Thursday, December 18, 2008

Carpal tunnel treatment NYC

Carpal tunnel treatment NYC



Carpal tunnel syndrome (CTS) is a disorder caused by pressure on the median nerve in the wrist. Numbness and tingling are characteristic symptoms of the disorder.



The carpal (pronounced CAR-pull) tunnel is an area in the wrist formed by bones and ligaments. It provides a protected passageway for the median nerve. The median nerve is responsible for feelings and movement in the hand, especially the thumb and first three fingers. When pressure is applied to the median nerve, the hand feels as if it has gone to sleep.

Carpal Tunnel Syndrome: Words to Know
Carpal tunnel:A passageway in the wrist, created by bones and ligaments, through which the median nerve passes.
Electromyography:A test used to measure how well a nerve is functioning.
Median nerve:A nerve that runs through the wrist and into the hand, providing feeling and movement to the hand, thumb, and fingers.
Carpal tunnel syndrome is most common among women between the ages of thirty and sixty. The disorder is a major cause of missed workdays because of the pain it causes. In 1995 about $270 million was spent for sick days taken as a result of CTS-related problems.



The carpal tunnel is a narrow passageway. Any swelling in this area causes pressure on the median nerve. That pressure eventually makes it difficult for a person to use the hand normally. Some conditions that can lead to pressure on the median nerve include pregnancy, obesity (see obesity entry), arthritis (see arthritis entry), diabetes (see diabetes mellitus entry), certain diseases of the thyroid and pituitary glands, and injuries to the arm and wrist.

One of the most common causes of CTS is repetitive motion. Repetitive motion is any activity that a person performs over and over again. Typing, working at a computer keyboard or cash register, playing some kinds of musical instruments, and working at certain types of factory jobs may involve repetitive motion. Repetitive motion forces a person to use the wrist over and over again and can lead to swelling in the carpal tunnel area, subsequent pressure on the media nerve, and thus to CTS.



Symptoms of carpal tunnel syndrome include numbness, burning, tingling, and a prickly pin-like sensation in the palm of the hand, thumb, and fingers. Some individuals notice a shooting pain that starts in the wrist and goes up into the arm or down into the hand and fingers. CTS can also lead to muscle weakness in the hand. A person may have difficulty opening jars and holding objects. In advanced cases, hand and thumb muscles may actually decrease in size. If left untreated, CTS can result in permanent weakness in the hand and fingers, loss of feeling, and even paralysis of the thumb and fingers.



The first step in diagnosing carpal tunnel syndrome is a simple one. The doctor asks the patient to hold his or her hand in position with the wrist bent for about a minute. The presence of the symptoms described suggests the presence of CTS. The doctor may also perform other simple tests to measure muscle strength and feeling in the hand and arm. Additional tests may be used to rule out other problems. For example, an X ray can show that a tumor is causing pressure on the median nerve.

The doctor may also order an electromyograph (pronounced e-LEK-tromy-uh-graf) of the affected area. An electromyograph measures the speed with which nerve transmissions move through the median nerve. It indicates the amount of damage that has been done to the nerve.

Illustration of the carpal tunnel, tendons, and median nerve (white line running up the wrist). (© R. Margulies. Reproduced by permission of Custom Medical Stock Photo.)



The first step in treating carpal tunnel syndrome is to immobilize the wrist, that is, prevent it from moving. A splint around the wrist is used for this purpose. Some people get relief from CTS by wearing the splint at night. Others may also need to wear the splint during the day.

Certain drugs may be prescribed to reduce pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (pronounced i-byoo-PRO-fuhn), are commonly used for this purpose. In advanced cases of CTS, injections of steroids may be necessary. Steroids also reduce pain and swelling.

In the most serious cases of CTS, surgery may be necessary. The doctor cuts a ligament in the wrist, increasing the size of the carpal tunnel. This procedure results in decreased pressure on the median nerve and, therefore, less pain for the patient. This procedure is almost always done in a doctor's office. A local anesthetic is used to numb the hand and wrist. The patient usually recovers quickly.



Without proper diagnosis and treatment, carpal tunnel syndrome may lead to permanent damage to the affected hand. In most cases, splints and anti-inflammatory drugs are able to control the symptoms of CTS. For those who require surgery, about 95 percent will get complete relief from the disorder.



The goal of CTS prevention is to reduce the amount of repetitive motion that places stress on the wrist. Ergonomics (pronounced ur-ga-NAHM-iks) can be a major help in reaching this goal. Ergonomics works with the design of machines and other equipment to make them less stressful for humans. For example, research in ergonomics has led to the development of new computer keyboard designs that are easier and less stressful to use. The early use of splints can also help prevent people at risk for CTS from developing the condition.

FOR MORE INFORMATION contact Dr. Shoshany (212) 645-8151


Butler, Sharon J. Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries. Oakland, CA: New Harbinger Publications, 1996.

Crouch, Tammy. Carpal Tunnel Syndrome and Repetitive Stress Injuries: The Comprehensive Guide to Prevention, Treatment and Recovery. Berkeley: North Atlantic Books, 1996.

Pascarelli, Emil. Repetitive Strain Injury: A Computer User's Guide. New York: John Wiley & Sons, 1994.

Brody, Jane E. "Experts on Carpal Tunnel Syndrome Say that Conservative Treatment is the Best First Approach." New York Times (February 28, 1996): p. 89+.

Glazer, Sarah. "Repetitive Stress Injury: A Modern Malady." Washington Post (March 12, 1996): p. WH12.

Carpal Tunnel Syndrome Description
Carpal tunnel syndrome occurs mostly in middle-aged women, who do repetitive extensive hand work (e.g. typing) and mostly in dominant hand. It is also often seen in production and manufacturing workplaces (with repetitive activities such as cutting meat, dressing poultry and assembling automobiles). The condition is also very common among musicians, who play string instruments and piano. During last 10-15 years people can get this problem as a result of extensive computer work (computer manufacturers now use warning labels to alert consumers that keyboard use may increase the risk of CTS). This is second most common (after lower back pain) for both males and females, reason for seeking for medical attention.

The carpal tunnel is a narrow tunnel on the inner surface of the wrist where tendons for flexing muscles of the fingers travel. When a person does repetitive and long (for hours) work with his wrist or fingers, the tendons became inflamed, which causes their swelling and compression of the median nerve. The same symptoms may occur after wrist trauma (e.g. Colles fracture – fall on extended wrist) or when one of the wrist bones is displaced and the median nerve is compressed.

Carpal Tunnel Syndrome Symptoms
People usually complain about numbness, tingling or pain in their hands along the median nerve distribution. The symptoms mostly occur at night and aggravate with repetitive hand motion. Without treatment hand muscles deteriorate and lose their ability to grip. CTS sufferers may become permanently disabled if they ignore the symptoms.

Carpal Tunnel Syndrome Differential Diagnosis
There are several similar to CTS conditions. One of them is De Quervian’s disease. This problem usually seen in people who do repetitive forceful grasp together with ulnar deviation. E.g. wrist in playing tennis (squash) or repetitive use thumb in work-related situations.

Physical therapy is the corner stone in managing carpal tunnel syndrome. The goal is to avoid the surgery, and in most cases we can do this. Physical therapy is combination of manual therapy with special modalities, which provide reduction of swelling and inflammation as well as relieve pain and other symptoms of carpal tunnel syndrome.

1. Manual therapy to the wrist with massage of neck and shoulders
2. Cold Laser Therapy (Erchonia Cold Laser) together with manual therapy.
3. Graston technique of wrist and hand
4. Kinesio-tape of the wrist and arm.
Dr. Steven Shoshany is a Certified Kinesio taping practioner.

Saturday, December 13, 2008

Physical therapy NYC

Physical therapy Our Physical therapist has been a fantastic addition to out group practice in NOHO, NYC Chiropractic/Physical therapy/Medical practice . So many patient need the assistance of a Physical therapist to help Rehab them from injuries.
The combination approach of having several Professionals under one roof has been beneficial to our patient outcomes and convenient to patients.
The other day I ad a new Chiropractic patient come in from Paris, and he was shocked that a Medical doctor, Chiropractor, Physical therapist, Massage therapist and a Acupuncturist all worked together in one office and all agreed with treatment protocols.
He went on to state that in Paris the Acupuncturist and Chiropractor disagreed and the Physical therapist disagreed with both of them and that the MD said that just to rest and take pain pills. This is all very confusing to the patient.
When we put Living Well Medical NYC together I envisioned all the doctors working together and discussing patient care and deciding on what would give the patient the best treatment outcomes.

Wednesday, December 10, 2008

Chiropractor NYC-Kinesio taping NYC

Watch video of Dr. Steven Shoshany a NYC Chiropractor discuss the benefits of Kinesio tape in treating injuries like Rotator Cuff injuries.
CKTP- Certified Kinesio Tape Practioner visit the Kinesio taping website at

Tuesday, December 02, 2008

Spinal Decompression In New York City, DRX 9000
Spinal decompression-What should patients expect with Spinal decompression treatment
I have been using spinal decompression in my NYC Chiropractic Clinic for over 6 years and have treated several hundred patients with spinal decompression. I also wanted to share patient outcomes(names withheld for patient privacy.)
Will every patient experience a positive outcome with spinal decompression and the DRX 9000?
Spinal decompression is a great tool that I utilize in my treatment protocol for patients that have Sciatica, Herniated discs, and spinal stenosis. It is by no means a guaranteed patient outcome. Studies conducted by the Mayo Clinic and a John Hopkins professor report a 75%-88% positive outcome.Visit my website to see those studies at
There is always going to be a group of patients that meet all the criteria and seem to be perfect for treatment and they do not respond. In my years of practice and utilizing spinal decompression I have also seen patients that respond amazingly well to the treatment.
I can think of one recent case:
She came in severely antalgic (lean to one side) on disability from work and having to have her sister bathe her in the tub because she couldn't stand for more than 5 minutes without shooting pain down her leg. She brought in her recent MRI, a nerve test that confirmed nerve involvement. She already had three epidural injections,(they will not do more after 3 usually) and was told she needed a microdisectomy.
She is only 39!Surgery was not an option.
I accepted her case and made it clear that this is not a guaranteed success and she told me the surgeon said the same thing.It was both a financial commitment and time commitment. She improved so much that now she is back to work, no longer taking bathes with her sister and recently joined a kickboxing class. She was diligent with her treatment protocol that involved spinal decompression, SOT blocking,Physical therapy on the SpineForce, Custom made corrective orthotics and home exercise.
I really feel that a patient must involve themselves after the treatment is complete and become aware of the core muscles(not just the abdominal's.) This refers to the muscles that run up the back and strech down the butt and front and inner thighs.This group of muscles is where much of the body's strength comes from,you use it to kick a ball, lift a heavy box, and even stand up straight.
She is the perfect example of a positve outcome. This treatmet was non-invasive and produced excellent pain relief when nothing else was working.

