Blog - Page 12 of 15 - Michigan Spine & Pain

Diabetes and Pain Management

Diabetes affects many Americans and many of our patients. Diabetics have multiple self-care items that they must be attentive to: they need to monitor their intake of carbohydrates, they need to maintain a healthy weight through a combination of diet and exercise, they need to monitor their blood glucose levels and they need to be compliant about taking their medication, whether that medication is insulin or other medications that help the body to process glucose.

Diabetes also brings with it other health complications, including a higher risk for cardiovascular disease.

Perhaps less well known, however is the number of diabetic patients who suffer from pain issues that are a result of their diabetes.

Diabetes causes a specific form of nerve damage which is called diabetic neuropathy, which can trigger these types of chronic pain:

Peripheral neuropathy: pain and/or the loss of feeling in the extremities (toes, feet, legs, hands and arms).
Proximal neuropathy: pain in the thighs, hips and buttocks, which can contribute to weakness in the legs, causing instability and balance issues.
Focal neuropathy: the sudden weakness of either one single nerve or a complete group of nerves, which can then turn into localized muscle weakness or pain. This can occur in a variety of places, behind one eye, in the neck, back, chest, inside the foot, etc.
Foot injuries and issues: special care has to be paid to the feet which can often be injured without the diabetic patient feeling the injury due to numbness in that area. When there are injuries to the feet that are left untreated, further complications and mobility issues may quickly arise.

Treatment of Diabetic Neuropathy

The most important step in developing a treatment plan is a consultation with pain specialists. It is important to diagnose correctly the root of pain, to be certain it truly is diabetic neuropathy and not a different injury or disease process. A correct diagnosis will lead the treatment team down the path of appropriate treatment and care.

Diabetic neuropathy isn’t necessarily curable; it is a chronic disease, just like diabetes itself. Your health care team will partner with you to manage your diabetic neuropathy. In general, keeping your blood glucose level at your targeted range is the best thing you can do to keep your diabetic neuropathy at bay. If your diet and exercise need monitoring or tweaking, you may need the help of nutritionists, physical therapists and diabetic educators.

Certain over the counter drugs often provide relief, including aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs like ibuprofen or a topical cream such as capsaicin. If you have been diagnosed with diabetic nephropathy (where there is kidney involvement, too), then you can only use anti-inflammatory drugs under a physician’s supervision.

Severe pain may require stronger prescription medication, either pain-reducing medicine, or medications that treat for depression and even seizure disorders (even if you do not suffer from depression or seizure disorders).

Other therapies may also provide a measure of relief including relaxation training and meditation, gentle massage, biofeedback, acupuncture and the use of transcutaneous electronic nerve stimulation (also known as TENS). Mild exercises that are tolerable, like light swimming, gentle stretching and leisurely walking may also prove to be effective not only in reducing pain but also in management of blood glucose levels.

Raking The Leaves without Breaking Our Backs

Gorgeous, vibrant colorful leaves: they are what make our Michigan autumns so beautiful. The leaves are everywhere, by the sides of roads and highways, in parks and forests…and in our lawns. We know we will eventually need to remove those leaves from our lawns. We are also aware that we have to attend to the chore before the first snowfall and before too many rainstorms make the leaves too difficult to move.

But for pain sufferers, we need to find ways to rake the leaves while still protecting our back. Raking leaves often includes bending, twisting and lifting. We need to be mindful of our body position and mechanics, so that we don’t cause pain or exacerbate pain we already experience. Obviously, a leaf blower that you can comfortably tote will make shorter work of raking, but you typically will still need to rake at some point in the operation.

