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Can plunging one’s entire body into a freezing chamber reduce muscle pain? For the professional athletes and celebrities who have made cryotherapy so popular, the answer is yes. If the media coverage is any indication, extreme cold is very hot.

Many athletes, movie stars and other opinion leaders have publicly extolled the benefits of Whole Body Cryotherapy (WBC) for losing weight, reducing pain, improving athletic performance, slowing aging and improving sleep. However, this relatively new treatment has not been vetted by any reputable medical organization and has had some tragic consequences for at least one young lady.

According to an article in Forbes magazine, “the recent death of 24-year old Chelsea Patricia Ake-Salvacion during a cryotherapy treatment has brought some increased scrutiny on a practice that has been growing in use worldwide.” To find out just how effective cryotherapy is in reducing back pain, Dr. Nayan Patel of Texas Back Institute was asked for his opinion on the extreme version of ice packs on a hurting back. Keep reading to get his thoughts.

Cold Therapy Has a Long History for Pain Relief

As they say, there’s nothing new under the sun. The Forbes article notes “The most long-standing and common form of ‘cryotherapy’ is the application of ice or cold packs to injuries to cause blood vessels to constrict, which reduces blood flow and alleviates pain, swelling and inflammation. While there is still some debate over the longer-term effects on healing, such localized (i.e., applied to specific part of the body) ‘cryotherapy’ certainly seems to have clear short-term benefits and has long been standard practice among health professionals.”

The article points to another type of localized cryotherapy that is often called “cryosurgery.” This is the use of very cold substances such as liquid nitrogen to freeze and remove lesions such as skin tags, moles and prostate cancer.

The new twist to this old idea involves the “whole body cryotherapy.” This involves the exposure of the entire body to subzero temperatures (below 200 degrees Fahrenheit) for about 3 minutes. The participant stands in a form of closet, wearing minimal clothing while being bathed in liquid nitrogen or refrigerated air.

The WBC began in Japan in the latter half of the 1970s and Japanese rheumatologist Toshima Yamaguchi is given credit for developing the process. From its start in Japan WBC has spread worldwide and is one of the fastest growing procedures in sports medicine.

It May be Quirky Enough to be Popular, but is it Good Medicine?

The spine specialists at Texas Back Institute treat hundreds of patients every week and many are suffering from back pain caused by either overuse or injury. Dr. Nayan Patel is one of these physicians and he has thoughts about the use of whole-body cryotherapy for pain treatment.

“Cold treatment can speed recovery,” he noted. “For example, ice can cause a restriction of blood flow to an injury that can prevent swelling and potentially inflammation.”

However, there is a risk in this type of extreme cold therapy. Dr. Patel explains.

“Just like when one is exposed to any cold temperature, you can develop freeze burns in the area of the skin exposed. This can lead to damage to the skin surface area.”

In terms of the time of this exposure, is there a limit in order to avoid this skin damage?

“When I instruct my patients, who are using traditional ice therapy, I tell them to limit the exposure to no more than 15 minutes,” he said. “Also, I ask that they do not repeat this treatment for at least two hours. Too much exposure to the cold can cause this ‘freeze burn’ which is the result of the lack of blood flow to the area.”

Why Does Cold Therapy Speed Healing?

“When we get an injury, whether it is a knee, ankle or back, the body sends more blood to that area,” Dr. Patel noted. Unfortunately, that increased blood flow causes swelling, encouraging all of these inflammatory cells to come into that area.  Over the longer term, this swelling causes restrictions of the joints and muscles, keeping the patient from getting up and moving again.”

“When someone has an injury, his or her physician will tell them to elevate it if it is a limb and you need to ice it so that the blood flow is somewhat restricted, reducing the inflammation.”

There has always been confusion about when it is appropriate to use cold and when to use heat. Dr. Patel explains the correct treatment.

“What I recommend in the first 72-hours of an acute back strain is to use ice. Do not use heat. This is because heat increases blood flow and ice restricts it to reduce swelling.”

“Eventually, the swelling comes down and the muscles get stiff,” he noted. “This is where you want to begin alternating heat and ice treatment over the next 3 to 4 days.”

But Does Cryotherapy Work?

According to the research and media coverage such as the Forbes article noted above, there is little scientific evidence to support many of the claims made by the owners of cryotherapy chambers. For example, there is no credible research to support its value as a weight loss procedure.

According to Forbes, “Health professionals have used WBC to relieve pain and inflammation from conditions such as arthritis, fibromyalgia, ankylosing spondylitis, and injuries. However, a recently published systematic review of the literature did not find compelling scientific evidence that WBC is effective in preventing and treating muscle soreness after exercise in adults. Without nearly enough scientific evidence, the U.S. Food and Drug Administration (FDA) has not yet approved WBC as a medical treatment.

A Bag of Ice is Just Easier

Dr. Patel has never used whole-body cryotherapy for himself or his patients. Why?

“It’s just much easier for a patient to grab a bag of ice out of the freezer than to track down a cryotherapy chamber,” he said.

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During the past century, the dramatic increase in the average lifespan has been remarkable. The National Institute on Aging (NIA) notes, “Although most babies born in 1900 did not live past age 50, life expectancy at birth now exceeds 83 years in Japan—the current leader—and is at least 81 years in several other countries.”

This increased human longevity, called “society’s greatest achievement” by the NIA, has created situations that previous generations have not had to deal with. The demographers who study trends in health care, employment, and myriad other areas are working in uncharted territories and so are the physicians.

Gerontologists, the medical practitioners who treat older patients, are witnessing great increases in the physical capacities of people who are actively pursuing life while in their 60s, 70s, and 80s! These older patients want to be strong and healthy, despite their age, and for many, this means building strength and muscle mass.

