You can now access the Spine Center at Altamonte's 2011 Best in Care Spine Edition via our website. This publication is full of useful tips that you can use in everyday life as well as educational feature articles. This publication was developed by spine care experts for you. Please click on the cover below and enjoy.
The prestigious American Physical Therapy Association hosted their 2012 Combined Sections Meeting (CSM) on February 9-11, in Chicago, Illinois. Florida Hospital Sports Medicine & Rehabilitation's and The Spine Center at Altamonte's own Katie Fowke was amongst the presenters at this annual event. Her poster presentation, entitled "Children and Adolescents with Sickle Cell Disease and Physical Activity: A Pilot Study" provided a unique educational opportunity to the several thousands of physical therapist in attendance.
This presentation was co-authored by Jennifer Tucker, Kristen Crosby, and Lindley Westervelt. Congratulations Katie and team. A JOB WELL DONE!
The November 2011, issue of Rolling Stone Magazine featured an interview with George Clooney during which he spoke about his battle with a debilitating injury. In 2005, Clooney was injured during a stunt scene while filming "Syriana". The media reported that during a rather physically challenging scene he suffered a spine injury. Little was known about the injury at the time, except that Clooney soon after began experiencing headaches.1 The actor's complaints were later found, by his physicians, to be attributed to a dural tear.2
A dural tear is a tear in the dura mater, the membrane covering the spinal cord. An injury to the dura allows cerebral spinal fluid (CSF) to leak out of its intended space, the spinal canal, and into the surrounding tissue. One of the most prevalent symptoms of a CSF leak is a headache when rising from a flat position to an upright position. Other symptoms can include nausea and vomiting. 3, 4
Intracranial hypotension is the term used when describing the loss of spinal fluid with neurological manifestations; including headache. Intracranial hypotension is among the potential complications of spine surgery. However, it has also been found to occur seemingly, spontaneously, or following a physical trauma like that experienced by Clooney.4 Research on aspects of CSF leaks appears to be improving. The number of studies being conducted has increased over the years. However, we have a lot yet to learn.
The treatment of a dural tear can vary depending on the size of the tear and circumstances surrounding the tear discovery. If a tear is found during surgery then it is usually repaired at the time of surgery. Bed rest, a blood patching procedure, a sealant and other surgical solutions are among the known treatment options.3, 4
A spine injury can affect anyone at anytime if the right circumstances present themselves. Before participating in any activity or therapeutic intervention, know the risks. Be cognizant of your body. If you suspect that something is out of the ordinary, follow-up with your physician.
References
1. George Clooney Contemplated Suicide After 'Syriana'Set Injury. (2011, November 14). Retrieved November 14, 2011, from Huffington Post: http://www.huffingtonpost.com/2011/11/14/george-clooney-contemplated-sui......
2. Walls, J. (2005, October 25). George Clooney considered killing himself. Retrieved November 14, 2011, from msnbc.com: http://today.msnbc.com/id/9546086/ns/today-entertainment/t/george-cloone......
3. Holwerda, T. (2009, December). Complications of Spinal Surgery. Retrieved November 2011, from Spine Universe: http://spineuniverse.com/professional/research/complication-spinal-surgery
4. Inamasu, J., & Guiot, B. (2006). Intracranial hypotension with spinal pathology. The Spine Journal , 591-599.
The Spine Center would like to congratulate Florida Hospital Sports Medicine & Rehabilitation team members and partners Ron Miller, Bill Hanney, Ian Young, & Sheila Klausner on their recent publication in the January 2012, issue of Orthopaedic Practice. Below is the article abstract for your enjoyment.
Application of Regional Interdependence in a 20-Year-Old Male Collegiate Baseball Player with Recurrent Nonspecific Low Back Pain: A Retrospective Case Report.
ABSTRACT
Study Design: Case report. Background: The concept of regional interdependence has been applied by physical therapists for musculoskeletal pathologies; however, little evidence exists to support its effectiveness in patients with low back pain (LBP). The purpose of this case report is to further investigate the concept of regional interdependence in a patient with recurrent nonspecific LBP and evaluate the results of this treatment approach with regards to changes in pain and disability.
