DUCK-DYNASTY-facebookYou might say the executives of the A&E cable network were pleased with the premiere of the 2013 season of Duck Dynasty. Actually, it would be more accurate to say they were happy, happy, happy – to borrow a phrase from the patriarch of the Robertson clan!  As USA Today noted, “Wednesday’s episode, which focused on a surprise wedding-vow renewal ceremony for Phil and Kay Robertson, attracted 11.8 million viewers and 6.3 million advertiser-coveted young adults (18-to-49).” This was no fluke. This episode was up 37% in viewers and 26% in young adults vs. last season’s premiere, which also set records.

So, what gives here? Why would almost 12-million viewers tune in to a reality show based on the often ridiculous exploits of a group of self-avowed, redneck duck hunters?

Dr. Ralph F. Rashbaum, M.DWe asked Texas Back Institute surgeon and avid outdoor sportsman Dr. Ralph Rashbaum that question and his response is consistent with media observers around the world, “It’s simple, really. This show is about family values. All of the hunting, fishing, duck calls and related hijinks are just supporting storylines to this.”

Whether it was intentional or not, Duck Dynasty and the Southern charm of the extended Robertson family has had a positive influence on a large number of people –  both city slickers and country bumpkins – who have developed an interest in hunting and fishing. While the fishing rod, shotgun and camouflage apparel manufacturers are (dare we say it) happy, happy, happy, this will inevitably lead to more people in the fields when the fall hunting season kicks off in September.

Unfortunately, some of these hunters will show up in Dr. Rashbaum’s examining room shortly thereafter. Before getting some advice from him about avoiding back injuries while swinging that shotgun, let’s take a moment to introduce Duck Dynasty to precious few who have not made the acquaintance of the Robertson family of West Monroe, Louisiana.

Meet the Folks who Work for Duck Commander

 

The storylines of the 1950’s situation comedy “I Love Lucy” worked around a one-bedroom apartment in New York City where Lucy and Ricky Ricardo managed to get into hysterical predicaments with the help of their neighbors, Fred and Ethyl Mertz. Similarly, almost every episode of Duck Dynasty incorporates the “Duck Commander” duck call factory. Unlike Lucy and Ricky’s home, this factory actually exists and this very successful company, started by Phil Robertson, has produced highly regarded duck calls for many years.

When Phil retired to hunt ducks, fish for crappie and teach his grandbabies “how to avoid becoming yuppies,” his son Willie took over as CEO of Duck Commander. The other Robertson son, Jase, is an employee of the company and, as the most of the funny premises of the show result from Jase refusing to recognize the authority of his older brother, Willie. He is usually joined in this harassment of his brother by their Uncle Si, Phil’s brother, a Vietnam vet, perpetual ice-tea drinker and full time philosopher, and the rest of the employees at Duck Commander.

Each week, these real-life characters deal with simple issues that are cleverly embellished to become a comedic crisis. In the end, everything gets worked out and the last scene of every episode has the entire family around the dinner table with Phil saying grace.

Duck Dynasty: A Boon for Outdoor Sports

The fun these folks on Duck Dynasty are having is resonating with men and women who have decided to take up the sports of hunting and fishing. Several outdoor sports trade publications have noted that the show has done more for increasing the popularity of these ancient pursuits than anything in the past century.

It’s estimated by the National Shooting Sports Foundation (NSSF) that more than 20.6 million people in the U.S. hunt each year and this number will likely increase with the popularity of this show and others like it. Two years ago, the NSSF noted that more than 8,000 U.S. hunters annually were injured while enjoying their time in the woods and as more novice hunters get out in the field, this number will likely increase.

As someone who is both an avid outdoor sportsman and highly-regarded spine surgeon, Dr. Ralph Rashbaum is in a unique position to offer some guidance to both novice and seasoned hunters and anglers. “Stamina and flexibility are the two most important factors in avoiding back strains or injuries, but common sense and proper safety precautions are even more important,” he said.

Hochschuler and Rashbaum 03Dr. Rashbaum continued, “I love to bow hunt and many times this is done from a tree stand to avoid the superior sense of smell enjoyed by deer. Climbing up to the stand can cause back strains if the muscles are not properly conditioned. Falling from a tree stand can seriously injure or facture the vertebrae in the spine. This type of accident is very common and it can be avoided with proper precautions.”

