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.

Two weeks ago, I spoke at the Health Freedom Expo in Chicago, and participated in a panel discussion with several other contributors to Martha Stewart’s Whole Living- it was a really fun event, and I had the opportunity to meet some of the readers of Whole Living, and visitors to my blog. Thank you so much for coming out to see me- it was fantastic getting to know some of you.

I’ve been out promoting the Back Together iPad app. The response from users so far has been wonderful. If you have an iPad, and you haven’t gotten Back Together Interactive, what are you waiting for? Join users who have been finding relief using this new and innovative approach to back and neck pain. Click here to download it now!

The manuscript for book two is getting closer!!! I am looking for an end-of-August or beginning-of-September release of this book, and it is turning out great. I am keeping some of the details of this one under my hat until it gets closer to being done, but you’re going to love it. In a related note- I have acquired the rights from my previous publisher for my first book, Back Together- Hands-on Healing for Couples, and will be re-releasing that one as well- with some great improvements. All of this will be coming to you under the new Back Together Media label. I am really excited about this.

I have a stack of viewer mails to respond to- look for one later today, and there should be a new post from me on the Martha Stewart website sometime in the next day or two.

Thanks for stopping by!

-Andy

One of the ONLY images of a shuttle docked with the International Space Station- photo taken from a leaving supply ship. Amazing! I watched the shuttle program in awe from day 1. Here's hoping the U.S. finds its way back into space SOON!

Now first and foremost- YES celiac disease is a real entity, and should be treated as such. There is reliable testing for the condition, and if you are worried you may have celiac- get tested.

Second- I have had way too many patients come in on gluten free diets that do not have celiac or gluten intolerance, after having been told by someone that this will help them with their back pain, fibromyalgia, or other painful condition.

I will state this as clearly as I can: If you do not have celiac disease, a gluten free diet will do NOTHING for you. It is an inconvenient and potentially expensive diet to follow. So don’t do it if you don’t need to!

If you DO have celiac, there is plenty of anecdotal evidence that suggests that in addition to all of the other GI symptoms it may cause, there can be associated joint pain- and back pain. In my own patient population, this seems to be one of the last symptoms to go away once a patient has transitioned to a gluten-free diet, so be patient and see if it makes a difference in your pain.

As for dairy- and in this case, this is purely anecdotal- it seems that some patients who DO have celiac disease have an unusual intolerance to some dairy products (that do not contain glutens) which can sometimes cause them fatigue, joint discomfort, and a few other often hard-to-pin-down symptoms. It is much easier to go dairy-free than it is to remain gluten-free, so this is an easier one to do your own trial with.

What are your experiences with celiac disease and back pain? Have you made any other dietary changes which have helped improve your symptoms? Share you experiences here on the blog.

Thanks for stopping by,

-Andy

Going gluten-free can be expensive and difficult- especially when cupcakes are involved! Be sure to check if this is something you really need.

Wow! When it rains, it pours. Really. Sometimes, just when you think things are about to level out, you get hit with an avalanche. Welcome to my world!

Things have been crazy here- between the iPad launch, some patient advocacy work, finishing Book 2, getting a new teaching appointment, preparing for some upcoming speaking engagements, and a whole mess of other things, I’ve just been swamped. I’m kind of hoping things will level out this time- ’cause I’m tapped!

Thank you for the amazing response to the iPad app!

Co-creators of the Back Together Interactive App- Me & Jessie Friedman.

Jessie and I are so pleased with the response to the iPad app. Your kind words have really been wonderful. We are currently working on an update to the intro video, which will soon include some great interview footage with some actual Back Together Interactive participants, as well as cleaning up the user interface to make your experience even better. The upgrade will be free to users- so look for it in the next few weeks.

Tell your friends & family members to get their copy today!

Catch me live in Chicago.

I am excited to be a guest speaker at the Health Freedom Expo in Chicago, June 10-12. I will be speaking on Friday, and be a participant in a panel discussion on Saturday. It looks to be a wonderful program, and if you happen to be in the area, it would be great to see you there.

My newest post on Whole Living Daily.

Here is the link to my most recent post on Martha Stewart’s Whole Living Daily. Check it out when you have a chance.

Check back regularly for new updates. I’ve been sitting on a few viewer questions for a while- look for some responses in the next week.

Best,

Andy

This belief comes from clinical experience- there are some patients who respond well to a given medication, and those who have no response whatsoever. Others who find dietary links to their pain, and others who notice no relationship at all.

So, rather than making a blanket recommendation regarding medications for fibromyalgia syndrome or FMS, I thought I would review some of the broad categories of medications available and explain their use. Let’s take a look:

Pain medications: These drugs have a huge range of strengths, and their efficacy is highly variable from patient to patient. Mid potency non-narcotic pain killers such as Ultram and Ryzolt help some patients, and have the benefit of being less sedating and less assisting than narcotics. Commonly prescribed narcotics such as Percocet have more pain relieving ability, but are somewhat more addictive, and have other side effects including severe constipation and somnolence.

Interestingly, when I said there is variation from patient to patient, there is a subgroup of patients with FMS who get no relief from any pain medications.

