Do the Alexander Technique

A medical doctor first recommended that I do the Alexander technique when I was fourteen and suffering from a back injury. Not only did it help my back, but it also taught me how to sit, stand, lift objects and walk with so much more ease. Even today people ask about my good posture, and it’s all thanks to my training in the Alexander technique.

The basic idea of the Alexander technique is to get rid of tension in the body, correct the misuse of muscles and change bad alignment habits in your everyday activities, for example, when you are sitting, lying down, standing, walking or lifting something. The goal is to improve your ease and freedom of movement and learn the proper way to perform different activities, without causing any strain on your body.

Alexander reeducates the mind and body and is one of the most popular techniques used by actors, singers and musicians, because it helps the performer relax onstage and use the least amount of energy for movement. I highly recommend the Alexander technique for everyone, because not only will it help you let go of unhealthy habits, but it will improve your posture and hence your confidence.

If you feel that your posture can be improved or that you carry stress unnecessarily in any part of your body, if you have a bad back or neck, or simply want to understand more on how your body is meant to move or aim to protect it from repetitive strains, then the Alexander technique is for you.

See a Chiropractor for Back Pain

Eight out of ten people suffer from some form of back pain in their lifetime, due either to poor muscle tone, bad posture, athletic or other injuries, disk problems, or a problem in the legs or buttocks. Emotional stress, long periods of inactivity, repetitive strain and heavy physical work can also cause back pain.

If you do have back pain, do not rush to a medical doctor. Instead, visit a chiropractor. Chiropractic is the third largest doctoral-level health profession, after medicine and dentistry. It is covered by most insurance policies and addresses lower back pain, neck problems, headaches and other chronic pain, and all sorts of athletic injuries.

Chiropractic is a system of therapy that returns the body to a balanced state by manipulating the spine and joints to restore normal motion and reduce any nerve interference. Many diseases are connected to poor alignment of the vertebrae. Chiropractors treat disease by manipulating the vertebrae in order to relieve pressure on the nerves.

Chiropractors are extremely well trained, so you can feel confident in a a chiropractor’s hands. If they can’t help you, they will let you know and will recommend that you consult a medical doctor. Finding the right doctor of chiropractic is just as important as finding the right dentist or medical doctor. It is best to get a recommendation from a friend or medical professional. You may even be able to get a referral through your health insurance.

Improved Back Surgery

What happens during a standard spinal fusion surgery?

Dr. Zahrawi: In the standard procedure you make an incision. The most common one is the posterior fusion where you make an incision in the back, in the middle usually, and then you have to retract the muscle to both sides. Then you have to remove bone to decompress the spine, because most fusions are associated with decompression. But if you don’t need to do decompression you don’t need to remove too much bone. If we are just doing strict fusion, after we expose the bone we do what we call decortication — meaning to roughen the bone. What then happens is it bleeds. When it bleeds it brings the cells necessary to perform the fusion. The cells come from the bloodstream of course. That’s in addition to the bone graft that we put on the bone that’s been decorticated (or irritated if you will), and the fusion happens. If you are doing a decompression, you have to remove some bone in addition to that in the posterior element.

How big of a procedure is standard spinal fusion for patients?

Dr. Zahrawi: It’s not only bigger in terms of time; there is more violation to normal tissue in order to get to the area that we like to put the bone. That area is way outside on the lateral part of your spinal column. So it violates normal tissue, and it’s a longer procedure.

What’s the recovery typically like?

Dr. Zahrawi: Usually, recovery takes at least a minimum of three months for fusion. If people don’t heal immediately, the next step takes about six months. So the least that you require is three months; it could go six months, it could go up to year and occasionally even two years — so it’s a long process.

Generally speaking, who would be a candidate for fusion?

Dr. Zahrawi: Fusion you can do for a variety of conditions. The most common one is deformity, like if somebody has scoliosis or another deformity. Then we do it for degenerative process, like if somebody has what we call a spondylolisthesis or somebody who has a significant stenosis where a wide decompression is required –then we have add the fusion to the decompression. We also do it for tumors, we do it for infections, and we do it for, what we call, degenerative disk disease.

