A Healthier New Year

Photo: Ruben A.Navarrete

Looking back on this past year, are you happy with your health? Are you as healthy as you should be or want to be? Are you physically doing all you hoped and expected at your age? You cannot change everything about your health. You cannot control if you get cancer or are in a bad car accident or if everyone in your family has high blood pressure. But what can you control to make you as healthy as possible in order to live every day to its fullest?

1. Attitude. I recently met a man who had been paralyzed from a car accident when he was 21. He had an unusually positive attitude, so I asked him how long it took him to accept the fact that he was paralyzed. His surprising answer was "about 3 months." He told me how God used the accident to change his life and show him that he was not living how he should. So now he is--from his wheelchair. He just got married and is working and volunteering. He is not bitter, angry or depressed but sees his wheelchair as his legs, and it takes him everywhere. 

Having the right attitude will help you this new year because you can see your life as an opportunity instead of a struggle. Even if your circumstances are hard, such as being overweight or struggling with a health condition, you can still make the most of what God has given you. If you can walk, don't just sit. And if you can run, don't just walk. Use your body to its utmost potential this year!

2. Exercise. This is one area that only you can control. You can choose to be lazy or active. It takes work and discipline to exercise effectively, but everyone can do it in some form. Picture yourself 10 or 20 years from now. What physical condition do you expect to be in? If you don't take practical steps in that direction, you will likely fall short of that goal.

3. Time. How have you spent your free time this year? Do you have any regrets? Did you spend more time on Facebook and Instagram than playing with your kids? Did you waste time on TV or video games? There is a time for restful leisure, but at the end of next year, wouldn't you rather say you trained for a marathon or went skiing or hiking instead of just talking about the latest celebrity news? Remember that you are not guaranteed another day or another year. Think about what really matters in your life, and invest your time wisely. 

4. Excuses. Making excuses for an unhealthy lifestyle will only put you in the same or worse condition this time next year. Everyone is tired of your excuses, and you should be too. Don't blame anyone or anything else. Simply choose to take charge of your body right now and all year long. If you have lost a good amount of weight this year, I can guarantee it was because you worked your tail off. And it has paid off! 

One of the most important things in life is to leave a legacy. You cannot take anything with you to the grave, but you can take souls to heaven with you. You may not be the next Billy Graham, but maybe your son will. Or maybe the person you influence will become the next Mother Teresa. Maybe you will start a company that gives millions to cancer research. Or maybe those two pints of blood you donate will save a child's life.

Knee Pain From Jogging

IT Band and Knee Pain:

If your pain is in the lateral or outer part of the knee (not the front nor within the joint) and feels muscular, then it may be coming from your IT Band. In this case, here are your guidelines for jogging.

1. Warm up for 5 minutes (fast walk, bike, etc).

2. Stretch for 5 minutes, including a lot of IT Band stretches. Hold each stretch for 20-30 seconds and repeat 3-4x for each leg.

3. Start jogging on a flat surface and at a slow-moderate pace. 

4. If you feel IT Band pain while jogging, you may need to stop and stretch.

5. Do not increase your pace, distance or frequency until you can do so without increased pain.
6. Stretch the IT Band after workouts and throughout each day.

For example, you may be able to jog 20 minutes, 3x/week without increased pain. Try to increase by 3-5 minute increments to see if you can tolerate more. Do not push through pain in order to maintain a certain pace or distance. In that case, you would continue to worsen the problem instead of giving it a chance to heal completely. The goal with jogging is to slowly progress in order to do so without pain. 

Pain in Knee Joint: Book for Self-Treatment:

If your pain is within the knee joint, I recommend a book called Treat Your Own Knee by Robin McKenzie. It will teach you which knee movements may treat your pain and which movements to avoid.

Knee Strengthening to Prevent Knee Pain:

Joggers need to do leg strengthening in addition to jogging. You should spend at least 1-2x/week doing strength training for the lower body including all major muscle groups. One of the single best exercises to stabilize the muscles surrounding the knee is Straight Leg Raise. Lie on your back with unaffected knee bent. Straighten your knee (of painful leg) and slowly lift the entire leg ~10 inches and slowly lower (keep knee straight the whole time). Repeat 3 sets of 8-15 reps. Once you can do 3 sets of 15 easily without weight, increase resistance by using an ankle weight. Progress slowly in 1-lb. increments.

Photo: celiajohnsononline.com

Cross Training To Prevent Knee Pain:

Frequently, knee pain can be prevented by cross training. If your goal is cardio exercise, replace 1-2 jogs per week with another form of cardio. I highly recommend biking, swimming, or cardio workout machines. Of course, there are various other forms of cross training such as strength training, plyometrics, flexibility, interval training or various sports.

Jogging Modifications To Decrease Knee Pain:

1. Jog on grass instead of roads/sidewalks.

2. Decrease distance. For example, instead of 3-4 miles each on 2 consecutive days, do 2 miles every other day.

3. Modify shoes using inserts, orthotics or a new type of shoe.

4. Decrease speed. Lower your pace and see if it changes your pain.

5. Try interval training in order to increase your power without having to do as long distances in order to achieve an excellent cardio workout.

Postpartum Jogging and Knee Pain:

After pregnancy, it may be challenging to get back into jogging, especially if you are having knee pain. Your knees may not be ready yet to return to 3-4 miles, as the ligaments are still lax from pregnancy/childbirth. Progress very slowly as your body tolerates. If you are first returning to jog since having a baby, try 1/2 or 1 mile of walking/jogging. Jog for a bit but stop and walk as needed (keep a moderate to fast walking pace). Once you work up to jogging for a mile with no walking needed, increase to 1.5 or 2 miles of walking/jogging. If it is painful, decrease your jogging intervals. Slowly, as your knees tolerate, you should be able to jog more and walk less. But do not push through moderate or severe pain in order to jog a certain distance or speed. 

Always consider why you are jogging. If for weight loss, there are alternate exercises that you can do, so find one that is not painful. If for exercise outdoors, try biking instead. If for alone time/mom's sanity, join a gym with good childcare. If for specific race preparations, take a longer time to train. If you continue to injure your knee, you may have to stop jogging completely, so it is better to treat and prevent the pain than to jog through it.

Best Book for Self-Treatment of Painful Joints

Do you have joint pain that you cannot afford much medical treatment for? Robin McKenzie, a world-famous Physical Therapist and bestselling author, wrote a series of books about self-treating pain in various joints. I would highly recommend any of these if you have pain but cannot afford much therapy or other treatments.

Treat Your Own Back
Treat Your Own Neck
Treat Your Own Knee
Treat Your Own Shoulder

There may be various editions of these. I would recommend looking at Amazon or other websites to find the best prices, but you should be able to purchase one for $10-$15.

For more of McKenzie's exclusively-designed products such as lumbar rolls and pillows, check out OPTP.com.

Of course, if you have serious joint pain that is not resolving, please see your physician and request a prescription for Physical Therapy.

Knee To Chest Back Exercise: Yay or Nay?

