Wednesday, April 30, 2008

New York Chiropractor, Spinal Decompression

Chiropractor NYC

Sunday, April 27, 2008

Spinal Decompression Therapy

Spinal Decompression Therapy

DRX9000 and Back Pain
Stop The Pain Before It Stops You!!
With the DRX technology, you can receive treatment of herniated and degenerative discs without surgery! If you are like many who suffer from chronic neck and back pain, you have probably tried several prescribed remedies to help ease your discomfort: frequent bed rest, high doses of pain medication. Perhaps even non-traditional approaches such as acupuncture. And like so many, you have come to accept the fact that you just have to learn to live with your pain.



You Don't Have To Live With That Pain Anymore!
Thanks to the concerted efforts of a team of top physicians and medical engineers, a major advancement in medical technology was made to effectively treat low back pain resulting from herniated or deteriorating discs. The result of their efforts not only significantly reduces back pain in 92% of patients, but enables the majority of patients to return to more active lifestyles.



The decompression can help if you have herniated and bulging lumbar discs with or without complication, degenerative disc disease, a relapse or failure following surgery or facet syndromes.



This new treatment uses state-of-the-art technology to gradually relieve neurocompression often associated with cervical (neck) lower back pain. The process has been proven to relieve pain by enlarging disc space, reducing herniation, strengthening outer ligaments to help move herniated areas back into place and reversing high intradiscal pressures through application of negative pressure.


For Lumbar Decompression
An upper chest harness / shoulder support and a pelvic harness are used to help distribute the applied forces evenly. Once in place, you are slowly reclined to a horizontal position. Following the physician's orders, the therapist localizes the pain, makes any adjustments and directs the treatment to the proper area. The pull of decompression helps to mobilize the troubled disc segment without inducing further damage to the spine. Following each therapy session a cold pack and/or electrical muscle stimulation pad is applied to help the paravertebral muscles consolidate and strengthen after treatment. This also prevents muscles from swelling and going into spasm.


For Cervical Decompression
Considering the DRX Technology?
Come by and take a free tour of our facility in Manhattan. We will answer any of your questions or concerns, including questions regarding financial issues.
www.drshoshany.com

The DRX 9000 is the only table that has double blind clinically studies proving its effectiveness.

Thursday, April 17, 2008

Herniated disc and Failed Back Surgery or F.B.S.

www.drshoshany.com
Recently I read a trade journal that mentioned back surgery and how long it can offer patients relief and the long term success rate. This immediately brought my attention to a patient I am currently treating, for his privacy I am just going to call him" James".
James was referred to me by his pain management doctor one of the top NYC doctors because they have exhausted all efforts to get him out of his debilitating leg pain. James had a laminectomy 8 years ago due to a herniated disc and at the time did not seek out any alternative treatments like Chiropractic. To make a long story short, after the surgery he had relief from his Sciatica and it lasted 8 years! This is unusual because most Failed Back Surgery or (F.B.S) patients that I have seen have a good one or two years until a relapse of a disc above or below.
He was carried into my office bent like a pretzel and he was on Vicodin and Muscle relaxer.
He had no interest in another back surgery and was ready to start the spinal decompression protocol. Getting off the table was painful but after the ice and the electric stimulation and bracing he was upright in 5 visits.
Today is his last visit and he still needs to work on his core muscles.
My Physical therapist will work with him on the Power Plate and the Spine Force and Med-X back strengthening equipment.
Another satisfied patient!
www.drshoshany.com

Wednesday, April 16, 2008

What is KDM (Kinetic Decompression Mobiliaztion) and how is it different from traditional spinal decompression?

www.drshoshany.com
KDM(Kinetic Decompression Mobilization)NYC

If you suffer with a herniated disc or have chronic neck and Low back pain consider spinal decompression before surgery.
www.drshoshany.com

To have an effective spinal decompression program several components must be addressed like 1) Nutrition- A combination of nutrients and herbs to help heal damaged tissues 2) effective rehab program which includes training on the Spine Force and Power Plate and the MedX medical grade strengthening equipment 3) custom bracing to support muscles and disc-back bracing 4) Heat prior to and ice post decompression along with a form of high volt stimulation 5) Patients must learn how not to re injure themselves- I conduct a weekly back care class that educates patients on proper lifting and body bio mechanics
6) one commonly overlooked area is the feet I conduct a computerized gait analysis to assess the biomechanics of a patients gait and build a custom made orthotic to correct the gait(the way patients walk) 7)Cox Flexion distraction- which is the only technique that (aka flexion-distraction or F/D) relieves back and leg pain and neck and arm pain. Disc herniation and/or stenosis may be the cause of pain. Or simple arthritis or a back sprain may be the culprit.

