It’s back to school time again, and each year many children get a new backpack to carry supplies, books, and homework. These carry-all backpacks often reflect the personality of the child, with many adorned with super heroes, princesses and more than a few Angry Birds.

back-to-school2While this efficient carrying case has been around for many years and has been used by millions of students both old and young, back experts such as Texas Back Institute physician Dr. Rey Bosita have noticed a problem with backpacks. They’re too heavy for some kids, and can cause long-term serious back problems.

We spent a few minutes with Dr. Bosita to get some guidelines on the proper size and use of backpacks. More on this later.

Backpacks Have a Colorful History

Backpacks, in one form or another, have been around since early humans used animal skins to carry meat from hunting trips. Just as with the school kids of today, these packs allowed prehistoric hunters to use the strong muscles in their backs to carry much more game for longer distances than if they were carrying it in their arms alone.

Historians note that the term “backpack” was coined by Americans around 1910; however, before it was known as a backpack, Europeans (specifically the Germans) called this carry-all a “rucksack,” which is a shortened version of the phrase “der Rucken” – German for “the human back.”

Up until the 1950’s, the backpack was primarily used for hunting and military purposes. These early versions were made of rugged materials and very heavy to carry. All of this changed when hiker Dick Kelty realized backpacks could serve a valuable function to the participants of his sport. He began experimenting with creating packs made of lighter materials and more compact designs. He also changed the weight distribution of the backpacks – by putting the skids of the pack in the back pockets of his hiking pants – allowing the hips to carry more of the load.

With this change, anyone who needed to carry several items while they were walking could pack these in a backpack and be on their way. It didn’t take long for parents and students to discover  these same, light-weight backpacks were ideal carrying cases for schoolbooks and homework papers.

The Problem with Backpacks

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For all of its efficiency, the modern backpack has its detractors, some of whom are backspecialists. In an article published in 2012 in the New York Times, it was noted that “heavy backpacks don’t just zap children of energy that might be better used doing schoolwork or playing sports. Lugging them can also lead to chronic back pain, accidents and possibly lifelong orthopedic damage.”

In this article on the dangers of backpacks for kids, the federal Consumer Product Safety Commission calculated that “carrying a 12-pound backpack to and from school and lifting it 10 times a day for an entire school year puts a cumulative load on youngsters’ bodies of 21,600 pounds – the equivalent of six mid-sized cars.”

In a 2012 report in the “Archives of Disease in Childhood,” researchers in Spain assessed the backpacks and back health of 1,403 pupils, ages 12 to 17. More than 60 percent were carrying packs weighing more than 10 percent of their body weight, and nearly one in five had schoolbags that weighed more than 15 percent of their own weight.

This study found that “1 in 4 students said they had suffered back pain for more than 15 days during the previous year; scoliosis – curvature of the spine – accounted for 70 percent of those with pain. The remaining 30 percent had either low back pain or contractures – continuous, involuntary muscle contractions.” Girls faced a greater risk of back pain than boys, and their risk increased with age.

Clearly, there is a potential problem with backpacks and kids. In many cases, they are either too heavy for the size of the child or they are being worn by the child incorrectly. We spoke with Dr. Rey Bosita, a spine specialist with Texas Back Institute, to get an idea on the “dos and don’ts” for backpacks with kids.

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Dr. Bosita noted pain often results when the weight of the pack pulls children backward, prompting them to bend forward or to arch their backs to keep the pack centered. These positions make the back muscles work harder and increase pressure on vertebrae on the discs between them.

If the child has to lean forward or seems unsteady when walking with a loaded pack, it’s too heavy.  This can lead to poor posture and shoulder pain.  Neck pain can also occur when the child is forced to look up from this position.

No parent or teacher wants a child to be injured by a backpack which is too heavy. So, what should be done to correct this situation? Dr. Bosita has some ideas.

Tips You Can Use for Back Safety and Backpacks

“The first thing we should look at is how the backpack fits the child and how he/she is standing while wearing it fully-loaded. The child should be standing straight up – with shoulders back. The backpack should be positioned in a manner that allows it to rest against the child’s back, straps a little tighter, so that the pack doesn’t sag too low,” Dr. Bosita notes.

