Jaclyn McDaniel
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Spine problems are extremely common. In fact, 62% of U.S. adults have sought treatment for severe neck or back pain. This often excruciating and unrelenting pain forces many people to consider spine surgery.

Advances in medicine have made these operations safer than ever. However, any surgical procedure carries some risk. In order to help with the decision-making process, Dr. Peter Derman, an orthopedic spine surgeon in North Texas and a member of the referral line of Texas Health Spine & Orthopedic Center, provided some guidance on the important questions patients should ask before opting for spine surgery.

The 6 Most Important Questions to Ask Before Spine Surgery

Are there any remaining alternatives to surgery?

As with any procedure, the decision to embark upon spine surgery should not be taken lightly. Dr. Derman agrees with this approach.

“While surgery often produces outstanding results in the right patient, it should be considered a last resort,” he said. “Non-operative strategies such as physical therapy, anti-inflammatory medications, and achieving a healthy weight should be first-line treatments and are frequently successful.

“Steroid injections targeted to the areas around compressed nerves might be considered next if symptoms remain. In uncommon cases of severe nerve compression or traumatic injury, your doctor might recommend surgery in lieu of these non-operative measures, but this is a relatively infrequent scenario. Before proceeding with an operation, ensure that your surgeon knows what treatments you’ve already had so that you can confirm that all non-operative strategies have been exhausted.”

 What surgery is being recommended?

“If you ask five spine surgeons how to manage a given problem, you might get seven opinions,” Dr. Derman said. “Because there can be such variability in treatment strategies, it is important to know exactly what surgery is being recommended and why.

“Some spine issues are amenable to decompression alone while others may necessitate fusion. To further complicate matters, strategies such as laminoplasty and disc replacement exist and may represent a middle ground. Even once a surgery has been decided upon, there are multiple techniques for accomplishing each, ranging from the traditional to the minimally invasive.

“You don’t need to master the intricacies of the procedure, but you are an integral part of the team and should understand the plan. If you continue to have reservations after speaking with your surgeon, a second opinion may be helpful.”

What sort of relief can you expect from the surgery?

The goals and expected outcomes of spine surgery may vary depending on the problem.

“The spine and nervous system are complex structures,” Dr. Derman said. “Issues such as disc degeneration, arthritis, and disc herniations can affect multiple different sites, producing a wide variety of symptoms affecting the neck, back, arms, and/or legs. Some of these symptoms are more amenable to surgery than others.

“If an operation is recommended, it is important to understand the goal of the surgery. Is it primarily to address pain shooting down the legs or arms? How much relief of neck or back pain can be expected? Is the aim to prevent symptoms from worsening or can you anticipate improvement? Asking these questions up front will help you decide if surgery is right for you and will help set realistic expectations from the start.”

 What are the risks of surgery?

Spine surgery may sound daunting but can be consistently performed in a safe manner,” Dr. Derman said. “However, there are inherent risks to any surgical procedure. Discussing these risks with your surgeon can help you decide for yourself whether surgery is worth pursuing. Many patients initially focus on rare, worst-case-scenarios when first considering spine surgery, so a realistic understanding of the risks often allows them to feel more at ease.”

 What is the recovery like after surgery?

The postoperative recovery period is also a critical time for patients. This is where the patient navigators at Texas Health Spine & Orthopedic Center can be of great service.

“Don’t wait until after surgery to make arrangements and accommodations for life during the recovery period,” Dr. Derman said. “Depending on the operation and your personal circumstances, securing child care, a helping hand at home, and/or time off work may be advisable. Ask your surgeon about how long patients undergoing this procedure typically stay in the hospital and when they return to activities such as driving and work. While there is some variability from person to person, having an idea of what to expect will allow you to prepare in advance.”

 What factors make for better spine surgery outcomes?

“We can’t always control the cards we’re dealt, but there are certain modifiable pre-operative factors that can help improve the outcomes of spine surgery,” Dr. Derman said. “Achieving a healthy weight, abstaining from tobacco use, minimizing opioid medication intake, controlling diabetes, and maintaining a positive attitude all contribute to the ultimate success of the operation. Rather than focus on what’s getting you down, work to optimize these factors before surgery to help ensure that the operation will get you back to the activities you enjoy!”


Physicians who are members of the referral line practice independently and are not employees or agents of Texas Health Spine & Orthopedic Center.

Jaclyn McDaniel
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Someone lucky enough to still have grandparents around may have heard them predict the likelihood of rain, based on the pain in their joints. While this prognostication prowess has been largely attributed to the tales of old wives, medical research has suggested that there may be some accuracy in weather predictions that are based on joint pain.

It has to do with barometric pressure. This common meteorological term, which is also known as atmospheric pressure, is the force exerted by the atmosphere at a given point. It is, in fact, the weight of the air.

Weather experts note that fluctuations in barometric pressure are usually a sign of weather conditions changing. A rise in pressure usually means improving weather while falling pressure may reflect the impending inclement weather. Barometric pressures will also vary with altitude and moisture.

Osteoarthritis and Barometric Pressure

According to Dr. Kwame Ennina joint replacement surgeon in the North Texas area and a member of the referral line of Texas Health Spine & Orthopedic Center"Osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time. While this painful condition can damage any joint in your body, it most commonly affects joints in your hands, knees, hips, and spine.

"Osteoarthritis can occur when the cartilage that cushions the ends of bones in joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. Several factors can cause the slick surface of the cartilage to become rough, and if the cartilage wears down completely, you may be left with bone rubbing on bone."

Factors that can lead to osteoarthritis include:

  • Gender – Women are more likely to have this condition than men.
  • Older age – This risk increases with age.
  • Obesity – Extra body weight contributes to osteoarthritis because it adds stress on the weight-bearing joints, such as knees and hips. Also, fat tissue produces proteins that may cause harmful inflammation in and around the joints.
  • Joint injuries – injuries from playing sports, repetitive stress from work or from an accident may increase the risk of osteoarthritis.
  • Genetics – Some people inherit a tendency to develop this condition.

