2 FEB 2016 · My name is Joe Risser. I'm a physician working for people with severe, chronic back pain. I started Backtivity to learn more about people who have beat back pain through exercise, share their stories with the world, and create more like them. It is my great pleasure to introduce 3 very ordinary people who have done exceptional things to beat pain. If you have an inspiring story you'd like to share, please email me backtivity@gmail.com or call 855-922-2584. Our first extraordinary ordinary person is Betty Lou Sweeney, a 70-something arthritic great grandmother who was near death, on 26 different medications, and with such severe knee and back pain she was unable to get out of a chair. But she made a decision to do something about it and went to a gym. She found a trainer to motivate her and discovered that she could do one exercise that even the strongest, fittest athletes find too difficult, the plank. At first she was able to hold it for a few seconds. But she continued to add seconds each day until she had held it longer than anyone previously was able to...37 minutes. Doing a plank for one minute is very good. I've known few regular gym goers of any age or level of fitness than can hold it more than 5. She also lost 115 lbs (52 kilos) in the process and cured her back. She's now, herself, a personal trainer in Wisconsin. My favorite quote, "This (life of illness, pain, and deterioration) is ridiculous. I firmly believe exercise is medicine. Maybe you haven't achieved something so far but never underestimate yourself because every one of us can have a success." Arthur's Transformation is another inspiring story of recovery from a life filled with pain and disability.  Arthur was injured while serving in the military as a paratrooper. Repeat jumps and injuries resulted in chronic, debilitating knee and back pain. He became inspired by watching videos of a former wrestler turned yoga coach, of all things. If you watch Arthur's youtube video, you'll see that he's not the typical yoga practitioner. He was very overweight, with crutches strapped to his forearms, having great difficulty bending his knees. At first, Arthur can be seen attempting to do a yoga pose. He's not able to kneel on the ground without grabbing onto a nearby chair for dear life. My favorite quote from Arthur: "Everyone told me that I would never walk on my own again. I believed it too. I had given up hope because others told me to. I took a risk and started this workout. But hopefully my story might inspire you to believe anything is possible." This is so interesting. First, that the so-called experts, the doctors, told Arthur give up, don't do too much. Lie down and give up. In line with that, he saw starting a workout as a risk. Think about that. If he did absolutely nothing, he would continue to deteriorate, eventually be bedridden, live a miserable existence, and die an early death. Yet, he considered exercise the risk. I saved the best for last. Tony the Fridge. Tony is just a regular guy or, as he put it, "I'm as ordinary as grass." He ran the length of Great Britain with a fridge, as in refrigerator, strapped to his back. And, in case your wondering what all that running and fridge-carrying has done to his back, Tony was kind enough to email me back to tell me that he had an MRI of his back and it's in perfect condition; "like a 16 year old's" according to his doctors. Those in the US will be hearing a lot more about Tony as he runs across the country with a fridge on his back to raise money and awareness to cure cancer, starting in June 2016. My favorite quote? There are too many to list them all.

