There is significant excitement among surgeons as well as among patients following the recent FDA, or Food and Drug Administration, release of the Charit� Artificial Disc (DePuy Spine, Inc.). The delight among patients with degenerative disc disease comes from the perception that there’s now a safe way to eliminate pain from degenerative discs while also maintaining normal movement. Several patients have developed advanced stages of disc degeneration requiring an additional fusion process or have heard about others with similar difficulties getting fusion processes before, who still continue with constant pain or had more than one effort at fusion. They’ve also discovered the successful results following disc arthroplasty in Europe which has been highly publicized by the media in America.
Lumbar Fusions and Other Discoveries
That is certainly an exciting new addition to the variety of therapies and methods for treating degenerative disc disease. An almost amazing quantity of progress has been made when looking at the way in which the evaluation and treatment for degenerative disc disease has developed over recent years. Many healthcare professionals are now able to recognize disc disorder with MRI and pain generators with discography and facet blocks. Now they could be performed through incisions that are barely observable either anteriorly through the abdomen or through the back where only a decade past, lumbar fusions were being performed through substantial posterior incisions. With the usage of instrumentation that is presently available, achievement rates for one amount fusions approach 90 to 95 percent. Regrettably, not every patient who has degenerative disc disease and contains a successful fusion has a successful clinical result. There’s still a number of patients for whom fusion will not effectively relieve pain.
Risks of Disc Replacement
Disc replacement arthroplasty has the prospect of the treatment of most of the spinal motion segment illnesses which are currently being treated both successfully and not by one of the numerous fusion techniques. At this comparatively early phase of disc replacement development, many healthcare specialists don’t know all of the issues which will be encountered following these procedures. Because the surgical strategy is via the abdomen either retroperitoneal or transperitoneal, in other words, around or through the gut, there are several foreseeable complications including vascular injury, thrombophlebitis, or vein inflammation accompanied by blood clot formation, nerve root injuries, injury to the ureter, and retrograde ejaculation in men.
It’s also known that several disc replacements have failed and have been converted to some fusion with varying clinical consequences. Removing artificial discs, especially at the L4-5 level, poses a substantial risk of vascular injury due to scarring round the prosthesis. Surely, it’s known that artificial joints produce wear debris where that is obviously not an issue with fusion and an inflammatory reaction which could escalate over time.
Early Results of Procedure
Spine specialists and other healthcare professionals in general are very positive and excited about total disc arthroplasty, and suitably so. Appropriate training via cadaveric labs and courses will help minimize the learning curve of the procedure, to avoid other possible complications. There will without a doubt be many improvements and modifications in the prosthetic layouts.
Early results are surely encouraging in the hands of the investigational surgeons but are fraught with the numerous problems common to the creation of a procedure that is new. Total disc arthroplasty is likely to be an option that is better than fusion for several degenerative disorders of the lumbar spine as layout advancements continue being made and as further encounter defines the indicators because of its use.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Brain injuries are common complications in our modern world. Approximately 2 million individuals experience a head injury in the United States alone each year. Although most brain or head injuries are not considered life threatening, they could sum up to billions of dollars in annual revenue. Brain injuries are often categorized according to patient response. Only 1 out of 4 reported brain injuries are considered moderate or severe.
Doctor of Chiropractic, Dr. Alexander Jimenez examines people that see�a chiropractor and their reduced�usage of opioids and other types of drugs.
The draft Guidance for Prescribing Opioids for Chronic Pain, issued in December 2015 by the U.S. Centers for Disease Control and Prevention, included �many complementary and alternative therapies (e.g., manipulation, massage, and acupuncture)� among its recommended non-pharmacologic approaches. However, when the final Guidance was released three months later, manipulative therapy and its 75,000 licensed chiropractic practitioners was not directly referenced. A recent study from James �Jim� Whedon, DC, MS, pictured, suggests that the CDC harmed its mission with its excision of explicit reference to manipulation. Patients using chiropractors were less likely to use prescription opioids.
