Why Do I Have Back Pain During Sexual Intercourse?

Question:
I’m married and honestly,before the diagnosis that I got two slight herniated discs on my lumbar, my back gets sore every time I have sexual intercourse with my husband. Do you think the pain comes from the said diagnosis? If so, could you give me advice of what I should and shouldn’t do during sexual intercourse to avoid the pain or in order not to aggravate my back condition? My second question is, is it risky for me to get pregnant since I’m having this kind of problem?

Answer:
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Ask The Back Pain Expert

Gotta comment or question about my answer to today’s “sex and back pain” question?  Let’s have it.  Simply fill out this form and I’ll get back with you soon.

Dedicated to Erasing Your Back Pain.

Malton A. Schexneider, PT, MMSc
The Back Pain Expert

Written by Malton A. Schexneider, PT, MMSc · Filed Under Questions

Is Back Surgery My Only Answer?

Question:
If you looked at my MRI and xray, would you HONESTLY tell me if you think surgery is now my only alternative?  Would you really give me a free phone consultation?  I’m taking vicodin everyday, and want to quit, but pain is too much.  I see a chiropractor 1 to 3 times weekly.  Tried traction and inversion tables.

Answer:
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Gotta comment or question about my answer to today’s “is back surgery my only answer” question?  Let’s have it.  Simply fill out this form and I’ll get back with you soon.

Dedicated to Erasing Your Back Pain.

Malton A. Schexneider, PT, MMSc
The Back Pain Expert

Written by Malton A. Schexneider, PT, MMSc · Filed Under Questions

Best Exercises To Reduce Low Back Pain For People With A Sway Back

Question:
What are the best exercises to reduce lower back pain when you have a sway back?

Answer:
By far and away, this is positively the best exercise to reduce back pain if you have a sway back:

Most people try to treat sway back without ever addressing the psoas muscle.  This is a huge mistake and will only lead to frustration because nothing is changing.  Obviously, stretching the psoas isn’t the only thing that needs to be done, but it’s the first thing that needs to be done.

If you have questions about sciatica, herniated discs, or any other matters related to back and neck pain, simply fill out this form and you’ll be taken to a special web page where you can ask your question.

Gotta comment or question about my answer to today’s “best exercises to reduce low back pain for people with a sway back” question?  Let’s have it.  Simply fill out this form and I’ll get back with you soon.

Dedicated to Erasing Your Back Pain.

Malton A. Schexneider, PT, MMSc
The Back Pain Expert

Written by Malton A. Schexneider, PT, MMSc · Filed Under Questions

Exercises For Herniated Discs & Sciatica Pain

Question:
Can exercise help get rid of herniated disc and sciatica pain?

Answer:
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If you have questions about sciatica, herniated discs, or any other matters related to back and neck pain, simply fill out this form and you’ll be taken to a special web page where you can ask your question.

Gotta comment or question about my answer to today’s herniated disc and sciatica question?  Let’s have it.  Simply fill out this form and I’ll get back with you soon.

Dedicated to Erasing Your Back Pain.

Malton A. Schexneider, PT, MMSc
The Back Pain Expert

Written by Malton A. Schexneider, PT, MMSc · Filed Under Questions

Best Treatment For Spondylolisthesis

Question:
Hi, thanks for this website and the great work you are doing. I have spondylolisthesis, grade 1 for past 4 yrs. Intermittently have episodes of very severe acute lower back pain brought upon by any moderate activity like resistance exercises in the gym or basketball… . I wanted to know what specific stretching and abdominal/ back strengthening exercises you would recommend for a person like me?  Also I have an exaggerated lumbar lordosis. I find relief whenever i bend forward and flex my spine to make a hump.

Answer:
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Gotta comment or question about my answer to today’s back strengthening exercises for spondylolisthesis question?  Let’s have it.  Simply fill out this form and I’ll get back with you soon.

Dedicated to Erasing Your Back Pain.

Malton A. Schexneider, PT, MMSc
The Back Pain Expert

Written by Malton A. Schexneider, PT, MMSc · Filed Under Questions

Can Pilates Exercises Help Spinal Stenosis?

