Most Common Causes of Back Pain and Sciatica

Yes. Sciatica can be crippling. Going for a walk with your spouse or playing with your children or grandchildren can easily become something you can’t fathom doing again.

But it doesn’t have to be that way.

In most cases, sciatica is treatable without medications, injections or surgery. The key is figuring out the root cause of your pain and addressing it.

In the past we discussed what sciatica is. We also said that an MRI is often not needed, and sometimes even detrimental.

But how does the sciatic nerve become painful?

There are various ways pressure can be put on the nerve. It can become pinched in between two bones, squeezed in between tight muscles or inflamed if there is inflammation from some other injury.

In this article we will look at one of the most common causes of back pain and sciatica.

Herniated or Bulging Discs.

Although these are not the same thing…they are very similar so we will not go into the technical differences here.

Let’s start by explaining a little bit more about the spine.

The spine is made up of many bones, called vertebrae. There are 33 in all. The top 24 move. These are the Cervical (neck), Thoracic (mid/upper back), and Lumbar (low back). The Sacrum and coccyx are fused together in the very low part of the back so they don’t move.

In between each vertebrae is a disc. This disc is made up of fibers on the outside that give it strength and shape as well as a gel-like inside to give it shock absorption and height make sure the bones don’t bump into each other.

If the gel from the inside start to put pressure on the outside (sometimes caused by weakness of the outside fibers) the result can be pressure on the nerve…which will cause pain.

The key to understanding disc problems…is understanding how the disc is affected by many different factors.

One factor is the position of the body and how it changes the pressure from the disc. Because of the natural position of the spine and the available mobility, different positions will cause different amounts of pressure in different areas. Bending forward will be very different than bending backwards.

Most disc related problems are due to too much pressure being put out the back of the disc, pressing on the nerve.

Positions that cause you to bend forward will push the disc toward the back and increase the pressure on the nerve.

To try and visualize this, imagine a balloon full of water. If you press on the front of the balloon, the water is pushed to the back.

This is basically what is happening to the disc. When you bend forward there is pressure put in the front of the disc so the gel inside is pushed toward the back…leading to pressing on the nerve and causing pain.

The most common situation for this is sitting. When we sit our back tends to round causing more pressure on the front of the spine and pushing the disc toward our back.

If you have pain in sitting…your disc may likely be the culprit.

Another important factor in disc pain is age. The reason for this is simple. As we age our discs become less viscous or, "dried out". This is one of the main reasons we get shorter as we get older. (Nope. That’s not a myth…it really happens. )

For this reason, disc problems are most common in those between 30 and 50 years old.

Does this mean you can’t have a herniated disc if you are over 50?

Of course you can! However, because there is less fluid in the disc, there is naturally less pressure on the nerve so even if the disc is "bulging" it may not be the cause of your pain.

Remember the first point. The pain will be worse with sitting…and get better with standing. If that is not the case for you…your pain is likely not being caused by a herniated disc.

So, in summary. If you are under 50 and have pain with sitting…you likely (though not definitely) have a herniated or bulging disc at the root of your pain.

The good news is, you can usually treat these issues without any invasive procedure (like injections or medications). The right exercises and postural education along with workspace modification can usually lead to complete recovery.

But be careful. The wrong exercise can make you worse…so don’t try to learn this on your own. Consult a physical therapist to confirm your diagnosis and develop an exercise program to target your specific issues.

If you don’t think your pain is due to a herniated or bulging disc…we will cover another common cause of sciatica in our next article.

Do I Need An MRI To Treat My Back Pain?

Before getting into the causes of back pain, I want to address a common question.

If your back is hurting…do you need an MRI before getting treatment?

We live in a world where medical imaging, though expensive, is readily available.

I had some stomach pain. I went to the doctor and he sent me for an ultrasound of my liver and gall bladder. I called the imaging center and scheduled an appointment for the next day. Showed up. Had the test. Done. (Everything was OK thankfully!)

But is imaging always helpful?

In the case of back pain, not only is it not always helpful, sometimes it is actually detrimental.

The 2 most common types of imaging studies done for back pain are X-rays and MRIs.

They are not interchangeable, as each one has a different purpose…and shows different things.

An X-ray is the more basic image. It shows bones. It doesn’t show muscles or ligaments or any other soft tissue. Just bones.

