Illustration: ADAM

Strong, functional ab muscles are a cornerstone to maintaining a healthy back – any back doctor, physical therapist, fitness trainer or chiropractor will tell you that. But being that we each have 6 abdominal muscles in all: the rectus abdominus on top, then two external obliques, two internal obliques under them and the very deep transverse abdominal muscle, doctors and researchers are not prepared to let it go at that.

A 2004 study involving 20 participants compared the size and activity of each abdominal muscle in people with low back pain to those lucky enough not to have back problems. The measurements were made after a chiropractic adjustment, or technically spinal manipulative therapy. The results showed that, as many Pilates instructors will tell you, the transverse abdominal muscle, or nature’s back belt, as I like to call it, does not work as well for people with low back pain as it does for those with healthy spines.

So what does this mean to you? That depending on your particular back problem, you may wish to get started on a core strengthening program, one that has you isolating and working the transverse abdominal muscle, for sure. And if you are already involved in a program, such as Pilates, pay careful attention to the instructions on how to access the deep abdominals.

Related:

• The 6 Abdominal Muscles, and what they mean to you.
• Transverse Abdominal Muscle
• Back Doctors
• Spinal Manipulation
• Is Chiropractic for You?
• Core Strength and Your Back
• Core Muscles Awareness Exercise
Pilates for Back Pain
• About.com's Pilates site - check it out!
• Prevent Back Pain

=============================== To stay up to date on back and neck pain treatments, news and issues and more, get the Back and Neck Pain Newsletter and join the discussion on the Back and Neck Forum. ===============================

Photo: Luis Alvarez

A few months ago, I blogged about an FDA safety warning for the use of Botox to treat spasticity in children. Since that time the American Academy of Neurology (AAN) has reviewed the medical literature on the subject, along with the literature that exists on the use Botox for dystonia. Their recommendation? That doctors should offer Botox to their patients who have Level A spasticity and cervical dystonia. (The AAN also made recommendations on Botox for other disorders, but that’s beyond the scope of this blog.)

However, we’ve gone from a possible safety problem to an officially recommended treatment in 3 months. In their report on Botox for spasticity, the AAN makes a few disclaiming assertions and calls for more research on this treatment. Essentially they say:

• Botox is now standard treatment for movement disorders such as cervical dystonia and spasticity, but patients’ response to this treatment has so far varied widely. So, as yet they do not fully know how it will affect you.
• A lot of injections are needed to to get the desired effects.
• At this point it is hard for them to tell if and how well Botox accomplishes the stated goals of treatment. This is especially true of those doctors who administer the therapy. In other words, Botox is now officially a standard treatment for spasticity and dystonia. In practice, however, a standard of care and expected outcomes all can agree upon is not yet in place.
• The technique the doctor uses when administering the injection is in need of further development.
• Information gleaned from reliable research studies concerning which muscles to inject and how much to give (dosage) did not yield all the necessary answers for a safe and effective Botox session at your doctor's office.
• The studies they reviewed didn’t answer all their questions about the safety of having Botox injections over the long term. Also, they think there may be a possibility that a patient could develop resistance to this medication after a while.

Related:

• FDA Safety Warning on Botox for Spasticity
• Is Botox Safe?
• Spasticity
• Torticollis
• About Dystonia
• More Info on Dystonia
• Deep Brain Stimulation for Dystonia

=============================== To stay up to date on back and neck pain treatments, news and issues and more, get the Back and Neck Pain Newsletter and join the discussion on the Back and Neck Forum. ===============================

_{Sources:
D. M. Simpson, J-M Gracies, H. K. Graham, J. M. Miyasaki, M. Naumann, B. Subcommittee of the American Academy of Neurology evidence-based review): Report of the Therapeutics and Technology Assessment Assessment: Botulinum neurotoxin for the treatment of spasticity. May 7, 2008
D. M. Simpson, MD, A. Blitzer, MD, DDS, A. Brashear, MD, C. Comella, MD, R. Dubinsky, MD, MPH, M. Hallett, MD, J. Jankovic, MD, B. Karp, MD, C. L. Ludlow, PhD, J. M. Miyasaki, MD, MEd, M. Naumann, MD and Y. So, MD, PhD. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review) Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology}

