An example of how spinal surgery can be overused.....
Showing posts with label Back Pain. Show all posts
Showing posts with label Back Pain. Show all posts
Tuesday, February 14, 2012
Wednesday, December 28, 2011
Treating Back Pain Effectively: We Don't Just Treat the Pain
Nice video from a Physical Therapist at the Jackson Clinics, giving a summary of how PT can help others recover from and manage back pain. He makes a good point that it can't always be prevented, but there are things we all can do to minimize our chances of developing serious back problems, one of which is staying mobile and fit. If you have 2-3 minutes, check this out.
Monday, December 5, 2011
OUTSTANDING ARTICLE
Most will be very surprised when reading this. This is an outstanding article written by Lorimer Moseley, a neuroscientist, regarding some common misconceptions about posture, MRI findings, and core strength, and how they relate to back pain. There is alot still to learn in the research about back and neck pain, and latest research is changing treatment approaches. If you have 5 minutes, check this out - very informative. If you have any questions, shoot them our way.
Monday, October 3, 2011
Is a Standing Desk A Good Idea?
Prolonged sitting is not the best thing for us at all. This article offers some interesting thoughts and ideas on the matter. In summary, we believe what the article proposes at the end, that standing in one place is not the answer, but movement and staying moving as much as possible is a better solution.
Tuesday, September 6, 2011
Thursday, August 11, 2011
AVOIDING SURGERY FOR LOW BACK PAIN: From the American Academy of Orthopedic Surgeons
Click the link below to read an interesting article that summarizes recent research findings about low back surgery. Note: these conclusions were reached by orthopedic surgeons from the AAOS. It makes many nice points, and the last paragraph sums it up pretty well in our opinion.
Avoiding Surgery for Low Back Pain - AAOS
Monday, July 18, 2011
Rolfing: What is it? Can it be helpful for back pain? Read on......
We've had a number of people ask us about Rolfing recently. This article gives a nice explaination of what Rolfing is, and what it is thought to do. The most current research shows that 1)Rolfing should not be the first line of defense in treating or managing muscular and joint pain, and 2) it may provide some benefit as an adjunct treatment for some people (it shouldn't be the main treatment you are doing).
A good point was made in the article that muscle and joint problems are multi-factorial, meaning that there are often a number of reasons why problems are occuring. That is likely one reason why the research behind Rolfing is weak. On the other hand, an abundance of research supports the benefits of physical therapy in improving pain and function. Having pain or a problem? See a good physical therapist!
COURTESY OF NPR
As I open the door to a somewhat antiseptic-looking medical office in downtown San Francisco, I'm quite certain I will not be getting a lavender-candles-and-wind-chimes kind of a massage — the kind that will leave me facedown in my own drool. I expect this to be painful. That's what I've been told anyway.
Greg Brynelson, a certified Rolfer and registered nurse with a loyal following, tells me to lie on my back. Rolfing Structural Integration is a type of deep — really deep — massage that was last popular when Nixon was president. Well, Rolfing has become a favorite again — this time among the yoga-Pilates-acupuncture crowd.
"Through here, it feels like I'm coming up against a wall," he says. "There's not a lot of give."
Brynelson has kind eyes and strong hands. Or thumbs. I think that's what's pressing into my neck.
Rolfing was named after its founder, an American biochemist named Ida Rolf. Her own health problems led her to believe that deep tension — even mild physical deformities in children, like pigeon toes — could be relieved by pressing into a type of tissue called fascia. Fascia fuses skin to muscle and muscle to bone, and it kind of keeps everything in place, like a snug pair of pantyhose.
Slouching over a computer and schlepping around kids can tighten and shorten your muscles, and with them, the fascia cinches down, like one of those vacuum-sealed beef jerky bags. Rolfers, like Brynelson, believe stretching out the fascia — getting it to be more soft and pliable — can improve posture and strength, and over time, reduce aches and pain.
A Closer Look
Since I had just had my fascia flattened, I wanted to see what it looks like. So I head to the cadaver lab in the basement of Stanford University.
Sakti Srivastava, a physician at Stanford's division of clinical anatomy, and I are looking at the fascia on a partially dissected human leg.
