davis' Success Stories, Videos, and Photos:

• Cardiovascular Cleanup
• Fixed Injuries, Got Strong, With Functional Exercise
• Fast Fitness - Better Legs and Pain Relief Comes From You Not The Exercise Ball
• Fast Fitness - Add Balance, Stability, and Portability to Military Press - Handstand Pushups
• Fast Fitness - Double Arm Strength, Endurance, Balance, Stability, and Free Inversion Table

Unrelated Random Fitness Fixer:

• Want Weightlifting? Plant A Food Garden

More from Mr. Davis next week, plus why he couldn't send us a photo this time - Healthy Aging Starts Now - Part II.

Labels: aging, fix pain, injury, lower back, readers inspiring story

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Prescription Acid-Reducing Drugs Produce Heartburn and Dependency

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.


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.


Related Fitness Fixer:

• Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
• Exercise is More Important Than Calcium Supplements for Bones
• Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
• FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others
• Forensic Anthropology and Bone Density

Unrelated Random Fitness Fixer:

• Married 63 Years With Good Balance

Labels: digestion, drugs, fix pain, injury

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Diver Down Flags - Boating, Swimming, SCUBA Safer and Smarter

My father, some of my brothers, and I loved swimming together in a cold river in the northern United States. We enjoyed fun discussions treading water at the turn-around points. One day, a speedboat left the boating lanes and came at us. I stared dumbly at the fast-approaching boat, because why would anyone run right over you when he could plainly see you? Everyone knew that people swim in the water. The prow churned the water right over us. We corkscrewed underwater like five clams in a row snapping shut, to clear the propellers. It is an acoustics fact that words attempted underwater are distorted. Humor columnist Dave Barry once wrote that anything said underwater sounds like "b-mmoogle" but Dad's blue stream was pretty clear through the roil of bubbles

We listened underwater until the propeller sound deepened, showing it was going away. We surfaced, and looked, and saw the boat turn around and head straight back for us. I thought it might be checking if we were all right, but Dad pushed all our heads back under. The boat smashed the water directly overhead again. Maybe the boat came to "finish us" but with the benefit of the doubt, maybe he just wasn't looking where we he was going again.

We dodged trouble. We are divers and have and use diver down flags. Boats not observing them is another problem. Every year, boats hit swimmers and scuba divers, and injure, disfigure, dismember, and kill them. Know your flags and prevent tragedies:

The Diver Down flag has a red background with diagonal white bar. It is notice to boaters that scuba divers are in the area and to keep clear. It was designed in the late 1950's so that boaters would not suddenly find themselves running over divers surfacing in their path. The "Diver-Down Flag" may be attached to a floating surface buoy and dragged around by a diving group if they will be ranging far from the entry point, or used as a stationary line for descents and ascents. It may also be flown by a boat used for divers. Some states prohibit flying the diver-down flag if divers are not in the water at the time. In that case, the dive boat will (is supposed to) raise the flag during dive activity then lower after all divers and swimmers are back onboard

Labels: injury, scuba, swimming

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Exercise in the Heat

Labels: aerobic, aging, circulation, heat, heat shock protein, injury, myths, perceived exertion, performance enhancing modality

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Fast Fitness - Hidden Source of Groin Pulls

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:

1. 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.
2. 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.
3. 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:

Fast Fitness - Don't Shorten Hip When Stretching Hamstring
Fast Fitness - Hip Stretch and Spine Stability Training When Stretching Legs
Is Bad Martial Arts Good Exercise?
Fast Fitness - Better Standing Hamstring, Achilles, and Inside Leg Stretch
Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs

Labels: fast fitness, fix pain, hip stretch, injury, leg stretch, martial arts

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How To Stay Underwater For A Month

Human beings have gotten all the way to the moon, but can't get far under the sea. In space we can wear special suits to decrease effects of pressure change and deliver air to breathe, but (in brief) the farther you go down underwater, the more these same conditions constantly change in difficult ways.

For ordinary scuba diving, divers wear a tank of regular air. A compressor squeezes ordinary filtered air into the tank, so that several times more air fits. For more time underwater than a tank allows, a diver can breathe from a special long hose from the surface. How far you can go depends on the length of the hose and the power to compress the air to the right pressure. With other specific training, you can wear a rebreather. A rebreather scrubs and reuses exhaled air instead of losing the exhale into the water (shortest description). In all these cases, the deeper and the longer you stay, the more nitrogen in the air you breathe dissolves all over your body.

When a diver starts back to the surface, pressure reduces all the way up, letting nitrogen back out. You need to come up slowly enough and not have stayed too long to be able to go directly to the surface without the nitrogen forming bubbles inside your body, part of the diving injury called decompression sickness or The Bends. Decompression sickness, and bubble formation, transit, and medical effects was a passion of my career work in physiology for many years. Still is.

On deeper dives, it works better to breathe less nitrogen. You can't substitute more oxygen at deep depths, because oxygen becomes increasingly toxic. You need a gas that doesn't make as much trouble during each depth and time. One choice is helium to replace some or all nitrogen, and part of the oxygen.

If you have lots of dissolved nitrogen or helium or other gases chosen for a long and/or deep dive, you need to stop on the way up, called a decompression stop. Where and when and for how long to stop is interesting, and the subject of research and arguments (discussions) among scientist and divers. Different Navies and commercial companies use different protocols, some known well, some closely guarded as company secrets.

For extreme depth diving for research, commercial work like oil drilling, mining, and communications, military surveillance, espionage, and "proprietary commercial interests," divers can spend time on "deco" stops, but for long dives, many stops are needed, some more than 10 hours. Doesn't work to do that, then go back to work the next day and repeat. One solution is to stay down inside the rig or habitat or other enclosure designed for that. I wrote a little of my work doing that in Living Under The Sea.

At each depth, you can only absorb a certain amount of gas. After that, no more fits. It doesn't matter how long you stay past a certain point, you have the same decompression obligation on the way up. Staying down until you are full of gas is called saturation diving. You can stay down a week or a month, then decompress once. Decompression can be done in the water, but there are problems of cold, darkness, bathroom needs, and gas supply. Another solution is inside a vehicle designed for that purpose. The decompression vehicle can be raised and removed from the water, and the divers inside slowly decompress safely. It was also experimented, to drag divers straight to the surface and throw them as fast as possible into a surface chamber to quickly compress them back to pressures at depth, then slowly release according to algorithms people back then decided were right. Tragically, some regular scuba divers heard about these two kinds of "surface decompression" and thinking it meant the water surface, managed to publish articles in diving magazines, and give lectures at dive shows, with that misinformation being widely repeated, that one could come straight to the surface after deep dives and float around in an inner tube and read dirty magazines, as the guys in the special recompression chambers did to pass the couple days they'd spend.

You wouldn't turn inside out from the huge pressure differential produced, as depicted in some science fiction movies, but it might kill you as effectively. That is a sample of what happens when reporters don't read what scientists write in their research articles, just repeat some sentences taken out of context, conclusions in the abstracts, or what someone else wrote.

Tomorrow - a fun story about NASA Astronaut Scott Carpenter in 1965. He lived 30 days underwater in SEALAB II, in the US Navy’s Man-in the-Sea Project off the coast of California. Commander Carpenter was breathing a helium mix during his surface decompression in a chamber. In tomorrow's post, hear a recording of what happens when he makes a pre-arranged phone call while breathing helium in the chamber to President Lyndon Johnson - Helium Speech - An Astronaut Calls the President of the United States.

Related stories:

• Space Walks
• Indiana Jones Rocket Sled
• Exercise and Medicine Underwater and at High Pressure
• Exercise and Fitness in Decompression Sickness Risk
• Living Under The Sea

Labels: aerospace, breathing, hyperbaric, injury, myths, scuba

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Knee Surgery - Arthroscopy Results No Better than Pretend Surgery

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."



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.


Related:

Surgery for Knee Arthritis, Meniscus, Unnecessary
What Works Better Than Knee Surgery?
Anterior Cruciate Ligament (ACL) Surgery Unnecessary
Hamstring to Quadriceps Ratios Not the Answer in Knee Injury

Labels: arthritis, fix pain, injury, knee, practice of medicine, surgery

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Fixed Injuries, Got Strong, With Functional Exercise - Real Life

This fun note and great story came in from Robert Davis:

" I have tried to find a way to contact you for a while now!

"I have a story I thought I would share and I am so glad I had found your books and website.

" I had injured myself via weight lifting in late October. I had felt the warning signs before this, however I ignored them and continued to train full out. The result was I had hurt my lower back very badly. The pain was unbearable.

" Sitting hurt. Getting up and walking hurt. To top all this off, I was so adamant that one's "back" health is determined by how well you can stretch forward bending! So this became a discouraging struggle as the more I tested that, the worse I hurt! I had many bad habits besides that and will go into that in a moment.

" I kept training "thru" the pain and bad movement thru to about November 24th. I kept aggravating the area thru bad habits (while doing these exercises. Arched back, rounding etc). I finally went to the doctor and he just made me do some simple movements and the typical straight leg lift. He had decided for now that it was not something all that bad and said that we would do a MRI (or was it CAT scan?) if it did not get better.

I struggled for the next few weeks as I was told to simply rest. I realize the fallacy in this because "just taking it easy" had lead to muscle weakness. It was now a double edged sword by Christmas. I hurt in my back, but when I tried to exercise it it was so weak it hurt more.

I finally ran across your website just after Christmas and before the new year. I started to play around with the ideas at first. I was still stuck though on "better" meant no more pain bending forward. So for a week or two more I played back and forth with these ideas.

" Finally around the 15th or so after the new year I decided "what the heck" I will order some of your books. They seemed more promising then anything I had looked at and I realized in an "aha" moment that it was a form of exercise, which I so very much craved at the time as I simply love to exercise. This "resting" was driving me nuts..

I was watching a show on TV one night on beaches and shell collecting of all things and the biggest "aha" came to me in the form of a little girl. I watched adults picking things up and they bend right over without thought. This went on for a while. Then I saw a child pick up shells. She squatted every time! I said to myself "jeez these books are absolutely right, I am basing everything on bad habits!"..

" I immediately started becoming aware of everything I did during and after exercise. I took your book "fix your own pain" and have almost memorized every chapter and decided if I am going to do this I am going to balance my whole body.

" So after weeks of this (trial and error). I slowly got better. Things I learned along the way are this.. Bending over to pick stuff up is not healthy nor is it natural (that child in the show!).. I learned even after doing weight training for 2 years that my legs were still not as strong as I thought. I learned I had developed bad leg positions from unhealthy squatting (on the knee joints instead of behind). I had further learned that I was holding my feet outward and I think this had come from doing leg pressed with feet slightly out to try to target certain areas.

" I learned to strengthen my core much more effectively and better thru the ab revolution and fix your own pain. I was a 500 crunch type person. I am no longer doing sit ups crunches or whatnot. The stuff in your ab revolution is much more difficult to do and healthier.

I learned to strengthen my body thru its own weight, destroying the myth that you need "weights" for gains as I found these exercises to be just as challenging, if not more in some cases because of the added balance and flexibility required.

" I am now sitting here writing this and I tell you that compared to the initial injury and repeated re-injury (doing the same exercises with bad habits) to now, I am close to 100 percent.

" The funny thing is, I no longer have the desire to go back to weight training, which is odd because that was my life! I have discovered a whole new world of fitness with body weight alone. I am trying more challenging things by the day and I have realized that this is actually more fun the weight training for health and I am getting the same, and often better results (since I am not a body builder, just love exercise and looking fit). I had gone and bought a few things like pull up bars and planche devices and am currently working on mastering some very difficult moves that require body strength alone, but at the same time a mindful awareness of how I am doing it by using your techniques (keeping the back straight with slight tilt etc, no arching).

" It is fun working up to one arm pull-ups in good form. Jeez, to think you could bench press close to 300 a few months ago but doing a few of these exercises in your book were hard! I was surprised I could not do very many pull ups or hold these planks and whatnot.. I am set on a new adventure and I love it because it feels so "free" and balancing. I don't have to spend a huge fee to go to the gym. My gym is my body and functional movement.

" Thank you for your knowledge. Having my back back (sorry for that funny saying!) is great. I intend to keep it healthy now and have begun the correction process of all my body, all the way to my feet!

" I don't look at my injury as a mistake anymore. I look at it as a life changing experience and a chance to explore more functional and fun ways of living. I have passed this site and your books on (not my personal copies!) to a lot of friends into fitness. Some are already reporting healing knees and what not and even re-considering how they live and workout!

" PS I have also changed to a Vegan diet just to see what happens. I was very intrigued by the 72 year old body builder who is vegan.

"You are a godsend.
Robert Davis"

Great work Mr. Davis! Robert has been sending me many insightful updates with photos, to be posted with his ongoing success stories. His next story starts here:
Cardiovascular Cleanup.

Vegan Health:

• 72 year old body builder - Mr. America Urges Goodness and Responsibility
• Vegan bodybuilder and mixed martial arts fighter - World Vegan Day is November 1
• Reduce cancer and chronic disease, green the world with World Vegetarian Day
  
• Junk food can be vegan and vegetarian with unhealthful additives, dyes, refined processed sugar and flour. Click the label "Nutrition" under this post for all posts on how to get healthy fun sports food and Healthier Fitness by clicking the label "Green Fitness."

Weightlifting and Weightbearing With Lower Spine Overarching (Sticking out too much in back) Compresses Vertebral Facet Joints:

• What is Neutral Spine and Why Does Sticking Out In Back Harm?
• Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats
• Prevent Back Surgery

Ab Revolution - Learning and Using Neutral Spine to Prevent Spinal Compression:

• No More Crunches No More Back Pain - The Ab Revolution™
  
• If Better Abdominal Muscles Are Your New Year's Resolution, Try This
• Back Pain From Running

Spotting Spinal Rounding in Exercise:

• Are You Making Your Exercise Unhealthy?
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch

Rest Isn't The Answer:

• Exercise and Aging - Don't Limit the Patient to Limit the Pain

Lifestyle Functional Natural Fitness:

• Getting Stronger Without a Gym
• Don't Confuse Exercise With Real Fitness
• How Often Should You Be Healthy?
• What is "Fitness as a Lifestyle?"
• More Fun Squatting
  
• Parcours - Old Fun Is New Exercise

• 
  

Labels: abdominal muscles, facet joints, injury, lower back, neutral spine, nutrition, readers inspiring story, squat

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Hamstring to Quadriceps Ratios Not the Answer in Knee Injury

A common myth is that injury comes from "muscle imbalance" in the thigh from too much strength in the quadriceps muscles over the hamstring muscles.

Early studies showed poor ratios of quad to hamstring strength. It was concluded that because of this, when the athlete would kick, for example, the overly strong quadriceps would overstraighten the knee, and the overpowered hamstring behind the thigh would not be able to stop the powerful straightening. The knee would overstraighten and hyperextend the joint, injuring it.

Athletes were put on hamstring strengthening training. Then they went back to kicking with the same bad habit of overstraightening as before.

The problem was simply that they athlete would hyperextend the knee. They were allowing it through bad training habits, not being made to do it by a strong quadriceps. Your muscles do not make you move. You learn though training and practice how to move in healthy ways.


What to do?
When you kick, don't fling your leg out and hyperextend (overstraighten) the knee. Control the end point position.
When you land from jumps or descending stairs, don't step down on a locked, straight knee. Control the end point position.

Muscle use is not automatic from muscle strength:

• Fixing Posture - No Exercise Needed
• Gluteal Muscles Myth - Shaking The Dog's Paw
• Good Life Works Better Than Bad Ab Exercise

Labels: anterior cruciate ligament/ACL, hamstring, injury, knee, leg strength, meniscus, myths, practice of medicine

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Surgery for Knee Arthritis, Meniscus, Not Needed To Stop Pain, Restore Function

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.


You don't have to have surgery to stop knee pain:

• What Works Better Than Knee Surgery?
• Anterior Cruciate Ligament (ACL) Surgery Unnecessary

How to fix and prevent knee pain from arthritis and most meniscus injury:

• Healthy Knees
• Daughter's Love Saves Parent's Knees
• Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
• You Can Fix Your Own Knees
• Prevent Knee Pain When Rowing
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why So Many Aerobics Injuries?
• Walking Softly Benefits Olympic Wrestler
• Save Knees When Squatting
• Arch Support Is Not From Shoes
• Strengthen Legs Without Knee Pain - Standing Lunge
• Down the Stairs
• Better Exercise on the Stairs
• Most Helpful Olympic Advice So Far

Next:

• Knee Surgery - Arthroscopy Results No Better than Pretend Surgery

Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, martial arts, meniscus, practice of medicine, repetitive strain, surgery

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Does Running Ruin Your Joints?

A study in the American Journal of Preventive Medicine found no evidence of accelerated rates of osteoarthritis among long-distance runners.

Further, weight-bearing exercise like running helps stave off osteoporosis by maintaining bone mineral density.



Posts showing good movement mechanics during exercise and daily life:

• Healthy Knees
• Spotting Back Pain During Running and Walking - What Do Abs Have To Do With It?
• Prevent Main Factor in Back Pain After Running and Walking
• Back Pain From Running
• Walking Softly Benefits Olympic Wrestler
• Why So Many Aerobics Injuries?
• Autumn Yard Work - Limiting the Person Instead of the Injury Again?
• Exercise and Aging - Don't Limit the Patient to Limit the Pain
• Not Old for the Olympics Part I
• Most Helpful Olympic Advice So Far
• Arch Support Is Not From Shoes
• Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs
• Is Bad Martial Arts Good Exercise?
• Common Exercises Teach Bad Bending
• Are You Making Your Exercise Unhealthy?
• Runner Fixes More Pain With Straighter Push-Off
  
  

Labels: aerobic, aging, arthritis, impact, injury, osteoporosis, repetitive strain, running, walking

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Overhead Lifting, Reaching, and Throwing Part II - Lower Back

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.

Fitness Fixer Posts on Related Topics:

• How to stop compressing your rotator cuff with your shoulder bone - Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury
• A reader tells how he identified the injury producing position in action in his yoga classes - Overhead Lifting, Reaching, and Throwing - More Part I
• Why hyperlordosis/overarching hurts the lower back - Innovation in Abdominal Muscles
• Watch two short movies to learn to restore neutral spine from an overarched position - Neutral Spine in 5 Seconds and How to Feel Change to Neutral Spine
• See the role of overarching in overhead lifts, Overlooked Ab Muscles in Overhead Lifts
• Learn to spot overarching during exercise - Prevent Back Surgery
• Coming on Friday Fast Fitness - How Abdominal Muscles Prevent Hyperlordosis When Carrying.

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

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Anterior Cruciate Ligament (ACL) Surgery Unnecessary

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:

• What Works Better Than Knee Surgery?
• Healthy Knees
• Daughter's Love Saves Parent's Knees
• Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
• You Can Fix Your Own Knees
• Prevent Knee Pain When Rowing
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why So Many Aerobics Injuries?
• Walking Softly Benefits Olympic Wrestler
• Save Knees When Squatting
• Arch Support Is Not From Shoes
• Strengthen Legs Without Knee Pain - Standing Lunge
• Down the Stairs
• Better Exercise on the Stairs
• Most Helpful Olympic Advice So Far

Meniscus. Coming Next:

• Surgery for meniscus repair found to be not needed to restore function or prevent later injury - Surgery for Knee Arthritis, Meniscus, Unnecessary.

Hamstring to Quadriceps Ratio:

• Hamstring to Quadriceps Ratios Not the Answer in Knee Injury

Helpful Books, available from my BOOKS page - www.DrBookspan.com/books:

• Fix Your Own Pain Without Drugs or Surgery
• Health&Fitness - How To Be Healthy Happy and Fit For The Rest of Your Life. THIRD edition.

Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, leg strength, practice of medicine, surgery

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FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others

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:

• Disc Pain - Not a Mystery, Easy to Fix
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
• The Cause of Disc and Back Pain
• Fix Disc Pain Without Surgery
• How Much Inward Curve Space Should There Be In The Lower Back?
• Fast Fitness - Prevent Back Pain When Rowing
• Fix Scoliosis and Arthritis Pain, Fix New Orleans
• Prevent Knee Pain When Rowing
• Prevent Main Factor in Back Pain After Running and Walking
• Prevent Back Surgery
• Gaze Perseid Meteors Without Neck Pain
• Prevent Neck Pain and Get Upper Back Exercise Carrying Backpacks
• Upper Back Exercise and Neck Pain Prevention Too
• 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 I
  
• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
• Cauda Equina - Result Not Cause
• Healthy Mother's Day
• Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
  
  

Also recommended, available from my BOOKS page - www.DrBookspan.com/books:

• Fix Your Own Pain Without Drugs or Surgery
• 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.

Labels: diabetes, drugs, fibromyalgia, fix pain, headache/migraine, injury, lower back, practice of medicine, stenosis, upper back

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What Works Better Than Knee Surgery?

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?

1. Physical retraining of how you use your knees in daily life when walking, running, and other activities.
2. 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.
3. 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:

• Healthy Knees
• Daughter's Love Saves Parent's Knees
• Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
• You Can Fix Your Own Knees
• Prevent Knee Pain When Rowing
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why So Many Aerobics Injuries?
• Walking Softly Benefits Olympic Wrestler
• Save Knees When Squatting
• Arch Support Is Not From Shoes
• Strengthen Legs Without Knee Pain - Standing Lunge
• Down the Stairs
• Better Exercise on the Stairs
  
  

Coming next Monday - Surgery for anterior cruciate ligament (ACL) repair found to be not needed to restore function or prevent later injury - Anterior Cruciate Ligament (ACL) Surgery Unnecessary.

Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, meniscus, practice of medicine, surgery

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Vertebral Artery Compression, Dizziness, Discs, and the Forward Head

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:)"

Here is my web site post that Miroslav used: http://www.drbookspan.com/NeckPainArticle.html

These Fitness Fixer Posts explain more:

• Quick Fix?
• Fixing Upper Back and Neck Pain
• Overhead Lifting, Reaching, and Throwing - More Part I
• Disc Pain - Not a Mystery, Easy to Fix
• 14,000 Miles on a Bike - Herniating and Fixing Discs
• Breasts Causing Upper Back Pain is a Myth

Labels: dizziness, fix pain, impingement, injury, myths, neck, neutral spine, readers inspiring story, repetitive strain, upper back

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14,000 Miles on a Bike - Herniating and Fixing Discs

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:

• To understand and stop disc injury - The Cause of Disc and Back Pain
• To see the forces that herniate discs - Disc Pain Not a Mystery Easy to Fix
  
• The first thing to do - Fast Fitness - First Morning Stretch
• Then retrain healthy biking position by noticing bad rounding - Are You Making Your Exercise Unhealthy? and retrain good sitting in general with Long Sitting - Simple and More Comfortable
• The hamstring stretches Kristin was given were contributing to her herniated discs - Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
• 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.
• She didn't need any surgery - Fix Disc Pain Without Surgery and Studies Say Back Surgery Not Needed
• Apply these principles to all your sitting sports - Prevent Back Pain When Rowing
• Apply these principles to all daily life - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending and How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
• When should you use these principles? - How Often Should You Be Healthy?

Kristin followed the principles (above). She quickly recovered and went on with her bike tour, which lasted a full year.
Here is Kristin's web page about the ride: http://www.earthcycle.org/index.html
Click here to download her pamphlet: http://www.earthcycle.org/Pamphletengadult.pdf
Here is a page on her web site on easy healthy household tips: http://www.earthcycle.org/factsEnv.htm
Click the photo links below to see more phots of Kristin.

Labels: biking, disc, fix pain, hamstring, injury, readers inspiring story, spirit, yoga

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Fixing Foot Drop

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.

Posts with specifics to try:

• Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier
• Cauda Equina - Result Not Cause
• Fix Disc Pain Without Surgery
• Studies Say Back Surgery Not Needed
• The Cause of Disc and Back Pain
• 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.
• Changing Thai Massage to Be Healthier Part I - Avoid Pressuring Lower Back Discs

Labels: disc, fix pain, footdrop/dropfoot, gait, impingement, injury, Parkinson, readers inspiring story, surgery

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Fast Fitness - Open Your Eyes and World View

Here is Fast Friday Fitness - learn a long-known, little talked-about world crisis encompassing health, politics, economics, pollution, and human rights. See the movie Flow to quickly learn several global practices that improve your health to know:

1. Water is the third largest global corporate-profit industry after electricity and oil, leaving surprising pollution, disease, graft, and social destabilization in its wake. Corporations seize local waters for resale, leaving the world's poorest without access to unpolluted water to drink and bathe, and frequently without any water at all. Over 1 billion people do not have safe drinking water, resulting in millions of sicknesses and deaths per year, including several millions of children and infants. Even Westerners are affected. Possibly 116,000 human-made chemicals, pharmaceuticals, and hormones are already identified in public water supply, consumed in the West through drinking and through the skin in washing. Known health effects range from stomach illnesses frequently mistaken for "flu," food-poisoning, or bowel problems, and breathing difficulties.
   


2. Be aware that you can turn on a tap and get water. An average American uses 150 gallons of water per day. Billions in developing countries walk miles and still cannot get more than five gallons. Staggering numbers of people around the world have total income averaging $2 (two American dollars) a day, and are being charged to travel distances and lift and carry water that was once available to them without charge.


3. When you buy expensive bottled water know that it is frequently ordinary tap water resold in deception, various pretentious "fitness waters" are not as healthful as eating ordinary fruit, and the bottling results in avoidable large scale pollution.

Posts of these issues and more things to do:

• Green Water
• Non-Plastic Non-Aluminum Sports and Fitness Food Carriers
• Junk Food Through Your Skin?
• Fitness Water
• Make Healthier Cleaners
• Meet the cook in our school in Asia- one of the many earning only a few dollars a day - Muay Thai in Her 90's

Labels: breathing, colds/flu/infectious, digestion, education, fast fitness, green fitness, injury, mind, movie/media fitness, nutrition

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How a Reader Stopped Recurring Pain, Got Stronger, and Said Aha!

Liz from New Zealand left a comment on the post Surfer's Myelopathy,

"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

• Quick movie of how to tuck a too large curve to neutral - Friday Fast Fitness - Neutral Spine in 5 Seconds

• Good bending for legs with neutral spine - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending

• Aha! When to use good bending for legs and spine - How Often Should You Be Healthy?

• Hip stretch - Fast Fitness - Better Posterior Hip, Iliotibial, and Piriform Stretch

• Watch for this common mistake when stretching - Better Hip Stretch - Check Your Ankles

• Reader Mike demonstrates the seated figure 4 in A Whole Big Fix

• Fast Fitness - Great Hip, Side, Leg, and I.T. Stretch

• Increase your hip stretch (carefully) with Fast Fitness - Balance, Strength, Stretch, and Socks

• Ivy's story - Getting More From a Hip Stretch

• Book - Fix Your Own Pain Without Drugs or Surgery.

Labels: biking, fix pain, injury, lordosis, lower back, readers inspiring story, squat, stretch

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Surfer's Myelopathy

I have received urgent inquires from physicians and reporters after an ABC news report came out on surfer's myelopathy - lower body paralysis occurring shortly after surfing.

The main suspected mechanism is standing or lying for long periods with the lower back so overarched that it interferes with blood flow to the spine below it, causing a "stroke in the spine."

Overarching is a topic of my laboratory research as it relates to compression of soft tissue and the joints of the lower vertebrae leading to chronic mystery back pain.

Overarching the lower spine is an avoidable bad posture. It is simply and quickly changed by holding the pelvis level in what is commonly called neutral spine. Compression which impedes blood flow is a different, serious effect. Until I can post separately on it, to understand and avoid one main mechanism, check:

• Prevent Back Surgery
• Back Pain in Pregnancy - and Why Men Can Get It.

Holding neutral spine is not just an exercise to do then stop and return to overarching during life activity. Neutral spine is a healthy normal position to maintain comfortably, not rigidly, during ordinary activities and exercise. To see some of the issues of neutral spine, click:

• Innovation in Abdominal Muscles.

To see details of neutral spine and two kinds of overarching (hyperlordosis) click:

• Neutral Spine or Not?
• and What is Neutral Spine and Why Does Sticking Out In Back Harm?

Labels: impingement, injury, lordosis, lower back, neutral spine, surfing

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Most Helpful Olympic Advice So Far

The commentators for US gymnast Justin Spring's great Olympic floor exercise routine last week told how Spring underwent months of rehabilitation for knee, ankle and other injuries. The commentators continued about his rehab, exercises, physical therapy teams, and surgeon. Spring landed the end of his difficult routine with straight-legged jolt. One of the commentators mentioned again about the surgeon who fixed the injury. The other commentator replied, "The surgeon should have told him to bend his knees."

The commentator is right. The best health care is not to collect money to cut and treat someone, but prevent the need for cutting them. Landing with a straight knee transmits impact to your spine, neck, ankles, hip, and knee joints. Landing with properly bent knees absorbs impact more through the muscles. Landing hard with a straight knee can push the upper and lower leg bones hard against the two tough pads in each knee called menisci (singular is meniscus) that help cushion each step.

Over repeated hard landings, holes and tears can bore through the meniscus. With repeated landings at an unhealthy joint angle, cartilage can overstretch or tear. The tough strap that crosses the middle of the knee joint, called the anterior cruciate ligament (ACL), can overstretch or tear with repeatedly landing on a twisted knee. More on this to come. It is mostly an avoidable training error, not a gender issue as previously thought. Ankle wear and injuries can result from the same. Injury forces increase when the landing is on knee or ankles allowed to sway inward instead of maintaining motion at the midline. These injuries can heal without surgery. More on this in posts to come.

Sometimes injury results from a single high-force landing, such as a bad parachute landing, jumping from extreme heights, or a car crash where a passenger sitting with straight legs is propelled forward (or the engine backward) hard against their feet forcing compression past strength. An example is an ankle injury called a pylon injury, where the far end of the lower leg bone crushes.

Know the mechanism of injury so that you can get out and have fun, and do extreme sports while you move in ways that reduce unhealthful forces. Preventing repeated bad movement habits can also give your joints a larger margin for occasional unexpected dings.

1. Check what you do with your knees when you step or jump down. From small landings, bend knees a small amount.
2. Larger heights and circumstances (carrying a heavy backpack) can benefit from more shock absorption using the thigh and hip muscles with deeper bending. It should not be the knees that take up the shock of the bending. It should be the muscles of the hip and leg.
3. Keep effort on the muscles through how you position your knees. Letting them slide forward shifts weight to the joint. Keeping knees back by only sticking out the backside in back can shift weight to the lower spine. Keep knees back with neutral spine and you will feel the effort in the muscles.

Here is how - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.
Here is why - Why So Many Aerobics Injuries?
Here is an example to get started - Down the Stairs.
Knee position when jumping - Healthy Knees.
Posts on avoiding surgery.
Check comments and replies already present in posts for more.
Click the labels below each post for more Fitness Fixer posts about each topic.
Try fun books.

Labels: ankle, impact, injury, knee, Olympics, practice of medicine, repetitive strain, stairs, surgery

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Flasher Exercises Not Best for Shoulder Pain

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?

• What do thumbs have to do with shoulder and neck pain? - Thumbs Can Show Tightness That Leads to Upper Back Pain

• Notice upper body positioning when exercising: Are You Making Your Exercise Unhealthy?

• Avoid rotator cuff and shoulder impingement and injury when raising arms: Overhead Lifting, Reaching, and Throwing - More Part I, and Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury.

• Avoid neck and shoulder pain when looking upward: Gaze Perseid Meteors Without Neck Pain

• Learn how to avoid injurious movement habits and how to have healthier daily life and exercise: Health & Fitness in Plain English new THIRD edition - How to be Healthy Happy and Fit for the Rest of Your Life.

Labels: biking, fix pain, impingement, injury, posture, practice of medicine, readers inspiring story, rotator cuff, shoulder

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Overhead Lifting, Reaching, and Throwing - More Part I

Nice e-mails and requests came in after Part I last Monday about the overlooked training habit which slowly impinges and tears the rotator cuff. Here is one that covers the points from all received so far.

Reader Hanson writes:

"Thank you Dr. Bookspan for exactly the missing link. I had been attending months of expensive private yoga lessons at [well known studio name deleted] for my shoulder woes without much relief, and maybe have worsened my circumstances. I thought becoming worse with yoga was preferable to surgery that my orthopedic surgeon at [top California facility name deleted] said was required. The yoga directress said more months were necessary (for her wallet?) and I must learn to cool my mind (before I questioned why I wasn't getting better?). I sure didn't question when she wore that little outfit. She showed me yoga poses to "awaken" the area and other fuzzy yoga talk. Poses were raising arms overhead, leaning over with arms overhead, sitting with arms up, and so on. My shoulders burned, she said it was "awakenening." Now I discovered from you it was "impinging." No one said anything about a forward head when I raised arms. I did the same as the directress did. She had this bad posture too. She said do it slowly if it burns. So I burned up my shoulders slowly. Instead of paying the yoga directress for another private session of self-injury raising my arms with head forward I printed your blog and held it overhead to read it. I didn't lean myself back and didn't tilt my head forward. The shoulder is already better. I found all those yoga lessons never prepared me to stand up straight. They told me yoga gives you posture, but it didn't give me anything except a worse shoulder. The "awakening" came from your blog saying use this for life not just exercise. I can lift arms without pain now. I keep my head straight, not forward. Can you put more pictures up of what to look for and can you tell people about your blog?"

• How to avoid neck and shoulder injury when raising arms: Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury
  
• Avoid neck and shoulder pain and herniated neck discs from the forward head in activities without arms raised: Gaze Perseid Meteors Without Neck Pain
• Detect and change a forward head: Breasts Causing Upper Back Pain is a Myth
• Stretch triceps without forward head: Friday Fast Fitness - Better Shoulder and Triceps Stretch.

Click the labels under this post for more Fitness Fixer posts on each topic.

See if your other questions are already here: Click and bookmark the new Fitness Fixer Index.

Labels: impingement, injury, neck, readers inspiring story, repetitive strain, rotator cuff, yoga

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Another Reason to Avoid Surgery - Catching Fire "A Bigger Risk Than Thought"

Operating room fires have seriously injured, even killed patients, and are more common than previously believed.

Data released by the State of Pennsylvania showed 28 operating room fires a year for the past three years in Pennsylvania. Nationally there may be hundreds of such fires, more than the 50 to 100 previously estimated by patient safety organizations.

Mark Bruley, vice president for accident and forensic investigation at the ECRI Institute in Pennsylvania said, "The numbers are higher than we expected…Having a fire on your face can be severely disfiguring and a horrendous experience. With throat procedures, where these fires often occur, they can be fatal."

Operating room safety specialists recommend:

1. That doctors use less than 100 percent oxygen during head and neck surgery
2. that surgeons store hot instruments off the operating table when they are not in use,
3. that doctors wait two or three minutes until alcohol-based products have evaporated from the skin before using cautery tools.

Globe Newspaper Company reported that Antoinette DiPhillipo entered the hospital for gallbladder surgery and woke in her hospital room with burns and blisters covering her midsection and abdomen. During surgery, a cautery instrument had ignited an alcohol-based product applied to her abdomen and chest, and a flash fire occurred. A surgical technician told health officials that he heard a sound similar to lighting a grill. Officials for the hospital made light of estimates of Antoinette DiPhillipo's burns and suffering, and denied that they did not tell her what happened in the operating room. They did say that the fire led to more aggressive prevention policies. DiPhillipo said, "I just wanted to know what happened and for someone to talk to me," she said. "It would have been nice if I had gotten an apology."

• More Fitness Fixer posts about how to avoid surgery for joint pain, click the label "surgery" below this post.
• See if your other questions are already here: Click and bookmark the new Fitness Fixer Index.

Labels: injury, practice of medicine, surgery

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Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury

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.

• When you lift arms upward, check if you lean your upper body backward (photo above) or tilt your pelvis out of upright neutral position. To see how to prevent the resulting overarched lower spine, and restore neutral spine, click Kettlebells Without Spine Injury, and to see short movies, see Fast Fitness - Fixing Yoga Warrior and Lunge Exercise to Neutral Spine and Friday Fast Fitness - Neutral Spine in 5 Seconds.
  

• More on the forward head and how to fix it - Breasts Causing Upper Back Pain is a Myth and associated links.

• More on back and shoulder during reaching - Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.

• Overhead weight lifting - Safer Overhead Military Press.

• More photos and situations for safer daily and exercise overhead movement, click Overhead Lifting, Reaching, and Throwing - More Part I.
  

Labels: fix pain, impingement, injury, repetitive strain, rotator cuff, shoulder

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Simulation Suit To Feel the Pain of Osteoarthritis

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.
  
  
• Posts on changing positioning that increases wear and tear and risk of osteoarthritis on the neck: Is Your Drinking Hurting Your Neck? and Gaze Perseid Meteors Without Neck Pain.
  
  
• Post on changing positioning that increases wear and tear and risk of osteoarthritis on the shoulder: Upper Back Exercise and Neck Pain Prevention Too.
  
  
• 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.

Labels: arthritis, fix pain, injury, practice of medicine

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Exercise and Aging - Don't Limit the Patient to Limit the Pain

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:

• Biomechanics - Why So Many Aerobics Injuries?
• Flexibility - What Does Stretching Do?
• Pounding - Walk Lightly - Shock Absorption for Happier Joints

I have some exciting developments about getting you information on Exercise and Aging. Will announce soon.

Labels: aging, fix pain, impact, injury, myths, running

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Indiana Jones Rocket Sled

The new Indiana Jones movie came out this past weekend, the Kingdom of the Crystal Skull. It is set in 1957 with fun fitness and iconry of the era, for future blog posts. Today - the Rocket Sled.

In the early part of the movie, Indiana Jones and the Soviet Russians brawl through a US military testing base in Nevada. Jones and a Russian officer wind up on a rocket sled, which blasts them on a speed track into the desert.

Rocket sleds are one of several devices that create and test the effects of high acceleration on equipment and the people who use them. High acceleration forces occur when jets take off quickly, when launching a space flight, to eject from a hit (compromised) fighter jet, on roller coasters and spin and fall rides, when you fall from a height, and any time you change speed and/or direction quickly. Interesting changes occur in the body under acceleration. Acceleration is one of the areas of my study as a research physiologist and was my work for a time at two facilities testing air vehicle and human systems.

G-force is a measure of acceleration, not force, but the term g-force is also used for the reaction force that results from acceleration. More on meaning, spelling, and math of g and G in another post. Too much g-force can result in g-LOC (Loss of Consciousness), pronounced "jee-lock"in English, but just as meaningful when using the Cyrillic pronunciation of "loss." When piloting a multi-billion dollar property (the fighter jet) G-LOC is not a good thing for anyone. The pilot may convulse, called "doing an Elvis" because the flailing looks like playing an air guitar - a real air guitar. Then the pilot may "ding" (lose consciousness) and the vehicle may "descend below the level of the terrain" (crash) and "disperse energetically" (explode) and "value unfavorably" (be destroyed), and the crew and anyone they land on may "achieve a negative health status" (die).