Here are a few tips on preserving your upper and lower back and reducing the chances for straining for neck and shoulders:

Warm Up: Just like all exercise, you don’t want to go straight from the bed to the flowerbeds. Do some light stretching or calisthenics before you even attack the leaves, especially if you live a particularly sedentary lifestyle.
The Right Rake: Be sure that your rake “fits” you, that it it is not too heavy and neither too long nor too short.
Just Shoe It: Wear supportive shoes that aid in good balance and protect you from the elements.
Love the Glove: Gloves protect your hands from blisters and of course the Michigan chills.
No Twisted Sisters: You really have to be mindful of how you move your body. Plant yourselves in front of the leaves and move the leaves forward or backward without twisting your spine or shoulders.
Change Your Stance and Your Hands: According to the American Chiropractic Association: “When raking, use a “scissors” stance: right foot forward and left foot back for a few minutes, then reverse, putting your left foot forward and right foot back.”
Heads Up: Try to look forward and up as much as possible to prevent neck strain and soreness.
Bend at the Knees: Avoid bending at the waist as much as you can. Bending the knees saves your back.
Stop and Stretch: After 15-20 minutes, stop for a moment and stand fully with the rake on the ground, hands on the hips and gently bend backwards. Do this 3-5 times before returning to your raking.
Hydrate: Bring your water bottle outside with you and take frequent breaks. If you are sweating, you need to drink a bit.
Rejuvenate: After you are done, do some light stretching and take a nice warm bath or shower to help relax those muscles. And just think: you won’t have to do this again for a while!

What Does A Chiropractor Do?

The easy answer is: a lot!

The goals of chiropractic treatment are relief of acute pain, management of chronic pain, education of patients on self-care and prevention of further injury or pain.

Chiropractic care can be a very effective element of pain relief treatment, particularly when it is a component of a multi-pronged treatment plan. Chiropractic care is particularly appropriate in treating the following conditions:

Back Pain
Neck Pain
Headaches
Disc Injuries
Pinched Nerves
Sciatica
Radiating Pain
Strains and Sprains
Muscle and Joint Problems

Chiropractors utilize a variety of techniques to obtain results for their patients.

The chiropractic treatment that people seem to be the most familiar with is chiropractic adjustment and manipulation. This is one of the most effective tools for pain reduction that a chiropractor can offer. Indeed, manual manipulation can give more relief, and lasting relief, than other therapeutic interventions, including drugs, particularly in the case of acute musculoskeletal pain.

Other treatments include:

Disc Compression/Flexion Distraction/Cox Therapy are related manipulation treatments that are utilized to decompress spinal joints and discs. A specialized piece of equipment, the Hill AirFlex table, allows us to coordinate hands on treatment with decompression traction to the spine. This technique can be used for treatment with disc problems, facet joint syndrome, lumbar stenosis, scoliosis and spondylolisthesis.

Massage Therapy/Trigger Point Therapy/Myofascial Release, Active Release Technique: These hands-on techniques are applied to areas of muscular pain and tension. They are used to help mobilize the soft tissues and adhesions, and include deep pressure and stretching procedures applied to sensitive points that are commonly found in the muscles.

Joint Mobilization Therapy: This therapy involves a deep stretching movement applied to the joints, ligaments, muscles, tendons and discs. These treatments work to restore mobility, range of motion, relax tight muscles, and help limit disability and pain.

McKenzie Technique: This patient education regimen includes teaching patients back care basics, correct posture principles and specialized stretching and exercises to help prevent and care for neck and back-related pain. Through individualized instruction patients learn ways to apply self-care treatments at home to help facilitate their rehabilitation and recovery.

Spinal Core Stabilization: These are exercises and stretches, prescribed to help strengthen the muscles that support the spine for improved control of body movements. Stabilization exercise works to help relieve pain, improve flexibility and limit the chance for re-injury and further bouts of pain.

Walking Isn’t Just for Warm Weather

Perhaps you remember from a previous blog post that walking is the most popular form of exercise for Americans.

The American Heart Association recommends 30 minutes of moderate physical activity at least 5 times a week, so that adds up to a lot of nice walks. In addition, several clinical trials indicate that pain-sufferers can decrease pain and depression with increased physical activity. Exercise is beneficial for controlling blood sugar, for lowering cholesterol, for combating depression and anxiety and for increasing self esteem.

During the gorgeous Michigan summer, it was easy to be motivated to walk outdoors. As the days get shorter and cooler, it is tempting to avoid the trails and roads and either exercise indoors, which is a good alternative, or head back to the couch, a not so good alternative!

It is still beneficial to be outside. For those who get the blues (seasonal affective disorder) during dark winter months, taking in light is paramount. Cold air that is not uncomfortable can be invigorating; you’ve heard people talk about “clearing their head”. Michigan outdoor air does that.