Question:
I have spinal stenosis. Is Pilates a practical exercise to attempt for stenosis?

Answer:
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Gotta comment or question about my answer to today’s Pilate’s exercises for spinal stenosis question?  Let’s have it.  Simply fill out this form and I’ll get back with you soon.

Dedicated to Erasing Your Back Pain.

Malton A. Schexneider, PT, MMSc
The Back Pain Expert

Written by Malton A. Schexneider, PT, MMSc · Filed Under Questions

Trigger Point Injections

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Spinal Decompression Therapy

Spinal decompression or traction has received considerable attention recently as an effective treatment modality for sciatica, herniated disc, and low back pain.  Spinal decompression is thought to work on the affected herniated disc by significantly reducing pressure within the disc by means of a traction force applied to the spine.

Spinal decompression can be applied in several ways including specialized spinal decompression devices (e.g. Vax-D, SpineMed, or DRX 9000), manually by an experienced therapist or doctor, or through the use of your own body weight as with inversion therapy.

The exact mechanism of spinal decompression is thought to have the following effects on the spine:

• Increase the opening through which the spinal nerve exits the spine
• Improve spinal mobility
• Decrease disc herniation, disc bulging, and disc protrusion
• Allow for a herniated disc to heal by improving the discs ability to attract and retain fluid
• Improve spinal joint function
• Alleviate bone spur pressure
• Decrease muscle spasm
• Restore normal spinal position
• Decrease low back pain

To accomplish these results, proponents of spinal decompression therapy have suggested traction forces of between 25% and 50% of the subject’s bodyweight be applied in order to overcome friction and attain sufficient separation of the spinal vertebrae.  In addition, some of the latest technologies claim to provide specific decompression to the exact disc level by varying the angle of the spinal decompression traction force. 

A review of the medical literature reveals conflicting evidence as to the validity of spinal decompression therapy.  Most scientific studies evaluating the effectiveness of spinal decompression alone on low back pain subjects with and without sciatica indicate no benefit over other forms of therapy including placebo.  While there are published papers purporting the effectiveness of spinal decompression, these studies typically fail to meet the necessary requirements of true scientific scrutiny. 

Although spinal decompression therapy has not been scientifically established as a valid form of sciatica, herniated disc, and back pain treatment, it is, nonetheless, an important component in a comprehensive sciatica and back pain relief program. In association with an active rehabilitation program, an appropriate back brace, and spinal education, you can benefit from the latest technologies for the treatment of sciatica and back pain.

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Physical Therapy

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Prolotherapy

Content provided by:
Thomas Bond, MD
Lafayette, LA

Sciatica and back pain can be the result of degenerative changes in the joints and soft tissues associated with the spine.  One of the many treatment options available to people suffering with acute or chronic pain is prolotherapy.

Proliferation Injection Therapy, also known as, “Prolotherapy”, is a technique by which a series of injections are used to stimulate the body’s natural healing of damaged tissues.  Various proliferative substances are injected into ligaments, tendons, and joints to encourage repair of damaged areas.  Specifically, Prolotherapy is used to:

• Strengthen weakened and loose ligaments and other joint-support structures; and,
• Stimulate new cartilage production within joints.

History of Prolotherapy
The earliest forms of Prolotherapy were practiced by Physicians in Germany in the late 1800’s.  The German technique was brought to America and later refined by an Ohio general surgeon named George Hackett, M.D.  Hackett, along with 2 osteopathic physicians – Earl Gedney & David Shuman – began using these techniques in the U.S. in the early 1930s. 

They were amazed with the clinical results they were receiving and therefore began publishing there work.  Dr. Hackett was published in the most prestigious medical journals of the day, including the Journal of the American Medical Association, and the American Journal of Surgery.  Hackett’s principal student and disciple was a general surgeon named Gustav Hemwall, who practiced his art in Illinois.  Hackett & Hemwall continued to not only practice Prololiferation Injection Therapy, but also trained other physicians how to perform these techniques. 

