Blog - Page 10 of 15 - Michigan Spine & Pain

Hitting the Road without Hitting the Pain Pills

Our Michigan weather seems to have turned the corner. We’re not quite wearing shorts yet, but maybe we can put the snow shovels towards the back of the garage. Is now the time to plan for a quick weekend getaway to see friends or family or an even longer spring break trip?

Road trips are more economical than airplane rides. But extended car trips do pose a risk for people who experience pain. Extended driving or riding time can exacerbate pain in the back, neck, shoulders, legs, knees and ankles.

Here are some tips to hit the road without exacerbating your current pain issues or creating new ones:

Adjust your seat (and bring along accessories) to ensure that you can maintain proper posture. Remove everything from your back pockets like wallets and cell phones. Bring a pillow or rolled towel and place it in between your lower back and the seat to provide additional support.
Start with good posture when driving. Your arms should be bent at the steering wheel and your knees should be bent too. It is a mistake to sit too far away. This adds extra strain on nearly every part of the body.
Support your head. Adjust your head rest so that it touches the middle of the back of your head. You want to do everything you can to avoid having to lower your neck or lift it up. Ideally, you are looking straight ahead with some neck support.
Wiggle! Staying still is not ideal, believe it or not. Instead, shift your body around, even lift up an arm occasionally and push it on the car roof, doing a little isometric exercise. Roll your neck and shoulders. Shift your hips to the left and to the right and tilt your pelvis back and forth.
Exercise at every stop. When you stop to use the restroom, utilize this extra time to stretch. Walk around for a few minutes (inside or outside, but briskly). You should also stretch out your arms above your head and by crossing the midline of your body. If you can do so, deep squats, done slowly, can also be restorative.
If you are already in pain, stretch cautiously. Although stretching will generally be helpful at rest stops, if you are already experiencing pain, don’t start vigorous exercises the second you get out of the car. You will already be stiff and somewhat inflexible. Give yourself a few moments to slowly “unwind” and only then try small movement stretching exercises (Extending your back, stretching arms to the sky, bending into a half squat are all small movement standing exercises.)
Be a backseat driver. If you are the rider and you begin to experience pain, lie down for a stretch in the back seat so you can change your position and get some relief.
Break up the driving. While lots of people can take on a 10 hour drive, your pain threshold may preclude this. Do not feel guilty about dividing your trip into smaller, bite-size portions.

When even sleeping is a pain…

Do you get enough sleep? Are there ways to get more?

The latest Sleep Poll conducted by the National Sleep Foundation says that patients with pain are typically operating on a sleep deficit. That is, those who suffer chronic or acute pain report that they regularly sleep for less than they think they need. When asked to quantify their sleep deficits, the average deficit is 42 minutes.

The study indicates that the sleep deficit can be attacked, but it takes motivated sleep behaviors. “Taking control of your sleep by being motivated, setting a routine bedtime and creating a supportive sleep environment are relevant even for those with pain,” said David Cloud, CEO of the National Sleep Foundation.

Sleep issues affect many adults at various times in their lives, but has the greatest impact on those with chronic pain. Twenty-three percent (23%) of chronic pain sufferers say that they have actually been diagnosed with a sleep disorder.

The National Sleep Foundation report also indicates that restorative, sufficient sleep is another indicator of good health. As you might expect, those whose health is good tend to report better sleep while those who have health concerns tend to report poorer sleep. And to add insult to injury, those who are at highest risk for developing chronic pain reported significant sleep deficits.

If you are running at a sleep deficit, what can you do?

Prioritize getting better sleep, moving it to do your to-do list. Understanding that you need to have a bedtime that allows you to get seven to nine hours of sleep is key.
Create bedtime routines that will bring you success. Go to bed in your bed at a reasonable bedtime. Unplug from all screens, both small and large. Switch to old-fashioned books before bed, the less stimulating the better.
Evaluate your sleep environment and make changes that work. People in pain tend to blame environmental aspects on their poor sleep. They tend to be more irritated by the condition of the mattress, the temperature, too much light or ambient noise. If these bother you, take steps to improve them, whether it means investing in new bedding, purchasing a fan, getting earplugs or eyeshades, soundproofing your environment or adding white noise into your bedroom environment.
Healthy lifestyle choices beget better sleep. Choose more healthful food options, exercise regularly, limit or quit smoking and reduce alcohol intake.

The complete 2015 Summary of Findings report can be downloaded at http://sleepfoundation.org/sleep-polls-data/2015-sleep-and-pain. The National Sleep Foundation releases its yearly poll to coincide with National Sleep Week, which occurs just prior to Daylight Savings Time.

