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The Bad Health Effects of Frequent, Prolonged Sitting

by Pain Doc | Sep 25, 2013 | Uncategorized

I’ve been saying for many years that one of the best things you can do to improve your health is to be more active. And one of the ways to do it that is low tech and doesn’t require a heck of a lot of thought is making a conscious effort to stand more than you usually do throughout your day; especially for those who have sedentary desk jobs.

When you stand, you burn more calories because you engage your erector spinae muscles, gluteal muscles and of course leg muscles. You can burn at least 100 more calories a day simply by standing for two hours more. It’s also better for your posture. And get this, other research says that sitting can cause your bad cholesterol levels to rise because it deactivates spinal muscles that prefer to burn fatty acids for energy.

A study just a few years ago revealed a positive correlation between hours spent sitting and premature death. The American Cancer Society study found that women who sit for more than six hours a day were about 40% more likely to die during the course of the study than those who sat fewer than three hours per day. Men were about 20% more likely to die. Now that is a risk factor that can easily be avoided.

If you have a desk job that requires sitting two or more hours straight, or is such that it is easy to get caught up in your work and sit for that amount of time or longer (common for software programmers, researchers, accountants and attorneys to name a few) you need to find a way to remind yourself to stand periodically and ideally do some simple exercises while you are at it, like squats, lunges or doing a couple of laps in your building’s staircase or stair well. Incorporating such a simple routine can have a huge impact on your health, now and in the future.

Lastly, check out this modern concept office workstation by Focus. It is much better for your back than traditional workstations that place max pressure on your lumbar discs, potentially increasing your chances of developing degenerative disc disease. The unique design of the Focus workstation results in much less pressure on your lower back and engages the spinal muscles and leg muscles more than a traditional chair with a back rest. This will allow you to work longer hours without as much risk. But still, it’s better to get off your butt every 20-30 minutes and walk to prevent the bad stuff from happening.

Spinal Stenosis – What it Is, and What to Do

by Pain Doc | Sep 14, 2013 | Leg Pain, Sciatica

Spinal Stenosis

Recently, Carrie Ann Inaba, one of the judges of the show Dancing With the Stars publicly announced that she has been suffering for quite some time from cervical spinal stenosis– a condition in which the canal that encases the spinal cord in the neck narrows and obstructs nerve tissue. She explained how her condition impacts her life, limiting her from doing the things she loves to do. To Carrie Ann’s dismay, she no longer dances with a partner for fear of getting whiplash and paralysis. That’s quite unfortunate for someone whose entire career revolved around dancing.

Although spinal stenosis is a generalized term for narrowing of the spinal canal by any cause, the most common type, which will be discussed here, is the type caused by osteophytes— growth of bony projections that narrow the openings where nerves pass through. Advanced osteophytic activity is also referred to as spondylosis. When it is severe enough to narrow the spinal canal (foramen) it then creates the condition known as spinal stenosis. For your information, other forms of spinal stenosis are those caused by herniated discs, spondylolisthesis, tumors or any mass that encroaches into the spinal canal.

In her article, Carrie Ann mentioned that spinal stenosis is a form of arthritis and that she is anxious to find a cure for it. Unfortunately spinal stenosis is not one of those conditions that can resolve on its own with rest, exercise and time and other non- invasive measures. And since the inflammation from spinal stenosis is secondary to irritation of nerves, it is technically not a type of arthritis. That is why anti-inflammatory medications have minimal effect on the pain associated with spinal stenosis, which is typically deep, sharp and radiating in nature.

Spinal stenosis occurs when vertebrae, the bones that comprise the spinal column gradually morph in a way that constricts the spinal foramen (canal), or space where the spinal cord resides. When there is less space for the spinal cord to move, it is subject to more abrasion with spinal movement; i.e. bending and turning your neck. The cord (actually, meninges or covering of the cord) rubs against sharp edges of the bony projections into the foramen with movement causing inflammation and injury to the nerve tissue, sometimes causing sclerosis (hardening). In advanced cases, especially cases of lumbar spinal stenosis (due to the more significant weight burden) the narrowing gets so advanced that there is constant pressure on the nerve roots. At this point, it is an emergency situation as renal function and sensation to the legs are affected.

