exercises - Ask Dr. P - The Pain Doc

Quick Exercises to Prevent Neck and Back Pain if You Sit Often

by Pain Doc | Feb 10, 2020 | Uncategorized

Did you know that by natural design, the human body is optimized for STANDING and WALKING, not sitting and lying down?

The evidence is longer and stronger legs for standing and walking compared to the arms. Your femur, tibia and fibula (leg bones) are longer and thicker than their counterparts; respectively the humerus, ulna and radius bones of the arm. Millions of years of evolution made our species homo sapiens develop this bi-pedal frame in order to survive and thrive. No other animal as far as we know has a frame like ours.

But there’s a problem: the bipedal design of man evolved during a time when there were no desks, computers and automobiles whose operation is better suited for sitting. Back then, there was only rough terrain to walk for miles in order to seek shelter and food. There was fast prey to subdue by foot in order to not starve.

Fast forward to today: just about all occupations these days involve using a laptop. White collar jobs, and increasingly blue collar jobs require sitting at a desk. Sitting is required for operating airplanes, trucks, and cars. To add to the problem, food is plentiful; overall less nutritious and higher in calories — no need to walk that much (expend calories) to get it while it packs on the pounds. Humans are much heavier than they were millions of years ago, on average, and it’s not due to muscle. This makes standing less tolerable, and makes sitting feel better on our feet.

ape to human

So the combination of frequent sitting and weight gain, which places more pressure on your joints, is a harmful combination that leads to pain and injury, affecting tens of millions of people. Osteoarthritis is the gradual degeneration of the joints, particularly the weight-bearing joints (hips, knees, feet, lumbar spine) and it is hastened with obesity and sedentary living.

Here are the detrimental things that happen in your body when you sit for prolonged periods throughout the day:

The pressure to your lumbar discs increases. Sitting removes back support from your legs, pelvis and abdominal muscles, which contract less when you sit.
Your postural muscles turn off somewhat, and as a result you burn less calories. Some studies connect this to a rise in bad cholesterol levels in the blood.
When you bend your neck to look at a monitor screen while sitting, it creates forward head posture. This strains the neck and upper shoulder muscles, and compresses the neck vertebrae; hastening osteoarthritis in the cervical spine. It can even cause tension headaches.

Sitting is an inescapable part of life. The key is to compensate for it by standing and walking when you can. Neutralize its effects. There are many ways to do this while living a modern lifestyle: walk to work, walk during lunch breaks, take the stairs instead of escalator, and do 15-minute workouts right in your office or work area, to name a few.

Drs. Brent and Tiffany Caplan, integrative medicine practitioners based in Ventura, California recommend the following simple stretches to do to counteract sitting:

Let’s talk about creep. No, I am not talking about a person unwelcomely staring at you all night from across the bar. I am talking about a constant load of stress applied to soft tissues (muscles, ligaments, fascia, discs) over an extended period of time resulting in a progressive deformation of those soft tissues. This can lead to muscles or ligaments changing their functional resting length and adaptively shorten or lengthen. These imbalances will lead to degeneration of your spine and will also set you up for future injuries. Creep to your intervertebral discs, the cushion between each spinal segment, may cause them to deform eventually leading to a herniated disc.

A common position that we are constantly in, as working professionals or students, is sitting. The sitting position, especially if in a poor slouched posture, puts an overload of strain in your neck, mid back, and lower back. It may also affect how well you are breathing. Poor respiration will lead to a decrease in oxygen supply to your body and brain!

So now that we know about creep and sitting how do we prevent it? The answer is simple. You should not sit for more than 20 minutes without taking a micro-break. These include Brügger’s relief position and the standing overhead arm reach. No pain should be felt during these movements. These movements are beneficial if you have any back or neck pain or want to support your spine and prevent any degeneration or future injury.

Bruggers exercise

Brügger’s relief position:

Do while standing or sitting on the edge of your seat.
Relax arms at side and turn palms outward, spread fingers, bring shoulders down and back, tuck your chin (attempting to make a double chin, not looking down but straight ahead).
Now exhale repeatedly as if trying to make a candle flame flicker but not go out. Be aware to make sure you are stomach breathing and not chest breathing. (To test this put one hand on your chest and one hand on your stomach. You should feel your stomach rising up and down as your inhale and exhale but your chest should remain still).

Do this for 10 seconds every 20 minutes.

standing overhead arm stretch

Standing overhead arm reach:

Stand up and gently raise both arms above your head with palms facing forward and elbows slightly bent.

Take a deep breath in through your nose and hold the breath while reaching up as high as you comfortably can (a stretch should be felt in your lower back).
Hold for a couple seconds then release the breath through your mouth and go back to the starting position.

Do 10 repetitions every 20 minutes.

Now you’re done and your micro-break only lasted 30 seconds, totaling a mere 1.5 minutes per hour, to maintain your health and prevent spinal injuries.

Dr. Brent Caplan & Dr. Tiffany Caplan
Central Coast Center for Integrative Health
1730 S Victoria Avenue, Ste 230
Ventura CA 93003

How Do You “Do” Health Care?

by Pain Doc | Feb 6, 2017 | Telemedicine

The Evolving Paradigm of Health Care

Health care. It’s one of those things that’s talked about regularly that carries sub-conscious assumptions.

I’d like to ask you today, “What does health care mean to YOU?”

You might say:

“Health care is being able to see a doctor whenever I need to, for a health-related complaint.”

Ok, fine. Let’s say you do. Now what?

You may then further elaborate, “Being able to ask the doctor what is causing the problem and what I need to do to get it fixed.”

Ok, you’re talking about getting a diagnosis and prescription. You ask the doctor about that nagging symptom, and he or she explains that it is being caused by a virus. Your doctor then writes a prescription and prints out a pre-written information sheet about your condition, which includes things you should do, and hands it to you and you are discharged.

That’s great. It’s reassuring to have access to a doctor whenever you are ill.

But, given all the tools that are available these days, was a doctor really necessary? Could a lower-cost nurse sufficed? Some RNs and Nurse Practitioners are very knowledgeable in disease signs, symptoms and treatment.

And did you know that there are some pretty accurate apps and websites (WebMD, ShareCare) that could have provided the same information to you in minutes, for FREE?

And, how much a month are you paying in health insurance to have this access? For my family, it’s $1,500/month and we’re all pretty healthy. Is it worth it?

My point here is that the old model of out patient service is getting a lot of challenges in this age of technology and big data access. It is time for people to start questioning how they wish to utilize, or “do” health care.

Another valid question is “Should this be called “sick care” instead?

After all, in this scenario the person seeks out the doctor AFTER the condition is already there; after he is ill or stricken with the malady.

So yes, a better description of this service is “sick care.” But although it’s a more accurate term, sick care sounds negative (which it is) compared to the term health care. When you hear the word health it evokes positive images like strength, energy, vitality and longevity. So don’t expect to see hospitals, doctors and insurance companies extolling their sick care services.

The Three Paradigms of Health Care Today

Returning to the questions “What is health care?” and “How should I use or do it?”, here’s another thing to consider:

Do you really need to take medicine, get a shot, see a physical therapist or get surgery?

Ok, in some cases you do; usually emergency cases like heart attacks and stroke.

The first paradigm of health care, which we’re all familiar with is having some procedure done to you by a medical professional. This is passive health care, where you receive it passively and includes taking medicine, getting surgery, and having therapy done on you.

The second paradigm of health care is the doctor or professional instructing you what to do to get well or for prevention; i.e. prescribing home care or lifestyle modification routines.

This is a big improvement from the first paradigm in the following ways:

(1) it gets you involved in your health, which trains you to be more responsible for your health and not reliant on a doctor;

(2) it is less expensive because you are in the doctor’s office less; and

(3) it is likely to be more effective and safer than visiting a hospital or taking medications.

Diet, exercise, home care strategies and other lifestyle modification interventions have a bigger, direct and longer-lasting impact on your health than medicine or passively receiving ongoing therapy (for a pain condition) such as physical therapy and chiropractic.

