ortho HEALTH ON TIME
WINTER 2017
We’ve Got Your Back
COPING WITH SPINE PROBLEMS
EACH YEAR, 15 TO 20 PERCENT OF AMERICANS EXPERIENCE LOW BACK PAIN that makes it difficult to work, sleep and enjoy leisure activities. According to the National Institute of Neurological Disorders and Stroke, low back pain is the most common cause of job-related disability and the second most common neurological ailment after headache. Back pain is usually described as acute or chronic. Acute pain: • Abrupt onset and usually caused by a sports- or work-related injury or trauma from an accident • Symptoms can include shooting pain, limited range of motion, inability to stand up straight, anxiousness and restlessness • Generally moderate to severe, but resolves after several days to several weeks in response to normal healing and pain-relief medication Chronic pain: • Persists for more than three months, and can persist for years, recurring even in the absence of an identifiable stimulus • People with chronic pain often experience depression, becoming withdrawn and inactive • May worsen over time if not treated appropriately Using these home treatments for a few days can help ease symptoms of sudden back pain: • Relax. Lie down in a comfortable position. This lets your back muscles relax. • Ice. Put ice or a cold pack on your back (10–15 minutes every hour) for the first three days. • Walk. Walk for 3–5 minutes on a level surface (no slopes) every three hours. Two helpful treatments for acute low back pain are staying active and taking anti-inflammatory medications, such as aspirin or ibuprofen.
MEASURING YOUR PAIN The NIH Pain Consortium Pain Intensity Scale rates pain intensity from zero to 10. One represents mild, bearable pain. Ten represents pain that is excruciating and unbearable. This system allows you to rate your pain at its best and worst and define what level of pain is acceptable to you. Pain Intensity Scale
0
None
1 2
Mild
3 4 5
Moderate
6 7 8 9
Severe
10
BE PROACTIVE ABOUT YOUR HEALTH! Visit us online at augustahealth.org/ortho, or call 706-721-2741.
A conservative but effective approach
Ted Hanson, PT, shows a patient how the lower spine moves and how to avoid stressing tender areas while exercising.
THOSE WHO HAVE UNDERGONE ANY FORM OF THERAPY understand that staying committed to the process is an investment. The good news is that Augusta University Rehabilitation offers a cost-effective, timeefficient form of physical therapy, — a conservative form of musculoskeletal care. What makes the treatment cost-effective and time-efficient is that “the physical therapist can put his or her hands on the patient if needed,” said Ted Hanson, a physical therapist at Augusta University Rehabilitation. “However, the goal is always to educate the patients on exercises to do on their own, which limits the need for excessive visits by the patients.” Mechanical diagnosis and therapy (MDT) is a musculoskeletal assessment process that can be used for the spine and more recently has started to be used for all joints of the body. MDT has been implemented internationally and continues
to gain notoriety for its effectiveness as a conservative treatment option. The system is designed to identify if the pain is mechanical — made worse by some movements and better by others — and, if so, to assist the body in healing itself. “If the patient understands the movements that worsen the pain, attempts to limit them and performs the movements that make the pain better, then he or she can control the problem,” Hanson said. “This will allow the soft tissue to heal.” Hanson provided the example of a cut finger: “You have to stop bending the finger to separate the cut’s edges and keep it straight so the tissue can heal and close the cut,” he said. MDT is an effective method for those patients who want control over their pain, need the guidance to “do the right things” to avoid the pain and don’t want to have to rely on medications or surgery. (CONTINUED ON PAGE 3)
To learn more about mechanical diagnosis and therapy, visit us at augustahealth.org/westwheeler. UVY-022
Augusta University 1120 15th St. Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID AUGUSTA UNIVERSITY
STRENGTHENING THE SPI How Bad is Your Pain?
ONLY ABOUT 1 IN 100 PATIENTS WITH LOW BACK PAIN ARE CANDIDATES FOR SURGERY WHEN LOW BACK PAIN DOES NOT RESOLVE in response to medication and appropriate lifestyle changes — such as weight loss, exercise and smoking cessation — surgery is an option, especially if long-term back pain affects a person’s ability to work and function normally. In extreme — and exceptionally rare — cases, back surgery is a medical emergency. For example, when a herniated disc compresses the bundle of lumbar and sacral nerves at the base of the spine, it can lead to numbness and disability in the lower body, loss of bladder and bowel control, and even paralysis. This condition, called cauda equina compression syndrome, requires immediate surgery to decompress affected nerves in order to prevent permanent damage. What to take for the pain Over-the-counter medications, such as aspirin and ibuprofen, can ease minor back pain and reduce inflammation. Acetaminophen also effectively blocks lumbar pain. Using pain medication allows you to remain active, which aids healing. In cases of recurrent pain, your doctor may prescribe the following: • Tricyclic antidepressants are most commonly used in cases of chronic back pain. A study published in the clinical journal Pain showed that of 57 men with chronic lower back pain, those who took nortriptyline experienced a 22 percent reduction in pain intensity. • Anticonvulsants can improve nerve pain and are useful to treat back spasms. • Opioids may be used to manage severe back pain for a short period. However, since they are addictive, long-term use is not recommended.
