Search Results: spinal stenosis

Therapy Proven to Improve Spinal Stenosis Surgery Outcomes

A recent study published in the pre-eminent journal Spine confirms that patients undergoing spinal decompression for stenosis had better outcomes if they participated in a rehabilitation exercise program.

This study was completed by the highly-respected Cochrane collaboration using a meta-analysis and systematic review. This research technique analyses and rates studies based on their quality and uses this rating to come to a scientifically supported consensus. Their conclusion was that the strength of the evidence supported post-operative therapy however it is best started at 12 weeks post-op and not at 6.

At The Orthopaedic Therapy Clinic our experience in working with post-operative patients concurs with these findings. For the first 12 weeks our program encourages light activity to allow sufficient tissue healing before engaging in a more intense therapy program.

To read more go to: http://www.beckersspine.com/spine/item/21023-5-findings-on-spine-surgery-rehabilitation-effectiveness

Therapy Proven Beneficial Following Spinal Stenosis Surgery

senior woman exercise therabandA recent study published in the pre-eminent journal Spine confirms that patients undergoing spinal decompression for stenosis had better outcomes if they participated in a rehabilitation exercise program.

This study was completed by the highly-respected Cochrane collaboration using a meta-analysis and systematic review. This research technique analyses and rates studies based on their quality and uses this rating to come to a scientifically supported consensus. Their conclusion was that the strength of the evidence supported post-operative therapy however it is best started at 12 weeks post-op and not at 6.

At The Orthopaedic Therapy Clinic our experience in working with post-operative patients concurs with these findings. For the first 12 weeks our program encourages light activity to allow sufficient tissue healing before engaging in a more intense therapy program.

Read More

Spinal Stenosis

Stenosis refers to a measurement of narrowing in the tunnels that contain our spinal nerves. This narrowing can be problematic as these nerves are the source of sensation and movement for our body. The goal of treatment at the Orthopaedic Therapy Clinic is to improve posture to reduce the strains on your low back and enhance your ability to walk. Read more…

Healthy Back On-line exercise program – Directional Preference

We are excited to announce our Healthy Back On-line exercise program.  We started this program as we recognized that many people were participating in on-line exercise programs however most of these programs are not specific for people who have injuries or have had back pain.  What makes our program unique is that it’s based on knowing your back’s directional preference and selecting exercises specific to your type of low back pain.    We use a Directional Preference System for low back pain to match your exercises to what your back needs.  This allows you to select an exercise class that is right for your back.

Click here for more information on registering in our back exercise classes.

Directional Preference and Back Pain Recovery

As we continue our War on low back pain and the back Attack/Acute pain finally subsides, most people begin to have periods where they have no pain.  At this stage in your recovery, you will find that some movements feel OK, or even make your back feel better, whereas other activities irritate.

When this happens, it is an indicator that you are ready to exercise.  What’s most important is to exercise using a program which respects your back’s Directional Preference.  This means your program should include exercises your back “prefers” and limit exercises which irritate.

The avoidance of irritation, combined with the benefits of exercising based on preferences, will help you to move forward to become stronger and return to a full and active lifestyle.

Knowing Your Back’s Directional Preference

Initially, most people will need their therapist or physician to help them understand the underlying pattern connecting these right and wrong movements. At first it may seem a bit random until the trained practitioner identifies the directionality.   However, once you understand the directionality, this knowledge will help you make better decisions on what to do or not do as you are recovering.  It will help you to choose exercises, safe cardio workouts and engage in everyday movements safely.

Directional Preference Designations

Most backs exhibit one of three Directional Preferences:

  1. Flexion preference – your back prefers forward bending
  2. Extension preference – your back prefers backward bending
  3. Neutral preference – your back is best if you keep it in neutral. It irritates if you go into more flexion or more extension.

Our New on-line Classes are for All Types of Back’s

We are launching our exercise series with videos and classes in  Mid April 2021. Click Here to learn  more about each class

These classes will be suitable for most backs as each exercise will be completed in a spinal neutral posture.  If your back is a bit more particular about its directional preference, you can still participate as each exercise will also include a reminder of a modification for flexion or extension preference.

Why use Directional Preference Rather than Diagnosis?

Our therapists, and many physicians, use the designation of Directional Preference to choose exercise programs.  This well-established format is used world-wide.  It is successful at helping people become more active because it respects the fact that even two people with the same diagnosis can have completely different directional preferences!

For  example, although most people with spinal stenosis will prefer flexion, there is a small group of people who will do better with extension.

A diagnosis of discogenic back pain gives limited insight into the type of exercise you need.  Some backs will need flexion whereas others will do better with extension.

These variabilities are why it is essential to know your Directional Preference to engage in safe exercise at this time in your recovery.

Key to your Success

The key to your success in this series is to:

  1. Respect your Directional Preference and use it throughout the series
  2. Commit to understanding the technique for each exercise.  Use the reference videos, or your therapist, to ensure you are getting the most out of the program.
  3. Apply the tips and activation strategies that work for your body to prevent/limit pain from exercise.  Recognize that not every tip works for every person.  This is why we provide you with several options on how to get the correct muscles working.  Once you learn what works for you, apply this throughout the exercise program.

We look forward to helping you get more active with safe exercise.  If you need further assistance, please call us at 416-925-4687 or contact your therapist at the following emails:

Healthy Back Flexion Program – Knowing your Back’s Directional Preference

We are excited to announce our Healthy Back On-line exercise program.  ( See Video here) We started this program as we recognized that many people were participating in on-line exercise programs however most of these programs are not specific for people who have injuries or have had back pain.  What makes our program unique is that it’s based on knowing your back’s directional preference and selecting exercises specific to your type of low back pain.    We use a Directional Preference System for low back pain to match your exercises to what your back needs.  This allows you to select an exercise class that is right for your back.