Case Description: The patient was a 20-year-old male collegiate baseball player complaining of recurrent LBP for 6 months who failed prior conservative treatment. Interventions emphasized manual therapy to the hip and exercises to address hip and lumbar muscle weakness. The patient was treated 10 times over a 4-week period. Outcomes of pain, function, and disability were recorded at baseline and 2 weeks, and 4-week follow-up periods.
Outcomes: At discharge, significant changes were revealed in the NPRS (Numeric Pain Rating Scale), MODI (Modified Oswestry Disability Index), and PSFS (Patient Specific Functional Scale). The patient had a favorable outcome and was able to return to sport specific training including baseball activities.
Discussion: Although there is a paucity of evidence supporting the concept of regional interdependence in patients with LBP, this case study provides a description of its application and subsequent outcomes for changes in pain and disability in a patient with recurrent LBP. More rigorous research designs are needed to imply causation and determine long-term outcomes.
Full Article Reference
Miller, R., Hanney, W., Young, I., & Klausner, S. (2012). Application of Regional Interdependence in a 20-Year-Old Male Collegiate Baseball Player with Recurrent Nonspecific Low Back Pain: A Retrospective Case Report. Orthopaedic Practice , 24 (1:12), 14-20.
Everyone has goals. What are yours? Are you frustrated due to feeling like you keep coming up short when it comes to realizing your health and wellness? Maybe it is time to try a different approach. Clear goals will help you stay focused and will motivate you to achieve your desired results. Below are 3 tips to assist you in setting your goals and achieving them.
Be Ready
When setting a goal, take in consideration whether you are ready or not to achieve that goal or your feelings at the risk of becoming frustrated if you do not accomplish it. Goal setting is the first and most critical step in the planning process. When setting goals that are specific, ask:
Be Realistic
A goal is realistic if you stand reasonably good odds of accomplishing it, given enough time and effort.
Be Committed
"Goals that get reached are those that are firm, well-defined, and to which the individual is truly and completely committed," says Susan Schachterle, director of the Denver–based Ahimsa Group, which provides consulting and coaching services to individuals and organizations worldwide. "Without that commitment, trying to reach goals is like grabbing Jell-O —you think maybe you have it, but there's really nothing to hang onto."
Most important strive for balance
Set goals across different areas of your life: health, finance, family, relations, learning, experience, career, etc. For instance, do not set ten career goals but then neglect your health, friends, and family.
The Spine Center located at the beautiful Lake View Plaza in Altamonte Springs is committed to helping you reach your wellness goals. In addition to minimally invasive surgical solutions our extensive menu of services includes physical therapy, pain management, massage therapy, and wellness programs.
We offer safe and effective wellness programs with highly skilled and trained exercise physiologists. Wellness Programs membership is open to the community; all participants receive a physiological assessment which includes blood pressure, body composition, flexibility, strength and cardiovascular testing along with educational material on nutrition, disease prevention, and body mechanics with access to our state of the art gym facility. You also have the opportunity to take advantage of tailored personal training sessions. Our highly trained staff is here to keep you energized and motivated.
Every individual has unique needs and a Wellness Program is no exception. Our programs focus on your physical needs including core strength, improving activities for daily living, and promoting a healthier quality of life. We invite you to contact us at (407) 303-5465 for more information about your tailored program. To schedule an appointment with Dr. Patel please call us at (407) 303-5452.
Tips compiled by: Luz Rivera, Exercise Physiologist
Sources: http://www.mygoals.com- http://www.donotgiveup.net
[This article appears in the January 2012, Florida Emergency Physicians, Quarterly Newsletter]
When discussing "health" the majority of us most often focus on the aspects of physical health. We often overlook the need for psychological health. However, we may encounter situations demonstrating that psychological health is just as important in an effort to maintain optimal physical function. A lack of balance between body and mind has the potential to lead to a physical decline or impairment.
