Low Back Surgery: 6 Steps To Full Recovery

Photo: Ted Hood. State Library of New South Wales.

If you have had a recent low back surgery, there are a few tips that will speed your recovery and help you to have a healthier back for the long term.

1. Practice good POSTURE. This may be difficult if you have a habit of slouching, but it is one of the most important ways to keep your spine healthy. Sit in upright, firm chairs with an extra lumbar support or rolled towel behind your low back. Avoid sitting in reclined positions.

2. AVOID BENDING FORWARD or bending down with your back. Learn how to do all your daily activities without bending your back. Many techniques can be used instead of forward bending, such as squatting, kneeling, sitting, pivoting on your hips, using a golfer's lift, or even crawling. Excessive forward bending is often the cause of back injuries, so eliminating bending decreases your risk of future back pain/injury.

3. AVOID TWISTING your back. This may be easy to do while still wearing your back brace, but once you are out of the brace, it is also important to avoid twisting. Maintaining proper spine alignment during daily activities and especially during strenuous activities will help to prevent back injury.

4. STAY ACTIVE. Find a low-impact exercise that you can start or continue, such as walking, stationary biking, or water aerobics. Depending on your stage of recovery, you may only be able to do 10 minutes at a time, but slowly progress as you are able. Mobility promotes healing, as long as you do not overdo and cause more pain.

5. FOLLOW DOCTOR'S ORDERS, such as lifting restrictions, activity restrictions, using a brace, using a cane, Physical Therapy, etc.

6. REQUEST PHYSICAL THERAPY. For the optimal prognosis after low back surgery, it is important for you to learn some strategies, exercises, postures, and functional activities from a Physical Therapist. It may take just a few visits if you are recovering quickly, or some patients need weeks or months of therapy if they are still having limitations or symptoms.

Does The Weather Really Increase Joint Pain?

Photo: Dale McDonald, State Archives of Florida

Almost all my older patients report they feel more pain when the weather is cold and/or rainy. But is it really true? Here is an example of someone who told me: "I woke up with a lot of leg and back pain, and I think it is just because of the weather." So my goal was to show that her pain could be improved, regardless of the present weather conditions.

On a scale of 0-10, pain was 7/10 at the start of our session. Her first exercise was the same one she had been doing for homework: lie face down on the mat and press up onto her hands. Doing this for a few sets decreased her pain from 7/10 to 5/10 and made her leg feel better. With a few more exercises in the same direction of movement (backwards or back extension), her pain further decreased to 1/10 and was located in the center of her low back and not her leg. Objectively, her baseline movements improved and became less stiff and less painful.

So, how much of her pain was weather-related? Some of it may have been caused or aggravated by the climate change, but most of it was movement-related. So within one hour of treatment with the proper movements, her pain decreased from 7/10 to 1/10, and the weather was still cold and wet when she left.

Hand, Foot, and Mouth Disease

If you have young children, you may fear "Hand, Foot and Mouth Disease," so here are some facts about the virus:

1. A child only gets it once in his/her lifetime.
2. It is more common in the summertime.
3. It can look like chicken pox, with small, red bumps not only on the hands and feet but also on the arms and legs. They can become open sores and secrete clear fluid.
4. It is highly contagious and is most common among young children and babies.
5. It can be present with no bumps or sores on the hands/feet.
6. It causes sores in the mouth that are terribly painful and limit the child's desire to eat/drink. The sores can cause excessive drooling.
7. The first symptom is often a fever of 100 to 103 degrees, which lasts for a few days.
8. The disease usually lasts 7-10 days or less.
9. Prescription medication is typically not needed.
10. Treatment is Tylenol and/or Motrin for pain/fever, drinking fluids for hydration, rest, and frequent hand washing.
11. I would recommend you keep the child in long pants, socks, and long-sleeved shirts. For prevention, do the same for your other children.