A 70-Year-Old Power Lifter

Instead of puttering around the garden or playing cards with his buddies at the golf course, Jim Yakubovsky, a 70-year-old former coach from Arlington, Texas, spends every other day in the gym pumping iron. Jim is a part of the new paradigm of people who are continuing to stay active as they age.

“I have lifted weights competitively for 30 years,” Jim said. “Due to some injuries, I have just recently retired from competition.”

As it turns out, Jim’s passion for building his body is exactly the right thing for him to be doing at his age. A non-weight training accident several years ago had him consulting with Dr. Michael Duffy of Texas Back Institute who subsequently performed a vertebra fusion operation. The operation was successful, and after recuperation, Dr. Duffy encouraged Jim to continue his weightlifting regimen. Dr. Duffy explained why.

“As we age, our muscle mass is on the decline and our basal metabolism also is lowered. This causes the body to store energy in the form of fat. In order to boost the basal metabolic rate, weight training can build muscle, which burns calories even well after the weight training sessions.

“By building muscle and maintaining a healthy weight, our bodies have the optimum situation to function and fight disease. Weight training can also help build stronger bone mass, which prevents the onset of osteoporosis.

A Strategy for Strength

There a difference of opinion as to the value of weight training for older people, but Jim Yakubovsky knows what works best for his body.

“You have to have a balance between your weight training and your aerobic work,” he said. “It is also important to include core exercises, especially if you are older than 60. Bone density is increased with resistive weightlifting. While it’s not necessary to lift 500 or 600 (cumulative) pounds during a session, if you are consistently adding weight to your session, you will have stronger bones.”

There are also differences in training for someone Jim’s age as opposed to a younger lifter. He explains.

“After you reach 60, you begin to lose muscle fiber. However, you can continue to add muscle mass and strength. My power numbers were actually better when I was 62 than when I started at age 40. I believe this was due to better training as I learned more about my body.

“In the past year, I have been doing more reps with lighter weight. From time to time, I increase the weight when I feel that it’s getting too easy to lift. The rule-of-thumb is to do fewer reps with heavier weight to build greater muscle mass. If the goal is to lose weight or maintain current size, it is best to do more reps with lighter weight.”

Listen to Your Body

“As you get older, you really must listen to your body,” Jim said. “And you need to know the difference between injury and soreness. As I have gotten older, I have found that my recovery time is longer. Weight training tears the muscles down, and it is critical to have the time for the body to recover. It is during this recovery period when the growth of muscle mass can occur.

“My standard schedule now that I am older is to take two days to recover after a workout. If I work my legs on Monday, I will work my arms and shoulders on Wednesday and my back work on Friday. However, every day I am in the gym I do core work. If someone wants stronger muscles, they must have a strong core. This can be accomplished by doing planksusing lighter weight kettlebells and doing crunchesAll are great for building core strength.”

Injuries can happen

“As we get older, we have to be smart about lifting in order to avoid injuries,” Jim said. “The weight should be gradually increased over time. You should be challenged with the weight, but overloading can lead to muscle strains and back injuries.

“I also believe older lifters should do a lot of stretching before and after a workout, and one of my favorite cool down exercises is getting on the rowing machine for about 15 minutes. This helps my back, shoulders, and legs.

“Under any circumstances, no one needs to look like they are 90 when they are only 70! All it takes is regularly working out.”

Is This the New Normal?

Jim Yakubovsky is the poster child for a healthy, active older person. He’s in better shape than many people who are half his age, and he loves life. Dr. Duffy has watched Jim over many years and had a final comment about whether others can maintain this type of lifestyle when they reach 70 and older.

“Each person starts with a set of genes or DNA, which obviously we cannot change,” he said. “Some people’s DNA profiles have higher ability to build and maintain muscle, whereas other people do not. I believe Jim has good genetics for building muscle, and he also puts in the time and effort over the years. Anyone can build muscle at any age, to a certain extent, but keeping it on depends on maintenance and diet!”


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#1 Degeneration of Discs and Bones Due to Wear and Tear

Gradual wear and tear may cause pain in the neck. The vertebrae and discs in the neck will wear down with age and, as they degenerate, someone may experience chronic, or persistent, pain in the neck.

“This is part of the natural process of aging,” Dr. Kosztowski said. “In some of us, the degeneration is quicker than others. This can be due to the type of work we do, our lifestyle, posture, and genetics.

“As we get older, the discs become shorter and they sometimes bulge, causing wear and tear on the joints. The ultimate result can be a narrowing of the spinal canal or damage to the nerves. In most cases, the pain resulting from this degeneration can be resolved with non-surgical measures, such as physical therapy. In more serious cases, surgery could be an option. Cervical (neck) surgery has progressed to the point where consistently good outcomes are possible.”

#2 Improper Sleeping Positions

The sleeping position, the number of pillows that are used and the firmness of the mattress can all affect how one feels upon waking in the morning.

“Improper sleeping positions are a huge component of neck pain,” Dr. Kosztowski said. “Sleep is something that many people don’t pay a great deal of attention to, but it has a tremendous impact on neck pain.

“It is very important to have a good sleeping position and a good bed and pillows. For example, a worn pillow can put the neck in a tilted position that can cause muscle strain. In many cases, it is recommended that patients who present with neck pain try sleeping on their side, with their neck in a neutral position. This will usually help.”

#3 Poor Posture and Text Neck   

In many cases, neck pain is the result of poor posture when sitting or walking. It can also result from constant mobile phone use, sometimes referred to as text neck, and long hours in front of a computer screen.

“This is something that we are all guilty of,” Dr. Kosztowski said. “And that includes spine surgeons! Bad posture has a tremendous impact on spinal pathologies of the neck and spine, and can aggravate any existing symptoms.

“Patients who are experiencing neck pain from poor posture will feel a muscle ache, rather than a sharp pain. It will likely feel like a ‘burning’ sensation at the base of the neck. The best way to stop this type of pain is to be conscious of better posture.

“This condition can be more serious if the patient is experiencing weakness in the arms and legs or a numbness and tingling in the arms. Another symptom that suggests something more serious is a lack of dexterity in the hands.”

#4 Stress and Anxiety 

Daily stress may cause the muscles of the neck to tighten, and pain can result from the excess strain.

“Psychological factors have a great impact on the way in which we perceive pain,” Dr. Kosztowski said. “Stressful situations also make us focus on pain more, which intensifies it.

“While it is easier said than done, stress management is extremely important for the alleviation of neck pain. In my case, I enjoy staying fit, and I try to channel my stress into physical fitness activities. Everyone is different, but finding some kind of coping strategy for handling stress is really important.”

#5 Sudden-Onset or Acute Torticollis 

Torticollis is a medical condition in which the head becomes twisted to one side. It can often be very painful to try and straighten the head after this occurs. While the cause of torticollis is not always known, doctors suspect that most cases are due to minor ligament or muscle sprains in the neck. Exposing the neck to cold temperatures for an extended period could also be a cause.

“This type of muscle strain can certainly result in pain, but it can also put the head in a position where the nerve roots are exposed and potentially damaged,” Dr. Kosztowski said. “This condition occurs in a large subset of the population.”

#6 Brachial Plexus Injury 

According to the American Society for Surgery of the Hand, the brachial plexus is a collection of nerves that connect the spinal cord in the neck to the hands. If these nerves are damaged, it may cause neck pain. Conversely, if an injury to the neck affects the brachial plexus, pain may also occur in the hand.

“There is a wide range of complexity with this condition,” Dr. Kosztowski said. “I have seen minor strains to the brachial plexus, which will eventually resolve on their own, as well as complete avulsions (tearing away) resulting from motorcycle accidents. In most cases, the injury is a strain and will resolve itself. However, in more severe cases, reconstructive surgery of the brachial plexus must occur.”

#7 Whiplash or a Sudden Jolt to the Neck 

Whiplash describes an injury to the neck where the head jolts forward and then back into place very quickly.

“In many cases, whiplash will resolve itself over time,” Dr. Kosztowski said. “This sudden jolt can result in a strain that causes damage to the soft tissues of the ligaments in the neck and, with therapy, these tissues can be repaired. Whiplash can also be severe, and result in a fracture of the cervical spine or nerve damage. If a person has had an accident or sports injury and the neck pain continues to worsen, seeing a spine specialist is advised.”

#8 Cervical Radiculopathy

Cervical radiculopathy, which is often referred to as a “pinched nerve,” occurs when irritation of the nerves originating in the spinal cord, in the neck, causes pain to radiate down the arm.

“Cervical radiculopathy is an impingement of the nerve roots,” Dr. Kosztowski said. “As the nerve roots are traveling down the spinal canal and then out into the body where they innervate (stimulate), they can get pinched up. This presents itself as a shooting pain down the arms and numbness or weakness in a region of the arm. The location of this numbness helps us determine which nerve is being pinched.”

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In a remarkable “sign of the times” for surgery, the Senhance robot recently became the first new robotic surgical system to receive FDA approval since 2000. According to an article in “Health Care Business,” during the procedure, “the surgeon sits in an ergonomically comfortable position and can see inside the patient’s body via 3D visualization. Senhance’s optical sensors enable them to move the camera and select commands by moving their eyes.”

This robotic, vision-directed surgery represents an exciting new horizon for all surgery, especially spinal procedures because it is minimally invasive. Dr. Isador Lieberman is a pioneer of robotic surgery and partner at Texas Back Institute. He remembers his first experience with this technology.

The Spine Robot

“About 18 years ago, I was challenged by the chairman of my department to come up with an idea for using robotics in spine surgery,” Dr. Lieberman said. “A philanthropic entity offered to make a matching grant to a university in Haifa, Israel on the application of robotics in spine surgery. The chairman of the department asked me to develop a proposal, which I completed and then promptly forgot about it! Several months later, I found that we had received a substantial grant to work on this robotics project, which got the nickname of ‘Einstein.’

“The real genius behind this work is professor Moshe Shoham from Technion University in Israel. I predict he will eventually win a Nobel Prize because of his brilliance. He is responsible for putting together most of the unique aspects of this surgical planning tool.

“This equipment marries a preoperative CT scan with intraoperative x-rays that accurately show the spine in a three-dimensional state. It enables the robot to place the spinal screws necessary for stabilization in the exact place where the surgeon planned on the CT scan. This has proven to be a remarkable advance.”

Planning for Spine Surgery

Dr. Lieberman uses this tool often.

“On a typical Sunday afternoon, after the Cowboys have won, I sit down and plan all of my surgeries for the coming week,” he said. “I consider questions such as where I need to reshape or remove bone and where the screws are going to be placed.”

“I save that plan and the next day take it to the operating room and then load it into the robot. It then does its registration, compared to the CT scan, and points me in the right direction as to where to place the screws. This increases the efficiency and accuracy of surgery.

“This tool is now being used all over the world. Plus, there are several other robots that are available to spine surgeons, as well. The one that I was involved with is one of three that are commercially available today.”

How Robotics Enable Minimally Invasive Surgery

In many ways, the “holy grail” of surgery – especially spine surgery – is a procedure that is “minimally invasive.”  Dr. Lieberman explains why.

“The concept of minimally invasive surgery involves minimizing the collateral tissue damage of surgery,” Dr. Lieberman said. “Our goal is to target the pathology in the most efficient and precise manner. Once the surgeon is working on the specific area, he or she is able to address this pathology and protect all of the other surrounding tissue. With less tissue damage, there is less likelihood of infection and other complications of surgery. The recovery time is also reduced.

“With the robot, I preplan the surgery in a virtual environment. I have the patient’s CT scan, and I can download this to my laptop. With this process, I know exactly where I need to make an incision and the exact size the screws should be and where the best bone is to attach them.”

