Balance and Back Pain

June 28, 2013

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After Sunday’s spectacular walk on a 2-inch steel cable across the Grand Canyon, aerialist Nik Wallenda earned a new title: daredevil. His exploits also suggest how important one’s balance is to daily activities – not just survival on the high-wire.  The physicians at Texas Back Institute have first-hand experience helping regular people correct the back pain which can cause a loss of balance, leading to potential injuries from a fall. More on that later, but first let’s briefly review one of the most dramatic walks in history!

Representing the next generation of the famous “Flying Wallendas” family, known for its daring and sometimes deadly stunts on the high wire, Nik Wallenda completed a tightrope walk that took him a quarter mile over the Little Colorado River Gorge in northeastern Arizona. He walked 1,500 feet above the river on the Navajo Nation near the Grand Canyon with no net or safety vest.

This feat was broadcast live on the Discovery Channel and had viewers around the world griping the arms of their chairs for more than 22-minutes. The life-or-death drama was further enhanced by the fact that viewers could hear Wallenda speaking to himself from the mobile microphone attached to the aerialist and see what he was seeing from a camera placed on the aerialist. Throughout the spectacle, he was heard praying and attempting to calm himself as the 40-miles per hour winds above the Grand Canyon buffeted his taunt cable.

After the stunt was completed, Wallenda was asked by the media to recount the things that were going on in his mind during his walk. He noted at one point during the walk he “knelt down and I thought of my great-grandfather and that everything I do is to honor him,” Wallenda said. “It took my mind off all this movement underneath me … and I was able to focus on him and regain composure.” Nik’s great-grandfather, Karl slipped and fell to his death from a high wire in Puerto Rico in 1978 when he was 73 years old.

Here’s is a brief video clip, courtesy of the Discovery Channel of Wallenda’s amazing walk across the Grand Canyon.

http://dsc.discovery.com/tv-shows/skywire-live-with-nik-wallenda/videos/final-moments-of-nik-wallendas-historic-walk.htm

Lack of Balance is a Big Healthcare Problem

Tightrope walkers such as Nik Wallenda have an uncanny sense of balance. How else could he and the rest of the Flying Wallendas successfully walk more than 1,400 feet on a steel cable no thicker than 2-inches?

Clearly, most people don’t have this superhuman sense of balance. In fact, many people struggle to keep their balance when walking on a perfectly flat surface. Why? Sometimes this is due to an inner-ear injury, but often this has to do with the effects of back pain.

The Center for Disease Control and Prevention (CDC) notes that “in 2000, falls among older adults cost the U.S. health care system over $19 billion dollars or $30 billion in 2010 dollars. With the population aging, both the number of falls and the costs to treat fall injuries are likely to increase.”

The federal agency also notes:

  • One in three adults age 65 and older falls each year.
  • Of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard for them to get around or live independently, and increase their risk of early death.
  • Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.
  • In 2009, emergency departments treated 2.4 million nonfatal fall injuries among older adults; more than 662,000 of these patients had to be hospitalized.

How Does Back Pain Affect Balance?

As these healthcare costs suggest, this lack of balance is a problem which is both painful and expensive. We talked about balance and how it is affected by back pain with Texas Back Institute spine surgeon, Dr. Jessica Shellock.

shellockCan back pain cause a loss of balance?

Absolutely.  When someone suffers from back pain, there is usually some amount of muscular spasm or imbalance that can lead to an alteration in their overall spinal alignment. That’s going to present many times as a change in posture, such as the patient leaning to one side or even stooping forward. Sometimes on a radiograph we can see a subtle curvature of the spine that’s not scoliosis but actually a musculature imbalance because of pain. When we are unable to walk effectively then our balance will be hampered as well.

Does this lack of balance due to chronic back pain affect only older people, or do younger people have this problem as well?

Anybody in pain because of their low back, whether young or old, can be affected.  However, one issue that preferentially affects the older population is degenerative changes in the neck that can result in compression on the spinal cord.  This can also cause balance problems.

Here’s a quick video synopsis of Dr. Shellock’s thoughts on back pain and its effect on balance.

What are the back injuries or diseases that can cause a loss in balance?

