Dr. Lederman and colleagues discuss the outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Title: Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Reuben Gobezie MD, Patrick Denard MD, Yousef Shishani MD, Anthony Romeo MD, Evan S. Lederman MD

Background

The purpose of this study was to evaluate functional outcome and healing of a subscapularis peel with a stem-based repair after total shoulder arthroplasty (TSA). The hypothesis was that the repair would lead to subscapularis healing in the majority of cases.

Full article: https://doi.org/10.1016/j.jse.2017.02.013

Journal of Shoulder and Elbow Surgery

Volume 26, Issue 9, September 2017, Pages 1603-1608

Join Team TOCA with Dr. Feng & the Arthritis Foundation for the Walk to Cure Arthritis!

Enjoy the beautiful Arizona weather by joining Team TOCA, Dr. Earl Feng (Orthopedic Surgeon, Arthritis & Total Joint Reconstruction) and the Arthritis Foundation in the Annual Walk for the Cure, Saturday May 5th, 2018 at the Phoenix Zoo! Dr. Feng is not only a TOCA Physician & Surgeon but also serves as a Board Member for the Arthritis Foundation!

At TOCA, each of us has an important role in helping the more than 1.2 million Arizonans living with arthritis including many our patients, our colleagues, and more than 6,000 children in Arizona alone. TOCA is proud to continue our support the 2018 Arizona Walk to Cure Arthritis on May 5th at the Phoenix Zoo. As a sponsor of the Walk to Cure Arthritis, our goal is to help more people with arthritis.

The Arthritis Foundation is the Champion of Yes for patients with arthritis who are being told “no” a lot. No, there isn’t a cure. No, you cannot play sports. No, you cannot pick-up your grandchild.

Here is how you can help!

• Through funding critical research for osteoarthritis to find better treatments and ultimately a cure.
• Giving kids living with arthritis the opportunity to attend Camp Cruz to meet other kids living with arthritis.
• Supporting programs like the Live Yes network for people in our community struggling with pain, connecting them with others with arthritis.
• Getting a patient get back on their feet so they can walk their dog.
• Helping a grandparent alleviate back pain so they can pick up their grandchild.
• Saying “YES” to a patient today!

The event features a three-mile and one-mile course, with arthritis information and activities for the entire family!

Let’s raise funds to find a cure for arthritis, then come together to support each other and walk! Every step counts, every dollar matters!  The Arthritis Foundation’s Walk to Cure Arthritis to help the more than 50 million Americans and 300,000 children with arthritis live better today and to keep the Arthritis Foundation’s promise of finding a cure for tomorrow. Be a Champion of Yes – join our team and raise funds to fight arthritis and find a cure, all while having A LOT OF FUN! If you aren’t able to join the team, we’d appreciate your donation to help reach our goal.

Click here to learn more about this event, join Team TOCA and/or Donate Today! Team TOCA

Event Location:
The Phoenix Zoo
455 N Galvin Pkwy
Phoenix , AZ 85008
Event Schedule:
Event Registration Starts 5/5/2017 6:30 am
Event Registration Ends 5/5/2017 8:00 am
Event Starts 5/5/2017 7:30 am
Event Ends 5/5/2017 10:00 am
Fees:
Walk to Cure Arthritis Registration: No Fees
Event Registration

To Learn more about Dr. Feng and TOCA visit: www.tocamd.com or call 602-277-6211

#Arthritisfoundation #WalktoCureArthritis #Results #Recovery #Relife#TOCAMD #TOCA #ArthritisPhxWalk #PhoenixZoo

Celebrate National PA (Physician Assistant) Week October 6 – 12th!

Each year from October 6-12, we celebrate National PA Week, which recognizes the PA profession and its contributions to the nation’s health.

This week is also an opportunity to raise awareness and visibility of the profession. Before it was a weeklong event, National PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program. October 6th is also the birthday of the profession’s founder, Eugene A. Stead, Jr., MD. Now the profession is 50 years strong!

History of the PA Profession

The PA profession was created to improve and expand healthcare.

In the mid-1960s, physicians and educators recognized there was a shortage of primary care physicians.

To help remedy this, Eugene A. Stead Jr., MD, of the Duke University Medical Center, put together the first class of PAs in 1965. He selected four Navy Hospital Corpsmen who had received considerable medical training during their military service. Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II.

The first PA class graduated from the Duke University PA program on Oct. 6, 1967.

The PA concept was lauded early on and gained federal acceptance and backing as early as the 1970s as a creative solution to physician shortages. The medical community helped support the new profession and spurred the setting of accreditation standards, establishment of a national certification process and standardized examination, and development of continuing medical education requirements.

What is a PA? (American Academy of PAs)

What is a PA?

A physician assistant (or PA) is a nationally certified and state-licensed medical professional. There are currently more than 100,000 clinically practicing PA’s in the United States! PA’s practice medicine on health care teams with physicians and other providers. They also prescribe medication in all 50 states.

 

What does a PA do? Well, at the most basic level, a PA is a medical practitioner who works under the supervision of a physician.

Physician assistants (PAs) work closely with doctors and handle duties that range from taking medical histories to setting simple fractures. They are allowed to prescribe medications in some states. Many PAs specialize in a particular area of medicine, such as pediatrics. A master’s degree is required, and all states require that PAs be licensed. Licensing requires passing a multiple-choice exam and completing continuing education courses to keep knowledge current.

Beyond the basic definition, however, the PA profession represents an essential part of the health care infrastructure in a number of important ways.

Physician assistants examine, diagnose and treat patients under the supervision of licensed physician. PAs can prepare casts or splints, suture small wounds and interpret medical tests. According to the American Academy of Physician Assistants (AAPA), these medically-trained professionals can also prescribe medications (www.aapa.org).

Some PAs specialize in a particular area of medicine, such as emergency care or geriatrics, and can assist doctors in advanced medical techniques and procedures. Physician assistants are often the first line of medical care in rural and underserved areas. In some cases, a physician assistant will refer the patient to a medical doctor or make arrangements for transferring the patient to a hospital or clinic.

During this week, TOCA is excited to honor our amazing PAs and to say a big thank you. We appreciate your dedication to patient care, and we recognize the impact that you make in the lives of those patients every day.

To read more about the dedicated Physician Assistant staff at TOCA Click Here

To learn more about TOCA or to schedule an appointment call 602-277-6211

 

#Recovery #Results #Relief #TOCA #TOCAMD #PA #PAWeek #ThankAPA #Patientcare #PhysicianAssistant #PADay #MyOrthoDoc

Congratulations Dr. Christopher Huston!

Congratulations Dr. Christopher Huston! Dr. Huston was recently named Top Doctor in the Physical Medicine & Rehabilitation category by Castle Connolly Medical Ltd. for 2017!

Dr. Huston is an expert in Interventional Spine, Neck & Back issues, Spine complications & Electrodiagnostics at TOCA.

Dr. Christopher W. Huston is fellowship-trained in the diagnosis, rehabilitation and utilization of interventional spine procedures for the treatment of painful spine disorders. He reviews for various medical journals, which has included the Archives of Physical Medicine and RehabilitationJournal of Physical Medicine, and Current Reviews in Musculoskeletal Medicine.

Dr. Huston has served on several award, planning, and spine committees for the Physiatric Association of Spine, Sports & Occupational Rehabilitation. Additionally, he served as assistant chief of physical medicine and rehabilitation at the Walter Reed Army Medical Center for the U.S. Army in Washington, D.C.

He has published various scientific abstracts, manuscripts, articles, and book chapters for various physical medicine, rehabilitation and spine disorder publications regarding spine disorders and interventions. Dr. Huston is regularly asked to present on those topics across North America. He is the TOCA Interventional Spine Fellowship Director. Physicians from across the country apply for the TOCA Interventional Spine Fellowship to work with Dr. Huston.

