A number of conventional standardized fitness tests, surprisingly, are not accurate. They do not test what they claim to test. To get real answers that you can use, it is important to know if you are doing what you think you are doing.
An example of a test that does not test what it claims is the "Sit and Reach" test. Sit and Reach is assumed to test hamstring flexibility, but is more a measure of how much you can round your spine. Many people can pass the Sit and Reach with little hamstring flexibility and an unhealthful angle at the hip - tilted back (shown by shorts side seam) rather than vertical. The Sit and Reach is required testing for numerous military, corporate, and school fitness programs
Another standard fitness assessment uses crunches or sit ups, supposedly to test abdominal muscle function. Bending or curling forward does not give a predictive measure of how well you can use your abdominal muscles to adjust your spine position for spine health, for sports ability, to prevent back pain, in short, to move in healthy ways in real daily life and work where you need it most.
A test may be reliable, which means it gives the same answer each time you test the same thing. For example, a scale should measure the same item at the same weight each time. A reliable scale may not be accurate. That means, it may be wrong by the same amount each time. But it does give the same answer reliably. Having a reliable test does not mean it will be accurate. Accuracy and reliability are both necessary components of devising tests that are actually helpful.
I worked years researching more prognostic and beneficial tests for several common fitness measures. If your military or police division, school, or industry wants to hire me to train you in simple new reliable and accurate tests, let me know.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right.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. Read success stories of Fitness Fixer methods and send your own. 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.
Fast Fitness - Better Standing Hamstring, Achilles, and Inside Leg Stretch
Friday, June 12, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - get a better stretch for the hamstring of the standing leg when stretching the other leg to the side:
When you stand with one leg stretching to the side, notice the leg you are standing on. It is common to stand with the foot turned outward and the hip rounded under you.
Instead, turn the standing leg to face directly ahead. Knee and toes straight forward. Not turned out, not even a small amount. Stand straight.
Notice the stretch move to the back of your leg.
My student Leslie is pictured above at age 68. I snapped this shot of her while she was waiting for one of my classes. The position of the foot on the standing leg isn't visible, but she is straight ahead. I had to snap the photo quickly before the club manager told us to stop.
Stand straight without leaning over, rounding your upper body, or letting your hip round under you. This is different from the way most people are used to.
The straighter you stand, the more stretch, while training the function of healthy posture - a functional stretch. You need to be able to lift one leg without being so tight that your back rounds and your hip rolls under. Think of stairs, kicks for dancing, aerobics, martial arts, stepping over things, stairs, much real life. If you are not only using bad mechanics for daily life, but training unhealthful tight mechanics with conventional bent over stretching, what are you accomplishing?
If you can't stand straight, lower your leg to where you can. There is little point stretching for health while practicing unhealthful ways.
What has happened in a year? She can now do 40 push-ups. We just don't have a video camera. While we get one, click the link to do your push-ups with her each morning while it is still only 30.
Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from fun ones. Before asking more, see if your answers are already here by clicking labels under posts, links in posts, archives at right, or in the Fitness Fixer Index.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Get certified - DrBookspan.com/Academy.
Hamstring to Quadriceps Ratios Not the Answer in Knee Injury
Monday, January 26, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
A common myth is that injury comes from "muscle imbalance" in the thigh from too much strength in the quadriceps muscles over the hamstring muscles.
Early studies showed poor ratios of quad to hamstring strength. It was concluded that because of this, when the athlete would kick, for example, the overly strong quadriceps would overstraighten the knee, and the overpowered hamstring behind the thigh would not be able to stop the powerful straightening. The knee would overstraighten and hyperextend the joint, injuring it.
Athletes were put on hamstring strengthening training. Then they went back to kicking with the same bad habit of overstraightening as before.
The problem was simply that they athlete would hyperextend the knee. They were allowing it through bad training habits, not being made to do it by a strong quadriceps. Your muscles do not make you move. You learn though training and practice how to move in healthy ways.
What to do? When you kick, don't fling your leg out and hyperextend (overstraighten) the knee. Control the end point position. When you land from jumps or descending stairs, don't step down on a locked, straight knee. Control the end point position.
--- 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 personal medical questions - Replies to Medical Questions. LimitedClass spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Fast Fitness - Don't Shorten Hip When Stretching Hamstring
Friday, December 19, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - Get a more functional hamstring stretch, and a built-in posturally helpful functional stretch to the front of the hip at the same time.
When lying on your back to stretch your hamstrings by lifting one leg:
Lie flat. Keep the leg you are not lifting flat on the ground, not bent at the knee and hip, or with upper body curled and neck craned, as pictured.
Don't let your pelvis and hip round under you. Don't let your backside curl up off the floor.
Keep your hip, leg, back, shoulders, and head relaxed, flat, straight, touching the ground.
It is a myth that you must bend your knee to protect your back. If you must bend your knee to protect your back, how are you supposed to stand on one leg and lift the other in real life to climb stairs, kick, and even run and walk, without curling into bent over, old-looking, tight, injury-producing position?
When stretching your hamstrings, remember function. Why practice a position that is rounded, tightening, and detrimental to how you move when you stand and extend your legs. Get stretch by lengthening you body enough to be able to straighten out.
Send me your photos of fixing this stretch. Doing is the best learning. I will publish the photos in a reader success post to come.