Whedon is currently a researcher at the Southern California University of Health Sciences, and is co-chair of the Research Working Group of the Academic Collaborative for Integrative Health. He is a relatively rare resource in the integrative health community, as a specialist in diving into huge data sets of insurers and seeking to extract useful information. Whedon is a veteran of arguably the most important research center in this type of work, The Dartmouth Institute at the Geisel Medical School at Dartmouth College.
Whedon�s research began with awareness that �little is known about the comparative effectiveness of non-pharmacological care for low back pain as a strategy for reducing the use of opioid analgesics.� What is well known, as Whedon shared in his poster and presentation at the 2016 conference of the Academy of Integrative Health and Medicine, is that patients with such pain are swimming in opioid prescriptions. Whedon�s presentation included a Baskin-Robbins-like list of 39 opioid varieties. He postulated that opioid use would be less likely among those receiving chiropractic care.
Association Between Utilization Of Chiropractic For Back Pain & Use Of Prescription Opioids
Preliminary results of a health claims study,� Whedon reports what he found through examining the New Hampshire All Payer Claims Database.� Of roughly 33,000 adults registered as having low back pain, slightly over a third saw a chiropractor. Of these, 38 percent had at least one opioid prescription. Of those who did not see a chiropractor, 61 percent had at least one opioid prescription.
The core question that interested Whedon was how many prescription fills the two sets of insured patients received. Those whose opioid prescription was integrated with chiropractic care had an average of 3.9 fills. Those who did not receive chiropractic manipulative therapy averaged 8.3 fills per patient. He estimated that the average per person opioid charges were $88 for those using chiropractors. The figure was $140, or 60 percent higher for those not using chiropractic care.
Whedon�s conclusions were, first, that the likelihood of filling a prescription for a high-risk drug of any type was 27 percent lower. Secondly, the likelihood of filling a prescription for an opioid analgesic was 57 percent lower in the chiropractic-using population.
�These are preliminary results,� Whedon cautioned. �We intend to analyze the data further, applying robust methods to reduce the risk of bias that can result from other differences between people who use chiropractic care and those who do not.�
Comment: While Whedon takes care to note that �no causal inferences can be made,� the associations should be of real interest to the CDC and other policy makers. A follow-up study might attempt to compare the whole costs of the chiropractic-using population and those who didn�t.� These costs could include, on the one hand, the cost of chiropractic treatment, and on the other, the costs of other medications or treatment that may be prescribed for those on longer-term opioid treatment who may end up cycling into the addiction.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at high heels at what they do to the back.
Ladies, ever wonder why you suffer from regular bouts of lower back pain?� Achy hips?� How about crazy tight leg muscles?� Don�t blame it on your cycling class, or too many squats or, the trainer you only see once or twice a week.� Look down.� Are you wearing high heels?� Bingo!� You�ve heard high heels are bad for you.� But it�s not just because they cause all kinds of pain and trauma to your feet.� High heels are also messing up your physical fitness. �They throw you out of proper postural alignment causing your joints and spine to take on more�wear and tear, which means aches and pains.
Is it possible to still look rockin� and save your joints? �My suggestion is more Athleisure-wear. �I know some fashion hard-liners say, no way will I walk around in yoga pants on a weekday!� But we�ve come a long way since those flare-leg, fold-over yoga pants.
Let�s chat for a moment about the evils of high heels.
First there�s the obvious.� They make your feet hurt.� Blisters, calluses and swelling are par for the course.� And pointy toes, fuhgeddaboutit!� I�m sure they were invented by someone on the Marquis de Sade�s payroll.� Second, they can lead to foot injuries like plantar fasciitis (usually from a bone spur that makes your heels hurt), hammertoes, bunions, and neuromas.� �Then there�s the domino effect.
Not only do high heels make your feet hurt, but problems with the feet can travel up the leg and cause injuries in the back, knees and hips. �Your knees take on extra pressure from the weight being pushed forward onto the balls of the feet. �Walking in this position makes your hip flexors and calf muscles short and tight. �And it doesn�t stop there.� Back problems are incredibly common in women who don�t give up their high heels.
