Tag Archives: exercise

Back Pain – the Bane of Being Human

by on July 7, 2015

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Back pain can be devastating. Just ask my wife. Prior to our upcoming wedding my wife decided she wanted to get in shape. She joined a gym and, in her zeal, she repeated the weight routine three days in a row. The next day she suffered severe lower back pain which subsequently has besieged her for the past 38 years. (I know this because we just celebrated our 38th anniversary.) Guess who has been destined to be the luggage shlepper and primary grocery shopper in our marriage?

My wife has not been alone in experiencing low back pain. 80% of adults suffer low back pain sometime during their lifetime. In younger people, pain is mostly due to mechanical factors – the interplay of spine, muscles, ligaments, discs, and nerves in the way of they fit together. Low back pain can be triggered by repeated straining such as at a gym, or by a fall or accident, or by a sudden action involving lifting a heavy weight or twisting abruptly. Oddly, a herniated disc can happen spontaneously without a specific injury. In older adults, the most common cause of low back pain is spinal stenosis which means narrowing of the spaces of the spine. With aging, some people develop spurs in their vertebrae, and ligaments around the spine may thicken which together may cause narrowing (stenosis) where the nerves exit the spine. This typically results in pain while standing and walking, and relief by sitting.

Red Flags
While most causes of back pain are not life threatening, there are some warning symptoms that indicate immediate attention is required. These “red flags” include history of trauma, fever, incontinence, history of cancer, unexplained weight loss, long term steroid use, and intense localized pain with inability to find a comfortable position. Coincidently, the reason there why there was a position available when I was hired at Kaiser was because my predecessor had died of back pain due to an epidural abscess, an infection near the spinal cord. While I don’t know the details of his illness, he likely had fever with his back pain, and unfortunately did not appreciate the implication. Life threatening cases of back pain with fever I have treated include pyelonephritis (kidney infection) and endocarditis (heart infection.) Back pain with fever can be a lethal combination.

The inability to find a position of comfort typifies a patient who present with an abdominal aortic aneurysm. For this reason alone, I routinely examine any older patient with back pain for the presence of a pulsating mass in the abdomen. During the course of my career, I have detected two patients with aortic aneurysms. They both were ex-smokers and were overtly grateful since delayed diagnosis is almost always fatal.

A patient with a history of cancer always raises a red flag to me even if the cancer occurred decades prior. The most common types of cancer that spread to bone are breast, prostate, lung, kidney and thyroid. While most doctors have been well educated about not doing unnecessary imaging studies, a patient who has a past history of cancer especially with any history of recent weight loss deserves x-ray evaluation.

When back pain is not spine pain
During the fifteen years I spent working part time in spine clinic at Kaiser, I was amazed the number of times a patient was referred for back pain actually had something other than a spine condition. Two of the most common conditions that can be confused with a spinal disorder especially in older adults include osteoarthritis of the hip and peripheral artery disease (PAD). Hip osteoarthritis can usually be distinguished by performing a hip examination during the visit and by getting hip x-rays. A person with good range of motion of hips does not likely have significant hip arthritis. PAD can usually be determined by checking all the pulses in the legs and feet. The other feature differentiating PAD from spinal stenosis is that patients with PAD do not have pain while standing, while spinal stenosis patients generally do. Sometimes, though, a patient might have more than one condition causing back and/or leg pain in which case more sensitive testing is indicated to evaluate circulation competency and neurological function.

Other causes of low back pain outside the spine include kidney stones, acute pancreatitis, herpes zoster (shingles), endometriosis, and fibromyalgia.

What is the scoop about MRI’s?
A common question from many people with back pain is whether they should get an MRI to pinpoint the cause of their problem. The problem is that most people even without back pain will have an abnormality on an MRI exam. Falsely alarming MRI results in patients who have back pain explain why back surgery in the U.S. is more than twice as high as in other countries. Yes, surgery corrects the problem seen on the MRI but this may be unrelated to the cause of the pain.