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
14,000 Miles on a Bike - Herniating and Fixing Discs
Monday, November 24, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Kristin S was run over by a hit-and-run driver while biking home from work. The car's trailer hitch crushed her face, nose, jaw, cheekbones, and eye sockets inward to her sinus cavities. After Kristin's reconstructive surgery, her step-mother, a student in my martial arts classes, asked me to make a house call to get Kristin back to physical activity. When I met Kristin, she had just had the wiring removed from her jaw, was moving slowly and painfully, and could barely open her mouth when she greeted me at the door.
We had a good session. I showed Kristin several of my rehab methods. She was a good listener and applied everything well. She rehabbed quickly and went back to biking, her socially conscious work, and her active life.
Kristin soon designed a bike trip called The EarthCycle Campaign to raise public awareness of ways to reduce common practices that waste and destroy world resources. Her trip extended 14,000 miles (22,530 kilometers) from Fairbanks, Alaska USA to Tierra Del Fuego, Antártida e islas del Atlántico Sur, Argentina.
I donated some of my books to Kristin to raffle along with her other fund raising activity for the trip, then off she went.
Along the 14,000 mile ride, Kristin stopped in villages and cities to exchange information about simple ways that we all can lower our impact on Earth's environment.
Months of biking passed. Kristin's back pain began.
Pain worsened as she rode mile after mile, through villages, open roads, and cities. She tried exercises she found on various web sites and doctors visited in cities she passed through. She did yoga. She stretched. The pain worsened. After one medical evaluation, the doctors told her results showed several herniated discs in her lower back. From there, she was told by every doctor that it was permanent and she had to stop biking. The rehab they gave her didn't help.
I received a short e-mail from somewhere on the road - "Help me, how do I fix this, they said I have to live with pain and have to stop the tour."
I chided her good-naturedly, "Kristin you should have read my books before selling them :-)" I e-mailed her back explaining the uncomplicated way that discs can be injured and also healed.
A herniated disc nearly always bulges (herniates/moves/slips/migrates/extrudes) toward the back of the spine, not the front. What pushes it to the back? You do.
Sitting with a rounded back physically angles the spine bones (vertebrae) closer in front and farther apart in back. The "opening" in back is often mistakenly written about as a positive way to make space for the nerves, but what is missed is that the bones pinching closer in front make unequal pressure, like squeezing a tube of toothpaste from one end. A little knowledge is a dangerous thing. Contents are squeezed outward to the other side. The discs are mashed and degenerated in front and pushed outward (herniated), little bit by bit, in back. At left (hopefully since we're still having graphics problems) is a graphic of the process from the post: Disc Pain - Not a Mystery, Easy to Fix. Two vertebrae are shown from a side view, as if you are sitting facing right. The right-hand drawing shows how sitting bent forward physically pushes discs (herniates them).
Sitting and standing straight would make space in a healthier way for the nerves.
Disc herniation is a process taking a few years, just like the damage of smoking or eating junk food accumulates until the heart is damaged enough to hurt.
I e-mailed Kristin telling her that a herniated disc is a simple injury, not a condition. It can heal if you understand and stop the bad postures that push the disc outward. In her case, it was sitting bent rounded over her bike, and unhealthful stretching and yoga. Here is what she did to understand and fix it all:
So was her yoga. If you already spend time bent forward and have the usually result of a flexion injury, you don't need more forward bending stretches - Getting the Right Yoga Medicine.
Questions come in by the hundreds. I make posts from fun ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
Feeling Better Than She Ever Has Part II - Fixing Herniated Disk and Reclaiming Active Life
Tuesday, April 15, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Barbara lives in a little town of 300 people in Yukon Canada - map at right. Part I of Barbara's story last Wednesday described why it didn't take six weeks to fix Barbara's herniated discs and severe sciatic pain and numbness, but it was six weeks until the "light went on" and she did the things to stop the cause of the injury, so it could stop hurting and start to heal.
Here is an insider's peek behind the scenes week-by-week:
"Dear Dr. Bookspan, "This is a bit of a long one, and probably reaffirms everything you've ever received in hundred and hundreds of emails and stories, but I wanted to share this with you anyway. I can’t thank you enough for working hard and sharing all your knowledge. I am almost completely pain free!
"After 6 weeks of severe sciatic pain and numbness and weakness of my left leg and foot, something just clicked on Thursday night and I became more determined than ever that I could get rid of the pain. Through your website, the Fitness Fixer, and reading lots of personal stories (on your web site and book), I realized that I had to fix (the) causes. I know this might sound dramatic, but you’ve changed my way of life.
"Pre-sciatica lifestyle: "A cycle of: 1) a few months, everyday, of "power" exercising with all the unhealthful postures and movement habits you talk about, then sitting at the computer in all the unhealthy ways you talk about and drinking coffee and smoking, feeling like I’d accomplished something in my day; 2) followed by a few months of complete laziness (not even power exercising). Power exercising consisted of running (without stretching at all) with bad form, and Hatha Yoga (forcing myself into the stretches and tons of forward bending).
"Sciatica struck.
"First two weeks: "I did absolutely nothing about it. I read stuff on the internet and was convinced from the stories that I had some debilitating disease that would affect the rest of my life. I thought the cause was that I didn’t keep up with my "power" exercising. But, I continued to sit bent forward in a chair, hunched over, bending wrong, doing yoga forward bends, smoking and drinking coffee. I know, how sad."
