15 Nov 2008 07:47 pm

Writer’s Block Nov 15

Nov 15, 2008

Sciatica and the Saline Story


Could saline solution be the magic cure for sciatica and other forms of radiculopathy?

I don’t know. Maybe it’s a dumb question.

But one thing is certain. It has been used in research studies to effectively treat sciatica with the same success rate as epidural steroid injections.

What’s The Deal?

If you’ve read my series on epidural injections, then you know that at one time I was skeptical of their use for the treatment of sciatica. There were several reasons for this not the least of which was a research study that appeared back in 2003 that seemed to cast steroids in a bad light.

Here’s what an article written about that study had to say:

“July 1, 2003 – Steroid epidural injections are no better than saline epidural injections for sciatica, based on the results of a randomized, double-blind trial published in the June issue of the Annals of Rheumatic Diseases.” [1]

At that point — because I wasn’t very interested in steroids to begin with — I decided there was no reason to waste any more time on them and moved on to other topics.

It wasn’t until years later that I would find myself revisiting the subject with fresh eyes and a bit more interest than before. This time I wanted to find out as much as I could about steroid injections and whether or not they could in fact play a role in helping people rebuild their backs.

So naturally, as I was gathering reference materials, I went back and dug up that old research article and took another look at it.

Here are some of the highlights:

“In this study, 85 patients with sciatica lasting 15 to 180 days thought to be caused by disk herniation received three epidural injections, at two-day intervals, of 2 mL prednisolone acetate (50 mg) or 2 mL isotonic saline.” [1]

(In other words, half of the patients got the steroid and half received saline solution.)

“Treatment success was defined as recovery or marked improvement on self-evaluation scales at day 20…” [1]

And the results were…

“At the end of the study (day 35), 49% of treatment patients and 48% of control patients were in the “success” group…” [1]

Isn’t that interesting? There was a fifty percent success rate in both groups.

What This Study Does Not Show Us:

Despite my earlier dismissal of steroid injections, a closer examination makes it clear that this study did not prove that epidural steroid injections were not effective.

All it really demonstrated was that something else (saline solution) was also effective at relieving the symptoms of sciatic nerve pain.

What This Study Does Show Us:

Rather than casting steroid injections in a bad light, what this study actually seems to be telling us is that both treatments produced the same success rate.

“The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded…” [2]

“Epidural saline injection for pain control in sciatica may or may not be efficacious.” [2]

This raises some very interesting questions:

Why were saline injections successful?

Is there a role for saline injections in treating sciatica?

Could saline injections (given either prior to, or post) enhance the results from steroid injections?

Since we know that some people are not candidates for steroid injections, perhaps they would respond favorably to epidural saline injections?

This might be worth asking your doctor about.

As always,


1. Steroid No Better Than Saline Epidural Injections for Sciatica – Medscape

2. Valat, JP, et al. Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial. Ann Rheum Dis. 2003 Jul;62(7):639-643.


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08 Nov 2008 07:13 pm

Writer’s Block Nov 8

Nov 8, 2008

Neck Pain Relief That’s Quick and Easy

Neck pain can be caused by anything from sleeping at a bad angle, a sudden movement, a sports injury or the ever-popular wife-parks-a-truck-on-top-of-your-Ferrari type automobile accident.


And, as luck would have it, the only real cure for strained neck muscles is rest. You just have to give them time to heal.

However, there are several options available to help you minimize the pain while your body is going about the healing process. (And some of them actually work.)

Read more…


01 Nov 2008 06:35 pm

Writer’s Block Nov 1

Nov. 1, 2008

Back Pain Is Not About Strength

Shaquille ONeal

Have you seen the commercial on TV featuring NBA basketball player, Shaquille O’Neal? You know, the one where he tells us how he uses the IcyHot Patch for his back pain?

Don’t you find that a bit odd?

I mean after all, you can’t get more physically fit than an NBA basketball player. So what’s the deal? How is it that a big strong superstar athlete like Shaq has trouble with back pain? Surely he must know a thing or two about building muscles?

The answer is simple.

How strong you are has nothing to do with back pain.

Is There Something We’ve Overlooked?

Ferrari Testa Rossa

Imagine strolling up to your brand new Ferrari Testa Rossa. You smile as the light dances across the shiny red surface gleaming in the afternoon sun. Reaching out, you open the door and fold yourself into the glove soft seat. Pulling the door shut, you’re instantly embraced in a world that only a lucky few will ever know; a world of Italian leather and finely polished wood that reminds you that you’ve arrived.

You turn the key and the engine instantly comes to life with a satisfying purr that belies the power lurking within. One jab on the accelerator and that purr becomes a roar, a rumble… that unmistakable Ferrari sound. For a moment, you listen as the music of 12-cylinders plays a symphony just for you.

You engage the clutch with your left foot and slip the gearshift into first. As you release the clutch and pull out onto the road, the yellow and gold Fall leaves scatter as the powerful Italian engine effortlessly accelerates to 200 mph. The sleek aerodynamic shape slicing through the wind as the finely tuned Formula One-inspired suspension grips the corners like it was on rails.

Too bad someone at the factory forgot to lubricate the tie rods.


How Important is Lubrication?

The fact of the matter is that every machine from the simplest household appliance to the most exotic automobile ever made requires lubrication if it is going to perform and operate properly.

Overlook the lubrication and you’re going to have problems.

The human body is no different. When you boil it down to its most basic form, it’s just a machine that carries us from place to place as we travel through this world. Our chassis is made up of hundreds of bones and joints all of which require daily lubrication if they are going to perform at peak efficiency and last us for a lifetime.

And yet, lubrication is the one area of fitness that no one ever thinks about.

I’ve read dozens of books and poured over mountains of research material and I am completely baffled that no one has ever thought to address this aspect of rehabilitation.

No one seems to understand this principle that is so fundamental to mechanical engineering and good preventive maintenance.

The Muscle Mistake

The reason big strong otherwise healthy men and women develop back and joint pain is that they have overlooked the other key elements of fitness; not the least of which are exercises specifically designed to lubricate your joints.

Most fitness programs emphasize strength, endurance and speed. Our competitive nature has misled us to equate performance with good health. The ability to jump higher, run faster, lift more weight and hit a ball farther has completely usurped what really matters.

What really matters is the overall health of your machine… even if yours isn’t a Ferrari.


So, for the record, keep in mind that rebuilding your back has almost nothing to do with strength or muscle building as many people incorrectly assume. Instead, it’s all about doing everything possible to restore health to your spine.

By the way, have you lubed your joints today?

Just thought I’d ask,

Photo Credits:

Ferrari Testa Rossa courtesy of Serious Wheels.

Wrecked Testa Rossa courtesy of Ready To Fix.


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