Degenerative Spinal Conditions

As we get older there is an increased risk of spinal injuries occurring, resulting from natural wear and tear of the bones and joints over time. Sometimes this causes minor discomfort that disappears with time or over-the-counter medicines but occasionally the results can be more severe.

Acute Disc Herniation

Also known as a slipped disc, acute disc herniation (ADH) occurs when one of the intervertebral discs (pads of cartilage between each spinal vertebra which provide shock absorption and spinal mobility) moves out of place. ADH can occur anywhere along the spine but is usually in the lower back. It can cause severe pain in the back and legs if the disc slips so that it is pressing against the spinal column. It can also produce neural symptoms, including tingling, numbness, and weakness in the limbs.

ADH can often be treated with rest and anti-inflammatory medications. Physical therapy may be used to gently introduce movement and extension back into the spine, however, if symptoms don't improve then surgery may be necessary to fix the problem. A microdisectomy, where the herniated portion of the disc is removed, leaving the undamaged section intact, may be sufficient. However, in cases of repeat occurrences or very severe herniations it may be necessary to remove the whole disc and fuse together the vertebrae from above and below it.

Spinal Stenosis

Spinal problems can also arise as a result of an abnormal narrowing of the canal through which the spinal nerves run. Most often this condition develops with age and becomes significant in a person's 50s, though occasionally it can be congenital. As the canal begins to compress the spinal cord and nerves it will cause a radiating pain, numbness, and weakness. If the canal narrowing occurs in the lower back then it will cause sciatica-like symptoms in the legs and buttocks, while if it occurs nearer to the neck symptoms can be more severe, with a risk of paralysis. Spinal stenosis rarely occurs in the thorax as the middle back is the most stable and strong area, allowing for minimal movement.

In many cases the symptoms of spinal stenosis can be relieved with medications however, if symptoms persist to an extent where the patient can no longer perform everyday tasks decompression surgery may be considered. This involves removing a section of bone in order to relieve pressure on the spinal cord.

Our doctors treat both conditions, at all levels of severity. if you require help with spinal pain call 212-241-6335 to book a consultation.

Our Tips for Reducing Back Pain

 Back pain can be debilitating and leave one feeling like they cannot do everyday activities. Before seeking surgical solutions, there are a range of activities that may help alleviate the pain, and get you back to moving as normal.

Pain Relief – As a first port of call, and as a short-term solution pain killers can reduce suffering. To counteract swelling and inflammation cold packs can be beneficial while hot packs work to lessen tension, cramping and muscle spasms.

Manual Therapy – This method involves a therapist using their hands to massage, gently move, and apply careful force to the muscles, bones and joints of the spine. This removes tension in the muscles and encourages them to relax though it will only be effective if used alongside other measures, such as those listed here.

Exercise and Stretches – Traditional thinking is that in order to fix back pain bed rest is the best option. It has since been found that it is better to remain active, to retain muscle strength and flexibility. At first avoid any heavy-duty weight bearing exercises and opt more for gentle stretches and yoga. Exercises that lengthen out back muscles, such as back-bends and the cat-and-camel move, are the best for reducing pain.

Aquatic Therapy – If exercise exacerbates back pain at first, this can be countered in aquatic therapy. This involves gentle movement in a pool. The buoyancy of the water helps to remove strain from the joints, putting less pressure on the back, while the warmth of the water can help increase blood circulation, relax the back muscles, and remove tension.

Electric Stimulation – It has been seen that mild electrical currents can reduce perception of back pain. Electric stimulation involves using a Transcutaneous Electric Nerve Stimulator (TENS) machine to send low-voltage electrical currents to the body, through electrodes placed on the back. The exact mechanisms of this therapy are unknown, but one hypothesis is that the currents work to scramble pain messages to the brain, so the brain does not process them. An alternate idea is that the electrical impulses stimulate the body to release endorphins which override the sensation of pain.

For the most effective recovery it is recommended that a combination of these techniques is used. Some, such as pain relief and manual therapy, only alleviate pain in the short term, and so it is necessary to combine them with other techniques, such as stretches, for long term improvements.  

Introducing Our Director of Brain Injury Research - Dr. Dams-O'Connor

 This week we are introducing Dr. Kristen Dams-O'Connor, the new director of the Brain Injury Research Center of Mount Sinai who specialises in traumatic brain injuries (TBI), and more specifically, the recovery process of TBI patients.