How to avoid herniating forces on the lower back discs during yoga and fitness stretches for the hamstring:Healthier Hamstring Stretching
"Third week: "Had to go back to work in the morning, teaching 4 and 5 year olds in a kindergarten class; in the afternoon, teaching reading strategies to Grade 1 and 2's - sitting in a chair all afternoon. No longer could I hobble around the house holding my backside and leg - full on activity - and pain, tingling, numbness in my left foot, and total weakness in my left leg. Felt like I was walking around all day with a Charlie horse going down my entire left side. Amidst all my continued Internet searches, stumbled upon your website when a friend said that slight forward bending doing dishes and getting ready in the morning leaning over the sink might be a cause. Your website made so much sense to me - if a slight forward bend is a bad thing, how much more unhealthy would my Hatha yoga program be, with all its constant forward bends. I might add here that the two people at work who talk about slight forward bending being a bad thing continually hunch forward while sitting and exercise using forward bends. Just something I’ve begun to notice."
Major news stories quote physicians saying that back pain is often a mystery and that no one knows why stretching isn't working. My readers regularly report that once they understand the simple principles, they see the unhealthful positioning that causes pain frequently - at the gym, in fitness magazines, and in exercise videos and classes:
"I started with lying on the floor propped up, upper and lower back extensions, pec and trapezius stretches, isometric abs, being continually aware of my posture and not doing ANY bad forward bending. Tried to do the lunges and squats for daily good bending, but my muscles were so weak and I practiced them half-heartedly. I tried to apply them in daily life but life seemed so fast-paced at work and I was in so much pain constantly, that I would get _ way into it and then just try to lean to the side to pick things up - result, I was contorting my body in very odd ways! I ordered a support brace and special support backrest (now I know why I never needed them) and seat cushion for my chair from other web sites, but also ordered your book Fix Your Own Pain, along with a few of your other books."
"Fourth Week: "Limping and terrible pain, my boss told me to visit the nurses station -living in a town of 300 in the far north, we have one general store and a health centre, doctor visits once every two weeks - and take every afternoon off during this week to rest up. He still needed me at work in the mornings. Taking my new prescription of Naproxen and trying the lunges and squats and some stretches but not really trying to apply them to the rest of how I was moving and bending and sitting. I would be in quite a bit of pain coming home from my mornings at work. In the afternoons I would basically throw in some stretches, but generally read (sitting badly) and nap for an hour. A lot of the pain would dissipate after my stretches and a good nap - only to be set into full force the next morning at work.
"Your book came in on the Friday and I was very excited. I read through it and practiced the retraining stretches that show how to restore straighter positioning throughout the day. I felt much better by Sunday night with the stretching. Still only half-hearted attempts at lunges and squats."
"Fifth Week: "Decided to start my morning off by doing my full range of stretches instead of sitting in the computer chair smoking and drinking coffee. I felt pretty good when I left for work. People at work were starting to call me "feisty" saying that I seemed to be walking better (that was probably because of my better posture from applying your method instead of just doing stretches!) Sitting in a chair almost killed me - after 25 minutes in a chair the pain was almost unrecoverable - to be endured for the next hour and a half at work."
Barbara was getting the idea about healthy movement, but was sitting in the same way that causes discs to be pressured. She thought it was "taken care of" because she used a commercial lumbar support she purchased the first week. However she was still sitting in unhealthy ways, right over the support:
"I could manage the pain better with frequent relaxing on my stomach propped up on arms and stretching, but I never felt complete relief until I got home at night. I still didn't realize it was bad sitting position, so decided to get rid of my chair and stand to teach. This was better, but the pain still kicked in(especially in my left buttock!). Once my left buttock got hit with pain it went downhill - down my whole leg, followed by the numbness and severe tingling. Midway through the week I went to see our visiting doctor - quick visit and the prognosis that I had a herniated disc L5-S1. He said it would heal. I was feeling pretty positive about this, as it seemed to coincide with what you say about herniated discs. Meanwhile, the sciatica was taking it out of me. I felt I was always either in pain, or awaiting a painful episode. I made it through, relieved that the weekend was underway. I decided to trying walking - every couple of hours I'd walk on my treadmill for 20 minutes and then do my stretches. I did this two times in the day, and then went for a walk outside in the evening (-35 degree weather so I bundled up really well). My dog and I headed out for what was to be the most agonizing walk for me. Half hour into the walk I started to get that butt pain but I was only half way home. By the time I got home after an hour walk, I wanted to hit the roof and I although I could alleviate some of the pain through lying on my stomach propped up, and stretches, I could still barely sleep. I was also completely consumed by whether or not I had slacked in my posture somewhere along the line while I was walking, or whether I was too tight or loose (still missing the big picture)."
"Sixth Week: "Still determined. Began the week at an all-day staff meeting where I lay on a gym mat on my stomach, propped up on my elbows- all day. Stretching at lunch and a couple of other times I walked out of the meeting to stretch. It almost floored me to do a 20 minute standing stint that we had to do during our meeting. Followed by a 2 hour course via video-conferencing where I did the same thing. When I got home the pain was less and I didn’t want to "over-do" it again, so I gently did my stretches throughout the evening- I didn’t try to walk. Next day at work, the pain was pretty bad from the beginning, but it was -60 degrees F outside and not many kids came to school - more time out to stretch when I needed to. Wednesday - more of the same. I tried to walk at night but got discouraged when I couldn’t walk for more than about 10 minutes without pain. Thursday - same thing, but I almost ran out of the school at the end of the morning to go to the nurses station. (We both wrongly assumed that I had overdone walking, not just walked in injurious ways.) She prescribed more Naproxen and told me to make sure that I walked but more frequent intervals. She also told me to keep stretching, but that lunges and squats were simply out - don’t do them. I kept wondering about this advice as I reread Ivy’s story and looked at the pictures of her doing those amazing squats and lunges. I spent most of my evening on the internet reading and rereading stories."
