Non-Surgical Spine Care Center Blog

Non-Surgical Spine Care Center Blog

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Sleeping Tips For Back Pain

What is the best way to sleep with lower back pain?

 

bed

  1.  One of the most obvious things to do is to take a good look at your mattress.  If it is too old and sags in the middle, this alone can increase your pain.  Since your bed is the tool that you use to get a good night sleep, make sure that your tool is working the best it can for you.  The investment into a new mattress can sometimes make all of the changes necessary to help you sleep.

  1. Try to avoid lying in bed too long.  Your bed should be for
    sleeping and is designed solely for that use.  Many people prop up pillows to watch television or read and this position can many times cause you problems.  When wanting to read or watch television, utilize a good firm back chair.

  1. Purchase a small support pillow or wedge that they
    put under their low back when sleeping
    .  This tends to help support the natural low back curve and decreases the low back pain, therefore increasing your nights sleep.

  1. Creating a slight distraction will take your mind off of
    the pain and allow you to fall asleep faster
    .  Putting soothing music at a low level or having a sound device that emulates the ocean or rain will allow your mind to relax and put you to sleep faster helping you to forget about the pain.

  1. Do not watch the news or read the news paper prior to going to sleep.  Hearing about the worlds problems will only make you more tense and less likely to get a good nights’ sleep.  Read something that is motivational prior to going to bed to sooth your mind and take your mind off of the pain in your low back while fatiguing your eyes.  Studying about meditation or listening to meditation tapes can also help you to fall asleep.

Trying some of these simple things can be very helpful to not only
being able to deal with your low back pain but are also good exercises in
tricking the mind to relax for a good nights sleep.

If you are experiencing back or neck pain be sure to contact us to schedule a no cost consultation.  Click here to request your consultation!

 

The Truth About Core Training

The idea of core training has become even more popular these days with trainers as well as doctors pushing their clients to strengthen their cores through specific core exercises that have been used over the last 10 years. Now while I’m also a fan of core training, I feel that many clients do not have a great understanding of the core itself.

For years, the core has been promoted as the abdominals and the back muscles. And for years, people have trained the muscles in those areas with multiple methods and devices that claimed they were the best. The problem with this is that the core has been pigeon-holed into the abs and the back when in reality the core is the entire trunk of the body including the abs, back, chest, upper and mid back, and buttocks. Basically the entire trunk if you take out the arms, legs, and head. When you look at the core as this, you recognize the need to train your core differently than what you were previously told.

When looking at this “new core”, think about what it’s responsible for. The core is responsible for stabilizing your spine so that you can make movements around it smoothly. When your core is weak, movements become disjointed and you move very guarded or clumsily. The core also is responsible for transferring forces from end to end and side to side in a way that prevents injury. When your core is weak, your moves from up and down and side to side (or anywhere in between) are unstable and injury can occur. Think about back pain in this way. If your core is weak and imbalanced, certain areas of your spine are now compromised and delicate structures like ligaments and discs pay the price of the faulty biomechanics.

So when training the core, consider your “exercises”. Are you doing exercises that challenge your core stability and strength as a functional unit or are you still just doing crunches and leg raises with a side of planks? Have you ever thought of a push up or squat as a core maneuver? In short, you should. Basic functional body weight movements like the push up, off the wall or on the floor, are a great core exercise in that it challenges multiple muscle groups together as a unit. The squat also forces your core trunk to stabilize in order for you to do the exercise right. When it comes to rehab for back pain, functional core exercises are the way to go in that they mimic real life activity better than a crunch or leg raise ever could. You should be training for both core stability and core strength which leads you to the ultimate goal of core balance

Article provided by Vishal Verma: Non-Surgical Spine Care Clinic Director.

 

 

Prescription Drug Abuse

Deaths from Drug Overdose

The Centers for Disease Control and Prevention has classified prescription drug abuse as an epidemic. The category of drug-induced causes includes not only deaths from dependent and non-dependent use of either legal or illegal drugs, but also includes poisoning from medically prescribed and other drugs.

