In the US, this is a way more complicated issue than it is where this conversation took place- Jamaica, where marijuana is often viewed as a cultural staple.

There has been a lot of discussion recently about the changing laws regarding marijuana use for medicinal purposes. Several states have modified or completely rewritten their laws in recent months to either make pot easier or harder to get, depending upon where you live and upon your particular circumstances.

I don’t want to get into the legal aspects of marijuana use- it is far too complicated an issue to get into here. This wedding guest asked me point blank whether I thought pot was useful for the treatment of low back pain.

My answer to this question is in three parts:

1) I think marijuana is a good muscle relaxant, and additionally reduces the perception of pain such that pain sufferers do not notice it as much.

2) Too much marijuana can ultimately decrease your activity levels, keeping you from going out and re-establishing good body mechanics as the source of your pain heals/resolves. And…

3) there is frequently some weight gain associated with pot smoking (the oft cited ‘munchies’ are to blame) which can get in the way of recovery.

I have several patients from around the world who use pot as a method of reducing their pain, and for them it works. I would not condone using something that is illegal, but perhaps that situation will change in the not too distant future. In the mean time, there are several legal alternatives to marijuana- not the least of which would be one of Back Together’s fine products….

Thank you for visiting today. Please keep those cards & letters coming- you help to keep the discussion interesting.

-Andy

Half Moon, Rose Hall Jamaica

Enjoy!

-Andy

The Rosetta Stone at the British Museum

“I woke up a few days ago, and when I got out of bed, I felt something ‘pop’ in my lower back. As soon as I stepped onto the floor, I knew I was in trouble. I had excruciating pain just over my left hip, radiating into the middle of my back.

I saw my GP that evening, and he prescribed something called a Medrol pack, and told me to take it easy for a few days. The medicine has definitely taken the edge off, but it really hasn’t gone away. It feels a little better after I walk around for a while, but I am afraid of overdoing it. How long should I rest it?”

-Stephen

First Stephen- I am sorry you are in so much discomfort, and second, thank you for your question.

That your physician gave you a Medrol Dose Pack suggests to me that you are in a considerable amount of pain. The Dose Pack is a tapering dose of steroids which helps to rapidly reduce inflammation. Now, I haven’t examined you myself, but judging by your description, your pain may be coming from your lumbar spine or your sacroiliac joint. The fact that you feel relief after taking a short walk supports this.

Assuming you have no other issues going on, you should feel slow improvement over the next several days.

As for how long you rest it, that largely varies from person to person. General rule holds true here- if you rest, you rust. Sure you need to give it a couple of days to calm it down, but after that initial acute phase, it is almost always in your best interest to slowly increase your activity levels as tolerated. Reintroduce your daily activities and exercises in a slow, progressive manner, and back off the ones that cause you pain. Your body needs to move, and remaining too sedentary will only cause you to stiffen up, and lose muscle tone. If you continue to feel discomfort ALWAYS follow up with your physician. Remember, your doctor isn’t going to come to you, so even if they’ve seen you- get re-evauated if your pain persists.

I hope this helps Stephen, and again, thank you for your excellent question!

Best,

Andy

There is only one steadfast rule regarding ice & heat: For the first 48 hours immediately following an injury, ice is better. Ice causes some vasoconstriction (the reduction in the diameter of the blood vessels) in the area being treated, helping to reduce swelling and promote healing. It also can partially numb the area for a short time, providing some pain relief.

In this doctor’s opinion, after the first 48 hours, it boils down to a matter of personal preference. Ice provides some of the pain relieving benefits, but heat can help to relax tense muscles- so there are potential benefits to either. Personally, my muscles recoil from cold and send me right into spasm, so I cannot really tolerate ice- so for me it’s heat, but I hear the opposite from plenty of people as well.

The one recommendation I will make here is to limit the time of either. If you are using ice, wrap your bag of ice in a thin towel or napkin so the cold gets applied gradually, and without ‘shock.’ Apply for 20 minutes on, 20 minutes off. With heat, the timing is not as critical, but prolonged heat can cause too much relaxation to the area, will cause vasodilation (an increase in the diameter of the blood vessels in the injured area,) and if there is still some underlying inflammation- could increase swelling. So 20 on and 20 off here is probably a good rule as well.

Hope this helps!

Insurance nightmares…

Last week, I asked you to share with me some of your health insurance nightmares. My wife and I have been dealing with a pretty complicated problem, which thankfully seems to be largely resolving. I am amazed by how many of you have had serious issues with your health insurance. I am preparing a piece or two on this topic- not strictly a back pain thing, but I felt important enough to discuss here on BackWords. Check back.

As always, thanks for visiting,

Andy

Coming soon: Back pain tips for riders of mass transit.

You know the old adage about not assuming things? Well boy is it ever true when it comes to back pain.

The vast majority of back pain is musculoskeletal (originating in the bones & muscles of your back,) but there are some conditions which cause back pain which have little or nothing to do with the back itself. Kidney disease, pancreatic disease, several cancers, and other conditions have back pain as their hallmark symptom.

So what are you supposed to do to help differentiate between run of the mill back pain, and something more insidious? Here are a few pointers, which should only serve as a guideline:

-First of all, if you have back pain (in particular pain which has no clear cause, such as having moved a lot of heavy furniture) which lasts more than 72 hours, go see your physician.

-If your pain is excruciating, don’t wait it out- consult your physician as well.

-If you have ongoing back pain (from arthritis, disc disease- really any idenitfied cause, and the symptoms change in any significant way, for example you suddenly develop sciatica, or other new symptom, consult your physician.

