I mention that things happen for a reason because for the past several months, I’ve been increasing the use of stretching in my practice, and I have been generally pleased with the results, as have my patients, and as such, I had planned to do a post on stretching. This patient was a perfect example for me to start this series: In spite of all types of complex interventions which failed to produce results, this woman’s pain was alleviated by giving her a simple self-stretch- and I got to look like a superhero..

It was not the previous physicians fault that they could not diagnose this pain- the truth is this: we use what we know, and stretching is just not one of the modalities doctors frequently use (although, I was a little surprised that her chiropractor didn’t catch this- but in the end, it just made me look smarter!!)

From time to time, studies come out which either validate or invalidate the value of stretching as it pertains to injury prevention or performance- and while I generally give value to studies, I often look to what my own clinical experience tells me, and that is this: stretching helps.

For several years, I’ve had the good fortune to work with several folks who are gifted in the area of stretching. My good friend, Jorden Gold, founder of The Stretch Zone in Miami, has been working with professional athletes and the general public for about a dozen years- and his experience mirrors my own. A good stretching routine will improve performance, prevent workout related soreness, improve range-of-motion, improve general body awareness, and yes- most likely prevent injury and reduce pain.

Tip o’ the Day: Even if you have no pain at all, take five to ten minutes at the beginning of your day to stretch!

Enjoy,

Andy

A sweltering day here in Philly- with the heat index, it’s hovering around 100 degrees. Still, I would take this weather any day over the snow we had this past winter. For those of you keeping score- I’m a Miami boy at heart- and I’m one of this folks who doesn’t care if it’s summer there, or whether it’s humid. Basically, I’m not complaining!

In any case- today a viewer question from Doug:

“I’ve had back pain in my upper back and neck for for the past two years. I never had any kind of injury which triggered it- the pain just kind of started one day, and got progressively worse. I’ve been to several doctors, and have had x-rays and MRIs, none of which found any problems in my spine. A friend recommended an orthopedic surgeon who helped him with his neck pain.

I saw him a couple of weeks ago, and he told me my back pain was due to a rotator cuff tear. He decided this without any MRIs of my shoulder, and in spite of my protestations that my pain was in my back, and that I had no pain in my shoulder.

He wants me to get an MRI- which I hope will confirm the diagnosis, but which I am really nervous about. I pretty much had a panic attack in the MRI machine.

My question is this: is it reasonable for me to get this MRI, given that I have no pain in my shoulder? I’ve heard that orthopedic surgeons just want to cut, and I’m just not that interested in surgery.”

Thank you for your question Doug. Your apprehension regarding the MRI and the possibility of surgery is common, and not unreasonable.

Rotator cuff tears are an interesting thing. Often, they do not present as pain in the shoulder itself, but more so in the structures surrounding the shoulder. The reason for this is that the surrounding musculature- including those in your back- have to work extra hard to stabilize your shoulder following a tear, and protect it from further damage.

Rotator cuff injuries are pretty easy to preliminarily diagnose using simple examination techniques and movement tests done in the office. Typically, an office based diagnosis is confirmed with an MRI. Based upon the information you’ve provided me (and as always, keeping in mind this is a ‘drive by’ diagnosis made without any physical examination on my part) it is very reasonable for you to go ahead and get the MRI, and if indicated, rotator cuff repair. Hopefully you can then find relief from the pain which has been troubling you.

I hope this helps.

Best,

Andy

A beautiful view of the Southern Lights as seen from the ISS.

“My doctor recently prescribed an anti-inflammatory for a sprained back. It does seem to take some of the edge off, but I feel like I am just putting a band-aid on the pain, without really helping things to heal. Shouldn’t I be doing physical therapy or something to help get myself out of pain?”
-Jason

Jason, thanks so much for your great question.