 

In 1990, the CDC reported that drug overdoses killed roughly 10,000 people. In 1999, it wasdrug overdose deaths 20,000. In 2007 approximately 27,000 unintentional drug overdose deaths occurred in the United States, one death every 19 minutes. Are you seeing the trend?  Prescription drug abuse is the fastest growing drug problem in the United States with this increase in deaths happening in the middle-aged, white demographic. CDC epidemiologist Leonard Paulozzi stated to Congress, “Mortality statistics suggest that these deaths are largely due to the misuse and abuse of prescription drugs.”

 

With 46% of Americans taking at least one prescription pill daily we need to ask ourselves if these drugs are really solving our problems? If so, why is the pharmaceutical industry growing every single year, with some of the biggest, if not the biggest, profit margins of any industry?

 

Prescription Drug Marketing

If you haven’t seen any drug commercials, you are not watching TV. It used to be the majority of commercials were trying to get you to buy a car. That fact may still hold true but these days you can’t get through a set of commercials without being pitched the latest in Restless Leg Syndrome medication or the best new pill to get you to sleep at night.

 

How much money is spent on marketing prescription drugs?  We have all seen the commercials, but that only accounts for a portion of total spending for the marketing of pharmaceutical drugs. Big Pharma spends millions on commercial email, online marketing, and print advertising. It is estimated that the industry spent $12.7 billion promoting its products in 1998.  The resulting estimate of $12.7 billion is high not only in absolute terms but in relative terms.  Among the 200 U.S. industries with the largest advertising expenditures, the pharmaceutical industry ranked 34th, and that was in 1998! The pharmaceutical industry has grown exponentially since then and the commercials have only gotten more rampant.

 

Problems with Prescription Drugs

            One of the main problems is that those prescription drugs you thought were non-habit forming can actually be very addicting. Those prescribed medications you thought could cure whatever ailment you have, might actually cause more side effects. Some will cause addiction and will ruin your life. Others will simply eat up your income producing absolutely no results except less money for you to spend on the things you need.

 

We need to take a step back and look at our lives. Do we actually have problems, or do we only think we have problems because of what some commercial told us? We need to make sure to educate ourselves by reading and researching all of the possible options and procedures available.

 

It is always important to spend some quality time with your physician and have a list of questions to ask them prior to consenting to what treatments are offered to you. A good physician is one that has the ability to educate their patient and the willingness to spend time with the family so that everyone is comfortable with the choices of care.

 

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The Danger of the Nocebo

When dealing with a back injury, most people rarely take into account the words that doctors use to describe the injury. We have all heard of the placebo effect, described by the NCCAM as a beneficial health outcome resulting from a person’s anticipation that an intervention—pill, procedure, or injection—will help them. What most people do not know about is placebo’s evil twin: the Nocebo.

Nocebo is the opposite of placebo. Instead of causing a positive result, it creates a negative or harmful one. Arthur Barsky, a psychiatrist at Boston’s Brigham and Women’s Hospital, found in a recent review of the nocebo literature that patient expectation of adverse effects of treatment or of possible harmful side-effects of a drug played a significant role in the outcome of treatment. Studies have shown that people are likely to get sick if they feel they have been exposed to a harmful chemical or infectious agent. In a recent article in Deutsches Ärzteblatt International, Winfried Häuser of the Technical University of Munich describes how nocebo responses can be brought about by unintended negative suggestion on the part of doctors or nurses informing the patient about the possible complications of a proposed treatment.

Nocebo and Back Pain

One of the most powerful nocebo effects in the field of back pain is when a care provider gives a serious diagnosis. The words “herniated disc” or “degenerative disc disease” do not have any inherently harmful powers of their own. However, the vision that they create in the mind of the patient is devastating. The patient views themselves as permanently damaged and in serious need of drastic treatment. It is no surprise that a patient’s pain gets much worse after a diagnostic MRI result. Nocebo is one of the reasons for the modern back pain epidemic.  Statements from physicians lead patients to a very poor outlook for their future health which can lead to further illness for the patient.

Below are some examples of statements that have caused patients to believe they are worse off than they actually are.

Diagnosis given by a chiropractor:

“Curvature of the spine and muscle imbalance, requiring ongoing treatment.”

