Dr Davis' Back & Wrist Pain Blog

Chronic Back Back. It's all about Lifestyle. Extremes Lead To Extremes.

San Francisco and Marin County Back Pain Doctor comments on the relationship between Lifestyle Choices and Chronic Back Pain:

I have treated thousands of cases of chronic back pain at my San Francisco chronic back pain center over the past 15 years, and we are currently in the process of opening up a clinic in Marin County, which is where I live.  The Marin County lifestyle is very active and there is a pent up demand for nonsurgical solutions for chronic back pain.  Anyway, I have noticed some commonalities amongst the chronic back pain sufferers I have consulted with and treated over the years. It seems that there is frequently something that is Extreme about their lifestyle. Maybe it is their diet, and they eat fast food all day. Maybe they work 80-100 hours per week. Maybe they do not exercise at all or expose themselves to tons of mental stress with no outlet for releasing it. Chances are, according to Saul Miller, in his book Food for Thought, If you choose to be extreme with one aspect of your lifestyle, you will probably suffer extremes in other areas of your life as well. In other words, Extremes Lead To Extremes. This way of thinking is in alignment with the Chinese concept of Yin and Yang. Sickness lies at the extremes; health rests squarely in the middle. According to Dean Black, in his book Contextual Healing, the problem is; we don't always know what's extreme and what isn't. This is the problem. We do not come with an owners manual when we are born. We learn about what to eat and other lifestyle choices from our parents and our teachers in school. The last thing on the list are any kind of back pain prevention measures. And in regards to diet and nutrition, typically the educational materials in schools are provided by the milk and dairy industries. So, what are we supposed to think. In addition, it's not like we get any help from our doctors who's care we are under for various ailments that for the most part are directly connected to our lifestyle choices. I have been told that the amount of time devoted to nutrition in medical school is very little. So, it's kind of up to us to figure it out on our own. Fortunately we have in an inner awareness that leads us in the direction of truth. When we hear truth we are able to identify it and there is a instinctive desire to learn more. Thankfully, when it comes to nutrition there is such an abundance of research that supports the health benefits of a plant based diet, that it makes it very easy to understand how and why this is the diet that we were designed to eat. The typical American diet is an Extreme diet. This is why over 60% of our population is obese. This puts extra stress on the the spinal bones and discs causing them to wear abnormally. Also, for every extra pound of fat you wear, your body needs to build 5 miles of extra capillaries (or something like that), arteries, and veins, putting abnormal wear and tear on the heart and other organs. It's the fast track to the grave. So, this is why we incorporate a Plant Based Diet into our treatment protocol. This diet also helps to reduce inflammation, which is a major cause of degeneration and pain. I am using diet as an example because molecule for molecule it is how you interact with your environment the most. If you could change just ONE thing about your lifestyle, it would have to be your diet. This would give you the most bang for your buck. The list of lifestyle choices or what we refer to as our CONTEXT is as broad as life. In addition to the food we eat there is the air we breath, the water we drink, the books we read, how much we exercise, how much stress we expose ourselves to, how much we relax, our mattress, our pillow, our shoes, our posture, the condition of the spine, etc. This is just a partial list of the CONTEXTUAL PARAMETERS that are adjustable by us. Actually the spine is adjustable, but you need me to do it for you. We have an invisible knob that is adjustable by us for all of our lifestyle choices. When you make lifestyle choices you either adjust yourself in the direction of illness or in the direction of health, the choice is yours. From my end it would be a lot easier to stay away from this topic. But if I did I would not be able to sleep at night. Sure, I know that the actual services I provide are the most advanced up to date technologies on the planet. But I also know that they will work best if the knobs are adjusted in the right direction.

Do I really have Carpal Tunnel Syndrome (CTS) ?

