Tag Archive for: back surgery

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Failed Back Surgery Syndrome? You’re not alone.

Back pain impacts approximately 80% of the population and the response to that has been more and more back surgeries being performed each year. However, despite more surgeries being performed, people aren’t having any less back pain. In fact, those that do get back surgery only have success rates of 50%, and after a few years, their results are no less successful than those who chose to have conservative interventions such as physical therapy and exercise for the same problem.

The American Society of Anesthesiologists estimates that 20-40% of all back surgeries fail. That statistic gets worse for patients who have a second surgery, estimating that only 30% of second back surgeries are successful. Should you have a 3rd or 4th surgery your success rate plummets. Only 5-15% of 3rd and 4th back surgeries have successful outcomes. Despite these statistics, approximately 500,000 Americans are still undergoing back surgery every year to relieve their pain. The Agency for Healthcare Research and Quality estimates that back surgery costs us $11 billion annually. That’s a lot of money to spend on something that isn’t even guaranteed to work. 

So why are we spending so much money on back surgery when for almost half of these people (and in some cases more), it’s not even successful?

Well – problem number one is if you’re dealing with excruciating, debilitating back pain that is having a significant impact on your life and happiness – surgery is often a very attractive option. If you’re told surgery will take away your back pain, which it often does in the short-term, why wouldn’t you want to choose this approach?

The second major problem is with the way back pain is typically diagnosed. Nowadays, doctor’s rely on imaging (X-rays or MRI’s) to decide what’s wrong with you and to formulate a treatment plan. They rarely take the time to talk to you about the events that led to your back pain, examine the way you move, or make certain that what shows up in your images is actually responsible for your pain.

For example, if they see a bulging disc and you’ve got coinciding leg pain – they assume that’s the source of your problem and recommend you cut it out. If you’ve got severe degenerative changes or stenosis in your spine, they recommend fusion.

What’s the problem with this approach?

Well, things like bulging discs and degenerative changes, among many other findings that show up in MRI’s and X-rays, are quite normal. They occur naturally as you age. It’s no coincidence that before the invention of MRI’s – there were far less surgeries being performed. What we do know is that 50% of the time, back surgery fails. Could it be because we are going in and tampering with structures that have nothing to do with the source of our back problem?

Let me explain.

We now know from research that 70-80% of all back pain is considered “mechanical” in nature. Meaning, the root cause or your pain is due to restrictions in your joints or soft tissue that impact the way you move. This, in turn, can make surrounding structures very angry and lead to pain. Findings such as bulging discs, disc degeneration, and stenosis are all a normal part of aging and there are plenty of people out there who have these exact same findings on their images – yet have no pain at all. That’s because for some, their joints move fully and freely, and these (normal) abnormalities don’t give them any trouble. But for those whose joints do not move well, that bulging disc has a better chance of getting irritated or causing something else (like a nerve) to get irritated. Removing the disc, or fusing your spine, won’t take away your underlying mechanical movement problem. It will put a temporary band aid over it until the problem either re-occurs – or shows up in another section of your spine – often years later.

Does this help you to understand why so many back surgeries are unsuccessful? 

It’s such a common occurrence they even have a name for it – “Failed Back Surgery Syndrome”. When your back pain is due to a mechanical problem – such as an underlying movement or mobility issue – surgery will not fix this. Additionally, MRI’s and X-rays can’t accurately diagnose it. When you do have surgery, you end up prolonging your problem further. Because you think that just because your back pain is gone, your problem is gone.

It’s only a matter of time before your pain returns, and it’s usually worse. Plus, your mechanical problem becomes more challenging to address once you’ve had surgery. But the good news is that it’s still possible to address it without a second back surgery. And it’s possible to address debilitating back pain without a first surgery altogether.

So if you’ve got back pain and are considering surgery, definitely think twice and be sure you’ve been fully examined by a mechanical back pain expert first. And if you’ve already had back surgery and it failed, still talk to a mechanical back pain expert. 

Remember that the odds of success for second and third back surgeries are very low. Even after a failed back surgery, it’s still possible to learn how to address back pain on your own and get back to doing everything you love. 

Did you know that we specialize in back pain – and have helped thousands of folks learn how to treat back pain completely on their own?

CLICK HERE to talk to someone from my team – especially if you’re considering back surgery and want to make sure you’ve explored ALL possible alternatives first.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at info@cjphysicaltherapy.com.

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3 Reasons You Need PT After Minimally Invasive Spine Surgery

Minimally invasive spine surgery (MISS) started to take off in the 1990’s and has since become far more common for spinal conditions such as degenerative disc disease, herniated discs, spinal stenosis, scoliosis, spinal infections, spondylolisthesis, compression fractures, and spinal tumors.

