Using their first pick in the 2014 NFL draft, the Dallas Cowboys showed their confidence in quarterback Tony Romo by choosing offensive guard Zack Martin of Notre Dame and passing on Johnny Football. This ended speculation that the ‘Boys would find a way to get A&M quarterback Johnny Manziel because Romo sustained a season-ending back injury last season. A few picks later, Manziel was chosen by the Cleveland Browns.

Football fans either love or hate the Dallas Cowboys. Maybe this is due to the team’s past success, its high-profile owner, its otherworldly stadium (“Jerry World”) or its long-time title as “America’s Team.” For whatever reasons, there is something about being a member of the Dallas Cowboys that magnifies every coach’s decision, player performance or injury. Such was the case when the team’s quarterback, Tony Romo experienced his back injury last year.

In a physically challenging game such as professional football, the age of players is always a concern of management. Romo is 34 years old. While this doesn’t sound old to most of us, the number of hits his body has taken over the years he has participated in the sport – from Pop Warner to NFL – means he is definitely approaching mature status in his chosen occupation.

There are, however, two other NFL quarterbacks who are older than Romo and still playing at championship levels. Peyton Manning (Denver) is 38 years old and Tom Brady (New England) is 36 years old. Both are expected to have outstanding seasons in 2014.

Tony Romo’s Prognosis is Tricky to Determine

Bosita On Mag Edited

We talked with Texas Back Institute spine surgeon and avid sports fanDr. Rey Bosita about the challenges Tony Romo might be facing in the coming season. As someone who has successfully treated many back injuries, Dr. Bosita brings a knowledge base beyond the scope of most sports fans and has several insights about the injury and its long-term effect.

“He had a herniated lumbar disc that caused severe pain, said Dr. Bosita. “His case was especially difficult because he had previous lumbar surgery just a few months before.”

While he was not the treating physician, Dr. Bosita reviewed the press accounts of the injury and had some thoughts about the potential for this injury to end Romo’s career.

“We will know about Tony’s back once the pre-season starts,” he said. “Back injuries can affect almost every aspect of a quarterback's job, including his ability to scramble to buy time, throw on the run, and absorb the weekly punishment from people like Demarcus Ware who are trying to kill him!”

Age and injuries have serious impact on the strength or weakness of a disc. The big question for the Cowboy management was: After having this type of injury and undergoing rehab, is the disc likely to be weaker or stronger in the coming years? In other words, will he be more or less likely to have this injury again?

“Unfortunately, discs always get weaker and degeneration is one way street,” Dr. Bosita notes. “Rehab will be very important or him to build up the core abdominal and spinal muscle tone to protect the weakened disk.”

He continued, “The Cowboy training staff should be closely watching his pain, strength, and endurance during the pre-season workout and training camp. I am sure that all of Dallas will be holding its breath when he takes the first few big hits of the season. Hopefully he will recover enough to play the whole season week in and week out and lead Dallas to the Super Bowl

 What Should the Cowboys Have Done?

The primary assets of any professional sports team are its players. Teams have invested millions of dollars on these individuals and getting a return of this investment is far from certain. This makes accurate player personnel evaluation critical to the financial success of the organization.

We asked Dr. Bosita to apply his knowledge of this type of injury and assume the position of team medical advisor. Knowing what he knows about the injury, how would Dr. Bosita advised the Cowboys with regard to Tony Romo – trade him or keep him?

“The value of a player in a trade is always difficult to assess, especially when he has been injured,” noted Dr. Bosita.

“Tony has also been the face of the franchise for many years and the whole offense is centered on him,” he said. “Trading him at this point would be very difficult in my opinion, especially because other teams would not be willing to give full value for a QB who has had 2 back surgeries. Hopefully he just bounces back and leads the Cowboys to 12 wins and the playoffs like we all want.”

“I’m personally pleased that the Cowboy didn’t choose a quarterback in the first round. They have some very good players and should build on this. They are using the draft to fill in some gaps left by departed players like Ware and building the depth needed for a strong playoff run late in the season when fatigue and injury can become big factors.”


For anyone reading the April 16, 2014 edition of The Wall Street Journal and contemplating implant surgery for a spinal-cord stimulator, the news was frightening. The headline set the stage: “When Spine Implants Cause Paralysis, Who is to Blame?”

According the newspaper’s analysis of adverse-event reports submitted to the U.S. Food and Drug Administration and a review of malpractice lawsuits, more than 100 patients have experienced partial or permanent paralysis in recent years after having spinal-cord stimulators inserted in their backs. The article went on to note, “In many cases, the injuries occurred after patients’ spinal cords were punctured or compressed by the stimulator electrodes, which are implanted in a narrow cavity of the spine called the epidural space.

Since this procedure was pioneered and has been performed by the skilled surgeons at Texas Back Institute more than 10,000 times since its introduction, it’s logical to ask two of these spine specialists about this story. Dr. Michael Hisey and Dr. Ralph Rashbaum, in separate interviews, both agreed the facts presented by the Journal about this procedure are not wrong. They also agree with the conclusions drawn by the experts interviewed by the newspaper – the problem is not with the spine stimulator device.

“It’s ‘pilot error,’” said Dr. Rashbaum. “The article rightfully pointed to the real problem of this procedure and that’s a lack of training for some of the physicians who are performing the surgery.” More on this later.

 How the Spine Stimulator Relieves Chronic Pain

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

The spine stimulator devices are made by several companies, including Medtronic, Inc.St. Jude Medical, Inc. and Boston Scientific Corp. Each uses electrical signals, which emanate from the implanted device and is then transmitted through electrodes connected to the spinal cord to block the pain signal before it is received by the Thalamus portion of the brain.

When properly placed in the back, these stimulators have an overwhelmingly high success rate. As one can imagine, for someone who has suffered chronic back pain for decades, this device is a god-send.