-If you develop incontinence of bowel or bladder, go straight to the ER- do not pass go, do not collect $200. I don’t mean to be glib, but this one is serious, and requires immediate attention. It may seem obvious, but I have had more than one patient who waited several days before telling anyone about this symptom.

-If small movements cause a feeling of ‘electrical shocks’ in your extremities, consult a physician.

These are the big ones which come to mind right now- there are others, but the take home point here is than not all back pain IS back pain, and some is more serious than others. If you have new pain which came from out of nowhere, or you have ongoing pain which has changed in some significant way, you need to be seen by your physician.

Insurance Nightmares…

I am looking for some of your experiences with insurance- particularly those which went less than well. Have you had an insurance nightmare? Please share it with me here- I am preparing a piece on appealing your denial of coverage, based upon a recent horrible experience my family has gone through.

Beautiful sky over Philadelphia last night- Spring is kind of here!

Sciatica is a blanket term for pain associated with the sciatic nerve- the nerve which exits your spine between L5 and S1, and innervates part of your leg. Irritation of the sciatic nerve can cause pain which radiates down the back of the leg. If pain radiates down the front or side of the leg, you are talking about a different nerve.

Now, there are a few things which can irritate this nerve, most predominantly a bulging or herniated disc, or compression of the  nerve by the piriformis muscle. It is this piriformis spasm or piriformis syndrome which is the focus of this stretch. Lets talk about the anatomy for a moment.

The sciatic nerve goes down the back of your leg, through your buttocks, where it passes beneath the short, thick piriformis muscle. The space through which this nerve traverses is kind of small, so when the piriformis is in spasm, or contracts- it reduces the size of the space through which the nerve travels- and compresses or irritates it, causing sciatic pain.

For this stretch, find a comfortable chair without too much padding, and which allows you to sit evenly with good lower back support. Take the painful leg, and cross it over the other, with the ankle resting on the knee of the non-painful leg.

Slowly lean forward with your upper body, resting your arms on your legs, until you feel the beginning of the stretch and then go just a little further. Hold this position for a few seconds, then return to a neutral position.

Repeat this a few times each session for 2-3 sessions a day. Give it a shot- you may surprise yourself how much this simple stretch can help. This stretch should not exacerbate your discomfort. If it does, it is possible that your pain is coming from a different source. If your pain lasts more than a couple of days, and you haven’t had it accurately diagnosed- you should definitely see your physician.

Be well, and have a fantastic weekend!

-Andy

I am on a serious Alphonse Mucha kick- I think I may start Summer painting early this year.

I grew up hearing warnings about cracking your knuckles. “If you crack your knuckles, you’ll develop arthritis when you get older.” So, now that I suffer from back pain, I’ve found different ways to “crack” my spine. For example, I’ve discovered that if my husband hugs me pretty hard around my upper back, I hear a refreshing pop. If he moves up another half inch or inch, I hear another one. If I’m in my car, I can push on the steering wheel and stretch my back in such a way that it cracks. So, what I’m trying to ask is – is this harmful and can it actually lead to more pain or back problems in the future?

-Randi

Thank you for your question Randi.

I get asked this by patients pretty much every day, and I cannot believe it took this long for me to realize I should cover this here- and the answer has two parts:

First of all, let’s talk about the ‘crack.’ Patients have come to expect a loud crack or crunch associated with osteopathic or chiropractic treatment- I can’t tell you how many times a week I hear ‘Doc- I need you to crack my back!’ In fact- with the treatment style I’ve developed over the past decade or so I actually do very little ‘craking’ at all. Some patients actually voice disappointment when they don’t have the satisfaction of the noise announcing that yes, they are cured! Sorry.

That being said, the cracking sound that so many folks associate with treatment is an interesting thing. You can make virtually any moveable joint in your body crack, but that sound should by no means be the goal of treatment. There are lots of thoughts on what is actually making the sound (One of the leading theories is the shift of nitrogen bubbles occurring inside the joint space when a corrective ‘thrust’ is applied.) Anatomically, there really isn’t much of a difference between cracking your knuckles, and cracking your back.

I’ve been a pianist most of my life, and more than one piano teacher told me I would get arthritis from cracking my knuckles, which by that time had already become a habit. I’ve done some research, and there is no evidence that cracking your knuckles, or cracking your back will cause you arthritis or any other problems.

Now, let me qualify that with two provisos: Firstly- I wouldn’t ‘crack’ my back if I were in the middle of a severe flare up of pain- you could irritate an area which is already inflamed, and potentially make your acute condition worse. Secondly- There have been numerous studies that have shown that when you ‘self-correct’ or ‘crack’ your own spine, you are very unlikely to correct the segment which actually needs to be moved. You may get the one above or below it, but you probably won’t get the one causing you discomfort.

I hope this answers your concern. And again, thanks for your contribution.

Be well!

-Andy

The minerals of the Dead Sea, thought to be so good for your joints, are apparently not so good for your bike!

discreplacement2

As I related in the video post, the disc replacement is a relatively new compared to most of what’s out there. It is a pretty elaborate procedure, and the recovery time will vary largely based upon the overall health, weight, age, and fitness of the patient prior to the surgery.

Below is an image of the prosthetic device itself.

One type of replacement disc prosthesis.

Thanks for visiting, in the next installment of this surgery series, I will review the foraminotomy and a brief wrap up. Look for more posts from Israel this week.

Best,

Andy