MidNite sleep aid - no help for chronic pain wakefulness

MidNite is a sleep aid with Melatonin and some herbs that's meant to help you sleep or get back to sleep. I am a restless sleeper due to chronic pain. I awake in the middle of the night almost every night, either from pain or because it's become part of my regular schedule. I tried MidNite hoping it would help, even a little. First, I took it before going to bed. Still woke up just as often. Then I tried taking it when I woke up. Didn't help me go to sleep any faster. And, one night for non-pain reasons I was having a hard time drifting off, and so I tried it then. Again, no help. So this product does nothing for me.

I guess that means I have plenty of Melatonin in my system? I guess I'm not really supprised, but keep in mind that not getting enough sleep sucks. The samples of MidNite were free, so I figured I had nothing to loose.

Home-made in bed laptop stand

A while ago I started looking for a way to lay flat in on my bed and still be able to use my laptop. I found some laptop stands meant for use in bed that looked promising, but they were either very expensive, or got bad reviews (suggesting low quality), or both!

After trying a junky laptop stand sold in bed bath and beyond,  I tried to make my own out of an old Ikea table (price: about $15). Basically you attach one set of legs as suggested by Ikea, and and then nail the other legs at right angles. You'll need to glue some kind of ledge for the laptop to rest against. I used crafter's Popsicle sticks.

The result was stable and exactly to my designed dimensions, but very hard to adjust. I would recommend mocking up the product by first using duct tape, and then using nails to affix the legs once you have the designed tuned to your needs. Keep in mind to mock up on a bed surface, because the legs will sink in a bit, making the whole thing a bit lower to the ground.

In the end I think I made it a bit too low/steep. Even so, I found it hurt my neck look at the laptop, so I gave up on it eventually. If you don't need to lay absolutely flat, this kind of stand would be much more likely to work out for you. I conclude that the laptop in bed stand, DIY or not, isn't for me. If you are OK propped up on pillows a bit, though, you might consider it.

Sneezing without pain

Chronic backpain sufferers know the damage an ill-timed sneeze can cause. The whole-body convulsion can set off pain where there was none before, or (more commonly) make bad pain so much worse.

Once you feel the urge to sneeze, it is almost impossible to stop it. The trick is to keep it from hurting.

First, fight the strong urge to inhale deeply.  Second, try to exhale as much as you can (this will take some practice, as it's the exact opposite of your innate response). With less air in your chest, your sneezes will be much less convulsive - more like a strong cough, if anything. After 3-5 of these mini sneezes the urge will pass.

You'll look and sound weird doing this, but it's worth it - since perfecting this technique nearly all my sneezes have been pain free.

Consider topical analgesics

Better known by brand names such as Bengay or Asperchreme, these product are essentially aspirin (in the form of Methyl-salicylate) in a cream, plus other additives that cause sensations of heat and cold (in that order).

As I have discussed elsewhere, long term oral NSAID use (ibuprofen, naproxen, etc) has some significant potential downsides, (heart burn, and eventually, ulcers) which is not true for topical creams. It is certainly worth giving then a try, though they are probably better for mild pain - I don't find them sufficient for severe pain.

There are lots of varieties, but they all pretty much contain the same three chemicals, though in slightly different ratios. Interestingly, some products will only list 1-2 of the chemicals as active ingredients, but often the other 1-2 will then show up as inactive ingredients. I guess they are  trying to differentiate themselves, but it seems pretty dishonest to me. Also, they don't have to list how much of the 'inactive' ingredients they include, making less clear what you are actually getting.

The three chemicals are:
(1) Methyl-salicylate(sometimes another salicylate bonding is used, such as Trolamine) is just a way to deliver aspirin. It is the most important ingredient in these kinds of creams. This means if you have habituated to aspirin already these products probably won't do much good. For this reason I advise avoiding aspirin in pill form. Better to save its effectiveness for topical use, where the chance of stomach complications are much lower.

(2) Camphor - another topical analgesic, which produces a cooling feeling.