It can often feel like pain medications are just, as you put it, a band-aid, but anti-inflammatories are an interesting sub group of pain medications. You see, while drugs like Motrin do reduce pain, they may actually help you to heal faster as well. Sprains and strains of muscles and other tissues result in inflammation which occurs in the form of swelling or edema. What this swelling can do is inhibit blood flow to the areas which are healing, and actually prolong the length of time it may take for you to feel better. While sometimes additional treatment like physical therapy may be helpful, it is important to note that every injury is different- and this may not be right for you. Additionally, some injuries require time to become less acute before implementing more physically intensive approaches. If you have questions or concerns, you should really speak to your physician, and tell them what you are thinking- they should be willing to discuss your treatment options, and the thoughts behind their treatment decisions.

I hope this helps.

Updates…

I have been working furiously to finish up the Back Together iPad application, and it is getting much closer to being finished. The other programmer, Jessie, and I have been going to great lengths to make this a truly great program. Check back here for more updates.

Next week, I will be headed to Miami to do the final shooting for my next book, ‘Back Pain: The One Thing.’ I am really proud of how this is all turning out, and I know you will really love the book.

As everyone embarks upon living up to their new years resolutions, you might have noticed that I haven’t posted a Fitness Challenge update in some time- check back later in the week for the latest news. In the mean time, why not let me know how you are doing with your own fitness goals.

Thanks for stopping by,

Andy

OK- Let's see how geeky my viewers really are. What's wrong with this picture?

I have a question about hyper mobility, and or releasing pent up gasses between vertebrae. In other words, I creek and crack a lot after 40 years of skiing, and swimming, and biking, and throwing myself off cliffs and cracking ribs, you know, that sort of thing. Should I ask it on your blog? When I do “crack” my neck, or lower back by stretching, it feels fantastic! I am in no pain, unless I sleep wrong, and this releases it. What is this?
-Adam

FIrst, I should begin by saying, that if the ‘crack’ does not induce pain, it is probably not doing you any harm. My grandmother used to tell me that cracking my knuckles would cause arthritis, and in spite of this, I did it anyway (sorry Grandma.) When I was in medical school, I started to wonder if this was true, and after exhaustive research employing a whole host of medical student lackies, I can state that there is no evidence that cracking your knuckles (or your back) will cause you arthritis.

Now, there have been informal studies that have shown that when you crack your own back, that you are usually unable to ‘self-correct’ the segment of your spine which actually needs to be moved- you are cracking the ones above or below it. It may provide you some relief, but ultimately it may not fix your underlying problem and you may find yourself in the same discomfort an hour, a day, or a week later. Having the correct segments adjusted by your Osteopath or Chirppractor may give you longer lasting and ultimately more satisfying results.

As for the release of pent up gasses- yes, there is a school of thought that believes that the sound you hear when you have your spine corrected is actually the shifting of nitrogen bubbles within the joint. After further research (and more lackies) I have found that there is no conclusive evidence about what that crack may actually be. As an aside, in my own practice, i do relatively little ‘cracking’ of the spine as my approach is based more on gentle mobilization. You would not believe how often I hear sounds of disappointment when patients realize they are not going to hear that loud ‘CRACK’ when I adjust them- they have come to associate that sound with relief.

I hope this answers your question. Thanks for visiting the blog.

-Andy

And once again, the stately grounds of Chez What are blanketed with snow.

Be the Boss of Your Pain by Timothy Culbert, M.D., and Rebecca Kajander, C.P.N.P. is an wonderful book that gives kids really wonderful tips and strategies for helping to reduce the effect of pain on their lives. With information on the physiology and psychology of pain, the book never panders, and is written in a comfortable, accessible style. The book lays out a mission statement in the first few pages, explaining that the goal is to help kids get rid of pain, make fewer visits to the doctor’s office, take less medicine, and basically how to get back into their lives.

With an approach that covers body, mind , and spirit- the authors include information on breathing and visualization exercises, as well as information about other modalities such as aromatherapy and acupressure- all in a way which is presented in a way children can understand and get excited about.