If you want to extend your outdoor walking, you need to be sure that you are staying warm, dry and safe.

What to Wear for Fall and Winter Walks:

Your should feel chilled, but not cold as you step out the door. During your walk, you should feel warm, maybe even a little sweaty, but not sopping wet.
If your body feels the right temperature, you probably nailed down your workout outfit. If your old sweatpants and a comfortable sweatshirt feels good, fine. Go for it!.
Lots of running and walking resources will give very specific guidelines as to how to dress. You can certainly consult these, but if you have clothes that work, don’t feel like you need to change what you’ve been doing.
Layered clothing that will serve to keep the warm air close to your body is very efficient. Investing in clothing that wicks away moisture (not cotton) is helpful.
A layer of fleece is great for cool walks.
If there is moisture or precipitation, an outer waterproof layer is a must (but it should be thin enough not to restrict movement or to cause you to overheat.)
A comfortable fleece hat, headband or earmuffs may be necessary, depending on the temperature and wind conditions. If the hat begins to bother you, you can always take it off. But if you forgot your hat, you can’t put it on!
Choose thick, absorbent socks that do not interfere with the fit of your shoes.
Inspect your shoes for holes or worn treads. Replace your shoes if necessary.
Gloves or mittens are a must in the cold weather. If you are on the fence as to whether you need them, bring them; you can always put them in a pocket.
Protect yourself from the sun (even if it appears not be shining). Wear sunscreen and protection for your lips, too. Sunglasses help as well.
If a scarf makes you feel warmer, go for it. Some asthma sufferers like to wrap a scarf loosely around their faces, although scientists are divided as to whether this actually makes a difference.

Cold Weather Walking How-Tos:

You need to give yourself time to warm up. If you are trying to get to a quick pace, start off slowly, do some dynamic stretching on the walk and perhaps do some stretching and calisthenics before you even walk out the door.
Get out there and walk. There is no reason to walk more slowly or for less time if you are dressed appropriately.
Cool down inside. You should not go directly from working out to sitting down. You need to cool down. But in cold weather, you don’t want to be in the elements, a little sweaty and not exerting yourself. That is better done inside.
Admit to yourself when it’s too cold. At some point, it may not be safe to be walking outside. Ice patches or combinations of temperature and wind that make frostbite possible may eliminate outdoor walking for that day.

Ideas to Make Your Walks More Exciting or Challenging:

Listen to great music that inspires you, whether it’s music with a fast tempo or fun music with happy lyrics.
Add some hills to your route.
Pick some places to go extra fast, what we could call an interval walk. (If you can run, go for it!) Vary where the intervals occur.
Use a walking app like Map My Walk to find new routes nearby that other users have tried.
Bring a walking partner, but not one who will slow you down during your walk.
If you have to resort to the treadmill, do whatever you can to make that exercise time more fun and challenging. Play good music, watch entertaining shows, make yourself go up and down hills and practice some intervals.

Help! My Hips Hurt After I Exercise

Hip pain under any circumstance is no fun. Hip pain that occurs as a result of trying to take care of yourself is even more annoying.

But, not all hip pain is the same. There are sources of hip pain that may preclude exercise, like deteriorating hip joints and of course fractures. But many, many people can safely walk, run, play golf or tennis or swim and keep hip pain at bay with simple exercises.

There are several muscles that function within the hips. The muscles that we are focusing on here include:

The gluteus medius, which is the main abductor (which means it is working when you pull your thighs apart) and external rotator of the hip.
The gluteus maximus extends the hip and assists with abduction and external rotation.
The tensor fasciae latae (TFL) is an abductor of the hip, and also helps with internal rotation
The piriformis, which abducts and laterally rotates the femur (the thigh bone)

Consider adding these stretching and calisthenic exercises prior to and after exercising or even on intermediate days if you run or walk on an every other day basis:

Clamshells: Clamshells are not difficult and require no equipment. Lie on your right side with your knees bent in front of you and your legs stacked on top of each other. Bend your right elbow and rest your head on your elbow. Slowly open up the top left leg (like a clamshell) and close that leg again. Repeat this for a total of 10 times. Then turn to the other side, lying on your left side and opening up your right leg. To increase the difficulty, you may wrap an exercise band halfway between your knees and hips to add some resistance. Try to eventually do 30 clamshell repetitions on each side.