Another important consideration for back safety is the weight of the backpack. What is the correct weight for a child’s backpack and how does a parent determine the weight of the pack? Dr. Bosita says, “The easiest way to determine the acceptable weight of the pack is to get the family scales out and weigh the child without his/her backpack. The weight of the backpack should be no more than 10 to 15 percent of the child’s weight. Therefore, if the child weighs 50 pounds, the backpack should not weigh more than 5 to 7 pounds.”

“Remember, everything adds weight to the backpack, including the pack itself, Dr. Bosita notes. “It’s a good idea to check the backpack weight with all of the materials connected to the pack (water bottles, knick knacks) and the books and school supplies being carried in the backpack (library books, binders).”

For the complete video of Dr. Bosita’s tips on backpacks, just click here 

Pack Only What’s Needed

When given the chance, younger children will stuff as many things as possible in their backpacks, much of which is not related to school work. Parents should take a minute each morning and afternoon to inventory the items being transported to and from school. If there are toys, games, handheld computer games, pet rocks, frogs and other non-academic items being packed in the bag, remind the child that these things should be left at home.

If he or she disagrees about the contents of the backpack, have a Plan B. Just tell them that you want them to grow up straight and tall and a heavy backpack might keep this from happening. This has the advantage of being the truth.

And if this fails, reward them with a treat  if they keep the back pack light.

With a dramatic increase in the number of advertisements and social media discussions, the concept of “minimally invasive surgery” – especially spine surgery – has become a hot topic. Experts in back surgery such as Dr. Michael Hisey of Texas Back Institute know that in many cases the hype is more about marketing than about medicine.

What is Minimally Invasive Surgery?

In a recent discussion, Dr. Hisey noted that the trend toward less invasive procedures in surgery has always been a guiding principle of Texas Back Institute for the past 35 years. “However over the past 10 to 15 years, this term – minimally invasive – has gained popularity,” he said.

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Since the first efforts to correct injuries or disease of the spine were made, over 50 years ago, surgery was recognized as potentially destructive to the structures of the spine. However, this was a necessary means to an end.

In order to gain access to the spine to complete procedures such as decompressing nerves, removing herniated discs, thickened ligaments, cysts and bone spurs, back surgeons are required to dissect muscle off the vertebrae.  While this can cause damage to joints and muscles and cause scarring around the nerves, it was necessary to address the patient’s problem.

Other collateral damage resulting from surgery were risks as well, such as  the spine being weakened when ligaments that hold the vertebrae together needed to be removed. Vertebral bones, including parts of joints, were removed in order to allow the surgeon access to the spine. This also weakened the spine and often caused scarring which led to further irritation and compression of the nerves.

Michael S. Hisey, M.D.

Every physician at Texas Back Institute is dedicated to pursuing minimally invasive surgery, in every phase of a patient’s treatment. Why? It’s one of the core philosophies of our practice. While there are many techniques and approaches, along with many high-tech tools used for minimally invasive surgery, all are centered around the core philosophy, to always perform the least invasive procedures possible

In fact, the surgeons at Texas Back Institute have pioneered many of the minimally invasive techniques which are used today. “Our physicians are always looking for avenues to advance minimally invasive spine surgery, ” says Dr. Hisey.

Common Misconceptions about Minimally Invasive Procedures

With all of the marketing noise about this minimally invasive surgery, what challenges do physicians and back surgeons face with patient expectations? Dr. Hisey says, “Many patients believe minimally invasive surgery can fix bigger problems than it really can. Unfortunately, not every back injury or pain from degenerative disease can be corrected with this type of surgery.”

“Patients are also surprised when we discuss the procedure and they learn there may not be a laser involved in the surgery. There are many techniques, but the use of a laser is not always a part of the procedure. Plus, this surgery is not less expensive to perform than traditional surgery. It takes a great deal of training and often specialized equipment for a surgeon to be able to perform minimally invasive surgery. This is often reflected in the expense of the procedure,” Dr. Hisey noted.

What Types of Back Problems Are Best Treated by this Surgery?

There are several conditions that lend themselves to minimally invasive surgery. Dr. Hisey notes, “Patients who have been diagnosed with a herniated disc are good candidates for this type of procedure.”

The American Academy of Orthopedic Surgeons notes that “a high percentage of back pain and leg pain is caused by a herniated disc.” The discs in the spine act as “shock absorbers” for the vertebrae and when wear and tear or injury causes them to herniate, intense pain in the back or legs occur.

