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Posted: 23 Feb 2013 05:23 PM PST

Faulty body mechanics is one of the leading causes of lower back pain, but regular strengthening exercises can help alleviate the problem.

AT some point in our lives, most of us will experience lower back pain, which interferes with work and daily routines. The dull pain can be annoying and persistent, while the shooting or stabbing pain can leave you with limited mobility for days.

The spine comprises seven cervical (neck region) vertebrae, 12 thoracic (upper back) vertebrae, five lumbar vertebrae (lower back), the sacrum and the coccyx. All these help keep our body erect, so it's crucial to take care of the spine.

As we age, bone strength, muscle elasticity and muscle tone tend to decrease. The intervertebral discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.

The causes of lower back pain are aplenty, and it can occur from lifting heavy objects, sports injuries, pottering around the house or in the garden, a sudden jolt such as a car accident, degenerative conditions, or other stresses on spinal bones and tissues.

If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain.

When these nerve roots become compressed or irritated, it results in back pain.

Too much or too little exercise, combined with the ageing process, also contributes to lower back pain.

However, in the majority of cases, lower back pain is caused by muscle weaknesses and imbalances, including a tight hamstring and lower back muscle groups, tight hip flexor muscles and weak abdominal muscles.

Most incidences of lower back pain can be treated without surgery. While you can take analgesics to relieve pain, apply ice and heat to reduce inflammation, or opt for surgery as the last resort, exercises to strengthen the back and abdominal muscles are probably the best method for a speedy recovery.

One of my students suffered a slipped disc a day before her holiday to Indonesia's Bintan Island, but thought the excruciating pain was nothing serious. The nagging pain had been there for a while, but like most people, she ignored it, hoping it would go away

On the ferry, she could hardly sit, and once she checked into her hotel room, she collapsed. She was wheeled into the hospital and given opium for a week.

The doctor insisted on surgery, but she flatly refused, and crawled her way to the acupuncturist instead. After a few sessions, the aches miraculously disappeared, but the pain started to radiate along her arm and shoulders.

Something was not right, and not wanting to consult the doctor again, she limped her way to the gym and sought advice. Luckily, she had the foresight to know that exercise could alleviate the pain.

She religiously attended Pilates classes twice a week, struggling at the initial stages. She could barely lift a limb while lying on her stomach, but with determination, encouragement and time, she improved. She also started lifting weights to gain more muscles and strength.

Today, after almost a decade, she's my model student and often acts as my push-up demonstrator. Not only can she do a 60-minute high-impact aerobic class, she can put many a man (and young boys!) to shame with the amount of weights she lifts.

And ladies and gentlemen, my star student is no youngster but someone in her late 60s, and a granny of three! Popo is always immaculately dressed and continues to inspire others.

"I feel I'm much fitter and stronger now than I was in my youth. I can keep up with the classes, and best of all, I know how to take care of my back," she says.

Many of my dance students at Universiti Malaya also have lower back problems, and I tell them it's something they have to live with, as there is a tendency for the pain to recur, especially with the pounding the spine takes while they're dancing.

I used to tape my bony spine for extra cushioning while I did back flips or rolls on the floor.

When you're in pain, simple exercises and yoga stretches do wonders for the spine. One way is to lie supine (face up) with knees bent, and slowly bring one knee into the chest and hold for a few seconds before alternating legs. Or, from supine position, put your calves up on a chair or stability ball, with knees bent. Since the lumbar supports the weight of the upper body, this exercise greatly reduces the pressure on the lower back region.

Another easy exercise is to lie in prone position (on your stomach). Lift one leg at a time and hold for a few seconds, alternating sides. Then switch to lifting off one arm at a time.

When you feel stronger, lift the right leg and left arm off the floor before switching sides. As your back strength increases, lift the upper body off the floor and hold. Switch to lifting both legs off the floor. Never lift both arms and legs off at the same time until you get stronger. Make sure the movement is carried out in a gentle and controlled manner, without jerking the limbs.

A yoga move that is good for any level, and serves as an excellent warm-up exercise is the cat-cow. Start in the quadruped position (hands and knees on the floor). Arch your back and look up as you inhale, and contract your belly and tuck your chin in as you exhale. Do about five or six rounds, then sit back on your heels with your arms outstretched to the front (child's pose) in order to stretch the back.

Here are some handy tips to prevent lower back pain, as suggested by the Aerobics and Fitness Association of America and the National Institute of Neurological Disorders and Stroke.

·Use backrests and lumbar support when sitting.

·Make sure seats offer optimal seating comfort and support.

·Quit smoking as it reduces blood flow to the lower spine and causes the spinal discs to degenerate.

·Reduce stress and anxiety.

·Change your position from sitting to standing and vice-versa, frequently. Walk around at regular intervals.

·Don't slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.

·Adjust table and work stations to comfortable heights.

·Avoid activities that are clearly associated with previous episodes of pain.

·Always keep loads close to your body, and use proper techniques when lifting, ie bend the knees and pull in your stomach muscles when lifting or lowering an object.

