Falls on ice, especially while carrying grocery bags and packages, and improper snow-shoveling techniques – putting stress on the back and neck rather than on the legs — remain among the more obvious sources of spinal stress, injury, and pain.

In fact, a 17-year study published in the American Journal of Emergency Medicine, estimates 11,500 snow-shoveling-related injuries are treated in United States hospitals annually, with more than 50 percent of them caused by ‘acute musculoskeletal exertion’ and another 20 percent, slips or falls. Adding to spinal dangers are those occasions when pushing a car out of a snow rut or climbing a ladder and reaching up precariously to hang December holiday lights.

Many people also are unaware that the very coldness of winter temperatures takes a toll on the spine when outdoors. Muscles tend to tighten in the frosty weather and symptoms of chronic conditions – like sciatica, which is a painful compression of nerve roots in the lower back, and degenerative arthritis of the spine – can become a bit more acute.

A study appearing in the European Journal of Pain reports surveying nearly 6,600 people in Finland and finding that 50 percent of respondents experienced some form of musculoskeletal pain at temperatures of about 7 degrees Fahrenheit. Another study, published in the International Archives of Occupational and Environmental Health and focused on Swedish construction workers, indicates that those working regularly outdoors in winter temperatures are at increased risk for developing neck and lower back pain.

The spine is a complex, columnar structure, whose myelin sheath, secured by bony vertebrae, protects the central nerve bundle linking communication between the brain and the rest of the body. Injury at any point along the length of this structure can have serious, life-changing consequences, including chronic, debilitating pain; loss of sensation; compromised physical or mental functions; decreased quality of life; and even death. Experts say the lumbar region – lower back – is the most frequently traumatized area of the spine. Spinal injuries can include stretched or damaged muscles and ligaments supporting the spine, rupture of one or more spinal discs, spinal and cervical fractures, and, in the most serious cases, paralysis.

Based on research published in a 2022 edition of Spinal Cord, the authors write, “Worldwide, traumatic spinal cord injuries have a considerable impact in terms of mortality and morbidity and represent a relevant burden for health care systems due to the expensive and complex medical support required by patients with spinal cord injury, in addition to [the] economic consequences deriving from loss in productivity. This condition is a leading cause of disability especially among younger people, with a high impact on years lived with disability.”

Of particular concern to me are winter activities – like sledding – that many people consider “innocuous” and often engage in without protective gear, such as helmets. A 2018 University of Wisconsin study in the Journal of Neurosurgery debunked theories that the “weight and bulk” of helmets make the wearers’ necks more prone to cervical fractures. The scientists, instead, determined that helmets significantly reduce instances of cervical fractures in crashes.

Although the Wisconsin study focused on motorcyclists, the American Academy of Orthopaedic Surgeons has recommended fitted helmets – at least for children under age 12 — in its guidelines for sledding safety. The organization also suggests sliding down snow hills, whether by sled, inner tube, or other method, be done in a sitting position facing forward, and in an area free of hazards like trees, streets, parking lots, or ponds.

Meanwhile, a much earlier study in the Journal of Trauma and Acute Care Surgery suggests even the sitting position predisposes tobogganers to spinal injury if they are thrown off the board or hit a hard bump on the way down.

And experts dismiss skiers’ claims that helmets obstruct the field of vision as simply an “excuse.”

Of course, people cannot expect to eliminate all winter hazards from their lives, but I offer these tips to minimize risks and help keep wintertime as safe as possible:

• Stretch and do some warm-up exercises before engaging in strenuous outdoor activities like clearing snow from the porch or driveway.

• Follow all guidelines for shoveling snow. That means putting all the lifting stress on the back, pushing rather than lifting snow whenever possible, avoiding throwing snow up and over the head and back, and taking frequent breaks.

• Use protective gear, including a helmet, when enjoying winter activities and sports like tobogganing, sledding, skiing, and ice skating.

• Wear warm clothing and dress in layers during cold temperatures outdoors. Make sure the lower back is covered. Tuck shirt into your pants. Footwear should be conducive to safe walking on snow and ice.

Stay active in the winter, despite the temptation to cocoon on the couch. Walking or swimming at a local indoor pool are great ways to maintain the strength of one’s core and back muscles.

