Archive for January, 2010

Avatar, Post from Ella Kirschner, Update on Fitness Challenge…

Sunday, January 31st, 2010

Go see Avatar:

This is not a movie review site, but….

I was reasonably convinced that I was the last person on earth to see Avatar, but apparently I am not. I finally got to see it last night, and all I can say is WOW! If the movie had no plot at all it would be worth seeing if only for the visuals. As it is, it has a pretty good plot, and is just a joy to watch. Go see Avatar. Go see it on a big screen. Go today.

My daughter’s first blog post:

My daughter really wanted to post on my blog. Ella is a 9 year old student and gymnast. She is very fitness oriented, and an enthusiastic supporter of Back Together (being my daughter and all…)  I have only edited these a little, so from out of the mouth of babes:

Hey! Ella (Dr. Andy’s daughter) here. First, thanks for coming to my dad’s website! He really appreciates all the support that you folks offer!

Here are a few suggestions that will help improve your daily life:

Every day when I wake up, i like to stretch. It really helps. Also, I like to do some conditioning work each day. Simply doing a few sit ups or push ups can tremendously improve your strength. Next, I really think that it is vital to take daily walks.

Also WATH YOUR DIET!!!!!!!!!!!!!- I have made rules that you really should follow:

Rule number one: Avoid trans fats. This can improve your eating habits.

Rule number two: Read the label!!!!!!!! As an example why, yesterday I went to the store and I got some tuna salad. What I did not notice was that it had 40 grams of fat!!!!!!!!!!(how did they get all that fat in there??????)

Rule number three: Watch the sweets they really add up.

Most important of all is to simply enjoy life.

Not bad for a first post, if I may pat my kid on the back for a moment!!

Update on the Fitness Challenge:

Well, I am just ending week 2 of the fitness challenge. I have done a pretty good job of sticking to my own rules here- a couple of minor slip ups here & there, but overall doing well. I had my first weigh in on Friday, and found that in two weeks I managed to lose 2 pounds. Not much, but this is a healthy pace, and slow & steady wins the race!

I have gotten a bunch of ‘before’ stories from people who feel that  weight has caused or exacerbated their back pain. I am amazed by some of the stories some of you have- it is remarkable to hear some of the different ways back pain has affected many of your lives. As I said before, my editorial staff will chose one that they think is the best, and it’s author will win a whole bunch of goodies from Back Together as well as some other folks who have kindly contributed.

Hope your weekend has gone well so far…

-Andy

One of Ella's first photographs.

One of Ella's first photographs.



B.T.T.o.D: Lose the portable car seat, and carry your child in a sling or on-body carrier.

Thursday, January 28th, 2010

Sure, those baby carriers that snap into your car to be used as car seats are an engineering feat, and they do serve two separate needs, but they are an ergonomic catastrophe. They weigh too much, place the weight of the seat and your child too far away from your center of gravity, and strain your upper and lower spine unnecessarily.  Added to that, many parents are schlepping around all manner of additional baby paraphernalia which weigh them down even more.

Try leaving the carrier in the car and investing a few bucks in a sling or Bjorn like carrier. They weigh next to nothing, place your child near your center of gravity, and have the added benefit of bringing your child up to eye level- fostering eye contact with you and those around you. This has been shown to be a really positive thing for a baby’s development.

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New study on integrated movement, follow up on the comfortable sex piece from yesterday, and a brief note about Back Together…

Wednesday, January 27th, 2010

Study on Integrated Movement from University of Gothenburg, Sweden:

A new study from the university discussed the concept of integrated movement- a process where patients are encouraged to have more body awareness in an effort to reduce their pain. I touched upon this concept in my book, Back Together, in the chapter discussing the learned neurologic response.

It is widely known that injured patients will subconsciously limit their range of motion on certain movements following an injury in an effort to find less painful ways to accomplish various tasks and activities. Unfortunately, these self imposed modifications become learned, and the altered body mechanics remain even after the injury has resolved. This can lead to further problems down the road because of irregular wear & tear on joints, as well as a higher likelihood of being re-injured.

This study focused on the use of Sensory Motor Learning, which is an extension of the concepts of the Feldenkrais Method (A widely utilized modality which encourages body awareness, and focuses on postural stability.) Basically, they found that patients who focused on these body skills had better control over their back pain and improved their mechanics.

