Pain-Lower back pain-chronic pain-back pain-neck pain-nerve pain-work related injuries-cancer related pain-traumatic insult-Sciatica

December 1, 2007

ALL About Pain-Lower back pain-chronic pain-back pain-neck pain-nerve pain-work related injuries-cancer related pain-traumatic insult-Sciatica

Filed under: Pain Management — Thomas @ 3:21 am

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01. Pain Management as a Method of First Resort, Not Last
by: Leslie McKerns

02. Lower Back Pain – Hip External Rotation
by: Jennifer Chu, M.D.

03. Lower Back Pain- Thigh Abduction
by: Jennifer Chu, M.D.

04. Low Back Pain- Hip Pain – Adduction
by: Jennifer Chu, M.D.

05. Back Exercises
by: Clinton Walker III

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01. Pain Management as a Method of First Resort, Not Last
by: Leslie McKerns

In treating acute or chronic pain, it has long been accepted that physicians had two basic options to alleviate suffering: surgery or pain medication. Now there is a third option–pain alleviating, non-invasive pain management procedures used as the method of first resort, not last.

Creative, innovative solutions to previously persistent painful disorders are increasingly making surgery unnecessary. Pain management includes pain alleviating treatment for back pain, neck pain, nerve pain, work related injuries, cancer related pain, traumatic insult, Sciatica (compression or irritation of the sciatic nerve), Spinal Stenosis (build-up of bone in the spinal cavity), Spinal Cord Injuries, Post Stroke Pain, Shingles, Herniated Disks and Reflex Sympathetic Dystrophy (RSD) also known as Complex Regional Pain Syndrome.

Pioneering pain management techniques performed by Board Certified Pain Management physicians include highly specific injection procedures eliminating pain at its source by isolating the nerve ending to the painful spot. The breakthrough process numbs or freezes the nerve and keeps it numb for up to a year. Benefits include avoiding costly major surgery, lengthy recovery times and the risks of infection or debilitating complications.

Who experiences pain?

According to the American Chronic Pain Association, pain affects 86 million Americans, causing losses to US business and industry of $90 billion. Back pain is the leading cause of disability in Americans under 45 years old, and more than 26 million Americans between the ages of 20 and 64 will have back pain during their lifetime. Many back pain problems occur following injury, strain and accidents causing fractures, lumbar muscle strains and ruptured/herniated discs.

Other causes of pain include degenerative changes caused by the normal aging process. The US Census bureau reported 78.2 million Baby Boomers in 2005, (nearly a quarter of the U.S. population). In 2006 there were 7,918 people turning 60 each day—representing 330 every hour. Baby Boomers are an active generation—working longer and playing harder than previous generations. Sports activities, repetitive stress and ambitious weekend projects account for painful conditions and injuries.

According to the National Osteoporosis Foundation (NOF), osteoporosis is responsible for more than 300,000 bone fractures annually, costing the nation $17 billion. According to the NOF, osteoporosis affects 44 million American men and women age 50 and older, and one in two women and one in four men in this age group will break a bone due to osteoporosis.

Recent advances in technology, new techniques and minimally invasive procedures in interventional pain medicine have eliminated many of the sources of pain, allowing patients to return to a normal level of activity.

What is the non-invasive nature of the treatment?

Over the last twenty years, many chemical and anatomic pain pathways have been identified and studied. The Board Certified pain medicine specialist often performs diagnostic injections, usually with enhanced fluoroscopic guidance. These injections isolate and confirm the source of the patient’s pain. Once identified, these painful structures are medically treated.

Medication can be injected at the exact site of the injury or compressive lesion. Epiduroscopy is the insertion of a fiber optic filament through a needle directly into the spine. This is connected to a television monitor to visualize the inside of the spinal canal, spinal cord and spinal nerves. This procedure has been effective in making accurate diagnosis, accomplishing precise injections, cutting of epidural adhesions and scar tissue and the removal of toxins liberated by injured discs.

Injured or painful facet joints can be injected with steroids. If long-term pain relief is not accomplished, these patients are often treated with Radiofrequency rhyzotomies. These Radiofrequency procedures numb the facet joints and eliminate the patient’s pain for approximately one year. These are outpatient or office procedures, which often provide immediate pain relief and allow the patient to return home after a 30-45 minute recovery period.

Discogenic pain due to injured and herniated discs is now being treated with new outpatient procedures called an IDET (Intradiscal Electrothermal Treatment) procedure and a Nucleoplasty. A special wire electrode is inserted through a needle into a disc and directed to the affected area of the disc herniation. Once in place, the electrode is heated with Radiofrequency or designed to create an electromagnetic field. This causes cauterization and vaporization of the disc, proliferation and tightening of the protein matrix of the disc, shrinking of small herniations and disc denervation or numbing. The final effect of this process is the relief of pain and the creation of more collagen within the disc.

