Back To Basics: A No-Duh Guide to Preventing Back Injury - and Maybe Even Surgery

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However, we do understand it is a stressful time for the patients. First of all, it is important to realize that steroid injections do not work immediately. Initially, you may feel immediate relief from the local medication that is used during the injection. As this wears off, you may even have an increase in pain following an injection. It is important to give days for the effect of the steroid to reach its full benefit. The steroid works to decrease the inflammation and by doing so, decrease pain.

What can you do? You can apply ice to the painful area. If you are able to take your anti-inflammatory medication, please do so as prescribed by your physician. Occasionally, your doctor will prescribe stronger pain medication to get you over the initial acute phase. Within two to three days following the injection, you should begin to feel slight improvement.

Slowly begin your prescribed home exercise and stretches. A little time and a positive attitude is beneficial. The goal is to get you back to your normal function as soon as possible. It is very important to schedule and present to the office for your follow up appointment. It is crucial for us to document the effectiveness of your injection, how much it did or did not help, what kind of symptoms you are still experiencing in order to continue to customize and treat your remaining symptoms.

This will also document effectiveness of the injection for your insurance company, as some improvement is necessary to assure proper coverage of these services or possible future services. Get a cortisone shot. Pretty much any pain? That mantra has been around for years. Too many steroids can lead to a number of unwanted side effects; such as: This is not to say that you should not have a corticosteroid injection.

They can and do work when used appropriately, but the old mantra of automatically getting 3 corticosteroid injections has fallen out of favor. There ARE other options for injections. There are 2 other types of medications which I have recently started to use for various injections. One is Traumeel and the other is Zeel. These are homeopathic i. Because of this, they can be administered more often in effort to help your pain. Traumeel is typically used for muscle and tendon injuries, whereas Zeel is usually used for arthritic conditions.

Traumeel is primarily made from plant based compounds, whereas Zeel contains both plant and animal based compounds. If you are vegan, vegetarian, or have concerns about the use of animal based products, please make sure you let me know prior to your injection. Os Odontoideum is the term used to describe a non-union of the C1-C2 anterior bodies. Most Ring Side Physicians are trained to look for neurologic changes of the boxers. I am a Registered Nurse at Shimspine. I want to share ways to improve the patient experience. In the end, it is about getting your needs met, and your questions answered.

These are some suggestions to help each patient be prepared for each visit, and get the maximum value from the Shimspine Doctor visit. At Shimspine, our goal is to provide a great patient experience. As our Patient, you can help achieve that goal by preparing for the visit, obtaining the necessary information and tests, and writing down your most important questions. Please spend some time on our website. Shim has made a video on what to bring, how to prepare, and what to ask https: This is a very frequent question.

Quite often following an injection procedure, your pain may significantly improve or even completely disappear for a certain period of time. Unfortunately, the pain may come back, especially if it is chronic or there is significant underlying degenerative disease. Yes, the pain did go way and come back. Most of the time for chronic conditions we are unable to actually fix the underlying problem.

So therefore, the treatments are performed in effort to help control the pain and allow you to increase your activity to improve your quality of life. Sometimes just a few hours. Obviously, the injection that worked for a few months is a better long term treatment option than the one that lasted for only a few hours. Despite this, however, sometime injection procedures are performed for diagnostic purposes. The relief from these types of procedures is typically only a few hours, but the purpose of the procedure is to help your physician determine the source of your pain and figure out which treatment options will be best for you in the long term.

So it is imperative to tell your physician on follow if you felt any relief, even for a few hours, following the procedure. Failure to do so may wind up actually hurting you in the long run by disqualifying you from a procedure or other treatment which may have the potential to provide you with longer lasting relief. All treatments have a time limited benefit to them, not just injections.

Massage therapy, Acupuncture, Chiropractic care, and medications rarely completely cure symptoms after one treatment. Medications are metabolized, hence they need to be taken at specific intervals. Likewise, the benefits from Massage therapy, Acupuncture, and Chiropractic care are typically short lived and treatments need to be repeated every few days or weeks. Most injections are the same way. Every treatment has an expected lifespan, and nothing will last forever; especially if your pain is chronic.

So, it is important for you to maintain the proper perspective when having a procedure, trying a new medication, or new treatment plan. Did it offer any benefit at all? How long did the benefit last? Accurate answers to these questions will help your physician develop the best treatment plan possible.

Most patients with chronic back pain are most effected earlier on in the pain cycle. This recent study also confirms that the science demonstrates a stabilization of the spinal segment motions as the disc degeneration process progresses. Depending on how old you are or feel , that may actually sound pretty good. Generally, however, it is a bad idea. No Fiber or Protein.