San Francisco-Carpal Tunnel Syndrome (CTS) is one of the most misdiagnosed conditions that there is. CTS is also very difficult to treat. I have spent the past 15 years in The San Francisco Financial District treating CTS and other repetitive stress injuries (RSI) at my Carpal Tunnel Injury Center. The reason CTS is hard to diagnose (and treat) is because the patient presents with pain, weakness, numbness, tingling, burning, or throbbing arms and hands. The classic sign is night pain in the hands that wakes you up. What makes it so difficult to diagnose is that nerve irritation in the neck where the nerves exit the spine can cause the same exact symptoms, and sometimes there is no associated neck pain. The nerves in the neck can be irritated by bones that are out of alignment (subluxations) and there are no symptoms. This interferes with the transmission of nerve impulses to the arms and hands and predisposes them to injury. So, if someone is using their hands a lot, like an office worker, hair stylist, assembly line worker, or daily computer user (anyone?), and the upper extremities are not receiving full power from the nerves, they can become inflamed, causing the symptoms we associate with CTS. It's common to see the diagnosis of CTS for any kind of hand/arm pain.  In actuality, CTS is usually not the problem. The problem is in the neck. I have found subluxations in the neck to be the missing link in many severe cases of RSI and CTS. The treatment must include neck, shoulders, arms, and hands, on both sides. Both sides because the side that seems the worst might actually have been compensating for the other side. We do nonsurgical cervical spinal decompression, spinal adjustments, upper extremity adjustments, massage, cervical traction, cold laser, and exercises for the neck and upper extremities (both sides) vs. just looking at the pain in the hand and treating the pain with pain pills or cortisone (and often times not even considering the neck) or even surgery.  The results speak for themselves. We have prevented many surgeries over the years and look forward to helping many more patients in the future. If you or anyone you know is suffering with CTS, you should give us a call before you consider surgery or cortisone (415-392-2225).

How To Prevent Chronic Back Pain

San Francisco and Marin County Chiropractor Dr. Eben Davis takes a look at some of the ways we can prevent chronic back pain

We treat many forms of chronic back pain at our SF Bay Area Back Pain Centers. Sometimes the back pain is brought on suddenly by some sort of a trauma, say a car accident or a slip and fall. But for the most part, what we see is slowly developing conditions that are the result of poor lifestyle choices and lack of attention to back pain prevention. Poor habits repeated over and over are one of the primary causes of chronic back pain. The problem is that we do not come with an "Owners Manual" when we are born that instructs our parents on how we should take care of our spines. So, this lack of spinal hygiene starts at a very early age and continues throughout our adult lives, eventually manifesting as degenerative spinal conditions and chronic back pain. Anyway, I found an interesting article this morning that could actually be used as a few chapters of the "Owners Manual" for back pain prevention (I might actually create this manual one day). Here is a paragraph or two from the article:

Back pain and back injuries are very common in our society. In fact, approximately 60 to 90 percent of all U.S. citizens will experience at least one back injury in their lives. Half of these people will experience multiple episodes of back problems. Many will undergo surgical procedures, and roughly 10 percent will see their condition become chronic. The ultimate cost to society in lost productivity and health-care resources totals in the billions of dollars. An even higher price, however, is paid by the people who have lost the ability to participate in the activities they most enjoy. Back problems can make fishing, golfing, or even just playing with children and grandchildren fraught with pain. In the worst cases, a back problem can interfere with even the ability to get dressed.

Despite all this, people still take their backs for granted, not realizing the dangerous positions they put their backs in every day. Almost everything you do requires the use of your back, and back problems are rarely the result of a single activity or accident. Most injuries occur over a period of years or even decades, as a result of various factors -- how you sleep or sit, what you eat, or how you deal with the emotional stresses at home and work. In this article, we will tell you how  to perform those tasks, and many more, without injuring your back. Just look at all the helpful tips spread out over these sections:
   

I recommend you read through these tasks and tips and incorporate them into your daily routine. If you are currently under my care and wish to consider something here that conflicts with your existing home care instructions, then please speak to us first before you do it. You will notice most of these things are in alignment with what we teach. If you have any questions or concerns I can be reached at 415-392-2225 or emailed at drdavis@best.com.

