New Standards for the Diagnosis of Lumbar Spinal Canal Stenosis
It’s one of the more common spinal problems for people over 55 – lumbar spinal stenosis.
You get low back pain and leg pain that’s worse standing or walking. You feel better bending forward or sitting down. And your legs tire prematurely when you walk.
The symptoms of spinal stenosis are commonly caused by narrowing of the spinal canal from gradual spinal joint degeneration. The nerves of the spinal cord get pinched, causing pain and leaving your leg muscles weakened.
Although spinal stenosis is common, the standards for diagnosing it are controversial. Some doctors focus on the nature of the pain and the way it behaves. Others focus on imaging studies such as MRIs that picture the amount of space available for the spinal cord.
The problem is that not everyone with stenosis-like symptoms has canal narrowing that shows up on MRI. And vice versa – not everyone with spinal canal narrowing has pain, weakness, or other symptoms.
Touch in Communication and Health
The sense of touch bonds families and groups, guides the brain of infants as they learn to understand the world, enhances healing, and serves as a private communication link between intimate partners.
Even though you rarely think about it, the nerve receptors in your skin are constantly engaged in picking up information.
And your tactile system is more sophisticated than you may realize. Here are some examples. Read the rest of this entry »
Hospitals Benefit From High Rate of Surgery Mistakes
It’s a tragedy that the current medical system has strayed so far from its basic mission of protecting people’s health. Financial incentives have become so skewed that they actually encourage sub-standard care.
Two recent articles offer powerful evidence.
Improving Hamstring Rehab Exercises
I always dread it.
I’m treating an athlete with a hamstring strain, and I have to pass on the negative news – hamstring problems are notorious for their high recurrence rate. Even though your muscle may be healed and tests show that you’ve regained normal strength, once you’re back participating in sports or fitness activities there’s a fair chance your problem will recur.
In fact, one study illustrated the limitations of the standard rehabilitation protocol for hamstring injuries – stretching and strengthening of the injured muscle. Unfortunately, 6 out of 11 injured athletes using this rehab strategy for their hamstrings had their problem recur within 2 weeks of returning to normal activities. Those aren’t good odds.
Rewrite Your Experience of Depression and Chronic Pain
Step 7 of Dr. Lavine’s Ten Step Program to Conquer Chronic Illness
Physical exhaustion and low mood, often inseparable from chronic pain, shouldn’t be ignored. In fact, surveys of fibromyalgia sufferers show that more than 80% experience an almost overwhelming level of fatigue that at times is worse than the pain.
The emotional aspect of physical fatigue is depression.
Of course, fatigue and depression are complex, and self-help guidelines such as these can’t possibly address your unique individual issues. I also recommend that you consult your personal physician, nutritionist, or mental health professional as appropriate.
For Step 7 of Dr. Lavine’s Ten Step Program to Conquer Chronic Illness, I recommend two self-help strategies. One is a simple method to address distortions of your mood. The second involves tested sleep strategies to improve the quantity and quality of sleep.
Weight Loss Secrets
Nearly everyone wants to lose a few pounds. In many cases, more than just a few.
In fact, it’s been theorized that if everyone who wanted to lose an extra 10–20 pounds actually lost the weight and kept it off, the cumulative disappearance of body mass would destabilize the earth’s orbit and send the planet hurtling off into interstellar space. (Actually, no reputable physicist has theorized that at all. I just made it up myself.)
But control of body weight is an important health and diet concern. And it’s a challenging medical issue.
Research deepens questions about low back mri
The March 25, 2013 edition of JAMA Internal Medicine tells the story: doctors are still ordering far too many low back MRI’s of questionable value.
Investigators first established “expert” guidelines that identified situations in which MRI’s were likely to yield useful clinical information.
Frailty Syndrome
For today’s guest article I’d like to thank Laurie G. Jacobs, M.D., director of the Jack and Pearl Resnick Gerontology Center, Albert Einstein College of Medicine and Vice Chair, Clinical and Educational Programs, Montefiore Medical Center.
This blog post first appeared in The Doctor’s Tablet, the official blog of Albert Einstein College of Medicine.
Frailty: How a Constellation of Symptoms Leads To Risk
by Laurie G. Jacobs, M.D. on March 12, 2013
Frailty Syndrome
Fragile: This Side Up. Few of us find much ambiguity when faced with a mail parcel marked with those four words. Yet the related word “frailty” often causes confusion among doctors and patients alike. The word “frail” applies to people, not things—and that’s where the topic becomes tricky.
Once Again Research Shows MRIs Not Helpful in Understanding Low Back Pain
In March, 2013, the New England Journal of Medicine published the results of a Dutch study on the value of MRI in assessing patients with sciatica.
Scientists took MRI’s of patients with sciatica and followed up with a second MRI one year later. They also charted patients’ recovery from back pain. Meanwhile, some of the patients had undergone disc surgery. Others hadn’t.
Those who had had surgery were less likely to have a herniated disc show up on their follow-up MRI. But the MRI picture of the discs didn’t correlate with freedom from pain. After one year, those who still had a visibly herniated disc were equally likely to be pain-free.
Even if the MRI showed the disc bulging out and pinching a nerve, it didn’t mean that the person was more likely to have pain.
Here’s a quote from study author Wilco C. Peul, MD, PhD, Department of Neurosurgery, Leiden University Medical Center, The Netherlands:
Read the rest of this entry »
Dynamic Control of Movement is Key to Low Back Pain
People with low back pain often also have poor control of low back movement. Fortunately, we’ve come a long way from the days when all we knew about control of low back movement was the idea of having “strong abs”. The dynamic control of posture and spinal movement is far more subtle. Scientists can now quantify some of the details:
