The View from Sports Center

Does Your Doctor Know the Latest?

Just to add to the level of confusion around what to do for something like osteoarthritis, a recent study found that most doctors are likely not following the recommended, evidence-based guidelines for treatment of the disease.¹

What are they doing?

Prescribing pain relief and anti-inflammatory medications and suggesting or performing surgery.

And what should they be doing according to the article?

Recommending weight loss and exercise.

So, why would doctors not follow the evidence-based approach of weight loss and exercise?

Two reasons.

First, it takes about twenty years for newly published research to make its way into clinical practice. For example, in the 70's Dr. Robert Salter discovered that moving joints after surgery produced a far better outcome than immobilizing them. Yet, in the 80's, we still had orthopedic surgeons who refused to use a Continuous Passsive Motion machine after knee surgery and instead placed the patient in a long leg cast.

Second, people do what they know and are comfortable doing. Doctors, most - not all - know very little about how  to help people lose weight and how to use execise to improve the structure and function of a joint. So, they stay with what they know. Drugs and surgery.

But, at least you know.

And physical therapists can help you with the rest. :-)

1. “Quality of Osteoarthritis Management and the Need for Reform in the US.” David J. Hunter, Tuhina Neogi, and Marc C. Hochberg. Arthritis Care and Research; Published Online: June 25, 2010 (DOI: 10.1002/acr.20278); Print Issue Date: January 2011.

 

In the coming weeks, I will have a very big announcement and an exciting opportunity for all of you who read The View.

It's a project I've been working on for three years and it's going to launch in the next few weeks. If you like The View, you'll love my new project. I can't tell you too much about it right now - would spoil the story. But, it's coming. Watch for it.

 

 

 

 

When You Have Pain, You Don't Have to be a Pain

There are some things in life that are simply priceless. Here's one; from a Hall of Fame client of ours. Unsolicited.

****************

Ellie, Katie, Doug, Christine and gang -

Quote for the day …

I've learned that even when I have pains, I don't have to be one..' 

Maya Angelou

Miss you guys … hip and knee are continuing to do great – it’s like I have a new life!!!  Have a great rest of the week!!!

Lori

P.S.  Give Hanna extra pats from me!

****************

Ok, so I'll admit that when I hurt, and that's been fairly often over the last three years from three different injuries, I'm not always the cheeriest person in the room. But, how do you do what Maya Angelou has learned?

1. Admit you hurt. At least to your self and perhaps to someone close to you. Denying your pain will usually make it worse because, well, you will do things in denial that will typically overload the injured area and the result is more pain which you then deny and on it goes.
2. Recognize that pain is a vital sign like pulse and blood pressure. When you hurt, something in your "system" is off. It could be physical, mental, or emotional. I hurt, typically at night in my sleep, mostly in my thoracic spine, when I'm under heavy emotional stress. It's my mind's way of letting me know and finding an outlet. Why at night? Because the unconscious is free. During the day, the unconscious part of your mind is not within your awareness. I haven't figured out why, in my case, that my spine hurts and not other body part like my foot or elbow but the unconscious will often use metaphors, for example in your dreams, and maybe I hurt there because the spine is the "backbone" and when I'm faced with situations or decisions that challenge my sense of stability or my "backbone", my mind uses it to tell me about it.
3. Breathe. Deep breathing has been shown to lower pain levels and anxiety which really go hand in hand. Sit or lie down in a comfortable position in a quiet space (or use Bose headphones - the ones that block out noise).  Close your eyes. Breathe in slowly and deeply and then hold your breath for about five seconds and then let it go. Let all the energy just flow out. Then repeat it. Clear your mind and focus on the breath. See how you feel after about five minutes.
4. Recognize that pain is three dimensional. Pain is physical, mental. and emotional. And the suffering, the part that makes you a pain to others, is from the mental/emotional aspect. Check your self during the day about what and how you're thinking about your pain. What line are you running through your head? I recently over loaded my right shoulder. Yeah, the one that I had a torn rotator cuff and spent all that time in prolotherapy and rehab. It happens. But, because it hurts, because I know what I gave up to get it fixed, my mind instantly went to,"Great. I probably just tore something else. Now, I'll be in prolo again, and rehab, and have to give up a bunch of stuff, and then I'll gain weight, and then my back will hurt because I gained weight, and then....." STOP THE INSANITY. Stop the projection into the future. Yeah, my shoulder hurts but it's not the same as before and even if I did tear something, I'll deal with it. But, the mental control is an active process. You choose your thoughts which then alter your feelings and actions.
5. Be thankful you can feel. Huh? Well, there is a condition, a rare genetic condition, that prevents people from feeling pain. It's called Congenital Insensitivity to Pain with Anhidrosis or CIPA. People with this disorder often die at a much younger age because the pain, which normally would alert you to a problem and then action, is absent. Pain is a vital sign. Remember that. It's there to help you. It helps you change. Click here for a post I wrote several years ago about pain and change. I think you'll like it.
6. Remind your self that you will get better. Most musculoskeletal conditions improve although sometimes you need some help along the way. One of my teachers said that pain is just a sensation. We attach meaning to it. If you can detach the meaning and think o fit as sensation, it will help you get better faster.
7. Choose. This is at the heart of Maya Angelou's statement. She is simply saying that she can choose to be a pain with others or not. Now, notice that she didn't say it was easy and that's because it's not easy. We have to balance denial against admission, admission against intrusion into other's space, and then action against inaction. We have to make a lot of choices along the way to move from being in pain and suffering to being in pain and living.

