New Guidelines for Back Pain

You’ve got back pain and up to 80% of Americans do or will have in their lifetime. Here’s a shocker–put on your seat belt:  Do not call the doctor.  This is advice coming from a doctor.  No, it’s not because you lost your Affordable Care Act insurance and now have to sell more blood to take care of your medical bills.  No, it’s not because the doctors aren’t pressured by Big Pharma to dole out the addict-inducing opioids, scans and injections.  It’s because doctors how have new guidelines handed down by the American College of Physicians for the treatment of back pain. This is big news, I’m pretty sure.

According to the previous guidelines, the first line of therapy was medication. This may be obvious to you.  Now, pills, even the over-the-counter pain relievers and anti-inflammatories, should not be first choice, according to the February 14 reporting in the New York Times, Lower Back Ache? Be Active and Wait It Out, New Guidelines Say and an accompanying opinion on February 17.  The new recommendation is to look for nonpharmacological therapies first.  Whaa?  No prescription pad, no trip to CVS, no side-effects, no out-of-pocket expense?  What could it be that is as effective as the almighty, chalky white, round pill?  Okay, you’re way ahead of me.  Yes, yoga.  But more, like exercise, acupuncture and massage therapy.  Did they mention yoga?  Yes, they did.

From the NYT:

“Doctors should reassure their patients that they will get better no matter what treatment they try, the group said. The guidelines also said that injections were not helpful, and neither was acetaminophen, like Tylenol, although other over-the-counter pain relievers like aspirin, naproxen or ibuprofen could provide some relief.”

Patient without acute back pain, that which lasts 4 weeks or less and doesn’t radiate down the leg, do not need to see the doctor.  They’re making an analogy to the common cold:  “it can be annoying when it happens, but most of the time it will not result in anything major or serious”.

The placebo effect even works wonders, even when the patients knew they were taking a placebo.  Studies have shown that patients with chronic low back pain reported less pain and disability on a placebo than those in the control group.

The article explains that some people with chronic back pain tend to shut down and avoid their usual activities.  This is the opposite of what needs to be done.  People need to return to their normal activities.  The article quotes a doctor stating, “I know your back hurts, but go run, be active, instead of taking a pill.”

Before you start cheering and thinking there was a least one speck of good news this week, it’s not all so rosy.  Patient want the quick fix.  There are incentives for doctors to push the pills, scans and injections.  Medical insurance does not pay for the remedies, like massage, tai chi, yoga, mindfulness training or chiropractic manipulation.  Doctors don’t often have a referral system for therapies outside the allopathic medical system.

Here is what I recommend if you’ve got non-chronic back pain.  Stop doing what’s causing the pain.  Much back pain is from our lifestyle, like sitting, doing stupid things or periodic tasks like weed pulling or a weekend pick-up basketball game.  After resting the area for 24 hours or so, start some gentle movement, but staying out of pain.  As time goes on, you’ll be able to move a bit more. You can add massage, acupressure or acupuncture, or other modalities you’re comfortable with.  Of course, there are reasons to see a doctor and to seek emergency medical care.  I’ve added a list in the Notes below.

If you’re interested in how yoga can help with low back pain, I have lots of information, so please feel free to ask me.

Notes:

Contact your doctor if pain: Is constant or intense, especially at night or when you lie down, spreads down one or both legs, especially if the pain extends below your knee, causes weakness, numbness or tingling in one or both legs, occurs with unintended weight loss, occurs with swelling or redness on your back
Seek emergency medical care:  Call 911 or emergency medical help or have someone drive you to the emergency room if your back pain: occurs after a high-impact car crash, bad fall or sports injury, causes new bowel or bladder control problems, occurs with a fever

Do You Hygge??