“One of the misconceptions about surgical robotics is that the robot actually does the surgery, however, the surgeon is doing the surgery, and the robot is facilitating that preoperative planning and making it more accurate.”

Vision-Directed Robotic Surgery

The latest robotic procedure to be approved by the FDA has the unique advantage of the procedure being guided by the surgeon’s vision. While this seems revolutionary, in fact, the process has been used for many years in other medical applications.

“Today we are very privileged,” Dr. Lieberman said. “There is all this amazing technology available, and we are only limited by our imaginations. Our challenge is to decide on how we are going to use this technology.”

“Using vision-directed apparatus technology is not really a new concept. In the operating room, one could harness what the surgeon sees in multiple views. As his eyes move, an electrical signal can be tracked, and it can translate that into a signal for the robotic device to move. It is another step in this robotically directed procedure.”

What’s Next?

Dr. Lieberman is gifted with a very robust vision of the future of medicine. As such, it is always interesting to ask him what he sees in his “crystal ball” with regards to robotics and surgery.

“I get very excited about the medical advantages of this technology in remote surgery. I can envision being in Texas and operating on someone in Africa. It will require the correct surgical tools and multiple modalities – sight, remote control, sensory or touch apparatus – but the surgery can be completed over a vast distance and help patients who do not have this expertise available to them.”

“At the present time, we are using robotics for the placement of screws,” Dr. Lieberman said. “In spine surgery there is so much more that we can do – cutting bone, trimming away herniated discs, placing cages and other surgical tasks. All of these procedures can be done with robotics, and I’m sure that will be a reality in the next one to three years.”

“Even beyond that, the technology is going to be such that (potentially) I can be seated in a control room and have three or four surgeries going on simultaneously. This is because (in this hypothetical scenario) I have already planned the surgery and I know what I want to accomplish with the procedure. It is at this point that I become the conductor of an orchestra – controlling each of the musical (surgical) instruments from a remote position. The process of surgeons helping patients can be increased exponentially.”

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The study, published in “Health Services Research,” was designed to determine if physical therapy reduced overall health care costs and patient outlay related to back pain. This included the number of opioid prescriptions and advanced imaging tests like MRIs and CT scans, as well as hospitalizations and ER visits.

The research found out that patients who saw a physical therapist before trying other treatments had an 89 percent lower probability of eventually needing an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of making one or more ER visits. Overall, patients saw significantly lower out-of-pocket costs — on the average $500 — when they visited a physical therapist first.

“The researchers examined 150,000 insurance claims that had the diagnosis of low back pain,” Dr. Bhuva said. “The researchers separated the participants into two groups. The first group went to physical therapy at the start of their treatment and the other group did not. The second group may have gone to physical therapy later in their treatment, but physical therapy was not used when they first began treatment.

“The researchers looked at the healthcare costs of both groups and, the patients who started with physical therapy realized considerable savings over the long run of their treatment. The reason for this is due to the fact that pain medications such as opioids, imaging, and visits to the emergency room are very expensive for the patient.

“I like to tell my patients who are undergoing physical therapy that this process is an ‘investment’ in their health. They put in the hard work initially, but the ‘return’ on this investment is a saving of money later on.

“This study also noted that the overall costs for low back pain can reach $100 billion a year. While it was not covered in this research, those of us involved in the practice of rehabilitative medicine know that two-thirds of these costs result from lower employee productivity and lost wages. If we can get patients back to work quickly through the use of physical therapy, we can reduce that loss in productivity costs.”

The Practice of Physical Therapy Has Never Been Better 

“It is also important to note that the practice of physical therapy medicine has never been better than it is today,” Dr. Bhuva said. “Physical therapists are highly trained and they can treat lower lumbar conditions such as strains, disc herniation, chronic pain from arthritis, sacroiliac pain and mild to moderate spinal stenosis.

“Most physical therapy is very ‘hands-on,’ which means that it works on the soft tissues and muscles. It also strengthens the body’s core and this can help align joints. All of this patient treatment is done at a lower cost than having multiple MRI’s, injections or surgeries.”

Not All Spinal Conditions Can be Corrected by PT

“PT is not a ‘quick fix,’” Dr. Bhuva said. “It requires time and effort, usually two sessions per week over a period of six to eight weeks. There are also situations when physical therapy doesn’t help.

“Our standard procedure is to start a patient on physical therapy and if they get no relief from the pain, we use tools such as MRI’s to see if we are missing something. There are also ‘red flag’ signs like significant weakness, balance issues, bowel or bladder issues – these suggest spinal cord compressions and often require surgery. However, the percentage of patients that fall into this category is very low.”

Using Physical Therapy Instead of Opioids

One of the most controversial issues in healthcare today is the use of opioids for pain relief.

“As this study showed, those who get physical therapy from the beginning of their treatment have an 89 percent lower probability of needing an opioid prescription,” Dr. Bhuva said. “The ‘opioid epidemic’ is definitely a hot topic among practitioners and patients. Some studies have suggested that over 150 people a day die from opioid overdoses. Anything we can do to avoid starting patients on long-term pain medications is worthwhile and physical therapy is definitely a part of this strategy.

“Finally, I believe that physical therapy or injections prior to surgery is ‘pre-hab’ rather than just rehab. The science behind this suggests that the stronger a patient’s supporting structure are core muscles and the flexibility of the spine -the better the recovery will be. Physical therapy may not eliminate the need for any kind of pain medications, but it reduces the dosage of these medications.”

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Not all back pain is alike. Even though it may seem to be occurring in the same area of the body, understanding the type of back pain is more important for its treatment than knowing where it seems to emanate.

Such is the case with pain that will often start in the lower back and then quickly “shoot” through the buttocks and legs. To the patient experiencing this pain, it is back pain or, perhaps, leg pain. However, to a spine specialist, this could be sciatica, and this knowledge plays a huge role in relieving this pain.