“Spondylosis can also be treated effectively with minimally invasive surgery,” Dr. Hisey said. “This condition is the result of degenerative osteoarthritis of the joints between the spinal vertebrae. When it’s severe, it can put pressure on the nerve roots causing pain and muscle weakness.”

Advantages/Disadvantages of Minimally Invasive Procedures

Because there is less damage to muscles, tendons and ligaments around the spine during a minimally invasive procedure, the recovery time for surgery is much quicker. Additionally, there is less blood loss and tissue damage” Dr. Hisey noted.  However, there are also disadvantages to this procedure. “It might not be able to remove or correct all of the damaged tissue.”

Why Choose Texas Back Institute for Back Procedures?

With so much marketing information and often unreasonable claims about minimally invasive surgery, many people with back pain are trying to research every option. Basing a potential life-threatening or, at the very least, life-altering decision such as spine surgery on a Google search should be done with extreme caution.

Dr. Hisey concludes, “For more than 35 years, our practice at Texas Back Institute has been based on doing what is best for our patients, not what currently popular procedure is featured on a TV spot. When it’s appropriate, and based on the expert diagnosis of our spine  specialists, minimally invasive surgery will be advised. However, this decision will never be based on ‘what’s hot’ in the media.”

When searching for a procedure to eliminate chronic neck or back pain, the Latin expression – caveat emptor which translates to “Let the buyer beware” – is appropriate. The spine specialists at Texas Back are constantly researching surgical methods which are minimally invasive. For us, this is not a fad. It’s the foundation of our practice.

It’s a Boy!

July 31, 2013

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On the evening of July 22, 2013, the fountains of Trafalger Square in London were gloriously illuminated by blue lights, signifying the heir to the British throne, Prince William, and his wife, Kate Middleton, had given birth to a prince. His Royal Highness, Prince George Alexander Louis of Cambridge, came into the world at a healthy weight of 8 pounds, 6 ounces and it seems the entire world took a collective breath.

In a time of 24-hour news cycles and second-by-second social network updates, the birth of the royal baby was the stuff of water-cooler discussions around the world. In fact, British bookmaker, Coral, noted that this birth was the biggest, non-sporting betting event in history. Everyone, it seems, is talking about babies and moms, royal and otherwise those of us at Texas Back Institute are no exceptions.

The spine specialists at Texas Back Institute treat many new mothers and mothers-to-be who are experiencing back pain associated with childbirth. While the world is fascinated with little Prince George, we chatted with Dr. Nayan Patel whose expertise in physical medicine and rehabilitation makes him an excellent source for analyzing the causes of back pain among pregnant and post-partum women. His insights shine some medical light on the back pain millions of mothers experience. However, before getting his thoughts, let’s take a look at the impact the newest prince has had already.

It’s a Boy!

With this much interest in the birth of Britain’s latest heir, one could predict some ripples running through the media and even the economy as a whole. However, very few could anticipate the tsunami of media coverage and economic impact transpiring immediately before and after the July 22nd birthdate.

On the economic front, the British birth has been very good for business – worldwide – resulting in a feel good bump in sales in a wide range of categories. The UK-based Centre for Retail Research estimates England will get a $373 million (US) boost, with $133 million in festivities, $123 million in souvenirs and toys and $117 million in books and DVDs. Because Americans and Australians can’t seem to get enough of the royal child, it expects exports to these two countries to exceed $57 million in sales.

Because of the popularity of the royal couple and their new baby, whatever choices they make in the way of “baby accoutrements” will likely drive big sales worldwide. Experts say the sales of prams and baby pushchairs should increase dramatically. They expect whatever baby clothes, cribs and toys the royals buy for little George will get the Baby Cambridge bounce.

Even US – based retailer, Target is celebrating the arrival of the royal baby. This company has been featuring Princess Kate’s maternity clothing throughout her pregnancy and is selling a special line of baby clothes in honor of the newest prince. Target’s campaign theme – “We may not know anything about being third in line to Britain’s throne, but we know about babies (and their first-time moms and dads)”- suggests a reason for our fascination with this event. More on that later.

