Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude.

In dealing with pain or suffering (whether it’s from your body’s parts being misaligned, your boss being an inhuman crankcase, or your brand new car falling to pieces), it’s important to remember that your attitude matters.

Now, anybody who really knows me knows that I have long had a bit of a pessimistic, skeptical streak in me, so don’t think I’m a gung-ho super optimistic nut-job.  FAR from it.  But let me share two quick scenarios with you before I tell you that optimism is a necessary part of dealing with chronic pain.

I once encountered a guy in a chronic pain workshop I was co-leading who had knee pain. It had been diagnosed as knee osteoarthritis. The doctors he’d talked with, the books he’d read, and the stories he’d heard all said knee osteoarthritis was hopeless. He asked me what I recommended for it. I told him that getting his hip joints to start moving in a functional way would take some stress off the knees which, it wouldn’t be far fetched to say, would help his knees feel a little less pain.

On a basic level, I was only asking that he believe that having his legs swing forward and backward while walking rather than landing with the knee pointing out to the sides would be beneficial. Walking with your knees pointing out to the side causes an obviously imbalanced impact on the knee joint and a shear at the medial aspect of the knee.  Dysfunctional hips could make his knees bend awkwardly in sitting so that even sitting could be painful…

But on a more important level, I was asking him to believe that a difference could be made to his diagnosed condition.

He responded with incredulity. “There’s nothing you can do about osteoarthritis. That’s what every expert in the world says. I’ve had consults with some of the best doctors.” And there was nothing I could say in that context to change his mind (though I did try and it did make for some awkward tension).

He didn’t believe he could get better, didn’t believe anything could be done, and probably figured I was full of some especially malodorous cow excrement.

I don’t know how he’s doing, but I’m guessing his situation’s not improved all that much.

I’ve also had many people come to my office and say, “I want to get better.  I know this is coming from my compensations around [injury or situation x], but the doctors and physical therapists say there’s nothing wrong with my body even though I can feel the pain.  I know something can be done, I’m just not sure what it is.”

These are the people who get better.  These are the people who figure out what the roots of the problem are and get on the path to solving it.  These are often the people who get better quicker.

So what I’m finding, and you can agree or disagree in the comment section below, is that Thomas Jefferson was right. Facing challenges, whether it be pain or something else is all about attitude.  Whether you believe your problems will end you or make you stronger, you’re going to be right. All you have to do is choose how you want to be right!

Over two years, the injured knees were assessed using a comprehensive numerical score that rated pain, function during activity and other measures. At the time of the original injury, the knee also had been scored.

At the end of the two years, both groups showed considerable improvement. The scores for the surgically repaired knees had risen by 39.2 points. The scores for the more conservatively treated knees also had risen, by 39.4 points.

In other words, the outcomes were virtually identical. Despite a widespread belief that surgery leads to a stronger knee, the results showed that surgically reconstructing the A.C.L. as soon as possible after the tear “was not superior” to more conservative treatment, the study’s authors wrote.

To read the rest of the article, click here to head over to the New York Times.

When pain is a result of poor posture, sleeping can often exacerbate the pain. Beds often tweak the body in ways that aggravate bad postural habits.

One that I often hear is back-sleepers using multiple pillows stacked up so high that their chins are tucked into their chests. These people generally have lots of neck and shoulder tension throughout the course of the day and have heads and necks that are thrust forward (mimicking their sleeping position!).

That issue has a quick fix, but there are other less well known issues that can hamper a good night’s sleep. Though I don’t have the time (or talent) to draw up a bunch of diagrams, Esther Gokhale has a book chock full of great tips that can help you adjust your sleeping position for maximum rest and recovery. It’s $16 from amazon.  It’s well worth it if you or someone you know needs to try to make their sleep feel a little more restful.

For people with chronic myofascial pain, simple adjustments like those in Gokhale’s book can be extremely helpful.

8 Steps to a Pain Free Back by Esther Gokhale

The veins in my right arm in this picture show you what good circulation looks like for me.

I was a student at UCLA.  I worked in an on-campus computer lab.  One winter, I injured my right shoulder in mid-air while snowboarding.  I struggled to figure out how to help my shoulder heal, but nothing was helping.  Physical therapy wasn’t helping. Sitting on my butt, chatting online, and updating my friendster profile while eating ibuprofen wasn’t helping.

And then the pain in my wrists set in.  At first it wasn’t bad, but it got progressively worse.  My elbows started to get tender.  I could feel tendons snapping and popping every time I straightened my arm coupled with a squelching sensation.  My forearms felt sore — glowing with inflammation.  My fingers began to curl up.  My palms discolored to a sickly purple.  The veins that had once bulged on my forearms — a sign of fantastic circulation — disappeared and were replaced with a cold numbness from just above my elbow all the way down to my finger tips.

So began the struggle.  I started taking supplements.  Vitamins B6 and B12 helped for while.  I don’t know how they helped, but they took the pain down as if by magic.  And then, as suddenly as I’d found that they helped, they stopped helping.

So I tried acupuncture. I tried electro-acupuncture. I tried chiropractic. I tried Chinese medical massage, I tried herbal remedies.  I tried acupressure.  I tried shiatsu.  I tried eating a Chinese beef tendon dish (that my mother can cook quite well, thank you). I tried eating more meat.  I tried eating less meat.

I sought help from my doctor who told me my problem was overuse and repetitive motion.

So I cut back on the computer.  I cut back on any attempts to do exercise. I upped the ibuprofen dosage.

And nothing got better unless I kept myself off the computer as much as possible.  Five minutes was all it took to set my hands off into their cold, numb state.  My doctor assured me that it wasn’t carpal tunnel syndrome (the wrong fingers were going numb, after all!), so that all I had to do was wear a brace and rest until the inflammation magically disappeared.

As long as I didn’t need to do anything, this strategy worked quite well.  No computer, no pain. No exercise, no problem.  Until my knee started pinching, my feet started aching and going numb, my hips started popping, my neck started hurting, and my back got stiff…

Which is all to say that resting wasn’t the solution.  Fixing the posture was.  As far as the wrists and forearms were concerned, the problems started clearing up as my shoulders found the right position to be in and learned to maintain that position (with the help of my hips, legs, and back).  As many of my clients will tell you (and my friends and family as well), I now spend a good deal of time typing away on this machine called a computer.

And you know what? As long as I do the work away from the computer to maintain good posture, my forearm veins stay full of blood, and I survive and thrive in the 21st century!

Think about this example. Your friend is lying in bed, sweating and coughing and complaining of congestion. His temperature is 103 degrees. He feels dizzy and weak and occasionally cold.

You would say he has a fever, right?

Now, would you say the fever is causing the headache? Would you say the fever is causing the intermittent feelings of cold? Would you say his hot forehead is caused by the fever?

It’s easy to let your tongue slip and say, “yeah, he has a headache from his fever” or “his forehead is hot because of his fever.”

But you’d be WRONG for the same reason diagnoses like “chronic fatigue syndrome” and “fibromyalgia” are wrong.

The reality is that a “fever” is just the name given to a set of conditions (namely, having a high temperature, feeling dizzy, getting chills, having a hot forehead, etc.). But that collection of symptoms isn’t caused BY the name. The name is just an easy way to refer to them as a group.  The fever is a phenomenon that’s caused by something else — an infection, generally.  It’s a symptom of something wrong.

Now I said that “chronic fatigue syndrome” and “fibromyalgia” are wrong.  Here’s what I mean.

The pain is a symptom of something wrong.  It isn’t the thing that is wrong.

But pain that is chronic, persistent, irritating, and consistent is starting to get names.  And those names make the pain sound like a disease.  And these pseudo-diseases are being treated as diseases to be managed with stronger pills and surgeries.

Chronic fatigue. Fibromyalgia. Regional pain syndrome.  Tennis elbow. Carpal tunnel.  Thoracic outlet.  These are all fantastic names.  Fabulous names, really, because they all sound so menacing.

What these names all have in common is that they are being used as disease diagnoses when they shouldn’t be.  None of these names even hints at the cause of the set of symptoms they describe.  Just look at the way they’re treated and discussed.

The same way fever doesn’t tell you the cause of the associated symptoms, the medical diagnoses for chronic fatigue syndrome doesn’t tell you the cause of your problem. Chronic fatigue doesn’t CAUSE you to be tired and in pain all the time.  Chronic fatigue is an easy name to refer to a situation where you’re in pain and tired all the time.  Now, lots of studies are done on the underlying physiology of the blood and the chemical levels and all that great fantastic stuff, but it’s all still just looking at a set of symptoms and hoping that addressing one of those symptoms will halt the progression of the other symptoms.  Since you don’t know the cause, all you can do is fuddle about with different treatments (mostly pills that disrupt the physiological changes that are happening).

Fibromyalgia doesn’t cause body-wide pain and tightness.  Fibromyalgia IS when your whole body hurts and you have lots of tightness. That doesn’t even begin to explain WHY everything hurts and is tight.  That’s a crucial, crucial distinction!  Without addressing the cause, all you can do is pop stronger pain pills to try to “manage” the disease…except the disease isn’t even a disease!  It’s a collection of symptoms.

Finally, take carpal tunnel.  Carpal tunnel doesn’t cause wrist pain.  Carpal tunnel IS wrist pain with impingement happening at the wrist.  But that still doesn’t tell you the cause of that impingement.  It just tells you that it’s happening, and that it’s also accompanied by pain.

That’s important for those who are now finding that carpal tunnel release surgery is only a temporary fix.

What’s important to note is that as chronic pain starts getting more and more names, people are getting more pills and more crazy surgeries. And yet the results are hit and miss or downright abysmal in terms of recovering quality of life.

Because of a simple misuse of words, these medical treatments aren’t treating diseases — they’re treating symptoms.  And the result is people with pain that never goes away and whose quality of life diminishes day by day.

It’s the diction of doom.  It’s like treating the fever without treating the infection.

We learn wisdom from failure much more than success.  We often discover what we will do by finding out what we will not do.  ~Samuel Smiles

As we age, our bodies cease being able to do certain motions — not because age automatically means we can’t do certain things, but because we aren’t challenging our bodies to do the things we used to do.  Kids, for example, run, jump, skip, hop, climb, crawl, tumble, and roll all the time, and their bodies have no problem dealing with it. 

Over time, as they become acculturated to modern life, told to sit still, forced to slouch in a desk for hours on end, they lose the freedom of movement and the range of motion and resiliency that they had.  Those who remain athletic, keep their resiliency. Those who don’t, lose it.

For adults, the easiest way to test your musculoskeletal health is to see what your body can do!  If you find you can’t even stand up from your chair without pain and stiffness in your hips, you have learned a valuable lesson.  If you find you can no longer reach something in the top cupboard, you have learned a valuable lesson.  If you find you can’t lie in bed for 2 hours without severe pain somewhere in your body, you also have learned a valuable lesson.

For some the lesson is more subtle.  Maybe you can’t twist your upper body in one direction, or one arm just can’t reach over your head like the other.  Or one hip pops and pulls every time you try to do judo throw.  No matter what the “failure” is, the lesson is the same.

The lesson is that your body needs more movement, more testing, and more failure so that you can gradually coach and coax your body back to a healthier, more resilient, more mobile state.  It takes a lot of failure, a lot of time, and a lot of testing of your limits to find how to best work with your body, but ultimately it’s the only way to restore the youthful ease you once felt in your body.

What is it? Well, it’s when a bunch of things in your leg and into your hip joint are misaligned. Your knee rotates in, your lower leg rotates out, and your arch collapses.  But according to the medical community, there is an easy fix!  What is it?

According to this website, it’s a screw/bolt looking thing.  It looks like this:

from curemms.com

Now, yes, it does look like it can be had from Home Depot for 25 cents in the bottom drawer of aisle 17.  But what in the world would you do with that screw/bolt looking thing?

You would have it surgically implanted in your ankle!  Why? According to curemms.com:

realignment of the foot under the leg (elimination of excessive pronation, or flattening and turning out of the foot) is what is needed. The HyProCure® device is made to address this need.

So think about this.  Your hip joint gets out of alignment because of what’s happening at your ankle.  And apparently your ankle gets so under the influence of mysterious forces that you need a screw/bolt looking thing to stop it from getting out of line. Does that make sense?  At all?  Any?

That screw/bolt thing sounds like a quick fix to me (sort of…), but doesn’t it make more sense to be trying to reprogram the muscles of your body to align your bones better?  You know with some hard work, a little problem solving, some exercise?

That’s what I think.  That’s what my physical therapist client thinks.  But we are extremely biased.  And neither of us are trained surgeons, so take what we think with a grain of salt.

What do YOU think?

In super simple terms, that means that after surgery your shoulder still won’t do the things you know it should be able to do.

Not exactly a fantastic result, in my opinion, but apparently others think shoulder surgery might still have some use.

Here’s what Dr. Michael Bey, one of the doctors involved in the study, said about shoulder surgery:

Our study suggests that surgery may restore normal shoulder strength but doesn’t necessarily restore normal shoulder motion.  It could be, however, because the shoulder pain goes away, there is value in surgery.

In my estimation, there are two things you go into shoulder surgery for: relief from pain and restoration of your ability to DO STUFF.  If surgery can only provide relief from pain, what’s the point?

There are a great many other ways to relieve pain. Pills, for example, also relieve pain but don’t restore function.  A slap in the face could relieve the pain you feel in the shoulder (the old distraction method…) but would also do nothing to restore function to your shoulder.

What do you think?  Is there a good reason to have shoulder surgery for rotator cuff injuries given the sacrifice you must make in function?

What part of your body does the tire represent?

For some, it’s that knee that goes out every few months and keeps them out of their running shoes.  For others, it’s the lower back that goes wildly into spasm, keeping them from playing tennis.  Or perhaps it’s the elbow that flares up after two hours of tennis and won’t settle down for weeks.

There is something that sets the body apart from a car that makes the metaphor fall apart, makes it a little hard to recognize exactly what’s going on, but ultimately means you can beat your pain.

Your body HEALS.  That’s right.  Your body’s way more complex than a car because it actually regrows bits and pieces of itself (bet you wish your car’s paint would do that!).

When a car tire goes bald, you have to replace it.

When your knee aches, you don’t get to replace it (unless you’re old and the doctor says so).  You rest it, and, over time, it heals enough that you feel comfortable using it again.  So you think everything’s fine.  The tread grows back on the tire.  But then you wear down the tread, and the knee hurts again. So you rest, and the tread grows back, and you wear it down.  And it grows back.  And you wear it down.  Eventually, you run that tire ragged to the point that your body CAN’T heal it fast enough and thick enough and then you REALLY need to replace that knee/tire.

But what if you fixed the alignment from the outset? What if you made sure that the knee wasn’t being used in a way that wore it down?  What if you straightened things out so that the tire could keep its tread at a healthy level so that you don’t end up with bald tires, bad knees, and a bunch of pain?

If you’ve been experiencing intermittent pain and are wondering what your posture might have to do with it, feel free to give me a call or book a free consultation by using the online booking tool on my website!  Your tires will thank you!

Think about the position you’re put in when you have your iPhone in your hand in front of your chest and your eyes pointing down at the screen.  Can’t visualize it?  Head over to a mirror and turn sideways to it.  Now look at your smart phone in your hand.  Now turn and look in the mirror.  Notice how much your head has to hang forward of your body? Notice how much your shoulders round forward?

It’s not pretty!

Good posture means having your head on top of your body, not in front of it.  You’re in a place of good balance.  But what happens if your head gets in front of your body?  You put extra strain from head to toe — literally!  Your spinal muscles have to work harder, your hip muscles have to brace, and your knees have to start taking on extra impact because every other part of your body is scared stiff by the head that’s about to fall off the neck!

So, tonight, when you get home, see if you can’t put the smart phone down and enjoy a nice walk outside.  It may be winter, but it’s San Diego!  Get outside and enjoy it!