Thursday, February 26, 2009

New York City Chiropractor-Herniated disc solutions


www.drshoshany.com
How is Spinal decompression different from traction?
Non surgical spinal decompression is very different from lumbar traction. Traction is basically a stretching of your spine. Decompression creates a vacuum effect in the spine. It has a traction component to it so it stretches your spine slightly opening up the nerve holes but it also suctions the discs back in place. Over a sequence of treatments the disc is then able to stay in place keeping the spinal canal and nerve canals free of interference. In our office we use the Drx9000 and with this protocol a patient wears an upper and a lower harness. This effectively takes the muscles out of the equation, so we can focus on the disc level.

You see, traction will often give some short term relief but soon after treatment gravity takes hold again and the spine squishes back to where it was.

Also, when traction pulls its often a straight linear pull that may cuase the muscles to spasm and prevent the adequate stretch. Whereas, decompression pulls in a cyclical fashion (pull and relax, pull and relax). In addition there is a feedback mechanism which can detect muscle spasm. If there is spasm the machine relaxes the pull; when the muscles relax it can pull again.


Because of these features the Drx9000 Spinal Decompression device will pull at much more force then traction but because it keeps the muscles and ligaments relaxed, not only will it feel comfortable it is able to create decompression or in others words suction the disc back into place.

Friday, February 20, 2009

Physical Therapy NYC- Physical therapy Manhattan


Sciatica, Chronic low back pain, Herniated disc treatment
www.drshoshany.com

Spineforce 3D Rehab and spinal decompression in Manhattan NYC.

3D Exercises Keep the Deep Spinal Muscles Fit
Don’t forget the little muscles! How exercising your deep spinal muscles help keep you young, strong, and healthy.

It is the most common and pervasive complaint: back pain. In fact, it’s been reported recently that over 85 million Americans suffer from back pain during their life. In a study of lower back pain(LBP) and the various treatment modalities dealing with LBP, it was reported that Chiropractic care was the most effective treatment modality.

However, the same study noted that for maximal patient improvement, exercise protocols needed to be added to Chiropractic Manipulative Technique. In the clinical setting, treatment and rehabilitative protocols have been varied, but consistent long-term relief has for the most part, eluded doctors and patients alike.

Everyone can be healthier and feel better with the correct approach. Get started and realize that you are on a path to be healthy and fit for a lifetime. It is important to lift weights at least twice per week for all the major muscle groups, perform some sort of aerobic conditioning a few times weekly, and stretch daily for both strength and flexibility. Doing all this exercise is helpful and necessary but what will actually take care of that aching back of yours is strengthening your core.

Like onions and Shrek, your back musculature has layers. Seven of them to be exact and it is the deepest layer that makes up your deep spinal muscles. The deep spinal musculature is the most important, yet most neglected muscle group of the body. Since it is your spine that is primarily responsible for all bodily movement, the health and fitness of these small muscles is crucial.

In this report we will discuss the individual muscles that make up the deep spinal muscle group, their actions, and their origin/insertion and action. In addition, exercise protocols will be developed to allow you to improve your core fitness, coordination, and balance.

There is a revolution going on in the fitness industry, and it is called core training(functional training). Examples of this type of training include: yoga, pilates, crossfit workouts(overhead squats mixed with pull-ups). When you hear about core fitness these days, it is all about the “hips, abs, and glutes” as the targets of core fitness. While it is true that the hips, abs, and glutes are core muscles, it is vitally important to realize that your primary core muscle group is the deep spinal muscle group. The deep spinal muscles are often weak, neglected afterthoughts in the chic world of “hips, abs, and glutes”.

The kinematic reaction to strengthening the deep spinal muscles results in increased muscle coordination, improved balance, and improved posture. This kinematic reaction extends to all bodily functions to balance the biomechanics of the spinal musculature which will reinforce and coordinate the body’s entire muscular system. Also, this helps to connect the deep stabilizer muscles to the superficial bodywall muscles.

One problem with traditional core fitness it that it is mostly unidimensional (think benchpress or leg extensions). What is required to improve core fitness, specifically deep spinal muscle fitness is to introduce multidimensional movements. How can we accomplish this task? Well on the low-tech side there is the wobble board or bosu ball, and then there is the high tech SpineForce machine with it’s rotating and oscillating platform.

