How to prevent back pain

Many of the cases of back pain in our office are preventable. Some do come in because of accidents or falls in which they have a new injury, but commonly we see chronic, long-standing back pain. There are many different causes of back pain, and I will address some of the more common preventable causes. This article from the Philadelphia Daily News is a very good introduction to some causes.

The overall problem is deconditiong, essentially a decrease in physical fitness. People who are overweight are more susceptible to back pain. People who are inactive are more susceptible to back pain. Sedentary people are more susceptible to back pain. People who smoke, drink, or take large amounts of caffeine are also more susceptible to pain.

The key to avoiding back pack pain is remaining active, and keeping movement in the lower back. People who participate in general low impact exercise tend to have a lower incidence of low back pain. Simple exercises like walking and jogging are helpful. It is important that exercise is consistent. Most people who set out to do an exercise program often start to ambitious. To begin with, start by walking (or lift light weights, or whatever you like to do) for up to 30 minutes 3 times a week. This should help to avoid the common burnout that occurs with most people who start exercises programs. Swimming is one of the best exercises for people with back pain, or wishing to prevent back pain. The low impact supplied by the water takes stress off the joints, and the added resistance is beneficial in building strength and well toned muscles.

Back Surgery?

I came across this video on Fox News.

This is good information. Reading a little more, this sounds pretty good. One of the problems I see with people who have had back surgery is that there is often significant damage to the surrounding tissues that continue to cause pain, or actually cause a more intense pain. As we can decrease the damage and inflammation at the location of the procedure, we are more likely to recover faster as did these people in the video.

Unfortunately, still many people have surgery before going through the proper steps. Many will not believe that it is relatively normal to have intense back pain for several days. Keep in mind that when you are dealing with progressive neurological deficit is when you traditionally should consider surgery. There are other reasons, but typically those are the types of conditions that will require the operation.

Bicyling to work

In the summertime people praised us for riding our bikes to work.  "How great!" or "Good for you!" they would exclaim.  As the weather got colder and we entered fall we would frequently be asked how many more days we would be riding.  I would answer, "Everyday."  This typically receives an awkward laugh and smile, as if it is impossible to ride a bike to work year round.  I am serious though.  Everyday.  I rode to school throughout the winter in both Utah and New York, and it hasn't been that bad.  This morning we rode in the snow to the Southside, and it is quite amazing.  

Summer riding is nice in good weather.  You can feel the cool wind through your helmet and appreciate all the greenery here in Pittsburgh.

Winter riding is different.  You can still feel the cool wind.  As long as I work the layers appropriately though, I am not cold.  More often, I am warm.  I have a couple of phases of layering depending on how cold the weather is.  So far, I am only in phase one.  Layers are the key.

Boston Qualifier

Congratulations to our most recent Boston Qualifier. Good luck in April!

Race Weekend 2

Akron went pretty well. Also congratulations to all those from De Novo who finished the Great Race! We are so proud of all of you.

Race Weekend

I am finishing up my taper for the Akron Marathon this weekend.  One more run, and then the race.  It's so exciting.  Also, some clients will be running the Great Race here in Pittsburgh on Sunday.  Everyone is ready to go.  All the training is complete, and now we get to enjoy the experience and see how fast we can run.  

Food as Friend

This NYT article discusses a "new trend" in dieting. I agree mostly with its premise. If people know what to eat, as opposed to what not to eat, they will make better choices, have a better diet, feel better, and be able to maintain a normal weight. Eating well is not about removing all the pleasures from our food, but its about weighing the value of the foods you eat. If we can add more healthy, whole foods to our diet, we will have less desire/capacity for the foods that are not as good for us.

Don't get me wrong. Those who know me, understand that I have a real soft spot for sweets. Anytime I am at an event where there are cookies around, they always catch my eye and I am tempted. I have learned about the quality and pleasure of food though. If its one of those ooey, gooey, melty, soft, to-die-for chocolate chip cookies I will definitely partake (I try to resist eating so many that I get sick). I have learned to say no to the 1 million to a box, cardboard looking and tasting chocolate chip cookies that frequent such functions. Its not worth it to me to try and satisfy my sweet craving with something that won't come close to satisfying it.

Also, it is easier to eat good foods if I prepare it before hand. At work, I eat quite well, and that is mainly because I bring all my food and know what I am going to eat at what time of the day. This eliminates the "what do I feel like right now?" portion of selecting food.

Overtraining

This overtraining article in NYT provided some much needed insight on the problem that occurs when athletes train too hard for too long. With overtraining, athletes feel sluggish, irritable, and notice performance decreases. The article discusses that it cannot happen with people who are running 20 miles a week, and that it only occurs when training with high mileage (or training) over long periods of time. This may be true, but I would argue then, that you can feel the effects of overtraining in a short period of time, no matter what your fitness. If you are feeling tired and sluggish and maintain a high volume, you may want to evaluate your training.