And one parting thought. Anger. Anger about your injury, surgery, position in life, what other's have done to you, wherever anger resides in you, do your best to deal with it and let it go because anger will find an outlet and usually it's in the form of pain. Anger is an unexpressed hurt. Someone or something hurt you and, in the moment, you failed to express it. You buried it. And over time, that buried anger will become entangled with other hurts and then one day you fly off the handle because someone cuts you off in traffic or brings you iced tea instead of Diet Coke. If this sounds like you, try reading Emotional Resilience by David Viscott. Lots of great, practical information on anger, the past, and what to do about it.

Life is too short to be a pain when you're in pain.

Agreed?

Babies, Back Pain, and Beliefs

"Nothing ever goes away until it has taught us what we need to know." -Pema Chodron

My niece, 25, just had a beautiful baby boy. Kellan is his name. And everyone that holds him just stares at him. You just keep looking at him. The curve of his nose, the way he wrinkles up his face, how hard he tries to open his eyes. All that is mesmerizing.

Now, he weighs 7lbs or so. Light as a feather really but before long he's going to be in the 20-30 lbs range and I wonder how my niece is going to feel lifting him in and out of his crib, the car, etc.

Will she be one of ~ 40% of mothers who, six months after having had their baby, still have back pain?

Just about every woman has back pain during pregnancy. Some experts argue that it's actually a good thing because it forces you to not do certain things that could be harmful to you or the baby. I don't know. I think that's a pretty tough sell to the expectant mom. 'Oh, it's a good thing that you can't sleep, walk, or generally move." Right.

But the expectation by most clinicians is that 2-3 months after birth of the baby, back pain should be a distant memory. It's a similar belief about back pain in general. It just sort of runs it's course in 2-3 months.

Well, that's not really accurate for the average person and it's not accurate for a lot of moms either.

I'm concerned for my niece because a mom will lift a child, a lot of times per day. According to the American Academy of Orthopedic Surgeons, a mom will lift her child up to 50 times / day or more. Let's do the math. Fifty lifts at 10 lbs is 500 lbs / day times seven days a week is 3500 lbs per week. Two and half tons. And when the child is a year old that lift will be 17 lbs. And then at two years of age, the lift will be 20-30 lbs. Any wonder why so many mothers have back pain when they lift 1000 lbs / day?

Because the pervasive attitude is that back pain goes away on its own, a lot of moms get left behind to deal with back pain that sometimes can turn chronic. And there are few things that rob you of your joy faster than chronic lower back pain.

But, we have a solution for moms with back pain. Ergomomics^TM (Christine came up with that). It's our special, focused program designed just for moms to help them learn how to reduce their pain, reduce re-injury, improve their lifting methods, and more. It's a short course program too: one visit per week for four weeks and you can bring your baby!

For now, yes, you have to come in to see us. We're working on other ways to to get this information out to those who need it but for now, it's an in-person thing. But, we're very friendly people too.

If you're a mom with lower back pain, come see us and if you know someone in this situation, tell them about us.

Ergomomics^TM helps moms with back pain so moms can enjoy their babies. You can learn more about the program by calling us at 512-206-0433.

PS - And, more and more dads are getting this malady as well. So, dad, if your back hurts lifting your child, we can help you too. 