Signs of advanced spinal stenosis include paresthesias, sharp pain with movement, weakness in the extremities, and muscle atrophy in legs and/or arms. Symptoms can be permanent if not treated early.

And what is the treatment for spinal stenosis? First of all, doctors will usually order MRI and x-ray to determine extent of narrowing. If it is caught early, physical therapy and lifestyle modification is recommended. The goal is to slow down or stop the progression of the narrowing.

Surgery is the only option for advanced cases. Since spinal stenosis involves physical structures compressing nerve tissue, there are surgical procedures that can enlarge the spinal canal by scraping off the encroaching bone material and buy the patient more time. Since bone is comprised of live cells, the movement of bony projections (called osteophytes) into the spinal canal is still likely after surgery and many who have had such spinal decompression surgeries develop the same problem several years later.

It’s not quite evident why some people suffer from spinal stenos more than others. But those who have a history of physical trauma to the spine like car accidents, sports injuries and falls are at a higher risk. The theory is that the injury event disrupts the normal alignment of the spinal segments resulting in accelerated wear and tear over time; much like how a loose screw in a machine accelerates mechanical failure. Some orthopedists hypothesize that the appearance of bony projections is the body’s attempt to fuse and stabilize adjacent vertebrae so they can no longer move separately; thus reducing the probability of injury. However, the nerves that share the space with the vertebrae get damaged in the process. If this theory holds true, then it is an inherent design flaw of the body’s self-healing mechanisms.

Also, heavy smoking and obesity, and general poor health can increase your chances of developing spinal stenosis.

I’m sure more than one doctor broke the news to Ms. Inaba that there basically is no “cure” for spinal stenosis once it is in its advanced stages, which appears to be her case based on her own description of her symptoms. It is a mechanical condition that mandates mechanical intervention. No amount of drugs will cure spinal stenosis from advanced osteophyte formatioin. Her only option at this point is spinal decompression surgery to widen the spinal canal and hope that the nerve tissue did not sustain permanent damage.

The best strategy for dealing with spinal stenosis is prevention. If you sustained injury to your spine from a car accident (even a low impact one that did not require medical treatment), a sports injury (including repetitious trauma like that related to gymnastics and football) or slip and fall, realize that “the seed” for spinal stenosis may have been planted in you already. If your injury event was over five years ago, get an x-ray to identify any levels where osteophytes are present; these are the sentinels of potential areas of spinal stenosis as they identify areas of biomechanical weakness. If there are some, the first course of action is to not worsen things. Avoid or reduce activities that regularly place trauma to your spine. Engage in specific exercises that strengthen the neck and lower back to offer more stability. Stretch often (yoga is a great choice) and take care of the insides of your body as well with proper diet, nutrition, hydration and adequate rest.

Lastly, the Cervical and Lumbar Posture Pump is a home rehabilitation device that tractions and separates vertebrae to hydrate the discs and increase nutrient absorption which can slow down the progression of spinal stenosis if done diligently on a regular basis. I have personally used them in my practice, and patients reported positive results.

An Often Neglected Approach to Self-Treat Disc Bulging

by Pain Doc | Aug 27, 2013 | Uncategorized

Disc bulges, or herniations, come in a variety of presentations. They usually are limited to the lower lumbar spine (L3/4 to L5/S1) and the neck (C4/5-C7/T1). In taking the medical history of patients suffering from disc bulges, there is usually a history of a sedentary office job that requires sitting long hours; a previous injury like a sports, work, or car accident injury; and in rare cases, no significant event or habit that could explain how the disc bulge occurred. In fact, there are studies that indicate that degenerative disc disease, which can include varying degrees of disc bulging, can be hereditary.