Castle Connel Medical LTD

Since 1991 Castle Connolly Medical Ltd. has been dedicated to helping consumers find the best healthcare in America. Along with the “Top Doctor” book series we publish, including our most popular volume to-date, America’s Top Doctors®, our website enables visitors to easily search for doctors by specialty, location or name. We also offer a “Top Hospital” search for patients in need of guidance on where to go for expert, local medical care.

The company was founded by two respected leaders in healthcare, John K. Castle and John J. Connolly, Ed.D. Dr. Connolly was the President of New York Medical College for more than ten years. Mr. Castle served for six years as a commissioner and executive officer of the Joint Commission (formerly JCAHO); he also served as Chairman of the Board of New York Medical College for eleven years and served on its Board for twenty-two years.

How Castle Connolly Identifies Top Doctors

At Castle Connolly Medical Ltd. we identify top doctors, both nationally and regionally, based on an extensive nominations process open to ALL licensed physicians in America. The Castle Connolly physician-led research team reviews and screens all nominated physicians before selecting those regarded as the most outstanding healthcare providers to be Top Doctors. Physicians do not and cannot pay to be selected as a Castle Connolly Top Doctor.

To read more about Dr. Huston visit: www.tocamd.com

For more information about Castle Connolly Medical please visit: https://www.castleconnolly.com

 

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD #TopDoc

Backpack Safety!

[vc_row][vc_column][vc_column_text]When you move your child’s backpack after he or she drops it at the door, does it feel like it contains 40 pounds of rocks? Maybe you’ve noticed your child struggling to put it on, bending forward while carrying it, or complaining of tingling or numbness. If you’ve been concerned about the effects that extra weight might have on your child’s still-growing body, your instincts are correct. Backpacks that are too heavy can cause a lot of problems for kids, like back and shoulder pain, and poor posture. Did you know that according to the Consumer Product Safety Commission, injuries from heavy backpacks result in more than 7,000 emergency room visits per year. Sprains, strains, and “overuse” injuries were among the top complaints.

When selecting a backpack, look for:

  • An ergonomic design
  • The correct size: never wider or longer than your child’s torso and never hanging more than 4 inches below the waist
  • Padded back and shoulder straps
  • Hip and chest belts to help transfer some of the weight to the hips and torso
  • Multiple compartments to better distribute the weight
  • Compression straps on the sides or bottom to stabilize the contents
  • Reflective material

Backpack Safety Tips:

  • Your backpack should weigh only 15% – 20% of your total weight
  • Use both shoulder straps to keep the weight of the backpack better distributed
  • Tighten the straps to keep the load closer to the back
  • Organize items and pack heavier things low and towards the center
  • Remove items if the backpack is too heavy and only carry items necessary for the day
  • Lift properly by bending at the knees when picking up a backpack

Remember: A roomy backpack may seem like a good idea, but the more space there is to fill, the more likely your child will fill it. Make sure your child uses both straps when carrying the backpack. Using one strap shifts the weight to one side and causes muscle pain and posture problems.

Help your child determine what is absolutely necessary to carry. If it’s not essential, leave it at home.[/vc_column_text][/vc_column][/vc_row]

 

If you or your child is experiencing neck or back pain the expert Physicians at TOCA and the dedicated staff are here to help! Call 602-277-6211 to schedule your appointment today!

 

#Recovery #Results #Relief #BackpackSaftey #MyOrthoDoc #BacktoSchool

Sciatica

If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have a protruding (herniated) disk in your spinal column that is pressing on the nerve roots in the lumbar spine. This condition is known as sciatica.

What is sciatica?

Sciatica (pronounced sigh-at-eh-kah)  is pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and can radiate down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. The pain of sciatica is sometimes referred to as sciatic nerve pain.

Symptoms

Sciatica may feel like a bad leg cramp, with pain that is sharp (“knife-like”), or electrical. The cramp can last for weeks before it goes away. You may have pain, especially when you move, sneeze, or cough. You may also have weakness, “pins and needles” numbness, or a burning or tingling sensation down your leg.

Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Symptoms are usually based on the location of the pinched nerve.

Causes

Sciatica rarely occurs before age 20, and becomes more commonplace in middle age. It is most likely to develop around age 30 and 50.

Perhaps because the term sciatica is often used loosely to describe leg pain, estimates of its prevalence vary widely. Some researchers have estimated it will affect up to 43% of the population at some point.

Often, a particular event or injury does not cause sciatica—rather it tends to develop over time.

The vast majority of people who experience sciatica get better within a few weeks or months and find pain relief with nonsurgical sciatica treatment. For others, however, the leg pain from a pinched nerve can be severe and debilitating.

Seeing a doctor for sciatica pain is advised, both for learning how to reduce the pain and to check for the possibility of a serious medical issue.

While sciatica is most commonly a result of a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can produce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Approximately 1 in every 50 people will experience a herniated disk at some point in their life. Of these, 10% to 25% have symptoms that last more than 6 weeks. In rare cases, a herniated disk may press on nerves that cause you to lose control of your bladder or bowel, referred to as cauda equina syndrome. If this happens, you may also have numbness or tingling in your groin or genital area. This is an emergency situation that requires surgery. Phone your doctor immediately. Aside from a pinched nerve from a disc, other causes of sciatica include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections in or around the lumbar spine, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

6 Most Common Causes of Sciatica

When discussing sciatica, it is important to understand the underlying medical cause, as effective treatment will focus on addressing the pain’s root cause as well as alleviating acute symptoms.

  • Lumbar herniated disc
    A herniated disc occurs when the soft inner material of the disc leaks out, or herniates, through the fibrous outer core and irritates or pinches the contiguous nerve root.

Other terms used to refer to a herniated disc are slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.

  • Degenerative disc disease
    While some level of disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica.

Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the nerve root(s) in the area.

Bone spurs, which may develop with spinal degeneration, also may press against a nerve, resulting in sciatica.

  • Isthmic spondylolisthesis
    This condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the L5 vertebra slips forward over the S1 vertebra.

With a combination of disc space collapse, the fracture, and the vertebral body

  • Lumbar spinal stenosis
    This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults older than age 60.

The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.

Lumbar spinal stenosis commonly occurs along with spinal arthritis, and arthritis can also cause or contribute to sciatica symptoms.

  • Piriformis syndrome
    The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.

This is not a true lumbar radiculopathy, which is the clinical definition of sciatica. However, because the leg pain can feel the same as sciatica or radiculopathy, it is sometimes referred to as sciatica.

  • Sacroiliac joint dysfunction
    Irritation of the sacroiliac joint—located at the bottom of the spine—can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.

Again, this is not a true radiculopathy, but the leg pain can feel the same as sciatica caused by a nerve irritation.

What are risk factors for sciatica? What are sciatica symptoms?

Risk factors for sciatica include degenerative arthritis of the lumbar spine, lumbar disc disease, and slipped disc, and trauma or injury to the lumbar spine.

Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar painbuttock painhip pain, and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. The pain relief by changing positions can be partial or complete.

When Sciatica Is Serious

Certain sciatica symptoms, while rare, require immediate medical, and possibly surgical, intervention. These include, but are not limited to, progressive neurological symptoms (e.g. leg weakness) and/or bowel or bladder dysfunction (cauda equina syndrome). Infection or spinal tumors can also cause sciatica.

Because sciatica is caused by an underlying medical condition, treatment is focused on addressing the cause of symptoms rather than just the symptoms. Treatment is usually self-care and/or nonsurgical, but for severe or intractable pain and dysfunction it may be advisable to consider surgery.