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Follow my recovery from a meniscus tear and right knee pain here. 

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Post-Prolo: Day 1

You can find my journal of post-prolo recovery and my shoulder rehab here. From the main page of the blog, look on the left hand side below READERSHIP and you'll see a link to "Shoulder Recovery and Rehab". It'll be one page so all of the entries will be together. When I add something, I'll post a link to it.

Onward....

Hip Swingers: More Motion and Less Load for Painful Hips

A reader sent me a question regarding how to apply the concept of low load, high volume repetition that we often use for knee pain to the hip. Here's his question and my reply.

"I am looking for something along the lines of your "tailgaters" program for the knee, in order to bathe that hip joint cartilage in synovial fluid, and maybe get it working a little better. Low load, and appropriate movement.  I've looked through both of your sites and haven't seen anything on this topic.  What do you think - is there a path here that will avoid surgery and let me get this thing back in working order? Got any suggestions? My reading of the MRI is that my hip isn't really all that bad, compared to some others I've read about. I want to stay young forever!"

Paul

*****

Thanks for reading Paul and for your question. 

I've used a number of techniques to improve weight bearing ability and joint strength in the hip and one for home is below:

HIP SWINGERS

• You'll need a heavy duty elastic band. The one we use is here and the ankle attachment is here.
• Attach the end of the band in the frame of a door. Make sure the attachment is up high and is secure (see photo example).
• Lie down on your back and connect the other end of the band to the ankle strap.
• • Many people are more comfortable with a foam wedge or a couple of pillows under the upper back.
• Slide away from the door so that your leg, in a relaxed position, is suspended off the floor about 6-9 inches.
• Now, gently swing your leg back and forth, up and down. This action is similar to the Tailgator for the knee. The foot should not strike the ground. If it does, slide away from the door a bit more.
• I typically suggest 5-10 minutes per session and two or three sessions per day.

The motion should be pain free and very easy with no muscle fatigue. Many of my clients will use this drill prior to other forms of exercise to "lubricate" the hip.

I hope this is helpful for you.

One More Reason Why Your Muscles Get Tight

"Have you heard of TMS (I think) or Tension Myositis Syndrome, I think is the name? (Dr. John Sarno coined the term.)   I have a friend who really believes this.  He thinks that is my problem since I keep having one injury after another without an obvious reason.  I have a hard time believing it though I can see how emotional and physical work together.  But I always have a hard time finding a middle ground between fear of every twinge of pain and stubbornness that makes me ignore the problem and keep going until something seems horribly wrong."

L

******

Yes, I'm familiar with Dr. Sarno's work and I agree with him on some of his ideas.

For those of you who are unfamiliar with him, Dr. Sarno believes that all musculoskeletal back pain is from the mind. It's real, not imaginary pain, but the source is your mind. 

Pain is three dimensional - physical, mental, and emotional - and we, both patients and practitioners, tend to focus on the physical aspect only. We search for a "cause" for our symptoms; some structural defect, weakness, inflexibility, etc. And, sometimes, the physical element is the driver of the pain but, sometimes, the pain is not from primarily a physical or structural cause. Sometimes the pain serves as a coping mechanism for subconscious feelings; feelings we do not want to acknowledge or experience and that are below our level of awareness and the pain serves as a way for us to not deal with these feelings. In other words, the physical pain is less painful to deal with than the emotional pain.

The reason that this is so difficult to accept is that the emotional driver is beyond our awareness so we dismiss it. Makes sense. If I am unaware of something, how can I assign value to it? So, instead we look for something that does make sense; something we did, some posture or activity that could be the culprit.

One of the most common physical ailments that most everyone agrees arises from things other than a physical cause is a "tension headache".  I often hear, "Well it's just stress. That's why I have a headache" and the person will have a vague idea of the stressor. But the solution that is suggested is usually some type of relaxation or "stress relief" therapy rather than finding the true source of the stress and dealing with it.

Stress is the response of the body to a demand whether it's caused by a pleasant or unpleasant mental, emotional, or physical stimulus and the response can be either pleasant or unpleasant. Love is stressful but most people would agree that it's pleasant. Losing your job is stressful and generally unpleasant. Either way, it's stressful.

So, a tension headache is the body's response, tight muscles, to a demand and in most cases the demand is mental or emotional (the mind) and you might wonder, "Why does my head hurt so much? Do I have a tumor or something?"