Again, I love it when a study reinforces what I see clinically. When I have patients recovering from back or neck injury, I often have them address the learned neurological response as part of their recovery. Basically, if a patient has pain performing a specific movement, I will ask them to look at their daily activities and try to identify and analogous, or mechanically similar movement which does not cause them pain. I will encourage them to take time from their day to do repetitions of the non-pain inducing movements followed by a few repetitions of the pain inducing movement- paying attention to the mechanical similarities and differences between them. Over the course of days or sometimes weeks, they will gradually shift the balance towards the movement which was originally causing them pain- but with progressively less discomfort, undoing the altered, damaged body mechanics established following their injury.

Follow up on the sex furniture piece from yesterday…

Thank you so much for all of the great feedback on yesterday’s piece on products to help  find comfortable positions for sexual activity. As happened with the previous post on this topic, I received several emails where people shared their successes and failures in this regard. Some folks were very grateful for the information, and were also glad to find that they were not alone with this difficulty. As I suspected, this is a really neglected issue for back pain sufferers.

A quick note about Back Together:

I created Back Together in an effort to provide a useful resource for people and their partners or spouses whose lives have been adversely affected by back pain. I hope to help as many people as I can to rid their lives of back pain. You may have noticed that I go to great lengths to use egalitarian language wherever possible, and I do this to underscore that back together is here for EVERYONE. In the past month I have received about ten emails from individuals asking me to refrain from using the word ‘partner’ in addition to spouse. Again, Back Together is for EVERYONE- And I want to be very clear that I do not and will not discriminate against anyone based on race, religion, sexual orientation, age- or anything else for that matter.

My wish is to slowly develop a community of people who are finding ways to lead pain-free lives- and that everyone is included and welcome, so you really don’t need to send me any more of these emails. Thanks.

Coming up:

-A new ‘One Thing’ segment with Pilates instructor, Amanda Mitchell.

-Some thoughts on preventing back injuries relating to falls.

-Reviews of two new studies regarding back pain and medications.

-As always, new Tips o’ the Day.

- And a whole lot more.

Thanks for visiting. Be well!

-Andy

Cynwyd Elementary participating in Treats for Troops- sending care packages to U.S. troops stationed in Afghanistan.

Cynwyd Elementary participating in Treats for Troops- sending care packages to U.S. troops stationed in Afghanistan.

B.T.T.o.D: Place a phonebook under your ‘mousing’ forearm to relieve stress on your upper back and shoulders.

Tuesday, January 26th, 2010

This one simple tip can help relieve much of the stress associated with extended time on your computer. By normalizing the position of your wrist, you can take stress off of the shoulder and upper back. You may find that computer time which used to cause you upper back spasm and discomfort will be a lot more comfortable. As always, pay attention to the height of your monitor, keyboard, and desk chair as well.

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Comfortable Sex: Some products for satisfying sex while recovering from back pain.

Tuesday, January 26th, 2010

When back pain occurs, it truly does affect virtually every aspect of your life. It can potentially change everything. For those of you who are familiar with my work, and my emphasis on your partner or spouse as a resource for healing, you know that I feel it is particularly important for back pain sufferers to be able to get back in touch with as much of their life before back pain as possible. One of the worst things that can happen when back or neck pain becomes a (temporary) part of your life is to abandon sexual intimacy, and all of the positive benefits that come with it.

Sex can have numerous benefits for pain sufferers;

-An endorphin release, which acts as a natural pain reliever.

-The slow mobilization of the segments of the lower back, sacrum and pelvis.

-The pleasure of intimate touch, and relief from the feelings of alienation which can sometimes accompany pain.

-The restoration of normalcy in a life which may have been drastically compromised by back & neck pain.

I did a post on this a little while back, and received many emails and messages about how couples found more comfortable ways to have sex- and it was really interesting (and sometimes entertaining really) to hear how people were able to reintroduce sexual activity into their lives. You can tell by the lengths some folks went to,  to see how much of a priority this was for them. More than a few of my viewers have swings installed their bedrooms- an elegant- if complicated solution.

I was contacted by a website, sensuouswife.com about some of the products they sell to help couples achieve comfortable sex. Their site is very interesting, and it is couples-friendly (ie: there are no threatening images of impossibly thin or chiseled models to make either of you feel inadequate.) Their product line is clearly aimed at heterosexual couples, but the products I described below could offer benefits to pretty much anyone. I have attached a few images from their site (with their permission of course) and some descriptions. The company provided some descriptions as well which are included under the images:

Wedge-ramp combination.

Wedge-ramp combination.

