Lying on the ground, his hands placed on cross his chest, legs slightly bow, such as general sit-ups, get up and lie down, repeat several times. As the number of personal fitness is determined visually. Poor, or from lack of physical exercise, could the help of other help, such as the feet hooked through the wardrobe drawers, or ask someone to help hold the foot in order to get up. Another Stretch your hands forward, or light set aside, and can help easy movement arose, although the effect is not as good as your hands across the chest is good, but it has a beer belly for the initial movement exercises.
letters CFP is circulated to all 19,000 Avoid sit-ups, toe-touching and sports References family doctors in Canada, plus causing sudden angulation of the 1. Livingston M: Treating back problems libraries, overseas subscriptions trunk. These points I stress daily with better, Can Fam Physician, 1984; and the press. A letter on these my patients. The only exercise I now 30:1136-1141. pages will reach this diverse prescribe is back arching, either prone 2. Cyriax J: Textbook of Orthopedic Medi- audience. Letters should be kept or supine (bridging) done in a sus- cine, ed 6. London, Balliere Tidall, 1976, p 550. brief and are subject to editing. tained (isometric) fashion, five times 3. Deyo RA: Conservative therapy for low References to any published in the morning and the afternoon. back pain. Distinguishing useful from material should be in keeping with I believe that tny ideas find substan- useless therapy. JAMA 1983; 250:1057- the Uniform Requirements for tiation in the writings of Cyriax2 who, 1062. Manuscripts Submitted to incidentally, states repeatedly that the 4. Livingston M: Back Aid. Philadelphia, George Stickley, 1982, pp 13-28, 82-84. Biomedical Journals. All letters rationale of most back exercises pro- must be signed, although grams is erroneous. correspondents' names will be G. E. Potter withheld at the writer's request. Vancouver, BC. A Case of 'Sailor's Eye' My niece, aged 16, noticed acute blurred vision in her left eye, and found her pupil to be dilated on that The author replies: side. She also had impaired color per- Back Exercises It was kind of Dr. Gordon Potter to ception and periorbital discomfort. Can Be Overdone comment on my "back problems" ar- This event occurred shortly after ticle in the May issue.1 sailing, and turned out to be a side ef- I would like to comment on the article However, I am surprised that Dr. fect of transdermal scopolamine "Treating Back Problems Better" by Potter feels attention to posture in the (Transderm V) applied two days ear- Michael Livingston. 1 relief of back pain is a "sacred cow". lier to prevent motion sickness. When I have had a special interest in back I have found posture to be a significant the patch was removed she inadver- problems for many years, and have factor. tently rubbed her eye before washing had difficulty assessing the proper role I agree that sit-ups may aggravate her hands, and the events described of exercise. Dr. Livingston, and many lumbar disc lesions. In my paper I did above occurred 15 minutes later. others in the fitness field seem to me to not, however, recommend sit-ups. The eye returned to almost normal go too far, as if any exercise is good four days later. for the back. There also prevails a cou- There is little hard evidence to sup- port one set of exercises over another.3 Barry Hamilton-Smith ple of sacred cows that seem to go un- The individual, firmly held opinions of Toronto, ON. challenged, i.e., that stomach muscles Dr. Potter and myself highlight the are important in back fitness, or that lack of adequate research in back prob- posture is an important factor in back lems. Are Super Tampons pain. This reasoning leads to the use of exercises such as sit-ups and pelvic Within a limited space, I described a A Health Hazard? tilting, which I know to cause a good balanced approach of rest, relaxation A 27-year-old single woman presented deal of mischief..I have seen three or and flexion and extension exercises. In to my office with acute urinary reten- four young people acquire surgical my practice, I first emphasize exten- tion. She previously had been well, disc lesions by simply executing sit- sion when patients have pain on flex- with no significant past medical his- ups. It makes no sense to show some- ion, and vice versa, and I have ob- tory. Having urinated last 16 hours be- one how to bend to protect the lordosis served that some patients experience fore seeing me, she was in distress of the back, then tell the same patient sharply increased pain on extension. I with bladder distention. In the emer- to do sit-ups or pelvic tilting. am thus surprised that Dr. Potter rec- gency room I attempted to catheterize If hard or soft disc fragments can ommends back arching only for every her, without success. On vaginal ex- migrate posteriorward, then surely patient. amination I found an o.b. (Johnson & flexion of the back is best avoided. I offer my suggested simple exer- Johnson) tampon. The string was com- People should sit with a pillow rolled cises for fellow physicians to test their pletely within the vagina so it was not up and placed behind the lumbar worth when used with rhythm and initially evident. Once the tampon was spine, both at home and in cars, and common sense. removed, the woman was able to urin- also at work if possible. Bend by using I have described these matters in ate normally. She was at the end of her the hips and keeping the back straight. more detail in my book, Back Aid.4 menstrual flow and had inserted the Never exert while leaning forward, Michael Livingston tampon before retiring to bed the night e.g., lifting groceries from a car. Richmond, BC. before. When she was not able to urn- 1992 CAN, FAM. PHYSICIAN Vol. 30: OCTOBER 1984
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