Well, depending on the product, your breakfast may have as much or more sugar than a piece of candy. Of course, no one will argue that yogurt is more nutritious than a candy bar, however it is important to be aware of what you eating…. This does not just apply to granola and yogurt. Breakfast cereals, breakfast bars, and prepared meals may have way more calories and additives than you may think. You may have noticed that fast food and chain restaurants have started posted Calorie and nutritional information on the menu. This was required by the FDA at the end of in effort to help consumers realize how many calories they are actually consuming.

Likewise, I recently looked at the label of a protein supplement bar while at a local pharmacy chain. Even more surprising, 3 pieces of chicken sausage has the same amount of protein with far less saturated fat and less Calories!!!!! When used appropriately to supplement a vigorous workout or meal that is fine. BUT, these are not appropriate snacks just because you are hungry. So, the take home message is to read the labels of what you are eating and be more aware of what you are actually consuming.

You will likely be surprised at the number of Calories, fat, protein, and sugars in what you are eating. The technology that allows spine surgeons to perform often complex procedures has grown rapidly in the last two decades. Some of these technologies including minimally invasive endoscopic and laser spine surgery has been joined by robotic assisted spine surgery in the last few years. These technologies have been developed with the potential to offer patient better outcomes and safer operations.

To date, many of these technologies has not been proven to be any more effective than traditional approaches. Some surgeons will go as far as to say that these offer more in terms of marketing hype than actual clinical benefit. Robotic assisted surgery continues to evolve. Robotic surgery has been used in the areas of prostate and gynecologic surgery since the early s.

Potential benefits for use of robotic assisted surgery include a shorter hospital stay, less blood loss, few complications, a faster recovery, and less scarring. To date, over 1. The da Vinci robot was used for the first time to perform a successful lumbar fusion in Robotic surgery utilizes a magnified 3D vision system and instruments that offer enhanced visualization, precision, and greater control than human hands.

The primary use of robotic assisted spine surgery has been for pedicle screw placement so far. To some, the use of robot assisted surgery is about expanding the limits of capabilities to develop newer techniques while other surgeons embrace this type of technology to improve upon outcomes and clinical results for procedures already being done. A systematic review of all published literature from to looking at pedicle screw placement comparisons between robot-assisted versus conventional fluoroscopy placed, found mixed results and insufficient evidence to recommend one technique over the other.

A matched cohort comparison study from Schalto B et al showed more accuracy by robot placement Advocates for the use of robotic spine surgery contend that if this system can truly reduce the rates of revision surgery due to errant screw placements, there will be significant cost savings that justify the high cost of this technology. The lack of good quality data makes it difficult to draw any firm conclusions about this new technology at the present time. In summary, robotic assisted spine surgery is in its infancy and offers hope for improving surgical outcomes.

The full capabilities of this technology are yet to be determined along with defining what specific conditions can be treated and who the ideal candidate is. More data is needed to evaluate whether the push for robotic assisted spine surgery is more about marketing hype or is a true sustainable technology that will produce better clinical results than conventional methods in spinal surgery. It does not matter that these feelings are experienced by anyone else.

Only YOU can feel what you feel in your own body. Most insurances, and plans use prescribed pathways or steps to authorize your care. It is almost cookbook. What if your unique set of complaints do not completely fit into the cookbook patterns? Patients also need to know that they are being treated as an individual. It means you will have a better, more confident attitude about your surgery.

Please avoid the Witch Doctor. Does it seem like you are able to predict the weather better than any meteorologist? Does your joint pain seem to worsen when it rains? Well, you are not alone. There is scientific validity to this phenomenon. The reason involves some pretty simple physics.

There is pressure inside and outside of your joints. Normally when the outside pressure changes, a healthy joint is able to adjust the pressure inside the joint relatively easily. Unfortunately, when your joint becomes arthritic, it is harder for the pressure to equalize. Similar to trying to clear your ears when flying if you are congested……not a fun thing to do. Stormy weather is usually accompanied by a low pressure weather system.

As the outside ambient pressure starts to decrease when the weather system approaches, your arthritic joints are not as easily able to equalize to the new ambient pressure. As a result, there is a relatively higher pressure inside the joint compared to outside of the joint.

This results in increased tension on the tissues, hence increased pain. While treatment of arthritic conditions can be complicated, the easiest way to help prevent this from happening is to maintain a healthy weight and engage in a regular exercise program. While you can not reverse arthritic changes that have already occurred, it is possible to decrease the stress on the joint and slow down the progression of the arthritis. This will result in an overall better quality of life with less pain.

The video above demonstrates a positive finding. Various studies have opined that a positive Hoffmann Sign highly correlates to the presence of cervical myelopathy. Many exercise fads have come and gone, each claiming to be the best way to get in shape, lose weight, and live longer. Some are extremely intense, and some are so minimal that they sound too good to be true. This exercise does not have to be performed in 1 session…it can be broken up into smaller segments. If you choose to do this, make sure that you do the exercise in segments of at least minutes.

