pain

Weight Loss After The New Year

/ Thomas Cohn, MD

weight loss doctorThe new year is here, and for many people, now is a time of a renewed attitude towards weight loss. For years, there have been countless pages of advice written about weight loss and dieting. There are more experts than one could believe, and everyone is willing to dish out advice. As our knowledge has grown more recently, weight gain and loss just seems to have become more complex. The advice used to be simple, calories in vs. calories out, and you could determine weight changes. If life were only so simple.

Weight Loss In Today’s Society

A recent article in the newspaper thankfully sheds more light on weight loss. The best advice may be simple – go see a doctor of medicine that specializes in weight loss. The reason for such advice is there are so many issues that can affect a person’s weight and a comprehensive analysis is often necessary. The more we try to help people with weight loss, the more factors we find that affect weight. No two people are alike. Some people will gain weight on low calorie diets, and we all know people who can eat just about anything and not gain weight. We do know that there are many factors and genes in the body that contribute to our body shape and metabolism.  

Obesity can be caused by many things, and what we eat is just part of the story. Medications from various heart drugs, to antidepressants and even some pain drugs can contribute to weight issues. Medical conditions such as diabetes, thyroid dysfunction, heart and lung disease, as well as abdominal conditions and depression all may affect our weight. Since many medical conditions directly affect our weight as well as the drugs we take, having a medical expert on obesity help design a program to control medical problems associated with obesity is often a first step.

Weight Loss Steps

The next most important step is probably taking a close look at oneself, and trying to understand personal factors that may be contributing to weight. These factors include the obvious, like our diet, especially what we eat, when we eat and how much we eat. Activity level is also a crucial factor. An inactive body does burn some calories, but being more active does increase the amount of energy used. Soft factors also contribute to weight, such as stress, anxiety, and how much we sleep.

Once we identify factors contributing to our weight, we need to make changes that are sustainable. Many diets fall into the category that are unsustainable, since they rely on one eating only packaged food from a special company. Changes do not need to all happen at once, as slow implementation fives the body time to make adjustments. Simple things like getting a good night of sleep, eating regular meals and taking a few minutes to exercise can make a big difference. Also, find a way to be accountable to either oneself or to another person. Being accountable tends to make a person more responsible.

Weight loss is extremely complex. There are many factors that contribute to a person’s weight. It takes a degree of dedication and the ability to understand what is happening in your body to facilitate weight loss. For the lucky, weight control is just a small amount of effort, while for others it often becomes a life long challenge. Seeking good medical advice is beneficial for any person looking to drop a few pounds.  

Managing Chronic Pain During The Holidays

/ Thomas Cohn, MD

Chronic Pain HolidaysThe holidays can be a wonderful time of year, but they can also be a time of stress, especially if you have to deal with chronic pain. Whether your pain is in the form of low back pain, arthritis or pulsing headaches, pain can make the holidays nearly unbearable. However, you can make the pain a little more manageable if you keep a few tips in mind. Today, we’re going to share four tips for keeping chronic pain under control during the holiday season.

Chronic Pain and The Holidays

Here are a few tips to keep in mind as the holidays approach.

1. Share Duties – No matter what you’re doing, be it wrapping presents, shoveling the driveway or cooking a Christmas feast, always recruit some helpers to take the burden off your body. Standing on your feet or over stressing your back can all cause inflammation to flare up, making pain worse. Always see if some friends or family are willing to lend a hand when you have a lot on your plate.

2. Travel Comfort – Whether you’re driving home from college or flying across the country to meet up with loved ones, if you aren’t prepared to travel, chronic pain can be exacerbated by the extended period in one spot. Consider these tips when attempting to keep chronic pain at bay when traveling:

  • Stand up and stretch during stops or when allowed to move about the cabin.
  • Pack a pillow to help you get comfortable in your seat.
  • Request a seat that will give you the best chance to get comfortable (aisle, captain seat, etc.).
  • Leave early so you can hit rest stops if need be.

3. Exercise – Exercise can not only help us relieve stress during the holiday season, but it can also prevent chronic pain from bubbling to the surface. Exercise helps oxygenated blood circulate through our bodies, which helps keep them in good working order, and exercise can release endorphins in your brain, which can impact our mindset and push away chronic pain triggers. If you’re feeling overwhelmed by the holidays, jump on the treadmill for a quick run.

4. Eat Right – This is one especially difficult to do during the holidays when gingerbread cookies and candy canes are bountiful. As we’ve stated on the blog before, junk foods, especially foods that are high in saturated fat and sugar, can trigger inflammation in our joints. Coupled with the cold weather, these inflammatory flare ups can trigger the onset of chronic pain. We’re not saying you can’t indulge here and there, but work in some fruits and vegetables between snacks to ensure your body is getting the right amount of vitamins and nutrients.

