TUESDAY, Nov. 27, 2018 (HealthDay News) –What if a simple zap to the spine could relieve the debilitating lower back and leg pain brought on by a herniated disk?
Such is the promise of “pulse radiofrequency” therapy (pRF), which sends inflammation-reducing pulses of energy to nerve roots in the spine, a new study claims.
The therapy is not new, having first received U.S. Food and Drug Administration approval in the 1980s.
But recent advances in CT scan technology now enable clinicians to deploy those energy pulses with much more accuracy, experts said. And the new research suggests the treatment could prove a boon to back pain patients for whom standard therapies have failed to do the trick.
“I was amazed with the results of pRF,” said study author Dr. Alessandro Napoli. “Especially having read, as a radiologist, numerous lumbar MRI scans of patients with recurrent hernia after surgery.”
And as a patient himself, Napoli added that “from personal experience I can tell you that the treatment is not painful, and the results are appreciated within days after a single treatment lasting 10 minutes.”
Napoli is a professor of interventional radiology at Sapienza University of Rome in Italy.
He and his colleagues plan to report their findings Tuesday at the Radiological Society of North America annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.
Lower disk herniation results when the insulating disks that sit between spinal vertebrae tear open, allowing jelly-like material to protrude and exert pressure on surrounding nerve roots. Beyond lower back pain, the condition often triggers sciatica, a pain that radiates down a patient’s leg.
Standard therapies include over-the-counter pain meds, corticosteroid spinal injections, and/or invasive spine surgery that sometimes involves disk removal and vertebrae fusion.
The problem, said Napoli, is that such options entail risks without assured relief.
“Steroid injections are effective only in portion of the patients, and generally require more sessions,” he noted. And though surgery safety has “largely improved,” Napoli pointed to the risk for bleeding and infection, the need for a minimum two- to three-day hospital stay, the high cost, and the fact that some patients ultimately realize little benefit.
By contrast, pRF is scalpel-free, delivering radio signals directly to affected nerves via a CT scan-guided electrode. The process, said Napoli, requires no hospital stay, is noninvasive, far cheaper and less risky.
“The rationale for using pRF on disk herniation is that we eliminate the inflammation process of the compromised nerve root,” he explained. “Without inflammation the pain fades, and the body starts a self-healing process that allows for complete resolution of the disk herniation in a large proportion of patients.”
For the study, the Italian investigators compared 128 lumbar herniation patients who underwent a single 10-minute round of CT-guided pRF with 120 patients who received one to three rounds of steroid injections.
All the patients had already undergone standard interventions, with poor results.
By the one-year mark following either treatment, a full “perceived” recovery was reported by 95 percent of the pRF patients, compared with just 61 percent of the steroid injection patients.
Dr. Daniel Park, director of minimally invasive orthopedic spine surgery at William Beaumont Hospital in Royal Oak, Mich., offered some caution on the findings.
He noted that because “the majority of people with back pain improve with time and exercise alone,” it remains an open question as to whether the pRF procedure really cured the condition.
Still, Park noted that diagnostic uncertainty can undermine the ability of surgery to get at the true source of a patient’s pain, given that “the problem with low back pain is that there are many causes of it, and physicians have trouble identifying the cause of pain.”
Nevertheless, he remains unsure if pRF is truly ready for prime time.
“Best case, I think [pRF] could be an option for people if they [have already] failed therapy and medication,” said Park. “It may be a similar option for people if they do not or cannot have steroid injections, but they need more treatment. I think this is experimental, and should not be first-line.”
The American Academy of Orthopaedic Surgeons offers more information on herniated disks.
SOURCES: Alessandro Napoli, M.D., Ph.D., interventional radiologist and professor, interventional radiology, department of radiological, oncological and pathological science, Sapienza University of Rome, Italy; Daniel Park, M.D., orthopedic spine surgeon, associate professor, orthopedic spine surgery, and director, Minimally Invasive Orthopedic Spine Surgery, William Beaumont Hospital, Royal Oak, Mich.; Nov. 27, 2018, Radiological Society of North America annual meeting, Chicago
Copyright ©2017 HealthDay. All rights reserved.
THURSDAY, Oct. 25, 2018 (HealthDay News) — Back pain is a common problem in the United States, but there are ways to protect yourself, an expert says.
“The back is a complex structure with many delicate parts, but with good judgment and healthy lifestyle habits — including proper lifting, good posture and exercise — it’s possible to avoid common back pain caused by strained muscles,” said Dr. Lawrence Lenke. He is director of spinal deformity surgery at the Spine Hospital at New York-Presbyterian in New York City.
For more complicated spinal problems such as scoliosis, stenosis, fractures or injuries, medical intervention is usually necessary, Lenke said.