Right before I took my orthopedic boards several years ago, I had a terrific headache. At the time, all I could think about was getting through the test. And, this damn headache was in my way. It wasn't until after I had finished the test (and the headache subsided), that I connected the dots. I was afraid of failing and rather than deal with that reality and all that it represented, my mind found a more convenient target. It was an elegant coping mechanism.

Where I disagree with Dr. Sarno is the idea that ALL back pain (or shoulder or knee or hip, etc) is emotionally based. A friend of mine fractured his thoracic spine from a particularly rough boat ride and had immense back pain. How he chose to deal with the injury and pain could then escalate the problem and prolong it (such as ignoring it, forcing his way through it, etc) but the initial injury and resulting pain was physical.

Whenever I see someone with a complaint that just "appeared" one day, I'm a little on edge. Insidious onset of symptoms is one way that some nasty medical problems choose to greet you. A friend of mine once had the sudden appearance of itching in her arms. Both of them . Like she had a rash or some type of allergic reaction but there wasn't a rash. She saw doctors, specialists and finally was diagnosed with a rare form of bile duct cancer. So, you have to take such complaints seriously and rule out more malicious and even life-threatening disease. Once that has been done, now the issue becomes, "why?" What we all want to know, as I mentioned in my post about my own shoulder pain, is Why do I have this? I didn't do anything. It really hurts! I can't do the stuff I want to do (and here's an article I wrote about this on Frozen Shoulder)!

Whenever you have symptoms that just pop up, you have to look at a few basic human emotions in addition to the potential physical (biomechanical, tissue overload, etc): fear, worry, anger. These emotions are hard to accept in ourselves and really deal with. We all have parts of us that are not so pleasing to admit or accept. Or, we may have deep hurts that have festered for years creating a sort of toxic nostalgia. Whatever the issues, they are usually trapped in the shadows of the mind like prisoners in a maximum security prison and just itching to get out. Depending on your view, dreams are a way that these issues do get out. You can safely express these emotions. And sometimes, if you really look at your dreams, they're freaky scary - which is why you're dreaming all that stuff instead of welcoming it as an actual part of you.

So, what do you do? Awareness is the first step and sometimes, depending on the chronicity of the issue, this can take a while - months or even years. And, it's not something that physical therapy or chiropractic or surgery or other forms of physical remedies will fix alone. And, it generally is not just a psychological approach either. It's a mind-body approach. You need both. You have to be open to the idea you could have repressed emotions that are manifesting as physical feelings and also at the same time, realize that gravity is real. Too much physical load, too fast, too often can hurt you.

My friend, Ross, asked me, gently, back in early 2008 after I had injured my self skiing, "So, have you admitted to your self that you're angry about all of this?" This question prodded me to look at not just the anger I had at the injury but other repressed emotions that were stirred into the anger pot. It was the pivot point in my recovery and one of the most important things I did. Maybe the most important.

To learn more about repressed emotions and how to deal with them, I suggest "Emotional Resilience" and "Emotionally Free" by David Viscot. Clear, concise, and practical.

Sometimes I use this one word at the end of emails or postings and I think it's appropriate here: onward. Just keep working on getting better, being honest with your self, facing things that are scary, and you'll be surprised at what can happen.

Onward.

Walked In and Wheeled Out

Her eyes were wide, mouth open, and arms waving. My physical therapy student looked like an emotional hurricane.

"You have to come now. Something really bad happened. I mean, oh my God, I didn't think this could, I mean it was just regular electrical stim, I, I, oh you have to hurry!" said my student.

"Ok, slow down. Take a breath. Tell me what happened," I said.

My student took a couple of deep breaths. "Mr. Williams came in for his appointment. I went to the waiting room and met him. He said his back hurt but it always seems to hurt. I showed him to an exam room and he got up on the table and I hooked up the electrical stim machine like I did the last time. I set it for pain relief and checked him and he was ok. So, I left the room to check on someone else and when I came back, when I came back he, he just..." and my student started crying.

"It's ok. Did you remove the machine?" I asked.

"Yes, yes, I did but he's, he's paralyzed!" my student blurted.

Paralyzed? Really? From electrical stimulation? There are very few things that produce that kind of injury in physical therapy. I was sure she was exaggerating. I walked into the exam room. Mr. Williams was lying on the exam table on his back.