But should you experience any type of back pain or suspected cervical or spinal injury following activity, contact an orthopedic specialist as soon as possible to minimize the risk of developing a more serious or chronic condition.

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. www.atlanticspinecenter.com

Kaixuan Liu, MD, PhD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery. He is the founder of Atlantic Spine Center.

1. Smoking

Smoking increases brain activity that makes people less resilient when it comes to responding to back pain. Smoking also causes premature aging of discs by decreasing blood supply to the discs in the back, thus leading to pain in the lower back.

2. The incorrect mattress

Old mattresses start to form dips from years of use. The dips in the mattress cause the spine to curve, leading to constant stiffness or pain. A mattress that is too firm can cause strain on pressure points in the knees, hip, shoulders, and back, which can cause backaches. If the mattress is too soft, your spine is not supported well enough, and the spine can fall out of alignment.

3. Your purse or wallet

Structural imbalances in the spinal column can occur when you sit on your wallet. This can happen because one side of your body is higher than the other, and an excess amount of physical stress is placed on the lower spine. This can lead to lower back pain and numbness. Carrying a heavy purse or bag on one shoulder can also cause a neck and spinal tilt that can lead to backaches. Remove your wallet from your back pocket when you are sitting down, and regularly switch your purse from one shoulder to another. 

4. Your wardrobe

There are unexpected items in your wardrobe that could be causing your back pain. Skinny jeans, heavy bags, strapless bras, high heels, and backless shoes are all clothing items that may be influencing your pain. Try to limit the amount of time you spend in these clothes to promote optimal wellness.

5. Dehydration

When you are dehydrated, the spinal discs lose water, and your spine is in distress. When this happens, the spine takes on the full shock of your movements, which can lead to pain. Avoid drinks with caffeine and drink plenty of water to avoid dehydration.

6. Your cell phone

Constantly hunching your neck over to look down at your phone compresses and tightens the muscles and tendons in the front structure of your neck. This creates imbalance and results in reduced mobility, shoulder and neck pain, a curvature formation at the upper back, and even headaches.

7. Incorrect ergonomic work set up

Many people have been working from home due to the pandemic. Working from home has led to slouching and hunching in front of our handheld laptops or work from home setups. Slouching can lead to neck and shoulder pain, back problems, and stiff hips. Make sure to sit all the way back in a computer chair and keep your thighs horizontal to your knees at hip level.www.nynjspine.comGbolahan Okubadejo, MD, FAAOS, leads The Institute for Comprehensive Spine Care, with offices in the greater New York City area, as a spinal and orthopedic surgeon. Board-certified and fellowship-trained, Dr. Okubadejo specializes in the treatment of degenerative spinal disease, spinal deformity, and cervical, lumbar, and thoracic conditions.Dr. Okubadejo earned his undergraduate degree at Brown University in Providence, Rhode Island, and his medical degree at Johns Hopkins University School of Medicine in Baltimore. He completed his internship and orthopedic surgery residency at Barnes-Jewish Hospital at the Washington University School of Medicine in St. Louis. Dr. Okubadejo completed a spinal surgery fellowship at the University of Pittsburgh Medical Center in Pittsburgh.Dr. Okubadejo is a published research author and has presented his findings at several major spinal conferences around the globe. While a surgical resident, he won the Leonard Marmor Surgical Arthritis Foundation Resident Award for the best research project. In 2017, Dr. Okubadejo formed the company 360 Dynamized Core, which is focused on creating innovative, spine-safe core fitness products and routines. The first patented product, 360 CoreBoard, launched to the market in 2020. Find out more at 360coreboard.comDr. Okubadejo believes in the power of preventive care, minimally invasive surgical procedures, open communication with patients, and personalized care. When he’s not caring for patients, he enjoys traveling, learning about different cultures and the arts, and playing golf.

The spine is made up of bones (vertebrae) stacked on top of each other, with jelly-filled discs that act as cushions between the vertebrae. Its natural shape is a gentle S-curve that leaves room for nerves and blood to run smoothly through the spine’s central canal. With the support of muscles and ligaments, the spine is designed to support the entire body evenly. When the spine’s alignment is compromised. the body tries to compensate for the imbalance by bending or flexing the spine and hips and tensing the muscles of the calves, hips, and back. This is a recipe for fatigue and strain and uneven wear and tear on back ligaments, joints, and vertebral discs.

