If Better Abdominal Muscles Are Your New Year's Resolution, Try This
Sunday, December 31, 2006
Healthline
Readers have been writing to ask about the conflicting reports in fitness magazines on how often you should work your abs. Some sources cite research studies saying you should rest between resistance training. Other articles say to exercise them every day.
It's common to debate fiber type and fatigue and conclude whether to schedule your abs daily or intermittently. Then people "do" abdominal exercise based on that, and completely neglect what abdominal muscles really do when you stand up and go about your daily life.
Abdominal muscles have their main function when you are standing. They do not automatically do anything to support your back or prevent lower back pain. The 'support' comes from how you stand. It has nothing to do with strengthening or tightening. Those are common fallacies.
Abdominal muscles attach from your hips to your ribs. When you use abdominal muscles, you prevent the distance between ribs and hip from lengthening, which bends the lower back, pinching it back like a soda straw. The article Fixing the Commonest Source of Mystery Lower Back Pain shows how this works. Abdominal muscles are like a guy wire attached to the front of a tree, keeping the tree from bending or leaning backward. Your abdominal muscles do not prevent leaning backward automatically, you need to deliberately use them to move to neutral spine. If you are not using your abs when you stand, your upper body will lean backward and/or your hip will tilt downward in front. This is called slouching. Your lower back overly curves inward too much, and pinches and pressures the joints and soft tissue of your lower back.
People who overly arch the lower back (called swayback and hyperlordosis) usually notice their back hurts after long standing, walking, running, and reaching and lifting overhead. They feel they need to lean forward or sit to relieve it. The bending over forward feels good at the moment because you stop the pinching backward that causes the pain. It is not a "fix" - it does not stop you from going right back to hyperlordotic slouching that causes the pain when you stand back up. Strengthening and stretches also are not the "fix" for this back pain. You can prevent the pain in the first place by not slouching in hyperlordosis. Then you will get built-in use of your abdominal muscles, and not need a temporary, palliative, stop-gap measure of bending over forward, or picking up one leg.
Using your abs doesn't mean sucking them in or making them tight. It means not letting your lower back overly-arch. When you tilt or tuck your hip under you to straighten your pelvis to upright rather than tilted, and bring your upper body to upright position rather than tilting backward, the muscles that reduce the overly large inward curve to neutral are your abdominal muscles. That is how abdominal muscles support your back - when you deliberately use them to stop slouching.
Plenty of people have 6-pack abs and have terrible posture and continuing back pain. In my practice, I treat patients with strong well-defined muscles who hurt their back opening windows because they overly-arch the lower back when they reach upward and lift overhead.
If "abs" are part of your New Year's Resolution, here is how to get functional healthy abdominal exercise:
Stop doing crunches. They are not functional, not healthy, and don't train your abs the way you really need them to work in real life.
Stand properly without overarching. That gives built-in abdominal muscles exercise all the time. Do not suck in or tighten. Just position your spine away from unhealthy overarching.
If you "worked" your abs all day all the time by controlling your spine and lower back positioning, you wouldn't need to go to a gym to do funny little crunches - neither every day, nor every few days.
Two weekends ago we were in Virginia on a medical consult with colleagues. One of the docs is an osteopath and collegiate team doc who really knows his orthopedics. I enjoy our discussions of the best techniques to retrain healthy muscle use. He mentioned that he discourages his team members from the overhead military press (lifting weight directly overhead with both arms). He mentioned the frequent, serious shoulder and neck injuries this exercise often produces. The numbers show that he is correct.
My colleague reminded me that the military press is not usually functional, which means that except in cases like my carpenter husband Paul who lifts substantial objects overhead all day at work, people do not lift overhead for daily life. Given the large number of injuries the overhead press causes, he'd rather people strengthen in other, more functional ways.
It is true that most lifting overhead is not directly over the shoulder, as in the military press. However, most people need to lift things overhead as part of daily life, and often use the overhead press during recreation, as in the photo, at right.
Here is how to do the overhead press in ways that I believe can keep it healthy, and how to transfer that healthy positioning to lifting laundry, groceries, babies, and other daily weights:
Keep your shoulders down and your chin in, then lift. By keeping head and shoulder position from drooping forward, you will prevent the shoulder bone from squashing your rotator cuff and other soft tissue when you lift your arm. Use the healthy shoulder, neck, and lower back, positioning in #1,2, and 3 (above) for every overhead lift, from pulling off a shirt, to putting away groceries, to lifting children, putting things on shelves or overhead racks, to lifting weights. You will get better exercise and prevent injury.
Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
Thursday, December 28, 2006
Healthline
A study from the University of Pennsylvania reported in the BBC News found that taking a class of drugs that reduce stomach acid, called proton pump inhibitors (PPIs), for at least a year increased risk of hip fracture by 44%. Taking the drugs for longer periods further increased risk. Proton pump inhibitors include Nexium, Prilosec, Prevacid, Zoton, Inhibitol, and others.