When Your Back Hurts…Keep Moving with Physical Therapy

When your back hurts, it may seem like you need to avoid movement. In fact, the opposite is true. You often can benefit from some rest initially. But extended bed rest can actually interfere with full and complete recovery. More movement is necessary for you to get back to your lifestyle and your routines, which helps stave off depression. More movement is needed to keep all of your muscular and nervous systems at optimum functioning. Extended sedentary time will take its toll on your back and on your circulatory, digestive and nervous systems. So, the key is to find ways to move while minimizing pain and helping with your recovery.

That’s where physical therapy helps.

Physical Therapy Goals: Physical therapy should help restore joint movement, increase flexibility, decrease pain and teach you how to move in ways that minimize back pain. In addition, you should learn exercises that you can do in our office and at home that will help you with stability and increased strength as well as endurance. Your physical therapist can help evaluate the effectiveness of therapy as you are making visits and adjust your program, even watching you do exercises to make sure you are getting the most out of what you put into your own treatment.

Physical therapy is most effective with motivated patients who are willing to keep up with assigned therapy both at home and in the office. Physical therapy is often accompanied by other treatments like doctor visits, medication, chiropractic care and psychological counseling.

Physical Therapy Treatments include services that are both passive (treatments that are administered to you) and active (therapy that you have to participate in like exercise and stretching):

Exercise instruction, whether weight bearing or light cardiovascular exercise, provides an individualized plan for rehabilitation and restoration of function as well as instruction on avoiding postures that cause further back pain. For back pain, exercises that emphasize increasing core strength are the most important to aid in your recovery. Examples of these exercises include crunches, leg raises, usage of abdominal machines, as well as modified hyperextensions like back bows and cobra stretching.
Coaching on ways to prevent further pain. Your physical therapist will help you come up with ways to modify your movements now to accommodate for pain and inflexibility, so that you can lift, bend, transfer from sitting to standing and do other daily life activities without risking re-injuring your back.
Heat and Cold Therapy can alleviate swelling and remediate acute pain and can be part of a first response to pain.
K-Laser (cold laser) therapy is useful for increasing blood flow and loosening tight muscles.
Massage applies gentle or firm pressure to sore areas, restoring flexibility and increasing blood flow to affected areas. Many back pain patients find massage to be both relaxing, so it combines a physical therapy treatment with psychological relief, too.
Manipulation of joints and bones can loosen tight tissues surrounding joints and reduce pain, in addition to improving flexibility.
Stretching exercise demonstration and instruction utilizing bands, machines, and just your body to increase flexibility and decrease pain is one of the most effective components of physical therapy.
TENS (Transcutaneous Electrical Nerve Stimulation) increases blood flow to painful areas and short circuits pain transmission. Many back pain patients derive relief from it.
Ultrasound therapy techniques may be effective in reducing pain and muscle tension.

Eating out Ethnically

It’s fun to eat out. It’s particularly enjoyable to eat at ethnic restaurants. The food is tasty and we have the opportunity to eat foods that we may not know how to prepare ourselves. But if you are watching your calorie intake, eating out can sometimes be tricky. So, we’ve created some tips for eating out in a variety of different venues that will allow you to have tasty meals without feeling guilty afterwards.

Chinese Food:

Healthy Choices: Dishes with lots of vegetables, particularly steamed or stir-fried with a minimum amount of oil. Hot and sour soup is also a good choice.

Try to Avoid: Deep fried foods like sweet and sour chicken, egg rolls, fried wontons, General Tso’s chicken, Kung Pao chicken, fried rice and lo mein dishes as well as spareribs and dishes made with duck.

Italian Food:

Healthy Choices: Marinara and most red sauces, lightly sautéed items, piccata dishes, grilled meats, salads with low fat dressing alternatives on the side, poached and sautéed meats with lots of filling vegetables

Try to Avoid: Most appetizers, heavy pasta dishes especially filled pastas, cream-based sauces like alfredo, fried dishes like eggplant or chicken parmesan

Mexican Food:

Healthy Choices: Grilled chicken and boneless beef, black beans (if cooked without lard), salsas, soft corn tortillas, fajitas without the fixings, salads without loaded cheese or guacamole

Avoid: Cheese sauces, fried tortillas, taco salad shells, excessive guacamole, beans cooked with lard

Mediterranean Food:

Healthy Choices: whole wheat pita, Greek salad with lowfat dressing on the side, grilled chicken kebabs as well as grilled lamb or fish entrees, vegetarian grape leaves, tzatziki sauce, hummus in moderation

Avoid: Fried foods like falafel, anything prepared with phyllo dough like spanakopita and baklava

Leg Cramps in the Middle of the Night: Causes and Cures

If you’ve ever experienced painful leg cramps in the middle of the night, you know they hurt! Waking up with shooting pains, typically in the calf, sometimes in the feet or even thighs can be scary and certainly interrupts needed sleep. Most of the time leg cramps are not a major cause for concern. But leg cramps that cause significant sleep disruption or cause lasting pain warrant a trip to the doctor. Consult your health care provider regarding your leg cramps and follow their advice.