When you absolutely must have spine surgery (more on that later) – MISS is a far better alternative to open-spine surgery.

You can expect less anesthesia, less blood loss during surgery, reduced risk of infection, less pain after surgery, less pain medication needed, smaller scars, shorter hospital stays, faster recovery time, and quicker return to daily activities and work.

But don’t confuse the term “minimally invasive” with minimal risk.

With MISS – you’re still at risk for many of the same consequences of open-spine surgery should things go wrong. Therefore, you want to make sure you really need spine surgery before you go “under the knife” – even if it’s a tiny one.

Risks of MISS include bad reactions to anesthesia, pneumonia after surgery, blood clots in your legs that could travel to your lungs, infection (although this is significantly minimized with MISS), blood loss during surgery requiring a transfusion, injury to the nerves of your spinal cord that could result in more pain (or even paralysis) than you went in with, and damage to surrounding tissues.

While rare, these are very real risks and they do happen. Risks like this don’t occur with conservative treatment – such as specialized physical therapy.

It’s why I’m a huge advocate of folks not undergoing surgery until all conservative approaches have been exhausted – and/or – you’ve got what we call a progressive neurological deficit occurring (such as quick deterioration in your muscle strength, ability to walk, or ability to control your bowel/bladder).

All that being said – assuming you really do need surgery and will benefit from MISS – you still need physical therapy.

I’m amazed at how many surgeons no longer prescribe rehab after a minimally invasive procedure. Just because recovery time is reduced – doesn’t mean you don’t need a specialist to help you recover properly.

Here are 3 reasons you need PT after minimally invasive spine surgery:

1. Proper scar management

Minimally invasive procedures already do a great job of reducing scar formation because the incisions are smaller and less invasive, but there is still an incision. And the incision with MISS is deep because you have to get to the layers of the spinal nerves, vertebrae, and discs. Because the scars are small, people mistakenly assume they will heal without issue. The truth is they might, but the odds of your scar healing properly are much better with professional scar management. Scar mobilization should begin about 2 wks after MISS.

A specially trained physical therapist will not only help you manage your scar healing, but teach you how to do it on your own as well. You’ll improve blood flow to the area of the incision (which promotes healing), increase soft tissue mobility, and help to reduce any swelling that might form in the area.

2. Restore pre-existing impairments

Odds are pretty good you didn’t end up with spontaneous MISS. You likely had a long road leading to your surgery. It’s critical you go back and address all of the problems that occurred prior to your procedure.

This includes everything from muscle weakness, to poor compensatory movement strategies your body adapted to deal with pain, immobility that occurred either because of pain or to protect you from pain, and residual numbness and/or radiating pain that is still in your legs. MISS might do a great job of quickly getting rid of your back pain, but something led to that pain to begin with.

The absence of pain does not equal the absence of a problem. Now is the perfect time to work with a specialist who will help you not only optimize your recovery from MISS – but make sure the problems/impairments that led you to the operating table to begin with don’t come back.

3. Restore deep core strength

Chronic pain tends to inhibit the ability for muscles to work properly. If you’ve been suffering from back pain for awhile – odds are pretty good your deep core strength is not where it needs to be.

Plus, good core strength is critical for the prevention of future back problems (yes – you can still get back pain after back surgery). Ideally, now that your minimally invasive procedure has either eliminated or significantly reduced your back pain, it’s more critical than ever to work with a specialist who can help you restore your deep core strength. They’ll know how to do it safely and effectively – to not only help you recover from your MISS faster – but keep the original problem from coming back – because it can.

If you’re considering any type of surgery – but especially back surgery – I always advocate getting a second opinion first – even if the procedure is minimally invasive. Eighty percent of the time – back problems can be resolved without surgical procedures.

CLICK HERE to get a second opinion from one of my specialists.

If you truly want to avoid surgery – and we think we can help you do that – we’ll let you know and get you scheduled with us as quickly as possible.

However, if you’ve recently undergone MISS, ask your doctor to refer you to physical therapy. Many surgeons won’t. It’s going to help you recover optimally and faster – and will set you up for the best possible future success when it comes to back problems.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or request a free copy of her guide to back pain, email her at info@cjphysicaltherapy.com or call 603-605-0402

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Piriformis syndrome and Sciatica – PT not working?

I recently polled my readers regarding their most important concerns when it comes to their musculoskeletal health. In other words, what questions were they desperately seeking answers for related to back, neck, knee, hip, shoulder, or ankle pain?

Here is a great question I received from John:

“I’m getting Physical Therapy for lower back pain and sciatica that is said to be from my piriformis. My PT treatment has consisted of various exercises and some massage. Eight sessions in and no change at all. I’m still having pain when sitting or walking a distance. What now?  Do I need an Ultrasound or MRI to see if there is any damage or tear to my piriformis?”

