OverSixty July 2023 Digital

ISSUE 5 | JULY 2023 | OVERSIXTY.COM.AU 14 LIVEWELL KELSEY KLOSS LIVE WELL Y ou might imagine exercise is bad for back pain, but experts say it’s just the opposite. “!e research is well docu- mented: Exercise does a bad back good,” says spine surgeon Dr Jack Stern in his book, Ending Back Pain . “For most peo- ple with low back pain, physical activity plays a strong role in recovery.” A strong, well-conditioned back is better at with- standing stress and protecting the spine compared to one not conditioned through exercise. !e following workouts are par- ticularly bene"cial for healing an aching back or preventing pain in the "rst place. Yoga stretches In a 2011 Archives of Internal Medicine stud y, 228 adults were assigned to either 12 weekly 75-minute yoga or stretching classes, or to read a self-care book about back pain. !ose in the yoga and stretch- ing classes saw much greater relief of symptoms. Yoga not only helps strength- en the back, it also stretches and relaxes the muscles that carry pain-triggering stress. People with lower back pain spe- ci"cally may bene"t from stretching the hamstring muscles (this expands pelvic motion, reducing lower back stress) by trying poses like a forward bend, stand- ing bent over and holding the calves, or the classic downward-facing dog. Yoga’s gentle stretches increase blood #ow to your back, which can help heal strains. Walking A 2013 study published in the journal Clinical Rehabilitation found a simple walk could be as e$ective as strength training. Researchers recruited 52 seden- tary patientswith chronic lower backpain and assigned half to muscle-strengthen- ing sessions and the other half to tread- mill sessions twice a week ("rst for 20 minutes, then eventually for 40 minutes). After six weeks, all participants report- ed less pain and less avoidance of daily activities, and there was no signi"cant dif- ference between the two groups, showing walking could be just as e$ective as other, more intensive workouts for back pain. As you raise your heart rate for an extended period, you’ll increase the #ow of blood and healing nutrients to your back. Cycling Many people blame bicycling for causing lower back pain, but with the right form, it can actually help discomfort. !e rea- son for pain while biking: fatigue chang- es how bicyclists move, causing them to spread their knees and bend forward more. However, many upright and re- clining bikes help riders avoid this pain- ful position, and may o$er a less jolting workout than, say, jogging. Experiment with di$erent types of bikes at the gym to see which is most comfortable for you. Pilates !ese stretching and strengthening ex- ercises are commonly recommended for those with back pain because they build up the body’s core andmobilise the spine. A Canadian study found that when 39 participants were assigned one of two treatments, Pilates training or care from doctors, those practising Pilates showed signi"cantly lower functional disability and average pain intensity. Hydrotherapy When you have chronic back pain, exer- cise is often easier with a splash because the water minimises stress on the back, according to Dr Stern. “!e buoyancy of water counteracts the gravitational pull that can compress the spine,” he writes. Many gyms o$er pool exercise classes or, if you’re hitting the water solo, sim- ple low-strain exercises can do the trick. Try “pulling” (take long strokes with your arms, leaving legs isolated to #oat behind) for an upper body workout that doesn’t twist and turn your lower back. 5 exercises to help improve back pain LIVE WELL It’s important to continue moving if you are experiencing back pain – the exercises listed here are ideal options Photo: Getty Images LIVE WELL After a year of terrible symptoms and fruitless tests, the internet provided a man with the name of his condition Illustration: Victor Wong Don’t let an aching back hurt your healthy lifestyle. Stay active with the best workout for your back pain ANNA-KAISA WALKER LIVE WELL D wane UnRuh can pinpoint the date it all started: Monday, September 11, 2017. !at morning, the 56-year-old public servant woke up with a strange and terrible ache inhis arms and legs he’d never felt before. “It was a deep bone pain that just took over,” he says. He lay down, thinking he’d just need to wait it out. But a day later, the limb pain was even worse. “I remember lying there writhing, like I