Click here for more information on registering in our back exercise classes.

Directional Preference and Back Pain Recovery

As we continue our War on low back pain and the back Attack/Acute pain finally subsides, most people begin to have periods where they have no pain.  At this stage in your recovery, you will find that some movements feel OK, or even make your back feel better, whereas other activities irritate.

When this happens, it is an indicator that you are ready to exercise.  What’s most important is to exercise using a program which respects your back’s Directional Preference.  This means your program should include exercises your back “prefers” and limit exercises which irritate.

The avoidance of irritation, combined with the benefits of exercising based on preferences, will help you to move forward to become stronger and return to a full and active lifestyle.

Knowing Your Back’s Directional Preference

Initially, most people will need their therapist or physician to help them understand the underlying pattern connecting these right and wrong movements. At first it may seem a bit random until the trained practitioner identifies the directionality.   However, once you understand the directionality, this knowledge will help you make better decisions on what to do or not do as you are recovering.  It will help you to choose exercises, safe cardio workouts and engage in everyday movements safely.

Directional Preference Designations

Most backs exhibit one of three Directional Preferences:

  1. Flexion preference – your back prefers forward bending
  2. Extension preference – your back prefers backward bending
  3. Neutral preference – your back is best if you keep it in neutral. It irritates if you go into more flexion or more extension.

Our First on-line Classes are for Flexion Preference

We are launching our exercise series with videos and classes for the Flexion Preference back however we expect to add Extension and Neutral preferences in the near future.

As you are participating in this program as a client of The Orthopaedic Therapy Clinic, your therapist will be able to help you to determine which class you should participate in.  Reach out to your therapist directly if you have any question on your directional preference.

Your assessment combined with the following elements of your history help us to know that you likely have a flexion preference back.

  1. Your back feels better when you sit.
  2. Your back feels worse when you walk
  3. Your back feels better when you bend forward or with pelvic tilt type of exercises
  4. Your back feels worse with back bending or cobra type of exercises

Why use Directional Preference Rather than Diagnosis?

Our therapists, and many physicians, use the designation of Directional Preference to choose exercise programs.  This well-established format is used world-wide.  It is successful at helping people become more active because it respects the fact that even two people with the same diagnosis can have completely different directional preferences!

For  example, although most people with spinal stenosis will prefer flexion, there is a small group of people who will do better with extension.

A diagnosis of discogenic back pain gives limited insight into the type of exercise you need.  Some backs will need flexion whereas others will do better with extension.

These variabilities are why it is essential to know your Directional Preference to engage in safe exercise at this time in your recovery.

Key to your Success

The key to your success in this series is to:

  1. Respect your Directional Preference and use it throughout the series
  2. Commit to understanding the technique for each exercise.  Use the reference videos, or your therapist, to ensure you are getting the most out of the program.
  3. Apply the tips and activation strategies that work for your body to prevent/limit pain from exercise.  Recognize that not every tip works for every person.  This is why we provide you with several options on how to get the correct muscles working.  Once you learn what works for you, apply this throughout the exercise program.

We look forward to helping you get more active with safe exercise.  If you need further assistance, please call us at 416-925-4687 or contact your therapist at the following emails:

Winning the War on Low Back Pain – Recovery or Recurrence?

One of the biggest problems I see when you are recovering from low back pain is that you are tricked into thinking you are completely  better when the truth is that you still have a long way to go.  After weeks of intense, unrelenting pain you wake up one morning and there’s nothing.  No pain.  No stiffness.  It’s gone!  You are thankful for the lack of pain and vow to take your life back.  You immediately start doing everything you used to do.  You go to the gym, book a Yoga class, take up running, find core strength video’s on YouTube, etc.  only to begin to hurt again.

Click here for the Video Winning the war on low back pain – Recovery or Recurrence

Relief changes to despondency.  Not realizing that the problem is your lack of a rehab plan you start to worry that whatever is wrong with your back is serious and for life.  You go into an emotional tailspin – reinforcing your return to being a  Prisoner of the Pain.

Avoiding mistakes in recovering from low back pain

The most common mistake I see in the Recovery stage of winning the WAR on low back pain is trying to do too much too quickly. This happens because we equate the absence of pain to full recovery.  The reality is that pain often abates when strength is around 40% of normal.

Whenever pain lasts for more than a few weeks most people are weaker than they realize.  If you have had a pinched nerve the weakness is compounded by loss in the strength in muscles supplied by the nerve. This weakness can be quite profound, causing;

Even when the pressure comes off the nerve the muscle may not immediately regain strength.

These are often the reasons your recovery fails.  Unless you understand these imbalances and look to correct the impact they are having on your body, your recovery can be very hit or miss.

3 Stages of Low Back Pain Recovery

The changes caused by low back pain and nerve pressure mean you need to make good decisions in your recovery from low back pain.  Your decisions need to build logically on each other until you return to your full and active lifestyle with a step-by-step plan.  These decisions start with the knowledge that recovery has 3 stages.

  1. Resolution
  2. Robust
  3. Resilience

Most people go through each stage sequentially however the stages typically overlap.  Each stage requires a change in therapy and should become progressively more demanding as you regain your strength, stamina, flexibility and coordination.

Recovery Stage 1 – Resolution

The hallmark of this stage in your recovery is that the pain is intermittent. Typically, the pain is provoked by certain activities and feels better when you do other things.

