Archive for July, 2011

Diagnosis and Treatment of Chronic Low Back Pain

Chronic low back pain in the US is a substantial problem, with 90% of Americans dealing with back pain at some point in time. Considering that 90% of that pain goes away within 6 to 12 weeks, that means at any one point in time that 10% of the US is dealing with chronic low back pain.

How often is chronic low back pain coming from facet arthritis or injury? Somewhere between 30 and 40%, according to the literature.

When diagnosing the source of the pain, a definitive answer can be elusive. History, physical examination, and imaging studies are often helpful, however, an exact pain generator is not always established. And when it is established, it is often only partially correct or just plain wrong.

Diagnostic injections, called blocks, are often performed of the facet joint or its nerve supply to establish facet pain. If the joint is a source of pain, then numbing it should decrease the pain being felt. If it is not, the pain number described shouldn’t change. How accurate are these diagnostic injections?

It used to be acceptable for patients to achieve 50% pain relief from diagnostic facet or nerve supply injections. However, numerous studies have shown that there is considerably more reliability in the diagnosis if the patient receives 80% pain relief. Some insurance companies require 80% pain relief on 2 separate occasions prior to approving a radiofrequency ablation.

One recent study in Pain Physician Journal 2009 showed that if the 80% criteria is used, at 2 years time 90% of individuals still continued to have a diagnosis of facet joint pain. With the 50% criteria establishing facet pain, the same study showed only a 51% maintenance of facet joint pain as a diagnosis.

How well do facet joint nerve blocks work? A number of studies have looked at the effectiveness of injections into and around the facet joints. Unfortunately, most of the studies have been small and/or not randomized. This does not mean the results are invalid, rather, the level of evidence is not as strong as what a larger study would bring.

Results for facet joint nerve blocks (medial branch blocks) have been positive, with an average of 80% pain relief lasting between five and seven months. Studies have also shown beneficial results that when the pain relief wears off, repeat injections work well, or the patient can undergo a radiofrequency neurotomy. Patients noted substantial improvements in overall health status, return to work status, functional, and psychological status.

Compared with low back surgery, facet joint nerve blocks are an extremely cost effective, low risk option for pain relief that work.

Methods For Obtaining Sciatica Pain Relief

When compression of the spine causes painful sensations in the back and gluteal area of the body, the affected person often seeks some form of sciatica pain relief. Sciatica pain affects only one side of the body. However, the painful sensations can extend over a huge portion of the affected side. Sometimes the person suffering with sciatica’s distinctive symptoms finds it almost impossible to walk.

In the past, treatment for this nerve disorder has been prolonged bed rest. Today, however, patients are confined to the bed for only two to three days. During that time, the use of an anti-inflammatory drug is recommended. By taking an NSAID, such as ibuprofen or prescribed codeine, a patient can obtain temporary relief.

In most cases, following two to three days of bed rest, the patient feels ready to engage in some regular periods of stretching. Stretching and warm up exercises help to prevent the development of a sore feeling in the connective tissues. That is a feeling that patients with injured muscle fibers frequently experience.

Stretching serves to eliminate such soreness. It also provides an additional benefit. By acting like a yawn, it relieves tension and helps to loosen the body. Of course, each stretch should be done properly. The patient should move gradually into each position, and then he or she should hold that position for a short time, usually between six to sixty seconds.

A few specific stretching exercises have been recommended. Many call for the patient to lie on his or her back. Once in that position, the patient can undertake a series of different maneuvers. He or she can do leg rolls and a hamstring stretch. The latter movement is also referred to as a knee chest pull. The knee is pulled toward the chest, and then it is held there for 15 to 30 seconds.

Later while standing, the same patient should plan to do some arm swings, some back led kicks and a couple wall stretches. The latter movement calls for placement of the palms on the wall and then a leaning against that vertical surface. In most cases, the combination of a short confinement, followed by performance of daily stretching manages to do away with the painful symptoms and achieve some sciatica pain relief.

If pain persists for more than four to six weeks, then the affected patient could well need surgery. Confirmation of that fact would require performance of a CT scan or an MRI. If those tests reveal the existence of a herniated disc or spinal stenosis, then a portion of the patient’s posterior arch must be removed.

Acupuncture Helps Alleviate Back Pain

Back pain is a very common condition in the U.S. Most people with chronic back pain seek care to alleviate pain. One of the proven therapies is Acupuncture. Several studies have shown acupuncture to be effective in treating back pain.

Many people who have not been exposed to this form of treatment often do not know where to start. I hope to provide a little more explanation of the whats and hows. In addition, I want to provide a few quick tips in selecting the right acupuncturist.