The study needs more work and questions remain, but this is not a surprising finding. The common practice of using proton pump inhibitors, as well as ordinary antacids, has long been identified in accepted studies to reduce calcium absorption.
Taking acid-reducing medicines contributes to other problems as well. You need stomach acid for health. Stomach acid is necessary to kill unhealthy germs and food-borne infection. Low stomach acid allows infectious organisms to grow in your system. Acid suppression is a known risk factor for traveler's diarrhea and other gastrointestinal illnesses. Although acid suppression is commonly used to treat ulcers, the resulting lack of stomach acid encourages overcolonization of the bacteria Helicobacter pylori that is associated with ulcers. H. pylori is not all bad, and has important functions in your system. But using acid suppression with H. pylori colonization present seems to be linked with an increase in the progression to gastric cancer.
What can you use for your stomach instead of acid-reducing medicines?
Pain, reflux, and constant burping are often a sign of low acid, not high acid. Drink a little apple cider vinegar in water and sprinkle balsamic vinegar, wine vinegar, or other vinegar that you prefer in your food.
Clinical trials indicate that the "good" yeasts and bacteria called probiotics in fermented food like sauerkraut and kimchi help control several diseases, such as reflux, ulcerative colitis, and irritable bowel.
Cabbage has been found in studies to be an effective antibacterial for stomach ulcers associated with Helicobacter pylori.
Broccoli sprouts have been found to specifically control H. pylori.
It is established in scientific studies in standard Western medicine that several spices have bacteria-inhibiting properties. Seasoning food with raw crushed garlic, onions, and fresh ginger root may inhibit strains of Helicobacter, E. coli, Staphylococcus, and Streptococcus, without harming beneficial digestive bacteria.
Garlic, allspice, and oregano have been found to have action against "bad" bacteria, followed by thyme, cinnamon, tarragon, and cumin.
Capsicum, such as chilies and other hot peppers, have moderate antimicrobial action. White and black pepper, ginger, anise seed, celery seed, and lemon and lime juice follow.
Researchers at the University of Kansas found garlic, cloves, cinnamon, oregano, and sage kill E. coli.
Use ginger root to sooth stomach pain, rather than medicines.
To reduce risk of osteoporosis:
Stop smoking.
Avoid drinking large amounts of alcohol.
Stop drinking colas. The high phosphorus content in both regular and diet colas are not good for your bones.
Avoid agents that reduce calcium absorption, such as antacids, and eating animal protein
Don't crash diet. Rapid weight loss is shown to lower hip bone density.
Check for wheat intolerance. People with Celiac, which is an autoimmune reaction to the protein in wheat, have higher rates of osteoporosis.
To build bone, stay active. Sedentary people lose bone even if they supplement with calcium. Exercise is the stimulus for bones to use the calcium. Get outside in the sunlight (sanely) for the several benefits of sunlight not available in pills and supplements. Get fun movement and exercise outside, at least a little every day.
To build bone in your upper back and wrist (two of the three principal sites of osteoporosis):
People with muscle and joint pain are frequently put on over-the-counter or prescription anti-inflammatory medicines. Several of these hurt the stomach lining. Acid-reducing medicines are often added to try to counter this problem. Along with the problems that acid suppression medicines can produce, a common, under-recognized side effect of acid suppression medicines is achy muscles and joints.
If stopping pain and helping your bones are New Year's Resolutions, reduce or stop the need for taking anti-inflammatories for joint pain by learning the healthy joint mechanics given throughout this blog. Often when people stop taking both their anti-inflammatories and stomach acid medicine, they feel better than when they were taking both together. You can stop your pain without medicine, then stop the need for the medicines so that your stomach, and your joints, can heal.
Readers have been asking what happened to the weekly reports of my martial arts classes. Others wanted to hear about my other classes including yoga. My martial arts students continued becoming skilled and disciplined. Next semester I will post some of the fun drills they do to build natural strength, discipline, and flexibility using themselves and each other instead of weights and equipment. In my yoga classes we learn that the poses themselves are not what gives good posture and focus. We learn what healthy positioning is, then apply it to how to move for daily life after walking out of the class.
In my sports medicine practice, I regularly see yoga teachers as patients for back, knee, and neck pain. That is because several yoga moves are not good for anyone - just as not all food is healthful. Many moves are fine, but other traditional poses injure joints, even when done "right" (or especially when done right), like bending over from a stand or a sitting position, whether the back is rounded or straight. We omit those moves and use others that are better stretches without the degenerating forces on the lower back and neck discs, for example, Healthier Hamstring Stretching. You don't have to injure yourself to get exercise. Fitness is supposed to be healthy.