A common theoretical model for degenerative discs goes like this: something happens that causes the disc to bear excessive weight, which over time forces fluid out of the disc causing it to dessicate. The outer fibers responsible for keeping the disc intact and the nucleus in place weaken, allowing the center nucleus to bulge outwards. Chiropractors often attribute this scenario to subtle misalignments in the vertebrae caused by minor trauma, prolonged sitting and insufficient support from the abdominal muscles and lumbar muscles. Normally the disc should support 80% of the weight above it and the facet joints (the smaller joints behind the disc) about 20%. But if a physical event changes the orientation of the vertebra, it can force the disc to support 90-100% of the weight, accelerating its demise.

Other models reference calcification of the vertebral end plates,the surfaces of the vertebrae above and below the disc, which then prohibits capillaries from feeding nutrients to the disc causing it to die. Bone calcifies in response to trauma; vertebral end plates can sustain “micro-compression” injuries from activities that place a heavy, axial load (perpendicular) to the disc. Examples include basketball, gymnastics, running, and parachuting.

An acute herniated disc can be extremely debilitating, as it tends to last a lot longer than a typical sprain/strain injury. It hurts, limits movement, can make sleep difficult and restricts you from work and physical activity. If it presses on a nerve root it can send shooting pains down the buttock and leg and cause numbness and weakness. The general recommendation for most cases of non-emergency disc herniations is to manage the pain using physiotherapy (ice, heat, muscle stim, laser), do physical therapy including stretching and strengthening exercises and wait for the disc bulge to self-resolve in 2-3 weeks. Once it heals and the inflammation goes down, the pain usually goes down as well.

If your disc herniation is pressing on a nerve root, the disc may shrink as it heals, removing pressure from the nerve. This is the best scenario obviously, as you avoid surgery and get your life back. At this point, it is prudent to avoid activity that risks re-injury (heavy lifting while turning torso) and do everything you can to strengthen your core muscles and spinal muscles to guard against re-injury. Functional exercises should be emphasized, for this purpose.

The thing that can dramatically increase the chances of full recovery without surgery is healing your insides– reduce systemic inflammation by getting down to a healthy weight and maintaining it; stop smoking, avoid alcohol as best you can, reduce stress, reduce insulin levels, maintain normal blood glucose levels, ensure that your gut micro flora is in balance, and get adequate sleep every day. Eat healthy, decrease your portions, and drink enough water to stay hydrated throughout the day. Exercise consistently, 20-40 minutes each time. This is what a healthy lifestyle routine is made of.

People who are in pain usually are concerned about knocking down the pain first, and ignore the health of the rest of their body. Remember, your entire body is essentially a colony of specialized cells that are interconnected via the bloodstream, nerves, and hormones. When one area is injured, the rest can come to its aid.

If you suffer from disc herniations, joint pain or other musculoskeletal form of pain and are overweight, pay more attention to getting yourself healthy inside; it’s the often ignored self-help method to treat pain.

How Insufficient Sleep Can Increase Your Pain

by Pain Doc | Aug 21, 2013 | Uncategorized

If you are suffering from pain, insufficient sleep can delay your recovery and even make your pain worse.

Eight-nine hours of sleep is considered ideal for most adults. Anything less than this, especially if your body is already compromised with obesity, diabetes, heart disease, high blood pressure, arthritis, or other systemic disease will make matters worse.

Insufficient sleep raises cortisol levels. Cortisol is the hormone secreted by your adrenal glands (above kidneys) and is involved in a number of physiological functions including stress response, mood, and metabolism. When cortisol levels remain abnormally high, it drives blood glucose levels up and suppresses insulin sensitivity of cells prolonging the high glucose levels. This is how sleep deprivation promotes obesity.

Insufficient sleep also abnormally lowers the satiety hormone leptin and raises the hunger hormone ghrelin. This combination leads to overeating. In one study involving rats, sleep deprivation delayed healing of burn injuries in the sleep-deprived rats.

But perhaps the most dangerous thing sleep deprivation can cause is increased systemic inflammation. Inflammation is your body’s way of quarantining an injury site and healing injured tissue. But if it is ongoing and present throughout the body in small amounts, it can damage blood vessels, nerves and other tissues.

