In a relatively small randomized, crossover, controlled trial, time-restricted eating (also known as intermittent fasting) did not lead to improvements in weight or other selected health parameters compared to participants’ regular eating patterns. For four weeks, the 12 women and five men (average age of 26 years) with overweight or obesity ate whatever they wanted from 7:00 am to 3:00 pm and fasted the rest of the day. For another four weeks, they ate as they wanted.

The researchers measured body weight, waist and hip circumference, body composition, and blood pressure, and did blood tests to measure fasting blood glucose, cholesterol, triglyceride, and insulin concentrations. They also asked the participants to rate their hunger.

Overall, the researchers found no significant changes in body weight or other parameters, however, when analyzed separately, the women did lose some weight (about two pounds) during the intervention.

Some studies have reported benefits of time-restricted eating on weight, blood sugar control, blood triglyceride levels, and appetite, but others (like this study) have not. There are a lot of variables to consider when conducting research like this (including age, weight, and health of participants, the length of the study, and the length and timing of the fasting period). Currently, it appears that time-restricted eating patterns are pretty much equivalent to traditional caloric restriction for weight and health. Some people may find the approach helpful, while others may not. As with most approaches to achieve your health goals, find something that’s right for you.

Recurrent Low Back Pain? Try Walking

A randomized controlled trial in Australia found an intervention that encouraged walking reduced the occurrence of low back pain compared to no intervention. The study enrolled 701 participants 18 and older (81 percent female, with an average age of 54 years) who were not already engaging in regular physical activity. In the previous six months, each participant had recovered from an episode of lowback pain that interfered with daily activities but did not have a specific, diagnosable cause (such as vertebral fracture or cancer).

The intervention group met with a physical therapist six times over a six-month period to develop a personalized progressive walking program and receive some education on pain science and low-back care. The goal was to be walking five times a week for at least 30 minutes a day by six months. Participants kept a walking diary and wore a pedometer, which measures step counts. At the three-month mark, they were asked to wear an accelerometer for seven days to measure daily step count, daily briskwalking steps, and minutes of moderate to vigorous physical activity.

The intervention group reported less episodes of low back pain (including activitylimiting pain) compared with the control group. The control group also sought the help of massage therapists, physical therapists, and chiropractors more often than the walking group.

If you suffer from recurrent low-back pain, regular walking may be helpful and is beneficial for overall health. (Make sure your healthcare provider approves.) Start slowly and work your way up to walking on most days.

Join the Trend—Improve Your Diet Quality

A survey of 51,703 adults from 1999 to 2020 found that diet quality in the U.S. improved a bit, at least in people who don’t struggle to get enough to eat.

Participants were surveyed on their typical dietary intake. Their responses were compared to the American Heart Association (AHA) 2020 continuous diet score (which is based on higher intake of vegetables, fruits, legumes, whole grains, nuts/seeds, and fish and shellfish). Less than 40 percent adherence to the AHA score was considered poor diet quality, 40 to 79.9 percent was intermediate, and at least 80 percent adherence was ideal.

The proportion of U.S. adults with poor diet quality decreased from 48.9 percent in 1999 to 37.4 percent in 2020. The proportion with intermediate quality diets increased from 50.6 to 61.1 percent. The proportion of U.S. adults reporting eating an ideal diet more than doubled (from 0.66 percent to 1.58 percent) but is still extremely low. Diet quality did not improve for people experiencing food insecurity.

We are headed in the right direction but have a long way to go. You can choose low or minimally processed plant foods and fish/ shellfish in place of less healthy, more processed choices more often. Let’s keep those percentages improving!

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If you want to stay well as you age, turn off the TV and get off the couch. That’s the message from researchers at Harvard’s T.H. Chan School of Public Health who found that replacing even one hour of TV with physical activity could benefit a person’s health. For a study published in JAMA Network Open, June 11, the Harvard team looked at 20 years of data from 45,176 people free of major chronic diseases (including cancer, diabetes, heart attack, heart failure, and stroke). Healthy aging was defined as survival to at least age 70 with no major chronic diseases and no impairment in subjective memory (defined as a person’s own perception of their memory), physical function, or mental health. Among the participants, 3,873 achieved healthy aging. The analysis showed that each increase of one hour per day spent engaged in light-intensity physical activity (such as household chores) increased the odds of healthy aging by 8 percent.