Additional info on Hand, Foot, and Mouth Disease:
http://www.cdc.gov/features/handfootmouthdisease/

Turkey Avocado Cobb Salad at Schlotzky's

http://www.schlotzskys.com/menu/salads/turkey-avocado-cobb/

The Turkey Avocado Cobb salad at Schlotzky's is one of the best salads I have tried lately. It has a ton of fresh ingredients, such as avocado, corn, just-cooked bacon, goat cheese, and black beans. As the name states, it is topped with turkey deli meat. And, of course, it has croutons, eggs and tomatoes. The serving size of this salad bowl is larger than expected, and it has fresh garlic bread on the side. My dressing choice was Raspberry Vinaigrette, but the salad was tasty enough that I only used dressing toward the bottom of the bowl. How can you say no to a salad so full of protein and good fats? You will almost forget it's a salad.

Does Pilates Cause Or Treat Back Pain?

Photo: State Archives of Florida

Yes, Pilates can cause back pain. And yes, it can treat back pain.

Pilates and Core Strengthening

Pilates has many great benefits, including core strengthening. Core strengthening is beneficial, as it incorporates deep muscles of the abdominals and back that often are weak, especially among individuals with back pain. Having a strong core is one piece of preventing back pain, but other components include postures, body mechanics and proper treatment of present back pain.

Pilates vs. Physical Therapy

Pilates and core strengthening alone will likely not eliminate present back pain. It may play a role in preventing future episodes of back pain, but alone it is not the solution to low back or mid-back pain. If Pilates could treat back pain, I would not have a job as a Physical Therapist. Clearly, there is more to your back pain than weak core muscles, so proper treatment/prevention is urgent. If your back pain comes and goes, get it treated now, and you can learn why it happens and how to decrease the pain and prevent future episodes.  

Pilates Exercises to Avoid

There are some Pilates exercises that can actually produce or aggravate back problems, and these should generally be avoided. Any Pilates exercise that puts your back into a forward-bent (AKA flexed or rounded) position is not ideal for most individuals and can be harmful if you have back problems. Which forward-bending exercises are safe? Cat/camel (on your hands and knees and you arch your back up and down) and abdominal crunches are fairly safe for most people. 

Preferred Pilates Exercises

The Pilates exercises that bend your spine backwards (AKA extended, as in the photo above) are safe and highly recommended for most healthy people. This includes positions such as lying face-down and pressing up onto your hands or lying on your back and lifting your hips. Likely there are many extension exercises incorporated into your Pilates class, so these are generally beneficial and less likely to be harmful.

If either direction of spine movement aggravates your back pain, stop Pilates workouts, and get medical attention.

Why You Should Get Physical Therapy For Your Back Pain

I recently treated a patient with leg pain that radiates from his back. It goes into his thighs and even down below his knees. This pain began 3-4 months ago, and he is unsure how it started. Before his session, I knew his walking had been problematic because when he stood up in the lobby, he significantly stooped over and could barely get his balance. He was using furniture and walls to hold onto. So my initial goal was to find an exercise that would immediately improve his ability to stand up and walk. 

I treated him for 10 minutes with one or two exercises lying on the mat. Then he stood up tall and walked easily back to his chair. He could not believe he was walking that well because since his symptoms began, he has the most pain and difficulty with initially getting out of a chair to walk.

So if you have back pain, you could possibly be only a few minutes away from pain relief. Schedule your Physical Therapy today!

Changing Crib Sheets Without Pain

There are a few baby-related tasks that can be near-impossible without straining your back, so here is what I do for changing crib sheets.

Photo: National Media Museum

1. Buy at least 3-4 crib sheets and 3-4 waterproof pads. I promise that the price of these is far less than a back injury.

2. Take the mattress out of the crib to change the sheets.

3. Layer your waterproof pads and crib sheets over each other so that when the top layer gets wet, you simply remove it and your clean, dry one is already there.

4. As soon as possible, remove the bumper pads. For safety reasons, they are not even recommended anymore. Changing the crib sheet is much easier when there are no bumper pads in the way.

5. Consider using a sheet saver. It is a sheet that actually attaches to the bars of the crib, so it is fairly easy to snap on or off (each sheet has at least 12-15 snaps). There are some safety concerns with this because it does not fit as tightly as a fitted sheet. To get it on or off, it still takes several minutes, and you have to be able to reach all four sides of the crib.