“Sciatica is not really a disease or injury, but rather it is a symptom where the patient experiences pain down his leg,” noted Dr. Michael Hisey, a spine surgeon at Texas Back Institute. “The condition gets its name in association with the large sciatic nerve that runs along the legs and controls many of the muscles in the leg.

“To use an analogy, the sciatic nerve is like a large river with many smaller tributaries composed of the nerve roots. These all come together behind the gluteus muscle (located in the hip area), forming the sciatic nerve. The nerve emanates from the lower lumbar spine and passes through the buttocks, down the back of each leg, to the soles of the feet and the big toes.

“Unlike many other nerves, which are usually small, wispy tissues, the sciatic nerve is about the size of a human finger. Pain can occur when the sciatic nerve is compressed, most often in the nerve roots.”

Concerned about lower back or leg pain? Contact us to discuss your symptoms.

 What Causes This Compression?

People who suffer from acute or chronic back pain are more susceptible to sciatica. The risk for this condition increases in patients who smoke, are obese or spend a great deal of time in sedentary positions.

“The most common cause of this condition is a herniated disc in the back where a piece of disc impinges on the nerve,” Dr. Hisey said. “When this happens, the patient experiences pain everywhere the nerve travels. Since many of these nerves go down the back of the leg, the pain is perceived in a different area of the body than from where it starts. The patient may say, ‘I have pain in my leg,’ but the pain is, in fact, coming from an upper area of the spine where the nerve is compressed.”

A Test to Determine Sciatica

“There is a simple test to determine if the pain is due to nerve compression,” Dr. Hisey said. “When the patient bends forward from the waist and attempts to touch his toes, if a sharp, ‘electrical’ pain goes down the leg, this suggests a compressed nerve, and in most cases, it is associated with an injury to the back.

“There is also another, less common sciatic condition called piriformis syndrome. This involves a small muscle that goes along the back of the hip that connects the pelvis to the femur bone. It allows for the rotation of the hip. If that muscle becomes inflamed, thickens or becomes stiff, it can cause compression of the sciatic nerve.”

When Should a Patient Seek Medical Attention?

“Pain is the most common reason patients seek medical help for this condition,” Dr. Hisey said. “However, the more serious reason for concern is bodily dysfunction.

“For example, if the herniated disc is large enough to cause one’s leg to hurt, it may also be causing nerve damage. The symptoms for this nerve damage are a weakness in the same leg that hurts, numbness, and, in severe cases, problems with bowel or bladder control.

“If the nerve damage progresses to this point and it is not treated promptly and properly, it can become permanent fairly quickly. In some cases, particularly after the severe pain subsides, some patients attempt to ‘ride it out.’ This is a mistake because the damage could become permanent.”

Treatment for Sciatica

In most cases, the treatment for this condition does not require surgery.

“Fortunately, most patients do not have this severe damage,” Dr. Hisey said. “They have a pain problem, and this can be treated in non-invasive ways.

“Most of these patients improve over time with physical therapy or chiropractic treatment and medication. Eventually, the body will absorb any small pieces of the damaged disc, but this can take quite a long time.

“If there is serious nerve compression, we do what is necessary to reduce this. Usually, this involves surgical removal of a fragment of the disc that is causing the compression.”

Using Regenerative Medicine to Treat this Condition

Research is currently being conducted on behalf of the FDA at Texas Back Institute to test the viability of using regenerative medicine to correct spinal injuries. This includes sciatica. While not yet proven, some feel that stem cell therapy could be used to “patch the hole” in the damaged disc.

“This is what I call ‘hopeful’ therapy,” Dr. Hisey said. “Unfortunately, stem cell treatment is often marketed as a cure for damaged tissue by unscrupulous practitioners. Since this treatment is not covered by insurance, some clinics are making a great deal of money from cash-paying patients for treatment that is not yet proven to work.

“When it comes to ‘patching the hole’ in the disc with regenerated tissue, this is problematic. Using another analogy, think of these discs as radial tires, with strong fibers on the outside and air in the inside. If these fibers tear and they are repaired with glue, they are not going to be that strong in the future.

“While some spine specialists believe that back pain may be reduced with the regenerated tissue of the bones, a herniated disc that can cause sciatica is a different situation. The regenerated tissue could be weaker than the original tissue of the disc. The jury is still out on using stem cells for herniated discs.

“If a piece of the disc is putting pressure on the nerve, the primary medical objective is to take the pressure off the nerve by removing the damaged tissue.”

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Whether it is chronic or acute, pain affects the quality of life of millions of Americans every day. Pain varies in severity, based on its cause and other factors. It is felt when special nerves that detect tissue damage send signals to transmit information about the damage along the spinal cord to the brain. Literally, billions of dollars are spent each year by consumers who are trying to “interrupt” this signal with non-prescription, over-the-counter (OTC) medications.

The Consumer Healthcare Products Association estimates that more than 2.9 billion retail trips are made each year for OTC medications and the average U.S. household spends about $338 per year on these non-prescription drugs. Among the most popular of these OTC medications are those that are used to treat pain including Ibuprofen, such as Advil® and Motrin ®, and acetaminophens, such as Tylenol®.

Professional Athletes: Setting an Example

Some physicians believe that the popularity of Ibuprofen is being driven by professional and amateur athletes who use it. Dr. Craig Lankford of Texas Back Institute feels this presents a dangerous situation.

According to the Wall Street Journal, “Ibuprofen has long been popular among athletes not merely to treat pain but to ward it off. But several studies in recent years have highlighted potential side effects including an increased risk of heart attack or stroke, kidney and gastrointestinal problems and even lower male fertility.

“Some doctors and academics argue that the widespread, casual use of Ibuprofen to pre-empt pain is a problem to which most athletes are blind.”

