The View from Sports Center

Why Fixing Posture Alone Rarely Fixes Pain

Time to Get Help

   

Will Lefty Be Left Out?

The View this week is a little earlier than usual. Reason? The final round of the US Open will be held this weekend at the Oakmont Country Club in Oakmont, PA. But this year the pre-tournament chatter is not about who will win. It's about whether Phil Mickelson, two-time Masters Champion, will be able to compete.

Over Memorial Day Weekend, Phil was practicing hitting out the rough at Oakmont and injured his right wrist. The injury was bad enough to force him out of his next two tournaments. He's had the usual battery of treatments for any type of athletic injury - ice, massage, rest, cortisone shots, and an elastic bandage - with minimal improvement. According to Phil, an MRI ruled out a fracture, and he saw two physicians who each rendered the same diagnosis: inflammation. And, as a result of the diagnosis, Phil has pursued a course of treatment to eliminate the inflammation consisting of cortisone injections, ant-inflammatory medication and massage.

So, why is Phil's wrist inflamed? What sort of injury does he have? We know what he doesn't have - a fracture - but beyond that I wonder if even Phil knows what's wrong with his wrist.

The more precisely you understand the reason for the symptoms, the easier it is to resolve the symptoms. Inflammation comes from all sorts of injuries: stress fractures, tendonitis, ligaments sprains, tenosynovitis. And, the treatment for one type of injury will be different than another or at least it should be.

So, in Phil's case, he likely has either an injury to one or more of the tendons in his wrist or the ligaments in the wrist. The treatment for a tendon injury involves stressing the tendon in the manner in which it will be used to facilitate healing and strengthening of the tendon. Tendons do two things for you: help move bones or help keep joints stable by transferring the force from muscle. Ligaments do one thing: keep joints stable. So, if you sprain a ligament, the last thing you want to do is move the joint a lot, or stretch it. Imagine spraining your ankle and then stretching it over and over. Doesn't work very well.

The dilemma for Phil is that in one case, a tendon injury, he needs to move the joint to stress the tendon while in the other case, a ligament injury, he needs to keep the joint still while he stresses the ligament.

All of the other things - massage, ice, ultrasound, taping - tickle your brain. Nothing wrong with any of them; nothing wrong with wanting to feel better. But, even though you feel somewhat better, maybe even a lot better, when you swing the club, stress the injured tissue beyond capacity, your injury springs to life. You may feel better but you're not really better.

So, what's your bet? Will Phil be in the final round of the US Open? Or will Lefty be left out?

Doug Kelsey

 

Movin' and Groovin'

The number on the red paper tab was "40." So, twelve people in front of me shouldn't be too bad. It was only 9:30AM and I had plenty of time.

I walked over to what looked like a waiting area and stood. After about fifteen minutes, I noticed a sign posted on the far wall. "FOR PASSPORTS, SIGN IN HERE." I walked over to the table and found the sign up page. There were a lot of names on the page. A lot. That's when I realized that the red paper tab I held in my hand had nothing to do with applying for a passport. There were at least twenty names ahead of mine. I signed my name to the next blank line and as I set my pen down, noticed a statement in small print at the very top of the first page. "Each name takes about twenty (20) minutes to process!"

Four hundred (400) minutes of waiting? No way. Can't be right. Turns out it wasn't. I waited, stood, oh, for about 120 minutes.

Standing still or nearly still for two hours should have left me with two very stiff, achy knees, a sore, angry spine, and a mood dipped in a sour grumpy sauce. After all, I have two banged up knees, a 50 year old spine that on MRI three years ago looked closer to 70, and a left ankle that snaps like a tree branch with nearly every step. But, I know how to withstand standing.

Osteoarthritis, Osteoarthrosis, Degenerative Joint Disease - these are terms used to described joints with weak or thin cartilage. Healthy cartilage and the fluid that bathes it (synovial fluid) act like a super shock absorber, and absorbs some of the force of standing. When these tissues are weak, the force of standing squishes the cartilage and then finds its way into other tissues in and around the knee: the synovium, tendons, ligaments, and bone. The result is an achy, stiff joint.

There are two secrets to help you withstand standing: movement and load sharing. When I realized I had a very long wait, I powered up my iPod and started shifting my weight from one leg to the other. Sometimes, in rhythm to the music; sometimes just every now and then. I also wandered around the room some as well. The weight shifting and wandering keeps the force from accumulating in my joints - less cartilage squishing action. Of course, wearing an iPod, you can almost look cool doing these things (well, some people really do look cool).