"In addition to a loss of flexibility and tenderness around the joints, osteoarthritis can cause chronic pain," Dr. Ennin said. "Research has suggested that this pain occurs more often when the barometric pressure is decreasing."

New Studies on Stormy Weather

In a recently published report, Dr. Elaine Husni, director of Cleveland Clinic's Arthritis and Musculoskeletal Center noted, "There is some consensus that lower barometric pressure and dropping temperatures correlate with more joint pain. The thinking is that the lightness of the air can cause the thin lining known as the joint capsule, which surrounds the joints and maintains lubrication, to expand and stretch nerves, causing pain. A similar phenomenon can occur with humidity changes. The shift in pressure can cause swelling around the joints."

The Arthritis Foundation points to several other studies that support the effect of the weather on joint pain. It notes that if the results of the various studies are combined, "the general consensus is that cold, wet weather is the worst for inciting arthritis pain." The group also notes that changes in barometric pressure seem to be more important for pain levels than the actual barometric pressure. This means that either a cold front or warm front coming in can ramp up the ache in one's knee or hip, but once the weather has settled in, that pain will even out.

"While more research on this phenomenon is needed," said Dr. Ennin. "The anecdotal evidence is certainly voluminous."

"It is interesting to note that some studies point to changes in patient physical activity due to weather and how this affected their osteoarthritis. Pain was lower on days that were sunny and dry and greater on those that were cold and damp. On inclement days, most of us stay inside and are sedentary, and this lack of physical activity is a well-known cause of increased pain from osteoarthritis. Thus, one might ask if the cause of this pain is the barometric pressure, the lack of physical activity due to bad weather, or both?"

What to Do About Weather Related Joint Pain

study tracked online searches for terms related to arthritis and knee and hip pain and weather changes over five years in 50 American cities. When the temperature fell below minus 5 degrees Celsius and 30 degrees Celsius, search volumes for hip pain increased by 12 index points and for knee pain increased by 18 points. When it was greater than 30 degrees, search volumes dropped by 7 index points.

While it would be great if everyone who has osteoarthritis could move to someplace warm and dry year around, this is not possible. It is, therefore necessary for these sufferers to take remedial actions in order to reduce the pain.

"I recommend osteoarthritis patients try to keep their core warm and dry during the fall, winter and early spring months," Dr. Ennin said. "We also suggest anti-inflammatory medications and regular physical activity, such as walking and losing excess weight. If the chronic pain persists, joint replacement should be considered."


Jaclyn McDaniel
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The futurologist John Naisbitt introduced the concept of “high tech and high touch” in his 1982 bestseller Megatrends. He maintained that in a world of technology, people long for personal, human contact. More than 30 years later, he has been proven to be prescient, especially in the technology-driven industry of healthcare. Jaclyn McDaniel, the director of the Texas Spine & Orthopedic Center, is well aware of this need for patients to receive high touch treatment.

“We’re trying to help patients feel connected,” McDaniel said. “This starts with our patient navigator. This is a person on our staff who is dedicated to each patient who comes through our system. Our navigator helps patients throughout their entire care process.  From determining which doctor is most appropriate for their specific condition to understanding what their next steps are in their treatment process. We help with it all.

“Patients have told us that not knowing what’s going to happen next can be scary when it comes to healthcare. Often, the patient doesn’t feel like they know whom to ask. It can be a tremendous relief when a patient has someone who can hold their hand and say:

You know what, I’ve got you, I’m going to take care of you and get you to the right spot. I’m going to get you to the right doctor and help you schedule appointments. Plus, I’m going to call you afterwards and ensure you had a good experience.’

“It’s the little things like these that make healthcare more human. They help remove the fear that most people associate with medical procedures out of the equation.”

The DNA of a Texas Health Spine & Orthopedic Center Navigator: Customer Service

“Our navigators are customer service oriented,” McDaniel said. “They understand that EVERYTHING is their job. If a patient needs help, on anything, our navigators find a way to get them the help they need. We sometimes forget about customer service in healthcare, but our navigators are absolutely focused on the customer.

“Our navigators are not necessarily nurses or medical personnel. We do extensive training, teaching them about our doctors; what they specialize in, what services they offer and what qualifies each patient to see each physician. This means that when our navigator makes a suggestion for a doctor, they know what that doctor specializes in and, in doing this, they help take the guesswork out of this very important decision.”

Eliminating the Insurance Confusion

Modern health insurance is anything but straightforward. As such, it presents another way the Texas Health Spine & Orthopedic patient navigator can cut through the chaos and get the patient what he or she needs.

“Managing a patient’s insurance can be very frustrating,” McDaniel said. “But it doesn’t have to be. By asking the right questions we can help effectively guide the patient to a doctor in their network. We work closely with each of the referral line doctors so we know what insurance each of our referral line doctors accept.

“We always try to place a patient with a doctor who is in their network. However, if the doctor is outside their network, we would alert the patient and offer to schedule them with another doctor. At the very least, we would do our best to make the patient aware of any increase in their out-of-pocket costs.”

Less Anxiety is a Real Medical Benefit 

In a recent interview, one of the Texas Health Spine & Orthopedic Center referral line surgeons was asked if the situation where patients are less stressed by the process helps with the patient’s recovery. He noted that when some of the anxiety is removed from the process and procedure, healing is enhanced.

“Most of the feedback we receive from patients is that we have made the process easier,” McDaniel said. “They are less anxious because they know what to expect.

“We communicate with each patient extensively and we try our best of pair them with the doctor who meets their medical needs and also their psychological needs. Our patient/physician matching process is not just based on the doctor’s specialty but many factors including location, availability and the specific needs of the patient.

“Our program is very intimate and this is sometimes lost in the fast-paced world in which we must operate. When it comes to healthcare, the fear of the unknown can take over. We do our best to ensure that our patients have as much information as they can absorb. Plus, we are here throughout the entire process. If something comes up where they are uncomfortable or they have questions, they call us and we get them answers.”

 Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.

Jaclyn McDaniel
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The food that supplies the fuel to power the human body can also help to repair it. This is true for all parts of this amazing mechanism – from the skin to critical organs such as the heart and lungs to the bones and joints that serve as structural support and enable movement.

