May 26, 2016
"My hands are clumsy and my arm feels weak!"
A narrowed, irritated, or compressed spinal canal in the neck area can cause a variety of problems in the upper extremities. One or both arms, shoulders, or hands may feel weak or not seem to function properly. It can be harder to button a shirt or hold onto things, especially smaller objects. Pain from the neck to the arms and hands may be present, as well as numbness. Even the legs and feet can be affected, causing unsteadiness and the need to hold onto something while walking. It may feel like the brain doesn't quite know exactly where the arms and legs are located in the space around the body. More extreme cases can result in decreased bowel and bladder control.
Depending on your exact symptoms and examination results determined by your orthopedic spine doctor, a diagnosis of cervical (neck) spinal stenosis, cervical spinal myelopathy, or cervical spinal radiculopathy are most likely. These conditions tend to come on gradually because narrowing or irritation in the spinal canal is most common with age-related factors. This includes arthritis, bone spurs, and years of poor posture or other activities that stress the spine. The conditions can also be brought on or exacerbated by trauma such as crashes or serious falls.
Treatment for problems caused by spinal canal narrowing, irritation, and compression is not usually surgical. Medication, physical therapy, injections, posture coaching, activity modification, and ice can relieve symptoms. More pronounced symptoms will need more intervention and for longer, so see your doctor sooner if possible. An orthopedic spine specialist will be able to properly diagnose and treat neck and back problems with great expertise. He or she will approach your concerns with a caring attitude and have the knowledge to create a treatment plan with options for your lifestyle and needs.
October 15, 2015
Why Low Back Pain Keeps Coming Back
Pain in the low back affects millions of people each year. Those with minor pain often don't seek treatment, especially if the pain goes away for a while or is only there during certain activities. People with low-level dull pain may learn to tolerate it rather than get help.
The spine needs a lot of support from the surrounding muscles. When that support isn't working right because of an injury or imbalance, aches, pains, deterioration, and displacement can happen. When it does, it's common sense to refrain from activities that aggravate back pain. This can allow inflammation to subside and along with it, the pain. Taking safe doses of anti-inflammatory medications and using a cold pack can also help. But too often the pain comes back either during a different activity or because the original activity can't be avoided. What's the best way to address the pain when it recurs?
Starting with the right diagnosis from an orthopedic doctor specializing in the spine is the best first step for effective treatment. He or she can help pinpoint the source of the pain and determine whether there's actual damage to structures, inflammation, or even muscle spasms. The doctor will want to know how bad it hurts, what triggered it, and what causes it to hurt now. A health history is also helpful so that the doctor knows about any special limitations they need to consider while treating you. The doctor will also want to know about your goals and lifestyle for returning to health. This can affect decisions about the speed and type of treatment that's best for you.
Less severe back problems, especially those that recur, often respond very well to physical therapy and a regular exercise program designed to strengthen the muscles around the affected area. Injections, medications, activity changes, ice, and rest may also be helpful. More severe back problems are sometimes but not always treated with surgery. Many surgeries can be done with newer, minimally invasive techniques that lessen recovery time and post-operative pain.
July 15, 2015
How effective is adult scoliosis treatment?
Scoliosis is curvature of the spine in the shape of the letter "S" or "C." It affects 2-3 percent of the US population. Many cases don't need surgery or even therapy. Having a doctor monitor the condition is enough for the majority of patients, and most people live perfectly healthy, active lives into adulthood despite having spine curvature. Women are much more likely than men to develop more severe scoliosis as they age. For any patient who is plagued with pain and other symptoms into adulthood, there are treatments that can help get them back to a healthy life.
Reducing pain is the main goal in treating adult scoliosis. This can be done using a combination of oral or injected medication, if necessary, and strengthening exercises. Physical therapy can be very effective, and aquatic therapy is also an excellent option. Doing strengthening exercises in a pool greatly reduces the stress on the spine. This allows patients to achieve better strength results with little to no pain.
Manipulation of the joints can also help keep mobility at high levels. It's recommended it be done only by a board certified orthopedic doctor specializing in the spine, because the neck area must be manipulated correctly in order to avoid injury. Bracing may be prescribed, but only in very rare cases to restrict movement and reduce stress on the spine.
