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Back Pain & You: When do you become your illness? When do you become you again?

Tuesday, April 27th, 2010

Yesterday, Terri Trespecio did a really nice post on my appearance on her show. In it she made this statement:

“Don’t overidentify with your back pain. There are far more interesting things you and I should be known for.”

I was so happy to read this!

So many people suffering with back & neck pain start to accept their pain as being such a fundamental, unavoidable component of their lives, that it actually starts to become part of their identity- shaping all they do, and influencing their attitudes about just about everything. Now that’s not to say that pain doesn’t or shouldn’t effect your life when you are suffering- that would be unreasonable. What I am concerned about is something more insidious.

I often make a differentiation between a person who is sick, and a sick person. Let me explain…

Assume there are two people with the same physical medical conditions:

The first, a person who is sick, wakes up and says “I am very sick, and it will be really difficult to all of the things I need to do today.”

The second, a sick person, wakes up and says “I am very sick, and I won’t be able to do all of the things I need to do today.”

It is a subtle distinction, but an important one.

When you are in pain- especially if the pain lingers for a while- it can so easy for it to become part of your who you are. You can see why- it’s always there- reminding you of its’ presence.

It is really important to avoid this quagmire, as it changes who you are, and gives the pain more power over you than it should. There are a few things you can do to help:

-Take a few minutes out of the day to reflect on those times when the pain was not so bad.

-Find gratitude for all of the things in your life which may be going well, so you don’t start to believe that nothing is right.

-Even if they are uncomfortable, try to participate in some of the activities you normally would.

-Remind your partner that you are still you, even when you are in pain. Don’t allow them to treat you as though you are fragile. That approach will only worsen matters, and make it harder to get out of this mindset, as you now have a reinforcer.

-Make sure you don’t give up on hobbies and diversions, even if it means modifying your participation in the activity (You may not be able to go horseback riding when you are in pain, but perhaps you could instruct kids on how to ride.)

These are just a few suggestions. It is critical to your overall well being that you not allow yourself to become your back pain.

Thanks for stopping by.

-Andy

My good friend Jorden Gold doing facilitated stretching on former Eagle, Chad Lewis

My good friend Jorden Gold doing facilitated stretching on former Eagle, Chad Lewis

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Fitness Challenge update, viewer letters….

Friday, March 12th, 2010

Fitness Challenge Update:

It looks like there are quite a few of us who are living up to our New Years resolutions!

When I was on my trip last week, I didn’t follow my diet as well as I could have, but there was tons & tons of additional walking involved, and the net effect was that I lost another 2 pounds- this brings my total loss to 9 pounds since starting. Not bad!!!

Now, this week I have all kinds of stress, my timing is all messed up, and I am jetlagged- so I am pretty sure my exercise will be a little off this week. Need to find some way to either compensate with added activity near the end of the week, or limiting my calories this week. I think I will go with plan A.

I have been getting regular updates from folks, and you should all be proud!!! Those of you watching from the sidelines who have a few pounds to shed- it’s not too late to join us.

Viewer Letters:

Last week I got a bunch of letters from folks. A couple of them caught my eye:

“Andy- My husband and I have been working on our weight together since you started your challenge. We’ve both been losing weight, and feeling the difference. It makes such a difference to be doing it along with you and your other readers- that we aren’t doing it alone…Sandra”

Sandra- thanks for the letter. You touched upon exactly the reason I embarked upon this quest in public in the first place- it is always easier when you aren’t going it alone. That is also the reason I have been pushing my partner-based approach to back and neck pain: having someone there to motivate you can make such a difference.

“We got your book as part of an engagement present, and we’ve been using it for about 3 months. All I can say is THANK YOU! This is the first book I have read which makes me feel like I am in control of my body. Mark and I do the techniques together a few times a week, and we really feel the results. The (psychological strategies) really help too. We just ordered your DVD program…Jen”

I am so glad to be able to help you both. I wasn’t clear from your letter if it is you, Mark, or both of you feeling pain- but I hope you continue to get the benefits. You will LOVE the DVD program.

Thanks for visiting,

-Andy

A Baptism at the Holy site at Yardenite, on the Jordan River.

A Baptism at the Holy site at Yardenite, on the Jordan River.

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Partner or Spouse as a Resource for relief from Back Pain

Wednesday, February 24th, 2010

I recently  had an encounter in my office which reminded me why I started to develop my couples-based approach to back pain in the first place…

About three months ago, I was working with a new patient who had been suffering with low back pain & sciatica. She had started to have issues with her blood pressure, and her internist wanted her to stop using anti-inflammatory medications- which were really the only drugs which had been providing her relief. He was concerned about the effect they were having on her kidney function, and consequently, her blood pressure.

I really gave some thought to her situation- she was in pain, she couldn’t take the only meds which were really helping her, and she had blood pressure problems.

