AN EPIDERMIOLOGICAL APPROACH TO AETIOLOGY

AN EPIDERMIOLOGICAL APPROACH TO AETIOLOGY

In epidemiological, one of the aims is to assess the independent association between a potential risk or prognostic factor. It is, however, extremely important to keep in mind that in most disease and injuries, a multifactorial casual model is needed to understand the onset and prognosis.

This can be effectively discussed using the ‘pie’ model, or the component cause model, introduced to epidemiologists by Rothman. Some prognostic factors that may be involved in recovery from WAD are introduced in two different ‘pie’ models.

According to the ‘pie’ model, all contributing causes in one of the sufficient causes, or ‘pie’ are needed, in order to recover from WAD. Each sufficient cause represents one of presumably several alternative routes leading to recovery. The interactions between contributing causes are illustrated as separate ‘pie slices’ included in the same pie. Slices in one ‘pie’ are said to interact, because it is their joint action that leads to recovery. In real life, of course, different distributions of biological, psychological and social factors occur among different people.

In the literature, there is no recognized necessary for recovery from WAD. Neither has any sufficient cause been identified. Instead, several contributing causes (i.e. factors that affect the cause of recovery) have been found. When linking this ‘pie’ model to the evidence of prognostic factors in WAD, numerous sets of possible ‘individual pies’ become obvious. In summary, several different sufficient causes for recovery from WAD exist; in other words, several alternative routes lead to recovery.

In research, the effect of individuals contributing causes, or risk factors, are usually investigated for the condition in question. Complete sufficient causes usually do not lend themselves to studies because few of these scenarios actually exist (exceptions include bacterial infection). Still, it is important to keep the ‘pie’ model in mind when interpreting and discussing empirical results on risk and prognosis. A single contributing cause may otherwise be confused for a sufficient cause. The whole picture for specific sets of sufficient cause is seldom discussed in the research of WAD or in other contexts.

The casual process is more complicated than explained by the ‘pie’ model, since effects are more likely to depend on other factors that happen simultaneously. For instance, some persons in pain may call for support from family members or workmates, which in turn may change the person’s future pain perception and behavior (positively or negatively). In other instances, pain intensity may cause depressed mood, or depressed mood may cause more pain (bidirectional). Nevertheless, this component cause model is a fruitful way to conceptualize WAD as it visualizes the multifactorial nature of WAD and how biological, psychological and social factors may interact.

Facts About Sciatica

The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg.

Sciatica (pronounced sigh-at-ih-kah) is a symptom of an underlying medical condition – it is not a medical diagnosis in and of itself.

Sciatica Nerve Pain

Sciatica is often characterized by one or more of the following symptoms:

• Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
• Pain that is worse when sitting
• Burning or tingling down the leg (vs. a dull ache)
• Weakness, numbness or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A sharp pain that may make it difficult to stand up or to walk

The Sciatic Nerve and Sciatica

Sciatica symptoms occur when the large sciatic nerve is irritated. The sciatic nerve is the largest single nerve in the body and is composed of individual nerve roots that start by branching out from the spine in the lower back and combine to form the “sciatic nerve”.

• The sciatic nerve starts in the lower back at lumbar segment 3 (L3).
• At each level of the lower spine a nerve root exits from the inside of the spine and then comes together to make up the large sciatic nerve.
• The sciatic nerve runs from the lower back, down the back of each leg
• Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg - e.g. the buttock, thigh, calf, foot, toes.

The sciatica symptoms (e.g., leg pain, numbness, tingling, weakness, possibly foot pain) are different depending on where the nerve is pinched. For example, a lumbar segment 5 (L5) nerve impingement can cause weakness in extension of the big toe and potentially in the ankle (foot drop) (See diagram of the sciatic nerve).

Celebrities and Chiropractic Care

Famous people who use chiropractic care:

Mel Gibson, Joe Montana, Lance Armstrong, Arnold Schwarzenegger, Robin Williams, Denzel Washington, David Copperfield, Whitney Houston, Alec Baldwin, Whoopie Goldberg, Ted Danson, Demi Moore, Macaulay Culkin, Steven Segal, Cher, Jerry Seinfeld, James Earl Jones, Clint Eastwood, Jane Seymour, David Spade, Shirley MacLaine, Madonna, Kenny Loggins, The Eagles, Van Halen, Michael Jordan, Scottie Pippin, Charles Barkley, Atlanta Falcons team, Dallas Cowboys team, Tiger Woods, etc.