"This is what fascia looks like," he says. It almost looks like the thin layer of white film you have after you debone a chicken and pull the skin off of it. If this person had bad posture or a chronic injury, Rolfers say the fascia would tighten, throwing off the person's gait and possibly leading to lower back pain or other aches.
Beyond Fascia
It's a theory that is largely taken on faith, many researchers say. Wolf Mehling is a manual medicine physician at the University of California, San Francisco who treats patients with Rolfing as well as other kinds of massage. Still, he says, it's hard to say if Rolfing can lead to long-term structural changes in the body.
"To my knowledge, there has been no randomized, controlled trials comparing Rolfing with other types of massage or bodywork," he says.
According to Mehling and other researchers, the few studies that have been done are too limited or flawed to draw any conclusions about Rolfing's effectiveness. Rob Landel, head of physical therapy at the University of Southern California, says the philosophy of Rolfing makes sense — if you can loosen up and improve your posture, your overall body movement improves, too.
Indeed, physical therapists are trained to work on soft tissue, like fascia. It's just that they work on other things, too — joints and muscles and ligaments. And that, says Landel, is why Rolfing probably couldn't stand up in a clinical trial.
"I doubt if it will end up being, 'Oh this is The Thing,' because our musculoskeletal problems end up being multifactorial," he says. "So, it's doubtful that any single approach is going to fix everybody."
More likely, Landel says, is that Rolfing could be shown to work for certain problems like low back pain, when combined with strengthening exercises and better posture.
Back To The Back
Which brings us back to my back. After pressing deeply into my right shoulder and neck, my Rolfer Greg Brynelson asks me to stand up and look in the mirror.
"Do you see how the left side is still grabbing?" Brynelson asks. "There's just more softness through here. Do you feel a little more movement?"
"It feels more relaxed, more fluid," I say.
And it's true: One shoulder has an easy, graceful slope. The other is hunched up, like it often is. As I put my shoes back on — a pair of very unorthotic heels — and sling my oversized, overloaded purse onto my shoulder, Brynelson looks at me with pity and resignation. Me and my fascia, it seems — we're a work in progress.
A good point was made in the article that muscle and joint problems are multi-factorial, meaning that there are often a number of reasons why problems are occuring. That is likely one reason why the research behind Rolfing is weak. On the other hand, an abundance of research supports the benefits of physical therapy in improving pain and function. Having pain or a problem? See a good physical therapist!
COURTESY OF NPR
Rolfing Back In Vogue, But With Shaky Evidence
James Gritz/iStockphoto.com Rolfing was named after its founder, an American biochemist named Ida Rolf. Her own health problems led her to believe that deep tension could be relieved by pressing into fascia tissue.
As I open the door to a somewhat antiseptic-looking medical office in downtown San Francisco, I'm quite certain I will not be getting a lavender-candles-and-wind-chimes kind of a massage — the kind that will leave me facedown in my own drool. I expect this to be painful. That's what I've been told anyway.
Greg Brynelson, a certified Rolfer and registered nurse with a loyal following, tells me to lie on my back. Rolfing Structural Integration is a type of deep — really deep — massage that was last popular when Nixon was president. Well, Rolfing has become a favorite again — this time among the yoga-Pilates-acupuncture crowd.
"Through here, it feels like I'm coming up against a wall," he says. "There's not a lot of give."
Brynelson has kind eyes and strong hands. Or thumbs. I think that's what's pressing into my neck.
Rolfing was named after its founder, an American biochemist named Ida Rolf. Her own health problems led her to believe that deep tension — even mild physical deformities in children, like pigeon toes — could be relieved by pressing into a type of tissue called fascia. Fascia fuses skin to muscle and muscle to bone, and it kind of keeps everything in place, like a snug pair of pantyhose.
A.D.A.M. Inc. via U.S. National Library of Medicine, National Institutes of Health Inflammation of the plantar fascia in the foot causes heel pain.
A Closer Look
Since I had just had my fascia flattened, I wanted to see what it looks like. So I head to the cadaver lab in the basement of Stanford University.
Sakti Srivastava, a physician at Stanford's division of clinical anatomy, and I are looking at the fascia on a partially dissected human leg.
