Autumn is prime time for shooting sports and anyone who has spent a morning in a duck or deer blind has likely experienced some back aches and pain from handling a shotgun or rifle during a hunting trip. While this is expected for older men and women who only get out in the field a few times a year, this back pain resulting from shooting can affect younger shooters as well – even when they are Olympic champions.

The back specialists at Texas Back Institute treat many injuries caused by strains caused by shooting every year and Dr. Richard Guyer has some insights to help infrequent hunters avoid this back pain. Before you grab your gun and gear, you might want to give his advice a shot!

Back Injuries Threaten the Career of Olympian

According to the USA Shooting Team, Sarah Scherer, a 2012 Olympian was forced to withdraw from the 2014 World Shooting Championships in early September as the result of a back injury. This condition prevented her from training properly and would have kept her from traveling and competing without significant pain and limitation of her shooting.

As with most athletes in this sport, Scherer has dealt with minor back pain throughout her career, but it worsened significantly in August 2014. According to news reports, pain from three herniated discs was so severe that she was sent home early and placed on an aggressive physical therapy program in hopes of getting her ready to compete.

All that effort proved insignificant in treating the pain and condition and thus Scherer, in consultation with the U.S. Olympic Committee medical team lead by USA Shooting sport physiotherapist Cathy Arnot and Dr. Bill Moreau, ultimately decided the best path was to not compete and aggressively treat her symptoms with surgery likely in the near future.

Scherer was a two-time NCAA National Champion in smallbore (.22 caliber) rifle at Texas Christian University while also leading the Horned Frogs to two national team titles. At the 2010 World Championships, she was a junior silver medalist in three-position rifle while teaming with Amanda Furrer and Sarah Beard for a team title. She earned a bronze medal in three-position at the USA World Cup earlier this season in Ft. Benning, Georgia.

According to the USOC medical team, Scherer has two disc extrusions- one at L3-4 and one at L4-5 and a disc protrusion at L5-S1. The end result is pain, loss of muscle function and sensation in her legs and an inability to get into shooting position without creating more pressure on the spinal nerves. Her symptoms have not responded to high dose steroids or physical therapy. The likely next steps for Scherer will include spinal injection, and a probable spinal decompression at the affected levels.

Prognosis for the Olympic Shooter

For a young woman, who has world-class conditioning and impeccable shooting form to be sidelined by these types of back injuries suggests a high degree of risk of back pain for those shooters who are older, perhaps out of shape and likely have less-than-world-class form.

“Sarah’s situation was likely caused by genetic pre-disposition in combination with the extreme wear and tear of constant training and competing,” Dr. Guyer noted. “Most weekend hunters don’t have her form and stamina, but they also don’t shoot nearly as much as she does.”

Could this type of injury be career-ending for the young shooter?

“Having not seen the x-rays, it’s impossible for me to say,” said Dr. Guyer. “However, if there is leg pain associated with this condition it is more serious. If so, a microdiscectomy, where a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement to allow the nerve to heal,  would possibly be in order. If her pain is centered only in her lower back, she might be a candidate for disc replacement because of her age and activity level. Fusion would be a secondary choice,” he noted.

How Hunters Can Avoid Back Pain and Injuries

This is the time of year when shotgunners are trying to bring back dove, quail and ducks and deer hunters are trying to fill the freezer with venison. Do you have any advice to help them avoid injuries or back pain that might ruin a hunting trip?

“Good posture is the key element of avoiding back pain when shouldering a shotgun or rifle,” he said. “If the hunter is sitting in a duck or deer blind, he or she needs lumbar support. It’s important to stand up and stretch from time to time, even if one is concerned that the game might notice the movement.”

“As always, the best cure for back pain from hunting is prevention,” Dr. Guyer said. “Before getting out in the field and handling a shotgun, it’s important to build strength in core muscles.”

“I also recommend getting some professional advice about proper shooting form. Before going on that hunting trip, go to the shooting range and ask someone who knows proper form to watch you swing and shoulder the shotgun or rifle and tell you if you’re doing it correctly. Then practice that form in the mirror until the gun is placed correctly on the shoulder every time a shot is taken,” Dr. Guyer said.

With more and more women taking up hunting and competitive shooting, are there gender-specific techniques or injuries females should be aware of?

“Unfortunately, back pain is ‘equal opportunity,’” he laughed. “It is gender neutral!”

If you have questions on how to avoid back injuries when hunting or target shooting, click here to speak with a Texas Back Institute specialist.