So we test.

A rocket sled is a small platform. Rockets propel it on the ground on rails. It creates high onset g-forces for a time limited to the length of the track. When personnel or equipment riding it sit as in a car or plane, they experience acceleration pressing them from front to back (on an x-axis).

To measure the higher g-forces with short onset experienced in jet bail-out procedures, a vertical ejection tower can be used. A small seat is propelled quickly upward by a contained blast force under it (like lighting a bomb). If they are positioned to sit upright, the acceleration acts on them from head to foot, on their y-axis.

To experiment with varying accelerations over different amounts of time and onsets, one device used is a centrifuge. A long support arm swings around and around a center anchoring point -like swinging a ball on a string around your head. A container, often ball shaped, at the end of the support arm holds the equipment or personnel being tested. The ball can rotate to position the people inside at any angle to simulate the changing positioning of a cockpit during maneuvers, for example.

What happens to the people in these testing devices? Often they throw up all over my nice equipment. Some of my test subject pilots used to have contests who could eat the worst thing to redisplay on testing day. One ate plastic bugs just for the fun he was sure to cause - then he didn't throw up, no matter what we did to him. In vertical (y-axis) ejections, there is high impact and acceleration forces on the discs and spine. Back injury is a concern for ejection scenarios. Vibration, both during acceleration and non-acceleration situations, such as for helicopter and jack hammer operators seems to be a high contributor to back pain. It is not known if the various vibration devices sold as fitness devices are of the kind (vibration frequency or amplitude) that contribute to joint pain. G-LOC is another consideration. Why do we test it? To see how to prevent it, if we can screen for who is more likely to get it, if we can train those prone to it to be more resistant, and so on, in g-force tolerance improvement programs (g-TIP).

The set of photos at right is a well-known one of USAF Colonel John Paul Stapp, M.D., Ph.D., riding the rocket sled. He was a pioneer of acceleration study and is also known as the originator of the expression "Murphy's Law" for things that can go wrong. The effect on his face along the x-axis is not from his high speed, but the acceleration which is increasing in photos ii and iii, and decreasing in v and vi. Even though his speed is greatest in photo iv, speed is not increasing or decreasing much, so there is little effect.

More on the interesting effects of acceleration and environmental testing from roller coasters to jets to movies in posts to come.

Related Fitness Fixer:

• Space Walks
• Helium Speech - An Astronaut Calls the President of the United States
• Altitude Sickness on Flights
• A Reader Asks About Osteoporosis and Walking Lightly
  
• Collapsing Astronaut Gives Healthy Reminder
• Click labels under this post for more Fitness Fixer on each topic. For example, for all posts on fitness issues portrayed in the movies or other media, click movie/media fitness.
  

Labels: aerospace, circulation, disc, g-force, injury, lower back, military fitness, movie/media fitness, performance enhancing modality

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Fixing Pain and Golf Easier With Real Life Movement Than Isolated Exercises

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."

Links used:

• Fix Your Own Pain without Drugs or Surgery
• Also recommended - Health & Fitness THIRD edition, How to be Healthy Happy and Fit for the Rest of your Life
• Understanding the hip tuck to neutral spine - Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine
• Fast Fitness - First Morning Stretch
• Lower Back Pain and Golf
• Web site Back Pain Article.

Labels: fix pain, golf, injury, lordosis, lower back, readers inspiring story, sciatica

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Plantar Fasciitis Part I

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:

• Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches
• Which Shoes Help Exercise, Fall Prevention, and Ankles?
• Arch Support Is Not From Shoes
• Better Achilles Tendon Stretch
• 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.

Labels: achilles stretch, feet, fix pain, injury, plantar fasciitis, pronation, running, walking

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Fast Fitness - Sprain Prevention and Rehab Training

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:

1. Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
2. Rise to toe and hold
3. 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.

Labels: ankle, balance, fast fitness, feet, fix pain, injury, sprain, toes, video/movie

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Feeling Better Than She Ever Has Part II - Fixing Herniated Disk and Reclaiming Active Life

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."

Here are posts and information Barbara used:

• Why bad forward bending is a major mechanism in disc degeneration and eventual bulging and herniation: Disc Pain - Not a Mystery, Easy to Fix
• Avoidable sources of bad bending that go unnoticed in common exercises: Common Exercises Teach Bad Bending
• 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:

• Fast Fitness - Fix Positioning by Watching Others
• What Does Stretching Do?
• Are You Making Your Exercise Unhealthy?

Barbara continues:

"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."

These are some techniques used above:

• Lie on floor propped on elbows - Fast Fitness - First Morning Stretch
• Pectoral stretch - Fixing Upper Back and Neck Pain
• Trapezius stretch - Nice Neck Stretch
• Lunge for daily good bending - Strengthen Legs Without Knee Pain - Standing Lunge
• Half squat for daily good bending - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.

"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:

• The Cause of Disc and Back Pain
• Does an Exercise Ball Make You Sit Straight?

Barbara continues:

"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."

• Walking wasn't Barbara's problem. She was overarching the lower spine while walking, making a hidden problem - Spotting Back Pain During Running and Walking - What Do Abs Have To Do With It?
• 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.
  
• Posts about how reader Ivy stopped the same sciatica problem: Inspirational Ivy and Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier

"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.

Labels: disc, fix pain, gait, hamstring, injury, lunge, readers inspiring story, sciatica, sitting, squat, walking

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Feeling Better Than She Ever Has Part I - Fixing Herniated Disk and Reclaiming Active Life

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:

• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
• Common Exercises Teach Bad Bending
• Bending Right is Fitness as a Lifestyle
• How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
• Disc Pain - Not a Mystery, Easy to Fix
• How to bend using the lunge - Strengthen Legs Without Knee Pain - Standing Lunge
• How to bend using the half-squat - Free Exercise and Free Back and Knee Pain Prevention -Healthy Bending
• Neutral Spine or Not?
• Lying comfortably propped on elbows to unload discs - Fast Fitness - First Morning Stretch
  
• Inspirational Ivy
• Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier
• and the books.

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.

Labels: disc, fix pain, impingement, injury, lunge, readers inspiring story, sciatica, squat, stretch, yoga

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Readers Ask About Watching Body Positioning

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.


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
• Herniated neck disc
• Numb fingers
• Shoulder pain and rotator cuff injury

Here are short posts to show you how to spot the cause of upper back and neck pain and what to do:
Breasts Causing Upper Back Pain is a Myth
Fixing Upper Back and Neck Pain The Cause of Disc and Back Pain
Disc Pain - Not a Mystery, Easy to Fix

One way to tell is to check your arm rotation, shown in
Thumbs Can Show Tightness That Leads to Upper Back Pain

Crunches, many common Pilates exercises and many other exercises done every day done for "health" are in rounded forward or bent forward positions. They are counterproductive to health, to posture, and to strengthening:
Are You Making Your Exercise Unhealthy?
Common Exercises Teach Upper Back and Neck Pain
and The Stretch You Need The Least


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.

Labels: arm, disc, fix pain, impingement, injury, neck, upper back

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A Reader Asks About Osteoporosis and Walking Lightly

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.

Labels: aerospace, biking, facet joints, fibromyalgia, fix pain, impact, injury, osteoporosis, plantar fasciitis, sunlight, swimming

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Cauda Equina - Result Not Cause

Bernie, age 80, promised in December he would dance at his daughter's upcoming wedding in
Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I.

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.

Labels: fix pain, footdrop/dropfoot, injury, lower back, practice of medicine, readers inspiring story, sciatica, surgery

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Can We Teach Young Doctors to Be Healthy?

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 occurs with nutrition. The medical school food at the wilderness camp is not healthy, and students have defended eating candy and junk food as reasonable, even saying that what they eat is not unhealthful - What Medical Students Told Me About Nutrition and When Did Health Become Thinking Out Of The Box?

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.

Labels: aerospace, altitude, children, cold, education, fix pain, green fitness, hamstring, heat, hyperbaric, injury, nutrition, practice of medicine, scuba, sitting, stretch, swimming

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Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II

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.



Next:

• Bernie dances at his daughter's wedding in Cauda Equina - Result Not Cause.

Related:

• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I
• Overhead Lifting, Reaching, and Throwing - More Part I
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
  
• Prevent Back Surgery
  

See Mr. Cleff Demonstrate:

• Fast Fitness - Quick Relaxing Hip Stretch
• Fast Fitness - Relaxing Hip, Leg, and Groin Stretch
• and Dynamic Partner Balance Challenge.
  
  

Labels: drugs, facet joints, fix pain, hamstring, impingement, injury, knee, lordosis, lower back, neck, practice of medicine, readers inspiring story, side, stenosis, stretch, surgery, yoga

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Is Your Drinking Hurting Your Neck?

A reader sent me this Hauku:


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.

For More Healthy Neck Motion:

• For looking upward, click Gaze Perseid Meteors Without Neck Pain.
• For neck and upper back health looking downward over desk, click Tax Preparation Health.
• For drinking and biking, with drawings of fixing neck and upper back while looking up, click Fast Fitness - Stop Neck Pain From Biking

Labels: fix pain, impingement, injury, neck, rotator cuff, shoulder, upper back, yoga

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Swimming and Pulmonary Edema Part II

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.

Related Posts:
Subjects Invited for Immersion Pulmonary Edema Study
Swimming and Pulmonary Edema Part I

Labels: circulation, cold, fix pain, injury, ironman, pulmonary edema/oedema, swimming, triathlon

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Swimming and Pulmonary Edema Part I

Reader Katharine asked:

"I am an Ironman Triathlete and have recently experienced symptoms of swimming induced pulmonary edema on two occasions this year and am trying to find as much information about this condition as possible. I have a background in swimming and have not experience this phenomena until recently. In both instances, my breathing became labored and fluid built up in my lungs during the early stages of a competitive triathlon swim.

"The most recent instance of what I suspect was 'SIPE' (Swimming Induced Pulmonary Edema) was on July 22nd at Ironman USA in Lake Placid. After the swim portion of the event, I had to be taken to the hospital as I was unable to breathe and was coughing up a 'pink frothy foam.' I felt normal within 24 hours and have still been able to continue to train as normal –initial ECG and Echo tests of my heart are normal, as well as a lung scan and x-rays of my lungs, throat and sinuses.

"The problem has only occurred in 2 out of 4 triathlon’s I have been in this year – and both instances occurred at approx. the 750m mark of an open water swim.

"It doesn't seem to be a common ailment so I’m trying to gather as much information on SIPE as possible from anyone who has studied it. I'm primarily trying to find out how to prevent it from happening. I am fine in training in the same 'open' cold water as I race it, so why is it happening on race day... Perhaps not enough of a swim 'warm-up' and an immediate elevation in HR... that along with added fluids in the days leading up to a long distance event such as an Ironman."

Warming up does not seem to be related to developing pulmonary edema. Why pulmonary edema can happen with swimming, what fluids have to do with it, and what to do, follow on Wednesday - click Swimming and Pulmonary Edema Part II .


Related Posts and Comments:
Swimming and Pulmonary Edema Part II
Subjects Invited for Immersion Pulmonary Edema Study

Labels: circulation, cold, injury, ironman, pulmonary edema/oedema, swimming, triathlon

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Fast Fitness - Aloe Inside and Out

Here is Friday Fast Fitness - aloe vera fresher and cheaper, and probably more effective than bottled, to help cell repair.






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.

Labels: digestion, fast fitness, fix pain, green fitness, injury, nutrition

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Rocky Movie Computer Fight Simulation

The 2006 Sylvester Stallone movie Rocky Balboa featured a scene where a computer simulation estimates the outcome of a hypothetical fight. Stallone's character Rocky is a retired heavyweight boxer. While watching ESPN news, Rocky is startled by a broadcast. It features a computer simulation depicting a fantasy fight, and predicts the outcome of how he would have fought in his prime against the movie's present-day heavyweight champion Mason Dixon. A real pro boxer plays Mason Dixon's character. Antonio "Magic Man" Tarver is a southpaw from Florida, and former light heavyweight world champion.

Computer generated fights that generate real probable outcomes in real time 3-D are not yet possible outside the movie industry.

An actual "fantasy fight" computer simulation was done in 1970. It was the SuperFight between Muhammad Ali and Rocky Marciano. Rocky (Rocco) Marciano was heavyweight champion of the world from 1952 to 1956. Muhammad Ali was three-time World Heavyweight Champion in the 1970s. Marciano and Ali fought in different eras and never fought an actual bout.

To make the SuperFight, probability formulas were entered into a computer. No drawings, just numbers. Ali and Marciano met in real life on a filmset to film numerous short segments showing possible parts of a fight. Marciano was already retired 13 years and wore a toupee. The short segments were then spliced together to match the already done computer outcome to make a movie that looked like a real fight or computer-generation of one, but was not. The predicted outcome had already been generated by computer, but the fighters and movie were the real people, not computer generated. The outcome may or may not have reflected actual ability of the fighters or the real outcome.

In the mid 1980s, I was investigating which differences in human movement determined injury potential and athletic performance. In one study, I wanted to know what made the difference between the punch of a black belt martial artist and the same punch by an athletic person without training.

In present day, a camera can be hooked directly to a computer, which picks up the locations of the person's joints at each point in time, generating a computer image of the person as they move in real time. Software automatically calculates, draws, and records the image on the screen. When I started, we didn't have any of that. I did it all manually.

I filmed two subjects using 16mm high speed filming. An athletic man who had never done martial arts was subject #1. My husband Paul, who had earned his black belt a few years before that, volunteered as subject #2. I put markers over the center points of their major joints, and bands around joints which initially faced the camera but would rotate during the punch, so that the joint center would still be determined. Both executed a front reverse punch with their dominant arm. (Paul had to use traditional hyperlordotic position to match the untrained subject, rather than healthier neutral spine position, just for this comparison. We have done other studies comparing my neutral spine adjustment and found it to be a stronger punch - try it here.)

After waiting a week for film developing, I went into a darkened lab and used a film projector to throw the image of each of the thousands of frames, one by one, against a large computer digitizing tablet hung on a wall. I then digitized each joint point of each projected image, in each frame, of both subjects, frame by frame, with a digitizing Graf-pen. I sent data points from each frame by (300 baud acoustic coupling) modem to a text editor on a mainframe in another building at the University's new computer center. I wrote my own FORTRAN programs to generate data summaries and used packaged International Mathematical and Statistical Libraries (IMSL) cubic spline programs and subroutines for data smoothing. This was all to get each knee, hip, ankle, shoulder, wrist, elbow, neck and other filmed joint points into a computer to see exactly where and how fast they moved. Projecting each frame against the wall also allowed me to trace the subjects' outlines to make series of line drawings of their punch, and to make stick figures showing joint center placement. Here are some data and the actual drawings I made:
























































Not long after, with improvements in automating this process, action video games were flourishing. I was invited to a computer-generated imagery (CGI) development studio to be their "movement representation figure." They put the dots on my joint centers and filmed me using high-speed 3D computer graphics modeling as I did martial arts and tumbling moves. Not just one punch, painstakingly done, but jumping, spinning, flying all over the studio, and up and down walls.

The software automatically generated a mathematical, "wireframe" 2-D representation of my three-dimensional form. From it they animated a wild female warrior action figure for their fighting/mission genre arcade and video gameplay. They also used skeletal animation for when I would morph (on-screen) into various animal forms. I never got royalties but it was fun.

This is a big fun topic. For more, click the label "martial arts" under this article. I can write more about motion capture analysis of various sports if anyone is interested. The Great Muhammad Ali has been diagnosed with "Pugilistic Parkinson's syndrome" of tremors, muscle rigidity and slowness - with the possibility, still not fully determined, if due from the damage of a boxing career. See Rocky IV and Head Injury.

Labels: computer, injury, lordosis, martial arts, movie/media fitness, neutral spine, Parkinson, speed

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Top Diabetes Treatment is Exercise

Diabetes causes such serious health problems that the risk of death is twice as high for someone with diabetes compared to someone of similar age without. More than 20 million people in the US have diabetes (colloquially called "the sugar" disease) with 2 million a year more cases diagnosed every year. Exercise has been found to be a top factor to prevent and treat diabetes.

Three main types of diabetes are type 1, type 2, and gestational.

Type 1 diabetes, where the body does not make enough insulin (in the body organ called the pancreas), is treated with injected or inhaled insulin, although nutrition and exercise changes are a fundamental part of management.

An estimated 90–95% of cases of diabetes in North American are type 2. Type 2 diabetes is also called non insulin-dependent diabetes and obesity-related diabetes. Type 2 was rare until modern sedentary habits combined with mass sales of unhealthful food.

Gestational diabetes is generally a form of type 2 during pregnancy.

In the recent past, type 2 diabetes developed only in adults as they gained weight, reduced activity, and increased packaged, commercial, unhealthful foods. An escalating phenomenon of type 2 diabetes in children is now occurring.

Approximately 85% percent of adults and children diagnosed with type 2 are overweight and less active than they could be. Type 2 is increasingly being found to be best treated with more fun movement and less bad food, a win-win situation.

Several studies have found that exercise and healthier diet are more effective than medicine for people with type 2 diabetes. A recent randomized controlled Canadian study published in the Annals of Internal Medicine found that people with type 2 diabetes who began exercising developed better blood sugar control, both from aerobic exercise and resistance training. Not exercising yielded no improvements in sugar control. People who combined aerobic exercise and also lifted weights had the biggest improvement. It is not known in this study if results occurred because of the type of exercise mattered, or because the duration of exercise was greater in the combined exercise training group. According to an editorial co-published with the study, "Doctors should prescribe exercise to all type 2 diabetes patients who are healthy enough to work out."

In the past people with diabetes and diabetes-related complications were discouraged from exercise. However, exercise has been known in the past, with recent substantiating studies, to be the top factor to prevent and reverse diabetic problems. According to William Kraus, MD, of Duke University Medical Center, "Failing to prescribe exercise to patients with diabetes is simply unacceptable practice."

Things To Help

• You do not need a gym or special clothes or equipment to get aerobic or weight lifting exercise.
• Go outdoors for a break every day that you can, for fresh air, sunshine, and fun movement.
• For both active and resistance exercise indoors and out, remember that daily healthful movement easily accumulates from your healthy bending, balancing while dressing, taking the stairs, and other daily real life movement.
• Have fun - skate, bowl, cycle, walk, go dancing, gardening, shoot hoops, take food to shut-ins and get them moving too, with improvised exercise of moving arms and legs, clapping, singing, and having fun.
• For fun exercise-as-lifestyle ideas, check through lists of Fitness Fixer posts, linked at the right of each article.
• For better nutritional mindset, click A Little Good Exercise, a Lot of Bad Food - Overweight Still No Mystery. Then for specific recipes and methods click the nutrition label under this and related posts.
  
• My post Hyperbarics for Diabetic Foot Injury gives more information on preventing amputations from diabetic wounds, and lists some of the ways that exercise reverses the contributors and complications of diabetes.

There is great hope. Have fun making a new healthier life.

Labels: aging, children, diabetes, endurance, feet, injury, nutrition, strength, weight loss

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Daughter's Love Saves Parent's Knees

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

To learn the techniques Katayon used:

• Strengthen and Retrain Function With The Lunge
• Strengthen Legs Without Knee Pain - Standing Lunge
  
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why this kind of bending gives better exercise and prevents pain and injury
• Reduce Knee Pain on the Stairs
• My free web site Sports Medicine page

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."