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

“I was one of the early adaptors of this technology,” said Dr. Rashbaum. “I’ve been performing this procedure for more than 37 years, more than 5,000 times and I’ve worked with all of the medical device companies who manufacture them. I have testified as an expert witness in cases related to these devices and have even invented devices from which I receive royalties from one of the companies – Medtronic, Inc.”

By any metric or criteria, Dr. Rashbaum is one of the internationally-recognized experts on spinal cord stimulators and it’s telling that he has serious concerns about the (lack of) training some physicians receive before performing this surgery.

Training is Inadequate 

“Two days, which is the standard amount of time manufacturers allocate to explaining this procedure, is not nearly enough,” Dr. Rashbaum said. “Our doctors at Texas Back Institute must go through a full year of training, mentoring from other physicians and operate under close supervision before being allowed to perform this procedure. Why? Unforeseen factors arise in surgery and you never want these factors to occur when someone is only just learning the procedure.”

“The real problem we see and that which the Journal rightfully pointed out is a lack of training in the proper implantation of these devices,” said Dr. Hisey. “The devices are sound. However, when you have physicians who have never had surgical training and proper mentoring by more experienced doctors certified to perform this surgery two days of training is not enough. Unfavorable outcomes will occur.”

What Can Go Wrong?

What are the types of physician errors which might cause paralysis in a patient undergoing this type of spine stimulator procedure? Dr. Rashbaum, who after performing more than 5,000 of these procedures has never had a patient failure resulting in paralysis, notes several.

“When implanting the device, an inexperienced surgeon will sometimes put too much pressure on the spinal cord causing a bruise or contusion,” he notes. “If this pressure is severe, it could cause damage to the spinal cord and paralysis.”

“The electrode leads can also be pushed too far in this procedure,” Rashbaum notes. “And this is often difficult to determine, especially if the patient is under anesthesia. My experience has taught me to keep the patient awake through the procedure, monitor their progress electronically and listen to the patient.”

“Another problem which might cause paralysis is an epidural hematoma,” he said.

“Infections can occur even with good technique. However, a good team using appropriate technique can significantly decrease the number of infections.”

“Epidural hematomas (blood collection) are another possible cause of cord injury. These can occur when the epidural veins (the veins around the cord) are torn by the electrode lead. Bleeding in the epidural space causes pressure on the cord and it can be significantly injured.”

“All of these errors are preventable with proper and extensive training,” Dr. Rashbaum concluded.

Training Future Spine Specialists

How does Texas Back Institute prepare its physicians for spine stimulator implant surgery and the other ground-breaking procedures such as artificial disc replacementSI joint fusionherniated disc surgery and any number of other specialized procedures? It’s the same way a concert pianist gets to Carnegie Hall. Practice. Practice. Practice!

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

“Every year we offer fellowships to 2 to 5 physicians who have graduated a residency and want to learn more about the specialized surgery Texas Back Institute is known for,” said Dr. Hisey. “It is extremely rare for a private practice such as ours to offer this year-long training to future doctors who will not necessarily join our practice.”

He continued, “We do this because we believe in the benefits of mentoring young surgeons. After successfully completing our fellowship program, they have participated and observed hundreds of procedures such as the spine stimulator implant surgery. Some of them are asked to join our practice and some go on to other practices. However, they are all better doctors when they leave.”

“For the physicians who join the Texas Back Institute, we require a one-year period of specialized training (Fellowship) in spinal surgery during which they will typically supervised by senior physicians for about 500 to 600 cases before they graduate,” Dr. Hisey said. “After joining TBI, each will have their cases reviewed and will be supervised over the first several months before they operate independently.”

What Questions Should a Patient Ask?

Every doctor hopes to avoid the tragedy of permanent paralysis noted in the “Journal” article and every patient should take some responsibility. What are the questions a person who is considering this spinal stimulator surgery? Dr. Rashbaum offers a few.

“A patient should ask their physician about the number of cases, complication rates and outcomes they have had related to the spine stimulator device,” he said. “In my practice my trial-to-implant ratio is higher than 90 percent. This is due to my extensive screening and evaluation of each client. If a physician performs a large number of trials and his permanent implant rate is low, this could be a red flag. For example, the pain reduction ratio should be at least 50 percent in the trial before the final procedure is attempted.

Let’s face it. Some physicians perform this procedure better than others,” Dr. Rashbaum said. “Just because a pain-management doctor or anesthesiologist goes through two-day training for spine stimulator implants does not mean he or she is qualified for this type of surgery. Errors can occur and the damage to the patient can be permanent.”

Dr. Hisey adds, “A two-day course might be adequate to learn the nuances of a modification of a technique which the surgeon is already proficient in but it does not replace surgical training or practicing a procedure in a supervised setting.”

Dr. Rashbaum reminds us, “We physicians must live by the oath we take – ‘Primum non nocere.’ First do no harm.”



When one hears the term “planking,” the first instinct is to smile. Similar to the wildly popular craze from the 1960s of twirling a circular plastic
tube around one’s waist – hula hooping – planking is usually associated with the strange and equally popular internet meme from a few years ago which consisted of posing for photographs while holding one’s body completely stiff.

We’ve all seen the pictures and some of us (who will go nameless) actually participated in this silly planking activity. However, it might surprise you to learn that planking and even hula hoops have become legitimate forms of exercise which yield measurable benefits. Even experts on back health have adopted a planking regimen.

“I use plank exercises every day as a part of my workout,” noted Texas Back Institute back surgeon, Dr. Isador Lieberman. To find out why, read on.

Planking Builds Core Strength

The professional kinesiology literature notes planking is an isometric core strength exercise which can be a part of yoga, Pilates and, in some cases, training for boxing. Isometric exercises are strength training where the joint angle and the muscle length do not change during the contraction. This type of exercise is done in a static position rather than through a range of motion.

Online reference site Wikipedia notes front planking is said to improve strength in these muscle groups:

  • Primary muscles: erector spinae, rectus abdominis and transverse abdominus
  • Secondary muscles: trapezius, rhomboids, rotator cuff, anterior, medial and posterior deltoid muscles, pectorals, gluteus maximus, quadricepts and gastrocnemius.


Performing a full plank involves six steps:

#1 Begin in the pushup position with your back completely straight

#2 Lower both your forearms to the ground so that both your elbows and fists are flat to the ground.

#3 Curl your toes under and engage your abs by tilting your pelvis and pulling your belly button toward your spine.

#4 Straighten your body but keep your neck and spine neutral. Imagine that you're a plank of wood.

#5 Flex your abdominals and squeeze your glutes.

#6 Hold this plank position until the muscle burning begins. Your body should make a straight line from your heels to the back of your head.

When asked if planking could really improve strength, Dr. Lieberman responded succinctly: “Absolutely.”

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An Expert Opinion on Planking and Back Health

With any form of exercise, even those which are isometric and have the least potential for strain, there is a possibility that planking can cause strains in back muscles. “This type of exercise must be done with the proper form,” notes Dr. Lieberman. “And it should be practiced as a part of a progression in an exercise program.”

As one of the leading spine specialists in the country, Dr. Lieberman examines countless patients each week and has seen an extensive range of back injuries. Has he seen or read any research about injuries related to planking?

“No, I have not seen any research related to injuries due to planking, however I have seen individuals who have over-strained their backs because of poor form,” he said.

Among other things, planking strengthens abdominal muscles. How do these muscles, usually associated with the stomach area of the body, affect back health?

“It’s all about alignment,” he said. “If the muscles are coordinated and have increased stamina, the spine has the support it needs to maintain alignment and stability during activity.”

Are there any physical benefits to maintaining a plank for a long period of time? Dr. Lieberman notes, “As with any exercise, the longer one can hold a plank the better the conditioning and the greater the benefit.”

There is always risk associated with any physical activity and undertaking a program which includes planking should not be considered without a checking with a spine specialist at Texas Back Institute. What should someone who is just beginning to use planking as a part of their workout watch out for?

“Do not let your back sag,” notes Dr. Lieberman, “And do not let your butt stick up in the air. It must be a plank.”

Have you had any experience with planking? Has it helped or hurt your exercise program? Let us know by posting below or sending us an email


It’s been a long time since Tiger Woods has missed playing a Masters Golf Tournament – back to 1995. However, he won’t be playing in the 2014 edition of one of professional golf’s biggest tournaments due to recent back surgery. Some feel he may never return to the form which enabled him to win his first Masters in 1997.

Since Texas Back Institute has internationally recognized expertise in this type of back surgery procedure, we asked Dr. Jack Zigler and Dr. Scott Blumenthal for their insights into the causes and effects of Tiger Woods’ back ailment and the surgery which will keep him away from the lush fairways of Augusta National. More on this later.

Woods Announces his Condition on the Web

Woods announced his medical status and subsequent absence from the PGA tour on his website ( on April 1, 2014, and this was no April fool’s day joke. He noted he had undergone a successful microdiscectomy for a pinched nerve which had been hurting him for several months. The surgery was performed in Park City, Utah, by neurosurgeon Dr. Charles Rich.

While the procedure was successful, Woods will be unable to play in the Masters Tournament, instead requiring rest and rehabilitation for the next several weeks. It was clear that this decision had been a painful one for the golfer.

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

According Woods, “After attempting to get ready for the Masters and failing to make the necessary progress, I decided, in consultation with my doctors, to have this procedure done,” Woods said.

“I’d like to express my disappointment to the Augusta National membership, staff, volunteers and patrons that I will not be at the Masters,” Tiger added. “It’s a week that’s very special to me. It also looks like I’ll be forced to miss several upcoming tournaments to focus on my rehabilitation and getting healthy.

“I’d also like to thank the fans for their support and concern. It’s very kind and greatly appreciated. This is frustrating, but it’s something my doctors advised me to do for my immediate and long-term health.”

Medical Analysis from the Experts at Texas Back Institute

The medical procedure which will determine the professional fate of one of golf’s best known players is called a microdiscectomy.

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

According to Dr. Jack Zigler a spine surgeon at Texas Back Institute, “A microdiscectomy is a surgical procedure to relieve pressure on a nerve root by removing a portion of the intervertebral disc that is pressing against it.  It is done under magnification so that only minimal manipulation of the nerve and minimal removal of healthy covering tissues are required.”

“The procedure is typically used for a herniated lumbar disc,” he said. “The disc, or shock absorber between the vertebral bones, can develop a weak spot or tear in its outer wall, allowing some of the “jelly” in the center to bulge or extrude, putting pressure on one of the nerve roots running down the leg.  This can cause pain, weakness, numbness, and tingling.”

The big question for any Tiger Woods fans concerns his long-term ability to play at the level he has been able to play for almost 20 years. Will this procedure affect the flexibility of that famous Tiger Woods swing?

“The procedure itself does not affect flexibility, Dr. Zigler noted. “However, if the disc has been very damaged by the herniation, it may collapse over time, and that could limit flexibility.”

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Professional golf owes much of its popularity, especially among young golfers, to the skills and personality of Tiger Woods. Every tournament organizer, including those at the Masters in Augusta, knows how much excitement Woods adds to an event. For this reason, the length of time he will miss due to rehabilitation is on the minds of many.

According to Dr. Scott Blumenthal, another spine surgeon at Texas Back Institute, “The rehab process begins immediately after surgery with sports specific activities resuming at about 4 to 6 weeks. Tiger’s return to full activities or sports is variable but generally he should be back playing in 2 to 3 months.”

