Could Your Foot Pain Be Caused by a Problem in Your Spine?

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Article featured on Spine-Health

This blog provides a list of common causes of foot pain and helpful pointers to help you understand the origin of your foot pain.

Foot pain caused by a spinal problem

Nerve root irritation or compression in the lumbar or sacral spine (lower back) may cause sciatica pain to radiate down your leg and into the foot. Specifically, compression of the S1 nerve root, also called classic sciatica, can cause pain along the outer side of your foot.

Nerve roots may be compressed or irritated due to a number of causes. Common examples include:

  • Lumbar herniated disc: Leaking of the inner contents of an intervertebral disc
  • Lumbar degenerative disc disease: Age-related changes causing narrowing and shrinkage of the disc
  • Spondylolisthesis: Slipping of a vertebra over the one below it
  • Lumbar spinal stenosis: Narrowing of the bony openings for spinal nerves and/or the spinal cord

The inability to lift the front part of your foot or frequent tripping while walking may be due to a condition called foot drop. This condition is typically caused due to compression of the L5 nerve root. Rarely, compression of the L4 and/or S1 nerve roots may also cause foot drop.

Foot pain caused by compression of nerves in the hip, knee, or leg

Foot pain can also occur when nerves are compressed or damaged along their path in the hip, knee, or leg. For example:

  • Peroneal neuropathy, a condition where the peroneal nerve is compressed or injured near the knee may cause foot pain and foot drop when you try to move your foot.
  • Sciatic neuropathy or damage to the sciatic nerve in the pelvic region (hip) may cause foot pain along the top of your foot with some degree of weakness.
  • Tarsal tunnel syndrome or dysfunction of the tibial nerve within the tarsal tunnel of the inner ankle may cause a sharp, shooting pain in your ankle area and along the sole of your foot.
  • Sural nerve entrapment can occur in the leg or near the ankle and typically causes shooting pain along the outer side of your ankle and/or foot.

Additionally, a corn may develop on the skin around your toes. Corns grow over time as a result of excessive friction, and they can compress nearby nerves, causing pain and other symptoms. Another possible cause of nerve pain in your foot is Morton’s neuroma, which is a thickening of the tissue around a nerve in the foot.

How to identify the source of your foot pain

With all the possible causes of nerve pain in the foot, it may be difficult to pinpoint the exact underlying cause. Here are a few useful signs to help you identify the source of your foot pain:

  • Foot pain that follows recent trauma to the lower back, hip, knee, or ankle may help indicate the site of nerve damage
  • Foot pain due to nerve root compression or sciatica may also be associated with other symptoms, such as pain, numbness, and/or weakness in the buttock, thigh, and leg; and typically affects one leg at a time
  • Foot pain that develops after wearing tight boots or shoes may indicate peroneal or sural nerve compression near the knee or ankle
  • Foot pain that develops after a hip injection or hip surgery may indicate sciatic neuropathy.

Nerve pain in the foot may also occur due to nerve damage from systemic conditions, such as diabetes or multiple sclerosis.

Twisting, bending, or a direct hit on your ankle and/or foot may injure the foot bones, ankle joint, blood vessels, muscles, and/or tendons, causing foot pain.

Schedule a visit with your doctor

It is important to schedule an appointment with your doctor to accurately diagnose the cause of your foot pain. Treatments for foot pain can differ widely and must be directed at resolving the underlying cause; not just masking the symptoms. For example, a lumbar herniated disc may require heat therapy and exercise, while a corn on your toe can often be treated with special shoes and warm water.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

6 Signs of Spinal Stenosis

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Article feature on Spine-Health

Does your back, arm, or leg pain seem to come and go, depending on what you’re doing at the moment? This sign may indicate spinal stenosis.

Spinal stenosis happens when the bony openings for your spinal nerves (foramen) and/or the spinal cord (central canal) become narrow. This narrowing may compress your spinal cord and/or spinal nerves and can develop at various points along your spine. Spinal stenosis is a condition that’s more likely to occur in people over 60 years of age and tends to worsen as the years add up.

Here are 6 typical signs and symptoms to watch out for if you suspect your pain is from spinal stenosis. Depending on the type and location of the stenosis, one or more symptoms may be experienced:

1. Neurogenic claudication

When the nerves in your lower back get compressed, you may experience neurogenic claudication in your legs. Neurogenic claudication usually has the following characteristics:

  • Constant pain and/or numbness in your legs while standing
  • Increased pain and/or numbness in your legs while walking variable distances and/or while bending the spine backward
  • Difficulty in performing upright exercises or activities
  • Improvement or resolution of pain and/or numbness with rest

Neurogenic claudication pain is typically relieved when you bend your spine forward (such as while leaning on a shopping cart/walker, squatting, or sitting and leaning forward).

