Reflecting on You

Build stronger, happier relationships—by taking a closer look at the part you play.

After years of counseling couples in transition, Denise Mosher knew a bad relationship when she saw one. And while her own 18-year marriage was not one of them, she still had the nagging feeling that it could be better. Increasingly, she was bugged by the little things: the fanny pack her husband left on the counter, the feet he didn’t wipe on the way into the house.

Then Mosher read about Naikan (pronounced NYE-kon), a little-known practice of self-reflection rooted in Zen Buddhism and developed in Japan in the 1940s. It looked like something that could help her decode her feelings and figure out what to do about them quickly, easily, and effectively. So the 40-year-old minister in Monmouth, Oregon, decided to give it a try.

Using Naikan, Mosher asked herself three questions about her relationship: What did I receive from this person? What did I give this person? And what troubles did I cause this person? Each day she repeated the exercise, and recorded her answers in a journal.

Naikan’s power lies in the details—the good, the bad, and the ugly truths that make up the mosaic of any relationship. But your focus is on the role you play, your actions and choices, and on what you received from the other person. What you uncover can be surprising. “People are often in denial about their ability to cause trouble in the world,” says New York psychologist Wylie Goodman, PhD, a traditional therapist who uses Naikan in her practice.

Couples who practice Naikan regularly don’t usually have to wait long to experience the positive results, Goodman says. “They quickly start acting differently toward each other,” she explains.

Mosher agrees. Once she started asking the three questions, she was able to stop letting her husband’s minor transgressions get to her. Instead, she began noticing all the things he does for her, like fixing her office computers after a busy day at work. And she started fessing up to her own annoying habits, like her chronic tardiness. “I’ve kept him waiting constantly, for over 20 years—every party, every appointment,” she admits.

On their own, these little details are, well, little. But Mosher says looking at them through Naikan’s lens has had a profound effect. Does she still want her husband to wipe his feet before stepping over the threshold? Sure. But reflecting on the three questions helps her keep those feelings in perspective. “They train the emotional muscles to move from complaining to gratitude,” Mosher says. “I’m aware of how lucky I am to have my husband in my life. Now, when we have a tough conversation, instead of complaining or nagging, I’m less shrill. I no longer feel like a shrew. Naikan is one of the most powerful, easily accessible things you can do for a relationship.”

For more information about Naikan, contact The Todo Institute, 802-453-4440, or todoinstitute.org.

To try Naikan for yourself, see page 134 of Health's May 2006 issue (on newsstands now).

Supplement Watch: What Works When Workouts Hurt

A little glucosamine may ease all kinds of aches and pains.

The popular pill got mixed reviews in a recent study sponsored by the National Institutes of Health (NIH). But some experts say it’s smart therapy for knee pain that drives you nuts or a cranky joint somewhere else. Here’s the lowdown:

How it works: Glucosamine is a natural compound found in humans and animals; the supplement is made from shellfish skeletons. And chondroitin, a related supplement, comes from cow and shark cartilage.

While anti-inflammatory drugs relieve pain by reducing inflammation, these supplements are thought to restore worn-down connective tissue (cartilage) that cushions bones. That’s important if you have joint pain, because it might be a result of osteoarthritis (OA), a common breakdown of cartilage. Roughly 20 million Americans have OA. And both glucosamine and chondroitin may help make a protein that builds and repairs cartilage.

What to expect: In the NIH study, 79 percent of people with moderate to severe osteoarthritis pain in their knees found that glucosamine and chondroitin reduced discomfort by 20 percent or more; 54 percent using a placebo got the same results. (People with mild pain got no relief.)

Brent A. Bauer, MD, director of the Complementary and Integrative Medicine Program at the Mayo Clinic, says the finding is reason enough for a patient with regular joint pain to consider several months of glucosamine-chondroitin therapy ($100 to $200 for three months). Both supplements seem to require two to three months to be effective, and Bauer recommends the combination (1,500 mg of glucosamine and 1,200 mg of chondroitin, three times daily) because it’s not clear if one works better. Side effects are mild (gas, soft stools).

To find a reliable brand, check with watchdogs like the U.S. Pharmacopeia or ConsumerLab.com. And don’t dump your ibuprofen or naproxen right away. Take them if you’re hurting, Bauer says, and see if you can cut back as the supplements go to work.

Stand Up to Back Pain

Poor posture can make you achy. Here are the 5 fixes you need.

Are you sitting up straight? Super—because if you slump, slouch, or hunch through the day, you may join the 80 percent of Americans who will suffer from back pain at some point in their lives. Recent research confirms that what you do every day can trigger soreness or spasms. So whether you’re at home Googling for a great deal on Jimmy Choos or sashaying down the street in those heels, you can save yourself some discomfort by babying your back. Here’s how.