The Ramp/Wedge combo (or the individual Wedge and Ramp, for those who don’t want to buy both at once) is probably the best starting place for couples working to make sex less painful.  They give excellent support in a number of configurations, and they are designed to change the height or angle to make penetration easier and more comfortable.  Sex is much less strenuous for both partners – the person lying on the shapes has much better support, and the person on top usually finds that they can get things lined up without supporting himself or herself in odd positions or angles.  The angling also bring the couple closer together, so that they can look into each others’ eyes and talk to each other without straining.

The Esse

The Esse

The Esse.

The Esse.

The Esse is also designed to give support in a variety of positions, allowing both spouses to relax and enjoy each other.  Most users find that the support allows the spine to curve naturally and comfortably.  The Esse also has the advantage of being narrow enough to straddle, which many couples find is easier on the hips and knees, since the legs can be used efficiently and naturally.

The Whirl.

The Whirl.

The Whirl is less well-known, but many people find it very helpful, especially if they are dealing with hip or knee pain, since it can support the movement of thrusting by rolling back and forth.

Each of these products are covered in a velvet-like microfiber fabric, which is very soft and comfortable, but also “grips” other fabrics.  So unlike most pillows, the Liberator Shapes won’t slide around on the bed during use.  This also means that if a couple wants to customize the support by adding another pillow or two (for example, some people find the Ramp more comfortable if they have a pillow behind their head) the pillow will stay put on the shape and not slip around.

In looking over the products, they seem to offer some simple solutions to some ergonomic issues sexually active partners can encounter when trying to find comfortable ways to have sex. The two most useful from a low back pain standpoint would be the Whirl, and the Esse- which has the added benefit of offering neck support for neck pain sufferers. I really like these products- give them a look.

For those looking for more information on sex and back pain, I have posted on this before, but there is also an excellent book available entitled The Joy of Comfortable Sex by Pierre Angier, D.O. (available on Amazon)

I am so happy that there are people and companies out there which are addressing this problem. Sex is way to important to give up. Bringing sexual intimacy back to a relationship which may have even be ravaged by back and neck pain can really help to get things back on track, and help further your quest to get back pain out of your life.

Thanks for visiting, and be well,

-Andy

B.T.T.o.D: Break up household tasks into manageable chunks.

Monday, January 25th, 2010

With all of the time restraints we all have on our lives, it can be tempting to try and squeeze an entire day’s worth of house cleaning and other chores into a single day. Rather than subject your spine to that much abuse, break up the chores into a few smaller more manageable chunks over a few days. That way everything gets done, but your back pays a minimal price. Be well!

Fitness Challenge Update, Coming This Week: Sex toys for folks with back pain

Monday, January 25th, 2010

The Fitness Challenge

As I related last week, the fitness challenge got off to a nice start- both for my viewers, and for myself. I am into week two. Several folks have asked what I am doing, so here is a brief synapsis of what I project the first 4-5 weeks to look like:

-Cardio 4-5 times weekly. It’s wintertime, so I am basically confined to my Nordic Track until the weather gets a little better. I am trying to do between 45 and 75 minutes.

-I am calorie counting, and trying to keep my caloric intake at around 2200 calories/day. I have tried to shift the bulk of those calories away from simple carbs, but I am trying not to be unrealistic about what I can & cannot do.

-I am lifting weights 3 times/week at the moment, alternating between push (triceps,chest,quads, etc…) and pull (biceps, back, lats, glutes, etc…) muscle groups, leaving about 24 hours to recover. I will ramp this up, but I have not been lifting regularly for several years, and I don’t want to push myself backwards by not leaving adequate recovery time.

-I have been trying to walk whenever I can avoid driving. We all get used to driving everywhere- I actually think this is one of the best lifestyle modifications one can make.

-I am trying to pay more attention to my sleep, so I have better energy levels available to do the workouts and activities I have planned.

So that’s where I am with things. I have been getting a lot of folks back stories over the past week. Here is a sample:

My name is Michael, I am 39 years old and have been suffering with back pain since 2000. I injured my back at work when I fell off a shelf eight feet in the air and landed on my back hitting a metal floor. My injury consists of 2 discs (L3L4 and L5S1) and a partially crushed vertebrae at L4.

Since my injury, I have been unable to really do any strenuous physical activity. Daily activities cause varying levels of pain. Sometimes I can’t even put on my own shoes. As a result of my injury and inability to sustain physical activity, I have put on about 70 pounds, and now weigh a massive 305 pounds. This weight gain has increased my pain symptoms and further reduced my ability to function in day to day life activities.

