How To Treat Back Pain At Home

Throwing your back out is a painful scenario that is actually quite common. It is typical for someone with an acute episode of back pain to tell me:

"I bent down to..., but I could not stand back up."

"I stood up after bending down, but immediately I knew something was wrong with my back." 

"I twisted my back and quickly felt severe back pain."

"My back has been hurting since I was moving a lot of stuff around recently."

What To Do For Acute Back Pain:

Step 1. Decide if it is serious enough to see a doctor immediately.

Reasons To See a Doctor Immediately For A New Back Injury:

1. You can barely walk.

2. Your pain is so severe that no over-the-counter medicine is helping.

3. You experienced major trauma to your back.

4. The injury caused you to lose sensation in your pelvis or legs.

5. The injury has changed your ability to control your bowel/bladder function.
6. You have noticeable weakness in one or both legs as a result of your injury.

Home Treatments For A New Back Injury:

1. Ice. Ice down your back or the painful area for 10-20 minutes at a time, throughout the day.

2. Over-the-counter Pain Medicine, preferably an anti-inflammatory (Advil, Aleve, Ibuprofen).

3. Rest. Find the most comfortable positions and avoid aggravating movements.

4. Time. If it is not a major injury, it should progressively improve over the next few weeks.

Should You Immediately See a Chiropractor For a New Back Injury?
Seeing a chiropractor may be a good option if you have one that you know and trust. Ideally, go to one that has successfully treated you in the past. They can rule out red flags and tell you if/when to see a physician. If your pain is not improving with chiropractic treatment, do not continue for more than 3-4 weeks.

Should You See a Physical Therapist For a New Back Injury?
Yes! However, most Physical Therapists require a doctor's prescription before beginning treatment, so be sure to ask your doctor for this. In my experience, most patients with a new back injury will significantly improve within 1-2 weeks of PT, and many patients will get immediate pain relief within the first visit. If your pain is not improving within a month of PT, follow up with your doctor for further testing or treatment options.

What To Do for Sciatica in my Leg

Photo: John Ragal

There are multiple causes of sciatica or back pain that radiates down the leg(s). The most serious cause of sciatica is when a nerve root in the spine is being pinched by a bulging disc or by arthritis-type changes in the spine itself. Not only can this cause shooting pain into the leg(s) but also weakness in the leg and changes in the sensation in the leg (for example numbness or tingling in a portion of the leg or foot). If this is the case, it would be diagnosed through MRI and treatment options would be recommended by your doctor. 

Physical Therapists treat many patients with such sciatica. The key to relieving this type of sciatica is to stop the compression of the nerve root in the spine where it is being pinched. This can be done through positioning and exercises. If you are completely compliant with Physical Therapy and get no relief from any sciatica symptoms, then your doctor may try injections (usually with Cortisone) to provide some pain relief. This is a steroid, which provides an anti-inflammatory response. If you do not want injections, you may be prescribed oral medications for pain relief and/or anti-inflammation. 

Other conservative treatments for sciatica are going to a chiropractor, mechanical lumbar traction (requires a MD prescription) or getting acupuncture. Also some people get relief from inversion tables. Aquatic Physical Therapy (doing therapy inside a swimming pool) is another helpful tool for patients with sciatica.

Pregnancy, Exercise, and Eating

Photo: Takis Markopoulos

You may be tempted to decrease or stop exercising while pregnant. Or you may be tempted to eat whatever you crave--no matter how unhealthy. But doctors recommend you continue to exercise throughout any normal pregnancy. And, of course, eating right is more important now than ever, both for your health and your baby's.

Pregnancy and Exercise:
If you normally exercise at very high intensity, you will need to decrease to moderate intensity during pregnancy. Your guideline is to keep your heart rate below 140 beats per minute. So if you usually run at 6.5 or 7.0 miles per hour, you will likely decrease your pace to 4-5 miles per hour now. This is difficult for women like me who like hard and sweat-pouring workouts. But you can still do most of your usual workout activities as long as you slow them down or modify them.