This week in yoga we did a fun, effective hip stretch. We stood on one foot and reached for the other ankle crossed over the bent standing knee (drawing at left). When we do this, we practice the daily healthy position of keeping the upper body upright and straight, with the chin in, not craned forward. One new student was not happy with my class. She was used to sitting on the floor in classes she ordinarily took. She was peeved that we did so much standing. Although people call yoga "mind and body," she didn't like that we used the body. Although people frequently say that yoga is about understanding and light, she whined and complained and cursed me under her breath for most of the class. She wanted to know why I was making everyone do an extreme and bizarre movement.
I told the class it was healthy and happy to do this move every day. I pointed to my crossed foot and spoke the name of this ancient move - "Putting on shoe."
I hope you will try this too, to get a normal and healthy hip stretch and better balance everyday. Remember that most of the world stands to dress - the ones lucky enough to have shoes. Stand up now and try it. You will get free balance, healthy hip stretch, and leg strengthening every day from daily life. When you get good at this fun move, keep your ankle crossed and bend the standing leg enough for you to reach to the floor to retrieve your other shoe or sock. Keep your chest up and your back straight to prevent practicing unhealthful rounded position. Even though this one bends over, it does not transfer the pivot force to the lower discs for several reasons.
Have fun adding new healthy movement to your New Year. Write your stories and take photos of how you make your life better by fixing your fitness to be functional and healthy. Send link to your photo sharing site of your examples, and I can put you up in lights as a role model for healthier life.
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The days are becoming longer and light is returning in the Northern Hemisphere. Native Americans, Shinto, Iranian Zorastrians, Buddhists, Christians, and non-faith based traditions all celebrate the winter return of light and life and enlightenment with trees, and lights, and cleaning the house, and giving presents, and lifting things.
In many of these traditions, is written that pain and darkness is high before the return of the light. The upper photo shows pain - unhealthy bending. The lower photo shows "seeing the light" - healthy bending.
For healthy holidays, check your bending for all the cleaning and lifting you do:
Don't lean over (upper photo). Keep your body upright and bend your knees. This bending gives healthful exercise and prevents straining back muscles and herniating (slipping) your lower back discs.
Many people think that lifting bent over strengthens back muscles. The problem is that, over years, it also degenerates your discs. Bend right to strengthen without also damaging.
Other people refuse to bend right because it hurts their knees. Done properly - both knees over your feet, and your weight back toward your heels, body weight shifts off your knee joints, to your thigh and hip muscles. You will feel the difference as soon as you try it. You get healthy leg and hip strengthening without back or knee pain.
For all my friend readers in the Northern and Southern Hemispheres, make healthy bending a New Year's Resolution and part of your healthy holidays and stronger New Year.
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Bad bending photo by subscription to Clipart.com Good Lifting photo (without halo) by iwona_kellie
I often hear from trainers, and read in exercise books, that you cannot get stronger without lifting weights. They say that body weight is not enough. Then I watch the trainers and read what the exercise books say to do to strengthen. Often the weights they teach to lift are far lighter than the resistance your muscles get from moving your own body during a real life activity.
I see women in exercise classes lifting little two and five pound hand weights, then bend over wrong to put the weights down and bend over wrong again to hoist up their 20-pound handbag. I see knee pain patients in rehab centers with two and three-pound weights strapped on their ankle, sitting down to do little leg raises. Or, they pull stretchy bands with their leg. Then they get up and walk away with injurious body mechanics, letting their knees and ankles sag inward because they are not using their leg muscles to stop it. The unhealthy sagging grinds away joint cartilage and prevents full use of the leg muscles. They don't understand why their knees, ankles, and feet still hurt even when they "Do their exercises."
Your body weight is the most important thing you need to lift. Following are things to start with, to strengthen without a gym or equipment. The main idea of these activities is not to "do" them as an exercise 10 times, but to use them to retrain your muscles how to hold your body in healthy position, then use that healthy positioning for all daily life:
1. Hold a pushup position, called the plank, described in the post Change Common Exercises to Get Better Ab Exercise and Stop Back Pain. Understand that the point of the plank is to learn how to hold your spine straight without sagging under your body weight. I see people doing the plank all the time in gyms and fitness classes, with their bottom hiked up in the air and their low back looking like a hammock, sinking under their body weight. That is not the normal lower back curve. It is injurious overarching. Done poorly this way, the plank does little to strengthen and just pressures your lower back. Done well, the plank is excellent to strengthen your wrist. The wrist is neglected in fitness, and the resulting weakness is a common source of injury. I will post more about wrists. Do the plank every day - that is how helpful and important it is. If you can't even hold up your own body weight, you may have serious weakness.
2. Use the squat for daily bending, described in the post How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending. The point is to use this healthy bending all the time instead of bending wrong. In posts to come, I will show another way for healthy bending using a lunge position with one leg in front and the other in back.
3. If you can't sit and rise from the floor without your hands, you are too weak and tight for ordinary daily life. Try Quick and Easy Strength and Balance Exercise. Also practice getting up from your chair (safely) without using your hands or leaning forward.