"Hi Mr. Williams. So, what's going on?" I asked.

"I can't feel anything in my legs and I can't move them. I'm trying right now but I can't make'em work," said Mr. Williams in a calm, steady voice.

"Can you wiggle your toes for me?" I asked.

"I'm trying. Right now," he said.

"Ok. Just relax. Stay still for now and let me check a few things," I said.

I checked the reflexes in his legs. Nothing. I checked his sensation in his legs. Nothing. I took a small pin from a reflex hammer and pricked the bottom of his foot . Nothing. I pinched his skin. Hard. Nothing.

Mr. Williams was paralyzed from the waist down. He had no sensation, no reflexes, and no movement.

"Mr. Williams, we're going to get you an ambulance and get you over to the hospital as quickly as we can. The doctors there will sort this out for you," I said trying my best to be calm.

This happened almost twenty years ago. Mr. Williams walked into our office and on the same day was wheeled out on a stretcher.

What happened? Did my student zap all of Mr. Williams' movement with an electrical stimulation device? Did he have some sort of rare disease? No. Mr. Williams' mind converted an emotional pain into a physical reality. His mind shut his body down.

Psychosomatic symptoms are hard to accept. It's hard to believe that we seemingly have so little control over our bodies; that our aches and pains could actually be more emotionally based than physically based. When you feel pain in your back, you of course assume that something in your back must be wrong. And sometimes that's true. But, sometimes, it's not. And what makes this even more complex is that in most cases there is a physical injury or surgery as well as emotional injuries that are blended together. It is this blending that leads to prolonged recovery. A purely physical source responds to physical measures (or medications). An emotional source is not so easy to tame.

Sometimes of course clinicians will tag patients with, "It's all in your head" when the clinician can't figure out what's wrong. It's a difficult process and the healthcare system doesn't make it any easier. Doctors are not paid much to listen, sort out symptoms, examine thoroughly, and then deal with emotional sources of physical pain. Doctors are paid by procedure (and this is true of most healthcare practitioners - not just doctors). They're paid to do stuff. This leaves the patient feeling alone and anxious which of course just makes things worse.

What do you do if you are faced with both emotional and physical injuries? Be brave. You have to accept that the symptoms could have an emotional source and be willing to look at it and talk about it (or some may prefer to write it out). Sometimes you have to get professional assistance but many times just accepting that there is an emotional source frees you to face it. And facing the emotional pain will lower the the pain you feel.

So, I'll share something with you. I get hurt. I have stress. I avoid some things and face others. I'm a work in progress and I have right shoulder pain. I have the signs and symptoms of something called "impingement syndrome". The problem is I don't recall doing anything in particular to cause it. It just showed up one day. It's as if the Wicked Witch flew in on her broom one day. "Hello, my pretty. Would you care for a dose of shoulder pain?"

So, I of course ignored it for a while. Well, I didn't ignore it really I just didn't sign up for shoulder rehab right away. I thought I could handle it (and yes, you can insert here,"Man, you are a slow learner!"). I couldn't handle it actually so I asked Christine to help me. She thinks I have biceps and rotator cuff tendonosis and maybe even a small cuff tear. Really? That's what I said. Really? From what?

This is reality. Over this past summer, my regular and consistent physical training became sporadic. There was a lot of "stuff" going on which impinged on my schedule and drained my energy. After about three months, I was able to get back to a more regular routine but I knew I had to go easy. So I did. Or at least I thought I did. So, perhaps the resumption of my training overloaded my shoulder? Or, was it something else in addition to that?

In October, I acquired 100% of my practice and recently started seeing clients again after almost a three year hiatus. I love helping people but after a three year break from the processes and procedures of healthcare, I felt rusty in spots. There's a reason we use phrases like, "a heavy load on your shoulders" or "can't shoulder the load". 

See where I'm going with this?

Pain is almost always a blend of physical and emotional "stress". The question is how much of each? I probably overloaded my shoulder in some way when I resumed training and the "load" of returning to clinical practice found an outlet in perhaps an already weakened area. The shoulder pain showed up around the time I purchased the practice and my resumption of training shortly before that. Hmmm...what do you think?

If I only look at the physical aspect, it will take a long time to get better. Yes, I have impingement, pain with certain movements, weakness in the arm and all of that has to be addressed. And if I'm really honest about it, I don't like it. I just want to get on with training and doing what I want to do when I want to do it. But, that's not reality. I have to do the work. If I only look at the emotional aspect, it will likely take a long time too. I have to face both potential sources and deal with them.