Dr. Donald Hohman, a joint replacement surgeon in the North Texas area and a member of the Texas Heath Spine & Orthopedic Center referral line, noted, “As many as half of all women and one fourth of all men 50+ will fracture a bone at some point due to osteoporosis. Plus, joints are being replaced at a rapid rate because of wear and tear over time. Diet can affect both of these conditions.”

According to the American Joint Replacement Registry, “Considering the number of ‘baby boomers’ reaching old age in the U.S. along with the prevalence of osteoarthritis and the growing obesity epidemic, it is expected that by 2030 there will be approximately 3.48 million total knee replacements and 572,000 hip replacements performed annually in the U.S.”

“In my practice, I treat more and more patients for pain from joints that have worn down and these numbers get bigger each year,” Dr. Hohman said.

Building Bone and Joint Health the Old Fashion Way

Medical science has come a long way in the treatment of joint and bone injuries and diseases, but there are other preventative and treatment options that are less invasive and taste much better. The right kinds of food can make a big difference in bone and joint health.

“Your bones need a variety of nutrients, including calcium and vitamins, C, D and K,” Dr. Hohman said. “Low-fat dairy products are well-known sources of calcium, and many are fortified with vitamin D. You can also get calcium in non-dairy foods, like salmon, mackerel, tuna, sardines and other fish along with white beans and tofu.

“Fruits and vegetables are an excellent way to get these vitamins and minerals. For example, calcium and vitamin K come from kale, collard greens, broccoli, spinach and cabbage. Vitamin C is high in red and green bell peppers, strawberries, Brussels sprouts, oranges and pineapples.

“There are also some types of foods to avoid. Those with high levels of sugar, such as soft drinks and candy, decrease bone strength. Plus, consuming too much saturated fat  (e.g. red meat and butter) can lead to a high level of homocysteine – a chemical in the body known to decrease bone mass.”

5 (Delicious!) Recipes for Bone and Joint Health

More than 40,000 people regularly follow chef/author Stacy Lyn Harris  on Facebook. The self-proclaimed “locavore” (someone tries to consume only locally-sourced, seasonal fruits, vegetables, meat, poultry and fish) is a regular guest on television food shows, has millions of visitors to her website every year, has sold thousands of copies of her cookbooks and is a wife and mother of seven children.

“Dinner at our house is a BIG production,” she laughed.

“In my work, I have tried to find the best, freshest and healthiest ingredients, whether they come from my garden or the local farmer’s market, and prepare them in a way that brings out their delicious flavors. Healthy foods can be scrumptious. It just takes some skill in their selection and preparation.”

The skills of this culinary were put to the test in a search for foods that enhance bone and joint health.

Southern Collard Greens

“Collards have been part of the Southern diet for centuries now. When I hear the word “collards,” I think of the days before the mega marts; the days when life was simpler, when every Southern family farmed the land. One can cook every part of these greens, from the leaf to the root, and they are one of the bone and joint superfoods .”

Click here for an easy, delicious recipe for collard greens. Your joints will thank you later.

Herb Pecan Crusted Trout

“Nutritionists are quick to tell you that you need at least three servings of fish a week. Amazingly, studies have found that those that eat trout a few times a week have a lower risk for dementia, depression, bipolar disorder, and Alzheimer’s disease. It is packed full of Omega 3 Fatty Acids, over 900 milligrams a day, and far exceeds the minimum recommended daily allowance of Omega 3 Fatty Acids, 250 milligrams a day.”

Click here for an amazing recipe for herb pecan trout that will help your bones stay strong.

Homemade Chicken Stock

“Traditional cultures the world over have included bone broth in their daily diets. Homemade broth is full of the amino acids necessary for collagen production; proline, glycine and hydroxyproline. This is critical for joint repairs. Recently, researchers have found that chicken soup has anti-inflammatory properties as well as the ability to decrease the number of cells that congregate in the lung area, thereby relieving the development of cold symptoms.”

Click here for a classic recipe for joint-repairing chicken stock/soup.

Southern Style Eggs Benedict with Homemade Hollandaise Sauce

“If you just stuck to the traditional recipe, you would serve your Eggs Benedict with ham, English muffins, a poached egg and hollandaise sauce. Well, here I was thinking to myself, “Why not make a Southern-style Eggs Benedict using a Southern Homemade Biscuit instead of the English muffin, a fried egg in place of the poached egg, and crispy bacon instead of ham?” Then I put my thoughts into action, and voilà! Southern-style Eggs Benedict, plus my homemade hollandaise sauce!”

Click here for a bone-building breakfast treat.

Greek Snapper

“Seafood is an excellent source of protein. It’s also low in calories as well as fat and cholesterol. Seafood is high in polyunsaturated fat and a great source of vitamins and minerals. Besides seafood’s health benefits, it is easy to prepare. In fact, this snapper recipe will take less than 20-minutes to make”

Click here for a flavor packed recipe for amazing snapper that only takes a snap to make!

More delicious, bone and joint building recipes are available in Harris’ latest cookbook, “Stacy Lyn’s Harvest”. Eat well and stay well.


If you’re experiencing joint pain that has persisted for more than two weeks, check your symptoms, and schedule an appointmentto discuss treatment options with a participating physician.


Physicians who are members of the referral program practice independently and are not employees or agents of Texas Health Spine & Orthopedic Center.

Stacy Lyn Harris is not an employee or agent of THSOC.

Jaclyn McDaniel
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One Day Before…

It’s hard to believe. No, it’s impossible to believe. The day you have been thinking about since you were a little girl – your wedding day – is only one day away! Your mother and father arrive later today, your sister and her husband come in tonight and the friends you’ve known since second grade, who have accepted the challenge of being bridesmaids, are still asleep at the hotel.

The flowers, church, catering, and entertainment are booked. Your dress is beautiful, and your future husband is handsome as can be! It all seems like a cool Gershwin song. What could possibly go wrong?

Unfortunately, everything.