Walking Relieves Back Pain

A new study from Macquarie University, in Sydney, suggests that regular walking is an effective way to manage chronic back pain. The study (The Lancet, June 19) included 701 adults, mean age 54, all of whom had recently recovered from an episode of low back pain. The participants were randomly allocated to a walking program or to a no-intervention control group. Participants in the walking program were advised to build up to 30 minutes of walking, five times a week over a six-month period. After three months, most were walking three to five days a week for an average of 130 minutes. Compared with the control group, the intervention group had fewer occurrences of activity-limiting back pain during the one- to -three-year followup period and a longer average period before they had a recurrence of back pain (a median of 208 days compared to 112 days in the control group). Walking is a good low-impact muscle-strengthening exercise for people with musculoskeletal pain; moreover, it can be good for easing the stress and depression that can accompany chronic discomfort.

Traumatic Brain Injury Risk

The number of older adults diagnosed with traumatic brain injury (TBI) is alarmingly high, according to a recent study from researchers at the University of California-San Francisco. TBIs range from mild concussion to more serious head injuries that subject brain tissue to severe damage and increase the risk of dementia, Parkinson’s disease, seizures, and depression. The study (JAMA Network Open, May 31) followed 9,239 Medicare enrollees, average age 75. Over an 18-year follow-up, 1,148 participants sustained a TBI. Contrary to studies looking at younger people, TBI was more likely among people who were healthier. It is possible this may be because these individuals are more likely to engage in physical activity. Keep in mind that the data reflect cases of TBI in which people were diagnosed and received care. Other research has suggested that many older adults do not seek a medical evaluation after a TBI. If you fall, let your doctor know, even if you think you haven’t hurt yourself.

Shingles Vaccine Uptake

New data (Journal of the American Medical Association, May 23), shows that uptake of the shingles vaccine (Shingrix®) among older Americans has increased, likely because of government action to eliminate cost sharing for vaccines covered by Medicare Part D. The policy was part of the Inflation Reduction Act and took effect in January 2023. To determine the impact of the new policy, a team from the University of California’s Mann School of Pharmacy and Pharmaceutical Sciences looked at monthly data on shingles vaccines administered between January 2022 and December 2023. The analysis showed that uptake of the shingles vaccine increased by 46 percent after the policy was implemented. The vaccine is recommended for people ages 50 and older and significantly reduces the risk of shingles and postherpetic neuralgia (chronic nerve pain that can persist for years).

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Signs, Symptoms, and Risk Factors

Pay attention to subtle signs that may signal osteoporosis, such as loss of height and back pain. Compression fractures in the spine can cause a gradual loss of height, which may result in a stooped posture. These compression fractures can also lead to back pain, which may be sudden or develop gradually over time. If you experience any of these symptoms, bring them to the attention of your primary care provider or a rheumatologist. “Certain women are at a higher risk of osteoporosis due to genetics,” says Alana Serota, MD, an osteoporosis expert at the Weill Cornell-affiliated Hospital for Special Surgery. “But aging, illness, medications, poor nutrition, and other lifestyle factors can significantly increase the risk of osteoporosis, as well, particularly in the first five years after menopause.”

Reducing Your Risk

There are steps you can take to reduce your risk of osteoporosis. Weight-bearing exercises such as walking, jogging, dancing, and strength training help stimulate bone formation and increase bone density. “Women over 50 should focus on maintaining a healthy diet and weight, engaging in regular exercise, getting sufficient sleep, and ensuring adequate intake of calcium, vitamin D, and protein. The goal is to consume 1,200 milligrams of calcium per day. Any not obtained through diet should be made up with supplements,” says Dr. Serota. Generally, the daily recommended amount of vitamin D is 600 international units (IU) for women ages 51 to 70 and 800 international units (IU) for women over 70.