Dove season begins in most states in September and many hunters will be donning the camo and swinging their 12 and 20-guage shotguns for hours. What does Dr. Rashbaum suggest for these hunters to avoid back strains and injuries?

“I’ve been on a 4-day dove hunt in South America, where my son-in-law and I shot more than 2,300 rounds of 12 and 20-gauge shells! Needless to say, we were tired at the end of the day (however, not as tired as the retrievers who brought back the birds!), but because we had conditioned our shoulders, neck and arms and had spent time stretching these muscles before the hunt, we were able to have an amazing experience and very little back pain.”

Fishing is also popular with the Duck Dynasty clan and millions of other outdoor sports enthusiasts. What does Dr. Rashbaum recommend to avoid back strain from a day of casting? “It really depends on the type of fishing you are thinking about. I love to deep-sea fish and also enjoy fly fishing in fresh water. These are two very different experiences and require different conditioning.”

“If you think you might fighting a marlin for two hours on the open sea, you should definitely get to the gym a few weeks before the trip and work on building strength in your back, shoulder and arm muscles. This can be done with weight training as well as such exercises as rowing and pull-downs. On the other hand, the most dangerous part of fly fishing is not from casting but rather from walking on slippery rocks to get near the fish. Having appropriate equipment – waders with boots that don’t slide and using a walking stick – will help with this.”

Life Lessons of Duck Dynasty

It’s interesting that the situations and values portrayed on Duck Dynasty seem to be as relevant to an urban audience as it is to that which is rural. While he lives and practices in the highly-urbanized area, Dr. Rashbaum is a big fan of the show. “The people on Duck Dynasty are the salt of the earth and represent the best of family values. Plus, they’re very funny!”

It appears that life lessons of Phil, his family and friends on Duck Dynasty go beyond frog catching and duck calling. As Uncle Si would say: “That’s a fact, Jack.”

Day 1

 

Annnnd we’re off! The 2013 Uganda Spine Surgery Mission officially began on Thursday, August 8 at London Heathrow Airport. This year’s team of six– the smallest team yet– gathered from a smattering of departure cities, including Dallas, Toronto and Tel Aviv. Flying in from Dallas were team lead Dr. Izzy Lieberman, his daughter (and chef extraordinaire) Danielle, and two veteran spine surgery missioners, scrub nurse Sherri LaCivita and medical equipment sales rep Rob Davis. Dr. Zvi Gorlick, a family physician in Toronto, joined the team for the first time, as did I (Jennifer Teichman), a medical student from the University of Toronto.

After a quick caffeine boost at the airport, we dumped our luggage at airport storage and scurried into London for the day. When a two-hour line thwarted our attempt to visit the Sherlock Holmes Museum, we hopped into a cab and found ourselves at Trafalgar Square after a quick drive-by of Buckingham Palace. All six of us clambered up the gigantic lion statues for our first team photo.

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Phone Booth

We met Ros Eisen, secretary of the Putti Village Assistance Organization for delectably crispy fish and chips at The Seashell, where Zvi insisted on ordering every dish on the menu that happened to be unavailable that day. Re-energized, we made our way to Big Ben, which several of us were surprised to learn referred to the bells rather than the clock tower itself. Dr. Lieberman surprised us with tickets for the London Eye, which proved to be the highlight of the day. We sipped champagne 40-something stories atop London and congratulated ourselves for a day well-spent. Then, it was back to Heathrow for our 9:00pm flight to Entebbe.

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The 2013 team on the London Eye

Quote of the day: “No time for dresses.”- Dr. Lieberman, after Danielle expressed a desire to change out of her yoga pants and into a dress for our day in London. We mean business!