Thoracic Outlet Syndrome After Motor Vehicle Accidents

Thoracic Outlet Syndrome After Motor Vehicle Accidents

                Thoracicoutlet syndrome (TOS) is a recognized sequelae of motor vehicle accidents (MVAs) in general, and whiplash injuries in particular. In 1977, Capistrant described 35 cases of TOS induced by trauma, 80% of which were whiplash injuries. Moore, in 1986, found that 33% of whiplash injury patients reported arm symptoms which he related to TOS. Sanders found that of 668 patients operated on for TOS, 32% had been involved in a rear-end accident and 25% had been in a side or head-on collision.

                Now, a new study adds to the body of knowledge of whiplash-induced TOS. In this report, 90 patients who had been sent to a Canadian pain clinic were diagnosed with TOS. Of these 90 patients, 32 (35.6%) has TOS associated with an MVA. The mean symptom duration at the time of the study was 37 months. 

                One half of the patients were chosen (not randomly selected) for surgery, the other half for conservation treatment. Only 7 of 15 (47%) of the surgical patients had “very good to excellent” results, and 3 of these patients later had recurrence of symptoms. In short, only 4 of 15 patients (26.6%) had good results from surgery. Six patients had reoperation, and only one of these had positive results.

                In the conservative management group, 3/15 (20%) had “very good to excellent” results, and 3/15 (20%) had modest pain relief. 60% had no pain relief.

                Surgical findings: “…13/15 patients (87%) were found to have primarily muscultendinous anomalies in the form of tight bands or thick muscle attachments.” This is consistent with reports by Sanders regarding fibrous bands in the scaleness in these patients.

                The low rate of surgical success in the treatment of TOS has been discussed by others, including Lindgren and Oksala, who suggested that surgical success may simply by placebo.

                One very important finding of this study was that 67% of the TOS symptoms were on the side of the driver’s shoulder strap, suggesting that the force of the body against the shoulder restraint during whiplash may be responsible for some TOS problems.

Stress Slows Wound Healing

Stress Slows Wound Healing

                That stress affects immune functioning has been well known for years. How stress affects the body’s ability to heal, however, has not been extensively studied.

                A recent study examined the role of stress in the healing process. Researchers studied 13 “women caring for demented relatives and 13 controls…” All twenty sic subjects were given a punch biopsy, to create a 3-5 mm wound. The wounds were cared for identically for all patients, and were photographed every 2-8 days. Also, all subjects were tested for blood cytokine levels -- a measure of immunological functioning.

                The researchers found that complete healing took an average of nine days longer in the subjects who were caring an ill relative. Caregivers also had decreased immune functioning, and reported higher levels of perceived stress.

                “Previous animal and human studies have shown that stress can increase vulnerability to infectious illness. The findings of this study suggest that stress-related alterations in immune function could have additional implications for health beyond infectious disease.”

Patients Prefer Chiropractic

Patients Prefer Chiropractic

                A recent study compared the difference in acute low back pain outcomes in patients treated by primary care physicians, orthopedic surgeons, or chiropractors. The study reports that there were no differences in treatment outcome among the different types of care, but that chiropractic and orthopedic care was the most expensive. When the patients were asked about the quality of care, however, the chiropractic patients reported their satisfaction as considerably higher. The chiropractic patients ranked higher: the information provided, their treatment, the results, the detailed history their doctor took, their examination, and having their problem explained clearly. Chiropractic patients also used significantly fewer medications for their pain.

                The focus of this study, however, seems not to be on quality, but cost. The lowest cost provider in the study was the HMO primary care physician, and the study suggests that acute back pain patients should be sent to managed care providers. To wit: “Patients and insurers need to address the trade-off between the substantially lower charges by primary care practitioners and the higher the level of satisfaction with the care that chiropractors and orthopedic surgeons provide.” Unfortunately, the decisions are typically made on the basis of cost, not what the patient wants. Interestingly, when the patient satisfaction was reported in this study, all non-chiropractic providers were compared with chiropractors, so that no information is given on the HMO patient’s level of satisfaction. Is it accidental that the HMO satisfaction information was left out?