When should I know treatment on spinal decompression is working?

The treatment protocol that has been shown to be the most effective calls for approximatly 20 visits over a 6 week period.
I have seen patients respond by the fifth visit and I have also had patients that completed treatment and really didn't feel results until weeks after the decompression sessions have stopped.
This reminds me of the first patient that I had that started on the DRX 9000.
He is a well nourished male with foot drop on his right foot and calf pain.
He had a MRI that confirmed presence of a disc herniation on his L5- S1 disc putting pressure on his nerve root and a NCV confirming nerve involvement.
He was diligent with his appointments and showed little progress throughout treatment. I was confused as to why he was not responding but we both where determined to make this treatment work.
He finished all his vists and still not much improvement expect a "looser back" he still had a foot drop and calf pain.Three weeks later I get a call and he was elated that all his symptoms have disappeared several weeks after we completed treatment.
I was relieved that he was better, and ordered a post MRI but instructed him to wait at least 3 months( blood supply to the disc is slow) and it showed a significant decrease in disc herniation size and a increase in canal height and increase in disc height! The point I am trying to make is that some patients respond quickly, some don't respond until after treatment is complete and some do not respond at all.

Another recent example is a young girl that tried Physical therapy, Epidurals, Chiropractic, Acupuncture and Vicodin, Cortisone.. basically everything expect surgery.
This was her last resort,
Today was her 20 visit, She went from being a overly medicated unhappy 34 year old women to a functional person that has returned to her normal activities without pain.

I wanted to post a clinical study below that was done on DRX 9000

Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study

Official Title: Pilot Study to Evaluate The Effectiveness And Safety Of Axiom Worldwide Drx9000™ Spinal Decompression System For Treatment of Low Back Pain

Further study details as provided by NEMA Research, Inc.:

Study Start Date: December 2006
Study Completion Date: April 2007
Primary Completion Date: April 2007 (Final data collection date for primary outcome measure)

Ages Eligible for Study: 18 Years and older
Genders Eligible for Study: Both
Accepts Healthy Volunteers: No


Inclusion Criteria:

Male or female, greater than 18 years of age
Able to understand possible risks and benefits and provide written informed consent (ICF) to the IRB approved clinical multimodal protocol
LBP with an intensity level of greater than 4 on an eleven point numerical pain rating scale (VRS) of 0-10 (with 0 - no pain and 10 - worst possible pain)
Completed the necessary diagnostic and medical history evaluations as described in the protocol to confirm the patient's diagnosis and eligibility for the study and DRX9000 treatment protocol.
Willing and able to complete a six week 20 session of DRX9000 outpatient treatments and a minimum of 6 months follow-up
Exclusion Criteria:

Evidence of neurological motor deficits on clinical examination
Evidence of spinal cord compression, metastatic cancer, tumor, hematoma, infection or compression fracture
Evidence of severe central stenosis with neurological deficits or nerve root entrapment
Litigation for health-related claim (in process or pending), Worker's Compensation, or Personal Injury
Previous spine fusion surgery, insertion of hardware or artificial disc
Hemiplegia or paraplegia
History of severe cardiovascular or metabolic disease, or abdominal aortic aneurysm
Unwillingness to postpone other types of therapy for LBP during the 6 week treatment sessions
Known alcohol abuse or drug abuse
Height less than 4 feet 10 inches (147 cm) or greater than 6 feet 8 inches (203 cm)
Body weight greater than 300 pounds (136 kg)
Contacts and Locations

Please refer to this study by its identifier: NCT00414596


United States, California
Vibrance Medical Group
Beverly Hills, California, United States, 90212

United States, Florida
Active Health and Wellness Center
Tampa, Florida, United States, 33614
Naples Anesthesia and Pain Associates
Naples, Florida, United States, 34108

Sponsors and Collaborators

NEMA Research, Inc.


Principal Investigator: John Leslie, MD Mayo Clinic Arizona

Study Director: Charlotte Richmond, PhD NEMA Research, Inc.

Study Chair: Joseph V Pergolizzi, MD Naples Anesthesia and Pain Associates

More Information

click here for more information about the DRX9000

Nema Research website

Study ID Numbers: P-AXW01
First Received: December 19, 2006
Last Updated: February 14, 2008 Identifier: NCT00414596
Health Authority: United States: Institutional Review Board

Study placed in the following topic categories:
Signs and Symptoms
Neurologic Manifestations
Low Back Pain
Back Pain

Additional relevant MeSH terms:
Nervous System Diseases processed this record on December 02, 2008
Another study underway
To administer the MSDR® (Musculoskeletal Disorder Reporting) instrument to document the musculoskeletal profile of patients with chronic low back pain, a prospective, non-randomized, multicenter treatment trial

Condition Intervention
Chronic Low Back Pain
Other: MSDR

MedlinePlus related topics: Back Pain

U.S. FDA Resources

Study Type: Interventional
Study Design: Screening, Randomized, Open Label, Parallel Assignment

Official Title: This is a Study is for the Purpose of Quantifying Function of the Back and Lower Extremities, and to Assess the Inter-Regional Biomechanical Relationships of the Neck, Upper Extremities, Back, and Lower Extremities in Patients Suffering From Chronic Low Back Pain.

Further study details as provided by MedAppraise, Inc.:

Primary Outcome Measures:
To document the musculoskeletal profile of patients with low back pain [ Time Frame: 1 year ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
To determine if a particular lower back diagnosis or MSDR® score can predict which patients will respond particularly well to the DRX9000™ treatment protocol and spinal manipulative therapy. [ Time Frame: 1 year ] [ Designated as safety issue: No ]

Estimated Enrollment: 200
Study Start Date: August 2008
Estimated Study Completion Date: January 2010
Estimated Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)

Intervention Details:
Other: MSDR
The MSDR® questionnaire establishes an individual's musculoskeletal functional status using information gathered from 1) a questionnaire the patient fills out regarding medical history, chronic medical conditions, and health risk factors; 2) anatomic pain survey completed by the patient; and 3) evaluation by a trained researcher of various patient biometric parameters related to range of motion. Stratifying an individual into a risk category with this evidence-based assessment tool then permits an assessment of which patients respond long term to therapy.

MSDR® demonstrates the ability to benchmark specific musculoskeletal findings (both clinical and sub-clinical) to ICD-9 Diagnoses supported by diagnostic, radiographic and/or MRI findings where clinically indicated.

Ages Eligible for Study: 18 Years to 65 Years
Genders Eligible for Study: Both
Accepts Healthy Volunteers: Yes


Inclusion Criteria:

Must have Informed Consent Signed
Lumbar Disc Herniations under 5mm without Sequestered Fragments
Lumbar Disc Bulging
Lumbar Degenerative Disc Disease (mild and moderate severity)
Non-pregnant Females and Males suffering from Chronic Low Back Pain from 18 to 65 years of age
Segmental Dysfunction Secondary to Dyskinesia
Unresolved Nerve Entrapment Syndrome
Patients must be able to comply with study protocol
Joint Fixation Syndrome
Premenopausal Female Patients, excluding patients who have undergone a hysterectomy, oophorectomy, or tubal ligation, must have one of the following methods of contraception and must have a negative serum or urine b-HCG pregnancy test performed within 48 hours before initiating protocol specified treatment.
Exclusion Criteria:

Contraindications to Spinal Manipulative Therapy
Lumbar Canal Stenosis resulting in significant neurological comprimise
Any Spinal Cord Compression resulting in significant neurological comprimise
Cauda Equina Syndrome

->65 years of age

History of Back or Neck Surgery
Acute Arthritis
Signs or Symptoms of Arterial Aneurysm
History of Active Cancer with Bone Metastasis
Widespread Staphyloccal and/or Strepococcal Infection
Acute Gout
Serious unstable medical illness such as cardiovascular, renal, respiratory, endocrine, gastrointestinal, or psychiatric.
Unstable Spondylosis, Spondylolisthesis, or Spondylolysis
Prior adverse experience with Spinal Manipulation Therapy
Uncontrolled Diabetic Neuropathy
Gonorreal Spinal Arthritis
Tuberculosis to the Bone
Maligancy with Metatasis to Bone
Excessive Spinal Osteoporosis
Syphlitic Articular or Peri-Articular Lesions
Active Low Back Injury Resulting from a Motor Vehicle Accident or Work Related Injury
Contacts and Locations

Please refer to this study by its identifier: NCT00732394


Contact: Eric K Groteke, DC 727-797-0500

Contact: Damon J Stafford, DC 727-797-0500


United States, Florida
Back2Life of Florida, Inc. Recruiting
Clearwater, Florida, United States, 33761
Contact: Tammy Cravotta 727-797-0500
Contact: Matt Erickson, DC 727-797-0500

Sponsors and Collaborators

MedAppraise, Inc.


Study Chair: Eric K Groteke, DC MedAppraise, Inc.

Principal Investigator: Luis Crespo, MD Crespo and Associates

Study Director: Mark Scinico, MD Concentra

Principal Investigator: Damon J Stafford, DC Back2Life of Florida, Inc.

