Monday, July 18, 2011

Understand Back Pain from Herniated Discs

When back pain is your everyday companion, you tend to look at every possible problem as the cause of your pain. Inherently, we want to understand what’s going on in our bodies, so it’s a normal tendency to look at any back pain diagnosis you see or read as the culprit. Of course, words like sciatica, lumbago and slipped disc are a part of the mix whenever we think of back pain, so it’s not unexpected to assume that’s what’s at the heart of the matter. However, who’s to say? And what do those “buzz words” mean to you for finding relief and getting back to normal, pain-free living? As you may or may not know, all three of these things can be related; a so-called “slipped” disc, actually called a disc herniation or disc prolapse, may lead to sciatica and lumbago (lower back pain). Why don’t we break it down a little so we can understand what’s the real reason for pain?

There are a number of factors that might increase the likelihood of a herniated disc, many of which are common sense and others which may not be so much. Let’s review a couple.

Firstly, of course, is age. As we get older, our spinal discs tend to hold water less efficiently, so the discs degenerate. It’s a natural part of aging, but it can be a big problem - the water and fluid inside of a disc is a big part of the reason it is able to function effectively as a shock absorber. Without, the fluid, trauma and injury can have a much more significant impact.

Next is genetics. It sort of goes without saying that if there is a history of back problems in your family, your chances of running into the same in your lifetime are greater. That being said, there are estimates around that approximately 80% of Americans will suffer from acute or chronic back pain at some point in their lives, so maybe back pain is more scripted into our lifestyle choices? Which leads us to...

...Exercise habits and body weight. This has a lot to do with what your body can handle. If you are significantly overweight, the load you place on your spine each and every day is greater than what it is designed to bear. The added strain can make disc herniation more likely. Exercising the muscles that support the spine and general exercises can have a major positive impact on the health of the back, effectively acting as a preventative measure.

Lastly, and perhaps most overlooked for its straightforwardness, is your work. Do you have a job that requires extreme strain to the back with regular heavy lifting? Or at the other extreme, do you have a job that keeps you stuck in a chair for hours on end? On the hand, the harsh physical job can cause herniation because of the hard work that is constantly demanded from the back. On the other hand, not using your back can lead the muscles that support it to atrophy. It’s important to consider these factors in examining your back pain and understanding its true source.

All this is great to know, but the fact is, if you’re in pain, you need help! Here at Living Well Medical in Downtown NYC, we help patients with herniated discs all the time. By combining several non-surgical techniques and treatments, we give patients the best chance of returning to active living without pain (and without resorting to riskier methods!). If you have back pain and need help, call today at 212-645-8151.

- Dr. Shoshany, NYC Chiropractor

Tuesday, June 21, 2011

Spinal Decompression: A Great Option Even After Back Surgery

Sometimes certain conditions or prior procedures, like back surgery (ex: spinal fusion), can rule out treatment using the DRX9000.
We see patients that have had back surgeries and have not found relief, and after a through evaluation we start providing care and help relieve their pain and discomfort using a variety of therapies, including Spinal Decompression.

Recently a patient came to us who was still experiencing back pain after he had surgery on his L5/S1 intervertebral disc. The patient stated that he also had L4/L5, L5/S1 herniations, and had been dealing with back pain for quite a long time. Sometimes people will go many years, suffering from lower back pain and sciatica before they even become aware of non surgical, drug free options.

While many people walk around with undiagnosed bulging discs, they may not even feel pain from them and therefore dont seek treatment. Usually when people start suffering from sciatica, a painful and sometimes dibilitating symptom of a bulging or herniated disc, thats when they seek out treatment. Often times people suffering form sciatica won't do a lot of research about their options because they just want to find someone to help them get out of pain as fast as possible. This often leads to heavy doses of prescription drugs that have many serious side effects and can also lead to addiction and after the treatment is stopped they are likely to experience a return of their painful symptoms. Pain medication masks pain and doesnt treat the cause of the pain.