Exercise Appropriate During Pregnancy:
Treadmill or walking/light jogging
Elliptical machine
Stair Climber
Stationary bike
Swimming
Yoga/Pilates
Weight training

Exercise Not Recommended During Pregnancy:
Fast Jogging/Running
High Intensity Cardio
Plyometrics
High Impact Aerobics

Pregnancy and Eating:
In the past 9 years I have been pregnant five times, so I understand cravings of all sorts: potato chips, chicken soup, fudge, popcorn, chocolate frosties, and even cheese grits. Most foods can be eaten in moderation during pregnancy. But here is a brief list of unsafe foods: fish high in mercury (including tuna), cold cuts, caffeine, alcohol, unpasteurized cheese, raw sprouts, raw sushi, smoked fish, raw or rare meat, foods prepared with raw eggs. Some of these are allowed in small amounts, such a serving of tuna per week. The book referenced below is very comprehensive about all types of foods and the recommended amounts during pregnancy. Generally, try to eat a wide variety of nutritious foods. Find foods full of iron and folic acid. Eat a lot of fruits and veggies! Drink a ton of water! All of these are great habits to start now and should continue when you are breastfeeding.

References: Murkoff, Heidi and Mazel, Sharon. Eating Well When You're Expecting. Chapter 7: "Eating Safely When You're Expecting."

Don't Wait Til January To Lose Weight!

Photo: Liz Navarrete

If you plan to start your new diet or weight loss plan in January, why not start today?!! Why not make today Day 1 of your weight loss journey? Today is December 14, so if you get started today, you will jump start your weight loss more than two weeks early, and it will motivate you to continue in the new year! Weight loss is a long and tedious process, so the sooner you start, the better! There are so many people that make a New Year's Resolution to lose weight, but do you want to be one of the many people that start well but then quickly fall off the bandwagon?

Think about if you had a jump start to quit smoking. Imagine you were hospitalized and unable to smoke for three weeks. By the end of the three weeks, your body was already adjusting to being smoke-free! It would be sooo much easier to then continue your life without smoking.

Being overweight started with unhealthy habits, so losing weight will require forming new habits. Anyone can start a new habit by repeating the desired activity every day for several weeks. So if you start a healthy habit on December 14, your new habit will be almost formed by January 1st! And by the end of January, it will be a solid and natural part of your lifestyle!

Any part of your weight loss that is not changing your unhealthy habits for healthier ones will likely not last. You can make drastic changes to lose large amounts of weight quickly, but if you are not forming long-term healthy habits, you will gain back the weight once your lifestyle reverts back to your old ways. So here is my action plan for you...today!

Step 1. Select your weight loss program, and write it down at the top of the first page of a journal, notebook, or note page on your phone. For example: My Weight Loss Plan: Dec 14, 2017: Weight Watchers. I will begin weight watchers today and complete it for two months.
Step 2. Select your exercise plan, and write it down. Example: I will walk in my neighborhood for twenty minutes per day, 5 days per week, for the next two months.
Step 3. Share your plan with someone who will hold you accountable regularly (every week or even every day).
Step 4. Weigh in. Write down your starting weight. You will not weigh in again for at least 1-2 weeks, if you are consistent with your new eating and exercising habits.
Step 5. Write down your plan for tomorrow that includes your new habits. For example, I will exercise for twenty minutes at 4:00 pm.  I will not drink any Coke. I will not buy any fast food.

Here are some other examples of healthy habits you may want to incorporate:
-I will start a "Subway Diet", which includes a 6-inch sub for every lunch this week (instead of fast food).
-I will replace chips with light popcorn.
-I will decrease my soda intake by 50%.
-I will eliminate sweet tea from my diet and replace it with unsweet tea.
-I will decrease fast food meals from three times daily to one time daily.
-I will pack my lunch for work this week, including healthy and fresh items.
-I will drink 5 glasses of water every day instead of sugary drinks.
-I will go to a Zumba class two days per week.
-I will not buy ice cream to keep at my house.
-I will join Planet Fitness and go there every day on my way home from work.
-I will watch one less hour of TV and replace it with cooking/cleaning.
-I will write down everything I eat tomorrow and share it with my accountability partner.
-I will buy a pedometer or Fit Bit, and take at least 10,000 steps every day.

4 Steps To Lose Weight After Failed Dieting

Photo: R.A. Navarrete

You may have been excited and compliant with your weight loss program, exercise routine or diet a few months ago, but recently you got off track. So how do you return to losing weight again?

