Pain Doc - Ask Dr. P - The Pain Doc

The Two Essentials for a Long, Quality Life

by Pain Doc | Jan 9, 2022 | Lifestyle Modification, Low Back Pain Exercises, Nutrition

As I transition out of mid-life, I face the inevitable things that happen at this stage of one’s life: parents, aunts and uncles aging and dying; birth of grand-nieces and nephews; and subtle changes in my body and physical ability. As someone with a professional background in healthcare, I can’t help but to analyze the health aspects of these mortal events.

The first I shall mention involves my mother and aunts (her sisters). In the gene department, I’d say they acquired good ones for longevity—mom is 88, and her sisters are in their mid-90s. However, their health status is starkly different. Yes, mom is a few years younger, but in terms of physical ability and vitality it’s as if she’s 20 years younger. One dear aunt has just weeks to live. She is barely ambulatory, and she is fading. Her body is frail, and her mind is diminishing. There were beginning signs of organ system failure during the past year – wounds not healing well; constipation, and swelling in the lower limbs.

The other aunt suffered several falls in the past year, breaking her leg each time, and is experiencing symptoms of congestive heart failure—fluid in the lungs and difficulty breathing. Both aunts require 24/7 assisted living at the time of this writing.

And mom? She still drives, speaks loudly and coherently (although her hearing is declining but not terribly); is able to vacuum and clean her home where she lives alone (dad passed in 2016), and even work in the back yard raking leaves, pulling weeds, and watering plants. She watches a lot of TV in the afternoons and, after chores and dinner, late into the night, yet is able to do all these things. She shows no signs of slowing down.

All three women fortunately did not develop dementia in their advanced age. Mom shows no signs of it at all, and I am hoping and praying I have those genes!

My dad, on the other hand, developed dementia during his last five years alive, and it played a role in his passing from an unfortunate hospital accident.

I attribute my mom’s stronger vitality, compared to her older sisters, to two things:

Give to Others. Stay Socially Connected. Avoid Isolation

She sends birthday cards to all her children (four, including me) every year, ever since we moved out of the house to go to college–without fail; on-time, every time.

For me, it’s birthday card every year for the past forty years. She does the same for her grandsons (3) and granddaughter, and now great-grandson. She’s very giving and considerate of others.

If you read authors in the Self-Improvement field, such as Brendan Burchard and Steven Covey, one of the common themes is giving. Something good happens when you give. The gesture is basically about giving out love. But to be able to give love, you must first be at peace with yourself, and have abundant love for yourself and your life. It’s like money – you can’t give others money unless you have money yourself to begin with; enough to spare.

When you love yourself, you aren’t sad; you aren’t depressed and most of all you value yourself so you take care of yourself. You don’t do things that will hurt yourself in any way and as a result, you achieve mental health, which promotes physical health. So believe me when I tell you that doing something as simple as sending someone a birthday card for 40 straight years carries a lot more meaning that it appears. It’s all about your attitude and outlook in life, which drives your actions. I do believe in the power of love. It’s one of the mysteries of being human.

My aunts, however, spent most of their lives isolated. Their spouses passed away when they were relatively still young and they never remarried. They sort of grew into living mostly solitary lives, over decades. I suspect that even with losing their spouses early on, that their isolated life was mostly due to their personality—their nature, which developed in accordance with their mindset. They are not as outgoing as my mom, and appeared to not mind being alone; at least that’s what they thought.

Do Whatever it Takes to Stay Physically Active, As Long as You are Able

The second thing that separates my mom from her sisters: she was consistently physically active all her life, and still is to this day. She is purposeful about it: she plans out her day the day before and has a set agenda– visit a friend, get some groceries, buy household things, go the bank; work in the yard, clean the house, and so on. She often mentions to me how she sweats in the back yard after doing some chores (she lives in Florida where the humidity and heat can be quite uncomfortable in the summer). She delivers food to friends who live nearby, out of the kindness of her heart. And, she goes to church regularly, where she gets most of her social interaction. Bottom line: my mother likes to stay busy and enjoys doing physical work at her age.

Compare this lifestyle to her sisters: neither was physically active, aside from going out to run errands when needed. They spent hours sitting on the couch and watching TV much of their day, for decades — a wholly passive behavior (I don’t want to say activity) both mentally and physically.

Neither of them worked a job: one aunt lived with her adult children, and the other was supported by her spouse’s death benefits. Neither toiled in their back yard. I doubt if they walked around the neighborhood for exercise, either. Neither had a hobby that kept them engaged in something. Today, their health is in steep decline.

