by Elyse M. Rogers


Judging by the letters and calls I receive from you read­ers, foreigners in Tokyo are an active bunch. And I’m proud of all of you. Particularly since it’s not always easy to stick to a regular exercise program in this city. Playing tennis, squash or even golf is an expensive and often time-consuming chore, even if you love the sport. And even simple jogging has its problems: mapping out a route which doesn’t risk life and limb in Tokyo traffic, and scheduling a time when auto exhausts are pumping out mini­mal pollutants.

But, alas, despite the wonder­ful benefits of exercise, things can go awry. A twisted ankle, sore back or a bad bruise can be the result of improper ex­ercise or sports, or can occur because we try to do too much too fast.

When physical problems re­lating to sports or exercise occur, they often need a special kind of treatment. And, as you might expect, when a new or different kind of special medical need is revealed, the result is a new specialty. In this case, Sportsmedicine. (The official spelling is all one word.)


But what I want to share with you today is a fascinating interview I had with the director of the St. Luke’s Sports-medicine Clinic in Saginaw, Michigan. (Sorry, not Tokyo’s St. Luke’s, but perhaps we can talk them into one later.)

At any rate, Kent Timm, director of the Michigan facility, has a lot of very interesting information for all of us whether we live in the U.S., Japan or anywhere   else on the globe.

Although I don’t necessar­ily believe the adage that “one must experience it to under­stand it and preach it,” there are situations where it definite­ly is better to go for help to someone who’s “been there” so to speak. Which is why Weight Watchers will only hire leaders who have conquered their weight problem, and AA (Alcoholics Anonymous) uses only former alcoholics for dis­cussion leaders and counselors.

So, if an exercise fanatic in­jures him/herself and wants aid from a sympathetic and I’ve-been-there kind of thera­pist, Kent Timm can fill the bill.

Not only is Dr. Timm an athlete now as a skier, a run­ner and a general exercise nut, but he was an excellent hockey player in high school with a good chance at either a univer­sity athletic scholarship or a bid from the pro teams. But that was not to be. After a “career-ending injury” (the good doctor’s own words for it), he had to give up hockey and re-think his career goals. Certainly the citizens of Saginaw, Michigan, would say that Timm’s misfortune has become their gain.

“I decided if I couldn’t play sports, then the next-best thing was to be associated with sports in some other capacity,” he says. And perhaps he also decided he might as well col­lect professional titles in lieu of sports trophies. Because he sure has a list:

1)    PhD in Exercise Science (Columbia University)

2)    Board Certification, Sports Clinical Specialist

3)    Board Certification, Ath­letic Trainer

4)    Board Certification, Back Specialist

5)    Masters Degree in Ortho­pedic Physical Therapy (University of Pittsburgh)

6)    Masters Degree in Sports-medicine   (Pitt)

7)    Masters Degree in Ath­letic Training   (Pitt)

In case you missed it, one of the degrees Dr. Timm doesn’t have is that of a “medical doctor.” Omoshiroi, ne? And there are no medical doctors on actual staff in the clinic although, of course, they are available in the hospital for consultation.

“We are not MDs and we know it,” Timm emphasizes. “We have a good relationship with the area physicians—they know that our main goal is to help them get their patients back to normal as soon as practicing our special exercises.


So I asked Dr. Timm to share some of his views on back problems. Here’s a sampling:

Preventing back problems. “Back problems are easier to prevent than to cure. In fact they are very easy to prevent.” And he tells us how: 1) Main­tain suggested body weight, and 2) Stay in good physical shape.

“Tons of studies” have been conducted, according to Dr. Timm, that show “if your muscles are healthy, your joints are healthy and your cardi­ovascular system is healthy, chances are you will never have a back problem.”

Slipped disc. First he ex­plained that a disc doesn’t actually “slip”; the term is used incorrectly to mean a herniated nucleus pulposus. And in case that doesn’t make it a heck of a lot clearer, let me explain: Between each vertebra in the spinal column is a disc made up of a fibrous outer layer with a jelly-type filling. If the disc begins to degenerate or is injured, the inside jelly-like substance oozes out. It’s the absence (or insufficient amount of) cush­ioning between the vertebra that causes pressure on the nerves and, therefore, pain.

Fortunately, herniated discs are rare because they are so painful that the victim would be in the hospital on his back, unable to move because of the pain. So, Dr. Timm says, what causes most people to have back pain is not a “slipped disc.”

