You don't have to live with pain

© Jolie Bookspan, MEd, PhD, FAWM
Director, Neck and Back Pain Sports Medicine
and the Academy of Functional Exercise Medicine

 

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Foot Pain - Pronation, Achilles, Stress Fractures

Frank Kaler- aerobics/yoga/spinning teacher, cyclist, general contractor- tells in his own words:
I began my athletic career as a distance runner in high school. In my first season, despite promising results, I began suffering from multiple stress fractures of the medial tibia (shin bone). I retired from running my first season. Looking for a substitute, I opted for bicycle racing which I enjoyed for about 5-years. During my sixth year as a cyclist I entered a triathlon. I thought that my bones had become strong enough to endure the stresses of running. Not long after beginning running I began to experience new pains: "big toe" (distal metatarsal) pain in both feet and Achilles tendonitis.

Somehow I finished well in my first big race, and afterwards went to a podiatrist to find out what the problem(s) were. He informed me that my symptoms were degenerative arthritis (over-use related), bunions (medial metatarsal) and Achilles tendonitis (distal insertion) due to undue lateral motion of my heel while running. The cause of these symptoms, he said, was pronation. He told me I needed an operation to remove the bunions and "repair" the arthritic joints. I was 22 years old. He also told me that I would need orthotic inserts in my shoes for the rest of my life. I had the operation, was fitted for the custom orthotics and I wore them religiously for almost 20 years. I tried to continue with triathlons after the operation using orthotics in my running shoes, but the tendonitis issue became chronic and I could not run more than one or two miles without severe tendon pain and moderate, but nagging, pain in my "big toes."

I came to think myself a debilitated, crippled, has-been. I never thought I'd be able to run comfortably or well in competition again.

For 20 years I relied on my orthotic "crutches" to allow me to walk with minimal comfort. They never allowed me to be comfortably athletic. I retired from competitive athletics.

Dr. Bookspan showed me the cause of my pronation was not "fallen arches" as the foot doctor had told me. She showed me that my arches were well formed. I had no genetic malformation of bones or joints, but I allowed my body weight to slump inward on my feet, pressing on the arches, flattening them.

I have learned that it is a sign of nothing more then improper "foot posture." How does this happen? I let it happen. Intentionally or not, I let it happen. Over time I nurtured a bad habit that neither doctors, coaches nor I ever recognized until Dr. Bookspan showed me that I can easily change it. My podiatrist saw pronation as the primary cause of symptoms which I suffered. He was wrong. Pronation was the primary symptom of something else: my bad posture. The bunions, tendonitis, etc... were secondary symptoms.

Dr. Bookspan showed me what proper foot posture is as I walk, stand, and run. I now am beginning to explore the new thrill of using my own musculature to properly posture my feet. Rather then relying on my orthotics to support my weight as I rock through each step, I rely on my self. I begin each step on my heel and now rock through my strides on the outer rim of my foot with plenty of air beneath the arch of my perfectly healthy foot, and rather then rely on my big toe to drive myself forward at the end of each step, I use all 5-toes and no longer feel any pain. I only feel strength.

My "REVOLUTION" occurred at least 30-years late. Had I understood this simple fact early in my athletic career, I never would have had the problems described. I probably would not have had the three stress fractures in high-school. I never would have created my arthritis or bunions or needed the operations. I never would have needed the orthotics. I would probably still be running in good form today. It's never to late to start.

Today I run, even box, without any foot pain, pronation, or stress fractures. As I continue applying what I have learned, to prevent my "two flat tires" I can exercise and live without pain. It is a great relief.

 

Knee Pain

Stephanie Schwartz- psychologist- tells in her own words: I hyper- extended my right knee sliding into 1st base at the Labor Day softball game. It was the final employee game on the field of Veterans Stadium where I worked as an usher for the Phillies and my single scored one of the winning runs for our team. Unfortunately, the RBI also left me with a pain in my right knee that lasted long after the game ended. Whenever I'd stand up, the underside of my knee would tense up and the pain would follow. It was especially bad in the mornings when I first stood up. I was always able to walk it off and even continue exercising. But after 6 weeks of this happening every time I stood up I began to seriously consider seeing a doctor. Then one Friday night in yoga class, the doctor came to me.