(3) Menthol - another cooling agent, which has the side effect of making the skin more permeable, allowing the salicylate to penetrate deeper. Menthol is also responsible for the strong smell of these products. For once, the 'fragrance' actually has something to do with the effectiveness of the product and isn't just added to improve marketability.

In addition to pain relief, there are a couple of other notable aspects of applying these creams. First, they all smell (of wintergreen (menthol), usually, though sometimes other fragrances are added as well). You'll get used to it. More notably, they burn a bit when applied. This actual contributes to the pain relief a bit, and becomes less bothersome as you get used to the creams.

You can limit the burning sensation to the area of application by wearing gloves. Unfortunately I've found that nitril gloves don't block absorption completely. Another cheaper option which actual seems to offer better protection is to use a sandwich bag to cover your hand. It is a bit more awkward at first, but much easier to put on and take off than a regular glove, and a heck of a lot cheaper. Once you are done with the bag, you can leave it in-between your skin and your cloths to prevent the cream from rubbing off.


Other pain creams

There are a few other options that are not aspirin based. You can now buy ibuprofen in a topical cream. This is a recent development, so hopefully the price will come down as more places carry it.  There are also some prescription NSAID creams, but these can be quite expensive and I have not tried them.
For something entirely different consider one of the hot-pepper rubs. These burn like crazy, but do seem to reduce pain after the burning subsides (which can take a while, perhaps as long as an hour). While a small tube will set you back $10, you only need a small dab, so it's relatively affordable. If you give this a try be sure to use as little as possible the first time, as the burning can take 30 minutes to develop and you really don't want to overdo it.  I find it makes my skin pretty sensitive so try to use it at a time when you don't have to wear clothing over the affected area.

Review: My Place laptop desk in bed (with dimensions)

The My Place laptop desk is intended to raise your laptop out of your lap, while simultaneously providing an incline for the keyboard, which makes typing more comfortable, especially when reclining. It's perhaps the most affordable laptop bed desk; just $35 at amazon, and at the moment, $30 at Bed Bath and Beyond ($20 + tax, after the ubiquitous $10 off coupon).

I bought it with the hope of using it while laying in bed, as in the Laptop Laidback and other similar products you can only buy online for ~ $100. It's not well suited to that purpose however. The underside of the desk is quite close to the ground (both front and back), so you have to lay absolutely flat (you can't put more than a small pillow under your knees). Conversely, the surface where the laptop rests is relatively high, making it difficult to find a comfortable angle for typing, esp. if you want to lay flat instead of propping your back and head up with a couple pillows. Indeed, if you do set the angle sufficiently high (~45deg.), the entire platform becomes unstable because it's too front/top-heavy. Even worse, if you have a ThinkPad, or any other laptop with a curved front underside, the lip of the desk isn't really tall enough to keep the laptop from sliding off. To be fair, the desk wasn't really designed with lying flat in mind. But at least for me, that's the only in-bed position in which I'm pain-free, and therefor the only position I'm interested in using it in.

If you are willing to sit partially up while using the desk, it might be worth considering, however. If so, here are a quick set of pros and cons to consider.

Pros:

1. Folds into a very compact package, for easy transport.
   
2. Though it's made of plastic, it's relatively stiff plastic, and relatively light. I wouldn't want to go hiking with it, but it's certainly easy to carry around the house, etc.
3. The incline for the desk is adjustable across ~10 increments.
4. The desk height can be doubled by unfolding the legs.

Cons:

1. The desk comes in two heights: too low (because of the poor clearance on the underside), and too high.
2. The desk isn't very stable because the legs are not very far spread apart, front to back. I wouldn't use it on a soft surface, especially when the legs are unfolded for double-height.
3. The distance between the lower clearance and the bottom edge of the laptop is 2.5" (see picture), trapping you under the laptop (indeed, on a hard surface, the "desk" actually puts pressure on my lap), while making the laptop itself too high up for ergonomic use (in my opinion).
   
4. The mousepad can also be raised on an incline, but after a few degrees it starts to slide down, making that feature not so useful. And because 25% of the desk is taken up by the mousepad, the laptop necessarily must be offset to the left, which isn't very ergonomic for typing.