Back Problems are incredibly common in women who don�t give up their high heels
Here�s why:
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Postural changes:�The S-curve of your spine has cushiony discs in between the vertebrae that act as a shock absorbers to protect them from stress. Like when you�re bending or jumping. �Wearing heels causes the lower back to arch more than normal because the body weight is pushed forward.� To compensate, the upper body has to lean back to maintain balance.� This puts extra stress on the discs. ��Spending hours with your body in funky alignment can lead to muscle spasms and back pain. �Tight hamstring muscles, which�attach to back of the pelvis and lower back, can also make your back ache.
Anatomical changes: Wearing high heels on a daily, or very regular basis, over years, can actually cause anatomical changes to your body.� In addition to the extra strain on your back and knees, the calf muscles can also shorten and the tendons can get tighter and thicker.
And It Can Get Even Nastier If You Get One Of These Spine Injuries:
Spondylolisthesis: it�s a mouthful, but is a common injury that can happen in the lower back from too much hyperextension (arching the back).� It�s when one vertebra slips forward over another.
Foraminal stenosis: I have this one congenitally and it sucks. This is a spine and nerve issue that occurs when anatomical abnormalities reduce the spaces the nerves travel through as they exit the spinal column.� The spaces are called foramina, and when they get blocked, the nerves get squeezed.� The pain can radiate through the buttocks and down the legs.� Symptoms are shooting pains, numbness, tingling, muscle weakness, spasms and, or cramping.
Sciatica:�The sciatic nerve is the longest one in the body. �It runs from the bottom of the lumbar spine all the ways down the legs. �When the sciatic nerve gets compressed it causes radiating pain, tingling, numbness and muscle weakness down the leg and can The pain can travel all the way to the bottom of the foot.
What Can You Do? �My Case for Athleisure-Wear To Combat Back Pain
It�s time for stuffy office attire to retire. �Comfy clothes and flat shoes can be very chic. �Have you seen the boards on Pinterest?� Thanks to this hopefully permanent fashion style, my jeans and heels spend more time in my closet than on my body.� Leggings and cute kicks are my go to�s.� Night out?� No prob.� I reach for my sleek workout leggings, a ruched top or off the shoulder top with some high heel sneaks (they�re wedges so not nearly as bad for you). �I also discovered these by Bluprint which I put to the test at 2 huge conventions where I walking and standing for hours on end.� The soles made of memory foam � like those beds!
My podiatrist friend, Steven Rosenberg, DPM has been preaching the need for comfy shoes to his female clients for years. �(Fortunately for his practice, not everyone listens!) �Dr. Steve says, wearing shoes designed more for comfort can help you live more pain-free. ��Because comfort shoes are made of�soft cushiony materials�with soft foam innersoles, those are what you should turn to for shopping, walking or standing for long periods of time to avoid�blisters, muscle spasms or arch cramps.� � He also says to check for arch support in your shoes. �If there�s none, you can buy ones to put inside.
Even after reading this, you may still not be willing to give up high heels for good. �Me either.� I still get glammed up once in a while.
Here Are Some Tips For When You Must:
Wear them for as little time as possible.
Try to opt for heels around 2� high
Steer clear of pointy toes.
Buy shoes with leather insoles to so your foot doesn�t slide.
Buy arch inserts or use orthotics to support your arches.
Vary your footwear so you�re not wearing high heels every day.
Gradual or lower slopes are a little better, go for platforms or wedges instead of stilettos
Thicker heels are better than spiky heels
Stretch and strengthen the overworked muscles.
Here�s How:
Stretch your leg muscles and hip flexors before and after wearing heels.� For the calves, stand on a step and let one heel hang down until you feel a stretch.
Try this convenient device, the foot rocker by Vive.� It stretches the calf and the sole of the foot relieving pain from plantar fasciitis.
Front of the hip and thigh stretch for before and after wearing high heels
Hamstring stretch for before and after wearing high heels
Massage and stretch the muscles in the soles of your feet.� Roll your foot on a golf ball before and after wearing heels and, get regular foot massages.
Strengthen and increase the range of motion in your ankles and feet.� Put a rag on the floor.� Using your foot, write the letters of the alphabet.� Also put a bunch of marbles on the floor.� Pick one or a few of them up using just your foot.� Put them down about 6 inches away without lifting your foot off the floor.� Try that 10 times.� If you don�t have marbles, you can do it with a hand towel.
