Categories
Uncategorized

POSTOPERATIVE PAIN AND YOU – Part 1

Hi, welcome to my 2 part series on postoperative pain and its management with movements, food, breath, and sleep. If this interests you read on

In part one will be sharing my thoughts on moving more and reducing dependence on pain meds while being in the hospital.

Part 2 will focus on how to live pain-free after surgery and not carry on with the pain to make it chronic aka A part of your life.

So let’s get on with Part 1.

After the surgery

In this stage, you are still in the hospital under medical supervision. This is the time your physical therapist will visit you and encourage you to move the whole of you as in walking or stair climbing or parts of you as in turning in bed, rolling, or specific prescriptive exercises. The movement program is tailor-made to your needs. The idea is to help you move more and more of yourself and aid the body’s natural pain regulatory response. 

Few of those for you

Windmill in the bed

Lie on to one side whichever comfortable. Bend the top knee and hip and place the knee on a pillow in front. Stretch both the arms in the front at shoulder level or whatever level comfortable. Breathe in into the belly counting to 2 and lift the top arm up such that you do not rotate your torso. Breathe out through the nose and return to starting counting the same count or even double of comfortable. You can repeat it every hour 2 to 3 times. This improves your lung function, the movement of the diaphragm which is the main respiratory muscle, and the abdominals which are important for a good pain-free posture

Bearhug

Sit cross-legged or in a chair, breathe in and lift the arms up and outward. Breathe out, curl the spine and hug yourself gently. Repeat and breath count as above. 

Belly breathing – Can do this in any position like sitting, standing lying, or even moving. This helps in improving the diaphragmatic movement and the overall quality of breathing. The mindful practice of this activates parasympathetic and keeps stress breathing low. Choose any comfortable position. Keep the spine neutral and relax or drop the shoulders. Breathe in counting to 4 such that the abdominals move out. Keeping the same neutral breathe out gently counting to 8 pulling the navel gently to the spine. Repeat as comfortable. 

Chin tucks in lying

Lie on your back and can bend both knees slightly by placing a pillow under them. Place the neck of the head and neck on a pillow too. Breathe out and gently try to bring the chin to the chest keeping the shoulders and the ribs relaxed. You will feel some work at the back of the neck and head. Repeat it 2 to 3 times every hour. This activity strengthens the postural neck and shoulder blade muscles.

Ball of power

This activity is a modification of Foundation training work. Lie on the back such that the head and the mid back are rested on 1 to 2 pillows. Slightly cup the fingers and press the fingertips together like holding an imaginary ball in the palms. Breathe in and lift the arms up with the elbows bent gently. Keep the lower part of your ribs on the pillows. Lift it up to a point where you can keep the ribs back down. Repeat 2 to 3 times each hour.

All of these movements work on building your stabilizer groups and with breathing being in relaxation, better lung function, immunity, and pain relief… Signing off, for now, will be back soon with part 2 of this series… Till then take care and live pain-free

Categories
Uncategorized

Indoor warriors

This blog is all about action items because as rightly said every life-changing journey starts with baby steps.  So here are the baby steps

  1. Open the windows and allow sunlight to stream in. It will allow UVB to come in which is a Vit D synthesis initiator. Bask in this anytime between 7.30 am to 9.30 am for maximum benefits.
  2. Add more Vit b12 to your diet. Vit b12 increases D3 absorption. A bowl of curd, 2 glasses of buttermilk, 2 helpings of greens, a cup of lentil or sprouts should do the trick.
  3. Go furniture-free as much as possible. You will be using more of yourself to hold the position.
  4. Add natural functional squats by getting on the floor more often.

Move more indoors

For every 40 min of chair sitting or any stationary position walk for 5 min barefoot or with minimal footwear. Walking is one of the best weight-bearing activities which helps in bone mineral synthesis. All in a day’s walk isn’t it

Find your balance

These 3 simple words have had a profound impact physically and philosophically in my life. Let us talk about the physiological benefits for now. 