Is degenerative disk disease common?

Dr. Zahrawi: Degenerative disk disease is very common. The fusion we do for degenerative disk disease is slightly different from the fusion we do for scoliosis and deformity. Fusion for degenerative disk disease has to involve the disk itself. If you are treating a patient with degenerative disk disease then the disk itself has to be removed in order to eliminate the pain. If you do only bilateral lateral fusion or, what we call, the far-out fusion alone, the patient is not as good as if you do the fusion between the body itself. When you remove that degenerative disk and replace it, sometimes it’s a bone graft sometime it is hormone. So you need to remove the bad disk and replace it with the element that can do the fusion.

Tell me about this new way you are performing spinal fusion.

Dr. Zahrawi: We have talked all along about posterior fusion. Again this is the most common one. Anterior fusion is a fusion that is done in front of the spine. It’s not a new procedure; it’s been done for a long time — done in a different way. Anterior fusion can be done in two ways. It can be done either strict anteriorly or it can be done laterally. Now anteriorly means you’re facing the vertebrae from the front. So you are facing the vertebrae face on — that is anterior fusion. So what you do after you do the exposure is you go to the disk again. You have to remove that disk and you have to put a bond there. That’s anterior fusion. There is another aspect of anterior fusion — we call it a lateral fusion. Lateral fusion is where you go perpendicular to the spine. Again you land on the disk and you have to remove it — you do the same procedure. You’ve got to remove the disk and you have to replace it with either a cage, bond, bone graft, hormone or combination of the above.

So you go in the side basically?

Dr. Zahrawi: Yes, 90 degrees to the spine exactly. So you have posterior fusion, you have anterior fusion, and you have lateral fusion. Lateral fusion is nothing new. We always went from the side to the back, but we always pulled what we call the psoas muscle, which lies right on the side of the vertebrae. What we’ve done in the past is gone laterally and pulled that muscle backward. That allows us to expose the disk and the vertebrae and do fusion that way. The new technology is that we are going through that muscle, the psoas, so that avoids pulling the muscles again. So if you can imagine where the psoas muscle usually lies is right on the side of the bone. So what we’ve done in the past, we’ve pulled the muscle sideways to get access to the disk. Now, we are going right in between these muscles. With that new technology we put dilators into these disks and do the procedure in a minimally invasive way.

So you have smaller instruments to go in there?

Dr. Zahrawi: What we do is, we make about an inch incision, we put a guide wire, and we position an X-ray right over the disk. Then over that guide wire we put dilators. The smallest ones, the first one is the size of a straw. So that straw dilator goes right over the guide wire. Then we move from that dilator to bigger dilators. These dilators go to about three-quarters of an inch in diameter. This last dilator is retractable. So if you were to retract it, it would give you about an inch-and-a-half opening. Sometimes it will be a two-inch opening all the way around, dilated. So actually we do not cut any muscles; we dilate these muscles. The X-ray and these new instruments guide us and position us right over the disk. So that’s how it’s minimally invasive. We are not violating any muscle. It’s a very tiny, small incision. We are avoiding muscle stripping and muscle cutting because otherwise you have to repair it and heal if.

What does that mean for patient’s recovery?

Dr. Zahrawi: It means a much faster recovery and avoiding a tremendous complication. Sometimes [with the old way] you get hernias through these incisions and the healing time is much longer. You have to allow these muscles to heal. You literally cannot do much for about six weeks until these muscles heal. With this surgery, even though you are going to avoid strenuous activity, the pain is much less because there is not much healing to be done. The muscle has not been cut, so there is no healing from that. You are only going to heal the bone itself, no muscle healing needed.

I know you have also another part of this procedure where you use the nerve guidance system. Can you tell me a little bit about that?