A Royal Pain in the Back

When all the media noise dies down (if only for a few hours) and Princess Kate is left alone to enjoy some quiet time with her baby, there is a very good possibility she will be left to deal with the problem that new moms everywhere have to deal with – chronic back pain. This pain often accompanies pregnancy and continues in many post-partum women.

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Dr. Nayan Patel of Texas Back Institute notes, “Back pain occurs in approximately 50 percent of pregnant women on some level. It can start as early at the first trimester and continue for as long as 18-months after delivery. It can be very painful and adds to the stress of being a new mom.”

What causes this pain? Dr. Patel says, “Many people feel the added weight of the baby strains the back muscles and causes pain. However, in most cases, the real culprit for the pain is the perfectly natural process of a hormone being released in a pregnant women’s system to allow for the muscle ligaments to expand and allow for the passage of the baby through the birth canal.”

Dr. Patel continued, “This can lead to a condition known as ligamentous laxity – basically loose ligaments – which can lead to sacroiliac joint dysfunction and pain. The sacroiliac joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis which are joined by strong ligaments. The sacrum supports the spine and is supported by an ilium on each side.”

How does Dr. Patel treat this condition? “With women who are pregnant, we are very careful to avoid anti-inflammatory medicines because the baby is receiving everything the mother is ingesting. So, for pregnant women, we often prescribe a visit to the chiropractor for adjustment therapy and physical therapy, especially aquatic therapy. As for post-partum back pain, we typically prescribe the anti-inflammatory medicines and if the pain continues, physical therapy,” he notes.

“Women who are pregnant are typically younger and this is case with Princess Kate. This youth allows the muscles and ligaments to rehabilitate quicker and if Prince George’s mom is experiencing any back pain, she will likely recover quickly.”

Why We are Fascinated by the Royal Baby

Whether Princess Kate has a royal pain in the back or not, she is without doubt the most high profile mom of the decade and perhaps in history.  What is it about this event that fascinates people around the world?  Child birth is the most common occurrence on the planet, and yet we can’t seem to get enough details about the royal birth.

Some of the more philosophical pundits and pop culture observers have suggested a reason for this fascination. The marriage of the British heir to the throne, Price William, to Kate Middleton a commoner was similar to a fairy tale to many people. The couple is charming and attractive and they are a real-life prince and princess. Their having a beautiful baby just enhances the fairy tale. And after all, most of us love happy endings in our fairy tales!

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In many ways, social media such as Facebook and Twitter are more a blessing than a curse for healthcare. Just ask Cheryl Zapata, Chief Development Officer at Texas Back Institute. Each week, more and more of her professional hours are spent researching the ways social media can help the physicians and professional staff of this 36-year old practice continue to deliver world class spine care.

While many, if not most, individuals use Facebook to LIKE the latest movie or keep up with the activities of friends and YouTube to see the latest TV show or music video, a medical practice such as Texas Back Institute has more serious, long-range goals for these revolutionary communication tools.

These plans are being formulated in the context of strict adherence to patient care and privacy. While the social media objectives of Texas Back Institute are quite serious, the brilliance of these social media and the reason for their meteoric rise in popularity among almost every age group partially lies in their informal and fun presentation of vast amounts of content. In the social media world, content is indeed king.

The executive team and physicians at Texas Back Institute recognize the amazing power for health information and patient-centered care social media such as Facebook, Twitter, YouTube and blogs can deliver. There has never been a more powerful healthcare communication tool than social media as a few quick examples will suggest.

Social Media is Affecting Healthcare Now

The foundation of social media is a very powerful form of crowdsourcing.  This term, coined in 2006, is defined by several online dictionaries as the practice of obtaining needed services, ideas, or content by soliciting contributions from a large group of people, and especially from an online community. It combines the efforts of “crowds” of self-identified volunteers, workers, friends on Facebook and followers on Twitter where each one on their own initiative adds a small portion that combines into a greater result.

Healthcare has many examples where the crowdsourcing aspect of social media enabled meaningful data for patient care. Epidemiology, which is the study of patterns and causes of illness and diseases among a given group, has used social media to solve healthcare mysteries in several, high profile cases.

For example, the July 18, 2013, edition of Clinical Infectious Diseases, it was noted  Facebook users in Minnesota were able to identify tainted food as the source of a strep throat outbreak. The outbreak affected 18 of 63 attendees at a banquet and after seeing multiple posts about team members falling ill, a parent alerted the Minnesota Health Department which conducted phone interviews and analyzed DNA from strep samples eventually determining the source of the illness was a pasta dish at the banquet.    