Those of us that have experienced back pain have a tendency to not look beyond the exact area of pain. If our back hurts, we want to know what specifically is wrong with our back and how to fix it. While looking at the location of pain is a necessity, it is also helpful to look at what other factors are accompanying the pain. According to the North American Spine Society pain is often the result of complex interactions involving both physical and psychological factors.1
A previous research study, conducted in New York, explored the presence of psychological distress affecting surgical outcomes in patients undergoing lumbar spine surgery. This study concluded that preoperative screening for psychological distress is likely to identify patients at risk for a poor surgical outcome.2 Physicians often utilize various tools for patients to self-report specific information including current condition, medical and psychological history. One large Danish study, while utilizing such a tool, was able to identify lumbar fusion patients with significant amounts of psychological stress, and concluded that the presence of the stress placed these patients at an increased risk for a poor outcome.3 While a more recent study, an analysis of a cohort of the Spine Patient Outcomes Research Trial, demonstrated that patients with spondylolisthesis and psychological distress had poor surgical outcomes.4
Each of us has our own specific stress threshold in which we can handle daily stressors. Family, friends, work, and of course health problems are among the stressors that we encounter on a regular basis. We each have our own unique methods of dealing with our specific stressor. These methods may include exercise, a hobby, meditation, or yoga -to name a few. These are not a substitution for additional medical support. Do not be afraid to talk to your physician about any psychological distress you may be experiencing. Working with your care team may improve your outcomes.
References
Back Pain and Emotional Distress. (2009). Retrieved 2011, from North American Spine Society: http://www.knowyourback.org
Trief, P., Grant, W., & fredrickson, B. (2000). A Prospective Study of Psychological Predictors of Lumbar Surgery Outcome. Spine , 25 (20), 2616-2621.
Andersen, T., Christensen, F., & Bunger, C. (2006). Evaluation of a Dallas Pain Questionnaire classification in relation to outcome in lumbar spinal fusion. European Spine Journal , 15, 1671-1685.
Blisard, R. (2011, October). SPORT study shows poor results in patients with spondylolisthesis, psychological dosorders. Orthopedics Today , p. 46.
Dr. Chetan Patel M.D., Medical Director of the Spine Center at Altamonte, appeared on FOX 35 Morning News on Monday, January 9, 2012. Dr. Patel discussed "Back Pain" and answered viewer questions sent in via an online chat.
Happy New Year! Take the holiday decorations down and put the wrapping paper and bows away. It's time for a little FOOTBALL! This week has been one of great energy amongst football fans as they gathered together for the much anticipated college bowl games. Orlando was host to South Carolina and Nebraska for the Capital One Bowl held on Monday, January 2, 2012, at our own Citrus Bowl Stadium.
Dr. Chetan Patel M.D., Medical Director of the Spine Center at Altamonte, was selected to be a part of the prestigious bowl Medical Support Team as team physician for the visiting Nebraska Cornhuskers. Dr. Patel remained sideline throughout the game providing specialized world class care to the Cornhuskers' elite athletes.
The bowl games signal the end of the college football season. Till next year sports fans!
Shoes have been deemed as an accessory to your wardrobe by society and the insurmountable influence of the fashion industry. Your choice of shoes provides you an opportunity to express yourself in a subtle or grandiose manner. The choice of color, material, style, and even heel height are deliberate picks that tell a story about you.
Most of us have not considered that how we express ourselves on the outside impacts how we feel on the inside. Do wearing high heels every day impact long-term physical health? This is not a question that you find yourself asking too often. However, it's a question that if asked might save you from experiencing new or additional discomfort.
We are often more concerned with fashion rather than function. We do not take into account the toll routinely wearing high-heels will take on our body. The simple process of getting dressed in the morning has the potential to create significant musculoskeletal problems later in life.
High heels force you to alter the alignment of your spine putting you at potential risk for developing back pain. Various aspects of the musculoskeletal system have been studied in association with wearing high heels. However, the research as it relates to the spine is minimal.
What we do know is that high heels, based on construction, alter your spine's natural alignment. Frequent disruption of alignment places uneven wear and tear on your vertebral discs, joints, and back ligaments. 1
One research study has shown that when wearing high heels for short periods of time, the upper body, lumbar spine, and pelvis are negatively affected. This study also suggests that wearing high heels for long periods of time can potentially cause the spine to become hyperlordotic or swayback .2 This condition can be painful due to added strain on the lower back and legs.