5. Hang from a chining bar, a branch, a pipe, a doorjamb, or any secure overhead. Don't worry if you cannot do full pull-ups, just hold on and hang. When you can do that, hang for as long as you can from a bent-arm position, and begin trying to raise yourself (do a pull-up). Maybe you will need to start by stepping up on a box to help raise yourself, and letting yourself slowly lower without using the box. Work up to full pull-ups. If that is easy, use fewer fingers to hold on.
When the above body weight activities become too easy, do them carrying functional weight, such packages, children, books, and other common things. It is crucial to health and independence to be able to lift and move your own body weight. In posts to come I will show you how to do more with these body weight activities for more strength and fun being active. Until then, do these every day and send your photos and stories of how you got stronger and happier.
Make it your New Year's Resolutions to be strong for real life in real ways.
Exercise Should Not Mean Stopping Your Life - It is How You Move In Your Life:
I received several e-mails from people who tried the Quick and Fun Arm and Body Strengthener in the previous post. Readers were happy with their new-found understanding that being able to hold up their own body weight is important, empowering, healthy, and fun. They wanted to know more about the benefits.
Strength training isn't just for big guys in a gym. You need strength to lift and carry things around the house and workplace, to lift packages, children, groceries, and yourself easily rather than struggle. By increasing strength, you can do daily activities more easily, and reduce your chance of injury while doing it. Strengthening is important to reduce, even reverse, many characteristics often mistaken for aging, Becoming weak, unsteady, and slow is not aging. Are you as active as previously? It is a simple example of "use or lose."
At the ACSM New York conference on aging earlier this month, experts explained how it used to be thought that rates of protein synthesis, meaning how much protein your body uses to rebuild itself, decline with aging. However, it is not aging, but disuse. When experimental groups of people in their 70s began being active again, their rates of protein synthesis became comparable to the groups of 30-year-olds.
In my lecture at the aging conference, I told how the common perception of not being able to get up from the floor is not aging; it is the need to regain the strength and balance to do it. Part of my lecture explained how elderly and debilitated people who could not previously lift themselves out of their chairs become more mobile from daily movement that strengthens, allowing them to get up and walk again. Everyone needs the strength to lift their own body weight up from the floor, from bed, and out of chairs. With strengthening, may people who previously needed walkers and canes, sometimes even wheelchairs, could walk unaided again, and stop needing many medicines.
Using muscles is a key part of osteoporosis prevention. The pull of muscle against bone thickens the bone. The stronger a muscle, the more it can pull on the bones it attaches to when you use it. Without exercise, you lose bone no matter how much calcium you eat. Even a young person in a cast loses bone from simple disuse.
Even people who don't do activities commonly regarded as needing strength, do daily activities like carrying grocery bags, a suitcase for travel, or a squirmy child. When your arms are weak, you are more likely to lean back to carry things on front of you, shifting the weight to your lower back. You should be able to carry everything you want without leaning back or to the side, no matter whether it is a child on one hip or grocery bags carried in front in both arms, or both. You should be able to carry a shoulder bag or knapsack on your back without leaning your body forward.
Strength is important for everyone. You don't need a gym or trainer to get stronger. You don't need to change clothes. You don't need to buy equipment. Several posts of this blog have shown how to move with healthy positioning. The next post will list several ways to use that healthy positioning to strengthen your body more each day - Getting Stronger Without a Gym.
Read success stories of these methods and send your own. See if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Upper body strength is important for health, making daily activities easier, and other benefits including preventing osteoporosis of the upper back and wrist, two major sites of bone loss in both men and women. It is often said in gyms and fitness articles that body weight is not enough to strengthen, and that you need weights and equipment. Fortunately, that is not true.
Here is a quick, fun, upper body strengthener using your own body weight. It has the added advantages of also strengthening core muscles plus training a fair amount of balance. It also gives many benefits of a tilt table or inversion machine. You can use this fun exercise anywhere you have even a small wall space. It is fun and not as hard as it looks. Be brave, and (safely, carefully) try this:
Stand with your back about a foot in front of a wall (face away from the wall).
Crouch down and put both hands on the floor - drawing #1 at right.
Put the bottom of one foot high on the wall - drawing #2.
Lift your other leg to the wall so that you are standing on your hands with both feet up on the wall - drawing #3.
Hold as long as you can. Keep breathing.
When you want to come down, just step one, then both feet back down to the floor the way you started in drawing #1.
Avoid this one if you have uncontrolled high blood pressure or problems with pressure in your eyes or brain. To keep this exercise fun and safe, when you are upside down standing on your hands, don't let your lower back sag into an arch. Keep your hip tucked to straighten your back and you will get free core strengthening while you do this. Don't let your body weight pressure your shoulders. Use your upper body muscles to maintain shoulder position instead of letting your shoulder joints grind under your weight. Don't fall down on your face. Use your arm strength and hold yourself up. Keep breathing and don't tighten and strain, which increases blood pressure.