The aforementioned patient described the painful symptoms following surgery as having increased, with pain in the lower right back and glute, and the pain would last for about half the day. There was a dull ache along with tingling and sitting would cause the pain to increase, these symptoms are not unlike sciatica, which meant that there was a possibility that one of the nerve roots in the lower back may have been irritated by the bulging discs. After having surgery just a year ago after a long and agonizing bout with pain the patient felt that another surgery was not going to be a feasible option, especially since the pain had returned so soon after surgery.

He inquired about Spinal Decompression and after an MRI and a thorough chiropractic evaluation and consultation it was determined that he would be a suitable candidate for spinal decompression.

The MRI findings showed that at L5/S1 there was some normal post-operative scarring towards the left side of the disc. There were some mild disc bulges but they had not yet compromised the nerve root. On the right side in the L4/L5 disc, there was some moderate posterior herniation.

The findings:
Vertebrae- Mild retrolisthesis of L5. The remaining AP alignment intact. Height, intensity and enhancement are normal.

Discs- There is a prominent left and rmidline soft tissue intensity at L5/S1, the far majority of it is scarring. There is a small left and right associated disc bulge.
At L4/L5, a small to moderate right posterior herniation. The remainder of the Discs are normal.

The treatment:
The patient will undergo a series of evaluations and decompression sessions, using the DRX9000, followed by Ice and STIM therapy. Along with continued chiropractic care and monitoring, he can also be moved on to physical therapy to help strengthen weak points, stabilize postural muscles, and make tight muscles more flexible.

Using a vast array of advanced treatment options we administer individualized treatment protocols for each patient and prouce results quickly and without the use of invasive procedures like surgery, and our results are unparalleled.

Thursday, May 26, 2011

The Vicious Cycle of Back Pain

There is no shortage of active people in New York City. From fitness enthusiasts to avid runners that run the entire bike path on the west side, everyone is trying to be active. However a de-conditioned person just getting back out after being shut indoors all winter, seething form the cold and the inactivity that comes along with it, may just be asking for pain and injuries.

Even people that are regularly active don't notice that over the winter and spring their activity levels fall, sometimes significantly. Making a conscious effort to be active and not let yourself get out of shape during the winter doesn't always mean that you didn't avoid a walk or just stayed in an extra night here and there, or cut your gym time short to stay warm under the covers just a little while longer.

And is it just the winter inactivity that leads to injury? Well, no, its sort of a complicated answer. Your body has an economy based around exercise, rest and nutrition. An increase in activity needs more fuel (nutrition), and time to recover. Rest, or inactivity requires less nutrition, so its also easy to over consume, if you over consume, you require more work to burn off the excess calories, that leads to more activity, and so on.

Exercise economy

As the previous statement went, theres also an exercise economy, where there is a risk/ reward system. According to the National Academy of Sports Medicine, The National Strength and Conditioning Association, and other evidence based training certifying bodies that research exercise and nutrition, low repetition, heavy, compound exercises build strength, while high repetition, light weight exercises build endurance. So weather you exercise to be strong or to increase your endurance, the trade off between training volume and exposure to injury is simple. The more you do, the more you risk. But if you don't do enough, you don't make many improvements.

Too much training?
Its hard to believe that most people do too much. Think about it, most people hit a wall in their training regimen, and to fix it they simply do more. Some people "run through pain" when they have shin splints, other people just start adding more sets to their weight training workouts. This upsets that aforementioned "exercise economy" because you are now simply giving your body more work to do, and probably with poor mechanics and execution.