The process works as long as you work the process.

So, if you find your self in this boat along with me, be brave. You can recover and feel good again. But, you have to do the work.

And, by the way, Mr. Williams was released from the hospital two days later with a pair of fully functional legs.

*****

Photo:

http://www.flickr.com/photos/state-records-nsw/ / CC BY 2.0

Do You Have Any Suggestions for My Plantarfasciitis?

Below is an email I received from a reader about plantarfasciitis. My answer follows her email.

Hello Doug,

I came across you site and you have the best information I have seen ever!  I have chronic plantar faciitis  and am trying to find a physical therapist or Dr. that uses a newton speed trainer as I read in your previous articles.  I am currently in the process of searching for affordable crutches, the TED sock (found it at Walmart), and ordering the night splint.  I can only stay on my feet without pain in the morning for a few hours then its downward from there.  I went to the site you had suggested on your site to search for a physical therapist but do not know what or whom I am looking for.  Do you have any suggestions for someone in my area?  I have no insurance but have saved money to pay for this.  Your answer will be greatly appreciated.

Thank you for your time,

Kate (not her actual name) -

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Thank you for your note and question Kate.

Unfortunately, I don't know of anyone with a Newton in your area but you should search for a therapist who is board certified in orthopedic physical therapy.

The Newton is only one of the components to overcoming something like plantarfasciitis.
Sometimes you can use a pool and walk in chest deep water to reduce the force on the tissue and then use that as one of the drills to increase the loading capacity of the foot.

Most musculoskeletal problems, like plantarfasciitis, break down into three main components: tissue injury (or disease), biomechanical faults, and mental/emotional attitude and reactions.

For the tissue injury in plantarfasciitis, we've had success by reducing the force on the foot in everyday activity while at the same time using specific exercises to increase the tissue's force capacity. To reduce the force during the day, I've referred a number of people for a pair of Z-Coils. Almost everyone has immediate relief. But, this is not intended as a long term solution. You'll still want to recondition the tissue in your foot and gradually get out of the shoes.

Some people also have restrictions or tightness in the fascial network that connects to the plantar ligament specifically the gastrocnemius (calf) and hamstring. Fascia is plastic but not elastic. So, you can alter the relative length but it's not easy to do and of course it's not supposed to be easy otherwise your muscle system would have inadequate support. There are a number of techniques practitioners use to facilitate change in the fascia such as Rolfing, Myofascial Release, and other forms of manual therapy. I would get someone to assess your flexibility and help sort out if you have biomechanical faults in the lower leg or hip that might be contributing to the overload in the foot.

And, finally, the choices you make each day have a large role to play in what happens with your body. I've had clients with, for example, a tibial stress fracture who simply refuse to stop running even though the leg is very painful and, as a result, interferes with other parts of their life. You have to listen to your body and respect it. After all, your body is you.

Piglet, Pain, Pooh, and Aging

“Supposing a tree fell down, Pooh, when we were underneath it?” asked Piglet.

“Supposing it didn’t,” said Pooh after careful thought.

Piglet was comforted by this.

---

When you hurt, your inner Piglet shows up. You see more bad things. Things that could be bad, things that someday could go wrong. What if I never get better? What if this is all I have the rest of my life? What if I wake up and my back hurts so much I can't get out of bed? What if..... And, if you let Piglet have his way with you, you'll be older sooner. You'll feel, move, talk, and think at the age of 50 as if your 80*.

Pain slows you down. It slices off entire sections of your life and I'm not talking about no longer being able to play linebacker in football. No. I mean you avoid taking the stairs, even just a few, because your knee hurts or your back hurts. Or, you give up yard work or walking your dog. And, your 52; not 92.

Feeling youthful is all about energy. Sure, some people think being youthful is the way you look but I have news for you. No matter how hard you try to look 20, it just ain't gonna' happen at 70. You can do things to improve your appearance but what makes you feel and seem younger is the energy you possess and use. And, pain zaps you of energy and can keep you from doing things to improve your energy.

