Arthritis: I just have to live with it

There are many different types of arthritis, but I am going to limit this article to osteoarthritis, because by far it is the most common type.  More than half of arthritics have this type.  Statistically speaking it affects 1 in 13 people.  It is probably higher in Schuylkill County because of our aged population.  That means there are about 12,000 to 13,000 with osteoarthritis in Schuylkill County. 

If you are arthritic, you may feel the ache, pain, and stiffness in any of your joints, but most commonly in your hips, knees, back, neck, or fingers.  Risk factors for osteoarthritis include:

• Being overweight
• Previously injuring the affected joint
• Using the affected joint in a repetitive action that puts stress on the joint (like walking and working)
• A diet that is pro-inflammatory.

The first three alters normal biomechanics, in other words arthritics move differently.  Think of your body frame as the frame of a car and the tires as your joints.  If the car frame is bent, the car can still run but very soon, the tires wear out.  At first, it might be hard to see the increase wear on the tires but it is happening.  This will eventually lead to the tire going flat or blowing out.

In your body, if the frame is bent or dysfunctional the joints wear out just the same way the tires do.  You never saw anyone with arthritis walk without a gimp or abnormal gait, did you?

Phase One: Dysfunction

Dysfunction occurs when there is injury to a joint or body frame.  Muscle tightness and shortness follows leading to restricted movement.  Muscles opposing the tight and shortened muscles usually become weak.  At this stage, people generally only complain of stiffness or tightness.  With time, a slight misalignment occurs at the joint and scar tissue begins to form.

Phase Two: Instability

Prolonged dysfunction and scar tissue (which is weaker than then original tissue) leads to instability or loosening of the joint.  Because the joint is weaker, it is not stable.  There is an increased risk for additional injury; inflammation, pain, and increased muscle tightness as the muscle try to provide the stability of the weakened ligaments.  At this point, you might be aware of clicking or shifting of the joint with certain movements.  X-rays are still normal.

Phase Three: Stabilization

At this stage, degenerative changes begin to appear.  Decreased joint space and bone spurs will start to show up on x-rays.  There is also thickening of scar tissue and the muscles even become tighter and shorter.  This is the body’s attempt to tighten up the loose joint.  Decreased motion leads to increased pain.

Treatment

According to PubMed Heath, a division of the U.S National Library of Medicine, National Institutes of Health “It is possible to greatly improve your symptoms from osteoarthritis and other long-term types of arthritis without medications.  In fact, making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation.  If needed, medications should be used in addition to lifestyle changes.”

Restoring joint motion and balancing the muscles (lengthening the shortened and strengthening the weak muscles) is a critical first step.  Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength.  Your exercise program must be tailored to you as an individual.  For example, not all knee arthritis has the same shortened and weakened muscles.  All joint dysfunctions are unique.  I general exercise program will not work very well.

At our office, we use the Functional Movement Evaluation of the National Academy of Sports Medicine to determine the muscle imbalances and treatment protocol.  One of the cutting-edge exercises we use is Whole Body Vibration (WBV).  It helps relax the tight muscles and strengthens the weak muscles without any movement to the arthritic joint.  We had patients as old as 96 on the WBV machine to exercise.  Most people cannot believe how much better they feel in just a few weeks.  Contrary to what most people think, there is a lot that can be done for arthritis, especially without all the side effects of medications.

We are committed to help you or a loved one that is suffering with arthritis and sharing this information may be one of the most evident acts of kindness you can give.

This information is solely advisory and should not be substituted for medical or chiropractic advice.  Any and all health concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your medical history.

© 2005-2010 WebExercises, Inc., Patent Pending, All Rights Reserved.

Begin lying on floor facing up.
Bend knees so feet are firmly on floor.
Extend arms upward toward ceiling.
Activate core muscles.
Lift hips off floor to attain a bridge position with knees, hips and shoulders in alignment.
Slowly return to start position.
Repeat for prescribed repetitions and sets.

Initially, you may develop some cramping in the back of your thigh. A simple hamstring stretch before and after may prevent this from occurring.
Slowly return to start position.
Repeat for prescribed repetitions and sets.

© 2005-2010 WebExercises, Inc., Patent Pending, All Rights Reserved.

© 2005-2010 WebExercises, Inc., Patent Pending, All Rights Reserved.

Fibromyalgia Medication

According to eHealthme.com there is lots be desired.  eHealthme.com is a website that reports a real-world approach to drugs.  Many drug interactions, side effects, or effectiveness cannot be detected when the drugs are approved.  They may be found only after drugs have been used by millions of people and for a long time.

The eHealthme.com site reports that  initially, 18% of fibromyalgia sufferers found Neurontin high or very highly effective.  This dropped-off to 13% when long-term effectiveness was reported.