San Francisco Chiropractor offers Nonsurgical Spinal Decompression as an option for Cervical Disc Herniations

Cervical Disc Herniations responding favorably to treatment with the DRX 9000 

San Francisco and Marin County residents now have another nonsurgical option for cervical disc herniations to consider, the DRX 9000. Up until recently nonsurgical options were considered to be pain killers, rest, physical therapy, and various forms of pain management and injections. Treatment for cervical disc herniations can be divided into two categories, surgical and nonsurgical. Here is a paragraph regarding treatment options from the Chicago Institute of Neurosurgery and Neuroresearch:

The treatment of cervical disc herniation can be divided into two categories, conservative (non-surgical) and surgical. In some rare cases of very large disc herniation causing significant pressure on the spinal cord, surgery may be considered the conservative option.

In general, conservative management consists of maneuvers to reduce pressure on the nerve root. Immobilization with the neck in a flexed forward position may be helpful. Straining should be avoided. Medication in the form of an anti-inflammatory such as aspirin, ibuprofen, naproxen, celebrex or vioxx may be taken. As these medications have side effects, patients should carefully read the package material or consult their doctor if taking any medications for longer than a few days. Physical therapy may be prescribed. This can consist of traction, mild stretching, exercise, heat, massage and ultrasound. These can be using in various combinations depending on the patient. A course of home cervical traction may be helpful. In some cases, a referral may be made to a pain management specialist or a physiatrist. These are doctors with special training in the diagnosis and treatment of pain. Various injections in and around the cervical spine can be performed. The particular type of injection depends on the individual patient. Up to 95 percent of patients will get better without the need for surgery.

Surgical treatment is reserved for patients who exhibit the signs and symptoms that require urgent decompression, patients who can not or do not wish to spend the time to allow conservative approaches to work and patients who have failed conservative management after a reasonable amount of time (six to eight weeks). Surgery for cervical disc herniation is divided into two approaches, anterior (from the front) and posterior (from the back). Since the disc is located in front of the spinal cord, the anterior approach is the more direct approach. The most common anterior operation is the anterior discectomy and fusion (ACDF). The disc is removed and usually replaced with a small piece of bone (either from the patient's hip or from cadaver donor). Sometimes, metal plates and screws may be used to assist the fusion. Depending on the type of surgery performed, a cervical collar may need to be worn for anywhere from a week to twelve weeks. The posterior approach is much less commonly performed. In this operation, a small amount of bone is removed from the back of the spine over the affected nerve root. Gentle retraction may allow removal of a soft disc. Few surgeons perform this operation.

As you can see, there is no mention of nonsurgical spinal decompression as it is relatively new. I have been practicing at my San Francisco location for 15 years. During this time I have treated thousands of cases with conventional chiropratic care (using my hands, exercise, and some instruments). I have treated hundreds of patients with cervical disc herniations, some successfully, some not. However, since I started incorporating nonsurgical spinal decompression into my treatment protocol I have been able to obtain better outcomes. I have also been able to initiate care with patients I would have referred out in the past. These are patients I would not even consider for conventional chiropractic. Sure, some cases will still require surgery, but some will avoid surgery. It's worth a shot. Surgery for cervical disc herniations is not much fun, and the success rates are a topic of debate.    

Obesity and Back Pain

San Francisco and Marin County back pain specialist comments on the relationship between obesity and back pain:

I found an article about the results of a survey conducted by the North American Spine Society (NASS) last year. Here are a few paragraphs (I recommend reading the entire article): 

In March 2005, NASS conducted a national survey of spine care professionals* to measure the impact of obesity on back pain. The survey unveiled an increasing trend in the number of obese patients being treated for spine-related disorders – up nearly 67 percent from just five years ago. According to the NASS survey, 44 percent of the patients they see are considered obese.