6. For crib sheet selection, buy the T-shirt material ones that stretch a little.

7. Change the sheets for a toddler bed the same way--by taking the mattress out first.

Chick-fil-A Cobb Salad: A Healthy Review

The Cobb Salad at Chick-Fil-A is a delicious and healthy alternative to your usual fast food meal. I have enjoyed it so much that my husband now eats it as well. The cobb salad is made with Romaine and greens, not iceberg lettuce. It's additional veggies are cherry tomatoes, corn, cabbage, and carrots, which are a nice variety. The extra yummy toppings are cheese, bacon, and fried bell peppers. Another healthy addition is hard boiled eggs. And it comes with crispy chicken unless you prefer grilled. With this alone, I love it even without salad dressing. But if you need dressing, I most recommend the Avocado Lime Ranch. This salad is filling, tangy, textured, and colorful!

Because I enjoy the taste of salads, I usually try them wherever I dine. Some other good, fast salads are at Which Wich, McAlister's Deli, Moe's, and Zaxby's. But the fact that my husband eats this one at Chick-fil-A means that it is likeable even for meat-and-potato fans. Lastly, I like it too much to even try their other salads.

Reference: www.Chick-fil-A.com

Unexplained Arm and Leg Symptoms

This post is about Central Cord Syndrome; please see the article from my last post for reference.

There is one diagnosis that is often not discovered until it is too late. It is called central cord syndrome or central cord compression. Your spinal cord is being compressed within a part of the neck, so you experience not only neck/arm symptoms but other symptoms in the lower body as well.

Neck Pain
Usual neck problems can cause neck pain and/or refer pain to the shoulder or down the arm. If this is your only symptom, you likely do not have anything compressing your spinal cord in the neck. You may have a neck diagnosis that can be treated with usual medical treatments such as medicine, Physical Therapy, injections, surgery, or other alternatives.

Back Pain
Similarly, low back problems can produce back pain and symptoms radiating into the buttock(s), hip(s) and/or leg(s). If this is your only symptom, you likely do not have Central Cord Syndrome. I highly recommend you request a prescription for Physical Therapy from your doctor in order to treat your back/leg symptoms.

Neck/arm AND Back/leg Symptoms
If you have neck/arm symptoms AND leg symptoms at the same time, you may need further medical attention quickly! Some leg symptoms are: difficulty walking, progressive loss of balance/falls, leg pain, and numbness/tingling in the leg. Other symptoms include loss of bowel/bladder control/function and/or loss of sensation in the pelvic region.

Examples:
1. You have a neck injury that appears to have resolved. But now you have progressive weakness in one or both of your legs.
2. You have knee pain that started without a knee injury. Actually it started around the time that you were in a car accident and hurt your neck. It keeps getting worse despite treatment for knee pain.
3. You have what feels like carpal tunnel syndrome in your hand(s). It has been going on for several years but is not improving with treatment. Also, your neck hurts and you have numbness in your leg(s) during the same period of time.
4. You have been treated for neck pain and it is mildly improving, but you recently notice that you cannot control your bladder like usual.
5. You have a neck injury that radiates pain and tingling down your arm. You did not notice at first, but you feel the same symptoms in your leg(s), which began at the same time.

Neck/Back Pain
If you have both neck/arm symptoms and back/leg symptoms that began at different times, then you may have 2 different problems that need to be diagnosed/treated separately. In this case, be sure to inform your doctor about all your symptoms so he/she can rule out a more serious problem such as Central Cord Syndrome.

Central Cord Syndrome: Arm/Leg Pain Coming From Neck

The following article is from NIH, and it summarizes a serious condition that can go undiagnosed for several months-years. So if you experience any or all of these symptoms, get medical attention immediately! I have seen this many times, and when symptoms are ignored for too long, they can become permanent.

What is Central Cord Syndrome?