How is this helpful? An X-ray can be used to determine if there is a fracture, like after a fall or if someone has osteoporosis (weak bones).

It can also be used to see if there is arthritis or degenerative disc disease (by looking at the spaces in between the bones) or to rule out cancer.

Of course, X-rays use radiation…which is obviously not ideal unless absolutely necessary.

MRI’s are much more detailed. They show all the muscles, ligaments and tendons, as well as all the other "stuff" in the body.

Unlike X-rays, MRIs don’t use radiation (though they can be loud and claustrophobic.)

Here is where it gets a little tricky.

Most people have something wrong with their back.

You didn’t misread that. Many people have disc problems in their back…and no pain.

A recent study showed that 30% of 20 year olds had bulging discs with no pain. That number climbed all the way to 84% of 80 year olds who had bulging discs with no back pain.

What does that mean?

It means that MRI imaging should not be used to determine the cause of your pain! You may have had a bulging disc for many years that you had no symptoms from. Then your back starts hurting and the MRI shows a bulging disc…which may have been there for years without causing any pain. This might lead you to make medical decisions that are based on the MRI and not based on your actual problem.

How should an MRI be used?

It should be used to CONFIRM a diagnosis that was reached based on your history and physical presentation.

It always amazes me when people come in for therapy and insist their back pain is due to the bulging disc in their back (they KNOW…because they have the MRI to prove it) but their symptoms are not at all consistent with a bulging disc!

So to answer the question "Do I need an MRI to treat my back pain?"

Usually not.

The best option is to see a physical therapist who can diagnose your back pain based on YOU… not a picture. If the therapist determines that more information is required to properly plot the best course of treatment…they will refer you to your doctor for further imaging studies.

What is Sciatica?

If you or someone you love has "sciatica" you are keenly aware of how devastating it can be.

Doing basic things like walking or sitting can become a monumental task simply too difficult to take on. It can truly sap the joy from life and leave you home alone in pain while everyone around you lives their life.

But what exactly is sciatica?

Most people misunderstand what sciatica is so knowing what to do about it is challenging. Once you have a more accurate understanding, you will be able to take the first steps in getting treatment.

First, and most important, Sciatica is not the problem.

Yup. You read that right.

Sciatica is not what is causing your pain. Rather, it is the description of your pain.

Let’s take a step back to get a clear picture.

The spinal cord goes down the back through the vertebrae (bones of the back).

At each level of the spine (i.e. L1, L2 etc.) the nerve branches out to communicate with a particular area of the body. Some of these nerves are for sensation, some are for muscle control…and some are for both.

The nerve roots from 5 levels of the spine (L4, L5, S1, S2, and S3 – each one named for the vertebrae above it) all combine to form one nerve…the Sciatic nerve.

The sciatic nerve is the largest and longest nerve in the body, about as thick as a mans thumb. Starting in the back it travels all the way down to the foot and branches off to various regions of the legs on its way.

Now back to our original point. Pain at any part of the body from where the sciatic nerve starts to where it ends could be called sciatica.

The problem is…that doesn’t tell you where the pain is COMING from…only where it is located.

To make this easier to understand, picture a garden hose. You turn the water on and water comes out the other end. Let’s say no water is coming out. Do you assume the hole is clogged? It may be…but more likely there is a kink in the hose somewhere between where it starts and ends and THAT is where the problem is. Unkink the hose and the water starts to flow again.

In the case of the sciatic nerve, if there is pressure on the nerve it can cause pain all the way down to the foot. That doesn’t mean you have a foot problem! The key is figuring out exactly where the root of the problem is (i.e. the kink in the hose) so you can treat the cause of the problem. Once you do that…the symptom of "sciatica" will go away.

That is why not all back pain is the same…and what worked for someone else may not be the thing that will work for you.

Because the sciatic nerve is so long there are many areas that can be the culprit and a thorough physical exam and history of your symptoms will help your physical therapist determine exactly where your pain is coming from so treatment can be tailored accordingly.

In the next few articles we will look at some of the more common causes of back pain and sciatica.

Sitting…The Right Way

Posture is one of those words that we all “understand” and yet most people can’t actually define.

For starters, let’s define posture.

Posture is the way you hold your body. Yup. That’s it.

Now we can start to get specific. There is good (or ideal) posture and there is bad posture.

This applies in any position. Sitting, standing etc. In this article we will be discussing sitting posture.