 

Day 2

 

We touched down in a rainy Entebbe around 7:30am, sleepy-eyed yet itching to get started on the mission! Our collective enthusiasm met its first challenge when my laptop was stolen from the airplane. As a newcomer to the mission, I learned my first lesson of the trip: keep your valuables on you at all times, no exceptions. Our first driver, Eric, then appeared not with the 40-seat bus we thought was to be provided by the Mbrara University of Science and Technology (MUST), but with a small pickup truck and a 6-person van. This was my first hint that things don’t always go as planned in Uganda. We loaded the truck with our bags, piled ourselves into the van and started the bumpy 60 minute drive into Kampala, the capital and largest city in Uganda. Our first stop was Case Medical Centre, a private hospital that served as a base for the mission in previous years. This year, however, we were only there to pick up the medical equipment they had stored for us from last year.  Danielle and I held down the fort by the luggage-laden truck while the rest of the team retrieved the equipment. Rumor has it that while hoisting a big bag of surgical equipment, Zvi lamented Izzy’s choice of profession, and graciously provided us with our first quote of the day: “Why couldn’t you have been an ophthalmologist!?”

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After a true feat of space-maximization, the equipment was loaded into the truck and sent off to Mbarara to await our arrival the next day. Meanwhile, we headed to our Kampala accommodations, the Speke Hotel, for a much needed shower and change of clothes. With the whole afternoon still ahead of us, we paid a visit to the Galilee Community General Hospital, a Jewish Hospital in Kampala interested in future collaboration with the Uganda Spine Surgery Mission. We toured the facilities, including the new hospital building currently under construction. It was particularly interesting to learn about some of the considerations given to building and maintaining a small hospital on philanthropic support; the constraints of space, funds, resources and expertise were evident throughout our tour of the main hospital and construction site. Nevertheless, the team agreed that the new hospital promised to be a valuable addition to the community.

The team returned to the hotel to rest before dinner, a good idea since dinner turned out to be a marathon for the stomach and palate. We feasted on delicious Indian cuisine at Khyber Pass, one of two kitchens at the hotel and a favourite of previous incarnations of the Spine Surgery Mission. By the end of the night, several pants buttons were unbuttoned (mine included), and our droopy-eyed procession made its way to bed.

Quote of the day (#2): “I’m so full, I don’t even have room for a tic tac”

Day 3

 

Move in day! We awoke to a beautiful morning in Kampala, and hit the road after a hearty breakfast at the hotel. First stop: The Nakumatt Oasis, the Zeus of all department stores. There, amongst the impeccably clean and organized isles, one can find everything from toothpaste and vodka to washing machines and power tools. It puts Walmart to shame. After stocking up on what is reportedly the world’s best coffee beans, we piled back into the van and continued the five hour trek to Mbarara. Newly paved, the road to Mbarara traverses a landscape of rolling green hills, flat valleys of cultivated land and dirt paths dotted with shacks selling local fruit, meat, fish and potatoes. There was a collective cringe as we passed trailer after trailer of live bulls packed tighter than sardines, their ferocious horns piercing the air above them. Every half hour or so, the serene landscape was broken by the bustle and dirt of a small village with decrepit store fronts ironically painted in advertisements for Coca Cola and Nokia. Within an hour of the ride, our clothes were covered in a thin film of copper-red dirt kicked up by fellow drivers and boda-boda cyclists.

 

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We made a pit stop at the Ugandan equator, where we stretched our legs and shopped for local artisan crafts. Like school kids watching their first science experiment, Zvi, Rob and I oo-ed and aw-ed at a demonstration of water spinning in opposite directions in funnels placed on either side of the equator. Cooler still, water placed in a funnel centered on the equator didn’t spin at all as it drained! Call me a nerd….

We arrived at our hotel in Mbarara, the Lakeview, and were pleased to find large, comfortable rooms. Anxious to start our work, we gathered our medical equipment and drove to the Mbarara Regional Referral Hospital, our base for this year’s mission. We were met there by a spectacular surprise: last year, the hospital had opened an entirely new wing including an Intensive Care Unit, Emergency Department and operating theatres. We set to work right away, unloading the equipment from the truck and transporting it to a temporary storage room in the Emergency Department.

 

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Unloaded and eager to explore, we began a tour of the new building. The Emergency Department is a bustling continuum of corridors and open spaces filled with beds and curtains, each bed occupied by a patient and surrounded by family members. The spill-over of family members sit quietly on benches lining the hallways, many of whom carry infants. It seemed many of these families had not been home for days. Passed the Emergency Department, we found the ICU, a stark contrast to the crowded hallways of the ER. The ICU is a quiet space with each bed contained in a separate glass room. Computer monitors displaying patients’ vital signs hang over the beds, much like one would find in any hospital in North America. Already impressed, we then proceeded to the surgical wing. Dr. Lieberman’s expression was that of a kid in a candy shop when he first laid eyes on the operating rooms. Big, bright, clean, well-equipped and windowed… we hadn’t expected anything close to this! The team’s excitement was palpable.