The other thing I did was use something I call load sharing. I shifted the weight onto my forefoot to take advantage of one of the heavy duty springs in the body: the gastrocnemius (calf muscle) and Achilles tendon. By placing my weight forward onto the front of my foot and bending my knee just a little, my calf muscle and tendon took a lot of the load that would normally go up through my heel and into my knee.  When the muscles felt a little tired, I would just shift my weight back off the forefoot for a minute or two.

I use these techniques, movement and load sharing, to protect my joints but I also work on restoring the health of my joints using a special form of exercise.  As my joints become stronger, the need for load sharing drops but I kind of like grooving to my tunes so I plan on movin' and groovin' for a long time.

So, the  next time you find your self facing a long wait on your feet, and you see a tall, bald guy with an iPod shifting to the beat, say hi - that guy might be me.

Doug Kelsey

P.S. - for those of you who missed our lecture on Runner's Knee, where I covered some of the basics of exercise for weak cartilage, get your copy of the CD today from our online store.

A Trip to the E.R.

"Now, the needle is really small but it's still going to hurt a little when I inject the anesthetic, ok?" said the E. R. doc as she stuck the needle in a clear, glass vial drawing the numbing agent into the syringe. When she had what she needed, she turned and carefully inserted the needle into the open wound on my right thumb. At that moment, a hot, searing, blistering pain erupted somewhere, everywhere, in my body; maybe it was my thumb. Hard to tell. And, strange words came out of my mouth - I may have invented an entirely new language.

Then, she did it again.

What landed me in the E.R. was impeccable timing. As I climbed out of my wife's car, I managed to slam the door on my right thumb carving out a nice chunk of flesh. I tried to convince myself that all I needed was a band aid but I knew better. So, off to the E.R. we went.

When I told this story to my family doctor, he chuckled and said, "Yeah, I usually give people the choice of not having the anesthetic. Hurts about the same." Whether I just had a couple of stitches or had the anesthetic, I had some pain to face in order for my thumb to heal.

It's universal with no short cuts. If you want something to heal, there's always some pain. The path of healing begins with moving toward the pain - not away from it. To heal the pain you have, you must face the pain you have. The most common reactions people have to pain (and this is any type of pain - physical or emotional), are to either ignore it, cover it up, or run away from it.  Moving toward the pain, gently, and accepting it, is what creates a healing response just like the stitch in my thumb.

The pain of the needle pales in comparison to leaving the wound open fending for itself. Infection, failure to close, surgery, the list is endless. Yet, I have done that, left wounds open, in other parts of my life because I didn't want to experience a temporary pain. I have had relationships, business and personal, fall apart because I avoided difficult conversations, confrontations, or situations that, had I faced those pains, would have helped close the emotional wounds in me or in the other party. I have delayed my own physical healing (read Helping the Blind See) because I didn't want to accept the painful reality of my injury.

To heal the pain you have, you must face the pain you have.

We all have pains in our lives. The question is, can you face them? Will you?

Doug Kelsey

P.S. - To learn more about pain; the three dimensions of pain; how pain is influenced by your thoughts and logic; what causes pain when there is no evidence of physical injury, and a lot more, order our CD.

Hurting and Thinking: Which Comes First?

Do you feel down and blue because you have back pain or do you have back pain because you feel down and blue?

The answer is yes to both questions. Back pain, if not handled properly, can get you down. At first, you think, "Ah, it's not a big deal. It'll go away." But, it doesn't. Routine exercise, workouts at the gym, or a jog in the neighborhood begin bothering you. So, you cut back. You ease up on the exercise and maybe quit jogging. The pain subsides, some, but not enough. Then, you notice that the routines of everyday life hurt. Now what? Do you just quit mowing the lawn, cleaning the house, carrying out the trash? Forever? Is your life destined for nothing more physical than punching a television remote?

When you give up certain activities, something you don't really want to let go of, you're not ready to let go of, you may experience a form of grief; a sadness that drapes itself over you. You may love running and when faced with the idea of giving it up because your back hurts, you may become irritable, lose interest in other activities, or feel generally down - all signs of depression. And, as you trudge through life under the weight of this sad, subconscious blanket, your back is apt to hurt even more. Your body aches from the weight of your thoughts.

Most people, when their back begins to hurt without any specific cause, are bewildered. After visiting their physician and hearing that there is nothing on an MRI or Xray to account for the pain, they become even more confused. But, in some cases, the pain in your back is like the pressure valve on a hot water heater. It keeps the system from completely coming apart. The pressures of life, disappointments, frustrations are sometimes just too much to face, so you face what you can - back pain. You may not believe me but that's ok. It's not just my opinion. About 54% of people who have chronic low back pain, are depressed prior to the onset of their back pain and about 46% are depressed after the onset of back pain. Back pain comes with an emotional tax.