More Information


Responsible Party: Back2Life of Florida, Inc. ( Damon J. Stafford, D.C. )
Study ID Numbers: TCT06-002
First Received: August 8, 2008
Last Updated: August 8, 2008 Identifier: NCT00732394
Health Authority: United States: Institutional Review Board

Study placed in the following topic categories:
Signs and Symptoms
Neurologic Manifestations
Low Back Pain
Back Pain

Thursday, November 20, 2008

Chiropractor, Chiropractic - New York City (NYC)

Chiropractor, Chiropractic - New York City (NYC)

NYC Chiropractor Dr. Steven Shoshany Now Certified in Kinesio Taping. Chiropractor NYC

Dr. Steven Shoshany, a Chiropractor at Living Well Medical in Manhattan, is now a Certified Kinesio Practitioner. This technique was made public during the Summer 08 Olympics on the shoulder of Kerri Walsh. What is this tape? Can this tape help you with your bad knee ot painful shoulder? Find out why elite athletes use this tape to help speed recovery of their injuries.
The Kinesio Taping Method enhances healing time and reduces swelling, and is fantastic in getting athletes and weekend warriors back to the activity they love without pain and restrictive braces and supports

New York, NY (PRWEB) November 11, 2008 -- Dr. Steven Shoshany, a chiropractor at Manhattan's Living Well Medical, PC, is now a certified Kinesio Taping® practitioner. Dr. Shoshany's certification is a unique addition to the physical therapy and rehabilitation services offered at Living Well Medical. Dr. Shoshany will offer the method alongside other cutting-edge technologies and protocols, including spinal decompression and cold laser therapy, at his practice, Living Well Medical in Manhattan NYC.

NYC Chiropractor Dr. Shoshany
Developed by Japanese chiropractor Dr. Kenzo Kase more than 25 years ago, the Kinesio Taping Method has quickly become the standard for therapeutic rehabilitative taping. Though Dr. Shoshany has used the Kinesio Taping Method for more than five years, the method has just recently taken the rehabilitation and sports medicine world by storm. The Kinesio® method gained worldwide recognition during the 2008 Summer Olympics when it was worn by many athletes, most noticeably by U.S. Women's Volleyball player Kerri Walsh.

"The Kinesio Taping Method enhances healing time and reduces swelling, and is fantastic in getting athletes and weekend warriors back to the activity they love without pain and restrictive braces and supports," says Dr. Shoshany.

Kinesio Taping is a technique based on the body's own natural healing process. The method uses a uniquely designed and patented tape, Kinesio Tex Tape, for treatment of muscular disorders and lymphedema reduction. The method is applied over and around muscles to reduce pain and inflammation, to relax overused, tired muscles and to support muscles in movement on a 24-hour-per-day basis. It is non-restrictive type of taping that gives support and stability to joints and muscles without affecting circulation and range of motion. In contrast, traditional sports taping is wrapped around a joint strictly for stabilization and support during a sporting event, obstructing the flow of bodily fluids -- an undesirable side-effect.

Kinesio Taping is also used for preventive maintenance, edema and pain management. It helps the body heal naturally, can be used preventatively, as treatment, in rehab, during competition or as a take-home treatment applied by a chiropractor. The tape can be used for anything from headaches to foot problems, including: muscular facilitation or inhibition in pediatric patients, carpal tunnel syndrome, lower back strain/pain (subluxations, herniated disc), knee conditions, shoulder conditions, hamstring, groin injury, rotator cuff injury, whiplash, tennis elbow, plantar fasciitis, patella tracking, ankle sprains and more.

Kinesio Taping involves two techniques. The first technique gives the practitioner the opportunity to give support while maintaining a full range of motion. This enables the individual to participate in normal physical activity with functional assistance.

The second technique, most commonly used in the acute stage of rehabilitation, helps prevent overuse or over-contraction and helps provide facilitation of lymph flow for a complete 24-hour period. Correctional techniques include mechanical, lymphatic, ligament/tendon, fascia, space and functional. Kinesio Tex Tape can be used in conjunction with other therapies, including cryotherapy, graston technique, massage therapy and electrical stimulation.

Kinesio Taping exhibits its efficacy through the activation of neurological and circulatory systems. This method basically stems from the science of Kinesiology, hence the name "Kinesio". Muscles are not only attributed to the movements of the body, but also control the circulation of venous and lymph flows, body temperature, etc. Therefore, the failure of the muscles to function properly induces various kinds of symptoms. Consequently, so much attention was given to the importance of muscle function that the idea of treating the muscles in order to activate the body's own healing process came about. Using an elastic tape, it was discovered that muscles and other tissues could be helped by outside assistance. Employment of Kinesio Taping creates a totally new approach to treating nerves and muscles.

For the first 10 years, chiropractors, acupuncturists and other medical practitioners were the main users of Kinesio Taping. Soon thereafter, the method was used by the Japanese Olympic volleyball players and word quickly spread to other athletes. Today, Kinesio Taping is accepted by medical practitioners and athletes in Japan, the United States, Europe, South America and other Asian countries.

About Living Well Medical PC. in Manhattan NYC
Living Well Medical is headed by Dr. Arnold Blank, a medical doctor who specializes in pain management. The facility is a hybrid between the medical and physical therapy industry, providing sports medicine, acupuncture, massage therapy, chiropractic care and herniated disc treatments utulizing non surgical spinal decompression. At Living Well Medical, each patient has an opportunity to meet with the doctor for a full evaluation, fitness test and to identify chronic pain issues. A personalized care plan is established and patients will meet weekly with their doctor, physical therapist and certified trainer to improve their quality of life through a combination of treatment, therapy and exercise.

Utulizing state of the art equipment like the DRX 9000 spinal decompression unit, Digital radiographic imaging,SpineForce,Erchonia Cold laser equipment,Poweplate and the Kinesis by technogym Living Well Medical provides the most advanced rehabilitation available in NYC.

Friday, November 07, 2008

Certified Kinesio taping practioner in NYC
I wanted to update my blog and let my readers know that I am now a Certified Kinesio taping practitioner or a CKTP.
Although I have been using Kinesio tape for the past 5 years in my practice, now I am official.
This technique has been helpful in my practice in conjunction with the graston technique in alleviating difficult to treat conditions like Carpal tunnel syndrome, lateral epicondylitis or tennis elbow, plantar fascitis and many other conditions.
I especially like the taping method for patients that suffer with sciatica and herniated discs.
My protocol for the herniated disc involves treatment on the DRX 9000 spinal decompression table, Spinal decompression Rehab designed to strengthen deep spinal muscles, core strengthening, postural stability and proprioception using the SpineForce.
I also utilize a lumbar orthosis and tape using kinesio tape to assist weak muscles and decrease the swelling in the injured area.

Is spinal decompression for everyone? I have seen patients that I thought would never respond because of pre existing conditions like a previous surgery respond amazingly to spinal decompression and I have also seen patients do everything we recommend and still need medical intervention to alleviate pain. I have seen published success rates from 75%-89% just visit this site has all of Axiom's latest publications and upcoming studies.
I have never seen anyone injured on this table or with this treatment protocol.
In my practice we offer Pain management with a Medical doctor, Acupuncture,Spinal decompression, Cold laser therapy, Physical therapy, Chiropractic, Medical massage and nutritional therapy.

Monday, November 03, 2008

NYC Spinal Decompresion NYC-DRX 9000

NYC Chiropractor-
Spinal decompression in Manhattan.
DRX 9000 in Manhattan.

What is a herniated disc?

The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged, it may bulge or break open. This is called a herniated disc. It may also be called a slipped or ruptured disc.

You can have a herniated disc in any part of your spine. But most herniated discs affect the lower back (lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in the upper back (thoracic spine). This topic focuses mainly on the lower back.

What causes a herniated disc?

A herniated disc may be caused by:

Wear and tear of the disc. As you age, your discs dry out and aren't as flexible.
Injury to the spine. This may cause tiny tears or cracks in the hard outer layer of the disc. When this happens, the gel inside the disc can be forced out through the tears or cracks in the outer layer of the disc. This causes the disc to bulge, break open, or break into pieces.
What are the symptoms?

When a herniated disc presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels. A herniated disc in the lower back can cause pain and numbness in the buttock and down the leg. This is called sciatica (say "sy-AT-ih-kuh"). Sciatica is the most common symptom of a herniated disc in the low back.

If a herniated disc is not pressing on a nerve, you may have a backache or no pain at all.

If you have weakness or numbness in both legs, along with loss of bladder or bowel control, seek medical care right away. This could be a sign of a rare but serious problem called cauda equina syndrome.

How is a herniated disc diagnosed?

Your doctor may diagnose a herniated disc by asking questions about your symptoms and examining you. If your symptoms clearly point to a herniated disc, you may not need tests.

Sometimes a doctor will do tests such as an MRI or a CT scan to confirm a herniated disc or rule out other health problems
Usually a herniated disc will heal on its own over time. About half of people with a herniated disc get better within 1 month, and most are better after 6 months. Only about 1 person in 10 still has enough pain after 6 weeks to think about surgery.

Can a herniated disc be prevented?

After you have hurt your back, you are more likely to have back problems in the future. To help keep your back healthy:

Protect your back when you lift. For example, lift with your legs, not your back. Don't bend forward at the waist when you lift. Bend your knees and squat.
Use good posture. When you stand or walk, keep your shoulders back and down, your chin back, and your belly in. This will help support your lower back.
Get regular exercise.
Stay at a healthy weight. This may reduce the load on your lower back.
Don't smoke. Smoking increases the risk of a disc injury.
What do most patients experience during treatment? How does it feel? How long does it take?

Spinal decompression and the herniated disc
These are just a few sample questions that a DRX9000 treatment candidate will most likely ask a physician prior to undergoing treatment.

Well, some patients may experience light side effects with this type of therapy. Mild muscular soreness during treatment may occur. The sensation would be similar to what a person might experience at the onset of a new exercise regimen.

Most patients find this therapy quite comfortable and relaxing. During an average 30-minute session, most patients experience a gentle stretch in the lumbar spine and tend to fall asleep.

Adjunctive therapies to non-surgical spinal decompression typically include electrical stimulation and cold therapy. Exercise and/or the use of a lumbar support belt are often prescribed to support the benefits of non-surgical spinal decompression therapy and improve patient compliance.
Dr. Steven Shoshany.
Living Well Medical.Chiropractic,Physical therapy,Pain Management,Accupuncture, Massage. All located at 632 Broadway suite 303 New York, NY 10012

Tuesday, October 21, 2008

Spine force on TV!