                The results of a recent British study, on the other hand, suggest that the extra cost and longer treatment time of chiropractic results in better outcome. The trial conducted by the UK Medical Council followed a group of randomly assigned hospital outpatient and chiropractic low back pain patients for three years. The study reports that the chiropractic patients were significantly more improved than the medically treated patients.

Time Codes PT

Time is money. This is especially true when it comes to coding therapeutic procedures or attended modalities correctly, particularly as they relate to time-based procedures. Your challenge is twofold: Use the coding policies required by insurance carriers and report your time correctly.

Three possible reporting standards are used: the Centers for Medicare and Medicaid Services (CMS) rules, as published in Transmittal AB-00-14; the American Medical Association guidance as published in the AMA CPT Assistant; and individual carrier policies.

Note: CMS’s usage rules are not part of the national standard code set stipulated in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Commercial carriers can follow CMS policy, AMA policy or adopt more/less restrictive coding policies of their own. When no policy is specified, a time-tested adage in billing states that if you are right with Medicare you are right with the rest of the world.

Because many commercial insurance plans currently follow Medicare Coding Guidelines or will agree that your application of those guidelines is a reasonable approach, this article focuses on the CMS standard.

What the transmittal says

 
The CMS transmittal dictates time reporting of 8 minutes or less: 

“Several CPT codes used for therapy modalities, procedures and tests and measurements specify that the direct (one on one) time spent in patient contact is 15 minutes. Providers report procedure codes for services delivered on any calendar day using CPT codes and the appropriate number of units of service. For any single CPT code, providers bill a single 15 minute unit for treatment greater than or equal to 8 minutes and less than 23 minutes. If the duration of a single modality or procedure is greater than or equal to 23 minutes to less than 38 minutes, then 2 units should be billed. Time intervals for larger numbers of units are as follows:

3 units: 38 minutes up to 53 minutes

4 units: 53 minutes up to 68 minutes

5 units: 68 minutes up to 83 minutes

6 units: 83 minutes up to 98 minutes

7 units: 98 minutes up to113 minutes

8 units: 113 minutes up to 128 minutes 

The pattern remains the same for treatment times in excess of 2 hours. Providers should not bill for services performed for less than 8 minutes. If more than one CPT code is billed during a calendar day, then the total number of units that can be billed is constrained by the total treatment time, see examples below.

Example 1: If 24 minutes of 97112 and 23 minutes of 97110 were furnished, then the total treatment time was 47 minutes; so only three units can be billed for the treatment. The correct coding is two units of 97112 and one unit of 97110, assigning more units to the service that took more time.

Example 2: If a therapist delivers 5 minutes of 97035 (ultrasound), 6 minutes of 97140 (manual techniques), and 10 minutes of 97110 (therapeutic exercise), then the total minutes are 21 and only one unit can be paid. Bill one unit of 97110 (the service with the longest time) and the clinical record will serve as documentation that the other two services were also performed.

An Uncommon Cause of Sciatic Nerve Entrapment

An Uncommon Cause of Sciatic Nerve Entrapment

                This report documents the case of a forty four year old woman who lost control while water skiing, and injured herself when both “hips were hyper flexed and hyper abducted with the knees fully extended.” Although she felt immediate pain, she continued to ski. “Shortly thereafter, she was unable to walk or bear weight on the left lower limb secondary to painful hamstring spasms.”

                The woman was treated with NSAIDs, walked on crutches for a few days, and then began a program of stretching and deep tissue massage. She was pain free in two weeks.

