DISC HERNIATION: Is there life after a disc injury?

The answer, almost always, is YES.

As some of you may know, I ruptured a disc in my lower back when I was 13 years old.  We were playing a running & dodging game at recess, and after a quick cut to the side, my back and legs suddenly seemed to stop working and I hit the ground.

Many years later I saw x-rays of my lumbar spine, and it became clear what had happened back then on the playground: I had damaged my 2nd lumbar disc.

The evidence was easy to see.  My entire lumbar spine looked great, except for L2.  That disc was dramatically thinner than the rest of them, the vertebrae above & below were thickened and misshapen, and there were large, hooked bone spurs (osteophytes) surrounding that joint.

Your spine is made up of 24 bony vertebrae, and in between each of them is a disc.  The discs perform 3 functions:

1. They act as ligaments, by holding the vertebrae and spine together.
2. They act as shock-absorbers, by carrying the downward weight (axial load) of your body while you're upright.
3. They act as pivot points, allowing the spine to bend, flex and rotate.

The disc itself is designed like a jelly danish.  The outer rim (annulus) is tough and fibrous, while the   "jelly" center (nucleus pulposis) is about the consistency of toothpaste.  It's when the nucleus starts to protrude through the layers of the annulus that problems start.

When a damaged disc bulges outward, the "bubble" can compress or irritate spinal nerve roots, which can cause the numbness, radiation pain, weakness and tingling associated with disc injury.  This most commonly happens in the cervical or lumbar spine.

The good news is, most disc injuries (even old ones) can be dramatically improved without surgery.  Don't get me wrong -- we can't replace damaged disc material, or remove osteophytes.

But what we CAN do is rebuild the muscular support system around the damaged joint, training it to take over the job of the disc.  Functional rehabiitation, McKenzie exercises, core stabilization, joint mobilization and flexibility training can all help make your disc injury a non-issue.  Even more importantly, good spinal maintenance can help keep your pain from coming back.

If you're in pain, don't despair --  for the huge majority of our patients, there IS life after a disc injury.  Come see me and we can figure out the right treatment for you.

-Daniel Bockmann, DC

To learn more about herniated discs, click here: http://www.nlm.nih.gov/medlineplus/herniateddisk.html

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JOINT PAIN: Should I give it some time, or go see a doctor?

This is a VERY common question, and a good one.  We've all had "aches & pains" before, and most of the time they go away on their own, without any special treatment or doctor visits.

But how do you know when giving it some time might actually be making it worse?  Here are some good general rules.

When to call 911:

1. Bleeding
2. Exposed bone or tendon

When to seek immediate medical attention:

1. Joint deformity (it "doesn't look right")
2. Inability to use the joint (it won't bend, bear weight, etc.)
3. Intense pain (enough to make you "wince", limp, etc.)
4. Sudden swelling (ever sprained your ankle?)
5. "Weird" symptoms (numbness, tingling, "doesn't feel right")

When it's okay to wait:

1. Pain only happens once
2. Joint moves normally
3. All symptoms are mild (feels "stiff, sore or achey")
4. Moving the joint actually relieves symptoms
5. Symptoms improve quickly

NOTE: If your pain starts happening more often, is more severe each time you get it, or takes longer to go away, see a doctor!  You could be doing additional damage.

And if you're unsure whether or not you should get help, DO.  It's always better to get it and not need it, than to need it and not get it.

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BODY MASS INDEX: Why your BMI may be lying to you

My BMI says I'm fat.  That's right.  My BMI is 25.7, which is well into the "OVERWEIGHT"  category.  And can you guess why?  It's because the Body Mass Index is literally a useless tool for measuring body fat.

And I'm not alone.  A Baylor study found that 1 out of 6 children who scored normal on the BMI actually had a high percentage of body fat.  And it found that 1 out of 4 children labeled as obese by the BMI actually had a normal percentage of body fat.

The problem?  It's too simple.  It tries to predict how much body fat you have, but only looks at your height and weight.  This would be like trying to predict how many people are in a building, but only looking at the dimensions of the building.  It's ridiculous.

But there is a much better solution.  Body composition testing.  If you want to get an accurate assessment of your body fat percentage, both skin fold caliper measurement and the Tanita scale will each give you quick & easy readings.  And both are a free service provided by most gyms.

Healthy body fat percentages, according to the American Council on Exercise:

• Men: 6-17% body fat
• Women: 14-24% body fat

And, staying within these ranges can dramatically reduce your risk of the following conditions:

1. Feeling miserable*
2. Dying young*

*( heart disease, stroke, high blood pressure, diabetes, cancer, gall bladder disease, gall stones, osteoarthritis, gout, sleep apnea and asthma)

So don't worry about your BMI.  Pay attention to your body fat percentage.  It's a much more accurate and helpful tool to help you get more out of life!

And if you don't know where to start, talk to a good personal trainer or fitness expert.  They can develop a do-able exercise and diet plan that works for you.

