I recently read "The Snowball", a biography on Warren Buffett. Many books have been written about this successful investor, but this one was appealing to me because it delved into more than just his investment ideas. Beyond his uncanny ability to crunch numbers and value companies for their investment potential, Mr. Buffett offers fascinating insights on a myriad of other topics. As a physical therapist, one particular analogy stuck in my head that I'd like to share with you.
Buffett asked the reader to imagine going into a car dealership to purchase a new car. In striking the deal, the salesman provides one caveat. "This will be the only car you will ever own, so please make your decision thoughtfully." Now, you've purchased the car and you've driven off the lot, knowing that it's you and this automobile for a lifetime. Buffett asks, "How would you treat this car? Would you give it only the finest oil and highest grade gasoline? Would you take it in for regular tune-ups? Would you make sure the pressure in the tires was always right? Would you take extra care in driving it where ever you go?" Most common sense folks would say, "Absolutely!" or they'd find themselves with a prematurely broken down car, with no way to get around other than their feet, a bike, a bus, etc. "Okay", Buffet asks, "If that is the case, then why would you treat your own body with any less care? After all, we are only given one per lifetime, and we're expected to make it last."
I wanted to share this with you because we're on the cusp of yet another new year, and it's the most common time when people vow to start taking better care of themselves. Gym's around the country salivate at the annual spike in memberships, knowing full well that by the end of January, usage will be right back to normal. I've had conversations with friends my age (I'm 39) who express that they want to get in better shape and eat better. Usually these goals are put on the back burner because of other obligations, mainly family and work. "I just don't have the time" is probably the biggest excuse not to get started. However, I would argue that by being a little bit more selfish about your own health, you will be more productive at work and at home with your kids. What do they always tell you to do on an airplane in the event of an emergency? Put your own oxygen mask on first before taking care of others around you. Otherwise, you will be of no help to them. Use that same mentality with your health.
I chose to write this blog at the risk of being preachy about the importance of taking care of yourself. It's certainly not news to anybody as we are all bombarded with constant reminders. Rather, I wanted to plant a seed of realistic encouragement. It is a daunting task to make significant changes in your life that will have long-term health benefits. Therefore, my advice is to pick something small as a goal rather than setting yourself up for failure. You'll be much more likely to throw in the towel if you set the bar too high and don't achieve your target right away. Whether it's a change in diet or an increase in physical activity, start small. That way, when you have one success, you'll gain the confidence and encouragement to set a new target. Eventually, these small achievements will begin to snowball into significant changes. And remember, the first few weeks of any new exercise routine are generally not too fun. Soreness and fatigue spike, while motivation wanes inversely. Stick with it though, because it WILL get better as you adapt to your new normal.
As I've stated in the past, it's never to late to make a change. If the idea of taking better care of yourself from a "you first" standpoint sounds selfish, think of how your kids will thank you one day. They will appreciate that you made the commitment now so that they won't have to take care of you later on in life. So, in 2012, I encourage you to invest in yourself so that the future dividends will pay you and your family for a lifetime.
Happy and Healthy New Year to all!!
Thursday, December 29, 2011
Tuesday, December 20, 2011
Why Santa Deserves Some Extra Eggnog
Is anyone working harder than the big man in the red suit this time of year? With just a few days before Christmas, I began to think about St. Nick and the likelihood that the dude is most likely dealing with some physical pain, especially related to his back. Here are some reasons why.
First of all, the grey beard is a telling sign. Santa is probably at least well into his sixties. Unfortunately for him and his contemporaries, the discs located between each vertebral segment of the spine have lost some of their elasticity over the years. Think of your discs as little jelly donuts. A thick fibrous shell protects a soft gelatinous center. With age, the fibrous shell loses it's ability to contort and adapt to different loads and forces. The fibers begin to break and the nucleus, or jelly, may begin to poke through to the outside. This is known as a "bulging disc". When it completely pops through you have a prolapsed, or herniated, disc. These bulges or herniations can press against a nerve root where it exits the spinal column. What you are left with is pain and/or tingling that can radiate down into your buttocks, leg, and even foot. In addition to possible changes in his discs, a person of Santa's vintage might expect to have some bony changes in their spine that can also lead to pain. Stenosis is a narrowing of the spinal canal (where your all-important spinal cord is housed and protected) and/or the spaces where the nerve roots exit the spine. The symptoms associated with this condition are typically exacerbated with standing and can cause radiating pain with walking. People with stenosis are the folks you see stooped over as they walk down the street, barely able to look up. These are just a couple of examples of non-traumatic, age-related back issues that can cause pain.
Along with his age-revealing beard, Santa has another evident physical characteristic which makes him prone to low back pain. The big round belly he developed through years of cookies, eggnog, and booze (let's face it, what else could possibly keep the guy so jolly in those frigid temps?) is likely effecting his back. A healthy spine is well-supported in the front, back, and sides. With his pot belly protruding in front of him, there is a stronger force being placed on his spine from the front. The big belly means Santa probably has some pretty weak abdominal and deep core muscles. Very doubtful he's partaking in any North Pole Pilates sessions. This unbalanced spine has an increased likelihood for developing painful symptoms.