“Because a professional golfer is in better condition, he would typically require less rehabilitation than the average person” Dr. Blumenthal notes.  “Professional golfers have strong cores, which are the key muscle groups that protect the disc against recurrent injury,” he said.

Sports talk show hosts love to speculate on the future prospects of professional athletes – especially Tiger Woods. Can Woods, who is 38 years old, come back from this procedure and perform at the high level we’ve all come to expect?

“Tiger Woods is a superbly conditioned, elite athlete, who is in the best condition possible,” notes Dr. Zigler. “Depending on the health of his disc after the herniation is removed and the annulus (wall of the disc) heals, he may easily be able to return to his pre-injury form and play at that level for many years. However, if he has lost a lot of the nucleus (“jelly), and/or the annulus fails to heal well, he will have problems functioning well.  After a disc herniation, everyone is at a slightly increased risk of recurrent herniation as well as disc space collapse and arthritis,” he said.

The legions of Tiger Woods fans miss seeing him storm his way to the 18th green at this year’s Masters Golf Tournament. They can only hope that medical technology, combined with his dogged determination to win will have him back at Augusta next year.


The blistering heat of last summer followed by ice and extended cold experienced during this winter can create a significant amount of stress on the materials within your commercial roof system.  Radical fluctuations in temperature cause expansion and contraction of the roof and building envelope resulting in conditions such as splits, gaps, holes in the membrane and issues with flashings that must be detected and addressed prior to the spring season’s first gully-washer.

“There is a lot of value in walking the roof before the spring rains set in.  After that first big rain is when leaks will appear, many that might have been avoided if a basic inspection was done prior,” said Tracey Donels, KPOST Company Service Manager.

Tracey went on to say “Think of it like performing maintenance on your vehicle before a road trip. You don’t wait until you are on the trip to perform the maintenance.  You do it in advance of the long drive.  The same is true of roof inspections between major seasonal changes, particularly before the April rainy season.”

According to predictions, North Texas is expected to have more rain this season than normal with the rest of Texas continuing drought conditions.  Neither bodes well for commercial roofing if appropriate inspections and preventative maintenance are not completed.

April Showers Bring…Angry Tenants?

“When you own or manage a commercial property, the last group you want to be first reporting a leak is your tenant.  By that point, the tenant is already in pain, and the property manager is under duress to make emergency repairs which are usually more expensive.  It’s far better to be proactive than reactive – to be ahead of the culprit rather than behind it,” said Scott Bredehoeft, KPOST Director of Business Development.  “You will want to eliminate as many potential problems as possible before your tenants have to report water in their space.  That can be accomplished by a visual inspection of the roof in early spring to look for obvious deficiencies and needed repairs.”

A simple visual inspection will identify obvious leak sources or contributors such as clogged drains, splits or holes in the roof membrane and flashings, and missing or loose tiles or shingles.

“Rather than taking your chances and putting the roof to the test during a heavy rain, an inspection will provide a basic punch list of items that are in need of repair.  Performing these repairs in a single maintenance call will save time and money as well as eliminate the headache later on caused by a leak,” said Tracey. “Waiting until you see a leak means not only fixing the roof problem but also repairing any internal damage, making the repair more costly and invasive to the tenant.” 

Commercial Roofing Weather Preparedness is Important

To perform a simple inspection is not difficult but does require some knowledge of what to look for as well as the best way to document.  The following checklist provides items that should be observed during a visual inspection.  It is important to ensure that these items are well-documented and photographs included so that a proper decision can be made as to the priority of the repair.


  • Clear drains, scuppers, gutters and downspouts of debris.
  • Clear roof of debris.
  • All HVAC access panels installed and secured.
  • All hoods on vent pipes secured and in place.
  • Roof hatch or ladder cage closed and locked.
  • Any splits or punctures in the roof membrane or flashings.
  • Any open seams or laps in the roof membrane and flashing membrane.
  • Cracks in exterior walls.
  • Split or open sealants on the building exterior.
  • Missing or loose roof shingles or tiles.
  • Inspect for obvious damages to HVAC, TV or Data Satellites, gas or electrical conduits (for reporting purposes only).

“Now is the time to be proactive since we have been through a heat cycle and freeze cycle.  Whatever impact the weather has had on the roof should be quite obvious, allowing for identification of any suspect issues prior to their exposure by a heavy rain,” said Scott.

As you are preparing for the spring rains, remember to schedule a commercial roofing inspection. Having an experienced roofing professional perform the inspection will provide better insight and uncover challenges that may not necessarily be discovered by someone without direct roofing experience.

“I believe in getting these inspections done now so that expensive repairs can be avoided later,” said Tracey.  “This will likely ensure less calls from tenants due to leaks, and more peace of mind to get through the upcoming rainy season.”



Every year in March, normal men and women who would otherwise be pre-occupied with their work and families spend hours computing elaborate game-theory scenarios. They take this copious research and carefully complete mathematical equations which (they hope) will lead to an elegant conclusion.

These people, scientists really, have a highly contagious disease that can only be described as madness. No doubt, this “March Madness” will infect you or someone you love and the physicians at Texas Back Institute have a professional duty to help you overcome this malady, inextricably tied to the NCAA college basketball tournament!

They Know Backs and Basketball

Several of the highly trained physicians at Texas Back Institute are not just experts on back pain, herniated disc treatment,artificial disc replacement and spine fusion. No. Some of them even know college basketball and we’ve asked for their help.

We’ve also asked the CEO of Texas Back Institute and an outstanding college player whose career may have been saved by the skill of two skilled surgeons at TBI to give us their insights to help you with your March Madness. They’ve all generously agreed to share their opinions on which teams they expect to make the Final Four to be played in AT&T Stadium in Arlington, Texas on April 5th and 7th, 2014.