First, John, I’m so sorry to hear you’re still having pain and not seeing any change after a good amount of physical therapy. When it comes to back pain and sciatica, it’s critical that you receive a thorough mechanical and movement examination by your PT before any treatment begins. This should involve repeated testing and retesting of movement and range of motion to determine:

1) where your pain is coming from and

2) what movement patterns trigger and relieve your symptoms

Without this first critical step, you risk missing the root cause of your pain and treating just symptoms. This type of testing is also essential to determine if physical therapy can even resolve your problem. If your physical therapist simply read the prescription from your doctor and dove into generalized treatment protocols – there’s your first problem right there – and it could explain why after 8 sessions you’re seeing no change in your condition.

In your case, it sounds like the massage is intended to treat your symptoms – perhaps your tight, tender piriformis that is believed to be causing your back pain and sciatica. This is perfectly appropriate, however, it’s important to incorporate targeted, therapeutic movement to make the most of what your manual therapy (massage) just did.

In other words, movement is the real “medicine”. Manual therapy is designed to enhance blood flow to and prepare your soft tissue (muscles and ligaments) to be better equipped to tolerate and perform the movement/exercise that is going to have a long-lasting effect.

If the massage and exercise are not done in a specific and targeted way – they aren’t going to have their intended effect. It’s possible this could be happening to you. If you’re not totally clear on what your exercise is for and what the intended effect is – chances are high your exercises haven’t been prescribed to you properly. If you suspect this to be the case, it’s worth your while to try for a different, perhaps more specialized physical therapist before you go jumping into diagnostic tests that could lead you down a rabbit hole of unnecessary procedures or surgery.

Now, let’s assume for a moment that you did receive targeted and high-quality physical therapy treatment and it’s simply not working. This does happen from time to time – but it should only be approximately 20% of the time for the majority of musculoskeletal problems such as back pain and sciatica. And in my opinion, it should be caught well before 8 sessions. In my experience, it takes about 5-6 (quality) PT sessions to figure out if a problem can be resolved with movement and natural means. If not, then a referral to another specialty is necessary.

Are you there yet? I can’t be certain.

But to answer your question about whether or not you need an MRI or Ultrasound… 

If quality, targeted physical therapy has been truly exhausted then yes – either of these diagnostic tests would be the next step in providing valuable information as to what more might be going on.

Ultrasound is a non-invasive diagnostic tool designed to visualize both organs and soft tissue. It could be a good option for examining your piriformis if you are certain that is where your problem is coming from. But piriformis syndrome only accounts for about 30% of all sciatica cases. And typically a tear in your piriformis will not cause pain to radiate down your leg. Most of the time, sciatica is caused by nerve impingement occuring in your lumbar spine (low back). If conservative treatment, like physical therapy, has been fully explored – an MRI could be helpful to see how badly a nerve is being pinched or irritated and whether or not a procedure or surgery is warranted. But in general, the research has shown time and time again that spine surgery is really only successful when you’ve got serious and progressive neurological deficits and symptoms.

In other words, you might have symptoms like foot drop, and your leg is getting weaker and numb by the minute. Otherwise, physical therapy – although it may be slower to work – has equal if not better results compared to surgery and it’s a lot safer.

The caveat, however, is you need to find a good physical therapist.

I hope this helps answer your question. Most importantly – don’t give up hope!

For the next few months I’ll be answering questions like these each week in my articles. If you’ve got your own questions regarding musculoskeletal aches or pains that you want answers for, reach out via the information below.

Local to Portsmouth and feeling frustrated with your current physical therapy treatment just like John?

Reach out – we’d be happy to provide a second opinion. CLICK HERE to request a Free Discovery call with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at info@cjphysicaltherapy.com.

Avoiding Radiofrequency Ablation in Your Back – Success Story

Have you heard of Radiofrequency ablation (RFA)?

If you suffer from chronic back pain – there’s a good chance you have. Perhaps it’s even been recommended to you?

It’s a common procedure used to disable nerve fibers that are carrying the pain signal to your brain.

Your brain is what decides whether or not you’re going to experience pain. So the goal behind this procedure is to kill (or in this case burn) the “middle man” – the nerve that is responsible for signaling the pain trigger. An electrical impulse is transmitted through a needle that is designed to burn the nerve endings responsible for your pain.

If it works – the results last anywhere from 6 months to a year – but they typically aren’t permanent.

Most of the people I talk to who rely on this for pain relief have to go back at least once per year or more.

But in some cases… the procedure eventually stops working all together…

And then what?

Well… you’ve usually got just two choices…

  1. Live with it
  2. Get surgery

The good news?