Labels: fix pain, injury, knee, leg strength, lunge, practice of medicine, readers inspiring story, spirit, squat

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Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier

Ivy had serious sciatica with foot drop. She had knee and other injuries. She was in awful pain. In this kind of foot drop, the nerve cannot serve the muscles enough to lift the foot to walk normally. The toes drag. The foot hangs limply and slaps the ground with each step.

Commonly, someone with foot drop is put in a leg brace for life. One surgery done for foot-drop fuses the ankle so the foot is rigid and doesn't hang. Other problems come over years from changes in walking mechanics. For the terrible pain, patients are often directed to drugs and surgery. These are not healthy.

We changed that:

1. Monday's post Inspirational Ivy told the essentials of stopping the cause of the sciatic pain and nerve impingement, rather than treat the results with unhealthy means. Links to specific methods are there.
2. Sciatica, disc damage, facet pain, and impingement are results, not the cause of pain. They are not a diagnosis. When you have them, find what is causing them. Then you can reverse the cause: The Cause of Disc and Back Pain
3. The post How Often Should You Be Healthy? explains when and how to apply it.

Ivy followed my directions exactly and used her brain to understand how to get the intended results, not just "do a bunch of exercises." When she first began, she wrote,

"Over the past few days, I have been very conscious of my movements and, hey presto, I have not experienced any tingling or pain. I have to take total responsibility for every movement I make. I am constantly telling myself 'Think before you go to the fridge or need to pick up something off the floor - think lunges.'"

I gave her simple gait retraining. Ivy quickly discarded the cane she had used for nearly 7 months.

Ivy went on to teach several neighbors in her community how to fix their own pain. One story is posted in Each One Teach One.

In April 2006, Ivy wrote,

"It is nearly 5 months since I started your wonderful programme so I thought it was time that I gave you an update. I am fit and well, the sciatica has disappeared, if I get a little niggle in that area, I ask myself as to what have I done wrong, my left knee (IT Band) is no longer a problem, my balance has improved immensely and the "dropped" foot is great, in fact, when I go for my daily walk, I no longer hear the plop, plop of which I hated. I can also now wear "normal" shoes.

"Without your help and support and putting me on the right road so to speak, I would still be in constant pain plus making the chiropractor richer. Please note, I no longer go to him for treatment - I DON'T NEED HIM."

At age 70, Ivy is steadily improving strength and range of motion using healthy movement for daily life. She is eating healthful vegetarian food. January 2007 brought this note:

"The reason for this e-mail being that I feel somewhat excited re a remark made by the son of one of my fellow villagers. His very words being, "How did you become the woman that you are now. I have watched you over the past couple of years - when I first met you, you were obviously in a lot of pain, what is your secret?"

"I also sent the photos to my son and daughter-in-law who live in the US, they too, could see the improvement - they thought I looked great. Mind you, over that 2 year period, I gradually lost 20 lbs."

What about Ivy's e-mail that I mentioned in the last post about the new hip stretch? I'm out of room again. Watch for the next post - Good Life Works Better Than Bad Ab Exercise.

Labels: disc, facet joints, feet, fix pain, footdrop/dropfoot, gait, iliotibial band, injury, knee, lunge, nutrition, readers inspiring story, sciatica, shoes, spirit, squat

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Prevent Back Surgery

I received an invitation to take a course to learn a new back surgery for damage to the facets. Facets are the joints at the back of each vertebrae (spine bone). The surgery was advertised as a good revenue producer.

In the surgery, the facet joint is cut off and replaced by "lumbar position preservation hardware" rigidly attached so that the area can no longer bend or arch backward. At right is an X-ray of the lower spine with surgically implanted hardware. The person is standing sideways facing to the right. Surgical facet rigid fixation surgery is considered innovative because it replaces the more drastic spine fusion. It also replaces repeated injections into the painful area. The seminar would teach me the surgery with a cocktail reception following.

Why does the surgery want to prevent arching the lower spine? The facets are in the back of the vertebrae. Chronically letting your spine arch (too much inward curve) squashes the facets in back. According to work I've done over years in the lab, the overarching, called hyperlordosis (or slouching backward), is a chief factor in damage and pain to the facets and surrounding soft tissue. That means that you can stop this yourself without the surgery.

Notice if you allow overarching when carrying things in back (1. left) and in front (2. right). The pictured overarching is not the normal curve of the spine. It is too much:

1. The left photo above is from the Fitness Fixer article Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain. You do not need to allow the pack to pull your upper body backward.
2. Right photo is from Healthier Carrying - Get Free Ab Exercise and Stop Pain. You do not need to lean back to offset weight carried. In both examples, the hip tilts forward in front, instead of holding vertically.

Two examples above show allowing the spine to arch too much when reaching overhead:

1. Left photo is from Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.
   
2. The drawing at right is from Back Pain in Pregnancy - and Why Men Can Get It. Imagine lifting your baby overhead (or any weight) and allowing your spine to pinch backward on the facet joints instead of standing upright and holding neutral spine.

Two examples above are from Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats? (1. left) and Overlooked Ab Muscles in Overhead Lifts (2. right).

You can stop overarching, thereby preventing crushing force on the facets, and instead, distribute the weight through the core muscles. It is a simple positional adjustment that takes seconds (shown below). It is a healthier approach than surgery over both the short and long term.

Following rigid fixation surgery, you will no longer be able to stretch your lower spine as far backward, even when you want to stretch for range of motion and better disc health. You will still be able to slouch your body weight backward - onto the implants. They may eventually wear, along with adjacent bone, from the chronic crushing. Because the surgically fixed area can no longer overarch, increased forces occur on the joints above and below which have to bend more. If you thought the spine in the x-ray above still looked overly arched, not neutral, you are right. The areas above and below the implanted devices are over-arching backward, and the backside is tilting out in back (hip axis is tilted anteriorly). After years, those facets may be next to break down. It is no surprise "when the pain comes back." The cause of the pain was never removed.

Instead of allowing your spine to be pulled into damaging position, use your muscles to hold neutral spine. Here is one easy way to learn to feel it:

1. Stand with your back against a wall. Touch heels, backside, shoulders, and head. Do you feel a large arch in the lower back making a large space?
2. Put your hands on your hips. Thumbs in back. Fingers in front.
3. Roll your hip so that thumbs roll down in back.

The large space between lower back and wall becomes a smaller space. Do not flatten against the wall or round your back. Just feel the strain come off the lower back. Use the new neutral for daily positioning. Simple. Check the photo at right (spine positioning is shown standing sideways, not with back to wall). Left is arching. Right is neutral. A small inward curve remains with neutral spine (right). Neutral spine does not mean rounding the back (which pressures the discs). Make the belt line level, not tilting down in front. The photo is from the post Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine. Click for additional ideas.

The muscles used to maintain neutral spine are your abdominal and core muscles. It is not strengthening ab muscles that stops pain or teaches you neutral spine. It is using them to prevent damaging spine position. You get built-in core muscle exercise through the same repositioning technique that allows you to avoid back surgery.

Labels: abdominal muscles, facet joints, fix pain, injury, lordosis, lower back, neutral spine, surgery, upper back

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Altitude Sickness, Viagra, and Bubbles on Flights

The previous post Altitude Sickness During Flights told how certain symptoms occurring during air travel are from exposure to altitude.

If a craft were not pressurized, air pressure inside would be equivalent to air pressure outside. At high altitude, there would not be enough air pressure inside the craft for crew to be functional enough to fly. Crew in unpressurized craft wear oxygen-delivery equipment. This was one of my areas of study with the Navy.

Passenger planes are pressurized. The inside is kept at higher pressure than actual flight altitude (equivalent to lower altitude). The pressure inside is still not as much as at sea level. Keeping that much air pressure inside would create extreme metal fatigue on the craft and huge fuel costs. Regular passenger aircraft keep interior pressure equivalent to mild altitude exposure.

In the last few years, Viagra (sildenafil citrate) has been tested by various groups, including the military, as intervention against altitude sickness. Recently, it was also found that the drug reduced symptoms, thought to be jet lag, after flights. My guess is that it was effective for symptoms from flights because of the same properties that may help reduce symptoms, in some, of altitude sickness.

Another component that I discovered many years ago in my work in altitude sickness, was a bubble component - an altogether new dimension to the altitude sickness puzzle. Decompression sickness bubbles can form in the body when coming up after a scuba dive. I found the same kind of bubbles can form in your body when going to elevations encountered in aircraft and mountain travel, with no prior scuba diving. More of this in future posts.

Decompression sickness is also an issue when going into space during extra-vehicular activities. Click Space Walks.

Altitude sickness in flight is different from (or in addition to) the motion sickness of flight motion, or being stiff after not moving enough during long flights. The post Exercise and Stretch for Long Travel Sitting covers some exercises and stretches to relieve those problems.

Altitude exposure is not always a bad thing - certain athletes use altitude training to expose their body to conditions that make it work harder and develop greater oxygen carrying capacity. Future posts will cover different kinds of athletic training at altitude, and training to perform better physically at altitude. Click the labels under this post for more on each topic.

Labels: aerospace, altitude, drugs, injury, military fitness, scuba

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Altitude Sickness on Flights

It has made recent news that certain symptoms during air travel are due to altitude sickness. This seems simple enough. Air pressure inside common passenger aircraft is equivalent to mild altitude exposure.

People who get symptoms when going to the mountains may get the same headache, tiredness, achyness, and other symptoms of altitude in flight. Drinking alcohol adds to symptoms. Severity of symptoms depends on several things, mainly how high the altitude, and how fast you reach it.

Cabin pressure varies with cruising altitude and type of aircraft. During a flight, the inside of a large commercial passenger air flights may range between 5000 to 9000 feet (~1525-2743 meters), occasionally higher or lower. Small lower planes flying may be able to maintain pressures closer to (or equal to) ground pressures.

How fast aircraft reach these altitudes depends on the flight path, final cruising altitude, type of aircraft, and other factors. Some of my commercial pilot friends say they will pressurize the cabin far more gradually when they see babies onboard, so that they (the babies) cry less as pressure changes around their ears. Pressure change on the ears is not altitude sickness, just simple air volume change. Earplugs do not prevent this problem, and can make it worse in some situations. Future posts can cover why.

Susceptibility to altitude sickness does not seem to be affected by better or lesser physical conditioning, or any kind of fitness or physical training. It is still a hugely interesting topic to understanding how the body reacts to and works at altitude, why certain interventions work or don't, and how soon you can fly after going scuba diving - important to risk of decompression sickness.

Reader Bill, athlete and pilot, writes, "Regulations require no more than a 10,000 foot cabin altitude (3048m) be maintained for commercial passenger flights. Anyone not acclimatized to altitudes between 7 to 10 thousand feet (~2-3 thousand meters) will feel some symptoms of a mild hypoxia, surely after several hours or/and a couple stiff drinks."

The next post tells more about altitude sickness on flights and more interesting issues and a few proposed cures - Altitude Sickness, Viagra, and Bubbles on Flights.

Labels: altitude, headache/migraine, injury, military fitness

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Independence Day for Fitness

Today is Independence Day in the United States. The Declaration of Independence was drafted in June of 1776. Signing began by July. The paper itself didn't grant independence - work continued until independence came a few years later. After getting the idea to do something, the next thing is to take action. Here are ideas for a life free from things that are unhealthy - pain, unhealthful food, and exercises that reinforce bad habits:

Freedom from junk food:

Instead of soda, put a red sweet pepper in a food grinder. Cut about an inch of fresh ginger root and add through the grinder. In about 30 seconds preparation time you will have a sweet, cool, red, slushy drink with an exotic tang of ginger. Healthy and good tasting.

Instead of refined sugar sports drinks, put a peeled whole cucumber into the food grinder or low speed blender with a whole kiwi fruit. It will make a sweet, cool, slushy, green drink.

Instead of processed peanut butter and refined sugar jelly, put fresh raw nuts and apple slices into a grinder, mill, or chopper. In less than a minute of preparation time, you have a sweet nut butter that you can spread on fruit slices, carrots, and other good foods. Try walnuts, almonds, other fresh raw nuts, and experiment with different fruit combination to make different sweet creamy fresh nut butters.

For more recipes, Healthy Martial Arts has an entire chapter on nutrition.

Freedom from overeating

Just as you can't go through red lights every time you just feel like it, or hit someone any time you just feel like it, you don't just eat anything you feel like it at any time. That is unhealthy. Some people say any denial is unhealthy. That is like saying you can just wet your pants when you feel like it. Self-control is cleaner in body and spirit:
Exercise Common Sense Discipline - Turn Down Halloween Junk Food
A Little Good Exercise, a Lot of Bad Food - Overweight Still No Mystery

Freedom from unhealthy drugs and medicines:

Masses of products crowding store shelves claim to fix this and cure that. Millions of dollars are spent. The products seem dazzling, but much is hype and many produce unhealthy effects. Then more dollars are spent on more pills and products for the new problems caused by the medicines. Many prescribed medicines cause new problems that can be avoided. Stop the cycle and save yourself time, money, and unhappiness. If it is not healthy, it is not health care:
Teen Dies After Using Muscle Soreness Rub
Human Growth Hormone
Is Your Health Food Unhealthful?
Stomach Acid Drugs Increase Osteoporosis and Hip Fractures

Freedom from physical pain and injuries:

At the Special Operations Medical Association conference two years ago, it was released that 62% of our American injuries in Iraq are "Disease Non-Battle Injuries"(DNBI) - not from combat or supporting operations, but occurring in the gym. At the ACSM conference last month, a research study reported that their American military units had 17% DNBI injuries. I asked them how they kept their numbers so low. They replied that the number was for evacuations - injuries so serious they required removal from the base. Some of the most common exercise and stretching practices are not healthy. It is not that they are not good for some people or that they are overuse or done "wrong" - they are inherently bad movements. The same high injury rate is happening to fitness and yoga and Pilates instructors and students. I wrote about this in Welcome to the Fitness Fixer. Here are some specifics on why and what to do instead:
Why So Many Aerobics Injuries?
The Stretch You Need The Least
Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
Safer Overhead Military Press
Are You Making Your Exercise Unhealthy?

Freedom from neck pain:

Fixing Upper Back and Neck Pain
Nice Neck Stretch
Breasts Causing Upper Back Pain is a Myth

Freedom from mental pain:

Healthier Heart
Exercise Your Sense of Humor
Which Ancient Exercise Gives Focus and Concentration?

Freedom from crunches:

Abdominal crunches are a popular exercise, but they are not healthy. This is new and different information, I know. Crunches "work" your abdominal muscles, but not in a healthful or beneficial way, whether done sitting or standing or using a machine. Crunches also train rounded bad posture that you know is unneeded and unhealthy when sitting or standing that way in real life.

The idea that strengthening the abdominal muscles stops back pain is a myth. Many muscular people have pain. They do their crunches, then stand and move in the overly-arched spinal posture that is the hallmark sign that the abs are not even being used, and which creates one major kind of chronic pain: Fixing the Commonest Source of Mystery Lower Back Pain

Crunches do not automatically make you use your abdominal muscles to position your spine to support your back. You do that on your own: What Abdominal Muscles Don't Do - The Missing Link.

Neutral spine has a small inward curve to the lower spine, just not a large one:
What is Neutral Spine and Why Does Sticking Out In Back Harm?
Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats?

The simple act of standing and doing all your activities and exercise without letting your lower spine overly arch, and instead keeping neutral spine, uses more abdominal muscle involvement than doing crunches: Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine.

Functional abdominal exercises use no forward bending: Abdominal Muscle Exercise - Better, Different, Not What You Think

The book No More Crunches No More Back Pain The Ab Revolution explains a healthier better way to use and exercise your abs (114 illustrations 124 pages). I have a number of copies of the new 3rd edition expanded to give to military personnel as gifts. Contact me to send one (free) to someone you know, to keep our guys healthy.

Independence is Healthy:
This post included links to a few past posts about being free of unhealthy things. Click the labels below each post for more related posts. Keep the things you do, eat, and think healthy. If a medicine is not healthy, it is not health care. If an exercise trains injurious body mechanics, use the time for healthier exercises that are more fun. There are better, healthier ways. Be free.

Labels: abdominal muscles, drugs, fix pain, holiday, injury, military fitness, neck, nutrition, performance enhancing modality, spirit, stress, upper back, weight loss

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Does Hyperbaric Treatment Help Muscle Injuries?

The previous post Does Hyperbaric Treatment Heal Sprains? covered research that looked into hyperbaric oxygen treatment for injuries like ankle and knee sprains, and muscle soreness.

Some professional sports teams have been using hyperbaric oxygen chambers hoping to speed recovery and enhance performance. Players spend time in a small pressurized enclosure, breathing high levels of oxygen. Other athletes and private citizens have purchased chambers, hoping for various gains. Like other helpful and specific medicines, hyperbaric oxygen helps some things and not others, and can have side effects. The post Does Hyperbaric Oxygen Help Exercise Ability? explains more of how it works.

Sprains and delayed onset soreness are not injuries where low oxygen prevents cells from doing their job to fight infection and rebuild. Elevating oxygen levels doesn't turn normal cells into super cells. It returns them to function. For non-geriatric athletes, sports injuries should not be hypoxic, which is an area of low oxygen. (Given the junk these athletes eat for "sports food" the state of their blood vessels should benefit by a closer look. See Is Your Health Food Unhealthful.)

A concern in hyperbaric medicine is that sensationalized use of hyperbarics for things that may not work will take the legitimate medicine of oxygen treatment and give it a sham image. Dr. Steve Thom, MD, PhD, past president of the Undersea and Hyperbaric Medical Society (UHMS) warns that some team physicians appear unaware of the risks of hyperbaric medicine. He stresses the need for proper medical clearance and supervision of the hyperbaric chamber. For certification and policy information, see the UHMS web site.

The idea that perhaps there are other effects of injury that are not from low oxygen has led to more research on sprains and muscle injury. A study presented here at the UHMS meeting this week by a group from the Tokyo Medical and Dental University in Japan was, "The effects of hyperbaric oxygen therapy on patients with muscle injury." They wondered if hyperbaric oxygen could reduce edema after muscle injury.

Dr. Kazuyoshi Yagishita and colleagues looked at twenty patients who sustained muscle injury during sports, who were admitted to the Tokyo hospital within seven days after injury. The patients received hour-long hyperbaric treatments for one to seven sessions. Patients were tested before and after each treatment for pain at rest and with motion, subjective evaluation of edema, muscle stiffness, and leg volume. All parameters slightly improved with treatment. They concluded that, in this study, in patients with muscle injury, hyperbaric treatment was effective. Dr. Yagishita told me he felt that further study is necessary to assess healing acceleration and intermediate and long-term results.

Related Fitness Fixer:

• Does Hyperbaric Treatment Heal Sprains?
• Exercise and Fitness in Decompression Sickness Risk
• Hyperbarics for Diabetic Foot Injury
• Exercise and Medicine Underwater and at High Pressure
• Respiratory Muscle Training for Swimming, Diving, and Running
• Get Muscles for Christmas
• Forensic Anthropology and Bone Density
• Tour De France 2008 and Increasing Aerobic Capacity
  
  

Labels: hyperbaric, injury, performance enhancing modality, sprain

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Does Hyperbaric Treatment Heal Sprains?

The Utah Deseret News reported on a game where teens scratched letters into their arms. In March, a 14-year-old girl playing the game became infected with necrotizing fasciitis, commonly called "flesh-eating bacteria."

The bacteria don't eat the skin as the name seems to say, but release toxic factors, which quickly destroy skin and muscle, causing pain, disfigurement, and a high death rate. Necrotizing fasciitis is a serious infection. The teen needed over 60 hyperbaric treatments and several surgeries. Hyperbaric oxygen treatment is done in a small room or chamber. The air pressure inside is increased so that the person can receive more oxygen. One or more people can get treatment in the chamber at once. The post Does Hyperbaric Oxygen Help Exercise Ability? explains more of how it works.