Can I exercise with a bad back?
Yes, some people can actually keep exercising with a back injury. Now, any time you are starting an exercise regimen, or thinking about exercising on an injury, make sure you talk to your doctor, or if you are under the care of a Physical Therapist, make sure you clear any exercise you are planning o do. Everyone is different and therefore everyone's injuries are going to require a different approach if not treatment altogether.
You want to stay away from exercises that load the spine, making herniated and bulging discs even worse, so stay away from deadlifts, and bent rows. What you want to do is focus on exercises that require "core" stability, or exercises that require you to have your lumbar, hips, and abdominal/oblique muscles work as one unit.
Try this:
Low cable row: Sit down on the machine and grab the cable handle, go for the single handle. Keep your back straight, and tight, now flex your abdominals, flex the obliques, and try to keep your hip complex tight too, so squeeze your butt a bit too. Make sure you can breathe, and go light on the weight, be careful not to make any sharp jerky movement, and don't allow your trunk to turn during the exercise.
Supine Bridge: Lay flat on yours back, bend the knees, and keep your hands at your sides. Start slowly and raise your hips up keeping your back and hips tight, return to starting position slowly.
Bird Dog
This is a simple Yoga movement, and here is a quick video demo for it:

Remember that for back pain, there are come great options for finding relief. A chiropractor can help adjust your spine and a Physical Therapist will help you strengthen the surrounding musculature.

Tuesday, May 10, 2011

Leg Pain: Is It Just a Muscle Issue?

Now that it’s nice outside, it’s normal to see more and more people running and enjoying the outdoors; the sunny season brings people back to life, out of the cabin fever days and into the spring fever days. Everything is just starting to come back to life. Of course, at the same time, it’s easy to have the winter months of relative inactivity come and bite you in the behind.

This is the way I have had more than one patient come to any office, Living Well Medical in NYC, complaining of leg pain, thinking it was muscle-related - it’s the first choice in a case of a person returning to active days. This is particularly true of people ages 50 and up because they are generally more susceptible to injury. However, based on the way the pain is described, it can become evident that leg pain is more than just muscular. That’s when things get more complicated.

Patients often say a few things that made me believe it might be something more.

Shooting, electric, burning pains are a component of the overall pain. This is sometimes an indication of a nerve-related problem like sciatica, but it cannot be confirmed without an in depth study like an MRI.

Patients also typically complained of some numbness in the legs, buttocks, feet or toes. Again, this is consistent with a pinched nerve that is inflamed and irritated, perhaps because of a herniated or bulging disc.

Finally, the patient complained that there was no real “comfortable” position - sitting hurt, standing hurt, even lying down hurt.

Just to be clear, none of the above is a definitive indication of a pinched nerve, but they do warrant more investigation, especially if the pain is persistent, as it often is. If you do have a pinched nerve, we’re here to help; services like spinal decompression, physical therapy, active release technique, chiropractic and so many others have been shown to be able to relieve pain and keep it away. The main thing to remember: if you’re in pain, don’t just ignore it! Call and find out more about getting help at 212-645-8151.

- Dr. Shoshany, NYC Chiropractor

Monday, May 2, 2011

Some Common Causes of Back Pain and How Spinal Decompression Can Help

What makes me a candidate for spinal decompression treatment?

Usually we would recommend Spinal Decompression for patients that have been suffering from:
Herniated discs
Bulging discs
Degenerative Disc Disease
Facet Syndrome
Additionally, patients that have not responded to physical therapy and chiropractic care may be candidates for non surgical spinal decompression.

What is the spinal decompression treatment experience like?

Thats the best thing about spinal decompression, the "side effects" of spinal decompression are limited to mild soreness which may cause mild discomfort for some patients. The soreness is not unlike how you would feel after a good workout. For most patients the treatment is very comfortable and relaxing, and the treatments last between 30 to 45 minutes. Patients often fall asleep since the stretch in the spine is not painful and feels good to most people.

Spinal decompression is often followed up with other therapies like cold/heat therapy, electronic muscle stimulation, and laser therapy.

What do the conditions mean?