Core Strengthening And Back Pain

/ Thomas Cohn, MD

Core StrengtheningIf you have had low back pain and have done physical therapy, you’ve probably been told about the benefits of core strengthening. The muscles that keep the spine stable are those known as the core muscles. These include the hip musculature, the large and small muscle along the spine, and the abdominal and pelvic muscles. When a person normally does strength training, the core muscles are often not included in an exercise program. Without specifically focusing on these muscles, they are often weak. Working the core muscles often is hard because it takes special exercises, they are boring to do, and sometimes it is hard to tell if you are working the correct muscles. Further, when going to physical therapy, many people are given fifty exercises, they all seem to be the same, and they take too long to get done in a reasonable amount of time.

A good core strengthening program can be done by just about anyone in about 15 to 20 minutes. If you have had low back pain, doing core strengthening combined with general muscle strength training should be done three times a week. This will be necessary to build and maintain the muscle function, and should decrease the overall pain level felt by a person. The nice thing about core strengthening is that it does not require expensive or significant amounts of equipment. For many people core strengthening can be done with no equipment. Helpful equipment would include 1.5 pound each ankle weights, 3-lb. hand weights, an exercise ball, a balance board, and rubber tubing with handles and a door loop to secure it in a doorway.

Core Strengthening Exercises

The first set of exercises does not require any equipment. Weight can be added to the ankles and the 3-lb. hand weight when it becomes too easy. Planks engage the whole body and especially the core muscles. A plank is done like a push-up, but one holds the body stiff like a straight board, instead of the arms straight, lean on bent elbows, and hold the position for 30-45 seconds, take a break then repeat. Making it harder, try holding the plank on a balance board, as this will make you engage the muscles to keep you from falling to the side. One level higher includes side planks, keeping the position on one elbow and leg on your side, hold on each side again for 30 seconds. Adding side leg lifts increases the challenge as does adding in ankle weights.

Superman

The next exercise that is easy to add is the “superman”.  In this exercise, you are on the floor on your hands and knees. From this position, stretch out one arm and the opposite leg, get them fully extended, reach as far as possible, and hold it for 5-10 seconds, keeping the back level. Switch and do the other arm and leg, and do a series of seven to eight of these. This exercise is good at working the small muscles along the spine and leg as well as arm muscles. When it becomes easy, strap on ankle weights and use the 3-lb. hand weight.  

Crunches & Leg Lifts

The next group of exercises is the one many people hate. Abdominal crunches and leg lifts. Abdominal crunches are like the old fashioned sit-ups, but one does not sit up at all. Lying on your back with your legs bent and feet flat on the ground, place your hands behind your head and start to bend forward at the waist tightening up the abdomen. There is no rule on how many crunches to do, but do as many as needed to make the stomach feel like it is working. Combine straight crunches with twisting to each side, as this allows one to make sure that you work more of the abdominal muscles, especially the obliques. The other good abdominal exercise is doing leg lifts. Again, lying on the back, but with the legs straight out, lift them off the ground 6-12 inches and hold them there for 10 seconds.  Making it tougher, spread the legs apart and hold them after having them together.  If it’s still not hard enough, add the ankle weights and do the exercise. Do a series of seven of them.

Working the small paraspinal muscles that connect level to level in the spine seems one of the hardest areas. Rubber tubing and bands seem to be an easy way to activate these, and to be able to feel them when you are engaging the correct muscles. Rubber tubing of different strengths with handles for each end and a doorway anchor (a nylon loop to thread the tubing through and an enlarged end, when placed between a closed door, this is a secured hold for the tubing) is great for these exercises. There are only a few exercises to with the tubing, but it is easy to feel you are working the back muscles. First, place the anchor in the top of the door, face the door, grab the handles, step back slightly and pull the handles down and hold for several seconds at your waist then slowly release the tension, and do seven of these. Turn around with your back to the door, take a small step out, hold the tubing with the elbows bent to the chest and slowly bend forward, hold the position and then slowly return to standing upright. The forward bending puts traction on the lower spine as well as makes one activate the muscles. Also with your back to the door, you can have your arms fully extended forward and bring the arms down in front of you, also activating lower spine muscles as well as arm muscles. Once those exercises are mastered, you can add in placing the anchor in the side of door frame at mid to lower chest level, and do arm exercises facing the door and away. These will work the arms, chest, mid and low back muscles. Doing a series of seven of each exercise often will only take between 5-10 minutes and does a very good core and upper body workout. Tubing is extremely portable and can be easily taken with you and used when traveling to keep up the exercise program.

Core body strengthening is relatively easy and does not require a lot of time or equipment.  A physical therapist often will give you too many exercises, but just choose some and do them. A rounded program hitting the major areas often can be done in a very short amount of time, three times a week. It does not need expensive equipment and can be done at home or when travelling. Feeling better takes the commitment to do the work. The simple stuff like exercise works the best to control pain, but it is up to you whether you will succeed.

