Sunday, September 30, 2012

Cat-Camel Stretch

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Cat-Camel stretches are just that: stretches.  They won't increase the strength of your abdominal muscles or back muscles, but they will stretch the ligaments, tendons, and smaller intrinsic muscles of the vertebral column.  Although there is some increase in intra-abdominal pressure, there is little compression of the disc spaces, so there is little chance of injury to discs, facet joints, or vertebrae.  It is a good way to start and finish the day, if you have morning and evening stiffness.  Most people with osteoarthritis of the spine do begin and end their days with mild to moderate stiffness of the lower spine and neck.

Remember, this is only a stretch.  You should only do 3 to 5 repetitions to relieve the stiffness.  If you do more, or if you have pain, then you may be damaging rather than helping your spine.

Start this stretch on all fours: hands and knees.  Slowly arch your back and tuck your head into your chest.  Slowly count to three.  Then slowly allow your back to sag and tilt your chin upward.  Again, hold this position for a count of three.  Repeat 3 to 5 times.

If you'd like to see this exercise done correctly, then go to the following YouTube site:

Sunday, September 23, 2012

What Causes Low Back Pain?

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Grab your right thumb with your left hand.  Now bend your right thumb toward your right elbow until you feel pain.  Got some pain?  Good.  Now stop bending your thumb.

How does that relate to back pain?  Bend at the waist into any position you like.  Hold that position long enough and you will eventually have pain somewhere.  Just like in your thumb, you are stretching muscles, tendons, nerves, and ligaments farther and longer than they were designed to be stretched.  You may also be compressing cartilage, discs, nerves, and bone longer and harder than they were designed to be compressed.  The pain is your body asking you to stop doing whatever it is that causes pain.  You have stressed your back.  If you stop stretching or compressing before you feel pain, or as soon as you feel pain, there is little chance you have done any permanent damage.  I.e., stop pulling on your thumb!

If you continue to pull on your thumb, or stress you back, then worse things happen.  A strain is a torn muscle or tendon.  A sprain is a torn ligament.  You can also damage nerves, tear cartilage, tear discs, and break bones, if you allow the stress to continue long enough.  Torn muscles, ligaments, and tendons take 2-12 weeks to heal, depending on how much damage you did.  Some cartilage doesn't have the blood supply to heal well, but most heals in about the same amount of time.  A bone contusion or fracture can take 6-18 weeks to heal.  Nerves can take three months to heal.

Most severely damaged tissue heals with scar tissue, which is not as strong as the original tissue.  To make up for the lost strength, surrounding tissue must be stronger than it was before the injury, or repeat injuries become common.

Chronic stress on your back causes pain, i.e. if you stretch or compress long enough you will have pain.  Poor posture, overwork, being overweight, sudden motions, etc. all can lead to back pain.  Most of our low back pain is due to accumulated stress: we sit too long with poor posture; we lift incorrectly, or too often, or too heavy an object; we weigh too much.

Some low back injuries occur from sudden changes in direction, i.e., trauma: falls, motor vehicle accidents, collisions in sports, etc.  The healing process is the same for both types of stress. 

After enough accumulated stress our pain becomes semi-permanent.  It doesn't go away when you let loose of your thumb.  Then you have to take time to heal; 2 -12 weeks.  Avoid the damage.  Change positions a lot.  Monitor your posture.  Lift with your legs and a neutral spine.  Get help lifting heavy objects.  Lose weight if necessary.  Keep active.  Exercise in moderation.  STOP WHEN YOU HAVE PAIN!

Monday, September 17, 2012

Bird Dog

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

The bird dog is a great core strengthening exercise.  The bird dog can be used by most people with low back pain.  If it causes you increased pain, or numbness, or any other symptoms, stop and consult your physician.  Some exercises make back pain worse, depending upon the source of the pain.  In any event, you should not be doing back exercises during the acute period following an injury.

The bird dog strengthens most of the abdominal and back muscle groups, without compressing the spine.  Compression of the spine is what causes, or worsens, bulging disks and irritated facet joints.  The bird dog also strengthens the ligaments and tendons that hold the spine in alignment, again without compressing the spine.