This time of year, Santa spends a ton of time sitting so that millions of kids can jump on his lap and make their requests, presuming they were given the green light by the "Elf on the Shelf". So what does that mean for the big guy's back? Well, a few things, perhaps. First of all, remember the jelly donut? Well, if you put one on the ground and stepped on the front half of it, the donut will compress underfoot and the jelly will look to shoot out the opposite side. Sitting essentially does the same thing to your discs. When we are seated without proper low back alignment, we are flexing our lumbar (lowest section) spine, meaning we bend it forward. That movement causes the vertebrae (spinal bones) to compress together in the front and gap in the rear. The same thing happens when you stepped on that jelly donut. The outside fibrous ring of the disc mushes down, and the nucleus (jelly) seeks to find space toward the back side of the spine. The nucleus shoots out the back where the nerve roots exit the spine, presses up against one of them, and pain! People who have bulging or herniated discs typically don't like to sit for long periods of time for this very reason. If indeed Santa is dealing with some lumbar disc pain, the cheery facade must be due in part to a healthy dose of Vicodin.
A second reason all that sitting might take it's toll on Santa's low back is the tightening of his psoas muscles, which are responsible for flexing his hips. When you sit, this muscle is put in a shortened position, and over time it can become chronically tight. "So what?" you might ask. Well, because of it's attachement to the spine, a tight psoas muscle might apply too much pulling force to those spinal segments, in turn throwing off it's healthy balance. This is an important muscle that should not be forgotten when addressing back pain. If you are someone who has to sit all day at work, make sure to learn how to stretch you hip flexors. Your low back will feel better as a result.
Another reason for Santa's potential back pain is what he's doing as he sits. The discs throughout our spines accommodate different pressures depending on our positioning. For example, there is a whole lot less interdiscal pressure when we're lying down as opposed to standing up. The greatest level of disc pressure in our low backs occurs when we're seated in a slumped position. To make matters worse, leaning forward to pick up a load, especially with a twisting motion, increases the pressure even more. What is poor St. Nick doing all day throughout every mall in America? Sitting, leaning forward, and hoisting one child after another onto his lap. A recipe for disc disaster. If he wanted to give his discs some relief at the end of his sitting marathon, Santa might want to lie on his back with his feet elevated and supported by a low stool (hips and knees bend at 90 degrees). This is the position with the least amount of pressure on the discs.
One final reason that sitting could be problematic. If Santa sits on a big fat wallet while he's navigating his sled around the world, two things could occur. For starters, a thick wallet might throw his pelvis off kilter. In the short term, probably not a big deal. But over the course of a long sleigh ride or drive, this could have a negative effect on the sacroiliac joint, where the pelvic bones meet the sacrum (tailbone). Again, all about balance. An additional hazard of a big wallet is pressure on the sciatic nerve, which originates from nerve roots in the lumbar spine, comes together as a big thick nerve, and runs down through your buttock to your leg. This nerve happens to run beneath a muscle in your buttocks called the piriformis. A tight piriformis may be enough to put pressure on the nerve, so it's important to learn how to stretch it. In addition, sustained direct pressure on that muscle and underlying sciatic nerve (as occurs with a big wallet and long drive) could be enough to cause sciatic pain.
Last but not least is the stress of Santa's job. Distributing millions of gifts to children worldwide over a 12 hour period has to get his blood pressure rising. Over the years in my clinic, I've seen first-hand the correlation between stress and back pain. In fact, there is a doctor at NYU named Dr. John Sarno who hypothesizes that back pain is nothing more than a manifestation of emotional tension and stress. He theorizes that physical pain is in many ways easier for us to cope with than mental stress, and that by expressing itself physically rather than emotionally, we are able to get up and function each day. Otherwise, the emotional stress would render us incapacitated. He therefore uses talk therapy as a central intervention in treating low back patients. I know he has devoted disciples who subscribe to his theory (Howard Stern is a famous example), and I can attest to the connection through professional as well as personal experience. In the weeks before I got married, I began to experience low back pain ( and my hair was falling out). It was by no stretch incapacitating, yet it was noticeable and annoying. I didn't feel stressed out but apparently I must have been. In the final days preceding the wedding, the pain ramped up. But then, as soon as we were lounging poolside in Hawaii.......no pain!
Is poor Santa and others like him destined for back misery? No, not necessarily. While there's not much to be done about his age, Santa can certainly help himself out with some general exercise, core strength training, stretching, use of a lumbar support roll while sitting, use of a money clip in the front pocket instead of a fat wallet in the back, and standing up at least once every half hour or so. Not every back patient experiences pain for the same reason, but these simple interventions are probably a wise idea for all of us if we hope to maintain good back health. Nobody is ever a lost cause, and it's never too late to start.
So, when Santa wedges his XXL body down your chimney this year, offer him some extra cookies and eggnog for his efforts. Better yet, give him some vegetables, a yoga/Pilate's mat, and a CD with some relaxing meditations. His back will thank you for it.
MERRY CHRISTMAS AND HAPPY HOLIDAYS TO ALL OF YOU!
First of all, the grey beard is a telling sign. Santa is probably at least well into his sixties. Unfortunately for him and his contemporaries, the discs located between each vertebral segment of the spine have lost some of their elasticity over the years. Think of your discs as little jelly donuts. A thick fibrous shell protects a soft gelatinous center. With age, the fibrous shell loses it's ability to contort and adapt to different loads and forces. The fibers begin to break and the nucleus, or jelly, may begin to poke through to the outside. This is known as a "bulging disc". When it completely pops through you have a prolapsed, or herniated, disc. These bulges or herniations can press against a nerve root where it exits the spinal column. What you are left with is pain and/or tingling that can radiate down into your buttocks, leg, and even foot. In addition to possible changes in his discs, a person of Santa's vintage might expect to have some bony changes in their spine that can also lead to pain. Stenosis is a narrowing of the spinal canal (where your all-important spinal cord is housed and protected) and/or the spaces where the nerve roots exit the spine. The symptoms associated with this condition are typically exacerbated with standing and can cause radiating pain with walking. People with stenosis are the folks you see stooped over as they walk down the street, barely able to look up. These are just a couple of examples of non-traumatic, age-related back issues that can cause pain.
