The Cleveland Clinic Journal of Medicine has a helpful, authoritative review of back pain, its causes, and advised treatments. Back pain is the second most common reason for doctor visits (after the common cold). I recommend sending it to anyone dealing with back pain.

Some of the key points:

• Most back pain has no recognizable cause and is therefore termed “mechanical” or “musculoskeletal.” Underlying systemic disease is rare.
• Most episodes of back pain are not preventable.
• Confounding psychosocial issues are common.
• A careful, informed history and physical examination are invaluable; diagnostic studies, however sophisticated, are never a substitute. Defer them for specific indications.
• Encouragement of activity is benign and perhaps salutary for back pain and is desirable for general physical and mental health. Evidence to support bed rest is scant.
• Few if any treatments have been proven effective for low back pain.
• Low back pain should be understood as a remittent, intermittent predicament of life. Its cause is indeterminate, but its course is predictable. Its link to work-related injury is tenuous and confounded by psychosocial issues, including workers’ compensation. It challenges function, compromises performance, and calls for empathy and understanding.

I would highlight the fact that exercise is helpful. (You should also exercise when you have the common cold, by the way.)

The last point about empathy and understanding rings true. Last October I woke up one morning with searing, unexplainable lower back pain. It dominated my existence for a couple weeks and I was able to do almost nothing else. I grew more understanding of what some must deal with on a daily basis.

Also, I never do exercises in the gym that come anywhere close to hurting my back. This includes squats. Unless you're extremely well instructed on how to use the weights, avoid back-related movement and stick with bodyweight exercises.

(h/t Andy McKenzie for the pointer)

Will Smith, one of my favorite actors and rappers, tells the audience at the 2005 Kid's Choice Awards that the keys to life are running and reading. The two minute YouTube clip is embedded below. Running because when you run you get tired and want to quit and have to train yourself to fight through the pain and be resilient, and reading because through books you can learn from the people who have lived before you. It's inspirational to hear this message delivered by Smith to a rap beat and interspersed with some riffs on hard work.

(hat tip: Max Marmer)

1. I take four Kirkland Natural Fish Oil Omega 3 pills a day. Each pill has 1000 mg of total fish oil with 300 mg of DHA and EPA each. 1200 mg/day seems to be a good target amount. Here's a page comparing fish oil to flaxseed oil. Here are all of Seth Roberts' posts on Omega-3. Here is Tyler Cowen on his flaxseed oil supplement which he calls "good for his heart, brain, and gums" and says "the Omega-3 ingredient has a scientific consensus in its favor, with no evidence for negative side effects."

2. I'm tracking personal metrics. I'm starting with sleep and exercise. I record in Excel when I went to bed, when I woke up, and how many minutes I exercised. See the article titled You Are Your Data to learn about the burgeoning Quantified Self movement. I hope to track nutrition soon. And maybe one day I will be able to carefully track my time spent on different activities.

3. I'm interviewing local neuro-psychologists to see if they can help me understand how I learn. I am still unsure how I process information best. People with learning disabilities work with these folks. I don't think I have a learning disability but I do think I could do a better job at taking in information in ways that are optimal for my cognitive makeup. I'm also researching SPECT scans, but these have its critics and are expensive.

I'm not a self-improvement maniac. But I am on the lookout for ways to become healthier, happier, and smarter, and all these things seem likely to help in one or all of these fronts.

Thanks to Seth Roberts, Andy McKenzie, Tyler Cowen, and a Child of the Kemp for their direct or indirect advice.

Growing up, exercise equaled sports. I played tennis, baseball, basketball, football, ping-pong, roller-hockey, home-run derby, and others. I eventually realized that if I wanted to get good I had to focus on one and I chose basketball. I started playing year-round, participated on elite traveling teams, dragged my ass out of bed at early hours to do agility and plyometric exercises, and worked near-daily on improving all aspects of my game. Playing basketball I learned a tremendous amount about teamwork, giving and receiving feedback, the importance and limits of hard work, channeling competitive instincts toward a firm goal, and mental focus. After my senior year season of high school I felt burnt out and stopped playing for a couple years.

With the built-in structure and commitment of basketball gone, I had to think about physical fitness in a context other than team sports. It’s not uncommon for athletes to stop exercising altogether when the whip of a coach is absent, but I had no problem jumping into a new self-designed program that would keep me in shape. I went to the gym every day and pursued various cardio and weight exercises. Here’s my post on diversity in your workout routine. Here’s my post on pushups and crunches.