Your doctor will likely need to differentiate this pain from vascular claudication, which can mimic neurogenic claudication.

2. Sciatica

Compression of the nerve roots in your lower back may lead to lumbar radiculopathy or sciatica (depending on the nerve roots affected). Sciatica is experienced as nerve pain and weakness typically felt in one leg at a time.

Depending on the nerve root(s) affected, pain may occur in your lower back, buttock, thigh, calf, leg, and/or foot. A pins-and-needles sensation, tingling, weakness, and/or numbness may also occur in the areas affected by pain.

3. Foot drop

Compression of the L4 and L5 nerve roots in the lower spine may cause motor weakness in your foot, resulting in foot drop. This condition typically causes a feeling of weakness while attempting to lift the foot and/or toes upward. As a result, the individual may involuntarily drag their foot or tend to trip while attempting to walk.

The compression of the S1 nerve root may cause weakness while walking on tip-toes.

4. Gait problems

Spinal stenosis can affect walking in different ways depending on its location within the spine, for example:

  • Lumbar spinal stenosis (in the lower back) may cause gait problems due to foot drop. The condition may also cause weakness in thigh and leg muscles, such as the quadriceps and the calves.
  • Cervical spinal stenosis (in the neck) with spinal cord compression may cause difficulty in maintaining balance while walking, especially in the dark. However, cervical spine stenosis with a pinched nerve does not cause gait imbalance.

Changes in gait may be too subtle to notice at first. Over time, the condition may present with progressively increasing falls.

5. Radiating arm pain

Cervical spinal stenosis may cause mild to moderate burning or shock-like pain in the neck, shoulder, and/or arms. Abnormal sensations, such as tingling, crawling, and/or numbness may be felt in both hands. The arms and hands may feel weak.

6. Loss of fine motor skills

Spinal stenosis in the cervical spine may cause difficulty in doing tasks that involve fine motor skills of the hand, such as buttoning a shirt. In the advanced stages, there may be difficulty with writing, eventually making holding a pen impossible. 6

If these symptoms sound familiar, check with your doctor, since spinal stenosis may get worse without treatment.

Red-flag signs and symptoms of spinal stenosis

Rarely, severe spinal stenosis may cause red-flag symptoms, such as bowel and/or bladder incontinence, numbness in the inner thighs and genital area, and/or severe weakness in both legs.

These symptoms indicate a serious medical condition, such as cauda equina syndrome, which must be treated urgently to prevent permanent loss of function in the legs.

An accurate diagnosis by a medical professional is necessary to determine the underlying cause of spinal stenosis. Depending on the cause and severity, your doctor may suggest nonsurgical treatments, such as physical therapy, pain-relieving medications, and/or activity modification. Sometimes, minimally invasive procedures, such as epidural steroid injections may be advised. Surgery is rarely advocated as the first-line treatment unless there are severe symptoms or neurologic deficits.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

How to Improve Your Posture at Work

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Article featured on Atlanta Spine Institute

How to Improve Your Posture at Work

A majority of Americans spend long periods of time sitting down while at work. Having an improper posture day after day can put those people at risk of chronic back pain, disorders, or future injuries. Read on to learn more about improving your posture at work.

Sitting Disease

The term sitting disease is a relatively new term. It refers to sitting for extended periods of time with little movement and poor posture, which results in multiple long term medical conditions, with chronic back pain being the most common. Even with a healthy level of exercise before or after work, the long periods of sitting can still cause health issues. Sitting disease is most often caused by the following:

  • Long periods without movement which can restrict blood flow to the spine.
  • Workstation or desk setup that causes neck strain, typically a result of monitors that aren’t at eye level.
  • Crossing your legs or ankles for long periods which can cause misalignment of the hips.
  • Slouching over with a rounded back, putting additional stress on your back.

Improving Work Ergonomics to Reduce Neck and Back Pain

Work ergonomics refers to fitting your job to your body and what it needs. For office work, this usually entails adjusting your workstation, desk, computer, chair, and your working habits to better fit your body. Improving work ergonomics generally focuses on keeping your body in a neutral position, not slouching over, and not leaning back too far. Some general tips to improve your work ergonomics include:

  • Rest with your feet flat on the ground and limit the amount of time with your feet or ankles crossed.
  • Keep your back against the back of your chair.
  • Make use of the lumbar support on your chair to help prevent slouching.
  • Adjust your computer monitors so that they’re at eye level, making sure that you’re not always looking down or up on them, which can strain the neck.