Along with his age-revealing beard, Santa has another evident physical characteristic which makes him prone to low back pain. The big round belly he developed through years of cookies, eggnog, and booze (let's face it, what else could possibly keep the guy so jolly in those frigid temps?) is likely effecting his back. A healthy spine is well-supported in the front, back, and sides. With his pot belly protruding in front of him, there is a stronger force being placed on his spine from the front. The big belly means Santa probably has some pretty weak abdominal and deep core muscles. Very doubtful he's partaking in any North Pole Pilates sessions. This unbalanced spine has an increased likelihood for developing painful symptoms.
This time of year, Santa spends a ton of time sitting so that millions of kids can jump on his lap and make their requests, presuming they were given the green light by the "Elf on the Shelf". So what does that mean for the big guy's back? Well, a few things, perhaps. First of all, remember the jelly donut? Well, if you put one on the ground and stepped on the front half of it, the donut will compress underfoot and the jelly will look to shoot out the opposite side. Sitting essentially does the same thing to your discs. When we are seated without proper low back alignment, we are flexing our lumbar (lowest section) spine, meaning we bend it forward. That movement causes the vertebrae (spinal bones) to compress together in the front and gap in the rear. The same thing happens when you stepped on that jelly donut. The outside fibrous ring of the disc mushes down, and the nucleus (jelly) seeks to find space toward the back side of the spine. The nucleus shoots out the back where the nerve roots exit the spine, presses up against one of them, and pain! People who have bulging or herniated discs typically don't like to sit for long periods of time for this very reason. If indeed Santa is dealing with some lumbar disc pain, the cheery facade must be due in part to a healthy dose of Vicodin.
A second reason all that sitting might take it's toll on Santa's low back is the tightening of his psoas muscles, which are responsible for flexing his hips. When you sit, this muscle is put in a shortened position, and over time it can become chronically tight. "So what?" you might ask. Well, because of it's attachement to the spine, a tight psoas muscle might apply too much pulling force to those spinal segments, in turn throwing off it's healthy balance. This is an important muscle that should not be forgotten when addressing back pain. If you are someone who has to sit all day at work, make sure to learn how to stretch you hip flexors. Your low back will feel better as a result.
Another reason for Santa's potential back pain is what he's doing as he sits. The discs throughout our spines accommodate different pressures depending on our positioning. For example, there is a whole lot less interdiscal pressure when we're lying down as opposed to standing up. The greatest level of disc pressure in our low backs occurs when we're seated in a slumped position. To make matters worse, leaning forward to pick up a load, especially with a twisting motion, increases the pressure even more. What is poor St. Nick doing all day throughout every mall in America? Sitting, leaning forward, and hoisting one child after another onto his lap. A recipe for disc disaster. If he wanted to give his discs some relief at the end of his sitting marathon, Santa might want to lie on his back with his feet elevated and supported by a low stool (hips and knees bend at 90 degrees). This is the position with the least amount of pressure on the discs.
One final reason that sitting could be problematic. If Santa sits on a big fat wallet while he's navigating his sled around the world, two things could occur. For starters, a thick wallet might throw his pelvis off kilter. In the short term, probably not a big deal. But over the course of a long sleigh ride or drive, this could have a negative effect on the sacroiliac joint, where the pelvic bones meet the sacrum (tailbone). Again, all about balance. An additional hazard of a big wallet is pressure on the sciatic nerve, which originates from nerve roots in the lumbar spine, comes together as a big thick nerve, and runs down through your buttock to your leg. This nerve happens to run beneath a muscle in your buttocks called the piriformis. A tight piriformis may be enough to put pressure on the nerve, so it's important to learn how to stretch it. In addition, sustained direct pressure on that muscle and underlying sciatic nerve (as occurs with a big wallet and long drive) could be enough to cause sciatic pain.
Last but not least is the stress of Santa's job. Distributing millions of gifts to children worldwide over a 12 hour period has to get his blood pressure rising. Over the years in my clinic, I've seen first-hand the correlation between stress and back pain. In fact, there is a doctor at NYU named Dr. John Sarno who hypothesizes that back pain is nothing more than a manifestation of emotional tension and stress. He theorizes that physical pain is in many ways easier for us to cope with than mental stress, and that by expressing itself physically rather than emotionally, we are able to get up and function each day. Otherwise, the emotional stress would render us incapacitated. He therefore uses talk therapy as a central intervention in treating low back patients. I know he has devoted disciples who subscribe to his theory (Howard Stern is a famous example), and I can attest to the connection through professional as well as personal experience. In the weeks before I got married, I began to experience low back pain ( and my hair was falling out). It was by no stretch incapacitating, yet it was noticeable and annoying. I didn't feel stressed out but apparently I must have been. In the final days preceding the wedding, the pain ramped up. But then, as soon as we were lounging poolside in Hawaii.......no pain!
