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How to Exercise with Back Pain

People with back pain need to exercise as much as everyone else, but they need to choose their sports carefully. Running, jogging, or any sport that requires jumping are usually poor choices. The bones of your spine are located one on top of the other, separated by pads called discs. Bones are much harder than discs, so when spinal bones are compressed and move closer together, they can flatten the discs like pancakes. Since the discs are shorter, they have to go somewhere else, so they widen and press on the nerves near them, causing pain. This is called a herniated disc. Anything that presses the bones closer together squashes the disc further and usually makes it hurt more. During running or jumping, the force of the foot striking the ground is transmitted up the leg to the back, which can compress the discs and cause pain.

The best sports for people with back pain are those that do not hurt when you do them. Riding a bicycle, walking or swimming do not exert a jarring force on the discs to compress them, so these exercises are recommended for people with back pain as long they don’t hurt while they exercise. Doctors often recommend special exercises to flatten the lower back, strengthen the belly muscles and stretch the lower back muscles. The key to exercising when you have a compressed disc is to stop exercising when you feel pain. You may need to try several different activities to find the right one for you.

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Dear Dr. Mirkin: How much do I need to exercise to lose weight?

In one recent study, researchers asked people to walk and count an extra 2000 steps each day (Journal of Human Nutrition & Dietetics, August 2006). This is really a minimal amount of exercise. They also kept complete food diaries. They lost weight and did not increase their food intake. When you start an exercise program, your appetite may increase, but this will not increase your caloric intake to equal the extra calories that you burn. For example, if you burn 600 calories with added exercise, you may take in 200 calories extra and you will lose weight.

Exercise helps you lose weight by raising your metabolism so you burn more calories for several hours after you finish exercising. However, only vigorous exercise that increases body temperature and makes you sweat will increase your metabolism enough to continue burning more calories after you finish. Overweight is a major cause of premature death and increases risk for heart attacks, strokes, cancers and arthritis. If you are out of shape and want to lose weight, get a stress cardiogram and ask your doctor to clear you for an exercise program. Start slowly and then gradually increase the intensity of your exercise over several months.

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Our personal exercise recommendations:

Diana's trike (outdoor fun for anyone)

A comfortable bike seat

Recumbent stationary bikes and spinning bikes
(if you can sit in a chair, you can get fit -- put it in front of the TV!)

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Dear Dr. Mirkin: Why did my doctor tell me not to take pills with grapefruit juice?

Taking certain medications with grapefruit juice can markedly increase their absorption. Many drugs are broken down in your intestines by an enzyme called cytochrome P450 that is normally there, so these drugs have to be given in higher concentrations to achieve adequate blood levels. Grapefruit juice contains bergamottin that blocks cytochrome P450, so that these drugs are not broken down and much higher amounts pass into the bloodstream. High doses of bergamottin may permanently damage the enzyme.

The following drugs should not be taken with grapefruit juice: calcium channel blockers such as felodipine, nitrendipine, nisoldipine, nifedipine, nimodipine, and verapamil; the anti-AIDs drug, saquinavir; the immune suppressant, cyclosporin; the tranquilizers, midazolam and triazolam; and the antihistamine, terfenadine. Other drugs may be added to the list as they are tested. In the future, grapefruit juice may be prescribed with several drugs to lower the dose required and make them less expensive, but at this time, doctors are unable to tell you how much of any drug to take with the juice. Until we know more, you should not take any drugs with grapefruit juice.

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Recipes for Clementines
The little citrus fruits in boxes are great for snacking. Try them in these salad recipes too!

Clementine-Black Bean Salad
Clementine-Wild Rice Salad
Clementine-Quinoa Salad

You'll find lots of recipes and helpful tips in
The Good Food Book - it's FREE

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Please visit our Fitness and Health forum
New topics include: chain-less bikes, flat feet, vertical leap, sugar alcohols, hemorrhoids, blood pressure and running, no bread, blood type diets, noni juice, more . . .

June 26th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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