Acupuncture is an ancient form of therapy involving inserting fine (hair like) and sterile needles into specific points in the body. The points used at any given treatment is dependent on the condition and may vary from person to person. The insertion of needle is usually described as a “mosquito bite”. Different strengths of the sensation will be felt at different points, but in general the stronger the sensation, the better the effect. The theory behind acupuncture is to stimulate the body to heal itself. Therefore, there are no side effects and is a holistic treatment in that the treatment guides the body to the root cause of the condition and allows it to heal itself.

From Traditional Chinese Medicine’ perspective, back pain is cause by blockage in the flow of “qi” (or energy). It is understood that the human body has many meridians that energy flows. When a meridian shows resistance for the energy to flow smoothly, it is manifested as different physical conditions – such as back pain. Acupuncture will act as a “traffic light” in that it direct the flow of energy in an orderly way to allow for a complete energy balance.

One should be very careful when deciding to visit a provider. Acupuncture is safe when performed by a qualified and properly trained provider. Acupuncturist are required to obtain licence and show appropriate training and continuing education in order to practice in the United States.

When selecting an acupuncturist, here are several quick and easy tips:

1. Ask to see a current licence from the acupuncturist
2. Ask your doctor for a referral
3. Ask your insurance company for an in network provider
4. Word of mouth from close friends and family

Lastly, as with any other form of treatment, there are never guarantees. However, acupuncture is one of the oldest form of therapy and has survived over two thousand years and helped countless number of people rid of their suffering. If you are suffering from back pain, give acupuncture a try!

Sciatic Nerve Treatments

Second only to the severe back ache associated with sciatica is the hip and leg pain that usually is a second symptom. Sciatic Nerve Treatments that don’t include therapy for your hips and legs are not likely to succeed and that’s a sure thing.

It’s good to remember that treatment for sciatic nerve pain is not a quick-fix. There are no miracles connected with this kind of therapy. When the back ache extends into the hips and legs the agony can be so great that all you really want is to get rid of your symptoms now and not think much of a long-term cure. In short, a lot of people look at the now and never the future. Clearly, however, the very best therapies are oriented toward relieving the reason for the anguish not just relieving the pain for the short-term.

Often, when pains in the hips and legs begin when there is no back ache associated with that pain, a lot of people think is it temporary or, worse, they don’t really take into account the proven fact that there can be a serious reason for this pain. A visit to the pharmacy, some over-the-counter pain medication, for instance, Tylenol or naproxen, and the pain seems to vanish for a while. Apply a bit of heat or some ice to the affected spot and pain of the past, until, that is, it returns with a vengeance.

As there are more than one reason behind hip and leg pain, it is best to seek your doctor’s advice early and not try to self-medicate. You could have a serious issue associated with arthritis, or you will have a torn ligament or torn cartilage. In unusual cases your pain could be triggered by bone tumors. Or you pain may belong to the broad concept of sciatica, abnormal pressure about the sciatic nerve inducing the sensation of sharp, possibly knife-like pain shooting out of your hip to your toes. In short, it is advisable to discover the reason for your hip and leg pain before you self-medicate simply because, usually, there is a specific therapy or group of options that are shown to work with each reason for pain.

Assuming, for the moment, your hip and leg pain is triggered by abnormal pressure about the sciatic nerve. Is that pressure the effect of a herniated or bulging disc? The consequence of spinal stenosis? Or is the anguish caused by an inflammatory reaction of the Piriformis muscle? Knowing the main cause indicates the kind of therapy which will work most effectively for you personally.

When the reason behind your sciatic hip and leg pain is because of a structural defect like a herniated disc, stenosis or perhaps a tumor, surgical intervention is nearly always the correct choice. Today, many procedures can be obtained which are only modestly invasive and some even enable you to walk out of of the hospital the very day of surgery. Your doctor can advise you on the best surgical option.

Many triggers for sciatic nerve pain aren’t, however, structural, rather those are the result of a personal injury or even the inflammation of one or even more muscles in the hips and legs. There are many treatments available to you for coping with the anguish and bringing about a long-term remedy for your pain.

I am in support of choosing the least invasive therapy first and of course, if that does not seem to work, turn to the more radical approaches. Personally, the place to start is with physical therapy. Learning a fundamental set of stretching and strengthening methods for the core muscles of the back and stomach is often all that is required to create an entire cure and avoid any recurrence of the pain. Accompanied by acupuncture, meditation and, even, Yoga, a combination of stretching and meditation, being active is the simplest approach to the situation.