What causes nocturnal leg cramps?

One answer (not so popular) is that we do not always know, but here are a few major culprits of nocturnal leg cramps:

Long periods of inactivity
Muscle tiredness or overexertion
Adults over age 50 are at highest risk for leg cramps.
Pregnancy
Dehydration
Diabetes (especially for those who have diabetic neuropathy)
A variety of diseases: Parkinson’s Disease, multiple sclerosis, kidney diseases, thyroid abnormalities
Exposure to cold temperatures, especially cold water
Certain medications are implicated including medications for COPD, blood pressure, coronary artery disease, congestive heart failure, high cholesterol, anti-psychotic medication, birth control, migraine headache treatments and diuretics.
Insufficient potassium and/or calcium
Sleeping in certain positions

What can you do when spasms occur?

Sometimes, in the middle of a leg cramp, it’s hard to keep your wits about you, but try these:

Stretch the muscle right away: walk it off, flex your toes or do gentle knee bends.
Warm showers or baths can provide relief if the area is still achy.
Massaging the area of the cramp can also provide relief.
Applying a heating pad to the affected area can also help.

What can you do to try to prevent nocturnal leg cramps?

Stretch your legs before you go to sleep. Avoid pointing the toes, but do flex the feet gently several times.
If you happen to own a stationary bike, 5-10 minutes of gentle biking just before bedtime appear to stave off cramps.
Before you go bed, untuck all of the bedclothes, so they are nice and loose.
Drink plenty of water (more than you think you need) throughout the day. Dehydration is a fairly common cause of leg cramps.
Some health care providers also recommend supplementing with sports drinks that contain potassium.

Lincoln’s Legacy: His Greatest Battle was with Depression

On President’s Day, it is a good time to reflect on the life of Abraham Lincoln. Lincoln appeared to suffer from clinical depression, and yet others were drawn to him. Amazingly for Lincoln’s time, those around him accepted his dark moods and did not stigmatize his mental illness. Had his peers and family rejected Lincoln’s depression, we may have been robbed of one of our greatest leaders ever.

Lincoln certainly faced unspeakable personal trials and probably the greatest challenges any U.S. president has ever had to face: the literal break-up of the nation. These facts alone would give him permission to be “down” sometimes. But Lincoln, just like many who face depression, would even be gloomy at what would seem to others the happiest of times: his first triumphant nomination for President, for instance.

Lincoln’s dark moods were infamous. His friends called him melancholy. He was known to cry in public and to even talk about suicide. Lincoln told a confidante that he didn’t carry a knife in his pocket, because he was afraid of the consequences. When Lincoln’s friends feared for his safety, they would band together to check in on him regularly.

Lincoln’s depression besieged him before effective drug therapy or talking therapy were helpful or even in vogue and so he did not have these in his arsenal in his great battle.

But Lincoln’s depression did endow him with three incredible gifts: the need for introspection, the desire to be productive and compassion for those who suffered.

What is most inspiring is how Lincoln used his depression to actually do great things. Lincoln would spend time in solitude, because he just couldn’t handle having to deal with people. It was during these introspective times that Lincoln worked out complex problems and heart-wrenching decisions. Lincoln’s wisdom actually was an outgrowth of his aloneness, which was a result of his depression. Perhaps his depression created an inward thinking process that allowed him to be a visionary.

Lincoln also had a great desire to accomplish something and to find some meaning in his life, even if it sometimes felt like torture. In order to be productive, Lincoln began to establish daily routines of learning, of working, of doing. He discovered, as so many who suffer from depression do, that having a routine, whether it is work, voluntarism or just a daily task list, forces a person to just keep going on, despite the brain’s message to quit or ruminate.

Finally, Lincoln’s depression gave him insight into all who suffer. It appears that his adversity gave him the strength to battle the evil spread of slavery, when others could allow it to continue to run its course. He truly believed in his cause, considering it a moral imperative.

For fascinating reading on Abraham Lincoln’s depression, we recommend Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness

Snacking Suggestions, all for under 150 calories

When you’re hungry, sometimes you just have to eat. If you’re trying to watch your weight, nutritionists suggest delaying your eating to make sure it’s not just boredom that’s driving the craving. They also suggest drinking water or a non-caloric beverage like diet soda or unsweetened tea. But, if it’s really food that you desire, try to aim for 100-150 calorie snacks. Some low calorie foods are already packaged to be 100 or 150 calories. Here are some other low calorie ideas:

1 cup sliced bananas and fresh raspberries
2 cups of microwave fat free popcorn
½ of an English muffin with a ½ tablespoon of low fat cream cheese
Premade Jello low sugar pudding
2 ounces of low-fat cheddar cheese
1 Clementine oranges (seedless and easy to peel) and 1 bar of dark chocolate
1 grande skinny latte from Starbucks
7 olives and 1 slice of Swiss cheese
7 tortilla chips and your favorite salsa

Sinus Headache or Migraine?

Two of the most prevalent types of headaches are sinus headaches and migraine headaches. Yet the treatment for each of these are quite different. How can you tell the difference between these two types of pain?

Migraine headache symptoms:

Moderate or severe pain in the head
The pain can be sudden or can come on gradually.
The pain is often accompanied by dizziness, nausea or vomiting.
The pain can be in a variety of locations, including just one side of the face or head, or even traveling down the back of the head and neck.
Light appears to exacerbate migraine headaches.

Unfortunately, many patients struggle with occasional or even chronic migraines. These patients tend to know the migraine triggers, that is the things that can turn into migraines like stress, certain food combinations, menstruation, weather patterns and other illnesses (including sinus headaches). For regular migraine sufferers, a migraine headache begins to follow a recognized pattern in terms of the development of the pain, where the pain travels in the head and even the duration of the pain.

Sinus headache (sinusitis) symptoms:

Moderate or severe pain in the head, above or behind the eyes, in the cheeks, and around the bridge of the nose.
Sinusitis can be on one or both sides of the head or the face.
Sinusitis typically does not involve the back of the head or the neck.
Sinus headaches often get worse when the patient moves their head, so coughing and lying down can be painful. Sometimes even touching the face can hurt.
Often, sinus headaches are accompanied by a runny nose, which can be clear or can be yellow or green in color.

Sinus infections, when untreated, can create even more problems. Unfortunately for migraine sufferers, sinusitis can also bring about a migraine.

Migraine headache treatment:

There are a host of medications that are prescribed for relief of migraine headaches. Some of these are meant to stop the migraine in process and other drugs are taken in the hopes that they will prevent migraine “attacks”. Drugs used for occasional migraine relief include over the counter aspirin, ibuprofen and acetaminophen, as well as over the counter drugs specifically combined with caffeine. These over the counter drugs have been known to cause ulcers and and other gastrointestinal bleeding. A large variety of prescription medications are also being used to combat migraine pain, including triptans which constrict blood vessels, Ergots, which include caffeine, anti-nausea medication, opioid medications (which have an inherent danger of being highly addictive), and steroid-based medication.

There are also some drugs that are perceived to prevent migraines. These include beta blockers, calcium channel blockers, antidepressants and anti-seizure medications.

Migraine sufferers may also benefit from certain lifestyle changes like quitting smoking, getting enough rest and beginning a moderate exercise program. In addition, in the midst of a migraine headache, sufferers can often find short-term relief by lying down in a cool, quiet, completely dark environment.

Sinus headache treatment protocols:

Sinus headaches are the result of either an allergic reaction an infection in the the sinus cavity. This infection can be viral , bacterial or fungal. Sinus headaches that are allergic in nature typically occur at the same time each year to correspond with the increased presence of the allergen, typically a pollen.

A variety of medications will be prescribed for sinusitis, including antibiotics for a bacterial infection, as well as decongestants. Allergic sinusitis will also be treated with antihistamines and steroid nasal sprays. Recurrent sinusitis may require surgery, if it appears that there is a malformation in the nose.

Please refer to your health care team for a definitive diagnosis and appropriate treatment for all headaches.

Stretching to Ease Lower Back Pain

Many of us suffer from occasional or even chronic back pain. The pain can be exacerbated during long travel, stressful situations, unbroken sedentary periods, as well as use and overuse: lifting, carrying, climbing stairs, even regular exercise.

There are a variety of stretches that can relieve back pain or even prevent further pain.

