On Tuesday evening, February 11, the Navigating the Medical System Lecture Series, as always hosted by Congregation Etz Chaim of KGH, featured an informative virtual lecture on the topic of noninvasive, conservative treatment for spinal problems. Dr. Mel Breite, Founder and Director of the Lecture Series, greeted everyone and introduced the speaker, Nasim Chowdhury, MD, FAAPMR, Chief of Rehabilitation at NewYork-Presbyterian Hospital.
Dr. Chowdhury shared that a physiatrist is a doctor who specializes in physical medicine and rehabilitation (PM&R). This field of medicine began with internal medicine doctors treating amputees in the VA in 1947. The focus of this field of medicine is to maximize human function, and they treat athletes and people with brain injuries. They see patients in the hospital as well as out of the hospital. Their team members also treat pediatric patients. Their main specialty is spine pathology, back, and neck pain.
He detailed the treatments he uses. First, he gives an expert physical exam. This is critical for diagnosis. Next, he uses imaging like MRI, CT, XRCT, etc. Then, he does blood work. He explained that the physiatrist works with a physical therapist, occupational therapist, speech therapist, and social workers. It’s a team-based approach to medicine, which is unique to his field. “We treat athletes at all levels and people with pain in any joints.” Regenerative medicine uses research to advance the field. Spasticity occurs after a brain or spinal cord injury, stroke, cancer, or malignancy. This constant muscular hyperactivity is treated with a procedure of an injection of Botox.
He shared a survey taken in the late 1990s that showed 12 visits per 100 people were for back or neck pain. These numbers have gone up. Back pain is the largest percentage of pain for adults, and this is true even for the 18-44 age group. Close to 25 percent of patients in his age group had back pain in the last three months. In 2015, 264 million days of work were lost due to back pain.
Dr. Chowdhury related that he encourages his patients to get educated about their health. He then shared diagrams of the spine. There are five regions of the spine: cervical, thoracic, lumbar, sacral, and coccyx. Vertebrae are boney architecture, and the disks between the vertebrae are called intervertebral disks. Ligaments keep the spine upright and nerves give feeling. Any one of these structures can cause pain. If someone says that he or she has back pain, this general diagnosis is meaningless. You need a much more specific diagnosis. The most important thing for the doctor is to figure out the pain generator. He does this through thorough physical exams, imaging, and blood work. The exam maneuver helps determine if pain is in the anterior, middle, or posterior.
Sciatica is a burning tingling numbness down the arm or neck or down the leg to the foot. He displayed images of herniated discs and pointed out where it bulged in the photo. He shared that the doctor studies how the patient walks and checks for sensation. He does strength checking to identify which level of the spine has a problem. He also checks reflexes to determine the part of the spine that has a problem.
He shared that therapy is a mainstay of treatment and the doctor and PT create an exercise regimen that is specific for the patient. It is critical to teach patients how to move safely so they don’t reinjure the affected area. Having a strong core is critical. Exercises to strengthen the core are important.
He listed medications that can help with pain, such as anti-inflammatory medicines, neuropathic drugs, and muscle relaxers. He shared pictures of exercises, like side plank, that work on the muscles of the core.
He also spoke about spinal stenosis, which is narrowing in the middle of the canal. One sign of this is if a person uses a shopping cart to alleviate pain. Vertebrogenic back pain is pain from the bone itself, and he typically sees less of this type of pain. Treatment for this includes working on posture to avoid increasing pressure on the bones.
He shared a study that showed that a physical exam is more important than imagery, in general, for a diagnosis of spinal pain. He said, “a basic tenet of medicine is you treat the patient, not the image.” Physical therapy is a critical part of his treatment of back pain. The goal of PT is pain control and to help restore range of motion and mobility. A strong core can help stabilize the spine. It’s important to create a home exercise program that the patient can perform at home.
He then shared how to sit properly, and he spoke about diet. Diet has a huge impact on how the body feels and can minimize inflammation. Processed foods are bad for inflammation. Avoid white flour, refined sugar, and sugary beverages, as well as a lot of red meat. Eat more fruits, vegetables, and berries, which are rich in antioxidants. Also, consume cruciferous vegetables and omega-3 rich oils like olive oil, and foods like avocado, seeds, and nuts. Quinoa and brown rice are anti-inflammatory, as well as plant-based lentils and chick peas. Some spices like cumin and turmeric have anti-inflammatory properties. Also, yogurt and kefir are good.
When seeking help with a spinal issue, you want a holistic approach that looks at the whole patient.
By Susie Garber