  • One incident will not cause a herniated disc. Despite the tales of “I picked up heavy box and my back went out,” studies have shown disc herniations do not come from a one single injury. (Unless you’ve been hit by a truck or such—that will do it.)
  • Back problems are best prevented by developing a strong back. As mentioned before, general physical fitness and good weight maintenance are the two major preventive factors. “If the back muscles are strong, they will keep the disc in place, stabilizing the vertebra. No special back ex­ercises are needed, any kind of aerobic exercise on a regular basis will do.”
  • Traction is not effective for most back problems. “If a patient truly has a herniated disc it will help by sucking the material back in and reducing the bulge.” In other back prob­lems “traction might help reduce pain but it probably won’t have any long-lasting effects after they’re out of traction.”


Even though most Tokyoites won’t be visiting sports medi­cine clinics in the U.S., the procedure used for evaluation is interesting. In the near fu­ture I think Japanese hospitals and clinics will start similar programs.

1) Complete history. This includes a detailed accounting of the incident that brought on the problem, family history, occupational history (do lifting at work?), health habits, any stress, etc.

2) Detailed physiological evaluation. This includes look­ing at the specific muscles in­volved, the nerves involved, the joints, the discs involved — everything. And to do that they have some extraordinary equipment that is connected to a computer so that a detailed evaluation of the structures and functions of the back (or other parts of the body) can be ascertained.

3) Assessment. Using the objective material available and the subjective evaluation of the health team, “we come up with an assessment of the patient’s situation relative to where he/ she should be to be considered normal or healthy.”

4) Program design. When the assessment is complete, a program is implemented to re­habilitate the patient so that he/she can get back to his previous level of optimum function.

That they take their “success rate” seriously, is indicated by how they define “success.” “We define success as ‘complete re­lief of pain with the ability of the patient to return to his/ her normally required activi­ties’,” according to Dr. Timm.

In other words, an injured high school football player must be able to return to his starting position and be able to play a whole game and do what his coaches want him to do before he’s considered a “success.” Be­lieve it or not, their current rate of “success” is a whopping 90%!


“Warming up properly” is the key to avoiding injuries, according to Dr. Timm. A five-to-ten-minute warm-up ses­sion beginning with stretch­ing and ending with brisk walk­ing or jogging is recommended. “When you’ve started to work up a sweat, you’re ready for strenuous exercise,” according to our expert.

If injuries do occur, the old RICE method is still in vogue. If you remember, “RICE” stands for Rest/Ice/Compression/Elevation. In other words, if you hurt your wrist, stop using it, sit with it on a high­er table, wrap it with an elastic bandage (not too tightly) and ice it down. After 30 minutes, unwrap and allow to warm up for 15 minutes, and repeat again for about three hours if necessary. If the area con­tinues to swell  or pain increases, see a physician.


The program does not come cheap, but those of us in To­kyo are used to that, aren’t we? It’s about $150 (US) (¥22,500 at ¥150 to $1) for the work-up and the same amount for a therapy session. Usually, about a nine-treatment session over 4 to 5 weeks are sched­uled. (After that the patient follows a program at home.) Fortunately, this service is covered by most private medi­cal insurance policies, workers compensation, etc.


Perhaps the most exciting thing about this whole program is the new equipment. Most of the back evaluation and thera­py equipment is made by CYBEX Corporation, and it combines computer evaluation along with bio-feedback for therapy sessions. (So the patient can lift weights and the com­puter will tell him if he’s doing it properly, for example.) The three pieces of equipment at the clinic cost a total of $140,-000, a healthy sum, but rela­tively inexpensive when you’re talking medical diagnostic equipment.

The MERAC unit is at the leading edge of technology right now, and guess what company makes it? Japan’s own Nissan. The clinic boasts that they are the only clinic in the world with two machine; that sit side by side in chrome splendor. These babies cost $40,000 each, and the title ex­plains their use—MERAC (Musculoskeletal evaluation/ rehabilitation and condition­ing).

Now that sportsmedicine is coming of age, exercise and sports should be more enjoy­able than ever. But, heed Dr. Timm’s warning: “It’s the oc­casional athlete that has most of the problems—the ‘Week­end Warrior’ types.” So, let’s get in shape and keep in shape!