In spite of the amazing advances in modern medicine, scientists have yet to determine the cause of scoliosis. This may surprise laymen because, according to the National Institute of Health, “scoliosis is estimated to affect 4.5% of the general population. In a nation of approximately 273 million people, this means that over 12 million cases of scoliosis exist, and almost 500 more are diagnosed each day – about 173,000 every year.”

The disease has been referenced in medical literature for hundreds of years and has even been alluded to in a Shakespearean play – Richard III. However, when the Bard wrote the description of the king as “that foule hunch-backt toade” he had no idea he was misdiagnosing Richard. New 3D visualization created by researchers and multimedia experts reveals that his scoliosis was the cause of his poor posture. More on this later.

The spine specialists at Texas Back Institute treat many scoliosis patients each year and we asked Doctors Raj Arakal andIsador Lieberman to explain this perplexing and sometimes debilitating spinal disease.

What is Scoliosis?

“Scoliosis is a side to side curve deformity of the spine that is greater than ten degrees,” Noted Dr. Arakal. “Patients can develop misalignment of their spine which can tilt them side-to-side or pitch them forward.”

“Often the mild curvatures are tolerated well, but sometimes the curves continue to worsen and pose risks of significant deformity,” Dr. Arakal said.

“This condition can also cause a loss of height, restriction of rib cage and breathing,” noted Dr. Lieberman. “Compression of the internal organs such as the intestines, lungs and heart, mechanical back pain, muscular back pain, nerve irritation, spinal cord compression, unappealing physical appearance with rib hump, prominent hip, asymmetric shoulders are also possible.”

What Causes Scoliosis?

This is still pretty much a mystery. Scoliosis often occurs during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.

“The cause is multifactorial,” notes Dr. Lieberman. Genetic predisposition, mechanical vulnerability, neurological contribution and asymmetric growth issues playing roles.”

“Trauma might play a role,”notes Dr. Arakal. “And it may be related to physiology of the discs.”

Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.

Did King Richard III Suffer From Scoliosis?

• According to research published in the scientific journal The Lancet, King Richard’s poor posture and (and perhaps his) unpleasant demeanor seem to be the result of scoliosis.”We wanted to know if Shakespeare’s description was accurate, or an exaggeration to help legitimize the Tudor monarchs on the throne at the time,” study author Piers Mitchell, an anthropologist at the University of Cambridge said “Based on the study of his bones, Richard III would be better described as crook-backed than hunch-backed.
• In a CBS News report aired in May 2014, it was noted the royal skeleton was discovered under a parking lot in Leicester, England and DNA tests confirmed its identity five months later. In order to figure out the extent of the king’s scoliosis, the researchers created physical and computer-generated models of Richard III’s spine by performing CT scans and then using 3D prints of the bones based on the CT image data.

“The 3D visualization shows that Richard’s spine was curved to the right and it was twisted to a degree, which gave it a “spiral” shape. The researchers also estimated that the king’s Cobb angle — a measure used to determine the extent of spinal deformities — was between 65 and 85 degrees — a curvature that would be considered significant these days. However, he also had a well-balanced curve, which means that his head and neck were straight and not angled to the side.”

“Richard did have a marked  spinal deformity due to scoliosis,” Mitchell said. “However, there was no evidence from his skeleton for his having a withered arm or a limp, as portrayed in Shakespeare’s play.”

Richard’s scoliosis likely started to develop in the last few years of adolescent growth, after he turned 10, the researchers wrote in the study. The monarch’s right shoulder was likely positioned higher than the left one, and his torso was probably relatively short compared with his arms and legs.

The report also noted previous research has already shown that the king would have been about 5 feet 8 inches tall without his scoliosis. But the new study suggests that, because of his spinal condition, he may have appeared shorter than he really was. “This may have made him appear less imposing as a ruler,” Mitchell said.

How Can Scoliosis be Treated?

Texas Back Institute is internationally recognized for effective treatment of scoliosis. “Patients diagnosed with this disease have several options for treatment,” noted Dr. Lieberman. “It’s important to maintain bone health and maintain physical fitness through exercise such as Pilates. We prescribe bracing for those who are in their growth spurt with certain types of progressive curves, medications for those degenerative curves with mechanical or neurological symptoms and as a last resort, surgery for those progressive curves in kids and for the progressive curves with debilitating pain and or neurological issues in adults,” he said.

If you have been diagnosed with scoliosis or have concerns about the possibility of having this disease, contact us for an appointment.