Apparently there is a trend sweeping Britain that I wasn’t aware of – the concept of Hygge (pronounced HOO-gah). It was one of the top 10 words of 2016, and there have been 20 books written on the topic (coming to a bookstore near you soon). And in the week since I learned the term, one of my favorite foodie blogs popped up with recipes. How could I be so behind-the-curve that I’ve never heard of the biggest thing to hit popular culture since Marie Kondo told us how to fold our undies?
Hygge is the Danish word for cozy, but seemingly doesn’t translate well to English, and is so much more than just cozy. It involves fuzzy knitted socks, candles (unscented), fires, blond wood, cake, glogg, and — other people. It appears that a raging snowstorm provides bonus points. All of this offers a great sense of comfort and contentment.
And who should know better about coziness and contentment than the Danes, who usually top the list of happiest countries. The US comes in at an unlucky 13th place. (Sigh — that topic is best saved for another posting ….)
Author Louisa Thomsen Brits calls it “a practical way of creating sanctuary in the middle of very real life.” And since timing is everything, it seems that there has never been a better time to create sanctuary in the middle of the very real life that looms ahead.
So how do YOU bring some hygge into your life? Best to stay home, gather family and friends, get everyone wrapped in blankets, serve a warm drink, light a fire and some candles. Probably no need to purchase anything new, although there seems to be an entire marketplace of textiles, knitting patterns and cookbooks to help you find your inner-hygge.
I got to practice some hygge of my own this week while visiting Cheryl during The Storm of 2017. There was hard rain for several days, with flooding, trees down and the power out. What better excuse to light lots of candles, bundle up (no heat in the house!) and talk, talk, talk. It happened that Cheryl had received mulling spices for Christmas, and there was a bottle of red open. That mixed with some home-pressed apple juice made for a delicious and warming before-bed drink.
Cheers to some hygge-ing of your own this winter.

No Bans: Yoga Wants You All

We are all different.  Some of us look different, come from distant unpronounceable parts of the world, act radically different even when given the same set of circumstances and pray and worship different idols in different ways.  However, inside each of us human beings, we are made up of the same goodies, like chromosomes and synapses and the like. All human beings have the same needs and wants.  All want to be happy and free from misery.  All want to have enough food and shelter and all want to take care of their families. All want to love and be loved, give and receive. No difference.

In yoga, we don’t care about your differences.  We take everyone. If you have a body and use lungs to exchange your C02, then we want you.  We don’t care about you color or creed or whether you can touch your toes.  We don’t even care if you have toes.  One of the great joys and challenges of being a yoga instructor is to recognize that every student is unique and not just in a physical way.  Each student has a different propensity to receive information and translate that to body movement.

Yoga is more, much, much more than you see on the cover of the fancy yoga magazines at the Whole Foods checkout line.  It’s too easy to dismiss yoga as another fad or only for skinny, white girls.  It’s said that yoga postures were originally used to prepare the body for long meditations.  Most of us don’t sit in meditation for hours, but we do have to sit in overpriced office chairs, faux-leather cars seats and Ikea’s Poang chair, one of which I own.  If you’re breathing and moving with conscious attention and focus on your body and state of mind, then you’re doing yoga. You can be sitting in a hospital bed raising and lowering your arms or on a peak doing a headstand.

I remember with affection one of my first yoga teachers, Larry Schultz. His studio was a large and carpeted with two loud, clangy industrial heaters that clicked on and off during the practice, blowing warm air on warm bodies. With tall ceilings it had once been a sewing factory in the changing south of Market area. Sometimes there was music, sometimes not.  No props, no mirrors.  The room was usually full, but not packed–30-50 students. Larry welcomed everyone, regardless of limitations or yoga experience. We all practiced as a group, each in our own way.  Some students were beginners, some were advanced. You did what you could and sometimes what you couldn’t and that was that. It made no difference.

Larry would often quote Patthabi Jois, “practice yoga and all is coming”. There was an innocence about the yoga practice and lots of freedom to explore your body and what it would easily do and where it resisted. Lululemon was just starting in Vancouver and Lucy was still Charlie Brown’s friend.  I look back on that time with fondness and a bit of longing. 

If you’re already a yogi or thinking about starting, my suggestion is to make your practice joyful.  Find some ease and wonder as you explore the limits of your balance and the strength of your biceps.  Marvel at when your body yields and what makes it holler.  Find a smile when your balance just won’t cooperate and also smile when it will.  Yoga is for everyone,
regardless.   