After Dr. Hackett’s passing, Dr. Hemwall continued training younger physicians in the ways of Prolotherapy for many years.  Today, the Hackett-Hemwall Foundation is a non-profit medical organization dedicated to the practice of Prolotherapy and to training interested Physicians this powerful set of techniques.  Dr. Jeffrey J. Patterson, Professor, Department of Family Medicine, University of Wisconsin Medical School trained and worked directly with Dr. Gustav Hemwall for many years and is currently the Director for the Hackett-Hemwall Foundation.

Injury & Healing
When any of the tissues of the musculoskeletal system (or the entire body for that matter) are injured, regardless of the cause, the damaged cells release their contents into the local environment.  The design of the overall system is such that if these normally intra-cellular contents are now outside the cell, the “alarms are sounded” that there is a problem in that area. 

“Help” (the working cells of our immune system) is then dispatched to the area to “clean up and fix the problem”.  This process is called our “local immune response” to injury and is characterized by inflammation.  Inflammation is simply part of this response – the immune cells order the blood capillaries to open and “make way” for more incoming immune cells – allowing fluid also into the area. 

Once the immune cells reach the damaged area they work to stabilize and repair the area.  This is accomplished by removal of destroyed cells and tissues, as well as, attempts to reconstruct the larger damaged areas. 

Unfortunately, human beings’ schedules do not typically coincide with those of their immune cells.  and thus, as we continue moving muscles and tissues in and around the damaged area, the “repair job” of the immune cells becomes overwhelming.  At this point, they begin to lay down scar tissue, which for the most part, is unstable and functions in a substandard manner. 

The area where the scar is laid down does not function properly which usually results in painful consequences.  Many forms of chronic pain are caused from this one consequence (the laying down of scar tissue leading to dysfunctional joint motion).  There is a very fine regulation to the inflammatory response during both acute and chronic pain/damage situations. 

How Prolotherapy Works
Prolotherapy works by stimulating the body’s natural healing response.  The particular mixtures and concentrations of the stimulant solutions cause the healing process to shift towards rebuilding the area with new cells, rather than laying down scar tissue. 

The way in which Prolotherapy is able to accomplish this is twofold:

1. Location of the Injection:  Prolotherapy injections are placed at the junction where ligaments and tendons fuse into bone.  This area is known to be rich in proprioceptive and pain fibers, and serves as a transition zone, having many different types of cells.  Some are “bone cells”, which help maintain the integrity of the bone.  Some are “tissue cells”, which maintain the different soft tissues (ligaments, tendon, and cartilage).  Other cells, however, are more impressionable or moldable (“naive cells”) and can be told which function they are to perform.  The specific placement of the prolotherapy stimulant solutions tell these naïve cells to take up the job description of “tissue cell” for that area, thus producing new, functional tissue cells. 
2. Proliferant solutions used:  there are many different types of mixtures which have the above-mentioned effect when appropriately placed, each with their own set of risks.  The classic stimulant solution used by Drs. Hackett & Hemwall:  the mixture of Dextrose, sterile saline, and Lidocaine.  When mixed in the proper concentrations and appropriately placed, this solution will stimulate naïve stem cells to become functional “tissue cells”, producing new collagen and/or cartilage.

Prolotherapy is a viable treatment option for people suffering with acute or chronic sciatica and low back pain.  Assembled below is a list of FAQ’s related to prolotherapy.

Frequently Asked Questions About Prolotherapy

What Types of Conditions Respond to Prolotherapy?
Any clinical pain syndrome whose symptoms stem from degenerative tendon or cartilage tissue, and/or ligament laxity with accompanying abnormal joint motion.  Some of the most commonly treated disorders are:

1. Arthritis
2. Whiplash Injury
3. Chronic Neck, Sciatica, & Back Pain
4. Repetitive Strain Injuries:  Tennis/Golfer’s Elbow, Carpal Tunnel, Rotator Cuff Strain, Bursitis, etc.
5. Sports Injuries:  Ankle sprains, Achilles’ tendonitis, Turf-toe, Jumper’s Knee, etc.
6. Hip and Buttock pain.
7. Fibromyalgia
8. TMJ (Temporo-Mandibular Joint) Syndrome.
9. Chronic Headaches.
10. ….and many, many more….

