Arthritis
Throwing my Back Out! And Self-Treatment
I’ve arrived, folks. I’ve made it! I am finally “threw-my-back-out-doing-nothing” years old.
One morning last week, I was doing my Qi Gong practice, followed by stretching. I got up off the floor, and I felt my familiar old friend—my right sacroiliac joint—a sprain-like, nerve sensation coupled with soreness, say hello for the first time in years.
In fairness, the stage had been set leading up to this relatively non-expenditure of motion. I’d spent the week before doing an inordinate amount of housework, hosting family staying with us, much more cooking and cleaning, a bit more indulging, not to mention a home’s worth of laundry after my daughter’s Lice sequel, so my body was spent. On the day before I jumped as high as I could on our trampoline and wrestled maniacally with 4-year-olds.
I spent the next morning in pain, obsessively trying to stretch, but to no avail. It was apparently too inflamed, needed first to set in before it could heal, the way it is difficult to resolve a virus in its first 12 hours—that is before it shows itself for what kind of virus it is. By afternoon I could barely walk (unfortunately in parenthood rest is rarely an option). I surely couldn’t lift anything, and wondered if I’d make it to work the next day!
- SIMPLICITY & REPETITION: I decided to minimize, to consolidate my rehabilitative routine to just a few reliable stretches, which is important in my opinion, then did them constantly. Some physical therapists make the mistake of assigning 8 or 9 daily exercises, most of which might be beneficial, but if one or two are potentially aggravating, they might keep people on the hamster wheel of suffering, not realizing they could be doing less and getting better.
- HERBS: Once in a while we are forced off of our soap boxes and bow in humility in front of that which we resist. I prescribed myself a non-holistic formula—not individualized to my unique pattern—but one simply for inflammation in the low back and lower body. Well worth it short-term, though in fact I did suffer a side effect as a result. While excitatory/warm-natured eucommia bark probably helped my back, it did impact my quality of sleep that night. I cooked it in conjunction with pearl barley, phellodendron bark, and other blood movers to promote circulation in the lower portion of the body, then drank it while my wife warmed up a heating pad for me.
- HEAT: As we say in Chinese medicine: “Ice is for dead people”—dead bodies to be exact, but most injuries are not ones of inflammation to the degree of compartment syndrome, which merits ice. Most are minor, protective inflammations surrounded by tight, hypertonic muscles and ligaments that need relaxation, which heat provides.
- ACUPUNCTURE: While lying atop my heating pad, I obviously could not needle my own lower back, but I could use “distal points” that connect the spine, ligaments, and erector spinae muscles. I used “Small Intestine 3,” located next to the pinky joint, to treat the spine, “Spirit Bone,” located at the junction of the first and second metacarpals, for its endogenous opioid-releasing effects and connection with the low back’s complementary (lung) vessel; finally “Triple Warmer 9,” atop the forearm near the elbow, also to send blood to its paired vessel. I left the needles in for thirty minutes, basically the duration of a TV show we watched (Wednesday—not thus far recommending), and when I got up to go to bed I was about 25% better. When I woke up the next morning I was 75% better, still having not taken one single, solitary NSAID. No judgement for those that need painkillers, but in my opinion, their side effects should be respected enough to reserve them for times of actual need—pain in times when we need to be active, as opposed to discomfort in times where we can relax.
I should continue to get acupuncture from someone else for this as well. Also, I must do my daily stretches, gradually incorporating more every few days, and probably call it a year on my trampoline wrestling career. I share this story not to brag—though it’s nice to brag—but to reiterate the value of constant and appropriate physical movement and attention towards our ailments. I went from being unable to walk to a full commute and pain-free workday overnight!
Slow & Steady Heals the Shoulder
At the end of 2022 I tore my rotator cuff, not throwing a baseball for some important league game, not in some random construction accident nor act of heroism. Instead, one of my first favorite paternal pastimes was throwing my daughter as high as I could into the air then allowing her to crash down on to my palm, elbows flexed, held tight by my bicep’s insertion.
Everyone says the same thing: You blink and they’re all grown up! This isn’t exactly an example of that, but I definitely didn’t take adequate note that my favorite play toy had grown from 15 to 25 pounds, and as an acupuncture colleague who was treating me for the issue remarked: “Would you throw a 25-pound weight up and down and catch it in your palm?”
To which I replied: “It depends how adorable and joyful the weight was.”
Typical presentation of a torn supra-spinatous: Pain radiating into my deltoid, especially with my arm extended to the side and/or behind me—even worse with inward rotation (trying to pour water from pitcher into our filtration system). Occasional pain while lying on my shoulder at night, and I couldn’t throw a tennis ball, let alone a baby anymore. I had to find other ways to enjoy parenthood. I also got used to pouring water with my left arm, which was probably a temporarily decent brain exercise anyway.