How do health-care professionals diagnose sciatica?

Diagnosis begins with a complete patient history. Your doctor will ask you to explain how your pain started, where it travels, and exactly what it feels like.

A physical examination may help pinpoint the irritated nerve root. Your doctor may ask you to squat and rise, walk on your heels and toes, or perform a straight-leg raising test or other tests.

X-rays and other specialized imaging tools, such as a magnetic resonance imaging (MRI) scan, may confirm your doctor’s diagnosis of which nerve roots are affected.

Nonsurgical Treatment

The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks.

Nonsurgical treatment is aimed at helping you manage your pain without long-term use of medications. Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may also help. In addition, you may find it soothing to put gentle heat or cold on your painful muscles. It is important that you continue to move. Do not remain in bed, as too much rest may cause other parts of the body to feel discomfort.

Find positions that are comfortable, but be as active as possible. Motion helps to reduce inflammation. Most of the time, your condition will get better within a few weeks.

Sometimes, your doctor may inject your spinal area with a cortisone-like drug.

As soon as possible, start stretching exercises so you can resume your physical activities without sciatica pain. Your doctor may want you to take short walks and may prescribe physical therapy.

Surgical Treatment

You might need surgery if you still have disabling leg pain after 3 months or more of nonsurgical treatment. A part of your surgery, your herniated disk may be removed to stop it from pressing on your nerve.

 

The surgery (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg.

Rehabilitation

Your doctor may give you exercises to strengthen your back. It is important to walk and move while limiting too much bending or twisting. It is acceptable to perform routine activities around the house, such as cooking and cleaning.

Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it is always possible for your disk to rupture again.

Physical Therapy and Exercise for Sciatica

Physical therapy exercises incorporating a combination of strengthening, stretching, and aerobic conditioning are a central component of almost any sciatica treatment plan.

When patients engage in a regular program of gentle exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of pain.

Sciatica exercises usually focus on three key areas: strengthening, stretching, and aerobic conditioning.

  • Strengthening exercises
    Many exercises can help strengthen the spinal column and the supporting muscles, ligaments, and tendons. Most of these back exercises focus not only on the lower back, but also the abdominal (stomach) muscles and gluteus (buttock) and hip muscles.

Strong core muscles can provide pain relief because they support the spine, keeping it in alignment and facilitating movements that extend or twist the spine with less chance of injury or damage.

  • Stretching exercises
    Stretching is usually recommended to alleviate sciatic pain. Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible.

Hamstring stretching is almost always an important part of a sciatica exercise program. Most people do not stretch these muscles, which extend from the pelvis to the knee in the back of the thigh, in their daily activities.

Another stretch that is often helpful in easing sciatica is the Bird Dog move: After getting on their hands and knees, individuals extend one arm and the opposite leg. The arm and leg extensions are then alternated. A more advanced version of this exercise is the Plank Bird Dog move, in which the extensions are done once the person is in the plank position on their hands and toes.

  • Low-impact aerobic exercise
    Some form of low-impact cardiovascular exercise, such as walking, swimming, or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment.

Aerobic conditioning also has the unique benefit of releasing endorphins, the body’s natural pain killers, which helps reduce sciatic pain.

These types of exercise may be done separately or in combination. Examples of types of exercise that may include both strengthening and stretching include yogatai chi, and Pilates.

For anyone in chronic pain or with a relatively high level of sciatica pain, one option for gentle exercise is water therapy, which is a controlled, progressive exercise program done in a warm pool.

When sciatica pain is at its most severe, patients may find the pain hard to bear and may need to rest for a day or two. However, resting for more than one or two days is generally not advised, as prolonged rest or inactivity can increase pain and will lead to deconditioning. Regular movement is important to provide healing nutrients to the injured structures that are causing the pain.

If you are experiencing back or neck pain the experts at TOCA are here to help! Call our dedicated team to schedule your consultation today at: 602-277-6211!

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD #backpain

What is Spinal Stenosis & How do I treat it?

What Is Spinal Stenosis?

Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or “vertebrae”) and shock-absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects the brain to the body. The cord rests in the canal formed by your vertebrae.

For most people, the stenosis results from changes because of arthritis. The spinal canal may narrow. The open spaces between the vertebrae may start to get smaller. The tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso.

There’s no cure, but there are a variety of nonsurgical treatments and exercises to keep the pain at bay. Most people with spinal stenosis live normal lives.

 

Healthy Spine

The spinal canal has a rounded triangular shape that holds the nerve roots without pinching. Nerve roots leave the spinal canal through openings called nerve root canals which are also free of obstruction.

Affected Spine

New bone growth within the spinal canal causes compression of nerve roots, which leads to the pain of spinal stenosis.

 

Causes

The leading reason for spinal stenosis is arthritis, a condition caused by the breakdown of cartilage — the cushiony material between your bones — and the growth of bone tissue.

Osteoarthritis can lead to disc changes, a thickening of the ligaments of the spine, and bone spurs. This can put pressure on your spinal cord and spinal nerves.

Other causes include:

  • Herniated discs. If the cushions are cracked, material can seep out and press on your spinal cord or nerves.
  • Injuries. An accident may fracture or inflame part of your spine.
  • Tumors. If cancerous growths touch the spinal cord, you may get stenosis.
  • Paget’s disease. With this condition, your bones grow abnormally large and brittle. The result is a narrowing of the spinal canal and nerve problems.
  • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Thickened Ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.

Some people are born with spinal stenosis or diseases that lead to it. For them, the condition usually starts to cause problems between the ages of 30 and 50.

Symptoms

Spinal stenosis usually affects your neck or lower back. Not everyone has symptoms, but if you do, they tend to be the same: stiffness, numbness, and back pain.

When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis:

  • In the neck (cervical spine).Cervical stenosis can cause numbness, weakness or tingling in a leg, foot, arm or hand. Tingling in the hand is the most common symptom, and many people also report problems with walking and balance. Nerves to the bladder or bowel may be affected, leading to incontinence.
  • In the lower back (lumbar spine).Compressed nerves in your lumbar spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.

 

More specific symptoms include:

  • Sciatica. These shooting pains down your leg start as an ache in the lower back or buttocks.
  • Foot drop. Painful leg weakness may cause you to “slap” your foot on the ground.
  • A hard time standing or walking. When you’re upright, it tends to compress the vertebrae, causing pain.
  • Loss of bladder or bowel control. In extreme cases, it weakens the nerves to the bladder or bowel.

If you’re having symptoms, you might want to talk them over with your doctor. If you’re having a loss of bladder or bowel control, call your doctor at once.

Diagnosis and Tests

When you visit your doctor, she’s likely to ask you questions about your medical history. After that, she might order at least one of the following tests to figure out whether you have the condition:

  • X-rays. These can show how the shape of your vertebrae has changed.
  • Magnetic resonance imaging (MRI). By using radio waves, an MRI creates a 3-D image of your spine. It can show tumors, growths, and even damage to discs and ligaments.
  • Computerized tomography (CT scan). A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones.

Treatment

Your doctor may start off with nonsurgical treatments. These might include:

Medication: Common pain remedies such as aspirinacetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen can offer short-term relief. All are available in low doses without a prescription. Other medications, including muscle relaxants and anti-seizure medications, treat aspects of spinal stenosis, such as muscle spasms and damaged nerves.

Corticosteroid injections: Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make inflammation go down. However, because of side effects, they are used sparingly.

Anesthetics: Used with precision, an injection of a “nerve block” can stop pain for a time.

Exercise: You can improve your flexibility, strength, and balance with regular activity. Your doctor may recommend a physical therapist to help you.