You don’t have to accept either of these options and you don’t even have to rely on this procedure at all if you don’t want to.

How do I know?

Because 80% of all spinal pain is mechanical in nature – which means it’s due to poor or insufficient movement habits. These habits – over time – result in compensatory strategies in your body. These compensatory strategies eventually lead to “pissed-off” muscles, ligaments, or nerves – which result in pain.

So you see…

Getting a procedure like RFA is really only a bandaid.

Why not find out what compensatory strategy might be happening in your body – and from there – what caused it to begin with?

That’s what we prefer to do and I’m excited to tell you about a recent success story where this actually happened…

I was re-evaluating one of our patients (“L”) this week and even though she is still working through some back pain – it’s nothing like when we first began working together.

When we first met – she couldn’t walk very far without back pain and she didn’t even think about getting on a bike. (Biking, hiking, and staying active are things she LOVES to do for herself and with her husband)

When we spoke this week – she was not only walking – but starting to do some trail walking – and she was using her bike trainer at home regularly – all with minimal or no back pain. The next step for her is to get on the road with her bike – we have a goal of her riding 30-50 miles!

I am confident we’ll get there 🙂

But the most important part of this ongoing success story that I want to share is this…

“L” told me that the most valuable accomplishment from working with us so far is that she hasn’t had to return for any RFA!

I almost cried when I heard this… not even remotely exaggerating…

Because not everyone has the courage to see a program through and trust in the process.

But “L” did – and I’m so proud of her for it.

She said one of her goals was to not need this procedure anymore…

I’m excited to say that as of today – she’s officially far past the point when she would normally have returned for her RFA procedure.

And it’s because of our program!

The biggest motivator behind everything I do – every email or article I write – is to empower you.

My mission behind CJPT & Pilates is empowerment by education.

We aim to give you all the information you need so you can make the best decisions for your health – and hopefully those decisions involve less pills, less procedures, and certainly not surgery 🙂

I wanted to share this story with you because it is a perfect example of just that.

Yes – “L” still has back pain – but it’s progressing and we’re working through it – but on her terms and not on the procedure/RFA’s terms.

If you want more details on how we helped “L” work through her chronic back pain and avoid procedures like RFA…

CLICK HERE to talk to someone on my Client Success Team to see if we are a good fit to help you avoid RFA.

Ready to get rid of your back pain? Lucky for you we have a totally FREE guide written by leading back pain specialist, physical therapist, and movement expert, Dr. Carrie Jose! CLICK HERE  to read her BEST tips and advice on how to start easing back pain and stiffness right away!

When exercise hurts your back instead of helps

When Exercise Hurts Your Back Instead of Helps

The research continues to show that the best treatment for back pain is exercise. But what do you do when exercising hurts your back instead of helps? 

What most people do when exercise flares their back up is they just stop. They simply wait for the pain to go away – and begin the cycle all over again. This is not the best strategy. Instead, why not figure out why exercise might be hurting your back and do something about it?

Here are 5 reasons why exercise might be hurting your back instead of helping:

 

1. Its the wrong type of exercise

While the research isn’t wrong about exercising and back pain – the type of exercise you choose is important. For example, walking is generally considered one of the best exercises for back pain sufferers. But there are certain types of back pain where walking flares you up. In these instances, it doesn’t mean that walking is “bad” for you – and it doesn’t mean you have a serious problem. Many times, it simply means you need a different type of exercise first that gets you back to walking normally. Same goes for strength training and core training. Exercise is good for back pain – but if it flares you up – don’t be quick to blame the exercise. You may just be doing things in the wrong order. Working with a back pain expert can help minimize this and make sure you’re doing the right exercises at the right time – and that won’t flare you up.

2. Stability training is introduced too soon

Stability training is an important part of back pain recovery – but I often see it introduced too soon – and typically before good mobility is fully restored. Mobility is something you always want to look at first. If you don’t have full mobility in your spine, there is a reason. And when your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. When it comes to stability training, there is often resistance or load involved. The last thing you want to do is add load to the spine that is already compensating and irritated. This is a sure-fire way to flare up your back and why exercise might be hurting you instead of helping.

3. You aren’t activating your core

Knowing when and how to properly activate your core is different from having a strong core. You can have the strongest abs in the world – but if you can’t use them when they count – it’s useless.  Knowing how to properly activate your core is essential when you exercise, but especially when you have back pain. If you don’t activate your core properly when you’re lifting weights, or performing complicated movements that require good coordination, you’re setting yourself up for injury. The ability to activate your core properly is developed through motor control training. It’s where we teach your mind how to recognize and activate specific muscles, during specific activities, so that it eventually becomes habitual. If you’re constantly having back pain every time you exercise or try to strengthen your core, it could be that you lack the ability to activate it when it counts.