Veteran wedding planners have proof of the pitfalls of weddings, and some of them are more painful than others. But have no fear! The mishaps and mayhem of those who have made this trip down the aisle before you have been meticulously chronicled below, and they can serve as your “Avoid These!” list.

 What to Watch Out for before the Big Day  

You know that part of the wedding vows that goes…”in sickness and in health?” Sometimes the sickness-and-health issues come up before or BECAUSE of the wedding.

Dr. Mark Lessneran orthopedic surgeon in North Texas and a member of the Texas Health Spine & Orthopedic Center referral line, has four tips to help keep you and your wedding party out of the emergency room!

“There are several potential health landmines that can cause a bride, groom or members of the wedding party to either miss or feel miserable during the wedding,” he said. “Here are some ways to avoid them.”

Tip #1

“Avoid improper, heavy lifting,” Dr. Lessner said. “This can involve mom’s suitcase, which is packed with more clothes than she would wear in a month, as well as those of seemingly small wedding decorations that need to be moved several times in order to be just right.

“If you MUST pick up an object, use your legs to lift; don’t bend. Then carry the item as close to your body as you can. This will help you avoid a back strain and help ensure that you are not suffering from back pain on the big day.”

Tip #2

“Watch your step on the dance floor,” he said. “Nothing ruins a post-wedding reception quicker than a trip to the ER for a sprained ankle, or worse.”

Tip #3

“Try and chill,” he said. “The mental stress of dealing with the wedding ceremony, friends, family and even the cute little ring-carrier, who doesn’t understand how to use his inside voice, can cause headaches, stomachaches and neck and back stress. Take a deep breath and then take a walk.”

Tip #4

“Many weddings have a rehearsal dinner on the night before the ceremony,” Dr. Lessner said. “These parties are great for families and friends but can be dangerous for the bride and groom. Falls or other minor accidents can put a big damper on the evening.”

 Tips for the Big Day

Once the big day finally arrives, every bride and groom feel a combination of excitement and anxiety. The ceremony and reception are planned to the last detail (including the obligatory group sing-along of: “CEL-E-BRATE-GOOD-TIMES-COME-ON!”) but there are still hazards lurking behind the champagne fountain!

Wedding planners offer these tips for avoiding or dealing with wedding day injuries:

  • For ceremonies that are scheduled for outdoors, have a “Plan B” for inclement weather. Otherwise, expect guests to be soaked and develop nasty colds!
  • Have a first-aid kit on site at the reception. There’s a good possibility that either your crazy Uncle Jimmy or your girlfriend from college – will bump his head, cut her finger on a crystal glass that she has just broken or twist an ankle from dancing while being over-served. It happens. Be ready for it.
  • After standing all day while wearing those gorgeous but extremely uncomfortable new shoes, the bride’s tootsies are most likely screaming in pain. It’s a good idea to have some more comfortable shoes available for her at the reception. That way she can “CEL-E-BRATE-GOOD-TIMES-COME-ON!!!”
  • Finally, watch the alcoholic intake of the bride, groom, their parents and the wedding party. When the ceremony is finally completed, there is a tendency on the part of participants to breathe a sigh of relief and toss back a few more drinks than they would normally consume. When this mild or serious inebriation is combined with dancing, accidents can happen that can result in sprained ankles, twisted knees and trips to the E.R.

Some people wonder how the tradition of the honeymoon came about. Why, they muse, does the new husband and wife take off on a long vacation that is someplace far away from their families, friends, and co-workers. After reading the above cautionary tale, isn’t it obvious?

They’re exhausted.

Don’t let injuries put a damper on your wedding plans. Contact us at Texas Health Spine & Orthopedic Center for an appointment.


Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.

Jaclyn McDaniel
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Home improvement cable television channels such as HGTV and The DIY Network are extremely popular, and every week their shows such as “Fixer Upper” and “The Property Brothers” illustrate how rewarding it can be for homeowners to take up their tools and “do it yourself.” Unfortunately, these DIY shows fail to mention the carnage – both to the structure and workers – that these projects can sometimes cause.

According to Home Safety Council, of the 43 million DIYers taking on improvements, one in five will end up in the hospital every year due to accidents that occur while completing these projects. When those people who are also hurt from hammers, wood, knives and other common home improvement objects, that number increases by more than 220,000.

home improvement website noted the ten, specific tasks that cause the most problems and injuries:

  1. Cleaning out the gutters. Combine serious height, a shaky ladder and wet leaves – what could possibly go wrong? Falling from as little as three feet can lead to serious injury.
  2. Taking down that old tree. Cutting down a formidable tree can lead to broken bones if it comes down the wrong way, and using a chainsaw can lead to some gruesome, life-threatening injuries.
  3. Roof repairs. Climbing up on the roof is always fraught with danger, and the worse the slope, the more likely you are to tumble to the ground. Some minor repairs that can be done from the safety of the ladder might be okay, but don’t climb on the roof to fix major issues.
  4. Carpentry work. It might sound easy enough but fixing that cabinet or building a bookcase might call for the use of power tools, such as table saws and nail guns. One false move with these handy items can land you in the hospital.
  5. Any electrical work. Where there is electricity, there is danger – without exception! Electric shock can be anything from a small warning jolt to a massive surge that stops your heart. If you must tackle a small job, like changing out an outlet, always wear protective gear and ensure the power is off at the main.
  6. Repairing a gas line. There are so many possible scenarios for danger when it comes to gas lines that it is impossible to list them all. When working with gas lines, always call in a professional.
  7. Landscaping. Again, there are power tools at play. That can always spell trouble. Fortunately, most homeowners manage to do this kind of work every year without injury. The trick? Keep your equipment in top condition.
  8. Working with chemicals. Whether you are painting your house or stripping the old finish from hardware, working with harsh chemical can cause serious problems.
  9. Demolition. Many homeowners try to save money by doing their own demo work before the contractor gets there. But demolition can release toxins into the air, result in falling wood, and make the whole area unstable.
  10. Simple household fixes. Sometimes the “easy” things result in injury because we don’t take into account just how dangerous they are. For example, moving heavy furniture, can easily injure your back.