Sitting posture is affected by many things including both internal and external factors.

Internal factors are those within your body, such as strength, energy level, postural alignment and habit.

External factors are those outside your body such as the type of chair you are sitting in or the location of the surface you are trying to reach.

Before going into any further detail lets take a look at what proper sitting posture is.

There a few worthwhile points to consider about this sitting posture.

  • His feet are on the floor
  • His knees are not bent too muchHis hips are higher than his knees
  • His back is straight (not leaning back on the chair)
  • His shoulders are relaxed
  • His head is straight and his neck is in line with the rest of his spine
  • These are key factors in maintaining proper sitting posture.

    Now take a look at this person sitting at their computer.

    Note how one leg is bent too much with the other leg crossed over, her back is rounded, shoulders are elevated, neck is forward and head is tilted up. OUCH!

    Sitting with any of these postural changes can lead to serious problems and pain. Things like knee pain, low back pain, shoulder tension and neck pain are common results from prolonged sitting in such posture.

    However, it can often be very difficult to "fix" your posture after years of sitting a certain way. It becomes a habit and we feel uncomfortable trying to maintain correct posture.

    This is not an easily rectified problem. It takes a lot of effort and exercise to retrain your body…but it is definitely worth it.

    Here are some tips to help you correct your sitting posture.

    1. Make sure your feet are planted firmly on the floor. If your chair is too high…use a step stool
    2. Make sure your knees are lower than your hips. An easy way to do this in a computer chair is to tilt the chair forward. If you can’t tilt your chair…consider elevating your seat a little.
    3. Keep your core muscles (abdominals) engaged (just don’t hold your breath!)
    4. Maintain the natural curve of your lower back
    5. Keep your shoulders relaxed
    6. Pull your shoulder blades down and back a little to engage your upper back muscles
    7. Keep your head directly over your shoulders (don’t poke your head forward)
    8. Try and get into this position regularly throughout the day. Even if you can’t maintain it for long, it will help train your body to get comfortable with this position.

      I know. This is a lot to think about and even if you try…you may still not get to that "ideal" posture.

      This is where your physical therapist plays such a pivotal role. Physical therapists are experts in movement and posture and can help you identify not only what your ideal posture should look like, but where you are going wrong and what you need to do to fix it.

      Your physical therapist can help design an exercise program to work on the weak areas that are making it difficult to maintain good posture and give you personalized tips to help you keep your ideal posture and avoid pain throughout the day.

      If you are experiencing any back, neck or knee pain and spend a good part of your day sitting…you owe it to yourself to consult with a physical therapist and get started on the road to improved posture and pain free living.

    When and why did your posture get so bad?

    Patients come to physical therapy for a wide variety of issues. We see everything from neck pain to foot pain and basically everything in between.

    One common issue that people ask about is their posture. Age doesn’t even seem to be a major factor. We have patients in their 20s and in their 80s concerned about their posture.

    After we help someone get into the correct posture they often ask “if THIS is proper posture why is it so uncomfortable?”

    To answer this question we need to start with a basic understanding of the human body, and it’s ability to adapt.

    Our bodies are uniquely able to adapt to the demands we place on them. A good example of this is gaining and losing weight. When someone gains a lot of weight, they don’t explode! Their skin and muscles stretch to accommodate their new weight.

    On the other hand, if someone loses weight their skin and muscles shrink and they aren’t left with tons of excess skin flopping around. (The exception to this is if the weight is lost too fast, as seen with various surgical procedures, then the weight loss happens too fast for the skin to shrink and the result is, in fact, excess skin)

    Let’s apply this concept to posture.

    The more time we spend in poor postural positions the more our muscles adapt to these new positions. As that happens, it becomes more difficult and uncomfortable to get into the proper posture…and stay there.

    Using the same logic, the more time you spend with the correct posture the easier it will be to maintain it.

    But how did our posture get so bad in the first place?

    To answer that we need to go way back to our childhood.

    It is truly amazing to watch a 3 or 4 year old. They sit straight, stand tall and bend down in a perfect squat…every time. No one has to teach them how to squat. They naturally do it correctly. The reason is simple. They haven’t yet learned any IMPROPER movement patterns so their body naturally uses the most efficient, and correct, technique.

    Take a look at the picture of this child bending.

    Then they go to school and it is downhill from there.

