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Three Simple Ideas to Plan and Keep Your Health Goals

by Pain Doc | Jun 26, 2021 | Lifestyle Modification, Nutrition

Photo by Pexels

By Jennifer McGregor

We use a lot of statistics to determine health, but being healthy isn’t just about numbers. Yes, some numbers matter, such as your weight and your blood pressure, but how you feel matters, too. And, truth be told, the numbers and the feelings are all interconnected; if those numbers are too high or too low, it’s likely you already feel out of sorts.

Many people struggle to make physical and mental health and wellness a priority. We often set ourselves up to achieve some pretty unrealistic health goals. Not only does that hurt us mentally, emotionally and physically, but it can also damage us financially, as well. How often do you spend loads of cash on crash diets, exercise equipment, and gym memberships that go unused for the majority of the year?

You shouldn’t feel ashamed of wanting to get healthier or when those goals go unrealized. However, you should feel motivated to pick up and try again. Check out these simple tips to help you start and stick to a head-to-toe health overhaul.

Be Confident in Who You Already Are

You have value just as you are. Working on becoming a healthier version of yourself isn’t a judgment call on your worth; it’s a sign of self-respect. Start by making little changes in confidence now. For example, you can stock up on makeup, skincare, and other beauty items. Consider going on Groupon to get deals on haircuts, facials, nails, and other beauty services to help boost your confidence in the ways you already radiate health and wellness.

Be Flexible in Mind and Body

A regular yoga and meditation practice can help you build strength in mind and body. Studies show that people who take up the practice can better manage stress, reduce the risk of injury, build lean muscle mass and improve flexibility. Being flexible isn’t just about being able to touch your toes (although that is a nice side effect). It’s about being compassionate with yourself when you do lose track. Feeling guilt or shame can keep you in unhealthy patterns.

Focus on Your Dental Health

Similar to the concept of a mind-body connection, your oral health is also linked to the rest of your body. Improper dental care can increase your chances of developing diabetes, for example. Maintaining good dental hygiene can help prevent health problems such as gum disease and heart attacks. In addition to regularly brushing and flossing, it’s crucial that you assess your teeth’s alignment. If they’re misaligned, you may have a harder time keeping your teeth clean, so it’s best to look into a treatment.

When it comes to alignment treatment options, clear aligners are a popular choice since they’re more discreet than traditional braces. However, keep in mind that not all clear aligners look exactly the same. Some aligners may be slightly more visible than others based on their texture. For example, Candid has a “frosted” surface, which can make your teeth look more natural. However, if you find that a “shinier” smile is more attractive, you can go with a smooth texture like the Byte aligners. Make sure you thoroughly research your options and choose the one that will best fit your needs.

Be Conscious of Not Only What You Eat, But Also Why and How

In American culture, we frequently rush through fast-food drive-thrus or pop a frozen entree in the microwave. While doing this from time to time isn’t a crime, you’ll want to make some major changes if those options make up the majority of your diet. It might seem like buying healthier foods will inflate your grocery bill, but you can maximize your finances by joining a meal delivery service. Many of them offer a deep discount on the first month, and even if you do continue the service, the cost per meal is actually often quite cheaper. While you gently shift away from eating fast food and processed meals, be sure to keep a food journal logging when you eat and how you feel. Connecting your eating habits to your feelings, thoughts, and behaviors can help you break some unhealthy associations you have with food.

All too often we try to make big changes happen overnight, and that’s why they are so hard to keep — we often take drastic measures too quickly. So, make progress with small, intentional steps to save time and sustain your success.

If you suffer from fibromyalgia, sciatica, or another type of musculoskeletal pain, you can seek out helpful articles that discuss pain relief strategies at The Pain & Injury Doctor.

How to Manage Hip Stiffness and Pain

by Pain Doc | Jun 14, 2021 | Hip Pain, Pulsed EMF

The hip joints are a key component to stabilization and ambulation of the human frame, so if you are experiencing problems with one or both of your hips, it is going to cause some loss of basic movements required by common activities of daily living, which translates to a reduction in quality of life. It is therefore imperative that you be mindful of your hip health at all times: take care not to place excessive shock trauma and repetitive stress to your hips; engage in exercises and stretches that condition your hip stabilizers.

Hip bone, or os coxae

The hip joint, or acetabulofemoral joint is a ball and socket type joint that supports the weight of the body in a static (standing) position and ambulatory position (running, walking). Its two articulating parts are the femoral head of the femur (upper leg bone) and the acetabulum of the pelvis (coxae), a bowl-like depression lined with cartilage.

Your hips bear quite a bit of repetitious force every day, and if you run and/or play sports that involve jumping and landing such as basketball or gymnastics, then those hip joints are really taking a pounding.

mountain bike shocks

The hip/pelvis complex, like a $10,000 mountain bike, is designed to absorb shock from multiple planes while simultaneously enabling movement. A high-end mountain bike can be ridden over uneven ground and can withstand shock forces from bumpy terrain, drops and jumps thanks to a multiple- jointed frame outfitted with shock absorbers. Like the mountain bike, the hip/pelvis complex enables the human body to absorb shock while ambulating.

The hip joints are balanced under the coxae, with the femoral heads partially inserted into the acetabulae and held in tightly by strong but stretchable capsular ligaments. Smooth, nearly frictionless cartilage lines the femoral head and the acetabulum. Comprised mainly of water molecules bound by proteins, cartilage is able to absorb shock and rebound, since water is incompressible. In youth, cartilage is thicker, suppler and more resilient than in those past age 40 but as you age your cartilage thins and is less capable of absorbing repetitive shock; hence the difficulty of running for exercise as you age.

Major hip muscles

Rear view of the hip muscles.

The Ilia and ischia of the pelvis serve as broad attachment points for the hip stabilizer muscles: gluteus maximus and minimus, psoas, adductor brevis and longus, and the deep hip rotator muscles (gamellus, piriformus). These are the hip mobilizers and shock absorbers that give the hip joints their main function of propelling the body on flat and uneven ground, and stabilizing them when the upper body needs a stationary anchor such as during heavy lifting.

So what are the main types of hip problems?

The most common problem that affects the hips is osteoarthritis. With so much pounding forces absorbed daily, the hips are prone to degenerative changes more so than other joints with the exception of the knees. Tiny fissures appear in the cartilage and gradually expand over time, like a windshield crack that grows longer from the constant dips and bumps of driving. The cracks turn into pits, and the hip joint starts to lose its smooth, fluid movement; giving way to clicking, stiffness, and limited range of motion. Although osteoarthritis is often referred to as a “degenerative joint disease,” this term is not entirely accurate. There is indeed a degenerative process involving progressive loss of articular cartilage, but there is also a reparative process in response to this degeneration that involves new bone formation, osteophyte growth, and remodelling. The dynamic process of destruction and repair determines the final disease picture.

In advanced hip osteoarthritis, the pit erodes all the way down to the bone, and at that point you start getting pain in your hips, and where there is pain there usually is inflammation. The hip capsule may fill up with inflammatory exudate, increasing the internal pressure of the hip joint and adding to the stiffness.

Normal hip joint vs. osteoarthritic hip

Risk factors, or things that will increase your chances of prematurely developing hip osteoarthritis are:

Previous injuries to one or both of your hips – a fall, sports injury, car accident, etc.
Participating in sports or other activities that involve high impact landings
Being overweight for much of your adult life
Smoking, as smoking restricts oxygen to tissues which is needed for maintenance and repair
Genetic factors – having a parent who got premature hip osteoarthritis

The genetic factors likely involve protein mutations that render the cartilage’s ability to bind water less efficient, making it extra vulnerable to shocks. They may also involve abnormal production of synovial fluid by the cells of the synovial tissue that surrounds the joint. Synovial fluid is analagous to motor oil in a car’s cylinder– it minimizes friction between the moving parts, so if production of synovial fluid is low, you will get erosion of the articulating surfaces; i.e. the cartilage on the femoral head and the acetabulum, accelerating the disease process.

Iliotibial band syndrome

Another form of hip pain and stiffness may be from iliotibial (IT) band syndrome. The IT band is a broad ligament that originates on the iliac crest of the hip bone; passes over the greater trochanter of the femur (that hard bump you can feel on the sides of your hips, right underneath the skin); and then inserts into the lateral epicondyle of the proximal tibia (lower leg bone). This is a condition that some runners get, and involves strain to the ligament and tenderness at its insertions points. It most often causes pain on the side of the knee, but can also cause diffuse, broad pain over the entire hip. Tenderness and pain at ligament insertion points (into the bone) typically involve micro-tears from mechanical stress, and/or inflammation to the periosteum, the thin layer of tissue where the fibers attach to the bone.

Xray of an aneurysmal bone cyst affecting proximal femur

Aneurysmal bone cysts, a benign but potentially destructive bone tumor may occur in the femur near the hip. It involves the growth of a tumor inside the bone, filled with fluid and blood. Normal bone is replaced by the tumor, which deforms and weakens the bone, making it prone to fracture. ABCs typically start in the first 20 years of life and can remain into adulthood if not dealt with. Make sure to rule this out before doing any physical therapy for hip pain; aneurysmal bone cysts are easily identified on X-ray.

There are other pathological conditions that affect the hip that can cause pain and stiffness, such as slipped capital femoral epiphysis (another pathology common to youth), fibrous dysplasia and other bone disorders but won’t be discussed in this article. Just know that these can be a long-shot cause of hip pain, and can be usually ruled out on X-ray.

Those with hip pain or discomfort due to progressive hip osteoarthritis know the consequences:

Very stiff hips upon waking in the morning, that improves up to a point as the day goes on.
Laborious walking; takes extra effort to move your legs
Aggressive movements like jumping and running are out of the question
For some, burning pain in the hips
Can’t stand for very long; have to sit

For those who have medical insurance, it’s a matter of time before they elect to have an artificial hip inserted.

So what should you do if you have hip pain from osteoarthritis, and are years away from considering hip replacement?

Here’s what I recommend:

Change your Diet: what you choose to eat day to day has the biggest influence on your health. Make 80 percent of your diet plant-based; and of that amount, about half of it raw (uncooked). Suggestions: green leafy vegetables such as chard, collard greens and spinach for the cooked; red leaf and green leaf lettuce, red cabbage, and endive for the raw. Basically, vegetables with purple and red hues are the best as they are rich in anti-oxidants.

Include protein, about 10 ounces per day. Organic grass fed meat, deep water fish, sardines, and pastured eggs are good choices. Whey protein and pea protein powder are also good.

Include fats high in Omega 3 fatty acids, and some saturated fat. Fats are a component of cell membranes especially in nerves, and they are a needed energy source for your body. Salmon, mackerel, eggs, nuts and seeds are good choices.

And of course, drink water throughout the day to stay hydrated. We humans are almost 80% water, and you lose water from your body with every exhalation.

Reduce daily stress in your life: if your life is stressful, make an effort to remove the stress. Stress has an adverse effect on your health and well-being. It can raise blood pressure, blood sugar, cholesterol and cortisol levels, which promote fat weight gain.

Get some negative ions: negative ions are abundant in nature; i.e. the outdoors. They can neutralize harmful positive ions that are plentiful where there is pollution and electronics; i.e. cities. Take off your shoes and socks, and walk on grass in a nearby park. This will “ground” your body, discharging some of your positive ions and equalizing your electrical charge with the Earth’s.

Do low-impact exercises for fitness: you don’t have to go crazy to get a good workout. Using your body’s own weight is sufficient. Planks, squats, pushups, crunches, and lunges are great. For weights, use kettlebells. Cycling can be a good exercise for those with early osteoarthritis of the hip, as the pedaling moves the hip in a non-weight bearing position.

Lastly, use a Pulsed EMF mat daily. Pulsed EMF is considered “energy medicine.” It is the external application of electromagnetic fields similar to those produced by your body, to augment the potential energy the body uses to help drive biological activity; i.e. molecular movement such as blood flow and nutrient transport. This can improve blood circulation and cell membrane transport of nutrients, proteins and wastes; thus improving cell function. In weak tissues, Pulsed EMF can stimulate healing by energizing reparative cells. Can Pulsed EMF help cause worn cartilage to regenerate? Several studies such as this one found that pulsed EMF can upregulate the expression of a gene that controls cartilage production in chondrocytes. It’s definitely worth a try.

Some studies show that Pulsed EMF can help cartilage regenerate.

Go here for more info on Pulsed EMF.

To recap, your hip joints are essential to a high quality of life. They serve to ambulate you, and enable your body to perform basic movements required of daily living such as lifting, carrying, and bending. They are also prone to degeneration, so be mindful of the health of your hip joints – avoid repetitive, high-impact activities that may accelerate degeneration. If you like running, change your running stride to one that more resembles fast walking, where there is minimal to no change in height of your head as you run and therefore minimal impact to your knees and hips upon heel strike when running. In fact, if you run, focus the impact of your foot on the ball of your foot as it contacts the ground, not the heel. Running can be good for health, and your bones, when done right – not too aggressively; with moderation.

Is It Possible to Improve Long Standing, Chronic Pain?

by Pain Doc | Jan 6, 2021 | 30 Day Pain Relief Challenge

In any sport that involves executing proper form such as a tennis serve, baseball pitch and boxing right cross, it is essential to follow through with the movement. You must commit 100% to the movement the instant you initiate it. When you do this, things go well—the movement is executed with power and precision, and you’re likely to have success.

If you are hesitant, the movement collapses or comes out wrong; it is basically doomed from the start. This is why any pro athlete will tell you that concentration and focus are equally important to athletic ability. The mind literally determines success and failure. So when you throw that punch, put everything into it!

Use this sports mindset for the things you set out to do in life, especially if they involve improving yourself, and you will succeed. Commit 100%. Follow through.

Some examples:

Changing your appearance – certainly achievable. There are even “makeover” TV shows that prove it.
Changing your persona, attitude and outlook – certainly achievable. Not easy, but if you commit to it and follow through, you are likely to succeed. Lots of motivational/ high performance gurus out there to help.
Losing fat weight is certainly achievable. Again, not easy, but achievable. If you’re overweight, it’s like going through life with a backpack full of rocks. It puts a burden on you and limits what you can do. Remove that backpack you’ve been carrying around for decades, and the change will be dramatic and amazing.
Improving your health—quitting smoking, cutting down on alcohol and drugs, exercising more: definitely achievable. Commit and follow through.

If your health is not where you want it to be, don’t be passive about it – be active. Health is priceless, and the number of years you have left in this life is a finite number and decreasing each day.

Without good health, all those other plans you have in your head, short and long-term, are jeopardized. Sure, you could do without certain things due to some physical limitation; that’s fine as long as you’re happy. But what if you didn’t have to? That’s something you need to find out.

This brings us to the issue I deal with – musculoskeletal health.

Musculoskeletal is exactly what it sounds like – your muscles, skeleton, and all its components: joints, tendons, ligaments, cartilage, fascia. This system carries your body and all its other critical systems. It enables humans to be mobile and perform incredible, physical feats.

Basically, your ability to do things in life is largely dependent on the health of your musculoskeletal system.

The longer you’ve been alive, the more demand you’ve put on your musculoskeletal system and naturally, the more likely you’ve experienced breakdowns. It’s just like any machine; the more usage hours the more likelihood of parts failing.

And if you participated in contact sports; a heavy labor occupation; have a history of physical trauma—accidents, falls then chances are, your musculoskeletal health is not 100%.

Conversely, if you had a sedentary job all your life and didn’t exercise, your musculoskeletal system is likely weak in strength and responsiveness, and you also have issues – back pain, neck and shoulder pain, etc.

Musculoskeletal pain is the #1 cause of disability, world-wide. It causes billions of dollars in lost productivity and medical costs each year. Drilling deeper, pain has other negative effects such as depression and emotional stress; pain killer addiction, and stress to the people close to the sufferer, which causes more problems and adds to the cost. Low back pain is at the top. Knee pain and hip pain are also high on that list.

Getting back to the original topic, is it possible to eliminate chronic, musculoskeletal pain just as you would unwanted weight?

Obviously, there is no definitive answer because of the many variables involved. No two cases are exactly alike, because people are different. Doctors can’t make a blanket statement that “chronic pain can be eliminated;” that would be irresponsible. The answer depends on the case.

THE NATURE OF MUSCULOSKELETAL PAIN

So, can your situation be improved? Let’s first discuss the nature of musculoskeletal pain so you can see what’s involved, and what needs to happen.

Acute pain from a recent injury has a very good chance of being eliminated with proper treatment/ therapy and time, as the body has amazing healing ability. However, the more extensive the injury (such as a really bad car accident resulting in a fractured pelvis, ribs and femur) the more opportunity for chronic pain to develop.

Chronic pain is a different beast. The body has gone through the normal stages of healing and repair, but something went wrong and pain persists. Cases that have reached a year of daily pain likely have crossed over to the central nervous system which is a bad thing. Generally speaking, the pain has “taken residence” in the brain and spinal cord. In other words, it’s not only being generated by the injured tissue; there is now self-running “memory” of the pain signals. It’s a very complex topic in neurology, and there is still a lot that is still unknown.

Chronic pain most often involves joints, and it’s no surprise. Joints are the stress point in a muscle-lever (long bone) system. This is where movement occurs, under a load (force). The weight bearing joints are the most vulnerable (hips, knee, feet, and lower spine) but non-weight bearing joints (hand, elbow, shoulder) can develop chronic pain from overuse/ old injuries.

Cartilage gradually wears out, and since cartilage isn’t easy to make the damage becomes progressive. The immune system begins to notice the damage and initiates inflammation. This leads to swelling and a bunch of inflammatory biochemicals that generate pain. In fact, most over-the-counter pain medications (aspirin, non-steroidal anti-inflammatory meds like Motrin and Ibuprofen) work by blocking the formation of these biochemicals.

If the pain becomes unbearable, surgery can help with artificial joints. But the drawback is that artificial hips and knees have to be replaced every ten or so years as they get loose—not a fun experience.

In some cases the patient cannot pinpoint it because it is diffuse, and appears to be generated in a broad area of muscle such as the back muscles.

Some of the factors (variables) that play a role in chronic pain are:

Age, sex and general health of the individual
History of repetitive stress to joints, or major injuries
Structures involved
Genetics
Mental health

So,

Younger people tend to heal better and more completely.
Females tend to experience more pain than males, for unknown reasons. For instance, in fibromyalgia, a condition involving widespread pain throughout parts of the body, females tend to be more affected about 60% of all cases.
Underlying health conditions such as diabetes, blood and auto-immune disorders can result in sub-optimal healing.
Your diet directly impacts your health on many levels. What you put in your body influences your digestion, mood, blood pressure, heart rate, strength, endurance, immune system and more.
Those in heavy labor (construction workers, movers, etc.) and who have a history of major injury are more likely to develop chronic joint pain.
Tendons and ligament strains have a better chance of healing than cartilage.
Genetics can be a factor in susceptibility to degenerative changes in joints. Your genes make all kinds of proteins; many of which play a role in structural integrity.
The research shows that patients who are more optimistic tend to have lower pain levels and higher function, compared to those who mentally embrace the pain, called “pain catastrophizing“ and allow it to dictate their attitude and mood. It’s validation of the brain-body connection; i.e. your thoughts can affect your body.

CAN YOU GET OUT OF CHRONIC PAIN?

Ok, now that you have a better understanding of what chronic pain is and the risk factors involved, you should have a better idea of your chances of improving your pain.

Whether you have all the risk factors, or just a few, I believe you can still improve your situation. But first we must define “improvement.”

While pain reduction is important, what’s perhaps more important is functional improvement. They tend to go hand in hand; i.e. the more pain you have, the less you are able to do (less function), and vice versa. The problem with this, though, is that chasing the pain with medication, chiropractic, acupuncture and other passive therapies without working around it and focusing on regaining your functional capacity (your ability to do certain tasks/movements) could be the wrong strategy. It traps your mind into thinking that your pain determines your ability; like a gate keeper, and as long as that pain gate keeper is there, you convince yourself that you cannot move properly. The consequences can be psychosomatic where your thoughts literally change your physiology and inhibit proper healing; and they can be limiting; causing you to avoid movement and stay bed-ridden, leading to muscle atrophy. Remember the brain-body connection—thoughts have a powerful effect on your body. Thoughts can imprison you, or they can liberate you.

Back to defining improvement. In the previous post, I introduced you to the Pain and Disability Questionnaires. This is a tool doctors use to “quasi-quantify” pain; i.e. assign a number to it. But they are so simple to use and available for free download (the links are at the end of this post), anyone can use them.

You select the pain questionnaire that applies to your condition—low back, neck, shoulder, upper extremity, lower extremity. Fill it out according to the directions and determine your “percent disability” or “percent functionality.” If you’re at 40% disability for low back pain, strive for 20% in about two months; then 10% after a couple more months. This provides something tangible to work with.

These questionnaires came about when doctors decided that improvement in common, every day movements/tasks such as walking up the stairs or raising something above your head is much more important and meaningful than improvement in pain, which is harder to measure since it is so subjective.

So, the 30 Day Challenge will focus on improving your Pain and Disability score; not so much on your pain level. As your score improves, your pain should improve anyways, but it won’t be the focus in this challenge.

Now that you know that we will be focusing on functional capacity, you can probably guess what the strategy will be to improve your pain/ disability score. The focus will naturally be on nutrition.

The fastest way a person can significantly and dramatically change his/her health metrics is through diet. The reason is simple – what you eat becomes you—the proteins, oils/fats, and fluids in your food become part of each cell in your body. Like many things in life such as clothes, shoes, houses, cars and bridges, if high quality materials are used in construction, it lasts longer. Use cheap materials, and the item will break down much earlier with use. So. eat high-quality, nutrient-dense foods, and your body will be stronger and will therefore last longer without breaking down.

Food, particularly plants, have numerous phytochemical nutrients that help your body work better—vitamins, minerals, co-factors, anti-oxidants. Eat those, and you get all these beneficial nutrients that your body needs to run its thousands of biological processes.

But as you will soon find out, it’s not just about what you eat. What if you ate the healthiest meals, but your body couldn’t absorb the nutrients very well due to a digestive problem?

Well, those nutrients will be excreted in your waste, and your body will be deficient in them. You can eat well but still be nutritionally starved.

So part of the strategy will focus on optimizing your body’s nutrient absorption potential. Think of it as flushing out your plumbing and fixing any worn out parts.

How and when you eat is also important. Should you eat three meals a day? Is it OK to skip breakfast? What’s the latest hour of the day that is OK to eat? We’ll talk about this, too.

Although it’s a 30 Day Challenge, you don’t have to start all the activities in 30 days. Try them out and implement them at your own pace. But the most important thing is to commit. Follow through. How badly do you want to get out of pain? To be able to easily do a 5-mile hike again, or go up two flights of stairs without losing your breath? Dramatic change demands dramatic commitment—perhaps a level that is new to you.

If you truly want to reduce your pain by at least 50%, you must give it your best effort, as if your life depended on it. Laser focus, ignore the nay-sayer thoughts that are bound to pop up (again, your mind can imprison you and it can also liberate you; you have the choice), and execute the plan faithfully and consistently. Do this, and you will reap the many rewards in life that better health brings.

The 30 Day Pain Relief Challenge will be based on video tutorials. Tomorrow, I will send you the first one, so keep an eye out for it in your In box.

Sincerely,

Dr. P

The 30 Day Pain Relief Challenge Kick Off

by Pain Doc | Jan 4, 2021 | Foot and Ankle Pain, Hand and Wrist Pain, Hip Pain, Knee Pain, Leg Pain, Low Back Pain, Neck Pain

It’s 2021 and time to kick off the 30 Day Pain Relief Challenge!

But first I want to acknowledge what’s on everyone’s mind.

2020 began with an unexpected crisis, the COVID-19 pandemic. A new corona virus strain emerged; highly contagious and deadly for certain individuals, and for which there was no vaccine. As of this writing, over 85 million people worldwide have contracted the virus, with 1.85 million dying from it. The United States is being hit the hardest, with 20.8 million cases and 352,000 dead. The numbers are expected to spike following the holiday season, thanks to many people choosing to get together in large groups and ignoring the risk. So please, remain extra vigilant the next two weeks because chances are, there are more viruses around you than there were a month ago, ready to find a new host.

As we navigate through COVID-19 in 2021, life must still go on. I know many have been hurt economically, and their number-one priority is to find a way to get back on their feet. It is not an easy thing to do, especially if you lost your job and the life skills you possess are in an industry that has been permanently impacted by the pandemic. If this describes your situation, I sincerely hope you find a way to re-position or re-invent yourself, to get back to earning a living.

While COVID-19 dominates the news and peoples’ attention, we must not lose focus on the many other challenges life presents that also need our attention. How would you rate your health at the start of the new year? How about your energy levels and endurance?

Quarantining and social distancing have a way of discouraging exercising and promoting over-eating, a terrible combination to health. When one is restricted from going outside and going to a gym (although a gym is not necessary for staying fit, but I digress…) and constantly bombarded by news of doom and gloom, the tendency is to stay home, surf the web, and eat, more than you typically do (what else is there to do in such a scenario?). And for many, the choice is high-calorie comfort food. This can lead to unwanted weight gain, muscle atrophy, joint pain, and so on.

If you are not feeling 100%, then I encourage you to open all the emails I’ll be sending over the next 30 days—the 30 Day Pain Relief Challenge is about to kick off, and email is how it will be executed.

And what exactly is the challenge? It’s about challenging yourself to get out of your comfort zone and do all the things I will suggest in the coming days so that you can get out of pain, or significantly knock it down to levels you haven’t experienced in a long time.

The other reward may be that you will lose 10 pounds or more; will have more energy, and will notice that your mind/ thinking is clearer. This is because the methods I’ll go over target your body and all its systems; not just the area of pain. It is wholistic.

But first let me explain how you will be measuring your results. After all, pain is subjective. You need some kind of tool to quantify your improvement, so read on.

Pain, aches, discomfort or whatever you want to call it affects your health. There is mental health and physical health; both important to happiness in different ways. Your physical and mental health are impacted, even just a little and perhaps unnoticeable to you, if you have chronic pain/aches/discomfort. Less-than-optimal physical and mental health impacts quality of life. Quality of life in this sense refers to your ability to physically do what you need or want to do; whether it be your job; recreational activity such as playing golf or swimming; or activities of daily living; i.e. taking care of yourself and your personal needs.

Why You Might Have a Disability if You Have Pain

If you live with chronic pain, you likely have some degree of disability.

“Me disabled?” you might be thinking. “No way!”

The word “disability” is often misconstrued. Disability doesn’t necessarily mean “disabled” and in a wheel chair. It simply means not being able to perform a certain task without some degree of difficulty or impediment; or not being able to do it at all.

Doctors (medical examiners) who issue disability certificates or write medical-legal reports are tasked to determine the degree to which someone is disabled. Their findings determine the patient’s disability compensation from the insurance company or government agency. They use observation, physical exam procedures, diagnostic tests like X-rays and nerve conduction; and instruments to measure strength, pain perception, reflexes, coordination, and range of motion. Any deficiency is expressed as a percent disabled, and there are laws that define levels of disability.

For example, in the insurance industry, the loss of both eyes, or the loss of two limbs equates to “100% disability.” Not being able to maintain a tight grip could be rated as 20% disability if the person’s occupation requires power gripping machinery.

Disability can also be subjectively quantified using Disability questionnaires where the patient rates his/ her ability to perform certain tasks on a scale of zero to some number; and the level of pain. In some questionnaires, the zero rating means you have zero difficulty doing the task (best score), while in others the zero rating means you cannot do the task at all (worst score).

For example, the following is one section of the Oswestry Low Back Pain Disability Questionnaire. Imagine having low back pain and rating yourself (0 to 5) on your ability to lift things:

LIFTING:

0 – I can lift heavy weights without extra pain

1 – I can lift heavy weights but it gives extra pain

2 – Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table

3 – Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

4 – I can lift very light weights

5 – I cannot lift or carry anything at all

When rating yourself, you must try to be as objective as possible—don’t over rate your ability; nor under rate it. Give each question some thought.

Then, you add up the numbers, divide it by the total number of points and multiply by 100 to get a percentage score.

If the zero rating is assigned to “full ability to do the task” (like the Oswestry above), then the score is interpreted as “percent disabled.” So, an individual with no low back disability whatsoever will score zero out of 50 and his rating will therefore be zero percent disabled; i.e. 100% functional. If his score is 30, then 30/50 x (100) = 60% disabled.

Below is an example of an Oswestry Low Back Pain Disability Questionnaire completely filled out:

oswestry low back pain disability questionnaire

In the above example, the total points out of all ten questions is 19, which is considered a Moderate disability, out of No, Mild, Moderate, Severe and Total Disability. In this case, 19/50 x 100 = 38% disabled due to low back pain. Now this person has a baseline for his condition, and can set goals to lower it each time; perhaps to 20% after a month, then 10% after three months of therapy.

If the zero rating is instead assigned to “no ability to do the task,” the score is interpreted as “percent functional.” This is how the Upper and Lower Extremity Disability questionnaires are designed. So a score of zero in this case means zero percent functional (totally disabled), and 30% means you are 30% functional (you lost 70% function in that limb).

Please note that Disability questionnaires are used as tools to quantify and set baselines for pain and functional capacity; your scores do not officially establish any disability you may have, they simply provide a more tangible interpretation of pain.

Quantifying pain/disability, even if subjective, gives you a sense of how significant it is; i.e. how much it affects your life. Secondly, it can be used as a tool to measure your improvement over time, after doing some therapy and/or rehabilitation (strength and coordination exercises). This lets you know if what you did works for your condition, and therefore, whether to continue or discontinue it.

For example, if your baseline Oswestry score was 60%, and you were prescribed some McKenzie exercises for one week and a follow- up score was 40%, it suggests that those exercises improved your condition and you should continue or progress to the next level. If it was 60% or higher, you should discontinue the exercises and try another approach.

You don’t have to see a doctor to use Disability questionnaires to subjectively assess your disability. They are fairly straightforward to use and you can download the forms from the internet (see below; I’ve done it for you).

Determine Your Pain/Disability Baseline

If you have low back pain, neck pain, shoulder pain, or lower or upper limb pain then I suggest monitoring your condition using the appropriate disability questionnaire. If you are getting therapy, your doctor should be having you fill these forms (or something similar) out each visit and going over the results with you. It’s substandard care if you don’t know if the therapy you are getting or exercises you are doing is helping; these questionnaires will prompt you to think about the change or lack of change in your functional capacity, and will help you assess your care so that you can take appropriate action.

