Deciding on the best health care for you
Medical Practitioners
A doctor of medicine can take the time to evaluate your condition and confirm your specific diagnosis. Medical doctors prescribe either over the counter or prescription only medication. They can prescribe medications that temporarily relieve inflammation, temporarily relax muscles, and temporarily relieve pain. Many medical doctors work with physical therapists and chiropractors to provide conservative management for the many back pain conditions a patient can experience. Orthopedic doctors have extended training in joint-related conditions such as this. While Orthopedic doctors can perform back surgery, this drastic step should only be used when all other treatment options have been exhausted, as back surgery carries many risks, and not usually recommended for most conditions.
Chiropractic Care
Chiropractors have the level of education befitting their title as doctors. Their focus is primarily on diagnosing and treating dysfunction of the muscles, nerves, and skeletal system without the use of drugs or surgery. As a particular back condition may at times warrant more aggressive forms of treatment, many chiropractors have developed good working relationships with medical doctors to enable a system of cooperative care to optimally benefit their patients. Chiropractic care helps increase the flexibility of the soft tissue of the spine and reduces the pressure that occurs from any restricted and minor misalignments of individual vertebral joint segments. This in turn helps to eliminate any nerve interference created from the dysfunctional area. This can be achieved by breakingdown scar tissue through techniques which adjust the spine, re-aligning the attached vertebrae, as well as performing release techniques to the fibrous portion of the soft tissue. Many doctors of chiropractic also use therapeutic measures such as ultrasound, electric stimulation, and heat therapy. A doctor of chiropractic should take the time to diagnose your condition and help determine its cause.
Massage Therapy
Many chiropractors have recognized the benefit of working in conjunction with massage therapists to loosen their patient's muscles as a precursor to treatment. This relationship works so well because the patient can be treated after becoming more relaxed and euphoric due to the natural release of endorphins, as well as the loosening of the musculature due to all the benefits of massage. Other benefits of massage depend on the type of massage being given.Swedish massage is usually a more superficial, relaxing form, and therefore is less likely to break down scar tissue and trigger a release of spasmodic musculature as a deeper type of massage would accomplish. It should be noted that due to the increase incirculation and release of lactic acid (a natural chemical irritant that is a byproduct of muscle utilization without oxygenation) with massage, it is possible that the area can feel more inflamed and tender temporarily.
Acupuncture
Eastern philosophy proposes that acupuncture utilizes needles to stimulate energy points and are referred to as meridians. The Western scientific explanation is that the stimulation from the needle puncture triggers natural pain relieving chemicals from the brain, a reduction in inflammation to the area through an increase in circulation, and a relaxation response to the musculature. As no scar tissue is being broken down from the injured tissue, increase in flexibility will be less likely than with a manual tissue and joint mobilizing type of therapy.
Physical Therapy utilizes a variety of modalities such as ultrasound, electric stimulation, massage, and thermal therapy to help relieve muscular spasms. Manual tissue and joint mobilizing types of therapy can be used to help increase tissue flexibility. Physical Therapy excels in the use of muscular strengthening exercises to build stability to weaken tissue. It should be noted that irritated muscles can become further damaged with strengthening exercises that are premature to the healing of the area. A prescription from a doctor is often needed prior to treatment with a physical therapist for most health insurances to pay for any care rendered.
Medications
One of the most frequent questions our health experts encounter is whether medication should be taken, and which one would be right for them. It is important to remember that medications are aimed at temporarily reducing pain, inflammation, and relaxing the body, but have not been proven to increase healing to the area. Here are some of the most commonly mentioned medications: For over-the-counter medication, Ibuprofen has been indicated for temporary pain relief. Studies have also shown that in higher amounts, Ibuprofen can act as an anti-inflammatory, but a medical doctor's prescription is needed for this dosage. Aspirin and acetaminophen are also indicated for muscle pain relief, but do not show anti-inflammatory properties in prescription dosages. Acetaminophen does not have warnings about adverse reactions for people with aspirin allergies, as it is not an aspirin derivative. It has also been demonstrated to be better tolerated by people with weak intestinal systems. While Aspirin is known to be more abrasive on the intestinal system, it may have other side benefits such as blood thinning that prevents the blood clots which can lead to strokes and myocardial infarctions. As these medications work to block pain and inflammation temporarily, it stands to reason that the need for these medications can occur when a person can no longer function due to the pain or when it hinders sleep and thereby impedes the body's natural healing process. A person on pain medication should consider that they may more easily overdo it during the temporary relief period, which could cause further injury to the muscles.
