Is Your Workout Causing Low Back Pain?

Finally back on top of things, here's a functional lesson on working out effectively, myth busting fat loss remedies, and healthy advice for back pain sufferers. Statistics show that 4 out of 5 of you reading this will benefit from this information! Enjoy!

- Dr. P

Written by Dr. Joe Mondoux (visit his Facebook Page frequently for updates)


Do you ever see people in the gym holding a dumbbell by their side and bending to either side? (Like the picture below)

Maybe that person is you? 

Have you been told that this is a good way to work your obliques or “love handles” and help manage low back pain?

Unfortunately this is not the case and this may even be causing your low back pain. Don’t have any? Well, keep doing these and more than likely you will!

The myth of “spot reduction” has long been busted, which is the idea that you can work out a certain part of your body, such as your “love handles” and you will decrease fat around the area. This right here should be a hint that doing this exercise will not make your “love handles” any more lovable.
What you are actually doing in this exercise is working a very large and deep muscle that runs along either side of your spine called the quadratus lumborum (depicted here). 

These muscles are the primary lateral flexor of the lower spine and has a propensity to become short and tight in most individuals. When this muscle becomes short and tight it compresses the lumbar spine which can then lead to low back pain. What is happening when we target this muscle with those dumbbell lateral bends? We are making this muscle even shorter and tighter - which does what? You guessed it, compresses the lumbar spine further and leads to low back pain.

Now I don’t want you to think that you should not train this muscle and that if you have been doing these lateral bends that you are a fool – far from it. This is a very important muscle when it comes to core strength and stabilization and when you only have so many tools in your toolbox there is only so much you can do. Therefore, I want to give you some more tools so you can work this muscle more effectively, target those oblique muscles properly, decrease your chance of developing/worsening low back pain, and build your exercise repertoire.

A great exercise to target those “love handles” is the kneeling cross-body chop (below). This exercise targets the oblique muscles as their main motion is rotation NOT lateral flexion. Exercises such as this will also work the quadratus lumborum, however they will train them in a way that will not overly shorten or tighten them.

Furthermore, this action mimics more common and realistic movements as opposed to bending to your side with a load. This is called functional training, which means we train the muscles in ways they are meant to move and move our bodies in ways that we were designed to move.

This will strengthen those muscles targeted but still will not decrease the fat deposition in the area. The only true way to decrease this and eliminate those love handles once and for all is to include more cardio into your workout and alter your diet (another topic of conversation).

There is nothing wrong with training to build size and look bigger, there is however something wrong with training muscles for size that don’t need it, which can actually have negative outcomes. Try switching out the dumbbell lateral bend for a more functional movement such as the kneeling cross-body chop. Your body will thank you, and you will be better off for it!

When the Doctor Says, "Don't Do That"

Here's another golden nugget from Dr. Kathy Dooley. The golden rule when it comes to degenerating joints and restricted motion is "if you don't use it, you lose it." 

- Dr. P

Dooley Noted: 4/21/15

An old joke persists: If you tell your doctor it hurts when you do something, the doctor will likely tell you, "Don't do that."

I truly believe this has pervaded our culture so much that certain movements and exercises have been avoided out of injury fears.

People hurt some knees when squatting, so squatting became bad for the knees.

Basketball and soccer had high incidents of ACL injury, therefore one shouldn't play those sports.

Running is probably the most bastardized activity of them all. If it hurts when running, then running must not be for you, right?

What bull.

I'm a doctor, and yes - I have placed patients on restriction from certain activities.

But it's only temporary until they do something important.

It's not that they shouldn't squat or run.

They must learn to squat or run the way that protects them from injuries.

It's not, "Don't do that."

It's more like, "Don't do that the way you did it when you got hurt."

With movement re-education, you can return patients safely to many activities.

But I give these patients fair warning.

If they want to safely do what they love, they may have to do some things they don't love.

If they lose stability in a squat below parallel, they may have to come above parallel for a little while to build some strength there.

(Don't gasp. Earn the right to go below parallel.)

If they lose stability or mobility in their runs at 2 miles, then they may have to be restricted to 1.5 miles with a stopping point for correctives.

(Running isn't bad for you. The way you run may not be right for you.)

Gait re-training may be necessary for someone with pain with walking or with running.

I would never tell someone who loves their activity that the activity is to blame. If the activity were at fault, everyone would have the same injuries.

They don't.

Educate, don't eliminate.

As always, it's your call.

- Dr. Kathy Dooley

On The Run From... Running?

Written by Dr. Prathap Addageethala

It's getting warmer out there, and people are starting to stretch their legs by getting out and putting in a few kms on the road. As North America thaws out from an exceedingly frigid winter, it's rolling into the hottest part of the year here in Southern India, where temperatures can soar past 37C with regularity.

I am planning to run a 10K for the very first time in May of this year. There. I said it. You know what they say, "speak your dreams into existence." And I'll be honest with you, I'm a bit nervous. That seems fairly normal considerig the longest race I have ever run was while I competed for my elementary school's cross country team. I can't even be sure that it was more than 5km back then, so if it wasn't, then 5km was my all time longest run. EXACTLY HALF OF HOW FAR I NEED TO GO.

In high school I was a decent athlete. During our mandatory timed mile run in Phys.Ed I posted a  respectable 6 minutes and change; during our 12 minute timed run, I chugged out 7 laps. A lot has changed since then! Two degrees, multiple injuries, and two moves across international borders later, I'm a slightly overweight and under-active healthcare practitioner. Doctors are human too!

I have had a longer hiatus from training and regular exercise than I'm proud to admit. So, naturally, my worries in running this middle distance race stem from that; will I be able to finish? will I injure myself? After doing some light reading about starting a running regimen, I noticed a few things. It seems that all fledgling runners go through a period of uncertainty. Everything that I read indicate that they are all normal concerns that engaging in a new physical form of rigorous training elicits. And rightfully so!

Common injuries that occur to novice runners (fairly common in experienced runners as well!) include shin splints, IT Band syndrome, cramping, sprains, and other strain based injuries. By and large, these injuries happen due to poor warm up/cool down strategies, and a case of "too much, too soon." As with any other form of exercise, it is best to build up to a challenging routine to give your body a chance for success. Feeling DOMS (delayed onset muscle soreness) is normal if you are just starting out, or just getting back into working out. Try to challenge yourself in each successive workout, keep an eye on your form (there is a proper way to run, believe it or not), and listen to your body.

Here are some tips and tricks on navigating the road, the trail, or the treadmill as you prepare yourself for your next athletic achievement! Incidentally, since I'll be on a major training kick in the weeks approaching the big race, I'll be blogging more about running as I come across valuable information to share. Keep an eye out for the "Running" folder in the coming weeks.

Make a run for it with these training tips:

• Stay hydrated! A common recommendation is to drink 8 cups of fluids a day. This is just a general guideline and not a hard and fast rule. Obviously if you are sweating profusely from an uptempo workout, you should be replacing the fluid lost with an extra cup or two of water, and it is recommended to replace electrolytes (salts) with a sports drink. This is a huge topic, and will be covered in a later blog entry. YOUR GOAL: 3L (12 cups) spread through the day. Here's a life hack on how to stay evenly hydrated through the day.

• Warm up dynamically (actively). Doing sport specific movements will aid you further in achieving athletic performance than your average hold-that-position (static) stretch. A healthy warm up for running may include a light jog for 5-10 minutes, followed by 1-2 sets of lunges, prisoner squats, leg swings, windmills, jogging butt kicks, walking knee raises, and walking mummy kicks. YOUR GOAL: Improve your flexbility and endurance of the muscles you engage most during your sport activity.

• Keep records but don't let it discourage you. Set some goals and work your way towards them. Your best bet to know if you're improving or subconsciously slacking off is to keep an accurate record of your running activities. Some people use heart rate monitors and other gadgets to keep electronic or digital logs of their runs, which is a solid idea. I personally use an app on my smartphone called MapMyRun, which features a simple and easy interface, and excellent in-run guidance. Only drawbacks to this app are that it doesn't do much for a treadmill workout (other than keep time), and you have to keep a clunky smartphone on your person during your run. YOUR GOAL: Record each workout, and challenge yourself to improve your times on a week to week basis.

• Get rest. I can't emphasize this one enough. Your body grows and repairs itself largely while asleep, so make sure you are doing what you can to get adequate amounts. In addition to the typical grogginess, mind fog, and irritability that one feels when not well rested, we also become more susceptible to injury and cramping. A growing body of evidence also shows that using an electronic device with a screen (smartphone, laptop, tablet, etc) just before sleeping can lead to a decreased quality of sleep. YOUR GOAL: 6-7 hours of quality sleep each night, turn off your electronics at least 30 mins before bed.

• Wear proper footwear. Unfortuately those 5 year old sneakers that you wear during any and all athletic undertakings will not suffice when it comes to a renewed dedication to running. Seeking out a running professional at a running specific sporting goods store is a great way to get a shoe that is tailor made to your body type and needs. It is easy to pick the wrong shoe from myriad choices on the shoe rack, so in this sense, a little research goes a long way. I really benefited a ton from Runner's World's "shoe advisor." And I really liked their tool for determining your own arch height and foot type. With moderate usage (around 25-30 km a week) it is recommended to get new shoes every 6-8 months. Even though the shoe might remain in good shape from the outside, the heel pad and cushions for the sole of your foot might be too thin to effectively absorb the repeated pounding of the pavement. Barefoot running is a completely different animal, so stay tuned for an article about that. For average height arches, and neutral foot roll, I can't think of a better shoe than Asics Gel Nimbus series. YOUR GOAL: Assess your footwear situation, and pony up for a decent pair of running shoes that are used exclusively for running. Runner's World has an excellent assortment that can fit every budget.

• Supplement intelligently. As I mentioned above, each of these tips and tricks can be their own blog entry or fill many pages in a text book. According to Examine.com (a trusted source for accurate and succinct health information backed by scientific research) the three supplements that absolutely work include fish oils, vitamin D, and creatine. Fish oils are excellent for joint pain reduction (at higher dosages) and decreasing free floating fats in the bloodstream which is fantastic for heart health. Vitamin D is essential for bone health, and is necessary in order to absorb Calcium, the bone-building staple. Creatine was a much-maligned supplement about 10 years ago, when claims that it created a higher incidence of kidney stones surfaced. The reality is that any protein-dense diet (with or without creatine) can create kidney stones and gout if proper measures aren't taken to hydrate responsibly. Creatine supplementation provides extra energy for your cellular processes, and has been shown to improve physical performance, and boost muscle growth. YOUR GOAL: Regular supplementation with a recommended multivitamin, fish oils, and creatine can help you surpass performance obstacles. Keep in mind, these are supplements, you know, in addition to a balanced diet rich in green leafy veggies, lean protein, and healthy fats.

It is always better to check with your MD regarding your current blood chemistry and physical fitness before engaging in a new, vigorous exercise regimen. Your chiropractor can help you manage your performance by decreasing joint pain and stiffness, improving your range of motion and flexibility, and by keeping your nervous system in optimal shape. 

See you out there!

- Dr. P