The instability inherent in these devices causes a kinematic muscular reaction in which the spine, the body’s center of gravity, strives to maintain equilibrium. This chain reaction travels to the deep stabilizing muscles of the spine via a reflexive action(solicitation). Deep muscle chains, specifically those crossing at the center of the body in an area localized between L3 and the pubic symphysis are strengthened.

The strength and flexibility of the deep spinal muscles, and therefore the spinal column and the nervous system are greatly enhanced by this approach. In short, you have to create three dimensional movement along the three axes of body motion simultaneously. Axes are lines, real or imaginary, about which movement takes place. The three types of axes are: Sagital; A horizontal line from a bodies front to back at midline. Abduction and adduction are action movements along the sagital axis.

Coronal; This axis extends horizontally from side to side. Flexion and extension are action movements along this axis. Longitudinal; This is a vertical line extending in a cranio-sacral direction. Movements of medial and lateral rotation take place along this axis.

Movement of the vertebral column is usually slight between two adjacent vertebrae, but as a whole the spinal column has considerable movement in all ranges of motion about the three axes.

The deep spinal muscle group includes names like Interspinalis lumborum, rotators cervicis, as well as latissimus dorsi. Lets take a look in detail at these muscles and their actions on the spine (superficial to deep).

Latissimus Dorsi- The origin is the spinous processes of the last six thoracic vertebrae through the thoracolumbar fascia from the lumbar and sacral vertebrae. The insertion is the bicipital groove medial tubercle of the humerus. The muscle acts bilaterally to assist in hyperextending the spine and anteriorly tilting the pelvis, or in flexing the spine and posteriorly tilting the pelvis.

Rhomboids-Major&Minor- The origin for major and minor rhomboid muscles are the spinous processes of the seventh cervical to the fifth thoracic vertebra. The insertions of the major and minor rhomboids is the medial edge of the scapulae. The action of the rhomboids is to adduct and elevate the scapula.

Trapezius Muscle-It originates from the seventh cervical vertebra for the upper muscle fibers, and from the first through the twelth thoracic vertebrae for the middle and lower fibers. The insertion points range from the lateral third of the clavicle and parts of the acromion and scapula. The action of the trapezius is to move the scapula in relation to the spine.

Erector Spinae Muscle Group(superficial): A-Iliocostalis. These muscles originate from the sacrum to the medial rib heads and they insert on the transverse processes of the lumbar, thoracic, and cervical spines. The action of these muscles is to extend the back and neck.

B-Longissimus. The longissimus muscle group which includes the thoracis, cervicis, and capitis sections, originates from transverse processes of the lumbar spine up to the lower three or four cervical vertebrae. The insertions for this group of muscles goes from the posterior margin of the mastoid process down to the superior transverse processes from where the muscle started. The action of the longissimus is to extend and aide in rotation of the spinal column.

C-Spinalis. The origins of the spinalis muscle group is by tendons from spinous processes of the first two lumbar vertebrae up to the seventh cervical vertebra. The insertions begin with the spinous processes of the superior vertebra. The action is to extend the back through each individual vertebral segment.

Transversospinalis(Deep): A-Semispinalis(first layer)- Originates from transverse processes of lower thoracic vertebrae to lower cervical vertebrae, and inserts on Spinous processes of the upper thoracic and all the cervical vertebrae, up to the occipital bone.

B-Mulifidi(second layer)-These muscles originate on the transverse processes of L5 through C4. The insertions span two to four vertebrae, connecting with the spinous processes of superior vertebrae.

C-Rotatores(third layer)-Originates from transverse processes of all vertebrae and insert on the lamina of the vertebral segment above.

Interspinalis. These small muscles in pairs are placed between spinous processes of contiguous vertebrae. Their action is multidimensional stabilization.

Intertransversarii. Small muscles placed between transverse processes of contiguous vertebrae in the cervical, thoracic, and lumbar spines. It also acts as stabilization for the spine.

In utilizing these deep spinal muscles, the body when put in a state of imbalance, has two methods of dynamic rebalancing: first it flexes forward/inward and second it extends back/outward. If we stress the spine with two modes of muscular action(push/pull), we will cause the deep spinal stabilizing muscles to act on the intervertebral discs while decoapting the articulation. This in turn creates an instaneous coordinated reaction in all bodily movements.