Diagnosis and Treatment

If you are diagnosed with osteoporosis there are several treatment options available. “When osteoporosis is treated, women can expect to maintain or even improve their bone density, depending on the medication used. This significantly reduces the risk of fractures. However, if osteoporosis is left untreated, bone density will continue to decrease, leading to a higher risk of fractures,” says Dr. Serota.

Available osteoporosis medications include:

Bisphosphonates: These medications are typically taken orally, usually as a once-weekly or once-monthly tablet.

Hormone therapy: This typically involves the use of estrogen or a combination of estrogen and progestin. Estrogen therapy can be administered orally in the form of tablets, or it can be delivered transdermally through patches or gels applied to the skin.

Selective estrogen receptor modulators (SERMs): Medications such as raloxifene are taken orally as a daily tablet. SERMs act like estrogen in some parts of the body, such as bone, but have anti-estrogen effects in others, such as the breast and uterus.

Monoclonal antibody medications: These medications, such as denosumab, are administered as an injection, and are typically given once every six months by a health-care provider in a clinical setting.

Anabolic Agents: These drugs, which stimulate bone growth, include PTH-analogues—teriparatide (Forteo) and abaloparatide (Tymlos), as well as the sclerostin antagonist romosozumab-aqqg (Evenity). “All of these approved treatments prevent fractures, and their benefits far outweigh their risks. Ultimately, the choice of treatment is a shared decision between the patient and doctor,” says Dr. Serota.

What to Expect

Medicare generally covers bone density testing DXA (dual energy X-ray absorptiometry) scans every other year for women over the age of 65. The Bone Health and Osteoporosis Foundation recommends that scans can begin as early as age 50 for women who have risk factors for fractures. For women who are diagnosed with osteoporosis, regular monitoring and follow-up appointments with health-care providers are crucial to ensure the effectiveness and safety of prescribed treatments.

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Hiatal hernias are common. Approximately 55 percent to 60 percent of adults over 50 have this condition, which occurs when part of the stomach pushes through the diaphragm— the muscle separating the chest from the abdomen. As women age, diaphragm muscles can weaken, increasing the risk of a hiatal hernia. Additionally, postmenopausal women often experience changes in abdominal pressure related to weight gain and this is a risk factor, as well.

A small hiatal hernia can become larger over time due to aging, increased abdominal pressure, or repetitive strain. To prevent a small hiatal hernia from worsening, maintain a healthy weight, lose weight if you have overweight or obesity, and avoid heavy lifting to minimize abdominal muscle strain. A small hiatal hernia is often symptom-free, whereas a larger one can cause stomach acid to back up into the esophagus, causing heartburn and chest pain. To prevent hiatal hernia symptoms, eat smaller, more frequent meals; avoid eating close to bedtime; and steer clear of alcohol, spicy foods, citrus fruits, coffee, chocolate, and tomatoes. To treat hiatal hernia symptoms, several medications can be used:

Antacids: These help neutralize stomach acid and provide quick relief. Examples include: Rolaids, Tums, and Mylanta.

H-2 Receptor Blockers: These reduce acid production. Examples include Pepcid, Tagamet, and Zantac.

Proton Pump Inhibitors (PPIs): These also reduce acid production, but are more potent than H-2 blockers. Examples include Nexium, Prilosec, and Aciphex.

If medications fail, surgery may be recommended. Discuss your concerns with a health-care provider, so you can get personalized advice.

I am considering trying a Pilates class. I’m 65 and have arthritis and lower back pain. Can Pilates help alleviate my pain?

Pilates, developed by Joseph Pilates in the early 1900s, focuses on strengthening core abdominal and back muscles, which support the rest of the body. It can improve flexibility and balance, making it beneficial for individuals with arthritis and lower back pain. Exercises are performed on a mat or a machine called a “reformer” that uses resistance for a low-impact workout. Due to its low-impact nature, Pilates is often easier on the joints and less strenuous compared with other exercises.

When researchers performed an analysis of several studies in an effort to find out if Pilates was helpful for older adults with chronic musculoskeletal conditions, they gave it a thumbs up. Their review of seven studies that included close to 400 adults over age 50 (about 75 percent were female) showed that Pilates was quite effective for reducing back pain, as well as other osteoarthritis and osteoporosis pain.

