Dr. Ronald Lieberman’s Delaware Spine Institute To Support Our Troops And Give Back with Free Back Exams to All Military Veterans and Personnel All Day.

WHO: Dr. Ronald Lieberman, a Leading Physiatrist, Board Certified in Physical Medicine, Rehabilitation and Pain Management, and a Nationally Recognized Leader in Acute and Chronic Back and Neck Pain Solutions. Voted Best Doctor in 2010.

WHAT: FREE Back Exams on Air Force Day for All Military Personnel and Veterans in the Greater Dover Community

WHERE: Delaware Spine Institute, 1673 South State St., Dover, DE 19901
(The Mill Stone Office Complex across from Moores Lake)
T: 302-674-8444

WHEN: Monday, August 1, 2011, By Appointment, 9 AM – 5 PM

WHY: Dr. Ronald Lieberman will celebrate the service of all military in the Dover community and give back with free back exams for all branches of the military in the community, especially Dover AFB Vets and current personnel on August 1, 2011, which is National Air Force Day. All military personnel of every branch, including veterans are welcome for a free back exam with proof of service in any branch of the U.S. military. The free back exams will be given by appointment only on a first come, first served basis. Please call today to secure an appointment on 8/1/11 by calling 302-674-8444.

ABOUT THE DELAWARE SPINE INSTITUTE

The Delaware Spine Institute, founded by Dr. Ronald Lieberman, is committed to providing expert spine (neck and back) care to the Dover and greater Dover region. We specialize in proactive treatment plans paired with non-surgical therapies. We specialize in treating patients with acute and chronic back and neck pain with or without nerve injuries or sciatica, as well as the chronic form of similar problems originating from spinal arthritis. The Delaware Spine Institute offers state-of-the-art techniques and holistic solutions for our patients, empowering them to return to the daily activities they enjoy. Visit http://www.de-spine.com for more information.

MEDIA NOTE:

Please share this week with your media audience. Thank you! In addition, the media is encouraged to cover this community service minded event and learn why Dr. Lieberman decided to give back and support our military and why this is so important for residents in the Greater Dover community.

The spring and summer seasons allure many of us to be more active than previously before in the winter. Many of us enjoy gardening and mowing the grass. Others would rather hire someone else to do it in order to free up our limited time to participate in sporting activities and enjoying one of most fulfilling simple things to do in life; playing catch with your child.

It turns out that we can use the mechanics of the golf swing as a wonderful model to help us understand what needs to be done to both condition and protect ourselves from back and neck pain from practically  any other movement.   We can also extract specific components of the golf swing and apply them to yard work, clamming, fishing, pulling weeds, shoveling dirt, starting a lawnmower, throwing out the trash or a water balloon. We can further apply the golf swing model to most summertime sports including basketball, soccer, Frisbee toss, inline skating and volleyball.  If we really think about it,  all activity  movements that require bending and twisting are observed in the golf swing.

An old friend and colleague, Gary Gray, who happens to be a very well known physical therapist, shared with me some amazing observations of how the spine handles the stress of a golf swing, allowing us to understand what the back does with any particular activity. He coined the term “golf swing faults and body fixes” to mean that when you watch the flaws of someone’s golf swing, they usually manifest from unhealthy movement substitutions for those that the player is unable to execute. When joint movements above and below the back are smooth and equal from one side to the other, coupled with a spine that is encased with a strong surrounding core of muscles i.e. the muscles that run from the knees to the chest, there is a minimal stress reaction to the spine. Otherwise the increased stress to the individual spine segments and components from repetitive motion wear and potentially cause pain. For instance, for an effective golf swing, the hip and trunk muscles require the flexibility and strength needed in the back swing and coordination where the middle back twists faster than the back and hips to allow full coiling of the trunk in the windup phase of the swing. If the hamstrings are tight, the quality and extent of this motion will be poor, leading to suboptimal follow through and a less powerful stroke. If there is muscle tightness in the back of the left shoulder, the same consequences will ensue. Unhealthy golf swing movements reflect unhealthy movement patterns that adversely affect the back and neck, which will replicate with any other activity that requires twisting, bending, pulling, pushing throwing and or swinging. Before we map out which spine structure  is causing a patient’s pain with an Interventional  spine  injection procedure, we work together with a physical therapist to identify orthopedic problems similar to the above conundrums.

For instance, a few months ago we saw a 68 year old male named George who was an avid golfer up until he underwent lumbar discectomy 2 years ago. His biggest complaint was that his back pain not only prevented him from playing 18 holes, but the severe back  spasms he developed from his long game interfered with his concentration and posture for his short game. After carefully listening to him, we noted on his physical examination that the muscles that twist the hips were extraordinarily tight. He had marked tenderness over the right sided back joints (facet joints). I asked him to demonstrate his golf swing for me and sure enough, in both his windup and follow through, most of the twisting occurred in the back and not at the hips. I had him see a physical therapist for corrective exercises to address this issue, but despite his improved flexibility, his back pain persisted. The MRI of his back showed that he had significant arthritis of the facet joints at the same level of his prior surgery. This is not surprising because once part of the disc is removed, its torque converting ability becomes compromised and thus shares more of its load with the joints behind it. These joints, through wear and tear as well as  age,  develop arthritis. After taking him to the Interventional spine pain procedure room, we were able to identify the joints in question that were causing his pain through the use of x-ray guided injections of anesthetic onto the actual nerves that allow those joints feel pain.  Although the relief was temporary and reproducible, the result allowed us to apply a specific solution to the problem in that we mapped out the structural cause of his back pain, namely the right sided facet joints. .  Through the judicious use of a procedure called Radiofrequency neurotomy, we were able to cauterize the nerves that were previously anesthetized, freeing him of his back pain and allowing him to return to play in a way that was quite gratifying.