For patients who do not respond to nonsurgical treatment, surgery may be recommended. Recovery from scoliosis surgery can take several months to a year. For that reason, only patients whose symptoms are keeping them from performing their daily activities are considered for surgery. A patient's overall health, their age in some cases, and their bone quality are also factors in deciding whether surgery is a good option.
May 14, 2015
Leg and back pain: Sciatica OR Piriformis Syndrome?
The sciatic nerve is the biggest and longest nerve in our bodies, made of five nerves that come together in the lower spine and run down the back of the legs to the toes. It's as big around as an adult's thumb at its widest point.
Since it goes through so many active parts of our body, it can get compressed or damaged in different ways. This results in a variety of conditions. Two of the most common are sciatica and piriformis syndrome. Here are the basic differences:
Sciatica pain starts in the low back and radiates down the leg. It's caused by bulging discs in the low back that compress the sciatic nerve. Bending forward usually makes the pain and the condition worse. Treatments focus on getting the discs to go back into place by strengthening the core and reducing inflammation in the area.
Piriformis syndrome pain stays in the hip and buttock area and does not usually radiate further. It's caused by inflammation in the piriformis muscle deep inside and toward the back of the hip. The sciatic nerve runs close to, or in some people, right through this muscle. When it the muscle swells, the nerve gets compressed and causes pain. Treatments focus on reducing inflammation of the muscle and stretching it.
With both conditions (and like most orthopedic problems) surgery is usually not necessary. You and your orthopedic doctor can discuss all the options for you and find a treatment plan that works with your lifestyle and fitness goals.
March 26, 2015
"I have headaches. How can an orthopedic doctor help me?"
Headaches and other symptoms can be signs of neck problems. Because the neck is made to move the head in many directions, it's also vulnerable to wear and tear and degeneration from aging, pinched nerve issues, herniated discs, and injuries such as whiplash and trauma from sports and falls.
Common symptoms of neck problems include:
• neck pain
• pain radiating down the back and into the arms
• difficulty moving the neck in some directions and/or to full rotation
• stiffness in the neck
• muscle weakness in the hand, arm, or shoulder
• tingling, numbness, or prickling sensations in the hand, forearm, or fingers
In less common cases, bladder and bowel issues and changes in walking can occur from a problem in the neck. This usually requires immediate medical attention.
An orthopedic doctor is well-trained and experienced in diagnosing problems stemming from the neck area. He or she will take a full health history, ask several questions about your current symptoms, and perform a thorough physical exam. The orthopedic doctor is also likely to use neck and reflex testing and MRI and/or x-ray imaging to determine the cause of your symptoms. Once a diagnosis is found, the doctor can help you understand your particular condition. Together, the two of you can plan the right treatment course for you and any of your family members who will be affected by your care.
Treatment for symptoms from neck problems is usually nonsurgical. Patients who receive medication, injections, physical therapy, hot/cold treatments, or even a pressure-relieving collar can experience improvements in a short time period. For those who don't respond to nonsurgical treatment or have a more serious problem, surgery may be the best option. There are a variety of effective surgical techniques and procedures available.
January 9, 2015
"I have back pain! At what point should I see an orthopedic spine doctor?"
The most common cause of back pain is "axial" in nature: it comes on after doing a certain activity or sport, or sitting for long periods. It feels dull or achy, but the pain is tolerable. It is relieved by rest and doesn't require much, if any, special effort to get rid of it.
Other types of back pain don't adhere to these same patterns. They might also feel dull or achy but perhaps don't go away with rest. They might also have happened after a certain sport or activity but they get worse instead of better. Some back pain travels down to the buttocks down the leg, or out to an arm instead of staying in the back. Pain might feel more intense or "shooting" in nature. It interferes with daily activities and exercise. These are all indications that something more serious may be going on.
An orthopedic spine doctor is often the best first stop when any of these things are occurring. They have specialized knowledge about the spine and how all the body systems work together. They can identify the root causes of back pain with a careful, in-depth examination, by taking MRI and/or x-ray images, and by getting your health history. Once a diagnosis is clear, you and your doctor can decide on a treatment course that will work for you. Together you'll set goals and even though every recovery is different, your doctor can help you set expectations for returning to normal life and your favorite activities.
Treatments for back pain vary widely depending on the situation. Most people don't require surgery but instead benefit from activity modification, anti-inflammatory medications, injections, or physical therapy. When surgery is necessary, advanced surgical techniques offer minimally invasive ways to fix, reconstruct, or even regenerate areas of the spine. (Orthopedic doctors are also called orthopedic surgeons because they do perform surgery sometimes, but only on a very low percentage of the people who see them. They're actually doctors who specialize in orthopedic problems and often sub-specialize in a particular area, in this case, the spine.)