    Why? Because they spend their days sitting in a chair, leaning over a desk.

    Then, for the rest of their lives, their default position is sitting in a chair.

    Over time, all this sitting creates weakness in their core and upper back leading them to develop poor movement patterns in everything they do.

    Don’t believe me? Take a look at my 13 year old, Ari, bending down to pick up his knapsack. OUCH! (and yes…we are working on improving his bending technique!)

    They begin to sit slouched over, bend using their back instead of a proper squat, and stand hunched forward.

    Gravity keeps pulling them down and they keep losing the battle, falling into progressively worsening posture.

    It has been said “sitting is the new smoking”.

    While the correlation between sitting and specific disease is not as direct as smoking, the overall effect on the body is catastrophic. Prolonged sitting over years and years leads to poor posture, weak muscles, poor endurance, poor cardiovascular and pulmonary health, back and neck pain (like herniated discs etc.) and countless other physiological changes.

    The greatest shame is that this is SO preventable. The challenge though… is we should be starting to fix this when we are children rather than when we are adults.

    If you are a parent (or grandparent) of young children you can (and should) encourage them to get out of their chairs and stand up! This can apply to play time as well as study time. Studying can just as easily be done standing up and the benefits are huge.

    Some schools have even implemented standing desks, but it is unrealistic to expect every school to do this. As parents we are responsible to teach our children a better way and encourage them to stand up.

    If you are wondering what you can do for yourself or if it’s too late…don’t worry. It is never too late to start improving your posture (although sometimes you can’t completely reverse the effects of bad posture).

    The key is to educate yourself on what proper posture really looks like and what exercises you need to be doing to improve your posture.

    Over the next few weeks we will continue to discuss posture, both sitting and standing, to help you get started on the road to improved posture.

    If however, you are anxious to start on the “straight” path sooner, don’t hesitate to set up an appointment and come meet with one of our therapists who specialize in posture.

    Post Holiday Recovery

    It’s hard to believe but the Holidays are now behind us, putting us in recovery mode. Not only from the extra piece of stuffed cabbage or potato kugel (or both!) at the Simchas Torah kiddush, but also from the added physical strain of dancing while holding the children, cooking and cleaning, and sukkah deconstructing. I’ve been thinking about my own plan to get back on track so I figured I would share my thoughts.

    Much of the activity of the past couple of weeks was far beyond the physical demands of our daily routine. Hours of standing can cause back pain in people with stenosis or knee/hip pain in people with arthritis.

    Building and taking down the sukkah is liable to cause back pain from lifting heavy panels and shoulder pain from hanging decorations and putting up/taking down the s’chach.

    Dancing with the kids on your shoulder can can cause neck pain or back pain.

    All of these take a toll on the body and may have left you sore and achy. If so, you are not alone. And here is what to do about it.

    First, identify the nature of your pain. Do you have sharp pain or general aches? Sharp pain is often indicative of an injury and warrants a trip to the doctor or physical therapist if it doesn’t resolve quickly. Aching, on the other hand, is often a result of simply overworking the muscles. This is the muscles’ way of letting you know they don’t appreciate the abuse, and they will require some recovery time to return to the way they were.

    First, avoid checking the pain. Every time a movement hurts… it is your body’s way of telling you to stop. What that means is if you have the pain every time you bend down to tie your shoe, don’t bend down just to see if it still hurts! Assume it will still hurt now if it hurt ten minutes ago. This will prevent you from constantly exacerbating the symptoms, thereby minimizing the ongoing strain on the muscles and allowing the healing process to take place.

    Next, try using a non-invasive method of dealing with the pain. This means, don’t jump to medication before trying either ice or heat…depending on what is wrong. (Not sure which one to use? CLICK HERE to read the Blog post “Ice Vs. Heat…What You Need To Know To Decide).

    Lastly, a good night of sleep and a healthy diet go a long way to healing the body.

    For a good nights sleep…get to bed early. Aside from giving your body more time to heal you will get many hidden benefits. (Research shows people who get to bed early have an easier time maintaining a healthy weight, worry less, get sick less and look better… not to shabby!)

    Eating adequate nutrition, including the recommended daily vitamins and minerals, helps the body function and heal properly. Eat properly balanced meals of the correct portion size and you will probably get all the macro and micro nutrition you need… including vitamins and minerals.