Take Breaks

Even with an improved work ergonomics, it is still important to take breaks, stretch, move around, stretch your legs, and promote blood flow. Research has revealed that taking a break about every half hour can significantly reduce the potential for health risks associated with prolonged sitting.

Listen to What Your Body Tells You

Awareness is another key factor in preventing chronic neck and back problems. If your body starts to become sore or stiff, analyze your work ergonomics. Maybe something needs adjusted, or maybe you just need more breaks. Try adjusting and see if the soreness or stiffness improves. If you suffer from chronic neck or back pain, schedule an appointment with your spine specialist to diagnose and recommend treatment to improve your neck and back.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Hip-Spine Syndrome: It’s Complicated (and Often Overlooked)

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Article featured on Brigham Health Hub

A patient with hip arthritis may experience hip or groin pain as well as trouble walking, while a patient with lumbar spinal stenosis may have pain down their leg, or neurologic symptoms such as numbness, tingling, or weakness.

“Hip-spine syndrome is a distinct syndrome where both hip and spinal problems are occurring together,” says James D. Kang, MD, Chairman of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital.

And yet, because hip and spine disorders have overlapping presentations and symptoms, it can often be challenging for physicians to determine if a patient’s symptoms originate from the hip, spine, or both. This can delay diagnosis and treatment, and many patients with hip-spine syndrome have seen several physicians and therapists or may have undergone various procedures that did not relieve their pain.

Hip-spine syndrome is a condition where both hip and spine problems are occurring in tandem.

“The first order of business is to make sure that the treating physician considers hip-spine syndrome in their evaluation. The problem is that many centers are so sub-specialized that hip surgeons only see hip problems, and spine surgeons only see spine problems,” says Dr. Kang.

“Our department is at the forefront of public awareness and academic awareness of this complicated syndrome. We are spearheading several efforts in orthopaedic research, including clinical investigations and patient outcome studies, trying to determine the optimal treatment plans for patients with hip-spine syndrome,” says Dr. Kang.

For patients with minor hip or back pain, Dr. Kang typically prescribes rehabilitation and physical therapy. Only patients with more advanced hip-spine syndrome who do not respond to physical therapy require invasive treatments, such as an injection therapy, or surgery.

Dr. Kang also recommends lifestyle changes to those with hip and spinal disorders, including weight reduction through diet and exercise. Since many patients with hip-spine syndrome have trouble walking or running, he recommends less active forms of aerobic conditioning, such as swimming and stationary biking.

For those with low back problems quitting smoking is also important, as prolonged exposure to cigarettes has been shown to impair oxygen delivery to tissues, and may cause damage to vascular structures of the discs and joints. Using anti-inflammatory medications can also help modulate symptoms.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Ways to Protect Your Spine as You Age

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Article featured on Brigham Health Hub

The human spine consists of discs and joints that, like a hinge on a door, can wear out with time. While you may hear worrying terms such as “degeneration” or “arthritis” to describe these changes, it’s a natural part of the aging process.

This wear and tear don’t necessarily produce symptoms. It’s only when changes cause structures in the neck or back to press on spinal nerves that a patient may experience pain with movement, tingling, numbness, weakness, or shooting pain into a hand.

At this point, a patient may visit their primary care doctor, and leave with a prescription for an anti-inflammatory and/or a referral to physical therapy. If symptoms persist they might visit a spine surgeon.

Matching symptoms with findings from imaging

Jay Zampini, MD is a spine surgeon in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital. He sees hundreds of patients a year suffering from a broad range of spinal conditions, from whiplash to a disc herniation.

“In my initial evaluation with a patient,” says Dr. Zampini, “I perform a physical exam and review X-rays or MRIs. I try to match symptoms with abnormalities on imaging.”

For example, if a patient has sensory problems or pain that radiates into the first two fingers in their hands, Dr. Zampini will discern that there’s likely damage to the cervical (neck) vertebra, probably C6.

He balances such findings with the understanding that imaging can present abnormalities that aren’t always responsible for symptoms.

Treatment starts with non-surgical options

Dr. Zampini was trained by Michael W. Groff, MD, a neurosurgeon and the Director of Spinal Neurosurgery at the Brigham. The two now work side-by-side to evaluate, diagnose and treat patients with conditions that affect the neck and back.

While Dr. Groff and Dr. Zampini are both spine surgeons, they don’t operate until a patient has exhausted all non-surgical options. In fact, 90 percent of patients experiencing back and neck pain won’t need spine surgery.

