Wednesday, July 29, 2009

Laser therapy for disc herniation in NYC

Laser Therapy for Disc Herniations

Cold laser therapy in Manhattan,NYC

By Fred Kahn, MD, FRCS(c) and Michael Patterson, MSc

Low back pain has obvious lifestyle and financial burdens; when it is accompanied by radiation of pain and numbness in the lower extremities, it can be truly debilitating. Lumbar disc herniations account for only 4 percent of low back pain patients, but account for a high percentage of low back pain costs.

A painful disc herniation results when a tear of the annulus fibroses allows migration of the nucleus pulposus (protrusion), resulting in nerve root irritation. Lumbar disc herniations typically occur in individuals between the ages of 30-40 years,1-2 when the nucleus pulposus is still fluid and the annulus is weakened by strenuous activity and age. Due to this relatively young demographic, poor treatment outcomes can result in decades of suffering for these patients.

Prior to the existence of imaging studies, little was known about the healing mechanism of disc herniations. Imaging studies have confirmed what has been long suspected: Disc herniations can decrease in size and even disappear spontaneously, leading to decreased pressure on the nerve root.3

In adult discs, blood vessels are normally restricted to supplying only the outer layers of the annulus. Low oxygen tension at the center of the disc leads to an anaerobic metabolism, resulting in high concentrations of lactic acid and low pH. These deficiencies in metabolite transport limit both the density and metabolic activity of disc cells.4 Collagen turnover time in articular cartilage is approximately 100 years5 and is theorized to be even longer in the disc.6The result is that intervertebral discs have a limited ability to recover from metabolic or mechanical injuries such as herniations.

There have been a number of mechanisms investigated in attempts to determine how disc herniations heal. It is generally accepted that the herniated disc fragments are reabsorbed.7-8 Histological investigations have shown the presence of granulation tissue with abundant vascularization surrounding the fibrocartilaginous fragments.7 Within the granulation tissue, the prevailing cell types are macrophages with fibroblasts and endothelial cells.8 These cell types have been demonstrated to be positively affected by laser therapy. Thestimulation of macrophages and fibroblasts could be the primary mechanism by which laser therapy heals disc herniations.9

Inflammatory markers such as IL-1, IL-6 and TNF-a are also present at the site of disc herniations, leading to higher prostaglandin E2 concentrations. Two studies have demonstrated that laser therapy is effective in reducing prostaglandin E2 concentrations.10-11 Bjordal has demonstrated that inflammation is greatly reduced 75, 90, and 105 minutes after active laser therapy compared to levels prior to treatment.11 The reduction in inflammation appears to be another method by which laser therapy promotes healing in disc herniations.

There is substantial published research on the effectiveness of laser therapy in treating LBP and lumbar disc herniations. The majority of these research articles discuss chronic (nonspecific) low back pain either alone12-14 or with exercise.15-16 These positively inclined studies seem to be absent in reviews from either the American Pain Society / American College of Physicians17 or the Cochrane Collaboration.18

In the review of laser therapy for low back pain performed by the American Pain Society / American College of Physicians, four trials (566 patients) demonstrated that laser therapy was effective and one trial (140 patients) found laser therapy to be no more beneficial than a sham laser device. The conclusion from this review was: "Non-invasive therapies (low-level laser therapy) have not been shown to be effective for chronic, sub-acute or acute low back pain."17 A letter to the authors regarding their bias against laser therapy and in support of pharmaceuticals19 only prompted the authors to downgrade the evidence supporting acetaminophen and cite the Cochrane study to support their stance on laser therapy.

The Cochrane study they refer to found that "three high quality studies (168 people) separately showed statistically significant pain relief with laser therapy in the short-term (less than three months) and intermediate term (less than 6 months) when compared with sham laser therapy."18 Two small trials (151 people), also included in the Cochrane review, independently found that the relapse rate in the laser therapy group was significantly lower than in the control group at six-month follow-up. The conclusion was that "based on these trials, with a varying population base, laser therapy dosages and comparison groups, there is insufficient data to either support or refute the effectiveness of laser therapy for low back pain."