4. You aren’t breathing properly

Not breathing properly can significantly impact the effectiveness of your exercise routine and impede your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise, and in order to activate your core properly, you must be able to breathe properly. Your deep core is made up of four parts: your deep abdominals, your deep back muscles, your pelvic floor, and your diaphragm. Your diaphragm is what controls your breathing. Let’s say you hold your breath when you exercise. When this happens it means your diaphragm isn’t expanding or contracting in the way it needs to for your deep core to be fully functional. Additionally, when your diaphragm doesn’t work like it should, it adds unnecessary strain to both your back muscles and your discs. If you’re not in tune with your breathing, and you aren’t timing it properly, it’s another reason why exercise might be hurting your back instead of helping.

5. You’re using improper form

The last and most common reason why exercising might be hurting your back is because you aren’t doing it right. There’s a lot of people out there who think posture and form don’t really matter. But they do. If you’re lifting weights – especially when frequently and repetitively – you want your spine to be in good alignment. It might not hurt the first time you lift with improper form, but it will hurt after several weeks or months when you get to your 100th rep. Same goes for body weight exercises. Just because you aren’t adding an external load to your spine doesn’t mean you can’t aggravate it by doing something with poor form over and over. This is where I see most people get in trouble. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture or it’s going to catch up to you and keep causing your back to flare up.

 

If exercising is currently hurting your back instead of helping  – it could be due to one of these 5 reasons. Get expert help to figure out which one it might be. Because at the end of the day – exercise really is good for your back. If done correctly, timely, and in the right order – it will help your back instead of hurt it.

Ready to get help with your pain or injury?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Why Strengthening Your Core Could Be Hurting Your Back

As you probably already know, we specialize in back pain and core strengthening via Pilates

So why on earth then – would we be writing about how strengthening your core could actually be hurting your back instead of helping?

One of the number one reasons people come to see us is because they want to strengthen their core – in hopes that it will put an end to their back pain.

But here’s the thing about core strengthening and back pain…

In most cases, it will make you feel better and possibly even take away your pain. But there are many times when going to core strengthening first is not right for your back, and can actually make it worse.

The biggest misconception I see when it comes to getting rid of back pain is that if the pain is gone – the problem is gone.

NOT TRUE!

And this is where people can get in trouble. If they try to strengthen their core too soon, back pain will come back with a vengeance.

Here are a few ways to tell if strengthening your core could be hurting your back instead of helping…

 

1. You feel stiffer after workouts.

As I mentioned previously, the absence of back pain does not mean you have addressed the root cause of your back problem. This is especially true if you’re prone to “throwing your back out” year after year.

One of the precursors to a full-blown back pain episode is stiffness.

If you find that your spine feels more stiff after your core strengthening routine, it could be a sign that you are aggravating your back instead of helping it. It’s only a matter of time before you wake up one morning stuck in pain and unable to move.

In our office, whenever we transition our clients from back pain treatment to our Pilates program, we teach them how to self-assess and check their spines.

This allows them to know if the core strengthening being done in Pilates is starting to aggravate them for some reason. If their self-assessment reveals a stiffening back, they know how to correct this before it turns into pain, allowing them to quickly get back to strengthening without skipping a beat.

2. Your neck hurts

I’ve spoken about this before, but increased neck pain or tension during or after core workouts is typically a sign that you’re not activating your core properly.

If you’re trying to work your core to recover from back pain, this could be a big problem for you. It’s only a matter of time before your back pain returns.

When you don’t know how to activate your core properly, you aren’t able to properly control pressure and tension in your abdomen. And you likely have difficulty controlling and coordinating your breath. When this happens, you can end up with unwanted pressure in your lower back every time you work those abdominals. This will eventually result in back pain.

This is one of those cases where core strengthening could be the right thing for your back, but you just aren’t doing it at a level that is appropriate for you.

Learning how to activate and build your core strength the right way is important all of the time – but it’s critical when you’re recovering from back pain.

3. Your hamstrings are sore and achy

A good core strengthening program targets more than just your abs. You should be strengthening your hips, glutes, and hamstrings as well.

While it’s normal to have some soreness after a good workout, when it comes to back pain, it’s important that you know the difference between muscle soreness and pain caused by nerve irritation.

Where you feel your pain and how it behaves is one of your best clues.

Let’s say that after a good Pilates session you notice soreness in both of your thighs and hamstrings the next day. This is typically considered “good” soreness. It’s symmetrical, feels better when you stretch, and likely subsides in 2-3 days. The more you work out, the less this soreness seems to occur.