Preventing Chronic Pain When Shoveling

/ Thomas Cohn, MD

Chronic Pain ShovelingA big snowstorm is coming our way, and odds are you’re going to need to bust out the shovel or snowblower when it’s all said and done. Moving all that snow is never easy, but it can be an even bigger headache if you’re also dealing with chronic pain. Today, we’re going to share a few tips for how to effectively move snow without triggering a chronic pain flareup.

Chronic Pain and Shoveling

Keep these tips in mind the next time you have to head out and shovel snow:

  • Warm up your body before you head outside. Do 5-10 minutes of light stretching exercises to ensure your muscles are warm before heading outside.
  • Grab a friend. The more people helping to move snow, the quicker the job will get done.
  • Take frequent breaks. Don’t try to get everything done in one session, because if you overwork your muscles, you’re more likely to trigger a chronic pain flareup.
  • Practice proper lifting techniques. Try to push the snow off your driveway instead of lifting and throwing it, as that can lead to back problems. When bending, bend at the knees, not the waist.
  • Stay warm. Cold weather can trigger inflammation in our joints. Put on enough layers so that you’ll stay warm when shoveling, and head inside to heat up if you start to get cold.
  • Take an anti-inflammatory medication like ibuprofen prior to heading outside to shovel to help keep inflammation at bay.
  • Invest in a snowblower. They can be pretty pricey, but if they help prevent painful flareups, they are well worth the investment.
  • Talk to your doctor. If you are dealing with a specific chronic pain condition, talk to your doctor to see if they have any other specific tips for preventing chronic pain flareups while you’re removing snow from your driveway and sidewalks.

Stay safe this weekend, and follow these tips before you head outside to shovel!

Understanding Nonspecific Low Back Pain

/ Thomas Cohn, MD

nonspecific back painA recent reading in a new issue of one of the many medical journals that showed up at my home was an article on the management and treatment of low back pain for general practitioners. Usually I hope to pick up an interesting piece of knowledge to add to my treatment regimen, but unfortunately this article was a major disappointment. The focus of this article was on “nonspecific” low back pain. For a person with low back pain, this is the category of everyone who does not need surgery right away since they do not have a huge disc herniation.

Low Back Pain

Low back pain does have many specific causes and detailing the problem leads the practitioner to treatments that may be more effective. It is very important to understand that there are many structures in the low back region that can cause pain. Oftentimes multiple structures may be causing problems and treatment may need to include a number of different things. Solving only one of five problems leaves four issues that may be equal or worse and provide no relief for a patient.

To successfully treat low back pain, a practitioner must fully understand all the structures in the body and how they can contribute to pain. There multiple body parts involved including joints, nerves, discs, muscles, ligaments, bursas, and various organs in the lower abdomen and pelvis that all can contribute to pain sensations. On top of all the stuff in the direct area, the brain also can be an important factor since it is necessary to interpret the sensory signals and their meaning. If there are numerous sensory signals, the brain can short circuit on them and overly amplify the quality of pain. At this point, central sensitization occurs and normal sensory signals in the body can become interpreted as pain; the equivalent of a short circuit is present in the nervous system.

When low back pain is not easily fixed with time, simple medication and exercise, then getting higher level expertise with an expert in Physical Medicine doctor is helpful. Pain experts come in all varieties, but you should stick to those who have the broadest knowledge, since they will be more likely to be able to determine what is actually the problem and develop potential solutions. Many people claim to treat back problems, but only those who take the time to look into your history, to fully look at what has been done as far as diagnostic studies, and to conduct a physical exam will be successful.

The Pain Management Approach

Pain that has not been solved quickly is often a complex problem. Before I see a patient, I try to review their medical history and what has been done for diagnosis and treatment. A patient’s history and story about their problems often is the most important key to understanding what to do for a person. After hearing what the patient thinks is the problem, then a physical exam can often lead to a series of diagnoses. Most of the time, a person can tell me some odd information that is the absolute clue to helping a person with their pain problem. Tailoring the right treatment to a person is where experience is extremely helpful and what determines a successful management strategy. Many people are afraid that they are wasting the doctor’s time. Rarely if ever is a patient wasting my time, especially if they want to get better and are willing to try various treatments.

The human body is a wonderfully complex machine, and answering the question of what is wrong is very hard. Since in the low back, many things can be wrong, simple answers are rare. As people get older, everything in our bodies does deteriorate and degenerate. Some things in the body can be repaired, but many things like the discs and joints in the body show normal degeneration, sometimes by the age 30 or 40. Currently we have no way to reverse aging, and treatment of pain requires managing of symptoms. There often is no way to “fix” the problem, but we can find strategies to manage the symptoms better.