The resounding statements from both of these meta-analyses were that "more studies are required" and "larger trials on specific indications are warranted." Lacking in the conclusions were any suggestion of "how many patients and studies" are required to provide sufficient evidence. A recent study examining the effectiveness of laser therapy in treating lumbar disc herniations as measured using clinical evaluation and magnetic resonance imaging (MRI) found that "low power laser therapy is effective in the treatment of patients with acute lumbar disc herniations."20

Invariably, studies provoke questions. Some of the more common parameters for consideration are duration and extent of laser therapy treatment, joules per centimeter square of irradiation, power settings, etc. One must conclude these studies and meta-analyses, although well-intentioned, may in many instances be misguided. In our experience, almost 40 percent of all patients presenting for treatment suffer from back problems characterized by severe pain, and more than 85 percent can be treated successfully with laser therapy.21

The financial justification for the use of laser therapy as the first line of defense in disc herniations is overwhelming. Data collected from the SPORT trial found that the average surgical procedure cost $15,139, which rises to $27,341 when other costs such as diagnostic tests and missed work are factored in.21 The cost of conservative treatment in that same study averaged $13,108. In our experience, even the most extreme example of a herniated disc patient (receiving 40 treatments), resulted in a total treatment cost of just $3,200. When diagnostic tests and health care visits are factored into this equation, the total cost of laser therapy is closer to $5,700. This is a savings of more than $20,000 versus surgery and $7,500 over standard conservative treatment. Moreover, laser therapy is noninvasive and no adverse events have been reported in more than 3,000 publications.

In summary, this review of the current literature clearly reveals some of the shortcomings of meta-analyses and the performance of studies without standardized methodologies. We conclude that medical convention has demonstrated that the relief of symptomatic disc herniations continues to be problematic; and that both conservative and surgical solutions in the majority of cases appear to be equally ineffective. While the application of appropriate therapy requires a comprehensive understanding of the anatomy, pathology and biomechanics of the spinal column, we feel that laser therapy presents the most logical and effective therapeutic approach in managing these pervasive medical conditions.

References

Adams MA, Hutton WC. Prolapsed intervertebral disc. A hyperflexion injury. 1981 Volvo Award in Basic Science. Spine, 1982;7:184-191.
Gallagher S. Letter to the editor. Spine, 2002;27:1378-1379.
Teplick JG, Haskin ME. Spontaneous regression of herniated nucleus pulposus. Am J Roentgenol, 1985;145(2):371-5.
Urban JP, Smith S, Fairbank JC. Nutrition of the intervertebral disc.Spine, 2004;29(23):2700-9.
Verzijl N, DeGroot J, Thorpe SR, Bank RA, Shaw JN, Lyons TJ, Bijlsma JW, Lafeber FP, Baynes JW, TeKoppele JM. Effect of collagen turnover on the accumulation of advanced glycation end products. J Biol Chem, 2000;275(50):39027-31.
Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine, 2006;31(18):2151-61.
Doita M, Kanatani T, Harada T, Mizuno K. Immunohistologic study of the ruptured intervertebral disc of the lumbar spine. Spine, 1996;21(2):235-41.
Groenblad M, Virri J, Tolonen J, Seitsalo S, Kaeaepae E, Kankare J, Myllynen P, Karaharju EO. A controlled immunohistochemical study of inflammatory cells in disc herniation tissue. Spine, 1994;19(24):2744-51.
Young S, Bolton P, Dyson M, Harvey W, Diamantopoulos C.Macrophage responsiveness to light therapy. Lasers Surg Med, 1989;9(5):497-505.
Lim W, Lee S, Kim I, Chung M, Kim M, Lim H, Park J, Kim O, Choi H. The anti-inflammatory mechanism of 635 nm light-emitting-diode irradiation compared with existing COX inhibitors. Lasers Surg Med, 2007;39(7):614-21.
Bjordal JM, Lopes-Martins RA, Iversen VV. A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med, 2006;40(1):76-80.
Toya S, Motegi M, Inomata K, Ohshiro T, Maeda T. Report on a computer randomized double blind trial to determine the effectiveness of the effectiveness of the GaAlAs (830nm) diode laser for attenuation in selected pain groups. Laser Therapy, 1994;6:143-148.
Soriano F, Rios R, Gallium Arsenide laser treatment of chronic low back pain: a prospective, randomized and double blind study. Laser Therapy, 1998;10:175-180.
Basford JR, Sheffield CG, Harmsen WS. Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil, 1999;80(6):647-52.
Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ, Karakoc M. Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Lasers Surg Med, 2003;32(3):233-8.
Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G. In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial. Aust J Physiother, 2007;53(3):155-60.
Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.Ann Intern Med, 2007;147(7):492-504.
Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri SA, Mortaz Hejri SO, Jonaidi A. Low level laser therapy for nonspecific low-back pain.Cochrane Database Syst Rev, 2008: CD005107.
Bjordal JM, Klovning A, Lopes-Martins RA, Roland PD, Joensen J, Slordal L. Overviews and systematic reviews on low back pain. Ann Intern Med, 2008;148(10):789-90.
Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniationmeasured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther, 2008;31(3):191-8.
Tosteson AN, Skinner JS, Tosteson TD, Lurie JD, Andersson GB, Berven S, Grove MR, Hanscom B, Blood EA, Weinstein JN. The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine, 2008;33(19):2108-15.
Kahn F. Low intensity laser therapy: The clinical approach. Proc of SPIE, 2006:6140, 61400F-1-61400F-11.