An Expert Looks at Ibuprofen

Dr. Lankford specializes in physical medicine and rehabilitation. Many of his patients are unable to function properly because of unrelenting pain caused by conditions such as arthritis and injuries. His experience with OTC medicines makes him an excellent source of information about the advantages and dangers of these drugs.

“Ibuprofen is in a class of pain treatments that are nonsteroidal anti-inflammatory drugs,” Dr. Lankford said. “It is commonly used for treating inflammation in the back and joints, which is often caused by arthritis.

“Even though it is readily available and, in most cases, effective, Ibuprofen comes with many medical dangers. It can cause damage to the stomach in the form of bleeding or perforated ulcers. Plus, if the patient has kidney disease, taking too much Ibuprofen can cause permanent damage to this organ.

“Ibuprofen also has some of the properties of a medication called Vioxx ™. This medication was used about ten years ago and was a very powerful anti-inflammatory drug.”

According to numerous news reports, including one from National Public Radio, “Shortly before the FDA approved Vioxx in 1999, the drug’s maker launched a study it hoped would prove that Vioxx was superior to older painkillers because it caused fewer gastrointestinal problems. Instead, the study would eventually show Vioxx could be deadly, causing heart attacks and strokes. Five years after its launch, the drug was withdrawn from the market. But by that time, billions of dollars of the drug had been sold worldwide.”

“As a result of these problems,” Dr. Lankford said. “Medical researchers took a closer look at a broad range of anti-inflammatories, including Ibuprofen.”

How Much is Too Much?

If professional athletes are seen using Ibuprofen constantly, how does an amateur athlete know when he or she is taking too much of the medication?

“Reading the label is a good place to start for an answer to this question,” Dr. Lankford said. “The Ibuprofen that is sold over-the-counter is composed of 200 milligrams in each pill. The directions on the label advise that a person should take no more than one or two tablets every six hours. Following these directions can help keep the medication dosage in line with what would be considered a healthy use.

“We would prefer that the patient avoids taking that level of medication every day. I get concerned when my patients take three Ibuprofen tablets, four or five times a day. This is certainly too much medication.”

Alternative Pain Relievers

Is there something that works as well as ibuprofen without the side effects?

“An alternative to Ibuprofen is acetaminophen or Tylenol,” Dr. Lankford said. “This drug does not have the same stomach irritation, kidney damage and the potential for stroke or heart attack. However, Tylenol has the potential for causing liver damage. As a result of this, its manufacturer has changed the dosage recommendations for this drug.

“Once again this shows the importance of reading the label of every drug, even those that are sold over the counter.

“For a more holistic treatment of pain, there are supplements that do not require a prescription. Many of my patients have had success using the herb turmeric, which contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties.”

Can common foods such as bananas help reduce pain?

“As we come to realize the deleterious effects of these medications, patients are searching for natural alternatives, such as bananas,” Dr. Lankford said. “There has been some basic research on this fruit, which is known to be an excellent source of potassium, and it suggests that it has anti-inflammatory properties. Fish oil is another naturally occurring substance that has been suggested to have anti-inflammatory properties for arthritic pain.

“While they might not work for every patient, nature has many remedies that we can use for pain relief and additional research is needed to determine their efficacy.”


Dr. Isador Lieberman is Stretching for Scoliosis and you can Join Him


It’s rare when a world-class spine surgeon and internationally respected scoliosis expert is also an enthusiastic yoga practitioner. However, such is the case with Texas Back Institute’s Dr. Isador Lieberman.  This high-energy physician is putting all of these skills in play during a special event on Saturday, June 25, 2016.

For the second year, Dr. Lieberman, Texas Health Plano Scoliosis and Spine Tumor Center and Texas Back Institute are combining forces for “Stretch for Scoliosis,” a two-hour, fun-filled event to promote the National Scoliosis Awareness Month . Held at the Plano Sports Authority , which is located at 6500 Preston Meadow Drive and running from 9:30 a.m. until 11:30 a.m., this special workshop will teach parents and children about how core strength and flexibility can be improved.

Screening for Scoliosis

Photo #2 (1)

This event will also allow scoliosis specialists to screen adults and children for this very serious, however controllable spinal problem. Dr. Lieberman explains.

“For those who might not be aware it, scoliosis is a curvature of the spine where people are either bent forward or sideways,” he noted. “This, of course, leads to discomfort and limited mobility.”

“Over the years, we’ve been big advocates in trying to improve posture. As a surgeon, I can improve the posture of someone suffering from scoliosis, but there are many people who have unbalanced posture, with a spinal deformity – whether this situation is caused by scoliosis or other factors – who could benefit from an active program of posture exercises.  This will help them regain their balance and improve their function.”

“Yoga, Pilates as well as general stretching all help with this condition and we designed this Stretch for Scoliosis program with this in mind,” he said. “This is our second year and we are trying to raise the awareness of how to keep one’s back healthy and maintain good posture using an active exercise program which includes yoga and Pilates type exercises that will allow someone with a spinal deformity to have a better quality of life.”

Texas Back Int

Scoliosis: More Than Just a Childhood Disease

Some believe scoliosis is limited to children. However, this is not the case.

“Scoliosis affects both children and adults equally,” Dr. Lieberman noted. “Scoliosis in children is typically secondary to a genetic issue. There is a scoliosis condition that develops in adult patients and most of the time this is related to  age-related degenerative conditions.”

“There is also a very subtle type of scoliosis found in very young children that progresses over the years and continues into their adult years.”

“We deal with all age groups,” he said. “And all age groups can benefit from a good yoga, Pilates and stretching program to help them maintain  fitness and balance in their spine.”

If Someone is Found to Have This Condition, Next Steps?

“A lot depends on what their symptoms are and how well they are functioning,” Dr.  Lieberman said. “We worry about the progression of the curve for a number of reasons.”