 

An orthopedic surgeon diagnosed:

“1 herniated disc, 1 ruptured disc, and severe degenerative disc disease at 3 levels. You will be in care for a long time, maybe forever.”

Another doctor warned:

            “You are in need of surgical correction or you will become disabled.”

 

In all of the above cases, the patient often had increased pain that got worse and worse with every negative diagnosis. As a patient, or the family or friend of a patient, you must be aware that optimism is of the utmost importance for the suffering person involved. This optimism must be established by both the physician and the patient’s family.  It is important to understand the effects of nocebo are very real and debilitating to yourself, your friends, or loved ones. As the great cardiologist Bernard Lown once said, “Words are the most powerful tool a doctor possesses, but words, like a two-edged sword, can maim as well as heal.”

 

Photo courtesy of  www.sxc.hu

The 1,2,3 on DDD (Degenerative Disc Disorder)

What is Degenerative Disc Disease?

Degenerative disc disease (DDD) is thought to be part of the natural process of growing older. Unfortunately, as we age our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The ligaments that surround the disc (annulus fibrosis) may become brittle or more easily torn with age. At the same time, the soft gel-like center of the disc (nucleus pulposus) starts to dry out and shrink. The combination of damage to the intervertebral discs, the development of bone spurs, and a gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the lumbar spine.  Degenerative disc disease occurs in approximately 85% of the population by the age of 55.  Time, injury, or trauma can accelerate the process and make it become much worse.

 

Symptoms of Degenerative Disc Disease

Degenerative disc disease can cause several different symptoms caused by worn out discs not functioning as well as they once did. Symptoms can include neck pain, low back pain, arm or leg pain, and weakness due to compression of the nerve roots. As the discs between the intervertebral bodies start to wear out, the entire cervical and lumbar spine becomes less flexible. As a result, people complain of back pain and stiffness, especially when walking, sitting, standing, or during times of heavy lifting.
The most common symptom of degenerative disc disease is neck or low back pain. When DDD causes compression of the nerve roots, the pain often radiates down the arms to the hands, or down the legs into the feet. In severe cases of lumbar DDD, where there is evidence of nerve root compression, individuals may experience symptoms of cervical brachial pain syndrome, pain that radiates into the upper shoulders, arms, and hands, or sciatica that radiates into the hips, knee, or lower extremity to the feet.  Severe enough pressure resulting in neck or low back disc pressure can also cause numbness, tingling or weakness into the upper or lower extremities.

Diagnosing Degenerative Disc Disease

A routine set of X-rays is usually ordered when a patient with neck or low back pain goes to see a doctor. If degenerative disc disease is present, the X-rays will often show a narrowing of the spaces between the vertebral bodies indicating that the disc has become very thin or has collapsed. Bone spurs begin to form around the edges of the vertebral bodies and also around the edges of the facet joints in the spine. These bone spurs, called osteophytes, can be seen on an X-ray. As the disc collapses and bone spurs form, the space available for the nerve roots starts to become smaller. The nerve roots exit the spinal canal through a bony tunnel located on either side of the vertebrae, called the neuroforamen. It is at this point that the nerve roots are especially vulnerable to compression.

In many situations doctors will order a CAT scan or an MRI to completely evaluate the degenerative changes in the lumbar spine. CAT scans and X-rays are best for viewing the bony structures of the spine whereas the MRI is able to view the surrounding soft tissue such as the discs of the spine.

A CAT scan is often used to evaluate the bony anatomy in the spine. These scans show how much space is available for the nerve roots within the neuroforamen and spinal canal.

An MRI scan is very useful for determining where disc protrusions or herniations have occurred and where the nerve roots are being compressed. However, if a patient has had any metal implants put into their body due to a hip replacement or pace maker, an MRI is not able to be used and the doctor will prescribe a CAT scan instead.

Treatment for Degenerative Disc Disease
Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. For most people who do not have evidence of nerve root compression with muscle weakness, the first line of therapy includes non-steroidal anti-inflammatory drugs and physical therapy. A soft lumbar corset is often prescribed in order to allow the back to have a chance to rest.