Central cord syndrome is the most common form of incomplete spinal cord injury characterized by impairment in the arms and hands and to a lesser extent in the legs. The brain's ability to send and receive signals to and from parts of the body below the site of injury is reduced but not entirely blocked. This syndrome is associated with damage to the large nerve fibers that carry information directly from the cerebral cortex to the spinal cord.  These nerves are particularly important for hand and arm function. Symptoms may include paralysis or loss of fine control of movements in the arms and hands, with relatively less impairment of leg movements. Sensory loss below the site of the injury and loss of bladder control may also occur, as well as painful sensations such as tinging, burning, or dull ache.  The overall amount and type of functional loss is dependent upon the severity of nerve damage.  Central cord syndrome is usually the result of trauma that causes damage to the vertebrae in the neck or herniation of the vertebral discs.  It also may develop in persons over the age of 50 due to gradual weakening of the vertebrae and discs, which narrows the spinal column and may contribute to compression of the spinal cord when the neck is hyper-extended. 

Is there any treatment?

There is no cure for central cord syndrome although some people recover near-normal function. There is no standard course of treatment, although drug therapy, surgery, and rest are often part of the program.  Magnetic resonance imaging (MRI) is used to indicate the degree of spinal cord compression and vertebral instability.  Vertebral instability due to acute traumatic injury or cervical disc herniation is often treated by surgery to prevent further damage to the spinal cord.  Recent reports indicate that earlier surgery may improve chances for recovery.  Numerous recent studies suggest that surgery also can be beneficial in individuals with persistent compression of the spinal cord and ongoing neurological deterioration.

What is the prognosis?

The prognosis for central cord syndrome varies, but most people whose syndrome is caused by trauma have some recovery of neurological function. Evaluation of abnormal signals on MRI images can help predict he likelihood that neurological recovery may occur naturally.  Those who receive medical intervention soon after their injury often have good outcomes.  Many people with the disorder recover substantial function after their initial injury, and the ability to walk is recovered in most cases, although some impairment may remain.  Improvement occurs first in the legs, then the bladder, and may be seen in the arms.  Hand function recovers last, if at all.  Recovery is generally better in younger patients, compared to those over the age of 50.

Reference: NIH: National Institute of Neurological Disorders and Stroke. <http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm>

Which Health Professional Should I See?

If you are experiencing pain or have an injury, there are many options for health professionals to treat your painful condition. So who should you see first? Going to your family doctor is usually the best first step, and he/she will direct you with initial treatments and referrals. However, sometimes you can go straight to another health professional or ask your doctor for a referral to someone on this list. I selected these few to emphasize because many patients have asked me about these options.

1. Physical Therapist: joint pain, new injury, old injury, chronic pain, weakness, balance/walking issues, shoulder pain, elbow pain, neck pain, mid back pain, low back pain, sciatica, pelvic pain, hip pain, knee pain, ankle/foot issues, gross motor delays in babies or children, muscle pain/strain, neurological injury (such as a stroke) 

2. Occupational Therapist: pain/injury of any part of the arm/hand, difficulty with fine motor tasks, hand/arm weakness, difficulty performing usual daily tasks, neurological injury (such as a stroke), developmental delay in babies or children

3. Chiropractor: new episode of spine pain, car accident, whiplash, chronic back pain, some areas of joint pain, alignment issues, low back/pelvis pain, sciatica

4. Massage Therapist: fibromyalgia, chronic pain, tight muscles, stress

MD Specialists for some common painful conditions:

1. Neurologist: nerve problems (numbness, tingling), neuropathies, neurological conditions (stroke, TIA, MS), unexplained weakness

2. Pain Management: chronic pain, need for injections (such as Cortisone), back pain

3. Orthopedist: specific for each joint. For example, find a shoulder specialist/surgeon if you have shoulder pain.

4. Neurosurgeon: new or chronic spine pain that may radiate away from the spine into the arm(s) or leg(s)

Always remember that you can choose your own health professional just like you select your pharmacy. Even if your doctor refers you to a specific therapist or specialist, you can request a referral to someone of your choice.

Inner Knee Pain from Jogging

If you have inner knee pain from jogging, see if you fit this scenario. The inner part of your knee hurts as a result of overdoing your jogging program recently. You have pain only with jogging. Other activities (walking, moving the knee) are not painful.

Treatment for Inner Knee Pain:

1. Rest, ice, over-the-counter medicine if needed.

2. Avoid aggravating activities such as jogging.

3. Knee straightening exercise (the one I showed you on facetime), with the hands-on overpressure.

               

General Knee Strengthening for preventing inner knee pain in the future:

1. Quad squeezes. Sit with your leg(s) extended in front of you or lie down with your legs straight.

          Squeeze your thigh muscles to lock the knee(s) and hold for 5-10 seconds.