Before you try any of these stretches, please get permission from your health care team.

If you would like to embark on a stretching regimen, be sure that you have a flat surface, free of debris, large enough to accommodate you if you lie down. Be sure to wear comfortable clothing that doesn’t restrict your movement. As you attempt each of the stretches, be sure to remember these tips:

Go into the stretch slowly and hold the position for 30 seconds, if you can. Repeat the stretch for a total of five repetitions, if you find that it feels good.
Do not bounce during a stretch.
Do not continue the stretch if you feel pain.

Try this sequence of stretches that have been found useful for low back pain relief. Some of these stretches may be known under other names, especially in various yoga practices.

Hugging Your Knees:

Lie down on your back. Bring your knees together to your chest and hug your knees as tightly as you can. Hold the pose and let go. If you want you can rock slightly to the left and right. This is a great way to begin a stretching sequence. If you’re not flexible, it’s okay. Just bring your knees as close to your chest as you can handle.

Half Snow Angels in the Air:

Still lying down on your back, put your legs on the ground, keeping your legs straight. Now lift both legs up a few inches in the air. Pull your legs apart and then back together slowly. Then lower your legs. Many people find that this stretch is too challenging, especially if you carry a lot of weight in your belly. Nevertheless, others find immediate relief from doing this stretch.

Cat Stretch:

Face down on your hands and knees. Slowly move your spine up, like you are a cat, arching your back. Slowly lower your back down before repeating.

Back Bow:

Lie down on your tummy. Stretch your arms out in front of you. Keep your legs together. At the same time, lift up your arms and your upper back as well as your legs. If you cannot do this move, just lift your arms. Slowly come down and take a breath before repeating.

Downward Dog:

This classic pose is a great stretch and is easier than it looks. Start on your hands and knees, with your hands slightly in front of your shoulders. Pressing back, raise your knees away from the floor and lift your tailbone up toward the ceiling. Keep your head down.

Climbing the Wall:

Lie down on your back in front of a wall. Put your tush all the way against the wall and put your legs against the wall. This is an easy pose that drains the fluid from your ankles and is incredibly relaxing.

Eat More of This (Fruits & Vegetables) When You Eat That (Dinner)

Winter dinners are a great time to indulge in warm comfort foods. After a day of on-the-go, or at-the-desk, coming home to a satisfying meal that also happens to help you meet your nutrition goals is a great way to conclude your day. Dinner, for many, is the largest meal of the day, not necessarily in volume of food eaten, but in the types of food served at one meal. Having a fresh salad, a soup, an entree and possibly even an occasional dessert make dinner a great opportunity for incorporating extra fruits and vegetables into your meal. Here are five easy ways to work more produce and more fruit into your dinner.

Eat Salad First: Dark green baby spinach and crisp romaine complement each other nicely. Also consider including any of these great fresh vegetables:

Peas
Tomatoes
Red onions
Celery
Carrots
Peppers

To keep your salad portion at a healthy size, consider a salad that is roughly about 2-3 cups of lettuce, 1½ cups of vegetables and no more than 1 tablespoon of a dressing.

Poach: Using chicken, beef or vegetable broth and a little white wine, you can serve a plate of warm and brightly colored vegetables as a decorative side to any grain, meat or pasta. Poaching involves cooking a food in just enough liquid to make it slightly tender, but never overcooked. Boil enough cooking liquid of your choice to just cover the vegetables. Add your selected vegetables once liquid reaches a boil and turn the heat down. Watch your food very closely and only cook for 2 – 3 minutes before checking for tenderness. Garlic, basil or any other spice is a great addition to poached vegetables. Seasonings can be added to the poaching liquid or directly to your cooked food.

Roast: Bake cut vegetables in a 375°F oven for 10 to 20 minutes (depending of the size of the vegetable). Look for a lightly browned appearance to know when they are done. Literally any vegetable is roast-able; with some experimentation you will be able to find your favorite! Some of our favorites are any type of squash, mushroom, onion, zucchini or carrot, as well as old standbys broccoli and cauliflower. Roasted vegetables are delicious when very lightly drizzled with a high quality extra virgin olive oil.

Mix It Up: Mix Veggies In: Are you a cook who loves to make your own tomato sauce? Try adding roasted or poached vegetables, finely chopped or pureed, into your sauce while you are preparing it. Try the same thing with your favorite casseroles, soups, stews or chili.

Make Dessert Count: Choose fruit, either fresh or baked, frozen or from the produce isle. Try not to add sugar, though! Make a point to enjoy the natural sweetness of fruit.

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