This post is part of a series summarizing the various laptop stands that can be used in bed.

Sulindac & TNF-A mediated pain: a bad combination?

Sulindac is a generic NSAID. TNF-A is regulatory chemical in the body that has been implicated in many inflammatory diseases (rheumatoid arthritis, ankylosing spondylitis) - more TNF-A causes greater inflammation. Interestingly, taking Sulindac can actually increase TNF-A, at least in special circumstances. According to a 2009 study in rats (Sulindac metabolism and synergy with tumor necrosis factor-alpha in a drug-inflammation interaction model of idiosyncratic liver injury), sulindac, when administered with a another inflammatory agent, can significantly increase the amount of TNF-A in the blood as compared to the inflammatory agent alone.

This reduction may be specific to the inflammatory agent (lipopolysaccharide), but it may also occur for any cause of inflammation (ie rheumatoid arthritis, or ankylosing spondylitis, though these are chronic, and the lipopolysaccharide injection was not). It's important to note that the same study found no TNF-A increase when the rats were only injected with sulindac. Something has to cause the TNF-A to be present before sulindac can make it worse.

Other interactions between sulindac and TNF-A have been documented. One paper found that sulindac made TNF-A more effective at killing cancerous cells. Great, but if TNF-A is instead causing needless inflammation then perhaps here too sulindac is increasing it's efficacy. Another paper also suggests that Sulidac can make TNF-A a more effective cancer cell killer.

While it's too early to conclude anything, there are lots of NSAIDs on the market, so it might be prudent to take something else if Sulindac has no special appeal for you. Which is to say, it's not going to cause extra damage, but it might not be as effective.

Two papers have compared sulindac to other common NSAID treatments for AS. A 1979 double-blind cross-over study found that patients preferred taking Indomethacin to Sulindac, though the effect was small, and there was no clinically assessable difference (I prefer indomethacin, myself)in pain. Another study compared diclofenac and sulindac, and found mild evidence that diclofenac was slightly more effective (I also prefer diclofenac).

Laptop bed stand: Acrobat stand/E-Table/etc ($45)

Several companies have been putting their name on this laptop stand, which allows you to use your laptop while laying on your back in bed.

The angle of the laptop can be adjusted over a wide range, but the height of the laptop can only be adjusted over a short (2 inch?) range. At least one owner has also labeled it as being a bit fragile. The upside is it's quite cheap, and portable. Find it for about $45 on amazon (shipping included). Some specs. A demo video.

Without having tried it, I should reserve judgement, but this doesn't look like a great solution to me.

This post is part of a series summarizing the various laptop stands that can be used in bed.

Laptop bed stand: LapDawg ($121)/Wizard($99)

This stand allows you to use your laptop while laying on your back in bed. It appears to be quite adjustable (see diagram).

There are a lot of different companies selling this product (or at least what appears to be exactly the same product).

Lapdawg has it at $121, which was the highest price I saw, but it comes with a 30 day refund of $89 (ie they don't refund the shipping charge).

Another copy sells this item under the name Wizard, for $99 (free shipping).

You can also find what appears to be the same item on ebay, usually under the name 'folding laptop stand'. The price goes as low as $86 with shipping.

The product looks great in pictures (see esp. those on lapdawg's site, which has a bunch of product photos that highlight all the possible positions you might want to use it in). It also seems to be the most adjustable stand around.

Unfortunately, people who have actually used it hands on report that it is pretty flimsy and tends to break within months. That's pretty bad for a ~$100 item. If you buy the Wizard version, it sounds like it's pretty easy to get replacement parts, often for free, but even so it's quite disappointing. User reviews 1, 2, 3, 4 (older version). I'm giving this an "avoid" rating overall, which is a shame because, at least in concept, it seems like the best stand out there.

This post is part of a series summarizing the various laptop stands that can be used in bed.

Computing from bed: laptop stands

Modern life includes a lot of computer use, which for most people means sitting down. Back pain can make sitting prohibitively painful. Laying down is often more comfortable. One option is to lay on your stomach, propped up on your elbows, with your computer in front of you. This is a cheap and easy way to save your back. For some people (myself included) however, this kind of constant extension quickly becomes painful. Even if it doesn't hurt now, given the extensive stress this can cause to your spine it would be wise to get up and move at least once an hour if you use this pose.

The other option is to lay on your back, with your legs propped up and your laptop balanced against your thighs. While putting little stress on your back, this can be hard on your wrists and your neck. To make this more ergonomic you need some kind of laptop stand to raise up the keyboard to a more ergonomic angle and move the screen up as well, so you don't have to bend your neck as far forward to see it.

If you don't need the laptop to be raised very much (ie your neck is still very flexible) then a fairly effective stand can be fashioned from a sheet of cardboard. I'll put up a post later showing how to make one. In the mean time, I'll be considering commercial options which give you a lot more control, one per post (click here for a list).

When McKenzie doesn't work: Alkylosing Spondilitis

If you've tried the McKenzie extensions with little to no benefit (I did, for several years) maybe you don't have a slipped disk. There's at least one condition that doesn't respond to back extensions at all: Alkylosing Spondilitis. It's kind of like rheumatoid arthritis, but it targets your SI joints (and often other joints as well). One of the other diagnostic features is that your pain will sometimes switch sides, for no apparent reason. About 10% of back pain cases are due to Alkylosing Spondilitis. A more offical diagnosis depends on checking your blood for HLA-B27, though this is not conclusive. An MRI or, x-rays can also help make the diagnosis, though X-rays usually only show disease progression after 4 or more years after pain onset.

AS treatments include NSAIDS and Tumor necrosis factor-alpha supressors.

How much fish oil do I need to take for reduced pain?

Of course, it's not clear. A 2007 meta analysis of 17 studies of inflammatory pain (mostly rheumatoid arthritis) found repeated evidence that fish oil consumption caused improvements various measures, such as reduced joint stiffness, pain levels, and number of NSAIDs needed to reduce pain to a reasonable level. While aimed at fellow researchers and not chronic pain suffers, the following quote sums the issue up nicely:

"In order to maximize the therapeutic effects and improve the quality and validity of future trials, it is recommended that all studies report concomitant analgesics and doses since without these data it is difficult to assess the true magnitude of effect of ω-3 PUFA supplementation. In addition, we recommend use of high-dose ω-3 PUFAs (at least 2.7 g/day of EPA and DHA) for a minimum duration of 3 months using a non-olive oil placebo control condition."

Let me briefly explain what's going on here. First, different studies found fairly different levels of improvement, from quite significant, to rather minimal. The authors are suggesting that this may be due to how much other pain relievers (analgesics) participants were allowed to use (sometimes this data wasn't even reported). ω-3 PUFA (omega 3) is the type of polyunsaturated fatty acids in fish oil (and a few other oil types). Finally, they are suggesting that doses of less than 2.7g of ω-3 PUFAs don't consistently lead to improvements, so future studies should set that as the minimum dose. Note also that benefits are not necessarily seen right away, hence the suggestion that studies should be carried out for at least 3 months.

So how many capsules should you take? It's key to understand that a fish oil capsule is not 100% ω-3 PUFAs (epa + dha). Thus, to get 2.7g of omega 3's, you can't just take 3 1g capsules. Instead divide 2.7g by the amount of omega 3's. For instance, that would be 9 capsules of kirkland fish oil.

Note that 2.7g is the minimum. How much more is useful is unclear. Some evidence suggests that a little more, (3.6g) would be better, or even more than that (6g!), but without more research (and without better understanding of the potential downsides of taking that much), it's hard to recommend such a large dose.

PS. I am not an MD. Think for yourself, don't just blindly follow my advice.

Why a disc herniation does not mean you should get surgery

This well written article lays out the evidence that a herniated disk may in fact have little to do with your back pain.  Briefly, while many people with back pain do have herniated disks, a random sample of people without back pain revealed 17-52% had some level of herniation.  This means that 'fixing' a herniated disk with surgery doesn't necessarily mean that your pain will go away. A herniation need not cause any pain at all (probably it did when it first occurred, but the pain may not have lasted long).  I won't bother to summarize the article any farther, since it's quite well written (complete with references!).  Definitely an interesting read. 