Balancing activities are whole-body movements recruiting more muscles and the larger part of the skeletal system. Larger forces call for better bone density aka stronger bones to withstand them safely. Here are a few balance movements which have helped me greatly

  1. Walk barefoot on as many surfaces as possible. You can try walking on a pebble way, sand, grass, or carpet.
  2. Cushion walk– Put 3-5 cushions on a non-slip surface 5 cm apart. Stand on 1 cushion with feet hip-width distance. Take a step onto the cushion in the front without losing balance. Then you can move back to the starting cushion. Start with 2 cushions at a time and can move up to 3-5 cushions. You can repeat 2-3 times every hour.
  3. Balance on 1 leg– Stand as above on a non-slip stable surface. Lift 1 leg up such that the hip and knee are bent to 90 degrees. Hold this position for 30 sec to 1 min each side and can repeat as above. 
  4. Side leg lift  – Lift one leg sideways 5-6 cms from the midline of the body without tilting or leaning. Hold as above. Repeat as above.
  5. Back leg raise-Stand as above and lift one leg to the back keeping the knee soft and straight. Lift the leg to about 5-8 cms and keep the toes pointed to the floor. Hold and repeat as above.
  6. Vrikshasana
  7. Chair pose in yoga ……… Signing off with FIND YOUR BALANCE. Cheers
Categories
Uncategorized

Bone health in captivity

We are as strong as our weakest link. This saying is aptly perfect in my practice as a pain clinician. Pain is our body’s way of telling us that it needs to be treated differently in short a lifestyle overhaul. In this perspective balanced living is vital to treat pain and remain pain-free.

For any chronic pain, fatigue, or weakness I run a blood profile specially VitD3, and have seen enough results now to say that nearly 75% of us are deficient in this naturally producing vitamin. So what has changed in the urban us?

Evolution and bone health

From the time of our evolution as homo sapiens ie present us our gene pool roughly remains the same. For our hunter-gatherers or even the farming ancestors, strong bones were essential for survival. Activities of survival like long-distance walking, occasional running, hunting, foraging for food, working for long hours in the fields, bearing and rearing children carrying heavy loads, and children placed great stresses on the skeletal system. Hence the requirement for robust bones.

So what has changed now if not the genes?

Our movement offloading. In the urban world, we have learned to outsource the so-called repetitive and boring movements. Driving for walking, robots for cleaning, washers for washing, elevator for stairs, and a supermarket jaunt for food. Even the food we get is pre-processed often not requiring the complete cooking process. 

All of these allow us to move less or not at all. When there is no stimulus to move and weight bear why should the body keep the bones robust? What you don’t use you lose…

Bone health and captivity

With the new normal our outdoor movements are reduced to non-existent. This makes us sunlight deficient. 

When your skin is exposed to sunlight, it makes vitamin D from cholesterol. The sun’s ultraviolet B (UVB) rays hit cholesterol in the skin cells, providing the energy for vitamin D synthesis to occur. That’s why vit d is the sunshine vitamin.

How does being low on Vitamin d feel like

  1. Getting sick often
  2. Fatigue
  3. Widespread muscle pain
  4. Mood swings and feeling low
  5. Weight gain
  6. Reduced appetite
  7. Low sleep quality.

If all of this is making you think about the action items please follow my next blog the Sunshine warriors. Will delve into the how to and what to … Till then open the glass windows and allow the sunshine to come in. Lounge in it and enjoy the warmth for 15 to 20 min… cheers

Categories
Uncategorized

LET GO

Taking my thoughts on the elusive and inefficient but defined 6 packs this blog is about how to create a strong and functionally efficient core. ( Not just abs). Cosmetically it will make you look taller, leaner, and smarter. Physiologically it will keep you well-aligned and injury-free.

So let go and breathe

Do the unthinkable relax your abdominals. Allow the flexible abs to stretch out during every breath and gently tuck in by itself with each breath out. Believe me, when you do it mindfully you touch the philosophical Let go… cool, isn’t it?

Align yourself

Overarchers

  This is for those of you who breathe into the chest lifting it up and pull the shoulders back to straighten yourself up. You also have always felt that the low back is curved forwards more than others and at any given point you can easily move your hand across the low back curve. 

Make sure to stack the lower ribs with the pelvis such that they are in the same line. If you feel that you are jutting your ribs forward just breathe in into the belly and breathe out gently tucking it back in. Repeat till comfortable.

Curlers

Oh, those rock-solid abs do not allow you to straighten out. You will see that you habitually sit on the back pockets and slouch chronically. So open up. Lift the rib cage up with every breath in. Be mindful to not poke the chin.

Movement nuggets

I come to my favorite part of movement prescription. So sharing a few movements have helped me to be aligned and pain-free.