20 JAN 2016 · Sometimes, we can learn a lot about one condition by comparing it to others. Back pain is often thought of as a chronic, recurring condition. By that I mean that it's rare that people have one episode of back pain in their life and never again. More often, they have one attack followed by others. Few people have subsequent attacks as often as every month; on the other end of the spectrum, few can go for 5 or more years between attacks. Like low back pain, diabetes is a chronic condition with fluctuating periods of control and can be influenced by lifestyle and activity. I often hear physicians say something along the lines of, "80% of people with (Type 2) diabetes could reverse it with lifestyle changes but less than 5% actually do." A study published in Diabetes Care in 2014 addresses the question, "Can diabetes be cured without surgery?" They followed 120,000 adults with type 2 diabetes. Over 7 years, only 1.47 percent of the entire group had a partial remission, 0.14 percent had a complete remission, and 0.007 percent had a prolonged remission. That's only 70 in a million. Oooookkkayyy... well at least it's not ONE in a million. Nearly as bad, the most likely to "cure" their diabetes were the least diabetic. People who were older than 65 years of age, were African American, had been diagnosed for less than 2 years, had an A1C of less than 5.7 percent at the start of the study period, or were taking no diabetes medicines at the start of the study period were more likely to have a remission. Keep in mind that one of the definitions of diabetes is an A1c of 6.5 or greater. So at 5.7, they were not technically diabetic at the time the study began. The question that comes to mind is, "How in the heck do doctors come up with a cure rate that's 1,000% more optimistic than it really is?" The answer is that this estimate, like a lot of estimates doctors give, are unfortunately based on nothing. Many things physicians and other healthcare providers tell their patients are based on an estimation of their own experience with no hard data to back it up. I train new physicians and I encourage them to find evidence contrary to something they hear me or any other physician say. And you'd be surprised how often someone has actually done a study confirming or disproving some trivial point but how often we get it wrong. The slightly good news here is that these were not 120,000 people who were in a program or even had a desire to cure their diabetes. All we can say about them is that they continued to be followed by this healthcare group for 7 years. Now imagine that someone in the group completely turned their life around. They were very unhappy with the diabetes diagnosis so became very active, ate better, did all those healthy natural things and after some time were no longer diabetic. So they stopped the medications and no longer needed to see a doctor. Well, there were probably a few such individuals this study missed but not many. So what does this mean for back pain sufferers? It may mean that it's actually a lot harder to completely resolve or cure back pain than we've been lead to believe. But the impact this news hopefully has on you is that, whatever you are doing to get your back better, you may need to do more. More may be in terms of more often like how often you stretch, or longer like when holding a plank, or more intense like when using weighted exercise. This also may help us talk about cure. In studying people with diabetes, they found that 200 TIMES more people had partial remission compared to complete remission. Maybe we should talk more about decreasing than eliminating back pain. I think everyone who has eliminated back pain can still cause it if they do enough of the wrong things. Most of all, I want you to hear that you don't have to live with it as it is. You don't have to accept that it's never going to get better.

14 JAN 2016 · ----------------------------------- What constitutes a back pain CURE? Studies pretty consistently show that about 10% (1 in 10) people who have suffered with chronic low back pain (defined as “pain between the lower ribs and gluteal folds, with minimal radiation to the thigh and never below the knee”, lasting at least 12 weeks, with daily or nearly daily pain, that is severe enough to interfere with daily activities -- sometimes loosely measured as a minimum pain level of 3 on a scale of 0 - 10 -- will discover a "cure." Cure is a big word In the context of low back pain, "cure" means different things to different people. Surprisingly, there are multiple definitions of cure even in the medical literature. This seems preposterous since everyone knows what cure means when talking about infections or cancer. But low back pain is a chronic condition in which the norm is recurrence. There have been attempts of defining a cure in the medical literature. There's even a review of 82 of those studies. Here are some of their findings: * 66 different measures of recovery were used among the 82 studies * 17 used pain as a proxy for recovery * 7 used disability or function * 17 were based on some combination of pain and disability * 9 used single-item recovery rating scales (e.g., Yes to, "My back pain has resolved.") * 11 used an anchor of "completely recovered" * 3 used return to work as recovery criterion * 6 used physical performance as recovery criterion When the same 0 to 10 pain scale was used, one study set the bar for 0, another at 1, another at 1.5 (Really???), and yet another at 2. I want to take a second to editorialize about the scientific strength of studies in medicine, in general. I have come to the conclusion that after hundreds of years and thousands of studies that mankind has dedicated to understanding pain, we have a very long way to go. At the end of the article reviewing these studies, the authors write, It is perhaps not surprising that wide variability exists in the measurement of recovery in low back pain. Indeed, this situation is not uncommon in health-care research. Lack of standardized definitions for key terms and outcomes is noted in studies of whiplash-associated disorders, drowning, falls, spasticity, peptic ulcers and schizophrenia. I suspect that anyone hearing this will say, "What do you mean, you don't know what drowning (or an ulcer, or back pain cure) is?" Medical science can learn a lot from other disciplines that some of you might not associate with "hard science." Economics comes to mind. One shining example is the work of husband and wife Princeton economists Angus Deaton and Anne Case (herself a chronic back pain sufferer) who discovered alcohol, drug abuse, and suicide among those with chronic pain is largely responsible for a recent increase death rate among middle aged Americans. How we Define Cure Combining clinical research with what we have learned from self-made experts, we have chosen the following criteria to define a cure: 1. Once had back pain lasting at least 12 weeks 2. Had back pain on at least half the days in any 6 month period 3. Nonspecific low back pain (pain located between the twelfth rib and the inferior gluteal fold for which no specific source of pain could be identified) 4. No longer taking pain medication regularly 5. Pain intensity had been a 4 or greater on a scale of 0 – 10 6. Pain intensity has been a 3 or less on a scale of 0 – 10...

