Archive for February, 2010

New interview by Carl Helvie…

Sunday, February 28th, 2010

Last week, I was interviewed by Carl Helvie for his holistic health show called oddly enough, The Holistic Health Show. Carl is a very interesting man with a really fantastic history. I encourage you to check out his site here, and give his show a listen.

Here is the link to download the show- I am one of four interviews in the show- and if I may say so, they are all good!

Thanks for the nice responses to the second part of my spinal surgery series.

Be well,

Andy

Photo from atop the beautiful Baha'i Garden, Haifa Israel...

Photo from atop the beautiful Baha'i Garden, Haifa Israel…

Mini Series on Spinal Surgery: The Spinal Fusion, and Overview…

Friday, February 26th, 2010

Last week, I gave a brief introduction to spinal surgery, which can be viewed here. In this mini-series, I want to provide a brief overview of these procedures so viewers will have a basic understanding of what’s involved.

Of all of the procedures I want to review in this series, the spinal fusion is the one my viewers seem to be most interested in- likely because it has been around for some time, and many people coming to this site have either had one, know someone who has, or may be a candidate for one in the future.

Spinal fusion is used when an intravertebral disc has been so compromised, that the spinal segment (the combination of the two vertebra, linked by the disc between them) has been destabilized. This destabilization can be painful, as the associated structures of this segment can rub up against the nerve roots at that level- or alter the body mechanics at that level causing irritation to the facet joints (the small joints which articulate the spine.) So patients with this type of compromise can have back pain as well as radicular pain- like sciatica

Like most spinal surgeries, it is usually only considered when all other conservative options have been either tried or ruled out.

In this procedure, the surgeon will go to the spinal segment in question, and ‘clean up’ the area around the disc from debris which may be causing irritation as best as they are able. Then, either utilizing stabilizing hardware or a ‘glue’ made from the patients own bone (A small fragment of the patients bone is harvested, usually from the crest of their pelvic bone, which is crushed into a gravelly mixture.This mixture of live cells then ‘heals’ back into a solid structure) the affected segment is ‘fused’ into a neutral position, resulting in a reduction of pain. Below is an x-ray from a patient whose segments have been fused with hardware.

image of spinal fusion

Recovery from this surgery varies in length depending upon the overall health of the patient, and their level of conditioning prior to the procedure. Most surgeons will tell their patients not to expect the full benefits, for up to a year.

I have a fair number of patients who have had spinal fusion, and many have done well with it. There are patients for whom this is the best option, but it does have its downsides, which can become a larger issue based upon the patients age, and their overall activity level. The two most notable from a mechanical standpoint are:

-A loss of flexibility at the level of the fused segment.

-Because each disc absorbs external stress and shock- the forces which would be absorbed by the fused segment are passed onto the adjacent discs, and may cause premature wear and tear on them.

Because of these two considerations, surgeons began to look at other options to help fix the pain associated with a damaged discs for patients who are more active and wish to maintain the highest level of flexibility. In the next part of this series, we will look at one of these options, the disc replacement.

B.T.T.o.D: Follow a round of golf with a ‘recovery period’ as though you were weightlifting.

Wednesday, February 24th, 2010

If you do not play golf, you probably don’t recognize how strenuous it can actually be. The lumbar spine and shoulders are subjected to tremendous torque, and the whole ‘drive’ portion of the game is a ‘ballistic’ exercise-  meaning there is instantaneous generation of enormous energy.

Be sure to hydrate before hitting the links, and take a few minutes to stretch.

Follow a round of golf with good hydration (not the cocktails you may be tempted to have) a good, high protein meal, and adequate rest to give your body the opportunity to recover (the length of time needed to recover varies from person to person- the simple rule is to wait until most of your muscle soreness has resolved.) This will ensure that you will be able to play throughout the season.

As the weather warms up here in the Northern Hemisphere, look for more tips and articles on getting the most pain-free experience out of Spring-Summer sports.