Lying on your back and bringing your knees toward your chest is NOT the best stretch for your back nor is it even beneficial. While it is common to do these types of back stretches, they are generally not good for your back because you are forcing your spine into a flexed position that it already does more than necessary. For example:

Ways You Forward Bend (Flex) Your Spine
1. Sit for long periods
2. Slump sit
3. Bend forward to reach for things
4. Sit in a reclined position

Clearly you achieve more than sufficient forward movement of your spine and do not need any additional stretching such as knees to chest. If your back feels tight and you want to stretch it, remember that your back muscles have been on a constant stretch during all of the above listed activities. So continuing to stretch your back in the forward direction will not decrease your back tightness.

Best Replacement for Knee To Chest Exercise
Roll over onto your tummy and press up onto your forearms or hands (your hips and lower abdomen will stay down). This can be done by repeating 5-10 times or by holding for 15-20 or more seconds. This puts your spine into a backwards position (extension), which is healthier for your back than knees to chest. The photo shows a pretty difficult stretch, so start with pressing up onto your forearms. If you tolerate that well, then you can progress up onto hands.

Photo: www.themanualtherapist.com

Remember to consult your physician before doing any back exercises. If you have back problems, I recommend you see a Physical Therapist before beginning this exercise. 

Do I Need To Lose Weight? Women, Weight Loss and Skinny America

Photo: Vince Connare

American culture is obsessed with women being skinny; almost every Hollywood actress is super thin. So why should you diet or exercise? Simply to lose weight and to become thin like the girls on TV?

Should You Lose Weight?
There are so many reasons to exercise and eat right other than to get down to your desired dress size. If you are healthy, eat well and exercise regularly, then likely you are maintaining a good weight, regardless of what any book or chart may say. This may mean you are size 16 or size 2. Your weight depends on many factors such as genetics, metabolism, medical issues, activity level, exercise history, muscle mass, and eating habits. You cannot control how God made you, so it is better to accept your body than to fight against it. Before you start a diet, check your motives because you may not even need to lose weight. If you are overweight, simply focus on improving your health through good eating and lots of exercise in order to jump start your weight loss.

How Do Naturally Thin Women Eat?
I rarely see thin people eating salads at McDonald's. The super-thin people I have known eat what they want. They do not overeat; instead, they may forget to eat when they get busy. But when they are hungry, they enjoy a wide variety of tasty foods that may be full of fat, calories and sugar. They do not necessarily exercise, so how do they stay so tiny? Probably everyone in their family is "small-boned." I have known many super-skinny women who are not healthy at all. So don't confuse being healthy with being thin. One thing everyone can learn from naturally super-tiny folks is that they rarely overeat.

Eating Should Be Fun!
My kids love lollipops and ice cream cones simply because they are fun to eat. I don't give them junk food all the time, but if they eat a healthy meal, I allow them a fun dessert sometimes. Moms, please don't go out for ice cream and just watch your kids eat their chocolate cones with sprinkles. Join in with the fun! That does NOT mean to order a large, extra-large or double-dipped cone with 5 toppings. Just order something small that you really love and savor every bite!

Exercise More To Eat More
If you exercise a lot, your appetite will increase. If you truly love to eat and cannot decrease your food volume to lose weight, try exercising more. This will help to increase your metabolism and, of course, burn calories. Another benefit is that exercising will motivate you to eat better, so you may end up replacing your french fries and cookies with blueberries and protein shakes.

What Makes You Beautiful?
First, beauty comes from within, so spend some time today exercising your heart, mind and spirit. The Bible says that beauty is shown by a gentle and quiet spirit. Second, every woman has equal value regardless of how she looks. Third, being thin will not take away all your insecurities. Even the most attractive super models are self-conscious about certain things and may not even like how they look. A lot of girls want to be pretty in order to attract a boyfriend, but remember that being in a relationship does not increase your worth.

Food Addiction
It is interesting that obesity has been increasing throughout this skinnifying of American culture. I believe obesity is so prevalent because of food addiction and sedentary lifestyle. I recently heard: "Anything you cannot live without is an addiction." So if you think you are not addicted to your late night binge, try giving it up for 7 nights.

Weight in Other Cultures
Not every culture has skinny women all over their media. For example, in Latin America, female stars are generally very curvy. Some cultures even revere large women. Remember that each culture's view of beauty changes over time. Being skinny or tan or having a certain hair color may be in fashion now but not 20 years from now.

Overcoming Skinny American Culture
If you feel caught up in wanting to look like a model, spend less time reading magazines and watching TV. The media has more effect on your mind than you may realize. Focus on becoming healthier instead of thinner. Learn to enjoy food but within logical limits. It may sound like an impossible task for most women, but try to accept your body. Then maybe you won't put so much pressure on yourself or those around you.

Reading Position That Decreases Back Pain

Photo: Rachel Sian

Do you read every night before going to bed? Next time you do, lie on your tummy and prop up onto your forearms as you read. This is an ideal position because it arches your back, which is a very healthy movement that most of us rarely do. Our backs do a ton of forward bending each day, as we sit, slump, bend, stoop, and recline. But how often do we stretch our spines backwards? This is one reason why so many elderly folks, or even younger individuals, are hunched forward and cannot stand tall or even sit up straight.

If you do not achieve any backward movement of your spine in daily life, you will progressively lose the ability to fully bend backwards as a normal spine should. So lying face-down and propping on your forearms is one easy way to start moving your spine in the right direction. At first it may be a little uncomfortable, but soon you will grow to like it. Start with 3-5 minutes, and if it feels fine, increase your time up to 10-15 minutes or even more.

Not only is this healthy for your back, but it has good potential to decrease your low back pain! 70% of patients with low back pain need backward movements to get better!

Lastly, this position is the perfect adjunct to reading your Bible every night. That way you are promoting both your physical and spiritual health.

Why All Women Should Take A Self-Defense Class

For your own safety, I strongly urge you to sign up for a self-defense class immediately. There is nothing more important for women to know than how to defend themselves against rapists. I recently took my first self-defense class, and I highly recommend that all women do the same. Your only protection against attack is having some strategies that you are prepared to use at any time. Here are some things that surprised me from my class.

Is pepper spray effective?

While it can be effective, it is rarely used because most women keep it in their purse or on their keychain and do not have it ready to fire. Also, while spraying, some of it can get into your own eyes, making it difficult for you to run away. Since the class, I now carry my mace in hand with my finger on the trigger whenever I am alone outside.

Is it effective to put a key from your keychain between your fingers for a self-defense strategy?

Likely the key will fall back into your palm if you attempted to punch someone. It is more effective to hold a key between your thumb and 3rd finger, with the point of the key next to your index finger. That way you could use it to slash your attacker.

Which way should you run if someone is aiming a gun at you?
Run to the shooter's right. He will have a harder time tracking/hitting you than if you ran to his left. Run in a zigzag pattern, with zigzags every ~2 seconds.

What should you do if a "thief" asks for your wallet?
Throw it far, then run away. Remember that he may be more interested in raping, kidnapping or killing you than taking your money.

Should you run, fight, or do what he tells you if an attacker threatens you with a gun or weapon?
Run if you can. If you can't run, fight. Do not believe anything he says. Bad guys can't be trusted to tell the truth. Don't believe him if he says he only wants to rape you. Don't believe him if he says he only wants your money. His intentions are all bad, and he will lie to you. You have a better chance of survival if you run than if you do what he says. 50% of the time, he will not even shoot. If he shoots you, there is a high percentage that it will not be fatal. If his intention were to kill you with his weapon, he would have already done so. He wants to use his weapon to exercise control, power and manipulation.