There are many ways to hurt your back. Poor diet, lack of exercise, and lazy posture contribute as do the way you sit, turn, and lift. But high heels, worn regularly over years, also can play a significant role in causing changes to the anatomy like thickening tendons, shortened calf muscles, even curvature of the spine. Other problems include sciatica or pinched nerves, muscle spasms, and displacement of parts of the upper spine that cause the back and shoulders to hunch forward. 

There are two primary anatomical reasons that high heels can cause back pain. The first is that high heels force all the muscles from your foot to your back to tighten. The plantar fascia, one of the main ligaments of the foot, forms the arch on the sole of your foot. It connects to the calf muscles which connect to the hamstrings which connect to the pelvis and lower back. So when your shoe causes the plantar fascia to stretch, everything from your foot to your back tightens up putting strain on the lower back and causing pain.

The second anatomical problem is that wearing high heels forces you to walk on the balls of your feet. In flat shoes, your weight is evenly distributed across the foot. But in heels, your weight and center of gravity are shifted forward, the upper body has to lean back to maintain balance, and the resulting prolonged arching causes back pain.

Wearing high heels alters the shape of your spine, and it can’t do its proper job of absorbing shock when you walk. Over time, uneven wear on vertebral discs, joints, and ligaments causes pain.

The best way to reduce or avoid damage from high heels is to stop wearing them. But unless you already have serious back problems, you don’t have to give them up entirely. You can do a few simple things to reduce the strain on your feet and spine. I recommend these tips:

• Stretch before and after wearing high heels. Stretching the plantar fascia and calf muscles will loosen the hamstrings and reduce the risk of back pain. Try rolling your foot on a golf ball or get a professional foot massage like reflexology.
• Avoid wearing high heels every day. Try alternating days with flats or lower heels.
• The higher the heel, the more the risk of damage. Avoid heels more than 2 inches high. If you must wear higher heels, do so only for limited periods.
• Choose shoes with rounded rather than pointed toes. Make sure your shoes fit properly and have leather insoles to reduce slipping.

You don’t have to live with pain or the risk of permanent damage to be fashionable. Pay attention to your body. Don’t let minor discomfort escalate to a serious problem. Treat your feet and back well and they’ll support you for the long haul.

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. http://www.atlanticspinecenter.com, www.atlanticspinecenter.nyc

Kaliq Chang, MD, is an interventional pain management specialist board-certified in anesthesiology in practice at Atlantic Spine Center. 

There’s a great deal of focus on the obesity-related conditions – heart disease, stroke, type 2 diabetes, and certain cancers – that are among the leading causes of preventable, premature death, but often overlooked are the effects obesity can have on the spine. Excess weight places a great deal of additional strain and pressure on back and spine tissues. It shifts your center of gravity and taxes all of the muscles and joints at the core of the body.Back pain is often attributed to the normal effects of aging. While it is true that aging tends to weaken the spinal column – the stack of bones (vertebrae) and gel-filled cushions between them – excess weight accelerates the process, triggering a range of spinal disorders:

• Disc degeneration occurs when the discs between the vertebrae weaken, they lose moisture, and begin to collapse.
• Herniated disc, also known as a ruptured or slipped disc, occurs when a tear in the tough outer layer of the disc allows some of the soft inner material to protrude out of the disk. If the protruding material compresses a nerve, the symptoms of a herniated disc are felt wherever that nerve travels.
• Spinal stenosis is a narrowing of the spinal canal that can compress the nerves that travel through the spine.
• Osteoarthritis, which occurs when the protective cartilage that cushions the ends of the vertebrae wears down, can be triggered or exacerbated by excess weight putting additional stress on the spine.