But let’s say you feel an ache or a pull-down only one of your hamstrings after a Pilates class. You stretch and it doesn’t help. It possibly even aggravates your leg. You rest, the pain goes away, but then comes right back after your next workout.

This could be a sign that your core strengthening routine is causing irritation to a nerve in your spine.

If you don’t address the irritation, your leg won’t feel any better and your back will start to hurt as well.

Plus, if you feel pain or soreness anywhere in your body after a workout, it’s important that you learn to recognize the difference between good and bad pain so that you can correct problems before they happen.

Looking for ways to safely strengthen your core?

Our At Home Pilates 101 Get [Your] Back to Health program might be perfect for you, to apply and learn more CLICK HERE! We’d love to have you start your Pilates journey with us.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH. To get a free copy of her Guide to Easing Back Pain and Stiffness – click here.

Failed Back Surgery Syndrome. What you need to know.

Failed Back Surgery Syndrome. What you need to know.

I was recently doing some research on how often back surgery fails – and I came across more than one research paper talking about “Failed Back Surgery Syndrome”.

Say what?

I knew that approximately 50% of back surgeries were unsuccessful, but I didn’t know it was common enough that they had actually coined the term!

Failed Back Surgery Syndrome refers to patients with chronic, long standing back pain, with or without referred leg pain, who have had one or more surgical interventions that have failed to treat the pain.

It’s also known as “post-surgical spine syndrome” – and it’s estimated to occur in 20 – 40% of all surgical cases.

A systematic review of the literature of patients under the age of 70 suffering from disc herniations, and who underwent discectomies, found that between 5 and 36% of these folks suffered from recurring back or leg pain after 2 years. Another study by Skolaksy et al investigating 260 patients with degenerative changes in their spine who underwent surgery for spinal stenosis – found that almost 30% of these patients had either no change – or increased pain – 12 months after surgical laminectomy with or without lumbar fusion.

Despite these statistics, approximately 500,000 Americans are still undergoing back surgery every year to relieve their pain.

The Agency for Healthcare Research and Quality estimates back surgery to cost us $11 billion annually. That’s a lot of money to spend on something that isn’t even guaranteed to work.

So why ARE we spending so much money on back surgery when for almost half of these people, it’s not successful?

Well first, back pain is not fun. It can be excruciating, debilitating, and can have a significant impact on your life and happiness. If you’re told surgery will fix your problem (and it often does take your pain away in the short-term), why wouldn’t you choose this option?

Second, there is a major problem with the way back pain is diagnosed.

Most of the time, back pain is diagnosed via imaging (X-rays or MRI’s) and a treatment plan is based off of the results of those images. If you’ve got a bulging disc with severe leg pain or numbness, they recommend you cut it out. If you’ve got severe degenerative changes causing stenosis, they recommend fusion.

Back pain should always be diagnosed first with specialized movement testing.

Why?

Because we now know from research that 70-80% of all back pain is considered “mechanical”- meaning the root cause or your pain is due to poor mobility or movement habits, and not actually caused by the findings in your images.

Findings such as bulging discs, disc degeneration, and stenosis are all a normal part of aging and there are plenty of people out there who have these exact same findings and no pain at all. What typically happens is that your inefficient movement patterns, or immobility problems, will exacerbate these structures and findings – and that is when you start to experience pain.

This explains why so many back surgeries are unsuccessful and why more people than necessary end up with Failed Back Surgery Syndrome. When underlying movement or mobility problems go undiagnosed, and are not addressed first, your symptoms come back. It may not be right away, and could be up to a few years, but they do return. And sadly, they become even more difficult to address after one or more surgery has occurred.

So if you’ve got back pain and are considering surgery, definitely think twice and be sure you’ve been fully examined by a mechanical back pain expert FIRST.

And if you’ve already had back surgery and it didn’t work to fully resolve your symptoms and get you back to doing everything you love to do – there’s still hope for you – a good place to start is with a proper mechanical back pain exam to see what was missed prior to your surgery.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or to catch a replay of her online Back Pain & Sciatica Masterclass – visit cjphysicaltherapy.com

Are your Back MRI results reliable? Research says otherwise.

Are your Back MRI results reliable? Research says otherwise.

Whenever pain flares up – one of the most popular questions and concerns I get from clients is whether or not they need an MRI. When you have persistent pain that won’t go away, or shooting pain or numbness down your arm or leg, it’s scary. It makes sense to get a look inside with an MRI, right?

Not necessarily.

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. But what we now know from research is that all those findings on an MRI don’t always correlate with what’s actually causing your pain.

One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain. Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Let me explain.

When it comes to back problems – or joint problems in general – what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature.

That means your pain has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – which coincidentally is also the time that things like disc degeneration and other age-related changes show up on an MRI.