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Dr. Fred Kahn is a graduate of the University of Toronto, Faculty of Medicine, a fellow of the Royal College of Surgeons of Canada and the diplomate of the American Board of Surgery. He is the founder of Meditech International, Inc.


Dr. Michael Patterson received his undergraduate and master's degrees in medical biophysics from the University of Western Ontario. He is the research and education manager for Meditech.

Cold laser therapy is used in our NYC Physical therapy practice along with other cutting edge techniques and devices.
DRX 9000 non-surgical spinal decompression for herniated disc and sciatica, Graston technique for Soft tissue injuries.
www.livingwellnewyork.com

Thursday, July 09, 2009

Herniated disc NYC, New York City Herniated disc treatment, DRX 9000-Interview with Dr. Albrecht Heyer PHD-and Dr.Steven Shoshany

videoDR. ALBRECHT HEYER, PHD.,DSC interviews Dr. Steven Shoshany, DC,CCEP,CKTP on the benefits of spinal decompression to treat Chronic back pain,herniated disc and Sciatica. This video is from the "Heyer insights" originally aired on Manhattan,NYC Time Warner channel 35. I will be posting these videos on my Herniated disc page. This half hour video is very informative. Learn more about spinal decompression for herniated disc,Sciatica,leg pain by visiting my website www.drshoshany.com Dr. Heyer is a internationally recognized expert on health and healing and is in private practice in Manhattan. This interview allowed me the opportunity to discuss the different areas that our practice www.livingwellnewyork.com take in dealing with difficult to treat chronic back pain cases and herniated disc/sciatica conditions. Topics discussed include Sciatica/leg pain Disc herniation Chronic back pain orthotic fabrication Physical therapy and Rehabilitation Office ergonomics and methods to prevent back pain Chiropractic in NYC with Dr. Steven Shoshany call
(212) 645-8151

Tuesday, July 07, 2009

Kinesio tape for ankle sprain-Chiropractor NYC




I found this great article on how Kinesio tape helped a dancer with a ankle sprain/strain.
I have been using this tape with excellent results in my NYC Chiropractic practice.


Stuck on It
By Nancy Wozny

Houston Ballet trainer Mike Howard tapes Hitomi Takeda's legNavigating William Forsythe’s The Vertiginous Thrill of Exactitude last season, Houston Ballet corps member Hitomi Takeda took a serious fall, ending up with a lateral ankle sprain. With Stanton Welch’s world premiere of Marie and a tour of Spain on the horizon, an injury was the last thing Takeda needed. After a trip to the doctor, four days of rest, ice, compression, and elevation (the RICE protocol for injuries) and no signs of a limp, Takeda had her first application of Kinesio tape from Houston Ballet’s athletic trainer Mike Howard. The petite dancer sailed through Marie and the six-city tour without further strain. “I was wearing the Kinesio right under my tights,” she says.