“But each person with or without spinal problems can benefit from adopting healthier lifestyle habits to keep your spine as strong as possible,” he said.
Lenke offered this advice:
- Maintain a healthy weight, don’t smoke, do stretching and strengthening exercises that increase back and abdomen flexibility, and get regular cardiovascular exercise. If your job involves a lot of sitting, get up and walk around every 15 to 30 minutes.
- Maintain good posture even while sitting. Don’t slouch or hold your head too far forward. Be sure your feet are supported, hips are level with or slightly above the knees and your spine is slightly reclined. There should be a small arch in the lower back.
- When sitting at a computer, your shoulders should be relaxed and away from the ears. Your elbows should be at the sides, bent to about 90 degrees, and your wrists should be neutral — not bent up, down or away from each other. Your head should face ahead without being too far forward.
- When using a mobile device for non-voice activities, hold it up instead of bending your neck to look down. At just 45 degrees, the work your neck muscles are doing is equal to lifting a 50-pound bag of potatoes.
- When lifting, make sure objects are properly balanced and packed correctly so weight won’t shift. Keep the weight close to your body. And take your time. Bend at the hips and knees and use your legs to lift. Maintain proper posture with your back straight and head up.
The U.S. Office of Disease Prevention and Health Promotion has more on preventing back pain.
SOURCE: New York-Presbyterian Hospital, news release, Oct. 16, 2018
New research pinpoints three genes responsible for skeletal development that appear to be connected to chronic back pain.
The study authors said their findings could shed new light on the biological factors involved in the development of the condition and lead to new treatments for back pain, which is the leading cause of disability around the world.
For the study, an international team of researchers conducted a genome-wide association to search for gene variants associated with back pain. The study involved 158,000 adults of European ancestry. Of these participants, more than 29,000 suffered from chronic back pain.
The scientists identified three new genetic variants linked to chronic back pain. The SOX5 gene, which is involved in nearly all phases of embryonic development, had the strongest link to the condition.
Previous animal studies have shown that deactivation of this variant is linked to defects in cartilage and skeleton formation in mice.
The study also showed that another gene, which has been associated with intervertebral disc herniation (commonly called a slipped disc), was also linked to back pain. The researchers also identified a third gene involved in spinal cord development, which could affect the risk for back pain due to its influence on pain sensation.
The findings were published Sept. 27 in the journal PLOS Genetics.
“The results of our genome-wide association study point to multiple pathways that may influence risk for chronic back pain,” said study leader Dr. Pradeep Suri, of the U.S. Department of Veterans Affairs in Seattle.
“Chronic back pain is linked to changes in mood, and the role of the central nervous system in the transition from acute to chronic back pain is well-recognized,” he said in a journal news release.
“However, the top two genetic variants we identified suggest causes implicating the peripheral structures, such as the spine,” Suri added. “We expect that further large-scale genetic studies will reveal the importance of both peripheral and central contributors to the complex experience of chronic back pain.”
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases provides more information on chronic back pain.
SOURCE: PLOS Genetics, news release, Sept. 27, 2018
THURSDAY, Aug. 30, 2018 (HealthDay News) — Low back pain is a common health complaint. And if it sidelines you for too long, it can lead to weight gain, a loss in your fitness level and keep you from doing things you love.
But not moving isn’t the answer — specific exercises can help you get back to everyday activities. If you’re under the care of an orthopedist or physical therapist, you may be given a series of exercises to do up to three times a day.
Here are three in particular that may help.
Tummy contractions. Lie on your back with your knees bent, feet flat on the floor hip-width apart, and your hands on your tummy below your ribcage. Tighten your abs — it should feel as though your ribcage is being pressed toward your back. Hold for five seconds, then relax. Repeat 10 times.
Knee-to-chest stretch. Begin in the same starting position, but for this exercise, place both hands on the back of your left thigh and gently pull the knee to your chest. Hold for 20 seconds, then relax. Repeat five times with the left leg, then switch to the right leg and repeat the entire sequence.
Body stretch sequence. Sit on a large exercise ball with knees bent at a 90-degree angle to the floor. Move your feet slightly out to the sides for balance. First, lift your left arm straight up over your head, then lower it and repeat with the right arm; alternate five times. Next, slowly raise and lower your left heel, then slowly raise and lower your right heel; alternate five times. Finally, raise your left arm overhead and your right heel off the floor at the same time, lower them and reverse, raising your right arm overhead and lifting your left heel off the floor; alternate five times.
Another type of exercise that may help is yoga. According to a study published in the Annals of Internal Medicine, people who took a weekly class designed for those with low back pain were helped just as much as those who did traditional physical therapy, and needed less pain medication over time.
The University of California, Berkeley, has detailed information on low back pain and more exercises that can help ease it.
Copyright ©2017 HealthDay. All rights reserved.