Hyperbaric oxygen treatment is effective against necrotizing fasciitis and infections like gangrene in several ways. The bacteria involved are susceptible to high oxygen pressure, the low oxygen area of the infection is raised to a level where the body's white cells can do their job to clear the bacteria, higher oxygen pressure prevents white cells from sticking to vessel lining, and a few other nice effects to be covered in future posts.

Given that hyperbaric oxygen speeds healing in certain infections, crush injuries, problem wounds, diabetic ulcers, thermal burns, ionizing radiation injury, refractory osteomyelitis, osteoradionecrosis, and compromised grafts, it has been hoped by some that it would also be useful for sprains and muscle injury.

One study by diving medicine pioneer Dr. Fred Bove (my advisor for one of my dissertations) and his colleagues, found no effect of hyperbaric oxygen treatment on time to recovery for ankle sprains (Am J Sports Med. 1997 Sep-Oct;25(5):619-25). Another study by Dr. Michael Bennett and colleagues reviewed known past studies using randomized trials of hyperbaric oxygen on soft tissue injury (ankle sprain and medial collateral knee ligament injury) and muscle soreness after exercise. They found there was was not enough evidence that hyperbaric treatment helped ankle sprain, acute knee ligament injury, or soreness (Cochrane Database Syst Rev. 2005 Oct 19;(4)). Dr. Brad Bailey of San Diego did a review of the utility of hyperbaric oxygen for sprains and sports injuries and found no benefit for soreness, but a few studies that showed benefit in acute sprains and strains. There may be aspects of injury, not previously looked at, that may be helped. These are being looked at in newer studies. The next post will cover them.

You can do much to prevent and rehab sprains on your own:

• How To Treat Ankle Sprains and Prevent Them
• and No More Ankle Sprains Part II.

Related Previous Fitness Fixer on Hyperbarics:

• Exercise and Fitness in Decompression Sickness Risk
• Hyperbarics for Diabetic Foot Injury
• Does Hyperbaric Oxygen Help Exercise Ability?
• Exercise and Medicine Underwater and at High Pressure

Next post in this series about diving and hyperbaric medicine, written for you from the Exercise and Medicine Underwater and at High Pressure conference:

• Does Hyperbaric Treatment Help Muscle Injuries?

Labels: hyperbaric, injury, performance enhancing modality, soreness, sprain

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Exercise and Medicine Underwater and at High Pressure

For the next week, I will be at scientific meeting of the Undersea and Hyperbaric Medical Society (UHMS). My colleagues attending are flight surgeons, SEAL team captains, commercial divers, submersible and submarine craft personnel from navies of many countries, and scientists from all over the world who study the science of what happens to the body when working under different pressures, temperatures, and breathing gases - at altitude, underwater, and in the specialized dry compartments to build bridges and structures deep underwater. There are also physicians, technicians, nurses, and aerospace scientists and astronauts who use hyperbaric chamber technology to prevent or treat specific non-diving conditions. Allied health workers, divers, and non-divers also attend.

Originally, we were the Undersea Medical Society (UMS). As use of high-pressure oxygen chambers to treat illnesses other than diving climbed, more sessions on how hyperbaric oxygen works (and doesn't work) were added. Wound healing increased in focus. In 1986, we became the Undersea and Hyperbaric Medical Society (UHMS). Forums, sometimes strangely heated for brainy, cool-headed scientists, are held about which conditions legitimately respond to hyperbaric oxygen treatment and which are felt not to have evidence (no matter how much we wish it would work and alleviate the suffering of the patients).

Some of the established benefits of hyperbaric oxygen and some uses that are not shown to be effective are explained in the post and comments of Does Hyperbaric Oxygen Help Exercise Ability?

The meeting will cover many interesting topics in decompression bubbles that are thought to cause (or be part of) decompression sickness, or "the bends," and mathematical and empirical models of decompression. Decompression theory and bubbles were my research area for many years along with the effects of too much oxygen on the body during exercise underwater and in dry habitats underwater. The meeting will have many sessions in clinical hyperbaric oxygen therapy for several specific conditions (abbreviated HBO, HBOT, HB02 and other), chamber equipment, and wound treatment. There will be a session of The Veterinary Hyperbaric Medicine Society. Animals get problem wounds that need help healing, too.

The national board exam for hyperbaric chamber nurse and technician will be administered. There is also a board exam for physicians in hyperbaric medicine held each fall through the American Board of Preventive Medicine & Emergency Medicine. I wrote the study guides for both exams. I tried to make them fun, user-friendly, and packed with understanding, not just lists of facts and equations to memorize. The guides cover the entire contents of both areas and are a nice review or compendium for anyone interested I the field. Info is on my web site books page.

I won't be staying at the fancy conference hotel but at a backpacker's hostel. Over the next week, I will try to get to Internet cafes to post on some of the interesting topics and research at the meeting - and swim and go underwater for real. That is good for a researcher in underwater exercise and medicine to do.


Here is the next post from the conference Hyperbarics for Diabetic Foot Injury.

Labels: aerospace, education, hyperbaric, injury, military fitness, scuba

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Teen Dies After Using Muscle Soreness Rub

A New York teen cross-country runner is reported to have died after using large quantities of a muscle soreness rub. According to various news stories, the medical examiner concluded she died after using too much Bengay cream containing methyl salicylate.

Methyl salicylate is a natural oil of wintergreen (betula oil) found in plants. It is used in many muscle rubs and creams to dilate blood vessels to bring blood to the area and redden the skin.

Deaths are rare, but salicylate poisoning is not rare or unknown. Poisonings using medicated oils account for "48% of acute salicylate poisoning cases treated in the general medical ward of the Prince of Wales Hospital" in Hong Kong (Vet Hum Toxicol. 1996 Apr;38(2):133-4.) Another study comparing severe salicylate poisoning from aspirin or topical oils found that the oils pose "the threat of severe, rapid-onset salicylate poisoning" because of the concentrated form and lipid solubility of the methyl salicylate in the rubs (Postgrad Med J. 1996 Feb;72(844):109-12.)

Some muscle rubs and balms contain other toxic ingredients, such as turpentine oil and camphor. The various preparations all "work" in various ways to relieve pain or mask it. I will cover more about the different soreness creams and preparations from around the world, their ingredients, and how they work in posts to come. The book Healthy Martial Arts covers ingredients in detail, how they work, and more on soreness and training.

Soreness in the muscles is common and normal after energetic activity. Muscle soreness does not just occur in the out-of-shape. However, your joints should not be sore after workouts.

If your joints (not muscles) are sore after activity, you may be using body mechanics that put joints in positions that grind or rub. You may also be shifting weight off your muscles onto your joints to make the exercise easier. Your joints should not be sore, hot, or swollen after any activity.

Here are a few ideas to avoid joint pain during or following activity:

To reduce knee joint stress during daily good bending (half-squat):
Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
and Bending Right is Fitness as a Lifestyle

Reduce knee joint stress in full squat:
Achilles Stretch in the Bathroom

Reduce knee joint stress when running, walking, jumping:
Healthy Knees

Reduce lower spine stress when reaching, running, walking:
Back Pain in Pregnancy - and Why Men Can Get It
the post tells why and has links to show how to restore the spine to neutral to stop the pain then and there,
and Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain

Reduce lower spine stress when sitting and bending:
Disc Pain - Not a Mystery, Easy to Fix

Reduce upper back and neck pain:
Are You Making Your Exercise Unhealthy?

Shoulder and rotator cuff:
Safer Overhead Military Press
and Upper Back Exercise and Neck Pain Prevention Too

Click the labels under each post to show all posts on that topic.
Sincere wishes to the family of this young girl.

Labels: drugs, fix pain, injury, performance enhancing modality, soreness

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Forensic Anthropology and Bone Density

A few weeks ago, I attended a lecture on forensic anthropology. In general, this is the study of things you can tell from human bones in a crime setting. How old was the person? Were they male or female? How big were they? What was their probable race or ancestry?

Why was I there when my work is with the living? Two main reasons. I am the science officer for the Vidocq Society, an international forensic society. I might evaluate data, for example in an aviation disaster, whether someone might have been conscious at each point when undergoing G-forces or different temperatures and amounts of oxygen after a depressurization at various altitudes. In a scuba death, I might advise on physical changes that occur with different situations. The second reason was to learn more about bones. Bones are remarkable. Your bones know a lot about you. What was your health like? Were you active? What kind of activity did you do? When I was small, I read about an archaeological dig in ancient Rome. The bones of a girl were recovered. The account stated they could tell she carried loads too heavy for her, and was therefore (in conjunction with other evidence) probably a servant or slave. I was riveted. How could they know that? I spent years after that learning more about telling how someone moved from looking at their bones.

Throughout your entire life, when you exercise you stimulate growth of new bone cells. The physical pull of muscles thickens your bones where the muscles attach. Using your arm muscles thickens arm bones. Using your legs strengthens leg bones, and so on. This is a main mechanism of how exercise prevents osteoporosis. Without exercise, you don't stimulate enough new cells to counter the normal loss as old ones break down. Your bones thin no matter how much calcium you eat. The post Exercise is More Important Than Calcium Supplements for Bones tells more about this. Bone demineralization is rapid and serious in astronauts in microgravity (Collapsing Astronaut Gives Healthy Reminder).

How you use your muscles causes them to pull differently, giving evidence about the kind of habitual motion. More interesting is that when you are active, your bones grow and shape themselves to facilitate your motion. An example of interest to readers following the posts on squatting is that people who habitually sit for normal daily life in full squat grow "squatting facets" on their lower leg bones. These are small areas on the bone that quickly grow to make squatting more comfortable. At one point, it was a debate in anthropology that squatting facets were a marker of someone of Asian ancestry, until it was found that others who squat also grow them, and that squatting facets disappear when the person adopts a Western sitting habit of chairs and no longer squats. Babies of all races can have them.

Someone who habitually slouches can change the shape of their bones, eventually deforming them. This can occur in the spine, knees, hips, ankles, shoulders, feet, toes - everywhere you pressure your bones. Changing positioning habits to healthier ones can, in many cases, reshape the bones back to healthier shape. Think of braces on your teeth. It's human bonsai. In cases of extreme dystrophies of the muscles, someone who sits without function of their trunk muscles to hold the spine upright, can eventually deform their spine until their ribs sit on their hip bones. How are you sitting right now? The recent post What Does Stretching Do? explained a bit of why stretching isn't reducing injuries. People are stretching, then exercising and going about daily life in bent over positions that rub and grind the joints and soft tissue.

You literally shape your own health. Use the articles throughout this Fitness Fixer blog to do healthy exercise in healthful positioning so that your bones will only tell good tales about you.

Labels: achilles stretch, aerospace, ankle, arm, feet, forensic, injury, leg stretch, osteoporosis, posture, scuba, sitting, squat, toes

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Exercise and Cancer

Regular physical exercise is documented to reduce risk of cancer. Exercise has also been found to increase survival in those with existing cancer, (JAMA and J Clin Oncol.) improving both number of years and quality of life.

Until recently (sometimes currently), cancer patients, along with heart patients and back pain sufferers were told to rest and stop activity. Inactivity creates new health problems and worsens existing health problems. Lack of regular exercise decreases strength, endurance, energy, blood sugar regulation, cellular repair (lengthy list here) and increases fatigue. Cancer treatments of radiation and chemotherapy do the same, and worse. This is called iatrogenic harm, which means injury or illness brought on by medical treatment. One medical report found that debilitating tiredness and loss of energy from cancer treatments can be more disruptive to the patient than the original pain of cancer. Another report called fatigue, "The most important consideration for the patient with cancer." Cancer fatigue can be a problem for months, even years, after treatments end.

Reader Dr. Zoe E., cancer survivor with personal experience writes:

"I don't think I'm quite ready for prime-time yet - but if I can be a source of encouragement to those trashed by chemo, I'm happy to be displayed.

"Yes, exercise helps if you can do it. Lots of people are lucky to experience low toxicity during chemo and are able to keep up their exercise programs or active life through treatment. Others are laid low and must stop treatment or are just trying to recover enough between treatments to continue them.

"While the Lance Armstrongs and Tony Snows of the world are inspirational, it would be a bad thing if the general population thought that people should be able to work and function during cancer treatment. Many, maybe most, can't and they shouldn't feel bad about it. Chemotherapy is as close to killing you as modern medicine gets."

Dr Zoe sent an update the day before yesterday:

"I did the Relay for Life on Saturday (a fund raiser for the American Cancer Society). It's a 12-hour team event where you keep one person on the track for the full time. I did the Survivor's Lap and several more with lots of rest stops. I managed to hang out there for 4 hours before I got too pooped. No photos though, I'm even more camera shy than blog shy! You can draw a picture if you want."

One of the benefits of exercise is that your body produces more of an interesting compound called heat shock protein. Heat shock proteins (HSP) are families of proteins that do several things including accompanying and helping other proteins under stress (called chaperoning). Heat shock chaperones keep the other proteins neatly folded when they are being deformed by stress factors such as infection, ultraviolet light, starvation, heat, and other harsh conditions. Heat shock proteins help cell survival and are thought to mobilize immune function against infections and diseases. One of the big stressors of focus in heat shock study is cancer. Heat shock proteins have been investigated for their role in activating immune response to cancer, and in cancer vaccine research.

Molecular physiology isn't my research area, so I haven't done any work in it personally. I just read the work of others. Heat shock proteins are intensely fascinating to me for their role in exercise, in increasing tolerance to hot environments (interestingly, cold too), and other extreme challenges to the body. I hope to post more about it from the sports medicine meeting next week.

Getting enough exercise to improve strength and quality of life doesn't only mean exhausting yourself or stopping your day to change clothes and go "do exercises." Get exercise that is healthy and fun, and as a normal part of how you bend and position your body in healthful ways during your day.

Some posts with ideas:

• What is "Fitness as a Lifestyle?"
• How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
• How Often Should You Be Healthy?

Labels: cancer, cold, heat, heat shock protein, injury, performance enhancing modality, readers inspiring story

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What Does Stretching Do?

Stretching has been shown in some studies to prevent injuries or pain, or improve athletic performance. Based on this, gyms are filled with people stretching - often in tight, unhealthy ways that re-emphasize the rounded forward postures that caused the pain and injuries in the first place. Other studies cast doubt on benefits of stretching for injury reduction, or indicate that stretching reduces muscle tensile contraction. Based on that, there are athletes who say they won't stretch at all. This is where I wind up back in the lab for more years to find out where the discrepancies lie and what to do about them.

The problem seems to be how people stretch, then how they then go exercise and incur their injuries. Another key issue is how they go about their real life outside of the gym and their stretching routine.

For many, stretching means producing a greater range of motion for any given joint, and bending forward to touch the toes. Many of these same people don't have the flexibility to comfortably lie flat without a pillow under head or knees, or stand with their back against a wall with the back of their head touching the wall without craning their neck or lower back. Their back and shoulders are too rounded forward. Their hip is too tight in front. Tight chest, shoulders, and anterior hip contributes to round-shouldered, bent forward posture. The average person is often too tight to just stand up straight. Consequently, they stand, walk, and do all activities at joint angles that impinge, grind, rub, and stress. This is functional tightness.

It is not a mystery when populations don't become more flexible or prevent injuries through conventional stretching routines. The idea of stretching needs to be reframed as specific retraining to restore healthy length to your muscles, so that you no longer stand, sit, and move with strained unhealthful positioning.

Stretching needs reform.

Several posts have introduced how ingrained unhealthful stretching is in popular fitness. Start with the following, plus the links I put in each, to see how to retrain your muscles and brain to stretch in ways that restores and retrains healthy positioning, rather than distort it:

• Are You Making Your Exercise Unhealthy?
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
• The Stretch You Need The Least.

For functional stretching, use these three stretches every day:

• Fixing Upper Back and Neck Pain
• Nice Neck Stretch
• Friday Fast Fitness - Better Shoulder and Triceps Stretch
  
  

For using healthful muscle length for movement and exercise:

• Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs

Labels: fix pain, injury, leg stretch, posture, stretch

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Freed From Pain, He Rides Again

Reader Bill Slabonik had sports injuries, motorcycle and bicycling accidents. He was a good exerciser and hard worker, doing all the conventional exercises and ways of lifting during his regular workouts, long hours sitting as a pilot, and vigorous work in the Coast Guard. I know these things because I've seen his x-ray and MRI reports.

Bill writes:

"After two years of waking every couple hours with extreme pain in my shoulders and both hands completely numb, I sought relief from the medical community. Thinking that something was wrong with my shoulders, I was very surprised to find out that I had degenerative disc disease in my neck and spine. I was scheduled for epidural injections and advised that if they did not help, surgery was the only alternative. I was advised that I might consider disability retirement.

Not being pleased with my choices, I was able to get a script from my family doctor for physical therapy. Two months of therapy gave encouraging if small improvements. Back spasms stopped and pain diminished somewhat. Encouraged by this I continued to search online for neck and back pain fixes until I was fortunate to find a website maintained by Dr. Jolie Bookspan. The articles made logical sense to me and I soon ordered her book "Fix Your Own Pain." I noticed rapid improvement as soon as I began to practice her methods. Encouraged by these results I chose to attend one of her clinics held at Temple U.

I have returned to an active, athletic life. Waking due to pain is a thing of the past. I am setting and achieving physical goals that seemed impossible only a year ago. I am hiking farther and riding faster than I could have dreamed of. I am using post-it notes in my car, at my desk and on my flight kit for the airplane as reminders to maintain good position.

The photo is my neighbor Ken and myself taking a break from the year's Pennsylvania State Police Memorial century ride. He is also putting your principals into good use. We rode 50 miles that Saturday morning without pain or discomfort. Ken is 61 years old and I'm 55. The amazing part is that I had over 180 miles for the week without pain. Ken and I have made a goal of riding together on each of our birthdays, the number of miles matching our age, i.e., a 62 mile ride this fall for Ken's birthday. Oh, the ride was from Hershey, PA to Mount Gretna, PA and back. A nice loop through the central PA farmlands. Thanks again for your encouragement and books. I am feeling fantastic today!

Your work has not only provided hope but is putting life into my years. I want people to know that there is help.

I normally shy away from putting myself out on display like this, but if it encourages others to fix their pain then it was worth it. Thanks again Doc. I'm out mowing the lawn by hand.. two hours..no pain...riding my bike to work tomorrow 42 mile round trip.. I'm not going to stop."

Sincerely,
LT William M. Slabonik
US Coast Guard (Retired)

Fun note: the surname Slabonik means "Free Man." Bill now signs his e-mail updates to me as Free Man

Read Bill's continuing adventure in Inspirational Update from Bill
And how the Lieutenant became the Captain in Reader Successes Endure - Next Update From Bill.

Labels: biking, disc, fix pain, injury, readers inspiring story, shoulder, spirit, upper back

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Does Hyperbaric Oxygen Help Exercise Ability?

Heavyweight boxing champion Shannon Briggs was in the Black Athlete Sport Network news for getting sessions in a hyperbaric oxygen chamber. According to the news, Briggs stated he believed the treatments would help him improve physically and get in better shape for his upcoming fight to undefeated heavyweight Sultan Ibragimov. What is hyperbaric oxygen treatment and what is the basis for use?

"Hyper" means more or above. "Baro-" comes from a Greek word meaning weight or pressure. Some words that use this word root are barometer, an instrument measuring atmospheric pressure, and bariatrician, which is a physician who manages obesity. In general, hyperbaric oxygen treatment consists of breathing 100% oxygen while inside a dry treatment chamber that is pumped to a pressure higher than you are breathing now.