Don't think of this as an extreme exercise. It can be simple; don't be afraid to try it daily. My Grandmother "downgraded" to this one in her 90's from full handstands (without the wall), because it is easier and safer.
When this exercise becomes too easy, rock side to side so that you stand with weight first on one hand, then the other, as if walking on your hands. Keep your feet against the wall for balance, at first. When this becomes too easy, stand only on one hand for increasing periods. Start doing small dips, like upside-down pushups. Increase until you can dip your head almost to the floor, then push back up to a handstand again. Work until you no longer need the wall.
You do not need to lift big weights in a gym to strengthen. Your body weight provides fun, effective strengthening, with no machines, gyms, or extra weights needed.
Reader Tries This and Shows How To Get Started, Even if You Think You Can't:
Read success stories of these methods and send your own. See if your questions are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
The web version of Grand Rounds is a weekly collection of many medical post from all over. Peanuts character, Charlie Brown once said, "In the book of life, the answers aren't in the back." Nurse Jones did the hard work to collect posts to provide answers important to our health.
More thanks to Nurse Jones for citing my post Get Muscles for Christmas, calling it "how to eat right during the holidays."
The purpose of the quadriceps stretch is to lengthen the front hip muscles. Check if you stretch in ways that do not get the stretch in the front muscles. When holding one foot in your hand behind you (or resting on a chair if you can't reach), if you increase the lower back inward curve, tilt your hip/pelvis forward, or bend the leg at the front of the hip (top drawing, left), not much stretch occurs, and the purpose of the stretch is lost.
Instead of "doing" a stretch, get the purpose of the stretch. Try this:
Look at the top drawing, then the second drawing below it at left. See the difference in the tilt of the hip and pelvis.
Stand and begin the stretch.
Tuck your hip under to reduce the lower back arch, as if you are starting an "abdominal crunch." Your hip (pelvis) moves from tilted forward at the top and out in back (upper drawing), to upright (lower drawing).
Don't curl or bend your upper body forward; just tuck to straighten the lower spine and hip.
When you tuck your hip correctly, you will immediately feel the stretch move to your thigh. Pinching and pressure will stop in the lower back.
Straighten your arm. Push your knee downward and backward.
Allow your lower back to arch inward again, and you will immediately notice the stretch will lesson or stop.
Tuck your hip under again and you will feel the stretch return to the front of your thigh.
I have seen a poster hanging in various gyms of "dos and donts for exercise and stretch." The poster shows this quadriceps stretch and says you should not pull your foot away from your body in back because that makes you arch your back. However, it is not pulling your foot away that makes you overarch (too much lordosis, called hyperlordosis). You allow over-arching if you do not tuck your hip - using your muscles to straighten your spine to neutral upright position, not tilted forward.
Many people start this stretch by lifting their leg forward at the hip, bending over forward to reach their foot, then pulling the foot behind them. The point of the stretch is to lengthen the front of your hip, not bend it. Instead of bending forward to reach your foot, stand straight, lift your foot behind you, and reach back. If you are too tight to reach your foot, place it on a chair or bench behind you. Work up from there. If your balance is too poor to do this stretch, stand near something for safety, but do not hold on. You will quickly improve balance by simply practicing it. You will not improve balance by holding on.
Remember - don't "do a stretch" - do the purpose of the stretch. Use this stretch with your upper body upright and straight. Keep your hip tucked under, your shoulders down, and get a nice stretch and balance exercise in one.
An article getting much attention in news and blogs carries the headline, "Don't sit up straight." Many people have been overjoyed to read this. The news articles state that recent studies say not to sit up straight due to the pressure it puts on the spine. But this is misleading.
The studies don't mean, "don't sit up straight." They mean, "don't sit vertically." They say that leaning back reduces compression on the spine. The articles I have written about healthy sitting are in line with these studies, and say to lean the upper body slightly back - less vertical vector, means less direct axial loading. You still need to prevent rounding your back when leaning back, shown in the drawing at left.
It is not "sitting straight" that is the problem. My article Disc Pain - Not a Mystery, Easy to Fix shows how rounding the spine forward under your body weight mechanically opens space between the back of your vertebrae, and pushes your discs outward, over years, into this space. The article reminds:"Pull your chair in closer to the desk, and lean your upper back against the seat back." That way you can lean back without rounding. You don't need to be vertical to be straight rather than rounded.
The article The Cause of Disc and Back Pain shows a photo of someone sitting vertically - head is above hips - but they are rounding the spine forward, putting unhealthy pressure on the discs and soft tissues. They need to straighten their sitting to reduce the outward force on the discs and the overstretch on the muscles and supporting tissue.