Do attackers select targets based on clothing or looks?
No. They care more about who is an easy target. They look for someone who is weak, slow, distracted, busy, on the phone, unaware, etc. Do not be the easiest target in the parking lot. Plan ahead where you go, where you park, whom you are with. Walk quickly and with upright posture so you look like someone assertive who would fight back or would not go down easily. Know who and what is around you at all times. Never assume that you are safe. I know someone who was attacked in Columbiana mall at mid-morning near one of the restrooms. She fought back, so eventually he ran away.


In order to learn specific fighting techniques and moves, you must take a self-defense class. I highly recommend the class I took from Sensei Chris Feldt; it was truly life-changing. He offers similar classes monthly, or find a convenient self-defense class near you. Taking the class from a Karate instructor was ideal!


Source:
Sensei Chris Feldt. Self-defense class offered at Samurai Karate Studio (located in Northeast Columbia).
<www.samuraikarate.net>

Pain in Achilles Tendon: How To Treat

Symptoms of Achilles Tendinitis:

1. Pain in the Achilles tendon.

2. Pain with walking when you first wake up in the morning.

3. Pain with aggravating activities or sports, especially if they involve running.

4. May progress to pain even with usual daily activities, such as walking.

5. Decreased pain when you are resting.

Causes of Achilles Tendinitis:

1. Repeated impact on the leg, such as jogging or sports.

2. Improper sports/exercise training, such as increasing pace, distance or intensity too soon.

3. "Running on uneven or loose terrain." (1)

4. Overpronation of the foot.

5. Tight calf muscles.

6. Incorrect shoewear.

Modifying Your Exercise To Decrease Achilles Tendinitis:

1. Rest from aggravating exercises. Replace with pain-free exercises, such as swimming or biking.
2. Eliminate running or greatly reduce your running. Do not jog on hills. Avoid jogging on roads/sidewalks.
3. Modify your shoewear or get fitted for orthotics.
4. Eliminate intervals.
5. Increase calf stretching, and perform prior to and after exercising.
6. Use ice or ice massage to the Achilles tendon, especially after your sport.
7. Consider seeing a physical therapist and/or a certified prosthetist/orthotist.
8. Ask your primary doctor for a referral to an orthopedic foot/ankle specialist.
9. Return to your sport at a slow, pain-free pace.
10. Incorporate eccentric calf strengthening (if they can be done pain-free). For example, stand and do a calf raise with both legs. At the top of the calf raise, release the good leg so that you are standing only on the affected leg. Use the affected leg to lower yourself back down. Repeat 3 sets of 10-15 reps.

Specific Reference: 

(1). Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. 2003: Mosby. Page 405.

General Reference:
Greenberg RC, Saltzman C. "Achilles Tendon Dysfunction," in Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. 2003: Mosby. Pages 405-410. 

Why Sleeping In Fetal Position Is Bad For Your Back

Fetal Position: Does It Cause Back Pain?
Side sleeping can be ideal for most individuals, but curling up too much into fetal position can actually cause back pain or at least contribute to it. Fetal position puts your spine into a forward bent or flexed posture, which is similar to sitting slumped or standing and bending forward. As much as fetal position may be comfortable, it is not healthy for your spine to be in that flexed posture for hours at a time.

Forward vs. Backward Spine Positions and Back Pain:
If you have never had low back pain, you can learn this lesson from those who do: most individuals with low back pain respond best to backwards bending or back extension exercises, not flexion or forward bending. In other words, having your back in a forward bent or flexed position is not very healthy for your spine (low back, mid back or neck).

Neutral Spine Sleeping Posture To Avoid Low Back Pain:
I am not saying you should sleep in a backward bent position either. Simply find a neutral sleeping posture which puts your back into a relatively straight position. This can easily be achieved when sleeping on your side by not bringing your knees up toward your chest. Have your knees slightly bent but do not pull up your legs so that your low back becomes rounded or flexed.

Pillow Between Knees To Prevent Low Back Pain:
To further improve your neutral spine position, sleep with a firm pillow between your knees or use a body pillow. My pillow of choice is a small, firm, rectangular one. I have seen pillows made for this purpose at Bed, Bath and Beyond, but they are more expensive than simple, decorative pillows which are just as effective (check the clearance rack at your favorite discount store).

Prevent Low Back Pain With Good Posture:
While you are looking to achieve a neutral sleeping posture, also work on neutral sitting postures during the day. For example, avoid sitting in a recliner or chair/chaise with your legs extended in front of you because that also puts your low back into a rounded or flexed position. In a desk chair, sit at the back of the chair with a lumbar pillow for added support. Similarly, avoid bending forward when you are standing or sitting; instead, use your legs to squat and maintain your back in a straight position.

Low Back Muscle Spasm

What Is Low Back Muscle Spasm?

One presentation of low back pain is muscle spasm. This can accompany a low back strain or many other lumbar spine diagnoses. Low back muscle spasm presents as sudden, severe pain in part of the low back with decreased ability to move it for a time. For example, you are in a bent position and you cannot straighten up. That muscle is hard/tight to the touch compared to the other back muscles. It may appear swollen; for example, the right side of your low back looks bigger than the left. This can be present for a few minutes-hours and can come repeatedly over a number of days to several months, depending on your activities, movements and postures.

How To Treat Low Back Muscle Spasm:

It usually requires you to change positions, and the severity decreases if you find a relieving position such as lying on your side or getting onto hands and knees. Any new injury needs to be treated with ice for at least 2-3 days to minimize swelling and inflammation. Muscle spasm can be decreased with the use of heat to relax the muscle. If there is not significant swelling or internal inflammation, you can use heat to treat the pain associated with muscle spasms.

Medical Treatments for Low Back Muscle Spasm:

For this diagnosis, you will likely be prescribed muscle relaxers, anti-inflammatory medicine and/or pain relievers. Certain movements, positions or activities may need to be limited to prevent the spasm from returning (for example walking less, decreasing housework, or not playing your sport for a time). Other treatment options are Physical Therapy, chiropractic care, massage, and acupuncture.

How To Prevent Low Back Muscle Spasm:

If you prevent all other forms of low back pain, you will prevent low back muscle spasms. This means:

1. Practice good postures.

2. Practice good ergonomics and body mechanics.

3. Exercise regularly for your overall spine health.

4. Avoid a sedentary lifestyle because all tissues, including your spine, thrive on movement.

5. Do back extension exercises (moving spine in backward direction).

10 Easy Ways To Add Exercise To Your Busy Day

Photo: NOAA's National Ocean Service

1. Do push-ups when you first wake up. Take 10-20 seconds to jump start your morning and your metabolism!

2. Hold a squat position while you brush your teeth. Or do a set of squats.

3. Stand on one leg to put on your socks and shoes by holding a squat position and crossing one leg over the other knee (be sure your back is straight).

4. Do straight leg raises while doing hair, makeup or other grooming activities. Stand on one leg and kick the other leg forward, sideways or backwards, keeping the knee straight.