1. Forget the salute
“Good posture is not standing like a soldier at attention,” says Arthur White, MD, a renowned back surgeon and author of The Posture Prescription. That General Patton stance puts pressure on the spine. Instead, White recommends standing in a relaxed, balanced manner. And you should check your stance throughout the day—when you’re waiting for a latté, say, or an elevator—and adjust as needed.

That’s what Jean Schatz of Wrentham, Massachusetts, started doing after severe back pain threatened to end her dental-hygienist career. “When I reposition myself, it always feels better,” she says. “I’ve actually had people tell me that I look taller.”

2. Put your feet first
High arches, flat feet: These foot problems, among others, can sabotage your posture and lead to an aching back. Women are particularly vulnerable; they suffer from four times as many foot ailments as men. And narrow, ill-fitting high heels are enemy number one. But doctors agree that custom-made corrective shoe inserts (orthotics) can improve most of these troubles. There are even “dress” orthotics for your pumps. “Orthotics can tilt the alignment into balance and relieve back stress,” says Robert Shmerling, MD, a Harvard Medical School associate professor.

They can be expensive, though—$250 to $400—and generally aren’t covered by insurance. But moderation can help, too. Wear those Choos for meetings and parties, but for extensive walking, slip on comfortable shoes (heels no higher than 1 ½ inches, or 2 inches for wedges).

3. Walk this way
Studies show that walking relieves back pain. But if your posture is poor, you may be taking a step backward instead. Bearing weight on one side or hunching as you walk may cause you pain over time.

Sherry Brourman, a Los Angeles–based physical therapist who specializes in “gait training,” healed her back problems by making a habit of walking the right way. Her advice: Unlock your knees and concentrate on keeping both your ribs and your pelvis “stacked.” Relax your buttocks and pull your stomach muscles into a “soft hold” (no clenching). Your feet should roll from heel to ball. Think balanced, not rigid, and don’t put too much pressure on your heels. Brourman recommends practicing four times a day for 5 minutes until the stance feels natural.

4. Lighten your load
Chances are one side of your body does double duty, from carrying a toddler around to schlepping your laptop home. And playing favorites throws off your posture, which can really strain your muscles, says Daniel Mazanec, MD, head of spine medicine at the Cleveland Clinic Spine Institute.

The best solution: Switch shoulders or hips periodically. Duh, right? But breaking this habit is not always that easy. Try resting your purse on your left shoulder on the way to work, then shifting it to your right shoulder on the way home. Also, whatever you’re carrying, be sure that you keep it as close to your body as possible.

5. Slump less, break more
Between work, Web surfing, and TV watching, you probably spend most of your day sitting, which is murder on your back. Throw poor posture into the equation, and look out. A landmark Swedish study shows that sitting upright increases the force on the spine by 140 percent, compared with standing; slump, and that number rises to 185 percent.

Rules to sit by: Line up head over shoulders and shoulders over hips, rest on your “sitz bones” (the two bones in your rear end), and place feet flat on the floor with legs at a 90-degree angle. And don’t just sit there; take breaks every 45 to 60 minutes to prevent strain, recommends Norman J. Kahan, MD, director of Sports and Occupational Medical Associates in Cupertino, California. He advises getting up and stretching. Neck rolls, chin tucks, and bending back with your hands on your hips can unkink muscles.

Pelvic Pain? Solve the Mystery

Use this checklist to explore the possible reasons—and remedies.

Remember New Year’s Day when you decided to jump-start your weight-loss program—by doing 500 sit-ups? That robo-routine could be the reason for the chronic ache in your pelvis. Then again, maybe not. One in seven women suffers from chronic pelvic pain, and the cause is often a mystery. To get relief, your first step (after the totally legit complaining) should be figuring out what’s wrong. Talk to your doctor about these possibilities, and to rule out ovarian cancer (which is rare):

It’s gynecological. Endometriosis—when uterine tissue grows outside the uterus—could be the culprit; roughly 10 percent of women have it. Also, prolonged pushing, a difficult forceps delivery, or certain types of incisions or lacerations during a vaginal delivery could lead to chronic pain. But don’t just assume it’s a female problem, cautions OB-GYN Andrea Rapkin, MD, director of the University of California, Los Angeles, Pelvic Pain Clinic.

It’s physical. Maybe it sounds odd, but a size mismatch between you and your partner could be to blame. If his penis is big, sex can bruise your cervix or tear the opening of your vagina. An injury from a fall could be responsible, too.

It’s intestinal or urological. Chronic constipation may trigger pain in the muscles of the pelvic floor, and malfunctions such as colitis, irritable bowel syndrome (IBS), and diverticulitis might feel like something more gyno than gastro. IBS is more common in women than men and often includes pain with constipation or diarrhea. Then there’s interstitial cystitis, a chronic inflammation in the bladder that can lead to pain, pressure, and tenderness.