SpineForce on CBS "The Doctors" Thursday October 23: SpineForce 3-D Rehab Exercise Technology is being highlighted on Thursday's episode of CBS "The Doctors," as a revolutionary device that is helping people with MS and other spinal cord afflictions to walk again. SpineForce was selected as one of the "Top 10 Medical Devices that Can Change Your Life." The segment will focus on spine and core strengthening as well as proprioception rehabilitation for neurological disorders and fall prevention. Click to go to link
Spine Force Manhattan-Spine Force NYC
Herniated disc-Sciatica-Physical therapy

Thursday, October 16, 2008

Instruments of Change- Graston Technique-NYC-

as seen on

Instruments of Change
Feeling a little stiff after surgery? Suffering from a sports injury and need to get back in the game 10 minutes ago? The Graston Technique could be just the thing to untangle your tissue.

By Jenny Lui
October 2008

An Instrumental Mix
Smoothing Out the Edges
Hurts So Good
Smooth Operators
Find a Practitioner
Tool Time
Graston - Right for You?

After knee-replacement surgery and multiple rounds of physical therapy, Roberta Gunderson, 53, was feeling like the Bionic Woman — that is, if the Bionic Woman had been left in the rain to rust. “I felt very stiff and robotic in the beginning,” says Gunderson of her recovery. “Like I was Frankenstein’s monster.”

Doctors told Gunderson, a biology professor at Wilbur Wright College in Chicago, that her postsurgery progress had plateaued and that her knee would likely not gain more than 106 degrees of flexion — far from the ideal 120 degrees. An avid cyclist, swimmer and golfer, Gunderson was determined to regain her former mobility, so she opted for a treatment called the Graston Technique (GT), a form of soft-tissue mobilization that detects and breaks up scar tissue that impedes normal function of muscles, fascia, tendons and ligaments. Clinicians rub stainless-steel instruments over the injured area, as if trying to iron out
tangled tissue.

After four weeks and seven treatment sessions, Gunderson’s knee went from 106 degrees of flexion to 116 degrees. “I was amazed at how much I improved in only a month,” she says.

An Instrumental Change
GT is a type of cross-fiber massage — a noninvasive, drug-free procedure that uses ultraprecise stainless-steel instruments to break up restrictive scar tissue. These instruments can be far more effective than a clinician’s hands alone because they are able to concentrate force while giving excellent feedback to both the clinician and the patient. (It’s worth noting, however, that GT is often used in conjunction with other therapies that involve hands, foam rollers and knobs.)

GT is used to treat a wide range of soft-tissue ailments, from tennis elbow to plantar fasciitis, because clinicians can easily adapt the technique to the situation and zero in on the offending area. “We are now able to diagnose things that used to go
undetected,” says Ted Forcum, DC, DACBSP, owner of Back In Motion Sports Injuries Clinic in Beaverton, Ore.

When the clinician runs an instrument over scar tissue, she can feel exactly what’s happening under the skin. “It’s like when you were a kid and you put a leaf underneath some paper and colored over it. But instead of an imprint of the leaf, you get a picture of the injury,” says Forcum, who used GT to treat U.S. Olympians in Beijing.

Smoothing Out the Edges
A lot of soft-tissue problems occur within the fascia, the web of connective tissue that supports muscles and organs and prevents us from melting into formless blobs. If you suffer an injury, however, the fascia tends to attempt to stabilize the area by binding to the muscles like poorly applied wallpaper, complete with air bubbles and clumsy adhesions. GT instruments smooth out those air bubbles.

If not addressed, these adhesions can cause an avalanche of kinetic chaos, because when a muscle or group of muscles becomes incapacitated, all the surrounding muscles, tendons and ligaments have to pick up the slack — which eventually causes them to become overworked and fatigued. Your only option: Break down the adhesions so you can rebuild a healthy balance.

The approach seems to be effective. “We’ve found that injured ligaments treated with GT showed accelerated healing in the short term and a clear increase in strength compared to injured ligaments that weren’t treated with GT,” says Terry Loghmani, PT, MS, MTC, associate clinical professor of physical therapy at Indiana University in Indianapolis.

Hurts So Good
Because GT involves direct manipulation of stuck tissue, patients can expect some discomfort during the procedure. “But it should never produce pain that’s intolerable,” says Richard E. Vincent, DC, who uses GT in his Falmouth, Mass., clinic. Patient and clinician should work together to figure out the appropriate intensity levels.

“With most patients, we will wait a day or two between treatments, but others — especially athletes — are accustomed to working through benign pain and use GT every day because they have to recover fast and perform,” says Valli Gambina, DC, a chiropractic sports physician in Venice, Fla.

After treatment, some soreness, bruising and swelling is actually desirable because it means the body is replacing adhesed tissue with healthy, linear tissue.

Smooth Operators
Sessions usually last about an hour, during which the clinician uses GT for only about five to eight minutes on each injured area. The rest of the time is dedicated to assessment, warming up, stretching and icing.

Unlike some other types of treatment, patients using GT can’t just kick back and let the practitioner do all the work. After treatment, patients must continue to stretch and strengthen the injured area. While it might seem counterintuitive to work an injured area, the immediate movement helps the tissue heal correctly.

Most patients will begin to notice positive results after three or four sessions, with treatment lasting about eight to 10 sessions. But some will experience results even faster. After her first session, Gunderson said she immediately felt looser and more flexible.

There are some people for whom GT isn’t right, such as those who have arthritis or who have recently undergone surgery or take blood thinners. But if you’re free of such contraindications and are suffering from soft-tissue issues, GT can offer relief — and improve the way you move.

Jenny Lui is a Chicago-based writer.

Find a Practitioner
To locate a GT practitioner, visit the Graston Technique Web site ( The site features a comprehensive database of certified GT clinicians for any area of the country, as well as Canada.

Tool Time
The Graston Technique uses six stainless-steel instruments. The different shapes give practitioners closer access to different parts of the body. Practitioners usually refer to each instrument by a number, but these tools also have nicknames.

GT1: “Handlebars”
Best for large muscle groups, such as shoulders, back and legs.

GT2: “Bottle Opener”
Best for small muscle groups.

GT3: “Tongue Depressor”
Best for pinpointing specific areas.

GT4: “Scanner”
Best for scanning and treatment.

GT5: “Boomerang”
Best for diagnosis and more aggressive treatment.

GT6: “Little Bottle Opener”
Sometimes referred to as the “can opener,” this tool is best for smaller regions, such as hands and feet.

Graston - Right for You?
The Graston Technique (GT) uses deep massage with stainless-steel instruments to treat scar tissue and restrictions in soft tissue, such as muscles, fascia, tendons and ligaments. GT is especially good for people who have plateaued in their recovery from an injury and for athletes who need to return to competition quickly.

During GT sessions, the clinician breaks up twisted and frayed scar tissue by running the instruments along the injured area. By guiding healing with stretching and strengthening, practitioners rebuild the soft tissue into healthy, linear tissue. If minor discomfort — akin to a really intense massage — makes you squirm, maybe GT isn’t right for you. But those who’ve experienced the benefits of GT say that the ends definitely justify the “ouch.”

Conditions commonly treated by GT:
Plantar fasciitis
Tennis elbow
Back pain
Postsurgical scarring
Muscular or skeletal problems
Carpal tunnel syndrome
Physical therapy-NYC-Graston Technique-Cold laser therapy-Kinesio-taping

Tuesday, October 14, 2008

Is The Economic Slump Making Your Shoulders Slump?

With the economy in its current troubled state, people are working to ensure better stature at their job – they’re staying later, taking on greater responsibility and working harder than ever to evade that pink slip that so many have already received. While a heightened work ethic is essential during these trying times, it can wreak havoc on a person’s back resulting in everything from dull aches to debilitating pain. According to the American Academy of Orthopaedic Surgeons (AAOS), back pain is often so severe that over 100 million work days are lost yearly – a trend that today’s workforce cannot afford to uphold.

According to New York City chiropractor Dr. Steven Shoshany, there are many steps Americans can take to ensure the time they put in at work doesn’t result in painful back problems.

Posture Perfection

Your body can tolerate being in the same position for roughly 20 minutes before it needs an adjustment. “Good posture relaxes muscles and makes it easiest to balance whether standing or sitting,” Dr. Shoshany says, adding that bad posture leads to muscle fatigue and injury.

Standing posture: Legs, torso, neck, and head should be approximately in-line and vertical, requiring the least amount of energy to maintain. Teachers and restaurant workers – who spend nearly seven hours a day on their feet – can stand in good posture by keeping one foot slightly extended and readjusting at least every 20 minutes. Resting one foot on a higher plane than the other is a great option if there is a set of steps of a stool conveniently located.
Sitting posture: Choose a chair that supports your back but if you have no choice, adjust it to meet your needs. The lower back should meet the chair and feet should be flat on the floor. “All of your joints should form right angles from your hips down,” Dr. Shoshany explains.

Have a nice trip, see you next fall!

Unsupportive shoes are difficult to walk in and can cause back-injuring falls. Dr. Shoshany explains that while the two may seem unrelated, the shoes people wear impact their ability to maintain healthy posture while sitting, standing and walking.

Nurses who often wear soft, resin-based shoes should opt for versions with ankle straps. The straps will keep feet secure, eliminating countless hazards as they rush from one patient to the next.
Wedges provide significantly more surface area than stilettos, making it much easier to walk and offering better support to the foot. Wedges are the safer option when racing from one appointment to the next and hurrying to get into cabs and trains.
Hardwood floors, marble and linoleum provide very little traction so “break” shoes in before wearing them to the office. Men should also be cautioned that when smooth soles are combined with smooth surfaces, spills are very likely.

Pain-Free Success

A common cause of back pain among writers and those in administrative or executive positions is a disorganized, cluttered workspace. According to Dr. Shoshany, all of the equipment you need should be readily accessible in order to limit the amount of squirming and uncomfortable reaching a person does.

If you’re on the phone a lot, use the speaker feature. If that’s not possible, use a headset or a shoulder rest extension.
Make sure your computer and monitor fit on your desk properly so your screen can be read from a comfortable position and computer discs can be inserted with ease.
Excess stress notoriously causes severe back pain and with the job market as shaky as it is, stress levels are higher than ever.