5. Squat several times while making the bed. It will strengthen your legs and help with your body mechanics.

6. Do knee extensions (kicks) while eating breakfast. Sit toward the back of your chair, with your thighs fully supported. Then extend one knee 10-15 times and repeat with the other leg.

7. Do back arches while driving to work. Change from slump sitting to overarching your back. Then relax back down to a neutral posture (back straight) and arch again. Repeat 15-30 times.

8. Roll your shoulders backwards while sitting at your desk. Repeat 20 times.

9. Raise up onto your toes (calf raises) while washing your hands. For a challenge, do this on one leg at a time.

10. Take a few minutes to do jumping jacks or mountain climbers while watching TV.


Exercise does not do itself. If you don't make extra effort to exercise, it will simply disappear from your lifestyle. Whether you need to lose weight or not, exercise is critical for the health of your entire body. Ideally, it is recommended that adults exercise >30 minutes/day, 5-7x/week (or more for weight loss). But honestly, some individuals are too busy to do 30 straight minutes of exercise. If that person is you, the only way to exercise will be a few minutes at a time. Please add in comments if you have additional exercises to share.

Plantar Fasciitis: Self-Treatment

If you have plantar fasciitis, it is very painful and can last a long time (months-years), but the more you do the following, likely the sooner your foot pain will go away. Here are some of the components of a Physical Therapy treatment plan and home exercise program. If you do these consistently and aggressively, you may be able to avoid PT.

Rest: Avoid aggravating activities, such as excessive walking. Avoid jogging and any exercises that increase your foot pain. If you want to exercise, try biking or swimming laps.

Motion Exercises: Move your ankles around (up/down, side to side, circles) whenever you are sitting or lying down, especially just before you stand up (for example: before getting out of bed in the mornings). Or spell out the alphabet using your ankles/feet (spell each letter of the alphabet 1-2 times before standing up).

Calf/Achilles Stretching: Hold each stretch for 20-30 seconds, and repeat 3-4 times. Do this several times throughout the day (3-5 or more times per day). The first 3 pictures show various ways to stretch the calf muscle (gastroc), so choose at least 1-2 of these. The fourth picture is a soleus stretch (lower part of calf) which is also important. The last photo is a plantar fascia stretch which is easy to perform anywhere in the sitting position.

Photo: foothealth.about.com

Photo: www.runwithholly.com

Photo: fitbie.msn.com

Photo: www.dailystoke.com

Photo: www.drwolgin.com

Deep Tissue Massage: Massage your heel and arch with very firm, deep pressure for 10-15 minutes, 1-2x/day.

Ice Massage: Rub an ice cube on your heel/arch for 5 minutes or until it becomes numb. Do this 1-2x/day.

Modification of shoewear: Modify your shoes if they aggravate your pain. Find the shoes that give the most relief. Ideally, stay off your feet as much as possible. It may be helpful to try various shoe inserts if you need additional arch support.

Disney World: Tips For a Pain-Free Vacation

Photo: wickedboy_007

We recently headed to sunny Orlando with 5 adults and 5 kids under age 4 to enjoy a fun-filled adventure at Disney World, so out of my own experience and observations, here are some tips to keep you and your family pain-free on your next Disney vacation.

1. Wear tennis shoes. I know that women may prefer to look cute, but 12-15 hours of standing/walking in anything other than tennis shoes will likely cause you more pain throughout the day. At Disney, your feet and legs will be tired regardless of your shoes, but you will feel better with good, supportive sneakers. I once wore flip flops at Carowinds all day, thinking I would get on a lot of water rides. But at the end of the day I could barely walk because my legs ached so much.

2. Use sunscreen and re-apply it frequently. Vacation is no fun if you or your kids get sunburned.

3. Do not try a new sunscreen on your first day of vacation. Thankfully we tested out a new sunscreen the week before vacation and learned that my son was allergic to it. So on vacation we resorted to our usual Banana Boat, and it worked great, just like last year. An allergic reaction to any new skin product can cause terrible itching, discomfort, redness, rash, etc, so don't risk it.

4. Wear a hat. This is one of the best ways to prevent getting a sunburn on your face.

5. Pack a ton of bottled water. Disney allows you to bring coolers (under a certain size), so pack them full of drinks. This will save you a load of money and will keep you hydrated. Trust me, you will need a drink even as you wait for the shuttle out of the parking lot. Then you will have to wait in line for the ferry or monorail, so you will likely finish your first bottle before you even enter the front gate of the park itself. If this was true for us in May, it will only get worse during the hottest summer months.

6. Arrive early at your favorite events to get good seats. Otherwise you will strain to see and you will hurt your neck from holding your child on your shoulders for the duration of the parade, show, etc. If you want a good view of the Electric Parade, arrive around Main Street more than an hour before the show starts in order to get a first or second-row view.

7. Take rest days between park days. Or plan water parks or smaller outings on those days. You will have to wake up early on park days, if you want to enter the park around opening time (9:00 am). This means arriving at the parking lot between 7 and 8 am. And likely you will not leave until after 10 pm, so you will be exhausted even on day 1 of your vacation. Try to build rest into your vacation, or you will truly need another vacation to recover.

8. Have sufficient stroller seats for all younger children. Our double stroller is not comfortable for sleeping, so we rented a double stroller for the week, and the kids slept great in it. It was well worth the cost. It is not comfortable to hold a sleeping baby for a long period of time. There are benefits to using infant carriers, in which your baby is strapped onto your chest or back, but I would not recommend them at Disney, simply for your own comfort. A stroller is ideal both for you and your baby. Plus it gives much-needed storage space!

Swimwear Tips For New Moms

If you are a new mom, you may have a little trouble finding the right swimsuit this summer season. It was hard enough finding maternity swimwear, but likely it will be even more daunting now because your tummy has not yet returned to its pre-baby state. Believe me--even though I have lost most of my baby weight before getting pregnant again, there is still some excess belly that may or may not disappear in the next few months-years. So here are my recommendations.

1. Buy a 2-piece swimsuit if you are breastfeeding. It does not have to be a bikini, but a 2-piece will make nursing your infant much easier, especially if you use a cover-up while nursing (which I recommend for your general modesty and the comfort of everyone around you). Try to find a top for your 2-piece that covers your belly, if you are self-conscious about it. There are a lot of cute tankini tops that cover most or all of your tummy. 

2. Buy a 1-piece for the most effective tummy coverage, if that is your goal. You never know when a wave or water slide may reveal the tummy you are trying to hide.

3. Buy a decent quality swimsuit. All cheaper suits either stretch out, thin out and/or fade. I once bought a swimsuit from Penney's, and I could only wear it twice because it stretched out and became too big. There was no savings there because I had to immediately buy another one. Don't forget the fact that swimsuit shopping is more frustrating than fun, so you should only have to do it once per year (or less). 

4. Don't walk around stores looking for modest swimsuit bottoms. Just find out your size and the brand(s) you like, and shop online. Even if you find something modest (such as shorts or a skirt to cover your suit), it is unlikely you will find the color and size you need. 