Is poor Santa and others like him destined for back misery? No, not necessarily. While there's not much to be done about his age, Santa can certainly help himself out with some general exercise, core strength training, stretching, use of a lumbar support roll while sitting, use of a money clip in the front pocket instead of a fat wallet in the back, and standing up at least once every half hour or so. Not every back patient experiences pain for the same reason, but these simple interventions are probably a wise idea for all of us if we hope to maintain good back health. Nobody is ever a lost cause, and it's never too late to start.
So, when Santa wedges his XXL body down your chimney this year, offer him some extra cookies and eggnog for his efforts. Better yet, give him some vegetables, a yoga/Pilate's mat, and a CD with some relaxing meditations. His back will thank you for it.
MERRY CHRISTMAS AND HAPPY HOLIDAYS TO ALL OF YOU!
Thursday, December 15, 2011
To Act or Not to Act.....
Rarely do I hear a patient report that they have a terrible tolerance for pain, and that the slightest splinter makes them curl into a fetal position on the floor. On the contrary, most boast that they have a high pain threshold. Then, when asked to describe their pain on a scale of 0 to 10, with 0 defined as "no pain at all" and a 10 as "having to call an ambulance", they report with a smile, "an 11". It makes me wonder about pain, how people perceive it, and how much people are willing to tolerate it before they take action.
I think it's safe to say the the vast majority of people don't rush to call their doctor the first time they feel something "different". Nobody wants to be an alarmist or be perceived as a problem patient by their primary care doctor. So, they wait. In most instances, time will certainly help them feel better, no matter the malady. Let me note here that I'm not talking about searing chest pain, or a femur that's poking through the leg of your jeans, or even a badly twisted ankle. For this type of pain, dial up that ambulance or get yourself to an ER on your own. Traumatic injury that leads to instant pain and swelling should be diagnosed right away so that proper intervention can take place. Instead, I'm referring to the ache or pain that may come on insidiously, without a discernible precipitating event. The type of pain that may be a "4 or 5" with certain movements, positions, or activities and a "0" at rest. The "It's annoying, but I can suck it up," pain.
What to do about such pain? While there is no one right answer for everyone, I do think there's some common sense advice to be offered. For starters, pain that wakes you up from your sleep should be heeded, not ignored. You can consider it a "red flag" for something more serious. I'm not talking about having some tendinitis in your shoulder and waking up by accidentally rolling on to that injured side. While annoying, this doesn't qualify as a red flag. I'm talking about visceral pain that wakes you and doesn't allow you to find a position of comfort in order to go back to sleep. Another consideration regarding pain is your ability to take it easy and try to rest whatever is hurting. If you have a competition looming 3 weeks down the road you may not have the luxury of delaying treatment. Or if you have tendinitis in your arm and a one-year old who isn't going to wait 6 weeks for you to pick him/her up, your option of rest is compromised. However, if your home life, job and recreation allow you to put on the brakes for a while, it's probably a good idea. Time and rest will allow you to discern if what's ailing you will resolve on it's own or require medical attention.
Just yesterday, I read an article on a physical therapy site which talked about the virtues of taking a "do nothing" approach to physical problems (as well as to a slew of other negative issues that arise in life). The author shared her story of unremitting elbow tendinosis for which she tried every conceivable treatment under the sun, to no avail. Finally, at the suggestion of a physician friend, she decided to do "absolutely nothing" for 6 months and see what happened. As it turned out, in her particular case it ended up helping. That sounds great, except for the fact that I'd bet most of you wouldn't or couldn't "do nothing" for the next six months while resting an aching joint. We have lives to lead and things to accomplish. Not only that, but how boring would it be to have to sideline yourself for that long of a period?
So, where does that leave us? As usual, the common sense approach probably involves some level of compromise. Hitting the panic button at the first sign of pain, or sitting on the sideline for long stretches of time both seem extreme. I would suggest that if you're experiencing some type of non-traumatic musculoskeletal aches and pains that are lasting more than a few weeks and that are not improving or even getting worse, it would be wise to seek some help. So often, people are more worried about the possibility of continuing to do more damage than they are about the pain itself. I've found that with a proper diagnosis and explanation of what's going on, people make a great leap in the healing process. Simply learning that you will not likely cause irreparable damage can be very empowering in dealing with pain.
Finally, I think it's important for people to recognize their options when confronted with pain. My advice is to start with the most conservative treatment and go from there. If you end up in a worse-case scenario whereby you require surgical intervention, at least you've exhausted your options. Surgery, no matter how "routine", is irreversible and always carries some level of risk. And beware the doctor who prescribes an MRI right away before trying any treatment. Recent studies have called into question the correlation between damage revealed by imaging and symptoms. This can lead a cut-happy doctor to point to an image and convince you that your only option is surgery. DO NOT let that happen to you. If you were going to put an extension on your house, you would likely seek three opinions and quotes. When it comes to surgical intervention, treat your body with no less care.
Unfortunately, we will all deal with physical pain at some point or another. It's not something that we should just accept as part of life though. A prudent approach to dealing with it can help you get back to normal as quickly as possible. But remember, pain is only a symptom. Without discovering why you had it in the first place and learning how to prevent its recurrence, it's likely to be a repeat companion in your life. Don't let it.