Barbara was lying face down propped up on elbows for long periods in a way that hurt instead of help. Instead of letting the entire spine gently extend backward so that the upper back "unrounded," she was "folding" a crease at the lower back, increasing pinching in the lower back.
"Friday of the Sixth Week: True Awakening! "I took Friday off work and first thing in the morning while I was doing my usual morning stretch routine, it just hit me! I became so obsessed with my posture, thinking that stretches should magically make my pain disappear, but I wasn’t viewing my body as how I used it during regular activity; I was also very guilty of giving up on certain things when they got "too hard" (lunges, squats). My balance was bad (despite trying to practice it while putting on my socks and shoes), my walking gait was horrible, I wasn’t really trying to do anything that required some effort, and I was continuing my bad habits of resting for hours before I tried to get back up and stretch again. Having reread some of the personal stories, I worked on my walking: feet straight ahead, feet hip-distance apart, heel to ball of foot, using my whole foot to walk - I was so focused on posture that I was holding myself stiff while walking instead of walking naturally with a bit of rotation at the waist). When I thought I was using my muscles, I was really just tensing them right up instead of truly using them. Reading posts and walking also made me realize how tight my Achilles tendon, hamstrings, and hips are. I decided to work on this through my stretches too. Next hour I was back up and walking, and stretching those areas after (using a counter to hold onto while doing a full squat, doorway hamstring stretch, and stretching my hip sitting on a chair rather than lying on the floor). Every hour I walked and stretched, and every walking session was longer, every stretching session I could actually stretch farther! Halfway through the day - now it was time to really engage myself in those lunges and half-squats - just do them and do them properly - no excuses - I need them for everyday life and unless I go beyond what I think I can do, I’ll never get to that point. They’re definitely not just part of an exercise routine, but unless I could do them with strength and stability in my living room, I knew I couldn’t do them in a fast-paced setting when I needed them.
"Time to stop making excuses. I was up and about constantly all day, walking, lunges and squats, stretching. By the end of the day, I can’t even describe my feeling of elation when I went to bed completely pain free, with my left leg hardly stiff at all, and some of the numbness in my left foot gone! Actually having been rather lazy, and in fear of lunges and squats doing more damage, they turned out to be the best stretches and strengtheners...now why wouldn’t I want to use these in all situations to get a beautiful natural stretch during my day! The confidence and calmness that all using your principles, and truly using my muscles to engage in activities is giving me give is fabulous. Not to mention all the energy! This is a new way of life for me. And quitting smoking is not a different story...it’s the same story...and my next step is to look into my eating habits and to quit smoking. It’s my life and my body is a temple...I’m sick of mistreating this temple with lethargy and apathy. No more unhealthy exercises in "power" work-outs and yoga for me...strength, balance and flexibility will is every moment, every day. Now I'm ready for your Healthy Martial Arts book...
"Thank you! Thank you! You (and Ivy) are my inspiration! Wishing for you all joy and true happiness in life (which I know you already have :) ). "Fondly, Barbara
"I'm truly thankful for your hard work and great insight into pain and how to live healthy in every day life!!
"PS I was frightened when I was told I had a herniated disk at L5-S1, and this was great news to me as I know I'm healing and I won't need any physiotherapists, etc. to help me through this! Your book Fix Your Own Pain is amazing - I think I've almost memorized it; two people at work have borrowed it already (including my boss) - I think they're seeing how much it has helped me. I'm thinking about giving your book to people for Christmas."
Summary "take-home" message - Barbara found that she doesn't have to "do" any exercises. That is the difference with this method and others. Moving for daily activities using the retrained healthful positioning stops the source of the injury. At the same time, it just happens to give much built in functional healthful movement. That is how exercise is supposed to be - a natural part of your human life.
There is more good news to Barbara's story, but that's enough for now.
We have been traveling for the past 2 months in Asia and are on the way to the chilly Smokey Mountains of Tennessee USA to teach medical students for a week during their rotation elective in Wilderness Medicine. This is the third year I will teach there.
I will teach the entire curriculum of diving medicine and physiology, plus a workshop on why commonly prescribed stretches are not healthful, and what to do instead. Several members of the Knox County Sheriff's Office from Knoxville TN have requested to attend my lectures, and several readers made the effort to find the class information on my web site and make arrangements to travel to the camp to attend.
As a physiologist, I design the techniques that physicians use. I spent many years as a military and university researcher in environmental physiology, which is how the body functions in the heat and cold, at altitude and underwater, breathing different mixtures of gases, doing different forms and intensities of exercise. It's important to understand why things work. If you don't understand, then you can't think for yourself, and all you can do is repeat the mistakes of the generation before you, who also were just repeating what they learned in a book from teachers who just were repeating what they had heard.