When you hurt, Piglet will convince you that there's nothing you can do; you might as well accept your poor, miserable lot in life and just do less and less and less; all is lost. Sometimes Piglet is in you and sometimes he's the people you associate with or talk to. Stay away from Piglets. Don't listen to Piglets. They are not helpful. Find some Pooh in you and get around some Pooh people. Pooh helps you see possibilities and possibilities fuel your efforts. A lot of the pain people have at the age of 50 or so is treatable. Back pain, knee pain, shoulder pain - most of it is musculoskeletal and most of it can be either eliminated or significantly reduced. It's not always easy but It's simple - modify your routines, exercise, improve your biomechanics and find your inner Pooh.

Is it worth the effort to do these things? Well, that's up to you. For me, absolutely it is. I had a nasty injury last year and said to Christine when she asked me what it would mean to me to not be able to do certain things anymore, "It's just....it's the start of the end. It's the end."

Piglet talking. Thankfully, Christine is almost all Pooh (just ask her clients - they know what I'm talking about). But actually, the injury was not the start of the end. It was the start of renewal. I feel better now that I did before I was injured. Mentally, emotionally, physically. Hard to do? Yep. Sure was and still is from time to time. Very hard. But worth it. 

Ignore Piglet. He's helpful when you're lost in the woods or on some deserted island struggling for existence but otherwise Piglet borrows trouble from the future. Find Pooh, fix your pain and find your energy again.

---

Today's post was inspired by Adam Schwartz who emailed me the link below. Thanks Adam.

*http://latimesblogs.latimes.com/booster_shots/2009/09/chronic-pain-older.html

Why Does Your Back Hurt?

Some say...

.......it's poor posture. Standing, sitting with less than ideal alignment creates too much stress on your back.
.......it's tight, inflexible muscles. Your hip flexors or rotators (including the popular piriformis) are too tight to allow you stand up correctly and move properly or they press on nerves making you hurt.
.......it's weak muscles. Your core muscles  - trunk and abdominal - cannot hold your spine in place as you move through the day leading to too much stress and strain.
.......it's muscles that are too loose and too flexible. You lack adequate support for your spine leading to stress and strain.
.......it's your joints. Deteriorated and weak, they transfer too much force to ligaments and tendons and bone.
.......it's your disc. Degenerated or herniated, the disc presses against nerve creating pain in your back, butt or leg.
.......it's your bone. You broke some part of your spine from a fall or other injury.
.......it's your tendons. You played too much, worked too hard or too long and ended up with tendonosis of the spine.
.......it's trigger points. Localized spots of tender knots in your muscles cause pain in the muscle and refer it elsewhere.
.......it's fascia that is too tight. The web of fibrous tissue woven in between and around muscles and other tissues has contorted and is pulling excessively on pain sensitive structures.
.......it's your mind. Anxious, worried, angry, lonely, sad, depressed are some of the emotions that your mind finds outlets for in the form of lower back pain.
.......you do too much. Too much exercise or activity on weak or injured tissue hurts the tissues of your spine.
.......you don't do enough. Sitting too much, not walking enough stress the spine beyond its' limits.
.......it's not your back. It's your prostate (men) or endometriosis (women) or kidneys or pancreas or stomach ulcer or infection or aneurysm among other things.
.......it's inflammation. Overload and / or overuse has caused tissues in your spine to become inflamed and inflamed anything hurts.
.......it's a disease. Ankylosing Spondylitis, Schuermann's, Crohn's are diseases that can cause spine pain.
.......you're old. You're supposed to have back pain when you get older, some believe.
.......you're obese. People who weigh too much, create too much stress on their spine and hurt as a result.
.......you smoke. Smoking damages the blood vessels of the disc leading to pain.
.......it's how you lift, bend or stoop. Bending over frequently, lifting heavy objects incorrectly stresses your back to the point of pain.
.......you bend and twist too much. The combination of forces created by bending and twisting at the same time wreak havoc on the weaker spots of your disc and ligaments.
.......you wear the wrong shoes. Heels too high, not enough arch support, too much arch support, too soft, too hard, create biomechanical headaches for your back.
.......you slept "wrong". A bed that is too hard, too soft or sleeping in an unusual position can overly stress your spine.

And, the pain can stem from any combination of the above. Is it any wonder why so many people hurt so much for so long? A simple mismatch of cause with treatment and the pain goes on and on and on.

Pain is a vital sign - like you're temperature or pulse or blood pressure. When something is off, when your pulse is racing or blood pressure is sky high, it requires investigation. The same is true for your back. Chase understanding your pain before you chase the pain away.

DK