So next time you�re shopping for shoes, think about your foot fitness first. �Look for fashion that keeps you closer to the ground and that will hopefully keep you farther away from the doctor.
Doctor of Chiropractic, Dr. Alex Jimenez examines Tiger Woods’ and his latest back surgery.
We have a look at Tiger Woods’ extensive history of injuries during his career. USA TODAY Sports
Tiger Woods Won�t Be Back For Some Time
Woods, that has made just three starts in a couple of years, likely won�t play again this year after he’d his back surgery that is fourth in Texas. The latest procedure alleviated pain in his back and leg, Woods announced on his web site Thursday.
That I’m confident this will relieve my back spasms and pain, and The operation went well,� Woods said in a statement. When fixed, �, I anticipate playing with my kids getting back to a normal life, competing in professional golf and living without the pain I’ve been fighting so long.�
Woods, who also has had four surgeries on his left knee, first had surgery on his back and then had two procedures in the autumn of 2015.
According to his statement, a disc in Woods back seriously narrowed because of causing sciatica, the three surgeries and severe back and leg pain. During the recent operation, the damaged disc was removed and the collapsed disc space was elevated to levels that were regular. The goal is to relieve the pressure on the nerve, the statement said. The procedure was performed by Dr. Richard Guyer of the Centre for Disc Replacement at the Texas Back Institute.
A Look At Tiger Woods’ Injury History
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Woods, 41, last played in February, where he shot a birdie-free 77 in the very first round before removing. Where he missed the cut his only other start was in the Farmers Insurance Open the week prior.
His only appearance on the golf course in 2016 arrived at the Hero World Challenge in December. While he finished 15th in the 17-man field, he tied for the tournament lead in birdies (24), seemed healthy and upbeat.
Before beginning therapy, he will be resting for several weeks. The recovery interval is usually about half a year. That would mean Woods, a winner of 14 major tournaments and 79 PGA Tour titles, won�t play in any of the four majors for a second straight year. He is now rated No. 788 in the world.
Woods is in good spirits after the surgery, said his agent, Mark Steinberg.
USA TODAY Sports, he believes somewhat that the large weight was lifted off his shoulders,� Steinberg told. �The three previous operations were somewhat temporary repairs. But it got to the point where the pain was more common and this latest surgery was something he had to do.�
Steinberg said Woods decided to take a conservative approach along with his back previously three years with his difficulties. That alternative wasn�t accessible this time.
�This just isn’t a temporary repair,� Steinberg said. � his physicians proposed him that this is the top path to a healthy, energetic lifestyle. He and his children were playing but he was in so much pain.
�Now he �ll possess a healthy life without pain.�
One, Steinberg said, that can include playing golf.
�Entirely,� Steinberg said. �He desires to get out (on the PGA Tour) again.�
Woods� last public appearance ahead of the operation was Tuesday in Hollister, Missouri, where he pronounced he�s designing his first public golf course. The course will probably be called Payne’s Valley in honor of Missouri native Payne Stewart. Woods is a partner on the project with CEO Johnny Morris and Bass Pro Shops founder.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at the cervical spine and low back pain.
Low back pain and leg pain are the most common cause of disability worldwide. As such new research based treatment approaches are needed. This new randomized trial by BCP Non-profit and Cairo University tested the ability of the cervical Denneroll orthotic to improve cervical spine curvature and its consequent effect on low back and leg pain. Great short term results were found where patients receiving the cervical spine Denneroll improved with low back pain, leg pain, neurological outcomes and disability compared to a PT only interventional group.
Surgery is a common approach to treat carpal tunnel syndrome. But, physical therapy may work just as well, a new study indicates.
Researchers found that physical therapy improved hand and wrist function and reduced pain as effectively as a standard operation for the condition. Moreover, after one month, physical therapy patients reported better results than those who underwent surgery.