"This is what fascia looks like," he says. It almost looks like the thin layer of white film you have after you debone a chicken and pull the skin off of it. If this person had bad posture or a chronic injury, Rolfers say the fascia would tighten, throwing off the person's gait and possibly leading to lower back pain or other aches.
Beyond Fascia
It's a theory that is largely taken on faith, many researchers say. Wolf Mehling is a manual medicine physician at the University of California, San Francisco who treats patients with Rolfing as well as other kinds of massage. Still, he says, it's hard to say if Rolfing can lead to long-term structural changes in the body.
Becoming A Rolfer
Rolfing isn't just for achy adults: babies, the elderly and even horses can all receive it. But to be a real Rolfer, practitioners must be trained and certified by the Rolf Institute of Structural Integration.
Rolfers "come from all walks of life," says Susan Winter, a spokeswoman for the institute. Some are massage therapists or nurses, while others are totally new to bodywork.
The certification program takes a year to 18 months to complete. Students learn about anatomy and ethics, and they receive instruction in the institute's special brand of therapeutic touch.
The institute offers three types of certification: At the basic level, students become Certified Rolfers. Then there are Certified Advanced Rolfers, who have at least three years of experience and completed the 24-day Advanced Rolfing Training course. Rolf Movement Practitioners complete an additional two-phase course that lasts 18 days.
To find a Rolfer who has received the official training, visit the institute's website.
— Whitney Blair Wyckoff
Rolfers "come from all walks of life," says Susan Winter, a spokeswoman for the institute. Some are massage therapists or nurses, while others are totally new to bodywork.
The certification program takes a year to 18 months to complete. Students learn about anatomy and ethics, and they receive instruction in the institute's special brand of therapeutic touch.
The institute offers three types of certification: At the basic level, students become Certified Rolfers. Then there are Certified Advanced Rolfers, who have at least three years of experience and completed the 24-day Advanced Rolfing Training course. Rolf Movement Practitioners complete an additional two-phase course that lasts 18 days.
To find a Rolfer who has received the official training, visit the institute's website.
— Whitney Blair Wyckoff
According to Mehling and other researchers, the few studies that have been done are too limited or flawed to draw any conclusions about Rolfing's effectiveness. Rob Landel, head of physical therapy at the University of Southern California, says the philosophy of Rolfing makes sense — if you can loosen up and improve your posture, your overall body movement improves, too.
Indeed, physical therapists are trained to work on soft tissue, like fascia. It's just that they work on other things, too — joints and muscles and ligaments. And that, says Landel, is why Rolfing probably couldn't stand up in a clinical trial.
"I doubt if it will end up being, 'Oh this is The Thing,' because our musculoskeletal problems end up being multifactorial," he says. "So, it's doubtful that any single approach is going to fix everybody."
More likely, Landel says, is that Rolfing could be shown to work for certain problems like low back pain, when combined with strengthening exercises and better posture.
Back To The Back
Which brings us back to my back. After pressing deeply into my right shoulder and neck, my Rolfer Greg Brynelson asks me to stand up and look in the mirror.
"Do you see how the left side is still grabbing?" Brynelson asks. "There's just more softness through here. Do you feel a little more movement?"
"It feels more relaxed, more fluid," I say.
And it's true: One shoulder has an easy, graceful slope. The other is hunched up, like it often is. As I put my shoes back on — a pair of very unorthotic heels — and sling my oversized, overloaded purse onto my shoulder, Brynelson looks at me with pity and resignation. Me and my fascia, it seems — we're a work in progress.
Wednesday, July 6, 2011
Cortisone (Steroid) Shots: What Do They Do?
Nice article explaining how cortisone (steroid) injections work, and what recent research shows about them. This may or may not surprise you. Good read.
http://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/
Monday, June 27, 2011
SIT UP STRAIGHT TO HELP BACK PAIN: Some Good Tips Here
Cheryl Senter for The New York Times
Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services, has 13-year-old Cassidy do yoga exercises to improve her posture.
EVERYONE wants to avoid back trouble, but surprisingly few of us manage to escape it. Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for such problems as herniated discs, spinal stenosis or lumbar pain.