One rare complication of neck surgery is called vertebral artery injury (VAI). According to a journal report published in the April 1, 2008 edition of Spine Journal, certain procedures sometimes cause this potentially fatal problem. These procedures include the anterior cervical decompression, the posterior atlantoaxial transarticular screw fixation (aka the Magerl fixation), and some of the new surgical techniques that involve screws. The authors of the report surveyed doctors covering a total of 5641 cases of neck surgery. They found between 0.3% and 0.5% of patients with the anterior cervical decompression and up to 8.2% of those with the Magerl fixation were injured in this way. The report also noted that neck surgeries done by inexperienced surgeons had a higher rate of VAI. (This is called an iatrogenic injury.)

A VAI can be one of a number of types of injuries to the arteries found deep in the neck, which are located on the bone on either side of the vertebral bodies of the cervical spine. Along with neck surgery, chiropractic adjustments, venous catheterization, diagnostic cerebral angiography, percutaneous nerve block, and radiation therapy may also cause this injury. VAI can be “catastrophic” as one medical author puts it, so if something doesn’t feel right after you have one of these procedures, please don’t hesitate to speak up, and suggest (strongly) to your doctor you be checked for VAI. And remember, the VIA is likely an iatrogenic injury.

_{Sources:
Neo, Masashi MD, PhD; Fujibayashi, Shunsuke MD, PhD; Miyata, Masahiko MD; Takemoto, Mitsuru MD, PhD; Nakamura, Takashi MD, PhD. Vertebral Artery Injury During Cervical Spine Surgery: A Survey of More than 5600 Operations. Spine. April 1, 2008.
Inamasu J, Guiot BH. Iatrogenic vertebral artery injury. Acta Neurol Scand. 2005 Dec.}

Photo: Adam Ciesielski

Today marks the last day of Neurosurgery Awareness Week, and the end of a week long annual meeting for neurosurgeons in Chicago, Illinois. The meeting was hosted by the American Association of Neurological Surgeons (AANS), a professional organization dedicated to "advancing the specialty of neurological surgery in order to promote the highest quality of patient care". I was able to attend the conference for one afternoon, and in the next few days and weeks, I will be blogging about some of the latest developments in spinal medicine I found while I was there.

Neurosurgeons are one type of back pain doctor, although the scope of the profession extends to all aspects of the human nervous system. For example, a neurosurgeon may specialize their practice on brain tumors, epilepsy, spinal cord injury, Parkinson’s disease, or, of course, back or neck problems. According to the AANS, neurosurgeons spend about half of their time helping patients with spine problems.

Typically, you would see a neurosurgeon for your back or neck after all conservative options were tried.

There is a difference between acute and chronic pain. There is also potential for relationship between the two. Symptoms of acute low back pain are often nearly the exact opposite of those that come with the persistent type.

It’s important to watch what happens to your back or neck injury in the weeks that follow, because if the pain lingers, you may be developing a chronic condition. Acute into chronic back pain occurs when scar tissue that forms to help heal and protect the area is re-injured along the way. This happens when you do not properly control inflammation. For example, you may gotten back into heavy physical activity too soon, or used heat or had a vigorous massage in the first few days – at a time when ice and/or over-the-counter pain medication, especially NSAIDs would have been a better idea.

Researchers and medical experts now know that some people have personality traits that may more easily lead to the development of chronic back problems. How about you? Do you receive a payoff for being in constant pain?

Treatment for chronic back and neck pain usually involves a multi-disciplinary approach, and is hopefully tailored to you as an individual.

Related:

• Stages of Injury Healing
• At Home Therapy for Mild Back and Neck Injuries
• Pain Management - Pain Medicine
• Find a Qualified Massage Therapist
• Chronic Pain and Depression
Acute Low Back Pain

Most experts sources estimate that around 80% of Americans will experience back pain at some point in their lives. Fortunately for many, the bulk of such problems are musculoskeletal in origin, and can be easily treated with simple things like exercise or massage therapy. But did you know that (according to the American Association of Neurological Surgeons) around 12 million people per year suffer from degenerative disk disease? The AANS goes on to say that around one million people with back problems have surgery each year.