If you're not happy with where you're at, do something about it!  :)

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PROPRIOCEPTION TRAINING: Making joints "bulletproof"

Ever sprained your ankle?  Did you notice afterward that the ankle didn’t feel stable under you, that it sometimes “gave way”, even after it stopped hurting?  Maybe you found that you kept spraining the same ankle, over and over, throughout your life.

Here’s why.

When you sprained your ankle, you also damaged its ability to protect itself.  This protection system is called proprioception (or kinesthetic awareness).  Proprioception is how your body “knows” where your limbs are, without looking.

By sensing your ankle’s exact position at all times, your brain coordinates the muscles around the ankle to make sure that the joint is always “snugged-up” and secure – never slack.  A joint without muscular support, even for an instant, is highly susceptible to injury.  (This is true for ALL joints – not just ankles).

This “awareness” of joint position is accomplished by thousands of small receptors in muscles & joints, all over your body.  These receptors keep track of how much tension is on a muscle, how fast the muscle is moving, and what position the joint is in.

If your proprioceptive system is damaged (like in a sprain), it may start to give your brain the wrong information about your joints.  Your brain becomes confused about what position your limbs are in, and can no longer coordinate safe movement.

Translation: your ankle feels wobbly & unstable.  And then you may sprain the ankle again.

But, here’s the good news: Proprioception is learnable. 

In fact, we use proprioceptive training in all of our rehab programs.  If you’ve been a patient of ours, you know what I’m talking about.  Proprioceptive exercises are complex, controlled movements that very often involve a balance challenge.  Although we use these exercises to help heal injured tissue during rehab, incorporating these same exercises into your own personal workout program can act as powerful protection for your joints.  Almost like surrounding your joints with Kevlar.

If you keep injuring the same joint over and over again, don't let it keep happening -- TAKE ACTION.  Each new injury may be further weakening the joint and leaving you susceptible to bigger and bigger injuries.  We can help you rebuild your "built-in" joint support system so you can start healing and get back to your life.

And then, most importantly, teach you how to stay healthy by "bulletproofing" your own joints.  It's easier than you might think!

-Daniel Bockmann, DC

To read research on how proprioceptive training prevents ACL injury, click here: http://ajs.sagepub.com/content/33/7/1003.abstract

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LAMINECTOMY WITH FUSION: What can happen if you don't take care of your back

As a chiropractor and a rehab guy, I observe surgeries every chance I get.  This morning I got to scrub in with one of Austin's top neurosurgery teams, Drs. Mark Burnett and Kitt Fox of Neuro Texas Institute, as they performed an enormously complicated triple lumbar laminectomy with fusion.

Since it is tremendously invasive, risky and has long recovery times (9+ months), this procedure is basically a last resort for someone with advanced spinal degeneration.  Most of the back side of the spine is removed, including the lamina, pars and facet joints, which relieves pressure from the spinal cord and nerves.  Then titanium brackets are drilled into the spine across several vertebral levels, effectively "bolting" them all together.  These joints will never move again, but this is necessary to support the spine after much of it has been removed.

Over breakfast Dr. Burnett told me something that each of you should know.  He said that this patient's lower back problem was in fact "a whole-body problem". 

Here's what he meant.

This patient was diabetic, overweight and sedentary.  His progressively worsening lower back pain, numbness, weakness and eventual inability to walk was most likely avoidable.  This surgery was most likely avoidable.

Which means, you get to CHOOSE whether you'll ever need a surgery like this.  Eating sensibly, exercising moderately and taking care of your spine can MASSIVELY reduce your risks of permanent disability, chronic pain or even death on the operating table.

If you feel like you have a "whole-body problem" and would like to fix it, come see me.  Like I always say, 

• "It's easier to keep you healthy than it is to fix you when you're broken."

Taking care of yourself is an investment, but the payoff is BIG.  What will YOU choose?

-Daniel Bockmann, DC

To read more about the procedure I watched this morning, click here: http://www.webmd.com/back-pain/decompressive-laminectomy-for-spinal-stenosis

To learn about Dr. Mark Burnett and his team, click here: http://www.neurotexasinstitute.com/OurDoctors/neurosurgery/dr-mark-burnett.aspx

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NO PAIN, NO GAIN: Fact or fiction?

We’ve all heard this expression.  But is it true?

This motto was first aired in 1982, when actress Jane Fonda produced a series of workout videos (you know the ones!), in which she used phrases like “No pain, no gain,” and “Feel the burn” to encourage her fat-burning viewers to work harder during exercise.  And it’s still used today.  Thousands of personal trainers repeat this mantra to their clients daily, reminding them that there is no meaningful reward without sacrifice.

There’s only one problem. Pushing yourself through pain can actually be dangerous.

Here’s a quick example.  A young woman came in to our office with pain in her right hip.  She had been training to run a marathon, and her speed and endurance were improving nicely.  Out of the blue, her hip started hurting when she ran – even during the first few steps.  The pain progressively worsened, eventually preventing her from running at all.