Many dance medicine specialists and dancers have begun to use Kinesio. Developed more than 25 years ago, the method drew worldwide interest last summer when the U.S. Olympic volleyball player Kerri Walsh wore the tape to support her shoulder during the 2008 Games in Beijing. Unlike traditional athletic tape, the latex-free Kinesio stretches easily, and permits greater range of motion, making it popular with dancers. “The old way of taping tried to support ligaments, but we have learned it gave less support than we suspected,” says Dr. Rebecca Clearman, M.D., a physiatrist who works with Houston Ballet’s dancers. “Kinesio, on the other hand, helps dancers self-correct. If a dancer is hyper-extending, it can serve as a reminder.”


Kinesio can be used to stimulate or relax a muscle, depending on the direction of the recoil of the stretched tape, says Jennifer Janowski, a physical therapist at Chicago’s Athletico, a sports medicine physical therapy facility. Janowski has been working with Joffrey Ballet dancers for five years. “I use Kinesio on just about every dancer who walks through my door for all stages of injury, from recovery to prevention,” she says. “It’s like a brace, but better, because of the neuromuscular input.” She recommends getting the tape applied initially by a dance medicine professional with a knowledge of dance mechanics until the injured person learns how to use the tape correctly.


Whether relaxing or activating, the tape gets placed along the line of the muscle. For activating, the direction of the tape goes from muscle origin to insertion. “For supporting a fatigued Achilles tendon you would start the tape from the muscle belly and then run it to the Achilles,” Janowski says. “This would reinforce the Achilles to help prevent tendonitis.”


To relax a muscle, reverse the direction from insertion to origin. If a dancer has knee pain from overusing his quadriceps in jumping, for instance, Janowski tapes the quadriceps away from the activation point. This allows the tape recoil to pull back the fascia (the thin sheath tissue that encases all muscles) and relax the tension on the knee cap. The tape’s degree of stretch determines the strength of the recoil action, so each application can be tailored to a dancer’s needs. “Of course,” Janowski adds, “the dancer also should be reminded of the ways that their body mechanics are leading to these problems.”


Kinesio can also speed healing in an injury site. The tape improves lymphatic drainage by gently pulling the skin away from the fascia layer. “The application is done in a criss-cross pattern with finger-like projections coming out of the tape. This is close to the body’s own drainage system,” says Janowski.


However, Kinesio has its limits. Most bone fractures need to be treated with a cast. The tape should not be used over an open wound, though once the wound heals, Kinesio can help reduce swelling. Clearman and Janowski agree that Kinesio hastens dancers’ safe return to the stage. “It allows you to perform while still protecting yourself,” says Janowski.


Takeda will be the first to admit that Kinesio is not a magic bullet. She still had to strengthen her ankle and make sure she was following the RICE procedure correctly. Six months after the injury, Takeda continues to use the tape from time to time. “I have to take care of myself and use ice periodically, but the tape keeps my ankle alignment in check. I don’t roll in as much anymore. And,” she adds with a smile, “I have finally learned how to put it on myself.”



Nancy Wozny writes about health and the arts from Houston, TX.



Photo: Amitava Sarkar, Courtesy Houston Ballet

Kinesio tape in Manhattan,New York City (NYC)
visit
www.drshoshany.com

Wednesday, July 01, 2009

Preventing back pain tips from Chiropractor NYC


Preventing back pain tips from Chiropractor NYC-Dr. Steven Shoshany D.C, C.C.E.P.
www.drshoshany.com


I wish everyone a Happy 4th. of July, If you are traveling this weekend read this article from the American Chiropractic Association below on ways to prevent Back from travel.


Travel Aches and Strains Can Be a Pain In Your Back


Traveling can be rough on the body. Whether you are traveling alone on business or on your way to a sunny resort with your family, long hours in a car or an airplane can leave you stressed, tired, stiff and sore.

"Prolonged sitting can wreak havoc on your body," says Dr. Scott Bautch, a member of the American Chiropractic Association's (ACA) Council on Occupational Health. "Even if you travel in the most comfortable car or opt to fly first class, certain pressures and forces from awkward positions can result in restricted blood flow. One of the biggest insults to your system from prolonged sitting is the buildup of pressure in the blood vessels in your lower legs. Contracting and relaxing the muscles helps the blood flow properly."