Rather than simply administering pain medication, Board Certified Pain Management physicians diagnose the sources of pain and provide pain relief through these and other minimally invasive techniques.
About The Author

Leslie McKerns of McKerns Development writes about issues in the professions. http://www.freewebs.com/mckernsdevelopment/

Want to know more about Board Certified Pain Management physicians and minimally invasive treatment options? Visit

02. Lower Back Pain – Hip External Rotation by: Jennifer Chu, M.D.

Lower back pain is commonly due to irritation of the L5 and S1 nerve roots. Hip pain may result secondary to pain and spasm muscles of the lower back and all muscles that cross the hip.

Patients may have trouble with external rotation of the hip due to pain and spasm of muscles that perform external rotation or from pain and spasm of muscles that perform internal rotation and thus limiting the performance of the external rotators.

This week, we shall talk about muscles that perform external rotation. To test these muscles, the patient should lie on his stomach and bend the knee up. The patient then turns the leg and foot in toward midline. This motion produces external rotation of the hip. To test the strength of the external rotators, the examiner must try to push the leg outward away from the midline.

The hip external rotators are:

* gluteus maximus lower fibers (inferior gluteal nerve L5, S1 primarily S1)
* obturator internus (L5, S1, S2)
* superior gemellus (L5, S1, S2)
* inferior gemellus (L4, L5, S1)
* quadratus femoris (L4, L5, S1)
* obturator externus (obturator nerve, L2, L3, L4)
* adductor magnus, lower portion (sciatic nerve, L5, S1)
* adductor brevis (obturator nerve, L2, L3, L4)
* piriformis (S1, S2)

03. Lower Back Pain- Thigh Abduction by: Jennifer Chu, M.D.

Patients with lower back pain often secondary to irritation of the L5 and S1 nerve roots will have difficulty not only due to the pain but due to weakness of the hip abductor muscles.

The most powerful hip abductor is the gluteus medius. It is supplied by the superior gluteal nerve (L4, L5 and S1). The L5 nerve root has the strongest representation in this muscle. The other hip abductors are the other muscles are tensor fascia latae and gluteus minimus which are also supplied by the superior gluteal nerve.

Hip abduction can be tested with the patient supine with the thighs spread apart. The examiner then pushes the thigh inward to the midline. The hip abductors can also be tested with the patient lying on his side with the tested side uppermost. The patient then lifts the thigh up against gravity.

The most functional way of testing for hip abduction is to have the patient stand on one limb. If he is standing on his right leg and if he has weakness in his right hip abductor muscles his opposite hip will drop. This testing is called the Trendelenburg testing. To prevent the left hip from dropping in the case of a right hip abductor weakness, the patient may lean over to the right. This is also an indicator of weakness of the hip abductors on the right side..

Jennifer Chu, M.D., founder of eToims Soft Tissue Comfort Center® is also President and CEO of eToims Medical Technology LLC, a medical device company with training programs in eToims® Twitch Relief Method. She is an Emeritus Associate Professor in the Department of Physical Medicine and Rehabilitation at the University of Pennsylvania, where has been on faculty for more than 30 years. http://www.stopmusclepain.com
04. Low Back Pain- Hip Pain – Adduction by: Jennifer Chu, M.D.

Patients with lower back pain from irritation of the L5 and S1 nerve roots often have weakness from pain and spasm in the hip abductor muscles and the hip extensor muscles. This allows for imbalanced contraction of the hip adductor muscles since the opposition muscles are weak.

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The hip adductors then become tight and shortened. This creates an even more unfavorable condition for the already weakened hip abductor and hip extensor muscles which must contract against tight and shortened hip adductor muscles. This creates a vicious cycle perpetuate the lower back pain symptoms.

The hip adductor muscles are:

* adductor magnus
* adductor brevis
* adductor longus

These muscles are supplied by the obturator nerve from L2, L3 and L4 nerve roots. The adductor magnus is also supplied by the sciatic nerve (L4, L5, S1).

Other muscles that also perform hip adduction are:

* gluteus maximus (lower fibers)
* quadratus femoris.

Gluteus maximus is supplied by the inferior gluteal nerve (L5, S1 especially S1 nerve root).

Quadratus femoris is supplied by the nerve to the quadratus femoris from the sciatic nerve (L4, L5, S1).

05. Back Exercises by: Clinton Walker III

A well defined and developed back is the dream of most men (and woman) . To achieve a well defined and balanced back you must incorporate several exercises. Your back exercise workout must have different exercise from different angles to develop all the parts for your Back. Developing a strong back is crucial to preventing injuries to other muscles during exercises. It also will help prevent lower back pain. 80-85% of people expericece lower back pain at some time in their life. Building a strong back also helps posture, and makes your waist look smaller.

To get the best results you need to do 6-10 reps of each exercise. Choose a weight that you can do up to 10 for three sets. Once you can do 10 then move to a higher weight for maximal results. You can build up your Back muscles by doing a variety of back exercises with and without weight.