Those recommendations do not sound like a lot, but the reality is that not everyone has the time to exercise on a regular basis. Between family and work life, household chores, and other commitments sometimes there are just not enough hours in the day to get everything done. The truth is that any exercise is better than nothing.

A recent article published in Medicine and Science in Sports and Exercise demonstrated that after 3 hours of sitting, be it in a car, at work, or on the couch, there was decreased blood flow in the superficial femoral artery. This was mitigated by standing and walking for just 5 minutes. Perhaps make it your goal to eventually reach or exceed them, but realize that some REGULAR exercise is better than nothing at all, even if it is just 10 minutes per day during your lunch break.

The results for the proper patient is similar to the original surgery. A minority of Surgeons will recommend repeat discectomy and Total Disk Replacement. The devices usually provide stability without causing fusion. But know that there are different surgical options. Please discuss them with your Surgeon. Some of the most commonly used medications in medicine are one form or another of steroids. There are generally two classes of steroids: Anabolic steroids and Corticosteroids. Anabolic steroids are the kind used to build muscle and are the ones abused by some athletes. The most common kind of steroids used in medicine are corticosteroids, and will be the type discussed here.

There are various different kinds of corticosteroids that are used. Some are used for anti-inflammatory and pain relieving purposes, while others are used to help regulate things like electrolyte and fluid balance. For anti-inflammatory purposes, steroids are typically given orally, intravenously, or by injection. Steroids can also work on certain neurotransmitters to decrease pain.

Numerous diseases such as asthma, allergies, multiple sclerosis, Rheumatoid disorders, certain vascular disorders, and sports injuries all respond well to steroids. Nothing in medicine comes without a cost. Too much of a good thing can be bad. Because your body makes steroids naturally, things can go wrong when too much is given from outside. Your body works very hard to keep things in balance. If there is too much steroid floating around in the blood stream your adrenal glands will decrease the amount made or even stop making them.

This is why patients are typically tapered down off of steroids…. All of these are potentially serious and some of these changes are irreversible. There is also the on-going debate as to whether or not inflammation is actually a bad thing following an injury. Inflammation initiates a complex cascade of events, which ultimately leads to healing of the area.

This is not to say that steroids are horrible. In certain conditions, the benefits of using steroids outweigh the associated risks. But not every condition justifies using steroids regularly. That is why it is so important to have a long term outlook when managing your symptoms or condition. A short term fix now may result in much greater consequences later on. Having accident Related Neck and Back Pain? Frustrated you cannot get an appointment to see your Family Doctor for the problem? Before we criticize our Family Physician for not giving you an appointment.

The health insurer will then reject payment for these services until it is determined that the liability insurance is exhausted. Orthopedic Surgeons, and Spine Specialists are used to dealing with injury situations. Orthopedic Surgeons are the doctors called in to do the emergency surgeries related to catastrophic accident related injuries. Call the office to see if we may be of help.

Unfortunately, the system is broken, very complicated, and unlikely to change under the current insurance model. So, here is my advice to you so that you can make the most out of your appointment with the least amount of difficulty:. In line with the above paragraph, be prepared for the visit and understand that all of your issues may not be covered in one visit. It is unfair to the remaining patients if you consistently use more than your allotted time. Some of the above suggestions may seem obvious, but are often overlooked. Simple things can help make your office visit more productive, efficient, and enjoyable.

The initial few weeks are very painful. Most patients choose to pursue surgery after weeks of non surgical care. Any change in physical demand causes increased pain. The patient is likely to fully recover. The third scenario is difficult. A very interesting question…and this does not apply only to doctors. It applies to chiropractors, acupuncturists, physical therapists, nurse practitioners, physician assistants, etc.

You see, as physicians and medical professionals, we are very good at taking care of acute and emergent medical issues. For example, no one will argue against the benefit of removing an inflamed appendix before it ruptures preventing a potentially life threatening infection. Or the benefit of using orthopaedic surgery to repair a severe fracture. Sure we have lots and lots of treatment options, but very few, if any, actually fix the problem. Most simply help control or manage the condition.

Think about heart disease, stroke, and chronic pain conditions.

Pain and Injury Survival Tips

For the purposes of this blog entry, I will focus on chronic pain conditions. And, there may not be anything bad about that. Sometimes the treatment is worse than the disease. My goal is to decrease your pain to the point where it does not interfere with your normal activities, while minimizing the potential side effects from treatment.

All medications and injections will have side effects on the body. Most of the time, these side effects are undetectable or tolerable. Other times, the side effects from treatment can be more debilitating than your underlying problem.

Funny Back Safety Video - "Back To The Suture" Preview

In addition, there are always risks associated with any treatment, no matter how benign the treatment may be. There are some emerging treatments which show promise, such as platelet rich plasma and stem cell injections, however the protocols for these treatments are still evolving and may not be appropriate for everyone. In certain cases, however, these treatments have been shown to be beneficial. In addition, certain conditions are amenable to improvement without any medical intervention. Smoking cessation, weight loss, dietary changes, and regular exercise can work wonders for chronic conditions such as low back and joint pain, high blood pressure, and diabetes.

