Tiger Woods Dealing With Back Spasms

March 10, 2014June 24, 2014 / Thomas Cohn, MD

Back pain affects 80% of the population at some point in their life. Tiger Woods has joined the rest of us normal people and now has back pain. Unfortunately, Tiger needs his back to be working correctly to in order to play golf at the highest level. He withdrew from a tournament last weekend, and this past tournament he struggled on Sunday after re-injuring his back. Woods spoke about the pain after the tournament.

“It is back spasms, so we’ve done all the protocols and it’s just a matter of keeping everything aligned so I don’t go into that,” said Woods. “If I feel good, I can actually make a pretty decent swing. You saw it (Saturday). I actually can make some good swings and shoot a good score, but if I’m feeling like this, it’s a little tough. It’s the same thing … it flares up. It’s just a matter of keeping it calm, and we had a quick turnaround from last week. … It will be nice to take this week off and get everything ready for Bay Hill.”

Most likely, Tiger strained some muscles, or possibly irritated a disc or joints in the low back. An irritated back will develop muscle spasms, and these spasms are painful and reduce the ability to move. All of us who have strained our back and have had this problem know how hard it is to move. Walking is difficult, and bending, lifting, and twisting is even harder. Add in the fact that he has to walk the length of the course and swing a golf club – it’s no wonder he had troubles.

Tiger Woods is likely getting the most aggressive treatment to resolve the low back strain causing muscle spasms. Treatment choices are numerous, but most likely include medications that reduce muscle spasms and aggressively influence healing. Likely he is receiving prednisone, a very powerful anti-inflammatory medication that may facilitate more rapid healing. Additionally, medications for muscle spasms and traditional anti-inflammatory medications like Ibuprofen or naproxen may be used. Intense physical therapy is also likely being used to improve movement and decrease the muscle spasms.

Professional golf requires Tiger Woods to be in perfect physical and mental shape to hit the ball adequately. Unless he is at 100%, it is unlikely that he can play at a competitive level. He needs to be mentally alert to judge all variables to make any shot and to concentrate, and many of the medications for spasms have some decrease in mental awareness. Physically, any muscle spasms in his back will change his swing slightly and prevent him from making the shot he wants.

Muscle strains and sprains in the back can resolve quickly if treated correctly and aggressively. Unfortunately, many times it takes a lot of work to control back spasms. Hopefully, Tiger will be lucky and he will heal quickly. He needs to be 100%, especially with The Masters looming next month. Golf’s first major is Tiger’s biggest priority at this point, so I wouldn’t be surprised if he withdrew or skipped other tournaments leading up to The Master in order to put his back in the best possible shape in his quest for another green jacket.

Related source: USA Today

Pain Injection Risks and Safety Procedures

March 5, 2014June 24, 2014 / Thomas Cohn, MD

Many patients with pain can benefit from various types of injections. These pain injections are preformed by interventional pain physicians who specialize in managing pain and reducing chronic aches.

Training of interventional physicians is variable; they include those trained in Anesthesia, Radiology, and Physical Medicine and Rehabilitation. A good interventional pain physician will be board certified in their specialty and have years of experience.

Types of Pain Injections

The appropriate injection will be determined once the problematic area is assessed. Most injections can be performed with minimal discomfort and will take only a few minutes once the procedure begins.

Every injection has the same four risks. They are:

Risk of Infection – The first risk is infection. Cleaning off the skin, and using sterile techniques and medications reduces this risk.

Bleeding Risks – The second risk is bleeding. If the patient does not have a bleeding disorder or is not on anticoagulation medication, then this is not a problem.

Allergic Reaction – The third risk is an allergy to a compound used with the injection. The most common is an allergic reaction to the X-ray contrast, however this risk is very small, less than the risk of being hit by lightning, and can be treated.

Needle Damage – The largest risk is the possibility of a needle causing damage to the structure that is being treated. Damage during a spine injection to the spinal cord or to a vascular structure that may cause damage to a nerve, spine or the brain is always a concern. Risk is minimized by using real time X-ray guidance known as fluoroscopy, and by having an experienced and knowledgeable physician administer the injection.

