“Dear Mark, I have a dilemma. I have a worn-out back, actrosis, edema, degeneration and 2 bulges l4-l5 and l5-S1. No nerve damage according to EMG and no entrapment according to MRI. Occasionally loss of feeling right toes, right leg and / or right buttock. They say it is radicular or something. Not treatable. Now I want to do some exercise myself despite the pain The pain clinic recommends Mensendieck / Cesar exercise therapy and stop everything else.
The physical therapist and manual therapist I go to in recommend medical fitness. The neurologist says that both are not scientifically substantiated. With exercise therapy I have to stick to the schedule they indicated, said the pain clinic and I am not allowed to garden. However, this is impossible since I have a 1300 m2 garden. So I tend to opt for medical fitness. But I’m unsure. Can you advise me?”
Excellent question and very understandable that there is some confusion when two different specialists give you advice which is directly opposite.
I think I can definitely get you started, let’s take a look at the points step by step.
In my opinion, the results of your MRI are promising. No nerve damage is the most determining factor. Things like degeneration and bulges sound scary, but nowadays we know that they are very common, even with people without complaints.
In the 40-50 age group, 68-80% of the population has this! And those are people without complaints, so they are not even aware of it! These factors therefore do not have to pose any restrictions at all.
I agree with your Physical Therapist in this area. Exercise programs that have been compiled with care generally have a tremendous influence on the complaints picture. It is important to find a therapist with a sports background who can look closely at the movements that are required during gardening. It would be even more ideal if he / she can drop by to see the garden and get an idea of how you are moving there.
Once this is clear, the necessary movements can be simplified to a level where the practice does not cause any complaints. From this point on, the program will be adapted to more and more resemble the activities during gardening. With good guidance, this should be all right.
During the build-up period I would recommend getting help for the garden. This can be a salaried person, but there are often also interns or volunteers who are happy to lend a hand. This way you can temporarily relinquish the difficult things yourself and for someone else this can be a very valuable learning period!
I hope this helps. If you cannot find anyone in the area, it is possible to request online guidance from us.
I’ve learned a lot from my month of fasting, mostly that this entire year of challenges is crazy.
Me and my good friend Matias clearly have this in common.
Crazy in a good way, I would argue but that is defintely debatable. January was easy as I am used to doing a month of no-drinking every year.
This month was dedicated to something different and harder , Fasting.
The basic idea was that we would practice “intermittent Fasting” or “IF” for the full month and as a bonus, do a 24-hour fast once and a 48-hour fast once.
Simply put, that means the following:
IF: Fast for 16 hours of the day, eat for 8
Example: I would start eating at 1pm and finish at 9pm, technically just skipping breakfast
24 hour fast: no solid foods for 24 hours, only water/coffee/tea (coffee/ broth is acceptable depedending who you ask but I chose not to)
48 hour fast: same as the 24 hour, just double as long.
I decided to bundle the questions of what I learned and got out of it in the 5 most important ones right here.
- Does fasting “work”?
First, you’ll have to define what you mean by “work” but I’m going to assume here that we are talking about weight loss since most of my clients are interested in that. The simple answer is yes, it works great for weight loss. For myself, I lost 1.4% of SC fat (the visible fat under the skin) and 1% of VC fat (the fat hidden inside the body). My visceral fat has been steady around 9.5 for a long time now and quality of diet did not seem to have major effects on it. This approach immedeately started to break that plateau.
I’ve seen much more impressive numbers with clients though.
One person stands out with a loss of 20kg while retaining most of his muscle mass (this is very rare when losing lots of weight) and an 8 point reduction of his VC (also very difficult to obtain) he will be answering 5 questions of his journey soon, by the way.
Aside from his results, there have been some other great results where fasting has been the only variable we changed and there have been serious changes in weight.
Personally, I’m more interested in insulin resistance, autophagy and mitigating inflammatory factors but we will get into that fun stuff another time.
- How hard is it?
To put this in perspective, let me tell you this: I used to be an absolute MONSTER when I wasn’t “fed” on time. So much actually, that my behaviour caused friction between me and my long-term girlfriend at the time (no that is not the reason we broke up, but close!)
I was “team breakfast” all the way, and could not imagine why anyone would voluntarily stay away from food for extended periods of time. I had so many questions and beliefs that were simply contradictory to doing this.
“Breakfast is the most important meal of the day”
“we need to eat frequently to keep the metabolism going”
“not eating limits brainfunction”
“I will lose all my muscle if I do this”
Truth is, during my actual experience this didn’t seem to be the case at all. What I noticed, was very comparable to the feedback I was getting from clients.
– It is not neccesarily easy but it is very simple. no need to count calories, weigh carbs, track intake, nothing of that. during a certain time frame you just do not eat. It takes a lot of planning, organising, shopping and decision making energy out of your day. Most high performers/ CEO’s I work with especially love this aspect.
– Doing this has changed my relationship to food and hunger. Whereas before hunger would compeltely affect my mood and behaviour, now I see it for what it really is, a feeling that will pass. Usually very quickly, in about 10-15 minutes. It is not so much that our body needs food, it’s more that our biological clock tells us it must be time since we always eat at this time. Breaking the fast also makes the first meal a bit “extra” special. I valued my food a lot more compared to other days where I allowed myself to eat whenever.
– IF is budget friendly. In my case, I would often sit down and grab a bite to eat between clients just because I wanted to. I did some calculations and that small change easily saved me 150$ in the month if not more.
- Did it affect my sports performance / recovery / sleep?
Workouts not affected, I can do conditioning workouts , BJJ, weights without any noticable difference in performance.
Sleep: not affected
Recovery: possibly slightly better (could be linked to the increase in human growth hormone HGH linked to fasting)
During 24 hour fast:
Workouts slightly affected, during BJJ quite sharp and energetic, weights & cardio slightly tired and sluggish during.
Sleep: Not affected (note, broke fast in evening)
Recovery: no noticable effects
During 48 hour fast:
Did not workout (felt super sluggish)
Sleep: did not notice any effects
Recovery : nothing notible but autophagy would be taking serious effect during this fast.
Conclusion: no noticable effects
- Would you do this again or long-term? https://www.healthline.com/nutrition/intermittent-fasting-guide
For IF (intermittent fasting) , the answer is YES. The main reasons are the convenience and the mental sharpness I get out of it.
It seems to have beneficial effects on my body composition as well, since I have not been very strict with my eating and still been able to drop fat and keep my muscle mass steady.
For 24, the answer is yes, probably. I have done a couple before and it has been WAY more easy than I expected. I get hungry maybe once or not at all, and I feel very clean and centered during this fasted state. There seem to be serious regenerative benefits from autophagy so it’s something I will look into a bit more.
48 though, is a different case because it’s a different animal. Compared to the 24 hours, I was feeling off, sluggish, slow. My last part of the fast was like moving through water, is the best way to say it. I realise there is serious health benefits in terms of stem cell activation but I’m simply not sure I can do it and still fuction during a working day.
- Would you reccommend this to others?
Yes. I think it’s clear that it’s an effective strategy to lose weight, help reverse chronic disease like diabetes type 2, optimize hormone levels (like HGH and regulate ghrelin) and change your relationship to food and eating in a positive way.
Starting Guide to fasting
What happens which hours of fasting?
Explainer video about fasting
Looking for Physiotherapy services in Phnom Penh? Here’s what to expect at Movement: Fitness and Health
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I do not condone body shaming. Or shaming of any kind.
Nor will I claim that my journey is something that you should aim for.
Mine was a long one, that forced me through over 15 years of hard work, injuries, relentless self-criticism, depression, therapy and finally, acceptance.
I really think you can skip a couple of those steps and save yourself some trouble.
Anyway, let me get to the story.
Looking back I’ve always been extremely shy.
I hated being in the spotlights and any time it did happen, my face would go full on tomato mode in instant. Inside, I would feel like a pressure cooker and all I wanted was just to dissapear from sight. And somehow, no matter how well I tried to hide, these moments kept finding me.
It was all not too bad, because luckily enough I never really got bullied. I had good friends and for some reason I always fitted in quite easily. Always a part, never the part that got the attention. I liked it that way,
Things got worse when I hit puberty. My friends grew bigger, stronger and most importantly, cooler. They dressed better, had the trending haircuts and well… they got the girls. I could never imagine getting what they had.
At around that time, my mother was in a long term relationship and my brother-in-law was pretty much the epitome of coolness. He was everything my friends were, but magnified. He was my way out. My hope.
But I could never spend enough time with him to get his coolness to rub off on me.
One day though, we were planning a holiday and he would come along. This would be my chance to spend time with him and absorb whatever I could learn off him. I was stoked.
The very first day, we were off to the pool and I could not wait to start picking his brain. But that was not how things went down.
When I came up, he looked me up and down and then, pinched my my chest. What he said then would leave a deep mark for a long time.
