The National Football League is about 4 months from the opening day kick-off and yet millions of football fans will be riveted to their televisions and computer tablets on Thursday, Friday and Saturday. Why? The annual NFL draft of amateur players occurs on these nights and for at least 254 players, it’s the most important day in their young lives.

Being chosen in the NFL draft is the first official step to becoming a member of a very elite club. It’s a club which can be very lucrative and one where the membership is short-lived – usually about 6 years. It’s also a business where the occupational hazard often includes debilitating back pain.

Since Texas Back Institute specializes in spine injuries, artificial disc replacement, and treatment of chronic back pain, we thought it might be interesting for players and fans alike to get a glimpse into how these supermen withstand the back pain resulting from playing professional football. For this analysis, we’ve asked Dr. Shawn Henry, whose specialty at Texas Back Institute is spinal surgery, to give us his expert opinion on how these men survive a  physically demanding of team sports. But first, let’s look at this year’s draft.

Who Gets the Top Pick?

For the players who hope to hear their name called from the stage at Radio City Music Hall in New York City, draft day is the next step in a journey which likely started when they were about 8 years old, competing in Pop Warner or Pee Wee football. Through high school and college, these athletes have excelled in a game that requires strength, speed, year-round conditioning and athletic instincts only a tiny percentage of human beings possess.

Using a formula that allows the teams with the worst record in the previous year to get the earliest choices and theoretically the most talented players, the NFL draft has gone from a little observed event, watched by a few hardcore sportswriters in the early days of the league, to a three-day, fan-friendly happening. This year is no exception. The hoopla around the draft is palpable.

While it is always possible for a last-minute “trade” to occur among the teams which can change the order of their drafting position, as it stands now the first five teams in this year’s draft and their likely picks (based on media reports) are:

(1)  Kansas City – Luke Joeckel, OT, Texas A&M

(2)  Jacksonville – Dion Jordan, OLB, Oregon

(3)  Oakland – Sharrif Floyd, DT, Florida

(4)  Philadelphia – Star Lotulelei, DT, Utah

(5)  Detroit – Eric Fisher, OT, Central Michigan

For the rest of the draft order, you can click here.

Based on factors too numerous to list, many of the teams have more draft picks than others. For example, San Francisco, which had an excellent year in 2012, has the most number of picks in this year’s draft at 13. Theoretically, this should enhance their status in the upcoming season. Whereas, New England, New Orleans, Chicago and Carolina with the fewest number of picks (5) should be at a disadvantage. However, NFL fans know  having lots of draft picks seldom translates to a winning season.

When the smoke clears on Saturday night, 254 players will realize their dream of playing in the National Football League, assuming they make the team. Unfortunately, not every player drafted makes the cut and others in  this group can  sustain an injury in the summer training camps conducted by every team  prior to the opening of the season and their dream will die.

As noted earlier, a typical NFL career is extremely short – usually about 6 years for a player who is on the opening day roster. The reason for this is obvious when one watches the games each Sunday. The human body –even the superhuman bodies of these highly-conditioned players – has not evolved to the point of sustaining the type of repetitive trauma experienced in a typical season without injuries.

Some of these injuries can be  associated with the neck and back areas of the body and for some insights about these we asked the opinion of an expert, Dr. Shawn Henry an orthopedic spine surgeon at Texas Back Institute.

Henry_MD_web_1Over a typical season, the bodies of professional football players take a tremendous pounding. What is it about these player’s bodies that allows their backs hold up under this abuse?

In order to have attained their position in the NFL, a player has spent his life building muscle mass. This is the most important aspect of his conditioning is what allows the player to withstand the constant trauma of a typical season. This muscle mass gives dynamic support to the spine. Every player in the league has built strong abdominal muscles, quadriceps and other muscles groups and these “load share” the impact of the constant hits to the spinal column.

As fans, we often hear that a player has sustained a “stinger.” What is a stinger and is this a serious injury?

Basically, when someone gets hit hard in the neck and shoulder areas, the impact causes a temporary trauma to the peripheral nervous system. This causes a short-term burning, stinging pain. However, since this does not affect the central nervous system, there is no potential for paralysis and typically goes away in a short time.

The NFL Players’ Association notes the most common back problem among their members is degenerative disc disease, associated with arthritis. What does this mean and how can a player avoid this?

Actually, the most common back problem for every human, not just a professional football player, is degenerative disc disease. The medical term for this arthritic condition is “spondylosis” and it is a condition that is exacerbated by smoking, obesity and trauma. A player is not likely to smoke, but he may have tendencies toward obesity and withstanding physical trauma is a part of the job description. This trauma and weight can cause injury to the disc. For an athlete, good conditioning is the only way to help protect your spine.

There will likely be a great many young athletes watching the NFL Draft this weekend thinking they might get a chance to perform in the Big Show in the future. What can a young football player focus on in order to strengthen his back muscles?

The key is to build core, isometric spine stabilization. Weak core muscles cause injuries. They should also work on flexibility and increasing a range of motion in their muscle groups, their cervical spine and their lumbar spine areas. They should also make certain the correct equipment – helmets, pads, collars – are used in practice and game situations.

In your practice, what is the most common back injury  you see in younger athletes?

The most common ailment in high school and college athletes is a herniated disc in the neck and a pars fracture in the lower back. This is most commonly seen among interior linemen because they extend their spine by arching their back when they come off the line to block. With repetitive trauma a fracture can occur. Interestingly, because of the tendency to extend the spine, this condition also occurs with some regularity among equestrian competitors and ballet dancers.

What is the NFL doing to help control the number of spinal injuries among players?

Because of the potential for long-term neurological disorders, the league is researching the effects and prevention of concussions among players. There is no correlation between concussions – which affect the central nervous system – and back injuries. As for the league’s efforts in helping to reduce back injuries, there have been many advances in helmets, facemasks and neck wraps. Plus, a few years ago the NFL  introduced rules which prohibit “spearing” and this has probably resulted in fewer incidences of spine and back injuries.

Injuries Are a Part of the Game

Based on viewer ratings, the National Football League has become the most popular spectator sport in the United States. The athletes in this game are big, strong and fast and when they collide, injuries will inevitably happen. As every NFL coach says a few times every season: “injuries are a part of the game.” Hopefully, with better conditioning and high-tech equipment, these spine injuries will be limited in the future.

earth day 3 recycling

Making Every Day Earth Day

For the past 43 years, April 22nd has been the day when America commemorates the changing of its consciousness about our planet and its finite resources. From its beginning in 1970, when “flower power” was a radical notion, Earth Day has become a touchstone for both genders, all ages and people of every political persuasion.

The founders of the movement could not have possibly imagined that almost 50 years later, grandparents would be talking to their elementary school-aged grandchildren about recycling, carbon footprints and natural resource conservation. However, that’s exactly what has happened and Texas Back Institute is proud to be waving the Green flag too.

The History of Earth Day

As notes in 1970, “Air pollution was commonly accepted as the smell of prosperity. ‘Environment’ was a word that appeared more often in spelling bees than on the evening news.” All of that changed when Senator Gaylord Nelson, U.S. Senator from Wisconsin and U.S. Representative Pete McCloskey of California joined forces to begin an organization that was to become the impetus for the annual celebration of Earth Day.

Here’s how the network news reports covered that first Earth Day.

Over the years, this original environmental “protest” has become more of a teaching opportunity. Anyone who has been reprimanded by a young child for such transgressions as littering or having a gas guzzling vehicle understands Earth Day and the sentiments that it commemorates has become a fundamental part of the American psyche.

In addition to heeding the admonitions from youngsters to “Save the Planet” and “Go Green,” environmentally sensitive business practices have been developed by many companies.   As such an organization, Texas Back Institute helps educate its staff about earth-friendly responsibility and saves money- all while saving the planet.

Every Day is Earth Day at TBI

From our beginnings, the goal of Texas Back Institute has been to perform as a center of excellence.  We do so by integrating the best of science and education with the exemplary business practices. We believe it is both good business and ethically responsible to conserve our natural resources. Over 35 years, Texas Back Institute has become one of the largest freestanding multidisciplinary academic spine centers in the world and along the way we have worked hard to reduce our own carbon footprint.

What does Texas Back Institute do to help conserve natural resources? A large medical practice can literally consume tons of paper and much of it must be shredded and destroyed in order to protect patient privacy. We’ve made it a point to find a document destruction firm that recycles this paper after the shredding and destruction have been completed.

