Category ArchiveWriter’s Block
Writer's Block 07 Feb 2009 08:13 pm
Feb 07, 2009
Neck Pain: When to See a Doctor?
It would be very easy to write and tell you to always see your doctor if you have neck pain. The problem is, you’re probably not going to do that. If you’re like most people (myself included), you’re going to wait and see if it doesn’t go away on its own.
Fortunately, most neck pain is not serious and will do just that. So, rather than give you advice we both know you’re not going to follow, here’s a checklist of symptoms that indicate when you should see your doctor right away:
Writer's Block 31 Jan 2009 04:11 pm
January 31, 2009
I’ve had several readers write to me over the years and ask my opinion on massage therapy and whether or not I thought it was effective for back pain relief.
Unfortunately, at the time I was unable to answer their questions as completely as I would have liked.
You see the problem with giving an opinion — or being able to recommend a therapy — is that there is quite often a lack of reliable information on the subject. Up until now, we’ve only had anecdotal evidence to suggest that massage therapy helped to reduce pain. And as you know, anecdotal evidence leaves plenty of room for doubt.
However, I recently ran across a study published in the Annals of Internal Medicine that finally lends some credibility to this very popular technique.
Writer's Block 24 Jan 2009 08:01 pm
Here’s what’s happening in the world of health and medical blogging…
That’s it, enjoy!
Jan. 24, 2009
Overheard in the OR:
“The theme this week for Grand Rounds is women’s health issues.”
“Tell me about it.”
“So, you gonna write anything?”
“Me? I wouldn’t touch that with a ten foot pole.”
“I hear you.”
“Speaking of women, how’s your wife’s…”
“About the same.”
“You told her there’s nothing really wrong with her?”
“I’m here on my day off, aren’t I?”
Meanwhile, back at the ranch…
The Catch-22 of Rehabilitation
One of the most important goals of rebuilding your back is the healing and restoration of herniated or degenerated discs. And, as I’ve covered in previous articles, hydration is an essential part of that process.
If you missed those past articles, here’s a brief recap: In order for a disc to be healthy, it has to obtain an adequate daily supply of moisture. Loss of moisture (the source of nutrients) is one of the main causes of disc degeneration.
Therefore, in designing a comprehensive rehabilitation program, disc-hydrating exercises are a must. To put it simply, the disc cannot recover if we don’t feed it.
The only problem with the above plan is that research scientists are now telling us that hydrated discs have the greatest potential for herniation due to increased hydrostatic pressure. The higher the moisture content, the higher the pressure pushing against the nucleus.
For example, McGill wrote:
“Herniations tend to occur in younger spines (Adams and Hutton, 1985), meaning those with higher water content (Adams and Muir, 1976) and more hydraulic behavior. Older spines do not appear to exhibit classic extrusion of nuclear material but rather are characterized by delamination of the annulus layer and radial cracks that appear to progress with repeated loading (a nice review is provided by Goel, Munroe, et al., 1995).” 
And here are some excerpts from one such study courtesy of PubMed:
“Compressive loads and rotational torques (flexion/extension) were applied so that the effects of four loading histories (hydrated, neutral dehydration, flexed dehydration, superhydrated) and two failure postures (neutral, flexed) could be examined.”
“When injured in a neutral posture, superhydrated specimens had a lower strength (22–29%) than dehydrated specimens.”
“CONCLUSIONS: The spine may be more prone to injury early in the morning when the discs are at their greatest level of hydration and/or when they are in a fully flexed posture.” 
And so we have what’s known as a Catch-22.
In order to restore the degenerated disc, we have to hydrate it. If we hydrate this weak disc, it is in greater danger of herniation.
Quite a dilemma wouldn’t you say?
Does This Mean We Give Up On Rehabilitation?
Well, that’s what some people do.
In fact, one very common scenario I’m seeing with sciatica sufferers is that the person starts out with physical therapy and begins to see progress. They start to feel better and things are looking up when all of a sudden they experience a relapse.
Perhaps it’s because they became overconfident and tried to do something foolish like get back out in the garden too soon, or maybe they did nothing out of the ordinary. Either way, they find themselves back at square one with the same (or possibly even worse) symptoms than before.
At this point they get frustrated, discouraged and understandably disappointed. Just when they thought their problems were over, life throws them a curve and their hopes are dashed.
Some give up at this point and decide that rehabilitation just doesn’t work. Despite their initial improvement, they conclude that rebuilding those discs isn’t right for them.
So, they throw in the towel and decide to take what they believe to be the easy way out. They turn to surgery for the quick fix even though surgery is anything but the easy way out. It just seems like it at the time.
So What Should We Do?
All we can do — whether we’re the patient, doctor or therapist — is continue to educate ourselves on these possible pitfalls and try to avoid them if we can. At the very least, we should accept reality for what it is and not let setbacks get us down.
Continue to learn all you can about sciatica, herniated discs, physical therapy and the recovery process. Arm yourself with knowledge and the bumps in the road will at least be a little easier to handle.
Of course, it goes without saying that care should be taken during the rehabilitation process. When your physical therapist tells you not to do certain activities, they are passing on what they’ve learned from years of experience and you’ll be better off if you follow those instructions.
In addition, now that you know about the hydration Catch-22, don’t be surprised if you suffer a setback despite all your best efforts.
Just be aware that, even though you’re feeling better, it does not mean the battle is over.
The pain may be reduced or even gone completely, but until the disc has had a chance to fully heal, it’s important to understand that the nucleus can easily be forced back through the walls of the annulus.
In other words, keep in mind that once breached the annulus will provide little resistance to the nucleus under pressure. You may incur another herniated disc from something as simple as bending down to tie your shoes.
Just remind yourself that it too, will heal and don’t let it throw you off track.
I wish I could tell people that rebuilding your back is going to be easy. For some people it is. But for others, it can be a real struggle.
I still feel that the outcome — and the possibility for full recovery — is worth the effort.
Hang in there,
1. McGill, S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation, 2nd Edition. (p. 44-47) Human Kinetics (2007)
2. Gunning JL, Callaghan JP, McGill SM. Spinal posture and prior loading history modulate compressive strength and type of failure in the spine: a biomechanical study using a porcine cervical spine model. Clin Biomech (Bristol, Avon). 2001 Jul;16(6):471-80.
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