Dr. Facizewski is not alone in his observation. A startling 87 percent of spine professionals surveyed agree that obesity plays a significant role in back pain. The vast majority of those surveyed (94 percent) also said they recommend weight loss as a treatment option for their obese patients and, in follow-up treatment for patients who lose the weight, 55 percent found a significant improvement in their patients’ symptoms as a direct result of the weight loss.

The thing is, it is very difficult sometimes for patients to accept the fact that the extra weight they are wearing is contributing to their back pain. Actually, it hurts them in many ways. Not only does the extra load cause the discs and joints to wear down abnormally, the diet (obese patients are usually consuming a diet high in animal fat and protein) itself causes a chronic state of inflammation which accelerates the degenerative process and actually contributes to the transmission of pain impulses to the brain. This also makes it very difficult to exercise without pain, adding more fuel to the fire. So, what is the solution ?  What is the best dietary approach to lose weight  ?   We want something that is NOT a quick fix. Most fad diets cause dramatic weight loss initially that is mostly water. Then, you end up gaining more weight back than you lost.

I have found that the best approch is to consume the foods that the body was designed to eat. These are plant foods. The program that we recommend is The McDougall Plan. Here is a link to resource page on Obesity on Dr. McDougall's website. I have personally been on the McDougall program for 15 years. I do not have to worry about counting calories. I am never hungry. And my bodyweight is less than it was when I was in highschool. I am strong, have plenty of energy, and feel great. If you are interested in discussing the program in more detail, please contact me at 415-392-2225.

Is Spinal Degeneration Normal ? That's what my doctor tells me. Can it be reversed or slowed down ? Is it really part of the aging process ?

San Francisco and Marin County Back Pain specialist, Dr. Eben Davis comments on the underlying causes of Spinal Degeneration, and the potential solutions:

I consult with up to 25 patients per week to discuss whether or not they are candidates for our nonsurgical back pain regimen. These patients for the most part are not aware of the relationship between spinal degeneration and lifestyle. They have no problem making the connection between heart disease and a high fat diet, or smoking and lung cancer, but when it comes to the connection between smoking, diet, and back problems, they are lost. This does surprise  me. Most doctors just consider spinal degeneration a normal part of aging. Sure, to a certain extent this is true. But the spine is made up of cells just like the rest of the body. Cells of the body thrive within a certain context. If that context (internal environment) is healthy the cells are healthy. If that context is unhealthy (from poor diet, drugs, smoking, stress, etc) the cells are unhealthy, and therefore so are the organs, glands, tissues, and bones, which are comprised of cells. Lets just keep it simple by saying that your lifestyle plays a major role in the condition of your spine and discs. No matter what type of treatment you choose to have for your spine you need to also consider your lifestyle choices and take responsibility for creating a healthy environment for your cells to thrive.

Spinal Stenosis. What is it ? Is it Treatable ? How did I get it ?

The San Francisco and Marin County patients I consult with are often times confused about their diagnosis of Spinal Stenosis. I find that many chronic back pain sufferers that have had X-rays, MRI exams, and CT scans, which have revealed findings such as Spinal Stenosis, Disc Herniations, and various forms of DDD (Degenerative Disc Disease) and Arthritis, do not really understand what is going on and how these conditions manifest.  After doing an on line search on Spinal Stenosis I can understand why. Here is the opening paragraph of the Mayo Clinics Introduction to Spinal Stenosis:

Spinal stenosis is a narrowing of one or more areas in your spine — most often in your upper or lower back. This narrowing can put pressure on the spinal cord or on the nerves that branch out from the compressed areas. This can lead to a number of problems, depending on which nerves are affected. In general, spinal stenosis can cause cramping, pain or numbness in your legs, back, neck, shoulders or arms; a loss of sensation in your extremities; and sometimes problems with bladder or bowel function.