Staying Balanced During Winter 

Ever notice that sometimes you feel happy energetic, creative and enthused?  And, other times, lethargic, unmotivated and blue.  I’ll be damned if I can figure out why?  There are just too many variable.  Is it something I ate, did I sleep more, did I have more yogurt that day, was my yoga practice active or passive, was it the phone call from a friend, hormones, time of year, age?  Who could ever figure it out.
Here’s a clue.  The medical system related to yoga is called Ayurveda.  It puts people into 3 categories based on specific characteristics.  Like the Chinese system with the 5 Elements, Ayurveda’s “doshas” are related to air and ether (Vata dosha), fire (Pitta dosha) and earth and water (Kapha dosha).  Each dosha is helped (pacified) or aggravated by certain foods, exercise regimens, work, and general lifestyle.  When the dosha is “balanced” the individual is healthy, relaxed (but not lethargic),  energized (but not wirey), engaged (but not annoying), and confident (but not an ass).  Everyone is a combination of 2 or sometimes all 3.  You can take a test here to get a clue as to your dosha.  Eventually, you’ll want to get a full analysis from an Ayurveda practitioner.

Here we are in winter. Each dosha is affected differently by the winter weather, especially Vatas and Kaphas. Those with a Vata dosha (air) tend to be cold, flighty, lightweight and active. Winter’s cold, windy and irregular schedules bother Vatas.  Kaphas (earth and water) are also aggravated by the wet, damp and cold winter. The Ayurveda system offers specific foods, herbs and spices to balance the Dosha and bring back that loving feeling.
Vatas can benefit by warming up.  Eat warm and cooked food, like soups, stews, hot cereals, hearty grains.  Avoid salads (uncooked), ice cream (cold), and crackers/popcorn (light/airy).  Favor the sweet, sour and salty tastes and avoid bitter, pungent and astringent foods.  Essential spices are cardamom, cumin, ginger, cinnamon, salt.  The daily yoga practice should include calming forward folds and restorative poses and grounding standing poses, like Warrior 2.  Don’t forget a long savasana.
Kaphas, because of the combination of water and earth can become heavy and cold.  They need to also be warmed up.  Eat foods that are warm and stimulating with ginger, cinnamon and cloves.  Avoid cold and mucous producing foods foods like ice cream and cheese.  The winter can be hard on Kaphas who are prone to lethargy and depression.  They need to get up each day and do an active yoga practice (or any type of movement) to work up a sweat.

Regardless of your dosha, like the bears, get some extra sleep.  Include warm and nourishing foods in your diet.  Enjoy more time with family and friends and enjoy some quiet time with your favorite book.  Spring is around the corner.

Do Less

Ever notice how much is expected of us?  Wonder Women and Men, all of us. The demands of daily living become more complicated each year and our grasp on how to live a meaningful life threatens to loosen. The Joneses never seem to move. The pressure continues to look younger, live longer, have more stuff, and climb and social and corporate ladder.  It’s a complicated merry-go-round of do-do-do.  Are we really getting anywhere?

What if we actually did less?  What would our stress and anxiety level look like?  I’m guessing we’d be a lot more chill.  We create most of our stress by overburdening our lives with being busy.  We’re oh so busy, busy, busy.  The Archbishop Desmond Tutu in “The Book of Joy” notes that it’s hard to be joyful when we have continual feelings of being overwhelmed and not able to handle our work and family commitments or the digital devices that constantly are reminding us of all the things we are missing.

The Dalai Lama in the same book added:

“Stress and anxiety come from too much expectation and too much ambition. Then when we don’t fulfill that expectation or achieve that ambition, we experience frustration.  . . . Often we are not being realistic about our own ability or about objective reality. . . Unrealistic effort only brings disaster. So in many cases our stress is caused by our expectation and our ambitions.”

The Dalai Lama is encouraging us to be more realistic with our priorities.  When we see how little we need, then we can quit grasping and find more love and compassion.  He says what we are looking for is a “settled, joyful state of being and we need to give this state more space”. I wonder if we could find that settled and joyful state by doing a bit less.

I’m listening to “The Art of Not Giving a F*ck, a Counterintuitive Approach to Living a Good Life” by Mark Manson. He advances the message of the Dalai Lama and Archbishop Tutu, except that Manson peppers every sentence with at least a couple of f*cks. In continuing with the Dalai Lama’s thoughts about priorities and where we spend our energy, he posits that we have too many expectations.  From his book:

“Our culture today is obsessively focused on unrealistically positive expectations: Be happier. Be healthier. Be the best, better than the rest. Be smarter, faster, richer, sexier, more popular, more productive, more envied, and more admired. Be perfect and amazing and crap out twelve-karat-gold nuggets before breakfast each morning while kissing your selfie-ready spouse and two and a half kids goodbye. Then fly your helicopter to your wonderfully fulfilling job, where you spend your days doing incredibly meaningful work that’s likely to save the planet one day.”