What it’s important to understand is that disc degeneration, arthritis, and bulging discs are ALL a normal part of aging, but they often get blamed for problems they don’t actually cause. In other words, the source of your pain is often a movement dysfunction learned and repeated over time that is irritating you – not the age-related changes themselves. The best way to figure out if your problem is movement-related vs structure-related is… well… with a movement assessment… NOT an MRI.

So how does movement testing work and why is it more reliable than an MRI? 

This is a great question and not one that is easily explained… but I’m going to try!

When your back, neck or joint pain is mechanical in nature – one of the most important things to look at and pay attention to is how your pain behaves. Not necessarily where it’s located. With pain – the most important thing to determine is how it reacts against certain triggers and with different activities.

Does your pain come and go? Do you have good days and bad days? Can you change positions and influence your pain?

When your pain is variable, it’s the most reliable sign that your pain is “mechanical” in nature. It also means you don’t need surgery or any kind of procedure to fix it. In fact, a procedure or surgery could leave you feeling worse off than before. Let’s say you “cut out” the structure – or inject it to make it numb – your movement problem hasn’t gone away and it’s only a matter of time before it starts aggravating something else.

Take home point… MRI’s are a super powerful and amazing diagnostic tool – but their results when it comes to diagnosing neck, back, or joint pain MUST be taken with a grain of salt – and should absolutely be coupled with an expert mechanical joint evaluation before you decide on a treatment plan.

Because if you are dealing with chronic, long-standing aches and pains that have come and gone over the years – or have recently gotten worse – there is a 70-80% chance that it is a mechanical problem finally catching up to you and not a structural problem.

Figure out the root source of your neck, back, or joint pain by seeing a movement expert who specializes in mechanical pain FIRST. Because when you automatically assume that you need an MRI first, and you base your whole treatment plan off of those results – you can end up down a rabbit hole of unnecessary medical procedures or surgery that ultimately won’t give you the long-term relief you’re looking for.

 

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.

 

 

2 Reasons People Over the Age of 50 Avoid Exercises

Should Age be a Reason to Avoid Certain Activities?

We’re continuing with our topic of the month – Getting Fit After 50 – and people have been asking me…

Are there certain types of exercise I should avoid once I hit a certain age?

The short answer is no.

Most of our clients are over the age of 50 and they do everything from surfing, to playing tennis, hockey, running, and even tap dancing!

None of these activities are considered “easy on the joints,” but they do them anyway.

So why is it that some folks see age as just a number – where others use it as a reason to stop doing certain things?

After age 50, the number one reason I see people avoid activities they want to do is because of pain. The second most common reason is because they were told to.

Let’s start with pain.

Having been a physical therapist for twenty years, I know a thing or two about what goes through people’s minds when they are dealing with back or joint pain. In most cases, the pain itself is not the biggest concern. People are willing and able to tolerate a certain amount of pain at the expense of doing what they truly love. We do it all the time in our 20’s or 30’s… and don’t think twice about it.

But as we age – a little bit of fear starts to set in when we’re in pain.

We’ve typically seen or heard horror stories from friends or family who have paid the price for either pushing through – or ignoring pain all together. When we’re younger, we’re more likely to approach pain with a “wait and see” approach. But as we age – pain becomes a bigger concern and we’re more likely to seek professional medical help sooner.

This leads me to the second reason people over 50 will just stop doing certain exercises…

Because they were told to. And often by a well-meaning health care professional.

Let me explain that.

Our medical system is overloaded, and everyone does the best they can to keep up. But if you’re a musculoskeletal health professional who’s NOT up with current medical research – you’re likely to give advice based on “old-school” ways of thinking.

For example, diagnosing all musculoskeletal pain based on X-rays and MRI’s… If your X-ray shows “bone on bone” arthritis – then a joint replacement is assumed to be your only option. If your MRI shows a meniscus tear or bulging disc – then you automatically need arthroscopic surgery.

But the current research disputes this line of thinking…

And says 80% of ALL musculoskeletal problems – even when you’re over 50 – can be solved without surgeries or other procedures.

How your pain behaves is what matters most. Not your age or arthritis. The best way to explain this concept is with a case study!

This client (we’ll call him “Jim”) is 57 years old and was told knee replacement surgery was his only option to resolve the knee pain he was suddenly experiencing.

When he questioned the knee replacement and asked if he could wait, his doctor’s response was that because of his age – and because of the “bone on bone” arthritis that was showing on his X-ray – surgery was his best option. Otherwise, if he wanted to wait, he would need to stop the running and hiking he had been enjoying so much until very recently.

Research studies show that the indication of osteoarthritis on X-ray alone does not mean it’s the cause of your pain.

In other words, it’s entirely possible Jim’s knee pain could be due to something other than his “bone on bone” arthritis.