From the back pain standpoint, her issues seemed pretty straight forward- she had some problems with the movement of her sacrum, which were surprisingly easy to treat. In about four visits, I had restored normal function to her sacrum and reduced her sciatica & back pain symptoms. I then invited  her husband to join us for her next visit, and taught him some simple sacral mobilization techniques which I asked him to do daily. He had some trepidation about trying to do these techniques, but he left my office pretty much convinced.

There is an interesting phenomena which occurs whenever you manipulate the sacrum- you can stimulate the parasympathetic  portion of your autonomic nervous system, and the result can be lower blood pressure.

Well, after a few weeks of working with her husband, her pain had improved significantly, and when she went to her internist he found that her blood pressure had improved, and he wouldn’t need to add any additional medications. As a bonus, her husband, who had felt helpless to provide his suffering wife with any relief, now felt empowered by his ability to help- and they felt closer than they had in several years.

Donna & I drank the bottle of wine they gave me as a thank you gift last night.

I love when I am able to help my patients with their pain, but there is something so gratifying about being able to pass on this ability to a patients loved one. Ongoing pain can have such an adverse effect on a couple, and sometimes giving a partner or spouse the ability to provide relief can help their pain as well as their relationship. And in this instance, there were even greater reaching benefits.

Sometimes, I really love my work.

Thanks for visiting, and be well!

-Andy

I-Technique 7 Prone Thoracic Release 2

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Valentine’s Day; time to get Back Together- romantic tips for back pain, Happy Chinese New Year.

Friday, February 12th, 2010

At the heart of my Back Together program is the couples based approach to finding relief. A spouse or partner has more to gain from you feeling better than just about anyone else, so what better resource could one ask for?

We kind of think of Valentine’s Day as a ‘Hallmark Holiday’- an excuse to buy flowers and go out for an expensive dinner (I would love to know what the gross dollar amount spent on cards is!!!) I would like to propose a new addition to your Valentine’s day festivities…

Take a moment to talk with your partner. Ask them about how they are feeling- are you doing all you can for each other to find ways to feel good? I don’t mean sexually (although that’s important)- I mean with regards to your pain. Are you helping with the tasks that you or your partner cannot do? For many in pain, communication and validation from a loved one can help to relieve discomfort as much as anything else. While you are talking, touch each other- again, not sexually- therapeutically. Gently run you hands up and down each others backs- find tense or tender areas and gently rub and caress those areas. Take a moment to be aware of how each of you feels, and do some simple things to relieve any pain or stress. These tips are not just for those who complain of back pain- they are great for anyone with daily stress, folks who work too much, have too much housework- pretty much all of us!

Here are a few other suggestions:

-If you are having a romantic night out, before taking the suggestions I posted above, take a few deep therapeutic breaths while holding each other.

-If you choose to do an impromptu romantic massage, invest in a small bottle of massage oil- perhaps one with a soothing natural scent- lavender is always nice. It will help even a novice masseuse get better than expected results.

-If sex is on the menu for your evening, prolonged foreplay can help to enhance the release of endorphins associated with lovemaking, providing natural pain relief.

-If you have consumed a lot of wine, be sure to drink plenty of water between the time you finish dinner and the time you go to bed. It will help to prevent the alcohol from having a deleterious effect on your back & neck discomfort.

-Most of all, take a few moments to show and feel true gratitude for your lover. As I said above, your loved one is often the best resource for pain relief- feel and express some thanks.

I wish all of you a wonderful Valentine’s Day weekend.  And, if I may take the liberty of wishing my wife, Donna a wonderful Valentine’s day. I love you- thank you for all you do….

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The Year of the Tiger:

I would also like to take a moment to wish any of my Chinese viewers who are celebrating the new year this weekend a happy holiday. This year is the year of the Tiger- and for a whole host of reasons, I am expecting it to be a good one. My family will be spending the holiday in Philadelphia’s Chinatown. The Chinese Cultural Center of Philadelphia always pulls out all of the stops. If you go, bring your earplugs!!

.                  Gong Ci Fa Cai, Xin Nian Kuai Le

The Year of the Tiger

The Year of the Tiger

Have a wonderful weekend and be well,

-Andy

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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.

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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

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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…

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Product review: Back To Life back pain system, and a simple free technique.

Thursday, January 14th, 2010

I don’t usually do reviews of products directly claiming to reduce back pain, as I don’t want to have a perceived bias- having my own back pain reducing products.

I feel compelled to write on the Back To Life device for two reasons:

1) You can’t turn on the TV without seeing their infomercial PROMISING relief from your back pain.

2) Two of my patients have purchased them, and wanted to know my thoughts.

I suppose I should start off by saying that one patient actually did get some relief from the device. I asked him to bring his in so I could take a look at it. If you aren’t familiar with Back To Life, it is a white and blue plastic machine, about 20 inches tall that looks like a small stool:

UnitBasically, you lie on your back, place your legs on the leg rests on the top, and the device slowly moves in a combination of circular and flexion/extension movements.