This was not the first case solved by social media. The Los Angeles County Department of Public Health used social media to trace an outbreak of Legionnaire’s Disease at a trade conference held at the Playboy Mansion in Los Angeles in 2011. Last year, a social media-public health company called “Sickweather” accurately predicted the 2012 flu season six months in advance of the Center for Disease Control by using social media trend tracking. Clearly, social media is already involved in the delivery of healthcare.

Building a Community with Social Media

Many physicians, hospitals, clinics and healthcare executives are extremely mindful and even concerned about inappropriate use of social media by healthcare professionals. This causes a reluctance to embrace these tools. However, the fact remains these media are already being used to positively impact patient outcomes and they may be the most powerful tools to date for the practice of medicine.

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Cheryl Zapata believes when the medical practice goals and business practices of Texas Back Institute are properly aligned with social media, positive patient outcomes can occur. “The big thing social media can do for our practice is to build a community, where everyone – the patients, physicians and professional staff – is focused on patient care, pre-surgical education, preventative health practices and post-surgical therapy.”

She continued by noting, “We want our patients, our physicians and staff to be a part of something important. This community can be informed and built by timely and relevant social media content and we can glean insights about better patient care by monitoring these social media. Social media platforms are robust and extremely user friendly and it’s incumbent on us to take advantage of these communication tools.”

“We want more conversations among our physicians and patients, not less,” she noted. “And we want our physicians to be comfortable with the transparency social media affords.”

Even this blog you are reading is a part of the Texas Back Institute’s commitment to community building. “We focus considerable resources on building the ‘smart content’ in this blog which is updated every week and often several times per week. We want to be a part of the conversation our patients, physicians and staff are having. Perhaps this involves a blog post dealing “water cooler conversations” – sports injuries, news or technology – and how this topic relates to back injuries and health. If so, all the better.  We want to be relevant, accurate, timely and sometime entertaining.”

Post Your Comment

Texas Back Institute has built an international reputation through its leading-edge medical advances. For example, artificial disc replacement procedures were pioneered by the physicians at Texas Back Institute and it helped introduce this technology to the U.S. This same, innovative spirit is evident in the social media plans for organization.

The next time you see a YouTube video of information about post-surgical recovery of one our patients or a blog post about the back injuries and recoveries of Major League Baseball players; don’t forget to post a comment. We want to know what you’re thinking and how we can make this community even better!

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.

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.

Graduation

With the sound of “Pomp and Circumstance” ringing in their ears, the graduates of 2013 will be marching up to the stage and on to their future. There is a sense of accomplishment, pride and even relief at graduations because the participants feel they have completed something important. Texas Back Institute congratulates every graduate!

With graduations, it seems as if something has concluded, when in fact the term “commencement” suggests a beginning. This idea of “conclusion vs. commencement” has of course been employed by more than one valedictorian in their one, final address to their esteemed classmates.

Traditions of Graduation

This is the time of year when seniors in high school and college who have completed their courses successfully are awarded diplomas. This tradition goes back to the 11th Century when medieval colleges in Paris and Bologna reportedly began this practice.

Over the centuries, the traditions have evolved and changed, but many have remained remarkably similar to the original ceremonies. The students, who were known as apprentices in these early graduations, learned skills from the masters of the crafts and to note this accomplishment, they were give a “testimonial of skill,” now known as a degree.

The song that most of us associate with graduation ceremonies – “Pomp and Circumstance” – is a relatively new wrinkle on this ancient celebration. It was written by Sir Edward Elgar and first performed in Liverpool, England in 1901. Its melody, a combination of solemnity and dogged determination, is the perfect accompaniment to purposeful marching of the soon-to-be graduates.

Another interesting graduation ceremony tradition involves the attire of the honored matriculates. The cap and gown, which is worn by students and (in some cases) faculty, was once called a “hood” and this is believed to be dated back to ancient Celtic Groups. Capes and hoods were worn by the Druid priests to symbolize their higher intelligence.

What’s Next?   

After the music finally stops, the mortar boards are tossed and the diplomas are filed away, what happens then? The graduate – of high school or college – must commence the next stage of his or her life. For many, this means getting more education and beginning the process of deciphering how to spend the rest of one’s life.