“We believe that physical therapy should be the first therapeutic option for almost all patients with this condition,” said lead study author Cesar Fernandez de las Penas. “If conservative treatment fails, then surgery would be the next option,” said de las Penas, a professor of physical therapy at King Juan Carlos University in Alcorcon, Spain.
Also, one extra benefit of therapy over surgery may be cost savings, he noted.
Treatments for Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes squeezed at the wrist. It often arises from repetitive motions required for work, such as computer use or assembly line work. Symptoms usually start gradually, with patients noticing numbness and weakness in the hand and wrist.
Surgery for the condition generally involves cutting a ligament around the wrist to reduce pressure on the median nerve, according to the U.S. National Institutes of Health.
Results of Physical Therapy vs Surgery
For this study, de las Penas and his colleagues followed 100 women from Madrid who had carpal tunnel syndrome. Half were treated with physical therapy and half underwent surgery.
For three weeks, the therapy patients received weekly half-hour manual therapy sessions — meaning therapists only used their hands. The therapists focused on the neck and the median nerve. They also applied manual physical therapy to the shoulder, elbow, forearm, wrist and fingers. On their own, patients performed neck-stretching exercises at home.
After one month, the therapy group reported greater daily function and greater “pinch strength” between the thumb and forefinger compared to the surgery patients. After three, six and 12 months, however, improvements were similar in both groups. All participants experienced similar reductions in pain.
Study co-author Joshua Cleland is a professor with the physical therapy program at Franklin Pierce University in Rindge, N.H. “Manual physical therapy may be just as beneficial in improving function and symptom severity as surgery despite the severity of their condition,” he said, noting that 38 percent of those in the therapy group had “severe” carpal tunnel syndrome.
“These manual physical therapy techniques are commonly used here in the United States as well and should become a standard of practice for physical therapists working with patients who have carpal tunnel syndrome,” Cleland said.
Dr. Daniel Polatsch is co-director of the New York Hand and Wrist Center at Lenox Hill Hospital in New York City. He treats several hundred cases of carpal tunnel syndrome each year, of which 15 to 20 percent require surgery. Treatment should be decided on a case-by-case basis, Polatsch said. Mild cases may be treated with conservative approaches that can include splinting, injections, therapy and activity modification, he added.
“Surgery is necessary when there is muscle weakness or atrophy from the nerve being compressed at the wrist,” he said.
Polatsch added that this type of surgery is generally safe and effective.
Still, operations can have complications, said Cleland. He cited a previous research finding that “approximately 25 percent of individuals undergoing surgery for carpal tunnel syndrome experience treatment failure with half of those requiring an additional surgical procedure.”
According to the researchers, almost half of all work-related injuries are linked to carpal tunnel syndrome. And, more than one-third who undergo surgery for the condition are not back at work eight weeks later.
Because this was a small study focusing only on women, the study authors said that future studies need to examine men.
The study results were published in the March issue of the Journal of Orthopaedic & Sports Physical Therapy.
SOURCES: Cesar Fernandez de las Penas, P.T., Ph.D., professor, physical therapy, King Juan Carlos University, Alcorcon, Spain; Joshua Cleland, P.T., Ph.D., professor, physical therapy program, Franklin Pierce University, Rindge, N.H.; Daniel Polatsch, M.D., co-director, New York Hand and Wrist Center, Lenox Hill Hospital, New York City; March 2017, Journal of Orthopaedic & Sports Physical Therapy
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Chiropractic and Carpal Tunnel Syndrome
Carpal tunnel syndrome, which occurs when the median nerve, found between the forearm and the palm of the hand, becomes compressed at the wrist, can be treated in a variety of ways, including physical therapy and even surgery. New research has also determined that chiropractic care can be effective towards treating carpal tunnel syndrome and its symptoms. Chiropractor utilize manual manipulations to relieve the painful symptoms.
Patients who go straight home from the hospital following hip or knee replacement surgery recover as well as, or better than, those who first go to a rehabilitation center, new research indicates.
And that includes those who live alone without family or friends, one of three studies shows.
“We can say with confidence that recovering independently at home does not put patients at increased risk for complications or hardship, and the vast majority of patients were satisfied,” said that study’s co-author, Dr. William Hozack. He is an orthopaedic surgery professor with the Rothman Institute at the Thomas Jefferson University Medical School in Philadelphia.