    Remember, if you have aches or pains that do not resolve quickly see your doctor or physical therapist for further assessment and treatment advice, specific to your situation. Letting these problems linger often leads to additional problems over time.

    Happy recovery!

    A Safety Guide To Sukkah Building

    Sukkos is just around the corner and we have much preparation ahead.

    The sukkah needs to be built and decorated, food needs to be prepared and lulavim and esrogim purchased. With so much on our minds it is easy to forget the physical demands placed on our bodies, particularly in regards to the sukkah.

    The physical demands of building a sukkah usually include lifting, carrying, reaching overhead and looking up for prolonged periods (like when hanging decorations or putting up the s’chach).

    Hopefully, this article will help you avoid some common mistakes to prevent injury and ensure your new year begins with safety and good health!

    Step 1.

    Remove the sukkah from storage and bring it to the area where it will be constructed. This is a simple step from an instruction standpoint but a common area of difficulty from a practical perspective.

    Many of us store the sukkah in the garage. Then, over the course of the year we put things in front of it. Make sure to clear the space FIRST, so you can easily get the pieces out without requiring any maneuvering around obstacles.

    When dealing with panels, wood or fiberglass, be careful not to round your back when you lift them up. This places strain on your back and increases your risk of injury.

    If they are large or heavy…get someone to help you.

    Step 2.

    Unless you are in the construction business you probably don’t spend much time during the year doing activities similar to building a sukkah. Therefore, your body is not ready for a prolonged session of lifting, reaching, holding, tightening etc.

    In order to avoid injury, take breaks in the middle. Your sukkah will be completed whether it takes 2 hours or 3 hours. Taking the extra time up front can save you a lot of headache (or backache!) in the grand scheme of things.

    Step 3.

    Putting up the s’chach. The things to be worried about here are a combination of the previously mentioned concerns.

    The s’chach is often very heavy. It also needs to be lifted to the top of the sukkah and then rolled out (or placed on top one piece at a time). All the lifting can put your back in an awkward position and leave you more prone to injury.

    When possible, have someone help lift the s’chach so the weight is manageable. You may also want to stand on a sturdy step stool to make reaching the top easier.

    Step 4.

    You are ready to hang decorations; especially the beautiful pictures your kids made in yeshiva (don’t forget to cover them!) This usually requires frequent reaching to the higher areas of the sukkah. In order to prevent a shoulder or neck injury from this repeated motion,

    1. Use a ladder or step stool to help you reach where you need to.(Of course, take precautions whenever climbing on a ladder.) The less overhead reaching you do…the better.
    2. If you are reaching overhead…try to keep your arm in the "thumbs up" position. This will help you avoid shoulder injury.
    3. If you are hanging multiple decorations high up in the sukkah take frequent breaks. During these breaks move your head around (turning to each side, looking down, tilting your head to the side) to minimize the effect of repeatedly looking up while hanging the decorations.

    These are some of the common ways people injure themselves at this time of year. However, it is by no means a comprehensive list.

    Think about what you are doing and stop doing anything that doesn’t seem like a good idea. If something hurts while you are doing it…STOP immediately.

    Wishing you a happy and safe Sukkos!

    Healthcare vs. Sickcare… Which Will You Choose?

    It’s true. Our healthcare system is a mess.

    First they passed Obamacare, then they said they will repeal it, then they didn’t.

    Only one thing is certain…Nothing is certain.

    The only way to look at this system and maintain your sanity is to know that you are doing everything in your power to stay healthy.

    As hard as insurance companies and the government try, the focus of our entire healthcare system is still on treating the sick and not on maintaining health. If you really give it some thought you will realize our system would be better called a sickcare system!!

    • You notice that you are walking a little slower and occasionally feel off balance. BUT, you haven’t fallen. You figure the problem is probably not that serious so you keep going about your daily routine.
    • You have a nagging pain in your knee. It’s not excruciating but…you feel your knee. No need to do anything at this point.
    • You are walking to shul every day. It used to take 5 minutes. Now it takes 10 minutes. But you haven’t fallen so… no need to worry.

    While this is common, it is totally misguided!

    The time to begin taking care of yourself is BEFORE you have ANY of these issues. Or, if you already have some concerns address them IMMEDIATELY! Why wait until you fall, have muscle weakness, balance/walking issues, pain or other concerns to start taking care of yourself? Why not start the process while you are healthy so you can prolong your health?

