Here’s this week’s best in health and fitness…

Grand Rounds is up at The Covert Rationing Blog. Once again it contains a collection of the best in online medical writing. This week’s theme revolved around Independence Day.

Total Mind and Body Fitness Blog Carnival #56 hosted by FitBuff
Blog posts designed to help you improve your brain power, dating, exercise, family, grooming, money, nutrition, sex, stress and work.

Weight Management and Fitness Forum hosted by Weight Master. Articles pertaining to diet, weight loss, exercise, fitness, nutrition, and general health information.

E-Ninja World Blog Carnival 3rd Edition hosted by e-Ninja World. A blog carnival focused on the world of endurance sports, medicine and overall health and fitness.

A Carnival of Total Well-being - 2nd edition hosted by Ecopolitan Living This carnival summarizes ways in achieving total well-being - body and mind balance for cosmopolitan dwellers. How to live well, how to achieve work/life balance.

Enjoy.

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July 5, 2008

Aquatic Therapy for Back Pain

Tyler here is getting ready to do his water aerobics.

Looks like he wasn’t exactly expecting company.

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As you can probably guess, I’m often asked to comment on various forms of physical therapy and exercise programs. The following email is just such an example. (Edited and paraphrased for brevity.)

Dear Dean

What is Aquatic Therapy? Do you think there is any advantage to signing up for one of these programs?

Thanks in advance,
Debbie

Hi Debbie,

Thanks for the email. I’ll try to answer your questions as best I can…

What is Aquatic Therapy?

Aquatic therapy programs (sometimes called pool therapy or water therapy) are physical therapy sessions performed in a heated pool rather than on dry land. Many of the same exercises are performed and the same benefits obtained, but there are numerous advantages to exercising in water including:

• The warmth and buoyancy of the water helps certain individuals for whom regular exercise is difficult or impossible.
• The added resistance of the water helps to condition and strengthen muscles and joints. To get the same results on land would require the use of resistance bands or wrist and ankle weights.
• Finally, some people find the pool environment (sounds, warmth, camaraderie) helps them to relax.

Disadvantages of Pool Therapy

Despite the obvious advantages of pool therapy, it does come with some disadvantages:

• You have to work around their schedule.
• It takes much more time. You have to allow for traveling to and from the pool, changing and showering both before and after the session. A fifteen to twenty minute workout could take a couple hours out of your day.
• Programs are not available everywhere. You may have to drive a long distance to get to the nearest facility offering water therapy.
• Plus, there is the added expense if you don’t have insurance.
• Finally, I prefer to exercise every day — and I do some exercises several times a day. Most water therapy programs are only two or three times per week.

Who Might Benefit from Aquatic Therapy?

Just like any exercise program, everyone would benefit from aquatic therapy, but it is primarily designed for people who have difficulty exercising on dry land. If you’re not able to perform regular exercise due to pain, decreased bone density, disability or other health condition a water-based program may be just what you need. Water therapy is especially beneficial for people with arthritis or osteoporosis.

Because of the specialized nature of the exercises, water-based therapy programs should only be performed under the guidance of a qualified physical therapist. I don’t think it is something you would want to try to do on your own.

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So there you have it. Aquatic or water therapy offers many of the same benefits associated with a regular exercise program with some nice added features — if you don’t mind the inconvenience.

If this sounds like something you’d be interested in, your doctor or physical therapist may be able to recommend a program in your area.

Personally, I prefer exercising in the comfort and convenience of my own home. However, for some people, aquatic therapy is an excellent choice.

As always,
Dean

p.s. Another disadvantage of pool therapy…

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Grand Rounds is up at My Three Shrinks.

What with the anticipated release of the Apple iPhone 3G just around the corner (July 11), this week’s submissions were to have some connection to the iPhone, no matter how twisted the logic. Check out the clever “Clicky iPhone.”

Then we have…

Total Mind and Body Fitness Blog Carnival #55 Hosted by FitBuff. Again this week there are a variety of articles to help you improve every aspect of your life.

Also check out…

A carnival of Total Well-being - 1st edition hosted by Ecopolitan Living
This carnival summarises ways in achieving total well-being - body and mind balance for cosmopolitan dwellers. How to live well, how to achieve work/life balance.

(Update June 28th:)

The June edition of The Pain-Blog Carnival… is up at How To Cope With Pain. This month’s theme is summer/vacation. Lots of great reading.

Also, be sure to check out The Fifteenth Edition of the Carnival of Improving Life hosted by Improved Life..
Numerous articles on improving your life and furthering your career. Subjects include finances, fitness, nutrition, productivity, relationships, personal growth, and general health.

Enjoy.

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June 24, 2008

Can Herniated Discs Really Heal?

Reaching into the old mailbag again today.

Here’s a question from a reader who is concerned that her herniated discs won’t heal because she read that they have no blood supply.

Dear Dean,

I have been to your website several times and re-read many of the articles. Here is my story: In late May 2007 I started having low back pain on my left side.

My past history has been bouts with this (so I had been going to a chiropractor 1-2 times a week for several years - I was fine (pain free) - until May when I started to have problems. He increased my visits to 2-3 times. I did that till the end of this past Aug. 2007. I really was hurting and couldn’t stand for longer then 10-20 minutes.