I think it's safe to say the the vast majority of people don't rush to call their doctor the first time they feel something "different". Nobody wants to be an alarmist or be perceived as a problem patient by their primary care doctor. So, they wait. In most instances, time will certainly help them feel better, no matter the malady. Let me note here that I'm not talking about searing chest pain, or a femur that's poking through the leg of your jeans, or even a badly twisted ankle. For this type of pain, dial up that ambulance or get yourself to an ER on your own. Traumatic injury that leads to instant pain and swelling should be diagnosed right away so that proper intervention can take place. Instead, I'm referring to the ache or pain that may come on insidiously, without a discernible precipitating event. The type of pain that may be a "4 or 5" with certain movements, positions, or activities and a "0" at rest. The "It's annoying, but I can suck it up," pain.
What to do about such pain? While there is no one right answer for everyone, I do think there's some common sense advice to be offered. For starters, pain that wakes you up from your sleep should be heeded, not ignored. You can consider it a "red flag" for something more serious. I'm not talking about having some tendinitis in your shoulder and waking up by accidentally rolling on to that injured side. While annoying, this doesn't qualify as a red flag. I'm talking about visceral pain that wakes you and doesn't allow you to find a position of comfort in order to go back to sleep. Another consideration regarding pain is your ability to take it easy and try to rest whatever is hurting. If you have a competition looming 3 weeks down the road you may not have the luxury of delaying treatment. Or if you have tendinitis in your arm and a one-year old who isn't going to wait 6 weeks for you to pick him/her up, your option of rest is compromised. However, if your home life, job and recreation allow you to put on the brakes for a while, it's probably a good idea. Time and rest will allow you to discern if what's ailing you will resolve on it's own or require medical attention.
Just yesterday, I read an article on a physical therapy site which talked about the virtues of taking a "do nothing" approach to physical problems (as well as to a slew of other negative issues that arise in life). The author shared her story of unremitting elbow tendinosis for which she tried every conceivable treatment under the sun, to no avail. Finally, at the suggestion of a physician friend, she decided to do "absolutely nothing" for 6 months and see what happened. As it turned out, in her particular case it ended up helping. That sounds great, except for the fact that I'd bet most of you wouldn't or couldn't "do nothing" for the next six months while resting an aching joint. We have lives to lead and things to accomplish. Not only that, but how boring would it be to have to sideline yourself for that long of a period?
So, where does that leave us? As usual, the common sense approach probably involves some level of compromise. Hitting the panic button at the first sign of pain, or sitting on the sideline for long stretches of time both seem extreme. I would suggest that if you're experiencing some type of non-traumatic musculoskeletal aches and pains that are lasting more than a few weeks and that are not improving or even getting worse, it would be wise to seek some help. So often, people are more worried about the possibility of continuing to do more damage than they are about the pain itself. I've found that with a proper diagnosis and explanation of what's going on, people make a great leap in the healing process. Simply learning that you will not likely cause irreparable damage can be very empowering in dealing with pain.
Finally, I think it's important for people to recognize their options when confronted with pain. My advice is to start with the most conservative treatment and go from there. If you end up in a worse-case scenario whereby you require surgical intervention, at least you've exhausted your options. Surgery, no matter how "routine", is irreversible and always carries some level of risk. And beware the doctor who prescribes an MRI right away before trying any treatment. Recent studies have called into question the correlation between damage revealed by imaging and symptoms. This can lead a cut-happy doctor to point to an image and convince you that your only option is surgery. DO NOT let that happen to you. If you were going to put an extension on your house, you would likely seek three opinions and quotes. When it comes to surgical intervention, treat your body with no less care.
Unfortunately, we will all deal with physical pain at some point or another. It's not something that we should just accept as part of life though. A prudent approach to dealing with it can help you get back to normal as quickly as possible. But remember, pain is only a symptom. Without discovering why you had it in the first place and learning how to prevent its recurrence, it's likely to be a repeat companion in your life. Don't let it.
Tuesday, December 6, 2011
The Rubber Band in the Back of the Drawer
"I don't understand. I've been doing the same thing for years and I've never had a problem before. Why do I have pain now all of a sudden?" I hear some variation of this statement all the time in my clinic. It's a fair question, and one that has a relatively straight forward answer.
You know those rubber bands that you come across that haven't seen the light of day for way too long? If you ever need to use one of them, you know how ineffective they are. You go to stretch them over whatever it is you need bound together, and they either snap or just stay expanded, rendered completely useless. Now, think of the soft tissues in you body; ligaments, tendons, muscles, nerves, and fascia. Just like rubber bands, these parts of your anatomy require regular movement so that they stay strong and flexible. As we get older, unfortunately these soft tissues begin to lose some of their elasticity, making them prone to injury. This damage can be as slight as some mild inflammation, or as significant as a complete rupture.
Our bodies are amazingly complex machines. However, things can be simplified from a musculoskeletal standpoint when you consider that our movement is essentially driven by a series of pulleys and levers. Muscles and tendons pull (never push) our bony skeleton (supported by a vast network of ligaments) which responds with physiological movement (e.g., raising your arm over your head). In order for this series of pulleys and levers to work most efficiently, two main components are required: strength and range of motion.
Now, why am I choosing to write about rubber bands and pulleys? It's because I don't want any of you to experience to kinds of aches and pains that commonly arise when we treat our bodies like the neglected rubber band. As I mentioned earlier, so many of my patients are incredulous that seemingly benign activities such as painting a wall, playing recreational tennis, or simply sitting can lead to pain. I especially find this disconnect in people who are in their thirties. This is the most common decade for the types of overuse injuries usually associated with tendon damage. People in their 30's are generally still active to some degree or another. The problem is, they go about their weekend activities thinking they're still sporting a 22 year-old body. An old friend asks you to play a few sets of tennis? Sure, you think, I'm going to go out and crush him/her just like a did last time we played together. Only that was 15 years ago. A lot has gone on in that 15 years, and you may not be as Nadal-fit as your mind tells you.