Post-Injection Safety

Some pain clinics require all patients to have a driver for any procedure, but it usually depends on which injection you’re receiving. In the vast majority of procedures, the patient will feel the same or better shortly after receiving the injection. If the patient is nervous, I usually recommend they have someone drive them to and from the clinic, as there is little reason to compound the injection with fear. This is also a good piece of advice for anyone who will be receiving an injection for the first time. If you feel fine on the ride home from your first appointment, feel free to drive yourself to any follow-ups.

If you need help to move or drive before the procedure, it is unlikely the injection will give you the ability to do so in the immediate aftermath. In these cases, you absolutely should plan on having a driver. If you are sedated for your procedure, you’ll be required to have a driver since this definitely impairs the ability to make safe decisions behind the wheel.

After the injection is complete, the physician will likely use a local anesthesia to reduce discomfort around the injection site. This will make your drive home more comfortable, especially if you received an injection on your lower back or hips.

A good pain physician should be able to make you comfortable during the procedure. They can answer your questions and describe the procedure so you know what to expect. You should always meet the physician before the procedure so you can ask any questions you might have ahead of time.

Nonsteroidal Anti-inflammatory Drugs And Safety

March 3, 2014June 24, 2014 / Thomas Cohn, MD

The FDA recently ruled that available evidence does not prove that the painkiller Naproxen, often sold under the name Aleve or Naprosyn, is linked to greater reduction in heart disease than other nonsteroidal anti-inflammatory drugs (NSAIDs) on the market. A previous study suggested Naproxen was less dangerous to the heart than NSAIDs like Ibuprofen or Celebrex, but the FDA advisory panel did not find enough evidence to corroborate the statement.

The science of nonsteroidal anti-inflammatory drugs (NSAID) like Ibuprofen, Naproxen, and Celebrex is quite complex. The mechanism and effect on the heart attack risk is not really fully understood. These drugs reduce inflammation in the body by blocking enzymes known as COX-1 and COX-2. The newer drugs in this group were a bit more selective in blocking COX-2 enzymes, which led to a reduction in stomach discomfort. However, the overall effect of all these drugs is that they may disrupt the balance of other enzymes in the inflammatory cycle throughout the body and actually lead to more hardening of the arteries and an increased risk of heart attack and stroke. That said, the increased risk is similar to the risk of a poor diet, smoking, genetics, and diseases like diabetes.

The risk of all NSAID medications seems to be that they may increase the risk of hardening of the arteries and heart attack or stroke. The newer COX-2 drugs like Celebrex, and previous ones Vioxx and Bextra, made this more evident since they became very widely used. Once the effect was found with the more selective COX-2 drugs, further studies have shown all these medications have the same potential risk.

NSAID Use In America

The use of NSAIDs is widespread. The medications can be very helpful in controlling pain related to injury and chronic inflammation due to degeneration of joints and neck and back problems. Many people do take these medications on a long-term basis to control pain levels. These medications can be taken fairly safely, but knowing that they can cause problems, a person should work at reducing all their other risks to prevent heart issues.

The main issue with NSAID medications is not heart attacks with most people, but stomach irritation and bleeding and kidney injury. All these drugs are very well known as significant causes of gastrointestinal bleeding due to the enzyme affects of the COX system on the lining of the stomach. Severe bleeding is a common side effect from these drugs. The COX enzymes and other affected enzymes also can lead to damage to the kidneys. In reality, these drugs have hurt more stomachs and kidneys than caused heart attacks.

The take home message on all medications is that any drug has risks and can have bad side effects on the body. Whenever taking a medication, one has to decide whether the benefit going to outweigh the risk. If you can change your lifestyle such that a drug is not needed, that would be the best option. If changing your lifestyle options is not sufficient, then discussing the risks and benefits with your healthcare provider is the next step with regards to any medication.

Related source: Reuters