Surgery is offered only after all non-surgical options have been attempted, including non-surgical spinal decompression therapy, physical therapy, rest, and medications. If these treatments fail to adequately relieve the symptoms of pain, numbness and/or weakness over a significant period of time, the option of surgery may then be presented to you.

 

Degernative Disc Disorder

Stages of Degenerative Disc Disorder

Important Questions to Ask BEFORE Back Surgery

Back surgeon            Surgery is an important decision to make, especially when it is your back that will be operated on. The patient must always do their homework and investigate for themselves the various procedures available to them, both surgical and non-surgical. It is important to always ask as many questions as you can. You must remember that back surgery in many cases does not work, and sometimes because of underlying conditions, actually leaves you worse than you were before the surgery.  It is for this reason that, with the help of your doctor, all non-surgical back pain procedures need to be exhausted before deciding to have anyone perform surgery on your spine.

When researching your options, it is important to compare your own situation to others who have similar conditions as the one you are suffering from. Many times you will hear a Doctor say that a certain athlete has recently had this same procedure as the one being recommended to you and is back out performing their sport as good as they did prior to the injury. Remember, when comparing yourself with what procedures others have had, always compare with people that are similar to you.  Just because an athlete is doing well does not mean that you, possibly being a senior citizen or someone with many more years of degeneration, will do as well or have any success at all.

Take the time to do a great deal of reading, and again always compare the outcome of what you read to be in relationship towards other people of your same condition and age.  The work you put into your decision making can help you to find the right course of care, either surgical or non-surgical, leading you to less pain and increased function for the future. Before you make a final decision to have back surgery, be sure to ask your doctor as many questions as you can. It is your body and your decision as to what course of care you decide to take.

When speaking to your health care provider about your options to relieve your back pain and increase your function, be sure to ask these important questions:

 

1.      What is your Doctor basing his decision to have you have Surgery over attempting Non-Surgical treatment first?
2.      What is the long term outcome of each of the types of treatment being recommended to you?
3.      What are the safety issues related to the surgical procedure that is being recommended to you?
4.      What are the various non-surgical procedures that I can try prior to having surgery that have shown success with people my age and with my condition?

The above four questions are only a few of the things you should ask your doctor before having back surgery. Be sure to research on your own and clarify anything you are unsure about with your doctor.

If you are having trouble coming up with questions on your own, be sure to download our:

7 Important Questions to Ask Before Getting Back Surgery.

Non-Surgical Sciatica Treatment Options Video 2

This is Part 1 of Non-Surgical Sciatica Treatment Options video series.

See our Non-Surgical Sciatica Treatment Options article for more information.

Non-Surgical Sciatica Treatment Options Video Part 1

This is Part 1 of Non-Surgical Sciatica Treatment Options video series.

If you are interested in reading more, check out our original article on non-surgical sciatica treatment options.

Non-Surgical Sciatica Treatment Options

Before prescribing a sciatica treatment, physicians must first determine the exact cause of the pain. Sciatica pain is often described as a leg cramp, pain in the hip or the lower part of the back, and or numbness in the back of the leg. When the pain is severe, it can hurt to sit in certain positions, to walk, and even to sleep. Many people experience this type of “leg” pain without initially realizing that the source of the pain is actually related to a bulging disk in the spine that is putting pressure on the sciatic nerve. Physicians will administer a series of tests to determine the exact cause of the pain, and then recommend various sciatica treatment options.

Sciatica Treatment Options

Depending on their philosophy, physicians will either recommend surgical or non-surgical treatments for sciatica pain. While surgery may be the only option in severe cases that do not respond to other types of therapy, it is always smart to try non-invasive methods first, to try and prevent potential complications that can arise from spinal surgery.

Rest and Relaxation. Sometimes, the best method for alleviating sciatica pain is to simply rest for at least a few days. Physicians often recommend that over-the-counter medications, such as Ibuprofen, be combined with bed rest. However, in more severe cases prescription muscle relaxant drugs may be recommended.

Steroid Injections (“Cortisone Shots”). In some situations, physicians may recommend that cortisone (or a similar drug) be injected into the affected area. Cortisone, combined with bed rest, is often all that is needed to temporarily or permanently reverse sciatica pain. Pain relief may be experienced after a single shot, but some cases require a series of treatments.