October 23, 2014
What are the best types of beds and pillows for keeping your back healthy? Watch this short video clip to see Tiffany Rogers, MD, MPT give the expert's answer.
August 14, 2014
Does your lower back seize up?
There are several reasons someone can have lower back pain. Muscle spasms, which are spontaneous, involuntary muscle contractions, are a particularly painful type. They are usually caused by a sudden twisting-type injury and are followed by immediate acute pain, although sometimes the pain can take longer to set in. Muscle spams can also be a symptom of an underlying problems such as tendon or ligament tears, or a stressed or injured spinal column.
An orthopedic spine doctor can diagnose whether the muscle spasm is simply that or something more complex. Once the right diagnosis is reached, the right treatment can be given. For muscle spasms not caused by underlying problems, the treatment can include anti-inflammatory medications, physical therapy (with an emphasis on strengthening the core muscles), and ice or heat.
June 19, 2014
Young Athletes Can Protect Their Spines
When athletes ages 11-17 have low back pain, the most common cause is a fracture of the pars interarticularis, which is part of the vertebra bone. Genetics can play a role in predisposing a young athlete to this type of fracture, but overworking the area in sports is the main culprit. Volleyball, gymnastics, football, and weight lifting are among those often reported.
When the pars is fractured, the condition is called spondylolysis. Treatments include taking a break from the activity causing the back pain, anti-inflammatory medication, physical therapy, and wearing a back brace. Rare cases may require surgery.
Prevention is key to young athletes having a fulfilling sports experience. Some basic tips include resting (even bones need time off!), wearing proper footwear so torque and deceleration don't overload the spine, stability exercises to strengthen the core muscles and improve stability, and improving hip mobility, which is connected to healthier spine movement.
March 26, 2014
SHORT HOSPITAL STAYS AFTER SPINAL FUSION
Spinal fusion is surgical procedure that permanently connects two or more vertebrae in the spine. An orthopedic surgeon may recommend fusion to fix broken bones, stabilize the spine after the removal of a herniated disk, relieve chronic back pain, fix spinal deformities, or correct spondylolisthesis.
During spinal fusion, the surgeon places bone or a bone-like material in the space between two vertebrae, and metal plates, screws, and rods may also be used to hold the vertebrae together. Depending on the extent of the procedure and spinal segments fused, most patients spend 2-3 days in the hospital after the procedure.
Pain and discomfort may be experienced afterward, but the symptoms are usually well-managed with medication. It may take several months for bone healing or fusing to occur. The surgeon may recommend wearing a back brace, use of a bone stimulator, and physical therapy as part of rehabilitation.
To see a comprehensive video about back pain and the variety of options that can be used to treat it, watch this video: https://www.youtube.com/watch?v=CB-WkUdJdQU
Tiffany Rogers, MD, MPT is a fellowship trained board certified orthopedic doctor and surgeon. She treats back pain in a variety of ways, the least common of which is surgery. Dr. Rogers has a degree in physical therapy in addition to being a medical doctor. This gives her more complete knowledge and experience with spine problems.
February 4, 2014
Helping Osteoporosis of the Spine: Vertebral Compression Fractures
Osteoporosis of the spine causes damage and weakening of the vertebrae bones. As people with osteoporosis age, even everyday activities and minor missteps or falls can cause small fractures in the vertebrae. The waistline area or just above it are the most common sites for these fractures. Most fractures of this type are not painful, but some do cause pain and/or misalignment, and they require an orthopedic doctor's care.
Non-surgical therapies include pain medication and bracing. Depending on the underlying cause and severity of a patient's osteoporosis, there may still be a chance of more fracturing, even with these treatments.
Kyphoplasty and Vertebroplasty are minimally invasive surgical procedures that strengthen the fractured vertebrae by adding bone cement inside them. Kyphoplasty uses a ballon to inflate a damaged vertebra, which reshapes and realigns it, before filling it with the bone cement. Vertebroplasty injects bone cement into a vertebra to provide stabilization and strength, but does not address reshaping or realignment issues in the same way as Kyphoplasty.
In both procedures, the patient can usually remain awake but sedated or treated with a local anesthesia. Careful study of each patient's compression fractures can help an orthopedic physician advise if either procedure is appropriate.
November 6, 2013
Slipped Vertebra—A Trip to the Operating Room?
Degenerative Spondylolisthesis (DS) is a condition described as a vertebra slipping forward out over the vertebra below it. DS is caused by the weakening of the joints due to degenerative changes such as unstable ligaments. The most common sites are in the lower back at the L4-L5 and L5-S1 levels.
DS typically affects individuals over 50, women more than men. Back pain is the most common symptom, and causes vary. Pain tends to increase with lifting, prolonged standing, and walking up stairs and inclines.
Surgery is rare. More common treatments include activity modification, bracing, physical therapy, and medication. Surgery is recommended if non-invasive treatments fail or if nerve damage is an issue.
October 22, 2013
Is Your Spine Making Your Leg Hurt?
WHAT IS SCIATICA?
Sciatica is characterized by low back and buttock pain that radiates along the back of the thigh and sometimes to the toes. Numbness and tingling along with limited trunk range of motion can also present. People will sometimes complain more of leg pain versus low back pain. The pain can be described as dull, aching, or sharp. As we get older, changes occur in our spinal discs. In a herniated disc, the material inside the disc bulges against the spinal ligament.
WHO GETS IT?
This condition is commonly seen with people between the ages of 40-60.
HOW DO YOU GET HELP?
Treatments include short-term bed rest, physical therapy, medications and in rare instances, surgery. Statistics show that the condition resolves within 2-4 months with non-invasive treatment. Only a small number, about 2%, of patients will undergo surgery.
September 23, 2013
Do orthopedic surgeons always want to operate?
An orthopedic surgeon is first and foremost a medical doctor who helps patients get better. Most of the time that doesn't mean actually having surgery. The doctors at TOSMG estimate that for every patient who comes to them with orthopedic problems, less than 1 in 10* will actually have surgery. So what happens to the rest?
Physical therapy, rest, ice, anti-inflammatory medications, changing habits, injection therapy, and stretching are among the most common prescriptions for our patients. It's only when a combination of these more conservative treatments fail that surgery may be suggested. But the simple fact is that most people get better without it.
*Estimate only. Does not include patients who are referred for a surgical consultation, meaning that another doctor has already determined, and that the TOSMG doctor agrees, that the patient needs a highly trained, expert orthopedic surgeon in order to get the best outcome.
August 19, 2013
AS is a systemic condition leading to the inflammation of the spine and sometimes larger peripheral joints like hips, shoulders, and knees. The chronic inflammation can lead to the destruction of ligaments and causes ossification (bone growth) in the joint. The cause is unknown but research points to possible genetic and environmental factors.
Symptoms of AS include recurrent episodes of low back pain, morning stiffness, and limited back extension over a 3-month period. When/if the condition progresses the pain becomes more consistent and severe, and it can eventually affect the upper back and neck.
Management for AS can be in the form of anti-inflammatory medications and physical therapy for postural training, strengthening, and stretching. High impact activities and exercises that cause excessive flexion/bending are highly advised against. Surgery is rarely performed.
August 5, 2013
Strengthen your core!
Most people think of abdominals when they hear the word core. The core consists of muscles of the abdomen, pelvis, low back, and hips.
Core exercises are important in order to maintain balance and stability. Gym equipment is not required to keep your core strong. Any exercise that involves the use of abs and back muscles in a coordinated manner counts as a core exercise.
Example: A simple bridge is a great way of strengthening all of the core muscles. Simply lie on your back with the knees bent, keep your back in neutral spine. Then tighten your abs and squeeze your buttocks as you lift the hips off the floor. Make sure to breathe out when you lift your hips and breathe in when you lower them.
January 21, 2013
Did you know that tight muscles can cause headaches?
Chronic muscle tension can be due to bad posture, whether sitting, standing or walking in ways that put unnecessary stress on the body. Work habits such as cradling a telephone between the shoulder and ear, hunching over a computer keyboard or a forward head are common causes of muscle tension.
We are often unaware of how we contract these muscles because the actions become part of our habits. Continued muscle tension can lead to ongoing irritation of the nerves that lead to the head, and to chronic headache. Proper body mechanics offer new movement options to replace the poor postures. Physical therapy, aerobic exercise, and biofeedback can have strong headache-relieving effects. These are all good preventative measures that our knowledgeable TOSMG physical therapy team can show you. Talk to your physician about trying physical therapy as a conservative alternative.