Dr. Jolie's Warrior Yoga class focuses heavily on strength and balancing poses and education about injurious joint positions and pressures I was concerned about further injuring my knee, yet as the class continued I realized just the opposite was happening. My knee was feeling better, stronger. I walked out of class feeling better than I had in weeks. As I went back to my normal routine however, the pain returned.

The next Friday I went back to yoga class. Again I required more balance and performance from my knee than I ever did in my daily life. And again my knee felt better than it had all week! This time I decided to speak with Dr. Jolie after class to find out just what I was doing in class to bring me such relief and why the pain came back when I went back to my normal routine. I explained to her how I'd hyper extended my knee and how the pain kept lingering despite my best efforts to "walk it off." She asked me a few questions about where exactly on my knee the pain was (the underside) and how long it lasted (only when I first stood up after sitting for a long period of time). "I don't have any x-rays of you or anything but I can tell by the way your knees are bending inward that you're falling in on your arches. In class we always make sure students don't do that."

Huh? I'd never had a problem with my arches before. And besides, pain was in my knee, not my feet! But as I looked at the two of us in the full length mirror and watched her exaggerate my poor standing posture I realized it was true. And as I watched Dr Jolie's mirror image straighten out her posture I saw how ridiculously easy it was to correct. A simple shifting of my weight from the inner edges of my feet to the outer edges made a dramatic difference.

Over the next week I practiced shifting my weight to the outside of my feet. Just realizing when I was "doing it again" was more than half the battle. Walking and standing were such routine actions for me. They were so automatic I'd never considered how I was standing and walking. Once I became aware I was standing and walking poorly, fixing it was a snap. And the results came quickly and clearly. The more I stood and walked correctly, the less my knee hurt, which encouraged me to continue to practice standing and walking correctly. The pain hadn't come from the single injury that hyperextended it, but years of pressuring the knee inward. The positive momentum took on a life of its own! By the time I returned to yoga class the following Friday, I could stand up and walk just fine without any pain, no matter how long I‚d been sitting beforehand. After six weeks of nagging pain, it was a welcome relief!

It's been nearly a year since then. In that time I've continued to train almost every week with Dr. Jolie. Her yoga class, in addition to providing an awesome strength training workout, has taught me the power of knowledge. The key to eliminating pain is to pay attention to how we use our bodies, not just in class, but in our daily lives.

 

Low Back Pain Steve Kramer- "Photoenvisions" Freelance Photography in Chiang Mai Thailand - writes in his own words: How do you put a miracle down on paper and not have it sound like a loony UFO sighting? But I guess it's really not a miracle. It was just plain common sense. I had already resigned myself to a life of surgery followed by chronic pain, limited physical activity, and lots of medication. It was not a bright future. I had been told by several very, VERY qualified orthopedic surgeons in three different countries that the only remedy for my injured lumbar disks was surgery and pain medication for life.

"Nothing to be done about it so get used to the idea. Perhaps a 'Pain Clinic' can teach you how to manage the pain better." I was already eating more pain medications all day every day than I cared to be, and I wasn't happy about it.

From working with Dr. Bookspan I learned about obvious pressure I was putting on my back by bending standing and sitting in all the ways we already know you shouldn't do. Sitting, bending, lifting with a rounded back was degenerating my discs and pushing them outward. When standing and lifting overhead, I was arching my back, transferring the weight to the low back instead of using my muscles to keep from arching. To help remind me how to move with proper mechanics, she told me to watch how so many other people injure themselves through their own body weight.

I watched other people moving. I think THAT'S what really got me excited; seeing others who were complaining about the same back pain I was experiencing moving themselves all wrong! They were bending incorrectly, sitting incorrectly, and standing incorrectly. In general living their physical lives incorrectly. I could SEE it! Plain as the nose on my face. And it made sense. If you move your body correctly, you aren't putting the pressure on the spinal disks (or any other joints,) and you allow them to heal, and the pain stops. Simple as that.

The exercises that some of the orthopedic physicians had me doing were correct in theory but incorrect in practice. Yes, I needed to stretch my back muscles, but not by standing up, bending over and touching my toes. That was creating MORE pressure on the disks. Yes, I needed to strengthen my abdominal muscles, but NOT by doing stomach crunches that exacerbated the problem in my back and created more problems in my neck! So I began doing the exercises the correct way taught in her articles and books. No pressure on my spinal disks. I began paying attention to my posture when standing. Paying attention to the way I stood up from a chair, the way I reach for something on a higher shelf, the way I even get out of bed in the morning. With repetition it becomes ingrained and I won't have to think about it again. I don't need to go to the health club or gym for any of this. It's something that I do all day every day now, not just two hours a day, twice a week. That was less than four months ago. Today I don't take ANY pain medication, and I lift, carry, walk, and do more than before. A pain-free life. I like that."