Superman on the pillow

Lie on the chest with 2 pillows approximately 10-15 cms in height under the front of hips such that they are in the same line. Drop the head forward down and keep the arms by the side of the body palms facing you. Keeping the toes pointing forwards and the knee soft and straight lift 1 leg up such that the leg is in the same line as the pillow. Go up and down keeping the upper body and hips relaxed. While lifting up be mindful to not overarch the low back. Repeat 10-15 times.

Flying superman

Same starting position. Lift the 1 arm up keeping the above correctives in mind. Can keep the palm facing down and if you want to add some rotation keep it facing towards you. Repeat as above.

Want to sign off for now wishing you a Trainable, Efficient, and Pain-free body and mind… Cheers

Categories
Uncategorized

Your 6 packs and that neck pain

With the gyms finally, open I see dozens of urban fitness freaks frequenting them again. Every month parallelly I see a considerable number of patients who are gym regulars and confused about their every present neck pain. Memory foam ergonomic pillows rolled towel to no pillows they seem to have done it all with little or no relief. 

May the forces be with you

I am a strong believer in the power of forces within you and outside you to shape you. And let me tell you why

Our  urban forced abs

Abdominals aka abs are a flexible connection between 2 cages. The ribs and the pelvis. As they are functionally so strategic we have them oriented in different directions and functioning as a cohesive unit. This brings me to the most adored and photographed muscle of all “ Rectus abdominis” aka the Six-packs

Your neck and the six-packs

We have 2 recti abdominis muscles one on either side of the midline structure called the linea alba. They are long strip-like muscles connecting the lower ribs and the sternum or the breast bone to the pelvis. When contracted they bring the rib cage and the pelvis closer as in a curl up position. Optimal length and tension in these are important to keep the ribs, shoulder, and pelvis in neutral, maintain the normal curves and function of the spine and allow the diaphragm which is the main respiratory muscle to move fully. This in turn keeps the shoulders and neck relaxed. PS( for more details on these mechanics please read my previous blog  Breathing our immunity booster section Stress breathing ).

Dominoes effect

Those crunches, sit-ups, and roll-ups done to give definition only pull the ribs and pelvis closer, curl us up more, and flatten out normal curves. This curled spine shortens the pectorals which are our chest muscles. These in turn pull the shoulders forward and inwards. . To maintain a normal gaze the neck has to overarch and poke the chin forwards. 

Over a period this inefficient position sensitizes the neck, fatigues the stability muscle, and here we are The persistent pain, stiffness, and discomfort. 

So does it really matter what props you use when you sleep as long as you don’t correct how you use your body at rest and during movements?

Enough with the heavy nerdy part… My suggestion for a happy neck is to Do the unthinkable “ let go of your abs “ …I Will be putting up my next blog on how-to and till then Belly breathe and let go

Categories
Uncategorized

Hips don’t lie

I am super excited to talk about hips today. You guessed it right, I am a great fan of Shakira, and as she rightly sang “Hips don’t lie” they really don’t. Hip joints are the mobile connection between the thigh and the pelvic cage. They balance the movement and orientation of the thigh, knee, ankle, and foot. Decide which part of the foot strikes the ground, how much force it strikes with, and how does it clear the ground. They also give stability to the low back vertebra and the pelvic floor as strong muscles like glutes, flexors, rotators, and adductors cross the hip and move it in specific ways.

Our furniture cage

We love our chairs, furniture, and our desk jobs. All of these do not need us to use the hips to their full range and capacity. After a few years in this captivity, the body cleverly stops using it to its full capacity… If you don’t use it you lose it

Making do with weak hips

For starters, they are called compensations and over time become faulty patterns. 

Knee caps looking at each other( means the hips are rotated inwards ) while squatting or getting up from a chair.

One foot turned out while standing

Leaning forward a lot more while getting up.

Simple Check

 Unsupported Standing on 1 leg– Stand with feet pelvis width distance and parallel to each other. Lift one foot up keeping the hip and knee at 90 degrees. Try to hold this position for 30 sec to 1 min each side without losing balance, taking support, or hiking the hip.

Moving those Hips

Single leg standing – Same as described above. Try to hold for 30 sec each side and repeat 3-5 times every hour.

SIde leg standing– Stand the same as above. Lift 1 leg sideways upward keeping the balance. Repeat and hold as above.