Children suffering with painful conditions often face difficult circumstances- frequent doctor’s visits, and dependency on adults for relief can leave kids feeling helpless and out of control of their lives. Be the Boss of Your Pain gives kids an opportunity to regain some of that control. For those of you familiar with my work, you know that is the goal of much of what I do. I have a copy of it in my treatment room, and virtually every patient has picked it up, and commented on what a fantastic concept it is- offering tips which are also applicable for adults. Check it out.

Thanks for visiting!

-Andy

So, here is the link to an article in the New York Times this AM. Actually, this article was about the new show ‘Huge’ – a socially interesting concept for a show about the efforts of overweight teenagers to find dignity in their efforts towards transformation. However, the article also references the ‘gainer blog’ phenomenon (blogs devoted to finding ways to more efficiently gain weight. These blogs are not typically geared towards people who are ‘too thin’ trying to gain weight, but more towards overweight individuals celebrating and augmenting their obesity.) This was enough to get me doing some research. I have seen some of the people who proclaim that they are healthy in spite of being morbidly obese on some of the talk shows, and while they may be able to demonstrate good blood work- you simply cannot change the laws of physics. Your musculoskeletal system was just not designed to support tremendous amounts of weight, and even if one were to not exhibit any of the cardiovascular and endocrine issues associated with obesity, their feet, knees, hips, and yes- their spine- all are subject to greater wear and tear, potentially leading to pain, and surgical intervention. There are numerous studies out there which support this assertion.

The line in the article that caught me off guard was this notion that there is a conspiracy, and that this gainer phenomenon is ‘an outcry against the manipulations of a diet-industrial complex.’ If anything, the food industry is doing exactly the opposite thing- producing food products which promote obesity, and the media which provides advertising for these products puts all of them in our faces ALL THE TIME. This topic is poignant to me as I continue on my own fitness challenge, and try to get myself into the shape I know I should be. There are definitely social forces compelling many of us to get thin- particularly teenage girls- who are bombarded with images from all sides, so I don’t want to discount this notion completely- but I feel the greater force emerges from the food industry which continues to churn out numerous processed, fat laden, inexpensive, and apparently enticing foods. My suspicion here is born out by the disproportionate rates of obesity here in the U.S. relative to much of the world.

I don’t want to come across as against overweight people, but more in favor of a balanced healthy lifestyle. As someone who has battled with weight issues for much of my life, I can definitely feel empathy for those embroiled in the struggle to get fit.

Check back tomorrow for the Fitness Challenge update, and a book review of a really fantastic book for kids with pain syndromes.

Thanks for checking in!

-Andy

Be sure to check out the blog regularly for tips on how to prevent and relieve back pain. Back Together book and DVD programs available from Amazon.com. ORDER TODAY!

There is only one steadfast rule regarding ice & heat: For the first 48 hours immediately following an injury, ice is better. Ice causes some vasoconstriction (the reduction in the diameter of the blood vessels) in the area being treated, helping to reduce swelling and promote healing. It also can partially numb the area for a short time, providing some pain relief.

In this doctor’s opinion, after the first 48 hours, it boils down to a matter of personal preference. Ice provides some of the pain relieving benefits, but heat can help to relax tense muscles- so there are potential benefits to either. Personally, my muscles recoil from cold and send me right into spasm, so I cannot really tolerate ice- so for me it’s heat, but I hear the opposite from plenty of people as well.

The one recommendation I will make here is to limit the time of either. If you are using ice, wrap your bag of ice in a thin towel or napkin so the cold gets applied gradually, and without ‘shock.’ Apply for 20 minutes on, 20 minutes off. With heat, the timing is not as critical, but prolonged heat can cause too much relaxation to the area, will cause vasodilation (an increase in the diameter of the blood vessels in the injured area,) and if there is still some underlying inflammation- could increase swelling. So 20 on and 20 off here is probably a good rule as well.