Cymbalta was prescribed more often than Neurontin.  Nearly 30% found Cymbalta high or very highly effective initially.  This was reduced to 15% when long-term effectiveness was reported.

The most highly prescribed drug, Lyrica, was nearly 32% high or very highly effective initially.  The long-term effectiveness was reported at nearly 18%.

There appears to be a better treatment. 

In a study of transcranial electrical stimulation for fibromyalgia, it was found subjects that received transcranial electrical stimulation treatment had a 28% improvement in tender-point scores and a 27% improvement in the amount of general pain they felt.  There were no side effects reported.

But most surprising was that only 5% of the treated patients reported having sleep disturbances after treatment, compared with 60% who had sleep problems before beginning electrotherapy treatments.

In addition, 90% of the treated patients reported that their quality of life had improved as a result of treatment, while 20% of the patients who were in the fake treatment group said their quality of life had declined.

I could not find a study that compared the effectiveness of any of the drugs against the effectiveness of transcranial electrical stimulation.

This past week we had a fibromyalgia patient with low back pain so bad she could not lay on her back.  Within the first 15 minutes of only transcranial electrical stimulation she was able to lay on her back with very little pain!

Transcranial electrical stimulation appears to “normalize” the central pain sensitization abnormality that is believed to be the core problem of fibromyalgia.

We are committed to help you or a loved one that is suffering with chronic low back pain, and sharing this information may be one of most evident acts of kindness you can give.

This information is solely advisory, and should not be substituted for medical or chiropractic advice.  Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your medical history.

Begin seated in a chair with good posture.
Extend leg.
Attempt to write alphabet from A through Z with toes, moving ankle in all directions.
Repeat for prescribed sets.

© 2005-2010 WebExercises, Inc., Patent Pending, All Rights Reserved.

Example of Fast Twitch and Fast Twitch Muscle Fiber

A recent study has shown a difference in muscle fatigue in fibromyalgia patients.  In the study two groups of patients were utilized, one with fibromyalgia and the other normal controls.  In the first test the subjects upper arm muscle was stimulated using electrical current to contract the muscle while measuring muscle activity with a surface EMG.  In the second test, the subjects were asked to flex their upper arm muscle and hold it for 3 seconds.  Muscle activity was also recorded with a surface EMG.

The researchers found that there was no difference in strength between normal subjects and fibromyalgia subjects.  There was also no difference in muscle fatigability when the muscle was stimulated/contracted by the electrical impulse.  However, there was a difference in fatigability of the muscle between the two groups when the subjects voluntarily contracted (under control of their brain) their muscle.  Fibromyalgia patients had a higher rate of muscle fatigue and it occurred much earlier.

Fibromyalgia sufferers activate a higher percentage of fast twitch muscle fibers (the ones that fatigue easily) compared to normal subjects.  The control of this activation is under the Central Nervous System (the brain and spinal cord).  Therefore, the researchers concluded that the altered activation is a Central Nervous System motor (muscle) control-processing problem.

Although it is well established that fibromyalgia is a central pain-processing problem, this is the first time research demonstrated a central muscle control difference between normal subjects and fibromyalgia sufferers.  The fatigue problem is not in the muscles, but is in how the brain and spinal cord recruit the muscle fibers and control the muscles.

Along with treating the central pain processing problem with transcranial electrical stimulation to increase the alpha waves it also explains why light exercise has been shown to be beneficial.  Additional studies have shown improvement in muscle fatigue symptoms with whole body vibration (WBV).  WBV exercise targets the fast twitch muscle fibers and therefore increases the number of fast twitch muscle fibers and fatigability is lessened.

An research paper can be found here:

Central motor control failure in fibromyalgia: a s… [BMC Musculoskelet Disord. 2009] – PubMed result

Half of these back pain patients had surgery to fuse two or more vertebra.  The other half had no surgery even though they had comparable diagnoses.  After two years, just 26% of the surgery group returned to work.  67% of the non-operative group returned to work.  There was a 41% increase in addictive pain medication for those who had surgery!

Two Level Lumbar Spinal Fusion

Despite these poor outcomes, fusion surgery is on the rise.  In July, another study in Spine reported that fusion surgery has increased 800% in the past 15 years.  Some areas in the USA are 300 to 400% higher than the national average.

Dr. William Welch, vice chair of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital commented, “Even when the surgery is a success, it rarely dispels 100% of back pain.”

Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine says, “the best results come about through a combination of approaches.  Each strategy may reduce pain by just 10 or 20%, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 to 80%.”