Treatment
Treatment of low back pain can vary depending if it is acute or chronic (more than 3 months). There are no hard and fast rules, but generally ice packs are advised for pain within 2-3 days of injury. Heat can help ease subacute or chronic pain. Bed rest after acute injury tends to delay recovery, and it is important to resume normal activity as soon as possible. Physical therapy can help strengthen core muscles that support the spine, but an interesting study from UCLA a few years ago showed that walking three hours a week was more effective than three hours of physical therapy a week. Epidural steroid injections can be given for low back pain associated with sciatica, but a recent NIH study showed that in patients with spinal stenosis who received epidural injections had worse long term outcomes than those who did not receive them. Surgery may be considered in serious injury situations or if there is progressive neurological deterioration. While there appears to be short term benefit in patients who have undergone surgery, long term benefits going out four years and ten years appear to show no clear advantage compared to those who have not had surgery. Although I am not fond of many of the medications advertised for low back pain, sometimes they serve a purpose in helping someone to become more active and exercise once again.

Prevention
Regular exercise is the best way to keep one’s back healthy. My wife has found walking at least 60 minutes a day helps to lessen recurrences of low back pain. She also stretches regularly, and does not wear high heeled shoes. When she is sitting in the car or a chair, she uses a lumbar support called a Sacro-Ease or an inflatable travel pillow. She avoids any significant lifting, but if she does lift something she lifts with bent knees, carries the object close to her, and does not twist. For me, running, biking, and doing yoga at the PJCC keeps my back in shape, but everyone has to find a regimen that works best for them.

Conclusion
While back pain can be disabling, it can also be managed with regular activity and awareness to prevent further damage. Three months ago my wife injured her back again when she missed a step getting out of an elevator while holding one of our granddaughters who impeded her vision. To avoid trauma to our granddaughter, she sacrificed herself by intentionally twisting her spine as she fell. I am happy to say that granddaughter and “Nana” are back in each other’s arms once again.

For further information about low back pain, visit the NIH site.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider

 

 

Is Pilates The Secret To Youth?

by on June 29, 2015

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PJCC MEMBER PROFILE: AUDREY GUERIN 

I usually don’t ask people their age, especially if it is a woman. When I met Audrey Guerin I was surprised when her age came up; she is 81. She has such a youthful appearance. I told her I needed to know her secret–and we’re sharing it here with you!

Q:  Audrey, I was surprised to learn your age after seeing your picture and then meeting you in person. What is the secret for how you stay so young?

A:  Age just seems like a number and that number does not define me. I listen to my body to Continue reading

Improving Your Memory

by on March 23, 2015

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“Memory is the mother of all wisdom.”
― AESCHYLUS

With advancing age, many adults worry not only about their health, but also about their memory. First, let us examine why we value our memory, and then look at some of the latest research in how to improve memory.

With the externalization of memory by cell phones, computers, digital photographs, books, and pencil and paper, one can wonder why we need our brains to remember anything at all. However, thousands of years ago the major way we passed along information was orally, which required focused attention and memory. Dating back 2500 years, the Iliad and the sequel, the Odyssey, were transmitted orally by the rhythm of the words. It is said that the Torah, or Five Continue reading

Functional Training: Taking Your Workouts To The Next Level

by on February 24, 2015

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By Chris Nash, PJCC Personal Trainer

As a fitness professional for more than 15 years, I’ve witnessed many changes in the fitness industry. It used to be that gyms were limited to traditional equipment, such as bench and leg presses, that worked just one or two muscles at a time.

But in recent years, a growing trend is functional training. This is a classification of exercise that Continue reading

Half My Size: A Weight Loss Journey

by on January 28, 2015

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By Randi  Reed, PJCC Assistant Camp Director

Everyone asks me what happened. How did I do it?

As a teenager at age 16 I weighed 350 lbs. If that sounds like it would be hard to overcome, it was.