Assistive devices: You might get braces, a corset, or a walker to help you move about.

Surgery

Some people have severe cases. They struggle to walk or have issues with their bladder and bowel. Doctors may recommend surgery for these people. Procedures such as laminectomy and laminoplasty create space between the bones so inflammation can go down.

Surgery carries its own risks. You should have a talk with your doctor about how much it can help, recovery time, and more before taking that step.

Many patients also try nontraditional therapies, including chiropractic and acupuncture. Again, be sure your doctor knows if you’re trying a nontraditional approach.

What You Can Do at Home

Some things you can do to help ease symptoms of spinal stenosis include:

  • Exercise. Think about moderation — not 100 push-ups. Just take a 30-minute walk every other day. Talk over any new exercise plan with your doctor.
  • Apply heat and cold. Heat loosens up your muscles. Cold helps heal inflammation. Use one or the other on your neck or lower back. Hot showers are also good.
  • Practice good posture. Stand up straight, sit on a supportive chair, and sleep on a firm mattress. And when you lift heavy objects, bend from your knees, not your back.
  • Lose weight. When you are heavier, there will be more pressure on your back.

 

If you are experiencing back or neck pain the experts at TOCA are here to help! Call our dedicated team to schedule your consultation today at: 602-277-6211!

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD

What Is Scoliosis, Causes and Treatment Options

What Is Scoliosis, Causes and Treatment Options: Scoliosis (pronounced sko-lee-o-sis) is a three-dimensional abnormality that occurs when the spine becomes rotated and curved sideways.

If you look at someone’s back, you’ll see that the spine runs straight down the middle. When a person has scoliosis, their backbone curves to the side.

Image result for scoliosisThe angle of the curve may be small, large or somewhere in between. But anything that measures more than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.

You probably don’t look directly at too many spines, but what you might notice about someone with scoliosis is the way they stand. They may lean a little or have shoulders or hips that look uneven.

What Causes Scoliosis?

In most cases, doctors don’t find the exact reason for a curved spine. Scoliosis without a known cause is what doctors call “idiopathic.”

Some kinds of scoliosis do have clear causes. Doctors divide those curves into three types:

  • Infantile idiopathic scoliosis: develops from birth to 3 years old
  • Juvenile idiopathic scoliosis: develops from 4 to 9 years old
  • Adolescent idiopathic scoliosis: develops from 10 to 18 years old

Adolescent scoliosis comprises approximately 80% of all idiopathic scoliosis cases. Adolescence is when rapid growth typically occurs, which is why the detection of a curve at this stage should be monitored closely for progression as the child’s skeleton develops.

Common Types of Curves

Image result for Common Types of scoliosis CurvesA scoliosis curve usually looks a bit like a backward C shape and involves the spine bending sideways to the right, which is also called dextroscoliosis. Sideways spinal curvature on the left side of the back is more like a regular C shape and called levoscoliosis. Here are four common types of scoliosis curves:

  • Right thoracic curve. If a straight line were drawn down the center of the back, this curve bends to the right side of the upper back (thoracic region).

See Thoracic Spine Anatomy and Upper Back Pain

  • Right thoracolumbar curve. This curve bends to the right side—starting in the upper back (thoracic) and ending in the lower back (lumbar).

See Lumbar Spine Anatomy and Pain

  • Right lumbar curve. This curve bends to the right side—starting and ending in the lower back.
  • Double major curve. Typically, a double curve involves right thoracic curve on top and left lumbar curve on bottom. People who have a double major curve may initially have a less obvious deformity because the two curves balance each other out more.

When Idiopathic Scoliosis Needs Treatment

Treatment options for idiopathic scoliosis could include:

  • Observation. Typically, a doctor will advise observation for a scoliosis curve that has not yet reached 25 degrees. Every 4 to 6 months, the doctor will take another X-ray of the spine to see if the scoliosis is progressing or not.
  • Bracing. If the scoliosis has progressed past 20 or 25 degrees, a back brace could be prescribed to be worn until the adolescent has reached full skeletal maturity. The goal of bracing is to prevent the curve from getting worse and to avoid surgery.

See Bracing Treatment for Idiopathic Scoliosis

  • Surgery. If the curve continues to progress despite bracing, surgery could be considered. The most common surgical option for scoliosis today is a posterior spinal fusion, which can offer better corrections with fewer fusion levels (preserving more back mobility) than what was done in years past.

In nonstructural scoliosis, the spine works normally, but looks curved. Why does this happen? There are a number of reasons, such as one leg’s being longer than the other, muscle spasms, and inflammations like appendicitis. When these problems are treated, this type of scoliosis often goes away.

In structural scoliosis, the curve of the spine is rigid and can’t be reversed.

Causes include:

Congenital scoliosis begins as a baby’s back develops before birth. Problems with the tiny bones in the back, called vertebrae can cause the spine to curve. The vertebrae may be incomplete or fail to divide properly. Doctors may detect this condition when the child is born. Or, they may not find it until the teen years.

Family history and genetics can also be risk factors for idiopathic scoliosis. If you or one of your children has this condition, make sure your other kids are screened regularly.

Scoliosis shows up most often during growth spurts, usually when kids are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may need to be treated.

Scoliosis diagnosed during the teen years can continue into adulthood. The greater the angle of the spine curve, the more likely it is to increase over time. If you had scoliosis in the past, have your doctor check your back regularly.

Degenerative scoliosis affects adults. It usually develops in the lower back as the disks and joints of the spine begin to wear out as you age.

A mild scoliosis curve can go unnoticed to the untrained eye. However, if the curve progresses, various signs and symptoms can become obvious.

Common Early Signs of Scoliosis

Oftentimes scoliosis is first suspected when someone notices something slightly off and comments. Some examples could include:

  • Clothes fit awkwardly or hang unevenly. A parent, friend, or even the person with scoliosis might notice that a shirt or blouse appears uneven, which could be cause for further investigation.
  • Sideways curvature observed while in bathing suit or changing. For instance, a parent could first notice the sideways curvature in an adolescent’s back while at the pool or beach.

Even if a newly discovered asymmetry appears minor, it should be checked by a doctor because scoliosis is easier to treat when caught early.

Symptoms of Moderate or Severe Scoliosis

Only about 10% of people with idiopathic scoliosis have a curve that progresses beyond mild and needs treatment.3 If that progression happens, the deformity becomes more obvious to other people and more likely to cause noticeable symptoms.

Some of the more common symptoms present in moderate or severe scoliosis could include:

  • Changes with walking. When the spine abnormally twists and bends sideways enough, it can cause the hips to be out of alignment, which changes a person’s gait or how they walk. The extra compensating that a person does to maintain balance for the uneven hips and legs can cause the muscles to tire sooner. A person might also notice that one hand brushes against a hip while walking but the other does not.
  • Reduced range of motion. The deformity from spinal twisting can increase rigidity, which reduces the spine’s flexibility for bending.
  • Trouble breathing. If the spine rotates enough, the rib cage can twist and tighten the space available for the lungs. Bone might push against the lungs and make breathing more difficult.
  • Cardiovascular problems. Similarly, if the rib cage twists enough, reduced spacing for the heart can hamper its ability to pump blood.
  • Pain. If curvature becomes severe enough, back muscles could become more prone to painful spasms. Local inflammation may develop around the strained muscles, which can also lead to pain. It is possible for the intervertebral discs and facet joints to start to degenerate due to higher loads.
  • Lower self-esteem. This symptom is commonly overlooked or minimized by outside observers, but it can be a significant factor for people who have a noticeable spinal deformity. Especially for adolescents who want to fit in with their friends, it can be stressful and depressing to look different, have clothes fit unevenly, or wear a noticeable back brace that may be uncomfortable or limit activity.