Dr. Zahrawi: The nerve-guidance system is because the psoas muscle is lying right over the side. Inside this muscle there is a lumbar nerves that leaves the spine and comes down through these muscles down to the legs. The dilators that we put over the guide wires have a sensor in them, so to speak. That sensor attached to the machine will measure the activity in these nerves and how fast they are responding to the stimulus. The closer you are to the nerve, the faster the response is. So that would tell us how close we are to that nerve. If we found the response is very fast and short, then we have to reposition and stay away from the nerve. What that does is provide us some safety, so we can operate between these nerves without violating them and damaging them. So that is an important part of the procedure that we call nerve vision.

So not only is it easier on the patient, but it’s safer too?

Dr. Zahrawi: Yes. Correct. It’s very safe. It’s safer since we are not going through the nerve the nerves, and we do not retract them like we do when go from the back – – it’s much safer.

Is this procedure being performed widely now, or about how many doctors in the country are performing this?

Dr. Zahrawi: Well again, the anterior approach is nothing new. The anterior approach has been done and continues to be used. What this does is it replaces the old procedure. Since we have this approach as a new minimally invasive procedure, it’s inviting a correcta lot more spinal problem that way. We can do a lot of the procedures that were done posteriorly by converting them to the anterior approach. So it’s not only the old anterior approach that you can do this way, we are shifting some of the posterior surgery to the front. We’re doing this for a couple reasons: First of all, it can correct deformity nicely, which is harder to do posteriorly. Number two, the recovery time is much faster. It’s becoming much more popular and I think time will show that it’s going to be even more popular.

How exciting is this for you as a surgeon to have this now to offer patients — this as opposed to what was available?

Dr. Zahrawi: I think it’s very, very encouraging. One more thing, as spine surgeons we always used to have a general surgeon in the room with us to do this procedure. Now we eliminate that. We don’t need the general surgeon because we are not exposing any vessels. So anytime we manipulate large vessels we always like to have a general surgeon or vascular surgeon in the room. With this procedure we are not anywhere close to these vessels, so it’s safer from that aspect too, and also we are eliminating the need for a vascular surgeon in the room.

So it’s easier for you too.

Dr. Zahrawi: Much easier, yes.

Is there any way to say how long the recovery time would be compared to standard fusion?

Dr. Zahrawi: There are two parts to the recovery. If we are talking about a fusion you are going to need the three months regardless. But in older people it takes a week to get out of bed comfortably and walk around. With the new procedure, the first day you can get up and walk around. The first recovery from the surgery itself is much shorter. The fusion itself, I have to say it’s probably going to take the same amount of time. It’s going to take about three months for a fusion regardless, whether they do it from the front or the back. What I would say the incidence — as you know there is no procedure perfect — of posterior fusion not healing when we do one level is about 10 percent. If you have two levels, it’s about 20 percent. Three levels — it increases as you include more levels. The data is showing that, the incidence for fusions not to heal is much lower when we do Lateral fusion than when we do the posterior one. So the success rate is higher with this procedure than the posterior one.

What’s the success rate?

Dr. Zahrawi: The success rate for the fusion is better when you do this lateral-anterior approach than to do posterior.

What Kinds of patients can have this surgery?

Dr. Zahrawi: There is two answers to that. The first one is if somebody has nerve damage or pressure over a nerve that has to be relieved. There is no question about that. If somebody has nerve damage it has to be relieved. The pressure has to be removed from the nerve. Now that’s one aspect. Another aspect of that is pain — if somebody is dealing with pain. Of course not every pain or back pain needs to be treated surgically. I encourage every patient to live with that condition, not to have anything done about it as long as they are active and it doesn’t require taking narcotics for a long time. Let’s assume somebody has back pain. If they take a couple Tylenol or aspirin, two or three times a day and function well and are able to exercise, I don’t think they should ever have surgery. Even if it means you take the pain medication every day — as long as you are not taking narcotics. Now, if somebody is taking narcotics for a very long time it’s a different story. I don’t think anybody should be on a narcotic more than three or four weeks, maximum, because as you know, after that you can become hooked on the medication. Then it’s very hard to take you off even if you have surgery. It’s very hard to stop this medication even if you have surgery later on for it. If it takes narcotics to relieve your pain, and it takes more than four to six weeks of narcotics, you should consider seriously having surgery. Think seriously about it; see your spine surgeon that you mostncomfortable with. See if the problem can be addressed surgically. If it requires no narcotic, that’s fine. Number two, if the pain is so bad that patient cannot do any exercise then that is also an area that needs to be addressed and evaluated for surgery. But if somebody can do the level of activity that he or she desires, they are good with that. If somebody just takes some anti-inflammatory or minor pain medication, even if you take the anti-inflammatory for six months or a year, it’s not a problem most of the time. There is no need for these people to have any surgery.

How successful is spinal fusion at relieving the pain?

Dr. Zahrawi: Again, not every patient with back pain is a candidate. There are a lot of cases that sometimes we can’t do anything about. But I’m talking about the lucky ones who find that something can be done about it. I would say about probably 30 or 40 percent of the people can benefit from surgical procedure. If the problem is that arthritis has spread out, there is really not much you can do about that. The more localized the problem, the better the result. If somebody has problems at one level, two levels — okay — those are the most successful. You go to three and four levels then your chance to succeed significantly decreases.

Oh! My Aching Back: Alternative Therapies

While some aches and pains can be easily cured, back pain often won’t go away. If you think you’ve tried everything, think again. Here we report on two alternative therapies that can make a difference.

Cheryl wants relief from her back pain. “I simply turned my head, and my whole neck just went out,” she explains.

Ellen knows the feeling. “I would get a fatigue that would turn into pain, and I’d just have to sit down.”

Both women turned to alternative therapies for help. Cheryl chose Pilates®, an exercise that uses specialized equipment and floor techniques to strengthen the back.

Certified instructor Maureen says Pilates® also increases flexibility and improves posture. “She learns how to strengthen her back, strengthen her abdominal core and initiate movement from her center,” says Maureen.

Cheryl hurt her neck and back in two car accidents about 20 years ago. Since then, she’s tried everything from orthopedic therapy to acupuncture. “I’ve never felt healthier. I’ve never felt stronger,” says Cheryl.

Neither has Ellen. She says, “Today I had some Feldenkrais work done and had a lesson, and I found just walking from the car to the office, I was moving my body differently.”

Ellen turned to Feldenkrais, a method developed 40 years ago. Feldenkrais uses gentle movements to increase range of motion. Certified practitioner Wallis Chefitz says it helps a person live a more full and comfortable life.

“What Feldenkrais does is you learn yourself from the inside out and learn how you move,” explains Wallis.

There are an estimated 1,200 Feldenkrais practitioners and 400 Pilates® instructors around the country.

Cheryl admits, “I will always do this. I’ll give up everything to do Pilates®.”

Ellen says, “As soon as I started going, I just started feeling differently about my body and how I moved and how I felt.”

Cheryl and Ellen say after years of searching, they’ve finally found something that works.

One Pilates® session costs about $50. Some insurance companies will cover it when prescribed by a doctor for physical therapy. Feldenkrais ranges from $70 to $150 an hour.

A Better Back Brace

Can you describe the traditional scoliosis braces that are in existence right now?

The traditional braces that exist now are all spin-offs of a brace that was developed in the 1940s, called the Milwaukee brace. Adolescents had nightmares about this brace because of a chin piece and a headpiece that were very apparent. The modern developments of that brace, called TLSO braces, have the same degree of success as the Milwaukee Brace. The brace is worn from the axillary area down to the groin and under clothing, without any accessory pads or metal bars that stick out. It is made of a variety of materials but is usually hard plastic. It may be a very rigid polypropylene or less rigid, such as an orthoplast. There are many variations of the scoliosis brace, but essentially they’re just differences in modularity or material.

What are the benefits and drawbacks of the traditional brace?