8 JAN 2016 · Most back injuries occur after a simple little bend or twist that the injured person had done thousands of times before without consequences. But some strong, active, young people injure their backs while lifting heavy weights. On one end of the strength spectrum are very strong individuals who lift a lot of weight. Most do not experience persistent back pain. In one study, only 23% of elite male weightlifters REPORTED low back pain over a 6 year period. I emphasize reported since it very well could be that some suffer in silence to prevent being cut from a team or competition. In this week's podcast, I speak with a former military service member who injured his back while weightlifting. Specifically, he was doing squats but it's interesting to note that he was not lifting at his maximal capacity. As he says, "We were goofing off at the time." He adds that, although he was well conditioned by the military, little attention was paid to core strength and flexibility. It's also interesting to note that many injured weightlifters return to full function. Our interviewee did not..."It derailed me from weightlifting."

29 DEC 2015 · People suffering with back pain often hear that, to relieve pain and get your back better, you first must have a positive mental attitude. "You have to imagine it to achieve it," the popular mantra goes. But, whether in the gym or the clinic, we have seen evidence that thinking happy thoughts not only doesn't improve one's condition, it can worsen the likelihood one will take the necessary steps to get better. The alternative mantra becomes, "If I imagine it, I don't have to actually do it." Among people with back pain, the positive thinking approach is often, "I just refuse to live in pain any longer." What too rarely follows is, "...so I'm going to do _____." From a science and medicine aspect, proving whether a good attitude helps (or precedes getting better) is especially tricky. We want hard data or at least something measurable to detect whether Group A (positive thinkers) get better faster than Group B (neutral or negative thinkers). We also want to know what came first: thinking positive or getting better. We're far from having a specific test like measuring brain chemicals but there are some pretty reliable measures of positivity. One researcher in particular, Dr Gabriele Oettingen, has authored more than 100 articles and book chapters and has synthesized the essence of these findings. In her book, Rethinking Positive Thinking: Inside the New Science of Motivation, she wrote, Approached by someone who wants to achieve a specific dream, many of us offer simple advice: think positive! Don’t dwell on the obstacles, since that will only bring you down; be optimistic, focus on what you want to achieve; imagine a happy future in which you’re active and engaged; visualize how much snazzier you’ll look when you’ve lost that twenty pounds, how much happier you’ll feel when you’ve snagged that promotion, how much more attractive your partner will find you when you’ve quit drinking, how much more successful you’ll be when you’ve started that new business. Channel positive energy and before you know it, all your wishes and goals will come true. Yet dreamers are not often doers. My research has confirmed that merely dreaming about the future makes people less likely to realize their dreams and wishes (as does dwelling on the obstacles in their path). There are multiple reasons why dreaming detached from an awareness of reality doesn’t cut it. The pleasurable act of dreaming seems to let us fulfill our wishes in our minds, sapping our energy to perform the hard work of meeting the challenges in real life. Those are pretty harsh words to those who strongly believe positive thinking is required to achieve positive results. But those harsh words are based on good, solid evidence. I think it's pretty cool that people make it their life-long ambition to study and conduct high quality research on this topic. As someone who treats chronic back pain, I often hear sufferers bring up positive thinking in describing family and loved ones' reaction to their pain. Those close to someone suffering want to offer encouragement while understandably often wanting the focus on pain to just go away. Pain takes a toll on everyone close to the sufferer. So they'll say something encouraging like, "If you think positive, the pain will go away." If not positive thinking, what are the alternatives? Should people suffering with back pain adopt a doom and gloom harsh realistic attitude of, "I'll never get better?" Definitely not. I think we can learn from the self-cured former sufferers. Among them, I most often hear an attitude of, "I have to work hard at getting better and I could be doing more." Yes, of course that sentiment includes first having the thought, "I can work hard" but it's uniquely different than,