Whether you have back pain and feel down and blue as a result or are down and blue then develop back pain, the emotional taxation is what makes beating back pain so difficult. You must exercise to build a stronger, healthier spine yet, if you exercise too much, too hard, too often, you hurt. When you hurt, thoughts scamper through your mind, half formed, looking for a place to call home; to take root and blossom into an orchard of despair. These thoughts are rarely full sentences and sometimes not even words but feelings: sadness, frustration, worry, anger. They're real and very powerful.

You become what you think about. For what you think about is what you talk about; what you talk about is what you do; what you do is what you get. The back pain cycle is snapped by changing how you think. Think first, then do. Avoid the trap of letting the negative thoughts take root in your mind. It will take a great deal a mental weeding to get rid of them.

For those readers expecting me to give you a new stretch or a magical spine exercise and are disappointed to learn that beating back pain begins in the mind, well, it's true. Beating any physical problem starts with how you think about the problem. Exercises are very important; sometimes stretching, yoga, Pilate's will help build strength, endurance, flexibility but without mastery of thought, it won't matter. None of it will work.

You can choose your thoughts. Stay focused on what you can do; what you have achieved. When you feel the blanket of sadness fall on your shoulders, acknowledge it and mentally cast it off. You can only have one thought at a time. Make them work for you not against you.

Guard your thoughts. Thoughts can hurt.

So, what do you think?

Doug Kelsey

PS - To learn more about back pain, sign up for our next free, one hour class held in Sports Center or buy our CD from our online store. Either one will completely change the way you think about back pain.

Polatin, P. B., R. K. Kinney, et al. (1993). "Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first?" Spine 18(1): 66-71

Drugs in Sports We Don't Talk About

Barry Bonds has been under the drug microscope ever since the book A Game of Shadows by Lance Williams and Mark Fainaru-Wada hit the bookshelves in 2006. The authors claim that Bonds used steroids illegally starting in 1998 because he was jealous of all the attention Mark McGuire had received that year in his home run chase with Sammy Sosa (steroid use was not officially banned from Major League Baseball until 2002).

Some people are upset because Bonds will very likely pass Babe Ruth on the home run list this year and may pass Hank Aaron to become the all-time leader in home runs. Baseball enthusiasts feel it's unfair. Ruth and Aaron racked up their numbers without steroids so why shouldn't Bonds?

Steroid use gets a lot attention in the media and it should. But, there's another drug that sneaks under the radar escaping scrutiny or debate. The drug is legal and easy to buy. Millions of athletes take this drug every day for a variety of aches and pains without a second thought. They should think again.

I'm talking about non-steroidal anti-inflammatory drugs (NSAIDs). You may know them as Advil, Motrin or Aleve.

I know people who take Motrin before they run or workout so they can run and workout. The pain would otherwise sideline them. A non-chalant use that begins as just one or two pills once in a while can lead to daily use of higher doses. Chronic, high doses of NSAIDs carry significant health risks with gastric ulcers, bleeding and kidney damage at the top of the list and can also interfere with your injured joint's ability to heal.

But, I am not the only one who's concerned about NSAIDs in sports. Marathon runners are advised against taking NSAIDs on race day by the International Marathon Medical Directors Association. If you run long distances, the combination of dehydration, loss of salt and moderate to high doses of NSAIDs can wreak havoc with your kidneys.  And, some physicians now argue that if you need to use a pain reliever to compete, you would be better off finding out why you hurt instead of masking the symptoms.

NSAIDs are performance enhancing drugs. They make you feel better, eradicate the pain and allow you to play when you otherwise would be on the bench. If you must take NSAIDs, don't play. Give your body a chance to heal. Feeling better and being better are not always the same thing. You may not hurt but as you continue to play, workout, or run, your injured tissue takes a pounding. Then, when you stop the drug, you may hurt as much or more than when you started it. And so, the cycle continues.

Barry Bonds will likely be the home run king and maybe he used steroids to get there. But, I'm more concerned about the chronic, habitual use of NSAIDs than whether Barry Bonds hits another home run. How about you?

Make today count.
Doug Kelsey

Gumby Bodies: When Stretching is a Problem

Have you ever noticed how flexible some people are? A friend of mine is so bendable, I swear you could fold her in half and easily slide her in the overhead bin of a 737 jet with room to spare. And, she would be completely comfortable. She could probably ride cross country, read a book and have dinner in that bin. If you tried that with me, I'd end up in the E.R.

