My dear friend Tannis Kobrinsky is featured in this month’s issue of Pilates Style Magazine. If you are interested in some great Pilates mat exercises (and who isn’t?), check it out.

Pilates Style article

Ready, Set, Walk! is the name of the article written by Karen Asp. I wrote the actual walking routines (one for AM, one for mid-day, and one for PM) and Karen wrote the article. In the January Issue of Woman’s Day – page 70.

Is my back pain all in my head??? I have patients ask me that question all the time.

Pain signals are processed in the brain – so it has to be involved somehow. Research has, in fact, linked anxiety and depression to back pain. But what comes first, the depression or the back pain?

Certainly either scenario is possible. You are depressed; you walk around slouched with no energy; you stop exercising and taking care of yourself. That is a recipe and a precursor for a back problem. But pain is depressing and often the psychological component occurs because of the back problem. A recent study found that 42% of people with back pain where depressed PRIOR to the onset of pain, while 58% became depressed AFTER the onset of back pain.

Depression is a reaction to feelings of hopelessness. So whether your depression came on before or after back pain, you are feeling a lack of control over your life – your job, your body, your financial situation, your relationships. The key to improving your back symptoms and your emotional state lies in your ability to re-kindle your sense of control and personal power. This is why I think life coaching is such a wonderful tool for people with physical pain. I’ve personally worked with a couple of life coaches over the years and The Handel Group is a coaching company that I highly recommend. The coaches at The Handel Group can help you understand how your reaction to life events creates stress, not the events themselves. Therein lies the control. You can change your physical and emotional response to stress by changing how you think about stress. The Handel Group will guide you through that process.

So is back pain in your head? Can you improve back pain with your mind? Well, sort of… You can change the way you respond to stressors in your life thereby decreasing your back tension and flare-ups… and improving other aspects of your life while you are at it.

To find out more about The Handel Group and to contact them about private or group life coaching go to www.handelgroup.com. If you tell them Chantal sent you, they will give you a discount on your first trial session. There is even a free, group session on August 13^th. Their website has more details.

A lot of people experience back pain AFTER (not during) a stint of driving. Usually this has something to do with the way they are getting out of the car. When you turn and put your left leg on the ground and push off with your right leg to get out, there is a tremendous amount of torque and compressive stress at the knee, hip and sacrum on the right side.

To avoid this problem, try this…when getting out of a car, imagine that you are wearing a very short and tight mini-skirt (come on guys, it’s just pretend!). Swivel both feet out of the car before you get out of the seat. It is a lot easier on your back.

Here is a quick tip for the day. If you are having back pain or hip pain during or after driving, this blog is for you.

When driving, make sure that your seat is up close enough to the steering wheel. If your seat is too far back, you will have to round your spine (slouch) in order to reach the gas peddle. This causes stress on the discs and spinal muscles. Pull your seat up closer to the peddle so that your knee is slightly bent and you can access the gas without straining your back.

Well, here we are…It has been OVER one year since I have been able to blog. The reason? It is not that I ran out of things to tell you – never! It was some kind of technical difficulty; I couldn’t log in to write.

So a special thanks goes out to my Techie friend, Johnny, who fixed the problem for me. I am now back in action and ready to talk about all things wellness, physical therapy and pain prevention.

First, let me say that during my year of blog hiatus due to technical difficulties, I was busy shopping around for a distribution company for my KNEE PAIN DVD. I am happy to report that, as of December 2008, my DVD will be in stores and will be distributed by GAIAM. It will be available for purchase on this website as well as anywhere GAIAM sells DVDs (Amazon, Barns and Noble etc…). I am really happy with the way the DVD turned out and I think it will help a lot of you out there who have been contacting me about your chronic knee pain.

When I was 5 months pregnant with my son, I started having terrible back pain. It came on suddenly and was with me long after my beautiful baby was born. As a physical therapist, you would think I would have been able to treat myself back to a pain-free state. Despite even several tries by my colleagues, the pain persisted long after my son’s first birthday. It wasn’t until one of my colleagues, a woman’s health specialist, tested my abdominals for something called a “diastasis recti” that I was finally able to successfully treat my back pain.

Diastasis Recti Defined

A diastasis recti is a separation of the rectus abdominus muscle (the 6-pack abdominal muscle). It generally occurs during the 2nd or 3rd trimester of pregnancy and can cause moderate to severe low back symptoms.

How To Test Yourself For a Diastasis Recti

It is always best to have a trained health professional, such as a physical therapist, check you for a possible diastasis. Here is a general way to check for yourself though.