Physical Therapy. It is not always necessary to work one-one-one with an actual physical therapist to help alleviate sciatica pain. Physical therapy can be as simple as stretching, taking short walks, and being as active as possible when the pain is not too much to bear.

Heat and Ice. Hot and cold packs are often recommended to help reduce swelling and to provide relief from nerve pain. Ice is used to numb the areas that are experiencing pain, and heat is used to help speed the recovery process by causing increased blood circulation in the affected area.

Spinal Decompression Therapy. One of the newest methods for relieving pain associated with sciatica is spinal decompression therapy. There is specialized equipment designed to add “negative pressure” to the affected disk(s). This type of therapy is completed over a series of sessions. Spinal decompression therapy is not painful and has produced positive results in many sciatica patients.

In cases where severe pain lasts more than several months, and none of the aforementioned non-surgical treatments have helped relieve the sciatica pain, surgery must be considered. Surgery usually involves removing the disk that is putting pressure on the sciatic nerve. There is always a certain level of risk with surgery, so it should be considered after non-invasive sciatica treatments have been attempted.

Exercises for Low Back Pain

Most of us will experience low back pain at least once in our lifetime. It is a common complaint, and can come from a variety of aggravating factors. It can be mild and “annoying”, and it can be debilitating and prevent one from working and simply performing normal activities of daily living. It is important to see a doctor when back pain is severe, persists or repeatedly occurs.

Staying active, exercising and stretching regularly, is a healthy part of prevention and treatment for most causes of back pain. Having strong stomach, back and leg muscles will better support your spine, taking some pressure off of affected structures. However, not all back and “core strengthening” exercises are created equal.

Some exercises may aggravate back pain. Those especially known to do so include sit-ups, toe touches while standing, leg lifts (lifting legs off of floor while reclined on back), and lifting weights above waist level. Also, those with back pain may differ in natural positions of relief from their pain. Some feel relief when sitting or having their hips in a flexed position. Others feel great relief when standing or arching backward, extending at the back and hips. Exercises that move one toward their more comfortable position are usually more effective in treating pain.

In general, the following exercises are known to be helpful for low back pain:

Alternate Knee to Chest & Hamstring Stretch

Lying on back with knees bent and feet on floor, alternately grab each thigh and pull it in toward chest while keeping the other foot on floor. Hold this stretch for 20 seconds before switching sides, and repeat 4 times. Then grab thigh and extend leg straight up to ceiling feeling a stretch in the hamstrings. Hold this stretch for 20 seconds before switching sides, and repeat 4 times.

Pelvic Tilt

From the same starting position as exercise above, use stomach muscles to pull bellybutton in toward spine pressing the hollow of your back into the floor. Then tilt pelvis, rolling hips and pelvis backward. Hold for 4-10 seconds and repeat 8-12 times.

Abdominal Hollow & Partial Sit-ups

Again, start by lying on back with knees bent and feet on floor. Take a deep breath in allowing chest and stomach to expand (rise). Then, exhale forcefully through mouth while pulling bellybutton in and slightly up toward spine. Hold this contraction for 4-10 seconds before repeating. Repeat 12 times, and do 2 sets.

As strength builds, one can place hands behind head and lift chest a few inches toward ceiling with this same exhale and contraction of abdominal muscles. Do not curl up, but lift as if there were a string from your sternum to the ceiling, and only lift shoulder blades slightly off of floor. Repeat 12 times, and do 2 sets.

Bridge

On back with knees bent and heels only on floor, engage abdominal muscles by doing a pelvic tilt (see above). From there, as if there were a string lifting from your pubic bone to ceiling, squeeze buttocks and lift hips toward ceiling. Hold for 4-6 seconds before slowly lowering back to floor. Repeat 12 times.

Always ask your doctor before doing any exercise for low back pain. Depending on the cause and intensity of your pain, some exercises may not be recommended and can be harmful.

Don’t forget to DOWNLOAD our FREE Patients Guide for more information about treatment options for chronic back and neck pain – it is located on the side of this page.