Your doctor may choose to add a muscle relaxant and maybe a pain medication prescription but most will only do if you are actively involved in physical therapy. Prescription pain medication like Ultram and muscle relaxants are for short-term use while learning to stretch your muscles by yourself. When strengthening and stretching your core takes over, the inflammation that was causing your sciatica goes away, there is no longer pressure on the nerve and, as long as you continue the exercise, it really is unlikely to recur.

There are also some herbal therapies that behave as muscle relaxants along with natural ointments that help relax your muscles too.

My point is simple. Get an analysis from your doctor before deciding which of the many sciatic nerve treatments meets your needs. Once you have a diagnosis, work with your doctor to find a treatment or set of treatment plans that you as well as your doctor are comfortable with. Then go out and carry out these therapies. If they’re not working, reassess, and try a rather more radical approach. Reassess and repeat until you find the right strategy to you. Each step of the way is a step toward an answer.

Why Does Prolonged Sitting Cause So Much Back Pain?

As this question stands, the position of sitting should not cause back pain; providing you do not sit in the same position for very long time, or you will begin to feel discomfort either your back or in your buttocks.

This is because your body is designed for movement, so if you do not move after a few minutes; then you will start to feeling uncomfortable in some parts of your body.

It does not mean that you have to keep getting up and sitting down. All your body is asking for is a slight adjustment or movement in your buttocks, so that the area you are sitting on is replenished with saturated oxygen fluid, or these cells will die.

Sitting in one position is known as prolonged sitting and has become an area of particular interest to many people, who sit all day in their productive employment. They are finding that sitting at a computer for extended periods of time is causing them considerable pain and discomforts.

All these people need to understand that they cannot sit for prolonged periods of time without moving. If they do not move, their body will inform them through discomforts in their buttock or spine that they need movement.

Our bodies are not designed to be statues, but we are a living organism that constantly needs movement for keeping us alive, active and healthy for survival in daily living.

In essence our body is a very sophisticated machine that coordinates all areas for rest and activity, so that we can remain alive and active for as long as possible for a comfortable quality of life.

This is how simple life is, but there seems to be serious lack of understanding about we need to move our bodies for different positions.

When we change from an upright standing position to sitting in a chair, the dynamics of our movement changes. Our body’s center of gravity is no longer in the center of our feet, but is now through our pelvic bones when we sit in a chair.

The pelvic bones bones are attached to the base of our spine. You can put hands on one, on each side of your middle below your waist. If you have gained some weight, you may find this difficult to feel under the fat, but they are still there.

The pelvic bones are shaped like a triangle and if you sit on your pelvic bones, you should feel their lowest point of the pelvic bone as you lean back; so that your full upper body weight goes down your spine and into both pelvic bones.

This is your center of gravity for your body in sitting. When you are sitting on your pelvic bones, your spine is vertically straight and no muscles in your abdomen are being used to hold it upright.

Using this pelvic position for prolonged sitting is called the neutral position and is the best position that you can possibly use when sitting in a chair, for any type of productive sitting.

There are many other professionals, such as ergonomic specialist and chiropractors, who want you to sit more forwards, so that you need to purchase equipment for making you more comfortable. This is not necessary, as there is no harm in sitting in the neutral position.

Do Workouts Need to Be Long and Grueling?

Answer me this:

Why is it that there are so many coaches out there who think the way to improve their player’s performance is by throwing them up against the wall every workout till the point of sickness?

Why is it that those same coaches shut their minds to any outside information that serves to go against their ideas of a topic that which they have zero knowledge and background in?

Too many coaches out there think that the lacking factor in their player’s performance is “mental toughness” rather than an issue in poor preparedness in things including technique, tactical preparedness, special strength and power, and poor energy system development to name a few. You know, things a good coach should be able to develop, or at least understand.

Of course just telling your athletes to go run a few miles and some gasers is pretty easy and doesn’t require any thinking…so there’s that…

While the accepted term of “mental toughness” is important in sport, it becomes easily overplayed in today’s common sport training philosophy.

Granted there are some kids who truly lack “mental toughness”, however, occasionally an athlete is only showing that behavior due to the reason that they are already naturally gifted in their sport discipline. Doing things that lesser players are being called upon to do seems meaningless to these athletes because they already know that they are better come game day. This is another reason for the need of individualization in the training process.

When it comes to training myself and designing programs for others, I prefer to urge on the side of under-training. My goal as a physical preparation coach is to provide just enough of a stimulus to elicit the desired biological response.