“Stress can cause muscles to tense, making you more prone to injury and also causing muscles to form painful knots,” says Dr. Shoshany. “As busy as everyone is at work, taking a quick walk outdoors or around the office is a great stress buster.” He added that a brief walk also provides an opportunity for the body to stretch and regain its healthy posture.
Taking the simple, common sense steps that Dr. Shoshany recommends can considerably reduce existing back pain and prevent more from developing no matter the industry or how much time you spend at work. If existing pain does not subside or continues to grow, Dr. Shoshany says that there are many in-office treatments that chiropractors can offer to mitigate the pain and get your back back on track.

About Dr. Steven Shoshany D.C, C.C.E.P.

Dr. Shoshany is a chiropractic healthcare specialist with a diverse background. He holds a doctorate degree from Life Chiropractic University. Dr. Shoshany specializes in both spine and sports related injuries. His background is in Chiropractic, Pediatric Chiropractic, and Sports Injury Management and is a spinal decompression specialist. Dr. Shoshany’s skilled chiropractic background creates unique insight into many problems. His practice has a primary focus of delivering highly effective, state-of-the-art, gentle Chiropractic care to people of all ages. Living and working in New York City offers Dr. Shoshany the ability to offer emergency Chiropractic care when needed. For more information, please visit

Tuesday, October 07, 2008

Spinal Decompression NYC for Herniated discs
I wanted to update the Blog on the status of one of our most recent "difficult back pain" patients.
For her protection I am using her first name.
Jenifer came to my NYC Chiropractic office last week fresh out of the hospital.
She voluntarily left the hospital because they recommended a back surgery after her CAT scan revealed multiple level disc herniations.
She stumbled into our office and we had to use a wheelchair to get her back into our office.
Once I had confirmation that she had a contained disc herniation we began treatment on the DRX 9000.
She has already had 6 treatments as of yesterday.
What a difference the spinal decompression has made in 6 visits.
She is now able to walk with the assistance of a cane and has had several nights of sleep.
This is huge for her, because she was facing a invasive back surgery and now she is on the road to recovery.
This week we are starting the Rehabilitation on the Spine Force.
I hope to have a video testimonial from her shortly, she is the reason I have spinal decompression in my Manhattan office, and the reason I got into Chiropractic in the first place.
To many patients are told surgery is the only way and are forced into something.
Surgery is not always the only solution to a painful herniated disc.
research on the benefits on Non Surgical spinal decompression click
When Chiropractic care is combined with Physical therapy and spinal decompression the results are amazing.

Sunday, September 28, 2008

Chiropractor NYC

Dr. Steven Shoshany-NYC ChiropractorInnovative Chronic Back pain treatments include the DRX 9000, Cold laser therapy, Kinesio taping, SpineForce 3 Dimensional Rehab.Physical therapy,Graston technique.

read more | digg story

Saturday, September 27, 2008

What does Kinesio Taping do?

Dr. Steven Shoshany NYC Chiropractor and Spinal Decompression Specialist

What Does Kinesio Taping Do?

Kinesio Taping gives support and stability to your joints and muscles without affecting circulation and range of motion. It is also used for Preventive Maintenance, Edema, and Pain Management

Kinesio Taping was invented by a Doctor of Chiropractic, and is utilized- especially by SPORTS Chiropractors throughout the world. Kinesio Taping helps the body heal naturally, can be used preventatively, as treatment, in rehab, during competition, or as a ‘take home’ treatment applied by the Chiropractor (medical doctors give drugs, chiropractic doctors give tape) .

Kinesio Taping is a technique based on the body's own natural healing process. This Kinesio Taping exhibits its efficacy through the activation of neurological and circulatory systems. This method basically stems from the science of Kinesiology, hence the name "Kinesio". Muscles are not only attributed to the movements of the body but also control the circulation of venous and lymph flows, body temperature, etc. Therefore, the failure of the muscles to function properly induces various kinds of symptoms.

Consequently, so much attention was given to the importance of muscle function that the idea of treating the muscles in order to activate the body's own healing process came about. Using an elastic tape, it was discovered that muscles and other tissues could be helped by outside assistance. Employment of Kinesio Taping creates a totally new approach to treating nerves, muscles, and organs. The first application of Kinesio Taping was for a patient with articular disorders.

For the first 10 years, chiropractors, acupuncturists and other medical practitioners were the main users of Kinesio Taping. Soon thereafter, Kinesio Taping was used by the Japanese Olympic volleyball players and word quickly spread to other athletes. Today, Kinesio Taping is accepted by medical practitioners and athletes in Japan, United States, Europe, South America and other Asian countries.

The Kinesio Taping Method is applied over muscles to reduce pain and inflammation, relax overused tired muscles, and to support muscles in movement on a 24hr/day basis. It is non-restrictive type of taping which allows for full range of motion.

In contrast, traditional sports' taping is wrapped around a joint strictly for stabilization and support during a sporting event obstructing the flow of bodily fluids... an UNDESIRABLE side-effect.

Kinesio Tape is used for anything from headaches to foot problems and everything in between. Examples include: muscular facilitation or inhibition in pediatric patients, carpal tunnel syndrome, lower back strain/pain (subluxations, herniated disc), knee conditions, shoulder conditions, hamstring, groin injury, rotator cuff injury, whiplash, tennis elbow, plantar fasciitis, patella tracking, pre and post surgical edema, ankle sprains, athletic preventative injury method, and as a support method.
Contact Dr. Steven Shoshany in Manhattan for Kinesio taping
visit website

Friday, September 26, 2008

Spinal decompression Manhattan NYC-Herniated disc Center

Last night I had an interesting new patient come into the office.
She came into the office in a severely antalgic lean (this means she was hunched forward and bent to side).
She came in with her hospital discharge papers and was in serious pain. The type of back pain that required her to take (Vicodin, Percoset, Darvoset and one or two muscle relaxers).
She was not even standing upright and was writhing in pain and basically collapsed at the front desk.
Now as a Spinal Decompression specialist and a Chiropractor practicing in NYC for over 10 years I have had my fair share of patients coming in with back pain and herniated disc issues.
The thing is she was told that she needed a surgery but she refused and left the hospital and came into our office.
She was unable to lay down on her stomach, on her side or any other position without screaming in pain (Not the type of patient that you want when new patients are in the waiting room).
I reviewed her MRI and she had Multiple disc herniations from the second Lumbar down to the fifth Lumbar.
She was interested in Non-surgical options. Tomorrow is her first visit on the DRX 9000 spinal decompression table, I look forward to helping her and seeing her walk out of the office feeling better.
This is not going to be a particularly easy case.
The nice thing about the DRX 9000 is that it starts in a vertical position and slowly brings the patient to a horizontal position and when the treatment is done it returns the patient slowly back up.
Another great tool that I will use is the Cox flexion distraction decompression table.
Cox Technic is performed on a specially designed chiropractic instrument (The Cox Table for flexion-distraction) which has a movable headpiece and a movable caudal piece (that part on which a patient's legs lie). Each section flexes, extends, laterally bends and circumducts (combination of flexion and lateral flexion), and long-y-axis plane distracts.
Once the patient is better and in less pain I use the SpineForce to Rehab the muscles and supporting structures.

Wednesday, September 24, 2008

Funny article about how health insurance is killing you!!!

Man Succumbs To 7-Year Battle With Health Insurance
September 22, 2008 | Issue 44•39
View it on the Onion click to view

—After years of battling crippling premiums and agonizing deductibles, local resident Michael Haige finally succumbed this week to the health insurance policy that had ravaged his adult life.

Enlarge Image
A healthy Michael Haige and his wife, six months before his courageous struggle with health insurance began.
Haige, who had suffered from limited medical coverage for nearly a decade, passed away early Monday morning. According to sources, the 46-year-old was laid to rest at Fairplains cemetery, surrounded by friends, family members, and more than $300,000 of mounting debt.

"I miss Michael every single day, but at least he can finally rest now," said Sheila Haige, who watched as insurance rates ate away at her husband over time. "What Michael went through, the humiliating forms, the invasive background checks, the complete loss of dignity and hope—I wouldn't wish that kind of torture on anyone."

Once a healthy and happy father of two, Haige saw his life forever change seven years ago when health insurance professionals diagnosed him with a preexisting condition. As months passed and his line of credit continued to deteriorate, the former high school football coach would experience excruciating headaches and bouts of nausea every time another hospital bill arrived.

"My dad always seemed invincible, like there was nothing in the world that could hurt him," son Ryan Haige said. "But then, one night, I found him bent over a stack of UB-92 and HCFA forms, and he was crying. I'd never seen my father look so scared in all my life."

Added Ryan, "Making those payments each month—it was killing him."

While family members refused to look at Haige's insurance plan as a death sentence, it soon became clear that their loved one was facing the biggest fight of his life. Countless visits to doctors, claims adjusters, and loan officers proved futile, with Haige being told at every turn that his case was hopeless.

"They said there was nothing they could do for him, that modern medicine was powerless against this monster," Sheila Haige said. "Still, Michael never gave up. He kept saying that he was going to beat the odds, that he was going to find some way to get coverage."

According to an independent study released last month by the Mayo Clinic, health insurance is the nation's No. 2 cause of death, claiming the lives of some 400,000 Americans each year. A silent killer, health insurance often strikes without warning, its harmful and profit-based policies avoiding detection until it is far too late. Although the cruel bureaucratic disorder does not discriminate, statistics have shown that senior citizens, young dependents, and those woefully underemployed are most at risk.

"I can't tell you the number of patients I've had to deliver the bad news to over the years," said Haige's longtime family physician, Dr. Howard Silverman. "It's never easy to look someone in the eye and tell them it's going to have to be out-of-pocket. For most of these poor people, prayer is the only hope."

Toward the end of Haige's seven-year ordeal, family members said, the once loving husband and father had become an empty husk of his former self.

"I remember the last thing he ever said to me," said eldest son Mark Haige, holding a small picture of his father during happier times, before the endless battery of co-pays began. "He took my hand in his, and he said, 'Son, promise me you'll never sign up for a high-deductible, network-model HMO.'"

While still angry and in shock over Michael's premature passing, Sheila and her two children say the whole experience has taught them the importance of family.

"If Dad were still with us, I know he would want us to be here, at home, supporting Mom," Mark Haige said. "She really hasn't been doing so well ever since Bankers Life and Casualty denied her life insurance claim."

I thought this was funny, and wanted to post it to my blog, everday patients complain about how their health insurance drives them crazy.
visit my website if you are interested in Chiropractic care in Manhattan.