17 DEC 2015 · I spend about half my time doing clinical research and half treating "real patients." They are certainly different conditions. In a nutshell, real patients are scheduled for appointments and those visits are getting shorter and shorter. Much more time is required for these patients if we are doing our jobs right by updating our findings on physical exam, asking about side effects of medication, quality of life, function, sleep...the list is long. On top of that, because fewer physicians treat chronic pain, those who do are getting backlogged, often taking months to get an appointment. Patients in clinical trials are sought after. They must meet very rigid and specific requirements that usually include all aspects of a condition -- history, a diagnosis (based on very specific criteria), medications, labs, imaging, other treatments, and more. In evaluating someone for participation in a trial, they receive the most extensive and accurate testing/diagnosis, not to mention what is often a new, improved treatment. I want to give you some examples using 2 actual clinical trials. The first is an exercise-based study and the second is medication-based. 1. Exercise-based clinical trial for low back pain [you can follow along with by reading the trial details here] I found this particular study by going to a government website, clinicaltrials.org, and entering search criteria "low back pain" and "exercise." You'll probably also want to limit the search based on country and/or state though there are times when you may be willing to travel some distance (e.g., if you have a rare condition or are willing to participate in a study in the early stages of experimentation in people -- usually identified as a "Phase 2" trial). I'll bypass some important but obvious details such as where and when the study is being done. After that, probably the most important thing to focus on is what the study is evaluating. You should be on the default tab, "Full Text View." Near the top of the page, you'll see Purpose which is to investigate if high-intensity resistance training can induce additional beneficial effects, for patients with moderate to severe long term pain in the low back So, if you don't want to participate in a high-intensity resistance training exercise, this wouldn't be for you. Neither would it be right if your pain wasn't moderate to severe or if pain is in your neck or upper back. Next, do you meet the Eligibility criteria? Both the inclusion and exclusion criteria are important. Much of this is in doctor talk but you can easily google the interpretation. As an example, "Pain intensity ≥ 4 on numerical rating scale" is just those happy to sad faces representing pain. How are they assessing whether this experimental treatment actually works? Look under Primary and Secondary Outcome Measures and you'll see a list of questionnaires, strength tests, and disability scores. Finally, what are people participating in the study actually doing? In this study, they list doing's (or interventions) under Arms. Not as in Upper Body Workout but an experimental arm doing High-intensity resistance training and the Active Comparator (or usual care arm) doing General physical activity. Now, to anyone doing hardcore weight training -- strength training with Theraband Elastic bands it's just not possible to reach a level of "high-intensity resistance training." So this may be a deal-breaker for you, not worth inquiring any further. Take note that one group is basically getting the same 'ol advice that they would get by going to a physician/ GP. In other studies, it may be a placebo or sugar pill with no active ingredient. 2. Medication-based clinical trial for low back pain [you can follow along with by reading the trial details here]

2 DEC 2015 · In this episode, Bobbi, who suffered with back pain for years, talks with Joe Risser, MD about the many pain medications she has taken. Most were ineffective and many had intolerable side effects. The medications include anti-inflammatories, muscle relaxants, short- and long- acting opiates, benzodiazepines, and others. She speaks very openly about what helped and what didn't in this brutally honest discussion.