“We treat problems with the spine very conservatively. We start with anti-inflammatory medications and physical therapy, then pain management, if necessary. I might also encourage patients to continue care with a physiatrist,” says Dr. Groff.

The vast majority of patients recover after physical therapy. If a patient returns to their surgeon with persistent symptoms, the next step can be taken.

When spine surgery is needed

“If we exhaust all non-surgical options and the patient still experiences symptoms, such as pain with weakness, gait problems, or difficulty with bowel or bladder function, then we start to consider surgery,” says Dr. Groff.

Surgery is recommended if a patient has been suffering with symptoms for6 weeks or more. Likewise, severe cases of disc herniation that may risk paralysis, and serious conditions, are corrected surgically.

“If you do require surgery, the Brigham has an integrated approach to spine care and all the clinical resources of a world-class academic medical center,” says Dr. Groff.

At Brigham Health, a multidisciplinary team of surgeons, physiatrists, physical therapists and pain specialists collaborate to get patients back to their lives as quickly as possible.

Spine care is part of the Brigham’s larger ecosystem, so patients with co-morbidities, such as hypertension or diabetes, have access to resources that can address any complications that may crop up as their spinal condition is being treated.

Keep your spine healthy by knowing your limits

In most conversations with patients, Dr. Zampini usually illustrates how our spines change throughout our lives by telling a personal story about a devastating injury he suffered that changed how he now thinks about his body.

Dr. Zampini was 38-years-old when he ran a half-marathon in less than 90 minutes. It was blistering pace, a personal best, but the strenuous effort fractured his pelvis. “I was completely overdoing it, running as if I was still 25-years-old,” he says.

It was a wake-up call, and he changed his mindset during the eight months of recovery. He began listening to his body more.

“Some of my patients can relate to my story, because they’re trying to do things their bodies just can’t handle for their age,” says Dr. Zampini.

He advises his patients to understand and respect their limits. What kinds of activities and levels of intensity can you realistically handle given your age and level of conditioning?

To avoid injuries, Dr. Zampini advises patients to strengthen their core muscles, which include the lower back, hips and abdomen. These muscles work together to keep your body balanced. He also advises people to use proper technique when performing high-intensity movements and to modify movements or use lighter weights to lower intensity.

For those who work in an office, it’s also important to customize your work space to avoid muscle imbalances and repetitive injuries.

Exploring the best way forward with a spine expert

After Dr. Zampini recovered from his pelvic injury, he switched from running to lower-impact activities, including the elliptical and stationary bike. He also stretches and does yoga exercises every morning before he sees patients in his clinic.

“I still jog occasionally, but I don’t race anymore. I’ve accepted what I can and can’t do, and I’m happy about that,” says Dr. Zampini.

Both Dr. Zampini and Dr. Groff encourage anyone who has had to give up an important activity to seek consultation from a spine expert to explore the best way forward.

“In many cases, certain activities can be reclaimed in a responsible way,” says Dr. Groff. “It’s gratifying to see patients get back to the activities they love.”

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Techniques and Technology Improving Outcomes for Complex Scoliosis Surgeries

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In Scoliosis Surgery, Lengthy and Complex (Albuquerque Journal), Dr. Anjali Subbaswamy (a Pediatric Intensive Care Physician at UNM) answers questions regarding a patient whose pediatrician has suggested she may need surgery and is wondering what that entails.

She notes a recent observation of markedly improved conditions post-surgery, prompting her to ask her colleague  Dr. Antony Kallur (a Pediatric Spine and Orthopedics specialist formerly with UMN and currently with New Mexico Orthopaedics) what might be contributing to the improvements:

Q: My 14-year-old daughter has scoliosis and her pediatrician thinks she might need to have surgery. What does that entail?

A: The surgical repair for scoliosis is Posterior Spinal Fusion, and it is a surgery performed often in my hospital. It is a long surgery, often taking between 6 to 8 hours. The children usually, but not always, come to the Pediatric Intensive Care Unit (PICU) afterwards for postoperative care. They might stay in the PICU for 1 to 4 days, depending on how they recover. After that, they go to our inpatient Carrie Tingley Rehabilitation Unit, where they receive physical and occupational therapy. These therapies facilitate their ability to resume their activities of daily living, and also enhance their recovery. The therapists will give you exercises to continue at home. The entire hospital stay is typically 5 to 7 days.

There are 3 different kinds of pediatric scoliosis, all of which may require surgical treatment. They are idiopathic scoliosis, neuromuscular scoliosis and congenital scoliosis. Idiopathic scoliosis is by far the most common type. This affects otherwise healthy children, who have a sideways curve in their spine, which measures greater than 10 degrees. Your pediatrician may have done the Adams Forward Bend test to assess this, followed by some X-rays.