While these recommendations are based on complex scientific theory and offered by highly intelligent professionals, they are fans just like you and they put their sneakers on one foot at a time, just like you do. These predictions are offered as a public service to help you through this tough time. Needless to say, they should not be used for the purposes of wagering!

The Experts Weigh In

When putting together a NCAA Basketball Championship strategy, it’s always a good idea to get someone who knows the game from the inside out. Who knows more the strengths of the teams in the Big Dance than a very talented college player?

Dr. Guyer and Dr. Hisey of Texas Back Institute were pleased to treat Arkansas State, All Conference forward Kirk Van Slyke last spring when his play on the court led to a herniated disc.  You will be reading more about Kirk in future posts. However, his surgery and treatment were successful and he had a great senior year.

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Kirk Van Slyke

Senior Forward
Arkansas State University

Kirk knows a lot about what it takes to win at the collegiate level, so his picks for the Final Four carry considerable weight. Here are his thoughts.

“Because of their balance, Florida is clearly the team to beat in this tournament. They also have talent and they’re experienced. Most likely, you see them in Dallas.

The other three teams could certainly be cutting down the net after the final game. These teams include: ArizonaMichigan State and Louisville.”

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Dr. Andrew Block 

College: Haverford College
Specialty: Clinical Health Psychology

Dr. Block is a very contemplative man in his practice but when it comes to college basketball, he has the nerve of a riverboat gambler. He has a sleeper in his predictions for the winner of the Big Dance. We think he’s been doing some research. By the way, the best three-point average in college basketball belongs to the Creighton Bluejays and this fact was not lost on Dr. Block!

“I believe KansasVirginiaCreighton (yes, you read that correctly!) and Duke will make the Final Four.”

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

 Dr. Stephen Tolhurst

College: University of Chicago
Specialty: Spine surgery

Dr. Stephen Tolhurst has the calm demeanor of someone who knows something about round ball. If you’re looking for some good picks for your brackets, you might want to seriously consider his picks.

“These are my thoughts on the NCAA Final Four:

University of Florida – They are clearly the strongest overall team

Michigan State – They always play well in the tournament and I want to see Michigan beat them in a big 10 tournament rematch

San Diego State University – Hey, my parents are big fans and that’s good enough for me!

University of Michigan – This is where I did my orthopedic surgery training and I have been a big fan of watching their resurgence the past few years. Go Blue!

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Trish Bowling

College: Texas A&M University
Chief Executive Officer Texas Back Institute

March Madness affects everyone on the TBI team, including the CEO, Trish Bowling. She believes Wichita State is for real and has this to say about this year’s Final Four.

“I have to say Kansas will make it to the Final Four for my Aunt Kay who is the biggest Jayhawk fan of all time (even though I am a K-State fan). I also like Virginia, Arizona and Wichita State for the championship bracket. Since I have not followed college basketball at all this year, these predictions should probably be taken with a teeny, tiny grain of salt!

Let the games begin. Whoop!”

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Dr. Renato Bosita 

College: Stanford University
Specialty: Spine Surgery

There few physicians with the breadth and depth of knowledge that Dr. Renato Bosita has about medicine, sports and pop culture. You might remember he was our go-to guy for our blog post on the “Best TV Doctor” shows of all time. The guy is a wealth of information!

Because of this, serious college basketball aficionados should pay close attention to Dr. Bosita’s learned opinion.

“Here are my predictions (and reasoning) for the Final Four this year:

Arizona will be there. Although the Cats tend to choke a lot, this year they have just too much talent not to make the Big Dance. It would be a shame to see them fall short again, but I would like to see the moms of their players crying after an upset loss to someone like Kentucky, especially because Julius Randle from Prestonwood Christian Academy in Plano plays for John Calipari.

Louisville will be around for the final tip-offs. You can’t bet against Rick Pitino’s hair. In the tournament, guard-play dominates the opening 2 rounds while frontcourt play separates the real teams from the pretenders in sweet 16 and elite 8. Louisville has the tradition and the balance needed to avoid the early upset and then make the big push through to Dallas.

Wichita State is undefeated and you can’t top that. I love the fact that they are a non-traditional team from a small conference that is having a great season and proving last year was not a joke. They deserve a #1 seed. I hope their run continues to get to Dallas and beat Arizona, until the Shockers’ glass slipper is shattered by an even darker dark horse in the Final Game . . .

STANFORD wins it all! Every year a team comes out of nowhere and makes it to the Final 4 or Elite 8, like George Mason, Villanova, Butler, Providence, and Virginia Commonwealth. This Stanford team is loaded with seniors and is playing for respect. Stanford also has three experienced game-changing players, a scoring point guard Chasson Randle who can neutralize the SEC and ACC press defenses, Dwight Powell in the post, and Josh Huestis who can block any shot inside the paint. I hope they beat Duke and Harvard and any other school with average SAT over 2000 on the way to the Final 4. Stanford will win their first NCAA basketball title since 1942! Go Cardinals!

So, there you have it. The basketball experts at Texas Back Institute have once again made their annual predictions and the games can officially begin. Oh yeah. They still have to PLAY the games and that’s where it gets a little trickier!


Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,  The practice of specialty medicine is changing rapidly and as the healthcare industry shifts from “volume” to “value,” organizing spine care patients into an integrated, comprehensive service line is more important than ever. As a part of its commitment to enhancing the delivery of spine care throughout the United States, Texas Back Institute was pleased to sponsor The Second Annual Spine Business Summit, held in Frisco, Texas on February 26 and 27, 2014. During the two-day conference, current best-practices among spine specialty clinics were presented and discussed. Much of the thought-leadership of this important summit was supplied by the spine specialists at Texas Back Institute.