Anything that can cause back pain, such as a herniated disc, pinched nerve, muscular strain or ligamentous sprain in the back can result in a loss of balance.  Degenerative changes in the neck or mid-back that create spinal stenosis, or pressure on the spinal cord, can result in a loss of balance.

How can these back problems, and the concurrent loss of balance, be corrected by surgery or therapy?

Understanding the source of the pain is key.  For example, if the cause of the limp is due to muscular pain or a ligamentous injury, physical therapy to address the problem and restore balance may be very successful. Alternatively, if compression of the spinal cord is causing the problem, we can take surgical actions to relieve this compression. In most cases, physical therapy can correct the root causes for muscular pain and misalignment of spine and also help many patients with pain from a herniated disc. Surgery is always the last resort in patients who’ve failed to respond to these more conservative measures.

Don’t Try This at Home

Walking across the Grand Canyon on a 2-inch steel cable is not something anyone – except maybe another Flying Wallenda – will do. The amazing sense of balance  Nik Wallenda showed was no doubt learned at an early age and could even be genetically determined. Most of us just want to be able to walk down a flight of stairs without taking a tumble.

If back pain is keeping you from maintaining your balance, it could be as simple as working on muscular strength with the specialists at Texas Back Institute’s physical therapy department. If  your condition is more serious, state-of-the-art diagnosis and appropriate therapy from our spine  specialists can have you back on the tight-wire of life sooner than you think!

Summer’s Back!

June 21, 2013

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Since the official beginning of summer is June 21st, the spine specialists at Texas Back Institute are preparing for the annual spike in the number of back injuries. “The primary culprits in this rash of acute back injuries are the accidents which occur when people get outdoors to enjoy some summer recreation,” notes Dr. Daniel Bradley, a spine surgeon at Texas Back Institute.

Activities such as mountain biking, water skiing and wake-boarding have an unusually high incidence of back injuries associated with them. Overdoing it on the golf course, tennis or basketball court can also lead to a visit to Dr. Bradley’s examination room. Even lifting those heavy suitcases into the car for summer vacation has the potential of causing painful back injuries.

So, how can you avoid the backache blues this summer? We asked Dr. Bradley for his advice.

Tips on Avoiding Summer Back Injuries

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“The best strategy for avoiding back injuries from summer recreation is to build core strength through proper conditioning before undertaking the activities, Dr. Bradley said. “Of course, this is easier said than done because in the summer, the weather is warm and we want to get out and play 36 holes of golf, rather than the 18 holes we are used to playing. Plus, we all believe we are in better shape than we really are.”

What is it about biking, equestrian sports, water skiing and wake-boarding that is makes them so dangerous to back health?

“The sudden pull on the ski line from the boat can cause trauma to unconditioned back muscles. However, this pales in comparison to the impact from falls that occur from a bike, horse, skiing and wake-boarding. A fall from this high speed can lead to strains and sometimes fractures to the vertebra of the back.”

What about swimming? Are there any potential back problems associated with taking a refreshing dip in the pool?

“So long as you’re careful on the depth of the water in which you’re diving, swimming is actually the best type of exercise anyone can do – in the summer or any other time of the year. In fact, we recommend regular swimming for those who are rehabbing from other back injuries. It’s extremely low impact and offers an excellent aerobic workout, while exercising all of the muscle groups.

Some summer sports such as fishing, tennis, golf and jogging seem to be pretty mild recreation. What are the possible problems with these activities?

“These activities are highly repetitive and sometimes involve twisting motions. While they are not high impact, they can exacerbate existing back pain if some form of stretching and muscle warm-up is not completed before the activity. By loosening up the muscles, they are more flexible and less likely to be strained by the motions of these sports.”  

How can someone determine when their back pain is related to soreness resulting from inactivity or a severe injury requiring medical attention?

“Any pain that does not subside after icing and over-the-counter pain medication over 2 or 3 days might require medical attention. Also, a physician should be consulted for any back pain which runs down the legs or arms and weakens these muscles.”

Summer is hot. Does heat have any effect on back pain or injuries?  

“Heat-related illnesses such as a heat stroke affect the central nervous system not the spinal muscles. I am not aware of any back injuries that are caused by the body overheating. However, the heat and fatigue can cause a person to be more careless in their physical activity and this can cause accidents. Plus, insufficient hydration can result in muscle cramps which can lead to injuries in the back and other areas of the body.”