The ability and rapidity of the body to react to forces and imbalances is possible if the deep stabilizing muscles of the spine are active and in synchronized coordination. The resulting decrease in pressure on the intervertebral discs is greatly beneficial to our patients.

Doing multidimensional movement exercises on a Spineforce machine for fifteen to thirty minutes four to five times a week is a good proscription for all of us and our patients. Try this exercise program for two weeks and you will feel and see the improvement. Now go out and get fit. Marc S Golub, D.C.

New York Ciy SpineForce is available at Living Well Medical-
A full service Comprehensive Physical Medicine and Rehab facility utulizing state of the Art Rehab equipment.
Dr. Arnold Blank MD
Dr. Steven Shoshany DC
Monika Pickwiticka DPT.
Acupunctre- Licenesed Massage and Neuromuscular Treatment.
Certified Kinesio taping and Erchonia Cold laser therapy, Graston technique.
Mckenzie Physical therapy, Cox Flexion Distraction -7th. Generation table, DRX 9000 spinal decompression.
www.drshoshany.com

Monday, February 09, 2009

Herniated disc treatments-NYC

Herniated disc treatment NYC
I found this information and wanted to to inform readers, visit the website they have great pictures and explantions.


Clinical Evaluation and Treatment Options for Herniated Lumbar Disc
S. CRAIG HUMPHREYS, M.D., and JASON C. ECK, M.S.
Chattanooga, Tennessee Degeneration of the intervertebral disc from a combination of factors can result in herniation, particularly at the L4-5 and L5-S1 levels. The presence of pain, radiculopathy and other symptoms depends on the site and degree of herniation. A detailed history and careful physical examination, supplemented if necessary by magnetic resonance imaging, can differentiate a herniated lumbar disc from low back strain and other possible causes of similar symptoms. Most patients recover within four weeks of symptom onset. Many treatment modalities have been suggested for lumbar disc herniation, but studies often provide conflicting results. Initial screening for serious pathology and monitoring for the development of significant complications (such as neurologic defects, cauda equina syndrome or refractory pain) are essential in the management of lumbar disc herniation.

The intervertebral disc is responsible for the attachment of vertebral bodies to each other, providing flexibility and absorbing and distributing the loads applied to the spinal column. With aging, the disc undergoes significant changes in volume and shape as well as in biochemical composition and biomechanical properties. Lumbar disc herniations are believed to result from anular degeneration that leads to a weakening of the anulus fibrosus, leaving the disc susceptible to anular fissuring and tearing.1



FIGURE 1. Four concentric layers of the intervertebral disc: (1) an outer anulus fibrosus, (2) a fibrocartilaginous inner anulus fibrosus, (3) a transition zone and (4) the central nucleus pulposus.
Symptoms of a herniated lumbar disc may often be difficult to distinguish from those of other spinal disorders or simple back strain. To effectively manage this disorder, it is crucial that a complete medical history and physical examination be performed. It is also important to understand the natural history of herniated disc and subsequent radiculopathy, the probability of spontaneous improvement and the contribution of diagnostic imaging studies or referral to an orthopedic specialist. This article discusses a standardized approach to the diagnosis and conservative treatment of a herniated lumbar disc. This approach will lead to more efficient use of diagnostic studies and a reduction in unnecessary referrals and ineffectual surgical procedures.

Etiology of Disc Degeneration

The intervertebral disc is arranged in four concentric layers: (1) an outer anulus fibrosus composed of dense collagen fibril lamellae; (2) a fibro cartilaginous inner anulus fibrosus; (3) a transition zone; and (4) the central nucleus pulposus2 (Figure 1). The framework of the disc is composed of collagen fibers in the anulus, which provide tensile strength, and proteoglycans in the nucleus, which provide stiffness and resistance to compression.

Several factors, including genetic factors and changes in hydration and collagen, are believed to play a role in the development of degenerative disc disease. It is widely accepted that the water-binding capability of the nucleus plays an integral role in the physical properties of the disc. In the healthy disc, the nucleus distributes the applied forces equally throughout the anulus. Decreased hydration of the disc can reduce the cushioning effect, thus transmitting a greater portion of the applied loads to the anulus in an asymmetric distribution,3 which could lead to injury, as illustrated in Figure 2. Increases in the collagen content of the nucleus and in its crystallinity have been reported to be partially responsible for disc degeneration.4

The possibility of genetic effects has been investigated in other spinal disorders, such as scoliosis, spondylolisthesis and ankylosing spondylitis, but few studies have searched for genetic factors in degenerative disc disease. One study5 reported a strong familial predisposition to discogenic low back pain and suggested that the etiology of degenerative disc disease includes both genetic and environmental factors.