The Lesson Here

So, based on this real-life study, if you desire to live a long, quality life (not a long life being infirm) learn from my mother: it starts with your mindset/attitude. Your mindset drives your actions. Your actions directly determine your mental and physical health – it’s that simple.

When you have love for yourself and your life, you naturally want it to last as long as possible and as a result, your subconscious mind guides you in doing things that maintain your health and extend your life—avoiding destructive thoughts (envy, hate, anger, resentment, regret); eating healthy, getting enough sleep, and exercising regularly.

When you don’t have love yourself and your life; OR you fail to take a moment to affirm it often, you take life for granted. You become undisciplined with your actions. You don’t have purpose. You take unhealthy, dangerous risks – spending too much time on the internet and social media; developing addictions; eating too much sweets and junk food and not enough whole, natural foods; consuming alcohol excessively, and avoiding exercise. Perhaps drugs and tobacco enter the picture, too. Then, this lifestyle becomes entrenched and harder to get out of because you become overweight, have low energy, and are in a negative mood. Exercise and socializing with others are the last thing on your mind, and you avoid both. You eat food that may taste good, but doesn’t nourish your body. These actions stress your body, and payback is imminent. Unless you have good longevity genes like my mother and aunts, you can expect your lifespan to be shorter than what it could be; and/or, you can expect to live with chronic illness, severely impacting your quality of life — not a great way to spend your golden years.

I will add to this that one can make change for the better at any age. Of course, the sooner in life, the better. As a person ages, it is more difficult to change adverse behavior, due to the thought patterns that take root in the mind, which are basically the habits and rituals that give one short-term satisfaction. But, it’s not impossible. It just requires digging in deep, and having that desire and determination to change. Loving life, and wanting to experience it for as long as you can. For many people, a wakeup call has to occur before they take action, like a friend dying unexpectedly from a heart attack. Don’t wait for that to happen, because if you do, it may very well be your sudden illness or death that shakes a friend into action.

Once you change your mindset, the next challenge before you is execution. Here are a few tips:

Make small, gradual changes that are easy to accomplish. This sends a positive signal to your subconsciousness, and lays the groundwork to build upon. Examples: buy healthy foods for the week every Sunday at 6:00 PM; walk 3x around your block Mondays, Wednesdays and Fridays; etc.
If you slip and revert to an old, unhealthy habit don’t be too hard on yourself. Definitely do not throw in the towel. Get up, and keep trying. It’s all about consistency in effort.
Create simple health routines. Routines are things you do the same time of the day, every day. Stay on a routine long enough, and you won’t have to remember to do it; it will come naturally.
For your physical activity, schedule it on your calendar. Hold yourself accountable. Better yet, recruit a close friend to be your accountability partner. He or she will have the role of encouraging you to stay on track.
20 minutes of exercise a day is better than an intense, 2 hour exercise every other week. Consistency is more important than intensity.
There are exercise options for every age and ability. Exercise doesn’t necessarily require sweating gobs of sweat; getting out of breath, or pounding your joints. You need to learn what’s right for you. Stay tuned for lots of examples of physical exercise for those over 40; those who are not physically fit; are overweight; or have some form of physical disability.

I cannot stress enough the importance of staying physically active to living a long, quality life. Humans, like all animals, are designed by nature to move frequently. When you don’t move enough, muscles atrophy and support to your spine and joints weakens, inviting injury and joint degeneration. Your heart, being a muscle, becomes weak so oxygen and nutrient delivery to your cells, including your brain cells, becomes sub-optimal. Your blood sugar rises because it isn’t being burned at a fast enough rate, leading to obesity and diabetes, and even Alzheimer’s disease.

Lack of physical activity even promotes gut disease, including constipation. Digestion benefits from physical activity, since your intestines are muscles themselves that require oxygen and nutrients delivered by your heart.

Bottom line, use it or lose it—being sedentary; failing to engage in consistent, moderate physical activity for years will cause a decline in your health that will be difficult if not impossible to reverse. Make it a priority in your life.

To complicate things, technological advancements have reduced our need to be physically active, and if it weren’t for advances in medicine and sanitation, human lifespan would probably be in the 40s especially with the abundance of and easy access to high-calorie, low nutrient processed food.

That’s it for now. It’s a new year, a time when people contemplate their lives and their future. If you are someone who needs to make a change, now is the best time. Stay tuned for more advice on staying healthy, vibrant, and out of pain and extending the lifespan of your body.

How Pulsed EMF and Red Light Can Help With Low Back Pain

by Pain Doc | Nov 29, 2021 | Low Back Pain

Low back pain affects nearly everyone at some point in their lives. Medical researchers have long known that most cases of low back pain self-resolve after a couple of days with rest and palliative measures such as application of hot packs and cold packs.

But for some, low back pain returns, and eventually becomes chronic. “Chronic” means that pain has reached a level where tissue healing has for the most part completed, but there is recurring pain. Chronic pain is usually characterized as dull, persistent pain; as opposed to the sharper acute pain, which is the type of pain associated with recent injury or major aggravation of a previous injury; characterized by heat, redness and swelling. Chronic pain is believed to be central nervous system driven; meaning that some of the pain signals are emanating from brain and spinal cord neurons as opposed to nociceptors, the special pain-sensing fibers found throughout your joints, tendons and muscles.

If you have acute low back pain– again, from a recent injury, or aggravation of a previous back injury resulting in swelling and pain, the standard protocol agreed to by most orthopedic specialists is rest, ice for the first two days, followed by an optional hot pack for the next 3-4 days. “Rest” doesn’t mean bed-ridden. When used in this context, rest means no heavy lifting, bending at the waist, or activities that place undue pressure on the spine such as running or jumping. However, you should move your body in ways you can; i.e. do not mentally “catastrophize” it because studies show that this mindset can actually lead to poorer outcomes, such as taking a much longer time for the pain to resolve, and atrophy of the back muscles which reduces support to the spine and therefore predisposes it to further injury.

If you have chronic low back pain, the goal is to manage it so that it has a minimal effect on your activities of daily living– standing, sitting, walking, bending, and other activities that require similar use of the spine. If your chronic pain is mostly central nervous system in origin, it would be worthwhile to practice mind-body techniques. This includes yoga, meditation, and practices of that nature. Having control of your thoughts can be helpful in controlling chronic pain. It’s not all about ignoring your pain, but rather, not amplifying it by mentally embracing and validating it. The best approach is to continue as best as you can with your regular life activities– the things you did before the injury event. Modify them to accommodate any physical limitation, if necessary. For example, if you used to run, try speed walking. It’s less jarring to the knees and low back, and you burn the same number of calories. What’s most important is getting out there and staying active; i.e. “move through the pain.”

You can of course try to alleviate acute or chronic low back pain by using certain modalities. The ones I recommend are red light therapy and pulsed electromagnetic field therapy. Red light (emitted by a light emitting diode, or LED) has a wavelength range of around 660 nanometers. It is electromagnetic energy at a wavelength that can influence biological activity in a positive way. Studies show that light at this wavelength gets absorbed by cell mitochondria, which respond by becoming more active. Mitochondria are the parts of a cell that extract energy from ATP, the molecule synthesized from glucose (sugar) in the diet. A recent study showed that applying red light to your eyes in the morning can even improve eyesight. If you have an injury and/or inflammation, red light therapy can be helpful in accelerating the healing rate.

If the original injury event was within a year, it is possible to eliminate your chronic pain and have it never come back again. You see, in some cases of ongoing pain, it could be that your injury still has the potential to completely heal but it just needs a boost on energy. Cells are dormant or at a low energy state and there is not much activity going on; i.e. protein (collagen) synthesis and cell division/ new cell creation. Here’s where Pulsed EMF can help. Pulsed EMF, known as “energy” medicine, is the only modality that works by increasing the action potential of cells. Like voltage that drives electrical current, a strong action potential across a cell membrane will enable the cell to improve its metabolic rate. Nutrients and oxygen will move across the membrane into the cell, while waste products and CO2 will efficiently exit the cell through the membrane. When the cells are more energized, their healing capacity increases.

To further enhance healing of an old injury, apply 30 minutes of Pulsed EMF twice a day, followed by ten minutes of red light therapy. What’s great is that you do not need to be a licensed doctor to acquire these modalities. They are safe enough to use at home and there are no studies that show a harmful or negative effect in the use of these machines. If you wish to get out of pain sooner and in the long run, you can’t go wrong with Pulsed EMF and Red Light therapy. When combined, they serve as a powerful treatment for injuries and pain.

Pulsed EMF and Red Light also can serve as maintenance therapy for those who have no health issues. Living in a modern society, our cells and tissues are constantly exposed to unnatural and even harmful electromagnetic fields from things like cell phone towers and powerful transformers in buildings (Pulsed EMF generates EM fields with the same frequency and wavelength profile as those naturally produced by the body itself, at higher amplitude). This saps our energy and weakens and drains cell energy. Applying pulsed EMF re-energizes the body very much like how you recharge your cell phone battery every day. Your body will feel the difference with the energy boost Pulsed EMF provides.

Two Modalities to Heal Low Back Pain in Half the Time

by Pain Doc | Oct 20, 2021 | Low Back Pain, Pulsed EMF, Red light therapy, Self Treatment

Hey, I know there are millions of pages on the internet on how to fix low back pain. It can be a dizzying experience searching through them. It’s information overload.

I began blogging on this site around 2010, but actually have been writing articles on things like exercises for low back pain, neck pain, sprains and strains and so forth, since about 1994 when the internet was in its infancy. Fast forward 28 years, and now there are tons of articles and videos online, including mine. Much of the online content for treating low back pain is good: well-written, easy to understand and follow, and backed by evidence. Others are mediocre; just a re-hash of old-school approaches to treating back pain (rest, ice, no heavy lifting, etc.).

If you know me, when it comes to teaching others how to self-treat pain, I like to write fresh, interesting and innovative content. I figure that there are more than enough good videos on stretching and exercising for low back pain. What I like to do is explain the etiology of pain and propose interventions to prevent that pain from developing or getting worse.

If you have acute (recent onset) low back pain, research shows that in most cases, it will go away on its own if you just take it easy for a couple of days. Sure, icing, applying hot packs and no heavy lifting are obviously recommended to prevent re-aggravating the condition. The problem is that most people can’t afford to wait that long, and don’t like being in pain. They have a job, they have responsibilities to other people, and, they want to have fun and do the things they want to do.

For these individuals, there are a couple of home therapies I recommend, to shorten the healing time.

When you have low back pain, muscles and ligaments in and around your spine are generating pain. Something was disrupted mechanically, and inflammation is going on – blood vessels are releasing histamine and heparin and the inflammatory cascade is active—heat, redness, swelling, pain. The inflammatory chemicals irritate sensory nerves, causing some of the pain; as well as the pressure from the swelling. The nerves themselves may be over-firing; generating a level of pain that is not really proportional to the amount of tissue injury.

So with that, my go-to home therapy is a combination of Pulsed EMF and Red Light. Pulsed EMF is an externally-applied, pulsed electromagnetic field. The field, which is similar in frequency to the body’s own natural EM fields, passes through your body and essentially energizes the membranes of cells.

Cell membranes let things in and out of the cell, especially synthesized proteins, nutrients, oxygen, and waste products. They do this via active and passive transport, which both rely on membrane potential—a weak voltage created by negatively charged ions on the outside of the cell, and positive ions on the inside. Like how a battery’s voltage can power a light bulb, a cell’s weak voltage along its membrane powers the exchange of molecules in and out of the cell.

When cells (in this case muscle, bone, nerve, blood vessel cells) are physically damaged or weakened, this exchange is hampered and the tissues are slow to recover and return to a normal, non-pain state. Pulsed EMF lends a boost to this energy, helping cells become more robust in their healing and recovery activities.

Red Light therapy also can energize weak cells, but via photobiomodulation. Cells absorb red light in the 660-720 nanometer wavelength (electromagnetic energy), due to their molecular composition. Photons strike the nucleus, mitochondria and membrane, which changes the oxidative state of the cell. When this happens, it triggers cell signaling pathways related to metabolism and energy production. The cells increase their ATP output, which gives them more energy to repair damaged sites and synthesize needed repair proteins.

Pulsed EMF devices for home use are very easy to operate. Usually, it’s a matter of just pressing the power button, and sometimes a Mode button and Timer button. One of the better models is the BioBalance. You can order it with a full body mat, or a pad. Simply find a comfortable place in your home such as your sofa; place the mat on it, and lie down so that your low back is directly over the mat. No need to remove clothing; the pulsed EMF field passes right through. Do it 3x day for 20-30 minutes/ day to help your body heal and recover.

Another option is the OMI full body PEMF mat. It is lower power than the BioWave, but sometimes that works just as well, as the EM fields are very subtle. You don’t want fields that are too strong. Remember, your body already produces weak magnetic fields; you just want to complement them with a boost of comparable energy.

Red Light therapy is also a great investment in your health. I recommend getting a red light LED wrap, or LED panel. The wrap is a flexible pad embedded with red light LEDs emitting red light and infrared light (660, 820 nm). The red light diodes create photobiomodulation while the infrared diodes provide deep penetrating heat to dilate blood vessels and increase oxygen delivery to cells.

Red Light panels come in different sizes. The small ones are popular for treating facial skin conditions and beautification. The larger panels are better for treating pain. You can mount or hang the panel on the wall, and position yourself so that you are exposed to the red light (usually requires standing up).

In summary, if you are prone to getting lower back pain or have chronic pain issues, Pulsed EMF and Red Light Therapy are two, powerful and safe modalities that can be used at home for self-treatment and are easy to operate. Best of all, they have a long history of medical research to support their use in treating pain and healing injury. It does require a modest investment, but what is more important to your health and well-being? Without this, nothing else matters.

Do You Burn the Same Amount of Calories Walking vs. Running?

by Pain Doc | Sep 3, 2021 | Low Back Pain Exercises

If you ran one mile, would you have burned the same number of calories as if you had simply walked?

Intuition tells us that, for equal distances, running requires more energy than walking and therefore burns more calories. After all, running is a lot more sweaty and uncomfortable!

But …does it?

In order to find the answer, we need to define three important terms and understand how they are related.

The first is Energy. In physics, energy is the quantitative property that must be transferred to something physical in order to perform work on it, or to heat it. A less descriptive definition of energy is “the ability to do work.”

Visualizing energy is elusive, like an invisible force that can change into different forms, but most of the time the presence of energy can be visualized when the transfer occurs. For example, if you burn firewood, the invisible chemical energy in the wood is converted to heat energy, which you can see as fire. With regards to human movement, energy moves through our muscles, joints and bones.

The second is Work. Work is the energy transferred to or from an object via the application of force along a displacement (distance). In its simplest form, it is the product of force and displacement: W=F*d. So, think of work as “energy in action.”

Work and Energy have the same unit, called a Joule, which is the energy required to move 1 kg a velocity of 1 meter/second. So, when you walk one mile, your musculoskeletal system is performing work (W) by moving the weight of your body (F) over one mile (d). Weight is a force, as it is the mass of your body x gravity (acceleration).

The third is Calorie. In food science, one Calorie is the amount of heat needed to raise the temperature of 1 kilogram of water 1 degree Celsius; hence the phrase “burning” calories. Foods that we eat contain calories, which are represented by the energy stored in the bonds of the atoms of carbohydrates, fats and proteins. One gram of fat contains about 9 calories, while one gram of carbohydrate or protein contains about 4.

Calories are important to us because they are central to fat (not water) weight gain and loss. With the overabundance of high-calorie foods, weight loss is a concern for many. And along with calorie restriction (dieting), exercise is the means by which people try to lose weight. Exercise requires energy and work, which in the human body is sourced from calories. For those wanting to lose weight, the calories that are desired for burning are not in the food from a recent meal, but rather in the bonds of stored triglycerides; i.e. fat cells. Those unwanted fat cells are the result of the surplus of calories consumed (more than your body needed) over years and years.

People wanting to lose weight are interested in the best forms of exercise that will help them burn calories and use up those unwanted fat cells.

Before we address the original question of whether or not running one mile burns more calories than walking one mile, lets first discuss the two, main approaches to exercise: cardio and resistance.

Cardio exercises are exercises that result in sustained, increase heart rate. They are characterized by continuous movement of the body. Examples include running, walking, cycling, and the many types of aerobics classes such as cardio kickboxing. The continuous movement of your muscles in cardio exercises, when done for over 20 minutes burns fat and strengthens the heart muscle. A stronger heart is able to pump more blood to cells and increase cardiovascular endurance; hence the name.

Resistance exercises emphasize placing resistance on the large muscle groups, i.e. the legs, arms, back and core. They force the muscles to generate power, which burns calories just like cardio exercises. The resistance can be weights, resistance bands, or the weight of your body (squats, planks, pull ups, crunches).

This brings us to the calorie-burning effects of running vs. walking. Let’s say Tom, who has a mass of 50kg, walks one mile in 12 minutes, then runs a mile in 8 minutes. Did he burn the same amount of calories in both miles?

Since Work=Force x Displacement, the work Tom generated in both cases was as follows:

Force=mass x acceleration (of gravity on Earth, in this case)
Force=50 kg x 9.80 m/s2 = 490.33 Newtons (the unit of force)
Work=490.33 N x 1609.34 m = 789,107.68 Joules = 789.108 kJ

Since 1 calorie is approximately .239 J, Tom burned about 188 calories walking, and another 188 calories running because in both cases, he moved the same amount of force (his body weight) over the same distance…

THEORETICALLY.

The human body’s use of energy is not as easy to calculate compared to a machine. There are many variables in human movement; particularly in the way the muscles are used.

Let’s address the critical factor that will help us answer the original question – the biomechanics of walking vs. running. Do they use the same muscle groups in the same way? Do the muscles perform more work in one vs. the other given the same distance displaced? Is energy use the same in both?

I propose that energy expenditure in running is significantly higher than in walking, and here’s my argument.

If someone walks a mile in 12 minutes, then runs one in 8 minutes, it is conceivable that he burns the same amount of calories each time, because although running burns more calories per unit time (there is more muscle twitching with running), it is over a shorter time than walking. It is sensible that walking that extra four minutes makes up the balance.

Let’s make the comparison even closer: suppose Tom walked a mile in 12 minutes and “ran” the next mile in 12 minutes as well. This can be done at a certain threshold—the point (speed) where one can still walk fast or run at a light pace. It is best realized on a treadmill, because you do not change the treadmill speed but can either walk fast, or use a running movement. You’ll have to try it to know what I mean. For me, that threshold is 4 mph. I can switch between walking fast and running at a light pace. In this scenario, the times for completing both miles are equal (walking one mile in 12 minutes, then running one mile in 12 minutes), which makes the question of which burns more calories more interesting, and definitive.

Have you tried to figure out what specifically changes when you switch between walking fast and running? Lately, I’ve been speed walking a mile using a treadmill and running a mile, at the same pace, and tried to sense what was happening as I switched between the two.

Here’s what I discovered:

I immediately sensed that running made me breathe harder. An increased respiratory rate from exercise signifies a higher metabolic rate in the muscles (more glucose being used up in the citric acid cycle, which demands more oxygen).
Running felt harder to do than walking fast. This is evidence that I was expending more energy running than walking.
My strides were the same running vs. walking. In other words, I was not taking more frequent, shorter strides during running; they were about the same length.
I was bobbing up and down more during running. This was evident from my visual field—I noticed a significant increase in the vertical up and down movement of objects I focused on (the treadmill faced an open window, with trees in the distance). I estimated it to be about 2-3” every stride.
I sensed more muscle expenditure in my lower leg (calf) muscles and foot muscles when walking, compared to running.
I sensed more muscle expenditure in my upper leg (quadriceps) when running; i.e., stronger contraction in my legs compared to walking.

My conclusion is that, although fast walking and light running were done at the same speed, there were differences in the biomechanics of the movements. Unlike walking, running involves a subtle vertical push upwards, generated mainly by the quadriceps muscle starting at the heel strike phase (leg forward position, initiation of propulsion) through the mid stance to toe-off , that lifts the entire body up about 2-3 inches, compared to walking. This was evident even as I tried my best to stay level while running.

running gait

So, my theory is that running a mile burns more calories than walking a mile, and the extra work/ calorie burning in running comes from the stronger concentric contractions (meaning, more muscle fibers firing which uses more glucose) in the leg muscles to generate that extra vertical height against gravity PLUS the stronger isometric contraction that occurs when landing from that extra height, from heel strike to mid stance. So, switching to a running gait gives you a double whammy of calorie burning over walking, even when doing it at the same pace and over the same distance as walking.

Another way to look at it is potential energy. In physics, potential energy is the potential energy associated with gravity, which is released when the objects fall towards Earth. Hydroelectric power comes from the potential energy of water stacked high by a dam, and released at a lower level. The movement of water due to gravity is harnessed by the generator, which produces electricity. This is also a good example of how energy converts to different forms; from potential to mechanical to electrical.

Potential Energy = mass x gravity x height (above ground). When you run, because the biomechanics causes your whole mass to rise 2-3” higher than when walking, potential energy builds up and then releases, which travels through your muscles and bones as a force that needs to be dampened by muscle contraction (or you would collapse), which burns more calories.

So, if you were told that walking a certain distance burns the same amount of calories as running the same distance because of the formula W=F*d, where F and d values are the same in both cases, it’s likely not true. The faulty assumption here is that your body mechanics are the same when they are not. Running 3 miles feels you are doing more work because you are. Your heart rate is faster (this alone burns additional calories), your muscles and joints ache more, and your breathing rate is higher than if you walked the same distance. It’s all because with running, you are expending more energy elevating your body an extra 2-3” with each stride. This effort requires more calories in generating that lift, and absorbing it.

So yes, running is a great cardiovascular exercise to burn calories and lose weight. It does place more stress to your joints, so make sure you can handle this; otherwise, you are better off walking for exercise. But, you will need to walk a greater distance to burn as much calories as running, so it’s going to take you more time to lose weight with walking, compared to running.

If running is just too uncomfortable for you, try speed-walking because ultimately, any movement is better than none when it comes to staying fit and maintaining a healthy weight.

Nicola TL, Jewison DJ. The anatomy and biomechanics of running. Clin Sports Med. 2012

How to Strengthen Your Joints and Avoid a Life of Chronic Pain

by Pain Doc | Jul 21, 2021 | Arthritis, Hip Pain, Knee Pain

When I talk about the nature of joint aches and pain such as hip pain, knee pain and shoulder pain, I explain that the human body is basically a biological (living) machine. Like a machine, it has moving parts comprised of levers connected by some kind of mechanism that redirects force. Think car engines, certain power tools and watches.

In the human musculoskeletal system, those levers are the long bones such as the femur and ulna, and the connecting mechanism/ force redirectors are the joints. Like a machine’s mechanical components, joints will gradually wear out with use. The more hours/years of use, the more likelihood of breakdown. Think football players and those in heavy labor jobs.

When a moving part of a machine gets prematurely damaged from an accident like dropping or overloading, it gets repaired—a replacement part is installed and/or a mechanic puts things back together and makes necessary adjustments. However, the machine is never the same. The accident typically causes moving components to misalign ever so slightly, which results in more friction and accelerated wear and tear, leading to impaired efficiency and eventual breakdown again.

Similarly, if you twist and injure your knee, hip or other joint and get it repaired surgically, or by a chiropractor or physical therapy/ rehabilitation it is never quite the same—most people will lose some degree of functionality because the natural alignment has been permanently altered. You may lose a few degrees of arc of motion; hear some clicking sounds with movement (called crepitus), and lose some strength in the affected joint. Worst case, you will experience chronic pain.

Your joint health obviously plays a huge role in your quality of life. The good things in life involve movement, which depends on joint function. Your joints must be able to first of all exist without pain. They must be able to move your body in the manner you wish to move, without mechanical limitations. And, they must be able to withstand forces while they move your body parts– jumping, climbing, lifting, carrying, etc. That’s the best case scenario.

But what if you are one of the millions of people who have some form of joint pain; either from wear and tear, or from an accident such as a sports injury, work injury, fall, or car accident? These things happen to almost everyone at some point.

It depends first of all on how bad it is. How much structural damage occurred will determine the extent to which your joint can be rehabilitated/ returned to normal.

Unfortunately, the tissues that comprise joints are of the type that do not regenerate very well. This includes tendons, ligaments, cartilage and muscle. As I wrote before, tendons, ligaments and cartilage are classified as connective tissue, which does not contain many living cells, per unit mass. They are mostly protein filaments (collagen, elastin) embedded in a special matrix whose main function is structural. The few cells found in connective tissue are mostly dormant (chondrocytes, fibrocytes) and can effect minor repairs and maintenance: tiny tears of collagen can be repaired, but large tears cannot. Tears/injury to cartilage, such as a meniscal tear or rotator cuff tear, are either repaired by surgical reattachment, or left alone to become chronic leaving the individual with a certain percent loss of function.

Compare this to skin tissue, classified as epithelial tissue, which can heal relatively fast due to the high density of cells (they divide in number to create new tissue) and blood supply. Think of the last time you got a cut– how relatively fast it healed, and is no longer noticeable.

So if you are fortunate to not have joint pain, think proactively now to keep it that way.

If you are experiencing any level of joint pain and/or dysfunction, learn things that you can do to reclaim some of that function AND slow down the progression, which is what I can help you with. Even chronic cases of joint pain can be improved, so don’t give up hope. You may not be able to make the pain go away entirely, but if you can reduce the severity of your pain by 50% and/or increase range of motion by a couple of degrees, that can translate into a dramatic improvement in your quality of life.

The Two Main Approaches to Maintaining Joint Health

Let’s review the main joints involved in everyday movement patterns.

First of all, the weight bearing joints of the lower extremities: hips, knees, ankles, foot joints. We can also include the lumbar spine (low back). These joints have the dual task of bearing the body’s weight (and more than your weight if you do high impact activities) while allowing ambulation—running, walking, climbing, etc. and are therefore larger in terms of surface area contact and number of ligaments.

Secondly, the non-weight bearing joints of the upper extremities: shoulder complex, elbows, wrists, and hands. While they don’t bear as much weight as the hips, knees, ankles and feet, these joints are involved in anything you do with your arms/ hands. They are smaller and generally have more moving parts, so these joints are vulnerable to degeneration as well, especially the glenohumeral joint of the shoulder.