    Think of a car. Every few thousand miles you need an oil change. You don’t wait for your car to breakdown and then get towed to the mechanic only to find out you needed an oil change. You get your regularly scheduled maintenance and barring any unpredictable circumstances your car rides smoothly.

    In the example of the car think of the high cost of towing your car and paying the mechanic vs. the relatively low cost of an oil change. In your body you have the same option. You can do nothing to maintain your health and then dedicate all your time and resources to healing your illness, OR, you can spend some time on maintaining your health and enjoy life!

    OK. You probably agree that everyone should do some exercise. So you start walking every day. That should be enough. Right?

    Wrong.

    Walking every day is great aerobic exercise which is good for your cardiovascular system but it won’t help you build muscle. Strengthening exercises will.

    You might be thinking that your goal isn’t really to build muscle anyways so why do you need to do strengthening exercise?

    Beginning at age 40 your body begins to lose muscle mass. This process accelerates as you age so the older you get the faster you lose muscle. (The technical term for this is sarcopenia.)

    Losing muscle mass and strength not only robs you of the ability to perform even the most basic tasks of daily living over time, (things like getting out of a chair or walking up stairs) but also increases your risk of suffering devastating injuries, or worse, from sudden falls and other accidents.

    Resistance training (using weights, machines, bands, other devices or body weight) is essential for increasing muscle mass. In addition to building muscle, strength training can also promote mobility, improve health-related fitness, and improve bone health. Since it is far easier to prevent or slow the progression of muscle loss than it is to treat it later in life, it makes sense to begin your strength training program today.

    Are you concerned about injuring yourself while exercising?

    You are not alone. Too many people avoid exercise due to fear of injury. Unfortunately, this is not without merit. Many people do in fact hurt themselves because they do exercises incorrectly or they simply do the wrong exercises.

    This is why having appropriate guidance in your exercise routine is critical. Learn what to do…and how to do it. Then you can continue doing it on your own.

    People always ask me…how long will I have to do exercises for after therapy.

    My answer is simple…Only as long as you want to be healthy.

    This quote from Jim Rohn really sums it up nicely…“Take care of your body. It’s the only place you have to live.”

    Wishing you good health.

    Having a Happy, Healthy, PAIN-FREE, New Year

    Everyone has returned from their summer break, hopefully rejuvenated for a new year.

    As the Holidays approach everyone prepares differently.

    Women prepare endless amounts of mouthwatering delicacies.

    Children learn the do’s and don’ts in school.

    Men get up early to attend selichos.

    Chazzonim gargle raw eggs (…supposedly).

    …and people with pain (in their back, knee, hip etc) wonder how they are possibly going to make it through all those hours of davening, much of it standing.

    I wanted to share some tips to help those in pain get through this time of year.

    Different parts of davening create different demands on the body. There are three basic areas to tackle. Sitting, standing and moving.

    Much of davening is sitting. This can be of tremendous benefit to people with knee pain or spinal stenosis… but often causes difficulty for people with other types of back
    pain (like SI joint dysfunction or herniated discs).

    If sitting hurts your back, try placing a rolled up towel in the small of your back. Then, sit up as tall as possible allowing the towel to fill the gap between your back and the chair. If this helps relieve your pain it can be very helpful in shul.

    However, keep in mind that this only works if the chair has adequate back support. This will not work in a folding chair which has an opening on the bottom… so plan accordingly.

    Difficulty standing presents a very big challenge. We spend a lot of time standing on Yom Tov (both in shul and while cooking/cleaning etc.) and this can cause pain in the knees, hips or back.

    The most obvious solution is to avoid standing. Since this isn’t always an option we will break down the suggestions based on where your pain is.

    If you suffer from knee pain, you will likely have difficulty maintaining your knees in a locked position for an extended period of time. Even if you are able to remain that way, you may pay a steep price when you try to bend your knees after standing in one place for a long time.

    To avoid this, shift your weight onto one leg and allow the other knee to bend. Then switch legs and allow the other leg to bend. Just unlocking the knee will provide much needed relief to the joint. Also, don’t wait for the stiffness to set in before trying this. This should be done periodically throughout the time you are standing to avoid the onset of pain.

    Another great idea is to stand on a cushioned surface. Not too thick, just a small rug or foam pad, so the pressure on the knees will be diminished. (Standing on a hard floor for hours will put your knees through the wringer!)