The "Don't Sit Straight" study, and subsequent reports of it, missed that you have less vector force on your spine while sitting vertically at 90 degrees if you don't also round your spine, than if you lean back as they say but round your back. You can lean back and still pressure your spine by rounding. Look at the drawing, above left. The person is leaning back, as the study reports you should do, but the person is also rounding the lower back. This is one of the most common slouching there is. It is more pressure and more unhealthy than sitting vertically but not rounding.
Healthy sitting is simple when you understand, not just memorize a bunch of strange rules. More posts about healthy sitting to come. Until then, straighten your spine by not rounding forward. Move your chair in closer, and lift your upper body up to lean your upper back against the seat back. Yes, that does make your spine straighter - in a healthy way.
Read inspiring success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Readers have been e-mailing me to ask what supplements to buy for holiday presents to get muscular and slim. This post will cover a bit about protein supplements for exercising.
Advertising for protein supplement products wants you to believe that eating more protein builds muscle and causes you to lose more fat. Neither is true. When you exercise more, you use a small amount more protein than when you are not exercising. It takes very little protein to build more muscle. Most of the rest of muscle weight is water. Drinking extra water also will not build more muscle. All you need to do is healthy exercise. On an average Western diet, you do not use all the protein you eat, even when exercising hard and lifting weights. You break down unused protein, excrete the byproducts, and store the extra calories eaten as fat.
Protein supplements made with whey, dairy, and unfermented soy are a major cause of a bloated uncomfortable gastrointestinal tract. (Unfermented soy also is also increasingly being found unhealthy, and recommended to be limited.) Many protein supplements have sweeteners like sorbital and corn syrup, which produce more painful gas. More serious, high protein diets contribute to several major health problems. Eating high protein is long known to be a contributing factor in reduced bone density and osteoporosis. Animal protein, including the animal protein in dairy, increases urinary calcium loss. New studies are showing that high protein diets may increase risk of cancer and shorten life span.
Good quality protein is available without meat, dairy, or supplement powders. Try oats, brown rice, beans, lentils, sesame seeds, nuts, chickpeas, muesli, peas, seaweed, kelp, brewers yeast, hummus, tahini, and spirulina. These have protein, antioxidants, many nutrients, and fiber. It is not true that you need to carefully mix specific foods in each meal to get complete proteins from vegetables, grains, and legumes. Proteins combine on their own in the body over the day of eating a variety. It is another food myth that you must avoid eating protein with starch (carbohydrate), or not eat one food group in combination with others. Nutrients usually work better together.
You can build much strength and muscle without eating any supplements or high protein diets. Many are not "fit." In short, save your money. Do honest exercise in healthful ways. You will be healthier and wiser and look better. Take the money you save and make a real gift of the season by donating to impoverished areas or going to a shut-in neighbor and doing their vacuuming. That is the spirit of the season and fitness as a lifestyle together.
Photo model - Paul Plevakas, vegetarian athlete, who uses the natural exercise in my books and on this blog. This copyright photo is on the cover of the book Healthy Martial Arts.
Click the label nutrition for more "fitness" supplements.
--- Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
A physician contacted me, saying he had three successful disc surgeries and had slipped another disc. He wanted a consult with me before his fourth surgery. I told him it was like having three successful tonsillectomies. That is not a successful surgery. He had never stopped the reason he was pushing his discs out of place, one after the next.
Surgery for back pain and sciatica is considered by some as a solution, but an alarming number of people have pain that continues after surgery, or their pain stops initially while on pain medications and rehab following surgery, but then returns. The reason is that, except for unusual situations like bullet wounds or tumors, surgery does not stop the root cause of back pain. Because the cause continues, you continue doing harm to your back until it hurts again.
Degenerating or slipping discs are not from aging, or fate, or heredity, or a disease. The term "degenerative disc disease" is a misnomer. It is not a disease process, or a germ, or inherent factor or weakness that makes discs unhealthy. There are external factors, like smoking cigarettes, which contributes to disc degeneration. However, the majority of damage to discs and the soft tissue of the back and neck is usually chronic forward bending that physically pushes the disc outward until it presses on nearby soft tissue and nerves.
Disc damage occurs daily from avoidable bad bending in daily life, unhealthy sitting position, and many common exercises and stretches. Just as not all food is healthy, not all exercises and stretches are healthy, even some of the most common ones in gyms and yoga and fitness studios. The daily harm to your back is usually painless and something you are not aware of doing, until it accumulates, like smoking for years, until one day you get symptoms. The pain may come on suddenly, but was developing over years.
The physician who had the three surgeries, and three discs already removed, had gone back to all his bad bending, lifting, and sitting, and pushed out another disc. If he had stopped the injurious mechanics, he could have let the disc heal. Pain can often stop within days using this method. He probably never needed the first three surgeries. Having a fourth disc surgery will not stop him from going back to the injurious habits that caused the discs to break down and push out of place.
