Sex and Back Pain

gender-312411This post is gonna be a quickie (yes – the pun is totally intended).

A recent research paper (1) was published examining which sexual positions are best (in other words most pain free) for people suffering from back pain.

I can tell you that this topic is not one that many of my physical therapy patients bring up independently. In fact, in my over 17 years practicing as a Physical Therapist I can only recall a handful of times that it did.

But I’m sure it’s an issue that many of my patients would like answers to – even if they are uncomfortable mentioning it.

Years ago when I worked for a company in Alabama we were instructed to hand out a booklet on the topic when it was brought up by patients. You read that right… A booklet. Welcome to the 1950s.

But I digress… Back to the study and it’s findings…

The research basically suggests that if you have pain when you flex (or extend) your back that you should simply use your hips. And it give suggestions on positions that are best depending upon the type of spinal dysfunction you have.

Sounds simple (sort of)…

But I can tell you that for most people it’s not.

When you have back pain it’s challenging to isolate specific motions (i.e. differentiate between using your hips and performing spinal flexion).

This research sounds to me like a case of creating complexity out of something much more simple.

In other words – if it hurts (i.e. moving a certain way or trying a certain position) don’t do it.

In fact according to “Dr. Eeric Truumees, an orthopedic surgeon in Austin, Texas, who’s familiar with the study findings” “the Canadian study is based on an understanding of the mechanics of back pain that’s not universally accepted.”(2)

So what’s the solution??

Here are my suggestions:

1. If your back pain is affecting your ability to do “normal things” (i.e. having sex) then perhaps you should seek care from a qualified specialist. About half of the patients that come to my Arvada clinic suffer from back pain and we have had consistently excellent outcomes decreasing and often eliminating low back pain with several weeks of treatment.

2. Learn self-management techniques like proper use of moist heat (to relax muscles) and cold (to decrease pain), use over the counter pain and anti-inflammatory medicines.

3. Be open and creative with your partner. First let them know that you are suffering from back pain and that certain positions are a problem. Then get some pillows, share some ideas, and have some fun.


1. Stuart McGill, Ph.D., professor and director, Spine Biomechanics Laboratory, faculty of applied health sciences, University of Waterloo, Ontario, Canada; Eeric Truumees, M.D., orthopedic surgeon, Austin, Texas; Chris Maher, Ph.D., professor and director, musculoskeletal division, Sydney Medical School, University of Sydney, Australia; Sept. 11, 2014, Spine


More “Miracle Cures” For Back Pain and Migraines

Lumbar-painHere We Go Again… Every time a celebrity doctor mentions some “new” supplement or product that supposedly gets rid of back pain and headaches I get flooded with questions from my physical therapy patients about them.

Sometimes the recommendations are valid. Some of the products and supplements really can help with pain and other problems.

Sometimes they are… well let’s just say sometimes they aren’t such a good idea.

Apparently last week on the Dr. Oz Show he (and some guests) did just that.

For a summary of the show’s content you can CLICK THIS LINK

So in preparation for the questions I expect to get from my patients I did some research on the two supplements mentioned.

What Is Corydalis and What Does It Do?

The first one is Corydalis which is an herb used in Chinese medicine.

One study (see the references below) was done with mice and rats. Findings showed that, at least in the test subjects (remember – mice and rats) an extract of the herb did show anti-inflammatory effects. As in all animal studies this may or may not be true for humans.

Another study showed that the libanoridin coumarin isolated from corydalis “can be considered as a potential anti-inflammatory agent.” (2) I couldn’t find libanoridin for sale as a supplement online.

The next study I found was another one that used rats as the subjects. This study used protopine extracted from corydalis at a dose of 500-100 mg/kg and found results that were “suggestive that protopine acts as a potent inhibitor of thromboxane synthesis and PAF with anti-inflammatory properties.”(3) In other words – the results suggest that this extract may act as an anti-inflammatory. However consider that for a 150 lb (68 kg) this would require a dose of 3400 to 6400 mg (or 3.4 to 6.4 grams). And I was, incidentally, unable to find protopine for sale from any supplement company.

Finally – the last article I came across was a human trial. “Results from this study suggest that C. yanhusuo and A. dahuricae may have a potential clinical value for treating mild to moderate pain.”(4) This, in my opinion, must have been the article that was used by the producers to validate the segment on the show.

The test used in this last study is the cold pressor test. I did not have access to the full pdf version of the study (only the abstract) so I’m not sure how the test was done nor am I certain about what conclusions the authors came to regarding the use of those supplements / substances for other types of pain.

What Is Magnesium Citrate and What Does It Do?

migraine-headacheMagnesium is a naturally occurring mineral. Magnesium citrate is simply magnesium with citric acid (and apparently it has laxative effects).
Magnesium deficiency has been linked to the development (aka pathogenesis) of migraine headaches.
The first study was a human trial and looked at subjects with migraines without aura. According to the authors the “results have made us think that magnesium is a beneficial agent in prophylaxis of migraine without aura and might work with both vascular and neurogenic mechanisms.” (5)
The next study is one you may want to look at if you are suffering from migraines. You can find a full pdf copy of it HERE.
From the abstract: “Studies have shown that preventive treatment with oral magnesium and acute headache treatment with intravenous magnesium may be effective, particularly in certain subsets of patients.” (6)


Before I give my opinions here’s my disclaimer…
ALWAYS check with your doctor before trying any new supplements to make sure they are okay to try (and that they don’t interfere with any other medications you may be taking).
That said…
It seems, at least from my quick research into these supplements, like magnesium may show some promise for migraine headache sufferers. Magnesium citrate is a relatively inexpensive supplement and seems to be well researched for this application.
I’m less confident about the corydalis. It may have at least some anti-inflammatory properties but I wonder about it’s potency and cost efficiency compared to the large variety of other available anti-inflammatory supplements and medicines. 
Of course it’s up to you to decide how to proceed. At least now you know what the research says!


1. Kubo, M., et al. “Anti-inflammatory activities of methanolic extract and alkaloidal components from Corydalis tuber.” Biological & pharmaceutical bulletin 17.2 (1994): 262-265.
2. Kang, Kyong-Hwa, et al. “Anti-inflammatory effect of coumarins isolated from< i> Corydalis heterocarpa</i> in HT-29 human colon carcinoma cells.” Food and chemical toxicology 47.8 (2009): 2129-2134.
3.Saeed, S. A., et al. “Anti-thrombotic and anti-inflammatory activities of protopine.” Pharmacological research 36.1 (1997): 1-7.
4. Yuan, Chun‐Su, et al. “Effects of Corydalis yanhusuo and Angelicae dahuricae on Cold Pressor‐Induced Pain in Humans: A Controlled Trial.” The Journal of Clinical Pharmacology 44.11 (2004): 1323-1327.
5. Köseoglu, Emel, et al. “The effects of magnesium prophylaxis in migraine without aura.” Magnesium Research 21.2 (2008): 101-108.
6. Mauskop, Alexander, and Burton M. Altura. “Role of magnesium in the pathogenesis and treatment of migraines.” Clinical Neuroscience 5.1 (1998): 24-27.

What To Do If You Are In A Car Accident In Arvada


By W. Robert Howell from Charlotte, NC, United States (still here.) [CC-BY-SA-2.0 (], via Wikimedia Commons

The City and Community of Arvada website has a great resource for Arvada residents that have been in a car accident. And with the weather already starting to change – including heavy rain and hail – and what looks to be a possibly heavy snow season this may be something you should bookmark… Just in case.

I’ve been treating Arvada residents that have been injured in auto accidents for over 14 years. Most are overwhelmed by not only their injuries but by how much they have to deal with after the accident.

So I’m going to provide some tips about the tips – to give you a better understanding of WHY the tips are valuable and important.

First open the page Ask Arvada – Accident – What To Do

Check out each tip one by one and refer to this blog post for explanations.

Tip #1: Just knowing what to do (i.e. having read the tips) will go a long way towards helping you keep calm. So by reading this list you’ve already taken a crucial step (good job!).

Tip #2: Assess the situation for you and everyone else in the car. If you or anyone appears to be injured enough that moving them is either not possible or you deem to be a bad idea (i.e. they are not conscious, they are in severe pain, they are disoriented) – stay in the car. If staying in the car poses a risk then make the best decision you can given the facts of the situation.

Tips #3 and 4: If you are able to – call the police (or dial 911) and wait for them to arrive. This will allow them and any medical personnel to assist those in need as well as to properly document the accident.

Tip #5: If there are any witnesses – collect their names and phone numbers. If you have a cell phone or device that can take pictures then take pictures of both vehicles (from many angles as indicated by the damage) and of the location (i.e. street signs and traffic lights or stop signs).

Tip #6: This one is self-explanatory

Tips #7 and 8: These tips are very important… Many people say “I’m fine” and refuse an ambulance. Many of my patients tell me that they just wanted to go home. They say that the adrenaline from the accident masked how they really felt but once the adrenaline wore off they found out how injured they really were. And they tell me that they wish they had gone to get checked out. My advice is that if you are injured – go get checked out right away. Next follow up with your doctor and seek the appropriate care.

If you find yourself in need of physical therapy then give my office a call. I can also help you decide whether or not you might be best served by seeking to retain an attorney. I’ve worked with over 100 attorneys in the metro-Denver area and can help you choose the best one for you (and one that’s close to or in Arvada if that’s your preference).

New Medical Facility To Be Built In Arvada

Did You Know…

arvada-sports-medicine-clinic-proposedThe Arvada City Council approved the preliminary plan for a new primary care facility in Arvada.

The proposed site is on 64th Avenue and Quaker. The emphasis will be on sports medicine – a natural partner with physical therapy.

In my opinion this will be a great addition to the list of excellent healthcare providers in Arvada. More options for care are always a good thing!


Are You Ready For Fall In Arvada?

arvada-fall-coloradoThe Fall season here in Colorado is only weeks away. And if you live in Arvada then you know that there are tons of outdoor activities to enjoy! But nagging old injuries and recent onset aches and pains can stop you from doing the things you love. If outdoor activities are calling you but pain is holding you back… What better time than right now to get rid of your muscle and joint pain?


Outdoor Activities Near Arvada

Here’s a list of three popular outdoor activities that are great nearly all year round – but are particularly awesome to do in the fall. And if you live in Arvada they are all super close!

Fly Fishing

fly-fishing-near-ArvadaThis is by far one of my personal favorites! I love to fly fish in the fall. And it takes me only 15 minutes to get from my office in Arvada to Clear Creek in Golden.

There are several physical problems that can put a damper on fly fishing. The most common are shoulder, elbow and wrist injuries. Also prevalent are back and knee problems (particularly if you are wading).

For details on specific types of problems that are common for fly fishermen (and women) check out these articles:

Overuse Injuries in Fly Fishing

Prevalence of Orthopaedic Maladies in People Who Flyfish: An Internet-Based Survey

I found this great post on “Escaping The Crowds in The Fall” that you should definitely check out. It has some great tips on both where to go and which flies to be sure to have in your fly box.


This activity requires the least preparation and has the most minimal gear requirements. In fact you can just get in your car and drive from your home in Arvada, get on I-70 and within an hour or two you’ll be able to enjoy some of the most breathtaking views of the year.

Even though you don’t technically require any gear – I strongly suggest you get a great pair of socks and some good hiking shoes. The socks are in my opinion more critical than the shoes. I’m a huge fan of Merino Wool socks. I have several pairs that I wear only for hiking and for fly fishing.

Obvious and common problems that can limit hiking are knee and ankle pain from arthritis and, of course, low back pain.

To enjoy the fall colors at their most splendid check out this article called My Favorite Colorado Fall Hikes.

The listings include details about how to get there, if the trails are dog friendly, trail distances and even bathroom information!


fall-biking-near-arvadaThe third way you can enjoy Fall in Arvada is to get out on your bike. Biking is a great activity but one that is plagued with several common injuries. This thorough article on Bicycling and Pain should prove useful in helping you identify what’s holding you back.

For ideas on where to go check out this list of 5 Fall Bike Rides

Be sure to bring a tire repair kit along with water and snacks!

 Getting Physically Ready for These Fall Activities

1. Get A Physical Exam

Now is the time to get in for a physical with your family doctor. Be sure to mention any physical pain or problems you’ve had that may limit or get flared up with activity. If you live in Arvada – there are several excellent MDs right in your neighborhood. If you have a specific physical issue such as a chronic shoulder problem or arthritis in your knees ask your doctor is physical therapy is an option.

2. See A Specialist About Your Problem(s)

As a Physical Therapist – I specialize in treating muscle and joint pains. And I can tell you from experience that many problems can be significantly improved (to the point where there are little to no physical limitations) relatively quickly. But the longer you wait to deal with the problem the worse it tends to get. And then it gets harder to “fix”.

I have many patients that come in on an “as needed” basis. Many simply need a home exercise program. Some come in for a few “tune ups” before (or after) they take part in weekend activities.

If you live in Arvada – come on in for a visit. My clinic is on 58th Avenue (aka Ralston Road) about half way between Kipling Avenue and Wadworth Boulevard.

My 2 Secret Kinesiotape Tips To Decrease Knee Pain

Kinesiotape has been around for more than 25 years.

I’ve been a licenced and practicing physical therapist for over 17 years…
And up until 6 years ago I had never even heard of it!

I was speaking at a national conference in Dallas.

Before my session started I was walking in the hall outside of the conference room.

There were several vendors set up in booths and I was passing the time looking around.

I saw one of my buddies talking to a vendor at a booth with a big sign that said “Rock Tape” – so I walked over and said hi. My friend introduced me to a guy named Greg.

It turns out that Greg was the founder of Rock Tape. It also turns out that Greg is a really smart guy. He is an MIT grad and former VP of several very successful companies. And here he was at a booth at a health related conference selling tape.

I figured there must be something to this stuff… So I decided to learn more about it. And once I started using it – I loved it. But more importantly my PATIENTS loved it and the (almost) instant feeling of relief they got when I put it on them.

6 years later I use Rock Tape daily in my physical therapy practice. And I’ve developed 2 novel taping techniques for knee pain that have been amazing (according to my patients).  I’ve never written about those applications… Until now.

I decided to share them because I haven’t seen them anywhere else. And they are super easy to do. And they work. Fast.

So if you are ready to give them a try – go grab your Rock Tape (or whichever brand of kinesiotape you like) and a scissor.

Oh yeah – you should also put on a pair of shorts or some pants that are loose enough to roll up above your knees.

Secret Taping Technique #1

This first application is my go to technique for all kinds of knee pain.

The only contra-indication (i.e. reasons you should NOT use this technique) is if you have any open wounds / cuts / abrasions or scabs on your knee. But that’s true for all taping – I just thought I should remind you.

In order to use this technique you need to know two anatomical landmarks:
1. Patella
2. Tibial tuberosity

Once you check those out you are ready to go.

The Patella Tendon Technique

1. Cut a 4″ piece of tape and round the edges.
2. Put the foot of your affected leg (the one you have pain in) on a chair.
3. Remove the top portion of backing and firmly apply the top tag end of the tape right above your patella (aka knee cap). Really make sure the top 1/2 to 1″ of tape is securely taped to your skin.
4. Bend your knee as much as you can by slowly squatting forward.
5. Remove the backing and stretch the tape to 50%. An easy tip for this is to stretch the tape to 100% and back off by half.
6. Secure the stretched tape over your knee cap towards your tibial tuberosity. Tape slightly over (on top of) the tibial tuberosity.
NOTE: Leave about 1/2 to 1″ of un-stretched tape for the loose tag end.
7. Flatten down and secure the tag end of the tape.

That’s it! Now that you have that one done let’s get to the next technique…

Secret Taping Technique #2

To do the next technique you need to know one anatomical structure (a muscle) and it’s origin (where it starts from) and insertion (where it ends):

Gastrocnemius muscle

Look at the image and locate the Inner Head – that’s the one we are interested in.

The Inner Head (Medial) Gastroc Taping Technique

This kinesiotape application is a bit tricky to do by yourself. I’d highly recommend that, for best results, you find someone to help you (an assistant). Have them read through this description with you.

1. Cut a 7″ piece of tape and round the edges.
2. Lay on your stomach with your affected leg straight. Dorsiflex (pull your foot up so you get a stretch in your calf) your foot and straighten your knee.
3. Have your assistant remove the top portion of backing and firmly apply the top tag end of the tape right below the inner gastrocnemius (where the muscle belly meets the Achilles tendon).
4. Remove the backing and stretch the tape to 50%. An easy tip for this is to stretch the tape to 100% and back off by half
5. Secure the stretched tape over your inner gastrocnemius towards the bend in the back of your knee.
NOTE: Leave about 1/2 to 1″ of un-stretched tape for the loose tag end.
6. Flatten down and secure the tag end of the tape.

Great job…You are done!

What’s Next?

If the application was done correctly AND your knee problem is related to muscle and/or joint pain then you should notice a reduction in tightness and discomfort of your knee.

Many of my physical therapy patients tell me that they feel a difference (i.e. decreased intensity of pain, decreased tightness) within minutes of applying the kinesiotape.

You can leave the tape on for several days (refer to the manufacturer recommendation for this). It will stay on during bathing (bath or shower) and exercise.

If you feel any discomfort or itchiness that’s too much to bear or if you simply want to be done with it – take the tape off.

I recommend that you remove the tape while it is dry versus after bathing. The water and heat seem to activate the tape and make it harder to remove.

If you decide to give this a try – I hope you find it to be as beneficial as my patients do. Please feel free to post your comments. Good Luck!