“What’s all this? Look at that belly, and those fluffy nipples. You’ve got some bitch tits going on!!”
I spent the holiday and many after hiding, afraid to show myself especially without a shirt on.
Not very long after, I saw a Men’s Health magazine at my doctors place. I obsessively read every part and from then started to devour every magazine and book on the topic. My obsession began.
Little did I know that even though my body would soon start to change for the better , the extreme focus on my appearence would only cause an endless pursuit towards an appetite I would never be able to satisy.
I’ve come a long way since then, but it has only really been the last two years where I have been able to let go, of focusing on how I look and shift the focus on how I feel, how my body works. I’ve shifted my focus from self-sculpting to self-care and it has been a massive load off my shoulders. But that has been a process for more than 15 years now.
The shy insecure, scarred boy is still in there somewhere. But instead of hiding him, I’ve decided to embrace him and care for him.
I can only hope my experience helps you on your journey.
I am 65 years old and have a lot of complaints about my back .. osteoarthritis, scoliosis, increased lordosis, pelvic torsion ..
And a well-worn hip.
I have always been fitness until 2 years, but also got fibromyalgia .. too many complaints and I stopped ..
Do exercises at home with light weights and elastic and on the exercise bike.
I now have a spit and think it is advisable to start building up more muscle.
GP prescribes pain relief for nothing else ..
What do you recommend, low-level fitness or pilates for example?
Sorry for the long mail!
Answer (Mark Chen, Physiotherapist/Personal Trainer)
Thank you for your question. That is quite the list! Fortunately, none of the problems need prevent you from having a pain-free life.
I agree, strength training can help a lot.
It is important that a strength program is designed by someone who knows what they are doing.
Pain due to a scoliosis / lordosis often has to do with a imbalanced amount of stress on the muscles and joints as a result of the abnormal shape of the spine.
A properly chosen exercise program should be aimed at making the “underloaded” muscles work more, and the “overloaded” muscles less.
Pilates can be a good option for this because of the focus on tightening the right muscles. Nevertheless, I would go for a personal approach under the guidance of a physical therapist.
OCA is a company that focuses on an active approach to health complaints and they have locations all over the country. Take a look and hopefully they can help you on the right track!
A friend of mine, a very good golfer, has a lot of lower back pain (facet joints) as a result of playing and training a lot.
Manual therapy increases the symptoms. Is treatment on a traction table a possible solution?
Mark Chen, Physiotherapist:
Thank you for your question.
I personally do not consider a traction table as a ‘solution’. It can, however, provide a good relief of the discomfort and can therefore help as a way to start the recovery.
Traction works by relieving pressure on the facet joints. It ‘pulls’ the vertebrae ‘apart’ and gives space, so to say.
This can certainly provide some relief, once it has been determined that pressure, or ‘compression’, plays a significant role in causing the symptoms.
So it’s mainly a matter of trying. If there is no clear change in symptoms after 3-4 times, I would consider another method. It’s also worth noting, that it is fairly easy to create traction on the lower back yourself. For example, you can hang on a horizontal bar or use a Gym ball and lie down on it face down.
With both methods it is important that you fully relax the muscles.
Finally, I would advise him to have a good look at the mobility of the spine. Golf is, after all, a fairly one-sided sport that therefore loads the body (and especially the hips and spine) in an unbalanced way. With a view to the long duration, it is certainly advisable to follow an exercise program that keeps and maintains a muscular balance on the spinal system through flexibility and stability training.
I can help with that via online guidance, but there are of course plenty of Physiotherapists / Personal trainers who can help with that!
Hopefully this will help your friend!
Physio-Fitness is a way for you to work on your physical discomfort or injury under supervision of a professional .
After a personal consultation and assessment , the therapist will design and instruct a corrective exercise program for you.
During the Physio-Fitness classes, you will be able to exercise and get instant feed-back and answers to your questions.
This class is perfect for:
- Posture correction (anybody with an office job)
- (chronic) Low back/ hip / shoulder pain
- When you have tried any sort of therapy except training
- When you find it difficult to create the time to do your exercises at home
- If you want to get started with fitness, but have some weak points to work on
Currently, the class is on Monday 12- 1 PM.
- Please note the maximum attendance is 4 pax per class (currently 3 attendees)
- if you don’t require the full hour, coming in late or leaving early is fine
- Class is only available when you have a program designed for you
- Monthly Fee (1x pw basis) 60$
- Drop- in 20$
You can go here to make an appointment for a (free) Assessment
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