Sitting more comfortably

As an office worker there's little I do everyday besides work at my computer. If only I could sit comfortably I'd be much happier with the job.  There are enough causes of back pain that what works for one person might not for the next, but here are some of the things I've done which help me. If they don't help you, just remember to keep on experimenting. Every 5-10% percent improvement is worth it!

1) mkenzie back roles help a lot. Almost any chair is made better by adding one. I've also found that paper towel roles can be useful, as they compress less than the mkenzie rolls.

2) Some amount of reclining can help. The worst possible thing is to sit in a chair that forces you to slump forward. 

3) getting your feet under you can help. IE if you have a chair without arms you can sit with your legs wide and your feet directly below your rear, pushing lightly on the ground. I find spending at least some of my sitting time this way helps. It's especially helpful if you have to sit in a bucket seat.

4) standing some of the time really helps. I have an elevated desk (about 4 feet off the floor) and this allows me to stand for 30 minutes at a time. It took a long time to adjust to this, but it's clear that it helps a lot to not sit all the time. On the other hand, it's critical to not stand all day. Esp. later in the day I need to mix standing with sitting.

5) trying the chair out before buying is pretty important. Just because it's expensive doesn't mean they made it lower back pain friendly! After many years of looking for  a better chair I've come to the conclusion that a $10 yoga ball from walmart is the best option for me.

Using google calendar to keep up with your exercises

It's hard to remember to do your exercises and stretches - but with google calendar, you can get reminder emails, and get the satisfaction of deleting those messages after you do each set of exercises. This is particularly helpful if you are doing an every-other-day exercise.  By having the reminders sent to your inbox, you ensure that your regular everyday practice of checking your email is all you need to get reminded. 

One of the tricks with lower back exercise (and stretches)  is to start at a very moderate level, and then ever so slowly increase the intensity and rep count. This ensures that you don't injure yourself. If you have trouble remembering to do your exercises, however, this slow ramp up process will never progress far enough to actually gain muscle strength and greater mobility.  This is one big reason why something like google calendar's reminders are so helpful.

To set up reminder emails, add an event to your calendar, and then click on "edit event details".  Set "Repeats" to weekly, and then check off the days you want. Then click on "Reminder" (under options) and set it to email you 10 minutes before (or whatever).  Try to add the event to our calendar around the time of day when you could actually do the exercise (the assumption being that you check your email pretty often). 

Back extension exercise

There are lots of websites which suggest a wide range of exercise and stretching for treating lower back pain. Heck, this is one of them. But do you ever wonder what evidence supports these exercises? I've decided to start reading the primary academic literature on back pain treatment, and summarizing the approaches which have more than anecdotal support. 

One of the old standards of lower back pain treatment is the back extension exercise.  The idea is to increase the strength of the muscles that allow you to bend backwards when you are lying on your stomach. At the same time, this helps with mobility, and supposedly can help improve blood flow to the disks and reduce pain by recalibrating the pain-sensitive sensory neurons in your back.  Because this exercise has been around for a while, there's lot of documented evidence that it can help chronic lower back pain. For more info, see this review article "Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises" published in 2008 in The Spine Journal (Note that a journal subscription is required, so you'll need to go to your local university library to read this, unless the following PDF link still works :-). This posting is largely based on the info in that artcle, so if you want more detail, be sure to check it out.

The back extension exercise can be done with a yoga ball (aka balance ball), as shown in the picture.  Face toward the floor, and place your hips on the ball. Trap your feet against a wall. Place your hands on your hips (or behind your head for more resistance), and bend backwards to the pain-free limit of your range. Be sure to take it slow and smooth, with about 2 seconds to bend backward, and 4 to return to the starting position. 