 

EVERYTHING HURT!
A special story in his own words by Christopher Michael Emmolo

I had started training in the fighting arts when I was 12. When I was 16 I was diagnosed with floating kneecaps. The orthopedist said that by strengthening the muscle surrounding the kneecap it would prevent them from floating (which caused them to lock or give out). This was very painful. He gave me exercises to do over the summer and said that if they didn't work that he would do surgery. He prescribed ibuprofen for the pain. I spent the summer doing the exercises. They didn't work. I wore knee braces from the time I was 16 until just a few years ago.

When I was 17 or 18 I dislocated my elbow wrestling in a high school tournament. Several doctors had told me that it had not been dislocated, but I knew better - I was the one who put it back in. My orthopedist told me that not only had I dislocated the elbow, but I chipped it when I put it back in.

By the time I was 20 I was taking ibuprofen regularly. I was also on medication for a hiatal hernia. By the time I was 25, one of my doctors told me that if I didn't quit the martial arts, I was going to suffer from debilitating arthritis my entire life.

At age 29 I was taking the prescription Naproxin twice a day, the equivalent of three Aleve tablets, twice a day. By the time I was 30, I feared that the doctors may have been right. I had just earned my black belt in Kagedo at the time. I was not able to train much of the subsequent year due to my debilitating arthritis, spending days in such pain I could not get out of bed.

In February of 2004, I went to the emergency room for abdominal pain. A few tests were done, but the doctors found nothing really conclusive. They diagnosed me with a spastic colon and put me on Bentyl, Nexium, Zantac, and one other prescription I cannot remember.

Finally, in the summer of 2004, just after turning 31, I went to see the doctor again. The pain in my joints was too much for me to bear. I would wake up in the morning and lie there for over an hour before I was physically capable of moving. I would be in so much pain that I would not be able to bend my knees, and barely my elbows. My shoulders hurt constantly. My neck and shoulders would grind all the time. I was in so much pain that I was faced with the thought that I may never be able to train in the martial arts again. The doctor prescribed Neurontin and Tramadol for the pain.

In November of 2004 I attended a martial arts seminar with Dr. Bookspan at the Eastern USA International Martial Arts Association's annual event. I had met her the previous year at the same conference. My instructor and I were giving a seminar immediately following Dr. Bookspan's so we attended hers.

Her seminar was her Ab Revolution core training method that she developed – a sports medicine approach to training. During her seminar, I learned one of the best ways to develop my abs. More importantly, I learned the basics of proper body positioning, and could already feel the difference.

After the conference weekend ended, as we were all leaving, she reminded me how to stand and move with healthy positioning to eliminate the injurious pressures that training and moving wrong can cause.

She said that she could fix me up and we began an email correspondence and exchanged emails several times a day. She started by asking some basic questions: "Where does it hurt?" "What medicines are you taking?" and so on, plus careful checking of piles of things that might be causing the pain. She gave me things to try after explaining the concept so I'd understand what I was doing, not just go through the motions. I read her articles, started doing the stretches, and even some of the exercises. After just one week of working with her, I noticed such an improvement that I felt that it was time for me to try going without my arthritis medicines. I felt great. The pain in my joints had been reduced at least 80%. That's better than any of the medications I was taking. During the next couple of weeks I kept reading the articles on her web site, and we would discuss them, how I felt, my diet, and so on. After about 10 days I had stopped taking the four medications I was prescribed for my stomach and digestive problems.

What specifically did we do? I'd worn orthotics since first or second grade, and I walked pigeon toed. This was made worse by training in Kune Tao, another martial art I practiced, that required a pigeon toe stance that I used even for normal walking. My feet pointed inward which caused me to fall in on my arches, which then added to the pain in my knees, and caused pain in my ankles. Dr. Bookspan told me to make sure that my feet pointed forward, neither out nor in, and referred me to one of her articles, "How To Fix Your Own Knee Pain." It worked. Simply making sure that my feet did not point inward and cause me to fall in on my arches drastically reduced the pain in my knees, and eliminated the pain in my ankles. I hold my own arches up and no longer need the orthotics.

