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Massage: A Natural Reaction to Pain

What did you do the last time you bumped your head or had a sore muscle? More than likely, you rubbed it. Throughout time, touching has been a natural human reaction to pain and stress, and healers in all countries and cultures have developed a wide range of therapeutic techniques using touch.

Having a massage does more than just relax your body and your mind -- there are specific physiological and psychological benefits related to massage, ranging from calming the nervous system and reducing tension and anxiety, to improving circulation which allows the body to pump more oxygen and nutrients into tissues and vital organs, stimulating the lymphatic system which carries away the body’s waste products, and helping with pain management in conditions such as arthritis, sciatica, and muscle spasms.

In the soothing environment of our centrally located Manhattan, New York offices, our massage therapists work under the direction of our physiatrist (MD) who pinpoints the problem area. “Our massage therapists will use a variety of techniques to promote healing and relaxation, as well as to promote greater flexibility and range of motion,” says Dr. Kessler. “Massage helps to improve blood circulation, decrease pain and inflammation, helps to relax the muscles, and makes you feel better.”

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Posted by Spine and Sports Medicine on 11:31 AM


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Sweet Dreams?

You have probably spent over 25% of your life sleeping. With that much of your life spent under the sheets, it makes sense that proper sleep and a good mattress can go a long way towards mitigating back pain and improving your health.

However, approximately two-thirds of patients with chronic back pain suffer from sleep disorders and a new study indicates that frequently interrupted sleep can make a person more susceptible to pain by altering the body's natural systems that regulate and control pain.

During the study, researchers tested the pain thresholds and pain inhibition of 32 women subjects. Those in a group that had been woken up eight times during the night showed an increase in spontaneous pain, while those in control groups who slept undisturbed did not, showing that disrupted sleep impairs natural pain control mechanisms that are thought to play a key role in the development, maintenance, and exacerbation of chronic pain.

“A sleeping disorder associated with chronic back pain should always be addressed as part of a multi-disciplinary, chronic pain treatment approach,” says Dr. Kessler. “As with any symptom of a chronic pain syndrome, the sleep disruption should not be treated in isolation without taking into account proper treatments for the chronic back pain problem that is part of the cause of the sleeping problem.”

In many cases, the right mattress can certainly help, and for those with chronic pain, getting continuous, undisturbed sleep is key to controlling the pain.

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Posted by Spine and Sports Medicine on 3:44 PM


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Death, Taxes, and Degenerative Disc Disease

Certain as death and taxes, degenerative disk disease happens to everyone. However, not everyone who has degenerative changes in their lumbar spine has pain. Many people who have "normal" backs have MRIs that show disc herniations, degenerative changes, and narrowed spinal canals. Yet, every patient is different, and not everyone develops symptoms as a result of degenerative disc disease.

One of the most common causes of back pain and neck pain, and also one of the most misunderstood, degenerative disc disease is not actually a disease -- it is part of the normal aging of the spine. In this condition, the discs in the spine -- pillow-like pads that separate the interlocking vertebrae that make up the spine and act as shock absorbers --eventually lose their cushioning. The breakdown of the discs can result in back or neck pain, as well as osteoarthritis, herniated disc, or spinal stenosis.

When we are born, each disc is comprised of about 80% water, which gives it its spongy quality and allows it to function as a shock absorber. As we age, the water content decreases and the disc becomes less effective. Additionally, the proteins within the disc also change composition, and most of us will develop tears into the annulus fibrosus (the outer hard core of the disc). Unlike other tissues of the body, there is very little blood supply to the disc, so once a disc is injured, it cannot repair itself, and a spiral of degeneration can set in, known also as Spondylosis.

“Pain from DDD is initially treated with ice or heat and with nonprescription medications,” says medical director Brian Kessler, MD. “Further treatments depend on whether the damaged disc has resulted in other conditions. Physical therapy and exercises are often recommended, and in some cases surgery may be recommended if the pain is severe and disrupts a person’s ability to participate in everyday activities.”

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Posted by Spine and Sports Medicine on 1:19 AM


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Summer Travel Plans? Watch Your Back!

If you're planning a trip, watch your back. Summer is the time for travel, but it can also be the cause of low back pain. Air travel in particular is hazardous to spinal health. Slouching for several hours in an ergonomically dysfunctional coach seat compresses the discs between the vertebrae and makes any pre-existing spine condition worse. And there’s no break once you get back on the ground, as you lunge forward to yank your heavy suitcase off the luggage carousel. Then there’s all that walking through the airport that slowly compresses the low back, so that if you have even a hint of arthritis in your lumbar spine joints, you can anticipate a spike in pain. But there are things you can do to make travel more bearable for your back, say our physical therapists:

 • Sit with your bottom fully lodged at the back of the airplane seat and place a firm cushion in the small of your back.