Back leg standing– Stand same as above. Lift 1 leg backward keeping the knee straight and the toes pointed forward. Keep the ribs in line with the pelvis while lifting the leg backward. Hold and repeat as above.

 Knee caps facing forwards always –While getting up or sitting make sure to keep the knee caps facing forwards.

Chair squat- stand facing the back of a sturdy chair. Place your palms on the back of the chair. Keeping the knee caps forward and bend the knee 5-8 cms keeping the weight on the heels. Breathe in as you go down and out as you come up. Repeat as above. Make sure to keep the ribs in line with the hips.

The key to keeping those hips healthy and active is to use them regularly during the day. Make your day’s natural movement rich with getting on the floor if medically possible, walking barefoot, kneeling, and crawling … Signing off for now and hoping that you move those hips more ….

Categories
Uncategorized

21 healthy changes for 2021

I call 2020 a phenomenal year and before you tag me as a chronic cynic let me add that it has made us embrace uncertainty and trust the wait. As an analytical person, I started making small doable changes in my routine and am amazed at the positive effects they have on me and my family.  So Sharing them with you…

  • Drink a glass of water as soon as you wake up in the morning
  • Have your breakfast within 45 min of waking up
  • Stretch in the bed for 5 min before getting off
  • Wake up with natural light
  • Avoid seeing any screen for 30 min after waking up
  • Start your day with 3 to 5 belly breaths
  • Eat a protein and carb-rich breakfast
  • When on the potty relax, lean forward to empty your bowels fully
  • Take small sips of water every hour
  • When working from home try different sitting positions like long sitting, floor sitting, cushion, or cross-legged sitting
  • Take a 15 to 30-sec movement break every hour
  • Give your eyes the much-needed TLC they require. After 1 to 2 hours of screen time gently massage your closed eyes with the palm of your hands
  • Snack every 2 hours
  • Stroll for 10-15 min after every meal
  • Sleep and wake up at the same time every day
  • Be outdoor for 20-30 min every day to get your regular dose of vit d
  • Turn off the electronic devices 1 hour before your sleeping time
  • Even if you wake in the middle of your sleep try belly breathing and keep the eyes closed instead of looking at your screen.
  • Set realistic goals for yourself and others
  • Practice gratitude
  • Accept that any change is difficult but the key to success is the belief that you are doing the right thing for yourself.

Signing off for now with the hope that these habits help you to be the most fabulous version of yourself…… Happy upgrading

Categories
Uncategorized

MOVEMENT VARIETY AND YOU

An otherwise lazy Sunday afternoon turned into an eye-opener thanks to my children inviting me to play with them. There were climbing, hanging, crouching, and sliding activities. A child’s play soon turned out to be the most challenging play for the mom. I have always been proud of my ability to do structured fitness work but 30 min into these movements I was completely exhausted much to my surprise.

A deeper thought made me realize how much I had cast myself into repetitive movements denying myself the movement variety. It had slowly made the movement maps in my brain fuzzy with disuse. That’s why I found the natural movements so unnatural. We are designed to move and move task-oriented. That’s what would engage our brains else after a few times we function on autopilot. Thus we compromise innate fitness for aesthetic fitness.

So how to move naturally in the urban world? I am listing a few things which have helped me and hoping to add to this

1. Move with a purpose.. a walk to get groceries or walk the dog.

2. Ditch the tracking apps. Those numbers don’t mean anything to our brains.

3. Slowly transition to floor sitting

4. Try to wear your pants with minimal support.

5. Stack your pots and pans on the lowest rack. You will be able to add more squats to your day.

6. Use a squatty potty 

7. Play on the floor with your children.

8. Accept that any change would be difficult in the beginning so be kind to yourself.

HAPPY UNCASTING

Categories
Uncategorized

FROZEN SHOULDER AKA SHOULDER PAIN

Hi, this blog is dedicated to one of the most common conditions of the shoulder “ Frozen shoulder” also called Periarthritis of the shoulder.

What is it?

A condition characterized by pain and stiffness in the shoulder most common in diabetics.

How does it feel?

Nagging pain soon turns into a sharp shooting and intense pain in the shoulder going up to the elbow.

Difficulty in doing movements which involve turning of the arm at the shoulder – combing hair, toweling the back, lifting and turning to wear clothes.

Increased pain at night causing disturbed sleep.

Feeling of fatigue.