First, select the best weight loss program for your individual needs. What have you tried in the past and failed? Choose something different. Or what has worked in the past? Do it again! Don't just try the latest craze or a diet that your best friend swears by.

Second, find accountability. You can't do this alone because it is too hard. You need someone to help you, especially during your moments of temptation. It can be someone you look up to, someone you relate to, or just someone who wants to help. It can also be a support group such as in Weight Watchers. Check in for accountability at least once per week, and be honest about your struggles. Without someone to hold you to your commitment, you could easily give in or give up. Call this person when you need motivation to resist overeating.

Third, exercise! Do not neglect this part of your weight loss program. It is just as important as eating right. Make exercise a habit in your daily routine by planning it into your day. It must become a priority, and that should never change (even once you achieve your weight loss). The cheapeast and easiest form of exercise is a walking or jogging program. Other convenient alternatives are workout videos or exercise equipment. But I don't recommend spending money on equipment or a membership unless you are committed to exercising consistently.

Fourth, remember that changing your lifestyle is permanent; it is not a yo-yo diet. The best way to lose weight and keep it off is to do so at a slow and steady pace. The healthy habits you form during this process should last forever. The same components that help you lose weight will also enable you to maintain your new, healthy weight. For example, if eliminating sodas and desserts has helped you to lose 20 pounds, don't add them back into your diet except on rare or special occasions. It initially takes willpower to say no to junk food or to say yes to workouts, but it will become a habit with time. Remember that on January 1, everyone says no to sweets. Be the person who still says no in June, October, or even December!

Low Back Surgery: 6 Steps To Full Recovery

Photo: Ted Hood. State Library of New South Wales.

If you have had a recent low back surgery, there are a few tips that will speed your recovery and help you to have a healthier back for the long term.

1. Practice good POSTURE. This may be difficult if you have a habit of slouching, but it is one of the most important ways to keep your spine healthy. Sit in upright, firm chairs with an extra lumbar support or rolled towel behind your low back. Avoid sitting in reclined positions.

2. AVOID BENDING FORWARD or bending down with your back. Learn how to do all your daily activities without bending your back. Many techniques can be used instead of forward bending, such as squatting, kneeling, sitting, pivoting on your hips, using a golfer's lift, or even crawling. Excessive forward bending is often the cause of back injuries, so eliminating bending decreases your risk of future back pain/injury.

3. AVOID TWISTING your back. This may be easy to do while still wearing your back brace, but once you are out of the brace, it is also important to avoid twisting. Maintaining proper spine alignment during daily activities and especially during strenuous activities will help to prevent back injury.

4. STAY ACTIVE. Find a low-impact exercise that you can start or continue, such as walking, stationary biking, or water aerobics. Depending on your stage of recovery, you may only be able to do 10 minutes at a time, but slowly progress as you are able. Mobility promotes healing, as long as you do not overdo and cause more pain.

5. FOLLOW DOCTOR'S ORDERS, such as lifting restrictions, activity restrictions, using a brace, using a cane, Physical Therapy, etc.

6. REQUEST PHYSICAL THERAPY. For the optimal prognosis after low back surgery, it is important for you to learn some strategies, exercises, postures, and functional activities from a Physical Therapist. It may take just a few visits if you are recovering quickly, or some patients need weeks or months of therapy if they are still having limitations or symptoms.

Does The Weather Really Increase Joint Pain?

Photo: Dale McDonald, State Archives of Florida

Almost all my older patients report they feel more pain when the weather is cold and/or rainy. But is it really true? Here is an example of someone who told me: "I woke up with a lot of leg and back pain, and I think it is just because of the weather." So my goal was to show that her pain could be improved, regardless of the present weather conditions.

On a scale of 0-10, pain was 7/10 at the start of our session. Her first exercise was the same one she had been doing for homework: lie face down on the mat and press up onto her hands. Doing this for a few sets decreased her pain from 7/10 to 5/10 and made her leg feel better. With a few more exercises in the same direction of movement (backwards or back extension), her pain further decreased to 1/10 and was located in the center of her low back and not her leg. Objectively, her baseline movements improved and became less stiff and less painful.

So, how much of her pain was weather-related? Some of it may have been caused or aggravated by the climate change, but most of it was movement-related. So within one hour of treatment with the proper movements, her pain decreased from 7/10 to 1/10, and the weather was still cold and wet when she left.