Even more vexing than the weekend warrior injury is pain associated with prolonged sitting. It's one thing to sustain a shoulder injury while gunning down you opponent at the plate on a Sunday afternoon. It's another thing entirely to understand that just sitting can cause pain. Simply put, we are not designed to sit all day. We are especially not designed to sit all day with a computer screen and keyboard in front of us. But this is exactly what so many of your jobs require of you. Have you ever experienced that ache between your shoulder blades, right at the base of your neck? You know, the one that comes on by mid-afternoon after you've been staring at your spreadsheets and documents all day, stressed by your deadlines? Or how about that dull ache in the small of your lower back after a long car drive? You are not imagining your pain, and there's a very simply explanation for it. Chances are, you're not sitting bolt upright, feet squarely supported on the floor, forearms supported by an ergonomically correct office chair, shoulders back in a military pose. That's not the real world. The more likely scenario has you slumped down with your lower back unsupported, your head jutting out to read your screen, shoulders rounded forward. Sound familiar? If so, you may ask yourself, "So what? I've been sitting like this for 15 years and I've never had a problem before." Well, that's exactly the point. I'm sure that your once proud rubber band thought (if it was able), "I've bound mail all over the continental U.S., including all those holiday catalogs, and I've never broken before!" But that was before it found it's way into the back of the drawer, much the way our bodies found their way into the inevitable grip of an office chair. If you don't use it, you'll lose it. In the situation I described, the structures in the back are likely being over-stretched and simultaneously weakened, while the structures in the front are being adaptively shortened and weakened. This doesn't happen over night, but is rather a cumulative process. And then, one day, the pain kicks in.
Wow, this all sounds kind of depressing! You hit your thirties and you just start unravelling? No hope but to start popping pain management meds (which the pharmaceutical companies would no doubt love)? NOT AT ALL! I believe there is a simple solution to these physical ailments which doesn't require a lot of time, money or energy. The aim is to try to recapture the symmetry that your 18 year old body possessed, and the measures don't necessarily require expensive gym equipment and strenuous exercise. The pain for which people seek treatment can usually be addressed in the short term, but that is only half the battle. If the underlying cause is not also take care of, then you will likely end up with the same overuse injury down the road.
I hate hearing people, especially relatively young folks, say, "I guess I'll just have to live with this pain." Do not resign yourself to such thinking. I believe there is a solution to everything, and in the case of overuse injuries due to poor posture and tissue condition, the fix may be a lot easier than you imagine. So many people believe that they just don't have time to help themselves, because life is pulling at them from multiple angles. But if you are willing to invest just a little in your health, you won't find yourself snapping like that old rubber band in the back of the drawer.
P.S. I purposely avoided mentioning specific interventions because I didn't want to generalize. However, if anything is aching, or if you know someone dealing with pain, please feel free to reach out. I'd be more than happy to offer some advice.
You know those rubber bands that you come across that haven't seen the light of day for way too long? If you ever need to use one of them, you know how ineffective they are. You go to stretch them over whatever it is you need bound together, and they either snap or just stay expanded, rendered completely useless. Now, think of the soft tissues in you body; ligaments, tendons, muscles, nerves, and fascia. Just like rubber bands, these parts of your anatomy require regular movement so that they stay strong and flexible. As we get older, unfortunately these soft tissues begin to lose some of their elasticity, making them prone to injury. This damage can be as slight as some mild inflammation, or as significant as a complete rupture.
Our bodies are amazingly complex machines. However, things can be simplified from a musculoskeletal standpoint when you consider that our movement is essentially driven by a series of pulleys and levers. Muscles and tendons pull (never push) our bony skeleton (supported by a vast network of ligaments) which responds with physiological movement (e.g., raising your arm over your head). In order for this series of pulleys and levers to work most efficiently, two main components are required: strength and range of motion.
Now, why am I choosing to write about rubber bands and pulleys? It's because I don't want any of you to experience to kinds of aches and pains that commonly arise when we treat our bodies like the neglected rubber band. As I mentioned earlier, so many of my patients are incredulous that seemingly benign activities such as painting a wall, playing recreational tennis, or simply sitting can lead to pain. I especially find this disconnect in people who are in their thirties. This is the most common decade for the types of overuse injuries usually associated with tendon damage. People in their 30's are generally still active to some degree or another. The problem is, they go about their weekend activities thinking they're still sporting a 22 year-old body. An old friend asks you to play a few sets of tennis? Sure, you think, I'm going to go out and crush him/her just like a did last time we played together. Only that was 15 years ago. A lot has gone on in that 15 years, and you may not be as Nadal-fit as your mind tells you.