          Repeat 30 repetitions, >3x/day.

2. Straight leg raise. I have a single post dedicated to this exercise, so check out the following link:

           http://thinklikeapt.blogspot.com/2012/05/best-single-exercise-for-knee-pain.html

Jogging warmup (for once you are healed from this episode):

1. Walk fast for at least 5 minutes.

2. Stretch your legs for at least 5 minutes, including calf, hamstrings and hip adductor stretching (google it). Hold stretches for 20-30 seconds and repeat 2-3 for each muscle group.

3. Try short bouts of jogging only if pain-free. 

4. Slowly and steadily (likely over several weeks), you should be able to increase the jogging and decrease the walking.

Jogging cool down:

1. Stretch for 5-10 minutes, including calf, hamstrings adn hip adductor stretching. Hold stretches for 20-30 seconds each, and repeat several stretches for each muscle group.

7 Easy Exercises At Your Desk

1. Do a runner’s stretch for your calf muscles. Stand facing a wall, put one foot in front of the other foot, and place your arms out in front of you on the wall. Push into the wall with your hands. Keep both feet facing forward and keep both heels on the floor. The leg behind you will get a stretch to the calf. Calf flexibility can help to prevent Achilles tendonitis and plantar fasciitis.

2.Stretch your arms up to the sky and reach up as far as you can. Hold this stretch for a few seconds. This stretches your shoulders and can help to prevent frozen shoulder.

3.Roll your shoulders backwards. Roll them upward, backward and downward. Do big circles and small circles. This will remind you about proper upper body posture, which helps to prevent neck and shoulder pain, especially related to sitting excessively at work.

4.Move your neck up and down as far as is comfortable by looking up and down. Hold for a few seconds each way. Feel the motion of your upper spine and your neck muscles. Good motion of your neck is needed for almost all your daily tasks. If you do not have full motion of your neck in all directions, you likely have a neck problem that needs treatment (such as Physical Therapy).

Photo: ergomomma.com

5.Bring your hands behind your back and join your fingers from both hands together. Then reach both arms upward until you feel a stretch in your chest. Hold for at least ten seconds. Most people have poor posture, so their chest muscles remain tight. This stretch can help to prevent such tightness.

6.Move your ankles around in circles. Circle both directions at least ten times. Ankle motion is important to maintain good circulation of blood through the legs, which can help to prevent blood clots.

7.Squeeze your shoulder blades together. Feel the muscles between the shoulder blades pinch together. Hold for 5-10 seconds. Repeat several times. Shoulder blade motion is important to assist with shoulder motion, and shoulder blade muscle strength assists with good posture.

Can breastfeeding lower breast cancer risk?

Can breastfeeding lower breast cancer risk?

Twisting and Back Pain, Joint Pain

Photo: joystiq.com

Twisting one of your joints in an awkward way is an easy recipe for injury, especially in the low back, shoulder, knee and ankle.

How To Avoid Twisting Your Back:

Turn your entire body by turning your legs.

Change positions in order to reach the object with ease.

Turn toward the object, then squat down.

Don't be afraid to get down onto your hands and knees to reach for something.

How To Avoid Twisting Your Shoulder:

Don't reach for objects in the backseat of the car.

Don't reach for an object behind you when you are sitting; simply turn around.

Don't close heavy doors carelessly.

Turn your body toward the object you are reaching for.

Keep your arms as close to your body as possible when reaching.

How To Avoid Twisting Your Knee:

Be cautious when playing sports.

Use a knee brace when playing sports if you have had a past knee injury.
Take time when turning around.
Don't turn your body if your knees are locked.

How To Avoid Twisting Your Ankle:

Use an ankle brace for your sport if you have twisted or sprained your ankle in the past.

Be extra cautious when walking, hiking or jogging on uneven terrain.
Try to avoid walking on ice. If it is icy, stay indoors (especially if you live in the South).
Watch where you are walking. Prevent falls by not doing 5 things at once.