Many senior centers, health clubs, and YMCAs offer Pilates classes tailored to older adults. Attend classes led by a qualified instructor to ensure proper technique, and be sure to inform the instructor about your arthritis and back pain in case position or equipment modifications are warranted. It sounds like Pilates will be an excellent choice for you, but just as with any new fitness program, it’s a good idea to check with your doctor to make sure that this form of exercise is appropriate for you.

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A:  In general, most back pain issues tend to resolve on their own in a few days, though sometimes it can take longer. Seek immediate medical care if there is loss of bowel or bladder control. If the pain is severe enough to keep you up at night or if you experience tinging, numbness, or weakness in your legs, these are signs to see your doctor as soon as possible. Because you describe pain related to lifting too much weight or doing so incorrectly, there are some at-home care treatments that can speed healing. The rule of thumb is to apply ice for about 10 to15 minutes, three or more times per day for the first 24 to 48 hours. After that, you can either keep applying cold compresses or treat with heat, whichever feels better.

There are many convenient products that can be heated in the microwave or frozen. Just be sure to have a cloth layer between your skin and the heat or ice to avoid damaging your skin. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with swelling and pain and include ibuprofen (Advil, Motrin) and naproxen (Aleve). People with a history of stomach ulcers, high blood pressure, heart disease or taking blood thinners may need to avoid NSAIDs. Acetaminophen (Tylenol) is not an NSAID but can help relieve pain. If your back pain doesn’t resolve in four to six weeks, see your doctor. Meanwhile, it’s important to stay active, but do so wisely. Lifting weights the day after a back injury, for instance, will get you into trouble. Reinjury is all too common and not worth the extra pain or the prolonged recovery time. Strength training is vital to aging well, so do keep it up. If you have questions about technique or how much weight to lift, consult with a physical therapist or personal trainer. 

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Managing stress through techniques such as relaxation, mindfulness, exercise, social support, and by seeking professional help, when needed, can help reduce its negative impact on health and well-being. Read on to learn about the effects of stress on health and how to reduce stressful influences in your life.

The Hormonal Connection

We tend to associate stress with mental and emotional health, but often overlook the impact that stress can inflict on physical health. “Chronic stress may be associated with overexposure to cortisol and other stress hormones that, over time, can take their toll on physical health and contribute to increased risk for heart disease, digestive problems, depression, memory impairment, and a weakened immune system,” says Susan Evans, PhD, Director of Education in Psychology, Weill Cornell Medicine, Department of Psychiatry.

10 Ways Stress Can Make You Sick

Weakening the immune system: Chronic stress can suppress the immune system, making the body more vulnerable to infections, viruses, and other illnesses.

Inflammation: Stress triggers the release of hormones, such as cortisol and adrenaline, which can promote inflammation. Chronic inflammation is associated with a wide range of health problems, including cardiovascular disease, autoimmune disorders, and digestive issues.

Heart health: Stress can impact the cardiovascular system by raising blood pressure, increasing heart rate, and constricting blood vessels. Chronic stress can contribute to hypertension, heart disease, and stroke.

Digestive problems: Stress can disrupt functioning of the digestive system, leading to stomachaches, diarrhea, constipation, and nausea.

Mental health disorders: Prolonged stress can increase the risk of developing anxiety, depression, and post-traumatic stress disorder.

Sleep disturbances: Stress can interfere with sleep patterns. Chronic sleep disturbances can weaken the immune system, impair cognitive function, and increase the risk of chronic diseases.

Weight gain: Stress can influence eating behaviors and food choices, leading to overeating, emotional eating, or cravings for unhealthy foods high in sugar, fat, and calories. This can lead to obesity and a higher risk of diabetes.

Muscle tension and pain: Stress can cause muscle tension and stiffness, leading to headaches, neck pain, back pain, and other musculoskeletal problems.

Memory impairment: Prolonged stress can result in shrinking of the hippocampus, which is a part of the brain critical to memory.

Pain: Chronic stress can aggravate existing pain conditions such as fibromyalgia or temporomandibular joint disorder.

Adopt Helpful Coping Strategies

Life events such as divorce, retirement, or the death of a loved one can disrupt routines and create stress. Even positive life changes can be accompanied by stress due to the adjustment process. “Women in midlife experience stress that includes significant hormonal fluctuations during menopause, including estrogen depletion. These changes can play havoc on well-being,” says Evans.

Reducing the harmful effects of stress involves adopting healthy coping strategies and lifestyle habits. “When patients present in my practice with physical and emotional symptoms of stress, first I encourage getting sound and adequate sleep—at least seven to eight hours per night. This may be the most important buffer to the effects of stress. I also ask patients to exercise regularly and adopt a healthy and nutritional diet,” says Evans.

If stress is hindering your life, consider professional help. Therapy, counseling, or medication may manage stress and improve your well-being.

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Exercise tops the list of effective choices for stress reduction, and the benefit is amplified when you’re doing something you love. When you’re passionate about an activity, you’re more likely to put in the effort to improve your skills. This can lead to a greater sense of accomplishment and satisfaction with your fitness journey. For example, many people who partner dance and play team supports routinely experience the challenge and satisfaction of skills improvement.

Some people enjoy a wide variety of actitives, while others prefer to focus on a few. Below are some insights and injury prevention strategies for three popular outdoor activities perfect for summertime.

Picking Up Pickleball

According to the Sports & Fitness Industry Association’s Topline Participation Report, pickleball has been the fastest-growing sport in America for the third consecutive year. Pickleball is a paddle sport that combines elements of tennis, badminton, and table tennis. It is played on a badminton-sized court with a slightly modified tennis net. Players use solid paddles made of wood or composite materials to hit a perforated polymer ball, similar to a Wiffle ball, over the net. The game can be played as singles or doubles, and it is known for its accessibility and ease of play, making it popular among people of all ages and skill levels. But if you’re not careful, you’ll pickup some injuries along with this new  sport.

UCLA physical therapists certainly have seen a rise in pickleball injuries. Players report pain in their  hamstring and calf muscles along with knee injuries. Another common injury is lateral epicondylitis, known as tennis elbow, now referred to as pickleball elbow. This overuse injury can resolve on its own with rest, but sometimes can become chronic and debilitating. Low back pain from sudden deceleration and flexion in the back can be a consequence of weak core muscles. But you can reduce injury risk with the right approach to the sport.

“Don’t start from doing nothing to playing pickleball for one to two hours several times a week,” advises physical therapist Karen Hamill, DPT, UCLA Department of Rehabilitation. “Progress slowly and focus on fun more than being competitive.” Preparing for the game can help reduce injury risk.

Train your legs: Pickleball requires agility, quick side-to-side movements, and balance. Practice at home by doing simulated exercises such as quick side-to-side steps that incorporate diagonal patterns.

Practice with the paddle: Improve your paddle swing by incorporating your whole body for power. Hit some balls on your own to improve your technique.

Strengthen shoulders: As a preventive measure for shoulder injuries, Simon Angell, physical therapist assistant at UCLA Westwood, recommends working on shoulder strength and stability, with a focus on the rotator cuff, which is composed of four small muscles attached to the head of the arm bone (humerus). “Arm circles with both arms reaching out shoulder height in front or to the side are a great way to work and train those muscles,” he says. “Try doing them with palms facing up for more activation of the rotator cuff. Start with 10 repetitions forward and backward. If you can do more, go for it.”

Working Out in the Water

Exercising in the water can be an ideal choice for people rehabbing from injuries (for example, knee problems) because the forces on weight-bearing joints are reduced, and the buoyancy aides in mobility and range of motion. “Hydrostatic pressure helps to reduce swelling and facilitate healing,” says physical therapist Leena Uranwala, MPT, UCLA Department of Rehabilitation. “It is like a full-body compression garment that provides support, increases circulation and proprioceptive awareness. Many of our patients immediately feel decreased pain, enhanced mood, and a sense of well-being in the water.” Heated pools (86-88 degrees) can be especially beneficial because the warm water helps reduce pain by relaxing tight or spasming muscles and increasing blood flow.