Did he really need surgery? And did he really need to stop some of his exercises because of arthritis or his age?

Ceasing his activities would have certainly made Jim’s arthritis worse. And if he went through with the knee replacement without being completely sure if arthritis was the main cause of his knee pain – he not only risks unnecessary surgery – but also risks getting set back several months for recovery.

This would delay his ability to get back to running and hiking even further.

Although age is most of the time NOT a factor in your choice of exercise… it is a factor when it comes to how quickly you’re able to recover from surgery.

So here’s what happened.

We prescribed him a corrective movement strategy to see if arthritis was the main factor causing his knee pain. And just like we see over and over again – his knee pain significantly improved after just a few visits!

Research says that if pain responds quickly to a corrective movement done repeatedly – your pain is primarily due to a mechanical origin – and not arthritis. Arthritis doesn’t change that quickly – in fact it doesn’t change at all (unless you get surgery). But mechanical pain does.

Turns out that Jim’s knee pain was due to some mechanical imbalances in his knee joint, and NOT the arthritis. Arthritis was a factor for sure – it made his knee stiff – but it was not the main cause of his knee pain.

If you’re getting older… know that age related changes like arthritis are quite normal and nothing to be afraid of.

And arthritis, along with your age, are certainly not reasons to avoid exercise.

Jim was given medical advice to have a surgery he does NOT need yet based solely on his X-ray and his age. But there are SO many other factors worth considering as well.

Should you Rest when your Back Hurts?

Back pain is the most common type of problem we see here in our office. And the number one question I get from people who’ve hurt their back is, “should I rest until it feels better?” 

The short answer is “no.” 

But I understand why this is confusing. It’s scary to move, or know which exercise is best when something hurts, especially if it’s your back. We also get conflicting advice from the medical community. Many people suffering with back pain have been told they should rest, ice, lie down, and use their back muscles as little as possible until they recover. They’ve been told they should limit their movement and activity until their pain goes away.

Well what if I told you that for 80% of all back problems – movement is actually the BEST medicine.

Research even supports this. Most back pain falls into the category of what we call “mechanical low back pain” – and this type of back pain responds best to movement over anything else. It’s important to note that although movement is good when your back hurts, you want to pick the right type of movement. Generally speaking, early movement like walking is considered one of the best things you can do for your back, along with very specific mobility exercises in a direction designed to relieve your pain quickly. But you’ll want to avoid things like lifting heavy weights at first, or bending/stretching over excessively. If your back pain involves an irritated nerve, stretching forward, even though it might feel good, can often worsen your problem.

So what’s the big deal? Why is it so bad to rest until your back pain goes away?

Although most back pain will go away on its own with time, the problem with resting instead of moving is that it can prolong the time it takes to truly heal. And in some cases, rest can make your back problem worse. Too much rest leads to deconditioning of your muscles, and can even lead to biomechanical changes to the curves in your spine. Resting may take your back pain away, but it’s going to leave you feeling much stiffer and weaker, putting you at risk to just hurt your back all over again. One of the biggest problems I see with back injuries is a lack of mobility, sometimes due to weakness and sometimes due to not moving around enough. A flexible spine is a healthy spine. That’s why choosing activities like walking and corrective stretching exercises over rest will not only relieve your back pain, but will give you a better chance at keeping the pain gone over time.

Another issue with too much resting, especially lying down, is the impact on your discs.

Back problems frequently involve some variation of a bulging disc, and when you lie down, your disc changes in size. Lying down does relieve pressure from your disc, but also causes it to absorb more fluid, making it bigger. You won’t know this is happening until you go to get up. That enlarged disc will not feel good when it gets pinched. It’s why most people who are dealing with back pain feel worse first thing in the morning, just after getting out of bed. Their pain eases once they stand and start moving around a bit. When you walk around and move, you get natural compression of your disc, keeping the disc bulge smaller and thus, less of an irritant. A bulging disc in your spine is a pretty classic form of mechanical low back pain, and we already know that mechanical back pain responds best to movement.

Remember that the absence of back pain does not mean the absence of a back problem.

Back problems can be complicated and they love to linger under the surface until one day, a certain movement just tweaks you. The best way to figure out a back problem – and heal a back problem quickly – is with movement. As tempting as it is, don’t just rest to get rid of your back pain. Try walking, and even some easy stretching, and take note of what happens. You’ll either start to feel better the more you move or worse. If your pain is easing up with the movement you’ve chosen – you’re on the right track! If your pain is not responding or getting worse, then it’s a clue you need to see a professional. Either way, movement is your friend, because it’s going to tell you something. Rest won’t do that for you and if anything, potentially prolong the issue when you could have been doing something about it.