Healthcare Questions Answered at the Summit

The Spine Business Summit answered many questions for the administrators of hospitals, health systems, academic medical centers, community hospitals, physician clinics, hospital management groups and healthcare consulting groups. These included:

  • How does an organization develop a comprehensive Spine program?
  • How to leverage navigation and outcomes collection to engage physicians and the community?
  • What are the best tried and true marketing strategies for a spine program?
  • What are the key components required for The Joint Commission orthopedic and spine certifications?
  • How does an organization differentiate/brand a Spine service line?
  • How are costs controlled and how are third-party payor relationships managed
  • How are physicians incented such that the program generates a favorable financial return?
  • How does an organization resolve “physician engagement” issues?
  • How does an organization increase collaboration among neuro and ortho surgeons?
  • How does an organization quantify “success?”
  • How can an organization improve reimbursement for spine?
  • What are the best practices in collaborating with physicians under both employed and non-employed models?

Thought Leadership from the Spine Specialists at TBI

Some of the most important presentations at the Spine Summit were given by the spine specialists at Texas Back Institute, including:

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas, In his presentation on the final day of the conference, Dr. Blumenthal offered the “Current Innovations in the Spine: Successes and Challenges.” He noted, “One of the exciting areas of spine care has been the ongoing development of new interventions.” He focused his presentation on three areas: (1)  Total disc replacement (2)  Disc regeneration, including stem cell (3)  Minimally invasive spine surgery.

Since the first total disc replacement in the United States was performed by Texas Back Institute in 2000, as a part of an FDA trial, the clinic has a unique perspective in the history of this intervention. The challenges and opportunities of each of these interventions were presented to the attendees with a better understanding about each being the objective. The Spine Business Summit, which also offered all attendees an opportunity to tour the state-of-the-art Texas Back Institute facility, proved to be invaluable to the hundreds of administrators and physicians who are driving the “value” in spine health.


Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Twice each year, “Fashion Week” occurs in the major fashion cities – New York City, London, Milan and Paris. During the month of February, clothing designers show off “what’s hot,” or rather, what will they believe will be hot for the coming fall and winter, by staging elaborate fashion shows and media events.

Each show combines music, elaborate choreography and dozens of svelte models dashing around the stage. Many of these models spend hours on their feet, walking the runways while wearing high-heel shoes. While these shoes look great with the clothes, they can be painful to wear and there is even some concern about their effect on other parts of the body including the spine. Even if you’re not a “fashionista,” if you’re a woman, you probably wear high-heels at some point during the week.

They may be very flattering to one’s legs but do these shoes damage your back? We chatted with Dr. Jessica Shellock, a spine surgeon at Texas Back Institute, to get her perspective on high heels and their effect on spine health. Keep reading to get her stylish medical opinion.

In Fashion, Nothing Exceeds Like Excess

According to the Wall Street Journal, the just completed New York City Fashion Week shows featured diverse collections which have “prescribed a utilitarian yet luxe antidote to the polar vortex.” This included alpine sweaters, puffer coats in leather, fur and embroidery and cozy flat-soled boots. Well-known fashion designers such as Donna Karan, Tory Burch, Michael Kors, Ralph Rucci, Diane von Furstenberg and Marc Jacobs presented their collections and each garnered glowing reviews.

There were many highlights of the NYC Fashion Week shows. These include:

  • Designer Stuart Vevers fireman’s coat, complete with toggle buttons and constructed of black motorcycle-style leather for Coach.
  • Ralph Rucci had one of the more spectacular coats of the week. The Wall Street Journal fashion editor – Christina Binkley – noted it was lined with Barguzin sable with an outer layer of Nappa leather. She opined, “The coat looked as suitable for driving a dogsled as for hurrying down Fifth Avenue.”
  • Plaids were big at the show with Tracy Reese and Marc by Marc Jacobs contributing several designs using this garment staple.
  • Pants in this year’s show seemed by many to be inspired by actress and icon Katherine Hepburn. They were wide-legged and often long.
  • Jackets and tops will have “voluminous sleeves and curvaceous backs” next fall and winter.
  • Fur bags will be hot next fall. Designers Tory Burch and Derek Lam all had new variations on this old theme
  • It wouldn’t be Fashion Week without the unusual. Designer Rodarte created gown with Star Wars images of Yoda, R2-D2 and Luke Skywalker printed on the skirts! Tres chic!

Can High Heels Ruin Your Back?

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

Many of those (very) thin models who pranced across the runway during Fashion Week, showing off the latest of haute couture, were balancing their exaggerated gait on a pair of high heel shoes. While the history of high heels is storied – they first came to be used in 9th Century Paris to keep horseback riders’ feet in the stirrups – most women wear them because they give the illusion of longer, more slender legs.

However, after an entire day at the office or several hours on the fashion runway, many women wonder if this illusion is worth the pain. Plus, some non-medical analysts have suggested that high heels can permanently injure one’s back.

“Wearing high heel shoes does not injure a woman’s back,” noted Texas Back Institute physician Dr. Jessica Shellock.

“However, for people that are already predisposed to back pain, wearing high heels might lead to episodes of increased pain. There’s more of a risk of developing foot problems (i.e. bunions) with longstanding use of high heels than back problems,” she said.

Spine Surgery in Dallas Texas, Back Surgery in Dallas Texas,

One hears stories of women who have had back surgery being forced give up wearing high heels. Is it advisable to avoid high heels after back surgery?

“I think it’s reasonable to limit or avoid high heel shoes for at least a short period after back surgery, notes Dr. Shellock.

“Wearing high heel shoes causes a woman to hyperextend her back for balance. Depending on the specifics of the surgery, a woman might have restrictions from her surgeon such as avoiding hyperextension. The hyperextension might also increase muscular pain in the area of a surgical incision, so in my practice I try to encourage patients to avoid heels for at least a number of weeks after surgery and stick to shoes that have better cushioning and more ankle support.”

