Newer Surgery

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Arthroscopic (endoscopic) minimally invasive surgery is a newer take on minimally invasive lower back surgery.  For years orthopedic surgeons have been using arthroscopic techniques on knees and shoulders.  Also, for years they have been doing minimally invasive procedures through small tubes in the lower spine and neck.  It was inevitable that the two techniques would eventually merge.

Arthroscopic surgery is done through several small incisions.  Through one incision, a camera is placed.  Through other small incisions, instruments (grinders, cutters, suction, probes, etc.) are used to remodel the joint in question.

In recent years these arthroscopic techniques have been applied to the spine.  The spine consists of many very complicated joints.  Access to them is difficult, whether open, micro, minimally invasive, or arthroscopic techniques are used.  The hope is that when arthroscopic (endoscopic) techniques are used, there will be less collateral damage to muscles, joints, ligaments, tendons, and nerves, and therefore shorter recovery times.

With micro and minimally invasive techniques visualization of the surgical fields can be difficult, increasing time under anesthesia for the patient.  With the newer arthroscopic techniques, that may change.  Shorter, more accurate, less invasive surgeries will benefit the patient and speed his recovery.

Keep this technique in mind if you face the prospect of surgery.  Understand that it is relatively new; not many surgeons are trained in it or have a lot of experience with it, yet.  Also remember, there are very few indications for surgery.  See my posts from July 12, 2012 on back surgery and August 6, 2012 on minimally invasive surgery to understand the pros, cons and reasons for having surgery in the first place.

Good Review of Imaging for Back Pain Patients

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Go to this web site for a neuroradiologist's take on imaging for lower back pain.
http://news.georgiahealth.edu/archives/6656/comment-page-1#comment-2125

When you finish that article, you might compare it to my post here from May 22, 2012.

The Plank and the Push-up

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

The Plank

Core strength diminishes lower back pain.  Two more exercises that require core strength are the Plank and the Push-up.  Start with the Plank.

Again, as with other core exercises we have discussed, start on all fours, on knees and hands.  Drop to elbows and knees and let your abdomen sag to the floor.  Your elbows should be directly below your shoulders.

For beginners, stay on your knees and straighten your body; your butt should be off the floor, but not elevated any higher than a straight line between your shoulders and knees.  That is the Plank position.  Hold that position for 5-10 seconds then relax.  Repeat until you are able to hold the position for 20-30 seconds with 5-10 repetitions.

Intermediate exercise is the same, but off your knees and on your toes.  Hold the position for 10-20 seconds.  Repeat up to ten times, increasing the hold time to 45-60 seconds.

Advanced exercise includes lifting an arm or leg off the floor and holding the proper position, like the Bird-dog we discussed earlier.

You can check out your technique by watching these videos:

http://www.youtube.com/watch?v=MHQmRINu4jU

http://www.youtube.com/watch?v=kiA9j-dR0oM

Or reading this Fox News post:
http://www.foxnews.com/health/2012/11/06/are-doing-push-ups-wrong/

The Push-up

Once you are doing the advanced Plank with ease, it is a relatively easy transition to, or add, push-ups.

Beginner push-ups start on your knees and hands, hands directly below shoulders, trunk straight as when doing the Plank.  Bend your elbows and drop your chest within 2”-4” of the floor, maintaining a straight back.  Once you can do beginner push-ups with ease, get up on your toes for intermediate push-ups.  Keep your trunk straight.  These are harder.

There are numerous versions of push-ups, some very advanced, others extreme.  Many can be seen at this web site:

http://artofmanliness.com/2009/07/21/push-ups-exercises/

Pick the one you like.  The best exercise is one that you will do.  If an exercise is too hard or it causes you pain, it the wrong exercise to be doing.

As with most core exercises I have recommended, there is very little compression of discs or facet joints with these exercises, cutting down on irritation of those structures.  If these exercises cause you pain, then you should not be doing them.  Start slowly.  There is no rush.  If you can only add one push-up a month, you will still be doing 12 by the end of the year and 24 by the end of two years.

 

One More Exercise

The Sidebridge

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

The sidebridge also strengthens abdominal, lateral side, and back muscles, without compressing the disc spaces or the facet joints.  If it is painful, stop.  You may have to start with just one cycle and gradually increase the number, or you may not be able to do this exercise. 

Beginners start on the floor or mat lying on one side or the other and leaning on that elbow.  They have their knees bent.  By tightening the muscles on the side away from the mat they straighten their body and lift their hip from the mat until it is in a straight line between knees and shoulders.  Hold that position for a count of 3-5, and repeat 10 times as you get better.  Do both sides.

The intermediate exercise is done on the toes, rather than knees.

Advanced exercise is rolling from one elbow to the other while on the toes, and dipping to the mat.

You can see the beginner and intermediate versions at this website: http://www.youtube.com/watch?v=Yh2U0XSPIv8

No Post This Week

We are visiting the grandchildren in Virginia this week.  Have limited internet access. Should resume posting next week.