Are “Cortisone Shots” the same as Prolotherapy?
NO!  Cortisone and all of its derivatives, called corticosteroids, are powerful inhibitors of the local immune response and inflammation.  They actually act in opposition to Prolotherapy solutions.  This is not to say that corticosteroids do not have their place in Sports & Orthopedic Medicine.  They most certainly do.  However, there is ongoing debate as to what exactly the role is and mounting evidence that these substances may in fact turn the naïve osteoprogenitor cells toward the laying down of scar rather than new, functional tissue.

Who should consider receiving Prolotherapy?
Anyone with a painful condition of the musculoskeletal system that is not having success with their current treatment approach.

How do I know if I’m an appropriate candidate for Prolotherapy?
Certain aspects of a patient’s general medical condition can potentially affect the outcomes of Prolotherapy.  Tobacco use, Poor Nutrition, Vitamin and Mineral deficiency, and Obesity are just a few which may negatively affect outcomes.  Because of this fact, many physicians will choose not to perform the procedure on patients with these conditions. 

Who performs Prolotherapy and how can I be assured of his/her competence?
Unfortunately, there are many healthcare providers who claim to “do Prolotherapy” that are not appropriately trained.  Two of the most credible sources of information regarding Prolotherapy are the Hackett-Hemwall Foundation, and the University of Wisconsin Medical School in Madison, WS.

What is the cost of Prolotherapy?
This varies some from region to region and amongst physicians, but the national average is approximately $250/area.  An “area” is defined as a unilateral (one side, either right or left) region.  For example, a left knee = $250, a right shoulder = $250, a lower/lumbar spine = $500 (both sides), a “neck” (cervical spine) = $500. 

Will my Insurance cover the cost of Prolotherapy?
Insurance will cover the initial consult only.  Medicare and other insurances will not cover prolotherapy!

Are these injections painful?
They can be.  This really depends on the patient’s pain level, tolerance, emotional state, etc.  Patients who have difficulty with pain can typically be prescribed some conscious sedation to help them relax and more comfortable.

What type of limitation will I have after the injections?
We advise patients that they will be “sore, stiff, and slow” for 3 – 5 days.  “Sore” meaning tender, “stiff” meaning feeling tight (this is the tightening process of the tissues beginning), and “slow” meaning not as sharp physically.  This time period is variable, but patients can typically resume their pre-procedure activities within 24-48 hours.

Will Prolotherapy take the place of my Pain Medications?
Potentially, YES!  Again, this is variable, but some patients no longer require narcotic pain medications after receiving a series of Prolotherapy.  This is obviously dependent on the specific patient and his/her own unique set of variables and other influences.

Where can I find more credible information about Prolotherapy?
If you have an interest in learning more, you can research prolotherapy further by visiting http://www.prolotherapy-hhf.org or http://www.prolotherapy.org.

Dr. Thomas Bond is the founder and clinical director of Total Care Health and Wellness Center where he specializes in sports and orthopaedic medicine and prolotherapy and spinal injection therapy.  He is a Board Certified physician in both sports medicine and family practice.

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Massage Therapy

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Facet Joint Injections

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Medications

Medication Use for Sciatica and Back Pain

Medication, by far and away, is the most widely used conservative treatment for sciatica and back pain. Medications used to treat sciatica and back pain are prescribed individually or in combination with other types of medication with the goal of reducing pain and assisting people with maintaining function.  And while some medication use is recommended for acute sciatica and back pain, the effectiveness of long term use to treat chronic pain has not been established.  The purpose of this article is to provide an overview of the various classes of medication used to treat sciatica and back pain.
Opioids

Opioids, also known as narcotics, are utilized for their analgesic or pain relieving properties.  Opioids bind to the opioid receptors in the brain which, in turn, release endorphins to achieve pain relief. Most musculoskeletal pain responds to opioids as do some forms of headache pain. Common brand names of prescribed opioids include Darvacet, Vicodin, Lortab, Vicoprofen, Oxycodone, morphine, and Duragesic patches.

Side effects associated with the use of opioids depends on the person and also if the correct dosage was taken. The potential side effects of opioids are constipation, stomach upset, itching, and drowsiness.