We left the hospital elated and even more motivated to kick off a great week at Mbarare. After an “edible” dinner at the hotel, we headed to bed for a good sleep before our first big day at the hospital.

Quote of the day:

“It’s ok, you can take your skirt off here.. we’re all medical professionals”

“The food is…. edible….”

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Dr. Lieberman’s first glimpse of the OR

All Star Back Care

July 15, 2013

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When Dr. Rey Bosita of The Texas Back Institute talks about back health and baseball, his voice reveals his passion for both subjects. He clearly loves the game and his medical profession. This makes Dr. Bosita the ideal source to share information and opinions about the 2013 Major League Baseball All-Star game and how these athletes deal with back injuries.

Since Texas Back Institute is the Official Spine Specialist for the Frisco RoughRiders, the AA affiliate of the Texas Rangers baseball club, Bosita knows all about baseball-oriented back injuries. Before getting his thoughts on back injuries and ball players, let’s take a brief look at the 2013 MLB All-Star game.

The Fan Favorites

This year’s All-Star game will be played at Citi Field in New York City, the home field for the National Leagues New York Mets, on Tuesday evening, July 16, 2013. As always, the game will be nationally televised on Fox and the festivities begin at 7 p.m. (Central).

The MLB All-Star game owes much of its popularity to the fact that professional baseball fans can vote on the players who will take the field. Of course, this “popularity contest” format has gotten negative comments in the past – particularly from traditional baseball fans who feel that a player’s on-field abilities and performance in the first half of the season, rather than his name identification – more often than not, the popular vote reflects what type of season the starting lineup players are having. A great example of this is Baltimore Oriole’s first baseman, Chris Davis.

After being traded from the Texas Rangers to the O’s, Davis is having a remarkable year at the plate – 85 RBIs and 33 homeruns. In the All-Star voting, he finished with 8,272,243 fan votes to edge out last year’s triple-crown winner, Miguel Cabrera of the Detroit Tigers, who amassed 8,013,874 votes. Since neither plays for teams in large metropolitan markets, where vote totals can be manipulated by in-stadium promotions and both are having great years, it appears the fans made the correct, non-partisan, decision.

On the National League side, St. Louis catcher Yadier Molina was the leading vote-getter and he joins 4 other Cardinal teammates to make the Midseason Classic lineup. The NL player who has gotten lots of attention for his amazing season after being called up from the Los Angeles Dodgers minor league team, Yasiel Puig, failed to make the All-Star team this year.

2013 Major League Baseball All-Star Starting Lineups

The American League Starters include:

Joe Mauer (C – Twins)

Chris Davis (1-B – Orioles)

Robinson Cano (2-B – Yankees)

J.J. Hardy (SS – Orioles)

Miguel Cabrera (3-B – Tigers)

Mike Trout (OF – Angles)

Adam Jones (OF – Orioles)

Jose Bautista (OF – Blue Jays)

David Ortiz (DH – Red Sox)

For the National League:

Yadier Molina (Catcher – Cardinals)

Joey Votta (1B – Reds)

Brandon Phillips (2B – Reds)

Troy Tulowitzki (SS – Rockies)

David Wright (3B – Mets)

Carlos Beltran (OF – Cardinals)

Carlos Gonzales (OF – Rockies)

Bryce Harper (OF – Nationals)

Over the course of their careers, most if not all of these All-Stars have had to deal with injuries and some have been serious. Unlike football, baseball is considered a non-contact sport. However, there are more than a few collisions between runners trying to make it home and catcher trying to guard the plate and the constant swinging and throwing can take its toll on these athletes. Injuries to the spine and back are very common in this sport and we talked with Texas Back Institute surgeon, Dr. Rey Bosita to shed some light on how playing baseball can be dangerous to your back health.