Can It Be Prevented?

No. So forget the rumors you may have heard, such as, “Childhood sports injuries can cause scoliosis.” Not true.

Likewise, if your kids are in school, you may be concerned about the weight of the textbooks they carry. While heavy backpacks may cause back, shoulder, and neck pain, they don’t lead to scoliosis.

And what about poor posture? The way a person stands or sits doesn’t affect their chances for scoliosis. But a curved spine may cause a noticeable lean. If your child isn’t able to stand upright, ask your doctor to look at her spine.

Adam’s Forward Bend Test

Image result for Adam’s Forward Bend Test

involves a healthcare professional observing the patient bending forward at the waist 90 degrees with arms stretched toward the floor and knees straight. From this position, most scoliosis signs that present as asymmetry are clearly visible in the spine and/or trunk of the body, such as:

The first step toward getting an idiopathic scoliosis diagnosis is typically the Adam’s forward bend test, which primarily looks for abnormal spine rotation.

 

 

This test

 

  • One shoulder or shoulder blade is higher than the other
  • Rib cage appears higher on one side (also called a rib hump)
  • One hip appears higher or more prominent than the other
  • The waist appears uneven
  • The body tilts to one side
  • One leg may appear shorter than the other

The Adam’s forward bend test can be useful in detecting scoliosis located in the upper or mid back, which is where idiopathic scoliosis usually occurs. However, the forward bend test is not as effective at detecting scoliosis in the low back because it does not involve rib rotation.

Scoliometer to Measure Spine Rotation

As part of the forward bend test, the clinician might use a scoliometer, also called an inclinometer, to estimate the angle of trunk rotation (ATR). While the patient is still bending forward, the clinician can put the scoliometer flat on the back in the area or areas where the asymmetry looks the greatest.

As a general rule, if an ATR of at least 5 degrees is recorded, the patient will either be scheduled for a follow-up exam or referred to a doctor who can image the back for more accurate scoliosis testing.7,8 X-ray imaging is needed to measure the degree of the curve and confirm scoliosis.

Cobb Angle Measurement

The lateral curve of scoliosis is described by the Cobb angle. Using an X-ray of the full spine, the Cobb angle is found by drawing a perpendicular line from the spine’s most-tilted vertebra above the sideways curve’s apex and a second perpendicular line from the most-tilted vertebra beneath the apex. The angle formed where those two lines meet is the Cobb angle.

A Cobb angle of at least 10 degrees is typically considered the borderline for a scoliosis diagnosis.

Key Components of a Scoliosis Diagnosis

When diagnosing idiopathic scoliosis, there are 3 key components to take into consideration:

  • Lateral curvature. The lateral (sideways) curvature of the spine is measured by the Cobb angle. The bigger the Cobb angle, the greater the spinal deformity.
  • Axial rotation. In addition to the sideways curvature, the spine abnormally rotates along the vertical axis. Spinal rotation can affect rib rotation, as well as curve rigidity.
  • Skeletal maturity. Often estimated by the Risser sign (amount of calcification at the hip bone’s ridged top as seen on the same X-ray as the Cobb angle), the amount of skeletal maturity remaining is critical to making scoliosis treatment decisions in children and teens.

Understanding these components of a scoliosis diagnosis can help the medical team evaluate the severity of the curve, likelihood for progression, and which treatment options could be best.

Idiopathic Scoliosis Is a Diagnosis of Exclusion

Idiopathic means a condition is of unknown cause. As such, idiopathic scoliosis technically cannot be diagnosed until other types of scoliosis are ruled out. Other types of scoliosis could include:

  • Congenital scoliosis. This type of scoliosis is present from birth and is the result of the spine not forming properly.
  • Neuromuscular scoliosis. Many types of neuromuscular conditions can lead to muscle problems in the back that result in scoliosis. A few examples include cerebral palsy and myelodysplasia.
  • Degenerative scoliosis. Also called adult onset scoliosis, this type of scoliosis results from the deterioration of the facet joints in the spine.
  • Nonstructural scoliosis. This type of scoliosis, also known as functional scoliosis, occurs due to a temporary cause that only affects lateral curvature without spinal rotation. For example, a difference in leg heights could potentially cause a sideways curve in the spine that is corrected with a shoe insert.

If scoliosis starts to cause a noticeable deformity or is at high risk of doing so, a doctor might prescribe a brace to prevent the curve from getting any worse. Typically, a brace is worn until the adolescent has reached full skeletal maturity.

Knowing if a person’s scoliosis curve is likely to worsen is crucial to developing a treatment plan. Bracing is a major time commitment and uncomfortable for adolescents—both physically and emotionally—and is usually not prescribed unless the curve is at significant risk for progressing.

Brace Options

There are two general treatment options for scoliosis bracing:

  • Full-time bracing. These braces are designed to be worn 16 to 23 hours a day. The goal is to wear them all the time with exceptions for bathing, skin care, and exercising.
  • Nighttime bracing. These braces use hyper-corrective forces (which put the body out of normal balance and cannot realistically be applied while a person is standing and/or performing daily activities) and are to be worn at least 8 hours a night.

Choosing between full-time bracing and nighttime bracing can depend on size and location of curves, as well as what the patient is willing to do. Some studies have found that nighttime bracing tends to be more effective because patients are more likely to wear a brace at night as prescribed, but other studies have found that full-time bracing—when adhered to as directed—could work even better.

Other Nonsurgical Treatments Unproven

While some people claim that treatments such as physical therapy and manual manipulation can help stop the progression of scoliosis, there is little scientific evidence to support these claims. Bracing is currently the only nonsurgical treatment that has been proven to reduce the natural progression of idiopathic scoliosis curves.

However, if given the okay by a doctor, exercise is healthy for people with scoliosis and helps keep the back strong and flexible.

When Bracing Fails

Sometimes an idiopathic scoliosis curve continues to progress despite bracing. If this happens and the curve progresses past 40 or 50 degrees, surgery may be considered.

3 Goals of Scoliosis Surgery

Scoliosis surgery typically has the following goals:

  1. Stop the curve’s progression. When scoliosis requires surgery, it is usually because the deformity is continuing to worsen. Therefore, scoliosis surgery should at the very least prevent the curve from getting any worse.
  2. Reduce the deformity. Depending on how much flexibility is still in the spine, scoliosis surgery can often de-rotate the abnormal spinal twisting in addition to correcting the lateral curve by about 50% to 70%. These changes can help the person stand up straighter and reduce the rib hump in the back.
  3. Maintain trunk balance. For any changes made to the spine’s positioning, the surgeon will also take into account overall trunk balance by trying to maintain as much of the spine’s natural front/back (lordosis/kyphosis) curvature while also keeping the hips and legs as even as possible.

In addition, any adjustment of the spine must also consider the possible effect on the spinal cord. The health of the spinal cord must be monitored throughout the surgery.

Surgical Options for Idiopathic Scoliosis

There are 3 general categories of scoliosis surgery:

  • Fusion. This spinal surgery permanently fuses two or more adjacent vertebrae so that they grow together at the spinal joint and form a solid bone that no longer moves. Modern surgical approaches and instrumentation—rods, screws, hooks, and/or wires placed in the spine—have enabled spinal fusion surgeries to achieve better curvature correction and faster recovery times than in the past.

An advantage to spinal fusion surgery is that it has a long-term record of safety and efficacy for treating scoliosis. While a drawback to the procedure is that any fused vertebrae will lose mobility, which can limit some of the back’s bending and twisting, today’s spinal fusions tend to fuse fewer vertebrae and maintain more mobility than in the past.