Medicines typically work by altering or “jury-rigging” your physiology to counter the symptoms you are experiencing, which gives the “illusion” of health. This is not natural, and there is almost always blow back by your body; i.e. side effects, some which create more problems (such as how taking Aspirin for pain can give you ulcers; or how taking too much Ibuprofen can cause renal failure).

Ongoing chiropractic or physical therapy is almost as bad, because anything passive risks your body becoming dependent or addicted to it, which again leads to blow back in the form of weakness and reduced coordination of muscle and joint systems.

Finally, the third paradigm of health care is when YOU get involved in researching your condition thoroughly, and then getting instruction on how to resolve your health condition from legitimate sources.

Now, this paradigm gives you the most freedom, but it also has some drawbacks. You need to learn how to differentiate between legitimate websites and the extreme ones. Health is an art as well as a science, so there are gray areas and some people are known to take excessive liberties in their writings about health.

Traditional medical websites obviously have an “allopathic medicine” bias. This is good in that the information is usually backed by research (evidence-based medicine), especially when on reputable, authoritative sites like Cleveland Clinic and Johns Hopkins.

(However, in recent years I have seen WebMD warm up to natural medicine; i.e. herbs and traditional natural remedies; although they are careful to use non-committal words and phrases such as “…may be helpful” and “…some anecdotal cases show that herb x reduced pain..”)

But the traditional allopathic websites are not as in-depth into alternative health favorites such as nutrition, herbs and things like electromagnetic therapy and grounding.

Then there are the alternative health websites. These sites are usually written by bloggers; some of whom have credentials (unfortunately, you will have to verify it yourself by doing internet research) and some who do not– just health enthusiasts who read other sites and report on them. Be more cautious about the information you get from these sites. That’s not to say that you can’t find useful information on some of them; some are really good despite being written by non-doctors.

Alternative health websites fit in better with this third paradigm of health care by virtue of the nature of alternative health, which essentially IS about implementing lifestyle modifications to achieve health from within. Things like diet, nutrition, herbs, exercise, breathing, meditation, massage, stretches, and using safe, energy emitting devices to enhance your body’s healing.

Fix chronic pain at home using nutrition, lifestyle modification and techniques used by physical medicine professionals.

ShareCare

Online medical consultation with real doctors.

Cleveland Clinic Online

Online medical consultations and prescriptions by real doctors.

WebMD Symptom Checker

Interactive symptoms checker and medical report and recommendations.

Mercola.com

The world’s largest natural health care website featuring articles on wellness, prevention and the dangers of common medical interventions.

What Causes Radiating Arm Pain?

by Pain Doc | Aug 31, 2015 | Hand and Wrist Pain

Just like how sciatica/ leg pain is usually caused by a bulging disc in the lower back or by a muscle pinching the nerve, arm pain and/or numbness & tingling is usually caused by a bulging disc in the neck or by a muscle pinching a cervical (neck) nerve root or plexus.

The nerve roots that come out from between your cervical vertebrae converge to form three main nerves that service the arm: the ulnar, median and radial nerves. If any of these nerve roots are pressed by a bulging disc, a bone spur or thickened ligament, it usually causes radiating (traveling) pain from the neck down the arm; usually all the way down to the fingertips.

The specific area of pain/tingling depends on which nerve root is being pinched. In fact, that is how doctors diagnose the precise problem area. For example, numbness down the medial (inner) side of the forearm down to the pinkie and ring finger can be produced by compression of the C8 & T1 nerve roots. Numbness in the outer forearm, thumb and first two fingers is associated with the C6 & C7 nerve roots.

arm dermatomes

Radiating arm pain can also be caused by thoracic outlet syndrome, where muscles near the neck and upper shoulder pinch the nerve plexus (where the roots converge). This will be next week’s topic.

Self Treatment for Radiating Arm Pain

If you have significant neck pain accompanying your arm symptoms, then it is likely you have a bulging disc in your neck. It feels like a focused, sharp pain deep inside the neck on one side. Massage does not help this kind of pain.