In addition, these are generally things that you can do without direct medical supervision. Despite how it may appear, the purpose of this blog entry is not to discount any of the treatments we do. On the contrary, many patients note tremendous benefit with various treatments. But rather, the real purpose of this blog post is to help you as a patient set realistic expectations in terms of outcomes. If you decide that your pain is tolerable and not interfering with your normal activities, then treatment may not be needed.

Likewise, if your symptoms are bothersome enough to interfere with your daily activity, then it is worthwhile to explore what treatment options are available. If this is the case, however, it is also necessary to understand what the long term goals are. The results of both the meta analysis and the prospective study revealed very similar data.

This a valid question, which often is not as obvious as you may think. But, did you know there are many other fields which have expanded to offer doctorate level degrees? For example, you can now get a doctorate in business administration. In addition, psychologists, pharmacists, physical therapists, physician assistants, nurses, and nurse practitioners also have the ability to obtain doctorates in their fields. This is not to discredit the hard work it takes to earn a doctorate level degree. The grey area occurs, however, when this distinction is not made inherently clear to patients, be it deliberate or not.

If your clinician has one of those degrees, then you are being treated by a physician who has gone to medical school. I am not saying that you cannot be treated by another clinician, or that non-physicians provide inferior care. This is a personal decision that you should make. Cold Temperatures are associated with more back pain.

It also stratified the location of the workers in terms of province locations from the north, to the warmer south. There is scientific data to support that statement! Surprisingly, the answer can be yes. Your body actually has receptors that respond to nicotine throughout the central and peripheral nervous system. This, however, is a good thing and a bad thing. It is good because stimulation of these receptors through a complex process ultimately results in the release of various neurotransmitters that reduce pain.

It is a bad thing because the introduction of nicotine which is not a naturally occurring substance in the body can alter the normal functioning of this process. So, if nicotine stimulates a natural pain relief pathway, why do smokers still have pain? Why is smoking actually associated with worse pain? Just like anything in life, too much of a good thing can be bad. Similar to street drugs and prescription pain medications, when the body is exposed to nicotine on a constant basis, it becomes dependent on the chemical and tolerance develops.

This results in dysfunction of the pathway, to the point where it may no longer result in any benefit, no matter how much is used. Over stimulation of the system can also result in a paradoxical hypersensitivity to pain, just like what occurs with the prolonged use of opioid medications. The truth is smokers are more likely to have chronic pain than non-smokers. These conditions all can result in chronic pain. So, then, what about other forms of nicotine? The same thing applies. Any introduction of nicotine such as through e-cigarettes, topical patches, chew, gum, etc.

The take home message: By doing so, you may be setting yourself up for problems later on which may directly lead to you suffering from chronic pain. Bad choices sometime have bad consequences. The study was performed at Stanford University by Carragee et al. There were volunteers. The average age was 39 years. All had no know prior history of back pain. All volunteers were followed every six months to see if these people who were at risk for have lumbar disk disease would have a significant change in there spine with minor trauma.

The results showed minor trauma was NOT associated with a significant adverse Low back pain event. The study concluded that Minor Trauma does not appear to increase the risk of serious low back pain episodes or disability. Over all good news! Let me explain to you what I mean by it:. In general, when you go to a supermarket for your groceries, how is it laid out? Where are the fruits, vegetables, dairy, and fresh meat? Where are the frozen dinners, snacks, and other processed foods?

Easy……The healthier foods tend to be on the perimeter of the store, whereas the processed foods are located more in the aisles. This is not to say that everything on the perimeter is good and everything in the middle is bad. After all, the hot dogs are usually not too far away from the lean chicken and the doughnuts are next to the multigrain bread in the bakery.

Likewise, items like olive oil and whole grain cereals are found in the aisles. Just like frozen vegetables are found in the same aisle as frozen pizza. Therefore, this advice is just a rule of thumb, and not an absolute rule in regards to shopping. The important thing is to be smart when shopping. Buying frozen broccoli and roasting or steaming it at home is much healthier than buying the box of frozen broccoli and cheese, even though both dishes contain broccoli.

Likewise, getting sliced bologna at the deli is likely not healthier than getting pre-packaged turkey breast. Just because the deli has freshly made fried chicken and it is on the perimeter does not make it any healthier than the frozen chicken nuggets. When in doubt, look at the label and compare the calories and ingredients. This is a good place to start, but is not the only thing you need to do to lose weight and be healthy. More diet and nutrition tips will be presented in future blogs, so please keep reading.