And remember: It’s fixable. The pain may be chronic, but you don’t have to suffer. Experts say all of these underlying problems are treatable. Remedies may include hormonal therapy, antibiotics, pain relievers, antidepressants, counseling, relaxation exercises, physical therapy, or even surgery. And exhale now if fear of a disease like ovarian cancer is keeping you from seeing a doctor; pelvic pain is rarely a symptom. In fact, Rapkin says the chances of cancer being the problem are very low among premenopausal women.

Is That Stomach Pain All in Your Head?

Cut stress and that irritable bowel may disappear.

When bathroom issues put a cramp in your life, the most effective treatment may target both your gut and your mood. A Boston University study found that people with irritable bowel syndrome (IBS) were 40 percent more likely than those who didn’t have IBS to suffer from depression, too. IBS is a common disorder, especially among women. Depression doesn’t bring on IBS, experts say, and IBS doesn’t cause depression.

“But often the two conditions travel together,” says Olafur Palsson, PsyD, an associate professor of medicine at the University of North Carolina. Why? Nobody knows for sure—stress hormones may play a role—but the right remedy may address the connection. If you’ve got chronic gastrointestinal problems, experts suggest the following steps to get real relief:

Keep a daily mood and symptom diary for a week or two, noting any relationship between stressful events, mood swings, and your symptoms. “That way you can present a whole picture to your physician,” Palsson says.

Tell your doctor if you think you may be depressed. And speak up, too, if you’re experiencing headaches or puzzling pain and fatigue. The Boston University study found that irritable bowel also seems to be associated with migraine and fibromyalgia, a syndrome in which people feel overwhelmingly achy and tired.

Don’t be surprised if your doctor suggests a depression medication. Studies show that certain antidepressants actually relieve some symptoms of IBS, particularly abdominal pain. And that’s something to feel good about.

Help for Hurting Hands

Chances are, that achy feeling is nothing serious. Here’s how to find out—and get better fast.

Your hand and wrist ache after working at the computer all day, and they sometimes start feeling numb. Maybe the pain is centered on your forearms. Uh-oh: It’s carpal tunnel syndrome (CTS), and soon you’ll need a date with the surgeon, right?

Probably not. Research in recent years has found that things like typing and sewing rarely cause carpal tunnel, explains Barry Simmons, MD, Harvard Medical School’s chief of hand and arm surgery, who recently edited a special report on the topic. It’s more likely that you have a repetitive-strain injury, caused by overworking the muscles and nerves in your hands and forearms.

CTS happens when a nerve passing through your wrist gets pinched, usually because of arthritis, obesity, water retention due to pregnancy or PMS, or because you were born with a too-small passage, Simmons notes. (See “Car-pal Tunnel, or Just Over-use?” at right for some specific symptoms of both problems.)

The good news: For an overuse injury, you don’t need to go under the knife. Surgery won’t fix the problem, in fact. Try over-the-counter medicine to relieve the pain, and rest your hands regularly. Stay off the computer or limit your use to 20-minute sessions with 10-minute breaks, for example.

Wear splints while you work to keep your wrists from bending too high or low, and use a keyboard tray or adjust your chair so the keyboard and mouse are below your elbows and your wrists are level.

If these steps don’t seem to help, make an appointment with your doctor, who can do specific tests to determine the real problem, and can refer you to a hand specialist if it’s necessary.

Carpal tunnel, or just overuse?

The two conditions can feel similar, but these subtle clues can help you tell them apart.

Carpal tunnel syndrome

–Numbness and tingling on the palm side of the fingers is common.
–Pain may shoot up the arm when you stretch your wrists.
–Pain may wake you up at night or be worse in the morning.
–You may have trouble making a fist, or lose coordination in your fingers.

Overuse injury

–Numbness and tingling appear over the back of the hand, if at all.
–Pain is dull, and usually in your forearms.
–It hurts the worst after the activity that caused the injury.
–You can’t lift heavy objects because your hands feel tired.

Take That! (for pain)

Here’s the latest on over-the-counter fixes.

Menstrual cramps again!? Before you grab another pain pill, check out the chart below. It reveals which of the most common nonprescription pain killers works best for cramps (and a host of other ailments). To get the skinny, Health talked to Richard Dart, MD, professor of surgery, pharmacy, and medicine at the University of Colorado Health Sciences Center, and Leland Lou, MD, associate professor of anesthesiology and pain management at University of Texas Southwestern Medical Center at Dallas. Caveat: You’ve probably heard about heart risks linked to ibuprofen (Advil, for instance) and naproxen (Aleve). Although the risks are decidedly small, recent studies show both may increase your odds of a heart attack if you take more than the recommended dose for four or more days. Still, they’re safe (and naproxen may be safest) when taken for just a day or two. In other words, follow the instructions on the label—please.