5. Don't take the kids with you while shopping. It is frustrating for all parties involved.

6. Don't shop separately for swimsuit tops, bottoms, cover-ups or accessories. You will end up making more trips to more stores, only to be unhappy with your final purchase (because you made it in haste, being annoyed with shopping for so long). I recently shopped for a skirt or shorts to go over my one-piece black swimsuit, and I finally found one at the third store I searched. Once it was washed and ready to wear, I went back to find my black swimsuit (from before having kids) was no longer wearable and had to be trashed. So then I had to go out again to find a tankini top to match my new, black bottoms.

7. Shop early for swimwear (long before vacations and pool trips). Vacation prep week is stressful enough, so plan ahead to make your life easier. That also gives you time to shop online, which might be the best way to go (although I have never done so before). 

8. Do not assume that your size swimsuit is easy to find. During my search, I found that the smaller sizes were impossible to find in the more modest suits. The most common sizes I found at Belk (I went there twice recently) were 10 and above (both for tops and bottoms). 

9. The best brand (and most expensive) I found at Belk was H2O Wear, which had a lot of modest one-piece and 2-piece suits to choose from. If your budget is $100, this would be a good option for you. After summer season, you likely can find these on sale/clearance. If you are going to pay $60-$80 for a decent suit anyway, you may find it's worth it to get a higher quality suit such as H2O brand for $20-$40 more. 

"Defeat Chronic Pain Now:" Book Review

I recently found Defeat Chronic Pain Now at the library and read the first chapter last night. I was happy to see that the topic of chapter one is low back pain, which is terribly common, especially among sufferers of chronic pain. It was even better reading that the authors (Bradley Galer, MD and Charles Argoff, MD) recommend Physical Therapy within the first few lines!

Myofascial Cause of Back Pain?

They talked a lot about myofascial pain and trigger points as a main cause of low back pain (and referred leg pain), which I do not completely agree with. Being trained in the McKenzie method of Physical Therapy, which involves mechanical treatment of back pain (or moving the spine in specific directions in order to decrease pain), I have found that trigger points are not a great factor in treating low back pain.

Combining Treatments for Back Pain

I agree with Galer and Argoff about the need for a combination approach to treatment, which often includes medicine and "Active PT," the term they use to describe Physical Therapy that involves active exercise and movement to treat the painful condition. They discuss various medicines used for back pain and their benefits. 

Work Injuries and Chronic Back Pain

Page 15 briefly talks about chronic back pain related to being unhappy at work. There is research that shows a correlation between chronic back pain among those who are unsatisfied in their jobs. This is among individuals who have sustained a back injury at work. I totally disagree with their discussion of this research. Their second paragraph states that if you do not like your job, you are at risk for chronic low back pain. Research does not say why there is a correlation between work satisfaction and back pain. It only shows if there is a correlation among the researched population. Clearly, the population being studied included only those with work-related injuries. There is no endnote identified about this research, so it is hard to clarify this matter.  

I have never treated someone who developed low back pain because he/she was unhappy at work. Low back pain usually has a specific cause and can be treated very effectively. Individuals with work-related back injuries are a completely different demographic than the general population and any research involving them should not be applied to those without work-related back injuries.

Active Physical Therapy for Low Back Pain

Galer and Argoff list some other possible treatment options for chronic low back pain and briefly discuss their benefits and precautions. Again, they include Active Physical Therapy at the top of the list, which I truly appreciate and also highly recommend!

One statement I must rebuttal is: "Many--if not most--physical therapists are trained in only passive, 'feel good' therapies, such as warm baths, gentle massage, and ultrasound" (page 22). This may have been more true 50 or 30 years ago but not anymore. Passive modalities such as these were only part of one class out of my three years of graduate school, so clearly we are trained in much more than that. Otherwise our "Active PT" would not be so highly recommended throughout chapter 1.

Recommended Book for Chronic Pain?

So do I recommend this book? Based on chapter 1, yes. It is worth reading if you have chronic low back pain. But you may also want to look at some other back books to see how their treatment approach is different (such as Robin McKenzie's Treat Your Own Back).

Reference: Galer BS, Argoff CE. Defeat Chronic Pain Now! 2010: Fair Winds Press. Chapter 1: Beating Your Back Pain.

Mattress Firmness And Low Back Pain

Firm Mattress and Low Back Pain? Traditionally, you have heard that a firm mattress is the best for your back. I have known many individuals that have less back pain when sleeping on a very firm bed or even on the floor instead of a soft bed. Those are the same people that do not lie in bed to sleep more than 6-8 hours, even on Saturday morning! They do so after finding that sleeping in too long increases their low back pain.

Soft Mattress and Low Back Pain? There are also many individuals with low back pain that sleep on various types of mattresses that do not aggravate their backs. It would be extremely obvious to me if softer mattresses were the culprit of back issues because all my patients over the years would have reported this to me. So I cannot say that softer mattresses are bad. 

There is one statement that I have heard repeatedly from patients: "I need to replace my bed because it is old and I sink into it too much." Clearly, if you sink down into the mattress excessively, your spine is likely being pushed out of alignment (so your back is not in a comfortable, neutral resting position at night). On the other hand, a too-firm mattress could also potentially put your spine out of alignment if your hips or buttocks cannot sink in sufficiently.

Research on Mattress Firmness and Back Pain:

I recently found one research article about this topic. The study included over 300 individuals with chronic low back pain, and they were divided into two groups: firm mattress or medium firm mattress. To my surprise, the study showed a better response to medium-firm than firm mattresses. Those in the medium-firm mattress group reported better outcomes about their back pain during various daily tasks than the firm mattress group.

Conclusion: Despite common recommendations, there is not overwhelming research that associates firm mattresses with less low back pain. Clearly, there is at least one study (see above) that links a medium-firm mattress with better back outcomes than a firm one. So find what works for you. Take the time to try out a lot of beds, and save up so you can afford the one you prefer, as some are very expensive. If you shop around, you should be able to find a good-quality name brand for $300-$400 (which includes a 10-year warranty).

Specific Mattresses with Good Back Support: Out of my recent personal experience of mattress shopping, here are some mattresses that I liked. Keep in mind that there is a wide range of mattresses within each name on this list, so you will need to shop around to find the one you prefer. Higher-quality mattresses come with longer warranties, so it may be worth it to pay more for a longer-lasting mattress.
1. Sealy Posturepedic
2. Simmons Beautyrest
3. Simmons Beautysleep (a cheaper option)

Reference: Kovacs FM, Abraira V, Pena A, et al. "Effect of firmness of mattress on chronic non-specific low back pain." Evid Based Med 2004;9: 119.

4 Components of Weight Loss

            It is never too early or late to lose weight if you are overweight or obese. Even if you became obese at a young age, you can change habits now and lose weight! It takes determination, discipline and hard work, but the rewards are countless! One of the biggest benefits of weight loss is having less pain, including back pain. Moreover, it is easier to prevent obesity than to treat it. So if you have found yourself 10 or 20 lbs overweight, start working to reverse the trend. Otherwise that could turn to 50 or 100 excess pounds that you never expected to have.

4 Components of Weight Loss  

1. Change in mindset. Admit that food controls you and recognize why you overeat. Until you know what your problem is, you cannot fix it. 

2. Change in activity level. You must increase your daily amount of activity and exercise in order to lose weight. No pill or diet by itself can replace the benefits of regular exercise. 

3. Change in eating habits. You cannot eat the same amount or kinds of foods that you have been eating and lose weight. Look at your eating habits and start to modify them. 

