Are you fat on the inside?

We all know that what’s on the inside is what counts……even the fat.

Now I know you are all motivated (even if not enough) to lose the external fat. We all want to look good, right? But, fat on and in our organs can be just as damaging – maybe even more so – than the fat that jiggles on the outside.

This is a bigger problem in people that don’t exercise – even if they are thin. Research shows us that it is better to be an overweight exerciser than a skinny couch potato. In fact, according to an article published on msnbc.com, many sumo wrestlers may be less healthy than their less active fans!

So, don’t just drop the danish (is that as hard for you as it is for me?) and pick up a dumbell!

(Click here to read more).

My back hurts. What kind of treatment should I get?

It is hard to be a patient with back pain. Everywhere is conflicting advice. Surely, though, your healthcare team will give you up-to-date and unbiased advice, right?

In short, not a chance! Most (MD’s, DC’s, LMP’s, PT’s, DO’s, ABC’s, etc) are going to tell you either: a) you’ll be fine, just wait b) you need whatever it is that I do. If their treatment fails, you may get one referral to someone else that they like (personally). Otherwise, the pain is in your head…or there is nothing more to do…or just keep getting my treatment…or….

Since nobody is going to give you a straight answer, here is my guide on how to use the different providers:

Family Practitioner (MD or DO): They are going to be fairly good at ruling out a nasty cause of your pain, particularly cancer and infection. If you have an exotic arthritis, they will probably figure it out with time.

Massage Therapist (LMP): Massage is a great adjunct to other treatment, but not enough usually on it’s own. Combine with Physical therapy and/or chiropractic.

Chiropractor (DC): I wish I could say, go find a chiropractor and he will help you with what he can and manage the referrals for the other care that you need (massage, physical therapy, surgical consults, etc.). Many do this, but not most.

Chiropractic adjustments are very efficient and effective treatments for a majority of back and neck complaints. Combined with physical therapy exercises it is even better in most cases. Generally, the chiropractor should be able to guide you through the exercises that you need, which should not be too many – if so, you may need a physical therapist.

Unfortunately, many chiropractors treat everyone the same and just crack your back without good diagnosis or making sure you get the other treatment you need. Finding a good chiropractor can be difficult, but it is worth it.

Physical Therapist: For most back pain, physical therapy exercises are effective and often necessary. PT’s tend to give to many useless exercises along with the useful ones. Often a chiropractor can give you the exercises that you need more efficiently, but if it is more complicated, or your chiropractor can’t handle it, you will need a PT. You can’t throw a dart at the phone book here either and have a reasonable chance, but good PT’s are out there.

Surgeons (MD, DO): You probably should not have back surgery. Just having a herniated disk does not mean you need back surgery. However, if you do, go to a neurosurgeon that does mostly spine surgeries. You will have the best luck here.

What about cortisone injections and prolotherapy and those fancy traction machines with an “86% success rate” and…and how much treatment do I need? Next time.

Warning: This is a (very) general guide on who does what well. It is to help you find someone to treat you, not so you can diagnose yourself and ignore medical advice given to you. If you are unsure of your current treatment or diagnosis, etc, get a second opinion from a live person in the flesh, not a blog!

Exercising for Back Pain

To prevent back pain our focus is coordination and endurance. To get that we do what are called functional exercises. Functional exercises are those in which you use different muscles together in a (somewhat at least) natural arrangement.

This is as opposed to isolation type exercises. Two examples of functional exercises are the bench press and the squat.

In the bench press we use our chest, shoulders and triceps together in a normal way (i.e. similar to how we might use them together in normal life). An isolation exercise would be the pec butterfly. This uses only the pec (chest) muscles. And it is not very similar to how you might use it in normal life.

The squat also uses your quadraceps, buttocks, etc working together as those muscles usually do. A leg extension just works one muscle, the quadraceps, and is an isolation exercise.

It is a good idea to use functional exercises as much as possible in your workout. When you workout with functional exercises, you are less likely to miss, or underwork an important muscle. Functional exercises also engage the stabilizer muscles that we mentioned recently.

These concepts apply to all your joints, not just your spine. So next time you are at the gym, try to figure out how much of your workout is functional. (Sorry, but this is an important homework assignment).

Next time we will get back to our back pain vaccine exercises. Until then, keep working on the bird-dog.

The Back Pain Vaccine

Last time we talked about endurance exercise being important for back health. Today I’ll show you an exercise.