Removing discs, even part of them, means that the cushion and shock absorption between your vertebrae is reduced. This predisposes to early arthritis. A worse situation follows fusion surgery. It is a belief that stopping motion in a joint via fusion surgery will stop pain. But it also stops function. If you want an active life, it is setting you up for more problems. Even if you do not value being active, because fused back bones cannot move when you bend and sit and move, the vertebrae above and below the fused site must move more than usual, squeezing the discs and bones more than they are designed for. Fusion surgery is often a predisposing factor to forcing people into future back surgeries.
I sent the physician my free articles showing, step-by-step, how to stop disc pain. I sent him several of my books for his own use and for his waiting room. I called to follow-up on several occasions, urging him to simply stop the cause of disc injury so that he would not need the surgery. He told me he was not interested and had decided to go for his fourth back surgery. I hope his luck in avoiding surgical complications holds out as well as his good insurance.
The post Common Exercises Teach Bad Bending will get you started understanding common exercises that harm. There are far better exercises to do instead that give you fun, healthy movement without harm to discs. I am not in favor of doing less to avoid pain. I want my patients to have their life back and more. You can do this in fun ways and without surgery.
--- I make posts from fun mail and success stories. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Many back pain patients who come to me say the same thing; that they have gone for several opinions and were told each time that surgery was the only answer. However back pain, even chronic pain, sciatica and disc pain, are simple to stop with quick and non-surgical methods.
News articles are now reporting that back surgery is not more effective than non-surgical methods.
Patients are often told that if they don't have the surgery, they might become paralyzed. A recent New York Times article stated, "Many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded." The Times article quoted Dr. Steven R. Garfin, chairman of the department of orthopedic surgery at the University of California, San Diego, "I think this will have an impact. It says you don't have to rush in for surgery."
More important to your health is what is not being reported. The Times article said, "No one who waited had serious consequences, and no one who had surgery had a disastrous result." It is important to know what is meant by, "no one who had surgery had a disastrous result." It is not considered "a disastrous result" if you go through the pain and fear of surgery and still have back pain, or are worse after surgery. It is not considered "a disastrous result" if you lose your job because of the time lost to surgery and recovery, and your family won't talk to you because they think you're a complainer. It is not considered a "disastrous result" if the medicines given during and after surgery cause problems you didn't have before, or worsen existing problems, and then you are given more medicines to counteract the first ones, each with their small (or large) health drawbacks. It is not considered a "disastrous result" if you get far more out of shape and gain large amounts of weight because you could do less after your surgery, and your overall health declines from it.
There is no national database where people who have the same or worse pain after surgery are counted. There is no clearinghouse where people who get new problems because of the surgery are counted or helped. Often, there is no way for surgeons to know that their patients still have pain years later.
Patients may be referred to physical therapy but as their pain, disability, and misery grow, they "are lost to follow-up." I hear these things every day because these patients show up in my office and e-mail me everyday saying they have no money left and will I please help them. They are at the end of what they can endure.
Exercise programs for back pain often fail because they do not stop the cause of pain. Personal trainers and Pilates instructors come to me all the time as patients with herniated discs because they do unhealthy bending and stretches for their exercise. There are far better exercises and stretches you can do instead. Some of my patients are doctors. Their own doctors said there is nothing else to do but live with pain. People often tell me, "You don't understand, I *HAD* to have the surgery, because of the pain." I do understand, and you can stop the pain without surgery, often better and faster.
Use The Fitness Fixer every day to change your idea of exercise from a bunch of artificial moves, to real health that is built-in to your daily life. You don't have to have back pain, and you can be stronger and healthier than before - without surgery.
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Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Last weekend we were packing up to drive to the New York Chapter American College of Sports Medicine conference on aging. It was early and cold. At the corner where we parked, an elder woman waited at the bus stop. She stood straight as a penguin; her things hung over her walker. We were late getting on the highway. I had to get to the conference to give my lecture. I was already going to miss the first lecture given by an expert on metabolic changes of aging. This was an important conference where we would learn important ways to help older people.
She was standing alone. I thought that if she had family she would not be standing alone at a bus stop early in the morning. There was no telling where she needed to go. I wouldn't get all my required continuing education credits if I did not attend all of the meeting. We had to drive all the way to New York, and at this rate I was not even going to be on time for my own lecture. The answer was simple. We opened the door and asked her, "Where can we take you?"
We bundled her into the truck, and asked her name. "Dottie!" she said, pointing to a mole on her forehead. My husband held out his big hand and said, "I'm Paul." Dottie looked at Paul, nearly seven-feet tall, squashed in his seat with his long legs bowed around the steering wheel and his hair brushing the ceiling. She sang, "Tall Paul, he's my all…" and Paul replied, "Annette Funicello," recognizing the old song and singing it along with her. Dottie was on her way to religious services across town. We enjoyed lively conversation with her all the way there. We passed a Greek restaurant. Dottie said, "You won't believe this but I used to belly dance there." My own Grandmother studied belly dancing into her 90's so I believed Dottie. I said, "Belly dancing is good for the hips." Dottie winked, "Belly dancin' is good for lots of things."