Saturday, September 20, 2008


Kinesio tape becomes trendy fitness item


Phil Dalhausser has a tale of the tape that ends with him winning an Olympic gold medal.

The beach volleyball player strained an abdominal muscle in the crucial run-up to the Beijing Games when he couldn't afford a bad match, let alone to sit one out. He might have missed three weeks, but with the help of sports chiropractor Ernie Ferrel and Kinesio Tex Tape -- a product few outside the world of physical therapy knew about -- he helped the United States win in men's beach volleyball.

"I love the stuff, to be honest with you," Dalhausser said.

The Olympics were Kinesio Tex Tape's coming out party. Now it is the latest trainer's tool to become an American fitness fad, a Breathe Right strip for the new century.

The tape actually has been widely available for years. But hidden away under clothing for nearly three decades, it had never gotten quite the exposure it received until American beach volleyball player Kerri Walsh -- also part of gold-winning duo -- used it on her shoulder in China.

The life of Kinesio Taping director John Jarvis has been a hectic run of meetings, interviews and consultations ever since.

"With her wearing almost nothing, it definitely drew attention to the black (tape)," Jarvis said. "They were calling it everything from the spider web to the tarantula, you name it."

The company's Web site averaged 1,000 to 2,000 hits a day before the Olympics. It peaked at 400,000 hits, 4,000 e-mails and 1,200 phone calls a day after NBC commentators named the product on air.

"We received reports back from Google we were the second-most Googled term the first three days of the Olympics right behind Michael Phelps," Jarvis said. "So it's not bad company to be with, that's for sure."

As with many trendy fitness items, the tape soon will be making an appearance on a knee joint near you. But Ferrel cautions it's not a cure-all. He's been working with it for years and admits he's still learning how it helps.

"I think I'm scratching the surface," Ferrel said. "I think it's a good product for certain applications. For all applications? No. Sometimes you have to support that joint, you have to compress it."

What makes Kinesio tape different from your grandpa's tighty-whitey athletic tape is its wide range of uses, while still allowing the wearer to move and flex. Traditional athletic tape supports a joint with a stiffness that's more cast-like and has no real uses on injured muscles.

When Dalhausser called on his abdominals to help block three straight shots in the final set of the Olympic gold-medal match, the tape -- used in conjunction with massage therapy -- helped stop his muscle shy of the point of pain as he stretched out, then pulled forward with the muscle as he attacked.

No pain, all gain.

"The ab's gotten better, but I still put it on," Dalhausser said. "It's more of a mental thing. It's like when you roll your ankle, even though your ankle's better, you still throw on a brace or whatever. It's kind of the same kind of thing."

Among the first to use the tape post-Beijing was Patty Schnyder. The world's No. 11 tennis player had a tight abductor muscle going into her U.S. Open quarterfinals match against Elena Dementieva.

"So for a change I decided to try out this tape," she wrote in an e-mail to The Associated Press. "The normal wrap/support can be a little restrictive with the other muscles and this tape is able to focus on the specific muscle. It took away the pain instantly."

Ferrel, a member of the AVP Tour's medical board from Santa Barbara, Calif., treated Dalhausser with the tape in two ways. When applied while the athlete is at rest, the tape's wavy structure "pooches" or bunches the skin, pulling it away from the muscle and creating space that allows for extra circulation.

During competition, the tape can be used to support or limit a specific muscle or muscle group. It stretches up to twice its length, so a trainer can apply different amounts of tension as needed.

Ferrel, a self-described early doubter of the tape's therapeutic value, said it works in a variety ways.

"It gives you let's say that confidence that you've got a little more going for you than without it," Ferrel said. "To what degree? Is it 1 percent, 2-3-4-5-10? Well, I contend that if it's 1 percent at the Olympic level, that's a lot."

The ultimate test of the tape for Seattle Mariners head trainer Rick Griffin is baseball's 162-game schedule. He encountered the product more than a decade ago while speaking at a seminar in Japan and has used it since.

His biggest success came in 2001 when he used it daily on Bret Boone's ailing knee. The All-Star second baseman hit .331 with 37 home runs and 141 RBIs. He finished third in the MVP voting and used the tape for the next several years.

"A lot of guys don't like to put a big bulky wraps on," Griffin said. "We've found that putting the Kinesio tape on hamstring injuries or groin injuries or calf strains takes enough of the pressure away the guys are able to play every day."

Kinesio Taping sells about 200,000 rolls a year in the U.S. to medical professionals, who most commonly use it to treat lower back pain. Entry into the retail market was in the works before the Olympics. Now, every major pharmacy and sporting goods chain is clamoring for the tape.
Kinesio tape is sold at Living Well Medical in Manhattan call (212)645-8151

Wednesday, September 17, 2008

Plantar Fascitis treatment in NYC

Plantar fasciitis is a painful inflammatory condition of the foot caused by excessive wear to the plantar fascia that supports the arch or by biomechanical faults that cause abnormal pronation. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition.

Plantar fasciitis was formerly called "a dog's heel" in the United Kingdom. It is sometimes known as "flip-flop disease" among US podiatrists. The condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.

1 Treatment
1.1 Surgery
2 References

Many different treatments have been effective, and although it typically takes six to eighteen months to find a favorable resolution,[2] plantar fasciitis has a generally good long-term prognosis. The mainstays of treatment are stretching the Achilles tendon and plantar fascia, resting, keeping off the foot as much as possible, discontinuing aggravating activity, cold compression therapy, contrast bath therapy, weight loss, arch support and heel lifts, and taping. Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, "flip-flops", and any shoes without a raised heel. Molded foam clogs such as CrocsRx have been approved by the American Podiatric Medical Association and United States Ergonomics[3][4] as a healthy alternative to flip-flops. To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.[5]. Patients should be encouraged to lessen activities which place more pressure on the balls of their feet because it increases tension in the plantar fascia. This is counter-intuitive because the pain is in the heel, and the heel is often sensitive to pressure which causes some patients to walk on the balls of their feet.

Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.[6] Recurrence rates may be lower if injection is performed under ultrasound guidance.[7] Repeated steroid injections may result in rupture of the plantar fascia. This may actually improve pain initially, but has deleterious long-term consequences.

In cases of chronic plantar fasciitis of at least 10 months duration, one recent study has shown high success rates with a stretch of the plantar fascia.[8]

Pain with first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. These have many different designs, some of which may be hard and may press on the origin of the plantar fascia. Softer, custom devices, of plastizote, poron, or leather, may be more helpful. Orthoses should always be broken in slowly.

Therapeutic ultrasound has been shown in a controlled study to be ineffective as a treatment for plantar fasciitis. More recently, however, extracorporeal shockwave therapy (ESWT) has been used with some success in patients with symptoms lasting more than 6 months.[10] The treatment is a nonsurgical procedure, but is painful, and should be done either under sedation, or with local anaesthesia either with or without intravenous sedation (twilight sedation). Local anaesthesia by injection of drugs into the area can also be painful, and may incur the risks of neuritis, bleeding, and infection. ESWT re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. It can take as long as six months following the procedure to see results. Results are variable, and one 2002 study reported ESWT for plantar fasciitis had no benefit.

Most patients should improve within one year of beginning non-surgical treatment, without any long-term problems. A few patients, however, will require surgery. Over 95% will then be relieved of their heel pain.

Prolotherapy has been shown to be effective in treating Plantar fasciitis.

Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve. [14] Surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone.[15] An ultrasound guided needle fasciotomy can be used as a minimally invasive surgical intervention for Plantar Fasciitis. A needle is inserted into the Plantar Fascia and moved back and forwards to disrupt the fibrous tissue.

My Plantar Fascitis treatment involves
Graston Technique
As published in
August 2007

Plantar Fasciitis Treatment
by Mike Ploski, PT, ATC, OCS
© 2007 BioMechanics

Plantar fasciitis is an inflammatory condition of the plantar fascia characterized by pain at the heel and the medial arch of the foot. Clinical findings often reveal limited range of motion with ankle dorsiflexion and first metatarsophalangeal joint extension, an abnormal gait pattern, decreased foot strength, or abnormal posturing of the subtalar joint.

Conservative treatment approaches are often successful in managing this condition and revolve around reducing pain, promoting healing, restoring ROM and strength, and limiting those biomechanical deviations caused by structural abnormalities.
Soft tissue mobilization techniques can restore functional mobility to the plantar flexors and plantar fascia. They can be performed manually or with instruments. These procedures also can be used to promote tissue healing in chronic stages of soft tissue dysfunction.

The Graston Technique is a form of manual therapy that uses patented stainless steel instruments to restore soft tissue motion. The tools help the clinician to detect and then break up fascial restrictions (scar tissue). This procedure has been shown to be highly effective in the management of both acute and chronic cases of plantar fasciitis.

Along the gastrocnemius muscle: The rough, granular feel of fascial restrictions will be palpable as the Graston tool is drawn across dysfunctional tissue.

At the 1st MTP joint: Once lesions are found, the clinician can use smaller instruments to manipulate the soft tissue and break them up.

At the medial calcaneal tuberosity: When friction-type motion is applied at the origin of the plantar fascia on the medial calcaneal tuberosity, blood flow to the area is stimulated. This can result in new collagen production that in turn can accelerate the healing process.
Go to this link to see full article
in conjunction with
Cold laser therapy
Recent Harvard study Cold laser more beneficial than Ultrasound-Click to view

Kinesio taping
Muscles constantly extend and contract within a normal range, however, when muscles over-extend or over contract, such as when lifting an excessive amount of weight, muscles can not recover and become inflamed. When a muscle is inflamed, swollen or stiff due to fatigue, the space between the skin and muscle is compressed, resulting in constriction to the flow of lymphatic fluid. This compression also applies pressure to the pain receptors beneath the skin, which in turn communicates "discomfort signals" to the brain and emdash, thus the person experiences pain. This type of pain is known as myalgia, or muscular pain.Kinesio Taping® alleviates pain and facilitates lymphatic drainage by microscopically lifting the skin. The taped portion forms convolutions in the skin, thus increasing interstitial space. The result is that pressure and irritation are taken off the neural and sensory receptors, alleviating pain. Pressure is gradually taken off the lymphatic system, allowing it to channel more freely.