4. Perseverance over time. There is no easy way to lose a lot of weight, no matter what the ads may say. It takes time and hard work. Do not give up! Keep working at it and you will succeed. Find the help you need, whether it is an exercise partner, a weight loss group, a gym membership or an appointment with a nutritionist or dietitian. 

Most importantly, do not leave out any of these four components or you are less likely to get the weight off and keep it off.  Do not forget to consult your physician about your weight, in case it is related to a medical problem.

Additional reading on WEIGHT LOSS:

http://thinklikeapt.blogspot.com/2012/04/weight-loss-perseverance.html

Recommended Weight Gain During Pregnancy

Table 1. Institute of Medicine Weight Gain Recommendations for Pregnancy
Prepregnancy Weight Category	Body Mass Index*	Recommended Range of Total Weight (lb)	Recommended Rates of Weight Gain† in the Second and Third Trimesters (lb) (Mean Range [lb/wk])
Underweight	Less than 18.5	28–40	1 (1–1.3)
Normal Weight	18.5–24.9	25–35	1 (0.8–1)
Overweight	25–29.9	15–25	0.6 (0.5–0.7)
Obese (includes all classes)	30 and greater	11–20	0.5 (0.4–0.6)
*Body mass index is calculated as weight in kilograms divided by height in meters squared or as weight in pounds multiplied by 703 divided by height in inches. †Calculations assume a 1.1–4.4 lb weight gain in the first trimester. Modified from Institute of Medicine (US). Weight gain during pregnancy: reexamining the guidelines. Washington, DC. National Academies Press; 2009. ©2009 National Academy of Sciences.

Source: The American College of Obstetricians and Gynecologists. "Committee Opinion: Weight Gain During Pregnancy." Number 548. January 2013.

Normal Weight: It is clear that there is a range of recommended pregnancy weight gain based on your pre-pregnancy weight. Pregnant women always hear the general statement that 25-35 pounds of weight gain is the recommended amount, but based on the above chart, that is only the case for women who were "normal weight" prior to pregnancy.

Underweight: Underweight women are recommended to gain more, even up to 40 pounds. This may be harder for you than your "normal" and "overweight" counterparts because likely you do not overeat nor do you gain weight easily. Also, it may be hard for you to gain enough weight because you may be concerned about losing the weight after Baby is born. You need to be more inintentional about how to increase calories in order to gain sufficient weight during these 40 weeks. Try not to worry too much about "getting fat" because pregnancy is the one time in your life it is actually good to gain weight!

Overweight: The recommended range for you to gain is lower than the "normal" and "underweight" categories, so work with your OB to form a strategy for proper weight gain. Otherwise, you may gain too much and risk having difficulty losing that weight postpartum. This may be difficult if you generally enjoy overeating and are indulging yourself even more now that you are pregnant. Or if you generally diet to lose weight, do not be afraid to gain the recommended 15-25 pounds now that you are pregnant.

Obese: Unfortunately, you have the lowest recommended amount to gain compared to the other groups of women. The only way to successfully gain under 20 pounds is to have a plan. Be sure that your plan includes accountability in order to ensure you are following through on your OB's guidelines. Gaining excessive pregnancy weight would only contribute further to your obesity and make your long term weight goals harder to achieve. Be sure to get specific advice from your doctor about how to keep your weight gain in the recommended range of 11-20 pounds.

Postpartum Weight Loss: How To Lose Baby Weight Quickly

Photo: Cornell University Library

2 ways to ensure postpartum weight loss and to return to pre-pregnancy weight are:

1. Do not gain excessive amounts of weight during pregnancy.

2. Breastfeed for at least 6 months, and ideally for 12+ months.

According to a research article in The American Journal of Clinical Nutrition, among a Danish population, postpartum weight loss was associated with breastfeeding. That population was selected because Danish women tend to breastfeed more and for a longer period of time than in other countries. The two major factors they considered were pregnancy weight gain and breastfeeding.

Is pregnancy weight gain correlated with postpartum weight retention? Researchers found that more weight gain during pregnancy was associated with more postpartum weight retention. In other words, the more weight they gained, the more weight they retained afterwards. This was true after 6 and 18 months postpartum.

Is breastfeeding correlated with postpartum weight retention? Researchers found that breastfeeding was associated with more postpartum weight loss for all groups of women except the heaviest.

There are obviously many strategies for postpartum weight loss, including healthy diet, exercise, belly binding, etc, but breastfeeding alone may be the single most effective way to lose your baby weight! Personally, I have found this to be true three times in the past four years. Each pregnancy, I gained ~35 pounds, and within 6-9 months (while breastfeeding) I returned to pre-pregnancy weight.

The women I know who have lost their baby weight in less than 6 months all gained much less weight than I did. For example, a friend who gained 15 pounds during pregnancy lost it within 1-2 months. A friend who gained 20-25 pounds lost it within a few months. Some women even lose it immediately, within days or weeks.

Do not fret if you gained a lot during pregnancy because breastfeeding can help you lose that weight. You just may have to work harder to lose the weight or it may take longer for you. Clearly, there are times when your OB may recommend you gain more or less weight during pregnancy, based on many clinical factors. Remember that your baby's health is more important than your size, so be sure to follow doctor's orders.

Tune in tomorrow for a discussion about how much weight you should gain during pregnancy based on your pre-pregnancy size.


Reference:  Baker JL, Gamborg M, Heitmann BL, Lissner L, Sorensen TIA, Rasmussen KM. "Breastfeeding Reduces Postpartum Weight Retention." American Journal of Clinical Nutrition. Dec 2008. Vol 88. No 6. 1543-1551.

Low Back Pain: Treat With One Exercise

Photo: Chakra-Jnana Yoga/Facebook

Backbends. Stand up, put your hands on your hips or low back, and bend backwards (obviously not beyond a comfortable stretch), likely around 30 degrees. Hold 1 second, then return to upright. Repeat 5-10 times. This is the single best exercise for the majority of patients with low back pain, and the following explains why.

1. Convenience. You can do this exercise anywhere to treat or prevent low back pain. It does not require equipment or even lying down. While there are various forms of back extension (lying on your tummy and pressing up onto forearms or hands, lying on your back and lifting your hips into a bridging position, various yoga poses, etc), this exercise is the easiest one to perform no matter where you are.

2. Back Extension Exercise helps 70% of patients with Low Back Pain. Moving your lower spine into a backward-bent position (arched) is one of the most effective ways to undo the force of continual forward bending and slumping that we all perform excessively every day.

3. Back Extension treats Low Back Injury which occurred in a flexed (forward bent) position. If you have Low Back Pain which began with a specific injury or traumatic event, think about the position of your back at that time. Were you lifting something? Bending forward to pick up an object? If forward movement caused your injury, back extension may be the direction of exercise to treat it. Even if you were injured in another way, this still is the direction of force that the majority of patients with low back pain need in order to minimize symptoms.


Caution: This exercise is not safe or appropriate for all individuals, so consult your physician first, especially if you have low back problems, painful medical conditions, balance problems, or anything else that may inhibit your safety. If performed in a gentle way, it is likely safe for most individuals without low back pain. No one should perform this forcefully or into an excessively far backwards position.

