Inversion Tables and Low Back Pain

May 8, 2019 / Thomas Cohn, MD

I am often asked about various techniques to help with low back pain. The questions usually are about physical therapy or a home exercise program, and back braces and equipment for independent exercise are common areas of interest. In general, being consistent with a comprehensive exercise program with stretching, strengthening and aerobic conditioning is the most important. How to do your exercises is highly variable, so find what works best for you.

Stretching exercises for the low back require no special equipment. A well-rounded program can be learned from a physical therapist, and it is also easy to find basic exercises on the internet. The simplest is just bend over, keep the knee straight and touch your toes. This can also be done sitting on the ground and bending forward. This stretches the back and the hips. The counter stretch is doing pelvic tilt exercises. Balanced stretching makes sure opposing muscles do not become too tight. More advanced stretching can be done with formal activities like yoga. For those who like group activities, yoga as well as Tai Chi are excellent in working on gentle motion and stretching. Foam rollers are not recommended for the low back area.

What About Inversion Tables?

Another common question asked is whether an inversion table would be helpful. The answer is not straightforward. First, you must not have eye problems, uncontrolled blood pressure, or possible problems with brain swelling. If you have lower leg problems or foot or ankle issues, inversion tables would be difficult to use. The purpose of an inversion table is to use gravity and the weight of the body for traction to the low back region. Anchoring the ankles and being upside down can produce this effect.

The first attempt at this was the use of inversion boots; these were metal sleeves with hooks fastened to them and one would hang from a bar hoping that the bar or boots would not fail. One person I knew was an ironworker who strapped on his boots and hung from the steel girders or beams in buildings he was constructing – not especially advised. This evolved to the inversion tables, a device that hooks in your ankles while standing on a platform of a table that can pivot the body position. Most tables allow one to rotate to a variety of angles including all the way inverted. Complete inversion is not needed to be effective, but try to be at least 60 degrees angled.

If you are going to buy an inversion table, it is important to invest in a very sturdy one that can support your weight easily and has a large base that it is stable as you change positions. Whether this will help your back is unknown. The best way for it to help is to do the inversion and immediately lie down in bed afterwards so gravity and standing does not reverse the effect of the upside down position. This requires having the equipment bedside.

The last question I often receive with regards to low back pain is about wearing a back brace. In general they are not recommended. The appropriate time to wear these is only associated with stabilizing the back after surgery to allow good healing. Using a back brace to control pain and prevent movement is typically a poor strategy. Wearing a back brace does not control movement and pain well. The down side is it allows the muscles to become weak and tight since they are not working in their normal manner. Further, back braces do not help prevent back injuries when working. The better treatment for painful low backs is exercise and a healthy diet.

Spine Surgery and Work Ethic Fueled Tiger Woods’ Masters Win

May 1, 2019May 1, 2019 / Thomas Cohn, MD

Tiger Woods coming back to win a major tournament in golf after multiple spinal surgeries appears to be a sports miracle. Most physicians wrote Tiger off once he developed low back problems. Performing at the level of a professional athlete with any physical dysfunction, especially with lumbar disc problems, is extremely difficult.

To compete at the highest level of any sport usually requires excellent physical and mental fitness. Anything that is less than perfect usually generates only average results and not the level necessary to be at the top of a sport, especially in golf, where even tiny issues with your swing can cause the ball to end up far away from your intended target. Aside from the physical aspects, there are also significant mental components, and one must not have any distractions like pain.

Tiger’s Journey

News reports with regards to Tiger Woods have clarified his struggle over the last several years. Tiger has had a single L5-S1 disc problem for several years. This is the bottom disc in the lower back and often takes the most force from activities. It is also the disc that most likely will go bad over time and degenerate or have a disc protrusion. For the last several years, Tiger has struggled with treatment, doing extensive conservative options to no avail. Additionally, he has had multiple surgical decompression operations with removal of parts of the herniated disc. Despite all the work, he still had pain and difficulties related to the L5-S1 disc. Ongoing symptoms impaired his ability to mentally and physically play golf.