My funny acupuncturist friend helped a bit—a lot of sports medicine, trigger points and gua sha techniques—though no classical points, and improvement was always temporary. For two years my intermittent, moderate pain continued, and I was terrified of the notion of surgery and determined as such to avoid it.
I continued to go for treatment, occasionally poked and cupped myself at home as much as I could (though the supraspinatous is located behind the shoulder, making local self-treatment relatively impossible), and got very diligent with my daily Qi Gong practice: Shoulder rotations, shoulder rolls, neck rolls and rotations, “silk reeling” exercises, which are great for creating unique notches of negative space around the joints for the corresponding breathwork’s oxygen to enter. “Qi moves the blood,” is one of our most ancient maxims, which means where oxygen goes, fluids follow. I couldn’t tell you when it happened any more than I could when my daughter jumped from 15 to 25 pounds, but somewhere between years 2 and 3 of my injury, enough fluids got to the tendon and joint for my pain to disappear!
Today I am unsure if the tear is still there—I’m 47, not 27, so my shoulder may never again be perfect. I continue to do my Qi Gong regularly, preventively, not only for my shoulder, but other vulnerable tendons and ligaments as well. Slow and steady heals the shoulder!
If you have chronic pain it is something that requires daily attention, an at home regiment, self-massage and gentle movement anywhere from 10-20 minutes 1-2 times a day, and patience, the “patient patient,” if you will. If you stop, if you half-ass it, or give up, you’ll likely be resigned to the “blue pill,” surgery and well… literal blue pills, either of which will eventually wear off. I often recommend tailored Qi Gong homework exercises to my patients with our sessions, but if you’d like local Qi Gong teacher referrals, please let me know—happy to refer!
What do Gout, Varicose Veins, & Neuropathy Have in Common?
What do neuropathy, gout, and varicose veins have in common? In western medicine not much, aside from being awful inconveniences, ranging from sources of extreme pain to discomfort and/or a significant cosmetic preoccupation.
For neuropathy you go to the neurologist, for gout to the rheumatologist, and for varicose veins you might see your primary care, who will likely refer you to a vein specialist. The neurologist may or may not inquire about venous circulation, and it is very unlikely the rheumatologist will ask about numbness or tingling in your feet.
But from a Chinese medical perspective, all of these conditions fall under the heading of impaired circulation in the lower extremities, caused by either weakness, inflammation, or both, leading to a misdistribution of bodily fluids, which exacerbates the former, which exacerbates the latter, and so on.
They are different in specifics only as a result of individual genetic proclivities—in fundamental mechanism they are the same. Someone with a colder bodily constitution—prone more to hypothyroid or hypotension, will be more susceptible to varicosities, whereas people with warmer body types—prone more to hyperthyroid or hypertension, will be more susceptible to gouty arthritis. The former are well advised to eat plenty of lamb and red meat, while the latter might consider being mostly vegetarian.
Neuropathies can go either way in the way of temperature, as they are more telling of issues with fluid metabolism. We find that neuropathy patients are either unusually thirsty, unusually not thirsty, or they urinate excessively or not enough. In either case, their body is clearly weakened to some degree, and it is imperative they get to sleep by 11pm, so nerves can properly regenerate.
While inadequate urination obviously leads to fluid retention which can clog neurological pathways and impair circulation, excessive urination can dry vessels of their healthy synovial fluids, causing us to feel parts of our body we previously took for granted as being unaware of.
Holistic medicine should modulate the organ function that is causing the improper excretion of fluids in addition to treating local blockages causing pain or discomfort. Easier said than done of course, as such conditions generally took many years to form, plus might be aggravated by present challenges, such as diet, stress, or medications being used to treat other conditions. However, through a course of treatment of acupuncture, herbal medicines, and dietary modifications, one should see improvement over a proper course of treatment, 120 days.
Please be discerning in your choice of clinician. If you see someone—whether east or west—who is failing to assess or treat beyond the immediate site of pain or discomfort, I would highly recommend getting a second opinion.
Spring Wind!
Did anyone else notice how many times in the past week the weather said something like 52 but felt more like 32? Spring wind! In the lunar calendar we are already well into spring, the season the ancient Chinese correlated with pathologies of “wind.” What does that mean?
“Wind pathologies,” in Classical Chinese, basically refers to anything that moves within the body. Think joint pains or almost any pains, also neurological tics, from Restless Leg to Parkinson’s disease, finally many dermatological conditions that traverse different body parts and seem to constantly change in shape or surface area covered. Where does it come from?
The pathology of autumn is dryness, hence all the foliage drying up and sinus issues it commonly brings. Following is the bitter cold of winter, which consolidates said climate of dryness, constricts our blood vessels, thereby offering fewer pathways for lubrication, whether to our skin, orifices, or otherwise.