Degenerative Disc Disease:
Is when a intervertebral disc is deteriorated, and dehydrated which leads to the degradation of the disc's ability to handle the loads placed upon it. Degenerative disc disease also contributes to bulging, herniated discs, and stenosis.

Facet Syndrome:
The facets are located towards the back of the spine and help keep the vertebrae aligned. Facet syndrome is usually characterized y inflammation, pain and stiffness that increases with activity and decreases with rest.

Often associated with a herniated or ruptured discs, sciatica occurs when a disc in the lumbar spine impinges no a spinal nerve that leads to the sciatic nerve, interfering with normal nerve activity. Sciatica can be acute or chronic, and is associated with pain that shoots down the buttocks and the leg. Tingling and numbness are also associated with sciatica, along with some loss of sensation.

We always use a combined approach towards treating back pain. Along with other treatment methods like Physical Therapy, Cold Laser, and the Graston Technique, we have helped mmany people suffering from chronic, painful conditions.

Thursday, April 21, 2011

L5 S1 Paracentral Disc Herniation and Foraminal Stenosis

Here is a sample diagnosis of someone suffering from back pain.
"L5 S1, small para-central disc herniation, superimposed on an annular bulge, bilateral foraminal stenosis present, and degenerative hypertrophy of the facet joints."

Well that's a lot to think about and that's just an abbreviated sample report. An entire diagnostic report can be a few pages long, along with a doctor's notes, and possibly even more on top of that from previous treatments, not to mention the possibility of failed treatments or surgeries in the past.

Its understandable that patients can become confused, depressed, and don't really know where to turn and may feel like they are losing an uphill battle. No one would argue that the medical care system is fairly daunting, and not really set up to provide readily available answers. However you have to understand that the medical language is set up to be easily, uniformly, read and digested by medical professionals. So naturally theres a feeling that the patient is given a report in difficult to understand language and then set off to find a specialist. Terms and conditions are based in facts and studies. Diagnosis are backed by medical findings, not guessing, so essentially a fact based language that doesn't infer, to avoid potential problems, is best suited to provide for our safety.

With that out of the way, lets dissect the report above and try to offer a better understanding of whats going on and the available treatment options.

L5/ S1
This is usually how a diagnostic report starts out, by listing the physical location of the problem. L5 is the 5th Lumbar vertebrae, its located in the lower back, and S1 refers to the first sacral (sacrum) vertebrae. Its not unusual to have multiple bulging or herniated discs, along with other spine problems like a lordosis (exaggerated curvature.

Para-central Disc herniation
This is a way of noting the location of the disc herniation, since the discs are round and can herniate from a few different locations. A para-central herniation is located next to the center of the disc. Lateral would mean side, posterior meaning back, etc.

Annular Bulge
The "annulus" is located on the outside of the spinal disc, and wraps around it - kind of like the word annular means once a year, meaning something is cyclical.

Foraminal Stenosis
Stenosis means that something is narrowing or narrow. The foramin is an opening in between the vertebrae that allows the nerve roots to pass through to the spine, and over time, due either to spinal stenosis or other factors, like debris, these openings can become narrow and interfere with the nervous system.

Facet Joint Degeneration
The facet is the connective/ support structure that lies between each vertebrae, and this support and connective structure can wear down over time and cause problems with the spinal structure.

So this is basically a multifaceted problem, that requires an approach that's not all that unusual or difficult. Living Well Medical has been leading the way in treating pain with a multidisciplinary approach. Using Physical therapy to address structural weaknesses, and chiropractic, and decompression to de-stress and de-load the spine, a combination of therapies has been the most efficient way to treat painful conditions. those conditions often being complicated ones.

Thursday, April 7, 2011

The Most Effective Non Surgical Back Pain Treatment

As an "alternative" treatment, Chiropractic remains as the overwhelming favorite in the US for many painful conditions. Chiropractic adjustments target the spine and the soft tissue of the body. Most people may not know about adjustments of the extremities and joints other than the spine.

