<\/p>\n
Q: How is spinal stenosis different in the upper back and the lower back?<\/p>\n
The principles are similar but there is an additional factor of concern, meaning when we go back to the anatomy lecture, there\u2019s that one additional structure that runs through that central canal that is more important than any other nerve and that\u2019s the spinal cord. On one end of the spectrum the key component is to make sure that spinal stenosis does not going to\u00a0 point where it is affecting the spinal cord, it starts causing issues with balance, with bowel and your bladder. Having said that the idea in principle is very similar when we were talking about equating issues with the neck and the shoulders versus your back and your hip flexibility. We see very commonly, we share patients quite a bit, that have issues of both the neck and the shoulder and they\u2019re tough nuts to crack because you got to address them both together. The idea is that you can have rotator cuff tear and a little bit of a quote unquote, pinched nerve coming from your neck and one influences the other and biomechanically you need to address both. But which do you address first? Is there a surgical repair that needs to be done on that shoulder as you keep putting pressure on your neck? Or does the neck need to calm down and then you can do a rehabilitation program that addresses both together?<\/p>\n
<\/p>\n
Q: What is that about sleeping on the side that is not good?<\/p>\n
Not that it\u2019s not good. It\u2019s just when we lie on our side we have a tendency to kind of curl up in a fetal position and in fetal position you are bringing your knees closer to your chest and that has the same principle of sitting in a chair where the muscles, the hip flexors can tighten down through the night. Now people ask me all the time \u201cWhat position is best one to sleep in? What kind of pillow should I get? Should I spend $9000 on a [inaudible]?\u201d And I\u2019m like \u201cAre you doing your exercises? Why don\u2019t you start there?\u201d But the idea is this, you want to try and sleep comfortably. Don\u2019t try and force yourself into a position because that\u2019s the right one for you. But there\u2019s certain things to think about and the bottom line is that when we\u2019re talking about the neck, you want to be in relatively neutral position. The pillow, if you\u2019re a side liner, if you think about it needs to be a little bit bigger in order to keep you in a neutral position versus if you\u2019re lying on your back you need a relatively smaller pillow to keep you in a central posture position. The back itself is different. Nothing is good about sleeping on your stomach. That is the only [inaudible] out of all of this. I used to love to sleep on the stomach and it\u2019s just not good.\u00a0 But the idea is that when you\u2019re sleeping on your side you can have a tendency to get those hip flexors a little bit tight. That\u2019s kind of an issue.<\/p>\n
<\/p>\n
Q: How much calcium is recommended for an adult male?<\/p>\n
It\u2019s the same dosage for men and women. Its\u2019 a 1200 to 1500mg a day of calcium and there\u2019s basically two forms: calcium carbonate also known as OsCal and calcium citrate also known as Citracal. The calcium citrate is easier to digest and tends to produce less gas, which I can tell you from personal experience as we get older, is a good thing. What I tell patients is go to the drug store and find an OsCal or Citracal and right next to it will be the store brand which is just as good and costs half as much. 1500mg of calcium a day and 800 units of vitamin D.<\/p>\n
One thing that I was told, maybe you can [inaudible] on this, is in my understanding and I\u2019m no osteoporosis expert, but I understand our gut can\u2019t absorb more than 500 or 600 of the calcium in one sitting? You actually need to split it up throughout the day?<\/p>\n
It is better to split it up, to do it that way. Unfortunately most of us have a hard time remembering to take something more than once a day but from a physiological point of view, yes, it\u2019s better to split it up.<\/p>\n
<\/p>\n
Q: Do pillow wedges or support braces help relieve night back pain and discomfort?<\/p>\n
Yes, so here\u2019s the thing today, you know, I do tell patients to get relief from their back symptoms to sometimes do that. I think that\u2019s more to get things to calm down in the acute stage when you\u2019re experiencing a flare. But in general, once again, you don\u2019t want to be doing that every night because the idea and the component is the same. You are facilitating those flexibility issues, such that then during the days as soon as you wake up and start to stand up those muscles have been tightened down all night long. But it does, the same principle of \u201cOh, my back\u2019s bothering me let\u2019s go sit down.\u201d And it opens up that canal. So that\u2019s why you can get through relief that you get. Less pressure\u2019s put through the spine when you\u2019re in that position.<\/p>\n
<\/p>\n
Q: When confronted with a sport\u2019s related injury\u2026would you recommend heat or ice?<\/p>\n