If you have low back issues and have not seen a Physical Therapist, ask your doctor for a referral/prescription, and find a spine PT near you!


Reference: McKenzie, Robin. Mechanical Diagnosis & Therapy: Lumbar Spine. 2009: The McKenzie Institute International, Part A.

Further reading: McKenzie, Robin. Treat Your Own Back, 9th ed. 2011: OPTP.

Does My Child Need Physical, Speech, and/or Occupational Therapy?

Pain prevention is just as important for your children as it is for you! So the more you know about what to expect, the more likely you can prevent painful or difficult medical/developmental issues during your child's early years of life. Your child may benefit from Physical, Speech, and/or Occupational Therapy in order to maximize his/her strength, motor skills, communication, eating, swallowing and overall functioning in daily life.

Here are a few brief checklists (from hceip.org) for parents of young children, to know if your child is developing at age-appropriate levels. Obviously, there is a range of norms for developmental milestones, which your pediatrician is monitoring regularly (at well visits). However, the pediatrician does not see your child on a daily basis, so you are the best person to assess his/her development! As the parent, take the initiative to know what your child should be doing at various ages, especially during the first few years of life. If you feel your child needs any therapy, request a referral or prescription from your pediatrician.

One major benefit of early intervention (of PT, OT, or Speech) is that it may be covered by various medical programs, to decrease your out-of-pocket cost. Also, it will help to decrease your child's need for therapies in the future. Do not be afraid or ashamed to put your child into one of these types of therapy because it truly will help! It does a disservice to your son/daughter if you choose not to use PT, OT or ST once you know it is needed. Having a child be able to do age-appropriate activities will improve the quality of life for your whole family. Plus, it is fun for children! Pediatric PT's, ST's and OT's love to play games in order to make learning as fun and engaging as possible!


Article 1: When Should a Parent Refer a Child to Physical Therapy?

http://www.hceip.org/physical/when-to-consider-physical-therapy/

Article 2: When Should a Parent Refer a Child to Speech Therapy?

http://www.hceip.org/speech/when-to-consider-speech-therapy/

Article 3: When Should a Parent Refer a Child to Occupational Therapy?

http://www.hceip.org/occupational/when-to-consider-occupational-therapy/

Diastasis Recti: Treatment and Exercises

Photo: miraclephysicaltherapy.com

Diastasis Recti is a condition that many pregnant women experience, including me, being pregnant three times in the past four years. So here are some exercises to treat Diastasis Recti. You may begin these exercises after pregnancy, once your OB advises. They go in order from easiest to hardest. Only perform #1 and #2 if your separation is >2 cm. Once it decreases below 2 cm, you can progress to #3 and beyond, progressively. Technique is everything, so follow all instructions carefully.

1. Mini Abdominal Crunches: Lie on your back with your knees bent. Cross your hands over your abdomen so your hands can push your rectus abdominus inwards toward the belly button. Exhale and slowly lift only your head, but not so far to see a bulge (diastasis recti). As you perform the head lift, gently push the hands inwards. Then slowly release the head down and rest. Repeat 5-10 times. Then progress to 15-20 repetitions over the next few days. Finally, progress to 25-40 repetitions. Do this for several days, and check the amount of separation of your Diastasis Recti. If the separation is improving, the exercise is getting easier, and you can perform 30-40 repetitions at once, you may be ready to progress to #2. The photo shows a towel being used to pull inward, which is an alternative to using your hands to pull.

Photo: getactive.com

2. Mini Crunch/Pelvic Tilt: Lie on your back with your knees bent. Cross your hands over the abdomen as in #1. The mini abdominal crunch with arms pulling inward is the same as in #1. But this time add a pelvic tilt concurrently. To do so, tilt your pelvis backward so your abdomen is drawn in and your back is flattened out (likely you recognize this from early pregnancy exercises). Exhale as you do the pelvic tilt. Then lower your head slowly, and finally release the pelvic tilt. Repeat 5-10 times. Progress to 20, then 30+ repetitions. Only progress to #3 if your separation is <2 cm and has been improving as you have done #1 and #2.

Photo: http://www2.nau.edu

3. Pelvic Tilt/Heel Slide: Lie on your back with knees bent. Perform a pelvic tilt (flatten out your back) and maintain it. Slowly slide one foot forward (making the knee straighter) as far as you can while keeping the pelvis tilted backward, then slowly return the leg to the starting position (still keeping the pelvic tilt), and repeat with the alternate leg. Every time you extend one of your legs, exhale. Repeat 3-5 reps on each leg. Progress to 5-10 reps on each side. Increasingly do 5-10 additional reps until you can do a total of 30-40 reps on each leg with full range of motion (knee becoming fully straight) and, of course, a proper pelvic tilt throughout.

Photo: befitmom.com

4. Pelvic Tilt/Double Heel Slide. This is the same as #3 but performed with both legs sliding forward together. It is significantly harder than #3, so only progress to this exercise if it can be done with a maintained pelvic tilt throughout. Hold the pelvic tilt and slide both feet forwards, but not so far as to lose the tilt. As you get stronger, your range of heel slide will progressively increase. Practice slowly and exhale as you extend the legs. Then slowly return both legs to the starting position. Repeat 5-10 reps. Progress to 10-20 reps, then 20-30 reps.


Reference: Kisner C, Colby LA. Therapeutic Exercise; Foundations and Techniques, 4th ed. Philadelphia: F.A. Davis Company. 2002. Page 695.

Back Health Survey Discussion: Risk Factors for Low Back Pain

The discussion points here respond to the questions from yesterday's post, entitled "Back Health Survey."

1. How frequently do you perform moderate-high intensity exercise? In general, back health is improved as you do regular exercise, especially cardio exercise and strength training. However, it is important not to injure your back during exercise with excessive, early high intensities or uncontrolled bending/twisting.
   
2. How many hours/day do you sit on most days of the week? Likely, you have minimal control over how much you sit at work, but the rest of your day is yours to stand and walk more! Too much sitting puts your spine in a rounded or flexed position for long periods of time (unless you practice perfect sitting posture with additional lumbar support). Also, sitting does not promote cell growth and circulation as well as standing/walking, so it can lead to spine issues later in life.

3. How often do you perform back strengthening exercise or core strengthening? I recommend you do this at least 2-3x weekly, even if only for 5 or 10 minutes each time. Good back strengthening includes back extensions (backwards bending or arching of the back). Abdominal strengthening is also good (crunches are better for your back than full sit-ups). Core strength exercises of all varieties are great for your spine health, as they strengthen the deep abdominal and spine muscles, which will give natural spine support when you do strenuous daily tasks.
   
4. What is your usual sitting posture? First, check the chair you sit in to ensure it is ergonomic. Then add a lumbar roll (rolled up towel or round pillow) behind your low back. Sit at the back of the chair, then add your additional lumbar support.
   
5. What is your present weight status? Extra weight puts more strain on all your joints, including your spine.

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)? Low back pain comes in repeating episodes, so if you have had several, you likely will have more in the future. But it is not too late to get treatment, of which Physical Therapy can help significantly! Not only will you learn exercises but also things to avoid and how to self-manage your symptoms.