Most mild to moderate cases of cervical disc bulges resolve with exercises and manual therapy. The severe cases usually require surgery to remove the disc portion that is pressing against the nerve. If you have a severe case, get a consultation from a spinal surgeon and a second opinion. If done in time, surgery can resolve the arm pain, but if the entire disc is removed the surgeon will fuse the vertebrae above and below the disc which will reduce your neck range of motion somewhat.

If the disc bulge or offending structure is allowed to compress the nerve root for an extended period it may result in permanent injury to the nerve. This means after surgically removing the bulge, you still may have numbness down the arm. This is why, for nerve compression conditions, time is of the essence.

Non-surgical candidates can do exercises to reduce the bulge size. For typical posterior bulges (bulges that protrude towards the back and one side of the vertebral body) try this: while standing, use your posterior neck muscles to pull your neck straight back, as far as you can; hold for 3 seconds. It may feel uncomfortable if your disc bulge is acute. Keep your chin tucked in so that the top of your head is level. Do eight times, twice a day for a couple of weeks; note changes in your neck pain and arm pain. Discontinue if it aggravates your condition. This movement gently presses the backs of the vertebral bodies together, which pumps the disc bulge back to center.

If the exercises help but you hit a plateau, try side bending your neck towards the side of the pain, very slowly; repeat six times. Again, note changes; discontinue if it aggravates the pain.

Recommended Lifestyle Changes

Forward bending of the neck and anterior weight bearing of the head (forward head posture) tends to make the cervical discs more vulnerable to bulging because in this position the vertebrae press the front part of the discs, pushing the jelly center (nucleus) towards the back.

Axial forces (straight down through the spine) to the neck can also make disc bulges worse. Any activity that involves jumping creates axial forces — running, basketball, gymnastics, mountain bike riding, sky diving, etc. It’s not a concern unless you do it frequently.

If you have a bulging disc in your neck with arm pain, here are some suggested lifestyle changes:

Use a contoured neck pillow and sleep on your back.
Work on improving your posture: eliminate forward head posture.
Get a standing desk if your job requires a lot of sitting– it’s better for your back and neck.
Use the Cervical PosturePump device to hydrate your cervical discs
Strengthen your neck muscles so they offer more support to your neck.
Avoid excessive jumping. If you like running, consider getting Z-coil or Gravity Defyer shoes (see below).

Treatment Accessories to Reduce Arm Pain from Disc Bulge

PosturePump Disc Rehydrator

This device uses specially designed air bladders, inflated by a hand pump to spread apart and extend neck vertebrae. This expands the discs, drawing in fluids and nutrients and also stretches the neck into its normal, ideal curvature.

Anti-Shock Specialty Shoes

These specially designed shoes have powerful springs in the heel that significantly dampen the forces generated from running. Less shock to your feet, ankles, knees, hips, low back and neck.

Vari-Desk Height Adjustable Portable Desk

Place this lightweight desk on your traditional sit-down desk and switch its height between standing and sitting in less than five seconds. Choose to stand for as long as you like, then switch back– great for easing into standing while working, if you’ve been a desk sitter for many years.

Best Exercise for a Strong and Functional Low Back – Russian Kettlebell Exercises

by Pain Doc | Dec 18, 2014 | Uncategorized

Russian kettlebell exercises are a great way to strengthen and condition your pelvic stabilizers, promoting a strong back that is less prone to movement-caused injury.

The pelvic stabilizers consist of all the muscles connected to the pelvis working in synergy to enable you to lift, push and carry (perform work). They include:

Erector spinae group (quadratus lumborum, multifidi, rotatores, iliocostalis)
Abdominals (rectus abdominus, obliques, transverse)
Gluteal muscles
Quadriceps muscles
Hamstrings
Hip rotator muscles

In this video, I demonstrate the proper form for doing these exercises:

Think of your pelvis as a powerful hinge; a “bio-mechanical hub” that connects your torso to your legs. The pelvis’ engineering enables you to stand upright and bear a load by serving as an anchor/ attachment point (resistance-counter force) for the muscles performing the work. It is truly a biological marvel and should be targeted for exercise so that one can meet the physical demands of life more easily.