We dropped Dottie off at her destination and made sure she had her hat and scarf and gloves and some of our food and a hug. We gave her our number and said, "We won't be passing by in time to take you back home. Call us to go somewhere else sometime."
We met heavy traffic getting to the Lincoln tunnel. I won't get all my continuing education credits from the conference that was supposed to teach us about how to help old people. In posts coming soon I will tell about the lecture I gave on improving musculoskeletal health for older people. Although it is a common misconception to think that ruinous losses of bone density, strength, balance, and flexibility are unavoidable with aging, it is not the case, and at any age, even advanced years, you can still get stronger, faster, more flexible, and better balance through easy daily activity. You can also improve the most important aspect of helping aging people - by helping.
I heard a radio program about yoga for senior citizens. The yoga program directors made the usual statements about yoga helping strength and balance. Then they said something that seemed at odds with their goal. They said, "If your balance is poor, do the moves sitting down or hold on to the wall." The very thing that you need to improve your balance is to practice standing and (safely) not holding the wall. If you sit and hold on, you prevent practicing balance.
Balance that helps your normal daily life is easy to improve at any age. All you need is to stand up and balance. Balance is quickly lost with sitting and disuse.
How does balance practice help you? You have receptors in all your joints that sense positioning. They can tell if you are about to fall. They tell your body to send signals to your muscles to steady you. If you don't use your balance sensors with balance practice, they become slow and unable to sense positioning well. You may tip over far enough to fall before your receptors sense it and can tell your muscles to pull you to upright position. Balance practice also improves your muscles. Without balance practice, your muscles become too slow and weak to prevent you from tipping over and falling. If you have let yourself become tight, brittle, and weak from lack of general exercise, you may strain, tear, or break something from a fall that would not have otherwise caused any harm.
Years ago when I left working in the hospital to go into private practice in sports medicine, I found that by making house calls you learn the reasons for people's pain and injuries that you will never see in a hospital or clinic exam setting. It was the first time I ever saw anyone have to sit to put on or take off their shoes. Here are a few quick, functional (real life) ways to improve balance:
Stand up when you put on your socks or hosiery.
Stand up to put on your pants. Lift one leg in front of you, keep your upper body comfortably straight and upright, and slide on each pant leg.
Stand up to put on your shoes. Try two ways: holding the foot in the air front of you to place the shoe, and by crossing the ankle on the opposite knee.
For more balance, after putting on one sock or shoe, remain standing on one foot and do a small squat on one leg to reach the other sock or shoe on the floor.
Remember that you should be able to walk well and balance without hard supportive shoes holding you up. Support should come from your own body. Don't diminish your body's self-support and built-in exercise by wearing inflexible "supportive" shoes.
If you can't stand to dress yourself, and you have at least one working leg, you may be too tight and weak and unsteady for healthy normal life. To get started:
Practice standing on one foot without holding on to anything. If balance is poor stand near a wall for safety to get started and have a skilled friend help. Practice one-foot balance standing for at least 10 counts without holding on. Increase how long you can balance.
Stand on one foot and swing the other forward and back, side to side, without holding on or touching down. Safely.
If you use a cane, practice walking holding it off the ground. Use your brain to do this intelligently and safely to improve balance, strengthen your body, and reduce dependence on the cane.
Balance is "use or lose" and can be quickly improved with safe smart practice. You don't need to go to a gym. Use balance skills as part of your daily life.
The Wilderness Medical Society will run the next wilderness medicine elective from February 5 to March 2, 2007, in the Smokey Mountains of Tennessee. Three of my students from last year, Neeta Abraham, Yvonne Chow, and Joey Brunkhorst, are pictured at left. I didn't do that to them. They were preparing for scenarios that simulate locating and rescuing injured adventurers.
I'll be at the elective again in February to teach three units of underwater physiology, scuba science, and diving medicine, some fun seminars in orthopedics, and a workshop on stretches that harm and how to change them to stretches that help. It's good for future doctors to know which of the traditional stretches and exercises are adding to injuries or are not effective, and what to do instead.
The wilderness elective is designed for 3rd and 4th year medical students, residents, and allied health profession students from accredited schools. The elective includes a 48 hour Wilderness First Responder Course and ends with a 4-day overnight field trek through the mountains, with the itinerary planned by the campers. In between are plenty of lectures, hands-on practice, and practice in outdoor rescue scenarios from first aid to advanced life support. It is directed by Dr. Tom Kessler, a wilderness medical society member, global doctor, volunteer physician for Native American reservations, exceptionally knowledgeable practitioner, and kind teacher with an on-target sense of humor.
The Wilderness Medical Society has extended the application deadline, which normally closes in August. Space is available for only 24 students. Check the WMS elective site for information, or e-mail Dr. Tom Kessler at tkphs@yahoo.com.