FIGURE 2. Distribution of load in the intervertebral disc. (A) In the normal, healthy disc, the nucleus distributes the load equally throughout the anulus. (B) As the disc undergoes degeneration, the nucleus loses some of its cushioning ability and transmits the load unequally to the anulus. (C) In the severely degenerated disc, the nucleus has lost all of its ability to cushion the load, which can lead to disc herniation.
Clinical Assessment

Medical History
Information from the medical history allows the physician to target the physical examination, leading to an accurate diagnosis. The symptoms related to spinal disorders must be differentiated from those of other potentially serious conditions, including metastatic and rheumatologic disorders, fracture and infection. The Agency for Health Care Policy and Research (AHCPR)6 has developed guidelines for the management of acute (less than three months' duration) low back pain. The AHCPR recommendations are based on "red flags" for spinal fracture, cancer or infection (Table 1).

Rheumatologic disorders often begin in the appendicular skeleton before progressing to the spine. Inflammatory arthritides such as ankylosing spondylitis result in generalized pain and stiffness that are worse in the morning and relieved somewhat throughout the day. In general, if a disc herniation is responsible for the back pain, the patient can recall the distinct time of onset and contributing factors, whereas if the pain is of a gradual onset, other degenerative diseases are more probable than disc herniation.

The most common levels for a herniated disc are L4-5 and L5-S1. The onset of symptoms is characterized by a sharp, burning, stabbing pain radiating down the posterior or lateral aspect of the leg, to below the knee. Pain is generally superficial and localized, and is often associated with numbness or tingling. In more advanced cases, motor deficit, diminished reflexes or weakness may occur. Generally, only the relatively uncommon central disc herniation provokes low back pain and saddle pain in the S1 and S2 distributions. A central herniated disc may also compress nerve roots of the cauda equina, resulting in difficult urination, incontinence or impotence. The medical history and physical examination may disclose bowel or bladder dysfunction. In such cases, immediate referral to a specialist is required for emergency surgery to prevent permanent loss of function.

Often the most difficult aspect of evaluating patients with symptoms of a central herniated disc is differentiation between low back strain and herniated disc. Pain caused by low back strain is exacerbated during standing and twisting motions, whereas pain caused by central disc herniation is worse in positions (such as sitting) that produce increased pressure on the anular fibers. Questions about whether the patient's pain became worse while driving to the appointment and sitting in the waiting room may be revealing. The pressure on the intervertebral disc is increased during sitting and bending postures, as opposed to standing or recumbent positions7 (Figure 3). This explains the exacerbation of herniated disc symptoms when the patient is in the sitting position.

Physical and Neurologic Examination of the Lumbar Spine
A complete physical and neurologic examination can reveal defects at specific levels. The first assessment in the physical examination is a search for any external manifestations of pain, including an abnormal stance. The patient's posture and gait should be examined for sciatic list, which is indicative of disc herniation. The spinous processes and interspinous ligaments should be palpated for tenderness. Range of motion should be evaluated. Pain during lumbar flexion suggests discogenic pain, while pain on lumbar extension suggests facet disease. Ligamentous or muscular strain can cause pain when the patient bends contralaterally.

Motor, sensory and reflex function should be assessed to determine the affected nerve root level8 (Figure 4). Muscle strength is graded from zero (no evidence of contractility) to 5 (complete range of motion against gravity, with full resistance). Examination of the lumbar spine by neurologic levels is helpful in locating the source of the patient's symptoms (Table 2).