The first course of action in preventing joint degeneration, which tends to start in most people around age of 40, is through diet and nutrition. Eat a wholesome diet rich in phytonutrients; i.e. plants. Phytonutrients are vitamins and minerals naturally found in plants that are important co-factors in numerous biological functions, such as enzymatic activity, tissue repair and anti-inflammation. Some like turmeric are strong anti-oxidants. Think of oxidation, or oxidative stress, as the body’s version of rust. Oxidation is what causes rust and decay in metals; oxidation in the human body damages cell membranes, proteins and DNA. It is caused by excess free radicals— oxygen-containing molecules that have an unpaired electron, making them highly reactive. They take electrons from tissues in order to return to a stable state, which damages them. In fact, oxidative stress is a leading theory of aging and joint wear and tear. Eating a diet rich in phytonutrients—green, leafy plants and plants with hues of blue, purple, and orange equips your body with the nutrients it needs to counteract oxidative stress. Thus, think of a plant-based diet as being protective of your joints.

On the contrary, eating a diet rich in processed foods and added sugar can place a burden on your body. Not only is there a lack of nutrients, there are ingredients that can raise your triglycerides and bad cholesterol; form plaque in your arteries, and even cause toxicity. They must also put a strain on your liver, lymph system and kidneys, the organs involved in detoxifying your body.

Next, move those joints! You’ve got to find the right balance between helpful movement that exercises and strengthens your joints, and the ones that can cause damage. I’m not saying to avoid things like weight lifting and running, because when done properly, they benefit your joints.

Basically, repetitive jumping activities and wrong running technique that “pounds” your knees, hips, feet and spine joints have the potential to cause tiny cracks in your cartilage, which can expand into pits and eventually tears. An example of the movement you should avoid is playing basketball often, where you run on a hard court and jump and land hard to do layups numerous times; often landing on one leg first.

Running is a great aerobic exercise, and I do it myself, being in my mid-50s. But do it wrong, and you are setting yourself up for hip, knee and foot pain. With running, first of all, I highly advise running no more than 20 miles a week. You don’t need that much cardio from running, and running beyond this point every week turns the tables, as the cardio benefit is at the expense of your hip, knee and feet joints. Long distance running is especially not advisable, as it can generate excessive free radicals, causing oxidative damage to your body. Repetitive pounding especially if you are over the age of 40 when cartilage loses its thickness and pliability can cause micro-tears which can expand as you keep doing it, like a tiny, 2mm crack in a car windshield that gradually grows into a really big crack with every bump in the road.

Also with running, definitely do not use a jumping type movement. Think more in terms of really fast walking. Keep your feet close to the ground as you run, and land on the forward half of your foot (toes, ball and arch) rather than your heel. Your head should not bob up and down as you run; or it should be minimal.

Do closed kinetic chain exercises. This means the levers involved in movement (i.e. for lower extrmities, your lower leg and foot) are secured to the ground during force generation. A perfect example are squats and lunges. With this type of exercise, you have more control, and you isolate the muscle better because your leg is secured to the ground with your weight.

For upper extremities, an example is planks and push ups. Chin ups as well — same concept, the levers are firmly secured as you exercise the muscles and joints in a controlled fashion.

Remember, joints are comprised of two bones connected by ligaments. A tendon (the ends of a skeletal muscle) crosses over the joint and connects somewhere on both bones (origin and insertion points). So when you do squats, you are strengthening the ligaments and tendons of the joint, giving it more support. With more support, the joint is more stable and able to withstand forces better; i.e. it will last longer. How does it happen? Wolf’s Law of physiology states that connective tissue increases in mass in response to repeated loads. It’s one of the body’s many survival and environmental adaptation mechanisms. The mechanical stress signals to the brain to mobilize cells to secrete more matrix and collagen to handle the load. This is why resistance exercises are highly recommended for women who are at risk for osteoporosis—it builds up bone mass and turns down bone loss.

Conversely, being sedentary leads to muscle, bone, and connective tissue atrophy. Weak joint components will increase your risk of injury.

But again, be careful not to overdo it. Do the movements slowly and controlled, and focus your mind on controlling the primary mover muscles rather than your rep goal. This will maximize joint strengthening and minimize injury.

Summary of Main Points

Proper joint function is necessary for everyday movements, and therefore is critical to quality of life.
Joints are prone to injury and degradation due to their daily use.
It is advisable to be proactive to ensure your joints stay healthy throughout your life because joint components are comprised of tissues that do not regenerate well. One major injury can mean lifetime dysfunction.
The recommended approaches to maintaining joint health are a plant-based diet rich in phytonutrients, and closed kinetic chain exercises to strengthen your joints so that they are more durable and resistant to injury and degeneration.

Next time, I will discuss more ways to keep your joints healthy, and if you already have chronic joint issues, things you can do to reclaim function.