The American Academy of Orthopedic Surgeons (AAOS) provides the following information: If the spinal curve is between 25 degrees and 45 degrees and your child is still growing, your doctor may recommend bracing. Although bracing will not straighten an existing curve, it may prevent it from getting worse to the point of requiring surgery. Your doctor may recommend surgery if your child’s curve is greater than 45-50 degrees or if bracing did not stop the curve from reaching this point. Severe curves that are not treated could eventually worsen to the point where they affect lung and heart function. That is the main medical reason for intervening.

Now, here’s some good news. I have personally noticed that the patients I get from the operating room after this procedure are in much better condition than in years past. They are more stable in terms of their breathing and blood pressure, they start eating and drinking sooner after surgery, they start sitting up and getting out of bed sooner and their pain is better controlled. It is frankly amazing to me that some of these children don’t have to come to the PICU after surgery. This surgery takes a long time and involves blood loss and many hours of anesthesia. All of those factors are stressful to the body, and these children used to come out of surgery somewhat unstable. They would require active management of their fluid balance, blood pressure, pain and breathing. We would check labs and replace electrolytes and clotting factors. Nowadays, we barely do anything except watch them closely. They typically come out of the operating room breathing on their own, with stable blood pressure and good pain control. These changes are striking improvements, and prompted me to ask my colleague Dr. Antony Kallur, “What has changed?” 

Here’s Dr. Kallur’s answer:

Well, things definitely have changed for the better in a lot of ways.

First of all we understand the importance of three dimensional correction and restoration of spinal alignment. Anesthetic techniques have changed very much and are safer with newer medications and ability to keep children unconscious but maintaining baseline nerve and brain function so that we can monitor the child’s spinal cord.

Neuro-monitoring; which is now used all the time for any scoliosis surgery has made the surgery very safe reducing the incidence of neurological injury.

The surgical techniques and our understanding of how to correct the spine and the alignment that needs to be restored has made the children able to return to all activities after healing from surgery without any restriction. The implants used are advanced to help us correct the spine and maintain alignment to healing and can be placed safely. Titanium implants used now are also biocompatible and incidence of infection is negligible in healthy children. Our incidence at Carrie Tingley hospital is ‘zero’ in healthy children.

These days, the child does not need to stay in bed or use a brace after surgery. The newer instrumentation techniques mean that need to harvest child’s own bone (from the pelvic bone) as graft for achieving fusion/healing is not needed.

The recovery from scoliosis surgery has become so much easier to the child and family compared to how it was 10 to 15 years ago. So, we achieve better correction and alignment with safer surgery with a quicker recovery and return to activities. I hope things go very smoothly for your daughter!

Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Antony Kallur is a Pediatric and Adult Orthopedic Surgeon and Pediatric Spine Specialist at New Mexico Orthopaedics. 

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300 or utilize our self-scheduling tools here.

 

5 Benefits Of Aquatic Therapy For Spine Pain

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Article featured on Spine Health

The pool is a great place to take your workouts or physical therapy exercises. Here’s a look at five reasons why your back benefits from aquatic therapy.

Benefits of Water Therapy For Your Back

Your back can benefit from a water therapy session, but it’s important to note that aqua therapy may not be right for everyone. If you are dealing with a fever, infection, or an open wound (including a surgical incision that has yet to fully recover), water and the chemicals in the pool can make the problem much worse. If you have any of these conditions, speak with your doctor before moving forward with water-based therapy.

Here’s a look at why your back can benefit from water therapy:

  1. Decreased load bearing. Aqua therapy can decrease the stress placed on your spine because of the buoyancy provided by the water. If you are dealing with a disc issue that makes movement painful or if you are trying to re-strengthen your spine weeks after a surgery, aqua therapy can take some of gravity’s stress off your spine, which allows you to focus on your therapy exercises.
  2. Increased mobility. Along a similar vein, because of the buoyancy of water, we are often able to twist and turn more freely in water, which allows us to do range-of-motion exercises that would not be possible on land. Increased mobility is a benefit of water-based therapy.
  3. Natural resistance. If you do trunk twists on land, you’re not going to encounter any resistance and thus won’t be working your spinal muscles very hard. Try doing them in water instead. Water is roughly 600 times more resistant than air, so simple land workouts will be more effective when performed in the water.
  4. Decreased pain. Many people who suffer from back pain remark that it’s less painful to do a water workout than a normal land routine. This makes sense, because the water helps to increase blood supply to sore muscles and joints. The feel of the water is also comforting, which helps take your mind off your pain.
  5. No falling. Spinal surgery or other painful spinal conditions can have a negative impact on our balance. A painful nerve sensation or a momentary loss of balance on land due to a spinal condition can send us toppling to the earth, which can lead to fractures or other injuries. However, balance isn’t an issue when you’re up to your waist in water. You eliminate your risk of falling by conducting your workout in water, and it will also help to strengthen the muscles in your feet to improve your balance when you’re on land.

