Dr. Sean McCance - NYC Orthopedic Spine Surgeons' Blog

A Look at Spinal Manipulation Therapy and Back Pain

If you’ve ever been to a chiropractor or had a professional “crack your back,” you may have been a recipient of spinal manipulation therapy (SMT). Spinal manipulation, also called spinal manipulative therapy or manual therapy, is used in both Western and traditional East Asian medicine; in North America, it’s typically performed by chiropractors, osteopathic physicians, and physical and occupational therapists. Over 100 types of adjustment techniques are known throughout the world, but typically chiropractors will focus on eight to 10 varying approaches within their practice. Spinal manipulation therapy uses force, while spinal mobilization therapy is gentler. Some conditions such as osteoporosis, the patient’s size, or simply patient comfort may require spinal mobilization therapy. Chiropractic treatment can be extremely effective for acute neck or back pain due to muscle spasm, strain or sprain, and inflammation. If you’ve never experienced it before, it can be surprising just how much force can go into the manipulation of different joints of the spine. The most frequently used technique in SMT is the high-velocity low-amplitude thrust, which often results in an audible “pop.” A more sophisticated technique relies on using a flexion distraction technique that is somewhat gentler and safer. The goal of these techniques

April 8, 2015

Acupuncture and Back Pain

Does acupuncture work for pain relief? It’s a question that’s been debated by the medical community for some time, but of late, more and more physicians have come down on the side of supporting it, or at least maintaining that it does no harm. In 1998, the National Institutes of Health (NIH) stated that there was enough evidence to show that acupuncture has beneficial, pain-relieving qualities for adults suffering from postoperative dental pain, the nausea of chemotherapy, lower back pain, headache, myofascial pain, osteoarthritis, and carpal tunnel syndrome. There have been several important studies that report acupuncture is effective in reducing chronic pain. Most recently, a study in the Journal of Clinical Pain suggests that people being treated for lower back pain with acupuncture are less likely to gain benefit from treatment if they have low expectations for its effectiveness – an interesting twist to the earlier findings on pain relief. Emotion and attitude seem to have quite an impact on acupuncture’s efficacy. Dr. Felicity Bishop, author of the study, wrote: People who started out with very low expectations of acupuncture – who thought it probably would not help them – were more likely to report less benefit as treatment

April 1, 2015

What Spring Training Means for Back Injuries

It’s springtime again – or nearly there, anyway – and all sports fans know what that means: spring training and the return of Major League Baseball’s players to their winter training grounds. Unfortunately, as players come back to the stadiums, they also return to a heightened risk of back injury. Commonly known as overuse injuries, these lower back injuries can be subtle and usually occur over prolonged periods of time. They are the result of repetitive micro-trauma to the tendons, bones, and joints, typically caused by training errors involving a too-rapid acceleration of the intensity, duration, or frequency of a given activity. Studies show the majority of injuries occur in the beginning of the season due to lack of conditioning in spring training. These injuries decrease steadily each month starting in April and going through September, the first and last months of the season. According to Dr. Douglas Comeau, a sports medicine physician and assistant professor at Boston University School of Medicine, the most common injuries among fielders include hamstring and groin strains, and pitchers tend to strain or tear ligaments in the elbow or rotator cuff. “Major league baseball players might not take spring training seriously, but then need to play a whole game in

March 25, 2015

9+1: Derrek’s Patient Experience

Derrek is a patient of mine who has left a lasting impression – he recently ran his first half marathon after having a 2 level spinal fusion (see his xray to the left). He is a great example of patients who become more physically active after a spinal fusion than they were before, which is a common experience in our practice. Derrek’s back pain began eleven years before his surgery, when one day he woke up with terrible pain in his back. Over the course of the eleven years, after all else failed, his condition deteriorated to the point where he considered surgery. Failing to get the answers he was looking for after speaking to a doctor specializing in psychosomatic symptoms, Derrek came to my office. Here’s what he had to say about his experience: “Dr. McCance really did a great job explaining everything to me and my wife. He told us that surgery is what needs to happen now, or something much worse will happen later. “What I’m most impressed by is that Dr. McCance even explained the differences between psychosomatic therapy and surgery to my wife. He answered all of our questions and gave us two solid options.” Derrek’s options were

March 17, 2015

AARP’s Surgeries to Avoid

An AARP article that discusses common surgeries to avoid – including spinal fusion – has recently made its way back into the headlines. Specifically, it cites studies that show the frequency of this procedure has increased 1,400 percent between 2002 and 2007, and does not appear to be slowing down. The article suggests that the surgery is dangerous and is no more effective than physical therapy, which is inaccurate and misleading. Spinal fusion involves the joining of two or more vertebrae together, using screws and rods along with bone graft material, and sometimes cages (devices that support the vertebra). These techniques provide strong support for the spine, as well as correction of alignment and protection of the spinal canal and nerves. While spinal fusion has increased in frequency, in my experience it is a safe and highly effective treatment for patients when performed properly and for the right diagnosis. The key to success is careful selection of the patients who need a fusion (i.e., performing the procedure for the correct diagnosis), and also performing the surgery carefully to achieve maximal success (i.e., achieving a solid fusion). Where patients and doctors get into problems is when the procedure is performed for a