Preventing DIY Disasters
Dr. Rey Bosita is an orthopedic spine surgeon who is on the referral line of Texas Health Spine & Orthopedic Center. While he is a physician and not an accident prevention expert, he has treated his share of DIY mishaps. Here are some prevention tips he has learned.
“Ladders are accidents waiting to happen if they are used improperly, he said. “Falling from a ladder at even a few feet up can cause fractures to the spine, joints and other bones. One excellent DIY website suggests the following tips on avoiding the falls.”

When working on ladders:

  • Be sure the ladder is strong enough to hold your weight and the weight of your tools and supplies.
  • Whenever possible, opt for a stand-alone model. If you must use one that leans on a surface, be sure it’s placed against a solid, stable structure, like the surface of a wall rather than the edge of a gutter and that its footing is stable and on a non-slip surface.
  • Always place your ladder on even ground so it won’t tip over.
  • Stand on the lowest-level rung possible to get the job done, and never stand on the top rung.
  • Make sure your ladder is tall enough. If you use one that’s too short, you may lose your balance trying to reach the area you need to work on.
  • Only use one ladder at a time. Trying to balance between two can cause a fall.

“Lifting objects that are too heavy or incorrect lifting of any sized package or tools can result in a strain to back muscles causing a great deal of pain,” Dr. Bosita said. “In more serious cases, this lifting can cause a herniated disc or fracture of vulnerable joints in the spine. Here are some ways to avoid this.”

Precautions to prevent lifting-related injuries:

  • Be honest with yourself. Know your limits. If you know something is too heavy, do not try to lift it. Doing so can not only cause you to drop it, but in extreme cases, can even cause injuries like hernias, pulled muscles, pinched nerves and slipped vertebrae.
  • Get help. If you can’t pick up the equipment or materials needed for your project on your own, use machines or hire heavy lifting help. They are trained to handle and haul heavy items and/or have the equipment needed to do so safely.
  • Lift smart. If you must lift something heavy on your own, use proper form. If it’s difficult to do so, then it’s too heavy, and you need to find another way to move it.

“Tools are an important part of do-it-yourself home improvement,” he said. “Unfortunately, unless someone is a professional carpenter, plumber or electrician, these tools – such as nail guns and table saws – are used infrequently. If the user is unaccustomed to these tools, accidents will often result. Here are some tips from another DIY source on preventing injuries from tool use.”

Avoiding injuries from tools:

  • Hand Tools – Even non-power tools can be dangerous because every tool is capable of causing injury. Before you attempt to use a tool, know how to use it properly and safely. Do not use power tools with damaged cords, and do not use them around flammable liquids or gas.
  • Table Tools – Big saws and other table tools are clearly dangerous, and that’s why many of them have built-in safety precautions. Don’t let this make you too comfortable. Operate table tools with extreme caution and only when you’re in full possession of your wits. An accident with a table tool can result in a life-altering injury. Also, protect your eyes!
  • Knives – Knives are a common part of everyday life. When using knives for DIY, keep them sharp. It’s safer to use a sharp blade than a dull blade because it requires less force. Always cut away from yourself when using a knife and don’t walk around with it in your hand. Don’t use them for any other task than cutting, slicing, dicing or chopping. They are not for prying or any other use that could cause injury.

DIY: Don’t Injure Yourself

In spite of the ease with which professionals on TV portray home improvement and other DIY projects, they require the correct tools and the ability to use them correctly. When in doubt about these types of projects, ALWAYS call a professional and “Don’t Injure Yourself.”

Has a recent DIY project caused you to suffer from back or orthopedic pain? If this persists for more than two weeks, contact the referral line at Texas Health Spine & Orthopedic center for an appointment with a participating physician.


Physicians who are members of the referral program practice independently and are not employees or agents of Texas Health Spine & Orthopedic Center.

Jaclyn McDaniel
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The practice of yoga has been used to help people feel better – physically, mentally and emotionally – for more than 5,000 years. It started in ancient India and was passed down orally and (eventually) in written texts.

Yoga has gone from being an obscure, Indian religious practice to one of the most popular fitness regimens on the planet. The latest “Yoga in America” study  shows that 20.4 million Americans practice yoga, compared to 15.8 million from the previous 2008 study, an increase of 29 percent. In addition, practitioners spend $10.3 billion a year on yoga classes and products, including equipment, clothing, vacations and media. The previous estimate from the 2008 study was $5.7 billion.

Even orthopedic specialists and other physicians, who are trained to be skeptical about fitness fads, have realized the benefits of yoga. We had the opportunity to speak with Dr. Kwame EnninDr. Blake Staub  and Dr. Michael Landers all specialists who are members of the Texas Health Spine & Orthopedic Center referral line, to get their thoughts on how these physical and mental exercises can be an important part of a pain reduction and fitness program, especially for those who are age 50 and older.


Yoga Benefit #1: Reduction of Swelling and Increased Mobility and Strength of Joints

According to the website Yoga for Seniors, “As we get older, muscles tend to stiffen, our joints lose their range of motion and we become more susceptible to chronic problems such as osteoporosis, arthritis and heart disease. Yoga can help slow down the effects of the ageing process by maintaining muscle softness and flexibility, keeping the mind alert and awake, encouraging relaxation and strengthening muscles and joints. Its multi-pronged approach can encourage the body, mind and spirit to remain healthy and strong while reducing the effects of many age-related issues.”

“I have seen remarkable results for patients who maintain a regular program – two or three times per week – of yoga,” Dr.  Kwame Ennin, a referral line member and joint replacement surgeon said. These exercises are especially effective for the reduction swelling and increasing mobility and strength of joints.

“Research from the University of Pennsylvania studied the effects of yoga on people with knee osteoarthritis (OA). It found that subjects taking 90-minute, modified Iyengar yoga  classes once a week for eight weeks reported significant reductions in pain and improvements in physical function, as well as noticeable improvements in joint stiffness.

“The yoga poses were modified to accommodate the fact that people with knee OA may not be able to bend their joints as far as others, and Iyengar yoga allows participants to use chairs, blocks or other aids to help them balance during poses.