To do the bird dog, start out on all fours, on your hands and knees, preferably on a soft surface so you don't irritate your knees.  Begin by lifting one hand off the floor and straightening your arm to point straight ahead.  Hold that position for a count of ten, then go back to four on the floor.  Then point with the other arm and return to the starting position.  Next straighten one leg at a time.  That's the basic bird dog.  When you can do 4 or 5 cycles of the basic, you are ready for the next step.

In a more difficult version of the bird dog, you lift and point with left arm and right leg at the same time, then right arm and left leg, holding for a count of ten.  Repeat 4-5 times.

When that becomes too easy, you are ready for the advanced version of the bird dog.  Maintaining your balance on one leg and the opposite arm, you will move the arm and leg pointing.  Bend your leg and bring your knee forward.  Bend your arm, bring your opposite hand back; touch your hand to your knee, then straighten them out again.  Repeat 4-5 times, then use the opposite hand and leg and repeat.

For a visual check of technique, go to the following YouTube video:

Monday, September 10, 2012

What Does Work

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

In large scientifically planned studies of individuals with back pain, the following treatments have been found to have some merit statistically, i.e. they appear to be more useful than placebo treatments.  They apparently accelerate the healing process and/or diminish pain while healing occurs.

Rest, but not prolonged bed rest.
Ice, applied to areas of pain.
Heat, applied to areas of pain, muscle spasm.
NSAIDs (aspirin, Aleve, Motrin, etc.) taken as directed.
Muscle relaxing medication taken as directed.
Massage by PT, chiropractor, massage therapist.
Mobilization of joints by PT, chiropractor, or massage therapist.
TENS unit use.
Walking, slowly increasing activity.
Instruction on lifting techniques, posture, body mechanics.
Rarely, surgery for severe stenosis, severe spodylolithesis, sequestered herniated disc fragments, intractable pain, neurological deficits, or hemorrhage into the spinal cord.

Compare these to the placebos listed in the previous article.  Most of this stuff is relatively inexpensive (with the exception of the surgeries).  Most of the placebos are expensive and unwarranted.

You might also compare the above listing to the suggested low back pain treatment regimen listed in Chapter 1 of my book, viewable under.Initial Post and Blog Information.

Tuesday, September 4, 2012

Placebo Back Treatments

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Sorry this is late.  My wife and I went to visit friends in the Florida panhandle over the Labor Day weekend.

A placebo is a device that simulates treatment for a medical problem.  It is an inert substance, procedure, or device that has no known effect on a disease or healing process.  Even though it is given to a patient, the patient has no idea whether it is a placebo, a new active substance, or something already known to help his condition.

The best example I know of was the large study done with polio vaccinations.  In the 1950s, tens of thousands of children were given polio vaccine while thousands of others were given placebos (non-vaccine shots, saline).  After waiting to see which group got more cases of polio, it was statistically obvious that the vaccine protected children from the polio infection and the placebo did not.  The remainder of the children were then given the real vaccine.  I remember this because I got the experimental vaccine; my sister did not and she had to get a second injection.  Boy, was she upset.  Fortunately she did not get the disease.

Sometimes physicians will devise studies in which a sugar pill is given in place of an active substance, a sham surgery is done in place of a real one, or a sham exercise or device is used.  These studies are usually done with the patients' knowledge.  The patients know someone is getting a placebo, but not who until the study is over.  With luck the treatment proves effective and then all the patients can receive the treatment  The best studies have thousands of participants (better statistics), are blinded or double-blinded (limited number of people know who is in each group), and are prospective (planned ahead of time).  The more participants, the more accurate the statistics are at the end of the study.

Anecdotal results are unplanned serendipitous results.  "My cousin broke an egg on his head and his low back pain went away."  Such reports are generally worthless. When 80-90% of back pain goes away on its own, it is tough to attribute a reason for the recovery.

The following treatments for low back pain have not been proven more effective than placebo in large, controlled, medical studies, at least so far.  Don't waste your money paying for these things to treat your low back pain:

1.   Any form of traction, including VAX-D, DRS, DRX, Inversion Therapy, Lordex, etc.
2.   Trigger point injections.
3.   Facet injections.
4.   Sacro-iliac injections.
5.   Acupuncture
6.   Paleo (or any other fad) diet
7.   Magnetic Therapy (of any type)
8.   Prolotherapy
9.   Reflexology
10. Over the counter nutritional supplements
11. Qigong
12. Cupping