·Allow for adequate warm-ups and cool-downs before and after exercise.

·Always wear protective footwear and avoid exercising for prolonged periods of time on hard surfaces.

·Strengthen the abdominal and back muscles.

·Sleep on your side and put a pillow between your knees to reduce any curve in your spine. Always sleep on a firm surface.

·Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus and vitamin D helps to promote new bone growth.

·Avoid harmful movements such as straight-leg sit-ups.

> The writer is a certified fitness trainer who tries to battles gravity and continues to dance, but longs for some bulk and flesh in the right places.

Triggering trouble

Posted: 23 Feb 2013 05:22 PM PST

Inflammation of the tendon or tendon sheath of a finger can lead to a trigger finger.

HAVE you ever had the disconcerting experience of being unable to straighten your finger after bending it? If you have, odds are you have a "trigger" finger.

A trigger finger is a finger that "locks" after it has been flexed (bent).

At times, you can't even straighten it out without the help of your other hand pulling at the offending finger. Some may even hear a loud "click" as the finger is straightened.

A trigger finger is also known as stenosing tenosynovitis in medical speak.

The phenomenon could affect one or more fingers, although it commonly afflicts the little and ring fingers, as well as the thumb.

And bad news for right-handers - it has been found to be more common in the right hand.

It is common for sufferers of the condition to experience pain and stiffness of the affected finger. Often, a small lump of tissue known as a nodule develops at the base of the affected finger.

Approximately two out of 100 people develop trigger finger. Nobody knows what causes it, but there are several factors that can increase one's risk. These include:

·Being a woman

·People over the age of 40 years

·Certain medical conditions

·People whose work or hobby requires repetitive gripping actions, such as musicians, gardeners and construction workers.

Conditions that can increase the likelihood of trigger finger include those affecting the hand, such as Dupuytren's contracture. This describes a thickening of tissues in the palm, and when it progresses, one or more fingers bend into the palm and cannot be straightened.

Long-term medical conditions such as rheumatoid arthritis, amyloidosis, diabetes, carpal tunnel syndrome and people on dialysis, can also trigger (excuse the pun) the condition.

In fact, around 10% of people with diabetes develop trigger finger.

Although nobody knows what really leads to trigger finger, it is believed that some sort of inflammatory process is the culprit, with the inflammation leading to swelling of a tendon or its sheath.

In essence, a tendon is a tissue (fibrous cord) that is primarily responsible for attaching a muscle to a bone.

In the case of trigger finger, the tendon comes from a muscle in the forearm that passes through the palm and attaches to the finger bone.

When the muscle pulls on this tendon, the finger bends towards the palm.

A tendon sheath functions to protect the tendon.

Normally, as you bend and straighten a finger, the tendon slides easily in and out of the sheath. In trigger finger, the tendon can slide out of the sheath easily enough when you bend your finger.

However, it cannot slide back in easily (due to the swelling). The finger then remains bent.

The diagnosis of trigger finger is made almost exclusively by history and physical examination alone.

Around one in five cases will improve without any treatment. Simply resting the hand may resolve the problem without the need for treatment.

In certain cases, painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce swelling.

For some, splinting by strapping the affected finger to a plastic splint can be utilised to relieve pain and aid recovery. Some people wear the splint just at night. Splinting may be required for at least six weeks.

On occasions, corticosteroid injections are used to reduce swelling, thereby relieving symptoms. The steroid is injected into the tendon, and it is combined with a local anaesthetic to make the injection painless.

In recalcitrant cases, surgery on the affected sheath is carried out. It involves making a 1-1.5cm incision in the palm to perform a "release".

This is a relatively minor procedure that is generally used when other treatments have failed.

The release can also be achieved with the use of a needle, without the necessity of undergoing a "formal" operation.

This is the percutaneous technique. Studies have shown that the percutaneous technique can be as effective and safe as the conventional open method of surgery.

Following surgery, results are noticed immediately. However, with an operation, there is a small risk of some numbness to the finger.

Do not delay seeking formal consultation and treatment. If it is not treated early, the affected finger could become permanently bent, which will make performing everyday tasks difficult.

Early cases can be treated successfully without surgery.

> For more information on trigger finger, visit www.quillorthopaedic.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Young decision-makers

Posted: 23 Feb 2013 05:21 PM PST

Children should be allowed to make some decisions in order to help them develop their sense of self. Find out how you can help your children develop some decision-making skills.

SHOULD I involve my child in decision-making? This question, perhaps, has lingered in the minds of many a parent. Popular culture sees decision-making in children differently. This culture insists that parents make decisions for their children; from what they eat and drink, to what they wear, watch, hear and play.

But did you know that decision-making is, in fact, a very important skill for children to learn, regardless of their age?

Your children can gain several benefits from making their own decisions. Decision-making will influence how they behave and get along with others, as well as shape them into the type of adult they become and the life paths they choose.