This exercise is called the Bird-dog, because………………it makes you look like a bird-dog. (Google that if you don’t know what that is ). This is one of the best exercises for those multifidus muscles that we showed last time.

The elements of endurance and coordination are both present in this exercise. She is making one mistake and should move her “down knee” forward until it is straight up and down. Also make sure that your pelvis is level with the floor.

You want to hold this position for 10 seconds per side. Work up to doing this 10 times per day, for a total of 100 seconds per side – easy! If you do this less than three days per week you are probably wasting your time. 3-5 days is great. More than 5 days won’t add much.

How easy, or hard this exercise is will tell you something about the shape of your back muscles. If you are bouncing, jerking and generally having a hard time holding this position, good news! You have room for improvement. : p

When this gets too easy, don’t add ankle weights or have your little brother sit on your leg. Instead, lift the arm opposite your “up leg”. So lift your right leg and left arm, for example. Still hold for 10 seconds and 10 sets per side.

This is the first step to health and happiness…or, at least, less back pain!

Back Pain Myths: Strong Back Muscles

On a daily basis, I see patients who suffer more than they should because of some common back pain myths. Today’s myth: Strong back muscles will protect your spine.

Wrong!

Your body has two types of muscle (really more than this, but the others are in your internal organs), movers and stabilizers. Movers are big muscles that move your body parts, hence the name. Stabilizers are muscles that hold your parts in place and prevent you from being damaged while the movers are moving you.

Your multifidus muscle, pictured below, is an example of a stabilizer muscle.

To prevent back pain, you need your stabilizer muscles to have endurance. They protect your spine. If they work as long as you do, everyone is happy. If they quit before you do….ouch!

These muscles don’t need to be strong, but they need to be able to keep going and going….and going.

The problem with exercises for strength is that they tend to work the “movers” more than the stabilizers. And, when they do work the stabilizers, they can change them from slow-twitch (endurance) muscle to fast-twitch (powerful) muscle.

Studies of back pain patients show that high percentages of patients with chronic back pain have a different mix of fast vs. slow twitch muscle fibers. Studies also show that those with back pain tend to have very low endurance of their stabilizers – particularly the multifidus.

Tomorrow: preventing back pain with endurance exercises. Stay tuned!

Kids and Back Pain?

Kids get back pain. I know, for many of you, this is shocking. How could this be true? Kids heal fast….and they are practically made out of rubber, right? Well yes to the first point. To the second…maybe when they are very young…but that’s still a stretch.

We are talking here, more specifically, about adolescents.

If you read medical textbooks (hopefully not for their literary quality) in the past, it was assumed that kids didn’t really get back pain. That is, of course, until they turn 18 (or 21 depending on the state).

The absurdity here is pretty obvious to anyone paying attention….but nobody was. C’mon kids whine when you make them clean their room, eat brussel sprouts…..or get up before 9:00 am. So, now they are whining about their back….what’s new?

Finally, researchers came to the rescue. A study published in the summer of 2006 looked at just under 10,000 Danish teenagers. Close to 40% reported back pain. And, interestingly enough, it was tied to real physical factors.

The predictors of back pain were having back muscles with low endurance and being tall. Surprisingly, trying to avoid mowing the lawn did not make the list.

Running away from back pain

Running will wear out your back. Let’s get a show of hands. How many of you agree? OK, let’s change the statement just a little. If you have arthritis, you shouldn’t run because it will wear out your back. Hands one more time – a few more.

A group of researchers at Stanford looked at these questions. Let’s see what they found.

They followed 866 mature individuals (i.e. average age in the early sixties) for 14 years. They looked at members of a running association vs. non-members and at ever-runners vs. never-runners. The members of the running association ran about 26 miles per week.

The runners (anyway they sliced it) had slightly less arthritis, 35% vs. 41-43%. But more importantly, they reported significantly less pain.

So, go get your three miles in today and all will be well? No!! At the risk of stating the obvious, consider (rationally) your current state of fitness and start slowly. Don’t expect to pick up right where you left off before the kids, the Carter administration, or what have you.

Now that we have the obvious disclaimer out of the way, one last bit of advice. Pick something fun! If the thought of running is less pleasant than a root canal, DO SOMETHING ELSE!

The real goal is staying active consistently. If you enjoy your chosen method of exercise, you’re much more likely to keep it up and reap the benefits.