Thank-you to MyThreeShrinks at Shrink Rap for hosting Grand Rounds volume 4.40 last week with an IPhone 3G theme.
They included my post Is Your Drinking Hurting Your Neck? among their votes for the best medical posts of the week. The post shows how to prevent neck pain from drinking, eating, and talking on the phone, and healthier, range of motion and use of neck muscles.
Here is Friday Fast Fitness - Train children's balance and grip strength, use your legs, and have family fun.
Have young children sit on your feet, and hang on (sensibly, parent's permission, and all that). Babies are born with a grasping reflex and are stronger than you may expect.
Do any variety of walking, marching, dancing, and range of motion, while standing, or sitting, while they act as natural strength and endurance trainers and floor dusters.
Teach sharing, enjoyment, physical skills, personal interaction, and all the good you can think of.
Outside of all the debates of whether leg weights are helpful or not, fun activity with your family can develop many strengths.
Stop Lower Back Pain From Swimming and SCUBA Part II
Tuesday, June 24, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Yesterday's post explained the most common hidden cause of lower backache after swimming and scuba diving. Swimmers and divers who get this chronic pain are often misdiagnosed with SI (sacroiliac) joint dysfunction, arthritis, disc injury or various "catch-all" terms for back pain with unknown origin. Scans may show damage to the facet joints, which can occur from spinal overarching. Injections and surgeries and various anti-inflammatories are often prescribed. No shots, medicines, or surgeries are needed. You do not need physical therapy or strengthening programs. All you need to do is stop overarching and maintain neutral spine when walking, running, swimming, and diving. It is easy, and is a healthy and normal spine position. You do not tighten any muscles to do it. It is just learning a normal posture.
Check yourself to see if you stand in hyperlordosis:
Stand up and look sideways in a mirror. Your belt should be level, as in the left drawing of neutral spine. The side seam in dress or trousers should be vertical from leg to waist, as in left drawing, not tilted forward at the hip (middle drawing).
Back up slowly and gently into a wall. If your backside touches first, it may be an indicator that you lean forward at the hip. If your upper back touches first, it often is a good indicator that you lean the upper body backward (right drawing).
Stand with your back against a wall, with heels, hips, upper back and back of your head touching. There should be a small space between your lower back and the wall, but not a large space. Then raise both arms overhead to touch fingers to the wall behind you to simulate swimming with arms outstretched. See if the lumbar curve increases. You should be able to stand with the back of your head touching the wall without increasing your normal curve, and be able to raise your arms without increasing it.
If you have a large space between lower back and the wall, try this:
If you can't figure how to do that, put your hands on your hips, thumbs facing the back, and roll your hip under so that your thumbs come downward in back.
Feel the large space between lower back and the wall become a smaller space.
Lower back pain that is caused by hyperlordosis should ease right away. Learn how to easily, gently do this while walking, running, swimming, or whatever you do. This is done without tightening or clenching any muscles.
Keep the good new neutral spine when you walk away from the wall, and all the time. Apply it to when you are swimming and scuba diving.
Muscle Use is Not Automatic The muscles that hold neutral spine are your abdominal muscles. They do not do this automatically, which is why strengthening programs do little to stop back pain. Someone may have strong abs but stand and swim in arched posture, with continuing lower back pain.
Heavy scuba tanks don't make you arch your back or have bad posture. Not using your ab muscles to counter the pull, and allowing your back to arch is the problem.
When you are standing up wearing tanks, straighten your body against the pull of the load and maintain neutral spine. Do not tighten your abs, just move your pelvis. If you notice yourself arching while wearing tanks, straighten your body as if starting to do a crunch but don't curl forward. Only straighten to neutral spine. Don't tuck so much that you lean back or push your hips forward.
No More Lower Back Pain From Overarching Transfer this neutral spine skill to your daily life for carrying gear, putting cargo up on racks, heavy packages on counters, and whenever you lift and reach. Use neutral spine when standing, walking, running, reaching overhead, swimming, and scuba diving.