A recently published study from the University of Haifa in Israel concluded that those who do not sleep well are nearly one and a half times more likely to suffer from back pain. In a large majority of cases, there is no specific identifiable cause. It is estimated that at least half of those who suffer with back pain complain of difficulty sleeping , or insomnia. In this case, insomnia is defied by difficulty falling asleep, maintaining sleep, wakening during the night or waking up earlier than normal for more than one month. The study conducted by researchers, Dr.

Maayan Agmon and Dr. Galit Armon was based over an 8 year time period and included over examinations.


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The patients in this study were all healthy, employed adults. Each of the patients came in for a routine physical health exam on three occasions during the study period. Back pain was diagnosed by examination, had to be present for at least 3 months, and was confirmed by interviews. The study controlled for confounding variables including socioeconomic status and lifestyle.

The association was even greater for women. While the results showed that insomnia was a predictor for the development of back pain, back pain was not found to be a predictor for insomnia in this study. There are additional studies in the medical literature showing the opposite association, that sleep is commonly disrupted due to chronic low back pain. The reasons for this? Past research has shown that the quality of sleep may decline with age. There also can be a psychological component involved. Stress and worrying about insomnia may disrupt the sleep cycle even further.

There appears to be a connection between pain, inflammation, and the immune system. A study of sleep deprivation showed an increase in inflammatory mediators that are involved in autoimmune diseases Irwin M et al Archives of Internal Medicine There are likely other biological and physiological reasons for this adverse association that remain unknown.

Another new year will likely bring in another promise to lose weight matched with a new set of fad diets.

Pain & Injury Survival Tips

Odds are you WILL lose weight with any of these diets…. It is pretty simple actually. A lot of fad diets are not sustainable. I am prepared to give you the absolute secret to weight loss without any gimmicks, commitments, or money down!!! If it was that simple, dieting would not be a billion dollar industry with so many pitfalls.

Okay, so here is what you have to know and do. As I said above, any diet that results in you burning more calories than you consume will result in weight loss…. But, can you keep the weight off? Is the diet healthy to stay on for the long run? The reality is that lifestyle changes need to be made as part of the diet plan. Only by changing your lifestyle can you keep the weight off. As a matter of fact, I do not want you to.

The more dramatic the change you make to your lifestyle, the less likely you are to stay with it. Think about smokers trying to quit: Most wind up relapsing. Generally, the more successful patients are the ones who gradually phase out smoking over time. The same with weight loss. A combination of diet and exercise are ideal to make the weight stay off. Just like you would not go and run a marathon tomorrow without training, you should not make abrupt and major changes to your diet overnight. I recommend a gradual tapering down of prepared, processed, and sugary foods.

Notice how I said taper down, not taper off. Sure it would be great to eliminate these foods completely, however that is likely unrealistic. So, yes, you can still enjoy a piece of birthday cake or French fries on occasion, but realize that these foods are relatively high in calories and low in nutritional value and need to be balanced out by other means. The key is everything in moderation and nothing in excess. But for now, the purpose of this post was simply to explain the basic concepts of weight management and open to the door to future discussions.

Prudent surgeons will still weigh the risks versus the potential benefits. Your physician seems to be paying more attention to their computer than you. You are not alone. This has been a rising form of tension amongst both patients and physicians. Odds are that your physician is just as unhappy about it as you are.

Let me explain how this came to be. It is actually pretty simple: The intentions were good. In theory, computerized medical records are supposed to make medical information more legible, easier to share, decrease medical errors, and improve overall patient care. CMS actually initially incentivized physicians for using electronic medical records in the beginning. Unfortunately, things are not as simple as they should be. Some of the criteria make sense and are easy to comply with, such as sending a certain number of prescriptions electronically. Others have become costly, complicated, and burdensome.

As a matter of fact, in over , physicians will potentially face financial penalties because they did not meet the meaningful use criteria in The issue is very complicated, and would require way more than 1 paragraph in 1 blog post to explain. Safe it to say, however, physicians in general are not happy with the increasing requirements that meaningful use has thrust upon them. So, the next time your physicians brings a lap top with them into the exam room or sits behind a desk and starts typing on a computer during your visit, please understand that we are not doing this because we want to.

I personally feel bad for having less eye contact with patients and not giving as much direct attention during an encounter as I probably should, however there is currently no feasible way for me to complete my electronic charting requirements in a reasonable amount of time without doing so. As I said above, if given the choice your physician would likely take a sledge hammer to their electronic medical records and go back to the way things used to be.

Generally speaking, do not heat recently damaged tissue such as ankle sprains or muscle tears. Both ice and heat may help neck and back pain, but you should usually choose heat: Please see Heat for Pain for more information. See The Great Ice vs. Despite this, both ice and heat will usually help back and neck pain, and you should use whichever seems appealing to you. Icing may help with tendinitis and other chronic overuse injuries, but not because of any anti-inflammatory effect: Nevertheless, ice may stimulate recovery by other means.