If you are dealing with spine pain and you are looking for a refreshing way to complete your physical therapy exercises, talk to your doctor about developing a water-based exercise program.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

3 Tips to Keeping Your Spine Healthy

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Article featured on Brigham Health Hub

While the COVID-19 pandemic has changed our lives dramatically, back and neck problems are still as common as ever. In fact, some people are experiencing pain and other discomforts for the first time due to changes in their work locations and equipment as they moved from the office to home. The good news is that most spine conditions improve with time, physical exercise and getting back to your normal activities.

During the pandemic, Michael W. Groff, MD, a neurosurgeon and the director of the Neurosurgical Spine Service at Brigham and Women’s Hospital, had a virtual visit with a patient who was having neck pain along with tingling and weakness in an arm. The patient had undergone a previous surgery with Dr. Groff and feared he might need another.

While an MRI showed more wear and tear in the man’s neck, Dr. Groff reassured his patient that the condition would likely improve without surgery. The best course of action included physical therapy and performing exercises at home.

“I’m not one hundred percent certain that this patient won’t need surgery again,” says Dr. Groff. “But I reassured him that the path to recovery was to get moving and return to his normal routine. And neither of these things would further hurt his neck.”

Dr. Groff is co-chair for the editorial board of Journal of Neurosurgery: Spine. In this role, he and others have been distributing timely information about providing safe care for spine patients during the pandemic.

Keep your back and neck strong with an exercise routine

To keep your back and neck healthy, Dr. Groff urges his patients to perform any physical activity that helps maintain fitness, strengthens the core muscles and includes stretching. If you have back issues, the best way to stay healthy is to stretch often and keep your core strong.

Many people have found virtual exercise classes or routines that include Pilates, yoga or cardio workouts. To stay in shape, you can also use elastic bands, hand weights and/or perform isometric exercises, like planks or squats at home.

“It’s especially important to avoid being sedentary for long periods of time,” says Dr. Groff. “Being inactive can cause muscles that support the spine to weaken. This can sometimes lead to back or neck pain or exacerbate an existing spine condition.”

Getting regular exercise can have other benefits, too. It can give your day structure and help break up the monotony of staying at home for an extended time. Physical exercise can also help you maintain a positive outlook while navigating this challenging period.

When to seek care for back or neck problems

If you have an acute injury, like a pulled back or neck muscle, your pain will likely only last a few days. However, if your symptoms last 2 to 3 weeks and you have weakness or tingling in an arm or leg, contact your doctor.

For pain relief, Dr. Groff recommends ice for the first 48 hours and then alternating between heat and ice for several days after. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), can also help reduce pain and lower inflammation.

For flare-ups of back or neck pain, most spine care providers recommend only staying in bed for about 3 days. In the past, doctors used to recommend a few weeks of bedrest for flare-ups until a pivotal 2016 study showed that 3 days of bed rest is all patients need before they should return to normal activity.

“Staying in bed any longer than 3 days may lead to muscle weakening that can actually worsen a pain episode,” says Dr. Groff. “If you’re having pain, I usually recommend that patients rest and recover over a long weekend and then resume their normal activities.”

Back or neck pain usually doesn’t cause physical damage

If you have back or neck pain, how you interpret it can often impact how disabling it can become. Many patients ask Dr. Groff whether their pain is “all in their heads.” It is, he says, because all pain is experienced in our minds.

“If you’re in pain, most patients find it helpful to know that their pain is most likely not causing physical damage to their spines,” says Dr. Groff. “If you know you aren’t hurting yourself, you can feel better about exercising and returning to your routines.”

Dr. Groff hopes to help patients understand their pain from this new perspective. Doing so often removes the fear of physical activity, because getting back to normal life is a common pathway out of pain for many patients.

“The experience I’ve gained during the COVID-19 pandemic gives me the confidence to say that the Brigham is providing care that’s compassionate, technically excellent and safe for you and your family,” says Dr. Groff.

Dr. Groff can see patients both in person and through virtual visits, which allow him to stay in contact with patients who prefer to connect from home.