You may have trouble identifying the links between what makes the pain better or worse.  At this stage what is most likely happening is that your back is exhibiting what is called a “directional preference”. This technical jargon simply means that your back prefers certain positions and is made worse by other movements.

Most commonly the back has one of two preferences – it either likes to flex (bend forward) or extend (bend backward).   The therapy goal of this stage is to control pain  through movement. This is often when you can reduce or eliminate medication.  Your exercises will make you stronger and more flexible but most importantly they should make you feel better or at least not worse.

Flexion (bend forward) preference:

Flexion preference typically achieves pain relief with sitting and is made worse by walking.  The most likely structures at fault are the facet joints or spinal stenosis.  If this is your pattern, exercises such as knees to chest, Figure 4 stretch and stationary bike are the places to start.

It is  important to avoid/limit the direction you back doesn’t like.  In this case we term it an extension intolerance.  This means you should limit activities that put your back into an arch such as standing for too long, Yoga cobra poses or deciding this is the exact moment you need to paint your ceiling.

Extension (bend backward) preference:

Extension preference is often associated with pain relief from walking.  It is typically made worse by sitting. The most likely structures at fault are the discs or tight hip muscles (psoas, quads). Exercises such as Yoga cobras, sloppy push-ups, bridging and lots of walking can substantially reduce your pain.

In this early recovery stage you should avoid activities that put your back into flexion such as toe touches, hamstring stretching or deciding that you finally have to beat your high school sit-up record.

Recovery Stage 2 – Robust

The marker that you are entering the next stage in recovery is that you have minimal pain with basic activities such as sitting, walking, standing etc. It is still relatively easy to aggravate your back with heavier or sustained activities.

At this stage it may feel OK to bend forward to pick up a muffin or a Kleenex box but you still hurt if you go to the gym or lift the laundry basket.  You know you’ve overdone it when you pick up a case of beer for the long weekend and feel an immediate urge to crack open a bottle to relieve your back muscle tension.  In other words the intensity of the activity is the limiter, not the direction of the movement.

Often at this stage your pain gets worse as the day goes on. The more tired you are, the more you hurt.

These symptoms indicate that the intensity of the activity and fatigue are the irritating factors.  This tells us that it’s time to make a plan to resume cardio, strengthen your core and restore your flexibility.

At the start of the robust stage you may be still be exhibiting a directional preference.  You can still exercise however the strengthening and flexibility must respect the preference i.e. strengthen in extension.  As you progress you should be able to restore some  degree of the opposite direction of movement.

Recovery Stage 3 – Resilience

Resilience is about our ability to recover from our mistakes.  We all do it.  The weather improves and we decide to go for a two hour walk when the longest walk we have done in the last 6 months is 20 minutes. We decide to clean up our garage or return to gardening when the heaviest thing we have lifted in the last month is our coffee cup.

The problem with these decisions is that you have increased your physical demands too quickly.  However pat yourself on the back if you only experience mild discomfort or stiffness and recover from your low back pain within a day or two.  Mild symptoms and a quick recovery are indicators that you have restored some degree of resilience.

To fully  restore resilience your recovery plan needs to uncover and correct compensatory patterns.  We need to identify those pockets of profound weakness that the pinched nerve left behind and bring these muscles back to normal strength and coordination.  The failure to restore normal movements and efficient, coordinated movement patterns is what I find is the most predictive of recurrence and of your recovery not resolving within the expected 3 months.

How do you know you need to restore resilience?

  1. Exercise dependency. Your back exercises really help but whenever you stop them the pain returns.
  2. Inability to return to exercise, sports or household chores without provoking pain.
  3. Constant, low grade pain. The intense pain has lessened but now the pain never leaves.
  4. Your pain is still intense after 3 months

To get to the truly resilient stage you may need to find a spine therapist who understands how to find and correct the weaknesses and compensatory patterns left behind by your injury.  If you have pinched a nerve and the symptoms have lasted for longer than 3 months I can almost guarantee that these imbalances will be there. You and your therapist need to determine what is missing in your recovery and specifically address these imbalances.

Over the next few blogs I will explore each one of these stages more thoroughly and help you to find your own direction of recovery and to assist you in creating a dialogue with your spine therapist to partner in winning the WAR on low back pain.  Please contact us at 416-925-2687 or physio@orthophysio.com if you need assistance in putting your Recovery plan into place.

 

Juliette Woodruff – Bio

Juliette WoodruffJuliette Woodruff

Registered Massage Therapist and Acupuncture Practitioner

jwoodruff@orthophysio.com

Juliette joined The Orthopaedic Therapy Clinic Team in 2004. She is a graduate of the Sutherland-Chan College of Massage Therapy. After graduating her ongoing commitment to professional development has led her to complete studies in manual lymph drainage, craniosacral therapy and receive certification in contemporary/medical acupuncture from McMaster university.

Juliette is an integral member of our treatment team working to find solutions to pain and helping to relieve the barriers limiting recovery. She has worked with a diverse range of people including athletes, expectant mothers, and business professionals. She is particularly interested in treating conditions such as scoliosis, spinal stenosis, TMJ, and the thoracic spine. She believes in helping her clients to become an active participant in their own healing process through body awareness, postural education, and self-care exercises.

Juliette has a personal as well as clinical experience with the different stages of cancer. She works towards creating improved quality of life for her clients through education, exercise, acupuncture and manual lymph drainage techniques. She believes in implementing a variety of modalities and current knowledge to personalize client care.