Dr. Bautch and the ACA suggest the following tips and advice to fight the pains and strains of travel before they occur.

Warm Up, Cool Down
Treat travel as an athletic event. Warm up before settling into a car or plane, and cool down once you reach your destination. Take a brisk walk to stretch your hamstring and calf muscles.

In the Car:

Adjust the seat so you are as close to the steering wheel as comfortably possible. Your knees should be slightly higher than your hips. Place four fingers behind the back of your thigh closest to your knee. If you cannot easily slide your fingers in and out of that space, you need to re-adjust your seat.
Consider a back support. Using a support behind your back may reduce the risk of low-back strain, pain or injury. The widest part of the support should be between the bottom of your rib cage and your waistline.
Exercise your legs while driving to reduce the risk of any swelling, fatigue or discomfort. Open your toes as wide as you can, and count to 10. Count to five while you tighten your calf muscles, then your thigh muscles, then your gluteal muscles. Roll your shoulders forward and back, making sure to keep your hands on the steering wheel and your eyes on the road.
To minimize arm and hand tension while driving, hold the steering wheel at approximately 3 o'clock and 7 o'clock, periodically switching to 10 o'clock and 5 o'clock.
Do not grip the steering wheel. Instead, tighten and loosen your grip to improve hand circulation and decrease muscle fatigue in the arms, wrists and hands.
While always being careful to keep your eyes on the road, vary your focal point while driving to reduce the risk of eye fatigue and tension headaches.
Take rest breaks. Never underestimate the potential consequences of fatigue to yourself, your passengers and other drivers.
In an Airplane:

Stand up straight and feel the normal "S" curve of your spine. Then use rolled-up pillows or blankets to maintain that curve when you sit in your seat. Tuck a pillow behind your back and just above the beltline and lay another pillow across the gap between your neck and the headrest. If the seat is hollowed from wear, use folded blankets to raise your buttocks a little.
Check all bags heavier than 5-10 percent of your body weight. Overhead lifting of any significant amount of weight should be avoided to reduce the risk of pain in the lower back or neck. While lifting your bags, stand right in front of the overhead compartment so the spine is not rotated. Do not lift your bags over your head, or turn or twist your head and neck in the process.
When stowing belongings under the seat, do not force the object with an awkward motion using your legs, feet or arms. This may cause muscle strain or spasms in the upper thighs and lower back muscles. Instead, sit in your seat first, and using your hands and feet, gently guide your bags under the seat directly in front of you.
While seated, vary your position occasionally to improve circulation and avoid leg cramps. Massage legs and calves. Bring your legs in, and move your knees up and down. Prop your legs up on a book or a bag under your seat.
Do not sit directly under the air controls. The draft can increase tension in your neck and shoulder muscles.
Safe Travel For Children:

Always use a car seat in a car when traveling with children below the age of 4 and weighing less than 40 pounds.
Ask the airline for their policy on child car seat safety. Car seats for infants and toddlers provide added resistance to turbulent skies, and are safer than the lap of a parent in the event of an unfortunate accident.
Make sure the car seat is appropriate for the age and size of the child. A newborn infant requires a different seat than a 3-year-old toddler.
Car seats for infants should always face the rear. In this position, the forces and impact of a crash will be spread more evenly along the back and shoulders, providing more protection for the neck.
Car seats should always be placed in the back seat of the car-ideally in the center. This is especially important in cars equipped with air bags. If an air bag becomes deployed, the force could seriously injure or kill a child or infant placed in the front seat.
Make sure the car seat is properly secured to the seat of the vehicle and is placed at a 45-degree angle to support the head of the infant or child.
Chiropractic Care Can Help...
"If you follow these simple tips, you can enjoy pain-free, safe travel," says Dr. Bautch. "If you do experience pain and stress on your back, doctors of chiropractic are trained and licensed to diagnose and treat problems of the spine and nervous system."

We will be open Monday morning July 6th. for those sprained backs and tennis injuries!

DRX 9000 NYC, sciatica nyc, herniated disc nyc, non-surgical spinal decompression.
Call 212 645-8151 or visit www.drshoshany.com