January 7, 2013
Symptoms of a Spinal Compression Fracture
Being able to identify the symptoms of a spinal compression fracture is important. Notifying your doctor if you suspect a compression fracture is even more important. Compression fractures typically occur in men and women over the age of 50. Women are more susceptible than men. For those over the age of 50, compression fractures are usually due to osteoporosis. Treatment can help to reduce the chance of further fractures. Some methods of treatment include bracing, medications and weight bearing exercises. Speak to your doctor about the best treatment plan for you.
Here are some symptoms that can indicate a spinal fracture:
1) Sudden, severe back pain
2) Worsening of pain with standing, walking, bending or twisting
3) Loss of height
4) Deformity of the spine "hunchback" look
5) Some relief with lying down
The pain typically occurs with a slight back strain with common daily activities like
1) Lifting a bag of groceries or suitcase
2) Bending down to pick an object from the floor
3) Lifting a suitcase or groceries out of the trunk
4) Slipping on a rug or misstep
While not everybody experiences pain in the same way, with compression fractures, pain will subside while the bone is healing.
December 17, 2012
Save your Back: Back pain is one of the most common work-related injuries. It is often caused by ordinary work activities like sitting at the computer desk or lifting heavy objects.
Here are a few helpful tips to protect your back:
Sitting: while driving or sitting at your home or office chair, sit in a neutral position (no slouching or sitting with the shoulders rounded and head forward. Use a lumbar roll or rolled towel by placing it on the small of your back. Here's a head to toe check at the computer desk.
1. The top of the monitor should line up with the top of your head.
2. The screen should be positioned at arm's length.
3. Shoulders should be relaxed.
4. Wrists should be straight.
5. Ears, shoulders and hips should line up vertically.
6. Elbows should be bent at 90 degrees
7. Hips should be as far back on the chair as possible and bent at 90 degrees.
8. Knees should be bent at 90 degrees
9. Feet should be supported or flat. (If you are short, you can place them on a low step stool or book)
1. If you are a side sleeper, ly on your side with a pillow between your knees.
2. If you are a back sleeper, place pillows or a bolster under your legs (thigh to heels)
3. If you are a tummy sleeper, place a pillow under your hips. This is the least ideal position for sleeping, especially if you experience back problems
Carrying/picking up objects:
1. Keep your abdominals tight before and while lifting any object.
2. Keep the object as close to your body as possible.
3. Bend at the knees and hips as if sitting, and use your legs.
4. Pushing is recommended instead of pulling. Stay close to the object as you push it and use your legs.
5. The golfer's pick-up or "tripod" is recommended for picking up small, light objects. (Golfer's pick up is standing on one leg while picking up an object, as a golfer would to pick up a golf ball. Good balance and flexibility or upper body support is ideal with this technique.)
October 1, 2012
Piriformis syndrome is a disorder in which the piriformis muscle compresses the sciatic nerve. The piriformis is a flat band-like muscle located in the buttocks and assists in the stabilization in the hip joint. The sciatic nerve either passes through or runs alongside the piriformis muscle and branches out to innervate the muscles of the leg. Pain, numbness and tingling can originate in the buttock but can travel down the length of the leg, when the piriformis compresses the sciatic nerve. These symptoms can be triggered with firm pressure on the muscle, climbing stairs or sitting for extended periods of time. A physical exam using certain movements to elicit pain by a doctor or physical therapist here at TOSM can be used to help diagnose piriformis syndrome, although there is no definitive test. Avoidance of aggravating factors, rest, ice/heat and a stretching/exercise program are traditional treatments for piriformis syndrome.
July 13, 2012
iPad's have become a staple in many of our lives. Sometimes as modern technology advances, this can affect our general health. Many of recent iPad users have reported neck or shoulder pain, otherwise known as the "iPad shoulder." To prevent an "iPad shoulder," be aware of your posture and body mechanics when using the device. Just like a desktop computer, your iPad should be at eye level and a keyboard may be a great option to maintain proper body mechanics. Every few hours, stand up and stretch. One stretch that may be helpful is standing at a doorway and placing your shoulders and elbows at 90 degrees (similar to a goal post) and gently step one foot forward through the doorway. The name of the game – good posture and good mechanics with all electronic devices to prevent pain.