Side leg lifts: Lie on your right side with your legs extended in a straight line, with your left leg stacked on top of your right. Bend your right elbow and rest your head on your elbow. Slowly lift up your left leg, keeping the leg straight (do not bend the knee). Count to five and then bring your leg down. Repeat this 15 times. Then turn to the other side, lying on your left side and lifting up your right leg. To increase the difficulty, you may wrap an exercise band halfway between your knees and hips to add some resistance. Try to eventually do 30 side leg lifts on each side by repeating this exercise once more on each side.

One legged Glute lifts; this can also be called the one-legged bridge. Start by lying on your back with your knees bent and your feet firmly on the ground. Slowly do 5 pelvic lifts, counting to 4 each time, lifting your lower back off the ground, using your thighs to support the action. Now lift up your left leg into the air and continue to lift your pelvis for 4 seconds with just your right leg. Repeat for a total of 10 times. Bring your left leg down and do the entire activity from the beginning, but lifting your right leg. Try to eventually do a total of 30 glute lifts on each side, by repeating this exercise two more times per side.

Piriformis stretch: Sit up with your legs in front of you and your hands slightly behind you. Bend your left leg and cross it over your right thigh. Hold onto your left knee with your right hand. Now turn your shoulders towards your bent knee. Count for 10 seconds, breathing slowly. Place your left leg down. Now, bring up your right leg and bend it, and cross it over your left thigh. Hold onto your right knee with left hand. Turn your shoulders towards your bent knee, counting for 10 seconds, breathing slowly.

Hip pain should not be ignored. If your hip pain does not seem to go away, please contact your health care provider.

The Language of Pain

I want to talk about pain and I want to share with you a multiple choice test question someone once shared with me that really got my attention.

Q: Which emoji would you choose to describe each of the following four words: (FYI, for our friends who don’t text, emoji are those cute pictures people use when texting…)

A: Get it? It’s not difficult to see. There are multiple ways to talk, different language people can choose to use and even different pictures for the very same word. For one person vacation is a plane; another’s vacation is a tent.

Talking about pain is no exception. Your pain comes on with agony like a lightning strike; mine makes my whole day sad. The way you experience your pain and the way I experience my pain are so very different that often times describing it on a scale of 1 to 10 is insufficient for conveying important information to people like healthcare providers. Talking about pain effectively requires a degree of confidence. One has to believe that the language of pain is truly understood. Patients and doctors, patients and family and even patients and other patients must feel secure that they are effectively communicating “pain” with one another. I like the article recently published in the New York Times entitled “How to Talk About Pain” (http://www.nytimes.com/2014/07/13/opinion/sunday/how-to-talk-about-pain.html?_r=0), because it presents intelligent insight on the subject of pain and communication. The author, Joanna Bourke, Professor of History at London’s Birkbeck College is also the author of “The Story of Pain: From Prayer to Painkillers.” If you are interested in exploring further, Bourke’s book is worth reading.

Sleep Positions for Pain Sufferers

For anybody who deals with chronic, acute or intermittent pain, sleep can be problematic. Clearly, lack of restorative sleep can exacerbate pain, making us tired and unable to cope with regular life stresses the following day. Yet, good sleep can be difficult to obtain when the sleep positions don’t allow us to relax relatively pain-free.

Mattresses, couches and recliners: does it matter? It appears that you don’t necessarily need the newest mattress, but you do need to have a mattress that doesn’t create pressure points. Bursitis patients, however, need to be sure that they don’t sleep on too firm a mattress.

Couches contribute to a great deal of neck, back and shoulder pain, because they are not meant to be sleep surfaces. They do not provide adequate neck and back support. If you regularly fall asleep on the couch, you need to move yourself earlier to the bedroom.

A full recliner (and also an adjustable bed) is often a very effective solution for pain patients. Because it offers so many positions, there are more options to experiment with. Full recliners and hospital beds are also much easier to transfer in and out of to a standing position, which is helpful for hip, leg and back pain sufferers.