For exercise I think about two things: cardio and strength training. For cardio I do 10-15 mins on the bike (I read light fiction or magazines) and then 20-25 mins on the treadmill (I listen to music and try to just chill out). My strength training is more experimental. Since I’m no longer playing basketball there’s no external need to build muscle mass, so my motivation / interest fluctuates. On its own, increased strength just feels good, lifting weights uniquely relieves stress, and there are aesthetic / attractiveness benefits, too. Due to my frame and biology, I can put on significant upper body muscle mass within a few months if I keep a routine. But it can be a hassle screwing around with the machines.

A few months ago I started up a more vigorous strength training effort. However, instead of going into familiar free weights and machines, I focused exclusively on pushups, crunches, and pull-ups: bodyweight exercises. Because of my weight, these types of exercises have always been hard — ie the more you weigh, the more weight you’re pushing up. My question was: Can I actually get bigger this way or will I just maintain current strength?

My goal was to do 100 pushups a day, every day, and as many crunches and pull-ups as I could do. Within a few weeks I was doing three sets of pushups (35, 35, 30) in 10-15 mins and within a couple months I could do 50-60 pushups consecutively no problem. (There’s a whole movement around doing 100 pushups consecutively.) I felt / observed significant gains in upper body muscle mass. Most important I had no problem doing them daily because anytime I had some time to kill and a floor I could drop down and get it done. Much harder to invent excuses not to do it!

For Christmas my brother got me Perfect Pushup — two circular disks with handles that you put on the floor and they twist as you go down and push up. It stresses slightly different muscles and supposedly is better for your elbows. At the least using them keeps the basic pushup interesting. Again — avoid boredom by introducing variety into your workout.

Nutrition-wise, my basic operating principle is as it’s always been: “Eat as much food as I can.” I’m always hungry. I try to pre-eat before restaurant meals, I try to go to restaurants with known small eaters so I can finish whatever they don’t eat, and I snack / eat Clif bars throughout the day. So quantity hasn’t changed but quality has. Specifically, I have tried to eat more cottage cheese and nuts (solid sources of protein) and move my PB&J’s to wheat instead of white bread (if you eat PB&J every day like me this makes a difference).

So, after three months of a pushup-centric workout routine combined with a little more focus on my intake, I feel as fit as ever. The numbers bear it out. When I stopped playing ball my weight crept up to 220, even 225 pounds, which at 6′ 4″ I could manage but it still felt a little heavy. Now I’m down to 215 lbs which feels more comfortable. My physique is more cut. This involved no weight machines! Granted, bodyweight exercises will only take you so far — to re-introduce variety and push above my weight, I’m for the moment moving back to machines and free weights — but for the casual fitness person I strongly recommend keeping it simple and doing push-ups, crunches, and pull-ups.

Bottom Line: I highly recommend bodyweight exercises if you want a simple, easy, anywhere way to increase overall strength.

Jonah Lehrer has an interesting piece in the Boston Globe titled How the city hurts your brain…and what you can do about it.

He cites research that says "just being in an urban environment… impairs our basic mental processes. After spending a few minutes on a crowded city street, the brain is less able to hold things in memory, and suffers from reduced self-control." Constant stimuli — signs, noises, sights — leave us depleted. What to do? One psychologist says that immersion in nature can have a restorative effect. Walking through a quiet forest area can replenish the focus and attention that city life drained. Even spending time in nature within an urban area — say, a city park — can achieve a similar effect.

Thanks to growing up in the West, I've been lucky to spend a significant amount of time in nature and my personal experience matches this article all the way. I love the hustle-bustle of big cities but crave regular doses of open space, forests, and fresh mountain air. When I'm there — when I'm gaping at the spectacular red canyons of Utah, or on the peak of a mountain in Colorado, or hiking around the Sequoias of California, or simply letting the desert heart swirl around me in New Mexico, heat that comes out of the ground for miles on end, those open plains — when I'm there I enjoy myself, but I really feel the benefit when I've returned to the big city, recharged.

Day-to-day in the city, I think it's important to find those getaway nooks to relax for an hour. Golden Gate Park in SF or Central Park in NY are the obvious options, and they are wonderful. But sometimes, in San Francisco, finding a cement bench facing the water on a deserted road, and letting the foggy odor envelope the scene, can be just the thing.