                Two and a half months later, the woman began to experience “numbness in the lateral aspect of the left calf that extended onto the lateral and dorsal aspects of the left foot. Two weeks later, dropfoot developed.” After extensive testing, surgical exploration uncovered, “A portion of the origin of the hamstring muscles that was common to the semitendinosis and the long head of the biceps femoris had been avulsed from the ischial tuberosity and had been retracted about seven centimeters. The avulsed end of the tendon was surrounded by an exuberant fibroblastic response that had encased the sciatic nerve.” After dissecting the nerve free, the patient showed gradual improvement, and at one year was free of numbness, weakness, pain, or paresthesia. She was, however, 50% weaker in the left leg than in the right.

Prevalence of Chronic Pain Following an Auto Collision

Prevalence of Chronic Pain Following an Auto Collision

A very recent study (June 2010), published the assessment of whiplash-injured patients 30 years after injury, making this the longest follow-up of whiplash-injured patients to date. Once again, this study shows that a significant number of those injured in whiplash trauma will suffer with chronic symptoms. Thirty years after being injured, 40% of patients retain nuisance symptoms and 15% have significant symptoms and impairments, requiring ongoing treatment. (Rooker, Journal of Bone and Joint Surgery, British, 2010)

A 2005, 7.5-year prospective study on whiplash-injured patients found that 21% had intrusive symptoms that interfered with work and leisure, and required continued treatment and drugs. In addition, 2% of these whiplash-injured patients had severe pain and problems that required ongoing medical investigations and drugs. This means that 23% of whiplash-injured patients had significant problems more than 7 years after being injured. (Tomlinson, Injury, 2005)

Researchers at the Spine Research Institute in San Diego found that the number of people who develop chronic pain after an auto collision is as high as 10%. They also found that about 45% of people with chronic neck pain attribute their pain to a past auto injury. (Croft, et al.)

75% of patients with whiplash injuries will heal within 2-3 months. These patients sustained minor injuries to their muscles and ligaments, but not to their discs or facet joints. 25% of patients with whiplash injuries will progress to chronic symptoms. These patients injured their intervetebral discs, zygapophyseal joints, or alar ligaments. These patients will not resolve spontaneously and they become chronic. Bansley, Lord, Bogduk. Whiplash Injury: Clinical Review. Pain 58, 1994, 283-307.

Simply said, when the vehicle bends or ‘crushes’, it absorbs much of the impact. In slower speed collisions or collisions involving minimum vehicle damage, the impact velocity sustained is thus transferred to the occupants who absorb the effects of the impact trauma! This is confirmed in Foret-Bruno, Maag, Morris and Ono’s research involving over three hundred thousand test studies, which concluded: “In accidents less than 9.3 mph, 36% resulted in neck injuries; if speeds were greater than 9.3 mph, 20% resulted in neck injuries. Neck whiplashes occurred in 22% of collisions if traveling less than 31 mph; 17% whiplashes occurred if traveling greater than 31 mph. If the seat back broke, there was a 39% whiplash occurrence, whereas there was a 61% whiplash occurrence if the seat did not break. (This is because the broken seats have absorbed the impact velocity and thus decrease the shearing force transferred to the body). Fifty percent of neck injuries occur at low speed impacts with minimum vehicle damage.”

According to both the US Dept. of Transportation (USDOT) and the National Highway Traffic Safety Administration (NHTSA), traffic accidents can be broken down this way---
On average, from year to year, Motor Vehicle Crashes (MVCs) in the U.S. are statistically similar:

• 6,000,000 total accidents per year
• 3,000,000 claimed injuries per year
• Every 12 minutes, a person dies in a MVC
• Every 14 seconds, someone is injured in a MVC
• Accidents are largely the result of
1. Drunken drivers (40%)
2. Speeding (30%)
3. Reckless driving (33%)

Vacations = Health

Vacations are a chance to take a break from work, see the world and enjoy time with family. But do they make you happier?

Researchers from the Netherlands set out to measure the effect that vacations have on overall happiness and how long it lasts. They studied happiness levels among 1,530 Dutch adults, 974 of whom took a vacation during the 32-week study period.

The study, published in the journal Applied Research in Quality of Life, showed that the largest boost in happiness comes from the simple act of planning a vacation. In the study, the effect of vacation anticipation boosted happiness for eight weeks.