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Now Batting – Dr. Rey Bosita

Dr. Bosita was between appointments when we caught up with him and asked him about the most common back ailments for professional baseball players. He said, “Lumbar sprains and other muscular strains are the most common back problems for baseball players. However, the most serious injury is a disc herniation. This involves the damage to the disc, which cushions the vertebra in the spinal column. When a player has a herniated disc, there is intense pain and any movement – whether it’s swinging a bat or throwing a baseball – almost impossible.”

So, what causes a herniated disc?

Dr. Bosita noted, “It can occur as a result of repetitive stress, for example if a player is swinging a bat for hundreds of times each week. A disc can be herniated when a player takes a powerful swing and misses or it can be the result of a collision on the base paths.”

Texas Back Institute is the Official Spine Specialist for the Frisco RoughRiders team and because they are just starting their careers in professional baseball, these players tend to be younger than those in the “big show” in Major League Baseball. Does the age of a player have any effect on the likelihood of back injuries?

“Definitely,” notes Dr. Bosita. “Older players have much more wear and tear on their back muscles, discs and vertebra and the constant repetitive stress from playing more than 160 games a year can gradually wear down these back muscles and cartilage. Plus, younger players tend to be in better condition and their muscles can withstand the quick starts and stops of baseball.”

Bosita was quick to note that some older players such as retired Baltimore infielder Cal Ripkin showed remarkable conditioning and ability to play with pain. “During his famous and historic complete games run, Ripkin played with a lumbar compression. This would have incapacitated most players, but Ripkin continued to play every day with this condition.”

What type of conditioning exercises do professional baseball players use to avoid the back sprains and other, more serious injuries?

Dr. Bosita said, “Cross training exercises which are designed to improve flexibility and strength and proper pre-workout stretching and post-workout cool downs are the most important elements of a conditioning regimen. Since baseball players are required to go from a complete stop to full-speed at the crack of a bat, it’s important that they remain loose even when they are in the dugout. Stretching will help with this.”

The All-Star Team at Texas Back Institute

The All-Stars who take to the field on July 16th are at the very top of their profession. Their conditioning is impeccable and their knowledge of potential injuries is extensive. And yet, the odds are very good that at some time, in the course of a season, they will experience a back injury that can potentially end their season or career.

If these athletes, with all of their physical conditioning and knowledge can be sidelined by back injury, it goes without saying that non-athletes can also experience the pain and physical limitation of back injury or pain. When this happens, it’s a good idea to go to the specialists – the All Stars – who deal with these issues every day: Texas Back Institute.

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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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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What is it about the spring and summer that makes us believe our bodies are indestructible? Maybe it’s the warm weather beckoning us to get out of the house after a long, cold winter. Perhaps it’s the traditional warm-weather outdoor activities such as gardening, walking, biking, running or fishing. It could be the horror that comes from glancing at the full-length mirror in the hall and noticing  the winter weight – resulting from all the comfort food and no physical activity – is about to be displayed for the entire world to see the first time a swimsuit or tennis togs are worn.

For these and a myriad of other reasons, many otherwise sane individuals decide  the pleasant chirping of birds and distant hum of a lawn mower should be accompanied by the sounds of running shoes hitting the pavement and the huffing and puffing that comes from someone trying get back into shape. In moderation, this is a worthwhile and even healthy endeavor. However, if it’s overdone or done improperly, it can result in debilitating back pain, excruciating joint pain, herniated discs, sacroiliac joint strains and possible injury to the spine, neck and limbs.

In order to help you avoid this rite of spring, we’ve asked Texas Back Institute occupational and sports medicine specialist, Dr. James Cable, to give us some insights on avoiding the pain while realizing the gain of exercise and activity. Before getting this advice, it’s interesting to review the ways we abuse our bodies, in the hopes of getting into swimsuit shape.

The Numbers Don’t Lie

The Center for Disease Control (CDC) is the U.S. governmental agency charged with a wide range of public health monitoring and management duties and one of its missions involves promoting physical activities and preventing injuries. The agency’s website notes, “Participation in sports, recreation, and exercise is increasingly popular and widespread in American culture. These activities include organized sports (school or club) and unorganized sports (backyard or pick-up), such as basketball, football, and hockey; recreational activities, such as boating, biking, skiing, swimming, and playground activities; and exercise and training activities, such as weight-lifting, aerobics, and jogging.”

