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

In this post, Bernie, an 80 year old retired photographer tells how he was signed up to take my "fix your back pain" workshop in 2005, but was convinced by his doctors that nothing but surgery would help. After "completely successful" surgery, his pain returned and worsened. He returned two years later to me. December 2007, Bernie wrote:

"I was a professional photographer for over 53 years-freelance-meaning go any place, any where- for many varied clients and I am now 80 years old and retired from photography.

"Much of the time I carried a 40-pound camera bag on my shoulder when climbing a 75 ft radio tower, walking on railroad construction sites or climbing The Great Wall in China.

"When I was at my vacation home, I climbed ladders to paint, replace cedar shingles and install new windows.

"Both my knee joints were replaced (5/93 & 6/01). Sometime in 2003 I was aware of tingling in both of my lower limbs from the knees downward. That started my medical testing with EMG’s, MRI, CT Scan and X-rays. The diagnosis was spinal stenosis caused by age-related changes in my spine. Physical therapy was started and I had an epidural, which helped for about a year. Then a second epidural lasted for only 3 months.

"I had been volunteering in an E.R. for 7 years helping patients and I had to stop as it was impossible to walk or stand on my feet because of the strong tingling in both limbs. Then I was told that spine surgery was the answer, but continue P.T. with some changes of the therapy. So, two years later, with some relief… but not enough to continue, I stopped the P.T., had an MRI scan which showed further degeneration of L4 & L5 with kinking of nerve roots. All along there was a pain in my left flank, but that was overshadowed by the strong tingling in the knees. There had been suspicion of kidney stones or liver function but x-rays & all blood work proved negative. I was hurting more in both knees.

"The spring passed at my vacation home near Barnegat Bay with much pain and with me looking at my kayak that had remained in storage. I called for surgery to be scheduled.

"The lumbar myelogram & CT was done at Pennsylvania Hospital and surgery date was set.

"On March 10,2005 I found the website of Jolie Bookspan and e-mailed her with my “story” of pain. Her class to fix back pain was going to be held soon a few blocks from where I lived. She asked me to try the class first, (it was being held a week before the schedule surgery) but I told her that both legs are numb and I am walking like a drunk, the doctors said no amount of exercise or body mechanics would fix such structural problems, and am going thru with the surgery on May 11, 2005.

"Post-op recovery was hell. The summer was hell with pain killers and sleeping pills. At the follow-up exams, I was told “the surgery went well, no infection, you’ll be better in 6 to 8 months”. The laminectomy used a metal plate & 4 screws and a bone graft from my hip for the fusion of L4 & L5. The pain in my left flank remained throughout 77 physical therapy treatments. The surgeon prescribed Elavil and when I took it, I felt like a zombie. After I told him, I was told to try a half tablet. That made me feel like a half-zombie.

"No doctor had a solution except “try Tylenol, Advil, Fentanyl, and more”…a consult with a neurologist said that my twisted nerve would never get better. (So why all the surgery?) The pain in my left flank remained.

"Then I took Jolie's class on October 20, 2007 and she had the answer. My left flank pain was not a medical condition (I was put through every test including kidney function), but a muscle in spasm. I was doing the wrong exercises that I had learned in PT and they were making it worse. She taught me to do the exercises the correct way as shown in her books and articles in her websites.

"Five days later I reported to Jolie that I had been working at The Clay Studio, throwing clay on a wheel making pottery for 4 hours and felt good. Usually after walking the 5 blocks from my home to the studio both legs would tingle badly and I had to stop halfway to rest. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to checkup. You are one hellova person and I’m thankful that I’ve met you.

"I’ve had my back problems with the muscle spasm and damaged nerve for a long time…roughly 4-5 years…and I’m getting better since you came into my life. There is no other way to say it. Thanks Dr. Jolie for your passion for helping others.

"On your questionnaire in the first class I wrote that I wanted to be able to dance with my daughter at her wedding in January 2008. You have made it happen for me.

"I will dance."

Next - Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II - a look behind the scenes.

Follow-up Note - the wedding on the 4th of January was great and Bernie danced and danced. Here is a photo.

Labels: fix pain, impingement, knee, lower back, practice of medicine, readers inspiring story, side, stenosis, surgery

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Nice Neck Stretch

Here is a quick stretch, helpful after long sitting or working. It stretches the neck, upper body, and side of the body, helping restore muscle length to tight muscles.

• Put one hand behind you, as if in an opposite back pocket (photo at right).
• Slide the other hand down your leg toward your knee. Breathe.
• Tilt your head toward your shoulder, gently stretching the entire side of your neck and body.
• For best stretch to the side of the neck, look forward, rather than up or down.
• Don't lean your head or body forward or you will lose the stretch. Stand straight.
• Hold for a few seconds.
• Change sides and repeat on the other side. Smile. Keep breathing.

To tell if you are standing straight, do the stretch with your back against a wall. Keep the back of your head against the wall for the entire stretch. If it is not comfortable to stand against a wall with your shoulders, backside, and the back of your head all touching at once, do the pectoral stretch in Fixing Upper Back and Neck Pain. You can check for the upper body tightness that makes it uncomfortable to stand straight - Thumbs Can Show Tightness That Leads to Upper Back Pain.

Use this stretch, called the trapezius stretch, along with the pectoral stretch to restore healthy positioning to the upper body. Rounded upper body position while lifting contributes to shoulder trouble, explained in Upper Back Exercise and Neck Pain Prevention Too.

With good positioning you can lift more and avoid injury.

More good, quick stretches in the book Stretching Smarter Stretching Healthier.

Labels: fix pain, neck, posture, side, stretch, upper back

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Getting Stronger Without a Gym

I often hear from trainers, and read in exercise books, that you cannot get stronger without lifting weights. They say that body weight is not enough. Then I watch the trainers and read what the exercise books say to do to strengthen. Often the weights they teach to lift are far lighter than the resistance your muscles get from moving your own body during a real life activity.

I see women in exercise classes lifting little two and five pound hand weights, then bend over wrong to put the weights down and bend over wrong again to hoist up their 20-pound handbag. I see knee pain patients in rehab centers with two and three-pound weights strapped on their ankle, sitting down to do little leg raises. Or, they pull stretchy bands with their leg. Then they get up and walk away with injurious body mechanics, letting their knees and ankles sag inward because they are not using their leg muscles to stop it. The unhealthy sagging grinds away joint cartilage and prevents full use of the leg muscles. They don't understand why their knees, ankles, and feet still hurt even when they "Do their exercises."

Your body weight is the most important thing you need to lift. Following are things to start with, to strengthen without a gym or equipment. The main idea of these activities is not to "do" them as an exercise 10 times, but to use them to retrain your muscles how to hold your body in healthy position, then use that healthy positioning for all daily life:

1. Hold a pushup position, called the plank, described in the post Change Common Exercises to Get Better Ab Exercise and Stop Back Pain. Understand that the point of the plank is to learn how to hold your spine straight without sagging under your body weight. I see people doing the plank all the time in gyms and fitness classes, with their bottom hiked up in the air and their low back looking like a hammock, sinking under their body weight. That is not the normal lower back curve. It is injurious overarching. Done poorly this way, the plank does little to strengthen and just pressures your lower back. Done well, the plank is excellent to strengthen your wrist. The wrist is neglected in fitness, and the resulting weakness is a common source of injury. I will post more about wrists. Do the plank every day - that is how helpful and important it is. If you can't even hold up your own body weight, you may have serious weakness.

2. Use the squat for daily bending, described in the post How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending. The point is to use this healthy bending all the time instead of bending wrong. In posts to come, I will show another way for healthy bending using a lunge position with one leg in front and the other in back.

3. If you can't sit and rise from the floor without your hands, you are too weak and tight for ordinary daily life. Try Quick and Easy Strength and Balance Exercise. Also practice getting up from your chair (safely) without using your hands or leaning forward.