Even more vexing than the weekend warrior injury is pain associated with prolonged sitting. It's one thing to sustain a shoulder injury while gunning down you opponent at the plate on a Sunday afternoon. It's another thing entirely to understand that just sitting can cause pain. Simply put, we are not designed to sit all day. We are especially not designed to sit all day with a computer screen and keyboard in front of us. But this is exactly what so many of your jobs require of you. Have you ever experienced that ache between your shoulder blades, right at the base of your neck? You know, the one that comes on by mid-afternoon after you've been staring at your spreadsheets and documents all day, stressed by your deadlines? Or how about that dull ache in the small of your lower back after a long car drive? You are not imagining your pain, and there's a very simply explanation for it. Chances are, you're not sitting bolt upright, feet squarely supported on the floor, forearms supported by an ergonomically correct office chair, shoulders back in a military pose. That's not the real world. The more likely scenario has you slumped down with your lower back unsupported, your head jutting out to read your screen, shoulders rounded forward. Sound familiar? If so, you may ask yourself, "So what? I've been sitting like this for 15 years and I've never had a problem before." Well, that's exactly the point. I'm sure that your once proud rubber band thought (if it was able), "I've bound mail all over the continental U.S., including all those holiday catalogs, and I've never broken before!" But that was before it found it's way into the back of the drawer, much the way our bodies found their way into the inevitable grip of an office chair. If you don't use it, you'll lose it. In the situation I described, the structures in the back are likely being over-stretched and simultaneously weakened, while the structures in the front are being adaptively shortened and weakened. This doesn't happen over night, but is rather a cumulative process. And then, one day, the pain kicks in.
Wow, this all sounds kind of depressing! You hit your thirties and you just start unravelling? No hope but to start popping pain management meds (which the pharmaceutical companies would no doubt love)? NOT AT ALL! I believe there is a simple solution to these physical ailments which doesn't require a lot of time, money or energy. The aim is to try to recapture the symmetry that your 18 year old body possessed, and the measures don't necessarily require expensive gym equipment and strenuous exercise. The pain for which people seek treatment can usually be addressed in the short term, but that is only half the battle. If the underlying cause is not also take care of, then you will likely end up with the same overuse injury down the road.
I hate hearing people, especially relatively young folks, say, "I guess I'll just have to live with this pain." Do not resign yourself to such thinking. I believe there is a solution to everything, and in the case of overuse injuries due to poor posture and tissue condition, the fix may be a lot easier than you imagine. So many people believe that they just don't have time to help themselves, because life is pulling at them from multiple angles. But if you are willing to invest just a little in your health, you won't find yourself snapping like that old rubber band in the back of the drawer.
P.S. I purposely avoided mentioning specific interventions because I didn't want to generalize. However, if anything is aching, or if you know someone dealing with pain, please feel free to reach out. I'd be more than happy to offer some advice.
Monday, November 28, 2011
Don't Over Think it......Just Run!
http://www.nytimes.com/2011/11/15/health/nutrition/for-beginning-runners-advice-can-be-a-hurdle.html?emc=eta1
With the NYC Marathon in the rearview mirror, I thought that the above article was timely. It's an event that can inspire people to begin running or ramp up their mileage with the goal of competing one day themselves. I often hear casual runners say, "I run, but I could never do 26.2 miles!" To that I say, "If you can run 2 miles, you can run 26.2." It's just a matter of doing it the correct way so as to avoid injury.
I agree with the main thesis of the posted article in that I don't think you should attempt to overanalyze your running mechanics. These days, there is so much science behind movement and athletic performance. We can take an individual, hook them up to all sorts of monitors, video tape them, and assess the individual components of their movement and subsequent performance. That is all well and good, but the average person looking to run or work out for a healthy lifestyle does not need all of that. What the novice individual needs is just a little self motivation. It all starts there.
The trouble with seeking the "perfect running gait" is that we're not robots. Each one of us has different strengths, weakness, and biomechanical properties. How can I expects a runner who is 6'2" tall have the same exact mechanics as one who is 5'3"? I will use the world's most famous (or infamous?) athlete as as an example. Tiger Woods is renowned for his practice habits. He spends hours upon hours on the driving range, trying to replicate his swing to the point where it's automatic. He wants to take all thought out of it by burning his swing into muscle memory and making himself as robotic as possible. Many observers would agree that Tiger has a pretty sweet looking swing, which is validated by his prolific winning record. Now, take another successful PGA golfer with not quite as pretty a swing. Jim Furyk is another very successful pro golfer. He hasn't won as much as Tiger, but then again, who has? If you put Furyk and Tiger next to each other on the range, you'd ask yourself how Furyk ever won a tournament let alone a U.S. Open. He has a very quirky hitch in his swing that I'm sure no teaching pro would recommend. However, it works for him. What would happen to Furyk's game if he tried to mimic Woods' swing? Why would he want to? I would ask the same of runners.
A few years ago I took a course on running injuries and prevention. It was a very interesting class, and I thought the instructor really knew what he was talking about. He would take his subjects, put them on a treadmill, mark their bodies at certain points, and video tape them as they ran. Then, he could watch it back in slow motion, analyzing every angle and motion that took place. What became evident after watching several examples of runners is that everyone runs differently. However, something bothered me about the whole approach to the analysis and subsequent intervention. So I raised my hand and asked:
"If someone comes to you after running for 20 years without injury, why are you going to all of a sudden try to alter their running mechanics? After all, if it was the poor mechanics that caused this injury, then why was the person able to run for the past 20 years without incident?"
Now, I realize as a physical therapist that tissue changes over the course of aging, which makes it more prone to injury. However, if someone was running one way for 20 years, their tissue, both hard and soft, ought to adapt to the specific running pattern. I feel what's more important than trying to overhaul somebodies running style is try to assess why this injury occurred when it did. I would ask questions such as, "Have you recently returned to running after some time off? Have you increased your mileage and/or speed recently? Have you changed the surface on which you run? Have you changed your footwear recently? Have you begun any other exercises recently in addition to your running?" These questions may lead me to why all of a sudden, after all these years running, you've broken down. Then I would try to intervene, but not by making a drastic change to your style. Such intervention would include controlling the pain and inflammation for the current injury first, followed by correcting any weakness and asymmetries discovered during examination. This is not the same thing as trying to get you to run in a completely new and unnatural way.
