The 21st century upright woman

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The human spine is like a strand of pearls linked together by ligaments, muscles and connective tissues

by Ahimsa Porter Sumchai, M.D.

From the Afar region of Ethiopia emerged the two oldest fossil remains of early humans. Both female. They walked upright millions of years ago. Lucy was discovered in 1974. She was short and had a small brain but gathered nuts, berries, insects and eggs from unguarded nests about 3 million years ago in the woodlands of East Africa.

The latest “evolutionary debutante” was revealed on Oct. 2, 2009, when 11 research articles were published in the prestigious journal Science detailing 15 years of research culminating in the “reveal” of Ardi – Ardipithecus Ramidus – whose complete skull and pelvis crowns her as the greatest grandmother of modern day humans. She reigned over 4.4 million years ago and offers the strongest and most irrefutable evidence of human evolution ever discovered. About 2 million years ago these women evolved into the species Homo erectus. They walked upright out of Africa to populate the world.

What do we know about these primordial women? Their eternal strength and endurance speaks to us through the mirrors of time. We know they bore children and carried them on their backs. They bent and lifted and climbed to survive. They carried food, animals and tools on their backs. And like 85 percent of modern day women, they suffered from back pain.

Back pain is the single most common complaint seen in any primary care setting. It comes with the territory. The human spine is like a strand of pearls linked together by ligaments, muscles and connective tissues. There are seven cervical discs, 12 thoracic and five lumbar, in the normal spine. On assuming the upright posture, the center of gravity and all the forces the upper body is subjected to in work and play pass through the cervical and lumbar spine and are equally distributed through the hips, knees and ankles.

Exercise that strengthens the abdomen and core muscles of the trunk and pelvis prevents and treats back pain. Yoga and pilates have been found to be superior forms of exercise for strengthening the abdomen, back and pelvis. Ballet dancers and Olympic rowers include pilates in their exercise programs.

Back pain is growing in incidence as a direct result of the obesity epidemic. Abdominal fat is called truncal adiposity. It throws the alignment of the lower lumbar spine forward subjecting greater stress on the trunk and pelvis. Sitting at a computer station or at a secretarial desk for six to eight hours a day compresses the lower spine and pelvis. Smoking cigarettes decreases the blood flow to the spine. Processed foods that contribute to constipation increase strain on the abdomen and pelvic floor muscles. If you are not having a bowel movement every day, you can be carrying up to 10 pounds of fecal material stored in your colon that is an added load to your low back and abdomen.

The human spine can contain extra curves that are called scoliosis or kyphosis. When an extra curve appears in the area of the spine at the level of the shoulders – called the thoracic or dorsal spine – it produces a hunchback or kyphosis. Older women with thinning of the bones, called osteoporosis, will lose height as a result of the collapse of the spine in the thoracic region and the development of a hunchback. Some of you have seen women who can be flexed forward as much as 90 degrees because of this abnormal bend in the back.

Most women over the age of 50 have some degenerative arthritis of the spine called spondylosis. Additionally, women who have worked in occupations in which they have been subjected to repeated or cumulative loads to their spine may present with degenerative disc disease. In this condition, the “shock absorber” between the spinal elements called discs become flattened and extrude a jelly-like material into the holes where the nerve roots come out that are going to the shoulders, arms, hands and legs.

Like a telephone cable, the nerve roots always go to the same area. If you have low back pain with numbness, burning, tingling or loss of sensation in your foot, this means the S1 or first sacral nerve root is being compressed. This is called sciatica. If you have neck pain and restricted movement of your neck or hear popping sounds when you turn or flex your neck and also have burning, numbness or weakness in your thumb and index finger, this is a clear sign of degeneration around the disc and sixth cervical nerve root.

Many years ago, when I became the first African American woman to train in neurological surgery in the UC system, it was common to take people to surgery urgently if they developed sciatica as a result of nerve root compression in the lumbar spine. Now we know that most of these surgeries fail and that the failed back surgery syndrome has become a leading cause of back pain! When you compare people who undergo surgery with those treated conservatively with exercise, physical therapy, medications and therapeutic injections of steroids into the injured nerve root, in five years the outcome is the same.

In the 1980s when I was in surgical training, the American Medical Association, the leading organization of doctors, was fighting to keep chiropractors from practicing their profession. According to a recent study published in Consumer Reports in 2008, most people in our country trust chiropractors more than medical doctors to care for their back and neck pain complaints.

Most patients complain that medical doctors just prescribe addicting narcotics like Vicodin, Tylenol with codeine and Norcos with muscle relaxants that intefere with their ability to drive, care for babies and work. These medications include the addicting sedative Valium and Flexeril and Soma, which produce very unpleasant mental effects.

A new medication called Neurontin or Gabapentin is being prescribed to treat the symptoms of nerve root compression, which can be debilitating and difficult to control. Medications in the NSAID class including aspirin, Motrin or ibuprofen and Naprosyn can be effective but cause stomach upset and ulceration. The over-the-counter preparations you buy at the corner drug store or supermarket in the liquid gel form can reduce stomach upset, especially when taken with foods.

Medical cannabis has also emerged with growing scientific evidence to have a positive effect on musculoskeletal and nerve pain from spinal injury and degeneration. Studies performed at the San Francisco General Hospital, UCSF and UC San Diego support the role of medical cannabis in treating symptoms of back pain safely in people who do not have to drive, operate heavy machinery or work in public safety positions, where the cognitive impairment seen with chronic cannabis use can impair short term memory, psychomotor function and motivation.

The best thing you can do to treat and prevent back and spine pain is to lose weight and come as close to a normal BMI or body composition as possible. A BMI under 25 and a body composition less than 34 percent for the modern 21st century upright woman ensures a long life and eternal endurance and a place in history like our African greatest grandmothers.

Eat like Ardi and Lucy ate. Fresh food high in fiber, protein and healthy fatty acids, fish, mushrooms, lean non-processed meats, yogurt, low fat milk, cottage cheese and healthy dairy products. Fresh or frozen vegetables and plenty of dark fruit high in antioxidants.

Bay View Health and Environmental Science Editor Dr. Ahimsa Porter Sumchai can be reached at (415) 835-4763 or asumchai@sfbayview.com.

7 COMMENTS

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  2. I have been invited by allied health education to develope courses for fitness professionals on the exercise approach to treatment of low back pain. I will be including this article in the bibliography.

  3. This is a very informative article! Thank you for sharing it with us! I am trained in Pilates and nutrition, so I have first hand experience of the benefits of incorporating both aspects into daily life. I had terrible lower back pain after having my daughter 4 years ago and so sought help from osteopaths. This only gave me temporary relief and in actually fact, in my opinion, has added to the degeneration I already had in my cervical vertebrae. I finally discovered Pilates and Yoga and have been hooked ever since! I very rarely experience back pain now, unless I have been sitting or standing for too long, in which case I know that 10 minutes of exercises will relieve it. I am very interested in hearing more about treating lower back pain through exercise and the effectiveness of taking glucosamine and chondroitin to support the spine and joints. I find it very effective, however others still argue it is merely a placebo effect.

  4. Thanks Katharine. I have been working miracles with the Pilates reformer since 2005. I have clients with neuromuscular disabilities who have improved far beyond expectation and a triathlete with an acromioclavicular seperation of the shoulder who is demonstrating optimum range of motion. A Sports medicine/orthopedist did not want to operate on him.!

  5. You Dr. Sumchai, and professionals such as you, are needed to direct and focus our aging population to loose weight, exercise and eat right. Throughout the world age is associated with wisdom and experience. Now in the US, aging is associated with Alzheimer’s, other forms of dementia, illness and suffering.

    Many of our elders are too stiff and weak with no balance. Walking everyday 15 min or more is the best way to start limbering up and to build energy. To help with the back pain you refer to as well help with their body equilibrium they must also develop—strengthen—build the muscles in their core, the area between the shoulder blades and the upper hips or lower pelvic area-where the back is!!! When we develop our core in combination with aerobic exercise (walking), mental brain exercise as well as eating healthy, we ensure successful aging with the mental capacity of passing along our wisdom.

    For more information on core development: http://www.thebrainnerd.com/#!What-About-Your-Par

    For more information on good brain health: http://www.thebrainnerd.com/#!on-the-brain-blog/c

  6. Somatic exercise, or, as I have called it, 'Somatic Stretch' exercise, when used consistently and with the intention of connecting the mind to particular muscles for controlled bodywork, significantly reduces and even eliminates back pain by first, releasing deep-seated tension through long, slow, relaxed stretching so that body parts can move independently; second, by consciously realigning body parts into balanced posture; and third, by strengthening the support muscles that control each part so weight is "carried" and does not bear down on muscles, joints, nerve fibres and blood vessels.
    This method is different from yoga and Pilates by virtue of its quieting the stretch reflex. In this way it releases tension patterns from deeper levels of the body in a safe way and teaches people engaged in the method to self-correct their symptoms by paying attention to their body's "feedback" when working with the exercises.
    In addition, people are taught to work into tight areas of their body with balls of varying hardness and size as a method of self-massage. This "hurts-but-it-feels-so-good-when-you-stop self-treatment greatly helps the release of tension and works wonders for sensitive pain, such as sciatic pain, when used on the buttocks.
    I am currently in the process of writing a book to describe Somatic Stretch, the Jarvis Technique, which I began teaching in the late 70s.

  7. 'Somatic Stretch' exercise, when used consistently and with the intention of connecting the mind to particular muscles for controlled bodywork, significantly reduces and even eliminates back pain by first, releasing deep-seated tension through long, slow, relaxed stretching so that body parts can move independently; second, by consciously realigning body parts into balanced posture; and third, by strengthening the support muscles that control each part so weight is "carried" and does not bear down on muscles, joints, nerve fibres and blood vessels.
    This method is different from yoga and Pilates by virtue of its quieting the stretch reflex. In this way, it releases tension patterns from deeper levels of the body in a safe way and teaches people to self-correct their symptoms by paying attention to their body's "feedback" when working with the exercises.
    In addition, people are taught to work into tight areas of their body with balls of varying hardness and size as a method of self-massage. This "hurts-but-it-feels-so-good-when-you-stop" self-treatment greatly helps the release of tension and works wonders for sensitive pain, such as sciatic pain, when used on the buttocks. Working through the length of the spine and into the back of the waist helps maintain flexibility of the whole back area, which is essential for eliminating pain in both the lower and upper back.
    I am currently in the process of writing a book to describe Somatic Stretch, the Jarvis Technique, which I began teaching in the late '70s.

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