cal
vi Cer
racic Tho
WHAT CAUSES BACK PAIN? Herniated disc (top view)
Compresses nerve root
Disc Degeneration Normal disc Degenerative disc Bulging disc
Herniated disc
Thinning disc
Herniated (Protruding) Discs Intervertebral discs serve as shock absorbers and permit motion between the vertebrae. When they bulge out into the spinal canal, they press on nerve roots and cause pain. Discs, especially those in the lumbar region, usually become herniated after overexertion or trauma. Sciatica Sciatica occurs when herniated discs press on the sciatic nerve, the largest and longest nerve in the body. Pain caused by sciatica shoots down the leg and frequently radiates below the knee. Bending forward and sitting exacerbate sciatica-related pain.
bar Lum
Spinal Degeneration Spinal degeneration can occur in intervertebral discs, muscles, ligaments or cartilage. Decrease in water content in discs, tears in the surface and outer regions of the discs, and cartilage degeneration in the center of discs can contribute to degeneration, weakening the spine’s structure. Osteoarthritis Osteoarthritis, a progressive degenerative disease, causes cartilage to become weak and structurally unsound and wear away. Chronic joint pain, stiffness and restricted range of motion can occur with osteoarthritis in the lumbar spine. Spinal Stenosis Spinal stenosis is a narrowing of the spinal column due to increased bone formation. This causes nerve compression leading to persistent back and leg pain, which is most intense when standing. Osteoporosis-related Fractures An osteoporosis-related fracture can cause pain directly over the affected bone. This hormone-related disorder occurs when normal bone metabolism is disrupted, leading to decreased bone density.
Be proactive about your health! Visit us online at augustahealth.org/ortho, or call 706-721-2741.
al Sacr al cyge c o C
NE
A conservative but effective (CONTINUED FROM PAGE 1) approach Augusta University Rehabilitation staff includes a credentialed MDT therapist, Hanson and several others who have received significant formal education and are pursuing credentialed status. MDT therapists assess the patient through observation, a thorough verbal interview and a physical exam that consists of repeated movements, force progressions and continual reassessment of the patient’s pain location and intensity. Force progressions start with the patient using his or her own force; then the clinician uses his or her force if needed. “The majority of patients respond using their own force,” Hanson said. “Again, this produces patients who are independent in treating themselves.” With the information processed from the assessment, the clinician is then able to classify the patient’s pain as mechanical or non-mechanical. If the pain is classified as mechanically responsive, then the patient is deemed a good candidate for MDT. The symptoms are then further classified as one of three MDT syndromes: derangement, dysfunction or postural. A critical component of MDT is that patients are actively involved in their care, and that starts with educating them on the cause of their pain. Therapists focus on helping patients to understand the activities and positions that produce or increase pain, then walk them through exercises that focus on movements that reduce pain or other symptoms. MDT therapists seek to help patients to understand their pain and guide them toward becoming independent in their own care. In addition, the patient should be able to prevent future episodes by continuing the prescribed exercises.
Pain in the back The vast majority of back pain occurs in the lower back, or lumbar region of the spine, which consists of only five vertebrae.
COMMON SPINAL INTERVENTIONS
Long-term, chronic pain in the neck or back may call for treatment beyond exercise or medication. Here are a few common interventions. SELECTIVE NERVE ROOT BLOCK Pain in the neck area can be caused by nerve root irritation related to a herniated disc or spinal stenosis. Surgeons use X-ray guidance to inject a combination of an anaesthetic and a steroid at the nerve root to block pain and relieve inflammation.
LUMBAR SPINAL FUSION SURGERY The surgeon removes a portion of the vertebra, then uses a mechanical method, such as screws and rods, to attach a bone graft. Over time, the vertebrae and graft grow into one bone. The fused bone prevents movement against the nerves, reducing pain.
ARTIFICIAL DISC FOR CERVICAL DISC REPLACEMENT In cases of severe disc herniation or degeneration, surgeons may recommend a synthetic disc replacement. Unlike fusion, which stops intervertebral movement, disc replacement eliminates pain while preserving the patient’s range of motion.
To learn more about Augusta University Orthopaedics, visit augustahealth.org/ortho.