Juliette has a specific interest in the relief of pain and restoration of mobility in scoliosis. She has worked with clients following extensive reconstruction surgery as well as non-operative conditions. She has studied with Dr. Rudolph Weiss of Germany (Katerina Schroth’s grandson) and received a certification in his Scoliologic method. She has a developed an approach to the application of massage therapy in scoliosis which has been published by her professional alumni newsletter. SutherlandChan_FingerPrint

Juliette implements knowledge and clinical techniques from a variety of post-graduate courses such as: techniques for post-operative breast cancer, joint mobilizations, Structural Integration for structural alignment (Nisa), Scoliologic method, myofascial techniques, muscle energy techniques (METs), positional release, acupuncture and craniosacral techniques. She utilizes and incorporates several different treatment modalities to develop an individualized approach for each client based on their assessment.

Association Memberships

Juliette is registered with the College of Massage therapist of Ontario. She is a member of the Canadian Massage Therapy Association and the Canadian Academy of Medical Acupuncture

When did you lose it?

 

When we are younger the question “when did you lose it” provokes a completely different response than later in life.  As grandchildren enter our life, or as we finally find time to get back to the activities we were always meaning to resume, we are struck by the change in our physicality.  Suddenly and without warning we are no longer able to:

  • Get off the floor
  • Go jogging
  • Run for the bus
  • Walk an hour on the beach
  • Stand in the mosh pit with our kids at the concert

As we reflect on these changes we may also notice that other things have changed.  We’re stiff when we get up in the morning – even when we haven’t worked out the day before.  Its hard to straighten-up when we get out of a chair.  We find it easier to walk with our hands behind our back.   We avoid cocktail parties because the alcohol is insufficient to off-set our back pain.

Should you accept physical aging?

If you mention these changes to your health practitioner, they often bring up the “A” word.  When faced with the Age pejorative some give in and accept their fate.  Others rail against it, sometimes creating injuries as they are unable to accept the changes in their body.

There is no doubt that physicality changes as we age, however there are some changes we should never accept.  Keeping or restoring these physical abilities will not only help your quality of life, but many of these activities are predictors of longevity and independence.  Here’s what the research is telling us:

Can you still get off the floor?

I prefer my clients do their exercises on the floor, not only because of the firmer surface, but also because I want them to be able to get off the floor for the rest of their life.  Researchers have realized that this basic physical ability is a predictor of longevity.   We now know that whether you can get yourself off the floor, and the technique you use, is predictive of how long you will live.

When analyzed it becomes apparent why this simple movement would be so predictive.

  1. Falls are one of the most common problems as we age. Not only do we want to prevent falls we also need to be able to get off the floor when it happens.
  2. Getting off the floor requires balance, flexibility and strength. All these elements come together in this basic movement, making it a quick screen to determine your overall physical health.

If you are playing on the ground with your grandchildren or can manage your exercises on the floor, then keep this up.  If you struggle to get off the ground and avoid picking anything up off the ground, it’s time to have your physiotherapist or kinesiologist assess the barriers and develop a program to restore this important life skill.

Staying independent

I may have given up any dreams of Wimbledon, but the one physical expectation I will never give up is staying independent.  Anyone who has worked with me knows that I am obsessed with posture.  A few years ago, a study out of Japan gave me even more reason to maintain my obsession.  It looked at the predictors of independence.  Over a 20+ year period it analyzed which physical measures were predictive of whether you would need to go to a nursing home and require help with everyday activities such as dressing. It concluded that one of the key factors predicting the need for assistance was your posture.  In a nut shell, if you cannot stand up straight, with your spine directly over your pelvis, you are more likely to need help as you age.

You may have nagged at your teenagers to stand up straight, but it’s now time for your children to nag you.  Ask them what they have noticed.  Do you stand tall or are you bent forward when you walk? If you find it difficult to stand up straight, working on your flexibility and core strength should be on your list of exercises for the long term.

How low should you go?

In my youth the buzz was about Sebastian Coe breaking the 4-minute mile.  The headlines around the world read “How low can he go”? Usain Bolt and Andre De Grasse have taken over the headlines but the message remains the same.  Many of us have been brought up with the belief that faster is better however we now know that there is a range of speed which is ideal.  Throughout our lifetime we should target our running, and then our walking, for between 3.5 and 4.5 mph.  If you are metric it’s an 8-11 minute kilometer.

These numbers should guide us, our children and our grandchildren on doing enough, but not too much. Whether it is speed or strength there is an optimum demand – do more and you cause injury, do less and you might as well eat bonbons by the pool.

As we age, many people find they can’t walk.  The wear and tear on our spine has resulted in overgrowth of bone.  Spinal stenosis (narrowing of the spinal canal) gets in the way of our retirement. Instead of taking cruises and exploring the ports we take the bus tours or stay onboard – professing we prefer to read or play cards when the reality is that it hurts to walk.

Maintaining your spinal health is paramount to enjoying an active retirement.  Target 8-10,000 steps per day but also time your walk.  Your goal is to manage 3 km in 30-33 minutes every day.  If that causes back pain, leg heaviness or other symptoms then seek advice from your spine therapist.

Find me a chair!

Many of my clients hurt when they stand or walk slowly. They avoid shopping, limit visiting art galleries and decline invitations to cocktail parties.  As it gets worse even standing to cook causes pain.  Often attributed to aging this change in physicality is more likely due to poor back posture, tight hip flexors and weak hip muscles.

A protruding belly is often a marker that we have a sway back.  Many of my clients think they need to lose weight when a simple adjustment in their posture will not only relieve the pain in their back but it also looks better!  If you can’t stand for an hour consider seeing your spine therapist for an assessment of how to change your posture.

