Which is better for you: Captain Crunch or Crunches?

One of my favorite questions for back pain patients always inevitably involves the question of crunches.  Fox News recently discussed some contributors to low back pain and included crunches as one of them.  They won some points for that one! 

Crunches can definitely contribute to back pain and compression of the spine.  I never use them for back patients because they have more potential for harm than to help.  In addition, there are much better ways to strengthen weak abdominals.  Crunches most often cause a c curve to the spine, increase spinal pressure and strengthen the hip flexors more than abdominals.  

If a patient wants to strengthen abdominals, I vote for abdominal bracing and save the crunches for cereal or chocolate bars!

Not your average kettle of corn!

I live nearby a new strip center where they opened a gym.  It doesn’t have weight machines or aerobic equipment but the trainers stand outside and monitor the clients performing running drills and slinging kettle weights on the sidewalks for all to see. For a fee of around $185 per month according to the website, one can attend unlimited classes.   Watching in horror the men and women lifting heavy kettle weights and slinging them with a rotating motion while bent at the waist, it makes my physical therapy blood boil.  Whoever invented this type of exercise must have had some type of financial gain from multiple injuries! 

During the past week, I saw two 20 year old men and one 40 year old woman  who sustained lumbar herniated discs while performing the twisting and bending motion while holding onto a kettle weight.  As soon as they mentioned the words kettle weight and twisting, I knew how the injury occurred.  Two of the individuals this week performed the exercises under supervision of a trainer. 

Kettle weight slinging is a lumbar herniated  disc waiting to happen.  There are better ways to strengthen clients.  I don’t want my patient population to increase because of inappropriate training.  Body mechanics and basic principles are more important than creativity that has the potential for harm! Save the kettles for corn and fish! 

Can education reduce pain?

A new study just reported by The American Academy of Pain Management stated that education about fear avoidance of activity can be more effective than any specific exercise program for preventing back pain in the military.  This study has not been published yet but the results indicate that education about movement is key.  Often fear of pain or fear avoidance can cause us to avoid activity as soon as a little back pain starts.  Education about what to do about that pain and reducing that fear of movement can go far in reducing the incidence of back pain.

Why is that important?  Education about the influence of our brains and fear of movement can affect the outcome of any treatment.  I wonder if the combination of that education in addition to exercise had an even better effect on this group.  I feel another research study about the brew!

Is Sitting The New Smoking?

In the newest AARP magazine, there is an article called, “Is sitting the new smoking?”  At first I chuckled at the comparison, but as a physical therapist I educate patients about the dangers of too much sitting.  I talk to them about back pain, loss of muscle strength and balance issues.  If we don’t use what we have, we most definitely lose it. Sitting also causes higher blood sugar levels, higher blood pressure, and more edema in the legs. 

Can sitting be as dangerous as smoking? Well it doesn’t cause cancer but it does contribute to chronic disease that includes pain, diabetes, heart disease and stroke.  I have already seen evidence that the incidence of all of those chronic disease processes cause premature death and aging and affect more people than cancer in this society. 

So, my answer to this simple question is yes.  Sitting is the new smoking and has  as much of a stigma attached to it for the current generation.  What is to be done about it?  Education about the benefits of movement.  Movement is about health and life.  Movement is the  movement of 2012! Promote it as much as possible and live it every day!

Gyms Can Be Hazardous to Your Health!

Within the past month, I saw 5 patients who were injured in their respective gyms while working out with trainers.   One was performing dead lifts with more than his body weight and blew out a disc at the age of 24 and now has chronic low back pain.  One was working out with a trainer who claimed to be a body building champion and worked his shoulder so hard that he developed a bone spur and a tear of the rotator cuff.  Another simply torqued his back on the leg strengthening equipment and has difficulty sitting and standing. 

Personal trainers are not all the same.  Just because they were able to work up to Mr. America, doesn’t mean that they can teach you to do the same.  Pain in the gym does not equal gain!  If it hurts, it is not good.  I can walk through a gym and pick out all the potential patients in a few minutes.  If an athletic trainer does not respond appropriately when you complain of pain with a particular exercise, it is time to get a new trainer. 

Gyms can be hazardous to your health if exercises are performed incorrectly.  Get professional help from a physical therapist or a physical therapist assistant before you start.  It can make all the difference in the world. 

Can clothing cause pain syndromes?

Yesterday a middle aged woman came into our office complaining of neck and shoulder pain in addition to numbness and pain radiating in her arms.  She also had a positive test for thoracic outlet syndrome. 

When she stood in her shorts and tank top, I noticed that her bra straps were digging into her shoulders as close to the shoulder joint as they could be without slipping off and the sides were also much too tight and pulled into her armpits so tightly that they could not be budged at all.  When her straps were lifted up with much effort, she said the incidental numbness in her arms decreased and she demonstrated full range of motion of the shoulder. She had been fitted at a bra store with a minimizer which was a torture device.  When I asked her how she felt when she took off her bra at night, she responded “great”.

After some discussion about the appropriate fitting of a bra, the patient finally understood how the one she was wearing was contributing to how she was feeling.  Poorly fitting bras can definitely contribute to pain syndromes or even cause them.  If something you put on hurts, take it off.  Underwear should not be painful.  If you accept the theory that we need to hurt to be beautiful, you could be setting yourself up for a painful journey that may be irreversible. 