Lifting and carrying heavy dive gear with good lifting mechanics is good and functional exercise. With bad lifting habits, it is a common and obvious cause of lower back pain in scuba divers. A second major cause of lower back pain after SCUBA and swimming is often overlooked and can occur after scuba diving and after swimming laps with no gear lifting.
Hyperlordosis When swimming or finning face down and horizontally through the water, many divers allow their lower back to increase in arch. They look like they are face down in a hammock - shown by the figurine below:
A small inward curve belongs in the lower back. When you allow the normal inward curve, (normal lordosis) to increase, it becomes hyperlordosis or overarching (swayback).
For most people, hyperlordosis is most common when upright, such as standing, walking, and running. Swimmers and divers who allow their back to overarch when swimming face down often notice the pain after swims and dives:
How Hyperlordosis Causes Lower Back Pain Hyperlordosis pinches the joints of the vertebrae called facets and the surrounding soft tissue. When swimming and diving in hyperlordosis, the fulcrum of the kick becomes the facets instead of the muscles of the abs and hip. When standing upright with a hyperlordotic lower spine instead of neutral spine, the weight of the upper body presses down on the overly pinched-backward lower back. Running in hyperlordosis causes more of the banging and pressing.
People with lower back pain from hyperlordosis usually feel they need to bend over forward, or sit, or raise one leg to relieve it. Often nothing shows up on x-rays and scans. Eventually, hyperlordosis can damage structures enough to show. Until then it just aches a great deal.
The cause of this kind of pain is often unrecognized and people may be told they have a condition called sacroiliac, or SI joint dysfunction, or nonspecific back pain, or other names.
Fast Fitness - NoCost Hand Strength and Rehab Equipment
Friday, June 20, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness -hand exercise without rehabilitation equipment.
One of the exercises against repetitive strain syndrome is to exercise the muscles that open the hands. There are expensive commercial devices you can buy for this. One consists of a special glove with weights and pulleys to resist your ability to open your hand. Or you can:
Hold the fingers of one hand closed with your other hand
Open the hand against the resistance of the hand holding it closed
Do as many as comfortable. Repeat with the other hand. Vary intensity and number.
If you want to go high-tech, put a rubber band around the fingers instead of using your other hand. Push each finger in a variety of ways.
For the next 2 weeks we will be away attending the annual meeting of the Undersea and Hyperbaric Medical Society (UHMS). The post Exercise and Medicine Underwater and at High Pressure tells about the UHMS, the fun people, and the meeting. My friends and colleagues who attend are scientists and flight surgeons, SEAL team captains and commercial divers, submarine and aircraft personnel from navies of many countries. As we like to say, the rest have paying jobs.
I won't have computer access to see comments. Healthline will be changing format for answering reader comments and requests. Before you write with questions, check the hundreds of Fitness Fixer posts already here and all the replies already given to comments. If you still want more, click this post which gives a list of labels. Clicking a label will give all posts on that topic.
I will be posting as always, even on the road. Posts to come while I am away will cover swimming and other topics. Here are posts that cover some of the subjects we study at the meeting:
I am a career researcher in human performance in extremes of environment. That means extremes of heat, cold, altitude, exercise, injury, submersion, crimes (forensics) breathing different gases at different pressures (hyperbarics, see above), different g-forces, sometimes all at once. Many years of my work was spent on immersion physiology. If you are interested in scuba, diving medicine, clinical hyperbarics, wound healing in a hyperbaric environment, check my books page for three books on these topics.
In a hospital, Grand Rounds is a lecture for doctors about a patient or topic. On the web, the weekly Grand Rounds is a blog post that lists its vote for the best in online medical writing.
The post Junk Food Through Your Skin? about making your own healthier skin and hair care products brought in many notes from readers asking for more.