SSRI’S and other antidepressant medications: This is always an interesting part of any discussion about FMS- as there is a contingency of physicians who believe strongly that FMS is a psychological condition- their argument being bolstered by the fact that some patients get relief from antidepressant medications. My response is this: if you are in pain 24/7 and you aren’t at least a little depressed, there is something wrong with you.

Doctors have been using these medications for chronic pain management for some time, and ‘old school’ medications such as Elavil have had some good effects for some of my patients. More recently, drug companies have started formulating SSRI medications specifically for the management of pain, such as Savella- which for the right patient is a wonderful drug.

These meds have the advantage of having a relatively low side effects profile when properly dosed.

Anti-inflammatory medications: Anti-inflammatories or NSAIDs have found some use in the treatment of FMS. Like pain medications, they seem to have a subgroup of patients for whom they work, and others for whom they do nothing. There is a huge select of different medications in this category, in various strengths. While these drugs are essentially safe, they can be hard on the stomach for some patients and should be taken with food. Also, since these medications are excreted by the kidneys they should not be used in patients with kidney issues or poorly controlled diabetes.

Neurontin / Lyrica: These medications work on the central nervous system, and they essentially raise the firing threshold- the minimal input from a nerve required for it to send a signal- of the nerves causing pain. Originally used as an anti-seizure medication, Neurontin has a relatively benign side effects profile- the most common problem being somnolence- which usually goes away after the initial dosing phase. There is a very wide range of prescription doses, and finding the right level can often take some trial and error. Another benefit of this type of medication is that they interact poorly with vey few drugs, making them a good choice for patients with other medical problems.

This is just an overview of the major groups. There are others, as well as some alternative and supplemental therapies which I won’t go into at this time.

What have your experiences been with FMS and medication? Have you found any ‘wonder drugs’? Please share your experiences here on the blog.

Best,

Andy

Only 4 weeks until Kylie returns to New York. Here she is singing with my daughter Ella. Who's waiting in line with us?

Somehow, I managed to forget to link to my most recent Martha Stewart Whole Living Daily post. Check out this post on ways to avoid springtime injuries as we all start to get out and exercise after hibernating all winter.

The Back Together iPad app…

Thanks to everyone for your kind wishes and feedback about the new Back Together iPad app. Jesse Friedman (the youngest app developer in the world mind you!) and I have worked hard to create a wonderful, easy to use app that will demonstrate simple, safe, and effective hands on tools and techniques for preventing and relieving back and neck pain. If you’ve got an iPad, I encourage you to check it out.

Coming this week…

Responses to viewer questions about fibromyalgia medications, and more on yoga and back pain. I hope you’ll check back.

Thanks for stopping by.

-Andy

The traffic in London is about to get much worse...

Check out the screen shots from the final version!

Check back tomorrow for more information on this exciting new program!

Best,
Andy

The moral of the story is this: Different pharmacies can have different relationships with manufacturers and distributors, so it pays to comparison shop. Money is tight for most of us these days, so it is clearly worth the work.

Best,

Andy

It pays to comparison shop.

‘I’ve recently gotten back into working out after a few years- with school and my new job, I just didn’t have the time to work out like I did when I was in college. I’m a little older now, and I’m finding that even regular workouts are leaving me sore- particularly in my low back. It seems to wear off after a couple of days, but I am a little worried I may be hurting my back. What do you think?’

First, thank you so much for your question Jim.

Post workout soreness is often a normal consequence of hard exercise. If you have not been exercising regularly for some time you may notice more soreness than you used to. I am a little concerned that you seem to be feeling it mostly in your low back. There may be several possible reasons for this. First consider these three questions:

-Are you doing a disproportionate number of exercises that involve your back?

-Are you providing sufficient recovery time following your workouts?

-Have you exposed a possible weak area in your musculoskeletal system?

Look at your workout regimen. The first and second questions sort of go together. How have you broken up your lifting routine? Are you putting too much stress on your low back with your workouts, and conversely are you sufficiently working your abs to balance out the exercises you are doing? A good rule of thumb is this, and it’s and oldie but goodie: divide your sessions into ‘push’ muscle groups (Chest, triceps, quads, etc…) and ‘pull’ muscle groups (Back, biceps, glutes, etc…) By dividing them this way you will prevent overworking any group too much- including recovery time in your program, and ensure that you are getting balance in your workout. If you are finding yourself still getting sore, you can do ‘push’ on day 1, ‘pull’ on day 2, and take off day 3 before resuming. Three quick additional points- you can do cardio on pretty much any day, and ab crunches whether you are doing push or pull groups. Lastly, it goes without saying that you need to maintain adequate hydration and nutrition as you reintroduce your exercise routine- your body will require more of both as you burn more.

Now, if you’ve tried splitting up your routine, and you feel that your soreness is not improving, or is more than you think it should be, you should consider visiting with your physician to be certain that there are not underlying physiological conditions causing your back pain.

Ultimately, your workouts will pay off- it is always my feeling that if you rest, you rust- so I’m glad you’re back at it. Keep us posted on your progress.

Best,

Andy

Montego Bay, Jamaica- The weather is always better somewhere else...