The site continues, “Participation in sports, recreation and exercise activities contributes to health-related fitness; however, the risk of injury is inherent in any physical activity.” This is why the CDC is concerned about you or your family members’ participation in organized or individual exercise and recreational activities.

The public health agency references some serious public health data.

  • More than 10,000 people receive treatment in the nation’s emergency departments each day for injuries sustained in (recreational) activities.
  • At least one of every five emergency room visits for an injury results from participation in sports or recreation.
  • 1999, Americans made an estimated 1.5 million ER visits for injuries sustained while playing basketball, baseball, softball, football, or soccer.
  • Approximately 715,000 sports and recreation injuries occur each year in school settings alone.

And here is the most depressing part of these data.

  • Injuries are also a leading reason people stop participating in potentially beneficial physical activity.

The statistical breakdown on sports and recreational injuries is also interesting to contemplate – especially before jumping in to that full-court basketball game without warming up.

  • Children younger than 15 years account for about 40% of all recreation related emergency room visits.
  • Adolescents and young adults under age 25 have high participation rates in recreational activities and experience almost one third of all recreational-related injuries.
  • The population of older adults is increasing, and little is known about their injury risk during participation in Sports Related Exercise.  In 1996, emergency rooms treated more than 53,000 sports and recreation-related injuries among people 65 and older, a 54% increase from 1990.

This third point suggests even more mayhem as the Baby Boomer generation, which has a well-chronicled interest in feeling and looking healthy, ages. This zest for life and activity combined with the wear and tear on muscles and joints exponentially increases the potential for emergency room visits.

With All of These Fitness Options, Why is Obesity at an All-Time High?

With the popularity of “boot camps” and “cross fit” training along with the proliferation of high-tech workout facilities, spinning classes, treadmills and other fitness equipment, soccer camps, basketball camps, marathon training classes and any number of other sports and recreational opportunities men, women and children have numerous opportunities to get fit. With all of these opportunities, the intriguing question is: Why is the U.S. population – especially children – more obese than it has ever been in history?

The answer may have to do with the fact  pain and injuries discourage adults of all ages and kids from participating in regular fitness activities. This would also explain why the public health experts at the CDC are concerned about sports and recreational injury trends.

Before Undertaking Vigorous Activity – Read This

 Aside from the healthcare expenses, the human misery associated with spring and summer recreational activities are serious considerations.Therefore, before taking off on that 50-mile bike ride with no advance training, or having too much weight on the bench press bar, take a minute to read this advice from Dr. James Cable. He is a specialist in recreational and occupational back injuries at Texas Back Institute.

Dr Cable W Patient

What are the most prevalent sports and recreation related injuries  you treat in the spring and summer?

As people get more active – working out or doing yard work – the most common injury is a back sprain. Usually, if someone with a back sprain can take it easy and then slowly get back into gentle activity, they are able to overcome this problem. However, if they’ve given it 2 to 4 weeks to rest and they are still experiencing pain, they should probably get some medical attention. For a normal back sprain, one shouldn’t spend more than a couple of days in bed because any more than this will cause a loss in muscle strength. Conversely, they don’t want to exacerbate the injury. The best approach is to slowly test the water by slowly increasing the activity.

What can a person who has been inactive during the winter do to acclimate themselves to outdoor activities, without becoming injured?

They should use basic athletic training principles of gradual increases in the level of activity. For example, if someone is not accustomed to running, she/he should undertake a walking/jogging approach. This involves alternating three minutes of walking and one minute of jogging for a total of 30 minutes. Gradually, the individual should work to increase the number of minutes jogging, while still alternating with walking for a total of one hour. The key is to slowly ease into the activity. If it’s yard work your undertaking, you don’t want to be lifting 100 pound bags of cement unless you’re used to lifting this weight.

What are the types back injuries  you treat most often for those participating in spring sports and recreation?

The types of back injuries  we see the most of are those that occur from lifting, twisting and bending. These are back muscle strains, herniated discs and sacroiliac joint strains. The pressure from lifting that 100-pound of cement or twisting the body in the course of a pickup basketball game loads the spine in an awkward fashion. Under extreme conditions lifting heavy objects can result in the discs being ruptured.

Common aches and pains will always occur when someone takes part in strenuous activity. However, is there a type of pain or feeling that suggests  medical attention should be sought immediately?

