Two articles of interest for those considering back surgery

A New England Journal of Medicine article–Surgery versus Prolonged Conservative Treatment for Sciatica, Conclusions: “The 1-year outcomes were similar for patients assigned to early surgery and those assigned to conservative treatment with eventual surgery if needed, but the rates of pain relief and of perceived recovery were faster for those assigned to early surgery.”
The Journal of Bone and Joint Surgery–Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis, Conclusions: “Compared with patients who are treated nonoperatively, patients in whom degenerative spondylolisthesis and associated spinal stenosis are treated surgically maintain substantially greater pain relief and improvement in function for four years.”

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Pillows

When my neck pain was bad, I went through—I can’t remember how many pillows…firm, soft, overstuffed, feathers, brand names, hotel, orthopedic etc.—trying to find one that didn’t leave my neck worse in the morning. Finally I took a medium polyester filled pillow, removed some filling from the center to cradle my head, then used the extra filling to form a “hump” at the lower edge to support my neck, and that was about all that “worked,” but even that wasn’t perfect because the fluff kept compacting. The fancy shaped orthopedic pillows didn’t help. The neck support area always seemed too thick and the new fangled “visco-elastic” material never shaped to my neck (which had lost it’s normal lordotic curve years ago). So I always ended up whittling away at the foam, reshaping it again and again until I had to throw the pillow out. (Some in my neck/back pain group put their memory foam pillows through the dryer several times to soften them. I think I tried it once but it didn’t help.) The one with the little styrofoam beads didn’t help either. I opened it to remove some of them; they got everywhere and stuck to everything, and still my neck didn’t like it. And then there was the water pillow that I ordered online. No matter how much or little I filled that thing, it still wasn’t comfortable. And besides it was heavy with all that water sloshing around and lifting it was tough on my neck.

From all this trying of pillows, it became clear to me, there was no “magic” pillow when one’s neck is inflamed and painful. Some can make it worse, especially the high, over stuffed ones that force your neck to curve into flexion/kephosis (“C” curve). But most won’t help reduce pain that’s already there because of long term poor posture.

Well my neck pain is gone thanks to my new posturally correct self. Currently, I have a nondescript, unmodified, no-name pillow that works fine. I have been thinking of getting a slightly firmer one because I always sleep on my side now. A far cry from when I slept rigidly on my back, towel rolls under the ends of my pillow to prevent my head from rolling to either side.

 

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Mattresses

When my back was painful and spasmed because I had to sleep motionless on my back all night long (because of my neck), my new Beautyrest mattress was just as hard on my back as the old Sealy Posturepedic. I could feel every little dip of the pattern stitched into the pillowtop…darn uncomfortable. I tried a thick visco-elastic foam topper and after one night—my back spasmed like crazy. The only help would be to sleep on my side, but that had to wait until I’d fixed my neck pain.

The neck/pain support group I belong to has discussed mattresses. The Select Comfort Sleep Number bed seemed to be the mattress of choice. Having separate controls to adjust firmness on either side of the bed for couples was mentioned as a great help. But one member said the massage feature was not helpful and noisy besides. He found the local reps to be very helpful. But of course the sleep number bed is more expensive than most. The Tempurpedic mattress has been mentioned. One woman’s comment was that it felt great in the store but once home, did not give support—it seemed to sag—and by the second night she was “crying in pain.” But she wasn’t helped by an old Select Comfort a friend lent her, either. (This woman was concerned about customer complaints about the pump on the Select Comfort breaking after the 2 year warranty period expired.) Another woman said her Tempurpedic made all the difference in giving her pain relief. And another was sore the next day after trying it in store.

There seems to be back pain patients on both sides—Tempurpedic vs. Sleep number. So which is the best mattress for back pain? Some advice included giving the mattress a try for an hour or two in the store, and then not to consider buying it until after you know how your back feels the next day. As with pillows, a lot depends on the state of one’s back. But how do you improve the state of one’s back if sleeping doesn’t rest it? What will help? Changing sleeping position, improving posture during the day, muscle relaxants, sleeping aids, having surgery if needed? It’s a major puzzle and a “pain” to go through trying to figure out.

Of note: one support group member highly recommends an adjustable “hospital” type bed. Check out if either Tempurpedic or Sleep number comes with adjustable head and foot controls.

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Poor Posture Everywhere

Having experienced and then overcome the chronic pain that poor posture caused me, I tend to think that everyone with poor posture will eventually develop some form of musculo-skeletal pain problem from it. But like a former smoker who rails against smoking, I tend to be over zealous.  I can’t help but see examples of poor posture; like the tall slender preteen in line at the grocery store with her father. From the looks of her uniform, she’s just come from playing a sport like soccer, so she’s not a couch potato, but her high thoracic hunch and rounded shoulders is a mirror image of her father’s posture. I get to wondering how bad his neck pain is, and how bad hers will be in the future.  Or there’s the checker, a young woman with the long, rounded swayback, exceedingly curled-in shoulders and a caved-in chest. I have this desire to snap their photos and show them what I see. I want to ask them, don’t you know your posture is ugly, and you’re messing your body up? But of course, it’s not my place to say anything. I know what comes of butting in. And really, these people don’t look like they’re in pain. (What does a person in pain look like?  When I was in the midst of my pain-filled days, could you see the pain in my eyes?) In fact some studies have been done (I have to find the references) that found that many people with poor posture don’t have spinal pain. But on the other hand those with back and neck pain, often do have poor posture. So there’s a question of what comes first, the injury, whether acute or repetitive, that “caused” the pain or the poor posture? But as I’ve said before, my posture was bad from the beginning. It was only after a bad neck strain at age 21 that my neck pain began and never went away. So it would be easy to say that the bad neck strain and accelerated arthritic deterioration seen in my MRIs were the cause of my worsening neck pain. If I hadn’t overcome that neck pain by improving my posture and strengthening shoulder blade stabilizers, I wouldn’t have known that the root cause was poor posture, and not the spinal arthritis.