was trying to crawl out of my skin,” he says. Even more worrying was the bi- zarre sensation in his head. Standing up for more than a few minutes was agonis- ing andmade himvomit. “It was like a #at iron pressing down onmy brain,” he says. Maxed out on the recommended dose of over-the-counter pain relievers, he went to his family doctor, who sent out half a dozen referrals to various special- ists. Based on UnRuh’s blood work, a rheumatologist ruled out arthritis and lupus, which can both cause joint pain and in#ammation. A workup from an in- ternist turned up nothing unusual, and a psychiatrist concluded that the pain was unlikely to be psychosomatic. UnRuhwondered if his symptoms were somehow related to a rare blood disorder that had turned up on a routine check- up two years prior: monoclonal gam- mopathy of undetermined signi"cance (MGUS) a condition that causes bone marrow to produce an abnormal protein. It raised UnRuh’s risk of developing multiple myeloma, a type of cancer that a$ects plasma cells in the blood. MGUS also predisposed him to developing am- yloidosis, another bone-marrow disorder that can cause kidney, heart, liver and in- testinal issues – plus nerve problemn. But after ordering a fat-pad biopsy, a haematologist found no evidence of ei- ther condition. “I remember her telling me, ‘If it’s amyloidosis, I’ll eat my shorts,’” UnRuh says. A clinical geneticist diag- nosed him with a rare connective-tissue disorder, Loeys-Dietz syndrome. Symp- toms can include headaches and joint pain, but it didn’t fully explain the rest of what UnRuh was experiencing. In addition to the pain and nausea, he now su$ered from constant brain fog, fatigue, di%culty swallowing, skin sensi- tivity, vocal tics, involuntary limb jerking, and a ringing in his ears. He struggled to "nd words for everyday objects and be- came unable to work. Even after a year of fruitless tests, Un- Ruh was determined not to lose hope. He turned to online patient communities for clues, and one day, a member of a tissue disorder support group posted about SIH – spontaneous intracranial hypotension. Involving abnormally low levels of cer- ebrospinal #uid (CSF) – the clear liquid that surrounds, supports and protects the brain and spinal cord – SIH is linked to a tear or hole in the dura mater, the outer membrane that surrounds the brain and spinal cord. As the CSF #uid leaks out, the brain can sag downwards within the skull, putting pressure on its lower struc- tures and causing symptoms that sound- ed very familiar to UnRuh, especially the head pain that worsened upon standing. A blogger with the condition gave him the name of a neurologist who had treat- ed her –Dr RobertoGiaccone. At UnRuh’s "rst appointment, Giaccone spent almost two hours examining him before tenta- tively diagnosing himwith a CSF leak. According to Giaccone, about 70 per cent of CSF-leak patients present with symptoms outside of the classic examples like nausea, neck pain and those head- aches while upright. For example, Un- Ruh was a&icted with verbal tics – he’d involuntarily blurt out randomwords like “"ddle” or “skittle”. Other neurologists concurred with his diagnosis and recommended UnRuh get an epidural blood patch. !e procedure involved injecting the patient’s own blood into the epidural space between the duramater and the spi- nal vertebrae. With luck, the blood would form a clot and seal o$ the hole in the dura,most likelywithin the spinal column. In March 2019, UnRuh "nally found himself in an operating room, where an interventional anaesthetist drew blood from an artery in UnRuh’s hand and then injected it into his lower spine towards the site of the suspected leak. “I remem- ber lying on my side on the table and the ringing in my ears suddenly stopped,” UnRuh says. “I thought, ‘What’s that noise?’ !en I realised it was clarity.” Following 15 to 20 per cent of epidur- al blood patches, the CSF leaks reoccur. But three years after his procedure, Un- Ruh remains in the clear and themajority of his symptoms have abated, although he sometimes struggles with memory and focus. Despite his su$ering, UnRuh considers himself lucky to have gotten a relative- ly quick diagnosis and to be almost fully recovered after a single procedure. “At Dr Giaccone’s o%ce they called me the miracle man,” he says, laughing. “I think that’s probably true.” He couldn’t get relief from headaches and joint pain Medical mystery !les BONUS SECTION