TABLE 1
'Red Flags' in the Medical History: Potentially Serious Conditions That May Present as Low Back Pain
--------------------------------------------------------------------------------

Possible condition
--------------------------------------------------------------------------------
Findings from the medical history
--------------------------------------------------------------------------------

Fracture • Major trauma (motor vehicle accident, fall from height)
• Minor trauma or strenuous lifting in an older or osteoporotic patient

Tumor or infection • Age >50 years or <20 years
• History of cancer
• Constitutional symptoms (fever, chills, unexplained weight loss)
• Recent bacterial infection
• Intravenous drug use
• Immunosuppression (corticosteroid use, transplant recipient, HIV infection)
• Pain worse at night or in the supine position

Cauda equina syndrome • Saddle anesthesia
• Recent onset of bladder dysfunction
• Severe or progressive neurologic deficit in lower extremity


--------------------------------------------------------------------------------

HIV=human immunodeficiency virus.

Reprinted from Bigos SJ. Acute low back problems in adults. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994; AHCPR publication no. 95-0642.




Specific movements and positions that reproduce the symptoms should be investigated during the examination to help determine the source of the pain. For example, the upper lumbar region (L1, L2 and L3) controls the iliopsoas muscles, which can be evaluated by testing resistance to hip flexion. While seated, the patient should attempt to raise each thigh while the physician's hands are placed on the leg to create resistance. Pain and weakness are indicative of upper lumbar nerve root involvement. The L2, L3 and L4 nerve roots control the quadriceps muscle, which can be evaluated by manually trying to flex the actively extended knee. The L4 nerve root also controls the tibialis anterior muscle, which can be tested by heel walking.

The L5 nerve root controls the extensor hallucis longus, which can be tested with the patient seated and moving both great toes in a dorsiflexed position against resistance. The L5 nerve root also innervates the hip abductors, which are evaluated by use of the Trendelenburg test. This test requires the patient to stand on one leg; the physician stands behind the patient and puts his or her hands on the patient's hips. A positive test is characterized by any drop in the pelvis on the opposite side and suggests either L5 nerve root or hip-joint pathology. Possible cauda equina syndrome can be identified by unexpected laxity of the anal sphincter, perianal or perineal sensory loss, or major motor loss in the lower extremities.





FIGURE 3. Relative increases and decreases in intradiscal pressure in relation to different body positions. Note that seated and bending postures apply more pressure to the disc than do standing and recumbent positions. This explains the exacerbation of symptoms of herniated disc when patients are in the former positions.


Nerve root tension signs are often used in the evaluation of patients suspected of having a herniated disc. The straight-leg raising test is performed with the patient in the supine position. The physician raises the patient's legs to approximately 90 degrees. Normally, this position results in only minor tightness in the hamstrings. If nerve root compression is present, this test causes severe pain in the back of the affected leg and can reveal a disorder of the L5 or S1 nerve root.



The most common sites for a herniated lumbar disc are L4-5 and L5-S1, resulting in back pain and pain radiating down the posterior and lateral leg, to below the knee.


A crossed straight-leg raising test may also suggest nerve root compression. In this test, straight-leg raising of the contralateral limb reproduces more specific but less intense pain on the affected side. In addition, the femoral stretch test can be used to evaluate the reproducibility of pain. In this test, the patient lies in either the prone or the lateral decubitus position. The thigh is extended at the hip, and the knee is flexed. Reproduction of pain suggests upper nerve root (L2, L3 and L4) disorders.

Attention should also be paid to any nonorganic physical signs (Waddell signs), which may identify patients with pain of a psychologic or socioeconomic basis.9 These signs include superficial tenderness, positive results on simulation tests (i.e., maneuvers that appear to the patient to be a test but actually are not), distraction tests that attempt to reproduce positive physical findings when the patient is distracted, regional disturbances that do not correspond to a neuroanatomic or dermatomal distribution and overreaction during the examination. Patients who are more likely to demonstrate such nonorganic signs include patients with work-related injury or those involved in litigation related to their injury.



FIGURE 4. Dermatomes of the lower extremities.





TABLE 2
Location of Pain and Motor Deficits in Association with Nerve Root Involvement at Each Lumbar Disc Level
--------------------------------------------------------------------------------

Disc level
--------------------------------------------------------------------------------
Location of pain
--------------------------------------------------------------------------------
Motor deficit
--------------------------------------------------------------------------------

T12-L1 Pain in inguinal region and medial thigh
None
L1-2 Pain in anterior and medial aspect of upper thigh
Slight weakness in quadriceps; slightly diminished suprapatellar reflex
L2-3 Pain in anterolateral thigh
Weakened quadriceps; diminished patellar or suprapatellar reflex
L3-4 Pain in posterolateral thigh and anterior tibial area
Weakened quadriceps; diminished patellar reflex
L4-5 Pain in dorsum of foot
Extensor weakness of big toe and foot
L5-S1 Pain in lateral aspect of foot
Diminished or absent Achilles reflex