As the article states, it's important to ease into running (or any other exercise routine for that matter). Bear in mind that when undertaking a new physical activity, it generally comes with some soreness in the initial stages. Stick with it though, it will get better. It's important to build up your strength and stamina in a gradual, step-wise fashion. That is how you will minimize your risk of injury, not by trying to overhaul your entire running gait. You must train your tissues to get used to the pounding that accompanies running.
So, if you decide you want to give running a try, go for it. Just lace up you shoes, hit the road, and let it come naturally. I would hate to think that people shied away from trying this very gratifying means of exercise simply because they felt they needed tons of coaching and analysis. Forget that......just run!
With the NYC Marathon in the rearview mirror, I thought that the above article was timely. It's an event that can inspire people to begin running or ramp up their mileage with the goal of competing one day themselves. I often hear casual runners say, "I run, but I could never do 26.2 miles!" To that I say, "If you can run 2 miles, you can run 26.2." It's just a matter of doing it the correct way so as to avoid injury.
I agree with the main thesis of the posted article in that I don't think you should attempt to overanalyze your running mechanics. These days, there is so much science behind movement and athletic performance. We can take an individual, hook them up to all sorts of monitors, video tape them, and assess the individual components of their movement and subsequent performance. That is all well and good, but the average person looking to run or work out for a healthy lifestyle does not need all of that. What the novice individual needs is just a little self motivation. It all starts there.
The trouble with seeking the "perfect running gait" is that we're not robots. Each one of us has different strengths, weakness, and biomechanical properties. How can I expects a runner who is 6'2" tall have the same exact mechanics as one who is 5'3"? I will use the world's most famous (or infamous?) athlete as as an example. Tiger Woods is renowned for his practice habits. He spends hours upon hours on the driving range, trying to replicate his swing to the point where it's automatic. He wants to take all thought out of it by burning his swing into muscle memory and making himself as robotic as possible. Many observers would agree that Tiger has a pretty sweet looking swing, which is validated by his prolific winning record. Now, take another successful PGA golfer with not quite as pretty a swing. Jim Furyk is another very successful pro golfer. He hasn't won as much as Tiger, but then again, who has? If you put Furyk and Tiger next to each other on the range, you'd ask yourself how Furyk ever won a tournament let alone a U.S. Open. He has a very quirky hitch in his swing that I'm sure no teaching pro would recommend. However, it works for him. What would happen to Furyk's game if he tried to mimic Woods' swing? Why would he want to? I would ask the same of runners.
A few years ago I took a course on running injuries and prevention. It was a very interesting class, and I thought the instructor really knew what he was talking about. He would take his subjects, put them on a treadmill, mark their bodies at certain points, and video tape them as they ran. Then, he could watch it back in slow motion, analyzing every angle and motion that took place. What became evident after watching several examples of runners is that everyone runs differently. However, something bothered me about the whole approach to the analysis and subsequent intervention. So I raised my hand and asked:
"If someone comes to you after running for 20 years without injury, why are you going to all of a sudden try to alter their running mechanics? After all, if it was the poor mechanics that caused this injury, then why was the person able to run for the past 20 years without incident?"
Now, I realize as a physical therapist that tissue changes over the course of aging, which makes it more prone to injury. However, if someone was running one way for 20 years, their tissue, both hard and soft, ought to adapt to the specific running pattern. I feel what's more important than trying to overhaul somebodies running style is try to assess why this injury occurred when it did. I would ask questions such as, "Have you recently returned to running after some time off? Have you increased your mileage and/or speed recently? Have you changed the surface on which you run? Have you changed your footwear recently? Have you begun any other exercises recently in addition to your running?" These questions may lead me to why all of a sudden, after all these years running, you've broken down. Then I would try to intervene, but not by making a drastic change to your style. Such intervention would include controlling the pain and inflammation for the current injury first, followed by correcting any weakness and asymmetries discovered during examination. This is not the same thing as trying to get you to run in a completely new and unnatural way.
As the article states, it's important to ease into running (or any other exercise routine for that matter). Bear in mind that when undertaking a new physical activity, it generally comes with some soreness in the initial stages. Stick with it though, it will get better. It's important to build up your strength and stamina in a gradual, step-wise fashion. That is how you will minimize your risk of injury, not by trying to overhaul your entire running gait. You must train your tissues to get used to the pounding that accompanies running.
So, if you decide you want to give running a try, go for it. Just lace up you shoes, hit the road, and let it come naturally. I would hate to think that people shied away from trying this very gratifying means of exercise simply because they felt they needed tons of coaching and analysis. Forget that......just run!
Tuesday, November 22, 2011
Hello everybody. This is my first-ever post. There was a time, not too long ago, when I would have laughed out loud over the notion of creating a blog. But through the advice of a good friend, I've decided to give it a shot. Why not? At the very least, I get to practice my typing skills and all my words get lost to an audience of zero. At best, I'll be able to share some articles and thoughts that hopefully will be helpful to people. I am a physical therapist by profession, and that will be the main tread throughout my postings. However, I'm also interested in healthcare, politics, sports, and a variety of other things. I imagine that random articles may pop up that inspire me to post and comment. This will be a work in progress, and I'm looking forward to seeing where this takes me. I hope you enjoy it!
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