Cox® Technic is a gentle, non-surgical, chiropractic spinal manipulation adjustment procedure.

95% of back pain and neck pain patients DO NOT require surgery.

Cox® Technic is a safe alternative to back surgery. It is also appropriate for failed back surgery patients who still suffer after surgery.

Cox® Technic is a well-researched (with research studies completed and underway), well-referenced (with over 90+ articles in medical and chiropractic journals) chiropractic spinal adjusting manipulation

Cox® Technic drops intradiscal pressures to -192 mmHg and increases the foraminal area by 28%.

Cox® Technic stops pain, realigns the spine and restores ranges of motion inherent to the spine while reducing low back pain, especially in radiculopathy (extremity pain--leg pain or arm pain) patients, better than active exercise therapy.
8) Effective pain non-narcotic pain relieving techniques like Cold laser therapy,ultrasound and the Graston technique
9) On-site medical care, some patients will have pain that may need medical management knowing that this is onsite and available to our patients is comforting.
10) Onsite Diagnostics using state of the art Digital radiographs that will determine the exact level of involvement and the ability to so patients when the area improves is vital to care plan. A Board certified radiologist will re-read MRI's to determine the level of disc herniation.

So to wrap this discussion up, I believe that I have the most effective spinal decompression protocol in Manhattan but don't take my word please visits my website at www.drshoshany.com and read patient testimonials

Monday, April 14, 2008

Spinal Decompression for Herniated discs

www.drshoshany.com
I wanted to let everyone know about my upcoming move and expansion.
After 10+ years at my 10 Downing St. location I am adding a new office and will move into 632 Broadway suite 303 NY,NY 10012. This office is located on the Broadway Between Bleecker St. and Houston.The phone number will stay the same.
This space is a state of the art facility, I now offer digital x-rays (low dose and quick reads)which will allow me the ability to do Pre and Post radiographs to show patients how the spinal decompression treatment increases their disc space.
Spine Force core strengthening and the Med-X spinal strengthening equipment and the Power Plate whole body vibration platform.
I will have a Board certified MD that can administer pain relieving medications and a Doctor of physical therapy to administer physical therapy.
I believe this will be the most complete spinal decompression protocol available anywhere. www.drshoshany.com
We will have an area for patients to warm up prior to decompression followed by a private spinal decompression room followed by a private PT room to receive Cyrotherapy and electro Stim.
Of course I will continue to offer Custom Bracing and Chiropractic care.
The Spine Force is great for Back and Core Strengthening,Fall Prevention
Protocols for All Ages,Shoulders, Hips and Ankle Injuries
Sports Performance Enhancement,Post Surgery/Spinal Decompression Rehabilitation
www.drshoshany.com

Sunday, April 06, 2008

Chiropractor NYC, Graston Technique

www.drshoshany.com
Graston Technique in Manhattan Call (212) 645-8151
I love this technique I helped me with my left shoulder that has bothered me over 8 months. Graston technique is a fantastic to work on Soft tissue, Ligaments and tendons. This along with Active release technique is a fantastic way to fix chronic shoulder soft tissue problems.
www.drshoshany.com
Manhattan, New York City

Graston Technique
 
How does the Graston Technique Work?
The Graston Technique is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and facial restrictions. The Technique utilizes stainless steel instruments designed specifically to detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.
Treatment with the Technique is conducted in concert with a rehabilitation regimen designed to restore athletes to their pre-injury level of activity. This is accomplished by implementing a functional progression program, which zeros in on imbalances throughout the kinetic chain. Flexibility, strengthening and muscle re-education is employed to provide the athlete/patient with optimal results within a minimal number of treatment sessions.