As long as you allow sufficient opportunity for tissue to warm up between applications, this is a safe and easy way to try to stimulate tissues to heal. Please see Icing for Injuries, Tendinitis, and Inflammation for detailed instructions, and some more handy tips, especially how to make a convenient icing tool out of a Styrofoam cup! Back pain is rarely an injury — that is, the pain is rarely caused by inflammation which might be helped by ice. However, back pain almost always involves muscular trigger points muscle knots , which are more likely to be aggravated by ice and helped by heat!

For this reason, the majority of people with back pain prefer heat, and a few have negative reactions to ice. For similar reasons, neck pain usually should also not be iced. Although experiments have shown that both ice and heat are modestly helpful for low back and neck pain, there are good reasons to err on the side of heat.

Ice should only be used on the back by patients who clearly prefer it for whatever reason , or when there is definitely a fresh injury. It is a worthwhile self-treatment for a wide variety of conditions that can benefit from an increase in stimulation and circulation: Contrasting is useful because it powerfully stimulates circulation without any significant risk of irritating tissue. Contrasting involves alternating between soaking in hot water and soaking in cold. Always finish with cold.

Use a double-sink, a pair of buckets, a detachable shower head Please see Contrast Hydrotherapy for more information. Although this folk wisdom may someday prove to have a sound rationale, clearly there is none that its advocates have thought of — or even tried to think of, it seems.

For a lot more detail — an absurd amount of detail, really — see Does Epsom Salt Work? Alternative health care professionals constantly recommend this, and seem to assume that throwing back a couple extra litres of water a day is essential to virtually all rehabilitation and general health. There are more important things to worry about. Sleep deprivation is an unsuspected and major aggravating factor in a great many cases of chronic pain or slow injury recovery. In his book Sleep Thieves , sleep scientist Stanley Coren of the University of British Columbia spells out just exactly how sleep deprived most people in our society probably are — and how much more significant the consequences may be than we realize.

An increase in aches and pains, immune system suppression, and weight gain are three common side effects of relatively mild sleep deprivation. And if you are actually suffering from significant insomnia, it gets worse. Of course, insomnia can be tough to beat, so see The Insomnia Guide for some of the best sleep repair tips you can find way beyond warm milk. Surprisingly, rest is often underestimated or simply ignored as a factor in healing.

However logistically awkward and emotionally frustrating proper rest can be, perpetual injury is worse. Particularly for overuse repetitive strain injuries, it is necessary to tackle rest like a major tactical challenge, and well-planned rest may be the only rehab strategy that offers any real hope of working. In such cases, the injury is perpetually and tragically re-aggravated, often by a misguided fear that resting the injury will compromise general fitness. But fitness is harder to lose than people think, not such a big deal to rebuild, and in any case the greater evil is to remain injured.

Failing to rest can easily lead to many years of chronic pain and reduced fitness. You particularly need relative rest , which involves remaining as active as you can — protecting your fitness — while protecting injured tissues as much as possible. Resting sounds simple, but it actually requires quite a lot of planning and savvy to do it properly, and psychological resistance can be fierce. For more of the why and how of resting, see The Art of Rest. Obviously good nutrition is generally important to health, but this does not usually require vitamin and mineral supplementation.

Despite the popular opinion to the contrary, modern food is actually quite nutritious, and most supplementation has turned out to be disappointingly futile. However, the point of this tip is much more specific: Therefore, consider a nutritional review when troubleshooting any mysterious or stubborn pain problem. Moderate supplementation might make a difference. While I would warn healthy people away from wasting money on supplements, I think issues of nutrition and supplements are worth considering for those suffering any kind of chronic pain. Detailed information about nutrition on this website is available only in a chapter by Dr.

Tim Taylor in our advanced muscle pain tutorial. But Vitamin D stands out, and is covered in the next tip. For chronic pain patients specifically — not just anyone, but people with a genuine chronic pain to solve — vitamin D has real promise. There is still no proof yet that D deficiency can cause pain, or that D supplementation can treat pain. But there is enough indirect evidence connecting them to be of serious interest, and supplementation is safe and cheap.

The maximum dosage commonly available over-the-counter in North America IU capsules of vitamin D3 is comfortably within the safe range. Naturally, you should run this by your doctor, who may have fair concerns: For more information, see own Vitamin D for Pain. Nearly all supplements suffer from a serious lack of good evidence of efficacy creatine is a notable, happy exception. Not one is a clear winner for pain, and the most famous ones — glucosamine and chondroitin, supposedly good for arthritic joint pain — are particularly suspect. Despite the generally bad news, there are a couple of nutraceuticals that are mildly promising for pain and probably worth considering….

Somewhere in the mess of generally disappointing nutraceuticals see previous tip , there is probably something that works at least a little bit for someone. All other nutraceuticals fail on at least one of those scores. Bromelain, an enzyme from pineapples, allegedly has anti-inflammatory properties that are, just maybe, actually real.