This problem occurs with some of the exercises and stretches given as physical therapy. An introduction to the problem is in the post What Does Stretching Do? In the past two years teaching at the camp, we encountered young students who were not interested to change bad stretches, and made a point of showing me after my lectures that they will keep doing their rounded bent forward toe touches, since "everyone knows" that is how it is done. However, Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch.
The problem can occur with medical treatments that are in the books, even though wrong. In my diving physiology lectures, I try to show that if you understand the physiology, you will know why certain treatments do not work or are not needed. Immersion in water, for example, creates many interesting effects such as distributing blood volume more out of the limbs to the body. This is similar to the effect that occurs in space, described in Collapsing Astronaut Gives Healthy Reminder. Recently, during our travels, Paul wound up in the hospital with a swollen leg. The doctor who was Chief of Medicine of the hospital, announced that the treatment was bed rest. Paul was told he must lie flat in bed for at least three to fours days with the leg elevated to drain the fluid. We understand that bed rest is often listed in books as a treatment for this, but it is wrong. I asked the doctor if going in the water could help. The doctor said that standing in the water meant the leg would be "hanging down" and the leg needed to be elevated to drain. If you understand immersion, then you know why immersion can more effectively treat limb edema and water retention than medicines and lying in bed. Extended bed rest is unhealthy, and reduces muscle and bone health so much that it is used to study the damage to the body from floating around during space travel. We escaped the medical care and went into the water. I will post more on immersion, edema, and health soon.
I will not have Internet access for the next week to read or reply to comments. Enjoy the Fitness Fixer using the links in this article. Start taking and sending in fun photos of your successes using all the fun techniques.
"I would like to take this opportunity to tell you that after suffering for many years from back (scoliosis) and neck (arthritis) pain, it was my good fortune to happen upon your website. I read every word, tried the movements and postures and found an immediate measure of relief from the pain that no doctor, chiropractor, physical therapist or massage therapist has been able to help (I am 56). I immediately ordered a number of your books, read them from cover to cover, gave them to my daughter and son-in-law and then ordered more for my son.
"I took your books with me to New Orleans, where I worked for 10 days as a volunteer building houses, and am happy to report the exercises and stretches allowed me to climb ladders, wield heavy loads and hammer nails without further consequence to my back and neck.
"As mentioned by most people, I found instant relief upon simply correcting the positions of my neck and back. I took the books to New Orleans with me and did most of the stretches, especially the side bending, back extension, hip and hamstring ones. I also took great care with my positioning with the construction work and lifting. "Before I found you, because I was in so much pain, I had stepped up my go-to stretching routine gleaned from years of aerobics and some yoga, which always included toe touching with straight knees and plow and all those exercises you say not to do. I thought it was good that I could touch my toes on the floor behind my head in a plow or my palms to the floor bending forward. Ouch!
"I've also been doing many of the strength-building exercises, trying to work up from the elementary to the more difficult. It's fun stuff and it feels SO GOOD!
"Thank you for putting so much information out there for the long-suffering public! Sincerely, Marla Black"
"PS - my daughter is a triathlete and she and her husband have been doing all the bad stretching and wrong postures. Her neck and back were starting to hurt. I gave them the books and they are already onboard and feeling the difference!"
We are here working in Asia. Everywhere, we see schoolyards with kids playing sepak takraw. Modern sepak takraw is played on a court with three players on each side. Players don't use their hands to volley. They use feet, legs, shoulders, and head to keep the ball in the air, volleying back and forth. Main features of sepak takraw are acrobatic mid-air kicks to keep the ball in play, and the athleticism and speed of the players.
Sepak takraw has been played in Southeast Asia for hundreds of years. The word "sepak" is Malay for kick and "takraw" is the woven ball. In Thailand, the game is often simply called Takraw. In 1984, a Thai inventor revolutionized the sport with a synthetic takraw to replace the slower traditional rattan ball.
Takraw has roots in Malaysian, Chinese, and other national games. In Bangkok Thailand, there are wall paintings at the Wat Phra Kaew (Temple of the Emerald Buddha) of Hanuman, the Vanara (Monkey-like) Hindu god, playing takraw in a ring with his monkey troops. The game developed into teams competing across a court with a net, about the size of a badminton court. This modern-day version is a Southeast Asian specialty.
Thailand wins most of the gold medals at the Asian Games. Here is a motion clip of just 48 seconds of playing Takraw. Click the arrow to watch.
Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
Thursday, January 17, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
In Part I of this post on Monday, photographer Bernie tells of fixing years of pain that doctors told him only surgery would fix, even after three surgeries. Here is a look "behind the scenes."
10 March 2005, Bernie e-mailed me:
"I've had this persistent paresthesias for 4+ years. I just learned about you yesterday. Where are your back & spine classes held. Tomorrow, I'm having lumbar myelogram & CT at (top name deleted here) Hospital. Before I consider anything else, I want to learn about your methods."
I wrote back with class information. I had two classes coming up. One was the next month. The second would be in early May and only a few blocks from where he lived. I told how we work to see change in pain right in class. I asked him to let me know the test results and that I hoped to see him in class.