“There are also mental benefits for arthritis patients. Yoga promotes relaxation and stress reduction.”


Yoga Benefit #2: Core Strength Improvement

Many yoga poses can help improve a person’s core strength. These exercises may help prevent injuries from falls, which may lead to dangerous conditions for seniors.

“I recommend such yoga exercises as the ‘planking‘ position to improve the core muscles of patients,” Dr. Blake Staub, referral line member and neurosurgeon said. “When core muscles are strengthened, a participant’s balance and stability can improve significantly. This can also reduce the chances of having a fall, which could cause spinal and joint fractures and possibly require surgery.”

Yoga Benefit #3: Better Overall Health

With proper instructions from a trained specialist, yoga can be safer than other types of workouts such as weight-training, golf, tennis and cycling. It is a non-contact exercise program that offers the camaraderie of a group activity that many participants enjoy.

“Just about any exercise program, when done on a regular basis, will have positive benefits for the participant,” Dr. Michael Landers, a sports medicine physician and referral line member said. “Such is the case with yoga classes. Regular yoga activities can lead to an improvement in cardiovascular health, lower blood pressure and cholesterol, better blood flow and aid in digestion and elimination.

“Many of my patients who practice yoga also report better sleep, an improvement in mood and a feeling of well-being.”


Are you considering yoga to alleviate spine or joint pain? Contact us to schedule a medical consultation with a referral line member about the benefits and challenges.


Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.


Photo Source: Adobe Stock

Jaclyn McDaniel
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Of all the paths you take in life, make sure a few of them are dirt.

~ John Muir

On a beautiful, warm spring morning, with a vast expanse of a green meadow below dappled in sunlight and the only sounds being the birds tuning up for the day’s symphony, those lucky enough to be hiking understand the essence of nature’s majesty. To these intrepid trekkers, who leave nothing behind except the tracks of their boots, traveling the trail is a spiritual experience.

With all this beauty and the opportunity to challenge nature (while getting an excellent aerobic workout), what could possibly go wrong?

Unfortunately, plenty! There are many hiking hazards, any one of which can put an end to or make miserable what would have been a glorious day in the wild.

That’s the bad news. Here’s the good news. With a little preparation, physical stamina and the right gear, hikers can enjoy their day in the sun without the pain from injuries. A well-regarded hiking website, “A Woman Afoot,” offers four tips to help hikers minimize hazards.

  • Know the trail. Read about the trail you want to hike. A friend’s recommendation is just not enough. You need to know the difficulty level, unique challenges, gear needed, water sourcing, camping options, terrain conditions, wildlife in the area, specific laws and regulations.
  • Know the weather. The best way to get yourself into trouble is to ignore weather forecast or to rely on what it is for a city nearby. Nowadays, we have better and better technology and scientific know-how to predict weather changes. Make sure you read them carefully and always be prepared for worsening of the conditions predicted.
  • Know your navigation skills. With the rise of technology, there are apps that make hiking so much easier! You may love your ViewRanger, and it may have saved you from many a tight spot. BUT you need to be very careful how we use our smartphones and not to rely solely on them. Batteries die, the connection might break. It is still important to have a regular map, a compass and know how to use both of them.
  • Take care of your body, especially your feet.

This final point – how to avoid hiking accidents that can cause pain and injury to your body is an area that calls for an orthopedic expert. We had the chance to speak with Dr. Chris SakowskiDr. Donald Hohman and Dr. Jack Zigler who are members of the Texas Health Spine and Orthopedic Center referral line.  We asked them about their suggestions for avoiding injuries when someone decides to take a hike.

Snatching Victory from the Jaws of da Feet

“Since a hiker is on his or her feet for most of the trip, foot injuries can be a problem for both veterans and newbies to the sport,” said Dr. Sakowski, an orthopedic surgeon specializing in foot and ankle injuries. “The most common aliment is the formation of blisters on the heel or toes. Improperly fitting boots are the primary culprit for this condition. However, even well-worn hiking boots can cause blisters when the terrain is different than what the wearer is used to walking. Some good rules of thumb for avoiding and dealing with blisters are:

  • Wear only shoes with good grip. Don’t go trail walking with just ordinary sneakers – they are made for asphalt, not the trail.
  • Whenever possible – take the boots off during breaks to let your feet air a bit.
  • Double socking systems helps to prevent blisters. For example, a hiker can wear a thin liner and a woolen sock over it. Or, a five-toe sock liner can keep toes from overlapping each other and causing blisters.
  • If blisters occur, having blister pads in the first aid kit can help get the hiker back home.

“Other foot injuries can result from hiking insoles that are the wrong match for your feet. If you have a high arch but you are wearing flat and wide boots, it’s likely you will feel discomfort and potentially pain at some point and problems like planter fasciitis can result. Sporting goods stores typically have footwear experts on staff who can help you pick the best pair of boots for your foot and the terrain you plan on hiking.”

Hiking Can Put You Knee-Deep in Pain

“Knee pain, especially among older hikers who may be experiencing the onset of arthritis, is common for this activity,” Dr. Hohman, a joint replacement surgeon specializing in hips and knees, said. “One strategy for dealing with this knee pain is to use trekking poles  when you hike. They can really help to spread the load out when going up and down steep sections. I especially find the downhill can be tough on the knees. Trekking poles can be a great help in lowering the pressure on the knee joints.

“Another piece of gear to consider is a knee sleeve support. This is an inexpensive way to get extra support on the knees.

“Finally, you can also consider taking a supplement that is good for the joints, like Glucosamine and or Chondroiton. Before taking these supplements, it is a good idea to consult with a joint specialist to ensure that they will not have adverse effects on other medications that you may be taking.”

How Standing Up Straight Can Prevent Back Pain from Hiking

Back pain can also occur among hikers because of poor posture.

“As you hike, you tend to slump forward as your body gets more tired,” Dr. Jack Zigler, an orthopedic surgeon specializing in spine surgery, noted.  “The trekking poles (mentioned above) can help with this problem by keeping the hiker’s posture in better alignment during a long hike. The extra support results in reducing the stress on your back. “


If you love to hike but pain is keeping you off the trail, contact the referral line at Texas Health Spine & Orthopedic Center to make an appointment with a referral line member.


 Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.


Photo Source: Adobe Stock

Jaclyn McDaniel
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Depending on where one lives in the United States, it is possible to fish year around. This may explain why so many men and women – approximately 33.1 million – have taken up angling. This popularity could also be due to the wide variety of types of fishing. There is freshwater fishing (27.5 million anglers in the U.S.) and saltwater fishing (8.9 million) using live bait or thousands of high-tech, artificial lures. Anglers can spin, cast or fly fish and, in a pinch, it is even possible to fish “old school” with a cane pole, a hook, a bobber and some earthworms for bait!

For all the modern advances that have made in the sport of fishing, one factor remains constant: overuse of the shoulders and back in casting and retrieving a line can cause pain and take most of the fun out of this great sport. This pain is the result of an angler using the same repetitive motion, in many cases, for 1,500 times during a day on the water. In the case of a tournament fisherman, it is estimated that this number of casts can double or even triple each day.

Fortunately, for those who love to “wet a line,” there are ways to avoid or at least ameliorate the pain caused by this repetitive stress of fishing. Dr. Mark Lessner an orthopedic surgeon in the Dallas/Fort Worth area and a member of the Texas Health Spine and Orthopedic Center referral line has treated his share of fishermen and fisherwomen, and he offered some different strategies to prevent and treat these injuries.

Why “Putting a Shoulder to it” Might Not be Good Advice

While there are many injuries associated with fishing, including angler’s elbow, pulled forearm tendons, rotator cuff injuries, carpal tunnel syndrome, frequent muscle cramping, knee sprains and tears and back injuries, the most common fishing-related injuries occur in the shoulder.

“In many ways, the shoulder is one of the most complicated joints in the body,” Dr. Lessner said. “And the most common shoulder injury is a tear of the rotator cuff. These tears can be caused by a wide range of activities, including sleeping awkwardly. However, in most cases, the cause of a rotator cuff injury is repetitive overhand motions like throwing a ball, lifting above the head, or casting a fishing line.

“Even a casual angler makes more than 1,000 casts per day and, if he or she uses crankbait or spinnerbait, this could increase to 2,000 casts. When the weight of a fishing rig, with the torque a rod generates during the casting motion and a heavy or complex bait such as an Alabama rig, are added to the mix, the result is an enormous stress on the shoulder.

 Avoiding Shoulder Pain

“As in most cases with an orthopedic injury, that ounce of prevention is worth a pound of cure,” Dr. Lessner said. “This can involve modifying the angler’s cast – or even learning to cast with the non-dominant arm.

“Learning how to use the rod tip to generate more distance when pitching or flipping is also a good technique, and great videos on this are available online. It is also a good idea to keep the upper arms close against the upper torso when overhand casting. By keeping elbows close to the body, this prevents the angler from using his or her arms and shoulders and forces the rod do the work.”

 The Core Problem of Back Pain from Fishing

Poor technique and the constant stress from repetitive casts can also cause back pain from fishing. However, these strains are caused by different forces from those in the shoulder.

“The primary cause of back pain from fishing is inadequate core strength and flexibility,” Dr. Lessner said. “When the back and abdominal muscles are not strong enough to support the spine, the casting and retrieval process of fishing (often while standing on shore or in a boat for several hours) puts a great deal of stress on the lower back.

“Fishing can cause muscle imbalances in problem areas like the upper back, shoulders, forearm flexors and extensors, which affect body alignment or posture and often results in back pain. Obesity can also exacerbate the stress on the spine from the repetitive motion.”

8 Ways to Protect Your Shoulders and Back While Fishing

Fishing guides and online resources suggest several tips  to avoid the repetitive stress injuries to the shoulders that can come from fishing:

Let the rod do the work. Arms and shoulders can never generate as much torque as a fishing rod.

Learn how to cast, pitch and flip with a non-dominant hand. Utilizing both the dominant and non-dominant arm is good for the shoulders, and being able to use both arms interchangeably allows anglers to cast to any target from any side or angle.

Review line options. A line with less stretch means anglers have to do less work with their arms and the rod.

If aches and pains in shoulders from wear-and-tear already exist, pre-medicate before a tournament or fishing trip. Take a pain reliever with breakfast. Stay on top of pain management with additional doses throughout the day. Be sure and read the directions on all medications and speak with a doctor before using any over-the-counter drug.

A few minutes of icing can go a long way for pain management. Keep some quart or gallon plastic bags on board and use them as ice packs.

Use a focused exercise regime involving light weights and lots of repetitions. This is effective in strengthening shoulders and arms, enabling better endurance through the stresses of casting. A five-pound dumbbell and a length of rubber tubing (for stretching) will achieve significant strength improvements. Stretching should also be a component of any routine.

Build core strength and lose weight. If the muscles are not strong enough to support the spine as you stand for hours fishing, lower back pain can occur. Likewise, being overweight can cause muscle stress during rigorous activity such as fishing.

Wear the right shoes and (if necessary) use a back-support belt. There are shoes designed with special insoles that distribute weight evenly available at most outdoor sports retail stores. A back-support belt might also be a good investment if pain persists.

If you are experiencing shoulder or back pain from fishing, or any other sport, contact us for an appointment today. We want you back on the water!

Jaclyn McDaniel
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Whether playing singles or doubles, tennis is a great way to maintain health, fitness, strength, and agility. It can be played as a sport or as a recreational activity with friends and family, and it helps to burn calories. It has been calculated that an hour-long game of singles tennis burns around 600 calories for men and 420 calories for women.

While it is not as high impact as sports like football, basketball or soccer, tennis brings its own set of injury risks. According to the U.S. Consumer Product Safety Commission, more than 21,000 people are treated in hospitals, doctors’ offices, clinics, ambulatory surgery centers, and hospital emergency rooms for tennis-related injuries each year.

