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.

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

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
Sciatica
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.

Sciatica:
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.

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.

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
Acupuncture
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.

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.”

So 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

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.