Chiropractic adjustments go beyond spinal manipulation, many chiropractors practice adjusting the extremities and also perform soft tissue mobilization to help ease pain in movement and allow the muscular imbalances to become less of a problem, weather its through tightness or the presence of adhesions and scar tissue build up. Furthermore many also practice other soft tissue treatment techniques, such as:

Graston Technique
Active Release Technique
Cold Laser Therapy
Deep Tissue Massage

Along with these techniques some Unique Treatment Facilities, like Living Well Medical, have a team of medical care professionals that form an integrated approach to help ease pain and speed recovery. Professional Massage Therapists, Physical Therapists, Medical Doctors and Chiropractic working in the same facility can better communicate a patients need and progress instead of sending notes and charts to another specialist, who may have no direct contact with the patients doctor. This can sometimes frustrate the patient and even slow progression towards full recovery.

The importance of communication between specialists, the availability of a various techniques, and the integration of them in to a comprehensive program is truly a cutting edge approach that only used to be available to professional athletes. Some techniques may be great for certain patients while others may not garner much of a response, so having a treatment protocol ready for every type of patient can mean recovery in a month rather than becoming a chronic issue to deal with for years, eventually leading to surgeries and more pain.

Chronic pain, especially back and leg pain, is treatable, without surgery. Non Invasive treatment is available to everyone, and is even covered by most insurances.

Monday, March 14, 2011

What’s in a Herniated Disc?

As an all-around pain relief center, we see all sorts of different problems, but if I had to put a name on the most common problem we see, I’d almost certainly have to say disc herniation. That’s one of the main reasons we continue to expand Living Well Medical with technologies and treatments that work well with ailments of the back and spine. Of course, lots of our treatments apply broadly, but the point is, we do a lot with backs, necks and spinal stuff. A technical term, “spinal stuff.”

disc herniationSo back to disc herniation, what the heck is it? And why does it happen? And why does it hurt so bad? Let’s take a quick look at these questions.

A disc herniation is when the inner part of an intervertebral disc (called the nucleus) is pushed free of a tear in the outer band surrounding it (called the annulus). I’ve it compared several times before to a jelly donut with the filling squeezed out. In so doing, the disc loses the vast majority of its function as a shock absorber and can even cause pain.

As to why, well that’s a little more complicated to answer because it varies from person to person. Suffice it to say that the most prevalent factors in disc injuries like herniation are age, wear and tear (like heavy lifting), and trauma. Overall lifestyle choices like healthy eating, drinking in moderation and not smoking are also important.

Then there’s the pain. Pain from a herniated disc is brutal. It’s among the worst things to suffer with, to be sure. And the reason it hurts so bad is often because it is crushing and inflaming the nerves that carry pain signals, sensory information and motor function to the various parts of your body! When a nerve root that is exiting the spine is compressed, we sometimes get the symptom set known as sciatica. Burning, numbness, pins & needles, and even muscle weakness are often the result. It’s a serious problem that can be completely debilitating.

Now that you know, it’s easier to see the whole picture. Disc herniation is a big problem with big pain. If you need help, give our NYC office a call at 212-645-8151. I’ll be glad to help.

- Dr. Shoshany, NYC Chiropractor

Monday, March 7, 2011

Chiropractor Dr. Shoshany on the Dr. Oz Show

Recently Dr. Oz, who is always looking for new and proven ways to help people get healthy, motivated, and happier, became aware of a new Cochrane review of Chiropractic treatment for lower back pain showed that Chiropractic adjustments were just as effective at relieving pain as more traditional medical care. While Chiropractic is not a new alternative treatment for pain, its almost as its position as the number one pain treatment alternative in the U.S is being reasserted, and its great to see a show with such a large audience recognize the results of chiropractic care for lower back pain.

Here is the par of the lower back pain segment with the adjustment performed in front of a live studio audience.

Wednesday, February 2, 2011

Do I Have a Herniated Disc?

