Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

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Healthy Relationships

Trust, commitment and good communication skills are the foundation of a healthy relationship. Invest in these skills every day, because good relationships improve your health and increase your happiness.


We all have times when we do not make ourselves clear. We say yes when we really mean no. We misinterpret or misunderstand what someone else is saying. We take over conversations. Most of the time, we know when a conversation is not going the way we want it to, but we may not know how to change it. 

Good communication skills can benefit your health and improve your happiness. Practicing new communication skills can make your conversations run more smoothly and help you feel better understood in your personal and professional life.

With practice, you can learn to say clearly what you feel, think, and want. You'll be able to express your likes and dislikes more effectively, accept compliments more graciously, deal with criticism, and say no – all without putting extra stress on your emotions and your body. And because you are communicating more directly, other people are likely to be more responsive to your needs.

Benefits of Good Communication

Communicating more effectively can help:

  • Decrease conflicts and stress.
  • Improve personal and professional relationships.
  • Improve mood.
  • Improve social support.
  • Decrease risk of heart disease, high blood pressure, and a weak immune system.
  • Build trust.

If you are being hit, hurt or threatened by a partner or spouse, call the National Domestic Violence hotline 1-800-799-7233 for more information. 

Don't Be Passive or Aggressive

People generally communicate in three ways with one another: aggressively, passively, or assertively. Assertive communication is the most effective – you stand up for your rights in a friendly way, without being aggressive.

Aggressive responses usually tell the other person "I'm superior and right, and you're inferior and wrong," without saying those words directly. This underlying attitude often makes people feel defensive and increases tension. Aggressive communication is not likely to resolve problems.

Passive responses send the message, "I'm weak and inferior, and you're powerful and right." Passive communication usually leads the speaker to feel a lot of bottled-up anger, resentment, and hurt feelings. Like aggressive communication, passive responses are less likely to resolve problems.

Assertive responses allow both people to say how they feel. It is not selfish to assertively express your beliefs, communicate your feelings, and stand up for your values.

You are communicating assertively when you can:

  • Say what you need and want without violating the rights of others. 
  • Express your personal needs and opinions.
  • Disagree openly without blaming the other person. 
  • Say no when you mean it.

Be Assertive

Being assertive is a great way to get your problems resolved. By saying exactly what you feel and what you want, you make it much easier for the other person to respond to your request. Here are steps to communicate your position assertively:

  • Say what you notice about the situationin an honest and nonjudgmental way.
  • Use "I" statements. For example, say: "I get really upset when you tell people about our private life," instead of saying, "You're always talking about our private life." Talk about how you feel instead of blaming the other person for making you feel this way. 
  • Tell the other person specifically what you need. For example, say: "If you want to share something about our private life, I would like you to check with me first. Can you agree to do that please?"

Learning to communicate differently can be challenging at first, but practice can make it easier over time.

Say "no" when you mean it

Even though saying "no" can be hard, it is an important skill that will allow you to better manage your stress level and your personal and professional responsibilities. If you say "yes" when you really want to say "no," you will likely develop some negative feelings. Here are a few steps to take when you want to say no:

  • Tell the other person that you need some time to think about it. 
  • Practice saying no before you tell the person directly. This way, you can get comfortable saying no, without the pressure of being on the spot. 
  • Remember that saying no to the request is not the same as rejecting the person who is asking. Show that you appreciate their position, but that you cannot meet their needs at this time. You do not need to explain why you are saying no. Offering too much information can weaken your position.  
  • If the person insists, repeat what you said the first time. This is called the "broken record" strategy. 
  • If it feels comfortable, you can offer another alternative. For instance: "I can not go shopping today, but I could go with you on Friday."
Be careful using the words "never" and "always" 

When you talk about how you feel, be clear and only state facts. Do not use "never" and "always," because they are rarely accurate and they do not give the person credit for the times when they do things differently. People like to be recognized when they do things well, rather than hearing only about times when they do not.

Here is an example: Instead of saying, "You never help me with the baby," you might say, "I would really like some help with the baby. When he cries, it would help me if you could check on him too. Having your support would make a huge difference to me. How does that sound to you?"

Or instead of saying, "You're always so loud and rude," say, "I really enjoy having quiet times when we are at home together. When you have the television up loud, it really bothers me. Can we compromise on a volume that we both can live with?"

What Is Your Body Saying?

A lot of what we communicate is through nonverbal body language. We send powerful messages when we smile, make eye contact, touch the other person, frown, look away, or get distracted. Being aware of how we look to the other person is a key component of good communication.