Then I ordered Lose the Back Pain (workbook & videos) tried that for about 3 weeks (dedicated) nothing seemed to even be happening. Then I went to have DRX9000 - decompression pulls (18 pulls). They were horrible - I screamed, passed out after the 18th one cause of shooting pain and muscle spasms after getting off the machine. The Doctor agreed that 2 more (20 was the prescribed treatment amount) wouldn’t make a difference. I finished those about 3 weeks ago. Now $6,000 later I feel no better. Promises,promises!!!

[snip]

My concern is the 1st L5-S1. I understand what you mean about having herniated discs with NO pain - but the pain I’m feeling in my lower left back - which sporadically shoots out to the hip like a knife brings forth screams, and tears.

[snip]

[I read] that discs cannot heal because there is no blood supply. Can you please give me some more insight on everything I’m hearing about?

I await your reply,
Carol

My response…

Hi Carol,

Stories like yours make me very, very sad. It’s unfortunate that we consumers have to wade through so much misinformation, ignorance and foolishness before we (if ever) find the truth.

On the subject of healing: It’s true that disks, ligaments, tendons and nerves all essentially have little or no significant blood supply but this does not prevent them from healing. It just means they heal slower than tissues (such as muscle and skin) that receive their nourishment from blood.

Here’s what the medical experts are saying…

“Herniated discs can occur anywhere in the spine, but most occur in the lower back. Most herniated discs heal on their own over time (one to six months).” [1]

“In summary, when faced with a disc herniation… Don’t panic. As long as neurological deficits are not deteriorating, observation is warranted… Consider exercise a treatment for acute disc syndrome. Most patients get well on their own and many disc herniations disappear.” [2]

” … In fact, some of the worst looking disc herniations on scans produce very little and sometimes no symptoms at all… Furthermore, large disc herniations often shrink and totally disappear on scans reflecting the body’s ability to heal.” [3]

So you see, herniated discs can heal despite the fact that they have little or no blood supply.

I hope that clears up some of the confusion.

Sincerely,
Dean

References:

1. Herniated Disc, Cedars-Sinai Health System
http://www.csmc.edu/3003.html

2. Nelson, B. The Herniated Disc: New Concepts and Treatments. Physicians Neck & Back Clinics [2005] http://www.pnbconline.com/research/herinated_disc.htm

3. Nelson, B. Disc Syndromes. Physicians Neck & Back Clinics [2005] http://www.pnbconline.com/research/disc_syndrome.htm

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It’s been such a busy week I haven’t had time to review any one specific site, but here are the latest links to the best health and fitness blog carnivals:

Grand Rounds is up at Marianas Eye. As most of you know, this carnival features the best of this week’s medical blog posts.

Weight Management and Fitness Forum 19th Edition hosted by Weight Master. A compendium of well written articles pertaining to diet, weight loss, exercise, fitness, nutrition, and just general health information.

Carnival of Improving Life 14th Edition hosted by Improved Life. Quality articles on how people can improve their lives and better their careers. Subjects include finances, fitness, nutrition, productivity, relationships, personal growth, and general health.

Carnival of Healing hosted by Libido and Health. A weekly round-up of blogs featuring information about healing, healthy living, self empowerment, and spirituality.

Total Mind and Body Fitness Blog Carnival #54 Hosted by FitBuff This week there are a variety of articles to help you improve your brain power, dating, exercise, family, grooming, money, nutrition, sex, stress and work… you name it.

Enjoy!

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June 21, 2008

Sciatica and Epidural Injections

Here’s another good question from this week’s mailbag:

Hi Dean

After four weeks of severe sciatic pain and not being able to walk more than a few yards, I finally got in to see an osteopath last week. He said I might want to consider cortisone injections as part of the physical therapy. I read about epidural steroid injections in the forum but I’m wondering what you think of them.

Any advice would be appreciated.

Allen

My response…

Hi Allen,

I’m glad you asked this question because I’ve been meaning to address this subject for some time now. Initially, I was skeptical of the use of steroids or other pharmaceuticals for treating back pain because of my long history of being a natural health nut.

There was a time when I viewed anything coming from conventional medicine — and especially the big pharmaceutical companies — as some sort of toxic poison.

I’m still not crazy about “artificial ingredients” so to speak, but I’d like to think I’ve gotten a little smarter when it comes to science, medicine and health over the past few years.

Which Brings Us to Epidural Steroid Injections

My first experience with the therapeutic use of steroids came about in an unlikely and rather unpleasant fashion.

A couple years ago one of the family cats came home dragging her hind legs. She was obviously injured so we rushed her to the Vet. Long story short, he gave her a steroid injection and sent her home with oral steroids to be given daily for the next week. Within a few days she was back up and around like nothing had ever happened.

We still have no idea how she injured herself, but we were sure she was going to be crippled and would probably have to be put to sleep. Instead, she fully recovered.

That was a real eye opener.

Then Came the Knockout Punch

Not long after that Ken (a.k.a. krd) started posting in the forum his experience with the epidural injections and how they knocked down his sciatica symptoms like Muhammad Ali taking on Howard Cosell.

I couldn’t ignore the evidence after that.

So now I’ve come around 180 degrees on the subject of steroids for the treatment of sciatica. If your doctor is recommending them for you, I believe they are definitely worth a try.

Keep in mind that they don’t work for everyone. This is probably due to the fact that sciatica has many possible causes and simply eliminating the inflammation may not do the trick.

Also, keep in mind that the epidural will not heal anything. It only eliminates the inflammation and swelling, which should give you relief from the pain. This relief is your window of opportunity to proceed with physical therapy to correct the cause of your sciatica.

As always,
Dean

References:

1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.

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