I had PCOS (Polycystic ovary syndrome) and I knew if I kept going and growing the way I was, I would have died. With help from my doctor to get the PCOS and hormones under control I Continue reading

In Search Of Sleep

by on November 4, 2014

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But I have promises to keep, and miles to go before I sleep, and miles to go before I sleep.”  Robert Frost

A relative of mine, Stewart, (not his real name) was driving home from LA, and fell asleep at the wheel. Stewart was 18 years old at the time, and on winter break from college. He drove to LA in the morning, and then, after spending the day there, drove home that night. Although he knew he was drowsy, he made the decision to drive home. The last thing he remembered was listening to a 49er Monday night football game before he dozed off without warning. His new 1996 Toyota Corolla was totaled when the car crashed into a barrier on the side of the highway Continue reading

High Blood Pressure – The Hidden Killer

by on August 5, 2014

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On April 12, 1945, President Franklin D. Roosevelt was sitting in his living room having his portrait painted by artist Elizabeth Shoumatoff, who later became most renowned for “Unfinished Portrait” of FDR. Also present was Lucy Mercer, Eleanor’s social secretary, but most notorious because of her affair with the president. His dog, Fala, and two cousins were in the room as well according to biographer Doris Kearns Goodwin. At 1:00 pm, FDR complained of “traffic pain at the back of my head,” and collapsed, unconscious. His cardiologist quickly arrived and recognized the signs of a cerebral hemorrhage, a type of stroke. One could argue that one of FDR’s visitors that day triggered his stroke, but it is much more likely that years of untreated high blood pressure led to FDR’s demise at the age of 63.

High blood pressure or hypertension still remains a hidden killer at large. It is estimated that high blood pressure kills approximately 1000 Americans each day due to its effects on Continue reading

Fitness Tip: Bosu Squats

by on April 7, 2014

Utilizing a BOSU helps to engage a number of muscles that might get overlooked in a normal workout. Standing on the BOSU requires balance which works your core. Add in the squats to work your upper legs while giving your core a good workout.

This fitness tip is presented by PJCC Personal Trainer Cynthia Newman.

Video by Teddi Kalb

Rule No. 1 – Warm Up

by on March 3, 2014

We all should know the importance of warming up before a workout. Your body needs to prepare your muscles and joints to withstand the added pressure and to avoid injury. Get your body ready for your workout with this multiple joint warm-up.

This fitness tip from PJCC Personal Trainer, Herman Chan.

Video by Teddi Kalb

The Secret To Being Happy

by on February 27, 2014

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It’s not surprising that many people these days are stressed or, dare I say, unhappy.

Take a newspaper, for example.  You’ll find negative, and downright depressing, headlines regarding the state of our government, the environment, even the economy.  It’s license enough to put anyone in a funk.

So what’s the secret to being happy?

The answer is far simpler than you would think.  According to NYU professors, Lerner and Schlechter, the secret to happiness is not one singular secret at all, but rather a series of proactive choices you make to fill your life with joy and meaning. Now for many of us, knowing how to identify those decisions can be difficult.  But the field of positive psychology has shown that the following positive interventions can help give you that “happy” head start:

Conscious Acts of Kindness: Hold the door open for someone, stick a dime in a meter about to expire, volunteer to wash the dishes for your spouse or parent.  These acts may seem small, but they reap big benefits.  According to Lyubomirski, Sheldon, & Schkade’s research in 2005, five acts of kindness during one day can contribute to people feeling much happier – with those feelings lasting for several subsequent days.

Gratitude Visit: Take stock of what you have in your life worth being thankful for.  This can be done in a multitude of ways: Keep a daily gratitude journal in which you write down three things you are grateful for or write a gratitude letter to someone you care about.  Researchers found that actively exercising gratitude significantly raised levels of happiness and lowered levels of depression (Seligman, Steen, Park, & Peterson, 2005).

Exercise: This is a no brainer.  Aside from the physical benefits, exercise also releases neurotransmitters in the brain that enhance mood and act as a natural antidepressant, making exercise the ultimate stress reliever!

Meditation & Mindfulness: Part of the reason why a lot of people are so stressed these days is the busy, hectic schedules we keep.  We’re multi-taskers, which after awhile can tax our mental well-being.  Meditation is a phenomenal way to quiet the “noise” in our minds, to better connect with our bodies and to become more aware of our present.  It also has been shown to improve one’s stress reactivity and recovery, attention, concentration and positive affect.  If you are unsure of how to best practice meditation and mindfulness or want to meditate with a group, the PJCC offers mindfulness meditations led by our own Rabbi Lavey Derby, Thursdays from 1:30-2:30 pm.

Now, go on.  Try something!  You can’t guarantee happiness will happen organically. So start small and see if you find yourself with a smile on your face.