Tim Taylor , a chronic pain specialist. Smokers are compromising so many aspects of their health that quitting is a vital pre-requisite for beating pain. See Smoking and Chronic Pain. The evidence strongly suggests that posture is not terribly important as a factor in any serious chronic pain problem. Poor posture and structural problems like a swayback excessive lordosis definitely do not necessarily cause pain.

Meanwhile, plenty of people with acceptable or excellent posture have terrible pain problems. Poor posture has got to be at least a contributing factor in some problems, and some postures are related to or confused with a more important concept: Probably the most effective approach is simply to increase levels of complex physical activity in your life. For more in-depth examination of the subject, see Does Posture Correction Matter?

What is much less well known is that it is a double-edged sword that cuts the other way: Assume a bold, confident posture. A temporary reduction in sensitivity is hardly a cure for chronic pain. But take it anyway! This qualifies as a good tip because it is such low-hanging fruit. For more about this idea, see the section about the emotional risks of posture in my big posture article.

People often deal with strain due to poor ergonomics: Ergonomic fine-tuning of your workstation and life is usually much less important than being generally active and taking regular breaks from whatever you do, however you do it. See Wobble Cushions for the Chair Bound for more. First of all, stop worrying about cracking your joints: The chiropractic profession would have us believe that joint cracking is essential to general health, which goes way too far.

But if it feels relieving , by all means, go for it, without guilt or concern, in reasonable doses. I offer an incredibly detailed analysis of the science of spinal manipulative therapy to customers who purchase either my neck pain or back pain tutorials. Some simpler related information is available to all in my article The Chiropractic Controversies.

Not all tissue damage hurts, and not all pain is caused by tissue damage. Pain is determined completely by the brain, after it considers many factors. Nerves send messages about problems to the brain, but the brain decides how much it matters and even tells the nerves how sensitive to be. Thus, we invariably hurt more when we are worried, and less when we are calm. For instance, many things that look scary on an MRI of your back are actually painless in most people.

This principle is of critical importance to pain management and recovery. Anxiety reduction through education needs to be a part of every difficult healing process. Continue reading on this topic with Pain is Weird. A closely related tip: Brains set the volume on pain see last tip , but squeezing practical advice out of that basic truth is tricky. Stress relief , the confidence cure , and personal growth are three examples, but they are all difficult.

Building confidence through learning? Stressors and mood disorders? They can be virtually invincible. Be kind to your nervous system. Make your life — or a joint — feel safer, gentler, more pleasant. Do it in general ways soak the whole system in a hot tub , but also more specifically: We can do this! Trying to create pleasantness is a very different creative challenge than trying to reduce stress. See Pain is Weird for more ideas about manipulating your nervous system. Orthotics can be a good-bang-for-buck solution to a variety of otherwise untreatable postural problems and gait dysfunctions.

On the one hand, I cannot emphasize strongly enough that things like leg length differences are much less important than physical therapists generally make them out to be. However, they can be a factor, and sometimes the stars line up and orthotics make a clear positive difference. Better still, research has shown that expensive orthotics are not clearly better than cheap generic ones.

There is one problem, though: Some people find the cure to be worse than the disease. If you do need customized orthoses for whatever reason, go with a reputable supplier. Certified pedorthists are by far the best choice. You should be quite cautious about purchasing orthotics from physiotherapists, chiropractors, and even podiatrists. For more information, see Are Orthotics Worth It? Should you get a joint lube job? The injection of artificial synovial fluid — slippery stuff — into a joint to decrease the symptoms of osteoarthritis has been in widespread use for many years now.

Considering how appealing and popular the idea is, and how common joint pain is — pain which may not even be arthritic — a warning about this stuff deserves to be a tip. Do not do it. Hylaluronic acid injection is completely washed up scientifically. Combining injections and wishful thinking is bad news. And sometimes people need to come to terms with the fact that years of self-sacrificial workaholism — for a common example — are actually the root cause of severe chronic pain.

D to the Inhumans movie. Mark Waid's Avengers offers a master class in superhero comics exposition, swiftly catching you up on everything you need to know through dialogue that neatly delineates its speaker. Hard to say what to make of the 2-page Max Ride preview, though. Both Avatar and Plants vs. Zombies are tie-in comics; Avatar to the brilliant Nickelodeon animated series, P vs. Z to the addictive videogame.

As a general rule, licensed comics tend toward suckage, but both of these are a good deal more original and idiosyncratic than they have any right to be. The Bandette story is a real delight, and provides a good sense of just how bright and stylish that comic, about a masked female art thief in Paris, truly is. Bodie Troll Diamond Comic Distributors hide caption. Bodie's a cute and fuzzy little troll who wants to be a terrifying monster.