Texas Back Institute is internationally known for its state of the art treatment of neck and back injuries, back pain, scoliosis, artificial disc replacement, occupational and sports medicine and its exemplary physical therapy practice. However, for the past 27 years, Texas Back Institute, led by one of the organization’s founding partners, Dr. Richard Guyer, has offered a select group of medical school residents a remarkable opportunity – a one-year fellowship to focus on spine surgery.

To anyone talking with Dr. Guyer about the Texas Back Institute fellowship program, it is immediately obvious that he is just as enthusiastic as the young doctors who are chosen for the program. Much like the master craftsmen who trained the apprentices in earliest institutions of learning, there is a commitment to teaching these future surgeons that goes beyond cursory. The doctors who emerge from this program are changed forever.

With his interest in teaching, we thought Dr. Guyer might be a good source of advice for graduates of any level – high school, college or graduate school. Here is that conversation.

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What areas of medicine will be in high-demand in the coming years?

There are so many opportunities in medicine, especially if a young man or woman is interested in computers, science or engineering. We’ve all read that more and more kids are interested in business, finance or high technology, but the opportunities in medicine are exploding. For example, the latest high tech robotic surgery equipment is still directed by a human who is a trained physician and many of the best practitioners of this specialty were video gamers when they were kids. Genetic engineering is going to be a very hot area of medicine in the coming years and this specialty requires a very analytical mind which many youngsters who are good at math and science possess.

If someone is graduating from college and accepted to medical school, what types of specialization might they consider for spine surgery or other specialties offered by Texas Back Institute?

When I first started in medicine, young physicians would spend a couple of years in medical school before they decided which specialty interested them. Things have changed a lot since then and now that decision is often made when they are in college. The types of procedures we do at Texas Back Institute involve a wide range of medicine. We handle spine surgery for both children and adults. Our doctors deal with trauma surgery which would be required for automobile accidents and other accidents. We treat injuries that are the result of aging – wear and tear damage. We also have quite a few sports injuries that our physicians treat. So you can see there is a wide range of opportunities just in the spine area.

How did the Texas Back Institute Fellowship program come about?

I’ve found that when you teach students, you learn as much as they do and I loved teaching. In the mid 80s, I approached my colleagues here and shared my passion about teaching. I mentioned that I’d really like to build a fellowship program here for residents who wanted to specialize in spine surgery. Since our beginning in 1986, we have trained more than 100 fellows and I have been the chairman of this program for 27 years. This keeps me young and sharp! We work hard at sharing the latest research and techniques about spine surgery for these young doctors and for everyone on the Texas Back Institute staff it is very gratifying when that light bulb comes on over the head of these talented young people.

How does the TBI fellowship program work?

These doctors have been through medical school and have completed their residency program. They find us through the network of former TBI fellows and through the American Academy of Orthopedic Medicine. Once they are accepted to the fellowship program, they work with all of the surgeons on our staff. They get hands-on training in deformative and degenerative medical issues, trauma, tumors and disc replacement surgery.

What are the criteria that Texas Back Institute uses to recruit new physicians to the practice? Does completing your fellowship help in gaining a position?

The last 4 or 5 physicians that we have hired have gone through the Texas Back Institute Fellowship program, so that suggests that there is an advantage of going through this training. When we recruit new doctors for our team, we look for a young woman or man with a high degree of intelligence, an excellent bedside manner, his or her ability to synthesize a large amount of information and apply it to treatment and most importantly we look for integrity.

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From Left to Right: Dr. Rey Bosita, Dr. Rajesh Arakal, Dr. Jack Zigler, Dr. Jason Sparks (Fellow), Dr. Richard Guyer, Dr. Ralph Rashbaum, Dr. Troy Morrison (Fellow), Dr. Kirill Ilalov (Fellow), Dr. Michael Duffy, Dr. Kenny Edwards (Fellow), Dr. Andrew Block, and Dr. Dan Bradley.

Successfully completing a course of study and celebrating this accomplishment with friends and family is one of life’s great pleasures. As speakers who are chosen to impart wisdom to a group of graduates are fond of noting, this ceremony is not the conclusion, it is the beginning. Congratulations to every graduate and their families. Now, let’s get busy!

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