• Select an aisle seat and get up and move around as often as you are allowed. If you wait until the pain starts, it's too late.

• Don't be a hero at the luggage carousel. Take your time. Bend your knees, not your back and avoid twisting your spine. Heavy suitcase? Ask for help.

• If your back acts up as you stroll, pick up the pace and lightly contract your abdominals as you walk. Increasing your core strength is a great long-term prevention strategy as well.

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Posted by Spine and Sports Medicine on 3:28 AM


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Why is Psychology an Important Aspect of Treating Pain?

Did anyone ever tell you the pain is “all in your head”? Well, pain is both a physical and psychological experience. Because the brain plays such a central role in the pain process, certain techniques that target a person's thoughts, emotions or behaviors related to pain are often effective.

“There are a number of self-management techniques for pain,” our Medical Director observes. These include relaxation strategies such as deep breathing exercises, muscle relaxation, guided imagery, and biofeedback. Relaxation techniques can give a person an increased sense of control over his/her pain. “This can help to reduce pain levels, and with less pain, a person is able to function better.”

Self-management techniques can also include cognitive skills such as "thought stopping" or "reframing," which can help people fend off some of the negative thoughts and feelings that often arise as a consequence of living with pain.

So, while pain isn’t “all in your head,” there are some actions you can take to help yourself psychologically manage different aspects of it.

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Posted by Spine and Sports Medicine on 7:28 AM


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Pain and Pregnancy

Back pain during pregnancy probably won't come as a surprise, but that doesn't mean you should ignore it.

According to a February 2007 study in the Journal of Manipulative and Physiological Therapeutics, despite a high prevalence of musculoskeletal pain during pregnancy, few women receive treatment for their low back pain. According to Clayton Skaggs, DC, the study’s chief author, 85 percent of women surveyed reported that they had not received treatment for their musculoskeletal pain, and that 85 percent of women who experienced pain in a previous pregnancy reported pain during their current pregnancy.

“Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy,” says our very own Brian Fradet, at Spine and Sports Medicine. “As a proactive step, health professionals should consider screening for back pain as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and treatment.”

So, say something. You don't have to grin and bear it.

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Posted by Spine and Sports Medicine on 10:14 AM


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Chronic Back Pain

My brother-in law has suffered from chronic back pain for a decade or so. He’s tried all kinds of things to ease the pain and recently had a spinal cord stimulation system implanted in his back. “That’s where a tiny programmable generator and electrical leads are implanted beneath the skin,” says our own Dr. Kessler of Spine and Sports Medicine. “Low-level electrical signals are then transmitted through the lead to the spinal cord or to specific nerves to block pain signals from reaching the brain.” Using a magnetic remote control, my brother-in-law can turn the current on and off, or adjust the intensity. So now, instead of pain he feels a mild tingling sensation. Approved by the Food and Drug Administration in 1989, spinal cord stimulation has become a standard treatment for patients with chronic pain in their back and/or limbs who haven’t found relief from other treatments. Joking around, I told my brother-in-law he could now be categorized as a cyborg, but he didn’t really care. He was just happy that the pain in his back was manageable again.

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Posted by Spine and Sports Medicine on 9:55 AM


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My wife, the Fish

My wife is a swimmer, always has been. She says she actually feels more comfortable in the water than she does on land. I think, perhaps, she was a fish in her past life, but that’s another story.


Like many sufferers of back pain, she responds well to water, and some physical therapy centers provide aquatic physical therapy. Our own Dr. Kessler of Spine and Sports Medicine says, "Water supports the body and minimizes the effect of gravity, making it easier for patients to start an exercise program. Aquatic therapy can be very helpful for elderly patients and disabled patients who may not have the strength to do some of the exercises outside the aquatic pool.”

Some of the most important properties of water that make exercise easier are buoyancy, viscosity, and hydrostatic pressure. These properties can counteract gravity, provide resistance, and improve muscle blood flow.

…And I thought water was just good to drink.

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Posted by Spine and Sports Medicine on 6:58 PM


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Pain and Posture

It’s one of those things passed on from parent to child without even thinking. I’ve even found myself saying it. “Sit up straight… Don’t slouch.” My kids hate it as much as I did when I was young, but over the years I’ve seen there’s more than a little truth to this age-old nag.

Bad posture alone doesn’t cause severe back pain, and the kind of sloping, slouching, shoulder droop my kids sometimes exhibit as they’re sitting in front of the computer isn’t going to land them directly in the emergency room, but it’s bound to have an impact on their musculoskeletal systems.


"Everyone can benefit from good posture," says our medical director Dr. Kessler. "Poor positioning of the body can be improved and it’s never too late to start trying to correct postural problems."