When you bend as easily and effortlessly as my friend and it seems as if your motion will go on forever, we describe it as being hyperflexible. When you're hyperflexible, you may have elbows that easily go well past the point of being straight, knees that seem to sway the wrong direction, thumbs that you can easily pull down to your forearm or may possess a striking likeness to Linda Blair from the Exorcist as you turn your head.

But, what I think is fascinating is that even though you may be as bendable as Gumby, you still want to stretch. In fact, you feel as if you must stretch. Stretching your already Gumbyesque body becomes the only way you feel comfortable. When I suggest to clients, using my best Obi Wan Kenobe style, that perhaps stretching is not the best thing to do, many often reply that if they do not stretch, they become anxious, feel uncomfortable, feel as if something has to pop or that they may even hurt. Stretching seems to be the cure and the ailment.

Here's why people with Gumby bodies want to stretch and why it becomes such a problem following an injury or surgery. As you reach the end of motion of some part of your body, you will feel a tightness in and around the area.  So, if you are stretching your shoulder, you will feel tightness and even some discomfort as you reach the end of motion. You may also feel some tension in your upper back. Muscles, tendons and the tissue surrounding the joints become taut and feedback information to your brain that you are near the end of your movement. These feedback signals help your brain coordinate your muscles when you move and determine how quickly the muscles produce force. Movement through a normal range of motion should not feel like anything more than a very mild stretch. When you feel tight, or something is strained, you are at the end of your available motion and are starting to go beyond normal motion.

So, for those of us who have "normal" motion, everyday movements tell our brain how to coordinate motion, how rapidly to develop force and that the joints are working properly. When you have too much motion, your brain thinks that your excessive motion is actually normal. Everyday movements are no longer enough. Your brain only gets the signals when you go to the extremes. This is why you feel the need to "stretch". You're just telling your brain what it needs to hear.

Gumby bodies always want to stretch. Although you may have had an injury, for example to your shoulder, you still feel the need to stretch. But, by stretching your shoulder, you greatly increase the tension and compression forces much like wringing out a dishrag. Injured tissues rarely respond positively to excessive twisting, pulling or pushing forces. So, your injury seems to linger, your recovery seems too slow and you wonder why.

If you have an injury and already know you are very flexible, probably the last thing you need to do is stretch. What will help you more is to become less flexible and increase your muscular strength. You'll need help for this so seek out the advice of a health care practitioner who understands hyperflexibility.

But, what if, during everyday motions, you feel like something is stretching? As if something is too tight or maybe it hurts? I'd love to tell you more and answer these questions, but in the interest of time and space, I'll have to answer it later. But, I will leave you with this thought: if it's tight, somethings not right. And, the solution rarely starts with stretching.

More later. Stay tuned.

Make today count.

Doug Kelsey

Why I Can No Longer Predict the Weather

If you live in Central Texas, the evening weather report sounds like this almost all year long: "Well, today will be partly sunny followed by a lot of sun then less sunny followed by complete darkness. Little rain is expected." I'm sure it's more complicated than that but it certainly looks easy and very predictable.

But, every now and then, the evening news will predict rain. Everyone around here gets very excited and nervous. We might even close a school or two just in case the roads become slippery. More often than not though, the next day, you will find yourself saying, "I thought you said it was going to rain!".

It seems predicting rain has and always will be a challenge. But, at one time, I had a special skill. I could tell when it was going to rain. I could feel it.

Stop laughing. It's true. And, I'm not the only rain maker in the world. People with joint injuries and damage to their cartilage often can feel the change in barometric pressure that accompanies a storm (barometric pressure measures the weight of air and when the humidity increases, the density or weight of air decreases). Scientists are still debating why this happens but it appears that one of the reasons is that the drop in pressure outside the joint increases the pressure inside the joint. One explanation is that with joint injuries, the fluid in the joint is thinner and lighter than in a healthy joint. So, when the pressure drops, the lighter, thinner fluid can expand more easily and stretches the lining of the joint causing an aching, painful sensation.

But, I no longer have this gift. While I could have made a handsome living being the only accurate rain predictor on T.V., I would much rather be muttering to myself about how poorly the weather forecasters are than have knee pain. How did this happen? How did I fall from grace as a weatherman? I made my joint healthier.

If you want to change your situation in life, you must change something you do each day. To make your joint healthier, you have to change several things. Here are a few:

Diet. You have to stay well hydrated up to 50% of your body weight in fluid ounces per day. Cartilage uses water to make itself tougher. Without the fluid, it will never change. Also, you need about 0.5 grams of protein per pound of body weight per day. A chicken breast the size of a deck of cards is about 20 grams. Protein is the fundamental building block for repair in the body. Without it, your tissue repair ability is compromised.