The positive clinical results achieved thus far have led to additional research that explores patient responses to the Graston Technique. Athlete outcome data that measures pain and function - including activities of daily living - continues to be gathered.

Product Use and Procedures
The patented Graston Technique Instruments - shaped to fit the contour of the body- are used to scan the area and assist clinicians to locate and then treat the injured tissue that is causing pain and restricting motion. Clinicians utilize the instruments to supply precise pressure to break up scar tissue, which relieves the discomfort and restores normal function.

Frequently Asked Questions

Q: How does the Graston Technique Work?

A: It is theorized that the Graston Technique is effective because it provides controlled micro trauma to the affected soft tissue structures. It also stimulates a local inflammatory response, which leads to remodeling and repair of affected soft tissues structures. The instruments allow therapists to specify the area that is being treated.

Q: Who can benefit from the Graston Technique?

A: Individuals who are experiencing pain and loss of motion and function following surgery, injury, cumulative trauma disorders and tendinitis may benefit from the Graston Technique. Some clinical diagnoses which have responded well to the Graston Technique include:

• Carpal Tunnel Syndrome (wrist pain)
• Scars
• Plantar Fasciitis (foot and arch pain)
• Adhesions
• Cervical Strain/Sprain (neck pain)
• Restrictions
• Lumbar Sprain/Strain (low back pain)
• Muscle Spasms
• Achilles Tendinitis (ankle pain)
• Muscle Pulls
• Rotator Cuff Tendinitis (shoulder)
• Trigger Points
• Patellofemoral Disorders (knee pain)
• Tendinitis
• Later Epicondylitis (tennis elbow)
• Muscle Strains
• Medial Epicondylitis (golfers elbow)
• Shin Splints

Q: Why is scar tissue a problem?

A: Scar tissue limits range of motion, and in many instances causes pain, which prevents the patient from functioning as he or she did before the injury.

Q: How is scar tissue different from other tissue?

A: When viewed under a microscope, normal tissue can take a couple of different fashions: dense, regular elongated fibers running in the same direction, such as tendons and ligaments; or dense, irregular and loose with fibers running in multiple directions.  In either instance, when tissue is damaged it will heal in a haphazard pattern--or scarring--that results in a restricted range of motion and, very often, pain.

Q: How are the instruments used?

A: The Graston Technique Instruments are used to enhance the clinician’s ability to detect adhesions, scar tissue or restrictions in the affected areas. Skilled clinicians use the stainless steel instruments to comb over and "catch" on fibrotic tissue, which immediately identifies the areas of restriction. Once the tissue has been identified, the instruments are used to break up the scar tissue so it can be absorbed by the body.

Q: Is the treatment painful?

A: It is common to experience minor discomfort during the procedure and some bruising afterwards. This is a normal response and part of the healing process.

Q: What is the frequency of treatment?

A: Patients usually receive two treatments per week over 4-5 weeks. Most patients have a positive response by the 3rd to 4th treatment.

www.drshoshany.com

Wednesday, April 02, 2008

Herniated disc treatment NYC

Herniated disc NYC
www.drshoshany.com
Call (212) 645-8151 for Herniated disc treatment in NYC
Dr. Steven Shoshany is the only NYC Chiropractor that has a Patent on his spinal decompression protocol.

I wanted to add some more information for my patients to learn about the herniated disc and how spinal decompression can help. In my Manhattan spinal decompression practice I focus on non-surgical treatment with the DRX 9000 and the Spine-force Core strengthening system.
I pulled the info below from a amazing Chiropractic website that has tons of pictures and descriptions of herniated disc. I posted a brief copy of some of the content on the site but it pays to visit the site to see the pictures and learn by pictures.
www.chirogeek.com


Disc Bulge | Disc Protrusion | Disc Extrusion | Disc Sequestration


In layman's terms, a disc herniation occurs when the inside of the intervertebral disc (nucleus pulposus) tears its way through the posterior outer portion of the disc (annulus fibrosus) and invades the space where the delicate neural structures reside (i.e., the anterior epidural space). The presents of this nuclear material in the anterior epidural space may irritate these neural structures, which in turn may cause the patient to suffer severe back and/or leg pain. In this tutorial we will explore just how a disc herniation occurs and discuss some of the more common classification of herniation.