On June 22, 2002, researchers at the annual meeting of the Endocrine Society held in San Francisco reported that sleep deprivation markedly increases inflammatory cytokines. This finding helps explain why pain flare-up occurs in response to lack of sleep in a variety of disorders. According to the researchers, even modest sleep restriction adversely affects hormone and cytokine levels. In a carefully controlled study, sleep deprivation caused a 40% to 60% average increase in the inflammatory marker IL-6 in men and women, while men alone showed a 20% to 30% increase in TNF-a. Both IL-6 and TNF are potent pro-inflammatory cytokines that induce systemic inflammation (Vgontzas et al. 1999; Vgontzas et al. 2001).

Interleukin-6, Tumor necrosing factor alpha, and C-reactive protein– these are the inflammatory markers that can be measured by a blood test. Get yours checked if you haven’t done so. Studies show that high levels are associated with heart disease, diabetes, stroke and early death. TNF-a especially attacks cartilage and bone and is found in high quantities in persons suffering from arthritis.

Life Extension provides the following nutritional interventions that one can use to counteract systemic inflammation:

The docosahexaenoic acid (DHA) fraction of fish oil may be the most effective nonprescription nutrient to suppress pro-inflammatory cytokines (it’s best to get concentrated EPA-DHA fish oil for this purpose).
Gamma-linolenic acid (GLA) is a precursor of PGE1, a potent anti-inflammatory agent.
DHEA is a hormone that decreases with age. DHEA has been shown to suppress IL-6, an inflammatory cytokine that often increases as people age. Typical doses of DHEA are 25-50 mg daily, although some people take 100 mg daily.
Nettle leaf has been shown to suppress the pro-inflammatory cytokine TNF-a. Take 1000 mg daily.
Vitamin E and N-acetyl-cysteine (NAC) are protective antioxidants with anti-inflammatory properties. Vitamin E that contains gamma-tocopherol and tocotrienols provides the most broad-spectrum protection. NAC is an amino acid with antiviral and liver protectant properties. Six hundred milligrams daily is recommended.
Vitamin K helps reduce levels of IL-6, a pro-inflammatory messenger. Vitamin K also helps in the treatment of osteoporosis by regulating calcium and promoting bone calcification. If you are taking Coumadin or other anticoagulant medicine, consult your physician before taking vitamin K.
Consuming at least 1000 mg per day of carnosine and/or 300 mg of the European drug aminoguanidine can inhibit pathological glycation reactions in the body.

Also, avoid eating foods that are cooked at high temperatures, as they tend to form advanced glycated end-products, or AGE. These are basically denatured proteins that can accumulate in your tissues and promote inflammation. Food that this pertains to are deep fried foods, junk foods/ chips cooked at high temperature, and charred foods from barbecuing.

Back to the point– make sure you get at least eight hours of sleep daily, especially if you suffer from back pain, neck pain, herniated discs, and post-surgical pain. Insufficient sleep can interfere with healing by raising inflammatory cytokines in your bloodstream, which may also increase pain levels.

If you have difficulty sleeping, here are some suggestions:

Avoid watching and reading emotional content (news on TV, newspaper, internet, emails). Better yet, unplug everything electronic 2-3 hours before bedtime.
Take a walk in nature frequently where there is no noise pollution
If you’re hungry around bed time, avoid eating anything with carbs or sugar; stick with protein (whey smoothie, plain Greek yogurt, boiled egg).
Read a book or listen to relaxing music.
Practice deep breathing and meditating
Do high intensity interval training 3-4 hours before bed time
Practice present-time consciousness (turn off stray thoughts, focus on the present moment)
If you have trouble sleeping, keep your eyes open and let yourself get drowsy
Make sure your room is completely dark, with no ambient light entering; make sure you have fresh air ventilating through
Move all electrical devices (alarm clock, cell phone, etc.) far away from your head
If you always have to get up to go to the bathroom, avoid drinking water 2 hours before bed (drink an adequate amount before then to get hydrated).
Try listening to hypnosis sleep recordings

That’s it, happy dreams and less pain!