Hozack noted that while in the past it was “not uncommon for patients to enter a rehabilitation facility in order to receive additional physical therapy,” most patients today do not end up going to a secondary facility. In fact, roughly 90 percent of Hozack’s joint replacement patients are discharged directly home following surgery, he said. “Considerable evidence has now shown that most patients do just as well at home,” he noted.
Hozack and his colleagues are scheduled to present their findings in San Diego at a meeting of the American Academy of Orthopaedic Surgeons (AAOS).
Home Recovery Following Surgery
Two other studies being presented at the meeting also found that recovering at home may be the better option.
One study found that patients who are discharged directly home following a total knee replacement face a lower risk for complications and hospital readmission than those who first go to an inpatient rehab facility. The study was led by Dr. Alexander McLawhorn, an orthopaedic hip and knee surgeon at the Hospital for Special Surgery in New York City.
McLawhorn was also part of a second Hospital for Special Surgery study, led by Michael Fu. That study found that hip replacement patients admitted to an inpatient facility rather than being sent home faced a higher risk for respiratory, wound and urinary complications, and a higher risk for hospital readmission and death.
Dr. Claudette Lajam is chief orthopaedic safety officer with NYU Langone Orthopaedics in New York City. She was not involved with the studies, but agrees that home recovery is the best option for most patients.
“The home setting is the single best way to get people back into their routines as quickly as possible after surgery,” she said. “In some cases, this cannot be done,” Lajam acknowledged. “Some patients live in settings that are inaccessible, [such as] a 5th-floor walk-up apartment where the patient would need to go downstairs to let the visiting nurse and therapist in the door.” For some patients, anxiety about the recovery process could also pose a challenge, she added. But “being in an institutional setting after surgery only reinforces the idea that the patient is ‘sick,’ ” Lajam added. “We have learned that this type of thinking slows down recovery. We want our total joint patients to start using their new joints as quickly as possible, and staying in bed at a nursing facility is not the way to do this.”
Hozack and his colleagues set out to see whether patients who live alone fare as well as those who live with others. All 769 patients enrolled in the study by Hozack’s team went home following either a total hip replacement or a total knee replacement. Of those, 138 lived alone (about 18 percent). Once home, all were assessed on multiple levels, including functionality (ability to move); pain levels; hospital readmissions; emergency department visits; unscheduled doctor visits; dependency on assisted-walking devices; and time before returning to work or being able to drive again.
Hozack’s team observed no differences by any measure. And while those who lived with others indicated relatively higher satisfaction levels at the two-week mark, by the three-month point there was no appreciable difference between the two groups.
“We feel that giving patients back their independence early on is the best way to promote a safe and effective recovery,” said Hozack. His team concluded that single-household patients who go straight home can expect to fare as well as those who have live-in support.
A recent Mayo Clinic study calculated that between 2000 and 2010, the number of Americans who underwent hip replacement surgery more than doubled, rising from just under 140,000 to more than 310,000 per year.
Meanwhile, AAOS figures indicate that in 2010 more than 650,000 knee replacement procedures were performed, with about 90 percent involving total knee replacement. AAOS estimates from 2014 show that 4.7 million Americans now live with an artificial knee and 2.5 million have an artificial hip.
Findings presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.
SOURCES: William J. Hozack, M.D., professor of orthopaedic surgery, Rothman Institute, Thomas Jefferson University Medical School, Philadelphia; Claudette Lajam, M.D. assistant professor and chief orthopedic safety officer, NYU Langone Orthopedics, New York City; March 14-18, 2017 presentations, American Academy of Orthopaedic Surgeons meeting, San Diego
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: What is Chiropractic?
Chiropractic care is a safe and effective, alternative treatment option utilized to diagnose, treat and prevent a variety of injuries and conditions associated with the musculoskeletal and nervous system. A chiropractor, or doctor of chiropractic, commonly uses spinal adjustments or manual manipulations to help correct the spine and it’s surrounding structures, improving and maintaining the patient’s strength, mobility and flexibility.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