Stages it presents and tips to manage

FREEZING

Sharp and intense pain

Sleep disturbance

What to do

Apply ice / hot pack 3-5 min every hour for pain relief.

Belly breathing 3-5 times each hour.

Wall angle- Stand against the wall with feet shoulder-width distance. Slightly pinch the shoulder blades together without pushing the ribs forward. Keeping the arms by the side with palms facing the body, breathe in and slowly turn the thumbs outwards keeping the chest and shoulders relaxed. Repeat 3 to 5 times. Once comfortable in this position raise the arms sideways by 5 cms keeping the elbows straight and repeat the same movement. Increment by 5 cms till your arms touch the ears.

FROZEN STAGE

Pain is less but there is more restriction of movement especially rotation.

What to do

Move the joint slowly in pain-free ranges 2-3 times every hour.

Focus on keeping the shoulders down and relaxed during movements.

Start with 30 min of walking which improves the overall pain sensitivity.

Wall angle

Rotation with bent elbows-Be seated comfortably. keep the elbows close to the ribs bent at 90 degrees and maintaining this position and the lower ribs down open the hands outwards keeping the fingers and the wrist in line with the forearm. Once opened to the maximum pain-free point try to bring the hands towards the midline to make a namaskar position.  Repeat 3-5 times every hour.

THAWING STAGE

 The pain is less , range of movement is uptill the shoulder or 90 degrees . Overhead movements are still painfull and require you to twist the body, hike the shoulder or bend sideways.

What to do

Same as above.

Shoulder blade squeeze– Be seated with the neck and shoulders relaxed. Breathe in and gently pinch the shoulder blades together without pushing the ribs in the front. Hold for 2-3 counts breathe out and relax. Repeat 2-3 times every hour.

Standing against the wall and leaning to 1 side with the ribs-Stand against the wall with the lower ribs against it. Drop and relax the shoulders, jaw, and even your belly. Lift the arm up to shoulder level sideways such that the little finger is against the wall and lean towards the same side without moving the hips and the feet. Stop and ease into the position where you feel a pull in the lower back. Repeat as above.

Kneeling on all fours- Be seated with the buttocks on the heels position on the floor or any firm surface. Place the hands forward with palms on the floor and shoulder-width distance. Keep the elbows straight but soft and come to kneeling position such that the palms are directly under the shoulders, knees hip width distance and the shoulders relaxed and down. Breathe in into the belly, pinch the shoulder blades together , out and relax. Repeat as above.

Hope all these techniques help you .. Keep moving as the movement moves you

Categories
Uncategorized

MOVING WITH PLANTAR FASCIITIS

Hi, welcome to my new blog on Plantar fasciitis, a condition very common to anyone with feet. It is the inflammation of the sheet-like tissue in the sole of the foot just near the heel.

Our fascia plays a very important role during weight-bearing activities. It acts as a shock absorber, helps in proper weight distribution in the foot, and acts as a spring to help the foot clear the ground aka Push off.

As it is constantly used it often gets overused and inflamed.

Common symptoms are

Pain in the heel during standing and walking.

Burning in the sole

Severe pain in the morning as soon as getting up from the bed which eases a bit with movements.

Most patients find walking painful and ask me if they could avoid it completely for some time. My answer to this is no and here is why

Walking if done correctly improves the circulation to the foot, motor control of the small muscles, and maintains the extensibility of the fascia. All of these are essential for quicker healing and being pain-free. Listing a few strategies which have helped my patients

Barefoot walking on soft surfaces like carpet, beach sand, or grass. This can be done for 5 minutes every 1 hour.

Toe splay–  Be seated in a comfortable position. Keep the foot relaxed. Try to open the toes out keeping the toes and the heel in contact with the ground. Repeat 3 to 5 times every hour.

Foot mobility work-  Be seated as above with feet hip-width distance. Without changing the position of the heel curl the toes such that you would want to scrunch a towel under the foot. Repeat as above.

Wring stretch- Place the foot to be stretched on the opposite knee. Hold the toes loosely with one hand and the heel with another. Gently turn the toes in one direction and the heel in the opposite direction. You will feel a stretch or pull in the sole of the foot. Hold the position for 10 to 15 counts. Can repeat as above. Can do it the first thing in the morning as soon as you wake up.

Ball rolling– Place the foot on a tennis ball and gently roll lengthwise. Repeat 3-5 times every hour.

Hope these strategies help you to manage your pain and be pain-free… Take care