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.

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...

I first read the book when I was 12, and I’ve read it every couple of years since then, which is why it is so surprising that I’ve missed something so clear. In the first book or ‘ring’- called ‘The Earth Scroll’, he lays down the rules necessary to learn the art of military science. They are as follows:

1) Think of what is right and true.

2) Practice and cultivate the science.

3) Become acquainted with the arts.

4) Know the principles of the crafts.

5) Understanding the harm and benefit in everything.

6) Learn to see everything accurately.

7) Become aware of what is not obvious.

8 ) Be careful even in small matters.

9) Do not do anything useless.

Now, these seem like pretty good rules for just about anything, but somehow I missed something: These are the basic tenets which make a good physician. As I looked back at all of the people who I learned from- the physicians who were my role models- those I admired the most closely followed these rules. I sure try to myself.

I know I have a fair number of medical students reading my blog- you should take this list to heart, it will serve you well.

I just think it’s cool having something in common with the Samaurai. Maybe I should start carrying my sword to the office. Well, maybe that’s not such a good idea…

Thanks for stopping by,

Andy

Self portrait of Miyamoto Musashi.

Are you making any of these mistakes? Do you know someone who has?

Tomorrow: Viewer Question and iPad app update.

Thanks for stopping by,

Andy

Now it isn’t that I’m so smart- her problem was pretty straight forward. The other doctors should have seen what was wrong with her, but it boils down to the fact that people know what they know, and they do what they do. This is true for physicians and patients.

I am working on my second book, which is largely about the lifestyle factors which can either cause or relieve back pain, and in researching what has worked and what hasn’t worked for patients it has become really clear that for all of this rhetoric about ‘thinking outside the box’, no one really does. We learn things throughout all of our lives which cause us to behave and respond in certain ways- and those are the things we stick with. They become part of our identiy.

The woman I told you about only needed a pretty simple stretch to fix her problem. In medical school, we talked about stretching for about 15 minutes- so it clearly wasn’t a priority. Stretching wasn’t to become part of what we as physicians know. I probably wouldn’t have understood how straight forward this patient’s pain was had I not been open to understanding the role of stretching in helping to relieve back pain. This only came about because a friend of mine, Jorden Gold, is a stretching coach- really rammed it down my throat. Now, stretching is a regular part of my treatment plans. I increased my knowledge base, and expanded what I know, and what I do- and I am a better physician as a result.

I truly believe that most back pain is the cumulative effect of a ton of lifestyle factors- many of which are based upon things we know- and behaviors we may have been doing for a really long time. As you take your journey through recovery- try to be ok with the fact that you know what you know, and sometimes what you know may be wrong, or simply not enough. Be open to new ideas methods- who knows what you might learn?

Tomorrow- the three mistakes most back pain sufferers make.

Thanks for stopping by,

Andy

Spring is coming soon!

-Andy

Thanks so much to Helene for digging this one up- brilliant!

Best,
Andy