Celebrating the Summer Solstice

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June 21st is the longest day of the year in the northern hemisphere and is known as the Summer Solstice. This is when the tilt of the earth’s semi-axis, in either the northern or the southern hemisphere, is most inclined toward sun around which it orbits.

While there are many myths and legends associated with the Summer Solstice, the most interesting place to celebrate the longest day of the year is at Stonehenge, located near Wiltshire, England. Many scholars believe this pre-historic monument was built to serve as a celestial observatory which helped predict events such as solstices, equinoxes and eclipses of the sun.

Online references note that during Summer Solstice, Stonehenge provides visitors with a visually stunning view of the rising sun. It can be seen rising above the ‘Heel’ Stone when one stands within Stonehenge facing north-east through the entrance towards the stone. The ‘Heel’ Stone stands just outside the main entrance of Stonehenge.

Whether you celebrate the beginning of summer at Stonehenge, in your backyard pool or favorite golf course, Texas Back Institute reminds you to exercise good judgment about the activities that can affect your back. Chronic back pain can take the fun out of this wonderful time of year. It can limit your ability to participate in the activities that are fun and can help you stay fit and healthy.

Don’t overdo it. Stay hydrated. And make this the best summer ever! 

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For Father’s Day 2013, forget about neckties and golf balls as gifts!  Rather, remind yourself of this…

What are the most important things your father ever gave you?  Most likely it wasn’t a set of golf clubs, your first car or anything tangible.  Perhaps you can thank Dad for your witty sense of humor, problem-solving ability or knowing right from wrong.  These are the most valuable things we carry with us for the rest of our lives.  Show Dad your gratitude by giving him something just as important.

At Texas Back Institute, we’re focused on overall spine health.  As anyone who has ever experienced back and neck pain knows, a healthy spine is crucial to one’s quality of life.  “Use Father’s Day as a spring board for a new way of living,” suggests Dr. Rey Bosita, a Texas Back Institute spine surgeon, who himself is a father of four  young boys.  From that perspective, we recommend healthy activities and actions that will be a meaningful investment in your relationship with Dad.

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Dr. Bosita and his family are sure to have an active Father’s Day!

Go on walks together.  This will not only enhance your general well-being but will boost your neck and back health as well. “Ask your dad about his health and fitness habits.  If your dad has been sedentary, start off easy and build yourself up to longer and faster walks.  Most importantly, make a commitment to your dad to walk with him regularly.  Consistency over time is what will improve his and your health.”

Taking walks together also fosters conversation.  Dr. Bosita notes that “walking and talking can help reduce stress and emotional pain which is usually carried in people’s neck and back.”

Commit to Annual Exams.  And follow through!   Serious health issues can usually be prevented if discovered early.  We all know dear old Dad sometimes avoids going to the doctor.  Make it a family affair and follow with a lunch date!

Or better yet, do what Dr. Bosita did with his dad.  He made it a Guys Day Out!  The day started with morning golf followed by lunch.  The tour of check-up appointments followed, from 1-5pm that afternoon, including “the dentist, eye doctor, primary care physician and a specialist,” says Dr. Bosita.  And naturally one works up an appetite after all of that, so he and his dad finished the day at their favorite steak house for dinner.  Father/son time and investment in your quality of life all in one day – pretty good by any measure!

“You have to create the same efficiencies in your health care as you do in your job everyday.  It’s all about commitment.  Time and money are the same thing.  Put them where your heart is,” advises Dr. Bosita.

Summon the child within.  What are the activities you enjoyed as a child with your father?  What are the activities he enjoyed with his father as child?  Consider bringing out the fishing poles and dusting off the tent.  Or perhaps your dad likes strolling art galleries or working on a project.  Whatever it is, do it together.

Dr. Bosita brought along the grandparents with his family to Disney World!  He laughed saying, “my father-in-law sure got his exercise walking all around the Magic Kingdom and Epcot Center- while pushing strollers and carrying kids. It was tough but it was great to spend time together as a family.”