Hyperbaric oxygen treatment is used to treat two kinds of scuba diving accidents - decompression sickness and air embolism, which can result from rapid pressure reduction if you come up too fast. Hyperbaric treatment has also been found effective for treating wounds that do not heal because they do not have enough oxygen, certain infections of problem wounds, diabetic ulcers, and other conditions to be covered in future posts.

Hyperbaric oxygen is a documented modality in treating problem wounds which have a poor blood supply (are hypoxic). Bringing additional oxygen to the deprived area makes the body better able to repair itself. There is no current evidence that hyperbaric oxygen speeds healing of normal injuries, sore muscles, or that it improves physical ability. In sports injuries there is no lack of oxygen. Often the opposite problem occurs. For example, an area that is hot and swollen may have plenty of oxygen and blood supply. Adding more oxygen would not make it heal faster. There are occasional debates about using treatment chambers for athletes. As evidence becomes available, I will add it here. There is heated debate whether hyperbaric treatment is applicable to conditions such as vascular headache, brain injury, neurologic conditions, and others.

For a sick patient with problem wounds, diving injuries, carbon monoxide poisoning, or gangrene, hyperbaric treatment can be life and limb saving. Regarding athletes who believe it will make them a better athlete, and feel they should use hyperbarics regardless of hard evidence, there are minor side effects to hyperbaric treatments. Without the ability to heal regular muscle soreness or improve athletic performance, the side effects would not be helpful, and could be potentially detrimental to the athlete.

See books about hyperbaric chamber treatment, and becoming credentialed on my web site books page, www.DrBookspan.com/books.

Labels: fix pain, hyperbaric, injury, martial arts, performance enhancing modality, scuba

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Thaipusam - Exercise of Body and Spirit

At the end of January, I posted about the celebration of Thaipusam. Readers have been e-mailing, asking for photos and stories about our work there studying the devotional piercing, and the medicines, exercises, and nutrition practices done to prepare for, and heal from the festival.

Thaipusam is a Hindu celebration of deep devotion (bhakti) and thanks to Muruga (also called other names including Subramaniam), the son of Shiva. Thaipusam is celebrated in many places around the world, with the largest observances in India, Singapore, and Malaysia.


For more than a month before the full moon in the Tamil month of "Thai," the faithful begin mental and physical exercise and preparation. They eat vegetarian food, eat sparingly, pray, do acts of kindness and good deeds, exercise, wash, use medicinal incense, say kind and positive things out loud, refrain from bad action, and from smoking and alcohol. They say that these practices improve their physical and mental endurance, and reduce infection or scarring from the devotional piercings.


This year, in Kuala Lumpur Malaysia where we studied the festival, there were over one million devotees at the Batu Caves. Two nights before Thaipusam, the faithful begin an overnight fire-lit procession from the Maha Mariamman Temple in Chinatown to the Cave, 15 kilometers away, an 8-hour journey. Many carry pots of milk symbolizing purity and life-giving, flowers, fire, and other offerings.

The faithful make an enormous celebration of happy song, drumming, dance, the air filled with the smell of incense and flowers, and chanting "Vel Vel! Vel Vel!" A Vel is a symbol of the lance given to Muruga by his mother, to win in the battle of goodness over evil.

Muruga is regarded as a destroyer of evil and preserver of good. He is usually depicted with a vel (lance). For that reason, in the Thaipusam celebration of thanks to Muruga, silver or steel vel in various sizes are pierced through the skin of the back, cheek, and tongue, a symbol of stopping evil, purifying yourself, and becoming more noble.

As devotees entered the festival grounds, many shaved and painted their head with herbs as a sign of pure thanks.

At Batu, there are 272 steps to the top. On the trip upward, a holy man, dancing each step one by one, turned to me and with three fingers daubed my forehead in a traditional triple stripe of Vibhuti sacred ash from his own forehead as a gift to me. He laughed then "doinked" my forehead with one finger and pronounced that I had a good third eye, and the sacred ash would keep it awake from then onward.


A highly devotional rite is carrying the Kavadi. We took the photo below of a kvadi-bearer, dressed in devotional yellow, pierced back and chest with vels. We have since seen this man's photo in the Wikipedia article about Thaipusam. He was a representational figure, that was certain. We got to talk with him and his family. We didn't want to interfere with anyone during their intense personal prayers, and tried to move out of his way through the packed bustling throng. But he stopped and smiled at us. A young man with him whipped a cell phone from his shorts and took *our* photo, click click! He called to me, "Hello Auntie!"


Many devotees there stopped to answer our questions about their lives, and to ask about ours, and to ask to take their photo with us - the funny tall foreigners.


Many of the faithful perform acts of thanks for a specific blessing received. This year in Penang, a man who prayed to heal an injured leg and recovered, walked the entire way to the festival on shoes made of nails.



The idea is not masochism (or reinjury), but showing outwardly and inwardly that the benefit received was far greater than the self-sacrifice given in return. The piercings aren't meant as a violent act, they are "only by expert hands" and a sign of will power, concentration, and piety. There are tourists who attend for just the festival day and try piercings as a stunt, or sometimes, to better understand the meaning of the festival and the thanksgiving it teaches.

The claims for the sacred ash is that its use prevents pain, bleeding, scarring, and infection. Part of what we found is that it naturally contains a styptic, similar to the shaving pencil that constricts blood vessels to stop shaving cuts from bleeding. It also contains natural local numbing and antimibrobials similar to clove oil. That's as far as we could go in studying that particular ash. Our bags of it were confiscated at the airport by United States TSA agents, along with all my wasabi paste and research notes on that and other work while there. I will post more in the future about these kinds of medicines, which are used in modern day patches and creams for muscle soreness.

More than just the chemical nature of the sacred ash, the weeks of preparing through physical exercise, nutritional improvement, daily mental exercises, and the great kindness of the family and friends supporting the kvadi-bearers go toward quick healing.



Do happy things, praise others, exercise a bit every day, eat things that are good for you and the environment. These things will prepare you to be strong in all you do.


Photos copyright by Jolie and Paul

Labels: holiday, injury, performance enhancing modality, spirit

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Rocky IV and Head Injury

The BBC news reported this week that, Kickboxing 'causes brain damage.' The news story stated that a recent study showed: "Kickboxing can cause damage to the part of the brain which controls hormone production." However, it is not kickboxing, but receiving blows to the head.

Recently I posted about the fun exercise training in the movie Rocky IV - Rocky IV and Healthier Exercise. After training to become healthier and stronger, the movie depicts Rocky sustaining severe head strikes as a symbol of determination or disciplined fighting ability. It is higher fighting skill not to receive these hits. It is hopefully not a surprise that it is also healthier not to get hit in the head.

The Turkish study that the above news item was based upon compared pituitary hormone function in twenty-two kickboxers who had boxed in national and international championships (16 men, 6 women) compared to controls of the same age who did not box. Levels were lower in the kickboxers (Tanriverdi F, Unluhizarci K, Coksevim B, Selcuklu A, Casanueva FF, Kelestimur F. Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism. Clin Endocrinol (Oxf). 2007 Mar;66(3):360-6). A previous study by the same group found the same results in eleven actively competing or retired male boxers (Kelestimur F, Tanriverdi F, Atmaca H, Unluhizarci K, Selcuklu A, Casanueva FF. Boxing as a sport activity associated with isolated GH deficiency. J Endocrinol Invest. 2004 Dec;27(11):RC28-32).

Studies like these, that compare groups, cannot tell if boxing lowered the hormone levels without measuring a "before and after" or including number and severity of head strikes sustained. Without more information, these studies would not be able to conclude if the boxing caused the low levels, head strikes caused the injury, or it was the case that the people started out with low levels then became successful competitive boxers. However, it is documented in the literature that head blows that lead to traumatic brain injury produce anterior pituitary dysfunction (Agha A, Rogers B, Sherlock M, O'Kelly P, Tormey W, Phillips J, Thompson CJ. Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab. 2004 Oct;89(10):4929-36). The previously mentioned Turkish researchers had earlier reported on a case study where they observed a boxer who received a head strike then suffered specific anterior hormonal effects (Tanriverdi F, Unluhizarci K, Selcuklu A, Casanueva FF, Kelestimur F. Transient hypogonadotropic hypogonadism in an amateur kickboxer after head trauma. J Endocrinol Invest. 2007 Feb;30(2):150-2).

Previous studies looked at neurophysiologic and neuropsychologic function and did not find long term damage in these areas (Haglund Y, Eriksson E. Does amateur boxing lead to chronic brain damage? A review of some recent investigations. Am J Sports Med. 1993 Jan-Feb;21(1):97-109) so it is new and helpful to localize that hormonal damage may be occurring from head blows.

Growth hormone is one of the hormones affected. The post Human Growth Hormone shows how it works and how to boost your own levels naturally and safely.

Aerobic kickboxing is not the kind of kickboxing where the studies are finding brain damage. The issue is strikes to the head and subsequent brain damage. Blows to the head can happen in any contact-style martial art, not just kickboxing. Head injury is also an in issue in motor vehicle accidents, falls, and domestic violence to family members of any age.

I will write soon about avoiding head injury in boxing and fighting arts, and other exercise. I am glad that the top competitors I faced in the ring didn't manage to land any head blows during my own full-contact martial arts and kickboxing bouts (or none I remember :-). To their credit, they managed other worthy hits. It is still not known what damage choke holds may produce, and is a topic of ongoing investigation.

The idea of the martial arts is to get out of a fight not into one. Fighting arts, as sport or entertainment, can be done, and won, without permanent damage to the other person, if all understand and fight for a greater good.

"To win one hundred victories in one hundred battles is not the highest skill. To subdue the enemy without fighting is the highest skill."
- Sun Tsu, The Art of War

Related Fitness Fixer:

• Headache From Head Position
• Fast Fitness - Hidden Source of Groin Pulls
  
• Fast Fitness - High Core Strength For The New Year
• Rocky Movie Computer Fight Simulation
• Human Growth Hormone
• Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
• Is Bad Martial Arts Good Exercise?
• Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique
• Grunting and Exercise
• Muay Thai in Her 90's
• Black Belt Hall of Fame 2008

Book:

• Effective, fun exercise, stretch, and improvement for body and mind, performance enhancing foods and drugs, avoiding injuries: Healthy Martial Arts.

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Labels: injury, martial arts, mind, movie/media fitness, performance enhancing modality, spirit

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Are Your Shoes Too Tight?

It is often taught that tight or snug shoes are needed for "support." However, tight shoes are not healthy for many reasons, or even needed. The posts Arch Support Is Not From Shoes and Which Shoes Help Exercise, Fall Prevention, and Ankles? explain more about the myth that support is from shoes.

Shoes worn snugly "for support" cause frequent problems. If your toes fit together like puzzle pieces or do not face straight ahead, as in the photo at left, it is likely that you frequently wear shoes that are too tight.

There should be space between each toe, and each toe should face straight forward, not turned toward either side (photo below right).



If you need toe separators (a soft foam device for separating toes) to paint your toenails, your toes are too tight and bunched together. Toes that are bunched together need regular stretching to separate them. Take your toes in your hands and gently pull them apart. Some of my patients use those toe separators to wear to bed. That is all right to start, but instead of only treating the result of a tightness problem, it is best to correct the problem with simple stretching before deformity progresses to the point where it is difficult to fix:

• Pull your toes away from each other with your hands.
• Straighten each toe gently.
• Make sure all toes separate and can wiggle.
• Practice wiggling your toes.
• Don't wear shoes that push your toes together or keep them from moving.
• Avoid tight socks and stockings - "tight" is anything that presses your toes together.
• When standing, don't tighten or clench your toes against the floor or each other. Don't press toes into the ground to balance so much that they buckle and bend. Keep your weight distributed over your entire foot, including your heel. Notice if you rock forward to the ball of your foot when standing.
• Take off shoes and all hosiery every day and let toes get sunlight and air.
• When you exercise and walk, make sure you do not walk "toe-out." Turning the feet outward, sometimes called "duck-foot" used to be thought the normal direction of the fibers and muscles. Now it is known that both feet should be able to comfortably face straight ahead.

Toes do many wonderful things for balance, walking, ability to jump and move quickly, for the shock absorption important to your hip, and more. See the post Healthy Toe Stretches for foot stretches. The next post will give fun stretches specifically for tight toes.

Labels: feet, fix pain, gait, injury, shoes, stretch, sunlight, toes

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No More Ankle Sprains Part II

The previous post How To Treat Ankle Sprains and Prevent Them promised another effective technique on the missing link in preventing and rehabbing ankle sprains in today's post. It follows below. First, it made news yesterday that a well known name in spine research, Stuart McGill, found what I have been saying for nearly 30 years of my research career - that tightening the abs and "sucking them in" inhibits healthful movement, and using the popular "draw in the abs" technique is making yoga and Pilates classes the sources of more back pain and problems. The post What Abdominal Muscles Don't Do - The Missing Link shows why crunches and Pilates are not the best exercises for core muscles, and the comment replies to Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain give more links on how abs really work. The next post will cover the news from Dr. McGill and my years of research of what works the abdominal muscles in healthier ways instead.

So today you get two breakthrough fitness posts in one. Now the promised second fun thing to do for more stable ankles. Maybe you never sprained your ankle but wear supportive shoes thinking that will keep you from sprains. Maybe you've sprained your ankle in the past, and rested it and keep it braced during activity thinking that will help, and did ankle exercises, usually consisting of "spelling the alphabet" in the air with your foot or using resistance bands. The "exercises" often do not prevent repeat sprains, leading people to think that exercise will not help and only bracing will "support" an ankle. Rest and bracing often make things worse - the numbers show many repeat sprains in people following this method. Why?

The missing link is receptors in your ankle that sense if you are standing straight on your ankle or if your ankle is bending outward, a movement called inversion. In an inversion sprain, the bottom of your foot turns toward the other leg and your ankle bends too much, overstretching or tearing the connective ligaments. Inversion is the most common source of sprains. There are two common beliefs in medicine - that strengthening will help prevent sprains, and that strengthening will not help. Both points of view are missing that preventing sprains requires something else - training the receptors that tell you if you are about to invert. This sense is called proprioception. Without it, the ankle does not send signals to your leg muscles to prevent you from turning it. With proprioception training, you learn how to sense ankle position and balance to keep it from inverting. Allowing inversion when stepping up or down is surprisingly common, even in people who exercise frequently. No wonder they get sprains. The last post showed the interesting proprioception drill of rising to toes while not allowing your ankle to invert. Try that first, then try this next step:

1. Rise to tiptoe and lower to full foot, keeping your ankles straight without allowing your weight to shift over your small toes. Keep weight over your big and second toe. Repeat at least 10 times.
2. Work up to rising to toe and lowering on just one foot (good for balance).
3. Work up to careful jumps, first coming down on both feet, then on one foot. Each time, land with your weight centered over your big and second toe, not turning your ankle outward, then roll gently down until the whole foot is one the floor.
4. Use the above stabilization technique each time you step up or down from anything, including stairs and curbs.
5. With this practice, you can train your ankles to deliberately hold healthy position with each foot-fall, reducing your risk of sprains, instead of letting the ankle turn outward.

Related Fitness Fixer:

Unhealthy Yoga Ankles
and
Better Hip Stretch - Check Your Ankles
show a common way that people predispose themselves to sprains by overstretching ankle ligaments without knowing it, and how to prevent it.

Coming Next:

Why Using Abs Is Not Tightening.

Labels: ankle, balance, feet, gait, injury, sprain, yoga

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How To Treat Ankle Sprains and Prevent Them

The post Which Shoes Help Exercise, Fall Prevention, and Ankles? showed why you don't need high top shoes, or arch supports, or orthotics to prevent your arches and ankles from sagging inward (pronation, arch flattening, or flat feet). You can quickly train your ankles and feet to hold straight stable position using your own sense of positioning that comes from receptors in the muscles and connective tissue around your ankle and foot. The post Arch Support Is Not From Shoes gives a simple retraining to restore healthy comfortable arches and prevent the pronation that can cause knee, hip, ankle and foot pain. It's easy, built-in exercise-as-a-lifestyle.

What about feet and ankles that turn the other way - bending outward, not inward, at the ankle so that you may turn your ankle causing a fall or sprain? What if you already have sprained your ankle and want to get back to activities and prevent future sprains? The same simple principle applies. Using easy positioning training, you can teach your ankles to sense when they are turning too much to the outside, and quickly send signals to your ankle, foot, and leg muscles to straighten your ankle and prevent a sprain. This works well, even with damaged and overstretched ankle ligaments, and is key to rehabbing a sprain.

Wearing supportive shoes, an air cast, splints, taping, and elastic bands to brace an injured ankles is a common practice that perpetuates weak, unstable ankles because these devices prevent sense of balance and positioning. Wearing these things to "support" non-injured ankles for hiking and walking is just as bad. Within only one day of wearing an ankle brace, whether you have a sprain or not, balance is quickly diminished. You can put a healthy person in an ankle brace and test their ability to stand on that foot without the brace at the end of one day and find they are less able to balance and more likely to tip over. This problem compounds each day a brace is worn.

The missing link in ankle rehab and the reason for so many repeat sprains is staying in the bracing and not doing enough balance and positioning retraining after the last sprain. This is why resting an ankle, bracing it, and reducing activity can make things worse. It is also the reason why the usual ankle strengthening exercises have not been working, and people keep spraining their ankles despite strengthening exercises. The issue in ankle sprains is not as much strength as sense of positioning, called proprioception. You need simple and easy-to-do proprioception exercises. Would you like to try one?

1. Stand up. Keep both feet facing straight ahead, not turned out.
2. Rise up on tiptoe. Notice if you allow your weight to teeter over the small toes, tipping your feet and ankles outward. That is the poor positioning and lack of the stabilization that allows your ankle to turn in the outward direction that allows sprains. You don't want this bad positioning to occur any time you are walking, hiking, jumping, dancing, or moving in any way. Not even when sitting.
3. Shift your body weight over your big toe and second toe. Don't let your ankles sag inward or outward. Hold your ankles straight.
4. Hold standing up on tiptoe with straight, good positioning as long as you can. You can practice this on the phone, or when doing dishes or laundry. Make sure you use it in real life activities whenever standing on your toes to reach and lift.

Next: More fun ankle proprioception retraining to rehab ankle sprains and learn to prevent future sprains - No More Ankle Sprains Part II.

Labels: ankle, balance, feet, fix pain, injury, orthotics, pronation, sprain

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Why So Many Aerobics Injuries?

A recent New York Times article quotes aerobics teachers and devotees saying they now have painful, chronic injuries from years of aerobics classes. Why did this happen?

I receive frequent e-mails from aerobics instructors, many only in their 20s and 30s, saying they are too old to continue teaching because of pain and injuries from teaching. I am older than their parents. At the schools and clubs where I teach classes, teachers and trainers are often absent, or replaced, because of herniated discs.

The Times article quotes major aerobics spokespeople, attributing the injuries to jumping on "concrete floors in bad tennis shoes," and related how former well-known-names in the aerobics industry now teach low impact classes. The article continued, "A lot of people doing aerobics back then can no longer do any jumping whatsoever. They have problems with their backs, feet and hips."

Conventional "impact activities" are not the problem.