Enjoy,

Andy

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Partner or Spouse as a Resource for relief from Back Pain

Wednesday, February 24th, 2010

I recently  had an encounter in my office which reminded me why I started to develop my couples-based approach to back pain in the first place…

About three months ago, I was working with a new patient who had been suffering with low back pain & sciatica. She had started to have issues with her blood pressure, and her internist wanted her to stop using anti-inflammatory medications- which were really the only drugs which had been providing her relief. He was concerned about the effect they were having on her kidney function, and consequently, her blood pressure.

I really gave some thought to her situation- she was in pain, she couldn’t take the only meds which were really helping her, and she had blood pressure problems.

From the back pain standpoint, her issues seemed pretty straight forward- she had some problems with the movement of her sacrum, which were surprisingly easy to treat. In about four visits, I had restored normal function to her sacrum and reduced her sciatica & back pain symptoms. I then invited  her husband to join us for her next visit, and taught him some simple sacral mobilization techniques which I asked him to do daily. He had some trepidation about trying to do these techniques, but he left my office pretty much convinced.

There is an interesting phenomena which occurs whenever you manipulate the sacrum- you can stimulate the parasympathetic  portion of your autonomic nervous system, and the result can be lower blood pressure.

Well, after a few weeks of working with her husband, her pain had improved significantly, and when she went to her internist he found that her blood pressure had improved, and he wouldn’t need to add any additional medications. As a bonus, her husband, who had felt helpless to provide his suffering wife with any relief, now felt empowered by his ability to help- and they felt closer than they had in several years.

Donna & I drank the bottle of wine they gave me as a thank you gift last night.

I love when I am able to help my patients with their pain, but there is something so gratifying about being able to pass on this ability to a patients loved one. Ongoing pain can have such an adverse effect on a couple, and sometimes giving a partner or spouse the ability to provide relief can help their pain as well as their relationship. And in this instance, there were even greater reaching benefits.

Sometimes, I really love my work.

Thanks for visiting, and be well!

-Andy

I-Technique 7 Prone Thoracic Release 2

B.T.T.o.D: Keep a diary of your back and neck pain.

Tuesday, February 23rd, 2010

One of the most useful tools for understanding your back & neck pain is the pain diary. Each day, keep a small list of one word descriptions of your activities for the day (office, tennis, groceries, sex, etc…) along with a subjective rating of your pain level (0= No pain, 10= Worst pain ever) both in the morning and in the evening. Over a few weeks, look for patterns in your pain- occasionally you will find simply by changing the order of your week’s activities, or better spacing those activities which cause you the most pain, you can reduce your overall level of discomfort.

Try it- you may be surprised at what you find!

-Andy

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The One Thing: Bob Campbell, Physical Therapist

Monday, February 22nd, 2010

bobcampbellonething

Today, Bob Campbell, Physical Therapist from Rasansky Physical Therapy shares his ‘one thing.’ His clip is based on the observation (shared by many practitioners) that lots of patients will give up on their home exercises once their pain resolves. Remember- most back & neck pain is the result of lots of cumulative effects- and that some of these, if not most, are lifestyle issues. If you do not address the lifestyle issues which caused you back pain after you have been treated, your pain is not likely to stay away for long.

Thanks for checking in,

-Andy

Your are wasting your money going to your Chiropractor, Osteopath, Physical Therapist, etc…

Monday, February 22nd, 2010

I knew this tagline would get someone’s attention. I am not above being a little provocative if it will help me to make a point. So now that you are here, let me tell you a short story, which I was reminded of when editing this weeks ‘The One Thing’….

I was seeing a 32 year old mother of 3 for her back pain- let’s call her ‘Sue’- and after seeing her weekly for about 8 weeks, I managed to get her essentially pain free. We discussed her workout regimen, some home exercises I wanted her to do, some ergonomic things she could do around the house, and a few other things before I sent her home.