In fact, older adults make up many of Texas Back Institute’s patients.    They often seek out preventive measures for the sole purpose of being active with their adult children and grandchildren.  Physical therapy at Texas Back Institute is integral to this approach.   Physical therapy helps prepare you or your older parents for carrying luggage or children, handling squirmy toddlers or playing in the pool. The benefits include “improvements in core strength and endurance, cardiovascular fitness and proper lifting mechanics,” says Dr. Bosita.  So, by planning ahead for such a trip, you will enjoy your experience more fully by being physically prepared.

Dr. Bosita observes that “there are many common neck and back conditions, which surface as we age, like chronic back pain, herniated discs, degenerative disc disease and others.”  However, he continues, “It is never too late.”  Start this weekend with Dad.  He may wear a tie you give him once a year.  But sharing a life full of wholesome activities and meaningful relationships will certainly be his life’s treasure.

 

 

 

 

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The fact that June 5th was National Running Day was lost on many people. Why? The joints and muscles of most individuals are not flexible or strong enough to take the pounding that running requires. However, almost anyone can walk and this exercise seems to be as effective as running. There’s even recent research that proves this.

In April 2013, Paul Williams of Lawrence Berkeley National Laboratory in California and Paul Thompson of Hartford Hospital in Connecticut compared 33,060 runners to 15,045 walkers and found that it’s how much a person exercises, in terms of energy spent, not how long he or she spends exercising. While it takes longer to walk a mile than to run one, when these two exercises compared in terms of energy expended, they are comparable yielding the same benefit.

The researchers measured blood pressure, blood sugar and cholesterol at the beginning, and then watched for six years to see who got diagnosed with high blood pressure, unhealthy cholesterol or diabetes. Those who exercised equally (in terms of energy output) got the same benefit whether they ran or walked. This study was published in the American Heart Association journal, “Arteriosclerosis, Thrombosis and Vascular Biology.”

In addition to these physical benefits, walking lowers stress levels in most people. A study at the Department of Behavioral Science at the University of Texas M.D. Anderson Cancer Center showed university students who walked had lower stress levels than sedentary people or even those who exercised strenuously. Plus, walking can be done almost anywhere – on the street, in a park or in a shopping center.

Is Back Pain Keeping You From Walking Tall?

With all of these benefits, why isn’t everyone walking every day? Sometimes, back pain precludes this activity. This is where the spine specialists at Texas Back Institute can be of assistance. We spoke with Dr. Stephen Tolhurst, an orthopedic spine surgeon at Texas Back Institute about the benefits and challenges of a regular walking program.

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To watch a video interview of Dr. Tolhurst explaining the benefits of walking for the back, please click here. 

Are there benefits to back health that are derived from a regular regimen of walking? If so, what are these?

Walking improves one’s overall health and this affects the whole body including the back and neck. The back tends to be healthier and less susceptible to injury and/or disease such as arthritis when an individual is active. Additionally, walking can help to keep the core muscles – abdominals, back and legs – stronger and this supports the back and neck.

What are some lower back problems that can keep someone from walking and how does one know when these pains are serious enough to visit the physicians at Texas Back Institute?

There is a condition called spinal stenosis, which is an abnormal narrowing of the spinal canal that can occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. The symptoms of spinal stenosis include pain, numbness and loss of motor control. The location of the stenosis determines which area of the body is affected. This can cause a “rubbery” feeling around the leg when walking. This condition is serious and should be treated by a spine specialist.

There are also situations where pain shoots down one’s leg when standing or walking. This could be caused by a herniated disc or pinched nerve and should also be treated by someone on our staff.

However, mild to moderate back pain or stiffness during or after walking is usually not serious. If the pain is not getting worse, it’s probably safe to work through. In fact, the exercise from walking will likely help this pain and stiffness.

What are the most common factors that can cause lower back pain and keep someone from walking?

The number one factor is a sedentary lifestyle and the lack of regular activity. In this situation, core muscles are weak and walking can cause back pain. Obesity also plays a role in back pain and it’s no surprise regular physical activity can help to reduce obesity. Sleeping on awkward surfaces, such as a cot, floor or even a too-soft mattress, can cause back pain.

Some people experience “side stitches” when they walk. Is this a back problem or not?