Doing aqua aerobics or Zumba in the water may look easy, but according to Uranwala, people are often surprised at how tired they are after a few minutes of intervals and tend to slow down. “Remember the faster you go, the harder your muscles have to work to push and pull you through the resistance of the water,” she says. “Speed is the key, and it is up to you to dial the intensity up or down.”

© FatCamera | Getty Images
Try a water workout for refreshing summer fun.  If it’s outdoors, don’t forget the sunscreen, and wear a hat.

Water aerobics classes could be held in deep and/or shallow water. So, you may want to ask about the depth of the water you would be in during a class. Generally, you don’t need to know how to swim. Deep- water classes usually incorporate a floatation belt that fits snuggly around the waist to keep you upright while doing the exercises. Pool noodles can also be used under the arms. Other equipment, such as foam dumbbells, noodles and fins, may be used for resistance exercises. If you need assistance getting into the water, inquire about lift chairs or PVC wheelchairs.

Outdoor Bicycling and E-bikes

Bicycling outdoors is an excellent form of cardiovascular exercise, which can improve heart health, increase stamina, and help with weight management. The natural serenity from riding through parks or other nonmotor traffic areas can be an added mood booster. If it’s been a while since you’ve been on a bike, it’s best to ride on dedicated bike trails and areas where you can go at your own pace without the stress of traffic.

“Bike riding can be challenging for our balance and coordination,” says Angell. “Practice bike riding in well-lit areas and in a slow-paced environment to prevent injuries and maximize enjoyment. Riding midday on a beach cruiser near the beach is a much different experience than riding a bike at night in Hollywood with maximum congestion and anxiety.”

Of course, wearing a helmet is highly recommended. Consider adding rearview mirrors to improve safety. Have a water bottle holder on your bike. Make sure it’s easy to remove the water bottle from that holder and that the bottle itself is easy to drink from (some can be difficult to squeeze). Ensure your tires are properly inflated before you go, and have a plan in case you get a flat. If you want to ride at dusk or dawn, use reflectors, or better yet, flashing lights to make sure others can see you.

Electronic bikes (e-bikes) have become very popular. While they do enable people to ride farther and faster and help those who may lack strength, they can be hazardous. “E-bikes can be extremely dangerous if someone lacks enough trunk control, shoulder strength or neck motion to look behind them,” cautions Hamill. “There are some new e-bike tricycles that would be much safer due to having three wheels versus two.”

If you want to better prepare for a new sport, a physical therapist can assess your current fitness level and advise which exercises would benefit you and your sport most. Finally, whichever outdoor activity you choose, be sure to protect your skin from the sun, and wear sunglasses and/or a hat (see page 6 for more).

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Depression and Anxiety

Research shows that anywhere from 30 percent to 50 percent of people with chronic pain struggle with depression and anxiety. Other common emotional responses to pain include sadness, frustration, anger, or feeling misunderstood. There are numerous reasons for emotional responses to chronic pain, including that people who suffer from conditions associated with ongoing pain may isolate from others and, in many instances, may lack the mobility they once enjoyed.

What’s more, chronic pain-related stress and anxiety can actually make the pain worse. “In studies of patients with chronic pain, my colleagues and I consistently found that negative thoughts, such as self-blame and negative self-statements such as, “I am useless,” were associated with increased pain intensity, interference in everyday life, and distress,” says Susan Evans, PhD, Director of Education in Psychology, Weill Cornell Medicine, Department of Psychiatry.

Despite chronic pain’s association with sadness and negativity, Evans points out that pain and suffering are not necessarily synonymous. “For example, someone may report moderate pain intensity but experience relatively low levels of distress. This observation suggests that while we may not have control over the cause or the intensity of pain, we can employ helpful ways to cope with pain,” says Evans.

Coping Strategies

If you are dealing with the emotional side of chronic pain, Evans recommends seeking support from mental health professionals, such as psychologists or therapists, who specialize in chronic pain management. They can help you explore tools to manage your emotions, such as cognitive behavioral therapy (CBT), mindfulness meditation, and stress reduction.