An organization that collects data about tennis injuries is the International Tennis Federation (ITF). The ITF Sports Science & Medicine Commission (SSMC) is comprised of a group of sports scientists, physicians and tennis administrators from different parts of the world. Its members analyze and discuss the six areas of sports science relevant to tennis, including physiology, psychology, nutrition, biomechanics, motor learning and sports medicine in order to maximize healthy participation in tennis, reduce injury risk, and to facilitate optimal performance.

This commission offers three common tennis injuries and we talked with Dr. James Walter, an orthopedic surgeon, Dr. Richard Guyer, a spine surgeon and Dr. Chris Sakowski, a foot and ankle surgeon, all in the Dallas/Fort Worth area and members of the Texas Health Spine & Orthopedic Center referral line, who offered tips on their treatment.

Advice on Treating the 3 Most Common Tennis Injuries

#1 Tennis Elbow

 According to the ITF, tennis elbow is the most common and also the most painful elbow injury in tennis players. An estimated 50 percent of all tennis players will suffer from tennis elbow in the course of their career. Players older than 35 are particularly at risk.

“Tennis elbow, which is also known in orthopedic medicine as lateral epicondylitis, is an overuse injury of the extensor muscles of the wrist,” Dr. Walter said. “It is caused by inflammation of the tendons joining the forearm muscles to the outside of the elbow.

“This condition is similar to ‘golfer’s elbow,’ but it occurs on the outside lateral aspect of the elbow rather than the inside medial. Symptoms of tennis elbow include pain or burning on the outside of the elbow and weak grip strength. You may find that the symptoms are worse with forearm activity. The pain may also radiate into the arm, wrist and fingers.

Treating Tennis Elbow

“Tennis elbow can be can be controlled by training modification and relative rest,” Dr. Walter said. “Physiotherapy such as friction massage, ultrasound and a standardized exercise program aimed at the mobility of the elbow and wrist along with stretching exercises and strengthening of the muscles of the forearm, upper arm and hand and manual therapy often have good effects.

“A corticosteroid injection may have a positive effect in the short term, but the long-term results are less positive than those of physiotherapy or rest. A more conservative approach is advised, especially with competitive tennis players. Some players may consider PRP or stem cell injections. Surgery is always the last option, but this can be considered if the pain persists for more than a year.”

#2 Lower Back Pain

Low back pain is very common among tennis players according to the ITF. “Low back pain may have various causes, such as postural abnormalities, muscle dysfunction (imbalances, shortening or weakening of muscle), overuse, instability and articular dysfunction in the lower back. In tennis, the combined rotation, flexion and extension of the back during the serve may cause problems.”

“Because tennis serves require a combination of hyperextension or bending the back, and side-bending and rotation of the trunk, pain and even stress fractures are a common injury,” Dr. Guyer said. “This motion puts stress on the vertebrae in the lower back and can over time cause additional stress on the portion of the vertebra which can cause muscle strains or in extreme cases conditions like spondylolisthesis, where the can vertebrae slip forward.”

Treating Lower Back Pain and Stress Fractures

“Rest, anti-inflammatory medications (e.g. Tylenol) and ice are recommended to relieve pain and muscle spasm,” Dr. Guyer said. “However, I don’t recommend bed rest beyond two days, as this can have detrimental effects on bone, connective tissue, muscle and the cardiovascular system.

“If the pain continues for more than two weeks, or if it is accompanied by other symptoms – such as shooting pain in the leg extending as far as the foot, a tingling sensation, numbness or loss of strength – a spine specialist should be consulted for further treatment.”

#3 Sprained Ankle

The ITF notes that a sprained or twisted ankle is the most common tennis injury. In most cases, the injury is caused by landing on the outside of the foot, with the foot turning too far inwards. The relatively weak lateral ankle ligaments are then injured. An injury of the much stronger ligament on the inside of the ankle (medial ankle ligament) is far less common (5-10 percent of cases).

“Depending on the severity of the injury, the ligaments may be overstretched or torn, resulting in instability of the ankle,” Dr. Sakowski said. “The symptoms are pain and swelling around the ankle, mainly on the outside, later followed by discoloration of the skin.

Treating a Sprained Ankle

“While this is a common tennis injury, it can lead to more serious complications if prompt action is not taken,” he said. Here are the actions to take in the first 48 hours:

  • Don’t play tennis or lean on the ankle.
  • Cool the painful area directly with ice, a cold pack or cold running water for 10 to 15 minutes. Repeat this several times a day (every 2 hours). Do not place the ice directly on the bare skin but cover the ice or cold pack with a towel first.
  • Apply a compressive bandage immediately. This will help with the swelling of the ankle.
  • Elevate the lower leg and the ankle above the heart whenever possible (i.e., lie on the floor and place the entire leg on several pillows) to decrease swelling.

“Immediate and adequate first aid is important to help assist in a speedy recovery. In more serious cases, a visit to the doctor is recommended to rule out a fracture and to determine whether crutches or a boot is necessary.”

4 Tips on Avoiding These Injuries

  1. Get the right gear

Tennis professionals advise that players choose a tennis shoe with good support to help prevent ankle injuries. It is also important to ensure the racquet has the correct grip size and string tension to reduce stress on elbows and shoulders. A professional can help you to choose the right racquet.

  1. Warm up thoroughly before playing and build core strength

It is critical for a player to have a good warmup before a game. This can help to lessen the chance of injury and improve one’s game. Core and shoulder-strengthening exercises can also help to prevent injuries while serving.

  1. Proper technique will help prevent injuries

Getting advice from a tennis pro is well worth the time and money it costs. This will help the player avoid extreme arches of the back while serving and balance his or her upper body weight by bending knees and raising heels instead. It is also important to be careful and try not to land on the balls of the feet while jumping, as this could result in an ankle injury.

  1. Don’t overdo it

Practice on the court is important, especially as it relates to the development of good technique. However, too much play can do more damage than good. The body needs time to recover between practices and matches, and overexertion can affect the quality of play and worse, susceptibility to injuries. Don’t overdo it and have fun!

If you have injuries from playing tennis that has persisted for more than two weeks, contact us to connect with an orthopedic specialist on the referral line.

 Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.