When did you lose it?

Although ageing is inevitable, the changes of physicality are not.  The one system that is not affected by age is our muscles.  Research is showing that we can build strength into our 80’s, and that limiter is only because we have yet to study the 90 year olds. If you are over 50, the only physical restriction on my list that you should consider accepting is jogging.  None of the other losses in physicality need to be attributed to age.

To quote one of my colleagues, Dr. Adonis Makris, D.C. , you not only need a financial plan, you also need a physical plan to stay healthy and active.  Although it’s best to start this plan by age 60, even if you are older an exercise program can help to restore much of what you have lost.  If you need help with your physical plan our physiotherapists, chiropractor, massage therapists and therapeutic fitness team can help to target your program to change the dialogue around “when did you lose it?”

Do I Need Back Surgery?

backinjuryMaureen Dwight, Registered Physiotherapist, Clinical Musculoskeletal Specialist, Advanced Spinal Practitioner ISAEC

When you are experiencing searing low back pain, sciatic leg pain or repeated episodes of back spasms, it is natural to wonder if surgery might be the answer. In the 30 years I have been working with spinal surgeons in downtown Toronto I have seen an evolution in our understanding of who benefits from back surgery and who is better off managing their symptoms with a cocktail of time, medication and therapy. We now know that even when your symptoms are intense, surgery is unlikely to be the solution. Long term studies tell us that given enough time there is a 95% chance that you will recover without surgery. In fact most people will see substantial improvement in their symptoms within 3 months.

That said, three months can seem endless when your back pain won’t let you get out of bed or the pain in your leg doesn’t let you sit for more than a few minutes. At this stage in your recovery it can be hard to hear that there is no instant solution however when the pain begins to lessen, and it will, most people are relieved that they avoided surgery. The right combination of medication and physical therapy can help many people manage until natural healing takes away the symptoms.

When is back pain an emergency?

Most experts agree that there is one back condition which should be treated as an emergency. The condition is called Cauda Equina syndrome. This uncommon condition results from pressure on the spinal nerves in the lumbar area where they fan out to look like a horse’s tail. Pressure on these nerves can result in loss of control in the bowel or bladder functions.

If your back pain is accompanied by a sudden loss in control of either of these functions this should prompt a trip to the emergency department. Left too long these changes can be permanent.
Discussion of this condition often prompts people to worry about their stress incontinence (peeing with strenuous activity, coughing, sneezing), or urinary frequency however these are not signs of cauda equine syndrome. With this condition you have:

• Uncontrolled urination and/or
• Uncontrolled defecation and/or
• Numbness, tingling in the anal and/or genital area

Despite the potential serious nature of this condition you still may not need surgery. Depending on the severity of the pressure on the nerves and on what your surgeon finds in the examination, he/she may choose to monitor the situation. Close monitoring of the symptoms is required and if you are receiving therapy, manipulation of the spine should be avoided. Once your symptoms stabilize a core exercise program should be instituted with a knowledgeable spine physical therapist.

Surgery for Sciatica

Sciatica is a particularly nasty condition which often starts with lower back pain but as it worsens the pain extends into the buttock and leg. It is typically caused by a pinched nerve and depending on the location of the pressure and the intensity of the symptoms, the pain can radiate down to your calf and foot.

Whether you are a candidate for surgery is determined by the cause of the pressure and your response to conservative treatment. Once again most episodes of sciatica will see substantial improvement within 3 months however if the pain persists and is caused by a herniated disc, or a narrowed spinal canal (stenosis), surgery can be an option.

Herniated disc and sciatica

The most common surgically treated sciatica is caused by a herniated disc. In this condition the center of the disc (nucleus) breaches the outer rings (annulus). If the disc protrusion is large or if it is located more to the side (laterally) it can pinch the nerve by pressing it against the walls of the spinal tunnels (canal and foramina).

Surgery for this condition is elective – meaning that once the surgeon confirms that you will benefit from a procedure you can decide whether you would prefer surgery or would like to try to manage your symptoms conservatively. In the most common type of procedure the surgeon removes the offending nucleus to relieve the pressure on the nerve (i.e. discectomy, microdiscectomy).

The intensity of the pain can prompt many people to choose surgery, and this option should help you to get rid of the pain more quickly, however if you decide that surgery is not for you the long term studies confirm that even with this condition most people get better. With time the pressure comes off the nerve as the herniation shrinks, much like a grape drying into a raisin. The pain abates once this natural process creates sufficient space in the spinal tunnels for the nerve to function.

Treatment of Disc Herniation Sciatica

While you are waiting to get better, or to see the surgeon, your therapy team’s focus should be on helping you to manage your pain. Your body needs time to heal and medication and/or other pain relieving types of therapy i.e. acupuncture, massage, physiotherapy, can be helpful to get you through the wait. Once the worst is over the focus should shift to physiotherapy to restore your core, correct your posture and education on long-term prevention strategies.

Therapy is also important if you decide to go the surgical route as it will help you to maximize your recovery. When opting for this type of surgery it is important to understand that the primary goal is to relieve your leg pain. After a successful procedure you still may have low back and/or buttock pain. When you are ready to begin therapy your physical therapist will work with you to restore core strength as this will help to manage these residual symptoms.

Sciatica and spinal stenosis

Sciatica can also be caused by an over-growth of bone which can be a result of wear and tear on the spine. For the pain to radiate down the leg this over-growth of bone is usually restricting the nerve as it exits the spinal canal (foramen). On your MRI the radiologist may differentiate the location of the narrowing by indicating it is at the foramen or in the lateral recess.