20 March 2005 he wrote back:
"Thanks for asking, I never expected you to keep in touch. The myelogram and CT showed moderate central spinal stenosis at L4-L5. Severe facet joint arthropy & hypertrophy of ligamentum flaxa causing compression of the lateral recesses stenosis of L5 on both sides, kinking of L5 nerve root sleeves on both sides. I have a copy of the xray, showing the "hourglass" at L4-L5
"(name deleted) is the attending, 3-B Orthopaedics. He said the next step is surgery, by ( ), at ( ) Hosp. I asked if strengthening of my upper body would help support my spine. He said "try it" so I'll be at physical therapy next week to start.
"I have a commitment for the weekend of April 2-3 so can't attend that class, much as I'd like to. Since I live at (close to) your class at Temple CC is my best chance of attending. Cordially, Bernie Cleff"
I checked back in to make sure he was signed up for the May class and to ask what he was doing in Physical therapy. He wrote:
29March 2005 "The phys therapy that I'm getting concentrates on my core muscles. Thanks for getting in touch...very kind of you."
I wrote back saying that conventional core exercises were not the best thing. Usually they are forward bending actions that will further compress the discs, the nerves, and also do not retrain the abdominal muscles in the way they work when you go about daily life. Strengthening does not automatically support the spine. I wanted to make sure that he had my Ab Revolution book, which was then out in a training manual version. He said he had it with him for PT. I found out two years later that they had the book, but they were not using it, and were doing traditional forward bending abdominal exercises.
10 May 2005, the day after the Fix Your Own Back Pain workshop was held, Bernie wrote me,
"Hello, I did sign-up for your class at TUCC on Monday 5/9, but I was too tired to attend. On top of that, I am scheduled for spine surgery at ( ) on Wed 5/11/05, with ( ). After having 2 epidurals and physical therapy I decided to go for the surgery. My nerve that is pinched is in the shape of an hourglass (at L4- L5) and (the doctors told him) that no body position or exercise changes are going to help at this time. Both legs are numb and I am walking like a drunk. It is kind of you to keep in touch. I hope to meet you at your fall class."
Days later, Bernie had the surgery. He tells about it, and his next two years, in Part I of this story. The doctors all considered his surgery a "complete success." They said the surgery went completely according to plan, with no complications. His recovery was in line with expected results. The fact that his pain returned, was worse, and complicated by limited movement from his plates and screws and other surgical hardware not a factor to them. They felt the limited movement was beneficial and a goal of the surgery. The commonly held idea is to stop motion in the area to stop the pain.
In late October of 2007. I arrived to teach the Fix Your Own Back and Neck Pain Workshop. I had 16 people waiting for me. One was Mr. Bernie Cleff, a funny white-haired muscular man of 80, who was in much pain.
We had a fun, energetic class. One of the students was a young man from India. He sat unsmiling as I mentioned various yoga poses that can injure discs in the neck. I explained that I am not against all yoga, and studied years to become a teacher myself. He sat unsmiling. We did three specific techniques to stop the neck pain process and a beautiful smile radiated from the young man from India. He had three herniated discs in his neck from his yoga practice of the specific moves I had mentioned, together with sitting badly at a computer for his work. He already knew those yoga moves hurt his neck. He had just been worried the pain would never stop. When the pain stopped right there in class, he smiled.
Another of the students was a golf pro, who I consulted with afterward to test out my work on lower back pain and golf. More on this in Lower Back Pain and Golf.
Mr. Cleff did great in the first class. This class was done over two weeks. I gave the students things to try during the week before the second (last) class.
Oct 25 2007, he wrote me:
"Today (Thursday) is my class day at The Clay Studio, working over the wheel for 5 hours. I felt good with very little noticeable pain. Usually after walking the 5 blocks from my home to the studio both my legs would tingle badly and I would stop to rest halfway. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to check-up. You are one hellova person and I'm thankful that I've met you.
"I've had my spine problems with the pinched nerves for a long time - roughly 4-5 years - and I'm slowly getting better since you came into my life. There is no other way to say it. Thanks Jolie."
He was improved in one class, and he felt that he was "slowly" getting better. I like an empowered student who does not want to dawdle to get better. The day after the second of the two sessions, Bernie wrote:
28 Oct 2007
"Last night, I walked about 7 blocks to restaurant AQUA (great value, low cost & delicious) and back home another 7 blocks.
"Upper back extension causes no pain, lower back does. I can do plank on elbows, holding for 60 seconds now, no pain.
"If you want to make photos of a geriatric doing your things, it's OK with me. as you've seen, I'm not bashful or delicate. I will work at getting better, my daughter is getting married January 5 and I want to be able to dance with her and my wife."
Bernie went back to his doctors to ask about a small amount of remaining pain. They told him he should have more surgery and gave him prescriptions. He wrote to ask me:
"On Nov. 2 I have a follow up with the spine surgeon (same guy) and on Nov 14 a consult with a Neurologist ( ). Do you have any suggestions about a pain med FENTANYL, which was suggested by a doc at the V.A."
I wrote back that Fentanyl is a surgical grade narcotic. It is used "off-label" for back pain and there have been deaths. I asked him to tell me more about what hurt, and when, so we could stop it without any harmful medicine, and also what the neurologist said.
14 Nov 2007, he wrote:
"I had an office visit with the neurologist at ( ), he said my twisted nerve at L5 will never get better and I will always have pain."
They told him to have another spine surgery, and take Fentanyl, and he will always have pain? Then why did they put him though all that surgery?
He wrote:
"Hello, I still have some tingling in both knees...but much better than 2 weeks ago! There has always been pain in my left flank between spine & hip, never told you because the knees were my greatest problem… The lower back pain persists, but only left side. When I do the trap stretch leaning to left--puts much pressure on that pain. Leaning to the right feels like a good stretch. Any additional suggestions?"
I found that that he was still doing "their" exercises. Conventional exercises of bending forward to stretch the hamstrings are often prescribed for back pain. The assumption is that tight hamstrings have something to do with back pain. However, bending forward is one major contributor of this kind of back pain. I changed how he stretched his hamstrings to one of the ways we did in class.
He was also continuing to overarch his lower back when walking, which was a large source of the tingling pain. When he used the Trapezius stretch, he was also overarching, which makes pain when bending to that side. This kind of pain is often confused for spinal stenosis. One classic sign of stenosis is pain when bending toward one side. However, the narrowing is not true stenosis, but just overarching which narrows and pinches the area. For someone who has stenosis, not pinching the area further with overarching is frequently enough to stop pain.
What was complicating everything was his surgeries. They were considered "completely successful." The two knee replacements were "completely rehabbed" meaning he could bend his knees enough to sit in a chair. He could no longer stretch the front of his hip enough to prevent the kind of tightness that encourages standing and moving in overarched position. The back surgery put a plate in his back to prevent much movement. That meant that even small overarching movements were enough to pressure the newly immovable area. The back hurt, and the tight back and hip were compressing nerves going down both legs.
After we fixed these issues he wrote two mails:
"Jolie You hit on the spot. I will keep at it gently."
and
"Jolie, a quick note to tell you today I walked 12 blocks, stopping to stretch hamstrings.. often on steps or fireplug....as you suggested...also lunge stretch. I will dance at my daughter's wedding. Much thanks.
"There will not ever be more surgery on my body."
For the flank pain, he had been for many tests, and was even scheduled for a kidney evaluation. The muscles in the area were so tight, that I biked over to his home to do a sports medicine technique to stretch it out for him, and checked his other stretches. I went over how to stretch the front of the hip without overarching his lower back. His sweet funny wife made me lunch. We got some fun photos of things as gifts for you, of fun stretches and activities.
He wrote:
"I've had x-rays, MRI, bloodwork, surgery, injections, no Dr. had any solution. YOU HAD THE ANSWER. No wonder so many people have thanked you."
He did the work and gave me the credit. That's a good man.
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.
Prevent Main Factor in Back Pain After Running and Walking
Thursday, October 11, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
One of our readers, Nick, wrote me that he had had slowly increasing lower back pain despite exercising regularly. He ran, he stretched, he did abdominal exercises. Nick's doctor told Nick to give up running and take up low impact activity. Giving up running made Nick miserable but he did it. The pain came and went, but overall did not change. One day during a walk, his pain had spread into the back of his hip and was unendurable. He didn't feel able to make it back home, and wound up in the emergency room.
His x-rays were inconclusive and he was sent home with anti-inflammatory medicines, instructions to stretch his hamstrings, and rest or try other non-impact activity. This is a common story that readers mail me. It is unfortunate because:
The real cause of the pain was missed.
You do not need to give up running.
This kind of back pain is not inflammatory so does not benefit by anti-inflammatory medicine, which often causes its own problems.
Impact is not the problem. With a little common sense you can see if you clomp instead of walking or running lightly. Use leg muscles to step lightly instead of bashing down with no control. You should be able to run and jump with little impact. Many people walk with higher impact than a good runner lands during running. Future posts will cover this.
Most important was the missed cause - lower back pain during and following running, walking, lifting, and other upright activity is usually from allowing the lower spine to over arch. This hyperlordosis is not caused by an anatomic problem "condition." It is a bad posture, which is easily correctable. Hyperlordosis is one of the most commonly missed causes of lower back pain. Left drawing shows neutral spine. Right drawing shows one kind of hyperlordosis.
In the left neutral spine figure, the hip is level and horizontal from front (ASIS) to back (PSIS). The hip is also vertical from the top of the leg (greater trochanter) to the center crest of the hip. The right drawing shows allowing the front of the hip (pelvis) to tilt forward, which increases the lower spine angle. A small inward curve in the lower back is necessary for disc health and shock absorption. A high angle is as painful as any other pinching and pressuring of an area.
This is what I had Nick do. You can try it too. Check yourself these two ways to see if you stand in hyperlordosis:
Stand up and look sideways in a mirror. Your belt should be level-green line in left neutral drawing. The side seam in dress or trousers should be vertical from leg to waist - black arrow in left drawing, not tilted forward at the hip
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 is usually a good indicator that you lean the upper body backward, which increases a second kind of hyperlordosis. See Neutral Spine or Not? for more.
Here is how to reduce an overly large arch:
Stand with your back against a wall, with heels, hips, upper back and back of your head touching.
Put your hands on your hips, thumbs facing the back.
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.
Keep your heels, hips, upper back and the back of your head touching the wall and stand tall and straight. Lower back pain that is caused by hyperlordosis should ease right away.
Keep the good new neutral spine when you walkaway from the wall, and all the time.
More step-by-step instructions and photos in the Ab Revolution manual.
Check back often. I am working on the next part of this post: Another Common Cause of Back Pain With Running.
Nick was quickly able to return to running by stopping hyperlordosis. So was Ted - Back Pain From Running. Recognize hyperlordosis. It will save office visits, even emergency room visits, tests, time, money, stress, and worry. Reduce hyperlordosis to neutral spine with a simple repositioning technique to stop and prevent much pain.