“I can still meet with patients and discuss their symptoms during virtual visits,” says Dr. Groff. “I can review imaging and develop a care plan that’s tailored to their unique circumstances. I can also follow up with patients to see how they’re progressing.”

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Degenerative Disc Disease and Sciatica Facts

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Article featured on MedicineNet
Sciatica can result from lumbar disc herniation (“ruptured disc”) or spinal osteoarthritis when nerves in the low back are irritated by the abnormal anatomy in the low back.

What is the design of the spine?

The vertebrae are the bony building blocks of the spine. Between each of the largest part of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae of the cervical spine), 12 vertebrae in the mid-back (thoracic vertebrae of the thoracic spine), and five vertebrae in the low back (lumbar vertebrae of the lumbar spine). In addition, in the mid-buttock beneath the fifth lumbar vertebra are five sacral vertebrae — usually fused as the sacrum bone followed by the tailbone (coccyx).

What is the purpose of the spine and its discs?

The bony spine is designed so that vertebrae “stacked” together can provide a movable support structure. The spine also protects the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a bony arch behind the spinal cord that shields the cord’s nerve tissue. The vertebrae also have a strong bony “body” in front of the spinal cord to provide a platform suitable for weight-bearing.
The spinal discs are pads that serve as cushions between each vertebral body that serve to minimize the impact of movement on the spinal column. Because the discs are situated between vertebrae, they are sometimes referred to as intervertebral discs. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) surrounded by a firmer ring of tissue (annulus fibrosus). With injury or degeneration, this softer component can sometimes rupture (herniate) through the surrounding outer ring (annulus fibrosus) and irritate adjacent nervous tissue. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.

Degenerative Disc Disease Symptom

Low Back Pain

Pain in the low back can be a result of conditions affecting the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

What is degenerative disc disease? What causes degenerative disc disease?

As we age, the water and protein content of the cartilage of the body changes. This change results in weaker, more fragile, and thin cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). The gradual deterioration of the disc between the vertebrae is referred to as degenerative disc disease, sometimes abbreviated DDD. Wear of the facet cartilage and the bony changes of the adjacent joint is referred to as degenerative facet joint disease or osteoarthritis of the spine. Trauma injury to the spine can also lead to degenerative disc disease.
Degeneration of the disc space and its contents is medically referred to as spondylosis. Spondylosis can be noted on X-ray tests or MRI scanning of the spine as a narrowing of the normal “disc space” between the adjacent vertebrae.

What are degenerative disc disease symptoms?

Degeneration of the disc tissue makes the disc more susceptible to herniation. Degenerative spondylosis is another name for degeneration of disc tissue. Degeneration of the disc can cause local pain in the affected area. Any level of the spine can be affected by disc degeneration. When disc degeneration affects the spine of the neck, it is referred to as cervical disc disease. When the mid-back is affected, the condition is referred to as thoracic disc disease. Disc degeneration that affects the lumbar spine can cause low back pain (referred to as lumbago) or irritation of a spinal nerve to cause pain radiating down the leg (sciatica). Lumbago causes pain localized to the low back and is common in older people. Degenerative arthritis (osteoarthritis) of the facet joints that can be detected with plain X-ray testing is also a cause of localized lumbar pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.

What are the symptoms of radiculopathy and sciatica?

Radiculopathy refers to nerve irritation caused by damage to the disc between the vertebrae. This occurs because of degeneration (“wear and tear”) of the outer ring of the disc or because of traumatic injury, or both. Weakness of the outer ring leads to disc bulging and disc herniation. As a result, the central softer portion of the disc can rupture through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column.
It is important to note that many people have degenerative spines without having any symptoms. When nerves are irritated in the neck from degenerative disc disease, the condition is referred to as cervical radiculopathy. This can lead to painful burning or tingling sensations in the arms. When nerves are irritated in the low back from degenerative disc disease, the condition is called lumbar radiculopathy, and it often causes the commonly recognized “sciatica” pain that shoots down a lower extremity. This condition can be preceded by a localized low-back aching. Sciatica pain can follow a “popping” sensation at onset and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, lumbar radiculopathy can be accompanied by incontinence of the bladder and/or bowels.

How do health care professionals diagnose degenerative disc disease, radiculopathy, and sciatica?

Degenerative disc disease, radiculopathy, and sciatica are suspected when the symptoms described above are noted. The doctor can sometimes detect signs of irritated nerves during the examination. For example, increased radiating pain when the lower extremity is lifted supports the diagnosis of lumbar radiculopathy. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect the nerve irritation. Health care professionals can visualize degenerative spondylosis using plain film X-ray imaging of the spine, CAT, or MRI scanning. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning.