When I get someone to the point they are feeling pretty good, my goal is to see them for occasional maintenance, perhaps every 6-9 months- with the option of them coming in sooner if they ever had an exacerbation. I never got into the whole ‘I need to see you every week for the rest of your life’ thing (the exception being some of the professional athletes I work with who put themselves in harms way pretty regularly.) I booked Sue for six months, and she was so happy for her relief.

I came into my office one morning about 3 weeks later, and there was Sue- looking none-too-happy with me.

I asked Sue what brought her in. She had full return of her pain, and was incredibly frustrated by her setback. I didn’t want to discuss this in the waiting room, and scare off other patients, so we went back into the treatment room.

Had she fallen, been injured, over did it in the gym?  No- none of the above- her pain was back and she was pissed.

She got up on my treatment table and I began to palpate her spine. Lo and behold, her spine was right back where we had started. It was as though I had done nothing at all. It was at this point, I pursued a different line of questions….

Had Sue taken any of the ergonomic suggestions we discussed for her house? No.

Had Sue been doing any of the specific exercises I had prescribed to help keep her back moving? No.

Had Sue changed her child care situation to involve her husband a little more, so she wouldn’t be the only one picking them up? Nope.

Basically, she left my office the previous visit feeling great- did none of the things we discussed to help maintain her wellness, and was really annoyed when her pain came back.

Here’s the bottom line: If you are going to a Chiropractor, Osteopath  -or anyone else who does manual medicine or body work- you are wasting your time and money if you don’t address the lifestyle issues which caused your back pain in the first place. Back pain is not just a structural  thing. I talk about the pain triad with many of my patients- that is the essential 3 things which I feel contribute to back pain. They are as follows:

Structural issues: These are what they sound like- problems associated with basic structure and function. These things can usually be measured or imaged with x-rays or MRIs, and they can usually be fixed with manual medicine, therapy, and addressing underlying ergonomic concerns.

Psychological Amplifier: This is the part of your mind which gets frustrated or annoyed with the effect back pain has on your life, and can actually make it worse.

The Learned Neurological Response: This is the part of your central nervous system which controls modification of your normal body mechanics in order to find less painful ways of functioning following an injury or compromise, and sometimes has a difficult time resetting once the structural cause of pain has been addressed.

Almost all of my patients have each of these factors contributing to their discomfort- perhaps to different degrees, but they are all there.

For you to really control your back pain, rather than having it control you- you need to look into each of the components of your back & neck pain, otherwise you will forever be at the mercy of physicians and therapists to find relief from your discomfort- and throwing money out the window. Really- give this some thought the next time you experience an exacerbation. Take your practitioners suggestions and information- and use them!! This is the only way you will find lasting relief.

Best,

Andy

One week to the Philadelphia Flower Show- Spring is four weeks away!

One week to the Philadelphia Flower Show- Spring is four weeks away!

Back pain odds & ends- the Olympics, Chiropractors & Osteopaths wasting your money treating your back pain, viewer fitness updates…

Sunday, February 21st, 2010

Following the Olympics:

I subscribe to google alerts for different stories relating to back and neck pain. This week, I have read about a hundred stories about olympic athletes and their back and neck injuries. If I hear one more interviewer ask the question ‘why do you think so many olympic athletes are having injuries?’ I will blow a cork! Aren’t there better questions they could ask? How about questions about their love lives? What kind of car are they drivin’?

Olympic and professional athletes are training at a much higher level than most of us ever will. Now, I know you are saying to yourself  ”Aren’t they in peak condition? Shouldn’t they have less injuries?” Well, sure they are in peak condition- but if you look,  pretty much all competitive sports (save for maybe curling?) have become ‘extreme sports.’ The overall stats for lifting, jumping, running, endurance- most metrics used to rank athletic performance- have all jumped by leaps and bounds. There are records from Olympic games earlier in the 20th century, where commentators essentially declared that we were approaching the limits of human performance. WOW- how wrong they were! Virtually every major record has been beaten in the past 2 sets of Olympic games. The technology to make us all faster, stronger, better nourished for endurance, and with better performance psychology has advanced so far- but in the end we are all limited by the laws of physiology, and ultimately gravity. As you reach the higher echelons of performance, you are more likely to be injured, regardless of conditioning. Now that being said- the Olympic athletes have access to training and knowledge to help minimize their likelihood of injury- but there is only so much you can do.