Hope this helps!

Insurance nightmares…

Last week, I asked you to share with me some of your health insurance nightmares. My wife and I have been dealing with a pretty complicated problem, which thankfully seems to be largely resolving. I am amazed by how many of you have had serious issues with your health insurance. I am preparing a piece or two on this topic- not strictly a back pain thing, but I felt important enough to discuss here on BackWords. Check back.

As always, thanks for visiting,

Andy

Coming soon: Back pain tips for riders of mass transit.

You know the old adage about not assuming things? Well boy is it ever true when it comes to back pain.

The vast majority of back pain is musculoskeletal (originating in the bones & muscles of your back,) but there are some conditions which cause back pain which have little or nothing to do with the back itself. Kidney disease, pancreatic disease, several cancers, and other conditions have back pain as their hallmark symptom.

So what are you supposed to do to help differentiate between run of the mill back pain, and something more insidious? Here are a few pointers, which should only serve as a guideline:

-First of all, if you have back pain (in particular pain which has no clear cause, such as having moved a lot of heavy furniture) which lasts more than 72 hours, go see your physician.

-If your pain is excruciating, don’t wait it out- consult your physician as well.

-If you have ongoing back pain (from arthritis, disc disease- really any idenitfied cause, and the symptoms change in any significant way, for example you suddenly develop sciatica, or other new symptom, consult your physician.

-If you develop incontinence of bowel or bladder, go straight to the ER- do not pass go, do not collect $200. I don’t mean to be glib, but this one is serious, and requires immediate attention. It may seem obvious, but I have had more than one patient who waited several days before telling anyone about this symptom.

-If small movements cause a feeling of ‘electrical shocks’ in your extremities, consult a physician.

These are the big ones which come to mind right now- there are others, but the take home point here is than not all back pain IS back pain, and some is more serious than others. If you have new pain which came from out of nowhere, or you have ongoing pain which has changed in some significant way, you need to be seen by your physician.

Insurance Nightmares…

I am looking for some of your experiences with insurance- particularly those which went less than well. Have you had an insurance nightmare? Please share it with me here- I am preparing a piece on appealing your denial of coverage, based upon a recent horrible experience my family has gone through.

Beautiful sky over Philadelphia last night- Spring is kind of here!

Some helpful tips follow the video. Enjoy!

WhyIstillhavepain

Here are some things to pay attention to in your spine lifestyle. Addressing these few things may go a long way towards helping you to find relief. Take a look at these:

1) Make sure your workspace is as ergonomically optimized as possible. Good chair, good organization of work related materials, etc…

2) Get regular sleep. Optimize your sleep environment- supportive mattress, dark room, quiet. Don’t consume caffeine within several hours of your bedtime.

3) Get regular exercise, and exercise properly- maintaining an optimal body composition will help take the strain off of your back. Good form will ensure that you are working the correct muscle groups, and prevent you from harming yourself further.

4) Minimize the weight of the items you carry with your. Dump out the contents of your purse or briefcase and get rid of everything you don’t really need.

5) Make sure your car is as spine friendly as possible; Adjust seating and controls for easy, unstrained reach. Add a lumbar support (a rolled up t-shirt will do.) Set your mirrors so you aren’t cocking your head one way or another.

6) Consume plenty of water daily. This helps to eliminate cellular waste from your system, and allows you to heal and function more efficiently. Take a few minutes, several times a day to do some relaxing, restorative deep breathing exercises.

7) And as always, use a headset while you are on the phone- Cradling your phone between your ear & shoulder is one sure way to wreck your neck!

A good place to start is to pay attention to those areas where you spend the most time. Invite your partner to pay attention as well- sometimes an objective second party set of eyes will notice things you will not.

Be well!