For patients who have issues with mobility, or dysfunctional lumbar segments (vertebra in their low back which don’t move properly) this could potentially reduce your pain. If however you have disc herniation, or severe muscle spasms caused by nerve root irritation, spinal stenosis, or a few other common spinal conditions- it won’t do much, and in some circumstances could make things worse.

So, in short- if you have mobility or stiffness issues, it might be of some benefit. That being said, there is a great FREE alternative if you have a partner to work with- and the advantage is that you and your partner can communicate to see if you can make the technique better, or if it is hurting too much- and stop. The Back To Life device provides no such feedback.

Lie on your back- on the floor, preferably on a soft carpet or yoga mat (a bed or couch is too soft, and a really bad idea.) Ask your partner to gently raise your knees up to your chest. They should rotate your knees in small circles, a few times in each direction, getting larger in diameter with every few rotations. Try to make the circles large enough that you begin to feel slight resistance at the left, right, and upper extreme ranges of the rotation. Take a look at the video below:

leg circle video hd

As with any technique, clear it with your physician if you have not been doing exercises already- or if you do not have a clear diagnosis for your pain. Don’t do it at all if you have cancer not in remission, or an unhealed fracture.

Try this one out- it looks simple- but it really does help with low back pain and stiffness.

Enjoy,

Andy

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Merry Christmas, and some thoughts for your New Year’s Resolution…

Friday, December 25th, 2009

I want to extend wonderful holiday wishes to all of you! I hope this season brings you much joy and happiness.

Now is the perfect time to start thinking about New Year’s resolutions. For many of my viewers, the holidays are a reminder of all of the ways in which back pain has compromised their quality of life. This would be a great time to begin thinking about some of the lifestyle issues which may be contributing to your discomfort, and resolving to take steps to make them right. Back pain can frequently come from numerous cumulative factors- and your home & workplace ergonomics, exercise routine, and general frame of mind all contribute in their own way to whether you feel good or bad.

Let me share with you my two New Years resolutions, and then make a suggestion for you to add to yours;

1) 2010 will be the year I get my fitness back in order. I found some extra weight during my residency, which I have been in a constant battle to get rid of. This will be the year.

2) I will continue to try and improve the ways in which I try to help my patients, my readers, and friends to get rid of their back pain. I will continue to offer tips and suggestions here on the blog and through my programs to help as many people as possible to feel GREAT!

My suggestion to you, is that you make this the year to create a spine friendly life- look at you home, your workplace, you body, and your mind- and try to optimize all you can. The cumulative effect of your efforts will clearly pay off.

All my best, and Happy Holidays!!

-Andy

Rainbow over Palm Beach.

Rainbow over Palm Beach.

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Follow up on Bras, new Domain, The One Thing…

Wednesday, December 16th, 2009

Follow-up on the Bra Piece from Tuesday.

Thank you so much for all of the great responses to yesterday’s post on properly fitting bras. The comments have been really great.

A few additional comments I received via facebook & email:

“Don’t make the mistake of convincing yourself that a bra that is uncomfortable in the store will somehow become ‘broken in’ once you get home. If it isn’t right in the store, it won’t be right when you get home.”

-Susan

“Be sure to choose a bra appropriate for the situation- they make sports bras for a reason.”

-Jen

“If you are larger breasted like I am- choose a bra with wider straps which help distribute the weight of your breasts over a larger area of your shoulder, and prevent ‘digging in’.”

In the next couple of weeks, I will try to locate a bra fitting specialist who is 1) Willing to appear on camera, 2) Allowed by their employer to appear on camera, 3) May have some additional tips which may be helpful. If you are such a person- please drop me a line!

For the two guys who asked for ‘better pictures’- I think you are probably on the wrong site…

New, Additional Back Together Blog Domain!!!

For people who do not wish to go through the Back Together main sight, or who wish to bookmark the blog directly- you can now do so by pointing your browser at:

www.thebacktogetherblog.com

I hope this makes it simpler for folks to log into the blog, and view us via iPhone.

The One Thing Launches THURSDAY!

I have been planning this ongoing series of short videos for a while now. Starting tomorrow, I will be asking experts in different areas of back pain one question: If there was ONE THING you would recommend to people to prevent/eliminate back pain, what would it be? I am hoping that these occasional tips will come in handy. As they will be coming from different disciplines, such as physical therapy, physical medicine, chiropractic, orthopedics, and others- I am hoping they will give you varied and useful perspectives on back pain.

Tomorrow’s guest is Debra Rasansky of Rasansky Physical Therapy in Bala Cynwyd, PA. I hope you will tune in!

All my best- and be well!!!

Wishing for the Summer...

Wishing for the Summer…

-Andy

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