I am going to be 40 in August, and I can no longer ignore my weight issues. Since the beginning of the year, I have started talking to a nutritionist and have begun to painfully do small things- like just walk my dog around the block. I have increased my water intake and I am trying to cut down on junk food. In just a couple of weeks I have begun (a little bit) to feel like I have more energy. I hope this energy will allow me o gain some momentum in changing my life.

I would like to be part of your fitness challenge and gain from your professional knowledge in combining fitness with back pain management.

Sincerely,

Michael M.

This is an example of exactly the kind of people I am hoping will benefit from this challenge. Work with me over the next few months, and send us your ‘after’ stories. My editorial staff will pick one from the lot who will win a Back Together package, including books and DVDs as well as other prizes from some outside sources. Mike- thank you for sharing your story with us. I hope you continue to improve, and look forward to hearing about your progress.

Sex toys and back pain:

A couple of months ago, I posted about finding a comfortable position for intercourse when dealing with back pain, and there was a lot of feedback from viewers about their experiences- successes and failures.

Shortly thereafter, I was contacted by ‘couples-friendly’ website designed to sell sex toys, products, and aids in a comfortable non-threatening environment. Tomorrow, I will be posting a review of some of these products (simply from an anatomic/ergonomic point of view) as well as some information about this interesting and fun website.

Best, and I look forward to hearing from you soon.

Be well,

Andy

Holiday in the Tropics...

Holiday in the Tropics…

B.T.T.o.D: Empty unnecessary contents from your purse or briefcase.

Thursday, January 21st, 2010

In keeping with yesterday’s tip about switching sides when you are carrying a briefcase or purse- here’s another simple and practical bit of advice: Dump the contents of your bag onto your kitchen table, and eliminate those things you don’t actually need to have with you. I am sure you probably have all kinds of stuff you don’t even remember you had in there. Reduce the weight of your bag, and you reduce the stress on your spine and shoulders!

You can bet Maggie Thatcher had only the bare essentials in her purse...

You can bet Maggie Thatcher had only the bare essentials in her purse…

Sitting will KILL YOU!

Thursday, January 21st, 2010

So, perhaps that is a slight exaggeration- but I am always so happy when a study comes out that confirms what my clinical experience has been telling me all along.

If you’ve ever seen or read an interview with me, I am pretty much always asked what I think are the major causes of back pain- and I always cite our propensity to sit too much as a major cause.

From an evolutionary standpoint, we simply were not designed to sit as much as we do. We are hunter-gatherers! We should be out doing rather than sitting. In fact, the lumbar flexion caused by sitting places high degrees of stress on the area of your vertebral discs most likely to herniate.

I’ve been saying this for years- and now a study in The British Journal of Sports Medicine which basically confirms it.

The study essentially states that sitting too long will cause a whole host of health problems, but did not elaborate on how much sitting constituted too much. According to the study, figures from a 2004 survey suggested that Americans spend more than half of their time sitting- between home, their commute, work, and back again- and that this sitting had detrimental effects on ones well being.

The take home point is this: GET OFF OF YOUR BUTT!!!!

Speaking of sitting too much…

That’s how I got into the situation which precipitated the Back Together Fitness Challenge.

Since the initial posting where I invited viewers to follow along with me as I get myself back into shape- I have received several stories from people who want to participate in the challenge. I will share some of the stories with you as they come in.

An interesting development is that there have been several companies that have stepped in to sweeten the pot for the person selected as a winner. Originally, I was going to give the winner a Back Together package including Books, DVDs, etc… Some of these companies have offered to contribute some additional prizes. I will work out which ones make sense, and will keep you updated.

Best,

Andy

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Midnight in the City That Never Sleeps…

VIDEO: Viewer Question re: Foraminotomy & Siatica

Wednesday, January 20th, 2010

foraminotomy

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A response to a viewer question regarding the surgical procedure known as a foraminotomy. In this procedure, the hole where a nerve exits the spine is enlarged in an effort to relieve impingement of the nerve, and subsequent pain. Stenosis, or reduction in the size of this hole is a common source of sciatica, and other radiating types of nerve pain. Below is an image of the neural exit foramina between two vertebrae.

foramina

Stay tuned for updates on the Fitness Challenge, and coming next week Pilates instructor Amanda Mitchell shares her One Thing.

Thanks for all of the great feedback, and be well.

-Andy