Related:

• The Intervertebral Disk
• Illustration of Disk and Vertebra of Low Back
• Artificial Disk Replacement Surgery
• Alternative Medicine for Back and Neck Pain
• Chiropractic
• Spinal Stenosis Symptoms

Frida Kahlo (Mexican, 1907-1954) The Broken Column, 1944 Oil on canvas 15 11/16 x 12 in. (40 x 30.5 cm) Collection Museo Dolores Olmedo Patiño Mexico City © 2007 Banco de México Diego Rivera & Frida Kahlo Museums Trust

Recently, I was lucky enough to see the traveling exhibit of Frida Kahlo’s paintings. Khalo was a self-taught Mexican artist who began painting at the age of 18 when a near fatal bus accident left her in a body cast to heal her spine and pelvis. The accident fractured two of her lumbar vertebrae and caused her to experience chronic widespread pain for the rest of her life. For the next several decades, Kahlo was subject to corsets, surgeries, medications, and, of course, relentless pain. Sadly, she was unable to get relief from any of the attempted medical interventions.

In a reflection of the self-taught artist’s work, the American College of Rheumatology suggests that perhaps Kahlo suffered from fibromyalgia. In Frida’s time, it is likely that doctors knew little or nothing about this condition, and therefore did not diagnose it. But if you look at the painting entitled The Broken Column, you can see the nails placed around her body. (Fibromyalgia is identified by the presence of widespread pain, and can be precipitated by a back or neck injury.) The ACM suggests that the nails depicted in one of her drawings are located in approximately the same areas as the tender points used to diagnose fibro.

As I mentioned, Frida began painting as a way of dealing with the pain of the accident. Her art is fraught with symbolism that relates to her back and (other health) problems, along with her life events, including her marriage. According to the Philadelphia Museum of Art, her engagement with self portraiture helped her to “reinvent herself”. If you want to see more of Kahlo's paintings, check out the gallery on About.com's Art History site.

Related:

• Chronic Back Pain and Emotional Health
• About.com's Art History Site
• Chronic Widespread Pain
• Compression Fracture
• Burst Fracture

_Sources:

Fibromyalgia in Frida Kahlo’s life and art. CONCISE COMMUNICATION. ARTHRITIS & RHEUMATISM. Vol. 43, No. 3, March 2000, pp 708–709.

Frida Khalo. Philadelphia Museum of Art website.

Interested in limbering up your spine? Here's a free E-Course that can help you adapt a yoga program to your back problem.

People who injure their spinal cords are thrown into a new world with what is probably, to them, a very negative future staring them in the face. It may be that one moment of recklessness has altered their way of life forever. This is a time when they need family members and friends to understand what they are going through, and to be patient, and supportive.

Spinal Cord Injury Articles and Resources

• Exercising with Spinal Cord Injury
• Pressure Sores
• Complete Spinal Cord Injury
• Incomplete Spinal Cord Injury
• For Family and Friends.The quote "what fresh h--l is this?" may aptly apply when it comes to spinal cord injury.
• First Aid for Suspected Broken Neck Read this article to learn about how to avoid injuring the victim even more. You could make the difference between life and death, or the ability to walk again vs a life confined to a wheelchair.
• Life Rolls On - an excellent organization committed to raising awareness, hope and motivation.
• Apparelzyed - Another excellent website that enables paralyzed people and their caretakers to connect with one another. Good information about SCI on here, as well.

Illustration: ADAM

Vertebroplasty and kyphoplasty are two minimally invasive spine surgeries commonly used to treat compression fractures of the vertebrae. While spinal fractures can be extremely painful, these surgeries are generally regarded as safe, free from complications and are pretty easy on patient and doctor.

In a vertebroplasty medical grade bone cement is injected into the vertebra to help seal the fracture. The kyphoplasty goes one step further by attempting to restore the height of the vertebra.

Recently, a study was completed that looked at 884 patients with osteoporosis for 5 years after a vertebroplasty. The study revealed "dramatic pain relief and sustained benefit for the patient", according to press materials. The stated benefits included a big leap up in the quality of the patients’ daily activities.

• What is a Vertebroplasty?
• What is a Kyphoplasty?
• What is the Difference Between a Vertebroplasty and a Kyphoplasty?
• Compression Fractures of the Spine
• Vertebra-Definition
• Picture of Vertebrae and Spinal Bones
• More Info on Vertebroplasty and Kyphoplasty