March 10, 2015

10 Years Later: James’ Patient Experience

Meet James, a former patient of mine. James’ story began when he was lifting paving stones and felt a sudden shooting pain in his back, eventually traveling to his legs and toes. Knowing something was wrong, he immediately consulted a physician, but doctor after doctor couldn’t figure it out. He had undergone prior surgery for a herniated disk about 15 years ago. After receiving five different opinions with no clear answer, James was left with more uncertainty: “Five different guys didn’t seem clear on where my problem was. They thought it was scar tissue from a previous surgery I had 15 years ago or a herniated disc. Three of the doctors consulted each other and thought some kind of implant would be best for me.” James continued to look for someone who could provide a better answer. He didn’t want rods put in his back. When a friend recommended my services, James did his research and made his appointment the next day. What I did differently from the previous doctors was to get a high quality MRI and special Xray views. Once I got the results back, I assured him that the pain was not due to scar tissue left

March 3, 2015

Winter’s Effect on Back Pain

It’s no secret that this winter has been unbearably cold. With record lows this February in many cities along the Eastern Seaboard, including here in New York, you might be wondering: what exactly is this bitter cold doing to our backs? Winter in itself can make your joint pain worse – and in some cases it can be debilitating. In fact, some people with rheumatoid arthritis and psoriatic arthritis suffer from cold allodynia, which means they can predict approaching colder weather by how much pain they are in. In colder temperatures, the tissues in your body shrink, causing them to pull on nerve endings, which for many can result in joint pain. Also, cold weather can lead to muscle tightness, exacerbating lower back spasm. Additionally, many cold weather activities can cause back aches and pain – from the repetitive bending and twisting associated with shoveling snow to the chance of slipping on a sheet of ice, winter-related slips and falls are highly common. With Winter Storm Pandora on its way out and the potential for more still on the horizon before spring finally hits, protect yourself from extra pain with these helpful tips: Bundle up, including layers, hats, scarves, and

February 24, 2015

Regenerative Cell Therapy

Regenerative cell therapy is a major next step in medical research, with the potential to effectively treat the most complex diseases – including various forms of cancer. Researchers studying regenerative cell therapy look at both how stem cells may be used to replace, repair, reprogram or renew your diseased cells, and at how reprogrammed stem cells may be turned into specialized cells that can repair or regenerate cells. It has the potential to change the outcomes for patients who are left with little time and very few answers. In regenerative cell therapy, function is restored in damaged or destroyed tissues, rather than producing a new organ. This can be done either by intravenously injecting cells into damaged tissue or by inducing self-repair by recruiting from the patient’s own highly functioning tissues. There are a few different types of cells with various effects used in regenerative cell therapy, including: Induced pluripotent stem cells (iPSCs) – Cells that are taken from adult tissue and are genetically altered to behave like an embryonic cell. Embryonic stem cells (ESCs) – Cells that are taken from the inner mass of a blastocyst and have the potential to become any kind of tissue within the body.

February 17, 2015

How Weight Loss Can Affect Back Pain

Sure, it’s easier to gain weight than it is to lose it – but at what cost? Studies show that a healthy diet and exercise can help combat obesity and metabolic disease, and prevent future back problems. Weight loss can improve back pain for both men and women of all demographics. I have many patients who have successfully improved their chronic back pain with weight loss and regular exercise. Physical activity increases the exchange of nutrients between spinal discs and other spine structures. When an individual doesn’t participate in enough physical activity, the spinal discs are deprived of the nutrients needed to stay healthy and strong. Increased body weight causes extra stress on the lumbar vertebrae, facets joints, and disks, which can lead to increased rates of injury and pain. People who have difficulty losing weight and keeping it off are at higher risk of developing osteoarthritis, a chronic condition that causes sore or stiff joints due to the breakdown of cartilage that cushions those joints, especially when their BMI is too high. Major Benefits of Weight Loss More energy to participate in everyday activities Potential for improved body/self confidence Lower propensity for stiffness and weakness of joints Minimized recurrence of lower

February 10, 2015

Back on the Dance Floor: Kathryn’s Patient Experience

Kathryn is a former patient of mine who has left a lasting impression. Her back pain began when she hurt her L3/L4 disc after a spinning class, and she believes she aggravated the injury during a subsequent game of golf. Initially, Kathryn told me she didn’t think too much of it because she’s athletic and used to pushing herself outside her comfort zone. Kathryn thought this was something she could deal with – so she sought a massage treatment, iced her lower back area, and rested. Afterwards, she continued to play golf and attend spinning class. Unfortunately, what Kathryn didn’t do was listen to her body and get help when she needed it. I see this in a lot of patients; a good rule of thumb is if the pain persists, starts to travel down your arm or leg, and/or keeps you up at night, it’s time to see a physician. Unfortunately, the pain took a turn for the worse when Kathryn further exacerbated her injury lifting a mattress while vacuuming. Kathryn contacted my office and met with me to discuss different options that would work for her injury. Because she had severe nerve compression in her lower back due

February 3, 2015

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