Drone's the story of hacker who becomes part of a government military operation. And the too-brief excerpt from Creature Academy doesn't give you a lot to go on. Tough to get a bead on any of these titles, as the samples we get are so brief. Whether or not you got a sense of it from this, know that Mouse Guard, Adventure Time, Regular Show and Lumberjanes are great books to pick up. Katie Cook's Gronk — a monster who's left her monstrous life behind for life with a nerdy human and her pets — is hilariously fun, in a self-contained story that will make you want more.

Hero Cats is an intriguing concept pretty much right there in the name with some attractive art and distinct characterizations, but this excerpt doesn't leave you with a particularly strong sense of the book. Gronk is just plain great comics, filled with clever dialogue and plenty of jokes. My favorite of the all-ages FCBD offerings. The Comic Book Legal Defense Fund is a non-profit that defends comics shops, librarians and publishers from those who would seek to ban the distribution of certain comics. Each year, they commission writers and artists to produce stories that embody their mission statement.

The entries included here range from really on the nose Archie's Kevin Keller fights homophobic library patrons to the abstruse the Raving Rabbids rave rabidly. Overstreet produces yearly comic book price guides, and thus provides an invaluable service to the nation's geeks. Lots of mini-articles about comics history and collecting comics art; in terms of sheer volume of information, this book delivers the most bang for your buck. The buck you would have paid. If it weren't free. Even if you don't care about comics history, you can always stick page 22 on your dartboard. Or kind of lie it beside you on the pillow or whatever, that's your business, leave me out of it.

Rabbids Diamond Comic Distributors hide caption. Did you know there's a female Smurf besides Smurfette? Well, there is, and she's called Sassette. So that is a thing I just learned. But you will learn new things about Smurfs, so.

Stem Cells to Treat Back Pain

Sonic the Hedgehog Diamond Comic Distributors hide caption. Both Sonic and Mega Man are hugely successful video game franchises. You knew that, right?

Prolotherapy and PRP Injections

This comic lays the groundwork for the publisher's upcoming "Worlds Unite" crossover event, in which Both the ongoing Sonic and Mega-Man series get their own two-page "The Story So Far" spreads, explaining their surprisingly complicated backstories. Which is a good use of FCBD exposure.

Beaton's next book of strip comics that riff on historical and fictional themes: Jillian Tamaki's Super Mutant Magic Academy chronicles what happens when the pangs of adolescence combine with feelings of isolation in a super-powered boarding school environment — i. The Stuff of Legend's about a bunch of toys who attempt to rescue their owner from the Boogeyman.

The Stuff of Legend excerpt is mostly art-only before dialogue's been added so it can lend only a general sense of tone and story, but what's here is moody and effective. Thanatos Diver , on the hand, is bright and fun, and provides plenty of underwater intrigue while firmly grounding itself in the emotional lives of its characters.

Teen Titans Go is a great little show, and this story captures its flavor well. The Scooby-Doo tale has them meeting the Super Friends, and the story's filled with nerdy in-jokes for us doughy middle-aged fans of that TV series. Well at one point Robin the Boy Wonder intones "Crime never takes a slumber party," so.

I mean I'm in, anyway. Robots in Disguise Diamond Comic Distributors hide caption. The Transformers must covertly track down a team of Decepticons who've escaped from a prison ship that crash-landed on Earth. Oh and Bronies of the World, take note: If you or your kid really like the Michael Bay movies, know that this isn't that.

Because this is actually pretty good. Bob's Burgers Diamond Comic Distributors hide caption. So much of this great FOX show is bound up in its voice acting, you'd be forgiven for doubting if a comic could capture any of its magic. In fact, you just have been. Tina's adventures with the Equestrinauts. And a musical starring Gene, featuring frogs and farts.

What are you, made of stone? A grab-bag of solid Simpsons stories, most notably a tale in which Lisa imagines herself Pharaoh over an Egypt filled with Springfieldians.

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Penciller Nina Matsumoto's take on Lisa's Egypt grafts elements of Groening's classic Simpsons styling onto something closer to the real world; the effect is fascinating. And creepy as all get-out. Captain Canuck Diamond Comic Distributors hide caption. The original Captain Canuck first appeared in and enjoyed a fifteen-issue run that ended in This is a ground-up reboot for a new CC series, starting in May.

We get a taste of the new comic, an in-depth history of the character, a great poutine recipe, and dossiers on the comic's major players. This is how you do Free Comic Book Day, people. Also I was kidding about the poutine recipe. Chakra the Invincible Diamond Comic Distributors hide caption. While still a young girl, the headstrong Cleopatra, Queen of Egypt, is sent into the future, where she has been prophesied to bring peace to the war-torn galaxy.

Mike Maihack's heroine is smart and brave, and his storytelling in this brief glimpse is solid, but it's his gorgeous, expressive art that puts this book over the top.