Proving they are not afraid of a little ice, cold water being unceremoniously dumped on them, several physicians and friends of Texas Back Institute took the ice bucket challenge bright and early this morning. In doing so, they joined millions of others who are raising awareness about ALS (Amyotrophic Lateral Sclerosis).

This unusual campaign started innocently enough. Former Boston College baseball player, Pete Frates, created the challenge with his family in an effort to spread awareness of ALS, a disease that he has lived with since 2012. The challenge consists of people dropping buckets of ice water over themselves, recording it, sharing the experience to social media, and then nominating others to do the same. Participants are also encouraged to make a donation to ALS research or to the charity of their choice.

ALS Can Mimic Back Injuries and Diseases

The Texas Back Institute has a special reason for participating in this show of solidarity with sufferers of ALS. Because of its symptoms, such as the inability to grasp objects and the loss of some muscle use, ALS can mimic some spine conditions. In most cases, ALS is fatal, whereas most spine injuries can be treated with therapy or surgery.

Plus, many of the Texas Back Institute physicians have had friends or loved ones who have suffered from the disease. For example, Greg Knittel, a favorite high school teacher of Dr. Rey Bosita contracted ALS and passed away and to this day Dr. Bosita still considers him to be one of the most influential people in his life. To hear his thoughts on ALS, watch the video below.

Let the Dunking Begin!

Without any further ado, let’s get to the main event. Shall we? With this video, let it be known that the physicians and staff of Texas Back Institute support struggle of those fighting ALS and urge you to contribute to finding a cure for this disease.

According to a recent story in the Wall Street Journal, the most common form of spinal cord problem of Americans over 55 isspinal cord compression. Since this group is a part of the “Baby Boomers,” largest demographic group in U.S. history, this problem is affecting many people and perhaps you are feeling its impact too.

The medical term for spinal cord suppression is cervical spondolytic myelopathy, or CSM. The WSJ notes, “More aging baby boomers are experiencing neck stiffness, arm pain, numbness and weakness in the hands and legs—all signs of degenerative changes in the upper spine that are usually the result of everyday wear and tear. Strenuous activity or sports can exacerbate the damage.”

“The changes over time can lead to a narrowing of the spinal canal and put pressure on the spinal cord. Coupled with repetitive motion, the compression can injure the cord, which in turn can inhibit movement of the hands and impair walking, and may even lead to paralysis.”

The spine specialists at Texas Back Institute have seen numerous cases of this condition and Dr. Theodore Belanger is well aware of the challenges it presents. We asked him to give us some background on CSM.

What Causes CSM and Spinal Cord Compression?

“CSM refers to impingement of the spinal cord in the neck caused by degenerative arthritis,” Dr. Belanger noted. “There are many other things that can compress a person’s spinal cord, such as tumors, trauma, herniated discs, and other conditions, including degenerative arthritis, to which this article is referring.”

“Degenerative arthritis in the neck, and elsewhere in the body, is strongly associated with genetics and aging,” he said. “It is not a single disease that comes in a single form, and therefore there is not a single best treatment that applies to all patients. It also affects men and women equally.”

“In mild forms of the disease, your doctor may recommend simple observation. In severe cases, aggressive surgery may be necessary.” Dr. Belanger noted.

Why are Baby Boomers More Likely to be Affected?

“Because the underlying problem is degenerative arthritis, it affects older people,” he noted. “There are increasingly more people seeking healthcare in general in older age groups as a result of the “Baby Boom”. As the population ages, healthcare providers will see more people with conditions of the elderly, like arthritis and CSM.”

Current research noted in this article suggests the number of CSM surgeries has nearly doubled over the past decade to about 200,000 procedures a year, resulting in $4 billion a year in hospital charges alone. Past studies indicate two thirds of CSM patients improve with surgery, while 15-30 percent of the cases are not successful. Complication rates can be as high as 17 percent.

What are the Symptoms of Spinal Cord Suppression?

“Patients with spinal cord compression can present with different degrees of symptoms and findings,” he notes. “Very mild cases may have vague tingling in the arms or hands, while severe cases on the other end of the spectrum may be essentially quadriplegic (paralyzed in their arms and legs).

“The most common patient symptoms include pain, numbness and/or weakness in the arm(s), difficulty walking due to fatigue and feeling off balance, and electric shock sensations down the back or arms with extreme neck movements. Severe symptoms are generally worked up with imaging of the neck, such as by an MRI. If CSM is confirmed, referral to a spine surgeon is appropriate,” Dr. Belanger said.

What can a Patient Expect with Spinal Cord Suppression Surgery?