Fortunately, it seems that most of the scoliosis braces have the same results. They’ve been shown to be effective in halting the progression of curvatures of the spine in kids who are immature in their spine growth. On average, 85 percent of treated patients can be treated successfully, i.e. preventing the curve from getting worse. The drawback is that it is a rigid brace and it interferes with activity. For a patient who is involved in dance or other sports, there is the need be out of the brace to be active. Most kids are in the brace from 16 to 22 hours a day depending on their age. Removing the brace for more time than recommended could compromise your result.

How is the Spine Cor brace different from traditional ones?

The Spine Cor brace involves a totally different concept in treatment. The more traditional brace is one in which we try to restore the alignment of the trunk and the spine in the hopes of keeping it from deforming further over time. Essentially, we are waiting for the soft tissues of the back to tighten with age. The Spine Cor brace was developed in Montreal on the basis of a neurologic and muscular approach to the treatment of scoliosis. The brace is a series of elasticized straps that are attached to a harness that’s worn under clothing and allows full motion. It fosters realignment of the spine but it doesn’t rigidly hold it in place. In the Montreal study, children were encouraged to be active.

So this can possibly correct it?

The traditional scoliosis brace is essentially a holding device and does not provide correction. The Montreal group has been using the Spine Cor brace five years. They have noticed those patients with curvatures of the spine less than thirty degrees have been demonstrating correction in spinal alignment and in the rib cage shape. With advancing scoliosis, ribs actually deform, and may make it difficult to comfortably breathe. The overall Montreal experience in the past five years is that for adolescents with idiopathic scoliosis, the Spine Cor brace works as well as existing scoliosis braces in holding the curvature from getting worse. Ongoing research involves immature individuals with scoliosis curves less than 30 degrees. This thesis involves intervention before true deformation of bone, cartilage and disc occurs. By encouraging realignment, it is believed that some degree of correction of spinal deformity can be achieved. We are one of the research sites involved in early treatment of scoliosis with the Spine Cor brace and have been involved for almost one year.

Can someone go from wearing a traditional brace to wearing a new one?

It’s conceivable, but we don’t have very much information about what the effect is of changing types of braces. If someone’s been in a traditional brace for a period of weeks, I don’t believe there would be any problem in changing to the Spine Cor brace. However, strict protocols are followed for the research population. All of the patients in the study group must be still growing, have scoliosis curves less than 30 degrees, and have no history of prior brace treatment.

What are the differences between the two braces? Can this one save money because it grows with the patient?

The traditional braces, by virtue of the fact that they’re rigid, are made specifically and customized in a sense to fit the child’s body. These braces are adapted and changed as the child grows taller and becomes heavier. Some braces last for nine to 12 months before they need to be changed. During an average course of treatment for idiopathic scoliosis in a young adolescent, I would expect to use three braces. The cost of the brace that’s offered by the Spine Cor company from Montreal is roughly half of the cost of the three braces that would be required. The brace consists of elastic straps and the cost of replacing the straps is very modest.

Got Your Back

About 80% of Americans suffer from a hostile spine at some point in their lives — from muscle spasms, pinched nerves, and aching kinks to chronic, debilitating disk degeneration. What’s more, your posterior side is a pain in the butt… literally. While other body parts isolate their symptoms to the origin of injury, your back often shares its misery with your neck, hips, buttocks, and legs.

Check out these nonpharmaceutical methods for backing up your back.

Be gentle: Swimming, walking, and biking achieve cardiovascular benefits without overstraining your back. Pull up on your abs during physical activity to strengthen your core and reduce tension on your lower spine.

Be Goldilocks: Find a mattress that’s firm but somewhat forgiving. If it’s too hard, it can precipitate stiffness; too soft, it can overarch your spine. Accommodate your back’s and neck’s natural curvature with support: If you sleep on your side, put a towel under your waist, a pillow under your head, and one between your knees; if you prefer to be face up, place a pillow under your knees and one under your neck; avoid sleeping on your stomach if you can.

Be manipulated: Chiropractic adjustments can take pressure off inflamed disks, restore posture, mobility, and function, and ease neural and muscular tension. Get a referral from your primary physician, then set up an initial consult to learn the chiropractor’s health philosophy.