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Droopy Shoulders Syndrome

An exception to use of part 1 of Fix the Shoulder Blades Exercise is a condition called Droopy Shoulders Syndrome (DSS) that is mainly present in women with low set, steeply sloping shoulders and long, swan necks. Their collar bones (clavicles) slope down at the outer ends rather than the usual slope up. In lateral neck x–rays, all of the 7th cervical vertebra, the 1st thoracic and sometimes part of the 2nd are easily seen when usually the shoulders prevent visualization. Pain in neck, shoulder, arms, hands is aggravated by downward traction on shoulders and relieved by propping up the arms, and may involve Thoracic outlet syndrome. In DSS the shoulder blades are already held too low on the back and don’t need to be lower. Maintaining a slight lift of the shoulders so they are more squared helps. Part 2, Pinch the Shoulder Blades Together is still useful if shoulder blades are wider apart than 4 inches. Consult your physician or physical therapist. See “The Droopy Shoulder Syndrome,” L. Clein, and “The Droopy Shoulder Syndrome” by Swift and Nichols]

My neighbor had neck, shoulder and arm pain (around the biceps muscle). Her shoulders were obviously very sloped down, and her neck seemed very long. I urged her to see a physical therapist, which she did. Luckily the head physical therapist (not the assistant) knew how to help her. The advice was to keep her shoulders raised a bit. I recently talked to her and noticed her shoulders are more squared and she says her pain is gone. It has only been recently that I realized the clavicle (collar bone) in front in most people slopes up toward the outside ends., showing that the shoulder blades, which are attached to the clavicle near the shoulder joint are held a little higher.  But hers are straight horizontal. Wish I’d noticed whether her clavicles were downwardly sloped before she got the therapists advice to lift her shoulders.

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Fighting the Fatigue of Chronic Illness

Chronic illness may cause severe fatigue,  leaving little energy for work, exercise, or just getting out of the house to enjoy a pleasant day. And fatigue deteriorates posture, predisposing to neck, shoulder and upper back pain.  How to fight fatigue?   Here are some tips (modified from Ellen Greenlaw’s article, Fighting Lupus Fatigue and Boosting Energy,  at webmd.com.)

1. Treat Underlying Conditions that may be causing the fatigue.  These might include anemia, nutrient deficiency, depression, hypothyroid,  kidney disorders or one of a myriad of possible conditions.  Side effects of medication are a special case.   A change in dose or medication may help.(this is what helped me)  See a doctor for help finding an underlying condition.

2. Exercise Regularly to Boost Energy.  Start slow. Exercise during the time of day you have the most energy. Choose an exercise you like doing. Maybe a 5 minute walk in the park, exercise-cycling to a movie, cleaning the house to your favorite music and adding a few dance steps while your’re at it. Of course don’t overdo it.

3. Get Enough Good Quality Sleep.  Night-time sleep is important for healing.  Go to bed early, even if you have to drag yourself away from TV or the computer (something I have to do all the time). Avoid alcohol (which makes you sleepy but later disturbs sleep) caffeinated drinks, and overeating or eating a late dinner.
Try using a white noise machine at night. I have a Marpac. But there are several brands, many of which feature sounds like rain or waterfalls or heart beats. I found that the rain sound was okay (radio static is okay too) but couldn’t get to sleep with the other sounds. (For me with mast cell activation disorder, I discovered that the white noise machine lessened  my mast cell reactions to bad dreams. This may be so for  people with normal mast cells as well, thus lessening inflammatory mediator release at night and allowing for better sleep.)
If night-time sleep isn’t enough, then rest during the day. An afternoon nap or siesta can be refreshing. More frequent naps may help, but not too close to evening, which may interfere with night-time sleep.

4. Prioritize Activities.  Make an activity schedule for daily basics so you can plan rest periods and still get done what needs doing. Keeping to a schedule also helps avoid the stress of hurrying to get important things done on time.  Try to do the most strenuous things first when you have the most energy.  It may help to  break bigger projects into smaller, more manageable tasks. Then get done what you can, and what’s left, leave for a better time. Don’t stress over what you can’t do. You’ll get to it, as your energy allows.

5. Learn to Say No.  Your first priority is healing. After that are the activities that mean the most to you. If you know an activity will leave you exhausted, find another way, or say NO. Also avoid activities that increase your stress level.  Along with that, avoid people who add more stress to your life.  (Some people are just plain toxic.)

6. Keep a diary (or simply a daily graph) of your symptoms and  how you feel.  This little “research project” can help you figure out what activities or meds or time of day etc. make you feel better, and which make you feel worse. If you want to track your health online (some neat tools)  and want to join a social health network, you might consider www.patientslike me.com. (This site has a research staff (PhDs), who mine the data for research purposes and publish research articles in well regarded medical journals.

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