The spine is designed to support the body’s weight but excess weight makes it difficult for the spine to do its job properly and these conditions cause a variety of troublesome symptoms including chronic pain, numbness, and tingling in the neck, back, arms or legs.It isn’t always possible to eliminate wear and tear on the back, but there are steps you can take to reduce your risk. These include general best practices for good health including weight management, regular exercise, and not smoking.Maintaining a healthy weight or losing weight can reduce stress on the spine and other joints as well. Losing just four pounds reduces 16 pounds of pressure on the spine. But losing weight is not the only avenue to improved back health.I want to highlight these important factors:

• Regular exercise – cardiovascular exercise and weightlifting – strengthen the supporting muscles of the back, pelvis, and thighs and activities like yoga and tai chi stretch the muscles and improve flexibility. Exercise can also improve posture and improve the unnatural curvature of the spine that often results from obesity.
• Good nutrition can also help your spine. Foods that are high in calcium and vitamin D, such as dairy foods and leafy green vegetables, can help prevent the bones in your spine from becoming thin and brittle.
• Use proper lifting techniques. Do not bend at the waist. Bend your knees while keeping your back straight and use your strong leg muscles to help you support the load.
• Practice good posture when walking, sitting, standing, and sleeping. For example, stand up straight with your shoulders back, abdomen in, and the small of your back flat. Sit with your feet flat on the floor or elevated. Sleep on a firm mattress and sleep on your side, not your stomach.
• Stretch often when sitting for long periods of time.
• Do not wear high-heeled shoes.

Obesity takes a toll on the spine, and as more and more adults are carrying excess weight, we are seeing an increase in spinal disorders, particularly those that cause lower back pain. The best remedy is to lose weight but the good practices I’ve outlined can also improve back health for everyone at any weight.Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. http://www.atlanticspinecenter.com, www.atlanticspinecenter.nycKaixuan Liu, MD, PhD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery. He is the founder of Atlantic Spine Center. 

Compared with patients who saw a physical therapist late or not at all, those who saw a physical therapist at the first point of care had an 89 percent lower probability of having an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of having an emergency department visit, but a 19 percent higher probability of hospitalization.

According to a news release from Health Services Research publisher Wiley, the authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to more specialized care when low back pain does not otherwise get resolved by addressing musculoskeletal causes first. These patients also had significantly lower out-of-pocket costs, and costs appeared to shift away from outpatient and pharmacy toward provider settings.

“Given our findings in light of the national opioid crisis, state policymakers, insurers, and providers may want to review current policies and reduce barriers to early and frequent access to physical therapists as well as to educate patients about the potential benefits of seeing a physical therapist first,” said lead author Dr. Bianca Frogner, of the University of Washington Center for Health Workforce Studies.

The work was a collaboration between the University of Washington in Seattle and The George Washington University in Washington, DC. “This study shows the importance of interprofessional collaboration when studying complex problems such as low back pain. We found important relationships among physical therapy intervention, utilization, and cost of services and the effect on opioid prescriptions,” said Dr. Ken Harwood, lead for the George Washington University. “We are continuing our collaborative work to pursue further questions related to this study.”

The May is Posture Month campaign is supporting the solution of Lancet‘s positive health concepts with a call for everyone to dramatically improve posture awareness, exercise and habits.

The Posture Month public health initiative is supported by thousands of posture focused practitioners including chiropractors, therapists and trainers who educate people on the importance of posture for back and other muscle and joint pain, as well as staying healthy. The 2018 campaign will focus people on improving posture Awareness, Control and Environment with the theme “ACE Your Posture”.

An Indicator of Health

Posture shifts with back pain, causing some muscles to weaken, and others to tighten. Retraining body balance begins with awareness of how you truly stand and move, and then retraining deep stabilizing muscles for more accurate control to relieve back and neck pain, as well as muscle and joint pain. Strong posture is key in helping people stay healthy and active as they age.

Many people are concerned about “tech neck” and the chronic slumping associated with other tech-induced postures. I agree. Sitting, texting and typing folds the head and chest down, stressing the body and restricting breathing. This can shorten both your body (bent forward posture) and your life (the ability to breathe deeply is important). How you hold your body molds how your body holds you. Which is why it’s also essential to improve our posture environment by looking at how we sit, stand and move throughout the day.

A Plan to Improve Posture this May

The annual Posture Awareness Month campaign will share daily tips on how to ACE Your Posture. ACE stands for Awareness, Control and Environment.