CBT is a therapeutic approach that addresses the connection between thoughts, feelings, and behaviors. It can help individuals identify and change negative thought patterns contributing to anxiety and pain. “Cognitive skills for pain may include observing the relationship between one’s thoughts, emotions, and behaviors, and challenging and reappraising thoughts and beliefs,” says Evans. For example, she explains, someone may think, “This pain is the end of me,” but after further consideration, they may conclude, “I can still live a good life, despite the pain.”

Behavioral Strategies

Behavioral strategies that can help you deal with the emotional side of pain include progressive muscle relaxation, breathing techniques, and guided imagery.

Progressive muscle relaxation (PMR). This involves tensing and then relaxing different muscle groups. By doing so, a person can become more aware of muscle tension and learn to release it, promoting overall relaxation.

Deep breathing exercises. Controlled breathing can help reduce anxiety and promote relaxation. Techniques like “diaphragmatic breathing” involve deep and slow inhalation through the nose, holding your breath briefly, and then exhaling slowly through your mouth.

Guided imagery. Visualization or guided imagery involves creating calming mental images to counteract negative thoughts and emotions. This technique can help redirect focus away from pain and stress.

Mindfulness Meditation

Meditation practices, such as mindfulness-based stress reduction (MBSR), can be effective in managing anxiety associated with chronic pain. “A skill that is acquired in mindfulness is the ability to cultivate detached observation,” says Evans. This skill fosters “distancing” and “diffusion,” which are two techniques that can help with pain reduction.

Distancing: This involves mentally stepping back from your thoughts or emotions to create a sense of space between yourself and what you’re experiencing. When a challenging thought or emotion arises, instead of getting completely absorbed in it, you observe it from a more detached perspective. It’s like taking a step back to see the thought without becoming overwhelmed by it.

Diffusion: This involves loosening the grip of thoughts or emotions by changing how you relate to them. For instance, rather than taking thoughts and emotions too seriously or letting them control you, diffusion involves seeing them as passing events in the mind. You might imagine thoughts as clouds drifting by or use language that emphasizes their transient nature, such as: This, too, shall pass.

Effective Ways to Control Emotions

Acceptance of the pain can help in coping with the emotional burden. “Acceptance does not mean giving up. In the context of pain, acceptance means acknowledging the presence of pain and at the same time employing coping strategies that increase a sense of control and self-efficacy,” says Evans. Control is about feeling like you can have an impact on your circumstances, while self-efficacy means believing in your own ability to handle different aspects of life effectively. Both concepts are crucial for a positive mindset.

Chronic pain can lead to stress, anxiety, depression, and a wide range of emotional challenges, but chronic pain does not have to be synonymous with suffering. If negative emotions are consistently affecting your mood or ability to function, talk with your doctor. It may also be useful to seek help from a mental health professional.

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A: The word steroid can refer to different substances. Anabolic steroids are lab-made versions of testosterone that some people use illegally to increase their muscle mass and enhance athletic performance. The steroids prescribed for pain and inflammation are in a class called corticosteroids or glucocorticoids. These are powerful anti-inflammatory medications that include cortisone, hydrocortisone, prednisone, and prednisolone. They come in various forms, such as pills, creams, and injections, with the choice depending on the underlying cause of inflammation. Generally speaking, taking a low dose for a short period of time is best. For example, physicians may prescribe a seven-day course of prednisone for acute back pain injuries. Not everyone experiences side effects from short-term courses, but some people do. Minor side effects include nausea, difficulty sleeping, and restlessness. Tell your doctor if you experience serious side effects such as muscle pain or cramps, swelling of hands, feet, or ankles, and irregular heartbeat. The concerns about side effects are more likely to rise with more prolonged or high-dose usage for systemic diseases such as rheumatoid arthritis or other autoimmune or inflammatory conditions which may require frequent dosages or high-potency steroids. Serious side effects with higher-dose and/or longer-term steroid use include bone thinning, cataracts, high blood pressure, and type 2 diabetes. There’s little need to worry if you are treated occasionally with steroids for conditions like poison ivy, bronchitis, or occasional knee or back pain. However, it’s always wise to consult with your doctor or pharmacist if you experience any concerning side effects. When it comes to back pain, the most common cause is a muscle-related injury such as the one you described. Most back pain gradually improves within a few weeks with home care and perhaps some help from anti-inflammatory medications, as well as heat and ice treatments. Physical therapy can also be very helpful. Learning how to properly lift loads as well as strengthening core muscles may prevent future back injuries. However, if pain persists despite conservative management, contact your health-care provider to rule out other conditions or injury.