Imaging of the Herniated Disc

The major finding on plain radiographs of patients with a herniated disc is decreased disc height. Radiographs have limited diagnostic value for herniated disc because degenerative changes are age-related and are equally present in asymptomatic and symptomatic persons.10 Neurodiagnostic imaging modalities reveal abnormalities in at least one third of asymptomatic patients.11 For this reason, computed tomography (CT) also has limited diagnostic value for herniated disc.



Back pain caused by a herniated lumbar disc is exacerbated by sitting and bending; conversely, the pain of lumbar muscular strain is aggravated by standing and twisting movements.


The gold standard modality for visualizing the herniated disc is magnetic resonance imaging (MRI), which has been reported to be as accurate as CT myelography in the diagnosis of thoracic and lumbar disc herniation.12 T1-weighted sagittal spin-echo images can confirm disc herniation; however, the size of herniation is underestimated because the low signal of the anulus merges with the low signal of the cerebrospinal fluid. Conventional T2 and T2-weighted fast spin-echo images are used in the diagnosis of degenerative disc disease. MRI also has the ability to demonstrate damage to the intervertebral disc, including anular tears and edema in the adjacent end plates. As with CT scans, MRI can reveal bulging and degenerative discs in asymptomatic persons; therefore, any management decisions should be based on the clinical findings corroborated by diagnostic test results.11

MRI has been traditionally used to obtain images in the axial and sagittal planes. Recent advances have brought about oblique images, which provide better views of certain anatomic structures that were not available with conventional methods.13,14 Oblique images are oriented perpendicular to the course of the neural foramen. It has been suggested that oblique MRI be added to the conventional technique to aid in the detection of foraminal impingement.



The gold standard for imaging of the herniated lumbar disc is magnetic resonance imaging.


Nonoperative Treatment

While low back pain and radiculopathy are common causes of disability, the majority of patients experience resolution of their symptoms regardless of the treatment method. In one study15 of 208 patients with radicular pain of either an L5 or an S1 origin, 70 percent had marked reduction in leg pain within four weeks of the onset of symptoms. It is beneficial to provide symptomatic treatment to patients with symptoms of herniated disc during the first six weeks of symptoms.

As a result, the family physician often takes on the role of educator, providing advice on methods of relieving the symptoms of herniated disc. Most patients with low back pain respond well to conservative therapy, including limited bed rest, exercise and, in selected cases, injections. It is the responsibility of the physician to determine the goals and optimal strategy for each patient. The condition should be thoroughly explained to the patient, including the likely natural history and the potential forms of treatment.

The rationale for bed rest relates to the reduction in both mechanical pain and intradiscal pressure in the supine position. The optimal duration of bed rest for patients with herniated discs is debatable, but bed rest is commonly recommended for two to seven days. However, studies suggest that bed rest in excess of two days is not associated with a better outcome16 and that continuing to perform usual activities as tolerated leads to more rapid recovery than bed rest.17 Excessive bed rest can result in deconditioning, bone mineral loss and economic loss.

The benefit of aerobic exercise for relieving radicular pain is controversial. Advocates believe that strengthening of the abdominal and back muscles can relieve symptoms, reduce weight and alleviate depression and anxiety. Exercise and massage techniques are easily taught to the patient and family members. Extension and isometric exercises are performed first and, after sufficient strength and pain relief are achieved, flexion exercises are allowed. Flexion exercises are delayed because flexion motions apply the greatest load to the intervertebral disc.



In uncomplicated cases of herniated lumbar discs, the majority of patients gain symptom relief within four weeks after the onset of low back pain and radiculopathy.


The McKenzie exercise program is believed to be one of the most beneficial. This program is individualized to the patient's symptoms and emphasizes exercises that minimize or centralize radiating pain.18 However, several studies have reported no significant benefits of exercise programs in terms of functional recovery, range of motion or pain severity.19,20 Exercise programs must be carefully designed to provide the greatest benefit, especially for patients with other conditions that limit strenuous activity. Determining the patient's limitations and the goal for therapy is important.

