Owww…. My disc hurts!

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One of the most common causes of low back pain is lumbar disc pain.  The disc has an outer layer made up of cartilaginous (annulus fibrosus) layers surrounding a gel-like center (nucleus pulposus). There is one disc between each bony vertebral level in our low back.  According to Stuart McGill, PhD, it behaves more as a ball-bearing joint than a “shock absorber” (that is for a later topic).  The anatomy allows us to bend our low backs with great flexibility in all directions. The outer third of the disc is innervated by sinu vertebral nerves, meaning that it can transmit pain signals coming from the low back.  The annulus fibrosus is thinnest near to where the nerves to our legs are traveling in our spinal canal.

A disc injury is a tearing of the outer layer allowing the inner gel to work its way to the outside of the disc. The tearing and subsequent leakage of disc material causes a lot of inflammation in the spinal canal. This inflammation can cause back pain, muscle spasms and irritate the nerves to the leg, causing leg pain. If the disc material causes pressure and compression of the nerves of the legs, this can lead to weakness.

Stuart McGill PhD showed that the lumbar disc material can herniate through the outer layer (annulus fibrosus) in as little as 20,000 repetitions of forward flexion or twisting through the lumbar spine. It is unlikely to cause a disc herniation if you bend backwards or sideways. Stooping, sitting, and bending at the waist are causes of disc herniation and subsequently back or leg pain.

His research also has shown that humans will bend forward over 1,000 times a day and backwards only 150 times a day. With this in mind, it is easy to see how we can cause a disc herniation just by doing our day-to-day routines. However, we move in ways that are safe for our discs, such as backwards, very rarely. Therefore, WE CAUSE LOW BACK PAIN BY THE WAY WE MOVE!

There is good news. Proper lifting mechanics can decrease your risk of lumbar disc herniations and back pain. For example, professional weightlifters lift extreme amounts of weight in a squatting position and you find that they do not get disc herniations more frequently than the general population. Why is this? They have proper strength and flexibility within their core, pelvis, and in their hips.

 

Most treatments for low back pain are reactive, meaning that treatment is started after someone is already experiencing back pain.  Most treatments do not decrease your risk of future back pain. Research shows that the only thing to decrease your risk of future low back pain is exercise. So again I encourage you to get into that exercise program and if you have pain with exercise, ask for help from a physical therapist and physician.

Good luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 

Dr. Colliver Earns Ultrasound Accreditation

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Ultrasound can be as sensitive as MRI for diagnosing many muscle, nerve, and ligament injuries.  In fact, some injuries can only be found by ultrasound, such as a dislocating tendon or nerve. Also, ultrasound is useful for guiding injections with more precision than standard injections without imaging.  However, it is very user-dependent, it takes a lot of training and practice for a provider to be skilled enough to know how to interpret ultrasound images.

Dr. Colliver has been using ultrasound in the clinic setting longer than any other physician in the New River Valley, and now has added a nationally recognized accreditation to his list of accomplishments.  Registered in Musculoskeletal Sonography Credential (RMSK) is only given to qualified individuals who pass a national examination and who continue regular education in ultrasound interpretation. For further information please visit the ARDMS website.

*Image originally published by www.uwhealth.org

Stick with that new exercise program!

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With New Years Resolultions abounding, lets discuss how to stick to a resolution to start exercising!  Naomi Beinart, BSc Psych, presented a recent review in The Spine Journal (December 2013, Volume 13, Number 12) of all the current research looking at this question.  According to Beinart, between 50-70% of patients with chronic low back pain stop their home exercise program, despite knowing that exercise is a major way to treat low back pain.

Here are some positive factors in predicting the continuation of an exercise program:

1. If you believe you have control over your health, and your back pain, you are more likely to keep exercising.

2.  Actively develop your own exercise program.  If you work with a personal trainer, or Physical Therapist to design a program specific to you and your needs, you are more likely to succeed.

3. Working with a health care provider or therapist while exercising  increases your success rate!

4. Psychological counseling to work on self-motivation will help you succeed.

In summary, the more you believe that you control your health, help develop your own exercise routine, and have supervision while exercising, the more likely you are to keep your exercise program and your New Years Resolution.  Some people may benefit from counseling to help motivate themselves.

For supervision, you can try working out with a friend who has lots of experience, or perhaps sign up for weekly sessions with a personal trainer.  Another option may be to enroll in an exercise class at a local community rec center.  If you have persistent significant pain with exercise, seek medical help.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

RFA of the Knee | Valley Sports & Spine Clinic

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Do you suffer from knee pain?  You are not alone.  Knee pain is one of the most common pain complaints in the U.S., and the number one reason for joint replacement surgery. Common treatments include exercise, pain medicines (Tylenol and Ibuprofen), and injections (steroids or Synvisc/Euflexxa).

If you continue to have knee pain, knee replacement surgery is an option you could discuss with an orthopedic surgeon.  However, some patients are not ideal candidates for surgery either because they are too young (less than 60), too ill for surgery, or choose not to have surgery.

Now there is another option for persistent knee pain, radiofrequency ablation (RFA).  The knee joint is supplied by six nerves (genicular nerves).  If you disrupt the nerves, you can block the pain signals from the knee.  The RFA procedure is done in two steps.  The first step involves temporarily blocking the nerves in order to see if most of your knee pain goes away.  If so, then you can proceed to the second step––radiofrequency lesioning (disrupting) the nerves that supply the knee.  This lasts for 6 or more months and can be repeated if needed.

RFA of the knee does not affect the strength or range of motion and the patient may still have a knee replacement surgery in the future.  To learn more about this exciting new option for knee pain, check out this article from the Journal of Pain, May 2011, by Choi, WJ:
Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial.

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

Sitting is Bad for Your Health | Valley Sports & Spine Clinic

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Having a regular exercise routine is important; but, how much time you spend sitting throughout the day may be just as important.  A British Journal of Sports Medicine article in 2009 correlates total sitting time in a day to “an increase risk of type 2 diabetes, heart disease, and other prevalent chronic health problems- even if you exercise regularly.”  Research now suggests being active throughout the day, whether you like lawn care, gardening, hunting or fishing, for example, reduces your risk for cardiovascular disease and other chronic health conditions.

Long periods of sitting leads to a lack of muscle contractions and decreased blood flow.  Dr Vernikos, former NASA specialist, conducted research that supports getting up from sitting around 35 times a day to reduce your risk of cardiovascular disease.  The author of the cited article suggests setting a timer to remind you to stand up and move every 15 minutes.

Sitting with poor posture increases stress on your discs in your low back.  This is a common cause of back pain.  If you have a herniated disc, you may find sitting to be intolerable.  Avoid sitting for more than 15 minutes and avoid long car rides, as both will aggravate a disc injury.

To read more about prolonged sitting and your health, check out:
The Importance of Intermittent Movement For Longevity, by Dr. Mercola

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver