Posts Tagged ‘Sciatica’

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A procedure for sciatica, follow up on yoga post…

Monday, July 26th, 2010

rfaetc
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Beth Rifkin was kind enough to submit a response to the yoga post last week. I am amazed by the variety of thoughts and opinions about yoga and how it can effect a variety of health conditions.

The other portion of the video is a response to a question from Trisha in Arkansas about a procedure called radio frequency ablation, or RFA. RFA can be used to treat several painful conditions- but it is not for everyone. Typically, it seems to be most useful for radicular conditions (radiating pain along the length of a nerve)- although many of the physicians doing it will tell you it is useful beyond that relatively small group of pain sufferers. In any case, it seems to be a far less invasive alternative to all out back surgery. I will be posting an interview with a physician who does dozens of these procedures each week in the not too distant future.

Thanks for stopping by!

-Andy

View of the Roman Encampment from the top of Mt. Masada, Negev Desert, Israel.

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Your spine is a metaphor for everything going on in your life….

Wednesday, June 9th, 2010

Many years ago, a cognitive therapist I was working with said something that stuck with me for a long time. She said that the spine is a metaphor for everything going on with your life, the good things and that bad- which is so true, and which lead me to the question I often ask patients: If it is a reflection of the good and the bad, which one are you going to focus on today?

I like to use the analogy of relating the spine to the trunk of a tree. When you look at the rings on a tree, you can see all of the history of the tree. In a museum here in Philadelphia, they have a cross section of one of the oldest elms ever cut down in the city. In it’s rings, you can see where there were fires, years of drought, places where the tree had been struck by lightning- they identified the rings that coincided with all of the major wars. By looking at the rings, you can tell what went on when, and the tree carried all of those ‘experiences’ with it until the day they cut it down.

Your spine is so similar- not that there are rings you can reference, but many of the aches and pains you experience can be tied to events in your life, and stressors happening today can effect all of the things  going on in your spine already. For many people, the spine is the first place their stress goes (In my practice, there seems to be an even split between the spine and the stomach.) For example, if you have a history of low back pain, don’t be too surprised if it gets much worse when you are going through a tax audit. The flip side, is that when you get the big tax refund, you may find that your pain miraculously disappears.

I have one patient with sciatica from her piriformis- I can tell how her business is doing by how tender her piriformis muscle is. If she’s had a lot of sales, I can really move her sacrum. If sales are slow however, I can barely touch her. I am often asked if stress causes this or causes that. I believe that stress doesn’t cause anything- it just takes those things that you already have and makes them worse- sometimes much worse.

It can be a very helpful exercise when experiencing pain to try to think about all of the things going well in your life ( I sincerely hope there is something!) It can become so easy to focus on the pain, and all of the negative ways in which it has effected your life- those are the bad ‘rings.’

Throughout your day, take a few moments to focus on the good ‘rings.’ Your family? Kids? Good experiences? Whatever- try and find it. It has become kind of a cliche to talk about ‘finding your happy place,’ but taking a few minutes to actually find it can get your mind off of your pain, and onto better things.

Be well,

-Andy

The rings in a tree trunk tell you all about the tree's 'experiences.'

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Video: Hobbies & Back Pain- You need something ELSE to think about…

Tuesday, June 1st, 2010

hobbies

Hobbies can be pushed aside when you are suffering from back & neck pain, which is particularly sad as hobbies and passtimes can do so much to restore a sense of normalcy and help psychologically when you are hurting. Think about some of the things you really enjoy, and find ways to bring them back into your daily activities.

-Set aside some time, several times a week to do the things you love. Again, obvious, but we all get so wrapped up in the stuff we have to do, that we often forget to make room for the things we like to do.

-If your hobby exacerbates your pain, perhaps finding an adjunct to your hobby can provide some satisfaction. For example, if you are a bodybuilder dealing with a bout of low back pain, while now is probably not the time to resume bodybuilding- maybe you could train someone else, or better yet- write an article about your experience and send it to me here to post on the blog!

-You may have to modify how you participate in certain activities. In Susan’s case (from the video) she had to take regular breaks while painting in order to remain comfortable. When I had low back pain following an accident, I  found that frequently changing the height of my piano bench helped prevent discomfort. You may need to experiment to find what works.

Our bodies and minds are so tightly linked, that leaving the activities you love behind will most certainly contribute to your pain. It may take some trial and error to find ways to make it work- but do the things you love- you will almost certainly feel better.

Be well!

-Andy

A view of our little patio garden- one of my hobbies.

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Welcome to new visitors: A little about me, Back Together, and the BackWords Blog…

Thursday, May 27th, 2010

Welcome!

I would like to welcome all of the new visitors here at the Back Together Blog- BackWords.

Since the inception of my blog over a year ago, I have been able to watch the slow growth of the site. More and more visitors are coming to the site looking for practical solutions to their back and neck pain.

With the recent surge I’ve observed, I thought this would be a great time to re-introduce myself and the blog, and hopefully encourage you to keep coming back and furthermore, invite your friends and family members to visit as well. You or someone you  know has back pain right now- so pretty much anyone can get something useful from Back Together and BackWords.

A little about me….