4. Stand to put on your hosiery, pants, and shoes: Better Balance by Christmas.

5. Hang from a chining bar, a branch, a pipe, a doorjamb, or any secure overhead. Don't worry if you cannot do full pull-ups, just hold on and hang. When you can do that, hang for as long as you can from a bent-arm position, and begin trying to raise yourself (do a pull-up). Maybe you will need to start by stepping up on a box to help raise yourself, and letting yourself slowly lower without using the box. Work up to full pull-ups. If that is easy, use fewer fingers to hold on.

6. Try the Quick and Fun Arm and Body Strengthener.

When the above body weight activities become too easy, do them carrying functional weight, such packages, children, books, and other common things. It is crucial to health and independence to be able to lift and move your own body weight. In posts to come I will show you how to do more with these body weight activities for more strength and fun being active. Until then, do these every day and send your photos and stories of how you got stronger and happier.

Make it your New Year's Resolutions to be strong for real life in real ways.


Photo by quailwood

Labels: abdominal muscles, achilles stretch, aging, arm, balance, fix pain, hamstring, hand, knee, leg press, leg strength, leg stretch, lower back, practice of medicine, shoulder, side, squat, strength, stretch, upper back

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Better Balance by Christmas

I heard a radio program about yoga for senior citizens. The yoga program directors made the usual statements about yoga helping strength and balance. Then they said something that seemed at odds with their goal. They said, "If your balance is poor, do the moves sitting down or hold on to the wall." The very thing that you need to improve your balance is to practice standing and (safely) not holding the wall. If you sit and hold on, you prevent practicing balance.

Balance that helps your normal daily life is easy to improve at any age. All you need is to stand up and balance. Balance is quickly lost with sitting and disuse.

How does balance practice help you? You have receptors in all your joints that sense positioning. They can tell if you are about to fall. They tell your body to send signals to your muscles to steady you. If you don't use your balance sensors with balance practice, they become slow and unable to sense positioning well. You may tip over far enough to fall before your receptors sense it and can tell your muscles to pull you to upright position. Balance practice also improves your muscles. Without balance practice, your muscles become too slow and weak to prevent you from tipping over and falling. If you have let yourself become tight, brittle, and weak from lack of general exercise, you may strain, tear, or break something from a fall that would not have otherwise caused any harm.

Years ago when I left working in the hospital to go into private practice in sports medicine, I found that by making house calls you learn the reasons for people's pain and injuries that you will never see in a hospital or clinic exam setting. It was the first time I ever saw anyone have to sit to put on or take off their shoes. Here are a few quick, functional (real life) ways to improve balance:

• Stand up when you put on your socks or hosiery.
• Stand up to put on your pants. Lift one leg in front of you, keep your upper body comfortably straight and upright, and slide on each pant leg.
• Stand up to put on your shoes. Try two ways: holding the foot in the air front of you to place the shoe, and by crossing the ankle on the opposite knee.
• For more balance, after putting on one sock or shoe, remain standing on one foot and do a small squat on one leg to reach the other sock or shoe on the floor.

If you can't stand to dress yourself, and you have at least one working leg, you may be too tight and weak and unsteady for healthy normal life. To get started:

• Practice standing on one foot without holding on to anything. If balance is poor stand near a wall for safety to get started and have a skilled friend help. Practice standing for 10 counts without holding on. Increase how long you can balance.
• Stand on one foot and swing the other forward and back, side to side, without holding on or touching down. Safely.
• If you use a cane, practice walking holding it off the ground. Use your brain to do this intelligently and safely to improve balance and reduce dependence on the cane.

Balance is "use or lose" and can be quickly improved with safe smart practice. You don't need to go to a gym or "do exercises." Use balance skills as part of your daily life.

For more fun and functional real life balance activities see the books Fix Your Own Pain Without Drugs or Surgery and Healthy Martial Arts.

Labels: achilles stretch, aging, ankle, balance, feet, fix pain, holiday, leg strength, leg stretch, practice of medicine, side, spirit, squat, strength, stretch, upper back, yoga

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