After the vacation, happiness quickly dropped back to baseline levels for most people. How much stress or relaxation a traveler experienced on the trip appeared to influence post-vacation happiness. There was no post-trip happiness benefit for travelers who said the vacation was “neutral” or stressful.”

Surprisingly, even those travelers who described the trip as “relaxing” showed no additional jump in happiness after the trip. “They were no happier than people who had not been on holiday,” said the lead author, Jeroen Nawijn, tourism research lecturer at Breda University of Applied Sciences in the Netherlands.

The only vacationers who experienced an increase in happiness after the trip were those who reported feeling “very relaxed” on their vacation. Among those people, the vacation happiness effect lasted for just two weeks after the trip before returning to baseline levels.

“Vacations do make people happy,” Mr. Nawijn said. “But we found people who are anticipating holiday trips show signs of increased happiness, and afterward there is hardly an effect.”

One reason vacations don’t boost happiness after the trip may have to do with the stress of returning to work. And for some travelers, the holiday itself was stressful.

“In comments from people, the thing they mentioned most referred to disagreements with a travel partner or being ill,” Mr. Nawijn said.

The research controlled for differences among the vacationers and those who hadn’t taken a trip, including income level, stress and education. However, Mr. Nawijn noted that questions remain about whether the time of year, type of trip and other factors may influence post-vacation happiness.

The study didn’t find any relationship between the length of the vacation and overall happiness. Since most of the happiness boost comes from planning and anticipating a vacation, the study suggests that people may get more out of several small trips a year than one big vacation, Mr. Nawijn said.

“The practical lesson for an individual is that you derive most of your happiness from anticipating the holiday trip,” he said. “What you can do is try to increase that by taking more trips per year. If you have a two week holiday you can split it up and have two one week holidays. You could try to increase the anticipation effect by talking about it more and maybe discussing it online.”

Mr. Nawijn said that while he expected the study results to show a prevacation happiness boost, he was surprised that the study showed that relaxed holidays didn’t affect post-trip happiness levels.

“People start working again,” he said. “They have to catch up. Usually there is a big pile of work for them when they get back from the holiday.”

doctors chiropractors

Alec Khlebopros, DC	Chiropractor in Charlotte, NC
Anthony Howe, DC	Chiropractor in Jonesville, FL
Anthony Staiano D.C.	Chiropractor in Atlanta, GA
Antonio Marotta, DC	Chiropractor in Clifton Park, NY
Andre Broussard, DC	Chiropractor in Lubbock, TX
Bob Woolery, DC	Chiropractor in Vallejo, CA
Belinda Mobley, DC	Chiropractor in Seekonk, MA
Benjamin Heath, DC	Chiropractor in Portland, OR
Brett Kinsler, DC	Chiropractor in Rochester, NY
Carmelo Caratozzolo, DC	Chiropractor in Woodbridge, VA
Chris Rizzo, DC	Chiropractor in Leland, NC
Clayton Clark, DC	Chiropractor in San Antonio, TX
Christopher Connelly, DC	Chiropractor in Stone Mountain, GA
David Young, DC	Chiropractor in Indiana, PA
Edward Lauterbach, DC	Chiropractor in Palmyra, VA
Edward Harriott, DC	Chiropractor in Mission Viejo, CA
Eric M. Patten DC	Chiropractor in Gulfport, MS
Frank Navratil, DC	Chiropractor in Torrance, CA
George Putnam, Jr, DC	Chiropractor in New Orleans, LA
Jay Hafner, DC	Chiropractor in Lakewood, CO
James Rosenberg, DC	Chiropractor in Boise, ID
John Zimmerman, DC	Chiropractor in Diamond Bar, CA
Jonathan Woodward, DC	Chiropractor in Dallas, TX
Jennifer Frost, DC	Chiropractor in Naples, FL
Kevin Fielden, D.C., J. Reed, D.C.	Chiropractor in Johnson City, TN
Kevin Smith, D.C.	Chiropractor in Venetia, PA
Kevin Venerus, DC	Chiropractor in Livonia, MI
Louis J Cavallo	Chiropractor in Longmont, CO
Marieke Zegelaar, DC	Chiropractor in the Netherlands
Matt Freedman, DC	Chiropractor in Eugene, OR
Michael Schrad, DC	Chiropractor in Longmont, CO
Mike Nemastil, DC	Chiropractor in Lexington, KY
Morgan Baker, DC	Chiropractor in Eagan, MN
Noah Edvalson, DC	Chiropractor in Boise, ID
Pamela Betz, DC	Chiropractor in Leland, NC
Peter Gala, DC	Chiropractor in Parker, CO
Randy Conger, DC	Chiropractor in Fort Mill, SC
Richard E. Rogovin, D.C	Chiropractor in Brandon, FL
Ruby Kevala, DC	Chiropractor in Ventura, CA
Rusty Russo DC	Chiropractor in Metairie, LA
Ryan Betzina, DC	Chiropractor in Lakeville, MN
Ryan Suh, DC	Chiropractor in Manhattan, NY
Scott Garber, DC	Chiropractor in Pittsfield, MA
Steven Gillis, DC	Chiropractor in Los Angeles, CA
Scott Cady, DC	Chiropractor in Sunnyvale, CA
Stephane Provencher, DC	Chiropractor in St. Louis, MO
Scott Stiffey, DC	Chiropractor in St. Louis, MO
Scott Swanson, DC	Chiropractor in San Francisco, CA
Trent Artichoker, DC	Chiropractor in Denver, CO
Tony Kim, DC	Chiropractor in Moreno Valley, CA
Todd Lloyd, DC	Chiropractor in Santa Rosa, CA
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low back pain - general information