The term 'Disc Herniation' (or 'disc prolapse' as they use in Europe) is a broad and general term that includes three specific types of disc lesions, which are classified based on the degree of disc disruption and posterior longitudinal ligament (PLL). The three main classifications of disc herniation are Protrusion (aka: contained herniation or sub-ligamentous herniation), Extrusion (aka: non-contained herniation, or trans-ligamentous herniation) and Sequestration (aka: free fragment).
General Information and Confusion:

In 1934 the syndrome of "disc herniation" was born when Mixter and Barr first proclaimed that a posterior rupture of the intervertebral disc that allowed nuclear material to escape and compressed the adjacent spinal nerve root(s) was a common cause of back and leg pain - sciatica (125). For nearly 70 years this assertion has held true without much challenge(170).

However, modern research as demonstrated that the relationship between disc herniation and its often associated sciatica are a far more complex and bewildering phenomenon than once realized. For example, since the invent of MRI, we have learned that some patients have disc herniation on MRI, yet have no pain at. And, visa versa, some patients have terrible back and leg pain, yet have no disc herniation! (Click here for the false positive rates for MRI.) Moreover, when post MRI is performed on some patients that once suffered disc herniation induced back and leg pain, the herniation is still there, yet the patient is gone. Conversely, some patients who fail to recover from back and leg pain, demonstrate a disappearance of the once prominent disc herniation.

Other ironies of disc herniation have been discovered as well. For example, we have learned from the work of Karppinen et al. that the size and severity of disc herniation do NOT correlate with the degree of patient pain, disability, or suffering (170). That is, small disc herniations and even disc bulges may causes just as much pain and disability as massive disc herniations and even extrusion.

Another strange irony is the fact that smaller, less complete, and innocent looking disc herniations (i.e., contained herniations, protrusions and/or disc bulges) are usually more difficult to treat and respond less favorably to decompressive surgery (discectomy) than do the larger and more advanced disc extrusions and sequestrations. (50) Moreover, symptomatic contained herniations have a poorer prognosis for recovery than do the larger more complete disc extrusions and sequestrations do. (50) And, to further cloud the water, we now know that sciatica (a horrible burning lower limb pain associated with disc herniation) is not always causes by the direct pressure from a herniated disc. That is, it can be caused from nuclear material "leaking" from the back of the disc onto the adjacent nerve roots, i.e., chemical radiculopathy(3,4) and/or from chemical and pressure irritation of the posterior intradiscal nerve fiber, i.e., the sinuvertebral nerves, which is called discogenic sciatica (1,2).

So, diagnosing a patient with complaints of back and lower limb pain is certainly not as easy as once believed.

TREATMENT OPTIONS: SURGERY VERSUS CONSERVATIVE CARE

Based on nearly thirty years of medical research, I can comfortably conclude the forthcoming with respect to treatment options for disc herniation induced back and lower limb pain: for patients who do not have the danger signs of compressive disc herniation--i.e., loss of bowl and/or bladder control (cauda equina syndrome); progressive worsening of their neurological state (atrophying muscles, progressive muscle weakness [foot drop]); and/or a worsening of their pain--conservative, non-operative care, will work just as well as having back surgery. In 1982, Weber--who won the prestigious Volvo Award for this work--was the first to suggested that back surgery for disc herniation induced back and leg pain was no more effective than letting old man time and mother nature (i.e., having conservative care [i.e., physical therapy, exercise and physical therapy]) work their magic. That is, he experimentally demonstrated that in the long run, patient who had back surgery got no better than those who didn't. The surgery group, however, did get better faster and were doing better at the one year mark; however, by three years, there were no differences between the surgery group and the non-surgery group. [Weber Study] Other investigators have confirms these findings. Recently (2007) Peul et al published the results of their medical investigation into surgical outcome of sciatica in the prestigious New England Journal of Medicine. They also randomized over 200 patients into either a disc surgery group or a conservative care (non-surgical) group. Again, as with the Weber study, the patient who had surgery got rid of their leg pain faster; however, at the one year follow-up, the surgical patients were no better off than that of the non-surgical patients. [An abstract of the study is here]

