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We often visit the doctor for lumbar or cervical pain and leave with an information sheet on spinal stretches. As a healthcare professional, I frequently ask patients if they are doing any exercise, and the common response is: «Yes, of course, my doctor prescribed some stretches, and I do them every day, but I still have pain…»

Let me make this very clear:

1. Stretching is NOT exercise.
2. Stretching is RELAXING and COMFORTABLE.
3. Exercise HEALS but requires EFFORT.

Conclusion: Healing takes effort.

Relying solely on stretching for temporary pain relief not only prevents healing but can also worsen the problem. In cases of spinal instability, which are more common in patients with poorly developed muscles, stretching only elongates and weakens the muscles further. Many patients report that stretching worsens their pain.

Therefore, stretching in isolation is not an ideal treatment; it should be combined with muscle strengthening and progressively and appropriately tailored to each case.

In general, definitive improvement of mechanical and muscular back pain will require high-intensity muscle strengthening. However, starting with high-intensity exercises is neither recommended nor usually feasible. Instead, a progressive workout program is necessary, utilizing stretching as a complement, intelligently, adapted to each patient’s pathology, morphology, and capabilities.

Here’s a summary of the key points:

• Stretching provides temporary relief but is not a cure for pain.
• Stretching can worsen spinal instability in some cases.
• Effective treatment for back pain requires muscle strengthening combined with stretching.
• A progressive exercise program tailored to the individual is crucial.

Remember, stretching can be a beneficial part of a comprehensive pain management plan, but it should not be the sole focus. Consult with a qualified healthcare professional to develop a personalized treatment approach that addresses the root cause of your pain and promotes long-term healing.

Back pain, especially in older adults, can become a debilitating condition. Advanced degeneration of the spinal elements can lead to incapacitating symptoms. In this article, we explore the challenges faced by older adults with spinal stenosis, herniated discs, and other factors that contribute to low back pain in this population.

Degenerative Changes and Spinal Stenosis

As we age, our backs and their segments undergo a series of wear and tear known as degeneration. This is a normal process that occurs over time. When we reach an advanced age, spinal stenosis may appear. Vertebral degeneration reaches a critical point where the elements of the back increase in volume and may begin to occupy the space through which the nerves must pass. The pain no longer only affects the back, but radiates down the legs, forcing people to stop due to the weakness it causes in the lower extremities.

Herniated Discs

Another issue that arises in adulthood is the appearance of herniated discs, which become more frequent as we age. A herniated disc is the result of a rupture of the vertebral disc, which can compress nerves as it exits the spinal canal, causing leg pain. Distinguishing between back pain and sciatica is crucial. Sciatica occurs when a nerve is compressed by some structure, either stenosis or a herniated disc.

The Importance of Exercise

Contrary to popular belief, a herniated disc itself does not cause pain. The presence of multiple herniated discs in a patient does not necessarily cause low back pain. They become symptomatic when they compress a sensitive structure.

One of the challenges is convincing patients with these ailments of the importance and necessity of exercise to compensate for this weakness in the disc. Combining medicine with physical exercise is a fundamental part of pain treatment.

Osteoporosis

Another common pathology in older adults that adds a layer of complexity is osteoporosis. The fragility of bones caused by their decalcification means that everyday tasks can result in microfractures. The simple act of bending down to open a drawer can put pressure on the vertebra and cause a fracture. When faced with severe back pain in patients around 70 years of age, the initial suspicion should include the possibility of a vertebral fracture, even if there is no obvious history of falls.

A Multidimensional Approach

Addressing back pain in the elderly is a complex and multidimensional challenge. From spinal stenosis to osteoporosis-related vertebral fractures, each case requires personalized treatment.

A few months ago, we encountered new diagnostic and therapeutic information on Premenstrual Syndrome (PMS) discovered and applied by Dr. Jorge Lolas. We have been reanalyzing the concepts of lumbago, cervicalgia, and women’s back pain as a whole. Of course, we do not ignore the traditional concepts and our accumulated experience throughout the years. This allows us to diagnose and treat spinal conditions whenever there is a treatable pathology. However, how many women go to see a doctor for lower back pain, dorsalgia, and chronic cervicalgia without an evident pathological substrate in the diagnostic tests? How many women are diagnosed with fibromyalgia when experiencing different types of pain? Why is fibromyalgia mainly manifested in women? Why are so many women hypersensitive to touch, to the extent of a sweet hug’s touch? There are also men in the same situation, but it is most common in women. It might be due to lesser muscle development, or higher sensitivity and tendency for women to suffer from stress due to family or work-related problems… but we are likely not considering other pathological processes, mainly because they are still unknown.

One of the most puzzling symptoms of PMS is low back pain. It is undoubtedly a type of dysmenorrhea that, instead of manifesting at the pelvis, is felt at the renal sinus. Patients visit their gynecologist because they associate it with premenstrual symptoms, at least initially. However, when the gynecologist does not find any problems (as usually happens), patients are directed to see a spine specialist, who may not find any issues, except by chance. An unsolved case…

Another common symptom is chronic cervicalgia due to muscle spasm, which is non-responsive to treatment on many occasions. Pain at the light touch of the skin is prevalent in severe cases. In these extreme instances, it is evident that other problems exist besides the muscle condition. It could be interpreted as a decrease in the pain threshold, indicating a pathological increase in the response of the skin and myofascial pain and tension receptors.

Why does the pain threshold decrease? There are numerous reasons. The psychogenic factor is among them and is currently the most significant. However, there are many inflammatory mediators that modify this parameter. When considering women and Dr. Lolas’ theory, the causal factor for pain hypersensitivity, never previously taken into account, is the increase in circulating prostaglandins. Where does this excess prostaglandin originate? A swollen cervix acts as a remarkable prostaglandin factory, generating an inflammatory and hyperalgesic state throughout the body, among other changes, including neuropsychological ones. It is intriguing that treatments for inflammatory processes exist in various body parts. Why has cervicitis been the only body inflammation that doctors have overlooked?

Definitely, cervical inflammation might cause back pain (and other symptoms). Fortunately, there is a treatment.

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Our Spine surgeon, Dr. Ferrández, one of the most experienced Spanish surgeons on lumbar and cervical anterior approaches, has been interviewed about total disk replacement by Jamie Litrun, the director of the most quickly growing Facebook group of spine patients.

Watch the interview here and learn about the indications, advances and limitations of this restoring technique.

Chilean Dr. Lolas' theories on the infectious origin of Premenstrual Syndrome and Premenstrual Dysphoric Disorder have been summed up in an article now published by the northamerican Open Journal of Obstetrics and Gynecology. Our team is treating PMS patients following this approach since october 2014, and has proven its success and permanent results in more than 40 women treated so far.

Download Lolas' paper here

Read more here…

Our Medical Team travels to Chicago for the AAOS symposium. A meeting with SpineMark representatives is scheduled, as well as with different spine surgeons from the US and Europe. First contact with Mazor Robotics, the first company developing a robotic arm for spine surgery, is also in the agenda.

SpineMark, the Californian company for networking of spinal centers is trying to establish in Spain. Marcy Rogers forsees great business oportunities in the country, as northamerican regulations make it harder for medical device companies and doctors to develop new implants or techniques. Spain is an ideal environment in Europe for scientific trials, implant testing and medical tourism. Medical services meet the highest standards, local doctors are well trained and regulations allow for foreing doctors to practise under certain criteria.

Dr. Akbarnia was invited for a presentation and surgical discussion within the context of SpineMark's new venture in Spain. He talked about his recently tested magnetic growing rod for early onset scoliosis, as well as new approaches to spine deformities in elderly patients.