Mild symptoms of spinal stenosis are often helped by pain relievers, physical therapy or a supportive brace. In more serious cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Although this usually provides some relief, it can't repair damaged nerves or stop the degenerative processes that often lead to spinal stenosis. Unfortunately, even after surgery, symptoms of spinal stenosis may recur or worsen over time.

I underlined the parts of the opening paragraphs of the introduction that are confusing to me. The medical community seems to just take it for granted that spinal degeneration is a foregone conclusion and there is nothing that can be done to slow it down or reverse it. If you read this opening statement carefully you would wonder why anyone would want to have surgery that MAY provide SOME relief (with all the risk of surgery), then, even after the surgery may recur or worsen over time. Not to mention the fact that the actual underlying cause (the degenerative process) is not even addressed. Sure, there are congenital factors that predispose some to stenosis, such as being born with a small spinal canal, or scoliosis. But, for the most part Spinal Stenosis occurs because of abnormal bone deposits, disc herniations, and ligament calcification and enlargement occluding the passageways where the spinal cord and nerves reside. These degenerative processes are the result of lifestyle choices made by us. What we eat (The typical American diet is NOT good). How much and how we exercise (our society sports a 60% obesity rate) . How much rest we get. What kind of pillow and mattress we use. How we setup our workstation. How much mental stress we expose ourselves to. How we relax. How many physical traumas we have had (sports injuries, auto accidents, spills and falls)and how we treated them. Add to this drugs (especially prescription drugs) and alcohol, as well as tobacco and caffeine, and you have all the ingredients for Spinal Degeneration (as well as most other degenerative conditions). All of these lifestyle components involve choices by us that either steer us in the direction of health or illness (degeneration). So, why not teach patients about the cause of degenerative conditions so they can learn to make better decisions. Healthier decisions will help create a  healthier internal environment (what we call "fertile soil") so degenerative and inflammatory conditions can be given the chance to recover and heal.  This famous quote says it best:

"The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease" -Thomas A. Edison

P.S.  The DRX 9000 nonsurgical spinal decompression system (In my  opinion) is the safest, most advanced method of enlarging the disc space and treating Spinal Stenosis. If done in conjunction with lifestyle modifications and inflammation reducing dietary changes, the results can be remarkable, even in the worst of cases.

Who else in San Francisco or Marin County Doesn't Want Back Surgery ?

San Francisco and Marin County Chronic Back Pain Sufferers should consider nonsurgical treatment options for Degenerative Disc Disease (DDD).

I like to stay current on surgical and nonsurgical treatment options for disc disease and herniated discs. This helps me to help patients make informed decisions about what is best for them. I will admit that most of the patients that seek me out do not want surgery under any circumstances. Some have had surgery already that did not work or relapsed. But, there are some that are considering all treatment options, and the  "Intervertebral Disc Replacement" is one of them, so I thought I would write about it today. In found this paragraph in the article very interesting:

The diversity of approaches and the variation observed in treatment strategies for low back pain indicates an absence of evidence-based support for any single method. While the rate of back surgeries including fusion of the spine has increased by over 600% between 1979 and 1990, there remains no operative treatment that has yielded reliable and reproducible good results in patients affected by chronic low back pain. The common denominator is that none of the techniques listed above are directed toward the restoration of normal structure and function of the affected spinal motion segment, and of the disc at the center of that motion segment.

     Wow, none of the current methods of back surgery are directed toward the restoration of normal structure and function. That's Great. And, that's also why nonsurgical spinal decompression was invented. The treatment objective is to reposition and heal the disc through the application of a negative pressure. Then, strengthen the outer ligaments and spinal muscles. I have written extensively on these pages as to how this treatment actually works and how we take it to the next level by incorporating a plant based diet, yoga, meditation, and supplementation. So, while it's important to know what the treatment options are for badly degenerated spines, every time I read up on them it reinforces my belief that nonsurgical spinal decompression should be considered first. You can always have surgery.