(HealthDay News) — Chronic back pain makes it more difficult to do your job, whether you’re behind a desk or operating heavy machinery.
The Mayo Clinic suggests how to avoid back pain at work:
- Maintain good posture.
- Lift with your legs and tighten your core muscles, and avoid twisting.
- When possible, use a lifting device.
- Alternate physically demanding tasks with less demanding ones.
- Limit the time you spend carrying heavy briefcases, purses or bags.
- Listen to your body. Change your position often and periodically walk around and stretch your muscles.
Copyright ©2017 HealthDay. All rights reserved.
Lower back pain is often related to tightness in the surrounding muscles. Here are four exercises and stretches that can offer relief.
Common everyday habits, like sitting at your desk for long periods of time, can leave you with lower back pain and decreased mobility. While we recommend consulting an orthopedic specialist to rule out a serious injury, in many cases a few basic physical therapy exercises can help relieve your symptoms.
Focus on exercises that help you stretch tight muscles, as well as strengthen the torso to relieve stress on the lumbar spine. While the pain may be concentrated in the lower back, muscles connected to the area, like the hamstrings, may also be a cause of discomfort. The following exercises can help you strengthen supporting muscles and release tension in the area as a whole
1. PIRIFORMIS STRETCH
The piriformis muscle in the buttock stretches from the bottom of the spine to the femur. Piriformis tightness, especially if it irritates the nearby sciatic nerve, can cause pain that runs from the lower back all the way into the legs and feet.
To stretch this muscle, first lie flat on your back. Cross your right leg over your left, grasping your right shin with your left hand. Gently pull your right ankle over to the left side of your body and up toward your chest. Hold for 30 seconds. Then bend your left knee and bring it up toward your right leg. Grasp your left knee with your left hand and gently pull it toward your torso. You should feel this stretch in your top leg. Hold this pose for 30 seconds, and repeat with the other side. This exercise can help relieve much of the tightness that can build from sitting all day or overusing the muscle.
2. PSOAS MAJOR STRETCH
The psoas major muscle, also known as your hip flexor, connects your lower spine to the top of your thigh, and can become tight and tense if you stay seated for too long. The discomfort may manifest in your lower back as well as your hips. Symptoms of an injury can include difficulty kneeling, standing for long periods, or rising from a seated position.
To perform this stretch, lie on your back, either with your buttocks at the edge of a bed, or on the floor with a towel or foam roller beneath your lower back. You want your extended legs to be able to drop downward, if possible. Bend one knee and bring it up to your chest, pulling it gently with your hands. Hold the stretch for 30 seconds to a minute, as long as you don’t feel pain. Repeat with the other leg, and stretch each leg at least three times.
3. HAMSTRING STRETCH
The hamstrings run down the back of your thighs, from the hips to the back of the knees These muscles can easily become tight and cause discomfort in your lower back, especially if you spend eight hours a day sitting in an office chair. Performing hamstring stretches for at least 30 seconds to a minute, twice a day, can go a long way toward easing tension.
One simple stretch is the chair hamstring stretch. While standing, place the heel of one foot on a chair so that your leg makes a straight line. Bending from your hips, lean forward and reach toward your toes. Stop and hold when you feel a stretch in the back of your thigh. Then repeat with the other leg.
Alternatively, you can try a wall hamstring stretch, which allows you to lie down and avoid stress on the spine. It’s best to use a doorway where you can stretch one leg at a time, but you can also lie on your back and put both of your legs straight up on the wall at once, with your buttocks next to the wall. As you inch close to the wall and straighten your knees, you should feel the stretch in the back of your legs.
4. BIRD DOG
This mat exercise will help you strengthen and stabilize your lower back. Start on your hands and knees with your core tight and your back flat. Extend one leg behind you, with your hips level, and hold for 5-10 seconds. Then simultaneously lift your opposite arm out in front of you and hold. Repeat this 10 times for each leg, and be sure to keep your core tight and your back in position throughout.
LOWER BACK EXERCISES TO AVOID
The above exercises are an effective way to relieve lower back pain. However, there are some exercises that can make the issue worse. Touching your toes, for example, can stress the spine and overstretch your hamstrings. We also advise against doing sit-ups if you’re suffering from back pain, since they tend to actually stress the hips and put pressure on the spinal discs.
It’s best to perform the above exercises after consulting a doctor, and under the supervision of a physical therapist. Be sure to warm up and cool down when you attempt these stretches, to avoid stressing the area and causing spasms or strains. Never force the body into a position that causes pain. In some cases, back issues may be related to “inhibited” muscles, which do not respond to strengthening exercises, and may require an orthopedic specialist’s intervention.
If you’ve tried these exercises and your back pain persists or worsens, the orthopedic specialists at CompOrtho can help you rule out underlying issues and help you develop a productive healing plan.