So the answer is of course that ill fitting clothing can cause pain syndromes as well as other problems.  Don’t accept clothing that causes pain even for the short term.  It may end up causing a long term  problem that won’t go away.

Leg Length Again?

Recently, I talked about a patient with a leg length problem.  Ironically, she came back for her second visit and announced that she was cured.  Her back pain was significantly better and she was able to stand and do things she hadn’t done in years.  Although thrilled with her progress, I decided to follow up in another week just to make sure there wasn’t another issue lurking in the distance. In the meantime, I added a few more millimeters to her lift just to balance things a bit more.

Later today another patient came in with a persistent lateral shift and a degeneration of her 4th lumbar disc. After a spinal injection, manual therapy, abdominal bracing exercises, stretching and both light therapy and electrotherapeutic point stimulation, she was about 25% better, but I was still determined to see better results.  I measured her leg length and noted a 3 centimeter difference,  which is significant.  When I questioned her about it, she said she did notice it when she bought pants “but blew it off”, just like a sleeve length problem.  We decided to try a 5 millimeter lift to start with and I can’t wait to see what will happen in a few days.  This might be the key to a better result. 

Small leg length problems can cause major back problems.  Education about little problems that can grow into bigger ones is key. Leg length should be assessed for every back pain patient.  Prevention with a screening for leg length wouldn’t be a bad idea either!

Is Yoga Healthy?

I just finished reading the article in the New York Times Magazine this week entitled, “All Bent Out of Shape”.  William Broad discusses the possible problems with  yoga.  Yoga is a type of exercise, a way of looking at the world and a type of mind body activity.  It is not the end all or answer to everyone’s problems.  It is not a panacea.  There are yoga instructors who take their poses too far.  It is for that reason that I tell patients that if they choose to go to yoga classes, they should make sure the instructor respects their limitations. Make sure the instructor knows if you have back pain or a neurological condition, don’t assume he or she can tell.   There should be supervision by the instructor so that those limitations are respected.  The final rule I always tell patients is that any exercise program should not be painful.  Exercise should not be painful and pain does not have to happen to have a gain.

Yoga can be healthy if done the right way! Supervision with a professional who respects the body is key!

A neck problem in a elbow costume or is it a elbow problem in a neck costume??

Recently a hand surgeon came into my office needing treatment for his “elbow problem”.  After my evaluation, I determined that this might very well be a neck problem instead of or in addition to the elbow problem and verbalized my findings to this professional.  To his credit, he said that he would agree to go along with my plan because I was the professional in this situation.  He also indicated that he thought he just needed some stretching and strengthening exercises. 

The symptoms he was mostly concerned about consisted of pain in his forearm and a limitation of the movement of his elbow.  His neck was quite limited and his body mechanics were also dysfunctional.  After some cervical traction, direct current ETPS (electrotherapeutic point stimulation),  postural education and some exercises to stretch his neck and strengthen his scapular muscles, he was a new man with full range of motion and no pain.  A home saunders cervical traction unit was also used on a daily basis to start to help maintain his pain relief.   

The hand surgeon was very happy to be discharged with all goals met in about 6 visits.  He turned to me on the last visit and said, “you know, I wonder if some of my hand patients are truly neck patients in disguise?”  I responded that all problems can have a central origin so I choose to look at every problem from all perspectives and treat accordingly and hope that other physical therapists do the same.  Most problems have a component of each and if you look at the spine as well as the extremity for any problems, you can usually pinpoint the answer to the dysfunction within a few visits.

Is it a neck in an elbow costume or an elbow in a neck costume? It doesn’t matter because practitioners should look at both when we are evaluating a particular problem.  The assessment and treatment should include a look at both and the problem will be answered within a few visits through appropriate treatment choices. 

To Exercise or Not?

My mother just had her 80th birthday.  She grew up when exercise was calisthenics and not too much fun.  She never had to lose weight, was lucky enough to not have diabetes or heart problems and can pretty much eat whatever she wants to without negative consequences.  Her days are spent driving to activities, playing bridge, reading and eating out with friends. 

On a recent visit, I noticed that her gait pattern had become wider with less hip movement and her walking had become much slower.  I mentioned something to her about physical therapy and she said that she would get to it at some point, but was too busy right now. Besides, she said she doesn’t like to exercise.    I worry that her lack of exercise has made her weaker resulting in a more unsteady gait.  The less she does at this point, the weaker and more unsteady she gets.  My fear of course is that she might fall and then her mobility problems could get considerably worse.

My mother’s generation did not voluntarily exercise unless it was a weight issue.  Walking was for those who couldn’t afford a car or to live in the suburbs.  She hates exercise and even hates the word exercise. Weight bearing exercise would definitely help to reduce complications from her osteoporosis.  It would also help to maintain her leg strength and balance.  The International Weight Lifting Association stated that seniors who do not perform any weight training lose up to 10 % of their strength each decade of life.  Falls are an inevitable consequence of the loss of strength and balance. 

Previous generations walked more and did more activities, out of necessity.  My mother has help for all household activities and she only goes to places that she can drive to with valet parking and minimal walking required.  As a physical therapist, I worry that all this help is actually making her more vulnerable and weaker.  Education about the need to exercise and to maintain strength is crucial at every age.  Our seniors need to understand that exercise may mean the difference between independence and some type of dependent living arrangement, my mother included. 

Exercise is the key to independence!