If you have had a recent surgery and spent time in a hospital bed, try to remember which positions in the hospital bed gave you the greatest relief. What angle did you keep your legs? Your head and shoulders? Did you lie on a particular side?

Pillows matter. Shoulder pain sufferers often have the hardest time finding a comfortable sleep position, but adding pillows to the mix can be helpful. Neck pain patients need to ensure that their pillows are not so large that they cause the neck to flex. Memory foam pillows are good, as are feather pillows that compress nicely, if you don’t have allergies to feathers. (Feather pillows do need to be replaced more often than foam pillows.) If you haven’t purchased pillows in a while, there are lots of varieties to experiment with: body pillows, small roll pillows, as well as pillows with various gradients in size and firmness. You can be creative, too. Often a rolled up hand towel is the perfect size.

Sleeping on your back is the typical sleep position for those recovering from spinal surgery. For those who are not used to this position, it can be a chore to fall asleep. Be sure to elevate your legs with pillows, so as to minimize the strain on your back.

Sleeping on your side is the most common recommendation for lots of pain patients, including those with osteoarthritis, bursitis, spinal stenosis as well as hip pain sufferers. Pregnant women should also sleep on their side for prevention of lower back and hip pain. For some patients, sleeping on the side can be made even more comfortable with a pillow placed between the bent knees, or by placing long body pillows along the back or stomach. Some people get more relief in a sleep position that includes a fairly straight body and legs; others prefer a more fetal, curled-up position.

Shoulder and hip pain sufferers should sleep on the unaffected side (if the pain is limited to one side).

Sleeping on your stomach is often recommended for patients with degenerative disease. A firmer mattress and a very thin pillow placed under the stomach and hips are also helpful. Sleeping on the stomach is not recommended for patients with neck pain.

Old sleep habits die hard. But it is important not to quit a new position just because it doesn’t feel natural. It can take a few weeks to for a new sleep position to stop feeling strange. Give the process time and really evaluate if you are getting a longer, more rejuvenating sleep before making any further changes.

National Pain Report Published

A note from Dr. Bleiberg’s staff: if you are a Michigan Spine and Pain patient who participated in this survey and would like to share your involvement in or personal observations of this important report, please feel free to share your thoughts with us. All comments, responses or observations by our patients to the Women In Pain Survey will be kept in the strictest of confidence.

Breaking News Press Release: Friday September 12, 2014

The National Pain Report today released its survey results on Women in Pain. More than 2,400 women who suffer from chronic pain completed the survey. It is the largest survey response we have ever had. We’re not surprised, because this is a very important and under-reported topic. We learned many things. For instance: 90% of women feel they have been discriminated against by the healthcare system. Eighty-four percent (84%) feel they have been treated differently by doctors because they are women.

We invite you to see the results of the entire survey on the National Pain Report website: Women in Pain Survey Results. (There’s a response section at the end of the survey. If you have thoughts, share them and we might use some of them in future news content.)

By the way, we shared these results this morning (Friday) in Los Angeles at the annual meeting of our survey partner, For Grace, which is a nonprofit dedicated to the issue of women in pain.

Thank you again for participating and for supporting the National Pain Report, the largest online news site dedicated to covering chronic pain.

Best Wishes,

Ed Coghlan, CEO, National Pain Report

Rheumatoid Arthritis & Osteoarthritis: Similar, Yet Altogether Different

When older Americans experience pain writing with a pen or doing keyboard work, performing simple repetitive physical motions like walking stairs or sitting and standing, they worry that arthritis is the culprit. The fact is, they are not alone in their worries. Currently, an estimated 52.5 million Americans reported that their doctor told them they had arthritis.

All arthritis, though, is not the same and recognizing the differences are important as a treatment plan is formulated. There are different treatment options and different disease processes between rheumatoid arthritis and osteoarthritis. Knowing the type of arthritis you have will affect many medical and lifestyle decisions.

Rheumatoid Arthritis:

The disease occurs because your immune system attacks the tissues in your joints, causing pain and stiffness.
Rheumatoid arthritis pain gets markedly worse over a course of months, or even weeks, and has a much more sudden progression than osteoarthritis.
Other initial symptoms of rheumatoid arthritis can be flu-like symptoms, including fever, tiredness and weakness.
Rheumatoid arthritis typically attacks the hands, wrists and feet, but unlike osteoarthritis does not usually affect the joint closest to the fingertip.
Rheumatoid arthritis sufferers are less able to decrease stiffness and pain with movement and find that it can take up to an hour for morning aches and pains to abate.