Chronic Pain: 2. The Case for Opiates
*As side effects can occur, always consult your medical doctor to determine if and what medication is appropriate for your situation.*
Any information given about conditions, treatments, and products are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on MY BACK PAIN.
Chronic Pain: 2. The Case for Opiates
*As side effects can occur, always consult your medical doctor to determine if and what medication is appropriate for your situation.*
Exercise for back pain
Healing through back pain exercise Active forms of back pain exercise (physical therapy) are typically necessary to rehabilitate the spine and help alleviate back pain. Importantly, a regular back pain exercise routine provides patients with the means to help avoid recurrences of low back pain, and helps reduce severity and duration of potential future episodes of low back pain. The natural stimulus for the back to heal is active back pain exercises, done in a controlled, gradual, and progressive manner. Movement distributes nutrients into the disc space and soft tissues in the spine to keep the discs, muscles, ligaments and joints healthy. And the converse is true too—lack of exercise can worsen back pain by leading to stiffness, weakness, and de-conditioning.
Exercises and Stretches for the Back
Muscular stretching can be a very important part of the healing process for tightened muscles of the back. It is essential to lengthen any shortened muscular tissue of the back to help prevent further pulling on the already shortened fibers. Muscular strengthening exercises will be important once the back irritation has subsided. Back strengthening exercises help to build stability to weak tissue. It should be noted that irritated muscles can become further damaged with strengthening exercises that are premature to the healing of the area. The exercises below are general exercises to increase flexibility and can help to stabilize the back. However, it should be noted that for most of these exercises, you should not feel the stretch in the back itself. For example, the back of the legs have a group of muscles called the hamstrings. These muscles originate in the lower pelvis and insert into the leg. When the hamstrings are tight, the back itself can be tightened due to the pulling on the pelvis. Therefore, stretching the hamstrings will not only loosen the leg muscles up but they will take the strain off the back.
Warning:
*The following back exercises should never be performed if they cause irritation to your back or any other condition while they are being performed! As each back condition is different, always consult your doctor before performing any of these
exercises to determine what exercises, if any, are right for your particular condition. If you have any discomfort after performing any of these exercises, discontinue and immediately and consult a doctor to properly assess your situation.*
exercises to determine what exercises, if any, are right for your particular condition. If you have any discomfort after performing any of these exercises, discontinue and immediately and consult a doctor to properly assess your situation.*
Sit-ups
Sit-up exercises should be done very precisely to avoid any traction to the spine. Place your knees up on a chair, with your legs and hips at a 90 degree angle. Support your neck but don't pull on it as you raise your upper chest, no more than 30 degrees. Look straight up with your eyes to keep from pulling forward on the head. Do 3 sets of 12 reps, or to your individual tolerance. It is important to concentrate on feeling the strain in your abdominal muscles and not your neck or back. Any pain you feel with this exercise should only be a local muscle exercising sensation to the abdominal area, without aggravating your condition.
Hamstring String Stretch
Sitting on the ground, with one leg straight and the other one comfortably bent in front of your body, bend at the waist and lean forward, keeping your back as straight as possible. Reach with your arms towards the foot until a stretch is felt under your thigh. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh area without aggravating your condition.
Back Flexion Stretch
While laying on your back, pull both knees to your chest while simultaneously flexing your head forward until you reach a comfortable stretch in a balled-up position. Do 8-12 repetitions this way holding each one for 8-10 seconds at a time. You should feel no pain with this exercise, as the stretch is designed to relieve tension on the back.
Gluteus Stretch
Laying down on your back, bend your right knee, and place your left leg over the right leg, resting the outside of the left ankle slightly above the right knee. Place your right hand around the outside of your right thigh and place the left hand around the inside of your right thigh. Lock the two hands together. Now pull forward towards your chest to achieve a stretch in the left gluteus portion of your buttocks. Do the exact opposite to achieve a stretch of the right gluteus portion of the buttocks. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh and buttocks area, without aggravating your condition.