Something that is neglected in the article is the importance of recovery. When training with high mileage, you need more sleep, to eat more, and be able to recover better. If you decrease your recovery time, it has the same effect as increasing your training. Sometimes rest and sleep is more important than some of the training runs.

Running in the dark and hills and marathon training

As I prepare for the Akron Marathon I am determined not to be burned by the hills from mile 15-22, and my training has mirrored this. I am incorporating much more hill running, and today to simulate the race I ran a 6 mile tempo run and then hit the hills fatigued to get used to the pain. It worked wonderfully, and I will probably do it again. The most exciting part of the run came at the beginning. I was running down a significant hill near my house. It is such a hill, that the sidewalk has stairs to help people go up and down. I usually don't run down the stairs, but try to stay with the steep slope of the road. I wear a red flashing light when I run in the dark as to be seen by all the oncoming traffic.

I was headed down such hill in the wee hours of the morning and noticed that a car was coming up, and of course it had its headlights on because it was dark. I moved from the road to the stairs to avoid the possibility of a head on collision with the vehicle (a battle that I would surely lose) and continued on my merry way. As the car passed me (again, with its headlights on) the passenger leaned out his window and yelled "Booo!"

Seriously.

Who passes a runner running in the opposite direction of their vehicle at 5 am and offer commentary that is appropriate for a sneak attack. Personally, I would have felt better if he said something derogatory towards me or my family than this. I could understand if they were passing me from behind with their lights off and the engine off in stealth mode, but head on? Give me a break.

Kinesio-tape

While watching the Olympics over the past weeks, I have noticed a little bit of kinesio-tape on some of the athletes in the events.  To begin with, I do not use it, nor do I know too much about it.  Do I believe it "works?" Probably, almost everything does a little bit.  While in chiropractic college we had a little seminar/presentation about kinesio-tape.  This presentation was given to chiropractic students and chiropractors (a population that has a greater than average understanding of human physiology and biomechanics), and the presenter focused on the fact that professional teams and athletes use the tape.  In fact, she had a handout with pictures of prominent athletes who use the tape.  For me, I would rather know the science, theory, and thought behind a therapy than who uses it.  As long as the idea is logical and reasonable, I don't have any issues with the procedure and consider the validity of it.  That particular presentation just turned me off to the idea because it was presented to me as if I would be impressed by the individuals receiving it.

Pittsburgh Training

As we continue to prepare for the Great Race. I am amazed by the great places to train here in Pittsburgh. North Park, Riverview Park, and Schenley Park are all wonderful and I am sure the others are just as good. What's most exciting is the diversity in training that we are able to do right here in downtown Pittsburgh. We are able to walk right out of our office downtown and train on a variety of terrains and surfaces all within a 5 minute warm-up jog. Some of my favorites are running around PNC Park and Heinz Field, both of which are less than a 4 mile loop from the office. We also do speed work on the jail trail and the trail on the North Shore. The many bridges offer an effective substitute for small inclined hills. If we want a more substantial incline, that's easy...it's Pittsburgh.

10k training

Our customized training is usually performed in our training studio in downtown Pittsburgh. We have some clients though, that aren't only training for strength, but also want to run and use running as a mechanism to get healthy. We encourage this. We are working with a client who decided he wanted to run a 10k later this year. We have been working on getting in mileage so he can run a quality race. His last race was in 1982, that was also his first, so we started from scratch. He has progressed quite well, and is noticing changes in how he looks and feels. Also, he has received comments from others. We recently set up a mock race for him (5k), and he exceeded our expectations. With a little more training he will be ready for his big race.

House Calls

How many doctors are willing to come to your house? We designed our practice to make the doctors accessible, and in so doing we figured we should offer on site services. The way it works is simple.

We do recommend that the first visit is performed in the office, to make sure we get everything set up right. We can then take our 15 lb portable chiropractic table to your house and give the treatments there. Many people will have problems where they "can't even move" and it's quite a hassle to try to get to the office. In those situations its nice to be able to take our services to them. It's possible because we don't need that much equipment to treat people. There is an increased value in our care when we do this.

We also offer on site fitness training which has been popular and successful with some of the local apartments.

Office Expectations

I have given several tours of the office recently, and try to be the best guide I can. We chose to abandon the typical health care office look for what we consider a more modern feel. Most offices in our area are white walled, sterile, cold looking facilities. We wanted something better, so our walls have color, we try to keep the lights low with the maximum natural light so it feels inviting. Most people who visit us comment on how comfortable the space is.

I believe that people want to feel comfortable at the doctors office, and we are doing our best to change the intimidating and sometimes obnoxious atmosphere. On the other hand maybe the consistency of the white walls and bright paintings are comforting because of conventional expectations of what an office should be.