It is very rare but if the person becomes paralyzed or loses control of their bowel and/or bladder, they should go to the Emergency Room immediately. Short of that, if one develops gradual numbness in legs or arms, they need to come in to see us. Neurologic symptoms such as dragging a foot or the extreme symptoms noted above are alarming and very rare, but if they occur after strenuous physical activity, a doctor’s exam is called for.

What is your best advice for someone thinking about getting into shape this spring?

Don’t get out of shape in the first place! The biggest battle involves the couch potato who has not been in shape for years. However, we live in the real world and lots of people are out of shape. Even athletes who fail to maintain a level of physical activity can get out of shape. However, if they have been in good condition before, it’s easier for them to get back into shape. The best advice is to do something; walking, ride a stationary bike just get moving a little. Fortunately, people who are not used to exercising will see benefits a lot faster, because their baseline is lower.

Since Sunday is Mother’s Day, here’s a story about my mom. We had some puppies and I gave my mom one of these little guys. She’s about 5’ 1” and at the time was a little overweight and had health issues associated with this weight problem. This is a lady who got no exercise whatsoever. Well, the puppy wanted to be walked and she started walking him around the block a couple of times each day. The effect of this minimal exercise was pretty amazing. She lost 20 pounds and her blood pressure normalized just by taking her dog out for a walk. If she can get into shape with this small commitment of time, anyone can!


 

Kentucky derby

Each year, on the first Saturday in May, horse lovers and sports fans turn their rapt attention to Churchill Downs in Louisville, Kentucky for the “fastest two minutes in sports.” Since its beginning in 1875, The Kentucky Derby has run consecutively each year and has become the premier event in thoroughbred horse racing.

Because of this pomp, pageantry and publicity associated with this race, many amateur riders become interested in equestrian sports and some of these will experience injuries from their new sport – especially in the area of the neck and back. This is where the advice of spine specialists at Texas Back Institute such as Dr. Ralph Rashbaum can come in handy. However, before getting some back health tips for equestrians, let’s take a two-minute look at the Run for the Roses.

A New Method for Qualifying This Year

The Kentucky Derby is a 1 and a quarter mile (2 km) race for 3-year old, thoroughbred horses and is the first race of horse racing’s championship series – The Triple Crown. Sports pundits call the race “The Run for the Roses” because the winning horse is draped with a blanket of stunning spring roses when it is in the winner’s circle after the race.

As every horse racing enthusiasts knows, there are hundreds of thoroughbred horses racing at tracks around the world each week. With this many horses, it’s interesting to note how the top 20 horses are chosen to line up at the gate in Louisville on Derby day. The eventual winner of the Kentucky Derby will have gotten there after competing in races around the country to qualify.

As the website of the Kentucky Derby notes, “This year marks the debut of a new way to determine which horses will join this select and storied field: The Road to the Kentucky Derby is a points-based system that replaces the previous selection method (graded stakes earnings) with a series of key races offering escalating points stakes during the course of the Derby year.

The Road to the Kentucky Derby is a long one, starting with the Prep Season races the previous September and building to a crescendo with the Championship Series in the weeks before the Kentucky Derby. Each race awards the top four finishers points that are tallied across all the races to determine the ranking of horses competing to make it into the Derby.”

For a listing of this year’s qualifying horses and their respective rankings, click here

Questions, Rumors and Facts about the 2013 Derby

As with all high-profile sporting events – the NFL’s Super Bowl, MLB’s World Series, and others – even the most minute facts, trends and rumors about the participants (in this case, the horses) entered in the Kentucky Derby are thoroughly scrutinized by experts and casual fans alike. This year’s Derby has a few questions that add to the drama of the race.