When beginning college at Colgate University, Dr. Dams-O'Connor intended to major in international relations; however, after taking an introductory course in neuroscience she was hooked, and chose instead to major in this field. Her research began in controlled laboratory experiments and she fell in love with the accuracy and certainty with which she could observe cause-and-effect relationships in her studies.

Following her undergraduate degree in neuroscience, Dr. Dams-O'Connor decided to do further studies in psychology so she could work more closely with patients who were living with neurological diseases. During her doctoral studies she worked at a clinical site for three years at the University at Albany , participating in programs that helped people with devastating brain diseases live more productive and meaningful lives.

Moving to New York, she carried out an internship in neurorehabilitation at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center. On completion of the internship she progressed to a fellowship in Clinical Neuropsychology at Mount Sinai. During this Dr. Dams-O'Connor began to focus her research more on TBI, taking an interest in the heterogeneous nature of these injuries, with no two cases being alike. This variability allowed her to apply her knowledge of empirically supported neurobehavioral interventions to unique individual cases.

Today, as well as being a director, Dr. Dams-O'Connor is also an Associate Professor in the Department of Rehabilitation Medicine at the Icahn School of Medicine, and the Director of Research. She is PI of two grants from the National Institutes of Health and Co-Project Director of the New York Traumatic Brain Injury Model System which, as well as carrying out research on brain trauma, also provides emergency medical services, acute care, rehabilitation services, and long-term outpatient care. In her career to date she has published over 60 peer-reviewed manuscripts and chapters on traumatic brain injuries, their treatments, and outcomes and her work is internationally recognised. In her current research Dr. Dams-O'Connor works primarily on studying the long-term outcomes of brain injuries including clinicopathological signatures of TBI. A key interest of hers is understanding why some patients display a full recovery after their injuries while others partially recover before regressing later in life.

You can read more about the Brain Injury Research Center here - www.tbicentral.org

The Best Exercises for Strong Bones

 With advancing age the risk of developing osteoporosis rises. This risk may be increased by having lower than normal peak bone mass, and subsequent greater than normal bone loss. The chances of this happening can be lessened by doing exercises that involve weight bearing. This is because when you do weight bearing exercises your bones adapt to the impact exerted by this extra weight and the pull of your muscles by building more cells, and thus become denser and stronger. The type of exercises that are most beneficial vary depending on age.

Children

For children, bone strengthening exercises can start before they can even walk. Crawling and active play begin the gaining of muscle mass. After they have learnt to walk unaided, activities such as climbing, walking and running, and jumping all contribute to the development of strong bones.

Teenagers and Young Adults

As children reach adolescence an active lifestyle is crucial to increasing bone mass. It is around this age that the most can be done to achieve a high peak bone mass in their early twenties. All sorts of competitive sports, from soccer to tennis to martial arts are beneficial, as are more individual exercises. Skipping, body weight exercises and high-energy activities such as aerobics and dance can strengthen muscles, while putting weight on the bones, encouraging them to increase cell production. In order to build up strong bones children should aim to undertake 60 minutes of exercise a day.

 

Adults

From your mid-thirties natural bone loss begins to occur. In order to reduce the rate of this, muscle-strengthening activities should be done at least twice a week. This can include doing some of the activities that young adults do, but also less exercise-focussed pursuits, such as brisk walking, stair climbing, carrying groceries, gardening and moderate-resistance weightlifting. These activities are less aimed at building bone mass as they are at maintaining muscle strength. Adults need less frequent exercise than children, but should aim to do at least 150 minutes of cardiovascular exercise a week, on top of muscle-focussed exercises.

Elderly

For elder individuals, or those at high risk of osteoporosis and fragile bones, it is advised to avoid particularly high impact exercises. However, maintaining a healthy, active lifestyle is beneficial. Going for a walk or doing necessary housework are both good ways of keeping active throughout the day. Swimming can improve stamina and joint flexibility in a low-weight environment, while tai chi is recommended as it is low impact but can improve balance and posture while strengthening muscles in the legs.

Until a bone is broken, there are no symptoms of osteoporosis. As the likelihood of developing it increases as you age the best preventative method is to build up strong bones at a young age and to sustain beneficial exercises throughout life.