Some physicians believe trigger point injections can provide extended relief for localized pain sources. An injection of 1 to 2 mL of 1 percent lidocaine (Xylocaine) without epinephrine is usually administered. The use of either ultrasound (phonophoresis) or electricity (iontophoresis) over the injected area may provide additional relief, although the benefits of these methods have not been proved. Epidural steroid injection therapy has been reported to be effective in patients with lumbar disc herniation with radiculopathy.21,22 Others have reported limited value from steroid injections in patients with radiculopathy.23,24

Surgical Indications for Herniated Disc

While most patients with a herniated disc may be effectively treated conservatively, some do not respond to conservative treatment or have symptoms that necessitate referral to a specialist. Any surgical decisions should be firmly based on the clinical symptoms and corroborating results of diagnostic testing. Indications for referral include the following: (1) cauda equina syndrome, (2) progressive neurologic deficit, (3) profound neurologic deficit and (4) severe and disabling pain refractory to four to six weeks of conservative treatment.


--------------------------------------------------------------------------------

The Authors

S. CRAIG HUMPHREYS, M.D.,
is an orthopedic spinal surgeon in private practice at the Chattanooga (Tenn.) Orthopaedic Group. Dr. Humphreys is also co-director of the Chattanooga Orthopaedic Group Foundation for Research. He received a medical degree and residency training at Loyola University, Chicago, and completed a fellowship in spinal surgery at the Medical College of Wisconsin, Madison.

JASON C. ECK, M.S.,
recently entered medical school at the University of Health Sciences in Kansas City, Mo. Formerly a biomedical engineer conducting research in spinal biomechanics and neuroradiology at the Chattanooga Orthopaedic Group, he received a master's degree in biomedical engineering from Marquette University,
Milwaukee.

Address correspondence to S. Craig Humphreys, M.D., Chattanooga Orthopaedic Group, Suite 303, 605 Glenwood Ave., Chattanooga, TN 37404. Reprints are not available from the authors.

REFERENCES

Saal JA. Natural history and nonoperative treatment of lumbar disc herniation. Spine 1996;21(24 suppl):2S-9S.
Buckwalter JA. Aging and degeneration of the human intervertebral disc. Spine 1995;20:1307-14.
Panagiotacopulos ND, Pope MH, Bloch R, Krag MH. Water content in human intervertebral discs, part II: viscoelastic behavior. Spine 1987;12:918-24.
Naylor A. The biochemical changes in the human intervertebral disc in degeneration and nuclear prolapse. Orthop Clin North Am 1971;2:343-58.
Postacchini F, Lami R, Pugliese O. Familial predisposition to discogenic low-back pain. An epidemiologic and immunogenetic study. Spine 1988;13: 1403-6.
Bigos SJ. Acute low back problems in adults. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994; AHCPR publication no. 95-0642.
Nachemson A. Disc pressure measurements. Spine 1981;6:93-7.
Klein JD, Garfin SR. Clinical evaluation of patients with suspected spine problems. In: Frymoyer JW, ed. The adult spine. 2d ed. Philadelphia: Lippincott-Raven, 1997:319-40.
Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17: 617-28.
Bell GR, Ross JS. Diagnosis of nerve root compression. Myelography, computed tomography, and MRI. Orthop Clin North Am 1992;23:405-19.
Boden SD, Wiesel SW. Lumbar spine imaging: role in clinical decision making. J Am Acad Orthop Surg 1996;4:238-48.
Haughton VM. MR imaging of the spine. Radiology 1988;166:297-301.
Humphreys SC, An HS, Eck JC, Hodges SD, Lim TH, Shepard LC. Oblique MRI as a useful adjunct in evaluation of cervical foraminal impingement. Loyola Univ Orthop J 1997;6:4-7.
Yenerich DO, Haughton VM. Oblique plane MR imaging of the cervical spine. J Comput Assist Tomogr 1986;10:823-6.
Weber H. Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine 1983;8:131-40.
Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med 1986;315:1064-70.
Malmivaara A, Hakkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, et al. The treatment of acute low back pain--bed rest, exercises, or ordinary activity? N Engl J Med 1995;332:351-5.
McKenzie RA. Prophylaxis in recurrent low back pain. N Z Med J 1979;89:22-3.
Faas A, Chavannes AW, van Eijk JT, Gubbels JW. A randomized, placebo-controlled trial of exercise therapy in patients with acute low back pain. Spine 1993;18:1388-95.
Gilbert JR, Taylor DW, Hildebrand A, Evans C. Clinical trial of common treatments for low back pain in family practice. Br Med J [Clin Res] 1985;291: 791-4.
Bush K, Cowan N, Katz DE, Gishen P. The natural history of sciatica associated with disc pathology: a prospective study with clinical and independent radiologic follow-up. Spine 1992;17:1205-12.
Dilke TF, Burry HC, Grahame R. Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J 1973;2:635-7.
White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine 1980;5:78-86.
Snoek W, Weber H, Jorgensen B. Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs. Acta Orthop Scand 1977; 48:635-41.
Copyright © 1999 by the American Academy of Family Physicians.
This content is owned by the AAFP.