Examples of common activities that heavily rely on pelvic stabilizers:

Standing up from a seated position; sitting from a standing position
Bending down and lifting something from the ground
Putting your carry-on luggage in the overhead bin of an airplane
Lifting up a child
Throwing a football
Jumping across a puddle

The exercises involve moving a kettlebell, which resembles a cannon ball with a large hand grip, by using the power generated from pelvic thrusting. The repeated thrusts are created by alternating antagonist-agonist* function of the pelvic stabilizers.

*Muscles work in pairs. The muscle that is undergoing a concentric contraction (getting shorter as it contracts) is called the agonist while its counterpart, referred to as the antagonist offers stabilization and measured control of the movement. Muscles switch from being agonist to antagonist and vice versa, depending on the movement. Examples: biceps-triceps, quadriceps-hamstrings.

Although it looks like the arms are involved due to their obvious swinging motion, they are actually not being exercised. The arms serve to connect the weight to the pelvis structure, like a piece of rope. The kettlebell “drags” your arms with it and moves via inertia after being propelled by the rhythmic pelvic thrusts.

Initiate the thrust with your leg muscles, driving power through your feet and channeling it into your pelvis and core to swing the weight forward. Do not use your arm muscles to swing the weight, and try to keep your lower back straight. The worst thing you can do is put too much load on your lower back muscles in the flexion position– this can cause a severe back injury, so avoid doing this.

The benefit of developing your pelvic stabilizer muscles’ strength and coordination is that it will be much easier to move your body; to make it do work. Going up stairs, getting out of and into your car seat, and lifting and carrying heavy things will be much easier. You’ll be pleasantly surprised!

Kettlebell exercises burn up a lot of calories, so they are also good for weight loss.

Remember to use good form and start out with a light weight, working your way up as you develop muscle strength and coordination. Kettlebells can be as light as 2 pounds and as heavy as 50 pounds. The one I am using in the video is a solid 40 pounds.

Simple But Powerful Posture Correction Exercise You Should Do Daily

by Pain Doc | Jun 27, 2014 | Uncategorized

The underlying theme of this blog is that by making strategic changes in your daily routine, you can save yourself a lot of pain and dysfunction now and later on in your life. And it’s my desire to share with you some of these simple changes.

Isn’t this a simpler and smarter way to live, rather than being indifferent or oblivious to the fact that your body slowly loses its resiliency as you age, and not taking appropriate, protective measures? If you perform regularly scheduled maintenance to your car, it will last a lot longer than if you do not. The same goes for your body, but the stakes are a lot higher.

One Popular Reason Why People Develop Pain

The problem I see is that most people forget that when you are in your 20s and 30s you can get away with things like prolonged sitting, staying out late and eating unhealthy things like burgers and fries frequently. At that age your human growth hormone is still giving you that fountain of youth energy and your musculoskeletal system, especially your joints, is still in good working order.

However, through your 40s-60s, your job and/or family responsibilities increase and you have less time for yourself, and you think you can take the same abuse that you took in your earlier years. This is where problems start to manifest.

You see, health problems such as degenerative disc disease take years to develop. Take an x-ray or MRI of your neck or low back, and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.

So, you are either in a situation where you can do lifestyle modifications to reduce the chances of disorders like this from affecting your health and quality of life; or, you already have the disorder, but need to find ways to stop it from progressing and/or reduce its impact on your health and quality of life.

You see, as long as you are alive, your cells have the capacity to regenerate or transform. Depending on the current state of your health and therefore your body’s recuperative capacity, it could take a long time or a relatively shorter time to see results.

For example, if you are overweight; a smoker and drinker and have a negative impression of life, those serve as extra barriers to healing. Get rid of them, and you’ve got a better chance.

A Simple Exercise to Do Daily if You Sit a Lot

Back to those “lifestyle modification” tips that can help you avoid a life of pain.

Here is today’s example, an exercise called Wall Angels. If you find yourself having a slouched upper back, rounded lower back and forward lunging neck, you’ve got to try these. When done regularly, they can help restore and maintain good posture.

Posture affects your spine, joints, muscles, breathing, energy levels and sometimes even mindset. It is critical to have good posture if you expect to achieve optimal health in your life.

Give it a try; all you need is an empty wall with no obstructions:

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