Pick two exercises from each part of the back for the best results. Every two workouts switch the exercises in each group. This keeps the muscles growing from the change in exercises.

Entire Back Exercises

Seated Cable Row

Sit down at a low-pulley rowing machine with your feet flat against the footrests and your knees slightly bent. Bending only at the waist, lean forward and grasp the pulley handle in front of you. Your palms should be facing each other. Keep your back FLAT and looking forward, slowly draw the handles back to your stomach while simutaneously leaning back at the waist until your torso is prependicular to the floor. The handles should reach your stomach just as your upper body reaches the upright position. Slowly return to the starting position by leaning forward from the waist while extending your arms in front of you. TO ISOLATE YOUR LATS ONLY do not bend forward at all, just keep your back straight up and down and move only your arms and squeeze your back.

t-bar row

Adjust the leg height so that your upper chest is at the top of the pad. Lay face down on the pad and grab the handles. You can use a palms down, palms up, or palms in position depending on what part of your back you want to work more. Extend your arms completely to start. Slowly pull the weight up and squeeze your back at the top of the movement. Do not lift your body off of the pad! Return to the starting position.

wide grip pulley row

cable row

seated row

Pullups

Reach up and grab the bar with a firm overhand grip. Your hands should be roughly twice your shoulder width apart. This helps work more of your lats, rather than your biceps. Straighten your arms and let your body hang from the bar. You can keep your legs straight or bend your knees and cross your feet. Slowly pull your body up to the bar so that the top of your chest nearly touches the bar and your chin is over the bar. Try to keep your body straight without arching or swinging. As you move upwards, focus on pulling your elbows down at an angle toward your rib cage. Once your lats have completely contracted at the top, slowly lower your body to the starting position. A spotter can lift your legs slightly if you need help on the last few reps. You can also add weight by using a special

Upper Back

one arm dumbell row

Begin with your right foot flat on the floor and your left knee resting on a flat bench. Then lean forward so that you’re supporting the weight of your upper body with your left arm on the bench. Your back should be flat, almost parallel with the floor. Reach down and pick up a dumbbell with your right hand. Your left arm should be locked at the elbow so it will support the weight of your upper body. Before starting, look straight ahead instead of at the floor in order to keep your back straight. Tighten your abs to keep your body from turning to the side as you lift the dumbbell. Concentrate on pulling your elbow back as far as it can go. The dumbbell should end up roughtly parallel with your torso. After you’ve rowed the dumbbell up as far as you can, slowly lower it to the starting position. Switch arms after one set.

lat pulldown

Start with your legs positioned snugly under the kneepads of a pulldown machine. Your feet should be flat on the floor. Grasp the wide bar firmly with an overhand grip. Your hands should be almost twice your shoulder width apart. Pull the bar down on top of your chest, arching your back slightly. Focus on keeping your elbows directly below the bar. Pause briefly with the bar in position right on top of your collarbone. Slowly raise the bar back to the starting position. Do NOT lean back too far and pull the weight down using your body weight!

Lower back

tow touch

dumbbell swing

deadlift

Bend at your waist with your head up, back straight and knees nearly locked. Hold bar with hands about 16 inches apart. Straighten up while holding the bar at arm’s length. Lower back down to the floor but do not let plates touch. This can be a dangerous exercise if not done correctly or done with weights that are too heavy. Can also be done standing on a bench or box (so that plates don’t touch the floor) or with dumbbells.

Hyperextension Bench

Lie face down on a hyperextension bench, tucking your ankles securely under the footpads. Adjust the upper pad if possible so your upper thighs lie flat across the wide pad, leaving enough room for you to bend at the waist without any restriction. Start with your body in a straight line. Cross your arms in front of you or behind your head. You can also hold a weight for extra resistance. Slowly bend forward at the waist as far as you can while keeping your back FLAT. Do not round your back. Slowly raise your torso until your legs and upper body are in a straight line again. Do NOT arch your back past a straight line!

Stiff leg barbell Deadlift

Stiff Leg Barbell Good Morning

Place a barbell on your shoulders. Keep your head up and your back completely straight. Bend at your waist with your legs locked, until your upper body is parallel to the floor. Return slowly to the upper position. Can also be done with your knees slightly bent.
About The Author

Clinton Walker III

I am a 32 year-old personal trainer from Birmingham, AL. My experience includes over six years of Personal Training. I have studied diet techniques, weightlifting, and nutrition for over 10 years. This includes the study of kinesiology at the University of Alabama. Viist my website at http://www.makeoverfitness.com for more information.

I Care Haven’s Health And Wellness

December 1, 2007

ALL About Pain-Lower back pain-chronic pain-back pain-neck pain-nerve pain-work related injuries-cancer related pain-traumatic insult-Sciatica

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