  • Growing systems (to delay fusion). Rods are anchored to the spine to help correct/maintain the spine’s curvature while the child grows. Every 6 to 12 months, the child has another surgery to lengthen the rods to keep up with the spine’s growth. Once the patient is close enough to skeletal maturity, the patient will usually get a spinal fusion.

If a spinal fusion is done at too young of an age (typically younger than age 10 in girls or less than 12 in boys), that could leave less room for the lungs to develop in addition to the child having an unusually short trunk compared to the limbs. To avoid these complications, the growing systems method helps guide the spine as it grows, preventing the curve from worsening as the spine matures and eventually becomes ready for a fusion if needed.

  • Fusionless. Current fusionless surgery methods employ growth modulation on the spine similar to what has been done in the past to treat unequal leg heights in growing children. The theory is that by putting constant pressure on a bone, it will grow slower and denser. By applying such pressure on the outer side of a spinal curve, the surgeon aims to slow or stop the growth of the curve’s outer side while the curve’s inner side continues to grow normally. As the spine continues to grow in this manner, the lateral curvature should reduce as the spine becomes straighter.

One fusionless method uses a vertebral tethering system, which involves placing screws on the outer side of the curve and then pulling them taut with a cord so the spine straightens. Compared to spinal fusion, fusionless surgery has the potential benefit of retaining more spinal mobility. However, this is a newer approach and long-term data about the risks and benefits are not yet available.

For an adolescent or young adult opting for scoliosis surgery today, by far the most commonly performed surgery is a spinal fusion.

 

If you or a family member are experiencing symptoms or discomfort from Scoliosis or suspect scoliosis, the experts in Spine Care,  Interventional Spine and Back, Orthopedics and Physical Therapy here at TOCA are here to help! For questions or to schedule an appointment call us today at: 602-277-6211!

 

#Results #Recovery #Relief #painfree #scoliosis

Cast Away: Fishing Safety & Boating in Arizona

Cast Away: Fishing Safety & Boating in Arizona! Arizona is blessed with diverse fishing opportunities, from the large reservoirs to the trout lakes in the mountains, and plenty of low-elevation fishing holes in between. Go out and catch a memory!

Recreational fishing (especially angling) is one of the most popular activities in the world, but as with other sports, it’s not without its risks. Most anglers are careful to avoid the obvious and most dramatic of fishing dangers (dehydration, hooking a finger, boat motor fires, accidental drowning, etc.). However, if you want to keep yourself in top fishing shape, you also have to protect yourself from more mundane fishing hazards – overuse injuries.

As the name states, overuse injuries are caused by too many uninterrupted repetitions of an action. The body parts involved become fatigued to the point of injury; this effect is intensified if the repeated action requires awkward or unnatural movements, such as is sometimes seen in bowling or pitching a baseball. Overuse injuries are notoriously stubborn to cure – but then again, it’s often those with the injuries that are stubborn. Because you must treat an overuse injury with rest (which means taking a sometimes lengthy break from the beloved activity that cause the injury in the first place), many people make the mistake of returning to activity before their injury is fully healed, creating a vicious cycle that can be difficult to break.

Angling provides the perfect conditions for an overuse injury thanks to the repetitive movements of casting coupled with the bad body mechanics that are common to so many people. As is often said, prevention is the best medicine. With a few simple tweaks, you can help stop overuse injuries from ruining your fishing trips.

Although it might sound silly, you should prepare in advance of a fishing trip the way you would for other athletic events. Keeping yourself in good physical condition will give you the endurance you need for long fishing sessions, and you will be less plagued by the aches and pains that can make your trip less enjoyable. Besides eating a balanced diet and exercising regularly, you should include stretching and strengthening exercises specifically geared for the muscles you will use during angling – your abdominals, back, and upper body.
Because fishing trips are often all-day affairs, it’s important to change up your activity. Alternate sitting and standing – but do both with good posture – to avoid unnecessary stress on your back and feet. Switch your grip and casting style throughout the day so no one motion or position is repeated excessively (and as an added bonus, this will help you master a diversity of fishing styles). And perhaps most important of all, take breaks to rest, even if you don’t feel tired. Remember that most people don’t realize they are developing an overuse injury until it’s too late.

Lastly, be realistic about your abilities. Seek coaching to fix any bad body mechanics you may have during casting. Shooting heads and sinking weights put extra strain on the wrists, elbows, and shoulders of anglers who aren’t adept at their use, so avoid them for all but short periods of time if you fall into this category. In addition, using heavy or long rods, longer lines, and fishing for heavy fish should all be engaged in sparingly unless you are expert enough to do so correctly.

Fishing memories can last a lifetime, so don’t let an overuse injury keep you from enjoying the water with your friends and family.
You throw a hook into the water, you sit and wait for a bite or you reel back in. Fishing is a great pastime, but in order for it to be truly enjoyable, you must be safe. Keep these important guidelines and tips in mind for a safe fishing experience.Image result for arizona fishing

1. Get physically prepared.
You don’t necessarily need to be in top physical shape to catch a fish, but you do need to be able to navigate in and out of a boat or possibly across rocks to your favorite fishing spot. Since regular physical activity is essential for your family’s health, make sure you stick to a daily fitness routine leading up to fishing season. Consider visiting the local pool to brush up on your swimming strokes in the case you fall out of the boat or into the water from the shore.

2. Check your fishing gear.
Fishing lines get old and tangled, fishing poles get worn, and lures can break. Open up your tackle box and discard broken fishing tackle. Restring your pole if the line looks ragged and replace your reel or pole if showing signs of damage. The last thing you want to do is cast out and hook someone or yourself due to faulty fishing gear. If you are going out on a boat, do a boat safety check and make sure your life vests are in good condition.

3. Dress up for the occasion.
Sturdy, protective footwear is especially important when fishing. It can keep you from cutting your foot on obstacles in the water or on shore, keep your feet warm, and prevent slipping. Wear clothing according to the weather conditions, choosing attire that will keep you cool in the heat and warm in the cold. Wear sunscreen regardless of temperature and consider a hat that shades your ears and face. Be sure you and the kids don those life vests if you are on the water. Life jackets are also important if you are wading in deep waters that have strong currents. Even if you are an excellent swimmer, a life jacket can help keep you safe in the event that you fall and hit your head.

4. Pack a first aid kit.
Image result for first aid kitWhile you are hoping for the big catch, you may fall and sustain a cut, get bit by insects, or get a hook in the hand. A first aid kit can come to the rescue for many injuries.
For scrapes and cuts, rinse the wound with clean water (this doesn’t mean pond water) and stop the bleeding by compressing with a clean cloth. Apply an antibiotic cream and cover with a bandage. Try to keep the area dry, changing bandage as needed.

For insect bites and stings, clean area with water, apply a cold compress if available, apply antibiotic cream, and take acetominophen or ibuprofen for pain. Be sure to remove ticks and stingers, if present, before treating. To avoid bites and stings, apply an insect repellent before you start fishing.

When it comes to fishing hooks, if the hook is embedded in the head or face, in a joint, or near an artery, seek medical help immediately. If the hook is embedded in the finger or elsewhere in the skin, clean area with soapy water. Tie a long piece of fishing line to the rounded part of the hook. Push the hook shank parallel with the skin and give the fishing line a firm, sharp yank. The hook should come right out of the entry point. Wash the area again and apply an antiobiotic ointment and bandage to keep it clean and dry.
Note: Be sure your family is current on your tetanus vaccinations.

5. Stay aware of your fellow fishers.
Keep distance between you and your fellow fishers to avoid hook or pole injuries when casting. Safety glasses are a good idea for kids to protect their eyes, especially as they hone their fishing skills. In addition, always know where your family members are and don’t let your kids fish alone. Employ the buddy system.
New anglers. Should always learn how to cast overhead first. This cast teaches the proper technique and is safer than side casts.