Proper posture or spine alignment increases your ability to maintain spine health. Dr. Chetan Patel, renowned spine surgeon and Medical Director at the Spine Center at Altamonte, recommends avoiding wearing high heels whenever possible. Dr. Patel further advises alternating high heels with other flat- soled shoes.
Do not just listen to your feet when making your shoe selections. Listen to your spine; it's holding it all together.
References
Lasich, L. (2010). High Heels and Flip Flops cause Back Pain. Retrieved August 03, 2011, from Spine Universe: http://spineuniverse.com/conditions/back-pain/high-heels-flip-flops-caus...
Opila, K., Wagner, S., Schiowitz, S., & Chen, J. (1988). Postural Alignment in Barefoot and High-Heeled Stance. Spine , 13 (5), 542-547
By Teresa Terry, RD, LD & Stacy Shankleton BSN, RN, CCRP
Sit down, slow down and enjoy your meals.
Studies have linked certain eating behaviors with overweight and obesity, one of which is eating too fast. One large Japanese study explored a combination of eating habits and concluded that eating until full and eating quickly had a strong association with being overweight .1 A prospective Western study, also found that rapid eating can be associated with weight gain. This study resulted with over 42% of participants gaining 10 or more pounds over a 7 year period.2
Taking the time to slow down and enjoy your meal can have a positive effect on your health. It takes approximately 20 minutes for your stomach to signal your brain that it is full. If you eat too quickly, you can over consume calories. Eating slower gives your stomach time to tell your brain "I've had enough" and if you listen, you won't feel over full or "stuffed" after meals.
A higher prevalence of low back pain has been shown to be present among those who are overweight.3 Studies are shifting from being exclusive to the cause of back pain in the obese to include interventions that promote weight loss and subsequently reduce back pain. Surgical intervention for weight loss, including gastroplasty and lap band procedures, have been shown to be accompanied by a significant improvement in low back pain.4,5 In addition, a recent study assessing the efficacy of non-surgical methods for weight-loss and reduction of back pain showed that conservative treatment options such as a medically supervised diet, exercise, and education show promise and warrant continued investigation. 6
Eating at a slower pace can send you on a path to maintaining a healthy weight and spine. Slowing down consumption is easy to say but harder to do! Here are some tips to help you slow down!
-Put your fork or utensil down between each bite. Using chopsticks can also slow your consumption.
-Chew each bite 20-25 times. This will also help with digestion since it begins in the mouth.
-Enjoy conversation and social time.
-When eating with a group, make sure you start eating after everyone else and pace yourself to finish last.
-Enjoy the texture and flavors in each bite.
As the saying goes "slow and steady wins the race".
References
Maruyama, K., Ohira, T., Maeda, K., Noda, H., Kubota, Y., Nishimura, S., et al. (2008). The joint impact on being overweight of self reported behaviours of eating quickly and eating until full: cross sectional survey. BMJ , 337.
Gerace, T., & George, V. (1996). Predictors of Weight Increases over 7 years in Fire Fighters and Paramedics. Preventative Medicine , 25, 593-600.
Urquhart, D., Berry, P., Wluka, A., Strauss, B., Wang, Y., Proietto, J., et al. (2011). 2011 Young Investigator Award Winner: Increased Fat Mass Is Associated With High Levels of Low Back Pain Intesnity and Disability. Spine , 36 (16), 1320-1325.
Melissas, J., Volakakis, E., & Hadjipavlou, A. (2003). Low-Back Pain in Morbidly Obese Patientrs and the Effect of weight Loss Following Surgery. Obesity Surgery , 13, 389-393.
Ahroni, J., montgomery, K., & Watkins, B. (2005). Laproscopic Adjustable Gastric Banding: Weight Loss, Co-morbidities, Medication Usage and Quality of Line at One Year. Obesity Surgery , 15, 641-647.
Roffey, D., Ashdown, L., Dornan, H., Creech, M., Dagenais, S., Dent, R., et al. (2011). Pilot evaluation of a multidisciplinary, medically supervised, nonsurgical weight loss program on the severity of low back pain in obese adults. The Spine Journal , 197-204.