Her doctor had told her that she had a tendonitis in her hip, and said she should be fine after a little stretching, rest & ice.  That didn’t seem to help.

After performing an exam & x-ray of her hip, i suspected a stress fracture.  An MRI confirmed this.  Less than two months of rehab later, we had her running again, and her hip was healthy.

Here’s the take-home point.  If this young woman had followed the “No pain, no gain” theory and continued to run, she could have developed avascular necrosis (AVN) of the hip, which could lead to a catastrophic fracture of the hip, and then required her to have a total hip replacement surgery.  Not a very pleasant experience.

In fact, joint pain is never normal.  Pain is like the red light on your dashboard, telling you when something is going wrong & needs attention.  If your engine was overheating, would you keep on driving?  Would stomping on the accelerator solve the problem?

We have a simple pain rule for our patients, called the “wincing” rule.  Following this rule can help you avoid injury during exercise or everyday life.  Here’s how it works:

The "Wincing" Rule
During any activity, if you have enough pain to make you "wince" (like the guy in the picture!), that means you may be doing actual damage to yourself.  Immediately stop what you're doing and see if your pain subsides.  If it does, resume your activity but at a lower intensity that allows you to work comfortably.  If you're running, for example, try running at a slower speed, or a shorter distance, or on flat ground instead of an incline.  Anything lower than a wincing  level of pain is generally okay to work through -- like an exercise "burn", or stiffness, tightness or soreness.

And, if you find yourself having to modify or eliminate activities on a regular basis, it’s time for you to come see me or another qualified health professional.  Pain that occurs routinely, or pain that becomes more frequent or severe, is a sign that some underlying problem needs to be corrected.  And with many conditions, the sooner you get the proper treatment, the easier it is to correct.

In summary, pain high enough to make you wince means STOP.  Pain levels below that are generally okay to work through.  And remember: Your body is pretty good about telling you what it likes and doesn't like.  Listen to it!

-Daniel Bockmann, DC

To see a list of the causes of joint pain, click here: http://www.mayoclinic.com/health/joint-pain/MY00187/DSECTION=causes

To learn more about avascular necrosis of the hip, click here: http://www.mayoclinic.com/health/avascular-necrosis/DS00650

chiropractor-austin-tx

BAREFOOT-STYLE RUNNING: How to make the switch without hurting yourself

So you've decided to change from your usual heel-pounding stride to the super-smooth barefoot-style stride.  You already know that BF style runners experience 7 times less impact than the heel-strikers.  You know that research suggests that landing on your forefoot can help you avoid repetitive stress injuries like runner's knee, stress fractures, plantar fasciitis and Achilles tendonitis. You know that BF style running requires less effort than traditional style because it is more efficient.

And you've had your eye on the sexy new Minimus trail runner from New Balance -- perfect for your new running style.

Making the switch can be a smooth & easy transition, or it can be grueling & painful.  Here's how to do it the easy way.

1. Build up slowly!  BF style running requires you to use muscles in your feet that are probably very weak, even though you may be an experienced runner.  Respect that.  For the first week, run no more than a quarter-mile to 1 mile every other day in BF style, then complete the remainder of your run in your usual style.  After a week, increase your BF style distance by a half-mile at a time.
2. Listen to your body!  Mild to moderate muscle aches are fine to push through, but a "wincing" level of pain means you may be doing damage.  Dial back your training until it diminishes, then resume at a comfortable intensity.  If you're limping due to calf soreness, that means you overdid it!  Persistant or increasing pain?  Stop training and come see me.  We'll get you back on track.
3. Continue with your usual mileage.  If you're a regular runner, understand that transitioning to BF style does NOT mean you have to decrease mileage.  Simply start each run in BF style, and finish in your usual style.  After several weeks (or months even) you'll be using BF style exclusively.
4. Less shoe is MORE.  So-called "minimalist" running shoes let your feet move more freely in BF style running, and there are a whole fleet of new ones coming out.  "Test drive" a couple, then pick one that feels the most natural and comfortable as you run in your new style.  (I wear the Nike Free, but I'm excited to try the New Balance Minimus!)

The main thing to remember is PATIENCE.  By switching to BF style you're now asking your calf muscles to do something they virtually never do: DECELERATE you. In traditional heel-strike running, your calf's only job is to ACCELERATE you forward by pushing off.  In BF style your calf now acts as a shock absorber, soaking up the impact of each landing.  And while BF style drastically reduces that impact, deceleration (or eccentric contraction) is a completely new job for your calves, so you have to work up to it.

Make the switch to BF style.  A safe transition means you'll soon be running softly & silently -- no more "pounding the pavement"!

Post your progress!

-Daniel Bockmann, DC

For more info on safe transitions to BF running, click here: http://www.barefootrunning.fas.harvard.edu/5BarefootRunning&TrainingTips.html

To check out the latest "light as air" minimalist running shoes, click here: http://www.barefootfootwear.com/

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