6. Never go fishing alone. Always fish with someone else and, ideally, with two other people. If one person is injured or in danger, a second person can stay with them while the third person seeks help. This is especially important when rock fishing. Let somebody know the location of your fishing trip, who you are going with and an approximate time you will be back.

7. Weather and fishing
Staying aware of weather conditions is an important part of fishing safety. Make sure you have the most up-to-date local weather information available and be prepared for sudden changes. For coastal locations, take particular note of unexpected tide and swell conditions.

Additional Fishing and Boating Safety Tips: 
• No drinking or using drugs while driving a boat.
• Abide by boat speeds and wake zone laws.
• Stay alert of debris, stumps, boulders when boating.
• Stay off of the water if there are lightning storms.
• Use your boat lights at night.
• Keep an extra fully-charged battery on board.
• Use caution with hooks, like baiting, knot tying, rigging.
• Don’t fish in unrestricted zones.
• Be sure you keep your area organized and clean.
• Carry maps of the areas you will be at.
• Bring a cell phone.
• Stay hydrated.

Arizona fishing and boating trips can range from a day of casting for trophy largemouth bass to fly-fishing for brown trout on Woods Canyon Lake. In order to experience the best fishing in Arizona, check for updates to fishing regulations, read local fishing reports, and find the best spot.

These 11 Amazing Spots In Arizona Are Perfect To Go Fishing
Image result for arizona fishing• Big Lake
• Cluff Ranch Ponds
• Dead Horse Lake
• Dogtown Lake
• Lake Pleasant
• Lake Powell
• Oak Creek
• Peña Blanca Lake
• Riggs Flat Lake
• Saguaro Lake
• Tonto Creek

 

 

If you experience an injury during your summer activities the Team at TOCA is here to help! Learn more about our Orthopedic Surgeons, Sports Medicine Physicians and Physical Therapy Team. To schedule an appointment call 602-277-6211!

Read more about summer time outdoors in Arizona: Arizona Hiking Tips: Take a Hike. Do it Right.     10 Common Summer Injuries  Men’s Summer Health & Common Sports Injuries

#Results #Recovery #Relief #family #summer #fishingfun #fishingsafety #TOCA #TOCAMD #AZFishing

Where Back and Neck Pain Begin

Where Back and Neck Pain Begin: Upper back and neck pain can stop you in your tracks, making it difficult to go about your typical day. The reasons behind this discomfort vary, but they all come down to how we hold ourselves while standing, moving, and — most important of all — sitting.

What is low back pain?

Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning and quality of life.

What is neck pain?

Neck pain is pain that occurs in the area of the cervical vertebrae in the neck. Because of its location and range of motion, the neck is often left unprotected and subject to injury.

Pain in the back or neck area can be acute, which comes on suddenly and intensely, or chronic, which can last for weeks, months, or even years. The pain can be continuous or intermittent.

Common Causes of Back Pain and Neck Pain

Fortunately, most episodes of back pain will heal with time: approximately 50% of patients will feel relief from low back pain within two weeks, and approximately 90% within three months, regardless of the treatment.

The majority of episodes of acute back pain are due to a muscular strain and these will usually resolve with time because muscles have a good blood supply to bring the necessary nutrients and proteins for healing to take place.

Even with today’s technology, the exact cause of back and neck pain can be found in few cases. In most cases, back and neck pain may be a symptom of many different causes, including any of the following:

  • Overuse, strenuous activity, or improper use such as repetitive or heavy lifting
  • Trauma, injury, or fractures
  • Degeneration of vertebrae, often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging
  • Infection
  • Abnormal growth such as a tumor or bone spur
  • Obesity due to increased weight on the spine and pressure on the discs
  • Poor muscle tone
  • Muscle tension or spasm
  • Sprain or strain
  • Ligament or muscle tears
  • Joint problems, such as arthritis
  • Smoking
  • Protruding or herniated (slipped) disk and pinched nerve
  • Osteoporosis and compression fractures
  • Congenital (present at birth) abnormalities of the vertebrae and bones
  • Abdominal problems, such as an aortic aneurysm

Back Pain Caused by Lumbar Spine Problems

For patients with low back pain that lasts longer than three months, or patients with predominantly leg pain, a more specific and definable problem for the pain should be sought. There are several very common causes of low back pain and leg pain:

In younger adults (20-60 year olds) the disc is likely to be the pain generator and conditions may include:

In older adults (over 60 years old), the source of back pain or leg pain is more likely to be the facet joints or osteoarthritis, and back conditions may include:

In addition to the above, there are several miscellaneous causes of back pain.

Neck Pain from Cervical Spine Conditions

While neck pain is less prevalent than lower back pain, there are several cervical spine conditions that may cause neck pain, arm pain and other symptoms, including:

Additionally, there are several miscellaneous causes of upper extremity pain related to conditions of the cervical spine.

Understanding Back Pain

he back and spine are designed to provide a great deal of strength, protecting the highly sensitive spinal cord and nerve roots, yet flexible, providing for mobility in all directions.Image result for Understanding Back Pain

However, there are many different parts of the spine that can produce back pain, such as irritation to the large nerve roots that run down the legs and arms, irritation to small nerves inside the spine, strains to the large back muscles, as well as any injury to the disc, bones, joints or ligaments in the spine.

Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Chronic back pain is typically described as lasting for more than three months.

Back pain can take on a wide variety of characteristics:

  • The pain may be constant, intermittent, or only occur with certain positions or activities
  • The pain may remain in one spot or refer or radiate to other areas
  • It may be a dull ache, or a sharp or piercing or burning sensation
  • The problem may be in the neck or low back but may radiate into the leg or foot (sciatica), arm or hand.

Other than pain, back pain symptoms may include weakness, numbness or tingling.

Fortunately, most forms of back pain get better on their own: approximately 50% of patients will experience back pain relief within two weeks and 90% within three months.

If the pain lasts for more than a few days, is getting worse, does not respond to back pain remedies such as a short period of rest, using ice or heat, lower back pain exercises and over-the-counter pain relievers, then it is usually advisable to see a back doctor. There are two instances in which emergency medical care is needed:

  • Bowel and/or bladder dysfunction
  • Progressive weakness in the legs

Fortunately, these conditions are rare.

Conditions That Can Create Back Pain

By far the most common cause of lower back pain is a muscle strain or other soft tissue damage. While this condition is not serious, it can be severely painful. Typically, lower back pain from a muscle strain will get better within one to three weeks.

Treatment usually involves a short period of rest, activity restriction, use of hot packs and/or cold packs for local discomfort, and pain medication. Over the counter pain medication used to treat muscle strain may include acetaminophen (e.g. Tylenol), ibuprofen (Advil), Motrin, or naproxen (e.g. Aleve). Prescription pain medications may be recommended for severe back pain.

Different Causes of Back Pain

Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease). Older adults (e.g. over 60) are more likely to suffer from pain related to joint degeneration (e.g. osteoarthritis, spinal stenosis).

In some instances, a patient may experience more noticeable leg pain as opposed to back pain as a result of certain conditions in the lower back, including:

  • Lumbar herniated disc. The inner core of the disc may lead out and irritate a nearby nerve root, causing sciatica (leg pain).
  • Lumbar spinal stenosis. The spinal canal narrows due to degeneration, which can put pressure on the nerve root and cause sciatica.
  • Degenerative disc disease. As the disc degenerates it can allow small amounts of motion in that segment of the spine and irritate a nerve root and cause sciatica.
  • Isthmic spondylolisthesis. A small stress fracture allows one vertebra to slip forward on another, usually at the bottom of the spine. This can pinch the nerve, causing lower back pain and leg pain.
  • Osteoarthritis. Degeneration of the small facet joints in the back of the spine can cause back pain and decreased flexibility. May also lead to spinal stenosis and nerve pinching.