18 NOV 2015 · As a physician who treats chronic pain, I have become increasingly frustrated by primary care physicians (Family Medicine, Internal Medicine, Pediatricians, Preventive Medicine) sending me chronic pain patients, basically saying, "You take care of that...

4 NOV 2015 · We spend a lot of our time practicing and evaluating exercise to either relieve or prevent low back pain. We continue to re-learn that simple is often better. When we talk to former back pain sufferers, one of the most common exercises they do is abdominal bracing (to clarify, we're talking about bracing the abdominal muscles by tensing them, not wearing a brace -- which weakens them). We also often practice bracing because it is the do anytime, anywhere, by anyone exercise. That includes when in a lot of pain or none; whether a ballet dancer or a powerlifter; while driving, sitting at a computer, watching TV, or between sets at the gym. The Science Behind the Brace Besides "Bro Science" (from gym rats) and "Pro Science" (from the self-cured), we have evidence from "Hard Science" (from Randomly Controlled Trials or RCTs) supporting bracing. The most thorough study and the positive results were reported in a TEN YEAR follow up comparing bracing to non-bracing among 600 people with low back pain. (the logistics of such a study alone is staggering) They summarized, Abdominal bracing added significantly to the effect of strengthening or flexibility exercises. One of the most important differences among groups was that those practicing bracing in addition to flexibility or strengthening exercises, exercised about twice as often as those practicing flexibility or strengthening without bracing. Pain frequency (measured as the number of recurrences per year) were also half those of the non-bracers.

29 OCT 2015 · Why did we create Backtivity? In a word... it's about justice. It is just not right that people with chronic back pain don’t get listened to and don’t have a voice. We think back pain may be the most overlooked health condition in the world. So we want to kick off a new and different kind of conversation. Listen to some despicable FACTS about back pain: * it is the number one cause of disability, * 4 out of 5 adults worldwide are affected, * the intensity of pain can be on a scale compared to torture And what is being done about it? Where are the "walk for pain" fund-raisers? Where is the telethon? Where is the war on pain being declared by presidents and prime ministers? Does this make you angry? It should. I'm a physician but I believe we can do better as a community than medicine has done as an industry. Admittedly, the medical profession has some messed up priorities. There's a wonderful quote I like to borrow: In the 18th century, Georges Clemenceau said, "War is too important to be left to the generals." Which I twist into, "Back pain is too important to be left to the doctors." But what can we do about it? We can organize. I invite you to join our community. We are creating a community of current and former back pain sufferers, and their supporters. What is this community going to do? Well, we can share and learn from each other. The problem with many grassroots attempts at solving medical dilemmas is that they throw too much at the wall hoping that something will stick. To prevent that, we're going to provide a short list of tips, tricks, and exercises that have already been scientifically tried and tested and shown to benefit other back pain sufferers. Then we'll ask members of the community to share which of these exercises  they are using, how often, how long, and how intensely. This is where we need to get specific. We want to answer questions like: What is the least amount of time spent doing an exercise that led to real improvement? Which exercises are most likely to lead to COMPLETE cures? Is it better to do a back endurance exercise 10 times a day for 1 minute or 2 times a day for 5 minutes? Next, we'll give you assessment tools to better measure your pain and how it interferes with your life. Assessments include limits on activity like, "Does your pain keep you from walking more than 5 minutes? 10? or 2 hours?" Finally, we'll combine that with some very basic demographic information -- Are you in the 20 - 30 age group? 40 - 50? How much do you sit, stand, or walk during the day? Have you exercised most of your life, not at all, or somewhere in between? Having that kind of specific information, targeted to your particular demographic, can help you find a cure. I guarantee, you will discover more than one way to cure your pain. But you know what may be the best value you get from being a part of this community? You can be inspired by the stories of others. You will hear from those who have been where you are now and they-got-better. It comes down to, "If they could do it, I can do it." So, yes, go ahead. Get angry. Then … get better. And that, my friends, would be a victory in this war. (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','//www.google-analytics.com/analytics.js','ga'); ga('create', 'UA-68954485-1', 'auto'); ga('send', 'pageview');