low back pain - general information

how common is low back pain and how long does it last? Low back pain is very common and it's becoming commoner. In the USA the number of people disabled by back pain has grown 14x faster than the general population1, a greater growth of medical disability than with any other disease. 21% of UK adults suffer backache in any fortnight2 and about 2% lose time from work annually with an average duration of nearly 26 days per episode. Happily most back pain gets better fairly quickly - for example one study3 found that of 100 patients consulting their GP, 44% were better within a week, 86% within a month and 92% within two months. It's encouraging too to know that back pain may well become less common4 when one reaches one's 60's and older. Even long term "failed backs" may well ease with time5 - typically with the pain becoming less constant. Despite the body's self-healing abilities, back pain can be hell. How can one get better quicker and reduce the chances of getting further attacks? If one is unlucky enough to have persistent pain, what can be done to help?

what causes back pain and how can it be helped? Factors associated with increased risk6 of low back pain and sciatica include physical fitness, body weight, car driving, smoking, height, psychological distress, and age group 30 to 50. Several different structures may be involved in mechanical back pain - for example muscles, ligaments, nerves, joints, discs and bones. Precise diagnosis is typically more a matter of opinion than hard fact7. Happily just as we don't have to know what virus we have and the kind of immune response that it has caused in order to recover from a common cold, so too a diagnosis of non-specific mechanical low back pain is usually quite good enough as a basis for developing effective treatment. When considering how to help back trouble, it is often useful to think in terms of three general areas: the treatment of back pain of recent onset, how to prevent back pain recurring, and how to help persistent long term pain.

recent onset back pain: Remember that the great majority of back pain episodes are likely to get better within days or a few weeks3 even with no specific treatment. Pain can often be eased with medication, massage, and local heat or cold. These measures may well make the back more comfortable, though they probably won't affect the actual speed of recovery itself. Bed rest does have a part to play in back pain treatment, but it should be used sparingly8. For bad back pain with no leg involvement, 2 days rest appears to yield as good results as 7 days. When there is pain radiation to the lower leg, one can try rest for up to 2 weeks. It is probably OK to get up to go to the toilet and possibly for eating too. Resting too much may well prolong the time it takes to get better. If they don't flare the pain too badly or for too long, walking and swimming are likely to help. Take it slowly and build up what you can do. The McKenzie exercises are also worth considering9. Physiotherapy, osteopathy, chiropractic and acupuncture can all at times speed recovery, but acute recent onset back pain usually gets better quite quickly on its own. Unless the pain is particularly bad, it's worth waiting at least a week or two before seeking help.