Muscle Atrophy from Kenalog (Cortisone) Injection

by Pain Doc | Aug 10, 2013 | Uncategorized

If you are considering getting a cortisone shot for pain or allergies, I highly recommend that you do your due diligence in researching the safety of cortisone injections before you do it.

What exactly is cortisone? It is a type of corticosteroid. Corticosteroids are a class of chemicals naturally produced in the adrenal cortex (adrenal glands above the kidneys) that are used to regulate multiple body functions. The cortisone in cortisone shots are analogues (molecularly identical) of these hormones that are synthesized in laboratories.

According to Medicinenet,

Corticosteroids can be taken by mouth, inhaled, applied to the skin, given intravenously (into a vein), or injected into the tissues of the body. Examples of corticosteroids include prednisone and prednisolone (given by mouth), methylprednisolone sodium succinate injection (Solu-Medrol) (given intravenously), as well as triamcinolone, Kenalog, Celestone, methylprednisolone (Depo-Medrol), and others (given by injection into body tissues).

Corticosteroids affect a number of physiological responses including inflammation modulation, immune response, carbohydrate metabolism, protein catabolism (breakdown), stress response, immune response, and behavior/mood.

Cortisone shots for pain reduction have powerful anti-inflammatory capabilities, which is why they are a popular with orthopedic doctors in the treatment of injuries and joint pain. Cortisone shots, when they work, act almost instantaneously. They reduce pain by reducing the inflammatory response around the localized injection. Cortisone shots also usually include an anesthetic drug such as lidocaine.

Side effects can include redness and temporary increase in pain, and dermatological effects like skin discoloration (especially in dark-pigmented patients).

Severe side effects from prolonged steroid use or large doses can include hyperglycemia, insulin resistance, diabetes mellitus, osteoporosis, cataract, anxiety depression, colitis, hypertension, seizures, fainting, peptic ulcers, erectile dysfunction, hypogonadism, hypothyroidism, increased menses, and retinal damage.

Kenalog (Triamcinolone) is a type of corticosteroid that is used to treat inflammation; particularly inflammatory skin diseases like lupus; allergies, rhinitis, and bronchospasm. It is known to cause plenty of undesirable side effects especially dimpling/pitting at the injection site. Women especially are known to get terrible side effects from Kenalog injections, notably prolonged/ painful menstrual cycles.

Previously I related a personal experience where, due to the urgency of the situation, I decided to get a cortisone shot for severe neck pain and spasm (which I found out later was hyperkalemic muscle paralysis and did not involve inflammation). I had three Kenalog injections along my left upper trapezius muscle, about a 5 mL dose. Normally I avoid taking medications and injections for pain as much as possible, but I was scheduled to drive a 400 mile trip the next day and needed immediate relief.

Well, it turned out to be a very bad experience. The shot atrophied the muscle, and now I am unable to raise it above shoulder level from the side. The doctors I consulted with were uncertain of the long term prognosis. I was advised to get physical therapy (which I have been doing myself) to encourage the muscle to regain its functionality. However, it doesn’t appear to be changing. An ominous fact I learned during my research of corticosteroids is that protein catabolism (breakdown of protein into its amino acids components) is one of the functions of natural corticosteroids. Could it be that the Kenalog shot “dissolved” some muscle tissue? I certainly hope that is not the case. If it were, it is not possible to rebuild that muscle tissue through weight lifting, as muscle hypertrophy from weight lifting works for existing muscle tissue only.

The experience was so bothersome that I decided to make a case study out of it for readers of this blog, and hopefully save someone from going through this awful experience. Before you get a Kenalog injection, make sure you know what you are getting into. My advice, skip it— the problems it causes appear to outweigh the benefits (see this internet message board on muscle atrophy from Kenalog injection). Instead, try less invasive procedures appropriate for your condition such as massage, chiropractic, acupuncture/cupping, botanicals/herbs, laser treatment, ultrasound, traditional Chinese medicine, gluten-free diet, ketogenic diet, fasting, juicing, and detox/cleanses.