Awareness: Improve posture awareness with a picture. Any camera works, but a free app like PostureZone (available for free from your iOS or Android app store) lets you measure alignment and compare pictures over time. You can find do-it-yourself instructions, as well as a directory of hundreds of participating practitioners offering free posture pictures this May on http://www.posturemonth.org/. Visit the site for daily tips as well.

Control: Strengthen posture by learning yoga, tai-chi, Pilates, StrongPosture® or other exercise programs that focus on posture and specifically accurate movement. Motor Control Exercises like these are specifically recommended for low back pain over most drugs and surgery by the American College of Physicians.

Environment: Design a healthy work and home environment: Upgrade your chair and consider a desk that lets you stand as well as sit. Look at the design of your mattress, and consider a pillow that keeps your head aligned with your body while you rest.

For many Americans, joint discomfort is that dark cloud hanging over all those sunny, summer plans. But it doesn’t have to be that way. Our friends at Cosamin for Joint Health have put together some essential travel tips to help make sure your next vacation is also a break from joint discomfort.

TRAVEL TIPS FOR JOINT COMFORT

Consider Space
No, we’re not suggesting you visit the Moon. We mean consider the personal space you have on the way to your destination. If you’re flying or taking a train, pay a little more for a seat with extra legroom so you can stretch out. If that price point is too high, try to get an aisle seat so you can easily get up and move around periodically. Keeping your joints limber while you travel is essential for arriving at your destination in comfort so you can get the most enjoyment out of that well-earned vacation.

Roll With It
When it comes to efficiently moving your belongings while you travel, nothing beats a quality rolling bag. By diverting extra weight from your body and reducing heavy lifting, you are taking all that unnecessary pressure off your joints. For even more joint relief, do your best to not over pack so transporting your luggage will be as cool and breezy as that ocean view.

Give It A Rest
It may sound like redundant advice for someone on vacation, but take some time to relax. If your trip involves a lot of walking and movement, be sure to plan some time-outs, whether it’s grabbing a refreshing beverage at a trendy cafe or stopping for a delicious snack. Even if you’re not particularly hungry or thirsty, the “people watching” is always worth the time.

Honesty Is The Best Policy
Chances are you’re not the only one on this vacation and that’s great! What is not great is lying to yourself or your travel partners about your comfort level. If you need a break or want to give that whitewater rafting lesson a pass, let your loved ones know. They will be happy to not see you in discomfort.

New Shoes, You Lose
Going on a more active vacation is probably not the best time to buy new shoes. Instead, go with a trusty pair that offers good support and a lot of traction. If you do want to purchase a new pair, do your research and find shoes designed to distribute weight and reduce stress on your joints. Be sure to give yourself a few weeks to break them in and ensure you are not adding to your discomfort.

Supplement Your Enjoyment
Take a premium glucosamine & chondroitin joint supplement that is clinically proven to help promote joint comfort and mobility both home and abroad. For those planning a more active getaway, a joint supplement specially formulated for faster action will help ensure comfort stays with you every step of the way. Just remember to pack enough pills to get you through your adventure!

For more information about how to improve your joint health, check out How Cosamin Works or talk to your physician about the benefits of Cosamin, a premium joint health supplement.

A release from the publisher notes that for most patients, the natural course of a herniated lumbar disk is favorable. The consensus is that surgical treatment is offered if the pain in the lower back and radiating down the legs persists despite a period of conservative treatment. Lumbar microdiskectomy is the most common surgical treatment, but data on surgical outcomes among elderly patients are limited.

Sasha Gulati, M.D., Ph.D., of St. Olavs University Hospital, Trondheim, Norway and colleagues compared patient-reported outcomes following lumbar microdiskectomy among 5,195 patients younger than 65 years of age and 381 patients 65 years of age or older. Data were collected through the Norwegian Registry for Spine Surgery, a comprehensive registry for quality control and research.

For all patients, there was a significant improvement in a measure of disability (Oswestry Disability Index; ODI).

There were no differences between age groups in average changes of the ODI, health-related quality of life, or leg pain, but older patients experienced more improvement in low back pain. Compared with patients younger than 65 years of age, older patients experienced more perioperative complications (4.2 percent vs 2.3 percent) and more complications occurring within 3 months of hospital discharge (12.4 percent vs 5.4 percent), while younger patients had shorter hospital stays (1.8 vs 2.7 days).