One side effect of opioids that is monitored very closely is physical dependency.  As the body becomes accustomed to the medication, the need for increasingly larger doses is necessary in order to achieve pain relief.  For this reason, physicians try and wean low back pain patients off opioids within two weeks.

Non-Opioids (non-narcotic), Acetaminophen

Non-opioids include two types of medications: Acetaminophen (Tylenol) and non steroidal anti-inflammatory drugs (NSAIDs).  These medications are used to decrease pain levels while increasing activity level.

The benefits are that it blocks the pain pathway to the brain. It works well for mild to moderate pain. They also work better with other medications to improve pain tolerance.

The side effects are minimal when taken as prescribed. Overuse of acetaminophen, however, has been linked to liver failure.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
The purpose of utilizing NSAIDs is to reduce the inflammatory effect. They may also decrease acute pain, swelling, and stiffness associated with common injuries and medical problems. 

Most NSAIDs increase bleeding and should not be taken before a surgery. Upset stomach is the most common side effect and can be eased by taking the medication with food.  Common NSAIDs on the market include Celebrex, Ibuprofen, Aleve, Advil, and Motrin.

Oral Steroidal Anti-inflammatory Medications

Oral steroidal medications are used to decrease inflammation.  This type of medication is used to assist with mitigating acute flare-ups of pain. To decrease swelling and inflammation around the spinal nerves a short course of a steroidal anti-inflammatory can be quite helpful and usually means a quicker return to activity levels.  The medication typically used for acute sciatica or nerve root pain is a Medrol dose pack.
Long term use of steroid medications has been linked to such problems as osteoporosis, diabetes, and poor wound healing.  Side effects include mood changes, increased appetite, indigestion, increased nervousness, and decreased sleep.

Anti-Epileptic (Anticonvulsant) Medications

The anti-epileptic medicines help with coping with the heightened stress normally associated with long term pain.  This is accomplished by stabilizing moods and managing neuropathic or nerve pain. Nerve pain is considered to be streaking, lightening, burning, tingling, pins and needles, or radiating pain.  Common medications prescribed from this group of medications include Neurontin, Topamax, and Lyrica. 
The side effects of anti-epileptic drugs include: drowsiness, dizziness, tiredness, swelling, upset stomach, tremor, blurred vision, dry mouth, constipation, anxiety, and weight gain. Abruptly stopping the use of this type of medication can cause the onset of seizures.

Anti-Depressants and Anti-Anxiety Medicines

Anti-depressant and anti-anxiety medicines are used to assist with decreasing pain and increasing overall mood. They also used to treat nerve pain by increasing the serotonin and norepinephrine activity.  Commonly prescribed anti-depressants include Elavil, Cymbalta, and Effexor.  Prozac, Paxil, and Zoloft are usually prescribed for their anti-depressant/anti-anxiety benefits rather than their pain relief benefits. 
Upset stomach, feeling hyper, drowsiness, and tiredness are the most common side effects of anti-depressants and anti-anxiety medicines. They can also cause sexual dysfunction, flat mood, insomnia, headache, and appetite changes. Some can cause carbohydrate craving and weight gain.

Muscle Relaxants (Antispasmodics)

Muscle relaxants are commonly prescribed for patients with back pain and are used to decrease pain associated with muscle spasms.  Muscle relaxants help keep muscle spasms under control, which is common following surgery, an injury, or increased activity.  Commonly prescribed muscle relaxants include Robaxin, Skelaxin, and Flexoril. 
The side effects of muscle relaxants are drowsiness, dizziness, lightheadedness, upset stomach, blurred vision, insomnia, low blood pressure and dry mouth. Physical dependence and addiction are common risks associated with some types of antispasmodics such as Valium and Ativan.

Sleeping Aids (Hypnotics)

Lack of sleep is a common complaint with patients suffering with sciatica and back pain.  Sleep loss has been associated with poor healing and heightened anxiety.  Sleeping aids will help a patient to sleep, which leads to one’s ability to cope with pain better.  Commonly prescribed sleep aids include Ambien, Halcion, and Lunesta. 
Sleeping aids cause daytime tiredness, nightmares, and dry mouth. Urinary retention, low blood pressure (which may result in falls), and confusion are risks for the elderly. Some medications may cause rebound insomnia when stopped and some sleep aids can also cause sleepwalking or amnesia.