I often times will have workouts that last only 10-20 minutes. Get in and Get out. This is often times known as density training. Working to improve the amount of work you can do within a given time frame, allows for more of your time and energy to be used towards nutrition, psychological recovery, and biological recovery.

If more coaches were to take the time to learn the basics of athlete physical preparation training, the outcomes for their athletes would be far greater than their current level. If we want to increase the proficiency of our athletes here in America, it is ever important for us to further our understanding of effective training means.

A Simple Exercise to Cure Sciatica

There are a great variety of sciatica exercises for you to choose from, but if your sciatica pain is significant then you will want stick to simple exercises. It is better to stick to a couple of basic exercises than a series of complicated exercises.

To find out which exercises would work well for you. You want to find out if you have sciatica which has been caused by lumbar disc herniation or if you are suffering from pirformis syndrome which creates sciatica like symptoms but is caused by too much contraction by muscles in the buttocks.

The way to find out the difference is to do a few simple tests. While sitting try to straighten your knee on the painful side, until your leg is parallel to the ground. If this causes you to suffer pain, then probably you are suffering form sciatica which has been caused by a disc problem.

If you find you are suffering from real sciatica then you should find relief through the basic McKenzie extension exercise. This exercise is performed by lying face down on a firm surface and then propping yourself up on your elbows, creating an increase in the curve of the lower back. Getting into this position may be painful at first, but within about 30 seconds, most people will notice a decrease in the severity or the range of the sciatica, or both. When the pain is lessening away from the spine you are improving.

Remember the key to finding a remedy for sciatica pain is exercising regularly. Most people can find the motivation to start exercising. The pain itself is a great motivator! But what will make the real difference in your life is the ability to stick with the exercises day in day out forever. Once the pain is gone most people will give up exercising but this is only a temporary respite. The exercise has done its work and the pain has gone but it is only temporary. People who give up exercising at this point often discover the pain returns with a vengeance. The key to true pain relief is consistency.

Exercise is not only great at giving relief to the symptoms it also helps to address the root causes as well. By strengthening the back and abdominal muscles you are less likely to suffer further back pain. As well as this your susceptibility to future pain is markedly decreased.

Massage During Pregnancy

First of all, it just makes sense. Massage therapy during pregnancy is appropriate for tight muscles that are in partial spasm and are producing aching (or sometimes sharp) pain. Stiffness is often present as well. What pregnant woman doesn’t experience this at some point? The muscles are fatigued from working harder while carrying more weight in increasingly awkward positions. And if you have a history of musculoskeletal pain before becoming pregnant, you are more likely to have it during those 9 months.

Now for the first thing you probably didn’t know:

Massage therapy may be covered by your health insurance. Some insurance policies cover it. Some don’t. It depends on whether it it considered a “covered benefit.” And it has to be performed at a healthcare provider’s office who is a participating provider for your health insurance company.

Massage during pregnancy is performed mostly in the side lying position with the use of supporting pillows.

Is it worth the time and trouble to go to a massage therapist during pregnancy?

Absolutely. Massage relieves pain and stiffness. It is a natural healthcare method which relieves the effects of stress and promotes relaxation. Massage makes life easier during daily activities, but it also:

  1. Prepares the pelvis for an easier pregnancy and birth with better muscle tone
  2. Decreases abnormal tension of the muscles supporting the uterus which can cause problems such as abnormal fetal position at birth – especially important if you feel pulling or straining in the abdomen while stretching
  3. Minimizes likelihood of medical intervention with drugs and surgery

Something else you may not know:

Chiropractic care using the Activator Method is a great complement to prenatal massage. Activator Method combined with massage melts away muscle tension like nothing else.

With the Activator Method there is “no cracking, popping or twisting” associated with traditional chiropractic treatment methods. Instead, a hand held instrument called an Activator uses a controlled, fast thrust which is comfortable for patients.

And chiropractic care during pregnancy is safe. Results from a soon to be published study involving several hundred pregnant women receiving chiropractic care indicated no adverse effects. The only complications were slight soreness after the first treatment in a handful of patients which was was resolved by the second visit. These research results were initially presented by Dr. Jeanne Ohm, a chiropractic researcher and instructor (who is also in private practice) at the American College of Nurse Midwives annual meeting in Boston, May 2008.

How To Deal With Elevated Cholesterol

Twenty years ago, rheumatoid arthritis was a condition that was generally progressive leading to increased disability and even early death.

With the advent of newer biologic therapies approximately seventeen years ago, most patients with rheumatoid arthritis will eventually achieve remission.