It is important to know the underlying condition that is causing the low back pain, as treatments will often differ depending on the causes of back pain.

How can back and neck pain be prevented?

The following may help to prevent back and neck pain:

  • Practice correct lifting techniques
  • Use telephones and workplace computers and other equipment properly
  • Maintain correct posture while sitting, standing, and sleeping
  • Participate in regular exercise (with proper stretching before participation)
  • Avoid smoking
  • Maintain a healthy weight
  • Reduce emotional stress that may cause muscle tension

Symptoms and Diagnosis

The cause of back pain can usually be diagnosed with a detailed description of one’s symptoms. The description of back pain symptoms, along with one’s medical history (and possibly diagnostic testing), will usually lead to a diagnosis of a general cause (such as back strain), or a specific condition (such as a herniated disc).

Back Pain Symptoms from a Sprain or Strain

Back sprain or strain symptoms generally include:

  • Pain is usually localized in the low back (doesn’t radiate down the leg)
  • Pain often starts after lifting something heavy, lifting while twisting, or a sudden movement or fall
  • Pain may include muscle spasms, tenderness upon touch
  • Pain is less when resting and worse during certain activities.

Lower back pain from a muscle strain usually will get better within one to three days.

Chronic Back Pain Symptoms

Symptoms that are part of a diagnosable chronic condition can include:

  • Leg pain (sciatica) and possible numbness. Pain can radiate down the leg to the buttock and/or the foot, and can be worse with sitting or prolonged standing. This type of pain can be due to a lumbar herniated disc.
  • Pain with certain movement and positions (such as bending forward, running). The pain tends to fluctuate, with low level or no pain at times, and then flare up at other times. This chronic back pain can be caused by degenerative disc disease.
  • Lower back pain, often accompanied by leg pain, which worsens when standing or walking for long periods. This pain may be caused by a small stress fracture in the back of the spine called isthmic spondylolisthesis.
  • Lower back pain that is worse in the morning and in the evening, and stiffness (usually in older adults). This back pain may be caused by facet joint osteoarthritis(degenerative arthritis).
  • Pain that is felt down the legs when walking and standing upright and that feels worse with more walking and gets better after sitting down (usually in older adults). This pain may be caused by lumbar spinal stenosis and/or degenerative spondylolisthesis.

There are many more conditions can cause lower back pain, leg pain and other symptoms; the intention of this article is to highlight the most common ones.

There are a few symptoms that are possible indications of serious medical conditions, and patients with these symptoms should contact a doctor immediately:

  • Difficulty passing urine or having a bowel movement
  • Progressive weakness in the legs
  • Severe, continuous abdominal and lower back pain.

What Can Increase The Potential for Back Problems?

There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, pregnancy and smoking. With that said, back pain is so prevalent that it can strike even if you have no risk factors at all.

Specific Risk Factors for Back Pain

Patients with one or more of the following factors may be at risk for back pain:

Aging. Over time, wear and tear on the spine that may result in conditions (e.g., disc degeneration, spinal stenosis) that produce neck and back pain. This means that people over age 30 or 40 are more at risk for back pain than younger individuals. People age 30 to 60 are more likely to have disc-related disorders, while people over age 60 are more likely to have pain related to osteoarthritis.

Genetics. There is some evidence that certain types of spinal disorders have a genetic component. For example, degenerative disc disease seems to have an inherited component.

Occupational hazards. Any job that requires repetitive bending and lifting has a high incidence of back injury (e.g., construction worker, nurse). Jobs that require long hours of standing without a break (e.g., barber) or sitting in a chair (e.g., software developer) that does not support the back well also puts the person at greater risk.

Sedentary lifestyle. Lack of regular exercise increases risks for occurrence of lower back pain, and increases the likely severity of the pain.

Excess weight. Being overweight increases stress on the lower back, as well as other joints (e.g. knees) and is a risk factor for certain types of back pain symptoms.

Poor posture. Any type of prolonged poor posture will, over time, substantially increase the risk of developing back pain. Examples include slouching over a computer keyboard, driving hunched over the steering wheel, lifting improperly.

Pregnancy. Pregnant women are more likely to develop back pain due carrying excess body weight in the front, and the loosening of ligaments in the pelvic area as the body prepares for delivery.

Smoking. People who smoke are more likely to develop back pain than those who don’t smoke.

When To Call a Doctor

Image result for When To Call a DoctorThe bottom line that everyone should remember is that if one is in doubt, consult a doctor. If back pain is getting worse over time, does not feel better with rest and over the counter pain remedies, and/or involves neurological symptoms then it is advisable to be evaluated by a back pain doctor.

When to See a Back Pain Doctor

In general, if the pain has any of the following characteristics, it is a good idea to see a physician for an evaluation:

  • Back pain that follows an accident, such as a car accident or falling off a ladder
  • The back pain is ongoing and is getting worse
  • The pain continues for more than four to six weeks
  • The pain is severe and does not improve after a few days of typical remedies, such as rest, ice and common pain relievers (such as ibuprofen or Tylenol)
  • Severe pain at night that wakes you up, even from a deep sleep
  • There is back and abdominal pain
  • Numbness or altered feelings in the upper inner thighs, groin area, buttock or genital area
  • Neurological symptoms, such as weakness, numbness or tingling in the extremities – the leg, foot, arm or hand
  • Unexplained fever with increasing back pain
  • Sudden upper back pain, especially if you are at risk for osteoporosis.

Back Pain Symptoms That Require Urgent Medical Care

The following back pain symptoms may be indications of a serious medical condition and anyone with these should seek immediate medical care:

  • Difficulty passing urine or having a bowel movement
  • Progressive weakness in the legs
  • Severe, continuous abdominal and low back pain.

People should also seek prompt medical attention if other unexplained symptoms accompany their back pain, such as fever, history of cancer, recent unexplained weight loss, pain that is so bad it awakens them from sleep, or pain after a trauma.

Diagnostic Tests for Indicators of Back Pain

Diagnostic tests can indicate if a patient’s back pain is due to an anatomic cause. However, because diagnostic tests in and of themselves are not a diagnosis, arriving at an accurate clinical diagnosis requires any test to be to be correlated with the patient’s back pain symptoms and physical exam.

The most common diagnostic tests include:

  • X-ray. This test provides information on the bones in the spine. An x-ray is often used to check for spinal instability (such as spondylolisthesis), tumors and fractures.
  • CT scan. This test is a very detailed x-ray that includes cross section images. CT scans provide details about the bones in the spine. They may also be used to check for specific conditions, such as a herniated disc or spinal stenosis. CT scans tend to be less accurate for spinal disorders than MRI scans.
  • MRI scan. An MRI scan is particularly useful to assess certain conditions by providing detail of the intervertebral disc and nerve roots (which may be irritated or pinched). MRI scans are useful to rule out spinal infections or tumors.

Injections may also be used to help diagnose certain types of pain. If an injection of a pain relieving medication into a certain spot in the spine provides back pain relief, than it confirms that is the area causing pain.

 

If you are experiencing back or neck pain the team of physicians and staff members at TOCA (The Orthopedic Clinic Association) are here to help! For more information you can read more about our Neck & Spine Physicians and The Spine Center at TOCA for non-operative and operative procedures. For questions or to schedule an appointment with our orthopedic spinal surgery and general musculoskeletal physical medicine and rehabilitation specialists call: 602-277-6211!

 

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