An even more effective way to save natural resources such as trees is to avoid using paper altogether.  We’ve done this by aggressively pursuing electronic health record keeping throughout our offices. Electronic health records (EHR) save on paper waste as well as computer resources. It also enables more efficient collaboration among our physicians by avoiding the massive paper flow and storage.

Texas Back Institute also uses a “PACS” system for digital imaging in order to eliminate the use of paper folders and the plastics, metals and chemicals in radiology film. Plus, certified recycler is used for all electronic equipment destruction and recycling.

We note these conservation tactics to show that it is possible for any enterprise – large or small – to reduce its consumption of natural resources. It takes planning and a commitment to efficiency in daily operations.

Saving Fuel and Staying Healthy

One of the tangential effects of Earth Day has been to encourage earth-friendly transportation such as biking. Several of the surgeons at Texas Back InstituteDr. Richard Guyer, Dr. Michael Hisey and Dr. Isador H. Lieberman – are cyclists and they find this sport helps them reduce the stress of their profession.

TBI Dr. Guyer biking

Dr. Guyer recently went all the way to Cape Town, South Africa to participate in the 109 km cycling tour around Table Mountain. This was a part of the “Pick ‘n Pay Cycle Tour.” For this event participants ride to support a charity of their choosing and Dr. Guyer along with many others dedicated their ride to the Jeffrey Allen Guyer Fund for Sarcoma Research now known as “Spinspiration.” The team has raised more than $50,000 and for more information, visit:

Since he is both a spine specialist and cyclist, we asked Dr. Guyer to share some advice on proper techniques for biking and back health.

Do any of your patients complain of back pain after biking?

Yes, but neck pain is actually more prevalent. This soreness is usually the result of the rider being in racing position – where they are leaning over the handlebars, gripping the steering handles – and arching their neck. This can be alleviated by periodically sitting up straight, while gripping the top of the handlebars and stretching while riding.

What precautions should someone take to keep from getting back pain from a long biking trip?

The most important thing a new rider should concentrate on is being in aerobically good shape and having a strong body core. The best way to work into this is to use a stationary (exercise) bike or spin bike to get the heart rate up and go through this training a week or two before climbing on the regular bike. It’s also a good idea to bike slowly around the neighborhood a few days before attacking a challenging course or race. Getting into biking shape by building up strength slowly will help to minimize the soreness from cycling.

Walking the Walk

The business staff and the spinal specialists at Texas Back Institute are focused on treating patients for chronic back pain, disc damage, artificial disc replacement, scoliosis and spinal injuries. However, we are also committed to saving natural resources with innovative business practices.

Join us in celebrating Earth Day 2013! Is your company or family doing anything to help conserve our resources? Let us know. Post them below.

golf masters

The annual quest for the most recognizable coat in sports is on again and the green jacket with the “Augusta National Golf Club” logo is up for grabs at the Masters Golf tournament. Watching the best golfers in the world play this stunning course is enough to motivate scratch golfers and duffers alike to head over to the driving range or neighborhood golf course and hit a few. However, sometimes playing this game leads to some unintended consequences and the skills of the back experts at Texas Back Institute are needed.

Before getting into the occupational hazards that every pro golfer has had to deal with at one time or another – back pain – it’s interesting to offer PGA fans a quick look at the group of golfers whom the experts in the game think have the best chance of wearing that jacket. Some, such as Tiger Woods, are internationally known and others are just beginning to garner sports headlines.

Players to Watch at the Masters

Never underestimate the defending champ. Because Bubba Watson won 2012 Masters in spectacular fashion – in a sudden-death playoff with a remarkable, 140 yard hook shot – he will be confident and ready to repeat his feat. The others on the course will have something to say about this.

Another name being heard around the hallowed halls of Augusta as a potential Masters champ is Ian Poulter. He finished 7th in last year’s Masters but had golf fans around the world talking about his great play for the European Ryder Cup team.

Is Rory McIlroy the heir apparent to the king of the course – Tiger Wood? Some smart golfers say yes and many expect this 23- year old from Northern Ireland to be in battling with Wood during the entire tournament. Unless something unusual happens, look for McIlroy name near the top of the leaderboard.