Fitness is not just in a gym. Health comes from all your actions. Commercial cleaners may have toxic fumes or compounds you absorb through your skin. They may be mass-produced in ways that pollute water sources, degrade air quality, generate industrial litter, and destroy resources faster than can be replaced. Healthier ways are simple and usually cheaper. Here are a few cleaners to try making on your own. Children who are able, can have fun helping you measure, mix, and get good physical and mental exercise from making things clean and healthy:
Rust Remover - Sprinkle salt over the rust. Squeeze a lime over the salt until soaked and leave for a few hours. Use the lime rind to scrub off the rust. When sanding, vinegar helps see the metal to determine how much rust still remains.
Furniture Polish - Squeeze the juice from a lemon. Good hand exercise. Mix in a teaspoon (5 ml) of olive or other oil. Apply thinly to the wood and use a soft cloth to make it shine. Experiment with how much oil you like compared to lemon. A thin rubbing of plain coconut oil makes great wood polish as well as nice skin cream and hair shiner.
Counters and Surfaces - mix a quarter cup of baking soda (about 60ml) and quarter cup of vinegar in a quart (liter) of water. For stains, sprinkle baking soda over the surface, wet with water, and allow to sit until you feel like wiping it off with a sponge or lemon rind. Plain white vinegar makes a nice disinfecting cleaner by itself.
Glass Cleaner - Add 1/4 cup white vinegar to a quart warm water. Add a tablespoon of cornstarch. Apply any way you prefer from a sponge, spray bottle, or crumpled newspaper.
More Fitness Fixer to make your cleaning into healthy exercise:
Fast Fitness - Fixing Yoga Warrior and Lunge Exercise to Neutral Spine
Friday, June 13, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - quickly change your posture to change your luck on Friday the 13th. Hyperlordosis (swayback posture) seems to be unlucky - it causes lower back pain. You can do this in seconds to make a certain change to healthier spine for yoga or practicing the lunge. If you don't believe in luck, you're lucky. It's just good posture and simple anatomy.
Reader David from Belgium demonstrates in this 20 second movie that he made for us:
First ten seconds - he steps into a yoga pose called Warrior pose, but allows overly arched lower spine. He also demonstrates leaning more weight forward of center line, which is a different issue.
Note how the belt line tips downward in front and the lower spine overly curves inward - more than a normal curve.
At second 11 he levels the hip to bring the posture to neutral spine. Then he kindly demonstrates overarching when raising the arms further. Instead, hold neutral spine and raise the arms from the shoulder, not the lower back.
To prevent shoulder impingement when raising arms, keep shoulders down and back, don't just chin and neck forward, keep them gently in. A forward head posture compresses the rotator cuff when lifting arms. See Safer Overhead Military Press.
I never expected repeated requests to see how to do neutral spine in different activities. It is the same. Just apply the same neutral spine and that’s all. I thought one post would do it, but will post each activity readers ask about. I am aware that there are yoga and fitness places which teach to overarch the spine as part of the move. Teaching swayback does not seem to be as helpful as teaching neutral spine. Changing lunge and Warrior pose to neutral also improves the stretch to the front hip muscles of the back leg. Lucky.
Perhaps he used the title line: "Baby-boomers are falling to bits. Too much exercise" to make the point of this post that most pain and wear comes from misuse and lack of exercise, not too much. Click the post to see.
In a hospital, Grand Rounds is a lecture for doctors about a patient or topic. On the web, the weekly Grand Rounds is an electronic post that lists its vote for the best the best in online medical writing.
"My Yoga teachers uses that, but you hold you legs at a right degree angle to the floor. It forces your back to be straight. Seems to me it sets you up for more shoulder action. I don't think I'll ever be able to do a handstand without the wall."
The handstand against the wall can be done with legs straight or bent as Ginger describes, or a variety of other stretches. However bending the legs at right angle, or any angle, does not "force" a straight back. Rounded back can still occur. Many people with tight hamstrings wind up rounding the back doing this stretch as Ginger describes because the back is the only place they can get the stretch from and they do not know how to transfer the stretch to the hamstrings. The shoulders also can be in any posture or level of "action" from good to bad depending on how much you know about posture and allow to happen.
The photo at right shows five of my students demonstrating the easy wall handstand in both positions. First at right in the foreground is Diana who hold straight good neutral spine. Next, also in good neutral spine is 67 year old Leslie who starred in the post Are You Stronger Than A 67 Year Old Lady? Click the post to do your pushups with her every day. Third in the middle, Johanna demonstrates right angle (photo taken just before reaching parallel to floor). This can be a fun stretch for hamstrings without loading the lower back.
Most important, use a straight handstand position in neutral spine to train straight body position against resistance, then transfer that knowledge to daily life. If you use the right-angle pose alone you do not learn that.
All my exercises are developed to be more than exercise alone. Instead of just "doing a move" or "holding a pose" use them to train how to move out of bad positioning into healthy position for everything you do.
The post Fast Fitness - Fixing Your Handstand to Neutral Spine shows a short movie of letting spine sag in the handstand and how to fix it so that you can train what to do when you are walking around, running, lifting weights, and just enjoying life. Instead of "doing" exercise, restore real life.
For doing handstands without the wall, it’s just real life balance and stretch training - a post soon will cover how.
Simulation Suit To Feel the Pain of Osteoarthritis
Monday, June 09, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
A BBC news article reported on a suit that gives wearers a "real life" insight into the pain and impaired quality-of-life associated with osteoarthritis (OA). The suit costs £20,000 and was developed by Loughborough University. They wrote: "The JOINT Osteoarthritis Education Programme will be made available to GPs throughout the UK, providing advanced training on the diagnosis and management of the condition, including both drug-based and lifestyle approaches to help improve mobility and minimise pain."
How does this suit work? The specs for this particular suit are proprietary to the company (that means they are not telling). Similarly marketed suits to simulate arthritis use a simple principle to produce the painful feeling - they use straps and other restrictive designs to hold the body in bent positions that cause the rubbing and strain.
The suit would be useful for the kind of health care worker who tells people to live with their pain instead of fixing the cause to stop the pain. Most other people don't need an expensive suit to show them how to hunch over and hurt all over:
The post Disc Pain - Not a Mystery, Easy to Fix shows how to understand the simple mechanics that damage discs. In my work, I have found it is one of the same mechanisms that increases wear and tear on the vertebrae contributing to spinal arthritis.
The second main wear and tear injury adding to spinal arthritis is standing with the lower spine arched inward too much (lordosis) - Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine. The muscles you would use to simply move your spine to a less arched position and restore neutral spine are your abdominal muscles.
Discs and vertebrae are living parts of your body. They can heal, when you stop hurting them, usually starting within days by stopping the harmful movements that aren't good for you anyway, and using healthy movement during daily life that gives you free exercise. Discs can heal without surgery, just like a sprained ankle. More on how to stop recurring ankle sprains is in How To Treat Ankle Sprains and Prevent Them and No More Ankle Sprains Part II.
Post on changing bad positioning that increases wear and tear and risk of osteoarthritis on knees: You Can Fix Your Own Knees.
Post on changing positioning that increases wear and tear and risk of osteoarthritis of the lower back: Prevent Back Surgery.
Use all the various articles on fixing injuries in The Fitness Fixer to see how to move in healthful positioning so that your exercise is healthy rather than injurious. You don't need to get treatments, or adjustments, or surgery, or shots, or medicines. It is a win-win situation where you do not have to give up favorite activities, and can become healthier than before. Just use healthy movement as part of normal daily life and get free exercise, better physical abilities, and stop the processes that cause injury, all at the same time.