Usually from my experience, acute injuries, when you\u2019ve just hurt something, ice is always the answer. 3 days of ice is pretty standard. Even after you\u2019ve done running and something\u2019s sore, ice is an anti-inflammatory and analgesic, it means it decreases the swelling plus it makes it feel better. Heat generates blood flow, swelling. It can actually make thing stiffen and hurt more. Heat is sometimes more chronic lower back kind of thing. Dr Kooch can answer about that but in general I almost always universally say that if it\u2019s hurting, I go with ice.<\/p>\n
I never go with heath, with one exception, prior to exercise. You\u2019re trying to relax the muscle, get things to loosen up a little bit, so that you can do the exercise but I feel the same way. The literature and this is where the problem is, and why you\u2019re asking the question because you might talk to and get 3 doctors to say ice and 3 doctors to say heat. My principle is the same, we\u2019re trying to reduce inflammation and ice is a natural anti-inflammatory. To complement the deduction they were trying to achieve with anti-inflammatories, I stick with ice. In general I leave any heat application to whatever therapy I\u2019m getting a patient into whether it\u2019s chiro initially or a physical therapy.\u00a0 Targeting that area for a purpose then always follow with ice after wards.<\/p>\n
<\/p>\n
Q: Is there a fitness program or machine that would work best to keep me in shape?<\/p>\n
It\u2019s between your ears. It\u2019s educating you about what your body needs. I want you to understand what your problem is. Where is your problem? Where your flexibility issues are? Where are your strength issues? When you go into a gym, you already have a basic routine that you can do without a lot of equipment. But then there\u2019s a lot of equipment that\u2019s out there. There\u2019s not just one piece of equipment that can take care of all your problems. Each of these pieces of equipment have a different, you know goal. The idea is that if you understand the principle of what you\u2019re trying to achieve to reach your goal, you can use that equipment whatever way you need it. In other words, if you understand that you should be thinking about postural awareness during a certain activity, then if you are keeping your postures correct, then you\u2019re safe and you\u2019re actually building up the muscles the right way. I always use the analogy of wading into the shallow end. You don\u2019t just go into a new gym and try every piece of equipment in the place. It\u2019s what happens with Curves. \u00a0Not that I have anything against Curves but you\u2019re kind of forced to do x, y and z instead of your body telling you what you should do. <\/em><\/em><\/p>\n I like Curves because we get a lot of patients from Curves. Zumba too. You probably want to do activities that are lower impact. You are going to be better on perhaps an exercise bicycle, or an elliptical, or a Nordic track than a treadmill. If you\u2019re going to use a treadmill you want to go low and slow rather than crank up the elevation. If you\u2019re going to use a weight type machine, just because you could bench-press 400 pounds 20 years ago, that\u2019s probably not where you need to start. You need to start very low and go up in maybe 10% increments every couple of weeks. And then you can avoid having to see one of us.<\/em><\/em><\/p>\n Cross training is important too. Don\u2019t just fall in love with one machine. [inaudible] that\u2019s all you do. You got to cross train and I think exercise physiology has changed a lot since the days of arm curls and dumbbells and light presses. Now I think things are a lot more core strength [inaudible] that\u2019s even more important and that has a lot to do with a lot of cross training and not doing the same thing over and over.\u00a0 That goes not only for the aging athlete but then year olds that we see constantly that decided that soccer is their sport at ten and all they do is play soccer 24 hours a day, 365 a year. That\u2019s a whole other topic for a whole other group but it has to do with the same idea of cross training and not doing the same sport or the same activity as your only exercise. <\/em><\/em><\/p>\n \u00a0<\/em><\/p>\n Q: Is there a test to detect what joint needs to be addressed first?<\/em><\/em><\/p>\n I think any of us has enough training and enough know how on an initial evaluation. Go through a reasonable checklist of the areas where the problems are and even based on just the history trying to determine \u201cHey listen, let\u2019s start picking [inaudible] in this area first\u201d because of a concern stand point. Really, that\u2019s the key thing. It\u2019s from a medical stand point. What area is of greatest medical concern? If you have just back pain, quote unquote, just back pain as we\u2019ve talked about, then the nerves are not involved. But your arm is not able to lift up above this area. Obviously your shoulder is going to be of more concern because you might have torn a rotator cuff. The idea is that any of us should be able to go through a reasonable checklist to try to determine, with you, about the right course of treatment. The idea is that if there\u2019s a back issue, these guys will send them to me. If there is an issue with a shoulder or knee, I send them back to these guys.