Tiger Woods is on a roll, again and this makes him the odds-on favorite to win his 5th Masters tournament. He has won three of his last six tournaments, he obviously plays Augusta extremely well (largely because this course favors great putters like Woods) and his confidence seems rise when the limelight is on him.

Meet Pro Golfer Donnie Wood 

Even though there is no contact in the game of golf, the sport can wreak havoc with a player’s back. Just ask Donnie Wood.  He’s a player on the senior tour who came to Texas Back Institute several years ago in so much pain that he found it difficult to get out of bed, much less drive a golf ball.

Often, older golfers such as Donnie experience chronic back pain as a result of wear and tear on their vertebrae. In his case, the pad that acts as a “shock absorber” between these vertebrae bones, called a disc, was damaged from injury or repetitive wear.

“As recently as 12 years ago, someone suffering from chronic back pain that was caused by degenerated or injured discs had only one surgical option,” said Dr. Jack Zigler of the Texas Back Institute. “Spinal fusion was the only choice if non-surgical therapy didn’t fix the problem.”  All of that changed in 2000, when three surgeons at Texas Back Institute performed the first artificial disc replacement surgeries in U.S. Since then, these three innovative surgeons – Drs. Zigler, Blumenthal and Guyer – have performed more than 1600 artificial disc replacements.

Golf and Back Pain

With the Masters tournament putting the sport of golf on the minds of men and women players, we asked Dr. Zigler for some advice – not about his short or long game – about the causes of chronic back pain.

Zigler 2

What is it about a golf swing that irritates the back of someone with minor back pain?

Dr. Zigler said, “Rotation, or twisting of the spine, stresses all components (the discs, muscles, and ligaments) in directions that are not used in normal walking, standing, sitting, or even lifting activities. This is why a sweeping or mopping motion, even pulling bed sheets, are some of the first movements noted to be painful when we injure our backs. The golf swing requires a tremendous coiling and uncoiling of the trunk above a relatively stable pelvis, stretching strained structures on the backswing and then actively accelerating them through the power portion of the swing.”

When should someone who enjoys playing golf be concerned about back pain and when should they seek a medical opinion?

“Normal aches are common, particularly if one is only an occasional golfer. Taking some Ibuprofen or similar non-steroidal anti-inflammatory medication and stretching very well before playing are the best safeguards. But even regular players can experience pain from overuse or over-straining of the back. With age, we all develop degenerative changes in our discs and recovery from minor injuries can take longer. Pain that persists despite a week or two of rest, or pain that occurs after every attempt at play should be evaluated. Similarly, any persistent arm or leg pain, numbness or tingling in the arms or legs, or any muscle weakness needs to be evaluated as soon as possible.”

Senior golfer Donnie Wood had a serious problem with his back, one that required artificial disc replacement. What caused this disc damage?

“As we all age, the structure of our discs, muscles, and ligaments in the spine change. There is a loss of water content and a change in the molecules of the proteins and sugars that are the structural framework of our soft tissues. Layered on these age-related changes are the small repetitive injuries that occur throughout our lives. These cumulative degenerative changes result in a stiffer, less forgiving disc that loses much of its shock absorber ability, and is less resilient to further stress and injury. Donnie’s disc had worn to a point that would not allow him to use his back the way he wanted without resulting in increased pain and protective muscle spasm. With no ability for the disc to heal itself, his options were to cut back on his activity (his work as well as golf, neither of which was a reasonable option for him) or to consider surgery. A fusion might relieve his pain nearly as well as an artificial disc, but it would put even more stress on the other segments of his spine. Disc replacement was a terrific option for Donnie,” Dr. Zigler concluded.

What did Donnie need to do after the operation (for rehab) in order to get back into golf-shape?

“For the first few weeks, he did a lot of walking so his muscles could recover from the surgery, and his artificial disc could heal to the bone in his spine. After 4 weeks or so, gentle range-of-motion exercise and stretching were done. Three to four weeks after that, core strengthening exercises were started and progressively increased. For most golfers, stretching and core strengthening are the keys to getting back into golf shape. The same strategy is used after disc replacement. I usually allow golfers to start putting at 4-6 weeks, chipping at 8-10 weeks, and start taking full swings at 10-12 weeks after surgery.”