-Andy

Victoria & Albert Museum, Kensington, London

I have been working with an outstanding nutritionist, Sarah Barts for some time now. Her approach to weight control is based on simple, common sense principles which help you not to just lose weight, but to maintain a nutritionally healthy lifestyle which will help you for the rest of your life. Recently, she has been doing some additional work as a personal chef. You should definitely check out her website here.

I asked her to contribute her top ten list of tips for helping to lose weight and maintain it. Check it out…..

Top 10 ways to eat healthier and lose weight.

As a registered dietitian certified in weight management and a personal chef, I’ve worked with multiple individuals wanting to eat healthier, enjoy food, and lose or maintain a healthy comfortable weight.  Through the years of working with multiple weight loss programs and countless hours of research, I have been able to see what works best for people.  Below is what I would consider the top 10 ways to eat healthier for prevention of chronic disease, help with weight loss, and overall improve relationships with food.

1. Eat more vegetables, the more colors the better.  Dietary guidelines suggest 2 ½ cups of vegetables per day.  Fill half of your plate at lunch and dinner with vegetables of multiple colors, and you will fulfill these recommendations.  Not only are they high in antioxidants and phytochemicals to help prevent cancer, they are also a good source of fiber
2. Limit drinks with calories, water is the best option.  4 ounces of 100% juice can have approximately 60 calories; 20 ounces of soda can have up to 17 teaspoons of sugar and close to 240 calories per bottle.
3. Eat healthy 90% of the time, leaving 10% of the time to choose what you want.  There is no reason to feel guilty if you have always adored a food that may not be as healthy.  Portion control and frequency is key.  Realistic healthy eating includes small amounts of the not so healthy, but delicious foods.
4. Eat slowly and enjoy.  Who doesn’t like to eat?  Why not enjoy it?  Slow down and distinguish what tastes good about your food.  This will give you time to evaluate what your likes and dislikes are, and check-in to your hunger or fullness levels.  (no need to clean your plate)
5. Stop eating when you are satisfied.  Yes – the food tastes are great!  It will not be the last time you eat it and you can always save the leftovers for later.  No negative feelings needed for not cleaning your plate – - “it’s either a waste or a waist”
6. Eat more whole grains and fiber.  Not only is fiber filling, which keeps you feeling satisfied longer, but it also keeps blood sugar in control, helps prevent colon cancer, and can reduce cholesterol.
7. Move more.  You might have a sedentary job, and work out at the gym for an hour a day, which is ok.  But, you will burn more calories if you are physically active throughout the day in addition to your gym visit.  Walk whenever possible, e.g. pace whenever talking on the phone, use a pedometer and shoot for 10,000 steps per day, park further from the store or your work, walk for 10 minutes at lunchtime.  Include an activity that you enjoy 1-2x/week.
8. Eat less processed foods.  If you can’t pronounce many ingredients on the label, your body is going to have a hard time with it too.  Eating foods with natural ingredients and less processing makes your body work the way it’s meant to, giving you more energy.
9. Eat small frequent meals.  This will take some planning on your part, but eating smaller meals and nutritious snacks between them not only keeps your metabolism working throughout the day, but it helps to prevent over-eating.  When meals are skipped and you get extremely hungry, there is more tendency to eat whatever kind of food is available and eat fast, thus increasing calories consumed.
10. Get rid of your diet rules.  If you have dieted multiple times, more than likely you have acquired the “good food/bad food” mentality and recite the multiple rules that you have learned over time.  The problem with diet rules, is they are most often accompanied by negative and guilty feelings when they can’t be followed perfectly.  Negative and guilty feelings are sometimes associated with an all or nothing way of thinking and sometimes the nothing can lead to over indulging.

Focus on eating foods that are nutritious, enjoy meals, eat slowly and moving more.

Brought to you by: Sarah Barts, RD, LDN

Certified in Weight Management

Personal Chef for Mindful Gourmet

sarah@mindfulgourmet.com

www.mindfulgourmet.com

484-744-1429

Old growth banyan tree, Key Largo.