Exercise. Injured joints need a special form of exercise that controls the amount and magnitude of force very precisely. You must have some form of aerobic exercise several days per week that causes you to perspire moderately. Cartilage has no blood supply. It receives its nutrients from the synovial fluid and underlying bone. By raising your core temperature, you increase the perfusion rate of blood in all your tissues including the synovium that supplies the nutrient rich fluid (plus, it's great for your heart and lungs).

Shock absorbing footwear. I wear Nike Shox during the day. They may not be the dressiest shoe but they are very comfortable and they reduce the force that will be transmitted to my knees. You might also consider inserts or Z-Coil shoes.

Supplements. Glucosamine has been shown to reduce pain and improve cartilage. Click here for more information about supplements and knee pain.

Attitude. Your life becomes what you think it will become. I choose, and this is very difficult to do each and every day, to focus on what I want, not what I have lost or do not have. You cannot do this alone. It is easier to slide into the misery pit than to stay out of it. You need people around you who will inspire you, motivate you, push you (especially when you don't want to be pushed) and hold you accountable.

You can change the health of your joints and restore an active lifestyle. But, you have to make the choice. I'm glad I can no longer tell when it will rain. In fact, I got caught in a rainstorm just the other day walking with my dog, Spencer. Makes me smile just thinking about it.

Will you join me as a former weatherman? Are you ready?

Make today count.

Doug Kelsey

P.S. Thank you to Amplifier, Sports Center's amazing product fulfillment company, for their support of the Hurricane Katrina victims. Together we were able to donate $1000.00 to the Red Cross.

Magic Magnets: Do Magnets Really Help Joint Pain?

People who hurt will do or buy just about anything to stop hurting. Companies that sell products claiming to magically relieve pain often create explanations that are marginally plausible but good enough to convince the customer.

Take magnets for instance. The magnet business is big business; a multi-billion dollar business and I don't mean the kind of magnet that you stick to your refrigerator. The kind I'm talking about you will find around the wrists of professional golfers, embedded in mattresses or sewn into knee or back supports. People who wear or use these small, metallic objects will swear to you that it's the magnet that cured their ailments.

But, is it true? Is there any truth to the idea that a magnet can cure knee pain or hip pain for example?

In a recent study published in the British Medical Journal, 194 people with hip or knee pain due to osteoarthritis, were split into three groups. One group wore a magnetic bracelet, one group wore a weak magnetic bracelet and one group wore a fake magnetic bracelet. The bracelets looked the same and the subjects did not know which type of bracelet they had. After three months, the subjects were re-evaluated and guess what? The group that wore the real magnetic bracelet improved more than the other two groups. The magnets seemed to work.

The researchers, however, cannot explain why the bracelet worked but did notice that the strength of the bracelet appeared to be an important factor (134-197mTesla). They concluded that the improvement may be due to the bracelet, a placebo effect or both and that a magnetic bracelet is a reasonable option to help manage the pain associated with osteoarthritis.

Keep this in mind though if you are thinking of buying magnets to rid yourself of pain: Pain is, in nearly every case, a symptom of other underlying problems much like fever is a symptom of certain diseases. While no one wants to hurt, sometimes pain can be the best thing that can happen to you. Pain is an agent for change if you are willing to listen, get advice and follow the advice. Finding the source and addressing it can be a vexing problem but I have seen many people overcome what appears to be insurmountable issues and restore an active, athletic lifestyle; one that will serve them well into their "golden" years. At the end of your journey, you will not only feel better but will greatly enhance the quality of your life by addressing the root problems.

When you chase the pain for the sole purpose of eliminating it, I think you miss a very important opportunity. Think of it this way: what do you want when you're 60, 70 or 80 years of age? Do you want to feel like you're 20 or 30 years younger? I call this your "future youth". We've all seen people who seem much younger than they really are and also people, who at the age of 30, seem like they have one foot in the grave. How do you suppose you will secure your future youth if when your body tells you "Hey, it's time for a pit stop buddy! Get this thing fixed!", you silence the message with a magnetic bracelet, fail to rebuild your aching, ailing joint and just move on with your life? I have news for you. By the time you're 60, you will feel 80 and your window of opportunity will be the size of your little finger.

Magnets are not a magical cure for whatever ails you. Magnets may help you feel better. But, are you really better? Have you restored your health, your abilities and secured your future youth?

Think about it. How young would you like to feel when you're old?

Make today count.

Doug Kelsey

Reference: Harlow, T., C. Greaves, et al. (2004). "Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee." Bmj 329(7480): 1450-4.