how to prevent back pain recurring: As a therapist, one of the first questions I would ask here is whether the back is really absolutely fine between attacks. If there are some minor symptoms even between flare ups, then it may reduce future attacks to treat the areas that are still giving trouble. For example one can use physiotherapy, exercises, manipulation, acupuncture or injections. If there are really no symptoms between attacks then treatment by a therapist doing something actively to you is unlikely to be useful. Self-help has much more chance of being effective. Becoming physically fitter10, losing weight, stopping smoking and doing something about stress may all be of use6. So too may modifying working conditions or reducing the amount of time spent driving. Some people find using a lumbar roll11 or changing their sitting position in other ways can be helpful. It clearly makes sense as well to learn correct ways to lift and carry. Increasing physical fitness seems particularly worthwhile as, like stopping smoking, [PTO] increased fitness can be helpful in so many ways (see the companion sheet on How important is physical exercise?). Improved heart-lung stamina is important - as a bonus this also improves one's psychological state and reduces death rates from heart disease and cancer. Strength and flexibility also need to be considered. Unfortunately 80% of adults don't take enough exercise.

coping with persistent pain: Surprisingly pain, distress and disability don't all necessarily worsen and improve together. It's usually more helpful to think in terms of overall quality of life rather than just concentrating on the pain by itself. Surgery has a limited place. It may be useful for well-defined nerve root symptoms. Physiotherapy, acupuncture, manipulation and injections all also have a part to play - so too may transcutaneous nerve stimulation (TENS)12. Gradually increasing strength and fitness is extremely important10. Informed advice about exercise may well be helpful, as too is reducing unnecessary medication. Connie Peck's book13 discusses these and other issues. The Back Pain Association14 is a good source of support and there are local group activities, including hydrotherapy. James Hawkins's tape15 gives useful general advice as well as introducing the use of relaxation. Long term persistent pain is immensely hard to live with. With determination and help it is certainly possible to make the situation considerably better.


books, references & other resources:


1. National Center of Health Statistics. (1981) Prevalence of selected impairment. United States 1977. Hyattsville, Maryland: Dept. Health and Hum. Services. 1981. Nat. Center of Health Statisitics. Series 10, Number 134.
2. Wood,P.H.N. & Baddeley,E.M. (1980) Epidemiology of back pain,in M.I.V.Jayson (ed) The lumbar spine and back pain, 2nd ed., Tunbridge Wells, Pitman.
3. Dillane,J.B.,Fry,J. & Kalton,E. (1966) Acute back syndrome - a study from General Practice, Br.Med.J. 2: 82-4.
4. Hay,M.C. (1974) The incidence of low back pain in Busselton,in Twomey,L.T. (ed) Symposium: low back pain, Western Aust. Inst. Tech., Perth.
5. Crook,J.,Weir,R. & Tunks,E. (1989) An epidemiological follow-up survey of persistent pain sufferers in a group family practice and speciality pain clinic, Pain 36: 49-61.
6. Ernst,E. (1991) Primary prevention of back trouble: what can we tell our patients? Phys Med & Rehabil 2(2): editorial.
7. Jayson,M.I.V. (1984) Difficult diagnoses in back pain, Br.Med.J. 288: 740-1.
8. Spitzer,W.O.,LeBlanc,F.E.,Dupuis,M.,Abenhaim,L.,Belanger,A.Y. et al. (1987) Scientific approach to the assessment and management of activity-related spinal disorders, Spine 12: Number 7S.
9. McKenzie,R. (1985) Treat your own back, 4th ed., Waikanae, N.Z., Spinal Publications. McKenzie has also written a book on self-help neck treatment. Both books should be available at £7.99 each from Ferrier's Ltd, 8 Teviot Place, Edinburgh EH1 2RB. Tel: 031-225 5325. They can no doubt be ordered through other bookshops as well.
10. Rodriquez,A.A.,Bilkey,W.J. & Agre,J.C. (1992) Therapeutic exercise in chronic neck and back pain. Arch Phys Med Rehabil 73: 870-5.
11. Lumbar rolls can be ordered from PO Box 275, West Byfleet, Surrey KT14 6ET. An alternative deluxe lumbar support - the Backfriend - can be bought from MEDesign Ltd, Clock Tower Works, Railway St., Southport PR8 5BB. Tel: 0704-542373. MEDesign also stock a variety of other equipment which can help those with low back pain - ask for their catalogue.
12. Ottoson,D. & Lundeberg,T. (1988) Pain treatment by TENS: a practical manual, Berlin, Springer-Verlag. There are many suppliers of TENS machines. One possibility is the Pulsar range made by Spembly Medical Ltd., Newbury Road, Andover, Hampshire SP10 4DR. Tel: 0264-365741. You may be able to borrow one from a physiotherapy or pain clinic.
13. Peck,C. (1985) Controlling chronic pain, London, Fontana. Out of print, so order a copy through your library.
14. Back Pain Association, 31-33 Park Road, Teddington, Middlesex TW11 0AB. Tel: 081-977 5474. Send SAE for their leaflets. The Lothian Branch of the BPA can be contacted through Mary Taggart, 36 Rosemount Buildings, Edinburgh. Tel: 031-229 8832. They run various activities including a weekly hydrotherapy session at the Astlie Ainslie.
15. Hawkins,J. (1992) Coping with persistent pain, self-help tape available from BHMA, Royal Shrewsbury Hospital South, Shrewsbury, SY3 8XF. Tel: 01743-261155. All proceeds go to help the work of the BHMA, a medical charity.