    The third potential problem area is while bending down. Obviously, the most serious issue is bending down to the floor and standing back up. This can hurt the knees and the back… It can also just be difficult to do.

    First, to make the task easier, set yourself up for success.

    Make sure there is a sturdy chair right next to you so you have what to lean on when trying to stand up.

    If you know in advance that it will be difficult, ask someone to assist you. They will have the opportunity to do a mitzvah and you get a lift!

    If you want to try and get down to the floor (and back up!) here are the steps:

    • Bend down and hold onto a chair with both hands
    • Supporting yourself on your hands and one leg, lower your other knee to the floor
    • Lower your other leg to the floor

    To get back up…reverse the steps

    • Hold onto a chair and get onto both knees
    • Put your stronger leg forward so you are only on one knee
    • Use the leg you put forward to stand up while pushing on the chair.

    This is not always easy to do. If you are unsure how this is done check out this video demonstration.


    Wishing you a happy, healthy, PAIN-FREE new year!!

    Ice vs. Heat…What You Need To Know To Decide

    One of the most common questions I get asked is… "should I be using ice or heat?"

    To answer this question it would be prudent to start by explaining how each one works. You will then be able to make a decision as to which to use based on what you are trying to accomplish.

    Heat causes the blood vessels to widen… or dilate. This is called vasodilation. This allows for more blood flow to the area.

    Ice does the opposite. It causes the blood vessels to narrow… or constrict. This is called vasoconstriction. This limits the amount of blood flow to the area.

    Let’s take a look at some common reasons people use either ice or heat, and figure out which one would be best.

    Say you are walking down the street and you step on a tree branch causing you to sprain your ankle.

    What is your concern? That the ankle will become swollen and inflamed.

    In order to limit the amount of swelling and inflammation you would apply ice. This will cause the blood vessels to narrow (vasoconstriction) and the limit the amount of inflammatory chemicals that can come to the area.

    Note: A good rule of thumb is to use ice for 72 hours after an injury…along with rest, compression and elevation. ( Always

    remember – RICE after an injury…Rest, Ice, Compression, and Elevation. Anti-inflammatories (such as ibuprofen taken in the correct dosage) may also be appropriate but you should consult your physician before beginning anti-inflammatories as there are often side effects or interactions with medications you may already be taking.

    Let’s say you wake up in the morning and you have a stiff neck.

    What is going on? The muscles and joints are tight (or locked) from being kept in an awkward position for too long… causing your neck to feel stiff and painful.

    In order to loosen up the muscles and joints you would want to apply heat. This will bring more blood flow to the area and allow the muscles to relax and the joints to loosen.

    The question of whether to use ice or heat becomes a little more complicated when there are the multiple factors involved.

    A typical example would be someone with arthritis. On the one hand the arthritis causes stiffness which can be relieved with heat. On the other hand arthritis causes inflammation which is relieved with ice.

    Which one should you use?

    It really depends on what your primary objective is in that situation.

    For example, if you want to do exercise and your arthritic knee is bothering you, you may want to use heat before you exercise too loosen up the joint and allow it to move better. When you are finished exercising it would be a good idea to put on some ice to prevent inflammation that could be caused by all of the movement that you just did.

    If you’re knee is inflamed, for example after spending a lot of time on your feet during the day, you would be best served by using ice. This will limit the swelling in the knee caused by the days activities.

    All this is assuming that you can tolerate either one. However, in my experience many people do not tolerate ice well. If that is the case, use heat to loosen up the muscles or joints, or just for pain relief… but don’t use heat when you are already inflamed! That would be like adding fuel to the fire.

    Note: How do you know if the joint is inflamed? Look at the area and feel it. If it is red or it feels warm…it is inflamed. Don’t use heat.

    Some typical uses for heat are:

    • Sore or knotted muscles
    • Tight or stiff joints
    • General pain…without inflammation

    Some typical uses for ice are:

    • Immediately after an injury
    • Joints or muscles that are sore from exercise or activity
    • General pain…If you tolerate ice

    Obviously, you are ultimately the one who will decide which one to use. If you have been using one or the other for your aches and pains…and it is working, then great! Keep doing what is working.

    If you weren’t sure which one to use, hopefully you will now be able to make an INFORMED decision.