How often and with what intensity should you perform this exercise? Evidence suggests that doing a little is better than nothing, so you may see benefit with as little as 1 session a week, 3 sets of 6 reps, for a period of 12 weeks. If you want to work harder, build up slowly to 3 sessions a week, with 3 sets of 25 reps, but keep in mind you are much more at risk of injury, and like most back exercises doing a little is much better than doing a lot and then injuring yourself. Interestingly, there is little published evidence that doing the more intense workout leads to a significantly better outcome; I would guess that's because people tend to over-do it.

Once caveat that the 2008 journal article mentions is that there isn't conclusive evidence that the balance ball version of this exercise leads to a measurable strength gain that can help lower back pain. They recommend using gym equipment to ensure effectiveness, but I suspect here that doing the balance ball exercises religiously over 2 months will give more benefit than going to the gym 3 times and then losing motivation. In any case, here are some external links for more info - the first is a video instruction on how to do the exercise on a balance ball, and the second shows how to do the supposedly more effective version of the exercise on more specialized gym equipment. 

video - exercise on a balance ball

figure - exercise on a specialized equipment you might find in a gym.  You could duplicate this at home if you lay over the edge of a bench or bed, and have somebody to hold/sit on your legs.

DIY: cheap icepack for your lower back

Whenever I do something physically stressful, like going on a fast walk, or anything that involves prolonged bending over or lifting, there's always a risk of pain afterwords. To lower that risk, I've found it very useful to apply an icepack to my lower back immediately after the exercise, even if there is as of yet no pain. To make this easier, you can make an icepack you can strap onto your back, allowing you to ice your back while still being able to move around the house. Here, I show you how to do that out of common household items.

The trick is to take a dress shirt, put a bag of peas just below the collar, and then tie the arms of the shirt around your wast. To demonstrate this more clearly, I recorded a video of how to do this.

Review and Recomendation: The Trigger Point Therapy Workbook

This is a review of Trigger Point massage, and a particular self-help book about applying the technique:  The Trigger Point Therapy Workbook by Clair Davies. I've been trying self-applied Trigger Point massage for a while now, using this book as my guide. I've found it to be a useful technique, and I recommend trying it. I've used it for back pain and hip pain, but the book contains sections for almost all areas of the body. 

The theory behind trigger point therapy is that muscles get knotted up in very specific locations in the body, and that the stress caused by these knots causes referred pain to nearby parts of the body where those muscles attach.  The Trigger Point Therapy Workbook  shows you where all these trigger points are, and the pattern of referred pain associated with each point. In addition, for each set of trigger points there is a lengthy discussion of the typical causes of problems at those points, how to locate the points by touch, and how to treat the trigger points. 

The treatment is almost always the same: high pressure massage of the muscle around the location of the trigger point. Exactly how the massage is done probably doesn't matter that much, so long as you get the spot right. The book's advice, however, can be helpful for figuring out how to get sufficient leverage and pressure for each point.  In many cases, the suggested massage tool is just a regular tennis ball, though sometimes more fancy tools like the thereacane are suggested. 

The book is a useful resource for finding the trigger points because the pain is usually referred. You may massage near the area of pain, but usually the actual point where the massage is needed is outside the area which aches. Interestingly, however, once you know the general area to search for the points, it's much easier to find them by touch than by religiously following the diagrams in the book. Nonetheless, the diagrams are important for figuring out the right areas to start searching. 

The book is very clearly written. It is intended to be read by pain sufferers, and while it doesn't dumb down the topic, care is taken to not be overly technical. It does suffer from overly grandiose claims for all the different conditions it might treat - in one section it even speculates that dyslexia may some day be treated by trigger point therapy.  Don't be too turned off, however, as in contrast to dyslexia, trigger point therapy really does seem to help chronic pain. On the other hand, I'm going to go out on a limb and suggest that there is less than 1% chance that trigger point therapy will ever provide a measurable help to dyslexics.  Oh well, like most self-help books you have to learn how to filter the good from the bad. 

In the end the book wouldn't be worth reading if it didn't help. Luckily, it does. In my own life, I've found that trigger point massage can significantly reduce my acute back pain around 30% of the time I apply it, and makes for at least some improvement almost every time I try it.  That's a pretty impressive level of improvement, in my book. It's well worth the $15 that it costs to buy it from Amazon (or other good online booksellers).  And, given that the only other tools you really need are a tennis ball, and perhaps a bottle opener, it's a very economical way to treat your pain.

Good posture for sitting

One of my reader's suggested I check out his website: www.lower-back-pain-toolkit.com. It turns out to have lots of interesting information, and has inspired me to put up a post about 'good' posture.

First, what is good sitting posture? The general/traditional view is that you want to sit upright, with a gentle s-curve in your lower spine from a lumbar role. See this link for a much more detailed discussion. Whenever this 'good' posture is illustrated, the person is almost always sitting with a 90 deg. angle between their legs and their torso. Undoubtedly, this is better than the forward slouch, where your back slowly curves forward and your chin ends up nearer your kneecaps than your hips.

This traditional view, however, may not be quite right, at least with respect to the 90 deg. angle between your hips and your back. MRI scans have revealed that when you sit in this posture, you actually put a lot of strain on the disks in your lower back. It may be significantly better to lean backward at a greater angle, such as 135 deg. See this BBC article for an example of this posture, and a short discussion of the science behind it.

In my personal experience, less than 90 deg. can quickly lead to pain. Exactly 90 deg. feels much better, at least in the short term. Greater than 90 deg. seems, however, to be the least painful of all. It can be hard to get a > 90 deg. position in a regular upright chair, however, without also leaving your back unsupported and hanging, leading to a reduction of lumbar lordosis. One way to avoid this is to role up a towel and sit on it. This will increase the angle between your hips and your back, while still maintaining the good lordosis. Another option is to slouch backwards, and then support your lower back by placing both of your arms behind your back.

Idea: trigger point massage in the bathtub

I've recently discovered trigger point massage. The basic idea is finding painful points on your muscles and applying deep pressure which is initially quite painful, but quickly reduces your overall level of pain in that area. This page has a neat trick, which I will try as soon as I have a bigger bathtub: take a rubber ball into the bathtub and combine the relaxing power of heat with the effects of trigger point massage. See http://saveyourself.ca/articles/bath-trick.php for the full article.

Cheap theracane alternatives

I've recently been trying trigger point massage for my lower back pain. I'll post more once I have had more experience. Trigger point therapy requires a fairly deep massage, which is rather hard to do with your hands, let alone if the points are behind your back.

The Theracane is basically a cane with some hand-holds, which is meant to make it easier to massage areas like your back. Experimenting in the store, I did not feel it was really suited to deep, high pressure massage, but it would still probably be a useful tool. Check out their website if you haven't seen the Thera cane before. The problem is that it goes for between $50 and $30, usually without any return policy. I've come up with a couple of $1-$5 alternatives which work pretty well.

First, you could always try doing a tennis ball massage, (just trap the ball between the wall and your body, and wiggle around). This works OK, but doesn't really make for a deep massage because the ball is too big. Also it can be difficult to pinpoint the spot you want on your body this way.

So, what I really suggest is to go to a kitchen store (I went to IKEA) and find a short kitchen tool which has a round handle, as in the picture to the right. The one I found cost 99 cents. Now, since it's not rounded on both sides, it may be kind of hard to hold comfortably, especially when applying lots of pressure. Solution: cut open a tennis ball, and stick the non-round part into it. Now, you have a nice soft handle, and a good, hard massage point. For extra force, I put the tennis ball up against the wall, and then lean into the rounded handle of the tool.

That works pretty well for the lower back. It's a bit hard to position the tool, since it's all happening behind your back, but your arms can be flexible enough to make it happen.

Much harder is to massage your upper back or neck. Perhaps you really need a Thereacane? No, there's a cheaper alternative, on the order of $5 at your local hardware store. Get a storage hook (here's one link, but it's probably better to check it out in your local store first). See picture below for a suggested model, but I'm sure you can use your own judgment on this one! It's really crazy how much you will get charged for "health related" items, as compared to everyday products that are just as good but have to appeal to the more cost-minded general consumer.