He’s Back in the Swing

The mechanics of swinging a golf club can cause serious pain when a vertebrae disc is damaged. Fortunately, there are alternatives available to professional and weekend golfers. Here’s how Donnie Wood sees it.

Top Photo credit: Flckr Creative Commons Pocketwiley

All others: Texas Back Institute


Gracie Rasmussen is a 13-year-old athlete who loves the sport of cheerleading. Her dream had always been to compete for Cheer Athletics, a nationally renowned cheerleading powerhouse.  She worked hard to make the team, spending hours in the gym each day perfecting every tumble, dance move and stunt.  Like most of the girls, she had to ice down parts of her body that would ache after practice.  For Gracie, it was her back that hurt the most, a pain easy to dismiss after watching the cheerleaders tumble, jump, stretch and flip over and over again.

It was actually a weekend off from cheerleading, spent on the lake with her family that brought her a diagnosis of scoliosis.  Gracie and her sister, Sawyer, were riding an inner-tube being pulled by a boat on the lake, when they both fell off and jarred their backs. An X-ray on Gracie’s back confirmed much more than bruising: it illuminated a severe case of scoliosis that was bending Gracie’s spine at a 65-degree angle.

“I was just so impressed with Dr. Lieberman,” said Lynn Rasmussen, Gracie’s mom. “He spoke directly to her.  He looked her in the eye and told her exactly what was going on. He worked her in and within two weeks, she was having surgery.”

“Gracie’s eight-hour surgery was an instrumentation correction fusion for idiopathic scoliosis – essentially, we realigned her spine and locked everything where it needed to be by using computer-navigated robotic assistance for the placement of the hardware,” noted Dr. Lieberman. “We use tools like this to achieve the best accuracy, effectiveness and efficiency we can for patients who need a procedure like this.”

Cheerleaders are known for their positive attitudes and strong spirits.  But it was faith, Gracie says, that pulled her through: “I was really nervous about the surgery, but I knew that I needed it. I had just made Cheer Athletics team – it was my dream to go there.  I just prayed about it.” A strong Christian faith and friends at her church, Prestonwood North Baptist Church, Gracie said, helped her through surgery and recovery. She spent eight days in the hospital at Texas Health Presbyterian Hospital Plano and continues physical therapy at home.

Almost a year post-surgery, it was mom Lynn who was the most nervous as her daughter prepared to do her first back flip on the mat at the gym where Gracie practices.

“I couldn’t believe it when she did it,” she recalled. “I was jumping up and down and saying, ‘Gracie, you did it! You did it! And she looked at me and rolled her eyes and said, ‘Mom, I’ve done this, like, a thousand times before.’ But I was thinking, ‘Yes, but you got it back!’ Nothing prepares you for watching your child relearn everything they knew, from lifting their head to walking to tumbling.”

Gracie’s passion for cheering pushed her to work hard through her recovery to continue the sport she loves so much.  Her coaches credit her strong work ethic and muscle memory for allowing her to get back onto the mat so quickly post-surgery.

“Tumbling is a lot easier now,” notes Gracie, when talking about her recovery and her return to her sport. “It’s straighter and it’s easier.” Gracie never knew that it was a curve in her spine that was causing her to veer off to the side during tumbling passes, something she had struggled to control. Even just months after her surgery, she felt that her back was stronger and that things were coming easier than they did before.

“Gracie is an athlete,” said Dr. Lieberman. “While we want the best outcome we can for all patients, we know that flexibility is particularly important for these young men and women.”

Gracie, who loves English and writing, is looking forward to writing the ending to this chapter in her life, which she hopes includes a spot on her high school cheerleading squad. One day, she wants to help others by going into the field of physical therapy or sports medicine, and she is excited to share her story with other patients who may be going through a similar experience with a diagnosis of scoliosis.

Her advice for them?

“Just trust the doctors and know that you will be stronger than you ever were.”

Spoken like a true cheerleader.


With just one lap to go in the NASCAR Sprint Cup Series Auto Club 400, driver Denny Hamlin’s day, took a sudden and violent turn for the worst. As a result of a collision with another driver, Joey Logano, Hamlin’s back was broken and he will likely be sidelined for the next six weeks. Was this accident caused by competition spiraling out of control? Will this crash end the career of one of NASCAR’s top drivers?