7. How far down did your low back pain symptoms radiate? Symptoms that radiate further down the leg are worse than those in the back only. That is because nerve(s) are being pinched in the spine, causing the symptoms to shoot downward. The key to treatment is to find what eliminates the leg symptoms and moves them more centrally, to the spine (AKA centralization).
   
8. How did your low back pain resolve? Your risk of future back pain is increased if your prior back pain has never resolved or has become chronic. In this case, you and your medical team have not yet found the ideal treatment plan, so all options should be considered, perhaps multiple times.

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)? This may be the single most important factor to decrease your risk of future low back injury! Simply begin to implement body mechanics changes in your daily life. Soon they will become habitual.

10. How much heavy lifting do you regularly perform? Heavy lifting can increase your risk for back pain unless it is always performed correctly (spine straight and using the legs only to do the work of lifting).

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)? Trauma obviously can cause major back injuries or worse (becoming paralyzed or even death), so proceed only with extreme caution, and practice utmost safety measures.
   
12. How often do you perform standing forward bending exercises (such as touching the toes)? This is one of the single worst exercises you could perform. Your spine does not need to be stretched into a forward bent (flexed) position. What is your reason for doing this exercise? If it is for hamstrings stretching, use an alternate technique. If you do this out of habit or from something you learned in your past, change it because this can majorly damage your spine.

Back Health Survey: Am I At Risk For Low Back Pain?

1. How frequently do you perform moderate-high intensity exercise?
     a. 5-7x/week
     b. 2-4x/week
     c. 1x/1-2 weeks
     d. rarely

2. How many hours/day do you sit on most days of the week?
    a. <4 hours/day
    b. 4-6 hours/day
    c. 7-10 hours/day
    d. >10 hours/day

3. How often do you perform back strengthening exercise or core strengthening?
    a. >3x/week
    b. 1-2x/week
    c. occasionally
    d. what do you mean by back or core strengthening exercise?

4. What is your usual sitting posture?
    a. upright, with extra lumbar support (lumbar roll, rolled towel, etc)
    b. upright, without lumbar support (decent chair but no additional lumbar roll or cushion)
    c. mildly slumped
    d. severely slumped or rounded

5. What is your present weight status?
    a. ideal body weight
    b. mildly overweight
    c. moderately overweight
    d. severely overweight

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)?
    a. no major episodes
    b. 1 major episode or injury
    c. 2-3 episodes
    d. >3 episodes

7. How far down did your low back pain symptoms radiate?
    a. no major low back pain in my past
    b. low back only
    c. low back and buttock(s)
    d. down to thigh (not below knee)
    e. down below the knee

8. How did your low back pain resolve?
    a. no major low back pain in my past
    b. completely resolved
    c. partially resolved
    d. never resolved

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)?
    a. All the time; with both difficult and easy tasks
    b. Most of the time, especially difficult tasks
    c. Sometimes
    d. Rarely

10. How much heavy lifting do you regularly perform?
     a. occasionally-rarely. Always with good technique
     b. frequently. Always with good technique
     c. occasionally-rarely. Without considering technique
     d. frequently. Without considering technique

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)?
      a. rarely and not likely to in the future
      b. once every few years
      c. multiple times per year
      d. very frequently

12. How often do you perform standing forward bending exercises (such as touching the toes)?
      a. never. not since elementary school calisthenics
      b. occasionally, when I need to stretch my back
      c. frequently, during my usual workouts
      d. daily or multiple times daily


Score: Count your score by assigning points to each letter answer.
Legend
a: 0 points
b: 1 point
c: 2 points
d: 3 points
e: 4 points


Results:
>30 points: Get to know your Physical Therapist and spine surgeon. You will be seeing us a lot.
20-30 points: Moderate risk unless you make major changes immediately.
13-20 points: Mild-moderate risk. Consider ways to improve!
6-12 points: Mild risk. But beware and don't become complacent in these areas.
0-6 points: You have a healthy back and are at low risk as long as you continue good habits!

Tune in next time for more discussion about these questions/answers!

Post your answer in the comments section. There will be three prizes awarded!
 

Do High Heels Affect Knee Pain?

Photo: State Library of New South Wales

Yesterday I took advantage of the perfect, Spring weather to play in the backyard with my daughter, and we ended up pulling weeds. So much for playtime, but for a 2-year-old it counted as fun. I was careful, of course, about my body mechanics for back safety. But in the process, my knee started hurting (I do not have any knee problems). As a PT, my first thought was: "what exercise can decrease my pain?" I sat on the floor with my leg extended in front of me, and I gently pushed down on my knee (into a straight position; AKA knee extension) and repeated ten times. Unfortunately, it did not help.

Afterward, I decided to wear 3-inch wedge heel flip flops because they felt better on my knee than my flat ones. Without time to explore further exercises, I continued my busy day, of which the next activity was to take my kids to Monkey Joe's for a birthday fiesta. Monkey Joe's is the ideal playhouse for kids over age 3-4, but most of the bounce houses and slides are too big for my daughter, so I had to accompany her on all of them. By the way, if you ever do so, be sure to wear socks (I regret being barefoot on the slides)!

Amazingly, at the end of the day, my knee no longer hurt! There are two possible explanations: my heels or my activity level at Monkey Joe's. Please understand that I would not usually recommend someone to do that much climbing when experiencing knee pain because it usually aggravates the knees. But one of those factors or the combined effect was surprising for my condition. Remember that my heels were not excessively high nor thin but a wedge. Also, my knee pain was mild and new. Chronic or recurrent knee pain likely would not respond the same way.

What is your experience with wearing heels and knee pain? Please share in the comments section for everyone's benefit!

Low Back Muscle Strain

Causes of Low Back Strain: 

One very common form of low back pain is due to a low back muscle strain. This usually occurs because of improper lifting, sports activities, twisting of the back, car accidents, or improper strengthening. General workout activities can contribute, such as a challenging exercise class, machine weights or free weights.  In these cases, one or several muscles of the low back are strained through over-stretching, over-contracting, moving too quickly, twisting or pulling. The muscles have a strain placed on them when they are in an awkward position or there is a traumatic force on them if they are in a neutral position.

Postures and Low Back Pain:

Another cause for low back muscle strain is having an unhealthy spine through habitual poor posture. If you sit all day in a slumped position, your lumbar spine (low back) is loaded into a forward or flexed position, and the muscles of your back are continually stretched (elongated). As a result, you may be more likely to strain a back muscle from light tasks such as loading/unloading the dishwasher. On the other hand, those with a healthy spine (through repetitively good posture and exercise) may tolerate light tasks but strain their backs when doing more strenuous work (ex: heavy yardwork). It is important that both individuals practice good posture and body mechanics in order to avoid straining the low back during routine daily tasks, and especially during difficult physical activities.

Treatment of Low Back Strain

Low Back Muscle Strain should first be treated with ice for at least 2-3 days. If you see a doctor, you will likely be prescribed a muscle relaxer, anti-inflammatory, and/or pain reliever. Other treatments are rest, ice/heat, massage, and Physical Therapy. Depending on the severity of the muscle strain, you may have pain for a few days to several months. This type of LBP can be prevented by maintaining proper posture/body mechanics, proper lifting, regular exercise, caution with sports activities, and maintaining a strong core.