Below you will find forms to assess any musculoskeletal pain you are having. If you wish to participate in the 30 Day Pain Relief Challenge, print out the appropriate disability questionnaire; rate your abilities as objectively as you can and calculate your score; set it aside, and be ready to fill out a new questionnaire after 30 days of diligently doing the things I will cover over the next 30 days.

My goal is for participants to experience at least a 50% improvement in their pain/ disability scores. If you have any friends who might be interested in participating, please refer them to my site, https://PainandInjuryDoctor.com and have them enter their email in the opt in form.

Download the Low Back Pain Disability Questionnaire

Download the Neck Pain Disability Questionnaire

Download the Shoulder Pain and Disability Index Questionnaire

Download the Upper Extremity Disability Questionnaire

Download the Lower Extremity Disability Questionnaire

The Good Thing That Came Out of the COVID-19 Pandemic

by Pain Doc | Oct 13, 2020 | Telemedicine

Dear Readers,

As you know, it has been a really tough 2020 so far, worldwide.

Here in the U.S. we’re still battling COVID-19; dealing with hurricanes, social unrest from racial conflict; a very divisive political situation, and here in California where I live, forest fires (about 400 burning at the same time at one point) enough to cause air quality warnings far away from the fires.

I know some of you are in Europe, Asia, Australia and the Middle East. I hope things aren’t so bad over there.

But enough of that. We must focus on living and make necessary adjustments to carry on with our lives.

There is an old Chinese saying that goes something like this: From crisis, there is opportunity (forgive me if I butchered it; no insult intended).

For the COVID pandemic, this turned out to be true: millions, if not billions of people all over the world learned that they could do a lot of things that they normally did in person, online. And for those who already did this well before COVID, they learned how to do it even better.

Shopping, buying groceries and sundries, attending school, working, holding meetings, attending church services, getting music lessons, and socializing are just some of the activities people learned how to effectively do online, thanks to being quarantined.

And, in my opinion, the most significant thing people are doing more of online, thanks to COVID: healthcare. Telemedicine, also called telehealth involves using a telephone and/or webcam to communicate with a health professional instead of in person, face-to-face for the purpose of improving one’s health. It also encompasses “consuming” health care content in digital format via the internet such as pre-recorded videos, slides, images, flow charts, white papers, and audio files and podcasts. I wrote about this over five years ago when I decided to transition my practice to a telehealth model.

Telehealth was just starting to gain traction right before COVID, but the pandemic accelerated its acceptance. The need to quarantine and social distance forced doctors and their patients to interact online, and things will never be the same (in a good way). We were hesitating at the edge of the swimming pool and COVID pushed us into that cold water, figuratively speaking.

Webcams, Internet, Wireless Connectivity and Mobile Devices Finally Transform Healthcare

The “planets aligned” for telemedicine, and very soon it’s going to be as common as buying groceries. To me, it’s overdue. I hope that telehealth not only enables healthcare for millions more lives on the planet, it will drive healthcare costs down. The cost savings to hospitals are obvious; and those savings should be passed on to the insured and paying patients. We’ll see if that happens. While I know people are used to tradition, starting from the days of the old country doctor with good bedside manners I think in 2020 and beyond, people are going to be just fine seeing their doctor online for simple and routine visits.

And the implications go beyond the actual care: telemedicine will save time and money on a macroeconomic scale, and will be actually good for the environment in more ways than one: less cars on the road (no need to drive to see your doctor); less electricity and other overhead expenses needed to keep a large building operable, less printed paper, etc.

Telehealth Is Ideal for your Average Doctor Visit

The vast majority of things that cause people to seek a doctor are non-emergency, and lifestyle related. Non-emergency means not life-threatening, or risk of serious injury. Lifestyle related means conditions that are largely borne out of lifestyle choices—high-calorie/ junk food diets; alcohol use, smoking, inadequate exercise, occupational/work-related, etc. and are usually chronic; i.e. having a long history–diabetes, high blood pressure, indigestion, arthritis, joint pain, etc. These conditions can be self-managed with proper medical guidance provided remotely via webcam. I believe that if lifestyle choices can cause illness, different lifestyle choices can reverse or minimize those same illnesses, which can be taught via telehealth.

Then there are the cases that are non-emergency, single incident: fevers, rashes, stomach aches, allergies, minor cuts and scrapes, and things of that nature. Sure, some cases of stomach aches and headaches can actually be something dire like cancer. But doctors know that such “red flag” scenarios are comparatively rare, as in less than one percent of all cases; therefore, the vast majority of them can be handled via telehealth. Besides, the doctor can decide at the initial telehealth session if the patient should come in the office, if he/she suspects a red flag.

A Typical In-Office Doctor Visit

Typically when you go to a doctor/ primary care physician, you are given a list of disorders and told to check off any that apply to you recently—stomach pain, headaches, vomiting, fever, etc.

Then, you are asked a bunch of questions related to your complaint. This is called taking your history (of your condition). The nurse practitioner or doctor may do this.

The doctor may or may not examine you, such as checking your eyes, ears, nose, and mouth; temperature, blood pressure, heart rate, lungs and so on depending on your history and complaint.

The doctor then takes this information and comes up with a diagnosis or two. You may be referred for diagnostic testing, again depending on what you came in for, such as an X-ray, MRI, ultrasound or blood test.

You may get a prescription for medications or medical device, and a printout of home care instructions, and then you’re done with your office visit.

With the exception of a physical examination involving touching and diagnostic tests, everything I just explained can be done via a telehealth visit on your computer. But as technology advances, more and more medical procedures will be performed remotely via a secure internet connection.

I believe that in the very near future, there will be apps and computer peripherals capable of doing diagnostic tests which will allow your doctor to get real-time diagnostic data during your telehealth visit. It’s already possible for blood sugar, body temperature, heart and lung auscultation and blood pressure.

Imagine wearing gloves with special, embedded sensors in the fingertips that transfer sensory information via the internet to “receiver” gloves that your doctor wears, 20 miles away. During a telehealth visit, you can palpate (feel) your glands, abdomen, lymph nodes, etc. and this sensory information is immediately felt by your doctor, as though he was right there palpating and examining you.

Or, imagine an ultrasound device that plugs into your HD port that transfers images of your thyroid to your doctor via the internet.

The possibilities are endless, and it bodes well for global health. Imagine all the people who can be helped, all over the world, via telehealth. It’s truly an exciting time in healthcare.

Telemedicine for Muscle and Joint Pain and Injuries

Every day, millions of people worldwide sustain or develop some sort of musculoskeletal (affecting muscles, joints, tendons, ligaments, bone) pain, whether it’s their low back, neck, shoulder, hip, knee, hand or other body part. If not treated right, it can become permanent or chronic.

Chronic pain, and even acute (recent onset) musculoskeletal pain can effectively be addressed via telehealth (this is the domain of my platform, Pain and Injury Doctor, and it’s my goal to help a million people worldwide eliminate their pain).

Available medical procedures for musculoskeletal conditions requiring an in-office visit such as surgery and cortisone injection are usually not the first intervention choice for such pain. Conservative care is the standard of care for the vast majority of non-emergency musculoskeletal pain and injury–an ideal application for telehealth.

For example, if you were to go to your doctor for sudden onset low back pain, you would most likely be given a prescription for anti-inflammatory medications, if not advised to just take over-the-counter NSAIDs such as Motrin, and rest. You would also be given a printout of home care instructions, such as applying ice every two hours; avoiding heavy lifting and certain body positions; and doing certain stretches and exercises. As you can imagine, such an office visit could easily be accomplished via a telehealth session. No need to drive yourself to the doctor’s office for this.

But what about chiropractic or physical therapy? You can’t get these physical treatments through your webcam. Yes, chiropractic has been shown to be effective for acute and chronic low back pain, but available studies typically don’t conclude that chiropractic for low back pain is superior or more economical than exercise instruction or traditional medical care. Same with physical therapy. However, as a “biased” chiropractor myself, I believe the benefit of spinal adjustments is not just pain relief, but improved soft tissue healing and structural alignment; two things that I believe can help reduce the chance of flare ups/ chronicity.

So get a couple of chiropractic adjustments if you can, but know that you can overcome typical back pain through self-rehabilitation as well (see my video on how to treat low back pain).

Yes, Many Types of Pain Can Be Self-Cured

logo Take a second to look at my logo. It looks like a red cross, but it’s actually four converging red arrows that form a figure of a person showing vitality, with arms and legs apart. The four arrows represent four pillars of self-care that my platform, The Pain and Injury Doctor, centers on:

Lifestyle modification (nutrition, mindset, healthy habits)
Using select home therapy equipment
Rehabilitative exercises
Manual therapy

These are four things that people suffering from pain are capable of doing by themselves, and sometimes with the help of a partner (manual therapy). All of the Self Treatment Videos on Pain and Injury Doctor incorporate these four elements of self-care (some are still being produced as of this writing). Isn’t this more interesting than a bottle of Motrin?

Conclusion

I will close with this: research shows that when patients are actively engaged in their healthcare, they tend to experience better health outcomes and it’s not hard to figure out why. By participating in your own health, you have “skin in the game;” i.e. you are invested in your health rather than being passive and wanting health to be “given” to you by a doctor through medicine or treatments. Mindset is what drives behavior, and those who are passive about their health are the ones who pay no attention until it’s too late—they don’t eat healthy; they don’t exercise enough; they voluntarily ingest toxins (junk food, alcohol, and smoking) and engage in health-risky behaviors. For many health conditions, by the time the primary symptom is noticeable, the disease has already set in; for example, onset of bone pain from metastasized cancer; or the first sign of pain and stiffness from knee osteoarthritis.

Being actively engaged and invested in one’s health will pay huge dividends in one’s quality of life, and longevity. So, in order for telemedicine/ telehealth to work for you, you need to have this mindset. You have to “do the work.” I can show you clinically proven self-treatment techniques to treat common neck pain, but they obviously won’t work if you don’t do them, and do them diligently.

Self-care for managing musculoskeletal pain is a natural fit for the telemedicine model of health care, which made its world debut this year. I’m excited to produce content that can help you defeat pain, without visiting a doctor’s office. I’m especially excited if your are one of the millions of people who don’t have health insurance or access to a health professional, and I am able to help improve your quality of life by showing you how to self-manage your pain.

If there is anyone you know who can benefit from this site, please share. Take care.

Dr. P