No one who has ever had a herniated disc would confuse it with a pleasant experience. The pain is outrageous, the disability can stop you dead in your tracks and overall, it can just make you miserable. But back pain comes in many forms, and really, none of them are a picnic. What’s more, treatment for a herniated disc will often diverge from that of other back-related problems. Basically, what I’m trying to say is that it’s important to know what’s wrong with you so you can move forward with the right treatment. So how do you know? What are the signs? I’ll cover that in some small way here; however, it’s important to note that this is in no way intended to be a replacement for a doctor’s opinion. If you are in pain, call us at Living Well Medical. With that said, let’s move on.

If you are familiar enough with the term ‘herniated disc’ chances are you know a little about how the back works, but just in case you don’t, we’ll start there.

Three of the major structures in the spine are the bones, discs and nerves. The bones are the basic support structures, the discs are the shock absorbers and the nerves carry messages and information throughout the body, to and from the brain. In a herniated disc, one of these shock absorbers can’t perform its function because it has burst open and spilled the contents of its nucleus which provides much of the shock reduction. Sometimes, that herniated material will push against the nerves. That in turn can cause a number of severe symptoms like pain, numbness, tingling, muscle weakness and burning sensations. So if you are experiencing problems in the lower back or legs like these, you may have a disc herniation.

That said, the only 100% accurate way to know if you have a herniated disc is through medical imaging like an MRI. X-ray studies can also help rule out other serious spinal conditions like spondylolisthesis, but that's for another post entirely. Nerve tests like electromyography (EMG) and Nerve Conduction Studies are also able to point out nerve irregularities. The main point is that only a doctor can tell you what the situation is.

If you are in pain, call our NYC office us at 212-645-8151. We can and enjoy helping people like you reclaim your life from pain like a herniated disc.

- Dr. Shoshany, NYC Chiropractor

Is spinal Decompression Therapy Right for You?

Every day we have patients come in to the office at Living Well New York, complaining of back pain, leg pain and numbness, as well as tingling in the leg. Patients often ask if their symptoms are the result of problems with inter vertebral discs, and if non surgical spinal decompression can work for them.

How can you tell if you're a candidate for Non Surgical Spinal Decompression:

If you suffer form chronic or severe back pain which is caused by bulging, herniated, or degenerative discs, sciatica, or facet syndrome.

If you have been told that you are a candidate for surgery.

If you have had a failed back surgery, or have failed back surgery syndrome.

How can you tell is you are not a candidate for Non Surgical Spinal Decompression:
If you have any retained surgical components such as fusion cages or titanium rods,

If you have a clinically unstable back.

If you have spinal infections or abdominal, or pelvic Cancer.

You have recently fractured vertebrae.

If you suffer from Osteoporosis

If you have ankylosing spondylitis.

If you have an abdominal aortic aneurysm.


How long until you feel results:

Many patients notice reduced pain after their first few treatments, and may even feel that the course of their treatment is complete, but this is only the start of the healing process, and stopping treatments early can result in remission, and symptoms can reoccur. Some patients may take several treatments to feel relief because their physiology may be different, and everyone if different so the healing times do reflect this.

Non surgical spinal decompression works:

Patients suffering from herniated and degenerated discs report immediate pain reduction, and even with one treatment, the bulging pulposus may be completely or partially retracted back in to the disc. However it is normal for long term pain relief to take longer.

Consistency is the key to results:
Like with most injuries, tearing in the walls of the disc require time to heal properly. Pain relief doesn't mean that the injury has healed. The disc needs time to seal up properly, and it is crucial to continue treatment to make sure that the newly retracted discs do not herniate again quickly.

Living Well Medical focuses on a non invasive multidisciplinary approach to healing and pain management. If you are in the New York City area, and are suffering from back pain visit us at our treatment center on 632 Broadway, located in the heart of Manhattan, or call us at: 347 562 2144