Dryness, in Chinese medicine, whether manifesting as a lack of blood, lack of healthy blood, mucosal metabolic fluids, or parasympathetic neurotransmitters, can give rise to physiological symptoms that might be metaphorically described as “wind.”
Another cause can be literal wind, as it gusts down the avenues and seemingly even turns corners to blow hats off our heads and make 52 degrees feel like 32. This causes a local constrictive response in the head, which contains our autonomic nervous system, which manages a great part of vital organ function. Am I suggesting the entire body is connected and that which accosts the head can in turn accost our entire physiology? Yes. Ask anyone who’s suffered a concussion. What can we do?
Wear a scarf. Wear a hat or a hood. Wear a hood over your hat. Wear a mask beneath the hat beneath the hood above your scarf. You don’t have to be sick or paranoid to wear a mask in the cold and/or windy months of the northeast. You can simply be protecting your many cranial nerves that traverse the face and have far-reaching physiological implications. Modern fashion is such that there are many stylish options for these accessories. With all we have already working against us—modern stress, western diet, the simple biology of aging—doesn’t it make sense to do the simple, little things to prevent or prolong the scale from tipping into Parkinson’s?
As for “wind prevention” by way of treating the root, which is to say nourishing blood and vital fluids, I have mostly the same old boring, science-based advice: Animal protein, eggs, cooked vegetables, small portions of rice or pasta, meditation, and going to sleep before 11pm. As for accessible, food-grade Chinese medicine, tea made from red dates, licorice, and/or pearl barley can also be helpful. For the spring we also recommend more sour foods, kraut, lemon, and/or vinegar with the intention of “astringing” as many of our good fluids as possible.
Lastly, happy Mercury Retrograde, an admittedly somewhat ironic salutation to those who “observe.” Remember to expect delays in transit and traffic and problems in technology and communication. Double check who you’re sending that text or email to. Accept that things will go wrong. Try to breathe. Ask people to clarify before shouting back at them. Breathe again.
(photo from a fun shoot back in 2007, one year pre-Chinese medical school!)
The Nuance of Positive Thought
As many of you know, I suffer from congenital gout disease, inherited from my father, surely exacerbated by growing up on an American diet, in addition to my own part of culpability in adolescent self-destruction. Thankfully, it is under control with an Eastern diet and medicine, a victory I take great pride in.
Between the winter holidays I am as guilty as many of pushing the over-indulgence envelope (relative to my own standards), and one night last week, as our toddler was giving us a hell of an evening in resistance to sleep, I experienced some pain in the distal inter-phalangeal joint of my big right toe (always the culprit, interestingly located on acupuncture’s meridian that corresponds with the pancreas!). It was the perfect storm of parenthood physiology: The body needs twice as much rest and self-care, and is allotted half (if you’re lucky). Needless to say, I was worried, as we all are when our Achilles heels rear their heads, that this would “turn into something.”
Because of said toddler insubordination, the subversive from within, plus an early workday the next morning, my wife and I had already conceded a good night’s sleep. Instead, just to unwind, we put on our latest favorite show, I soaked my feet in hot epsom salt water for 20 minutes, during which I needled points on my left hand to treat my right foot (a particular style and technique many of you have suffered through at my hands, no pun intended).
The next morning I woke up tired, only moments before my daughter did, insisting, requesting, yelling, and crying, offering me no moment of reprieve or transition into consciousness (it truly never ends) as I got everything ready for the day. I was tired. My head had that subtle pounding to it that heads have after going down too close to midnight and/or waking too early. I felt irritable and frustrated. BUT… my toe was pain-free!
When we are exhausted or irritable about something or someone, it can be challenging to focus on the positive—look at the bright side instead of the hole in the donut. I spent the day reminding myself, each time I got annoyed or felt resentful, of my right foot, my big toe, how much worse that could have gone, what it could have meant for the week to come, and how big of a disaster I avoided. Not to mention that my daughter did have pre-school the next day and the weather was nice! There have been instances in the past where my joint pain worsened, school was out, I was on full-time Dad-duty, and the weather was awful. All considered, I was very lucky. Sure, I was tired and the day wouldn’t feel or probably go as I’d planned or hoped, but I repeatedly made an effort to return my focus to that toe, and all the things that had gone right.
Patient sometimes come in and apologize for telling me everything that’s still wrong when overall they’re doing much better and so many things are positive, and I remind them that my office is the place to focus on the negative. Apprise me of every imperfection as it aids in the diagnostic process in our aim for physiological optimization. In the remaining 23 hours of every day though, try to focus on that healed part of you that was previously headed in a drastically different direction. I understand it’s not always that easy—the negative is not always as simple or temporary as a bad night’s sleep, a mild headache, or argument. For such instances I extend my sympathy and support.