Topical Agents

Topical agents are utilized when a local analgesic effect is desired.  These medications are combined with a cream or lotion and absorbed through the skin directly over the area that hurts, thus eliminating the need to be absorbed into the blood stream and the side effects of oral medications.  Commonly prescribed medications that can be used topically include Voltaren, Zostrix, and Lidoderm.

The primary side effect of a topical agent is skin irritation. If applied too frequently, these medications can result in too much absorption, which will then cause the same side effects of oral medications.

Summary

Current medical research advocates the use of analgesics, muscle relaxants and NSAIDs at regular intervals for a fixed period of time to effectively treat acute sciatica and back pain.  For chronic back pain sufferers, a short course of analgesics can be prescribed in order to facilitate a gradual increase in activities; however, long term drug use for chronic pain sufferers is discouraged. 

In addition to drug therapy to treat both acute and chronic sciatica and back pain, exercise therapy has been shown to provide excellent results and is, therefore, highly recommended.  The Erase Your Back Pain program utilizes a prescribed series of therapeutic spinal exercises that are designed specifically for your unique condition.  Get all the details here: Treatment For Sciatica and Back Pain

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Epidural Injections

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Back Surgery

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Alternative Treatment

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment

Chiropractic

Content provided by:
Graeme Teague, Doctor of Chiropractic
Christchurch, New Zealand

Chiropractic, a profession with those “for” and “against” it. It seems those for the Chiropractic way of helping back pain give glowing testimonials, and those against damning ones. Why?

As with all professions there are good and bad practitioners. The technique itself has good aspects and those not so good. It is up to individual practitioners as to which techniques they use and how they will apply them.

Most of you may believe that Chiropractic is a relatively new profession. However manipulation of the spine can be traced back as far as times of Hippocrates, and even further back in writings from China and Greece. The modern name of Chiropractic started in 1895 by Daniel Palmer and the profession of Chiropractic formed from there. Prior to this, even in ancient times, those treating the spine were called “bone setters” and even were consulted if fractures occurred.

Traditionally Chiropractic is a therapy that manipulates or adjusts the spine, and only the spine. They used heavy handed techniques and the “rack ‘em and crack ‘em” view of Chiropractic was strong. In modern times this has changed…

The philosophy of Chiropractic remains however, that your spine is an integral part in your health. The nervous system if interrupted will not only affect your aches and pains, it will also affect your general wellbeing. Chiropractic believes that by manipulating the spine and removing irritations around the joint, the nervous system will work correctly and health returned.

How this is achieved differs from each practitioner…

From a manipulation viewpoint – you have the traditional Chiropractors who still adjust the spine with heavy techniques. There is an audible sound as they manipulate. At time it may be painless and other times you may feel a bit sore from the adjustment.

There are techniques within Chiropractic that use machines, called Activator Guns, which will adjust the spine. These are painless and use a high velocity to “shock” the joint, helping the movement to be returned.

There are also even more gentle techniques that require no force at all on the joint and these encourage the joint to move better. Completely painless and even some of these techniques can be taught to be used at home to help reinforce the treatment in the Chiropractor’s office.

Chiropractic in general still looks at the spine as being a major factor in your health. But as research and education have improved, so has the overall technique. Now a lot of Chiropractors use nutrition, Acupuncture/Acupressure, Homeopathy, exercise and other muscle techniques to help improve not only your back pain, but also your general health.

It is up to each individual to seek help from a practitioner they identify with, the techniques they use and the approach to your health.

Dr Graeme Teague, DC, B.Sc, B.App.Sc, Cert.Hom, M.N.Z.C.A is a practicing Chiropractor in Christchurch, New Zealand. Dr Teague is a specialist in Applied Kinesiology and Acupressure. He is the author of self-help books The X-Pain Method, The Calm Mind, The Headache Code, and The X-Stress Method. Dr Teague has been practicing since 1991 and specializes in chronic and difficult back pain conditions. To get a free copy of his Back Pain Code Click Here! 

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment