The Back Pain Manifesto

If you have back pain, I can make you feel better.  You can walk out my door with less pain than you arrived with.  I can virtually guarantee it.

But that relief is temporary.

I'm more in the business of lasting, effective treatment programs.  And that means that under my care, your program is going to be based on exercise, body mechanics, nutrition, and fitness.

Do those things and you will be better.  And if you continue to do your exercises, use good body mechanics, eat right, and stay fit, you will stay better.

You might be surprised to know that most folks don't choose that route.  They want something passive--something where they lay down, get some kind of treatment, and are cured.  In 2-3 visits.

It doesn't work that way.  It takes effort.  And dedication. 

In a discussion about what it takes to stay healthy, a friend argued that I had a job that gave me the time to exercise and an income level that let me do healthy things.

That has very little to do with it. 

Check in with my alarm clock.  It says 4:30 AM.  That's because I've always exercised early.   Get it done before the day gets started.

Right now, it's 6 AM and I'm looking across the gym at a room full of mostly women who are doing a CrossFit class at Cherokee.  Many of them have young children at home so this is the only time they can exercise. 

Check with my boss.  This time of year, I'm working 60+ hours a week (it is football season after all).  During my slow period, I'm still working about 50 hours a week.  So no, my job doesn't give me the time to exercise.  I make it a priority.  I make that choice.

I don't watch television.  When people talk about their new favorite TV show, I have no idea what they're talking about because I don't have a favorite TV show. 

The way I see that equation is that you can either have back pain or favorite TV shows.  Your choice. 

If you would rather watch one of the dozen or more CSI shows, the nighttime soap operas, or something about drug addicts or zombies than feel good, so be it.  My brain doesn't have room for all that.

Sometimes I don't sleep enough but that too is my choice.  I've got too much going on and am perfectly willing to give up an hour of sleep to paint, play with grandkids, ride my bike, paddle, spend time with my wife, do things around my farm, watch a sunset...get the picture?

Again, it's all about choices.  If a little more sleep in the morning is more important than whether or not your back hurts, that's your choice.

There are plenty of people getting rich off of you because you want a quick fix.  You want to walk in and maybe get "adjusted" and that's all it takes.   Or get a prescription for one of those -codone drugs. 

It is never that simple.

And by the way, saying that your pelvis is "misaligned" or that your hips are "out of alignment" is one of the biggest farces perpetuated on the public that history has ever known. I keep a cartoon of two guys laughing hysterically with the caption "my reaction when someone tells me they got their pelvis realigned."

And pain medication relieves pain.  It doesn't correct the problem. 

You want that magic pill that once you take it everything is fine and you go on with your life.  If only life were really that simple.

Somebody told me this week about her daughter  (a teacher) who was allowing a chiropractor to inject her muscles with sugar-water.  First of all, if that chiropractor is doing that, it is highly illegal.  Second, how can a college educated person allow this to be done to their body?  Is there any part of that which even approaches sanity?

You want your back pain to go away? 

#1  Lose weight.  You're overweight.  Probably.

#2  Get good core strength, admittedly hard until you get #1 under control.  Start by walking.

#3  Exercise daily. Daily.  I've got another cartoon that says "if you don't have time to exercise an hour a day do you have time to be dead 24 hours a day?"

#4  Eat better.  If it contains white flour or white sugar, stay away from it.  Dietary fat is not the culprit--carbohydrates are.

#5  Turn off the TV.  Do you really need to sit around any more than you do already?

That's it.

It really isn't that hard but it takes persistence.  You must diligently do all those things.  You must consistently do that which will make you healthy.

The choice is simple.  Either take care of yourself, taking ownership of your health, or keep having back pain. 

One of my frustrations as a physical therapist is that I can work someone through all this, teaching them how to take care of their back and emphasizing a set of exercises that they can do at home.  

Maybe even get them on the road to better fitness and weight control. 

They leave me essentially pain-free with a concrete plan to stay that way. 

And then 2 years later they show up with the same problem. "Are you still doing the exercises I taught you?"  Uh....no.

They had the tools to stay healthy and pain free but for a million different reasons (excuses) they didn't follow through.

So they keep returning with the same problem.  Or get frustrated and start trying things to which there is no scientific basis. 

And about that...before you start some treatment out of the mainstream, check it out.  Get online and look it up.  If there is no scientific basis for it, why would you consider it?

If all it has going for it are testimonials and no research to back it up, smart people would stop right there.  Sure, we don't know everything, but if there is proof positive that it doesn't work or even that it might cause long term negative effects, why go there?

Ask the tough questions.  Expect tough answers. 

It's all on you.  

Football Mom Again!

I am an unabashed, unapologetic fan of football.  Especially high school football. 

I played for many years.  My son played and was quite good (if I do say so myself).  Even though his college career was ended with a rather catastrophic injury, I believe he would do it again (without that last injury).

But the game I love is under attack.  Parents are keeping their kids away from the game for fear of the injuries.  It is seen in some quarters as being too violent.

I happen to believe it is the best sport that we have for teaching life lessons. 

Lessons like teamwork and dedication and commitment. Like leadership and work ethic. Things that inarguably benefit our growth and development. 

You may recall an article that I wrote a couple of years ago based on a letter I received from "Football Mom."  

Football Mom had never wanted her boys to play football.  She wanted to shield them from a sport that she had lots of history with but that had lost her love.

This week, I got another letter from Football Mom.  I'm copying it her pretty much verbatim but changing a few things simply to make it generic to the sport rather than to any one school.

So here it is.

Dear Joe:

"I (Football Mom) had lost my way since the last article.  I became frustrated about the lack of 'success' they (my sons) were having on the football field. 

Let me say that the systemic discipline that Coach and his staff impart on 7th and 8th grade young men is something that I can't repay him with bars of gold.  My son has drank the golden kool aid of the cornerstone of football programming.  Discipline on and off the field.   

My son talked to me two nights ago about career paths he was considering including medicine and constitutional law and my rumblings about the requirements with my son replying 'discipline always wins mom.'

Then Thursday night happened.  My oldest son went into the Junior High Game for an extended amount of time. The first play his hands were clenched with nervous anxiousness, his feet moved as tentatively as he cruised taking his first baby  steps. 

I was frustrated,  I had taken him to the Junior High all summer at an insane early hour day after day, done load after load of teenage boy football laundry, drove circles dropping, picking up, repeat.

Then I watched as every play transpired the nervousness that only a mother can spot from the stands dissipated.  

He continued to contribute to his team even making an unassisted fumble recovery. 

So if you think this is where the story would end because of success you and I are both wrong.  As he gets in the car he is overflowing with pride excitement and happiness. 

An analogy that I immediate thought of was a friend years ago took me to see a waterfall and as we approached he made me close my eyes and I laughed and asked him why?  He said I want to see your eyes when you see it for the first time. 

So here I was on a normal nondescript Thursday night looking directly into my sons eyes and seeing the feelings of pure accomplishment and joy that HE felt of being an athlete.   What a gift I was given."

Dear Football Mom:

Nuff said.

Take Care of Your Eyes

It's not so much that I run out of ideas for this space (although some might think so, seeing as how I really get off on some odd topics from time to time) but more like what things can I write about that are relevant, that are important to you.

For you see at the heart of my column is education.  I guess I'm a teacher at heart.

So I looked back at the list of the columns that I've written through the years and one topic that seems ignored is eye care.  Only one column in 30 years about eye protection.

And it's a pretty big problem.  Something we just don't think about often enough. 

Lots of pro basketball players are wearing protective eyewear these days.  It goes back to Kareem Abdul-Jabbar, who started wearing eye protection after too many scratches to the eye.  He sort of made it cool to do so.  Now lots of athletes do the same. 

It was really apparent last week when I was riding bicycles with a friend who didn't have any eye protection.  I started to say something but then figured that this was a responsible adult and he didn't need me preaching at him.

I should have said something.

Think about it....traveling at maybe 30 miles an hour and a bug hits you in the eye.  Ouch!

Or, worse yet, a piece of gravel gets flipped up out of the road and strikes you in the eye.  Serious damage can happen, not to mention that you will probably wreck.

Most of the time, people on personal watercraft don't think about it either.  Back when we owned a couple of those things, a near-injury was what it took to finally convince us to always wear eye protection. 

I guess the one I worry most about is the motorcycle rider.  Sixty miles-an-hour and no eye protection seems insane to me.

An insect propelled into your eye at sixty is going to do some damage.

What kind of damage?

Everything from mild irritation to blindness.  Corneal abrasions or lacerations are very painful and are probably the most common eye injury of any consequence.  If you suspect anything more than just a little irritation, see you ophthalmologist.  Lots can be done.

Even if the injury to the eye isn't substantial, if you're riding a two wheeled vehicle, something hitting you in the eye can easily cause you to wreck.

Industrial workers have long since adopted protective eyewear in the workplace.  In most jobs where there is the risk of a projectile  ending up in the eye, protective eyewear is required.  The military has discovered the necessity of protection.

But then I'll see one of my buddies on a bicycle or somebody on a motorcycle without proper eye protection and I just cringe.

A Down Day?

OK.  I know this is the Sports Section and all and maybe what follows isn't much about sports but my answer to that is that sports are life and life is sports or something like that (and if you're already confused about where this is going, well...sorry about that).

Anyway, this is my favorite time of year.  Football in full swing.  Cooler mornings.  Crisp nights.  Time slows down a bit and life is full.

Yet I found myself fighting something last week.  Those around me kept asking me what was wrong.  

I guess I was more quiet than usual.  One friend suggested that my chemistry was off.  That's possible but how do you know?

Most people ask if anything had changed. 

Not really.  No major life events. My health is good.   I've still got most of my hair.  I can't quite stay up with Steve Bright on the bicycle but I'm still pretty decent. 

My six grandkids are the smartest, funniest, best kids around.  My kids have grown up into really great adults, making their own way in the world but letting us be a part of it.  I look forward eagerly to getting home to my wife each night and I'm not sure I can ask for anything much better than that.

My right knee is pretty much wore out (people ask me about my limp on a regular basis) but it really doesn't hurt me much so that knee replacement is still well off in the future.

So I got off by myself for a bit.  That's not something that my schedule allows very often (like never).  And I thought about some of the things that I've written about in this space.

And I remembered what a wonderful place that we live in.  Most people visit the Smokies (the most visited national park in the country).  We get to live here.  I mean, the Appalachian Trail forms the eastern border of our county!

Many people dream of a life on the lake.  We're surrounded by them.

I consider the climate around here just about perfect.  Go north and you get cold weather and snow that lingers so long that some of it was still around in July.  Go south and you get heat and humidity, bugs and sand. 

If you're into golf, we have golf courses all over the county.  Good ones.

We're blessed to have an outstanding college in the middle of town (Maryville College) which brings culture, sports, and academics to us.  Not been to the Clayton Center yet?  Big mistake.

And then there's Pellissippi State's Blount County campus--state of the art and giving us great educational diversity and opportunities.

Medical care?  Top-notch (even if I do say so myself).  A region with diversity and people that will give you the shirt off their backs. 

Lots of folks love the fall for college football.  It's a big deal around here.  At this point, everybody has a chance at a good season.  UT looks to be better but I'm hoping for a great season for my beloved Clemson Tigers (or at least another win over South Carolina).

I still prefer high school football.   On Friday nights, I get to walk the sidelines and be a part of something pretty special.  I'm living the dream with good friends, great family, and a job that I look forward to going to.