How to treat and diagnose a Herniated Disc in the Neck

A herniated disc can also be referred to as a ruptured disc, and a slipped disc. It occurs when disc which is located between two bones puts pressure on a nerve. This pressure in turn can cause the neck pain, the arm pain and symptoms of numbness and tingling. The two most common levels where a cervical disc can herniated is C5-C6 and C6-C7. So if for example a patient has a C5-C6 disc herniation, the disc is affect the C6 nerve root.

Symptoms of a Herniated Disc
A herniated disc presents as constant neck pain. You can also have pain traveling into your arms and hand with numbess and tingling as well. Depending on the level that is affected a cervical disc herniation can present in different ways:

* C4/C5 Disc herniation: This affects the distribution of the C5 nerve root. It can cause the deltoid muscle to be weak and also can cause shoulder pain. This affects the lateral upper arm. It usually does not cause numbness and tingling.
* C5/C6 Disc herniation: This affects the distribution of the C6 nerve root. It can cause numbness and tingling in the lower lateral arm, affecting the thumb and index finger. The muscles affected are the biceps and the wrist extensor muscles.
* C6/C7: This affects the distribution of the C7 nerve root. It can cause numbness and tingling along the 3rd digit (the long finger) and the triceps muscle. It can affect the triceps muscle causing numbess and tingling.
* C7/T1: This affects the distribution of the T1 nerve root. It can cause weakness including the ability to squeeze and hold on to objects. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

How to Diagnose a Disc Issue

First, a neurological examination that focuses on sensory, motor and relex testing is important.A cervical MRI is the best diagnostic tool to show if there is a disc issue.
How to Treat Herniated Disc
There are many treatments available to treat a herniated disc in the neck. Most people think of surgery, but there are many effective non surgical options with little side effects. Try traction for your neck- a gentle stretch in the neck can aid in some neck pain relief. Either you could use a special traction pillow or cervical traction unit to acheive this. Before starting traction, have your neck examined- an x-ray can pinpoint some important diagnosis information as well. A good cervical pillow such as the cervical traction neck pillow will help as well. Sleeping on 2 pillows may be too much and can actually cause you to have a stiff neck with more pain than you started with. Your Doctor may recommend a few treatment options to you; Perhaps cortisone injections, physical therapy, chiropractic, traction therapy, or maybe (depending on the severity) even surgery. Just know that there are non surgical options out there for you to try. For example, traction for the neck using a home cervical traction unit could really help you out. Click here for step by step home traction protocol using the Pronex Pneumatic Traction Unit. A traction pillow may also help you out at night to sleep. Finally, there is a treatment called non surgical spinal decompression using the Drx9000C for the cervical disc herniations. Spinal Decompression uses state of the art technology to apply a distraction force to relieve nerve compression in the neck.