Some people are born with a congenitally smaller spinal canal. Inflammation or more minor bony over-growths can comprise the nerves in these restricted canals more quickly.

In this surgical procedure the surgeon typically elects a decompression to enlarge the space for the nerves to exit. They remove sufficient bone and/or soft tissue to provide enough room for the nerves to function.

Treatment of Sciatica caused by spinal stenosis

When your sciatica is caused by stenosis most people try to manage their pain conservatively before turning to the surgeon for help. This can be quite effective if this type of sciatica comes on suddenly as this presentation suggests that there may be dynamic elements contributing to the compression. Soft tissue protrusions (discs, ligaments, etc.), inflammation and posture can all put pressure on the nerves in the canal. These dynamic contributors can be temporary and should respond to therapy consisting of posture correction and exercises to reduce the lordosis (sway) in the back. If inflammation is suspected the addition of ice, medication, acupuncture and/or other physiotherapy modalities to reduce swelling can be useful.

Even when the X-rays and MRI’s show a nerve entrapment or a congenitally small canal these approaches can help you to control your symptoms. Once the pain improves it is important to continue your exercises and be aware of your posture as the size of the canal is still restricted and resuming old habits can cause the symptoms to reoccur.

If your decision is to have surgery, therapy is still an essential component of your recovery. The restriction of the nerve in the foramen often leaves specific muscle weaknesses which can remain even once the surgeon relieves the pressure off the nerve.

If the weakness has lasted more than a few months it can be difficult to restore this strength as your body may have started to compensate. You begin to adapt to the weakness and learn to function without the muscle. A knowledgeable spinal therapist will know where to look for these specific weaknesses and then can help you to learn to integrate this strength back into your everyday function. Without this type of therapy I find that symptoms are more likely to occur down the road as compensatory patterns cause postural adaptations that contribute to the recurrence of dynamic stenosis.

Neurogenic claudication and spinal stenosis

Spinal stenosis does not always present as sciatica. When the narrowing is located in the central canal, rather than as the nerves exit the foramina, some people will experience a heavy, numbing sensation in their legs as they walk. They may also feel tingling in their feet. If these symptoms are relieved by bending forward, crouching or walking with a shopping cart your stenosis may be causing neurogenic claudication1.

Surgery is typically considered when walking becomes quite restricted. It is important to discuss with your surgeon your expectations for function as some people can have quite a restriction in their canal and yet are able to walk for several miles. Other people can’t walk a block before feeling symptoms. Getting a good surgical outcome is often determined by your expectations as your goal is to walk further without symptoms following the procedure. You may choose to delay surgery if you are functioning at a high level.

Treatment spinal stenosis with neurogenic claudication

Although the presentation is slightly different, the treatment is essentially the same for neurogenic claudication as it is for sciatica caused by spinal stenosis. Posture is an important component of your program as the more swayed (lordotic) your back is, the more symptoms you will have while walking.

If your decision is to have surgery, therapy is still an important component of your recovery. Many people have been inactive for months or years as the pain limited activity. Add to this the fact that spinal stenosis typically affects us as we get older and many people find that they have lost substantial amounts of fitness by the time they have surgery. In addition to working on posture and muscle imbalances your post-operative program should focus on regaining your endurance for walking to help you to return to favorite activities such as golfing, traveling, bird watching and/or hiking.

1 Neurogenic claudication causes similar symptoms to another condition where the restriction is in the blood vessels in your legs. This condition is differentiated by the term vascular claudication.

Registered Massage Therapists

Juliette WoodruffJuliette Woodruff

Registered Massage Therapist and Acupuncture Practitioner

jwoodruff@orthophysio.com

Juliette joined The Orthopaedic Therapy Clinic Team in 2004. She is a graduate of the Sutherland-Chan College of Massage Therapy. After graduating her ongoing commitment to professional development has led her to complete studies in manual lymph drainage, craniosacral therapy and receive certification in contemporary/medical acupuncture from McMaster university.

Juliette is an integral member of our treatment team working to find solutions to pain and helping to relieve the barriers limiting recovery. She has worked with a diverse range of people including athletes, expectant mothers, and business professionals. She is particularly interested in treating conditions such as scoliosis, spinal stenosis, TMJ, and the thoracic spine. She believes in helping her clients to become an active participant in their own healing process through body awareness, postural education, and self-care exercises.

Juliette has a personal as well as clinical experience with the different stages of cancer. She works towards creating improved quality of life for her clients through education, exercise, acupuncture and manual lymph drainage techniques. She believes in implementing a variety of modalities and current knowledge to personalize client care.

Juliette has a specific interest in the relief of pain and restoration of mobility in scoliosis. She has worked with clients following extensive reconstruction surgery as well as non-operative conditions. She has studied with Dr. Rudolph Weiss of Germany (Katerina Schroth’s grandson) and received a certification in his Scoliologic method. She has a developed an approach to the application of massage therapy in scoliosis which has been published by her professional alumni newsletter. SutherlandChan_FingerPrint

Juliette implements knowledge and clinical techniques from a variety of post-graduate courses such as: techniques for post-operative breast cancer, joint mobilizations, Structural Integration for structural alignment (Nisa), Scoliologic method, myofascial techniques, muscle energy techniques (METs), positional release, acupuncture and craniosacral techniques. She utilizes and incorporates several different treatment modalities to develop an individualized approach for each client based on their assessment.

Association Memberships

Juliette is registered with the College of Massage therapist of Ontario. She is a member of the Canadian Massage Therapy Association and the Canadian Academy of Medical Acupuncture

Igal Untershats

Registered Massage Therapist

igalu@orthophysio.com

Igal is a graduate of Sutherland Chan School of Massage.  As a registered Massage Therapist he brings a passionate interest in the application of soft tissue therapy for recovery after injury, restoration of health and injury prevention. 