So today you're going to find a smile on my face and a song in my heart (or in my earbuds).  Have a blessed day.

Dr. Ken Bell

Today, I'm going to tell a story of the extraordinary things that the human body can do.

One of the constants of my adult life has been my friendship and professional relationship with Dr. Ken Bell.  We arrived in Maryville about the same time over 33 years ago.

Through the years we have played tennis, climbed rocks, rode bikes, hiked, been snow skiing, and done all manner of physical pursuits together.  We've driven across the country twice together, hauling bicycles to Utah and Colorado.

He and I (and a couple of others) have taken several "mancations" together, usually having something to do with mountain biking.

But today, I am in awe of Ken Bell.

For the better part of a year, Dr. Bell has been training to compete in the Ironman Triathlon in Chattanooga at the end of this month. 

In May, he competed in a half-Ironman Triathlon in Chattanooga more as a training activity than anything else.

Let me back up a bit.  In 2005, Dr. Bell finally relented and had Dr. Eric Morgan, his colleague at Maryville Orthopedic Clinic, perform a Total Hip Replacement on him.

For years, I had watched Dr. Bell agonize as he tried to straddle a bicycle or rise from bed or chair.  

When it finally started to interfere with his work as a surgeon, he got it fixed.

It was not longer afterwards that he was back on the bicycle.  Swimming always came easy for Dr. Bell (but then so did most other athletic pursuits--a story for another day) but running seemed out of the question.

One day not much later, he was participating in a sprint (shorter) triathlon and was experiencing some hip pain while walking during the running portion of the competition.  So he broke into a trot.

And he found that the hip pain went away.  He hasn't stopped since. 

Zoom forward to today.  An Ironman Triathlon is not just an ordinary race.  It is a grueling test of physical capacity.

Swim  2.4 miles, bike 112 miles, and then run a marathon (26.2 miles). Definitely not for the faint of heart and definitely not for unfit.

So at this half-Ironman in May, Dr. Bell somewhat casually (he wasn't there to win) finished third and qualified for the Half-Ironman Triathlon World Championship.

Yeah...you heard me right.  The world championship.  In Zell Am See-Kaprun, SalzburgerLand, Austria.

So on August 20th, Dr. Bell headed for Austria to compete against 44 others in the 65-69 category.  He went early to get acclimated to the venues and the weather.

Alas, a serious family medical problem forced Dr. Bell and his wife Patty to return home 2 days before the competition started.

But rising from our small community is one of the best athletes in the world and that's a pretty big deal.

Oh, and he still plans on doing that full Ironman at the end of the month.

Not To Be Taken Lightly

One more time, I'm going to write about concussions.

For the past couple of years, concussions have dominated the popular and medical news media.  Several high profile cases have focused a lot of attention on an arena that really deserves a lot of attention.

Not that many years ago, if you could remember what you had for lunch (after a blow to the head, or after you got your "bell rung"), you went right back in the game.

The present state of awareness really started with a study that came out in 1994 that revealed evidence of significant brain trauma in NFL players that did not have a history of concussions.

Since then, lot of research and study has been done on the long term ramifications of concussions.  

And the results are scary. What we do know is that concussions are not to be taken lightly.  We know that there are long term effects even to relatively minor head trauma.

That when you "got your bell rung," actual damage was done, damage that could surface many years down the road.

And lest you think it is just a football thing, let me assure you that it is not. Any active individual can get a concussion.  (Heck, even an inactive individual can trip and fall in the bathroom and get a concussion.)

So, when is it a concussion and when is it just a bump on the head?

Without getting all medical about it (and because there really isn't a single definition of a concussion), a concussion is a blow to the head that disrupts the function of the brain. 

It may manifest itself as a headache, dizziness, nausea, blurred vision, or memory loss.    It can be slight, maybe where a blow to the head leaves you with a mild headache, to severe, in which you lose consciousness.  Either way, we take it seriously. 