<\/em><\/em><\/p>\n \u00a0<\/em><\/p>\n Q: Kettle bells for a person that needs to build up their back and stomach muscles. They are bad?<\/em><\/em><\/p>\n It depends on how you\u2019re doing it and how much you do it. Things like that are difficult because it\u2019s really how you do things more so than what you do. In other words, additional resistance, if I understand what a kettle bell is [inaudible]. The idea is that additional resistance [inaudible] in\u00a0 lot of the exercises you can do you don\u2019t even need to use additional equipment like that to kind of get the same results. It\u2019ll be safer. <\/em><\/em><\/p>\n \u00a0<\/em><\/p>\n Q: Is a treadmill better than walking outside?<\/em><\/em><\/p>\n I would actually say that a treadmill is better because they usually go with padding and so it\u2019s going to absorb a little bit of the impact. Whereas outdoor walking we do that most of the time on pavement which absorbs no impact. The other advantage of a treadmill is, if 10 minutes into your workout you\u2019re having pain if you want to stop, you\u2019re fine. If you\u2019re outdoors and you\u2019ve decided you are going to do a 2 mile walk, and 10 minutes out you realize you have to turn around and go back home, you\u2019ve got another 10 minutes to do that. I think that a treadmill is a more controlled environment and is more environmentally controlled in terms of temperature.<\/em><\/em><\/p>\n If you do the grades you are increasing the stress on the knee, particularly that<\/em> patellofemoral joint that I\u2019ve talked about which is more important in women. Lower elevation, you\u2019re better off. <\/em><\/em><\/p>\n \u00a0<\/em><\/p>\n Q: Free-weights versus machines?<\/em><\/em><\/p>\n It\u2019s the same type of principle as far as the kettle bells are concerned. I\u2019m a big advocate of trying to do activities and exercises that don\u2019t involve even you having to go to the gym, using your own body from resistance standpoint. In general, there\u2019s distinct advantages to each of them and disadvantages to each of them. Free weights in general I like them because they are free weights and the idea is that you can move and do whatever you want to do using those weights and there\u2019s certain amount of balance in what we call proprioception that we didn\u2019t even talk about which is a huge issue when we\u2019re talking about aging population. Strength is why we lose battles. If you don\u2019t use it you lose it. The free weights can be an avenue to address that. Now, it can get you into some problems if you\u2019re doing too much or you lose your balance. And that equipment, you\u2019re usually sitting down and you\u2019re safer sometimes by doing so. You lose some from that proprioceptive balance stand point but there\u2019s a safety factor that is not replaceable. <\/em><\/em><\/p>\n \u00a0<\/em><\/p>\n Q: Stop the running, start jogging or start to walk? Is it all functionality?<\/em><\/em><\/p>\n There\u2019s really no good studies that say that runners let\u2019s say get more arthritis than non-runners. I think you listen to your body. Instead of running marathons maybe you cut down to half marathons or just have a slower pace. There\u2019s not a hard and fast, \u201cAt 50 you can run, at 60 you can jog, at 70 you should be walking.\u201d If you have been a runner, don\u2019t give it up. If at 70 you decide you want to run, maybe you ought to rethink that.<\/em><\/em><\/p>\n \u00a0<\/em><\/p>\n Q: When should I ask my doctor about physical therapy?<\/em><\/em><\/p>\n It\u2019s hard to individualize these things because, we both talked about it, if you have meniscus tear and nothing else, no arthritis\u2026[inaudible] That\u2019s a difficult answer for us to give without treating he whole person. Arthritis pain overlaps with the meniscus pain. Sometimes you can get meniscus pain better with certain procedures and arthritis pain with other things. Pretty hard to individualize on which to go. Therapy is never a bad thing. Therapy is always good for multitude of reasons. It gets you moving and stronger and things more flexible but then again therapy isn\u2019t the answer for every problem either. <\/em><\/em><\/p>\n Thanks everybody. \u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Q: How is spinal stenosis different in the upper back and the lower back? The principles are similar but there is an additional factor of concern, meaning when we go back to the anatomy lecture, there\u2019s that one additional structure that runs through that central canal that is more important than any other nerve […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/163"}],"collection":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/comments?post=163"}],"version-history":[{"count":1,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/163\/revisions"}],"predecessor-version":[{"id":164,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/163\/revisions\/164"}],"wp:attachment":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/media?parent=163"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/categories?post=163"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/tags?post=163"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}