INNOVATIVE SPINE CARE A HEAVY SUBJECT MADE LIGHTER WITH OUR PATIENT- AND FAMILY-CENTERED CARE THE SPINE IS A SIGNIFICANT PART OF THE BODY. It provides our bodies with structure and support, allows us to move, and protects our vital nerves and organs. For that reason, spine care can be a heavy subject. Fortunately, those who are looking for relief from back pain can take a load off, unpack some of their concern and rest assured that Augusta University Orthopaedics will have their back – literally and figuratively. John G. DeVine, MD, and his team, including a fellow and a physician assistant, offer complete spine care. They treat all sections of the spine,
ASK THE EXPERTS ABOUT IMPORTANT HEALTH ISSUES
WHAT IS THE CONNECTION BETWEEN STRESS AND BACK PAIN? Medical professionals and psychologists have long noticed an association between stress and back pain. According to one theory, people with certain personality types or life pressures channel their tension into the upper or lower back. In other cases, people with a mild or acute back injury become fearful of causing more pain, and fall into a vicious cycle of inactivity, and shallow or more rapid breathing, which can contribute to tension in muscles along the spine, affecting recovery from back pain. Patients who feel that stress is a factor in their back pain can seek clinicians who use an integrated treatment approach that addresses physical factors as well as behavioral and environmental ones.
CAN EXERCISE HELP WITH BACK PAIN? While someone with sudden back pain might find bed rest or inactivity helpful for a few days, in the long term it is much better to return to controlled, low-impact exercise. Depending on the cause of the pain, a spine specialist or physical therapist may recommend an exercise program designed for the back that incorporates stretching, strengthening and aerobic activity. Movement and proper nutrition will aid in getting oxygen and nutrients to affected tissues, such as the discs, ligaments or muscles. Even if a specialized back exercise program is not needed, people with back pain who pursue walking, yoga, Pilates or tai chi can help speed healing and stave off future problems.
Dr. John G. DeVine Chief, Spine Surgery Service
• Board-certified in orthopaedic surgery and spine surgery • More than 20 years of experience
Charlie Wispert, PA-C Orthopaedic Spine Surgery
HEALTHY NEWS EVALUATING RISK A recent study shows promise for identifying genetic markers that can indicate risk for developing osteoporosis. Known as the “silent thief,” osteoporosis is a degenerative disease in which bone loss occurs over time. In the spine, the weakened bone leads to micro-fractures Normal bone density of the vertebrae, compression of the discs, pain and loss of height. Researchers analyzed DNA sequences in over 1,400 participants and found distinctive gene variants associated with higher risk for osteoporosis. The study leaders, who reported their findings in the Journal of Bone and Mineral Research, hope that in the near future results Osteoporosis of genomic testing of a typical blood sample, used in conjunction with an existing clinical fracture-risk calculator, can help physicians more accurately assess the risk of osteoporosis in patients.
Our Spine Team
BETTER TO QUIT In a paper selected by the North American Spine Society as one of the best submitted during 2016, researchers reported on a study of patients who had surgical treatment of spinal stenosis with myelopathy (poor coordination of the extremities) that showed poorer healing for those patients who smoked. While it has been known for some time that tobacco use adversely affects healing from spine surgery, this study showed that there was an additive effect — basically, the more cigarettes a person smoked over a lifetime, the less improvement that person would experience postoperatively. Lead researcher David Kusin, MD, of the University of Nebraska Medical Center, said that while he was not surprised to learn that smokers took longer to heal than nonsmokers, it was unexpected to see that the two groups had roughly similar degrees of severity in their symptoms before surgery.
• More than 20 years of experience, 17 of which have been spent in orthopaedics
Dr. Uzondu Agochukwu Spine Surgery Fellow
The spine team is available to see patients at Augusta University Medical Associates at West Wheeler, 1220 West Wheeler Parkway, Augusta, GA 30909.
If you or a loved one is experiencing back pain, call 706-721-2741, or visit us online at augustahealth.org/ortho.
Copyright © 2017 GLC, Skokie, IL 60077 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
Q&A
which includes the cervical, thoracic and lumbar spine, by providing all levels of care, from nonsurgical to minimally invasive to the most complex surgeries. Importantly, the spine team takes a conservative approach to care by exploring nonsurgical options first. “I spend the majority of my time educating patients about why they don’t need back surgery,” said DeVine, chief of the spine surgery service at Augusta University Orthopaedics. “Addressing each concern with surgery tends to do more harm than good.” DeVine specializes in treating the following conditions: • Back and neck pain • Radiculopathy • Degenerative disc (one or more nerves disease do not work properly) (spondylosis) • Spinal stenosis • Myelopathy (abnormal (a nervous system narrowing of the disorder that affects spinal canal) the spinal cord) • Spine trauma • Curvature of the • Spine tumor spine (scoliosis) • Spondylolisthesis in adults and (a vertebra slips into children the one below it)