Osteoarthritis:

The disease process occurs because cartilage (the tissue in your joints that cushions your bones) erodes. As a result, two bones begin to rub one another.
Pain from osteoarthritis develops gradually and worsens over time.
Osteoarthritis in the hand is very common, typically affecting the joint closest to the fingertip.
Joint pain and stiffness is usually the worst in the morning, but often improves after a short burst of movement and activity.

Fall Sports Injury Prevention

Fall sports in Michigan provide great opportunities for our youngsters: a chance to be a part of a team, an outlet for physical exertion, and the establishment of an active, healthy lifestyle. With that in mind, please be aware of the injury hot spots in the Michigan fall sports. In general, injuries can be prevented in the following ways:

Wear appropriate protective gear (especially customized mouth guards)
Be on the lookout for concussion symptoms
Stay hydrated
Stretch prior to and after working out
Be mindful of pain, as opposed to muscle exertion, and seek medical advice when pain occurs

In addition, it is very important that athletes maintain their strength during the off season, through weight training and cardiovascular workouts. Trouble looms when athletes begin the season “out of shape”, even if the first few weeks of practice include rigorous conditioning.

Some specific sport by sport injuries to watch out for:

Cross Country: As you would expect, the legs take the brunt of injuries, from knees and ankles to hamstrings, shin splints and quadriceps. Blisters can be common and when left untreated can create new problems. Parents need to assess their children’s shoes, socks and clothing for proper fit. Athletes need to pick up speed slowly at the beginning of their training and try to spend as much time on the track, which is a safer, more consistent, more giving surface than streets and sidewalks. Dehydration and sunburn can also be a problem.

Field Hockey: Hand and wrist injuries are the most prevalent, followed by ankle sprains, facial injury, concussions, knee and ACL issues. Hand issues are very hard to prevent. On the other hand, customized mouth guards are multi-purpose, preventing tooth injury and mitigating concussion. They are far better than one size fits all mouth guards.

Football: Head and neck injuries are the most troublesome (encourage students to tackle with their helmets up) with concussions being of primary concern, but leg and knee injuries are actually more prevalent. Shoulder injuries do occur as does lower back overexertion. Heat-related injuries are common in football as the extra padding contributes to dehydration. Being in peak physical condition prior to the season and staying hydrated are critical for football players.

Golf: Golf injuries tend to come from overuse and poor swing dynamics. Most vulnerable are hands, shoulders, lower back and elbows. These injuries can be lessened with stretching and warming up before playing and coaches’ attention to and correction of poor swing techniques.

Soccer: Soccer has a deceptively high concussion rate, because most students wear no protective gear. Other high injury sites include knees and ACLS, ankle sprains and breaks, and dehydration issues. Be aware that soccer games are played even in the rain and these conditions can be tough on ankles and knees. Also, a waterlogged leather soccer ball can become heavy and hard, making heading the ball much more dangerous.

Swimming and Diving: Shoulder injuries and knee injuries are the leading swimming injuries, followed by hip and back pain. Most of these injuries can be prevented with sufficient warm-ups prior to swimming at full speed, consistent strength training including an emphasis on developing core strength and coaching to correct defects in strokes.

Tennis: Tennis elbow is by far the most common injury, followed by stress fractures and injuries of overuse in the shoulder, legs and back. Tennis players must warm up before playing and must participate in the specific exercises that target the hands and wrist to prevent tennis elbow. Tennis players are also prone to dehydration, especially during extended match play.

Volleyball: Most common injuries are finger injuries and ankle sprains, followed by rotator cuff tendinitis, and lower back pain. Volleyball players must be constantly coached on properly addressing the ball when striking or spiking in order to protect their fingers. Ankle braces are recommended as preventive gear for those players who are prone to ankle turns. Staying in top physical condition is important for volleyball playing, where there can be explosive action followed by periods of inactivity.

1-800-586-7992