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Here is Friday Fast Fitness - Quickly strengthen and straighten the upper back, improve balance, and learn better shoulder position for reaching.
Last Fast Fitness Friday started this one for a strong base. Now that you have practiced, add the upper body:
Stand on one foot. Lift the other leg in back and bend at the hip until your body is perpendicular to your leg as in the photo, like the top bar in letter T. See how the body is straight in line with the brown field in the photo?
Hold both arms in front of you, parallel to the floor, hands level with, or above your head. Lift from your chest, not neck. Keep your shoulders down and back. Don't hunch or round your shoulder or it will impede raising the arms.
Hold straight as long as you can. Switch legs. Hold straight as long as you can.
Work with a mirror or friend until you can tell straight positioning on your own. Want less? Raise only arm. Breathe. Enjoy.
Related Fitness Fixer - "Unround" your upper back for healthier daily neck mechanics:
Here is Friday Fast Fitness - Quickly strengthen lower back and backside muscles, improve balance, stretch your legs, and learn straighter positioning:
Stand on one foot.
Lift the other leg in back. Bend only at the hip until your entire body is parallel to the floor (like the top bar in letter T) as in the photo. Do not droop your leg down in back or droop your chest in front. Do not jut your chin forward. Chin in. Look in a mirror until you can tell straight positioning on your own.
Hold straight as long as you can. Switch legs. Hold straight as long as you can.
Last October, Ivy from New Zealand left a comment on Fitness Fixer how she first found me while looking for relief from severe sciatica with foot drop. For 11 months, she had tried treatment and an exercise regimen from a chiropractor. Last week, she e-mailed me a funny update of improving mobility and health from a new stretch. I started writing this post just to tell of Ivy's stretch and how readers can have the same success.
I looked over my file of Ivy's comments on Fitness Fixer and her e-mails to me over the last two years - each story weaving to the next - of improving health, mobility, and joy of life for herself and people in her community. Reading them again was like sitting by a stream that sparkled over rocks on its way by, inspiring and lovely. Some are private, some I have her permission to tell.
Last October, Ivy wrote:
Ivy wrote, "I knew I should be feeling better than I was. During those months I was continually surfing the net looking for answers, then in November 2005, I discovered Dr Jolie Bookspan's "How to fix your own pain without drugs or surgery." Everything she described was ME, 69 years of bad habits had finally caught up with me.
"So began my journey to good health and freedom from pain. I began with the pec stretch, trapezius stretch, wall stand, sitting correctly at the computer without sticking out my chin, hamstring stretch, isometric abs (no more crunches), squats and lunges instead of bad bending.
You can imagine my joy when after 2 days I was free of pain. I was so excited that I contacted Dr Jolie, who in turn, took time out from her busy schedule to e-mail me giving me further advice and exercises which I might add, I follow religiously along with a daily 30 minute walk (weather permitting).
"Some months ago, I decided to follow a vegetarian diet. I feel so well and happy, in fact, I have loads of energy. I turn 70 at the end of this month (Oct 2006) and am looking forward to the next stage of my life feeling healthy and free of pain."
This year Ivy followed up when we were corresponding on making sure of healthy nutrition:
"This is the second winter that I have not had either a cold or 'flu. For someone who was always getting the 'flu, that is really something. I put it down to my healthy vegetarian diet."
Ivy used my free web site summary sheets on fixing pain, my books, and Fitness Fixer posts. Here are links to posts Ivy used:
Wall stand - this is a quick check of functional muscle tightness to see if you can use healthful positioning for normal activity. It is described in the first paragraph of the post Fixing Upper Back and Neck Pain, above.
Isometric abs (no more crunches) - this one isn't up on Fitness Fixer yet. It is in my book The Ab Revolution and Fix Your Own Pain, and on my web site summary on functional use of abs to stop overarching the lower spine. Ivy sent a photo of doing this exercise. I will post it when I post about this fun, different, functional abdominal exercise.
The posts on lunges, Doorway Hamstring Stretch, and Functional Achilles Stretch, feature photos that Ivy sent me. I had written Ivy earlier this year asking if she could send me photos demonstrating what she is doing. She invited a neighbor to visit and take the photos, had them developed, then mailed a pack of them to me from New Zealand. Ivy writes:
"My dear 86 year old friend took them and we certainly had a lot of fun doing what I will call a "photo shoot." Bear in mind her age when I tell you that while I was trying to hold the pose, she would press the incorrect button and would have to start all over again. I would lose what I would call the correct form and so it would go on... I can now sympathize with models who have to hold poses for what seems an eternity."
In February 2007 Ivy sent an update, signing it:
"I shudder to think where I would be if I had not found your web site over 15 months ago. I mean it when I say "Thank you for helping me get my life back." I am fit, I am healthy, what more can one want in this life. I have passion about what I do something that I haven't had in a very long time."
An example of a test that does not test what it claims is the "Sit and Reach" test. Sit and Reach is assumed to test hamstring flexibility, but is more a measure of how much you can round your spine. Many people can pass the Sit and Reach with little hamstring flexibility and an unhealthful angle at the hip - tilted back (shown by shorts side seam) rather than vertical. The Sit and Reach is required testing for numerous military, corporate, and school fitness programs