DISCECTOMY:

Treatment for severely symptomatic disc herniation-associate sciatica is best accomplished with traditional open discectomy or micro discectomy (99), BUT ONLY IF conservative measures have failed and/or if you have the danger signs associated with disc herniation: loss of bowl and/or bladder control (cauda equina syndrome); progressive worsening of the neurological state (root-related atrophying muscles, progressive muscle weakness [foot drop]); absent reflexes and/or a worsening of pain. Surgery timing, for disc herniation-related sciatica, is also critical. That is, you certainly don't want to wait any longer than one year before having the surgery (50). See the Surgery Timing Page for more information.

ENDOSCOPIC & LASER:

With regard to the non-invasive techniques, such as endoscopic discectomy, laser discectomy, etc. I'm not a believer and I do not recommend them. With regard to Laser discectomy, neither does a 2007 meta-analysis (a study of all the research ever done on Laser discectomy) by Goupille et al (26) who state, "this treatment cannot be considered validated for disc herniation-associated radiculopathy resistant to medical treatment." Until the inventors and proponents of these procedures step-up to the plate and published some high quality medical investigations (like what Peul et al just did) to prove their efficacy (effectiveness), then I'm not a believer. I can only think the reason the inventors of these techniques haven't done so is because they are afraid that the studies will show their techniques are no better than traditional discectomy or even worse. SO, STEP AND SUBMIT YOUR RANDOMIZED CONTROLLED TRAILS! PUT YOUR RESEARCH WHERE YOUR MOUTHS ARE!

THE TUTORIAL: THE BIRTH OF A DISC HERNIATION

Lets begin our tutorial with a quick review of the normal disc, and then proceed through each type of herniation. (For a full review of disc anatomy and physiology, please visit my 'Disc Anatomy Page'.)

The Normal Disc:
The 'Nucleus Pulposus' (pink #1), which is a water-rich gel-like mass of proteoglycan material, has the duty to support the tremendous 'Axial-Load' (weight) of the body. This nucleus is 'corralled' by the stronger 'Annulus Fibrosus' (green #2). The annulus is made out of concentric rings of a cartilage-like material called 'lamellae' (#9). It is this specially arranged collagen that gives the annulus the tremendous strength needed to hold that nucleus in place. Key Concept: The nucleus pulposus, because of the tremendous axial load upon it, is constantly trying to escape from the confines of the center of the disc. If it does manage to escape (tear) through the PLL (#7), the appearance on MRI is called a disc extrusion. The 'Posterior Longitudinal Ligament' (PLL #7) shields the delicate posterior neural structures and acts as a last line of defense against the potentially irritating nucleus pulposus. Note the posterior disc is 'concave' in shape, as outlined by the PLL. (It will not stay concaved for much longer!) The 'posterior neural structures', which are very sensitive to pressure and chemical irritation, include the following: 'Spinal Nerve Roots' (L4, L5, S1), 'Dura Mater or the Thecal Sac ' (red star), and the 'Dorsal Root Ganglion' (DRG). To learn about the anatomy and physiology of the disc go to: [Disc Anatomy]. And finally we have the Sinuvertebral Nerve (# SN). The Sinuvertebral nerve innervates (connects to) the outer 1/3 of the annulus fibrosus. These tiny nerve ending have the ability to carry PAIN messages to the brain and are thought to be on of the causes of discogenic pain. (Read my IDD page, for more information on discogenic pain.) Oh, one more thing; the epidural space (#8) contains the traversing nerve roots (L5) that are often the favorite target of the compressive disc herniation.

THE DISC BULGE: The First Step Toward Disc Herniation:

In order for a disc to herniate, its structural components must first 'weaken'. This weakening occurs as a result of Disc Degeneration. Disc degeneration occurs naturally, to some degree, in all disc, but in some people the process become especially severe and damaging. The 'bottom-line' of the degeneration process is that the annulus becomes dried (desiccation) and brittle, hence allowing for the development of Disc Bulging and full thickness posterior anular tearing, or Internal Disc Disruption.