• In the years I spent in the lab studying injuries, seeing patients, and teaching students, I have found that the problem is not that impact must be avoided. I see patients who are instructors of Pilates, stretch, yoga, rowing, martial arts, and Alexander technique for degenerating joints. It is simple misuse.
• It is not that people are doing the exercises "wrong" but the movements themselves.
• If you saw someone bend over at the waist or hips to hoist a suitcase or child, you know it is bad bending and it hurts the back. The same people will bend over the same way to lift weights in a gym or do yoga stretches. It is the same disc-injuring bending in all cases.
• The post Common Exercises Teach Bad Bending gives interesting examples from a class that is "low-impact." Wear occurs on the lower back and neck discs regardless of how expensive and engineered the aerobics shoes.
• The post Are You Making Your Exercise Unhealthy? shows you how to put the knowledge of bad positioning together in your mind with how people are exercising, to realize it is not rocket science when people have pain, even though they "do their exercises."

You can run, jump, walk without jarring impact

• Many people walk with higher impact than a good martial artist will kickbox.
• Many people are unnecessarily restricted from favorite sports and told to walk instead, based on the fallacy that running or tennis is necessarily higher impact, instead of looking at how heavily they clomp around letting spine, hips, knees, and ankles sag and grind.
• One story with helpful links is told in You Can Fix Your Own Knees.
• Another is Walking Softly Benefits Olympic Wrestler
  

What about body weight?

• Many of my obese patients with knee pain stand and walk with their knees in sagging positions. This is not a consequence of their body weight.
• When I show them to simply hold their knee from knocking inward (or outward) by using their own muscles to hold straight, the pain quickly goes away. They say that they can then, for the first time, *do* any real exercise to lose weight.
• Lightweight people can have the same knee and other pain. They may move heavily without good shock absorption or hold joints in angled painful ways.

The post When Did Health Become Thinking Out of The Box? explains more of why you don't have to have pain from exercising or even long sitting while studying (or watching TV). I don't take people away from their favorite activities when injured. I even use their sport as rehab, showing them how to do it in healthier ways so that they can do more, lift more, and run more than before, not less. Health care should not be "Limit to the patient to limit the pain."

Read Inspiring Patient Stories on my web site - how patients fixed their own pain and could do more than before.

Labels: ankle, disc, fix pain, hip, injury, knee, martial arts, planter fasciitis, shoes, yoga

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Unhealthy Yoga Ankles

Just as there are foods that are bad for you, and just as some common medicines have side effects to make you sicker instead of better, there are several yoga moves that injure directly or predispose you to later injury. This is true, not just for people who overdo the pose, or who are inexperienced, but because the move itself is inherently unhealthy.

When you sit cross-legged, don't let your ankles turn upward, as in the left-side photo, above left. By turning the ankle, you diminish the stretch on your hip and inner leg muscles, and put an unhealthy stretch force on the outside of your ankle. The outside of the ankle is not supposed to stretch much; it is supposed to hold your ankle straight so that it does not turn when you stumble. Overstretching the outside of your ankle is one of a few bad habits that predispose you to ankle sprains. Future posts will cover more on stopping ankle pain and sprains, and will give fun ways to strengthen your ankles. For now, try this when sitting cross legged:

• Straighten your ankles, as in the right-hand photo above. Preventing the bending will stop overstretching the outer ligaments and you will get more and better stretch in your hip. The hip stretch is better because the turning of the leg has to come from the hip, instead of keeping the hip raised and tight, but bending up from the ankle.
  
• Sit upright and straight. Don't round your back, not even a small amount.
• Lift your chest to sit straight instead of sitting rounded.
  
• If your hip is so tight that you cannot comfortably sit upright and straight, put both hands behind you to lean your weight on your hands and push yourself upright (right photo, above).
• You will feel more stretch, and practice better habits by sitting up straight than by leaning forward with your back and shoulders rounded.

If you get recurring ankle sprains, check to see if you are ensuring that your problem continues through the bad habit of overlengthening the outside of your ankle. Check if you sit poorly to do this stretch with your back rounded and hip curled under because you are too tight to sit in a healthful position. Sitting rounded puts huge herniating force on the lumbar (lower back) discs. Putting your hands behind you to straighten you takes weight off your lower back discs, and gives you a good hip stretch as you regain straight positioning.

As more people try to fix their health problems through medical exercise programs and yoga classes, it is good to make sure not to do things that make new health problems and perpetuate old ones.

Photos from the book Healthy Martial Arts

Labels: ankle, injury, sitting, stretch, yoga

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Forensic Science

Last weekend we visited the Siriraj Forensic Science museum in Bangkok (pronounced Silly-lot). Forensics is the science of crime. Why are we here?

I am the science officer for the Vidocq Society (pronounced Vee-doc), an international forensic think-tank for solving cold case murders. The Vidocq Society is named after the eighteenth century French detective Eugène François Vidocq, who is considered the founder of modern criminology. Vidocq was a former fugitive and police informant, and expert in surveillance and disguise. In his career-reversal, working in crime prevention, Vidocq was the first to make plaster casts of foot and shoe impressions, and introduced record-keeping and the study of ballistics into police work.

The Vidocq Society allows 82 members by invitation only. As the science officer for the Vidocq Society, my job is to make sense of some of the physiology and facts about the body used (and often not used) in forensic investigations. Real forensics is not like television forensics and often techniques shown on television are exaggerated, applied incorrectly, interpreted badly, or just false. Part of my job is to learn enough to help make sure we don’t do the same in real life.

It is important to check things, even if accepted as fact. For example it is not true that you can tell when someone died from their body temperature or stiffness. You can’t just check the books. Many of the most held old fallacies, were things we learned in school and from forensic books. Health and fitness is like that too. We just need to look a little further to learn how things really work.

Photo by 13bobby

Labels: forensic, injury

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Upper Back Exercise and Neck Pain Prevention Too

Western boxers and students of many martial arts are often taught to hunch their shoulders and lower their head to protect their neck. Box-aerobics students (and teachers) also often jut their head forward thinking it looks tough, or more authentic. It doesn't protect the neck as hoped, and conversely produces neck and shoulder problems, some immediately, others over time. It also reduces effectiveness of the punching exercise, and to people who know martial arts, it doesn't look tough, it looks weak.

Look at the photo at left. The student on the right is holding his head severely forward (orange arrow). The teacher at right in the foreground is holding his neck and head properly, relaxed and upright (white arrow). The teacher and student in the background also are holding their neck in position that is healthy for the neck and shoulder, and makes punching more effective.

What are some of the problems of forward head angle and hunched shoulder?

• Keeping your head forward brings it closer to your opponent, easier to hit.
• In case of a head strike, a tilted angle of the neck to the brain and skull is more likely to result in brain injury.
• Hunching the shoulder can injure the neck and shoulder muscles
• Hunching results in tight, aching neck and shoulders.
• When you keep your head and shoulders forward, it rotates the shoulder bone forward. When you raise your arm with your neck forward, the soft tissue of the rotator cuff gets pinched between the arm bone and the shoulder bone. Eventually the bones can saw away at the rotator cuff muscles trapped between them, enough to get a tear.
• The same pinching between shoulder and arm bone can compress the nerve(s) that go down your arm, resulting in tingling, pain, numbness, weakness.
  

All the above problems can easily stop and reverse when you stop the cause - the forward head angle and hunched shoulder. Start with the post Fixing Upper Back and Neck Pain.

The muscles you use to hold your head and neck upright instead of forward are your upper back and posterior shoulder muscles. It is a free upper back and posterior deltoid and shoulder workout by standing relaxed but straight, and exercising that way too.

When you watch movies of Mohammed Ali fighting, watch for his healthy, straight, graceful neck positioning. For doing martial arts and boxing aerobics, you can protect your chin and brace your neck without hunching and injuring your neck and shoulder. For exercise classes and just moving around the house you get more upper back exercise and stop injuring your neck and shoulder all at the same time by using your muscles to hold yourself upright instead of sagging. Stop neck injury from exercise. Exercise is supposed to be healthy.

More From Fitness Fixer:

• Is Bad Martial Arts Good Exercise?
• Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique
• Improve Stretch and Strength With Better Kicking
• Muay Thai in Her 90's
• Muay Thai Monks on Horseback
• Rocky Movie Computer Fight Simulation
• Rocky IV and Head Injury
  
• 2006 Black Belt Hall of Fame - Black Belts and Black Tie
• 2006 International Martial Arts Association Weekend
• 2007 Black Belt Hall of Fame

Labels: fix pain, injury, martial arts, neck, partner exercise, posture, shoulder, spirit, upper back

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Improve Stretch and Strength With Better Kicking

Thai boxing (Muay Thai) kicks are among the most devastating and effective kicks in the world. Thai fighters spend hours a day kicking heavy bags and posts, and years toughening their legs and shins for kicks and blocks by bashing them with pipes and against coconut trees. A blow from a Muay Thai fighter's leg is like a blow from a club.

When you practice moves that lift the leg for martial arts training, for self-defense, for dancing, or for exercise in an aerobics class, watch for several bad habits that increase strain on muscles and joints, and reduce effectiveness of the kick. It is not the point to kick someone else and wind up injuring yourself.

1. Look at the photo, above left. The teacher is holding his hip and neck straight. The blocking student is not. The orange arrow at the student's leg shows how, when the student lifts the left leg, the right leg pulls forward instead of remaining straight at the hip. This is a sign of tightness at the hip and poor technique. He needs to stretch the front of his hip and retrain kicking and blocking technique to prevent this common bad habit. Read more on this in the posts, Is Bad Martial Arts Good Exercise? and Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs.

2. Next, check the white arrow at the student's belt line. It is tilting up in front. The teacher's hip remains level as the leg is raised. Curling the back and letting the hip roll under, as shown by the white middle arrow is another sign of tight hip muscles in the front and back of the hip, and poor movement habits. When you raise one leg to kick, block, prepare to kick, do a knee strike (whatever), check if you curl your hip or round your back. Hold your back straight and upright for more exercise, a built-in hip stretch, and more effective technique.

3. Third, note the black arrow showing how the student rounds the upper back and neck forward, instead of holding straight. With practice, the student will learn to hold the neck straight as the teacher is doing.

For all the exercise you do (kick, block, ascending stairs, whatever is done raising one leg), keep healthful positioning. Yes, rounding the back is taught, and done for fighting, but you will be beating yourself up in the long run. You can still be an effective fighter and at the same time, prevent hurting yourself with common strains from unhealthful technique, plus get more exercise with healthier ways.

Previously:

• Thai Boxing

Related Fitness Fixer:

• Fast Fitness - Hidden Source of Groin Pulls
• Fast Fitness - Don't Shorten Hip When Stretching Hamstring
• Black Belt Hall of Fame - Black Belts and Black Tie
  
• Muay Thai Monks on Horseback
  
  

Labels: disc, fix pain, hamstring, hip, injury, knee, leg strength, leg stretch, lower back, martial arts, neck, partner exercise, posture, shoulder, spirit, upper back

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Safer Overhead Military Press

Two weekends ago we were in Virginia on a medical consult with colleagues. One of the docs is an osteopath and collegiate team doc who really knows his orthopedics. I enjoy our discussions of the best techniques to retrain healthy muscle use. He mentioned that he discourages his team members from the overhead military press (lifting weight directly overhead with both arms). He mentioned the frequent, serious shoulder and neck injuries this exercise often produces. The numbers show that he is correct.

I asked his opinion on my view that these injuries usually only occur when allowing mal-positioning, such as the forward head and rounded shoulders, and overarching the lower back. Read how these positions produce injury in the posts Breasts Causing Upper Back Pain is a Myth and Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.

My colleague reminded me that the military press is not usually functional, which means that except in cases like my carpenter husband Paul who lifts substantial objects overhead all day at work, people do not lift overhead for daily life. Given the large number of injuries the overhead press causes, he'd rather people strengthen in other, more functional ways.

It is true that most lifting overhead is not directly over the shoulder, as in the military press. However, most people need to lift things overhead as part of daily life, and often use the overhead press during recreation, as in the photo, at right.

Here is how to do the overhead press in ways that I believe can keep it healthy, and how to transfer that healthy positioning to lifting laundry, groceries, babies, and other daily weights:

1. Before doing lifting, use the quick check in Thumbs Can Show Tightness That Leads to Upper Back Pain.
2. Do the pectoral stretch described in Fixing Upper Back and Neck Pain.
3. Make sure not to arch your lower back to lift your arms, as explained in Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain

Keep your shoulders down and your chin in, then lift. By keeping head and shoulder position from drooping forward, you will prevent the shoulder bone from squashing your rotator cuff and other soft tissue when you lift your arm. Use the healthy shoulder, neck, and lower back, positioning in #1,2, and 3 (above) for every overhead lift, from pulling off a shirt, to putting away groceries, to lifting children, putting things on shelves or overhead racks, to lifting weights. You will get better exercise and prevent injury.

Labels: arm, injury, lordosis, lower back, neck, neutral spine, shoulder, strength, upper back

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Fix Disc Pain Without Surgery

A physician contacted me, saying he had three successful disc surgeries and had slipped another disc. He wanted a consult with me before his fourth surgery. I told him it was like having three successful tonsillectomies. That is not a successful surgery. He had never stopped the reason he was pushing his discs out of place, one after the next.

Surgery for back pain and sciatica is considered by some as a solution, but an alarming number of people have pain that continues after surgery, or their pain stops initially while on pain medications and rehab following surgery, but then returns. The reason is that, except for unusual situations like bullet wounds or tumors, surgery does not stop the root cause of back pain. Because the cause continues, you continue doing harm to your back until it hurts again.

Degenerating or slipping discs are not from aging, or fate, or heredity, or a disease. The term "degenerative disc disease" is a misnomer. It is not a disease process, or a germ, or inherent factor or weakness that makes discs unhealthy. There are external factors, like smoking cigarettes, which contributes to disc degeneration. However, the majority of damage to discs and the soft tissue of the back and neck is usually chronic forward bending that physically pushes the disc outward until it presses on nearby soft tissue and nerves.

Disc damage occurs daily from avoidable bad bending in daily life, unhealthy sitting position, and many common exercises and stretches. Just as not all food is healthy, not all exercises and stretches are healthy, even some of the most common ones in gyms and yoga and fitness studios. The daily harm to your back is usually painless and something you are not aware of doing, until it accumulates, like smoking for years, until one day you get symptoms. The pain may come on suddenly, but was developing over years.

The physician who had the three surgeries, and three discs already removed, had gone back to all his bad bending, lifting, and sitting, and pushed out another disc. If he had stopped the injurious mechanics, he could have let the disc heal. Pain can often stop within days using this method. He probably never needed the first three surgeries. Having a fourth disc surgery will not stop him from going back to the injurious habits that caused the discs to break down and push out of place.

Removing discs, even part of them, means that the cushion and shock absorption between your vertebrae is reduced. This predisposes to early arthritis. A worse situation follows fusion surgery. It is a belief that stopping motion in a joint via fusion surgery will stop pain. But it also stops function. If you want an active life, it is setting you up for more problems. Even if you do not value being active, because fused back bones cannot move when you bend and sit and move, the vertebrae above and below the fused site must move more than usual, squeezing the discs and bones more than they are designed for. Fusion surgery is often a predisposing factor to forcing people into future back surgeries.

I sent the physician my free articles showing, step-by-step, how to stop disc pain. I sent him several of my books for his own use and for his waiting room. I called to follow-up on several occasions, urging him to simply stop the cause of disc injury so that he would not need the surgery. He told me he was not interested and had decided to go for his fourth back surgery. I hope his luck in avoiding surgical complications holds out as well as his good insurance.

The post Common Exercises Teach Bad Bending will get you started understanding common exercises that harm. There are far better exercises to do instead that give you fun, healthy movement without harm to discs. I am not in favor of doing less to avoid pain. I want my patients to have their life back and more. You can do this in fun ways and without surgery.

Labels: disc, fix pain, injury, lower back, neck, practice of medicine, sciatica, sitting, surgery, upper back, yoga

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Studies Say Back Surgery Not Needed

Many back pain patients who come to me say the same thing; that they have gone for several opinions and were told each time that surgery was the only answer. However back pain, even chronic pain, sciatica and disc pain, are simple to stop with quick and non-surgical methods.

News articles are now reporting that back surgery is not more effective than non-surgical methods.

Patients are often told that if they don't have the surgery, they might become paralyzed. A recent New York Times article stated, "Many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded." The Times article quoted Dr. Steven R. Garfin, chairman of the department of orthopedic surgery at the University of California, San Diego, "I think this will have an impact. It says you don't have to rush in for surgery."

More important to your health is what is not being reported. The Times article said, "No one who waited had serious consequences, and no one who had surgery had a disastrous result." It is important to know what is meant by, "no one who had surgery had a disastrous result." It is not considered "a disastrous result" if you go through the pain and fear of surgery and still have back pain, or are worse after surgery. It is not considered "a disastrous result" if you lose your job because of the time lost to surgery and recovery, and your family won't talk to you because they think you're a complainer. It is not considered a "disastrous result" if the medicines given during and after surgery cause problems you didn't have before, or worsen existing problems, and then you are given more medicines to counteract the first ones, each with their small (or large) health drawbacks. It is not considered a "disastrous result" if you get far more out of shape and gain large amounts of weight because you could do less after your surgery, and your overall health declines from it.

There is no national database where people who have the same or worse pain after surgery are counted. There is no clearinghouse where people who get new problems because of the surgery are counted or helped. Often, there is no way for surgeons to know that their patients still have pain years later.

Patients may be referred to physical therapy but as their pain, disability, and misery grow, they "are lost to follow-up." I hear these things every day because these patients show up in my office and e-mail me everyday saying they have no money left and will I please help them. They are at the end of what they can endure.

Exercise programs for back pain often fail because they do not stop the cause of pain. Personal trainers and Pilates instructors come to me all the time as patients with herniated discs because they do unhealthy bending and stretches for their exercise. There are far better exercises and stretches you can do instead. Some of my patients are doctors. Their own doctors said there is nothing else to do but live with pain. People often tell me, "You don't understand, I *HAD* to have the surgery, because of the pain." I do understand, and you can stop the pain without surgery, often better and faster.

1. My posts The Cause of Disc and Back Pain and Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch show you how easy it is to avoid and fix pain from bad discs and sciatica, and give better exercises to do instead.
2. Understand how to stop the root causes of pain in the posts Breasts Causing Upper Back Pain is a Myth and Disc Pain - Not a Mystery, Easy to Fix.
3. Learn why it is not a matter of just strengthening abdominal muscles and realize what abs really do to help your back in What Abdominal Muscles Don't Do - The Missing Link and Change Common Exercises to Get Better Ab Exercise and Stop Back Pain.
4. Read real stories of exactly how my patients fixed pain without surgery.
5. Fix your back pain by Christmas - read Fix Your Own Pain Without Drugs or Surgery

Use The Fitness Fixer every day to change your idea of exercise from a bunch of artificial moves, to real health that is built-in to your daily life. You don't have to have back pain, and you can be stronger and healthier than before - without surgery.

Labels: disc, fix pain, hamstring, injury, lower back, neck, practice of medicine, sciatica, sitting, surgery, upper back

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Healthy Knees

My Tuesday night martial arts students worked hard last night on sweeps, falls, tumbling, and quick recovery to their feet. Each week they also learn a new jump rope technique. They have been getting good at fast skipping, crossing the rope in multiple spins to the front, sides, and overhead, and varied footwork during jumps.

When landing from jumps, it is important not to let your knees knock inward under your body weight (photo at left). It is important for knee health not only when jumping, but descending the stairs, bending for all daily needs, and even getting in and out of your chair.