Ergonomically Designed

We just finished a series of presentations on ergonomics. We usually enjoy giving them, but honestly I was quite worried about this one. Ergonomics is generally tedious, or so I thought. In preparation, we looked at the relevant research and were prepared to discuss proper angles and heights of chairs only to find out that it really didn't matter. Not that ergonomics don't matter, and that you shouldn't try to sit properly and work in good postures, but that the exact angles really didn't show much of a benefit in the research. What really worked is just moving. Taking short breaks and short stretches. So that's what we taught. Amazingly, ergonomics went from memorizing angles to stretching and quick exercises. People were engaged, and surprisingly interested in what we were discussing. I guess ergonomics can be fun.

Exercise Nutrition

Last week I came across this article and was worried what I might find on the inside. Most athletes, and people for that matter are so willing to try new things and to believe marketing by the growing business of sports nutrition, that it drives me crazy. I was relieved to read about people who take a common sense approach to nutrition post exercise. I get very excited when people show an ability to think for themselves (an ability I like to think I gained not too long ago), instead of just believing what someone else tells you.

I see many runners who are willing to drink each and every recovery drink and/or sports drink after every run, even short easy runs, when all this isn't even necessary. I personally opt for a little protein shake with some wheat germ and flax seed because it is convenient. I think it tastes alright too. It's not perfect, but it gets the job done for me. Real food is always better than processed food, but what's important is that you get some protein, and some carbs in following your training. You don't need a full meal right away, just a little something to help you repair. Most repairing will happen while you sleep anyway, so just take it easy and eat something.

Health Care?

Mass Health Care

I kind of thought this was going to be quite a mess. It looked like it was for the first little while, but according to The Washington Post, Massachusetts has done a good job with their health care plan. The number of their uninsured has been cut in half, and they say that there are only a few problems with people having to wait. Apparently the copays are even reasonable...for now. They are projecting that they will go up, which I imagine will cause the problem most people face of getting priced out of health care. Hopefully they can keep up with the preventative coverage and helping people before they need expensive procedures.

If people could only have access to the care they need at reasonable prices. I don't know what perfect health care looks like, and there seems to be problems with each system, but apparently France does a good job.

Accessible Doctors

Yesterday we ventured around our neighborhood in order to get a clear picture of what other doctors are in the area. We took the morning and walked the city stopping by all the offices we had found through various searches on Google and insurance websites. As Doctors of Chiropractic we have the need to refer to a variety of other specialists from time to time, so we wanted to be aware of what might be convenient for our patients.

We visited several offices, found that others don't exist, and that some never existed. We had some good conversations and contacts with a few of the more "progressive" offices in town, but I was put off by the "conventional" ones. The following is a typical encounter, and I am blending some details of each experience upon walking into the offices.

As we enter we are not greeted by the receptionist or nurse until we are standing directly in front of them. "What do you need?" she asks.

We explain our situation, that we are new in town and were just passing by to get a better understanding of the other doctors in the area and what they do best for patients.

"Well...this is a doctors office...who did you say you were? Chiropractors? Alright." she says.

"Yes, and we just wanted to stop by to make sure you exist from all the listings, as we will need to refer patients to your specialty," we say.

"We have 5 doctors here, but they are not all here at the same time, but somebody is usually here Monday trough Friday," she replies.

We usually end by asking for some business cards, in which we are reluctantly given one to share.

I understand that the function of front desk people is to filter all visitors, especially those who just stop by, so the doctor doesn't have to worry about the trivial things. I would just think that if someone came in offering to give you free business, without you putting in any effort, there would be a cordial response, and a minimal amount of gratitude.

www.denovopittsburgh.com

A different Style

New and different isn't always better. In general chiropractic offices are designed to treat as many people as possible in as little time as possible. This is achieved by seeing multiple patients at the same time and the doctor moving from room to room seeing each patient for 1-5 minutes. This system works very well for many doctors and patients. The patient usually spends about 20 minutes in the office signing in, receiving treatment or information from the chiropractic assistants, and then getting treated by the doctor. Because of this method, many people are required to work the office to make it efficient. The doctor needs to worry about the patients in the rooms, the receptionist signs people in, answers phones, and collects payment, and the assistant takes people back to receive the "non-chiropractic" treatments.

This style doesn't resonate with me. Throughout chiropractic college we are conditioned to spend time with patients. Most of our encounters in our clinical experience are allotted 30 minutes per patient. Now, most patients do not require this type of time, and most patients don't want to be at the doctor for that amount of time. Patients want to get in, get what they need, and get on with their lives. This is why I decided to practice a different way.

The more time a patient spends with their health care provider the more personalized care they will receive. For this reason, there is no staff in my office other than the doctors. It works beautifully. We use readily available technology to eliminate a need for additional people in the office. With our easy EHR, and online scheduler we are paperless. All our patients sign up for their appointments online for when it is convenient for them, and then miraculously show up on time. It's wonderful, and they enjoy being greeted by the doctors when they walk in to the office. Thus far, each patient has walked into the office and straight into a treatment room. Very easy and convenient for both doctor and patient. Check it out.

www.denovopittsburgh.com