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Archive for the ‘Pain Management’ Category

Scoliosis, or the sideways curvature of the spine, can cause back pain. The medical community has struggled to find an effective treatment for this type of pain, with most doctors believing that surgery is the only way to reduce the curvature. If you are unwilling to have surgery, then, you are left with pain medication to mask your symptoms and leave the causes untreated.

Fortunately, there are conservative treatments that not only ease the pain of scoliosis but actually reduce the curvature as well.

Why It Hurts

While some people with scoliosis experience no symptoms, others may experience back pain, neck pain, headaches, difficulty walking or standing for long periods of time, reproductive dysfunction and difficulty breathing. The symptoms depend largely on the location and degree of curvature, but also on your behaviors. If your head is off-center or one shoulder or hip is higher than the other, you may have scoliosis.

Some are treated in adolescence with bracing and surgery to reduce the spinal curvature, while others go untreated. Adults who experience scoliosis pain may feel it from muscles, spinal discs or both. The muscles of the back try to pull the spine back into alignment so they can return to their normal length and tension. These muscles are constantly overworked, trying to support the upper body without a stable spine to help. The discs of a curved spine also undergo asymmetric loading, which can cause bulging and herniation. These disc problems are often associated with nerve impingement, causing sharp, traveling pain.

Adults may have scoliosis from birth, or may acquire it due to osteoarthritis (if one side of the spine’s joints deteriorate faster than those on the other side). Those who acquire it will have added pain due to joint inflammation and friction.

Natural Treatments

If your doctor tells you that your only option is surgery, he or she may be wrong. Scoliosis pain has been shown to decrease with chiropractic care and physical therapy. While many doctors prescribe physical therapy as part of a pain management strategy for scoliosis, combining it with other treatments is not always considered. Contrary to what most seem to think, these treatments have proven their abilities to reduce spinal curvature as well as back pain.

Physical therapy is effective for scoliosis pain when it focuses on the relaxation of chronically-strained muscles and postural retraining. Yoga, for example, may be helpful. Chiropractic care is administered to restore alignment and improve nerve function.

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Multidirectional instability of the shoulder, MDI for short, refers to symptomatic instability of the shoulder and more than one direction. Typically this involves either anterior or posterior instability based on which direction involves the most symptoms. Activities that are repetitive such as baseball pitching, swimming, gymnastics or volleyball may lead to a gradual soft tissue elongation in young patients and resulting instability. Along with the anterior or posterior instability, most patients have symptoms from instability of the inferior glenohumeral joint.

Multidirectional instability is more common in patients who are female and in younger athletes. Often times patients are not able to point to a discrete incidents of trauma or a frank dislocation. The initial symptom that patient experiences may simply be pain which may make it difficult to diagnose. With activity however, patients may experience a dead arm, numbness and tingling in the arm, weakness or early fatigue.

On physical examination patients may have increased translation of the shoulder downwards. Also a physical examination there are multiple tests that the orthopedic surgeon can perform to see if instability is symptomatic anteriorly or posteriorly. Sometimes patients of multidirectional shoulder instability also have hyper laxity in general so this should be evaluated as well.

Additional diagnoses that should be looked at in patients where multidirectional instability is thought to be occurring include impingement syndrome, rotator cuff tear, thoracic outlet syndrome, biceps tendinitis, and cervical disc herniation.

MDI treatment should be centered around dedicated physical therapy. Strengthening and endurance of the rotator cuff along with the muscles around the scapula should be the focus of this treatment. As opposed to traumatic unidirectional instability, patient to have MBI experience much more success with physical therapy. If the patient fails 6 to 12 months of considerable conservative treatment, surgery can then be opted for.

Successful surgery for MDI has included both open and arthroscopic techniques. One of the procedures is called an open capsular shift procedure where the orthopedic surgeon decreases the volume of the joint to increase stability. This procedure remains the gold standard for treatment of MDI. However, arthroscopic surgery results have improved dramatically over the years and now rival those of the open capsular shift procedure.

The results of capsular shift procedures have shown it produces over a 90% long term shoulder stability. The overall excellent results are just over 60% with an additional 33% having good results. So the good to excellent surgical results approach close to 95%.

Along with a capsular shift procedure, additional considerations may include a procedure to close the rotator interval. This is typically an add-on to an inferior capsular reconstruction when a patient has instability in that inferior direction.

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