But back pain is notoriously difficult, and expensive, to remedy.
“The treatments are varied, and we don’t have great science showing what works best for particular patients,” said Brook I. Martin, an instructor of orthopedic surgery at Dartmouth Medical School. “There are questions about the safety and efficacy of a surprising number of therapies, including some types of surgery.”
Those with back pain inevitably end up with higher overall medical costs than those without, studies suggest. Dr. Martin has found that patients with back pain spend about $7,000 annually on health care, while people without back pain spend just $4,000 a year. (Insurers will pay the majority of these costs, but patients often bear some of these expenses in the form of insurance co-payments and deductibles.) These estimates don’t include costs for lost work days or diminished productivity.
Some back problems, of course, can’t be avoided. Over time, spinal vertebrae naturally degenerate and spinal facets become inflamed, causing stress and discomfort.
“The majority of back pain is the result of muscle and ligament strain or weakness, and can often be prevented by developing core strength and proper posture,” said Dr. Daniel Mazanec, associate director of the Center for Spine Health at the Cleveland Clinic.
Maintaining good posture not only helps you look better (there’s a reason inept people are called slouches), it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.
“Posture is the key,” said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services. “If your spine is not balanced, you will inevitably have problems in your back, your neck, your shoulders and even your joints.”
Sitting a little straighter now? Good. Here’s some advice that will help you make it a daily habit and stave off expensive back problems to boot.
THE D.I.Y. APPROACH First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.
There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.
When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.
Maintaining good posture requires abdominal and back strength. “It’s not enough to just sit up straight if your core muscles are weak,” said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one’s core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.
A CUBICLE CURE If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.
If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.
Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.
“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.
Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.
Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.
AN EXERCISE PLAN Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).
The American Physical Therapy Association’s Web site (www.moveforwardpt.com) offers a simple tool that lets you search for physical therapists by ZIP code and specialty.
Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.
If you decide to go out of network or to bypass your insurer, you’ll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.
A CLASS IN POISE If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.
Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.
Try one session to see if it’s for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher’s experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for the Alexander Technique.
Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.
Moral: Sitting pretty yields immediate, not just long-term, benefits
“The treatments are varied, and we don’t have great science showing what works best for particular patients,” said Brook I. Martin, an instructor of orthopedic surgery at Dartmouth Medical School. “There are questions about the safety and efficacy of a surprising number of therapies, including some types of surgery.”
Those with back pain inevitably end up with higher overall medical costs than those without, studies suggest. Dr. Martin has found that patients with back pain spend about $7,000 annually on health care, while people without back pain spend just $4,000 a year. (Insurers will pay the majority of these costs, but patients often bear some of these expenses in the form of insurance co-payments and deductibles.) These estimates don’t include costs for lost work days or diminished productivity.
Some back problems, of course, can’t be avoided. Over time, spinal vertebrae naturally degenerate and spinal facets become inflamed, causing stress and discomfort.
“The majority of back pain is the result of muscle and ligament strain or weakness, and can often be prevented by developing core strength and proper posture,” said Dr. Daniel Mazanec, associate director of the Center for Spine Health at the Cleveland Clinic.
Maintaining good posture not only helps you look better (there’s a reason inept people are called slouches), it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.
“Posture is the key,” said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services. “If your spine is not balanced, you will inevitably have problems in your back, your neck, your shoulders and even your joints.”
Sitting a little straighter now? Good. Here’s some advice that will help you make it a daily habit and stave off expensive back problems to boot.
THE D.I.Y. APPROACH First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.
There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.
When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.
Maintaining good posture requires abdominal and back strength. “It’s not enough to just sit up straight if your core muscles are weak,” said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one’s core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.
A CUBICLE CURE If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.
If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.
Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.
“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.
Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.
Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.
AN EXERCISE PLAN Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).
The American Physical Therapy Association’s Web site (www.moveforwardpt.com) offers a simple tool that lets you search for physical therapists by ZIP code and specialty.
Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.
If you decide to go out of network or to bypass your insurer, you’ll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.
A CLASS IN POISE If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.
Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.
Try one session to see if it’s for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher’s experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for the Alexander Technique.
Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.
Moral: Sitting pretty yields immediate, not just long-term, benefits
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