However, with that success comes a price. Because of the unique mechanism of action of biologic therapies- targeting specific points in the immune system- one of the logical problems has been side effects related to immune dysfunction.

Among these are an increased susceptibility to infection, increased chance of reactivation of tuberculosis, neurologic syndromes, increased insulin sensitivity in diabetics, elevation of blood lipids, and others.

One of the newer class of compounds that will be arriving on the biologic scene are the protein kinase inhibitor drugs. An example is the JAK – 3 group. These drugs block the signaling that occurs between the surface of immune cells and the nucleus of those cells. The end result is a “crippling” of the ability of the immune cell to over react.

What has been encouraging about these drugs are the following:

• They are oral
• They have an entirely different mode of action compared with the other biologics
• They also appear to work in patients that have failed tumor necrosis factor inhibitors

Probably, the JAK-3 drug that appears to be furthest along towards the FDA approval process is Pfizer’s tofacitinib.

There are drawbacks, as expected. Tofacitinib has been associated with changes in liver and kidney function, elevated blood pressure, reduction in white blood cell counts, and elevation of blood lipids. The latter is not surprising since inflammation and lipid metabolism are intimately associated with each other.

The issue has been… “What do you do about it?”

The answer comes from a study done at the University of Glasgow. Professor Iain McInnes, professor of experimental medicine and rheumatology presented a study in which 111 patients with rheumatoid arthritis enrolled in a tofacitinib study were followed. During the open label part of the trial, patients taking tofacitinib received a cholesterol lowering statin drug. The group who received the stain drug had a 35 per cent lowering of blood lipids versus a 5.8 per cent increase in the placebo group.

The findings of the study were underscored by Dr. McInnes assertion that the elevation of lipids seen with tofacitinib could be reversed by adding the statin.

This is similar to the situation where it is sometimes necessary to add a statin to patients taking another rheumatoid arthritis drug, tocilizumab (Actemra), which also elevates lipids.

Capsaicin: Real Pain Relief or Myth?

We’ve seen a huge boom in the quantity, quality and availability of all natural healing remedies for pain (whether temporary or chronic) in recent years. Unfortunately we’ve also seen a big jump in the number of ineffective pain management therapies posing as all natural solutions for pain, making it difficult for many people to sort through what really works and what’s just marketing hype. One of the most touted natural treatment of pain remedies to arrive in recent years has been topical capsaicin treatments. Does capsaicin really work to reduce pain in a safe and natural manner, or is it all hype?

Anecdotal and Clinical Proof

To make it very clear from the start- yes, capsaicin has been shown both anecdotally and within proper scientific studies to work as a natural pain remedy. A study conducted by the University of Oxford tested capsaicin creams with arthritis and neuropathy patients and found that about forty percent of the arthritis sufferers halved the level of pain they were suffering from by using the cream, and over half the neuropathy sufferers replicated those pain relief results with two months of treatment. Capsaicin has similarly been shown to reduce general pain significantly more effectively than a placebo in another study of one hundred and sixty people, and has been used to treat headaches from migraine sufferers.

But what is Capsaicin?

So now that you know that capsaicin has been proven effective as a natural healing treatment, you’re probably wondering what the cream actually is? Simply put, capsaicin is the ingredient that makes chilies and other peppers hot. It’s the component of those foods that causes that “mouth burning” feel and which makes your skin tingle when you come into direct contact with them. While the exact reason why capsaicin works effectively to treat pain hasn’t been proven, most researchers suspect it has to do with the ingredient’s ability to remove substance P from the skin upon contact, which is a chemical within your body that induces the feeling of pain.

The Top Uses of Capsaicin

Because of this capsaicin is almost always utilized as a topical treatment for back pain, neck pain, and other forms of localized muscles pain. Capsaicin cream can be purchased over the counter at pretty much any general store or drug store these days, and is reasonably priced. Pain management with capsaicin is easy enough- all you need to do is directly apply the cream to the source of your pain a few times a day. It usually takes a couple of weeks to begin to experience significant pain relief.

The way that capsaicin treatments are produced these days makes them better for natural healing of localized pain compared with full-body chronic pain. Capsaicin treatments are primarily formulated to deal with extremely localized predictable pains like arthritis or overworked muscles. Considering the prevalence of these forms of chronic muscle pain it’s no wonder that capsaicin is reaching the level of popularity and widespread acceptance that it is. There are no known negative side effects of capsaicin pain relief treatments when they are applied properly, though it’s important to avoid letting the cream come in contact with your eyes or other extremely sensitive parts of your body.