Piriformis Stretch
Laying down on your back, bend your right leg and pull up your right knee towards your opposite chest with your left hand. You should feel the stretch in the Piriformis portion of the right buttocks. Do the exact opposite to achieve a stretch of the left Piriformis portion of the buttocks. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh and buttocks area, without aggravating your condition.
Yoga and Meditation to Relax the Back
Regardless of the current situation your back is in, relaxing could be key to helping it heal. While meditation can always be useful for achieving this, Yoga can at times be irritating if caution is not taken. Yoga is a series of slow movements combined with stretches and meditation to allow for an increase in flexibility and relaxation to the muscles and joints, as well as to help optimally integrate the connection between the mind and body. However, what might seem to be easy maneuvers should still be treated cautiously, as your individual situation may prohibit certain Yoga moves. One simple meditation practice that is usually met with good success is to close your eyes and visualize yourself in the most happy and relaxing place you know of. Sometimes just taking the time to do this can be what you need to begin the healing process.
Correct Shoes for Avoiding Back Pain
While walking is one of the overall best exercises for your health, the shoes you choose to stroll in may just be the difference between hurting your back and helping to keep it strong and loose. High heel shoes put your spine in extension, which can impact the joints further when the vertebrae are already in a compressed state. Lack of shock absorption will further impact the joints with every step you take. Shoes that contain proper arch support can help take the pressure off those tired feet and add to increase overall shock absorption. Shoes with pressurized air or other cushioning chambers are necessary to protect the spine during the much harder impact a person will experience during exercise.
When to Use a Heel Lift
During standing a proper balance is needed between both hips to keep the back in correct alignment. When one leg is slightly longer, or the hip becomes fixated in a higher position, it may be necessary to supplement the lower side of the hips with a heel lift worn inside the shoe. When the spine is tilting to the lower hip side, a lift may allow the spine to realign properly, and thus take pressure off the back. If one leg actually grew shorter than the other, a lift may be needed on a permanent basis to prevent the spine from moving back to its incorrect position. A health practitioner should be the one to evaluate the situation and assess the correct size heel lift needed.Whirlpool and Jacuzzi Water Therapy
As previously mentioned, moist heat therapy is useful for increasing circulation and thereby loosening up the muscle tissue. In the case of a heated whirlpool, the heat will completely surround the area. Add to this the jet massaging action of a Jacuzzi and you have a great way to relax the muscles of the back. Waiting to use heat therapy until three days after the onset the Spondylolisthesis first occurred will give the swelling a chance to go down, as heat increases the inflammation to the muscles.
Electric Stimulation Devices
Electric stimulation is an effective way to reduce pain. This is accomplished though blocking the same pain receptors that cause the nerves to irritate due to the Spondylolisthesis. Micro-current is a specific type of electric stimulation which has been shown to stimulate healing to the injured tissue. Some electric stimulation units can charge the muscles to contract when the intensity is raised or it is placed over a motor point of the muscle. At times, this contraction causes the muscles of the back to loosen up by fatiguing them, while other times it may cause further irritation to the tissue. Home electric stimulation devices may not always be as effective as the more costly type usually found in a health practitioner's office.
Ultrasound
Ultrasound is an extremely effective way to stimulate proper tissue healing. Sound waves are generated from a crystal vibrating inside the head of the ultrasound wand and then transmitted through sound conducting gel to the tissue. This allows the sound waves to break down unwanted scar tissue, increase circulation to the area, and help relax the musculature. This can be extremely beneficial in the case where the Spondylolisthesis has caused soft tissue irritation to the back. Ultrasound can only be used in the presence o a licensed health practitioner.
Ice Packs
Ice can be used in the initial 72 hours of an injury to reduce inflammation and numb the pain associated with the Spondylolisthesis. One potential problem with ice is that temporarily it will tighten the musculature even more. Also it should be noted that ice should not be used for longer than 20 minutes to an area, as it will cause a reversal reaction which will allow the tissue to become more inflamed. For low back inflammation w recommend using a combined brace and ice gel pad to put a more firm pressure over the irritated area. This will also provide support over the injured area while providing ice therapy. Patients we surveyed feel that the brace and ice gel pad combination below works extremely well (see Soft Back Brace section for more information on bracing).