When children make good decisions, they will not only feel good, but also experience a sense of satisfaction and fulfilment because they have made those decisions.

On the other hand, if your children make bad decisions, then they may suffer for it, but also learn from the experience. This can help them make better decisions in the future.

So the question is, how can you, as a parent, help your children learn decision-making skills?

Starting the process

Giving your children some decision-making power should be done in stages, and is usually based on age, maturity and previous decision-making abilities.

It is dangerous to give your child complete freedom to make decisions.

Your children constantly make decisions, but you may be inadvertently interfering with this process by stepping in to "correct" them to ensure a good result. This is entirely normal as you do not want your child to fail or suffer embarrassment.

However, the time will come when your child will need to make his/her own decisions and you will not be available for him/her to consult. It is with this moment in mind that you should start training your child to make his/her own decisions now.

To help your children make decisions, you must first educate them about the decision-making process. It is hard to master decision-making, and many adults have not perfected this skill.

Start the process off with baby steps; first, help your child recognise when he/she has made a good or poor choice. When he/she snatched his/her sibling's toy and ran to his/her room with it, was that a good or bad choice? When your child decided to help you with gardening and helped you finish earlier, was that a poor or good choice?

Even better, involve your child when making decisions for the family (eg going on a holiday, buying an appliance for the house), especially if the decisions will also impact them. Try to get their opinion as this will help them build up their own self-confidence by contributing to the family's decision-making process.

Some tips

Here are a few ways to help your kids make decisions that are not impulsive, nor focused on immediate satisfaction:

1. Teach them to pause and think before leaping. A few seconds of thinking can prevent a lot of bad decisions.

Your child must also have an understanding about the issues at hand before he/she is ready to make any kind of decision. You should help and guide your child to identify and analyse the problem before coming up with possible options. Help your child to fully understand the issues at hand whenever he/she is faced with a decision-making dilemma, and then ask him/her how he/she thinks it can be solved.

2. Get them to ask themselves some key questions and evaluate their options. You will want your children to understand their options and decisions; so get them to ask themselves, "Why do I want to do this?" and "What are my options?"

Children often have different motivations and while they may know that doing something is silly, they may feel peer pressure or other reasons to do it anyway.

3. Evaluate the consequences. Get your children to then ask themselves, "What are the consequences of my actions?" or "How much trouble will I get in?"

Children need to weigh the risks and benefits of their decision, both in the short and long term.

4. Understand their decision. The most important question that children must ask themselves is, "Was my decision in my best interests?" Having these concerns, weighing competing options, and making a decision that is in their best interests, is the hallmark of a good decision-making process.

An easy way to remember how to approach the problem-solving and decision-making process is by doing it the IDEAL way:

·Identify the problem

·Describe possible options

·Evaluate every option (weigh the pros and cons)

·Act upon the best option available

·Learn from the experience whether the decision was good or bad

While children will not always make good decisions, they often like to be treated equally and be in control of certain things.

Breathing room

It is important to step back and let your kids choose freely as it is crucial for their development. Of course, you should not let that stop you from stepping in if your child's decision may lead to bodily harm. If there is a possibility of this happening, take back the reigns and make the choice for him/her.

Be sure that you take the opportunity to immediately discuss the reasons why you acted the way you did. In the future, there is a higher chance that your child will remember that his/her initial decision was unwise.

Learning to make consistently good decisions is a process that takes time, and no one can learn it overnight. As counter-intuitive as it may seem, you need to provide guidance to your child in order to help them become independent.

Location and situation

Most children don't do well in busy, chaotic surroundings, so it might be too much to expect your child to make reasoned, thoughtful decisions in such a scenario. Your child will be exposed to stimuli that he/she is not used to, and therefore, have trouble dealing with.

Other than the settings and surroundings, you should also be aware of your own verbal and physical approach when asking your child to make a decision. Try getting down to your child's eye-level by sitting at the table or crouching to talk to him/her; be sure that your discussion is as calm as possible and avoid becoming over-reactive.

Learning from mistakes

More often than not, most parents tend to focus on pushing their children to make the "right" decision in the hopes of shielding them from disappointment.

However, it's important to bear in mind that sometimes, it's the bad decisions that will teach your child the most, provided you do not over-react with negative remarks, or ridicule or belittle him/her.

You should instead offer your support, encouragement and emphasise any valuable lessons that can be learnt by your child's failures and mistakes; also discuss with him/her on how he/she can bounce back in the wake of setbacks and failures by adopting the right approach.

Give him/her the opportunity to discover things through trial and error. This will help your child feel empowered, so that he/she will be better prepared for all the bigger decisions ahead of them.

It is up to parents to guide and help their children develop good decision-making skills and grow up to become independent, responsible, and happy adults.

> Associate Professor Dr M. Swamenathan is a consultant psychiatrist. This article is a courtesy of Malaysian Paediatric Association's Positive Parenting Programme. The opinions expressed in the article are the view of the author. For further information, please visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Kredit: www.thestar.com.my

Ahad, 24 Februari 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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