Igal applies a focused and goal-oriented approach to determine the best techniques for maximizing your recovery.  Using myofascial release, Swedish massage, positional release, as well as several other techniques, he provides targeted treatments to reduce soft tissue adhesions and muscle tightness.  As an integral member of The Orthopaedic Therapy Clinic team he collaborates with your therapist to determine the most comprehensive approach to maximize your recovery. 

Igal has a particular interest in sports injuries and deep tissue massage.  He has worked with marathon runners and cyclists to reduce scar tissue and restore tissue resiliency after injury.  He has provided massage therapy for young athletes including the National Girls Gymnastics competition for young athletes between the ages of 5 and 15.

During his training he provided treatment to assist better breathing and relaxation for lung cancer patients at Princess Margaret Lodge Cancer Outreach Program.  He has helped patients with Multiple Sclerosis reduce pain and spasticity. 

Prior to training as a massage therapist, Igal was a jet-engine mechanic with the Israeli air-force and a high-rise carpenter.  He enjoys swimming, yoga and lifting weights. He is a percussionist and plays with an Afro-Brazilian percussion group.  Igal is fluent in Russian and Hebrew. 

 

Can an Inversion Table Help Relieve your Low Back Pain?

I am often asked whether Inversion Tables can help relieve back pain symptoms. You may have seen this treatment in the movies.  It really came into vogue after Richard Gere used Inversion boots in the old movie, American Gigolo.  The concept is that the table tips you upside down and gravity pulls on the weight of your trunk, head and arms.  This stretches your spine to counter the compression created when we are upright. By stretching (“tractioning”) the spine you can reduce the compression on the discs, joints and nerves, with the expectation that back pain can be alleviated.

Although it is a little different in a clinical setting as it is often applied  with a machine on a horizontal table, my early experience with traction was mixed.   At times it was very effective, at others there was no difference and occasionally it could aggravate low back pain. I suspect that if a clinical trial of inversion table treatment was done, you would see similar results.

If you are going to try inversion its important to balance the safety (risk) with the effectiveness, (benefit).  Using an Inversion Table to tip yourself from a slight incline to fully “upside down” is quite unique and unusual for most adults. Although you may benefit from the stretch to the spinal tissues, it can also have negative, potentially harmful effects.

Here are some of the pros and cons of inversion:

Benefits of inversion

  • Relief of low back pain
  • Applying traction type forces to the spine can be helpful in alleviating low back pain symptoms in the short term particularly if done as part of a more comprehensive program of exercise and education.

Risks of inversion

  • Inversion can make your back pain worse. 
  • If the traction-type force created as you suspend yourself “upside down” is excessive you can aggravate the “straight”/extension position of your spine. This may not be tolerated if you have conditions such as spinal stenosis (narrowing of the spinal canal).  You may get more pain if your core muscles are too weak to take the stretch.

Inversion can affect your heart

Another consideration is the effect that tipping will have on other body systems. For example, in the Mayo Clinic newsletter an article on Inversion Tables/Therapy mayoclinicpain@everydayhealth.com  highlighted the cardiovascular risks if you have a slower heart rate or high blood pressure.  They recommend that if you have a cardiac condition such as an abnormal heart beat or hypertension or if there is a history of stroke or future risk of a stroke that you should not use an inversion table. If you are seeing a cardiologist you should ask what your risks are for this type of treatment.

Other reasons to avoid inversion treatments

  • Any condition where there is increased pressure within the eye i.e. Glaucoma or Retinal disease . Tipping upside down will increase this pressure and put you at risk for damage to the optic nerve.
  • Inner ear problems such as vertigo, dizziness or infections
  • Obesity can be an issue if you have cardiovascular issues as well as from the increased load on your spine and legs
  • Pregnancy
  • Osteoporosis or bone weakening conditions and history of spinal fracture
  • Hernias
  • Taking blood thinning types of medication
  • Gastric issues, such as acid reflux
  • Presence of orthopaedic implants, total hips/total knee replacements

It is strongly recommended that before using an Inversion Table to treat your back pain you discuss any medical issues with your Doctor.  Your physiotherapist can provide you with guidance on whether this is a good treatment option for your back.

The bottom line on inversion tables and low back pain

If you are healthy, with no risk of any of the above conditions, “traction” type forces such as produced by an Inversion Table may be beneficial as part of a more comprehensive program of exercise. A trial of horizontal traction with your therapist can be the first step in deciding if this is the right treatment for you.  If you have back pain and would like to discuss this further or receive other treatment strategies to take control of your pain, please contact me at gsneath@orthophysio.com or 416-925-4687.