Doctors’ Choice Physical Medicine and Rehab has a combination approach that includes manipulation, physical therapy, massage, therapeutic exercise, neuromuscular reeducation (balance and stability training) and nutrition. We refer out or work with the patient’s family doctor or specialist for medication and epidural, if necessary.

The MSNBC article can be found here:

Back surgery may backfire on patients in pain – Health – Pain center – msnbc.com

We are committed to help you or a loved one that is suffering with chronic low back pain, and sharing this information may be one of most evident acts of kindness you can give.

This information is solely advisory, and should not be substituted for medical or chiropractic advice.  Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your medical history.

Christmas is almost here!  Can you feel the excitment?  We can here at Doctors’ Choice because Santa’s been here getting ready for his big night!  He’s exercising and Doc Novatnak has been treating Santa with his extra special care, making sure Santa’a able to carry all those goodies to the children of Pottsville and all of Schuylkill County. 

Santa’s a great patient.  He has made all of his appointments and cheerfully exercises and follows his treatment plan.  Good thing too, his back was a complete mess when he started treatment here at Doctors’ Choice a few weeks ago.  Dr. Novatnak is confident that Santa will make his rounds, and not have any problems with low back pain on Christmas Eve. 

Everyone at Doctors’ Choice has enjoyed having Santa here preparing for the holiday season. 

Merry Christmas to all of our wonderful patients!  Have a safe and happy holiday season!

Chronic Low Back Pain

Schuylkill County:  Did you know that about 10% of back injuries do not resolve in two months time and the back pain is considered chronic?  Is there something different about backs from other tissues or joints in the body?  Yes, there is!

In 1987, the journal Spine published Dr. Vert Mooney’s Presidential Address of the International Society for the Study of the Lumbar Spine.  In his address, he presented many known facts concerning chronic low back pain. 

This is what is special about disks!  In summary, Dr. Mooney said:

• The disk is the primary source of both back and referred leg pain. 

• Spinal mechanical problems (from an injury or long-term distorted body mechanics) reduce disk movements, which leads to altered disk chemistry.  

• The altered chemistry within the disk activates the pain nerve endings in the disk causing chronic pain.

• Therefore, the most rational approach to the treatment of chronic low back pain is mechanical therapy that restores the motion to the spinal joints and especially the disk.  (This means such treatment as manipulation, mobilization, manual muscle therapy work to restore body mechanics, and therapeutic exercise.)

• Prolonged rest is inappropriate management for chronic lower back pain.

Many studies support Dr. Mooney’s presentation. 

Dr. Stephen Kuslich and colleagues in the journal Orthopedic Clinics of North America presented one study in April 1991.  The title of their article was:

The Tissue Origin of Low Back Pain and Sciatica: A Report of Pain Response to Tissue Stimulation During Operations on the Lumbar Spine Using Local Anesthesia

Between 1987 and 1990, 193 consecutive patients were studied.  All of these patients were operated upon for complaints of intractable lower back and/or lower limb pain (sciatica).  Instead of the use of general anesthesia, only a “progressive” local anesthesia was used, leaving the patients fully awake and responsive.  (First, let us all be glad that we were not one of their patients that had spinal surgery under local anesthesia!) 

During the operation, the surgeon randomly “stimulated” various tissues in and around the exposed disk and spinal nerve/nerves by means of ‘mechanical force’, i.e., the ‘smashing of the tissue with a blunt surgical instrument, or the electric shocking of the tissue with low volt electricity.  

The patients were then asked to describe and rate any associated sensations of pain, numbness, or burning on an analog scale of 0 to 5, where 5 was severe pain that was exactly like their usual and customary pain.

Several of their important findings include:

• Back pain could be produced by several lumbar tissues, but by far, the most common tissue of origin was the outer layer of the disk.

• The lumbar fascia (tissue around muscles) could be “touched or even cut without anesthesia”, without producing any pain.

• Any pain derived from muscle pressure was “derived from local vessels and nerves, rather than the muscle bundles themselves.”

• “The normal, uncompressed, or non-stretched nerve root was completely insensitive to pain.”

In summary, these authors found the outer layer to “the disk” to be “the site” of chronic low back pain.

What To Do If You Have Chronic Low Back Pain?

A well-established finding in chronic low back pain is lumbar muscle weakness.  One of the treatments we use for chronic low back pain is MedX lumbar extension exercise.

This treatment strengthens the weak muscles and uses controlled motion to create and restore motion in the painful disk as Dr. Mooney almost 25 years ago.

To find out how successful the MedX treatment can be see:

Chronic Low Back Pain in Pottsville, Remarkable Treatment Results

We are committed to help you or a loved one that is suffering with chronic low back pain, and sharing this information may be one of most evident acts of kindness you can give.

This information is solely advisory, and should not be substituted for medical or chiropractic advice.  Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your medical history.