Thursday, February 05, 2009

Spinal Decompression combined with Acupuncture in Manhattatn


Acupuncture was been around for thousands of years and is a treatment that has proved successful for everything from back pain to helping women conceive.
Several months ago one of my patients told me about his Acupuncturists.
I invited him into my practice,and he slowly started to treat patients.
I have to say that I am thoroughly impressed with the results I have seen on both myself and difficult patients.
First for myself ,I have been getting acupuncture and I have noticed that I feel more balanced and less stressed.
Several of my patients that have tried EVERYTHING from Chiropractic,physical therapy etc. starting seeing the acupuncturist and I have seen a improvement in their outcomes.
I recently have combined spinal decompression with acupuncture and have seen some amazing outcomes.
Acupuncture can complement a Back pain treatment protocol.
If you interest in seeing a Acupuncturist in NYC visit our website at www.drshoshany.com
Dr. Zho Zhoung is a Licensed Acupuncturist and is a seventh generation Acupuncturist.
I honestly think he is the Best Acupuncturist in NYC.

Tuesday, February 03, 2009

Non Surgical spinal decompression NYC


Non Surgical spinal decompression NYC

What is Non-Surgical Spinal Decompression?
• Spinal decompression
Chiropractor • Spinal decompression

What is Non-Surgical Spinal Decompression?

Spinal Decompression is a non-invasive, non-surgical therapy where clinical results have been effective in over 86% of patients treated. The common problems of many back conditions are damaged discs and poor spinal muscle control. Spinal decompression treatment addresses both of these core problems. The Spinal decompression system creates a controlled unloading of the vertebra to decrease disc pressure thus increasing blood and nutrient exchange. This exchange of fluids is something the damaged disc needs to help it heal from the inside out.

Which conditions respond well to Spinal Decompression?

The conditions that respond well to spinal decompression include disc herniations (both single and multilevel), disc bulging, degenerative disc disease, facet syndrome, sciatica neuritis, lumbar and cervical radiculopathy, leg pain, carpal tunnel syndrome and osteoarthritis.

How long is the treatment program?

It depends on the complexity and extent of the rehabilitation needed, however we typically treat 3 times per week for 1 month, transitioning from passive to active treatments as the patient responds. The treatment is administered over a reasonable time frame and the patient’s response is continually evaluated. Further treatment may be necessary or a reduced frequency may be recommended at that time. The rehabilitative phase may include additional spinal decompression treatments, with spinal adjustments to enhance the results. Most patients are released from treatment after 8 weeks.

How does it work?

The gentle stretching and relaxing of the spine fosters a phenomenon called “imbibition.” This is the way a normal disc gets nutrition. This pumping action promotes nutrition intake into the discs, something often lost in damaged and degenerative disc conditions. A disc with poor imbibition, fewer nutrients and hydration, is more likely to become injured and painful. Tractioning the spine in a controlled, comfortable manner can help re-establish a more normal imbibition. This can re-supply the disc with nutrients and blood contact that help the disc heal from the inside out. The dramatic increase of pressure in the disc (decompression) can foster the drawing in of a bulge and help take pressure off a “pinched” spinal nerve.

Are spinal decompression treatments safe?

The spinal decompression treatments are one of the most gentle and comfortable therapies available. The treatments utilize FDA cleared equipment with proven safety and efficacy and have never been reported to cause injury. Most patients report a mild sense of stretch on their backs or hips, and often fall asleep during treatment sessions.
Visit my website at www.drshoshany.com