References

https://www.mayoclinic.org/diseases-conditions/…/inversion-therapy/faq-20057951

Author E. Laskowski MD June 30 2017

 

 

 

 

 

 

 

 

 

 

 

Headaches

Neck and Headaches
The Neck is a complex structure consisting of a series of vertebrae (bones), joints, discs, ligaments and nerves. Pain may be caused by any of these structures as well as from strain to the muscles of the neck.
Pain and swelling in the small joints (facets) can be caused by wear and tear (osteo-arthritis) or trauma (sprain or traumatic arthritis). A disc may cause symptoms related to degeneration, herniation, annular tear or bulge.
The nerves can cause pain to radiate down the arm if they are irritated from a narrowing of the canal as they exit the spine (foraminal stenosis) or as they course down the body (central stenosis). This narrowing can be caused by inflammation, a disc protrusion or over-growth of bone. Pressure on the nerves at the base of the skull and tension in the muscles of the neck can cause headaches.
When you are having symptoms the most important first step is to understand what you have. Your therapist will provide a thorough assessment to determine whether your symptoms are caused by the joint, disc, ligament, muscle or nerve. At The Orthopaedic Therapy Clinic your therapist will partner with you to determine the best course of treatment for your injury.
Once the injury is diagnosed the next step is to determine where you are in the recovery sequence. Treatment is based on your stage of healing as more acute injuries typically require a plan to reduce pain and inflammation however as you continue to heal the restoration of flexibility, rebuilding strength and re-establishing normal movement patterns will become the focus of your therapy. The final stage is to determine a strategy to help you return to full activity, sport and long-term prevention. Posture and restoration of motion are important factors in relieving pain and for promoting the long-term healthy functioning of your neck.
Our therapists have extensive experience in the care of both the acute and chronic neck conditions including disc herniations, bulges and degenerative spine conditions. We work with clients after many types of spinal surgery including discectomy, stenosis decompression or fusion. We also have experience in working with clients who are having pain or weakness related to less common spinal problems such as syringomyelia, spina bifida, spinal tumors and spinal cord myelomalacia (spinal cord compression).

Neck Pain101

Neck Pain 101

The Neck is a complex structure consisting of a series of joints, discs, ligaments and nerves. Pain may result from any of these structures as well as from strain to the muscles of the neck.  It can be challenging to diagnosis as pain may be felt in the neck, shoulder blade, chest or down the arm as far as the hand.

Joint or disc pain 

Pain and swelling in the small joints (facets) can be caused by wear and tear (osteo-arthritis) or trauma (sprain or traumatic arthritis). A disc may cause symptoms related to degeneration, or from a herniation, annular tear or bulge.

Nerve pain 

The nerves can cause pain to radiate down the arm if they are irritated from a narrowing of the canal as they exit the spine (foraminal stenosis) or as they course down the body (central stenosis). This narrowing can be caused by inflammation, a disc protrusion or over-growth of bone.

Muscle pain

Although muscles can refer pain to the neck the most common problem is a lack of support caused by weak or poorly coordinated muscles. Understanding these patterns of weakness and poor muscle support in conjunction with the restoration of good posture is integral to the long term health of your spine.

Determining the cause

At The Orthopaedic Therapy Clinic your therapist will partner with you to determine the best course of treatment for your injury. When you are having symptoms the most important first step is to understand what you have. Your therapist will provide a thorough assessment to determine whether your symptoms are caused by the joint, disc, ligament, muscle or nerve.  They will look at factors in your life that may be influencing your pain i.e. computer set-ups.

Your Treatment

Once the injury is diagnosed the next step is to determine where you are in the recovery sequence. Treatment is predominately determined by your stage of healing as more acute injuries usually require a plan to reduce pain and inflammation.

As you continue to heal the focus of your therapy shifts to the restoration of flexibility, rebuilding strength and re-establishing normal movement patterns. The final stage is to determine a strategy to help you return to full activity, sport and long-term prevention.

Our Therapists

Our therapists have extensive experience in the care of both the acute and chronic neck conditions including arthritis, disc herniation, disc bulges and degenerative spine conditions. We work with clients after disc, stenosis or fusion surgeries. We also have experience in working with clients with less typical spinal problems such as syringomyelia, spina bifida, spinal tumors and spinal cord myelacia.

Contact us by email at physio@orthophysio.com or by phone at 416-925-4687 if you would like more information or to book anothe appointment.

Low Back 101

Low Back
The low back (lumbar spine) is a complex structure consisting of a series of joints, discs, ligaments and nerves. Pain may be caused by any of these structures as well a muscle strain.
Pain and swelling in the small joints (facets) can be caused by wear and tear (osteo-arthritis) or trauma (sprain or traumatic arthritis). A disc may cause symptoms related to degeneration, herniation, annular tear or bulge.
The nerves can cause pain to radiate down the leg if they are irritated by a narrowing of the canal as they exit the spine (foraminal stenosis) or as they course down the body (central stenosis). This narrowing can be temporary if it is caused by inflammation or a disc protrusion or long-term if the cause is bone over-growth from degeneration.
Although muscle spasms can cause pain in the back, the most common muscle problem is a lack of support caused by weakness or poor coordination. Understanding your patterns of weakness and re-establishing muscle support in conjunction with the restoration of good posture is integral to the long term health of your spine.
At The Orthopaedic Therapy Clinic your therapist will partner with you to determine the best course of treatment for your injury. When you are having symptoms the most important first step is to understand what you have. Your therapist will provide a thorough assessment to determine whether your symptoms are caused by the joint, disc, ligament, muscle or nerve.
Once the injury is diagnosed the next step is to determine where you are in the recovery sequence. Treatment is predominately determined by your stage of healing as more acute injuries usually require a plan to reduce pain and inflammation. As you continue to heal the focus of your therapy shifts to the restoration of flexibility, rebuilding strength and re-establishing normal movement patterns. The final stage is to determine a strategy to help you return to full activity, sport and long-term prevention.
Our therapists have extensive experience in the care of both acute and chronic back conditions including disc herniation, disc bulge and degenerative spine conditions. We work with clients after disc, stenosis or fusion surgeries. We provide both operative and non-operative therapy for adult and adolescent conditions.
We also have experience in working with clients with less typical spinal problems such as spinal fractures, syringomyelia, spina bifida, spinal tumors and spinal cord myelacia.