The spine is a complex arrangement of bones, joints, muscles, ligaments, discs, a spinal cord and nerves. In a healthy spine the vertebrae, facet joints and discs are vertically stacked, held together by a system of ligaments that help support the alignment while allowing movement within a safe range. Comprised of three natural curves that form an S-shape, the spine is properly aligned when a person’s ears, shoulders, and hips are in a straight line. Without support from strong, flexible muscles, the back loses its three natural curves.

When poor posture sets in, muscles, joints and ligaments take more stress and strain than intended, causing fatigue, muscular strain, compression of blood vessels, and pain. In addition, faulty posture can affect the position and function of major organs.

Time, old injuries and bad habits take their toll on the spine as a person ages. But new treatments and better diagnostic tests can help keep back pain at bay throughout an entire lifetime.

"The spine goes through the aging process just like any other part of the body," says Dr. Kessler. "For patients with a history of back pain who are currently experiencing symptoms that are interfering with activities, the first step is proper diagnostic testing to determine the cause of the symptoms and the severity of problem. A series of imaging tests over a period of time can help determine the correct course of treatment.”

Computer use is one of the common causes of difficulties related to posture and positioning. One of the first things that happens with computer use is the user's head starts to move forward. Once the head moves forward, posture is thrown off and the body compensates for the shift. The neck moves forward, the shoulders become rounded and a compensatory sway in the back develops. The result of this poor posture is pain, muscle aches, tension and headaches.

Unfortunately, many of us adopt these habits in a whole variety of everyday positions - not only sitting at a desk, but also standing, walking, carrying things, even lying in bed. High heeled shoes, boots, tight clothing and wide belts can also shift our center of gravity and move us out of normal alignment.

Treatment goals for correcting postural problems include restoring range of motion, increasing flexibility and strengthening weak muscles. These goals can be accomplished through exercises and practice. Muscle relaxation techniques, massage and stretching exercises are also used to relieve pain and muscle tension.

"Of all the things that happen to our body," Dr. Kessler says, "poor posture is one of the easiest to correct."

Try telling that to my kids.

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Posted by Spine and Sports Medicine on 8:56 AM


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My Daughters Back Pack


My daughter complained of back pain the other day.

“From what?” I asked.

She pointed to her backpack, the one she carries to school every day. It looked innocent enough, sitting modestly on the floor in the hallway. She read the questioning look on my face.

“Try and pick it up,” she said, with a hint of defiance in her voice.

“Okay,” I said, accepting the challenge.

Reaching over from the waist, with my knees locked, I hooked my fingers through the arm loops and gave it a jerk. Immediately, I could feel a twinge in my lower back, but I lifted with my arm and got the backpack off the floor cleanly.

“See,” I said. “No problem.”

“Yeah, right,” my daughter laughed.

Lowering it back down to the floor and massaging the small of my back, I asked, “What the heck have you got in there?”

“The usual,” she responded. “It’s what I carry every day.”

Together, we sat on the floor in the hallway as she took the items out of her backpack one by one and stacked them into a pile: 1 copy of Arthur Miller’s “Death of a Salesman”; an oversize Spanish textbook called “Interacciones”; a humongous “History of Western Society, Vol. 2”; Vergil’s “Aeneid, Books I-IV”; “Principles and Problems,” a physics textbook; 1 history notebook; 1 geometry supplement; 1 pencil case; 1 daily planner; 2 classroom folders for biology; 3 school notebooks; 1 three-ring binder; 1 wallet; 1 cell phone; 1 make-up kit; 1 bottle of water; and $2.00 in quarters in case she lost her bus pass and had to pay for the ride home.

“Wow,” I said, as I gathered up the pile in my arms, careful now to bend my legs as I lifted, already feeling a little soreness in my back. “Let’s weigh this.”

With a little rearranging and my daughter’s skills in geometric positioning, we got it all onto the bathroom scale. Not the most scientific of experiments, but accurate enough to convince me of the hidden danger lurking for my daughter every day with that backpack.

“Low back pain is the most common health problem we see at Spine and Sports Medicine,” says Dr. Brian Kessler, our Medical Director, “and we’ve seen an increasing number of adolescents over the years complaining of back, neck and shoulder pain. Hauling a heavy backpack around every day can cause serious postural misalignments and vertical subluxations of the spine that can restrict movement and predispose kids to a number of ailments. We’re concerned that the damage inflicted now will be showing up 30 years later in even more serious back problems.”


According to guidelines from the American Chiropractic Association, students should carry no more than 10% of their body weight, and backpacks should have two adjustable and padded shoulder straps to equalize the weight.

I looked at my daughter’s backpack lying in the hallway. One shoulder strap was ripped nearly all the way through from the constant strain and the other was seriously frayed.

“Let’s go look at some new backpacks,” I said, as the pile of contents on the scale slowly toppled over like a wobbly Jenga tower.

“Great,” she said. “Then you can help me with my geometry.”

“Don’t push it,” I said.

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Posted by Spine and Sports Medicine on 8:24 AM


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