The last option for Woods was for a lumbar fusion at L5-S1. He underwent that surgery with an extensive anterior interbody fusion type intervention. After removing the offending disc, the L5-S1 disc space was restored with a spacer device and packed with bone so the L5 vertebral body becomes fused to the sacrum. Once healed, the hard work of rehabilitation began with extensive strengthening and conditioning. Fortunately, everything went well and his strength as well as his coordination returned. The fusion healed and his pain improved.

So far for Tiger Woods, everything has gone well after his surgery. Unfortunately, this probably isn’t the last we’ve heard about his spine. The lumbar spine is incredibly well balanced, and every single level is important to control motion properly. Golf requires a lot of twisting of the back with some bending. These motions put an extreme amount of force through all of the segments in the lumbar spine. Now that one segment does not move in the normal way, forces that once went through the bottom level now are transitioned to the next level, as well as the forces that naturally occur at the L4/5 level.

This level will likely have a degree of premature degeneration and could easily start causing problems within a few years. Having good body mechanics, range of motion and strength is key to a good outcome. Tiger has spent a year rehabilitating his back and strengthening it in order to play golf. If he is lucky, the stress of golf will not cause further back problems. Avoiding overstressing a surgically repaired area is often key to avoiding re-injuring, but Tiger will be testing that theory every time he tees it up from here on out.

Get Your Vitamins and Minerals From Food, Not Supplements

April 23, 2019 / Thomas Cohn, MD

Many people ask about taking dietary supplements, vitamins, minerals, and various natural compounds to improve their pain and their life. These are not officially regulated as far as how well they work. They are regulated only to the level that they cannot be toxic when ingested and they have become a billion dollar business.

Are They Effective?

Recently, a large study was done with regards to multiple dietary supplements, with an extra emphasis on medications with claims of helping with heart disease and natural degeneration caused by aging. Simply put, nothing had any positive impact on health for any of the compounds being pushed. The study was published in JAMA in January 2019 and looked at many different compounds. Included were ginkgo balboa, coenzyme Q10, coral calcium, and many others. These are all found in the vitamin and supplement aisle of many stores. None of these promoted items had any impact on cardiac health, dementia, cognition or any general component of health. Basically, none of these vitamins, compounds or minerals made a difference.

The answer of what really works is eating healthy. All these various compound are found in our fresh foods. Eating fresh food provides nutrients in a way through the gut that the appropriate vitamins and minerals are absorbed correctly and can be used by the body. In pill form or other concentrate, the body often will not be able to utilize the compound successfully. Many times the form of the compound in a pill is not absorbed or is destroyed by the body’s digestive processes. When we eat our food, our digestive system can find the nutrients and make sure they travel to the correct areas of the body. All the studies show that nutrients that come from eating a good diet are helpful, and adding a variety of supplements shows no benefit.

The best suggestion based on all these medical studies is save the money spent on supplements and spend the money on eating a healthy diet with fresh fruit and vegetables and low fat protein. Highly processed foods with high carbohydrate loads often do not have a high nutritional value. Develop a diet that comes from the outer aisles of the grocery where the fresh foods are found. None of the claims for supplements have really be proven, so save your money for now.

Opioids, Medical Marijuana and Chronic Pain

April 10, 2019 / Thomas Cohn, MD

When it comes to managing chronic pain, we’re always looking for new and better ways to help patients control their discomfort. If you’re a regular follower of our blog, you probably know that we’ve written a number of blogs on opioids and medical marijuana, but a recent study decided to take a look at what happened when these two treatment plans were used simultaneously. You might be surprised at the findings.

According to research presented at the 2019 American Pain Society Scientific Meeting, individuals with chronic pain who used both prescription opioids and recreational marijuana showed higher levels of mental health and substance abuse problems than those who use opioids alone. Now, the study makes a big distinction noting that patients were using marijuana recreationally and not medicinally, but it still shines a light on how problems can occur when people try to supplement their opioids with other substances.