Dr. Shellock continued, “From an even more practical standpoint, I think we can all agree that high heels put us at more risk for a potential ankle injury than comfy flats or sneakers. The last thing I’d want a post-op patient to experience would be a “twinge” of back pain or leg pain that led to a trip or fall and subsequently caused an inadvertent ankle sprain!”

Are there medical conditions related to the back muscles and spine which can result from high heels?

“It’s the fact that we tend to hyperextend the back when we wear high heels so that we can maintain our balance. This puts extra strain on our muscles and can lead to back pain,” notes Dr. Shellock.

“Plus, in patients that have facet-mediated pain or spinal stenosis, for example, extension of the back is what usually exacerbates symptoms. Wearing heels would lead to extension as we discussed and would therefore be likely to aggravate the pain. As with most things in life, moderation is probably the way to go!”

The very stylish Dr. Shellock concludes with some practical advice.

“With that being said, I absolutely love wearing high heel shoes myself. However, I limit my use! If I know I’m going to be on my feet in clinic for 8 hours then I might wear some equally stylish but slightly more comfy wedges or boots and save the killer heels for date night!”



fitness-series-3-68976-mEach year, during the months of January and February the hospital emergency rooms and the waiting room at Texas Back Institute are packed with people who were just trying to get back into shape. According to the National Institutes of Health, nearly 500,000 workout-related injuries occur each year in the United States. The major causes include people wanting to do too much too fast and overusing their muscles, as well as poor technique during weight training and other exercise regimens.


Even people who are in great shape can sustain life-changing injuries from accidents in a workout environment. Take the example of Kevin Ogar who was once a top-level Cross Fit athlete. He was performing a routine “snatch” with barbells at a competition in Costa Mesa, California on January 12, 2014, when he abruptly lost control of the weight bar. Media reports noted, “The massive weights fell onto the floor, bounced against another set of weights and hit Ogar in the back, severing his spine.” He immediately fell to the floor and is now paralyzed from the waist down.

If this tragedy can happen to a professional trainer who’s in excellent shape, what are the risks to a less-than-fit individual who’s more than a little rusty when it comes to proper workout form? Most neophyte athletes look to a personal trainer to help them learn proper form and develop workout regimens for losing weight and gaining strength.

However, how can one determine if a personal trainer knows what they are doing, especially as it relates to back injuries resulting from exercise?

We spoke with two men who have first-hand knowledge of how vigorous physical activities can cause back injuries. They also know how you can avoid these injuries in the first place. Skylar Richards is the head athletic trainer of FC Dallas, a franchise in Major League Soccer. Dr. Michael Hisey is a spine surgeon at Texas Back Institute and the team spine specialist for the professional soccer club.

The Players on FC Dallas Rely on Skylar Richards

As the official spine specialists for FC Dallas, Texas Back Institute is on call to help these world class athletes avoid back injuries and if these injuries occur, to help Richards get the players’ injury diagnosed and rehabilitated as soon as possible. We asked Skylar to explain the differences between an athletic trainer and a personal trainer.

“An athletic trainer is more medical-focused. We look at injuries – how they can be avoided and managed,” he said. “A personal trainer is a strength and conditioning specialist who usually operates out of a personal gym and helps you develop your physique and physical well-being. An athletic trainer will help an athlete get back to where they were before they were injured.”

As someone who deals with injury management, Richards has exemplary insights into the questions non-athletes should ask of a potential trainer before enlisting their help. For his thoughts into the credentials a personal trainer should have, please click here.

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So, what are the biggest problems a person who is just starting an exercise program – particularly weight-lifting – can encounter? The FC Dallas athletic trainer says it’s trying to do too much too quickly.

“You should always work on technique and motion first,” he says. “If you can move well, have good posture and align your spine in a way that it loads the weight correctly, you’re always going to be safe and that’s what’s important.”

If you’d like to hear the rest of Skylar’s thoughts on problems associated with working out, click the next video screen.

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In order to combat the epidemic in obesity – among both children and adults – a wide range of ages are now working out. We asked Richard’s opinion if one’s age should preclude vigorous workouts.

“You can always work with a qualified trainer at any age,” he noted. “That’s why it’s important to pick a qualified individual. They will know the appropriate exercises and the intensity of these depending on age and strength level.”

To hear Skylar’s thoughts on whether you can be too old or too young to exercise - click this video screen.

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Five Ways to Avoid Back Injuries When Exercising


The spine specialist responsible for treating the injuries and keeping the professional athletes at FC Dallas on the field is Dr. Michael Hisey a spine surgeon at Texas Back Institute. Because his practice involves treating professional athletes, as well as the rest of us who just want to get into shape, he has some excellent insights into ways both groups can avoid injuries when working out.


“While there are hundreds, maybe thousands of ways to keep one’s back safe while exercising, here are five general tips to keep your back safe from injuries.

#1 Warm up and slowly increase the activity

A person should always warm up before working out and then slowly increase the pace of the activity over time. Most people forget about this warm-up phase and then immediately go full speed on whatever activity they are pursuing. This is a recipe for back injuries. Professionals (like the FC Dallas players) arrive hours before a competition to prepare themselves for peak performance. Thoroughly stretching muscles before the activity helps prepare them for the stress – and warming down can be as beneficial as warming up. Stretching when muscles are already warm can lead to gains in overall flexibility.

#2 Be aware of gender differences

Women are more prone to back injuries during their menstrual cycle because hormones increase the looseness of the joints and make injuries more likely. Women are also more prone to ACL (anterior cruciate ligament – knee) injuries which can occur in basketball, racket sports, soccer and skiing. Men are more likely to injure themselves while doing Pilates, stair stepping and by using too much weight on free-weights and weight machines.