  • Highly successful trainer Todd Pelcher has 5 horses in this year’s race and he is teaming up with hall of fame jockey Calvin Borel on one of the favorites in this year’s race – Revolutionary. In 2010, the team of Pelcher and Borel won the Derby with Super Saver. Can they repeat this year?
  • One of the prominent prep races, The Bluegrass Stakes, was run on synthetic surface and since Churchill Downs is good, old fashion dirt, handicappers are trying to determine whether the winners of the race on synthetic surface will translate to the dirt track at the Derby.
  • Well-known and liked jockey, Gary Stevens, is returning to the sport at age 50. Stevens has been an actor and news anchor since retiring from racing a few years ago and will be riding one of the contenders – Oxbow – in this year’s race. Can someone who is old enough to be the father of most of the other jockeys win the race?
  • Highly respected trainer D. Wayne Lukus who is 77 years old and has been enormously successful at the Kentucky Derby will have two thoroughbreds in the race – Oxbox and Will Take Charge. Anytime Lukus has horses in the race, handicappers take notice because of his history.
  • The colt, Lines of Battle, is the only European entry in this year’s race and has won races going longer distances than the other horses in the race. Some feel that Lines of Battle is an excellent choice for a long shot.

Enjoy the Ride and Save Your Back

Just as NCAA’s Final Four tournament has the effect of getting many people out, shooting hoops, the Kentucky Derby energizes those who love horses. Since participating in equestrian sports can result in accidents and even long-term damage to the back, some caution and proper techniques should be considered before saddling up. To help us with this we’ve asked Texas Back Institute spine surgeon Dr. Ralph Rashbaum to give us some insights on back safety when involved in horseback riding.

In addition to diagnosing and treating patients with chronic back pain, herniated discs, back injuries and sacroiliac joint dysruption, Dr. Rashbaum has additional knowledge that most back specialists don’t have. He spent 16 years breeding Arabian horses and his wife and daughter have been involved in the sport of Hunter/Jumper equestrian competitions. With the Kentucky Derby approaching the final turn, we asked Dr. Rashbaum for some tips on back safety and riding.

RashbaumPatientWhat is the most serious health problem casual riders and competitors in equestrian sports should be concerned with? 

The biggest danger to the recreational rider is falling off the horse and injuring his/her spine, long bones (such as legs and arms) and pelvis. After a period of time, the ligaments of the rider get tired or become sore and the muscles become more lax. When this happens, a rider – especially one who does not ride on a regular basis – can be jostled off the horse and take a tumble. This can cause fractures in the vertebra and other injuries we would need to treat.

Are there any dangers to the neck and spine of riders who ride on a regular basis and if so, how can they avoid this? 

Riders who spend a lot of time pursuing this sport can experience a pinpoint injury or tenderness in the area where the sacroiliac joint and buttocks meet. This is not a spine injury but is caused by the repetitive concussion of the buttocks on the saddle when the horse is walking or jogging. This is not as big a problem when the horse is galloping.  Over time, this can result in a sharp pain. The best way to avoid this injury is to learn the proper posture and techniques for cushioning the constant bouncing when riding. This involves using the thighs and leg muscles to cushion the concussive bounces. This is a great argument for young riders to get professional instruction on riding techniques.

What are some physical signs a horse rider should come see a physician at Texas Back Institute? 

Anytime there is a burning pain, particularly if this runs down the leg and lower extremities, these suggest some problems and the rider should come see us. This is sometimes called “sciatica” and can be treated in several ways.

What is your opinion about the athleticism of the professional jockeys that will be riding in the Kentucky Derby Saturday?  

They are amazing athletes! Imagine getting into the posture they must get into in order ride – hips flexed, legs underneath, tremendous extension of the torso and neck all while keep their head up – for the length of time of a race. The jockeys who compete at this level have rigorous stretching exercises and are much more flexible than other athletes.

While their numbers are dwindling, there are still many men and women who raise cattle on large ranches. These folks spend a lot of time on horseback and this is not a sport but rather a job. What are the problems they should be aware of? 

Cowboys, whether they are working on a cattle ranch or competing in rodeos, have the same potential for concussive damage as a hunter/jumper contestant. Most learn, at an early age, how to reduce the concussive blows by using leg muscles to reduce this. However, rodeo contestants – particularly those who are involved in bulldogging where the cowboy ropes the calf, jumps off the horse, lifts the calf and then ties him – have a high risk of spine damage and disc herniation and we’ve seen a few in our examination rooms.

 

Protecting your neck and spine from wear and tear damage as well as injuries is an important part of enjoying equestrian sports. Plus, now that you have the scoop on the horses in this year’s Kentucky Derby, you’re ready for the race. All you need is a mint julep and you’re good to go!    

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