Over the past 15 years as a physician, I have had the wonderful opportunity to participate in an ongoing discourse with thousands of patients about ways to lead a better quality of life. During that time, I’ve worked with the young and the elderly. I’ve worked with professional athletes at the peak of conditioning, and the physically challenged. Every single one of these folks, to the last, had something unique to teach me.

I specialize in back and neck pain, but in my quest to help people find relief, I have found that addressing many lifestyle issues has a profound effect not just on pain, but on an overall sense of well being. As I began to dig a little deeper beneath the surface of people’s experiences, I realized that people can do an incredible number of small things, many of which had huge effects.

A little about Back Together…

In my own practice, it became very clear that the effects of back and neck pain don’t stop with the pain sufferer. Their partner’s, kids, family members- pretty much everyone they came in contact with- all were adversely affected by their pain. I developed the Back Together program to provide couples with simple, safe, and effective techniques to  help prevent and relieve back and neck pain. Bringing a partner or loved one into the equation seemed to be one key way to help people to make the lifestyle changes they needed to, in order to rid their lives of back pain. After all- who has more at stake in your well being than your loved ones?

To date, the Back Together program has helped literally thousands of people find relief. Through live programs, my first book Back Together- Hands-On Healing for Couples, and my DVD program, Back Together- I am proud to have been able to have helped so many people so far. But I am only getting started!

A little about BackWords…

I wanted to provide a truly accessible resource for people suffering with back and neck pain. A place where I could provide you insights I have made through clinical observations and practice, update you on new research and studies, and provide you with a place to ask questions and share your thoughts & experiences with others who may have similar conditions.

I have been really pleased with the response so far, but I am always trying to grow and reach more and more people- so as I said before. Someone in your life is hurting right now- send them on in.

Thanks for visiting, and please see all of the ways listed below to get Back Together!!!

-Andy

Click here to visit Back Together on Facebook.

For my Twitter feed, please sign on for BackTips.

Visit my main website for more information about back together.

Submit your questions or comments through this site, or by email to info@backtogether.org.


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Ice versus heat for back & neck pain, sciatica, and other painful areas…

Wednesday, May 5th, 2010

At least a few times a day, patients ask me about whether they should be using ice or heat to help relieve their back pain. It’s a good question, and unfortunately, if you asked 10 doctors, you might get 10 different explanations for why one is better than the other.

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.

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

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When it comes to back pain, make no assumptions, Insurance nightmares

Wednesday, April 28th, 2010

When do you need to consult a physician?

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!

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

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B.T.T.o.D: Back Pain Tips for Students Studying for Finals…

Thursday, April 22nd, 2010

Well, we are fast approaching the end of the school year, and with that comes finals season. Normally, during the rest of the year I don’t see a whole lot of teenagers with back pain, but this time of year I almost always see more high school and college age students who are hurting. As you will hear me say again and again- we simply weren’t designed to sit on our butts all day long. Watch my video tip of the day, then proceed to some other simple tips you can do to help protect yourself (or your kids!) from back pain while studying for finals.

studenttip

To prevent yourself from experiencing back pain when studying for hours & hours & hours….

1) As I said in the video, get up periodically (optimally every 45 minutes or so.)

2) Keep yourself hydrated. Avoid the temptation to use energy drinks, as they will actually leave you dehydrated. Water will help you prevent stiffness, and ultimately if you are drinking enough, it will force you to adhere to (1) above.

3) If you are seated at a computer for studying, make sure your monitor is propped up to eye level (old phone books make a great monitor stand,) and your keyboard is at a height which allows you to have a neutral wrist position (with your wrists flat.) If you are using a laptop, and external keyboard can help you to optimize your position, and they are no longer an expensive proposition.

4) Use a book stand rather than holding onto a heavy textbook which will force you into an anatomically compromised position.

5) If your chair does not have one built in, roll up a small towel or t-shirt to use as a lumbar support. Place it into the small of your back.

These few suggestions may go far in preventing you from having to take finals in pain. I hope they help. If you have any other thoughts or suggestions, please share them with us on the blog.

Best,

-Andy

Photo from in the studio during appearance on Martha Stewart Radio Tuesday.

Photo from in the studio during appearance on Martha Stewart Radio Tuesday.

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Piriformis stretch for sciatica and low back pain….

Friday, April 16th, 2010

Sciatica is one of the most nagging types of pain you can have- it is like a toothache in your leg! Here’s a simple self-stretch you can do to help alleviate it, but before I share it, you should probably understand a little about sciatica…

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

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B.T.T.o.D: For low back pain & sciatica, try crossing the other leg!

Friday, April 16th, 2010

We almost all have a tendency cross one leg predominantly over the other when we are sitting (If I don’t think about it, I almost always have my right leg crossed over my left.) Lower back pain, and sciatica can be worsened by a pelvic shift one way or the other. In much the same way I ask you to switch the side you carry your handbag or briefcase- try alternating which leg you cross, if you do cross your legs at all. This will help to even things out.

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B.T.T.o.D: If you have a choice, push rather than pull when moving a heavy object.

Tuesday, April 13th, 2010

Your body mechanics are such that you place yourself at higher risk for back injury when pulling a heavy object rather than pushing. If you must pull, try to utilize the most stable base you can- utilizing your legs rather than your back.

BT Signature

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