Are you really ready for your Back Pain to get better ?

San Francisco and Marin County Back Pain specialist identifies common trait with those that recover from debilitating Back Pain.

I have been treating chronic back pain in San Francisco and now Marin County for over 15 years. I treat conditions such as degenerative disc disease, spinal stenosis, facet syndrome, disc bulges, and disk herniations, using state of the art technology, along with hands on therapy.  I incorporate diet, exercise, meditation, and yoga into our treatment regimen. This program seems to work for most patients. Of course, the patients that put the most into it, get the most out of it. But, when it comes to making the decision to get started in the first place, I have noticed something similar with the patients that decide to put it off. There is always a reason they can't start. Here are some of the excuses I hear: My kids are starting school soon. I have too much work going on right now. I have to travel too far. I am going on vacation in 2 months. It's just not the right time. I am trying to sell my house. After the first of the year will be better, and on and on. Meanwhile, the degenerative condition marches on, often times with the symptoms being masked by harmful medications.  On the flip side are those that take action. The patients that decide to make getting better their number one priority and organize their life around the process are the ones that get rewarded. There will always be reasons why you should not take action. Like the old saying goes.. You can't keep doing the same thing and expect the outcome to be different.  Keep on doing what your doing, and your going to keep on getting what your getting. You can always find reasons not to do something.  Admitting something is wrong and that what you are doing is not working is the first step. Then, deciding to take action to fix the problem without letting anything get in your way is the next step. Of course this is all based on having found a potential solution to the problem that you are in agreement with. At this point the stars have all aligned and it is up to you to make it happen. Will you do it or will you put it off and remain a prisoner of your pain ? The choice is yours.

Bay Area Spine Center Offers New Hope for Senior Citizens with Chronic Back Pain

San Francisco Bay Area Chronic Back Pain Center comments:

We are achieving tremendous outcomes with elderly patients with severe, chronic back pain. We are treating them with the DRX 9000 spinal decompression system. Then we follow up with spinal muscle reconditioning on our Spine Force machine. There is an extensive home care regimen which includes a plant based diet, exercises, stretches, fish oil supplementation, meditation, breathing & yoga. Conditions such as disk herniations, spinal stenosis, facet syndrome, and disc degeneration all seem to respond favorably.   Often times there is no where to turn for senior citizens once a spinal condition has been around for many years. Some patients are no longer considered surgical candidates because it would be too dangerous. There is so much decay and degeneration that all that could really be done is complete fusion. Some patients are unable to exercise because it is too painful. Most have tried cortisone injections, acupuncture, and chiropractic. Sometimes these things help, sometimes they don't. Some patients are taking pain medication daily putting their kindeys and liver at risk. When we take on a new case we the first thing we do is set forth the treatment objectives and goals. We need to manage the expectations. There is no way we can make these patients normal again. This needs to be clear. What we can do, most of the time it seems, is take what's there and make the most out of it. Allow the spine to express it's potential within the limitations of matter. The DRX 9000 spinal decompression  sessions seem to be able to pump life back into the spinal joints and discs. I liken the process to a respirator, which helps the lungs to breath when they are unable to do so on their own. The DRX 9000 helps the spine to do what it would, if it could, which is pump the discs so they can exchange nutrients with the blood stream. This seems to reduce inflammation and , promote healing. This makes it so we can introduce exercise and therapy. The fish oil and the plant based diet (along with 80-100oz of H20 per day) also help reduce inflammation levels and cleanse the body, creating fertile soil for healing to take place. This is NOT magic. What it is, is the most advanced technology available today for the nonsurgical treatment of severe spinal conditions. We take it to the next level and beyond by incorporating the SpineForce and the Home Care regimen. We very much enjoy helping return lost life and function to our patients. We are opening up an office in San Rafael (Marin County) in a few weeks. There is a very active senior citizen population over there, and we look forward to serving them. For more info contact us at 415-392-2225.