Friday, September 12, 2008

Living Well Medical- A full service spinal decompression clinic

Herniated disc treatment protocol. This protocol is designed to not only relive pain but increase disc height and reduce pressure on spinal nerves.
Treatment consists of
Physical therapy- 3 dimensional Rehab on the SpineForce designed to strengthen core musculature
Medical Massage
Chiropractic care
Spinal decompression on the DRX 9000
Cold laser therapy
Oxygen Therapy to enhance blood oxygen levels
Nutritional support using exclusive formulas designed to support tissue healing.
Power Plate vibrational training
Kinesio taping for herniated discs.
NYC Spinal Decompression NYC
visit my site

Thursday, September 04, 2008

Sciatica treatment in NYC

Sciatica treatment in NYC
Contact Dr. Steven Shoshany at (212) 645-8151
or visit or

I wanted to give a exhaustive description and defintion of Sciatica so i did some research and found a site and posted information below. enjoy!


Pain along the course of the sciatic nerve, originating from irritation of or trauma to its fibers above the knee.It is a symptom-with-a-range-of-causes:
In the literature of 15th Century Florence, the term sciatica described pain at the ischial tuberosity. Tuberculosis and arthritis were cited as suspected causes. Historically, a broad and varying definition suggested unclear pathogenesis. Distal pedal pain due to intermittent claudication and nerve entrapment at the fibular head are now termed “pseudo-sciatica” and “peroneal palsy,” respectively, but they have often been mistaken for sciatica. More recently, similar symptoms deriving from thalamic cerebrovascular accident, multiple sclerosis, thoracic spinal fracture, and “phantom limb” phenomena have been called sciatica because they share a similar distribution of pain. Symptoms from these causes differ from our core concept in that they involve only the neurons in the central nervous system. While a patient may accurately describe the pain as “sciatic,” the word would describe only the symptom and not the common pathophysiology. We suggest that a CVA in the conus medullaris might be a limiting example of true sciatica if it involved the lower motor and sensory neurons, but question whether anything more rostral could be true sciatica. Another borderline case would be a (rare) mononeuropathy multiplex involving the proximal sciatic nerve.
A study of 700 surgical cases performed under local anesthesia confirmed the utility of this definition, finding symptoms were reproduced only when the sciatic nerve or its involved roots were stimulated, stretched or compressed. Regardless of other tissue involvement or injury, the closer the stimulus to the site of nerve compression or tension, the greater the pain suffered by the patient. This pain could always be eliminated by injection of Xylocaine beneath the nerve sleeve proximal to the site of compression. 1
Due to variance in definition, studies putting the lifetime prevalence of ‘generic sciatica’ at 35% must be interpreted cautiously.2,3,4 Two independent studies with more precise definitions similar to ours yield lifetime prevalence of true nerve-related sciatica at 5% in men and 4% in women. 5,6 It is thought that back pain affects approximately 14% of adults annually; about 1-2% also have sciatica. 7 This amounts to 13% of 40,000,000 back pain cases per year: more than 5,000,000 cases annually.
Three pathogenic groups contain the common causes of sciatica. There are also a number of infrequent causes as well as a short list of habitual impostors.

One level:Laterally HNP/bulging disc
SpondylolisthesisMultiple levels:Arthritis


One level:Medially HNP/bulging disc
SpondylosisthesisMultiple levels:Boney/Ligamentum flavum


Piriformis syndrome:Overuse/sitting
Anatomical Ischial tunnel:Overuse

Uncommon causes-

Infectious: e.g., Tuberculosis
Autoimmune: e.g., Lupus Erythematosis,
Lumbosacral plexus
Neuropathy: e.g., Mononeuropathy Monoplex


Sacroiliac joint derangement
Intermittent claudication
Thalamic CVA
Peroneal palsy
Morton’s neuroma

Differential diagnosis begins with the location of the pain and the accompanying symptoms and signs.

Diagnosis from muscle weakness:
Flexing the thigh (with knee bent) – Dx: Radiculopathy at L 1 – 2
Extending the knee – Dx: Radiculopathy at L 3 – 4
Walking on the heels – Dx: Radiculopathy L 4 – 5
Walking on the toes – Dx: Radiculopathy L 5 – S1
Difficulty controlling the bowel or bladder – Dx: S 1 – 2 – 3