“The details depend heavily on the health of the patient, the extent and severity of their CSM, and exactly which procedure is necessary, so it is difficult to generalize,” Dr. Belanger said. “CSM presents with a whole spectrum of severity, and even surgical treatment cannot undo all of the damage done by the disease, especially in more severe cases. I would encourage patients to have a frank discussion with their surgeon about reasonable expectations if surgery is being contemplated.”

Because of the pervasiveness of this condition, there is a three-year study being conducted at 10 large U.S. medical centers. It will compare three surgical techniques and create the national spine outcomes registry to help doctors and patients determine which treatment is best for the individual’s condition and situation.

“There are several surgical options available,” Dr. Belanger notes. “This study is attempting to sort out if there are differences in the outcomes for patients treated with one surgical plan versus another.”

If you have any of these symptoms for spinal cord suppression, or are concerned about other back pain issues, contact us for a consultation.

“I had lower back pain for years and finally one day I decided to do something about it,” said Celeste Reynolds. “I waited for two years after my surgery to share this information because I really wanted to make sure what I am saying is the truth about the surgeons and staff at Texas Back Institute.”

Thus begins a note from Celeste who came to Texas Back Institute because she couldn’t stand the pain any longer. Her story should be of great interest to anyone who is experiencing chronic back pain.

“As always, surgery is the last option we pursue”

Texas Back Institute surgeon, Dr. Jessica Shellock examined Celeste and she still remembers how much pain this project manager was suffering.

“Her diagnosis was multilevel degenerative disc disease, Dr. Shellock noted. “It’s not actually arthritis per se, since the discs are not joints.

“It is more an acceleration of the normal aging process of the discs that we will all experience over time – some people are more genetically predisposed to accelerated changes and earlier and/or more severe symptoms. It really is more hereditary than anything else,” she said.

“As always, surgery is the last option we pursue,” she said, “But after exhausting every other treatment regimen, on May 16, 2012, we performed the surgery.

“We try our best to do minimal fusions”

With the help of one of the founders of Texas Back Institute, Dr. Richard Guyer, Dr. Shellock performed both a fusion and artificial disc replacement procedure in hopes of eliminating the constant pain Celeste was experiencing. We asked her if this type of surgery is unusual.

“Not really unusual,” she said. “It’s difficult to get insurance carriers to approve these types of constructs (we call it a “hybrid” construct since it involves both fusion and disc replacement), so fusion alone is much more common overall. We completed one artificial disc replacement at L3/L4 and two fusions at L4/L5 and L5/S1.”

“In the setting of a multilevel problem as this, we try our best to do minimal fusion(s) if we can so that we give the patient a better chance of decreased need for future surgery. Since insurance carriers won’t approve multilevel disc replacement and this is often cost-prohibitive for patients to self-pay, we essentially do a compromise between the two options,” she said.

“I’m here to tell you that the best thing I have ever done for myself is getting my back fixed at Texas Back Institute!”

“I can’t explain how freeing this is,” Celeste said. “If I think about it too much, I’d start to cry.”

“Within six months, I was back to walking and moving with no pain,” she proudly said. “I credit the skillful hands of these two doctors for my quick recovery! Dr. Shellock and Guyer are so competent, knowledgeable and skillful and I would recommend them to anyone.”

“I went to physical therapy at Texas Back Institute,” she said. “And I followed the recommendations of the knowledgeable technicians there. The day I was released from the hospital I received one directive – to get up every half hour and walk for five minutes.”

Her lack of back pain has allowed Celeste to travel the world. Since her surgery, she’s created a spreadsheet of all the places she’s gone and it reads like an airport departure screen! Among other cities, she’s traveled to London, Barcelona, San Diego, Honolulu, Washington D.C., Atlanta, Denver and of course walked around her beloved State Fair of Texas!

“Freedom from pain is indescribable”

“Dr. Shellock is a wonderful human being,” Celeste said. “And totally amazing in her work.”

“I’m flattered and humbled by her words,” said Dr. Shellock. “I am so happy that she has done well and is back to all the activities that she hoped to be doing."

“I think that she represents a combination of the correct surgery for the appropriate indications, a great OR team, and a motivated patient with a wonderful attitude for recovery. It really takes all of these things for this type of success, and when they are present together we can see outcomes like this that can truly give someone back the quality of their life. This is what makes my job enjoyable!”

“Freedom from pain is indescribable,” summed up Celeste. “But it’s reachable through the great doctors and physical therapists at Texas Back Institute. I thank the good Lord I found them!”