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Could It Be Serious?

Generally, pain or stiffness on one side of the neck is a sign of muscle soreness. “However, if you are experiencing pain that radiates from your neck to your shoulder and down your arm, contact your doctor immediately, as this type of pain can be a symptom of heart attack,” warns David Thomas, MD, PhD, professor of medicine and rehabilitation medicine at Mount Sinai.

Neck pain that extends down the arm may be due to a pinched nerve. This can occur if you have spinal arthritis because the condition often causes bony outgrowths called bone spurs to develop on the spinal vertebrae, narrowing the space through which spinal nerves pass.

Dr. Thomas adds that neck pain extending down the arm also may signal a herniated spinal disc. “The spinal discs are rubbery shock-absorbing pads that sit between the vertebrae,” he explains. “A herniated disc occurs when the exterior of a disc ruptures and the soft jelly-like inner core bulges out from between the vertebrae and compresses the spinal nerves.”

Relieving Pain and Stiffness

Once serious causes for neck pain and stiffness are ruled out, you can take steps to relieve it. “Apply a heating pad for 10 minutes or so in the morning and/or evening, and if possible, several times during the day,” advises Dr. Thomas. Disposable heating patches that work for four to six hours also are an option and are available over the counter from most pharmacies.

Exercise can be helpful for relieving and preventing neck pain. A review published in the October 2023 issue of the Journal of Orthopaedic & Sports Physical Therapy pointed to stretching as most effective, along with exercises that strengthened the muscles of the upper back, shoulders, and chest, which help you maintain an upright posture. A simple neck-muscle-strengthening exercise you can do while sitting down is to place the palm of one hand flat against your brow and push against it hard while simultaneously pushing your head back with your hand (see this and other exercises, below). Also ask your doctor to refer you to a physical therapist, who can show you other exercises tailored to your needs, particularly if your neck pain is related to whiplash or nerve impingement.

Massage therapy may bring relief, too. “A licensed massage therapist will know how far to work the affected muscles, and can grade the amount of pressure based on what you find tolerable,” Dr. Thomas says. See Resources for information on how to find a licensed massage therapist.

Preventive Steps

Maintaining good posture is the key to preventing neck pain. Stand tall, with your head centered over your spine—it can help to imagine a string pulling your head upward. If you still work and have an office-based job, try to avoid sitting for extended periods at a desk with your head thrust forward. Take frequent breaks, and do neck stretches a couple of times an hour.

To avoid waking up with a stiff neck, sleep on your side or back, not your stomach. “Sleeping on your stomach requires that you turn your head to the end range of its rotation, which can cause muscle strain,” notes Dr. Thomas. To help change your sleeping habits, consider using a body pillow, which may prevent you from turning onto your stomach during sleep.

Think about the pillow you rest your head on, too—if it isn’t supporting the natural curve of your spine and you’re forced to bend your head forward, back or to the side, this may exacerbate neck pain. “Sleeping with too many pillows can have the same result,” Dr. Thomas adds, “since it tends to force your chin down to your chest, causing too much flexion in the neck.”

You can purchase pillows that are designed to maintain the natural curve of the cervical spine at department stores. “The pillow should support the space between your shoulder and chin, allowing you to rest your head in place without bending forward or back,” Dr. Thomas says. A memory foam pillow offers better support than a down pillow, which initially may conform to the shape of your body, but flattens over time.

Resources

The American Massage Therapy Organization has an online tool to help you find a local licensed massage therapist (http://tiny.cc/FindMT).

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