Photo: Robert Lerich

Okay, so you've heard (many times) that back exercise is one of the best ways to manage pain and related symptoms, and you're ready to get going.  Anything to relieve the pain!

Whoa, there.  If you have a condition, such as herniated disc or facet joint syndrome (and these are just 2 common spine problems, not the whole gamut), coming up with a program and best practices for sticking with it will likely be more complicated for you than for someone who has never had a neck or back problem.

First, if you have pain or other symptoms,  make an appointment with your doctor to get it checked.  If you can, sign up to see a physical therapist and let that person give you a home exercise program.  This is how to get started on the right foot, so to speak.

The key is the core.  Core strengthening is a major part of nearly every back wellness program.    Working the back muscles is important too.

Once  you've gotten started, let me know (below in the comments section) how it's going!  I'd love to know of your progress.

Related:

• Move Pain Out of Your Body
• Core Stabilization Training
• Should you exercise when your back is acting up?

Last month, I blogged about new guidelines issued this spring by The Congress of Neurological Surgeons and the American Association of Neurological Surgeons on the use of the steroid methylprednisolone immediately after spinal cord injury.

That same document reviewed a broad scope of other medical to-dos including surgical techniques, management protocols for specific cervical spine conditions and much more.

Advancements in medical technology was the main reason behind the update for one of those topics, namely vertebral artery injury, or VAI. Vertebral artery injury is perhaps best known as the (rare) instance of stroke following a neck adjustment by a chiropractor. I say rare because it's actually more common in situations where a patient is having neck surgery (although it's rare then, too). But when a stroke follows a chiropractic adjustment, it tends to attract more media attention.

Related: Vertebral Artery Injury

Up until this latest issue of the guidelines, the recommended way to diagnose VAI was by angiogram. This involved inserting a catheter (with dye) into a major blood vessel, and was risky, says Dr. Daniel Resnick, Professor of Neurological Surgery at the University of Wisconsin School of Medicine and Public Health, and President-Elect of the Congress of Neurological Surgeons.

Resnick goes on to say that the Congress of Neurological Surgeons now recommends CT Angiograms. "With a CT angiogram you no longer have to inject dye into a blood vessel," he informs me. "Instead, this is done through an IV."

"The risk for complication with a CT angiogram is much lower than with an angiogram," Resnick explains. "Radiation is the biggest risk."

It's a very reliable test, too.

The Real VAI Issue

But the real issue with VAI is that doctors don't actually know what to do when it occurs without symptoms, Resnick says. That is one reason why testing is currently being debated. "We need prospective studies that looks at treated VAI and compares the outcomes with untreated VAI to determine if treatment is, in fact, needed."

Resnick is not currently aware of any such studies.

Photo: click

If you're down for the count - i.e. you have a neck or back injury that's keeping you laid up as the weather gets good - don't fret!   I've got list of strategies and things you can do so that this time of healing and mending does not become wasted time.    Check it out:   Back Injury - Recovery Time, Yes.   But Not Lost Time.

If you take amitriptyline or other tricyclic antidepressant for your chronic back pain, as prescribed by your doctor, you are using this medication "off-label".  In other words, the FDA has approved your medication for a purpose other than spine pain management.  Even so, your doctor has  prescribed it (in a lower dose) to you because of your back.   The FDA has not approved the use of these drugs for back pain.

MDs are the only people allowed by the FDA to prescribe the use of a medication for off label purposes. But a recent lawsuit that invoked the 1st Amendment (Free Speech) may have begun to set a precedence allowing drug company sales reps to speak persuasively to doctors about off label use of their products. Another recent lawsuit, again invoking the First Amendment, now allows companies to obtain prescriber information from pharmacies, then turn around and sell those names to big drug companies for their marketing purposes.

Where does this leave you?

Sometimes off label use of a drug is substantiated by medical research, but often it is not.  If you take or are considering taking off-label medications, it's best to be as informed as you can about the drug - before you start taking it, if possible. Consumer Reports covers all the basics on how to do this in their short video called Off-label drug prescribing: What does it mean for you? Check it out; it's for your safety.

_Sources:

_{Consumer Reports. Off-label drug prescribing: What does it mean for you?. Consumer Reports. Website Last Updated Dec 2012.http://www.consumerreports.org/cro/2012/05/off-label-drug-prescribing-what-does-it-mean-for-you/index.htm}

_{Marcia M. Boumil, J.D., LL.M. Off-Label Marketing and the First Amendment. Perspective. N Engl J Med 2013; 368:103-105January 10, 2013DOI: 10.1056/NEJMp1214926 http://www.nejm.org/doi/full/10.1056/NEJMp1214926}