In sports, we start our evaluation immediately.   Decisions about how to deal with an unconscious athlete are simple--immobilize them, protect them, and get them transported to the nearest hospital in an ambulance. 

It's all those lesser injuries that take up most of our attention.

We start by administering a standardized set of questions useful in determining cognitive function.  Simple questions, really, but useful in deciding if the brain function has been impaired in any way.  

We perform balance testing , which can provide very important early information.

If symptoms go away quickly, we will just monitor their progress but the game that day at that time is over. 

Lingering symptoms used to mean staying up till quite late, watching for cognitive deterioration.  If there are several hours between injury and bedtime and the symptoms are not getting worse, sleep is generally OK.

Once they have no symptoms and have been cleared by their physician, we administer an ImPACT test, a computerized test of how the brain is functioning.  Along the way, we strongly (in no uncertain terms) insist that the athlete be honest about symptoms.  We don't want them hiding things from us.

If they have medical clearance and a negative ImPACT test, it still isn't over.  Our athletes then have to go through a series of exercises and activities that can take up to two weeks to complete and that's only if they have no recurrence of their symptoms.

This is one arena where we just don't take any chances.

Reflections On A Bike Ride

I went on a bicycle ride last weekend.  That should be no surprise.

This particular ride was a long ride uphill.  It was just me and one longtime friend.  And before you go all "aw heck, Joe's gonna talk about the bike again" let me tell you that this isn't about the bike at all.

It's about getting out and enjoying what we have in our backyard.

This particular ride (sorry) was on the Cherohala Skyway.

Have you ever made the trek from Tellico Plains to Robbinsville, North Carolina along Cherohala?  Oh.  My.  Goodness.

If you value these mountains, if you find these rolling hills beautiful, you owe it to yourself to make that drive.  The views are incredible.

And not many people visit the Cherohala.  In several hours on that winding path, we were passed by automobiles only twice (but by motorcycles a bunch of times).  It is an incredible if undiscovered asset.

I guess it doesn't get the attention of say the Blueridge Parkway since it connects one small, rural town (Tellico Plains) to another (Robbinsville).  By the way, drop by The Hub in Robbinsville for a meal or a shake.  Or both.

Of course we have the Smokies in our backyard and all the hiking trails there.  My wife doesn't consider it a good hike unless there is a waterfall at the end and Fern Branch Falls off of the Porter Creek Trail in the Greenbrier section of the Smokies is one of her favorites.

Lots of folks head for Ramsey Cascades nearby but this one is another worth your while.  On the way you pass by the Ownby Cemetery and the old Messer farm site.

And if you've never ventured beyond Bald River Falls at the confluence of Bald River and Tellico River, you've missed a gorgeous hike. 

Speaking of Cherohala, there is a short hike (1.3 miles) from the Rattlesnake Rock parking area to another gorgeous and rarely visited waterfall.  My wife and I visited in the middle of the winter when the ice was everywhere.

Lunch on a rock at the base of the falls was cold but magical.

We are surrounded by water in this area and lots of folks take advantage of it.  Fort Loudon is abuzz with ski boats and personal watercraft every weekend.

But there are other options.  A lot of folks have gotten into StandUp Paddleboarding (SUP) and Chilhowee Lake seems particularly suited for that.

We usually opt for canoe travel.  Put in at the Harrison Branch boat ramp where 129 emerges from the hills and you first see the Little Tennessee River.  Go straight across the river where motorboats can't go and explore the inlets and creeks on the other side.

Watch close and you may see a bald eagle.  If you keep looking, you can find Citico Creek and can travel for quite some distance before fallen trees force you to turn around.  Along the way, you will see everything from prehistoric-looking gar to birds of every ilk.  One day we saw a deer thrashing in the bushes.

My point is this:  You don't have to go far to see wonderful and amazing things.  And you don't have to run marathons or bike 100 miles to get in the middle of wilderness (or what seems like wilderness) that will take your breath away.

It's all in your backdoor.