I was used to hunching over a computer desk all day, followed by driving home in a contorted position which had me reclining back and reaching up for the steering wheel as though it were a handle. When I walked, my head hung forward, which caused my shoulders to round and hunch. Dr. Bookspan had me read a few of her web site articles including, "How to fix your own neck pain" and explained to me what was going on with my body. My arthritis was not getting progressively worse, my posture was! By following her instruction, I learned how to properly carry my head so that it is not hanging anymore. This forward hanging head was the cause of at least 90% of the pain in my shoulders! The rounding of the shoulders was causing pain in my elbows because of the position in which my arms hung. My shoulder would grind so badly that it was like there was gravel in the joints. After reading one of her articles and taking her advice, I began doing two simple stretches several times per day. These helped correct the posture of my head, neck, and shoulders, which alleviated all of my upper body pain.

Correcting my body positioning and ergonomics has had a profound impact on my life. Dr. Bookspan had corrected my posture and provided me ways to be sure that I am maintaining proper posture. Proper position is key. I had near crippling arthritis. If it rained, I could be assured of a very painful day. There were days where I was physically not able to bend my knees because of the joint pain. There were days where after taking medications to alleviate the pain and subsequently wreak havoc on my stomach, I could still only move from the bed, to the couch, to the bathroom and back and that was still too much. Dr. Bookspan gave me my life back. I no longer need to reach for the three prescriptions I took for my arthritis pain. I need only be sure that I am using proper posture, that my head is up and not forward thereby relieving shoulder pain instead of causing it. It also helps alleviate the back pain at the top of my back, between the shoulder blades. I make sure that if my head is up that my shoulders are back instead of rounded forward. This helps alleviate not just shoulder pain, but also helps alleviate the pain in the upper portion of my back between the shoulder blades, and coupled with Dr. Bookspan's pec stretch, it helps alleviate the joint pain in my elbows. I make sure my hips are under me, not arched behind me, which alleviates the lower back pain and makes it easier to point my feet forward, which takes the weight off my arches and alleviates the joint pain in both knees and ankles.

Then things took a back step. The day before Thanksgiving I was attacked by two teenage boys in a drug rage from what could only have been PCP. I was in a fight for my life, one of them had a piece of pipe to brace his fist, and I won. But I had a broken nose, a bruised ligament on the left side of the jaw, numerous cuts in my mouth and a few on my face, as well as heaps of swelling. Remember what Rocky looked like at the end of the first Rocky movie? I should have looked that good. What's worse is that I had a 6 am flight to New Hampshire on Thanksgiving day.

In order to see and to "eat", I had to employ some of the worst posture I've ever had. I couldn't close my mouth all the way, and still can't as of the time of this writing (December 2004). The emergency room doctor would not clear me to fly unless I agreed to take the pain medication, which I had tried to refuse. I was put on 800mg of Amoxicillin, 800mg of Ibuprofen, and 500mg of Vicoden. After two days I felt like garbage. I was in pain and my stomach was not happy. I couldn't eat solid food.

I emailed Jolie and let her know what happened because I thought it was the end of all the progress we had made. She told me not to worry that not only would I heal, but I wouldn't starve, and she would fix whatever damage the bad posture caused me.

She suggested putting healthy fruits and nuts and spices in the blender. I discovered a whole new world of healthy food. Fruit became my new sugar fix instead of my daily pile of junk food. I traded my two bottles a day of soda for water or healthy blender drinks. Her other dietary suggestions helped with some of the aches and pains I had from the attack and subsequent "after care." I was stunned.

The modifications Dr. Bookspan made to my diet caused me to lose an inch and a half off my waist. Most importantly, I felt great. In two weeks I had healed faster than was expected, felt better than I had in a long time and lost a few pounds. I just started being able to utilize proper posture again. After only a few days, I've noticed a dramatic improvement. My joints no longer hurt and I'm not constantly tired.

Dr. Bookspan has been referred to as "the St. Jude of the Joints." St. Jude is the patron saint of lost causes. I was a lost cause when she began helping me. Thanks to Dr. Bookspan, I have my life back!

 

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