Letting your weight fall to the inside of your knee joint, instead of holding your weight evenly on your knees using your own leg muscles, adds load and wear to the cartilage on the inner surface of the knee bones, stresses the anterior cruciate ligament (ACL) in the middle, overstretches the ligament on the inner side of the knee, and can damage a meniscus. A menscus is one of two small cushions in each knee between the knee bones. Letting knees sway inward more commonly damages the medial meniscus (the inner one) although either or both can be stretched or twisted by bad knee positioning. Letting your knees sway inward is not a "condition," and not unavoidable or something you are born to have. It is a posture you can control using your own muscles to hold your legs from swaying inward.

A while back I took a box-aerobics class because I had a coupon for a free week at a local club. The woman in front of me was stomping up and down as she swatted the air. Her knees bumped together every time her feet landed. Her feet were at least ten inches apart yet her knees bashed together, over and over, bending inward at the knee joint. It was alarming.

Don't let your knees (or ankles) sway inward under your weight. Use your muscles to hold knees in position, over your feet:

• When landing, land lightly - softly. Don't pound. The only noise should be the whirring of the jump rope, not your feet slamming the ground, transmitting shock to your knees and hips, and up your spine.
• Bend your knees lightly when you land. Don't land straight-legged.
• When you bend your knees for landing, don't let them sway inward.
• Keep kneecaps facing the same direction as toes, not twisting inward.
• Land softly, on the ball of the foot first. Quickly bring heels down while bending knees to absorb impact.

Remember healthy knee positioning during all activities. Look at your own knees and other people's knees when they take the stairs, and when bending to reach or retrieve things for healthy bending at home and work. Notice knees when you get out of your chair and sit back down. Don't let knees sway inward. Hold them in line using your thigh muscles, not letting them angle sharply inward.

It is easy to control leg positioning for healthy knee joints while you stand, bend, take stairs, exercise, and jump so that your daily life and exercise is healthy.

• More on keeping knees healthy during exercise, in the book Healthy Martial Arts and Fix Your Own Pain Without Drugs or Surgery

Labels: aging, ankle, arches, fix pain, injury, knee, leg strength, martial arts, orthotics, posture, pronation, strength, stretch

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The Cause of Disc and Back Pain

A UK Times article featured a physician musing that as medical students they were not taught in school to identify the cause of medical problems, but to treat symptoms (and give electric shocks to decerebrate frogs). The cause of the problem would still remain.

He mentioned how you may go to the doctor with painful tonsils, and be given a "diagnosis" of tonsillitis. He educates the reader that "Tonsillitis, for example, is not a disease but a symptom - of something else that caused the tonsils to be infected." He continued with how you may go to the doctor with pain down your leg, and be given back a "diagnosis" of sciatica, which just means "pain down the leg" but not what is causing the sciatica. A disc may be pressing on the nerve, but what is making the disc press? The sciatica and the bad disc are the symptoms. They are not the cause. Unfortunately, he stopped there, and for treatment said to go back to your activities with light rest. Nothing about what caused the disc to degenerate (break down) or protrude (herniate or slip) in the first place.

Understand The Causes:

1. Bad sitting and bending are main causes of disc degeneration and herniation.
2. Rounded sitting (photo on left) compresses the space between vertebrae in front and opens the space between them in back and squeezes the disc gradually backward into that space.
3. Bad bending (right) levers the weight of your upper body plus whatever you are lifting onto your lower back discs, whether you keep your back straight or rounded.

Strengthening your back will not stop you from sitting and bending wrong. Stretches or massage that feel good for the moment will not stop you from sitting and bending in the way that rounds the spine forward, pushing and squeezing the discs until, finally, give break down and squeeze out to the back (herniate).

A bad disc is not the diagnosis. It is not the cause of the problem. It is the result of what is causing the disc go bad.

You can treat the disc pain with pills, exercises, massage, and shots, but not remove the cause. When you continue the cause, the pain often comes back. You can undergo surgery to remove the disc, but of you do not remove the cause and continue injurious sitting, lifting, and bending, you continue harming your other discs.

What to Do:

• To stop the damage, stop the cause. Then it can heal.
• Main causes are bad forward bending and sitting. The post Disc Pain - Not a Mystery, Easy to Fix explains.
• The post Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending shows simple healthy bending.
• The post Are You Making Your Exercise Unhealthy (and several others) shows how to easily fix unhealthy sitting.

Labels: fix pain, injury, leg strength, leg stretch, lower back, posture, sciatica, sitting, squat, upper back

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How Often Should You Be Healthy?

A reader thoughtfully sent in the photos at left to help readers recognize unhealthy bending, and asked, "What is your advice when someone is having to bend to put dishes in the dishwasher? It just seems so uncommon to think to squat while loading the dishes."

There is no better time to bend in healthy ways than your real life. The whole point of fitness as a lifestyle is that your daily life is healthy movement - not to change clothes to do squats at a gym three times a week, then change clothes again, go home, and bend wrong all day. Healthy bending is for every time you bend. How often is that? The post How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending showed how we estimated that you bend an average of 400 times every day for ordinary activities. Why harm your back and miss free exercise for your legs hundreds of times a day?

Most people know and repeat, "bend your knees" if you quiz them on healthy bending. Bending knees slightly, as in the above photos, does not make bad bending healthy. Bending over forward pressures your lower back discs, whether your back is rounded (photo above left) or straighter (above right). You are still bending over and the leverage point is your lower spine. Bending right is simple:

• With feet side-by-side, comfortably apart, bend knees, keeping your torso fairly upright - as if not wanting something to fall from a shirt pocket (right drawing).
• Keep both heels down and shift your weight back to your heels.
• Pull your knees back over your heels. Don't let them droop forward under your body weight. When you shift your knees back, you will feel the effort shift away from your knee joint to your thigh muscles.
• Don't stick your backside out or exaggerate the lower back arch.

Unless you are moving in healthy ways for your real life, it is not a lifestyle and it is not healthy. Healthy bending is easy and life changing. It is free exercise and injury prevention. When should you do it? Each time you want your daily life to be healthy.


To Be Healthy:

The post Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending shows exactly how to make good bending a healthy normal part of your daily life for the hundreds of times you bend.

More photos and description of bad sitting and bending that causes back and disc damage and what to do instead - The Cause of Disc and Back Pain

Check the exercises you do for the same body positioning that would be recognized unhealthy if they were not renamed "exercise" - Are You Making Your Exercise Unhealthy?

Photos of readers using these practices in daily life - Household Fitness in the New Year

Click the labels under this post for all Fitness Fixer on each topic.

Books showing step-by-step good bending and getting built-in lifestyle exercise: Fix Your Own Pain Without Drugs or Surgery, and Health & Fitness in Plain English THIRD edition on my web site books page - www.DrBookspan.com/books.

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Read success stories of these methods and send your own. 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 certified - DrBookspan.com/Academy.
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Photo by Healthline reader
Drawing of Backman!™ © copyright Dr. Jolie Bookspan

Labels: disc, fix pain, hip stretch, injury, knee, leg strength, leg stretch, lower back, posture, practice of medicine, squat, upper back

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Is Bad Martial Arts Good Exercise?

This week marked several beginnings. The equinox began the journey of the sun away from the northern hemisphere bringing longer nights. The festivals of Ramadan, St. Sophia, Navarati and others celebrate origins and understanding. The university semester began, including the full-to-capacity martial arts class I teach on Tuesday nights at Temple U's Center City campus.

When I arrived, students were sitting on the floor waiting. Some sat in bad rounded posture that you know is unhealthy at your desk. They straightened when I asked them to. In past semesters there were students who refused. Once, one stormed out shouting she didn't understand why she had to sit straight when class hadn't started yet. She didn't know that class is always in session.

Students got their equipment - bending wrong to yank weights out of bins. I told them, "Healthy bending. This class is for health." Some didn't understand the connection. Others tapped those still bending wrong, "Teacher says bend your legs." Several looked surprised. One said, "I'm getting leg exercise before class even begins." I told her that class is always in session. I reminded students to use healthy bending at home and work for every time they bend (Disc Pain - Not a Mystery, Easy to Fix). I showed them how to get more exercise by helping others who came in late.

We began stances. Students sometimes have a stereotyped idea, sometimes learned from aerobic boxing classes. They stand with shoulders hunched up, upper back rounded, head and chin jutting forward, and their behind tilted out in back. I mimicked them. They giggled at how bad it looks. I told them, "You don't look tough. You look ninety." It's true that you use shoulders to block some strikes, but you are not supposed to hunch. Don't do things to harm your neck in order to protect your neck. Overarching your lower back so that your behind tilts out in back is a frequent cause of back pain in daily life (Fixing the Commonest Source of "Mystery" Lower Back Pain) and injury when giving or receiving a blow. It's silly to go to boxing class and beat up yourself.

Look at the photo above. It shows terrible positioning that injures, and perpetuates the tightness that causes more troubles. When you lift one leg to kick (or stretch or take the stairs), notice if your other leg pulls forward. That shows tightness in the front of your hip. Instead, stand straight and keep the standing leg from pulling forward. Don't round your body to lift your leg. You will get built-in anterior hip stretch, one of the places you need to stretch most, and prevent several problems that I will cover soon.

The point of exercise is to improve life. It is missing the point to exercise in unhealthy ways, training unhealthy habits. If you are interested in learning how to retrain healthy movement in martial arts or aerobic boxing classes that you transfer to daily life, let me know and I will post more on what my students learn.

Book:

• Healthy Martial Arts - www.DrBookspan.com/books. Winner of the Black Belt Hall of Fame Readers Choice Award.

Labels: hamstring, hip, injury, knee, leg strength, leg stretch, lower back, martial arts, neck, posture, shoulder, strength, stretch, upper back

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Common Exercises Teach Bad Bending

I teach martial arts, yoga, and other classes at gyms on evenings and Saturdays. This morning I watched the class before mine. The music was loud. I remembered the saying "If it's too loud, you're too old."

When you read the following, remember that you already know it injures to bend "wrong," as in the photo at left, with your upper body bent over instead of upright. You know not to pick up a suitcase or child like that. Previous posts explain how that gradually hurts your lower back and discs.

The class ran a circuit:

• They bent wrong to pick up a barbell for ten deadlifts, staying bent over while lifting.
• They put the barbell down wrong (bending over) and ran to do ten toe touches - more bad bending over.
• They ran to do abdominal crunches, rounding their back forward over and over.
• They got up and kicked a target baffle, rounding their back and pushing their chin forward like a pigeon with each kick so that each impact transmitted to their spine.
• They ran across the room, each footfall landing heavily so that each impact transmitted to their knees, hip, and spine.
• Then leg lifts, bending forward at the hip over and over.
• Back to bent-over deadlifts, then alternate toe-touches - bending over and twisting side to side (more pressure on discs than just bending over), then sitting and bringing knees to chest, then deadlifts.
• They bent over wrong to get dumbbells for bent over triceps curls (healthier when done standing upright.)
• Then standing squats by bending the hip forward over and over. The instructor coached them to stick their behind far out in back. This pinches the lower back adding to a second kind of back pain. Posts coming soon will tell more.
• They reclined with feet up, putting body weight on their rounded shoulders to bicycle their legs in the air, and so on, rounding, bending, and pressuring discs and lower back structures for the 45-minute class.
• They bridged up on shoulder and feet, to "stretch the other way" even though it bent their neck forward.
• They ended by hanging forward to stretch and bringing each arm across the front of their body to stretch the back of the shoulder. This is counter-productive. Most people are already round-shouldered from sitting and bending forward all day. The personal trainer outside the room was doing similar exercises.

One of the students said she comes to the class to strengthen because of back pain. The trainer said he also had back pain and that is why he exercises. Hopefully you can now see part of why.

I'm not just an Ivory-tower egghead who wants you to reduce activity, never lift heavy things, or never move quickly or through a full range of motion. Just the opposite. I'm a former full contact kickboxer (undefeated) in the US, the Netherlands, and Thailand. I want to show you how to have a healthier, more fun and active life, where you stop pain and injuries and do more. The exercises I learned in over 30 years of martial arts were all the usual but injurious ones. Many students dropped out with injuries. It was not the martial arts but some of the exercises. But which? I went back to the lab to study until I found why the injuries were occurring and what will train you better than what we were using. If it works better, I want to know and do it.

Watch other people exercising. It will remind you of many things to avoid. Start your way back to healthy movement by noticing what your exercises are really doing.

Related Fitness Fixer:

• Bending Right is Fitness as a Lifestyle
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
• Strengthen Legs Without Knee Pain - Standing Lunge
• Leg Exercise That Helps Your Back - Why The Lunge?
• Fast Fitness - Fixing Yoga Warrior and Lunge Exercise to Neutral Spine
• Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique
• Fixing Discs by Fixing Causes
• Readers Count - Second Missed Cause of Back Pain With Golf
• The Cause of Disc and Back Pain

Labels: arm, disc, fix pain, injury, lordosis, lower back, martial arts, practice of medicine, sciatica, strength, yoga

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Disc Pain - Not a Mystery, Easy to Fix

Discs are tough cushions between your spine bones (left-hand drawing). They are living parts of your body. When you bend forward, the front of your vertebrae (back bones) squeeze closer together. The space between the back of each vertebrae opens. After many years of bad habits of sitting rounded forward, bad bending over forward, and stretching by bending over forward, the discs are forced backward, like squeezing the front of a water balloon (right drawing above). They begin to break down (degenerate) and move outward to the back, also called slip or herniate. Herniation can continue over years until it suddenly causes back pain with one more bad bend, until the disc moves backward enough to touch the nerves going down your leg causing sciatica and other nerve pain, or even press on your spinal cord. This is avoidable and easily reversed.

Discs can quickly heal without surgery, if you change your bending and sitting habits in simple, healthy ways:

1. Sitting. When you sit, don’t round your back. You don’t need an expensive ergonomic chair. No chair makes you sit right. You just use your own muscles to sit right. Make sure you don’t tighten and strain to sit straight. Pull your chair in closer to the desk, and lean your upper back against the seat back. Don’t round forward or push your lower back against the seat. Many seat backs are rounded so that you have to sit poorly if you rest your back against them. Don't let this happen. I will write more about healthy sitting in future posts.

2. Bending. The average person bends hundreds of times every day for daily activities like laundry, kitchen, pets, gardening, children, household chores, and everything else. Check to see if you are bending badly each time, hurting your discs. Check at the gym if you add more forward bending for toe-touches, weight lifting, and exercise class. The post Are You Making Your Exercise Unhealthy? shows some easily missed sources. The post Common Exercises Teach Bad Bending shows more. Bad bending puts herniating forces on your discs hundreds of times every day. No wonder your back hurts.

Here is one way to get healthy built-in leg exercise and stop back pain by bending well for every time you bend to reach things very day:

• Stand with feet side by side, comfortably apart.
• Bend both knees. Keep both heels down touching the floor.
• Keep your upper body upright, as if you don’t want something to fall out of your shirt pocket.
• As you bend lower and lower, peek down and make sure you can see your toes. If you can't, that means you are letting your knees come forward, which shifts your weight to your knees.
• Keep your knees back over your ankles to keep your weight on your leg muscles. Many people won't bend with their knees because it hurts their knees. This good bending stops knee pain too.

With healthy bending habits, you get free exercise hundreds of times a day, strengthen your legs, stop knee pain, and let your discs heal, all at the same time.

Many Fitness Fixer posts tell more about the large contribution of good daily bending, sitting, and moving habits to healthy lifestyle and stopping the source of disc injury. Click the links in this post for more examples and information. Click the labels under this post for all Fitness Fixer posts about that topic, for example, for good bending, click "squat" and "lunge," for healthy sitting, click the label "sitting." For all posts explaining discs or sciatica and how injury occurs and can heal, click those labels.

Labels: disc, fix pain, injury, knee, lower back, lunge, sciatica, sitting, squat, strength, upper back

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Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch

You already know that sitting bent over your desk, steering wheel, and computer is unhealthy for your back. Then you go to the gym and sit bent over to touch your toes to stretch. It is the same bad bending. It is not magically different or healthy because it is called a stretch.

Sitting and leaning forward to touch toes, even with your back straight, is a common contributor to lower back pain. It may stretch your back and legs, but sitting, especially sitting bent forward puts high forces on the discs of your lower back.

The sitting hamstring stretch also practices the same bad bent forward posture that you already are probably overdoing at your computer, desk, and other daily activities. Modern lifestyle predominantly favors being bent forward, overstretching your back and tightening the front of your body until it becomes natural to slouch forward and uncomfortable to stand straight. Lower back discs become increasingly squashed and pressed outward from all the forward bending. It starts feeling “normal” to stand and move with your back rounded in unhealthy position.

Sitting and bending forward is not even the most effective way to stretch your hamstrings, even though it is a common stretch, and has been done for many years. Many things that are common and traditional are also not healthy, like smoking and hostility. Use healthy ways instead. The previous post Healthier Hamstring Stretching shows one easy effective hamstring stretch. Posts to come will show many more.Check back often.

Every day in my Sports Medicine practice, I see patients who are instructors of yoga, Pilates, and aerobics with ongoing back pain from doing bad stretches. They say they need the stretch because their back hurts. Then they learn that much of their pain is from the stretch. When they realize this, they smile, stop the bent over stretches, both sitting and standing. I show them more effective hamstring stretches to do instead. They quickly become more flexible from the better stretches, and the pain stops that they were getting from pressuring their discs and lower back with sitting bent forward. Have fun using your brain for stretching, and putting health back into fitness.

Related Fitness Fixer:

• Are You Making Your Exercise Unhealthy?
• Disc Pain - Not a Mystery, Easy to Fix
• Healthier Hamstring Stretching
• 14,000 Miles on a Bike - Herniating and Fixing Discs
• Common Exercises Teach Bad Bending
• What Does Stretching Do?
  
  

Related Book:

• Healthy Martial Arts - for all athletes, not just martial artists. Healthier smarter training for everyone.
  

Labels: disc, fix pain, hamstring, injury, leg stretch, lower back, sitting, smoking, stretch, upper back, yoga

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Healthier Hamstring Stretching

One of the most common stretches for the hamstrings is bending over from a stand to touch the toes. You already know that bending over with straight legs to pick up a package is unhealthy for your back. Bending over to stretch is just as unhealthy. Forward bending puts large forces on the discs of your lower back, and is not even a highly effective stretch for your hamstrings. Bending over to touch toes is a common contributor to back pain, whether you keep your back rounded or straight. I will show you more about exactly why in future posts.

Instead of bending over to stretch, or standing with one foot propped up on a bench or chair, an effective way to stretch the hamstring is to stand facing a wall and press one heel against the wall at about hip height.

• Keep your standing foot straight, not turned out; not even a small amount.
• Look down and see if your standing foot is facing straight ahead.
• Move your foot so that it is straight, or you will lose the stretch. As soon as you turn your standing foot straight, you will feel the stretch improve.
• Lift your chest and stand straight.
  
• Don't let your hip curl under.
  
• Smile and breathe.
  
• Hold a few seconds and switch legs.
  

Stretching is supposed to be healthy. When you stretch, don't practice bad posture habits by rounding your back, and don't practice things you know aren't healthy like bending over so that your body weight hinges on your lower back.

Stretch in ways to make your life healthier.

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Find more information in the replies already here to reader comments below this and other articles. Before asking more, see if your answers are already here. Click labels, links in posts, archives at right 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, free. Click "updates via e-mail" (under trumpet) upper right.
See Dr. Bookspan's books and learn how to get certified in functional exercise medicine.
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Drawings copyright by Dr. Jolie Bookspan from the book Stretching Smarter Stretching Healthier

Labels: breathing, chest, disc, fix pain, hamstring, injury, leg stretch, lower back, stretch

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