Study Results

Those weren’t the only findings that were of concern according to researchers. The team said that anxiety and depression scores were also significantly higher for patients who used both opioids and recreational marijuana, as were measurements of opioid dependence severity and alcohol and cocaine involvement. Researchers also noted that there was no difference in pain severity or pain disability between the group of individuals just using opioids and those using opioids and recreational marijuana.

“The things psychologists would be most worried about were worse, but the thing patients were using the cannabis to hopefully help with — namely pain — was no different,” said Andrew Rogers, University of Houston, who worked on the study. “Co-use of substances generally leads to worse outcomes. As you pour on more substances to regulate anxiety and depression, symptoms can go up.”

Abhiram Bhashyam, MD, MPP, of Massachusetts General Hospital in Boston, who was not involved with the study, said the findings provide even more evidence that patients shouldn’t assume that recreational marijuana will help with the effects of their chronic pain if they are already on opioids.

“This study provides further evidence that cannabis may not be an effective substitute or alternative to opioids for pain management,” said Dr. Bhashyam. “Studies like these are important for clinicians as patients increasingly ask about opioid-cannabis co-use for managing their pain. We lack robust evidence to provide appropriate guidance due to a paucity of research on this topic at present.”

Both opioids and medical marijuana can be helpful if you’re dealing with chronic pain, but it’s important to realize that there’s a significant difference between regulated medical marijuana and recreational marijuana, so don’t assume that what you pick up on the street will be beneficial in combination with opioids for your pain. As this study suggests, it doesn’t appear to help and it can certainly make some problems worse. If you’re considering medical marijuana or another treatment plan for your pain, consult with a physical medicine specialist first to ensure you’re making the right choice for your individualized condition.

The Importance Of A Support System When You Have Chronic Pain

April 4, 2019 / Thomas Cohn, MD

Whether you’re off pursuing your dreams of being a musician in New York City or trying out for the varsity basketball team, everybody wants to have a strong support system that they can turn to in a time of need. Another group of people who need a strong support system in their life are those individuals with chronic pain, but those with a chronic condition know that a good support system can be hard to find. Today, we share some tips for finding and building a strong support system if you have chronic pain.

Chronic Pain Support System

All of the following tips may not apply to your situation, but we’re confident at least some of them will. Here’s how you can build and learn to rely on a support system if you’re dealing with a chronic illness.

1. Find A Few Close Friends – You probably have one or two really close friends or family members that you can rely on when things get tough, and it’s important to lean on them when you need help. Just because you have a large family or a large network of friends doesn’t mean they are all going to be sympathetic to your cause and be reliable in your time of need. Recognize that not everyone is going to be part of your support system, so focus on the really reliable members of your support system instead of trying to involve a larger network of people.

2. Online Support – The rise of the internet has made it much easier for people to connect with other individuals who are going through the same thing. You can find highly specialized support groups that can allow you to talk to people who know what you’re dealing with. Try a simple google search and see what groups are out there. Find one or two that seem supportive and consider joining.

3. Share Your Experiences – A number of people find it helpful to share their stories with others. Whether you’re talking to your best friend on the phone or writing out your daily struggle on an online forum, it can be extremely helpful to talk about your experiences. Find a place where you can vent or be vulnerable, and let your story be heard.

4. Support Yourself – It’s also important to remember that you are the most important member of your support group, and you need to take care of yourself. You need to be getting regular exercise, eating a healthy diet and partaking in activities that contribute to a healthy physical and emotional well-being. If you have self-destructive tendencies, your support group may fall apart because others may think “Why should I care about them if they don’t seem to care about themselves?” Be your biggest supporter.

5. Professional Help – Finally, don’t be afraid to reach out to a professional for help. Whether you need a chronic pain specialist to help you get a grip on your condition, or you want to talk to a mental health counselor about your feelings and your concerns, please reach out for help. We want to be part of your support team, but we can’t get you help unless you connect with our office. Let us help you.

For more tips on building and maintaining a healthy support system if you have chronic pain, reach out to Dr. Cohn’s office today.