Figure #2 demonstrates the 'pre-cursor' to a disc herniation. This type of disc lesion - that bulges into the anterior epidural space without any area of focal-ness or out-pouching - would be called a 'Disc Bulge' on MRI (only because the MRI can NOT show the condition within the disc), although in reality it is a 'Grade 3 Radial Anular Tear' (you would need CT discography to identify the tear) that has disrupted the posterior annulus and allowed irritating nucleus pulposus material to enter into the outer fibers of the disc. Again, this in of itself (IDD) may cause severe and disabling pain in some unfortunate people; however, the subject of Internal Disc Disruption is not the focus of this page. Also note that the PLL, although bulged, continues to be intact and has not ruptured. As well shall see later, the PLL is the 'key' to differentiating between a disc protrusion and a disc extrusion. Finally, note that the Sinuvertebral nerves are irritated (red) and are sending pain signals on to the brain through the sympathetic nervous system (gray ramus communicans). Also note that this IDD may cause some referred lower leg pain as well (spinal nerve has some orange in it to indicate referred pain.)

DISC PROTRUTION: Posterior Longitudinal Ligament is still Intact.

Figure #3 demonstrates a 4 millimeter disc protrusion and represents a worsening of our disc bulge. The posterior of the disc is 'focally' or 'eccentrically' pushing backwards into the anterior epidural space and has contacted, and even somewhat compressed, the traversing nerve root (white star) and right front corner of the thecal sac. Note that the PLL (blue) still has NOT be disrupted and is still "containing" the near-herniated nuclear material.

The type of presentation in Figure #2. would be 'officially' classified as a 'Disc Herniation' or, more explicitly, a Disc Protrusion (aka: contained herniation or subligamentous disc herniation).

Although disc protrusions are seen in about 30% of the normal non-symptomatic population, nerve root compression is not, and if much more indicative of a 'problem. This patient may well be suffering right sided radicular pain (sciatica) and/or lower back pain as a result of compression/irritation of the traversing nerve root and/or irritation of the sinuvertebral nerves in the posterior of the disc.

THE DISC EXTRUSION: The Posterior Longitudinal Ligament has ruptured.

Figure #4. demonstrates a more serious progression of our pathologically degenerated disc: An 8 millimeter Disc Extrusion (aka: non-contained herniation, transligamentous herniation) is now present. The PLL (blue) has finally been defeated and has completely ruptured, hence allowing for further migration of the the nucleus pulposus into the anterior epidural space. Note the marked displacement of the traversing nerve root (white star) AND the exiting nerve root (green star) (which has now turned completely red with inflammation and venous congestion - the precursors for Radiculopathy). This Disc Extrusion is NOT typically seen in the asymptomatic person and is often an indication for surgical decompression; the sooner the better IF you're NOT improving with conservative care. Another interesting phenomenon about extrusions are the fact that these larger disc lesions have a greater ability to be 'reabsorbed' by the body! This 'shrinkage phenomenon' has been demonstrated time and time again in the literature; in fact, you can expect that in 80% of large disc extrusions, there will be at least a 50% 'shrinkage' of size (5,6). Unfortunately, this doesn't always mean that the pain associated with the extrusion will fade! Some patients recover from disc extrusion yet demonstrate NO change in the size of their extrusion at all, where others fail to recover yet their extrusion has markedly decreased in size! That just goes to prove that we still have a lot to learn about the relationship between disc herniation and pain!


DISC SEQUESTRATION: The Final End-Phase of the Disc Herniation.

Figure #5. represents the end-of-the-line for the cycle of disc herniation. Now we can see that a big 'chunk' or 'fragment' of nuclear material has detached itself from the main body of the extrusion is and loose in the epidural space. Note the resulting severe compression of the traversing nerve root (white star), the exiting nerve root (green star) and the lateral aspect of the Thecal Sac (blue star).

Sequestration (aka: sequester, free-fragment) may be excruciatingly painful (back and leg pain - sciatica) and, if centrally located, may occasionally cause the patient to lose control of their bowl and bladder function, i.e., Cauda Equina Syndrome, which is considered a 'Medical Emergency'!

As with the disc extrusion, the sequestration may also undergo a reduction in size from a combination of an immune attack {macrophage attack} and dehydration, although frequently the patient will need immediate decompressive surgery to beat this monster!