#3 Know your body’s limitations

If there is a history of lower back pain, knee or shoulder pain it is important to avoid sudden stress on these areas. It’s better to slowly build up the strength. In the case of back pain, it’s advisable to avoid back stretches on a stability ball until core stabilizing muscles are conditioned enough to allow these exercises. Once a back is ready for it, a stability ball can be an excellent way to activate these core muscles.

#4 Be careful to avoid too much repetition

Doing any activity over and over in a given workout can injure muscles and joints. The best advice to avoid repetition injuries is to (1) take a day off from exercising every other day and (2) vary the type of activities each session. For example, you could run on the treadmill on Monday and lift weights on Wednesday.

#5 Don’t make sudden moves

Many back injuries from exercise come from someone making sudden moves on either weights or machines without properly setting up. It’s important to test the weight before attempting to lift it and then slowly lift using proper form. This will save your back from muscle pain and subsequent damage to your discs.

When Your Back Hurts From Exercise

If your workout program results in a painful back or neck, try resting for a week and taking mild medication such as ibuprofen. If this doesn’t help, you should schedule a visit to see a spine specialist

For more information on avoiding back pain from exercise, please call Jaclyn McDaniel at Texas Back Institute 1-800-247-BACK. 


Reality TV stars Honey Boo Boo and her family were in an auto accident last week.  Fortunately, no one in the family featured in cable show “Here Comes Honey Boo Boo” was seriously injured.

News media from around the world have given prominent coverage to the accident, due to the public’s fascination with the family from rural McIntyre, Georgia. According to wire services, young reality star Honey Boo Boo and members of her family were in a car accident on January 6, 2014. The 8-year-old, along with her mother, Mama June, and older sister, Pumpkin, were passengers in the car being driven by the Thompson family patriarch, Sugar Bear.

According to TMZ, “the family was at a red light, waiting to turn left. When the light turned green, Sugar Bear began to make his turn, but a truck, which was allegedly speeding, ran a red light and smashed into the car.”

Honey Boo Boo’s family is not alone in feeling the pain of vehicle accidents. The U.S. Department of Transportation estimates there are over six million vehicular accidents every year in the United States. Worldwide, an estimated 1.2 million people are killed and fifty million injured in car accidents.  Some of these victims find their way to the examining room of back specialist Dr. Craig Callewart of Texas Back Institute. Recently, we chatted with him to get some insights about the physical effects of vehicle accidents. More on this later.

An 8-Year Old Reality Star

honeyboobooMs. Boo Boo, whose legal name is Alana Thompson, rose to fame after appearing in The Learning Channel’s reality show “Toddlers & Tiaras” which shared the trial and tribulations of young beauty contestants. The sub-plots included members of Thompson family as they found ways to scrape by on Sugar Bear’s meager earnings from his job as a chalk miner.

With the accident behind them, the family of Honey Boo Boo can hopefully get back to show business. The next season of the show begins on January 16, 2014. However, there may be complications from this car crash and we asked back specialist Dr. Craig Callewart to give us some insights about the injuries which might result.

After the Accident

Callewart“It’s very possible to walk away from an auto accident and have serious injuries show up later,” Dr. Callewart said.

“After an accident, the body is in shock and adrenaline covers the pain. So, the body of the accident victim will often fail to recognize the pain from injury until later.”

Since so many people are involved in vehicle accidents each year, there’s a great possibility that at some time or another we all will go through post-accident trauma the Thompson family is experiencing. It therefore seems prudent to see a physician – preferably a specialist such as those at Texas Back Institute – after an accident.

As a spine trauma specialist, what are the three things that Dr. Callewart checks on a patient who has been in an accident?

“For someone suffering from a neck injury, I first check for headaches,” he notes. “Having headaches suggest more severity in the injuries which can be caused by whiplash from the accident.”

“We also check for muscle spasms and sprains,” he said. “If these are being experienced by the patient, there is a possibility of more serious injuries.”

“Finally, I look for pain that might that might be shooting from the neck to in between the shoulder blades,” he noted.

Common Injuries from Car Crashes

In his practice, Dr. Callewart deals with many traumatic injuries to the back muscles and spinal column. What are the most common injuries that result from a motor vehicle?

“Muscle strains or ligament strains are statistically the most common injuries we treat after an auto accident,” he noted. “While not as dangerous as fractures to vertebrae, these injuries can be extremely painful and require rehabilitation and medication.

“Disc herniation or rupture in the spinal column, which less frequent, can also occur after a vehicle crash,” he notes. “The impact of the crash can force the discs between the vertebrae to compress and this can cause them to rupture.”

Pain and soreness are common for anyone who has experienced a wreck. Is there anything to be done to ameliorate this pain?

“While driving, don’t sit in bucket seats,” he notes. “The pain will be less if one rides with the hips up higher than the thighs.”

“After a crash, the victim’s neck will likely be sore and this is a good time to learn how to properly use the side and rearview mirrors when backing a car. When these are used properly, there is less likelihood of further neck strain resulting from quick head movement.”

Other ways to avoid this neck strain while backing is to purchase a small, self-adhesive inexpensive round mirror and stick in on the side mirror. This will afford a larger view for the driver. Dr. Callewart also recommends an enlarged rear-view mirror which can give a 160 degree view.

The best way to avoid the pain and injury of an accident is to avoid them altogether by driving safely and buckling one’s seatbelt. However, this is not always possible. As Dr. Callewart notes, “Car crashes simply follow the laws of physics. A heavy vehicle (mass) going at even a moderate speed (velocity) will result in a force or momentum that can cause great destruction.”

Accident behind them, Mama June, Sugar Bear and Honey Boo Boo will all be back for another year on TLC in January. You can bet the producers will find a way to work this crash into the storyline. Stay tuned.