“First, if these curves continue to progress, they are very unsightly. People do not want to be walking, hunched over or bent to one side. Secondly, as the disease progresses, the patients develop more mechanical fatiguing back pains. Just imagine trying to walk around each day, stooped forward. Even someone with a normal spine would develop that type of pain.”

“The third issue surrounding the progression of the disease relates to the spinal cord and the nerve roots.  Eventually, with the age-related scoliosis condition, the spinal cord and nerve roots can be compressed and when this happens, the ‘signal’ from your brain to your big toe cannot travel efficiently. This causes what we call the radicular or sciatic type pain from the nerves being compressed.”

“These are the types of issues we ask about during the screenings,” he said. “If the patient is functioning well, we typically recommend an active exercise program. This is more of a preventative measure and to promote a healthy lifestyle and not to treat the curve itself.”

“If, on the other hand, the patient is developing symptoms of the progression – either back pain or nerve pain – then we investigate them further and determine if we should be doing anything over and above an active exercise program.  This could include anything from medications to injections to minor surgical procedures all the way to major spinal surgery for reconstructions.”

Can Scoliosis be prevented?

In spite of fact that medical science has known about scoliosis for hundreds of years, no single cause or directed treatment can prevent scoliosis. It is however a very controllable spinal condition.

“We are getting smarter about it,” Dr. Lieberman noted. “One day we will be able to arrest the degenerative process by stopping the age-related degeneration and the spine will stay straighter.”

“One day we are also going to unravel the genetic components of scoliosis in kids. Once we have that, we will be able to prevent the disease. Unfortunately, today we still don’t have those answers.”

If you would like to listen to the complete interview with Dr. Lieberman, click on SpineTalk below.

If you would like to attend the free “Stretch for Scoliosis” on Saturday, June 25, 2016, just call 972.608.5107 to make a reservation to join Dr. Lieberman. If you are concerned about scoliosis, you can contact us, at Texas Back Institute to schedule an appointment.




The buzz around the phrase “Big Data” is loud and getting louder. As technology’s capacity to capture, store and analyze this data expands, it will affect the way companies treat their employees. What is fascinating to those in charge of managing business enterprises of all sizes is the predictive nature of this Big Data.

More and more large companies, with many employees, are relying on the big medical data supplied by so-called “predictive analytics” companies to reduce the cost of healthcare for their employees. This may be good business, but is it good medicine?

Two experts – one executive who works on the business side of the practice and one spine surgeon – at Texas Back Institute were asked to share their professional opinions on the efficacy of predictive analytics in saving companies money on healthcare for their employees.

The Rise of Predictive Analytics in Healthcare

According to a recent Wall Street Journal article on this subject, “Trying to stem rising health-care costs, some companies, including retailer Wal-Mart Stores Inc., are paying (predictive analytics) firms like Castlight Healthcare Inc. to collect and crunch employee data to identify, for example, which workers are at risk for diabetes, and target them with personalized messages nudging them toward a doctor or services such as weight-loss programs.”

The companies say the goal is to get employees to improve their own health as a way to cut corporate health-care bills. The employees are sometimes surprised by the fact that their personal medical data is being used to save their companies money, and the privacy advocates are often skeptical that this action meets the rigorous privacy guidelines of the Health Insurance Portability and Accountability (HIPAA)


The chief development officer and the patient privacy expert of Texas Back Institute, Cheryl Zapata explains what guidelines a company must follow to be compliant with HIPAA laws on privacy?

“A company can use the patient’s information if they have authorization to do so,” Cheryl noted. “However, more and more companies are using patient data without getting authorization from the patient. They are using what’s known as ‘de-identified’ information. This means the medical information about the patient can be analyzed, so long as the patient is not specifically identified. For example, the names, date-of-birth and other patient identifiers are taken off these records.”

Insurance companies are retaining the services of these predictive analytics groups in order to save money for their clients (the companies) and themselves. Is there any research which suggests that this leads to good medical outcomes, or is it strictly a cost-savings action?

“With regard to research, I can’t really point to anything specific,” she said. “I would say that it is a little bit of both – medical can be a cost-savings measure and that’s pretty much what every company is looking for.  And, it could also lead to better medical outcomes. For example, if patients needed more conservative care, they could be required to go through more conservative measures before having surgical intervention.”

“On the downside, it also interferes with the medical decision-making of a physician because there are so many requirements that have to be met before going to surgery. Unfortunately, there are times when the patient needs to go straight to surgery. In that case, it creates a barrier.”

Things You Do Which Can “Predict” Your Health

Crystal Ball

What are some actions which might predict an employee’s future expenses for healthcare? The WSJ article noted a wide range of activities. Here are a few:

  • Where an employee shops and eats will predict a healthy lifestyle.
  • Someone who spends money at a bike shop instead of buying video games is more likely to be healthy in the future.
  • Credit scores can predict if a person is likely to be readmitted to the hospital after a procedure. How? Those with lower credit scores are less likely to fill prescriptions and show up for follow-up appointments.
  • Even voting is a predictor. Those who vote in mid-term elections are engaged and mobile and they tend to be healthier, costing the company less money.

Predictive analytics companies, which mine this type of data, can legally obtain this information as long as the employee opts-in to their company’s wellness program and then re-sell it to their customers.

Other Ways Companies Can Save Money on Healthcare

Dr. Blumenthal

Chronic back pain is one of the most expensive conditions companies have to deal with. It accounts for literally millions of lost work days and billions of dollars in lost productivity and healthcare expenses. One of the senior surgeons at Texas Back Institute, Dr. Scott Blumenthal,  sees this every day in his examining room. He suggested several other ways companies might save money on healthcare and specifically on the treatment for back pain and injuries.