For good communication, your body language and tone of voice should match what you are saying. Some other things to consider:

  • Relax your arms and legs. 
  • Breathe normally in a relaxed way. 
  • Lean forward to show your interest. 
  • Make eye contact. 
  • Stay focused on the conversation. Do not answer the telephone or check your email, for example.

Manage Conflict and Criticism

You can avoid major conflicts if you address minor problems sooner rather than later. Use "I" statements instead of "you" statements to directly address your feelings and point of view. For example:

  • "I am doing my very best," not, "You always criticize me." 
  • "I feel like you are listening to me when you turn down the television while I talk," not, "You never listen to me."

Get back on track if the conversation wanders away from the main issue. For example: "I feel like we are getting very angry and we are not talking about the real problem anymore. Can we get back to what we said we wanted to talk about?"

Take some time out to think if the conversation is going off track and ask the other person to set another time to talk. This way, you can respond at a time when emotions are not as high.

Clarify everyone's position before you respond. If you understand the other person's feelings and position, it makes the rest of the conversation move in the right direction. You can say something like: "Here is what I think you mean…"

Reverse roles. Try arguing each other's position as thoroughly and thoughtfully as you can. Try to win the debate for the other side. This is a great way to understand all sides of an issue and appreciate different points of view. This can also help you develop empathy and tolerance for diverse opinions.

Learn to deal with criticism

Getting constructive criticism gives you the opportunity to develop new skills and lets you know how you can adopt new habits. It all depends on how you view the criticism.
Here are some things to consider when you're criticized:

  • Is the criticism reasonable? 
  • Is there a new skill that you can learn? 
  • Is the criticism based on fact or opinion? 
  • Is the critic open to providing input on how you can improve? 
  • Was there something that you could have done differently to avoid the criticism? 
  • How can you reframe feedback so that it does not feel negative?

In some cases, it is OK to say, "I see your point, but I see it differently." Take some time to think it over and gather more information. If you can find a way to accept the criticism without feeling bad, you will be more able take action to modify your behavior.

Don't Assume the Worst

We often make assumptions about how someone will respond when we have something to say. It is important to be aware of your assumptions and realize that you cannot really be sure what someone will say until you have the conversation. 

For example, Terry wants to tell his wife Sharon that he had a minor car collision. He needs to tell her but thinks that she is going to be very angry at him. He is concerned that Sharon will insult his driving and tell him that he is irresponsible, so he goes home feeling terrible. 

Sharon may or may not get angry, but Terry has already gotten stressed about their interaction. Terry will go into the situation with his guard up since he has already made an assumption about Sharon's response.

Communicating directly about a situation is the best way to state your position and keep things clear. You don't know what people are thinking, just like they do not know what you are thinking. Give them the benefit of the doubt and let them tell you how they feel.

Appreciate Others

Giving compliments and saying thank you are vital nutrients and make people feel great. You can shift the mood of a conversation just by letting someone know you appreciate them. Look for ways to practice praising.

When you tell someone that you appreciate them, be specific so that they know how to repeat the behavior. "I really liked how specific the agenda was. It helped me know exactly what we were going to cover and how much time to expect for each topic."

When you tell someone that they are doing something well, they may seem a bit uncomfortable, but inside they feel good.

When someone gives you a compliment, say "thank you," and let them know how good it makes you feel to hear specific positive feedback.

A sincere apology can help

At times we may say or do things that, intentionally or unintentionally, hurt others. Many relationships are hurt – sometimes for years –because we have not used the powerful skill of apologizing. Often all it takes is a simple, sincere apology to restore a relationship. To be effective, an apology must:

  • Be specific. Say what you did. Avoid glossing it over with just, "I'm sorry for what I did." You might say, for example, "I'm very sorry that I spoke behind your back." 
  • Point out that what you did does not represent how you see yourself or how you want to be. Explain the particular circumstances that led you to do what you did. Don't offer excuses or sidestep responsibility. 
  • Express your sadness, guilt, and shame. A genuine, heartfelt apology involves some suffering. Sadness shows that the relationship matters to you. Guilt conveys that you are truly upset about hurting another person. And shame communicates your disappointment with yourself over the incident. 
  • Acknowledge the impact of wrong-doing. You might say, "I know that I hurt you and that my behavior cost you a lot. For that I am very sorry." 
  • Offer to make amends. Ask what you can do to make the situation better or volunteer specific suggestions.

Making an apology is an act of courage, generosity, and healing. It makes it possible to renew and strengthen your relationship, and it can also bring peace within yourself.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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