Note: Physical therapists often treat each of these conditions with McKenzie exercises appropriate for the level and severity of injury.
Diagnosis from numbness and/or paraesthesias:
Inguinal region, including side of testicle, labia majoris: L1
Upper front and side of thigh: L2
Main region of front of thigh down to or including knee: L3
Inside of calf, top of foot: L4 – 5
First web space, very outside of foot, outside of calf: S1
Middle back of thigh: S2
Middle portion of testicles, penis, labia majora, anus: S3
Glans penis, clitoris: S4
*Adapted from Fishman LM, Ardman CA. Sciatica Solutions: Diagnosis, treatment and cure of spinal and piriformis problems. W.W. Norton. New York. 2006.
Prediagnostic treatment for sciatica: Given the painful nature of sciatica, analgesia often precedes diagnostic workup. Many patients have already started a pain control regimen with ibuprofen or another over-the-counter non-steroidal anti-inflammatory by the time they reach the doctor. Nonsteroidal analgesia can be used in ascending order of potency: Tramadol (g of ultram), acetaminophen (g), meloxicam (g of mobic), celecoxib (g of celebrex), ketorolac (g toradol), diclofenac (g of voltaren), indomethacin (g). If ineffective, propoxyphene HCl (g of darvon), acetaminophen/hydrocodone (g of vicodin), meperidine (g of Demerol), codeine, acetaminophen/codeine (g of Tylenol #3), acetaminophen/oxycodone (g of Percocet), hydromorphone (g of Dilaudid), and oxymorphone (g of Opana) can be utilized. It should be noted that some common synthetic and semi-synthetic opiates include enough acetaminophen to approach hepatotoxicity at prolonged higher dosages.
Practical diagnosis: The diverse etiology of sciatica makes it necessary to be comprehensive and precise when evaluating a patient. Many clinicians rely on imaging early on in a patient’s treatment. Plain radiographs are rarely useful in the initial evaluation of non-geriatric acute back pain. They do not reveal herniated intervertebral discs nor spinal stenosis, and the findings on plain films are often unrelated to symptoms. E.g., spondylolisthesis can be seen in up to 5 percent of normal subjects. 8 Immediate X-ray of the lumbar spine should be reserved for patients with alarm symptoms suggestive of infection, cancer, violent wounds or fracture; however, a normal plain film itself does not rule out these conditions. In general, MRI or CT and EMG are required for definitive diagnosis of many spinal conditions. Nonetheless, these studies are not acutely necessary in patients with sciatica unless major neurological deficits or severe pain are present. Imaging studies may sometimes be deferred until 4-6 weeks of conservative therapy have failed.
Once obtained, there can still be an issue of misdiagnosis. One well-known study found that more than 30% of a group of pain-free subjects had serious spinal abnormalities on their MRIs. 9 If spinal pathology can be painless, it can also coexist with sciatica that has a different cause. This prompts the clinician to use EMG as an extension of the history and physical exam to confirm the diagnosis.
Treatment for Radiculopathy and Spinal Stenosis by cause:
Herniated Nucleus Pulposus: Whether central or lateral, usual treatment begins with analgesia and McKenzie and manual medical techniques, extension exercises, paraspinal myofascial work, modalities, Alexander work, and/or Yoga. Tapering oral steroids (starting dose often dexamethasone 8 – 16mg) over a 6-day to 3 week period may dramatically lower a patient’s pain, enabling him or her to tolerate an effective therapy program. Translaminar or transforaminal epidural injections are sometimes beneficial, though studies demonstrating the efficacy of these common practices are lacking.
True disc-related sciatica has a very high morbidity. This makes surgery an appealing alternative to conservative treatment for some patients. Many studies support surgery as the most efficient treatment. One analysis of medication use, ability to return to work, leisure activity and pain score found that after the first year of treatment, 30% of conservatively treated patients were satisfied with their outcome, while 60% of surgically treated patients reported satisfaction. 10 Surgery continued to lead until differences became insignificant at 10 years and beyond. Another study found 99.99% identical outcomes in surgical and non-surgical patients after 10 years. 11 It should be noted that in most studies the more severely involved patients tended to enter the surgical group.
One study followed patients hospitalized for disc-related sciatica for five years, comparing the 1/3 that refused surgery with the 2/3 that did not. At 5 years, 82% of the non-surgically treated patients still had pain in a sciatic distribution, versus 68% of the surgically treated patients. More than 13% of the surgical group required an additional operation for recurrent disc herniation. Outcome studies of this small group of patients found 84% in the WHO 'Severe handicap’ group. 12
Surgery may be an appealing option for many patients given the generally more favorable outcome. However, a recent study found little risk of serious or permanent injury when surgery for simple sciatica was delayed more than 7 months. 13 Given this information, a rational approach to treating sciatica clearly caused by a herniated disc is to attempt conservative treatment for 4-6 weeks. If intractable pain persists, a microdiscectomy or similar procedure can reasonably proceed.
Anterior spondylolisthesis, the most common form of spondylolisthesis, in which the upper vertebra is moved forward relative to the one below, may cause radiculopathy if it truncates neuroforamina, and/or spinal stenosis if the intramedullary space is narrowed. It is graded I through IV by the quartiles of vertebral body displacement. It is often successfully treated with an abdominal binder or lumbosacral corset, abdominal strengthening and postural training (the latter by a physical therapist or Alexander therapist). Yoga and Feldenkreis are also helpful. Beyond grade II, be it antero- retro- or lateral listhesis, surgical procedures that reestablish the proper alignment often utilize hardware such as titanium cages, and usually meet with considerable, but sub-total improvement that may not last more than 4-5 years. Studies of conservative medical, chiropractic or surgical treatment of spondylolisthesis are few.
Arthritis may narrow neuroforamina to cause radiculopathy unilaterally or bilaterally at one or more levels. Often, periodic episodes of increasing severity, frequency and duration occur after age 65-70. Pain as well as motor and sensory complaints will be gradual in onset, and at least early on, are often positional. Conservative strategy reduces the attendant inflammation, lowers peripheral and central sensitization, and increases range of motion at neighboring joints to reduce compromise at the affected level(s). 14 Non-steroidal and/or steroidal anti-inflammatories, yoga, and physical therapy often accomplish these three goals, respectively. 15, 16, 17 Although quite effective, steroids must be used with caution in osteoporotic patients. More advanced or complicated cases of arthritis may require surgery to remove deteriorated bone and disc material, osteophytes, or other matter impinging on the nerves. In these refractory patients, an EMG is helpful in identifying and characterizing the levels warranting treatment, and the severity of impingement.
Boney growth and/or swelling of the ligamentum flavum may narrow the lumbar intramedullary canal, causing single or multiple level spinal stenosis and resultant sciatica. The former may have genetic or arthritic pathogenesis, the latter inflammatory or traumatic. Conservative treatment aims to reduce the girth of the canal’s contents: tapered oral or epidural steroids, traction, and postural work by physical therapists, Alexander therapists and osteopathic physicians have had success.
While ligamentous swelling may subside naturally, boney narrowing will not. Surgical intervention, sometimes requiring stabilization procedures as well, should be considered when a progressive boney thickening is documented, but before emergent intervention is required. Cauda equina syndrome, a rare complication of spinal stenosis in which ascending numbness or weakness and bladder or bowel incontinence results from extreme pressure on descending rootlets within the intramedullary space, is one such surgical emergency.
In a recent study of nonemergent spinal stenosis surgery, outcome comparison of control and intervention groups at 1 and 4 years favored surgical treatment. After 8-10 years, a similar percentage of each group reported low back pain was improved but sciatica relief continued to favor the surgical group. 18 Because it is generally progressive, surgery for spinal stenosis may wisely occur before it is utterly mandatory, since its necessity may arise after the patient is too frail for it. 19
Piriformis syndrome is an under-recognized cause of sciatica. This was validated when 239 patients who failed conservative or surgical treatment for the above causes underwent MR neurography. Piriformis involvement was found in more than 2/3 of them. 20 Symptoms arise from compression of the sciatic nerve as it exits the buttock in relation to the piriformis muscle, due to spasm or tightness in the muscle. The chief environmental causes are overuse at health clubs, from running, outdoor activities, excessive sitting, trauma from auto accidents and falls. Anomalous relationships between the sciatic nerve and the inferior gluteal artery or vein at the greater sciatic foramen are uncommon but demonstrated anatomic bases for pain.
Diagnosis is made by EMG through delay of H-reflexes in flexion, adduction and internal rotation (the FAIR-test). Comparing affected with unaffected limbs helps rule out radiculopathy or spinal stenosis, and may be used in the 90% of cases that are unilateral. 21 Neural scan imaging (NMR) will show asymmetrical development of the affected piriformis muscle, and evidence of inflammation or focal narrowing of the sciatic nerve. EMG and NMR will only be positive if piriformis syndrome is present, and not in simple SI derangement alone. However, these conditions occur together with some frequency. Since the piriformis muscle arises in part from the sacroiliac joint, it is possible that SI joint derangement causes piriformis muscle spasm in these cases.
Conservative treatment begins with EMG- or fluoroscopically-guided steroid and Lidocaine/Marcaine injection of the piriformis muscle near its lateral musculotendinous junction, as well as stretching and relaxing the muscle, using ultrasound, myofascial release and spray/stretch techniques. Appropriate home yoga therapy is often successful over time. 22 Botulinum neurotoxin A or B, 300 or 12,500 units, respectively, in four locations throughout the muscle, are reported to significantly relieve 60% to 90% of resistant cases. 23 Neurovascular anomalies and ventral piriformis muscle scars require surgery which appears to benefit 60-80% of cases. 24
Confusion resolved:
While the rare vascular and neurological abnormalites have been shown to cause piriformis syndrome, the common variations in anatomy do not. Piriformis syndrome is often attributed to one or both branches of the sciatic nerve passing through the piriformis muscle, an anatomic “anomaly.” Cadaveric studies show that approximately 15% of the population has at least one branch of the sciatic nerve that travels such a course. Interestingly, in these people, the anatomy is bilateral more than 90% of the time. The “anomaly” theory comes into question in that complaints consistent with piriformis syndrome are bilateral in less than 10% of patients. Further, at surgery only 15% of patients had anatomy consistent with the “anomaly” theory, the same percentage that is seen in the general population. 25
Ischial tunnel syndrome:
The FAIR test is occasionally positive when entrapment is at a site other than the piriformis muscle. Four percent of sciatic nerve entrapment in the buttock is due to entrapment as the nerve passes close to the ischium. 26 The pudendal nerve may be separately involved. Neural scan is the definitive diagnostic tool for ischial tunnel syndrome. In these cases, treatment begins with myofascial release, modalities, and postural re-training. Surgery is reported but outcome studies lack sufficient numbers to be persuasive.
There are many other causes of sciatica, ranging from tumor and fracture to gunshot wound. In all the pathogenetic mechanism and the diagnosis can be understood on the anatomical bases that we have attempted to provide. Multiple conditions can coexist in which the analytical “either – or” approach is not recommended:
Proper initial treatment for a herniated disc is extension exercises, which is contraindicated in spondylolisthesis and non-disc forms of spinal stenosis. For these spinal stenoses and spondylolistheses, flexion is standard, a treatment which is contraindicated for most herniated discs. In the occurrence of both conditions, lateral strengthening and spinal work such as the yoga pose vasisthasana have proven useful in alleviating pain, with Fonar evidence of anatomical improvement. 27 To distinguish whether spinal stenosis or neuroforaminal pathology is the major causative factor in a given patient’s pain, other provocative tests, and functionally sensitive nerve-conduction are often helpful, though currently at the experimental stage.
1 Kuslich SD, et al. "The Tissue Origin of Low Back Pain and Sciatica: A report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia." Orthop Clinic North Am 1991; 22:181-187.
2 Heliovaara M, et al. “Lumbar disc syndrome in Finland.” J Epidemiology Community Health 1987; 41:251-258.
3 Svensson HO, Andersson GBL. “A retrospective study of low back pain in 38- to 64 year old women: frequency and occurrence and impact on medical services.” Spine 1988; 13:548-522.
4 Svensson HO, Andersson GBL. “Low back pain in forty to forty-seven year old men: work history and work environment factors.” Spine 1983; 8:272-276.
5 Heliovaara M, et al. “Lumbar disc syndrome in Finland.” J Epidemiol Commun Health 1987; 41:251-258.
6 Manninen P, et al. “Incidence and risk factors of low-back pain in middle-aged farmers.” Occupational Medicine 1995; 45:141-146.
7 Deyo, RA, Tsui-Wu, YJ. “Descriptive Epidemiology of low back pain and its related medical care in the United States.” Spine 1987; 12:264.
8 Rothman RH, Simeone FA: Spondylolisthesis. The Spine 1992; Volume 1: 913-969.
9 Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. “Magnetic resonance imaging of the lumbar spine in people without back pain.” New England Journal of Medicine; 1994:69-73.
10 Weber H , '1982 Volvo Award in Clinical Science' "Lumbar Disc Herniation: A controlled, Prospective Study with Ten Years of Observation." Spine 1983; 8(2):131-140.
11 Agency for Health Care Policy and Research. Acute Low Back Problems in Adults. Clinical Practice Guidelines no. 14. Rockville, Md., 1994, Publication 95-0642.
12 Nykvist F, et al. "A prospective 5-year follow-up study of 276 patients hospitalized because of suspected lumbar disc herniation." Int. Disabil. Studies 1989; 11(2):61-67.
13 Carragee E, “Surgical Treatment of Lumbar Disk Disorders.” JAMA 2006; 296:2485-2487.
14 Wolff CJ, Salter MW. “Neuronal Plasticity: increasing the gain in pain.” Science. 2000; 288:1765-1768.
15 Raghuraj P, Telles S. “Effect of yoga-based and forced uninostril breathing on the autonomic nervous system.” Percept Mot Skills. 2003; 96(1):79-80.
16 Telles S, Hanumanthaiah BH, Nagarathna R, Nagendra HR. “Plasticity of motor control systems demonstrated by yoga training.” Indian J Physiol Pharmacol. 1994;38(2):143-4.
17 Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, Doyle EJ Jr, Gregory Juckett R, Munoz G, Kolar M, Gross R, Steinberg L. “Effect of Iyengar yoga therapy for chronic low back pain.” Pain. 2005; 115(1-2):107-17.
18 Atlas SJ, Deyo RA, et al. 'Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study.' Spine 2005 Apr 15; 30(8):927-35.
19 Agency for Health Care Policy and Research. Acute Low Back Problems in Adults. Clinical Practice Guidelines no. 14. Rockville, Md., 1994, Publication 95-0642.
20 Papadopoulos, EC, Khan, SN. “Piriformis syndrome and low back pain: a new classification and review of the literature.” Orthop Clin North Am 2004; 35:65.
21 Fishman LM, Zybert PA. “Electrophysiologic evidence of piriformis syndrome.” Arch Phys Med Rehabil 1992 Apr; 73(4): 359-64.
22 Fishman L, Ardman C, Relief is in the Stretch. W.W. Norton. New York, 2005.
23 Fishman LM, Konnoth C, Rozner B. “Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose-finding study.” Am J Phys Med Rehabil 2004 Jan; 83(1): 42-50.
24 Mizuguchi T. “Division of the piriformis muscle for the treatment of sciatica. Postlaminectomy syndrome and osteoarthritis of the spine.” Arch Surg 1976 Jun; 111(6): 719-22.
25 Broadhurst NA, Simmons DN, Bond MJ. “ Piriformis syndrome: Correlation of muscle morphology with symptoms and signs.” Arch Phys Med Rehabil 2004 Dec; 85(12): 2036-9.
26 Filler AG, Haynes J, Jordan SE, et al. “Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.” J Neurosurg Spine 2005 Feb; 2(2): 99-115.
27 Fishman LM and Saltonstall E. Yoga for Osteoarthritis W.W. Norton, New York. Scheduled for
I would have to disagree with some of their conclusions, especially recommendations for surgery after 7 weeks of conservative treatment.
I have found that spinal decompression combined with an effective physical therapy protocol can correct most cases of sciatica within one month.