“At Texas Back Institute, all of our treatment is individualized,” Dr. Blumenthal said. “So, if the patient is most appropriate for a conservative care, non-surgical doctor, they will be able to go straight to that doctor instead of a surgeon. This process helps us get our patients to the most appropriate doctor from the start, which can lower the need for additional appointments and in turn lower the cost healthcare.”

“Regarding chronic back pain and other chronic conditions, most of the time we are going to take a conservative approach,” he said. “Surgery is the last resort under those circumstances.  However, that does not apply to all spine care. If a patient has an acute situation, sometimes the conservative care approach can be the more costly approach because it’s more time-consuming. It’s all about individualizing treatment options for each patient.”

What does Dr. Blumenthal think about getting a second opinion for expensive procedures such as spine surgery?

“That’s where it comes down to data,” he said. “Right now there are very good outcomes-based data on what works and what doesn’t work. The fact of the matter is, for any elective procedure, I can’t see why anybody would not seek a second opinion.  There are many ways to approach treatment for spine conditions and seeking out a second opinion is always in the patient’s best interest.”

“We encourage second opinions. We do second opinions. If indeed surgery is needed, sometime we can find a less invasive option to get the patient back on their feet, back to work and feeling better more quickly. All of this is based on evidence-based medicine, in other words data.”

If your company is trying to find ways to control healthcare costs, start with a provider organization which understands the importance of using data to conservatively treat your employees with the best spine care in the world. Contact us for more information.


Anyone who spends a lot of time on an airplane has a clear understanding of the concept of misery. Except for those lucky travelers who are in “first class,” the other 200 or so people spend the duration of the flight cramped, with little leg room, closely seated next to other passengers who are often grouchy due to their own lack of space!

Cramped Passenger

Long flights can also be dangerous to one’s health because the tight quarters can lead to muscle cramps and, in rare situations, serious problems. According to WebMD, it’s not really a healthy environment. Leslie Kaminoff, a yoga therapist and breathing specialist in New York pointed out that the pressure in an airplane cabin at cruising altitude may make passengers feel like they are at about 8,000 feet – as though they were high up in the mountains.

“Just sitting and breathing in that environment is a challenge to the system,” Kaminoff says. “People don’t realize they’re at 8,000 feet of pressure and breathing is more labored. In the cabin, there’s less available oxygen in the air. This puts an added load on the system, which is trying to get the required amount of oxygen into the bloodstream.” Another factor which may disturb breathing is the air’s diminished humidity, which is generally below 25%, in contrast to a comfortable home environment where the humidity level is at about 35%.

The online source notes another risk during air travel: developing leg clots or deep vein thrombosis. It’s also known as “economy-class syndrome” — a condition often brought about during long flights. Periods of immobility increase the risk of this condition because sitting and leg room are cramped.

“You want to create a situation where your legs are moving and the muscles are contracting,” says Kaminoff. “The deep veins in your legs have one-way valves, where blood can only move toward the heart. The only thing that gets that venous blood from the lower body back up to the heart is muscle contraction.”

The Road Warrior Spine Surgeon

Dr. Hisey #2

Dr. Michael Hisey is a spine surgeon at Texas Back Institute and his work in the field makes him a highly-sought-after speaker for medical conventions all over the world. Because of this, Dr. Hisey has become somewhat of a “road warrior” and as such, is the ideal source for offering tips on avoiding the back pain which can result from hours and hours on an airplane.

He has also had some quirky experiences that can only happen to a doctor on a plane.

“Recently, I’ve had some long trips to Uganda and China,” he said. “I’ve also got a trip coming up to Singapore.

“Since the crew knows I’m a doctor, I get called on when there is any type of medical ‘emergency.’ One instance involved a Chinese General Surgeon who was up in first class and had a little too much to drink. He was really OK, just over-served. There was another time when a lady who was waiting in line for the restroom passed out in my lap,” he chuckled. “There are some medical issues, but mainly it has involved more minor situations on planes.”

New Products for Air Travel

There are several start-up companies which are targeting the frequent flyers like Dr. Hisey with new products that offer an alternative to the old standby of leaning back in one’s seat and hoping for the best. Has he tried any of these new products?

“I have used the neck pillows,” he said. “That’s about it. I’ve heard of some of these new products and would like to try them out. I’ve also had the occasional fluffy seatmate who leans on me and I just use them for a pillow! They’re usually very friendly!

There’s a new product which has recently started a Kickstarter campaign to raise funds for a self-inflating pillow. This is then placed on the tray in front of the passenger and allows him to lean forward and take a nap. Does this leaning forward approach seem like a good idea or a bad idea for back health?

“I think that it’s probably comfortable,” Dr. Hisey noted. “It’s going to put you in a forward-flex posture, but that’s not as bad as tilting your neck to the side or leaning back in a seat that doesn’t recline enough. I think the forward-leaning pillow might be quite comfortable.”

“That’s actually how my son sleeps on a plane. He’ll lay his face right on his lap. Only problem occurs when the person in front of him puts his seat back. Then he’s pinned!”

Tips on Air Travel to Avoid Back Pain

“You have to take advantage of the little space you do have and keep yourself moving,” he said. “Don’t just get stuck in one place. Don’t let yourself get blood-clots, which is the worst thing that could happen on a plane.

“I will rotate my shoulders regularly while in flight. Even if my rear end is still, I try to keep my back stretched out. I will keep my legs moving with my calves pumping up and down. I will also change the position of my feet frequently. All of these things can help. They will help you feel refreshed when you get off the plane.

“In most planes, the air is very dry,” he said. “So keeping yourself hydrated is important. There are a few planes – the new 787 is one – which humidify the air, so it’s not as bad as it would normally be. However, most planes don’t do this and they have very dry air. This will have the effect of pulling moisture out of your body and it is important to keep replenishing that. A glass of water every couple of hours is very important.”

As summer approaches, don’t let back pain stop you from having fun outside. The spine experts at Texas Back Institute are available to help you feel better. Just contact us for an appointment.