“Age alone should not be a contraindication to surgery, as long as the individual is fit for surgery,” the authors write.

That’s why it tends to surprise people when a spine surgeon (of all people) cautions against spine surgery.

Surgery is risky, it has a long recovery period, and often it just doesn’t work for chronic low back pain. It might even make the problem worse. My advice: exhaust every possible option first.

The good news is there are better options. The system is slowly shifting toward prevention and natural healing methods for spine conditions, and for good reason. Not only are these options a fraction of the cost of surgery, for many patients these methods simply work better.

I advocate for a holistic treatment centered on medically supervised exercise that takes into account the patient’s perceptions, habits, psychology, physical condition, lifestyle, and goals. When a patient fully commits to this more natural treatment regimen, surgery can usually be avoided.

If you’re thinking of pursuing back surgery, here are some reasons to reconsider.

“Minimally invasive” laser surgery is a marketing gimmick. You’ve probably seen ads for spinal laser surgery clinics encouraging you to mail in your MRI results for a “free consultation.” Don’t be fooled. First, an MRI alone cannot determine whether you need surgery. Second, lasers are minimally useful in back surgeries—mechanical grabbers and electrocautery are far more effective—and are primarily used because the notion of laser surgery appeals to consumers. Third, such procedures are still very invasive.

Despite the smaller incision, these laser-performed surgeries often remove bones and ligaments vital to the structural integrity of the spine, still cause scarring around the nerves, and often do not alleviate pain in the long run. And I have seen many patients who have undergone so-called ‘laser surgeries’ where it was clear that standard surgical tools like high-speed burrs were used and whose surgery had the same risks as traditional spine surgeries.

There is no widely agreed-upon surgical treatment for lower back pain. Based on a recent study in Spine, surgeons significantly disagree on methods for treating low back pain. In fact, there was 75 percent disagreement in how to treat back pain sufferers.

It is very telling that surgeons can’t agree on how to best approach a solution for back pain. This lack of consensus should warn patients to proceed with caution and to avoid surgery until they have exhausted all less-invasive treatment options.

Bad MRI findings are NOT a valid reason to have surgery. Simply having a disc abnormality or even a disc herniation on an MRI is not a good enough reason to undergo a spinal procedure. Unfortunately, when patients can see a dark spot, they jump to the conclusion that they need surgery to “fix it.”

It is very common for adults to have abnormal MRI readings—even those who don’t have low back pain or sciatica. It does not usually justify a surgery that will require weeks of recuperation and time out of work and could be ineffective at curing the pain in the first place.

Very often, surgery won’t cure back pain anyway. Spine surgery is best for relieving nerve compression, but it does not alleviate all back pain. Without an evident reason for pain, like instability, nerve compression, or a fracture, surgery has an inconsistent record of success and shouldn’t be rushed.

Most back pain will resolve itself when you take a “wait-and-see” approach. Your body has an impressive capacity to heal itself. Over my 20 years of surgical practice, I have been amazed at how many conditions, which I was taught were surgical, were in fact improved and in many cases resolved by maximizing the body’s own recuperative capacity. Many people have been conditioned to believe that surgery is the only answer for low back pain, and often, people don’t give themselves sufficient time and resources to allow natural healing to occur before going under the knife.

Give yourself plenty of time to heal and reassess your level of function after some time has passed. You can always opt for surgery later, but if you rush to cut, you can’t un-cut it later.

Conservative self-help programs combined with lifestyle changes often work better than surgery. My own integrated medical fitness program, SpineZone, located in San Diego, California has helped close to 7,000 patients recover from spinal injury or back pain without surgery. Not only do patients perform medically supervised exercises to strengthen the spine, they’re also schooled in lifestyle changes aimed at holistically reducing pain and improving their overall health—all under the care of a team of surgeons and specialists.

We’ve had countless patients tell us that our approach either eliminated their pain or lessened it dramatically. Most find that they not only were able to avoid surgery, they decreased or eliminated the need for injections and addictive opioids.

The bottom line? Surgery should always be a last resort for back pain.

A ‘wait-and-see’ approach, combined with taking proactive steps to becoming healthier, works far better than surgery. It gives your body the chance to accomplish what it already knows how to do: recover on its own. By taking control of your health instead of seeking out a ‘quick fix,’ you have a better chance of healing your pain and changing your life for the better.

Kamshad Raiszadeh, MD, is the author of Take Back Control: A Surgeon’s Guide to Healing Your Spine Without Medications or Surgery. He has an unusual perspective for a spine surgeon. Early in his career, he realized that for most chronic back and neck pain patients, surgery is not the best solution. He and his team set about designing, developing, and perfecting a program to prevent unnecessary procedures and medications. Infused with an emphasis on strengthening, education, and self-empowerment, SpineZone has helped close to 7,000 patients enjoy full and lasting recoveries. For more information, visit www.takebackcontrol.com,

A release from the university notes that this is the first study that clearly compared outcomes between surgery and an evidence-based, standardized physical therapy approach for lumbar spinal stenosis. The condition, created by a narrowing of the spinal canal that puts pressure on the nerve roots resulting in pain, numbness and weakness through the back and lower extremities, has caused decompression surgery to become the fastest-growing intervention in today’s older population.

A total of 169 patients aged 50-plus already headed for decompression surgery agreed to be randomly assigned into two groups: Those who would have the procedure, and those who went through two standardized, evidence-based physical therapy sessions per week for six weeks. After both groups were re-examined at intervals of six months, one year and two years, the patient outcomes appeared to be equal. There were no detectable differences between the groups in how their pain abated and the degree to which function was restored in their backs, buttocks and legs.

The release quotes principal investigator Anthony Delitto, Ph.D., chair of the Department of Physical Therapy, Pitt School of Health and Rehabilitation Sciences (SHRS), as well as a member of Pitt’s Health Policy Institute (HPI) and a consultant to UPMC, as saying, “Probably the biggest point to put across to physicians, patients and practitioners is: Patients don’t exhaust all of their non-surgical options before they consent to surgery. And physical therapy is one of their non-surgical options.”

Dr. Delitto, a physical therapist, and his SHRS colleagues have long puzzled over why some patients reacted well to physical therapy (PT) and others to surgery.

“The idea we had was to really test the two approaches head to head,” he said. “Both groups improved, and they improved to the same degree. Now, embedded in that, there are patients who did well in surgery, and patients who failed in surgery. There are patients who did well in PT, and there are patients who failed with PT. But when we looked across the board at all of those groups, their success and failure rates were about the same.”

The research project also revealed issues surrounding PT appointments and the cost of co-pay, which may prove enlightening to policymakers enmeshed in the charged atmosphere around health care, Dr. Delitto added.

Most patients didn’t finish the PT regimen allowed them under Medicare and prescribed by the researchers, and one-third of the patients failed to complete even half of the regimen. Another 16 percent didn’t show for a single treatment, though they had agreed to consider PT.

“One of the big things that we know held patients back from PT were co-payments,” Dr. Delitto added. “Patients were on Medicare, and a lot of them were on fixed incomes. Some of those co-payments had to come out of pocket at $25, $30, $35 per visit. That adds up, and some of the patients just couldn’t afford it.”

This publication marks the fourth national announcement in the past two months involving Pitt research into back pain and PT treatments:

• The Foundation of Physical Therapy announced in early February that SHRS and HPI are being partnered with Brown and Boston universities in a five-year, $2.5 million program to generate pilot studies as part of the Center on Health Services Training and Research, the first-ever grant to train future researchers and scientists in PT.
• In mid-February, Spine published a Pitt/UPMC research project showing the early addition of manual-thrust manipulation leads to significantly greater reductions in low-back pain and improved function at four weeks. The belief of therapeutic equivalence between manual-thrust manipulation and mechanical manipulation devices isn’t supported by the current evidence, wrote the team led by Michael Schneider, Ph.D., assistant professor of physical therapy, SHRS. The study was supported by the National Institutes of Health and National Center for Complementary and Alternative Medicine.
• In late February, the Patient-Centered Outcomes Research Institute awarded $14 million to UPMC and Pitt through the HPI’s Comparative Effectiveness Research Center to lead a clinical trial to determine how well an intervention that helps people better understand their back pain early on works toward promoting recovery and ultimately preventing chronic pain.