What is the treatment for degenerative disc disease, radiculopathy, and sciatica?

The treatment of degenerative disc disease, radiculopathy, and sciatica ranges from nonsurgical (medical) management to surgery. Medical management of radiculopathy includes patient education of the condition, medications to relieve pain (NSAIDs, analgesics) and muscles spasm (muscle relaxants), cortisone injection around the spinal cord (epidural injection), physical therapy (heat, exercises, massage, ultrasound, electrical stimulation), chiropractic manipulation and rest (not strict bed rest, but avoiding reinjury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (producing a small hole in the bone of the spine surrounding the spinal cord), laminectomy (removal of the bony wall adjacent to the nerve tissues), by needle technique through the skin (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

What is bony encroachment and spinal stenosis?

Any condition that results in movement or growth of the bony vertebrae of the spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foramen narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slipping of one vertebra relative to another), and spinal stenosis (narrowing of the spinal canal causing by compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). For example, lumbar spinal nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities.
Spinal stenosis (narrowing of the spinal canal) can occur at any level of the spine, but it’s most common in the lumbar spine of the low back. Symptoms depend on the level affected. For example, lumbar spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking poor circulation of the lower extremities).
Treatment of these conditions varies (depending on the severity and condition of the patient) from rest to epidural cortisone injection and surgical decompression by removing the bone that is compressing the nervous tissue.

What is the outlook (prognosis) of degenerative disc disease, radiculopathy, and sciatica?

The outlook of degenerative disc disease, radiculopathy, and sciatica depends on the severity of the condition, its precise cause, and the interventions used to treat the patient. When patients respond to conservative treatments, the result can be complete healing. Surgical repairs can require postoperative rehabilitation, including physical therapy.

Is it possible to prevent degenerative disc disease, radiculopathy, and sciatica?

Avoiding injury can prevent degenerative spondylosis and resulting nerve irritation. When the disease already exists, aggravation of existing symptoms can be avoided by limiting stressing or overusing the involved spine.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

3 Telltale Signs You Have a Slipped or Bulging Disc

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Article features on Spine-Health
When a disc in your lower spine bulges or tears, you may feel pain in your lower back and/or your leg. Here are 3 unique signs of a herniated or protruding disc to help you identify the underlying cause of your lower back problem:

1. Pain while sitting

An activity that exerts tremendous pressure on your lower spinal discs is sitting. If you have a herniated or bulging disc, this increase in pressure within your disc may cause the bulge to become more pronounced, which may aggravate your lower back pain when you sit.

2. Radiating pain into your leg (sciatica)

The discs in your lower back typically herniate or bulge in the posterior (back) and/or lateral (side) region, which is in close proximity to your spinal nerve roots. Herniated discs may affect these nerve roots through one or both of the following 2 methods:

  • Direct compression. When the disc’s bulge or leaking inner contents directly press on a spinal nerve root as it exits the spinal canal.
  • Chemical irritation. When a herniated disc leaks out acidic chemical irritants from the disc material, which may cause inflammation and irritation in the area around the nerve root.

The function of the affected nerve root is then altered, and you may feel a burning pain along with numbness, weakness, and/or tingling along the front and/or back of your thigh, leg, and/or foot. These symptoms are commonly referred to as sciatica. The symptoms and signs of sciatica typically affect one leg at a time.

3. Pain aggravated by specific activities

Your lower back pain and/or sciatica may worsen when you perform certain activities, such as:

  • Bending forward/down
  • Lifting a heavy object
  • Pushing or pulling a heavy object
  • Coughing
  • Sneezing

Lumbar herniated disc pain usually comes on fast. In most cases, there is no single, clear reason for the pain, such as a specific injury or traumatic event. Yet, the pain feels sudden.
This condition can be very painful, but for most people, the symptoms don’t last too long. Nearly 90% of people who experience painful lumbar disc herniation report within 6 weeks that they no longer feel the pain, even if they received no medical treatment for it.

Warning signs and when to see a doctor

Visit your doctor if you exhibit these 3 telltale signs of a herniated disc. Your doctor may recommend a combination of nonsurgical treatments, such as pain-relieving medications and a guided physical therapy program, as well as referral to an interventional pain specialist for image-guided lumbar injections—to help decrease inflammation and relieve the pain.
If you experience any difficulty in controlling your bowel and/or bladder movements, numbness in your inner thigh and genital area, and/or problems in starting urination, consult your doctor immediately. These symptoms and signs may indicate cauda equina syndrome, a serious medical emergency, which is possible with certain severe lower back disc herniations.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.