The spine experts at Texas Back Institute see the type of injury Hamlin sustained – an L1 compression fracture – with some regularity, but most patients don’t sustain this injury while driving in excess of 200 miles per hour! NASCAR fans want to know the nature of Hamlin’s injury, what’s involved in the surgical treatment for this lumbar region of the spine, possible long-term damage Hamlin might expect and what type of rehab he will likely undergo.  So, we asked a specialist.

As a spine surgeon at Texas Back Institute, Dr. Michael Duffy is an expert at dealing with this type of injury and this makes him a great source for explaining the ramifications of Hamlin’s injury. His practice is focused on helping patients overcome chronic back pain, spinal disc damage, Scoliosis and, in the case of an accident like Hamlin’s, spinal surgery. Before getting Dr. Duffy’s thoughts, a brief review of this NASCAR accident is in order.

A Recap of the Race

Hamlin must have been feeling great when the cars lined up to start the race at Auto Club Speedway in California. He had good reason. His qualifying time of 187.5 miles per hour secured the coveted pole position for his #11 car for the race and as such, he was the favorite to win. This early optimism would be shattered a few of hours later.

From the earliest days of stock car racing, NASCAR drivers have had reputations for highly competitive spirits. As the news wire services noted, “In the waning laps of Sunday’s race, the two were battling for the lead when they again made contact. Logano’s Penske Racing Ford slid across the nose of Hamlin’s Toyota before striking the wall. Hamlin’s car spun, then drove straight into the inside wall near the entrance to pit road. The impact lifted the car completely off the ground.”

Although, additional safety equipment has been added to the track as a result of Sunday’s crash. Unfortunately, this new safety equipment will not help Hamlin.

Medical Insights from Texas Back Institute

Twitter seems to be the social media of choice for NASCAR drivers, even those who are in pain. Hamlin’s tweet on March 26 had no good news for his fans. “I wish I got good news today… I didn’t. If me getting back in a car was based on pain tolerance then I would be in the car next week. There’s just more to it that I can’t control.”

Wire reports note that Hamlin was examined Tuesday by Charlotte-area neurologist and spinal specialist Dr. Jerry Petty, who determined that the driver would not need surgery but would have to be out of the car for at least six weeks. NASCAR takes this weekend off, and the Sprint Cup Series returns to action May 7 on the short track at Martinsville. If Hamlin keeps to his recovery timetable, he would miss five races and return May 11 at Darlington.

Duffy Headshot Square

We asked Texas Back Institute surgeon Dr. Michael Duffy to explain the importance of the L1 vertebra. He said, “There are 5 lumbar vertebras including the L1 and they give the spine stability. The usual patient for this type of compression injury is an elderly female whose L1 vertebra has deteriorated from osteoporosis. In the case of this driver, the force from this collision went up the spine and apparently the L1 took the brunt of the force and failed.”

Since there will apparently be no need for surgery, Dr. Duffy notes that a brace and non-activity are the appropriate treatment for this type of injury. Had this injury been more extensive, the patient could have undergone a more extensive range of procedures, ranging from a corpectomy – removing the damaged bone and replacing it with a fusion cage – to adding screws and rods to increase stability of the spine.

Wire reports noted that Hamlin had a history of back problems – torn and bulging discs. Will these previous problems affect his recovery from this fracture? Dr. Duffy says, “It’s definitely a possibility. Some spine injuries can result in osteoarthritis occurring in the part of the spine. This could result in back pain in the future.”

Does having a repaired vertebra make someone more likely to have other back problems later? For example, can this lead to osteoarthritis? Duffy notes, “Any time there is a compression fracture such as this, it changes the stress on spine and eventually arthritic changes could occur. This might take 10 to 20 years, but Denny could have back pain from this injury in the future.”

Drive Fast!

It’s been said that the sport of race car driving is simple – you just drive fast and turn left. However, when that speed is combined with even a tiny miscalculation in steering or bump from another driver, the ramifications can be serious.

However, Dr. Michael Duffy is optimistic about Hamlin’s prognosis. “It appears that the spine is stabilized and with the use of the brace and rest, a patient with this injury should recover. Hamlin should be able to climb back in the racecar in 6 to 8 weeks.”

This is good news for NASCAR fans and especially Denny Hamlin.

Photo of Denny Hamlin from

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