• Lie on your back with your knees bent
• Place one hand behind your head and, with the other hand, place two fingers just above your belly button.
• Do an abdominal crunch by lifting your head and shoulders off the floor
• Feel if there is more than a two-finger separation of the abdominals during the mini-crunch movement.
• Do the same separation test 2 inches above and 2 inches below the belly button.
• Anything over 2 fingers-width separation is considered a diastasis recti and should be treated.

Treating a Diastasis Recti

The good news is that a diastasis recti is easily treatable (there are a few severe cases that require surgery, but most are treatable with one exercise).

The exercise is simple:

• Place a towel (folded lengthwise) on a mat and lie down on the towel so that the towel wraps around your middle (at the umbilicus level).
• Cross your arms and grab each end of the towel
• As you do a mini-crunch, exhale and pull each end of the towel. Because your arms are crossed, this will have the effect of squeezing the towel tightly around you and essentially encouraging the rectus abdominus muscle to close completely.
• Hold that position for 2 seconds then lower your head and shoulders back down to the mat.
• Repeat 20 times at least once a day.

I began doing the “diastasis towel exercise” and had improvements in my back pain within 4 weeks. In 6 weeks, my three-finger-width separation had been reduced to a one finger-width separation. Now, if I feel the pain returning, I do the exercise for several weeks and the pain disappears completely.

Now that I have covered when to ice an injury, here is a tip on how to ice. You can always use a bag full of ice cubes, but they tend to be too bulky to contour any given body part. Frozen peas work a little better, but here is a recipe that works the best (and is much cheaper than the professional gel packs you can buy).

1. Fill a large Ziploc baggie with 3 cups of water and 1 cup of rubbing alcohol.
2. Before sealing the bag, release any excess air. Shake the contents together and place in the freezer for three hours. (It is best to double bag in case of leaks).
3. When you are ready for your ice treatment, place a towel or washcloth between your skin and the baggie.
4. When you are finished icing (after 10 minutes), place back in the freezer to re-freeze and use it again when needed.

I found this “recipe” in the August 2004 edition of runnersworld.com and tell my patients about it all the time.

As soon as people find out that I am a physical therapist, they inevitably start telling me about their aches and pains AND they ask me the BIG question: “When should I use ice and when should I use heat?” It makes for great cocktail conversation!

Here is the skinny…

Ice should be used immediately after an injury and for the 48-hour period following an injury. It should only be applied for 10 minutes at a time. Ice will help to decrease inflammation.

Heat should be used for more chronic problems and can be applied for up to 20 minutes at a time. Heat will help to minimize muscle tightness and spasms.

Now, here is where things get a little more complicated. If you are having an exacerbation of a chronic problem, then ice is appropriate. If you have any orthopedic problem ending in “itis” then ice is best, especially after you participate in any activity that makes your “itis” unhappy. For example, If you have shoulder bursitis or knee (patellar tendon) tendonitis and you have just finished playing tennis, ice that knee and shoulder after your game.

Another exemption to the rules: If you are using those “THERMAcare” heat packs that you can get at any drug store nowadays, you can heat for longer than 20 minutes. These packs are great to use while you’re sleeping and will stay warm for up to 6-8 hours. I often recommend these disposable heat packs to patients with chronic neck or back pain.

Now that you are up on the heat/ice issue, if we ever meet at a cocktail party you won’t have to ask me about that. But I would be more than happy to hear all about those aches and pain! As long as I can tell you about mine too!

It is a “Catch 22″; lose weight and your knees will feel better, but to lose weight you must exercise and that makes your knees ache. The heavier you are, the more stress is placed on the knee joints as you move. But move you must to solve the weight problem.

The best solution?

Start with the knee exercises and stretches that I recommend on this site. They won’t help you lose weight, but they will help to balance the muscles around the knees and will, ultimately, allow you to participate in any cardiovascular type of exercise (which will help you lose weight).

Try aerobic exercises that don’t place stress on the knees. Try swimming or water aerobics to start. Then move to a stationary bike (just make sure to position your seat up high enough so that your knees are relatively straight as they complete each cycle.) The Elliptical machine is a good next step as it affords a great workout with little pounding or stress on the knee joints. And by this time, you have probably lost enough weight that walking or even running on a treadmill won’t aggravate your knees.

Remember that for every 11 lbs. you lose, your knee symptoms will be 50% better! So find a low impact form of activity that works best for you and keep on moving!