“But, what if doing less causes me more stress because I’m not getting things done?”, you smartly ask.  Stressing about what what we’re “not doing” is causing us stress.  We falsely think that being busy will make us feel like we’re actually “doing” something and “being productive”.  Hogwash. This is often misguided busyness.  Much of our “doing” is constantly checking our “likes” on Facebook, checking the latest tweets by Donald Trump and watching another 30 minutes of The Crown.  Then, we berate ourselves for not having time to go to the gym.  We are not giving the proper propriety to what we do in a day, because there is soooo much to do–it’s overwhelming. We have projects that have been put off, phone calls to return, parents to call, volunteer work to do, and 2.5 kids to schlep to soccer practice. As Mr. Manson writes, “Living a good life is not giving a f*ck about more, but giving a f*ck about less”

Time is what everyone says they just don’t have enough of.  Doing less buys us time. Doing less lowers stress, leads to greater creativity, enhances the immune system and generally makes us feel better. If, and it’s a big “if” you can feel okay with doing less.  It may not be easy at first, but give it a try.

When someone tries to add something to your plate, instead of using the excuse that you’re “too busy” start saying “Thanks for asking, but I’m doing less.”  See what response you get. How does that feel?  Now take that time of “less doing” and write or paint or sing or sit and read with a cup of lemon-ginger tea.  What about hot bath?  Do something that brings you joy.  I think you’ll be surprised how easy it is.  Doing less may actually give you more.  

Forget Exercising, Just Move

As the new year starts a common mantras is “I need to exercise more”, which is just second to “I need to eat better”, which comes right after “I need to lose weight”.  “Exercising” brings the first-of-the-year-no-membership-fees gym membership  Gyms see over half of their annual memberships starting at the beginning of the year. This is OK, I’ve got nothing against gyms, except that 4 out of 5 people don’t even use their newly minted memberships and they’re expensive, loud, and filled with folks multi-tasking as they “run” on the treadmill, read the Wall Street Journal, and watch CNN on the overhead screen.. But, if that’s your thing and it gets you going, then bravo.
The word “exercise” often comes tethered with images of starts and stops, medicine balls (whatever they are), big metal pulley work-out machines, and before dawn wake up alarms.  Why not shift your mindset and think of “moving” rather than “exercising”.  Movement comes in so many forms, shapes and sizes. Think tai chi, rowing, swimming, running, fencing, dancing and, of course, yoga.  What about golf or tennis?
Here are a few ideas:
Tai Chi or Qi Gong –  This is a meditative practice that builds strength and balance through slow, deliberate movement.  It can counter stress and be done alone without equipment or fancy yoga pants.  According to Energy Arts  “the goal . . . is a feeling of relaxed power. Relaxed power comes when the muscles, rather than fighting and straining to do something, just loosen (open up) and allow the energy to flow through”.
Running, Cycling, Tennis –  If you need to lose weight, you’ll need to move more often and bring your heart rate up (get a heart rate monitor).  Walking and running just requires a good pair of shoes and maybe a sports bra.  Increase the value by calling your buddies to join you.
Walking –  That’s it– just walk. It’s universally accessible, lubricates joints, builds muscles, increases lung capacity.  Need I say more?  It can be done solo or with 100 of your best walking buddies.  If you want to expend more calories (i.e., lose weight) the pickup your pace or find an hill.
Yoga – Yoga is so much more than just exercising, but you can substitute it for trip to the gym.  In yoga we use our own body weight as resistance. Holding poses longer and taking them deeper can build strong muscles.  Heat up the room and increase the pace and you’ll get a cardiovascular workout. Don’t forget to balance it with a long, relaxing savasana!
Movement with others –  Add a secondary and incredibly important component to your movement: relationship.  More beneficial and healing than “getting in shape” is our connection to others.  Think team sports, like golf or soccer. Take salsa lessons, join a walking group or find a Zumba class.
Is the need for quiet and alone time more valuable than kicking a dirty ball around a soccer field with a bunch of rugged teammates?  Find a tree-lined single-track trail for a vigorous hike. Create a private space for dance or qi gong or shadow yoga.
Decide what movement suits you best. It can be structured or organic, sweaty or not, rhythmic or frenetic, expressive or introspective and team-centric or a solo affair. You have lots of choices. It’s not all about the gym.