Sports Illustrated photo from the Olympics- One of the few photos you will find here I didn't take myself. Please don't rat me out...

Chiropractors, Osteopaths, Physical Therapists, and all the rest- are all a waste of your money!

You may have read my ‘coming Monday’ post earlier in the week. I suppose the search engines latched onto the tag line- because I have gotten a ream of hate mail, primarily from Chiropractors and Physical Therapist. ‘How dare you call my work a waste of money- I help a hundred people a week with their back pain!’

Have you ever been on this blog before? If you read back a few posts and see what I am about you will know that I am not here to bash anybody. How about reading the post first? I am not calling any body a quack- and I am certainly not about to tout my work as any better than yours- wait and give it a read.

Fitness  Challenge Update

People must have thought I dropped the ball on the fitness challenge until they read the post yesterday. Thanks for the updates some of you sent in. I am so glad you are choosing to do this along with me, and hope we can all talk at the beginning of 2011 about how we met the challenge, and lived up to our New Years Resolutions!

Have a great remainder of your weekend.

Andy

Fitness Challenge Update

Saturday, February 20th, 2010

Well, I have been working on this for a little more than four weeks, and I will be honest and say that it has not been easy- I have slipped up on my diet more than a couple of times- but overall I have been doing a pretty good job.

My workout regimen has been pretty consistent since I started- I have been doing cardiovascular exercises  about 5 times a week. Due to the incredible amounts of snow we have had, I have had to limit my cardio to indoor activity- my Nordic Track Skier has seen a lot of action these past few weeks. I have been lifting with free weights about 3 times a week, and using my Gyrotonic Transformer in the office.

I can say that my sleep is better, I feel less exhausted as a result, and as of yesterday I have lost 4 pounds. That winds up being about a pound a week, which is not fast- but here I am going for long term results, not a quick fix.

I have been getting nice updates from some of the folks who are working out with me (virtually.)

I shared a story sent in by Michael M. when I first initiated the challenge- he has been doing fantastically- he has taken steps to modify his diet, and has been working very hard to find exercises which do not exacerbate his pain. I have really enjoyed speaking with him about his efforts over the past several weeks.

I have convinced a few patients to join me on my quest to get back into shape. I have had a couple of people who are working to lower their cholesterol and the fitness challenge is providing them a great opportunity to work toward that goal.

I wil say this- putting this out there: my fitness challenge to myself- has placed a lot of pressure on me. After all, I don’t want to look like a chump, so perhaps talking about it in a public forum is just what I needed for motivation. Folks in my office have been watching out for me, as well as people in my local Starbucks. All I can say is, I better show some results, huh?

I wish any of you joining me in their quest for fitness, the best of luck. If you are doing this for health reasons, the reward will be better health and a better quality of life. If you are doing it in hopes of reducing your back & neck pain- you are likely to reap those benefits as well.

Please continue to share your stories and experiences, and thanks for visiting!

-Andy

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B.T.T.o.D: For practitioners: Change the height of your treatment table regularly.

Thursday, February 18th, 2010

This one is geared largely towards Osteopaths, Chiropractors, Physical Therapists, Massage Therapists, etc…

Throughout your day, vary the height of your treatment table- not only to accommodate the size of your patients/clients, but also to keep your spine from getting acclimated to one position. There are many older practitioners out there with severe kyphosis due to the limited movement of their treatment tables- take advantage of the tools you have available, and change the height of your table throughout the day.

Best,

Andy

I-Technique 14-Sacral Circle 2