Low Back Pain Exercises - Ask Dr. P

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.

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