Hot Packs
Hot packs are useful for increasing circulation and thereby loosening up the muscle tissue. Waiting to use heat therapy until three days after the onset the Spondylolisthesis first occurred will give the swelling a chance to go down, as heat increases the inflammation to the muscles. It is believed that moist heat is better than dry, as there is less possibility for dehydration to the musculature. We found a simple to use moist heat pack (depicted below) which contains beads that activate upon being heated up in a microwave to give off moist steam without adding water. This occurs from a natural process by which the beads retain moisture from the air. The ease of use, combined with the comfort of this product, make it a very popular therapy with the patients we surveyed.
Mechanical Massage Devices
Many of the same benefits seen with regular massage can be accomplished with mechanical massage devices that penetrate deeply through a tapping action called percussion, and thereby disperse lactic acid in the soft tissue and increase circulation, giving an overall relaxing effect to the musculature. This can be very effective for the "knotted up" type of musculature. More superficial massage devices that just vibrate may serve to increase circulation to the tissue, but lack the other aforementioned benefits. It should be noted that the stretching of the muscular fibers will not occur like it does in manual massage. Percussive massagers should be used on slower speeds when the soft tissue is very inflamed, as it is less irritating to the area. We found an extremely effective, yet affordable variable speed percussive massager that can be used on the neck and back (pictured below) and feel that it meets every criteria we look for in a home massager.
Topical Analgesics for Pain Relief
Over-the-counter sprays, sports creams and ointments that have analgesic properties can be useful for pain control of the Spondylolisthesis, without any intestinal side-effects.Menthol is the active ingredient which works to block pain receptors and help relieve pain in the soft tissue and joints. The higher the menthol percentage, the stronger the formula. Some companies use as much as 16 percent menthol, but that much is not necessary to achieve results and can cause burning side effects. Menthol can be derived naturally from peppermint or be synthetically produced. Natural menthol penetrates the skin more effectively. Other ingredients such as capsaicin, peppermint and eucalyptus can also help to block pain. Keep in mind that capsaicin or capsicum are responsible for the burning/tingling sensation that occurs in the same pepper spray that police use to stop attackers. Use of these Cayenne pepper derivatives can leave residual numbness and tingling in an area for days after each use. Some companies are also using other herbs believed to have natural healing, relaxing and mild anti-inflammatory properties such as MSM (methylsulfonylmethane) and Glucosamine, but most only add trivial amounts. Glucosamine and MSM are usually taken in oral pill form. Dosages usually range between 1,000-1,500 mg a day. Glucosamine is currently undergoing many trials to determine effectiveness for helping cartilage repair. Studies have demonstrated that patients with deterioration of joint cartilage halt and even regenerate the tissue after taking Glucosamine for at least six weeks.For a topical pain reliever to work effectively it needs to have a good transport mechanism (ability to let ingredients be able to pass through the first layer of skin down to the deeper tissues below). In theory, supplements such as Glucosamine Sulfate and MSM have small enough molecules to pass through the skin barrier and not just affect the top of the skin, but rather penetrate deeper down. Because Glucosamine and MSM absorb so well, they also make great skin conditioners. Where as taking Glucosamine and MSM will affect your whole body, placing it over an area can add 28 times more than a pill would provide over a specific area. Topical pain relievers with oils and waxy substances like glycerin, strearic acid and cetyl alcohol would make a poor transport mechanism for ingredients like Glucosamine and MSM, yet some companies continue to use this ingredient. While methyl and propyl paraben are preservatives that offer an indefinite shelf life, they also lessen the penetration of a topical pain reliever. Therefore, the best type of topical analgesic is one that combines good powerful natural ingredients, with a good transport mechanism that has no preservatives, but also no oils to block penetration or eventually turn the formula rancid. Therapain Plus (shown below) meets the above criteria and has proven successful with the patients we surveyed.*Health Disclaimer*
