Photo: Anne Asher 2007 Licensed to About.com

Many people find gardening to be not only relaxing and personally fulfilling, but healing as well. But if back pain is getting in your way of accomplishing your vision for your garden, how healthful is that? Most of us use body mechanics that create pain when we add load or challenge to our physical work. Our minds are not on our bodies - we are thinking about the next thing we have to do to get our garden in shape. To this end, I have created a few illustrated, step-by-step, easy to follow guides for common gardening chores. So dig in - and healthy gardening!

Back Safe Gardening Guides

• Common Garden Chores and Your Back
• Weeding Without Back Strain
• Avoid Straining Your Back by Reducing the Need to Weed
• Dig Out Your Soil
• Empty a Wheelbarrow
• Get a Mower Going
• Safe Lifting Technique
• How not to lift
• Gardening and Back Pain - Index of Step-by-Step Guides
• Getting Ready for Yard Work, by About.com's Exercise, Paige Waehner

Photo: Jonathan Ferrey Getty Images

An expectant crowd watches as you fend off your adversary by jumping high and fast enough to miss him and smash the ball into the hoop instead. All eyes are on you and all of your teammates are expecting you to score. Now imagine doing this with your back in spasm.

This was Kobe Bryant's experience on Sunday in the Lakers vs Utah Jazz playoff Western Conference semifinal Game 4. It was not a home game for Bryant, or the Lakers. Although Bryant kept playing after his injury occured in the beginning of the game, monitoring his back spasm as he went, the Lakers lost 115 to 123. Kobe scored 33 points and 10 assists.

And although Sunday’s episode of back strain had him on his knees and wincing, neither he nor his colleges think it is anything to worry about in the long term. Bryant plans to play in tonight's Game 5, saying Monday “I can't imagine it'll be any worse than it was last night. It was pretty bad”.

Bryant is now on a round the clock treatment plan consisting of ice for inflammation, electric stimulation, massage and stretching.

Kobe Bryant is a three-time NBA champion, and was named the NBA Most Valuable Player for 2007-08.

And For We Mortals With Back Spasm

• Back Strain
• At Home Therapy for Mild Back Pain
• Over the Counter Pain Meds for Back Pain
• Stretching

=============================== 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: Goldstein

Whiplash is what is known as a hyperextension/flexion injury. This means that an impact of some sort, most commonly one motor vehicle hitting another from behind, forces the neck into an extreme arch (the head moves backward) and then very quickly into the other direction (the head moves forward). Whiplash injuries can cause neck sprain, neck strain, and facet joint problems.

Many people who have whiplash also have problems with their insurance companies. It seems the insurance companies don’t think the pain associated with whiplash is legitimate. A study done about a year ago found that patients who saw a chiropractor, added chiropractic treatment to their general practitioner care or had more than 2 visits to their GP had a “slower recovery”. The amount of treatment available to these whiplash patients was, of course, related to insurance coverage, but I won’t get into that here. The study concludes that more treatment means the doctors and the system are promoting patients’ fears that they won’t get better – fanning the fire, so to speak. It also says that having more treatment encourages patients to use “passive coping strategies”.

A new study has found that a patients' expectations of getting better (called self-efficacy) is key to whether or not they do get better. The authors of this study strongly suggest the initial diagnosis include an assessment of those expectations to help the doctor estimate how well the recovery process will go. They also think that the lack of self-efficacy might have something to do with the development of chronic back problems later on.

What do you think? Would your belief in your ability to heal after whiplash be a factor in getting better? Would you use passive coping strategies, or are you about actively taking responsibility for your recovery? Can you take responsibility without being under a doctor's care? Use the comment feature below and give us your point of view.

Whiplash Mini-Tool Kit

• How to Prevent Whiplash to Your Neck (should you have the unfortunate experience of being rear ended.
• After an Injury
• Taking Responsibility for Pain
• Articles about Whiplash
• Diagnostic Imaging Tests and What They Show You
• Understand Your Diagnosis - Diagrams of Parts of the Spine and Vertebrae
• Types of Back Pain Doctors

_{Sources:
Holm LW, Carroll LJ, Cassidy JD, Skillgate E, Ahlbom A (2008). Expectations for recovery important in the prognosis of whiplash injuries. PLoS Med 5(5): e105.
Pierre Côté, Sheilah Hogg-Johnson, J. David Cassidy, Linda Carroll, John W. Frank, Claire Bombardier. Early Aggressive Care and Delayed Recovery From Whiplash: Isolated Finding or Reproducible Result Arthritis Care & Research, June 2007; (DOI: 10.1002/art.22775).}

=============================== 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. ===============================

Today - May 12 - is Fibromyalgia Awareness Day. Fibromyalgia is a "chronic pain disorder", according to the National Fibromyalgia Association. It is sometimes brought on by a back or neck injury. Fibromyalgia is diagnosed by the presence of chronic widespread pain in addition to 11 of 18 tender points located in specfic areas of the body. These tender points are different from the trigger points that characterize myofascial pain syndrome. In fact, fibromyalgia is altogether a very different problem than myofascial pain syndrome. Myofascial pain is a postural problem, while fibromyalgia is a pain condition. Famous artist Frida Kahlo may have suffered from fibromyalgia, according to the College of Rheumatology.

=============================== 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. ===============================

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