Side stiches are not a back issue. While there are lots of theories on what causes them, no one is sure. They are not dangerous but they are annoying. When I’ve gotten them, I’ve used deep breathing techniques – after inhaling, breathing out through pursed lips to force the exhale – and this helps me. Stopping and stretching is also a tactic to use to work out this pain. Under any circumstances, this is not a sign of spinal problem.

How You Can Get Started

Just knowing the physical and psychological benefits of walking is not sufficient to motivate most people to “put on their walking shoes.” Texas Back Institute is involved in the specialized care of neck and back pain, spine trauma, scoliosis, artificial disc replacement and related spine surgery – not fitness counseling. However, we recognize physical fitness can have very positive effects on one’s back health.

With this in mind, here are a few fun suggestions to get you and your entire family involved in a daily walking program.

  • Bring along a walking buddy. This can be friends or family and if they’re excited about feeling better…all the better!
  • Walking has to be fun, otherwise it’s boring. Finding visually interesting places to walk such as trails in parks and greenbelts and then combining natural studies such as bird watching or tree/flower identification activities with your walking buddy.
  • Purchase an inexpensive pedometer, clip it to your waist and keep track of the miles you walk each day. Some of these steps will come from your daily activities. The average person’s stride length is approximately 2.5 feet long and this means it takes just over 2,000 steps to walk one mile, and 10,000 steps is close to 5 miles. Set a reasonable and attainable goal and then log your daily steps in a journal and try to add more steps each day.
  • Take the stairs whenever possible. Climbing stairs is a great aerobic exercise and when you take them, you’re not stuck in an elevator with 5 or 10 other people.
  • Get some tunes for your walk with your mobile device and ear buds. Music is a wonderful addition to any walking program because it not only distracts the walker from fatigue, but sports psychologists have noted that a steady beat can elevate a person’s performance by as much as 20%! In order to get you in the mood, why not download some tunes that have “Walking” in the title. Here are some:

Spring and summer is a great time for you to step up to a walking program. With this advice from Dr. Tolhurst you have some of the medical facts you need to get started. Now all you need is your walking buddy, pedometer and walking tunes and you’re good to go. Are you ready? Start walking.

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Two years ago, Keith Roberts was relocating his office. He began to feel immediate pain in his lower back after lifting a table. The pain became progressively worse from that point. His doctor told him it was just a sprain, but he soon learned more about his diagnosis.  After a regimen including rest and anti-inflammatory medications, he didn’t get better. “I’m a fairly active person and I knew there was something more to this,” he said. His first doctor ordered an MRI and the scan revealed a herniated disc. “My wife and I did a lot of research and we decided to try Texas Back Institute,” Keith said. “It was the best thing we’ve ever done.”

Keith made an appointment with Dr. Jessica Shellock and hasn’t looked back since. Texas Back Institute helped him navigate through the sometimes laborious paperwork involved with a worker’s compensation claim. “Without Dr. Shellock’s medical expertise and Tonya’s help with everything, I have no idea where I would be today.”  The Tonya he is referring to is Dr. Shellock’s medical assistant, Tonya Edwards. Medical Assistants are imperative to the delivery of healthcare for the providers at Texas Back Institute. They help obtain information about the patient including vital signs, medication, and their medical history.  They also assist the patient with future testing and appointments. “If it wasn’t for them, I wouldn’t have been able to get the surgery that I really needed to get better.”

After failing to respond to conservative treatment and without sustained relief following a microdiscectomy, Keith ultimately underwent a L5-S1 fusion in November 2012 with Dr. Shellock.  It was after progressive worsening of his symptoms at this point that I recommended the fusion,” said Dr. Shellock.  “He has done fantastic. “

He took three months off of work to recover properly and is now attending outpatient physical therapy sessions at TBI. He went from being very active to no activity and is now making a comeback. In April, he was able to complete his first 6-mile bike ride and this summer, his plans include a 12-mile hike in the Ozarks with his wife.  He and his wife are avid photographers and have donated art work for Dr. Shellock’s patient rooms.

“It’s amazing to go from being able to walk less than a half a mile and having so much pain to this,” said Keith. “I missed out on 2 years of my life and I would be missing more if it weren’t for Dr. Shellock.”

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