For books, try Fix Your Own Pain Without Drugs or Surgery and Health & Fitness in Plain English Third Edition. The Fix Pain book concentrates on how to stop injury process in each area, with patient stories in each chapter. The Health & Fitness new third edition covers back and neck pain, plus living and exercising in healthy ways, nutrition, and health issues including measuring body fat tests, bone health, heart health, and other topics. Descriptions on my books page.
--- Read and contribute your own success stories of these methods. 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. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Here is Friday Fast Fitness - How to know what heart rate will give you a cardiovascular training effect.
Several formulas calculate exact heart ranges and "target heart rates." There are a variety of commercial (expensive) heart rate monitors. Arguments in sports medicine continue on which is the right formula and if heart rates in water or at elevation can be calculated the same way. These issues will be covered in posts to come. For now:
Your body is smart. Heart rate generally follows "perceived exertion." If you feel your running or other exercise pace is moderate, your heart rate is likely to be at a moderate training range. If it feels light, then heart rate will likely be too low to give much training effect.
Find something you enjoy enough to continue more than ten minutes at a time.
Keep a pace that you feel is moderate to hard, depending how you like it.
If your running or other exercise pace feels moderate, it is also moderate for your cardiovascular system. If it feels hard, your heart and body and mostly likely working hard for your current level If it feels light, then it is too light to give much training effect.
--- Read and contribute success stories of these methods. 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 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. For personal evaluation take a Class. Top students can apply to become certifiedDrBookspan.com/Academy.
Mr. Jim Morris is the 1973 AAU Mr. America and 1996 Mr. Olympia Masters Over 60. He is now 72. Mr. Morris is a vegan bodybuilder who reminds people that body building involves selflessly looking outward to do good, rather than focusing only on appearance and commercialism. He urges real nutrition through healthy food, rather than artificial chemically produced supplements, and healthy movement rather than harming yourself to gain physical looks or heavier lifts.
Mr. Morris looked over my Ab Revolution book, and wrote to me that he wanted to order several copies for his clients. He wrote, "You are the first person I know of to finally get it right."
Later, after reading Health and Fitness in Plain English Third edition, he wrote, "I have a copy of "Health and Fitness in Plain English" I just received and every page I open to, I say, 'I wish I said that,' and then add, 'I have been saying it for years.' Glad someone finally put it all into print and in one volume. Thanks, Jim Morris."
Exercise and Aging - Don't Limit the Patient to Limit the Pain
Wednesday, June 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
A Reuters news item last week reports that "baby boomers" are accumulating wear and tear injuries, and they should consider cutting back on amount and type of exercise they get.
The article points out that contributors to injuries are biomechanics, poor flexibility, and "pounding" or stomping down unnecessarily hard when running, jumping, walking, etc. Even with that knowledge, the news report goes on to say the answer to reduce injuries is to cut back activity. In Sunday's Fitness Fixer post, Forearm, Upper Body and Hand Exercise, I wrote that it is not a healthful or useful solution to "limit the patient to limit the pain."
The Reuters article quoted a foot and ankle podiatrist saying, "It is really important that people continue to be physically active, but they need to think logically about how to remain active as they age… Probably when you start getting into your 40s and 50s, the half marathon is a great alternative (to full marathons). Or, if you did two or three marathons a year, cut it back to one a year or opt for 10K or 5K runs." The podiatrist himself is a marathoner. He stated, "Having run 25 marathons, it was hard for me to cut back."
I would suggest looking at biomechanics, poor flexibility, and "pounding" first, before telling someone to stop doing what they love:
I have some exciting developments about getting you information on Exercise and Aging. Will announce soon.
--- Read and contribute your own success stories of these methods. 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. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Thank you Happy Hospitalist for hosting Grand Rounds 4.37 this week and for including my post Indiana Jones Rocket Sled among the selections for best medical posts of the week.
The Happy Hospitalist said, "Where can you read about "doing an Elvis" while looking at pictures of an Air Force Colonel vomiting on himself? There's only one place. The Fitness Fixer. Nice, I tell ya. Nice.
Thank you Happy. Check the post to see that Colonel Stapp is not returning food, but experiencing the deformation forces, first AP (anterior to posterior) meaning his facial skin and deformable soft tissue press inward (or outward), then PA (pushing from the back toward to front). Click Indiana Jones Rocket Sled for that plus more fun things.
In a hospital, Grand Rounds is a lecture for doctors about a patient or topic. On the web, the weekly Grand Rounds is an electronic post that lists its vote for the best the best in online medical writing.
Students Balances, Listens, Fixes Father's Back Pain
Tuesday, June 03, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
My student Ginger sent the photo at right taken on her recent camping trip. Don't try this at home. It takes balance training, concentration, and a few changes to standard back bend technique.
Ginger is distributing the stretch along the spine so that no one area is compressed at an unfavorable angle, and is contributing most of the leg extension from the hip, not lower spine. More safe back extension stretch and strengthening methods will come in future posts.
Ginger is a good student who makes good use of my classes. Last week, while visiting her parents, she was out walking with her father. She told me that her father said that his back hurt from the walking. She looked, and saw that her father was standing and walking with too much inward curve to the lower back - hyperlordosis (swayback). Standing with the lower spine overarched is a slouch that compresses the spine unevenly downward, pinching the joints and soft tissue at the back of the lower vertebrae. Overarching is a large hidden cause of lower back ache during walking and running. This slouch is not fixed in the bone, it is a posture that is easily corrected. It does not require strengthening the back or core muscles, just using the ones you have. In moments, Ginger showed her father what I taught in class - how to change a slouching overarch to neutral spine. Ginger's father said the ache disappeared right there, and that was all there was to it.
The article Innovation in Abdominal Muscles gives an overview, and the comments give a link to another post with a short movie showing the concept.
If you want a whole book showing the concept, several techniques to achieve and use neutral spine, and examples of use in all daily life, try the book The Ab Revolution™ Third edition expanded. Part I of the book shows daily use without needing any exercises. Part II shows how to exercise using neutral spine to get more exercise, healthier exercise, and use abdominal muscles functionally to stop unattractive and damaging overarching.
During the part of the year that we live in the United States, we have a luxury - a washing machine. You put clothes in it, and it washes them for you. You come back later, hang out the clothes, and the Earth dries them for you. Luxury.
Recently the old washing machine could not wash any more. I always appreciated the machine, but I rediscovered something else. Washing clothes by rubbing them on a washboard, and wringing water from heavy canvas work jeans and martial arts uniforms is vigorous hand and arm exercise.
Occasionally, sources for arthritis information state that if you have arthritis of the hands or wrists, avoid wringing clothes and instead, purchase a tool that squeezes the cloth to remove the water for you. However, it is not use of the hands or a wringing action in itself that causes arthritis pain. Use of the hands improves function, improves joint health, improves the strength that allows you to accomplish more without strain, and is an important part of arthritis prevention and management.
Good use and exercise of the hands does not mean to move the area no matter how much it hurts. Misuse - bad movement habits - is often the culprit in wear and pressure on the area. Instead of craning the wrist and fingers back and levering the wringing action on the finger joints, wrist and base of the thumb, use the muscles of the hand and forearm, as well as the entire arms to power the wringing action. Start with fun gentle squeezing, let the hands warm through real life use, and continue to improve function through use.
There is no need to keep straight wrists or splint them to keep them straight. Splinting may temporarily reduce pain, but reduces strength and function which often leads to bigger problems. It is not a healthful or useful solution to, "limit the patient to limit the pain." Use your body, have fun, be active, and be able to move for normal daily function. Use healthful body mechanics and the actions will be far more likely to build you than injure.
More posts on strengthening the hands are on the way.
More on distributing weight on muscules of the arm and hand instead of compressing the joints:
Click the labels under each Fitness Fixer article for more on each topic.
--- Read and contribute your own success stories of these methods. 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.