Back Exercises Can Be Overdone - letters by jlhd32


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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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