So we can see that there are many layers of potential problems to a patient’s back pain that not uncommonly go overlooked or unappreciated that mandate unbridled attention to detail.

For any treatment in medicine that is offered, coupled to what the treatment has been proven to do is something called the placebo response. This means that sometimes a patient will believe they feel better from what a doctor has done for them but it really has nothing to do with what was done. You’ve heard of people taking sugar pills for various ailments and feeling better.

When you hear about an alternative therapy, consider that it is one that is “believed” to help. That is the key word, because there is otherwise no science behind it to really prove that it is truly helping. One of the reasons for this is that the patient’s problem is not clearly identified, therefore there is no problem directed solution. For example, cupping is “believed” to help constipation, diarrhea, menstrual cramps, weight problems, back pain, pinched nerve pain and headaches by using suction cups to cause intentional bruising and bleeding to “get the toxins out” amongst other beliefs. Blistering, burns and platelet problems have been reported in association with cupping.

Back in the old days, patients would see their family docs for a B12 shot. They’d “feel better” afterwards. Why? Did they have their B12 levels tested before and after the shot to find that they were deficient and had levels that were brought to normal? Of course not. They expected and believed that they felt better to a non-specific “treatment” that had nothing to do with why they felt better. Let’s not forget that the Shaman’s of an Indian tribe are believed to communicate with the spiritual world to “mend the soul” to treat various ailments, but fortunately there aren’t any bad side effects except for disappointment. The placebo response is abound and invites all types of “alternative therapies” to be offered. Can I interest you in a copper bracelet?

So, from a holistic point of view we first need to look at what can be done to prevent excess stress on your back when you are shoveling: Depending on your fitness level, if you are in poor shape, it might be best to avoid it all together for heart reasons as well, for which you should at least arrange for assistance before the storm actually hits.

Now what I’m about to say might be overly simple, but just like anything else, the basics are there for a purpose

• Obviously if you develop sudden low back pain, stop and get some help
• Just as though you are doing an exercise routine you need to pace yourself in how quickly,   how much actually lifting and the amount that you are trying to accomplish in a particular amount of time.  The take home point is:  take rest in between sets!
• Please make sure that you use salt or sand on icy areas and use boots with good traction,  otherwise  you’ll slip and jerk your back.
• Make sure your clothes are loose and unrestrictive and that your gloves give you a good grip , otherwise you wont even realize that you’re compensating or using “body English” to get the job done at the sacrifice of your back
• Try to use a shovel with
  • • a curved handle, which will help to keep your back’s curve in its normal position
    • a plastic rather than metal blade or even  a smaller blade for ease of less heaviness
    • that’s made to push rather than lift the snow since it’s easier to push than lift snow
    • a lubricant on the blade so it slides off easier

As far as using a technique that is similar to be aware of that is similar to doing a squat or dead lift:

• Maintain the normal curve of your back ; if u pitch forward and don’t bend your knees, you will  get injured
• Try to stretch out your leg and hip muscles before going outside. This should be a part of your daily exercise routine anyway and warrants a visit to your local physical therapist if you don’t know how.
• Grip: In order to disperse the weight of the snow, just like on barbell you don’t want your hands too close together. Hands further apart will give you more leverage with your lift.
• Keep the weight close to your body i.e. the further outstretched the shovel is from your body, the more torque stress is placed on your back.
• As u bend your knees and lift with your legs  twist with your hips and throw with your arms in order for you to safely load and unload the weight of the snow through your legs, hips, trunk and arms using multiple muscle groups  with the weight of the snow and not just your back
• Do not throw the snow over your shoulder since this will not disperse the weight the way I just described
• Try to get it done sooner rather than later since fresh snow is lighter

If you don’t take into account these precautions, you can herniate a disc and develop sciatica, injure a joint or disc and suffer severe back pain without sciatica, putting you out of work or from participating in your favorite activities.  In fact today we saw a former police officer who was recently removing snow from his driveway who was doing fine up until he increased the rapidity of his shoveling when he developed severe back pain that suddenly” grabbed him”.  Now he can’t stand, lift or perform in the bedroom without severe pain.

So when you end up coming to us we’ll get you back to your usual activity level using a nonsurgical holistic approach. Firstly we would place you into a physician directed physical therapy program. If you are still without relief, we would next define the specific structure in your back that is causing the problem. We do this through very carefully placed x-ray guided injections to spine, using an ultra-skinny needle as a surgical tool but without the surgical incision. If you are lucky enough not to have sciatica or a disc herniation, we can numb up different joints in your back with a drop of Novocain like your dentist uses or by pressurizing some of your discs with fluid if necessary if numbing of the joints do not take your pain away temporarily in order to weed out the source of your pain.  That way we focus structure specific treatment with a customized rehab program that makes sense, rather than a one size fits all approach. If you do have sciatica from a ruptured disc pinching a nerve, we can gently place cortisone around it, again using x-ray guidance to make it easier  for you to rehab your back.

If you don’t follow this advice during the winter, you may end up losing time at work (who can afford that especially nowadays?), missing opportunities that might have otherwise enriched your life such as playing with your kids, going on a dream vacation, driving to see a loved one for happy or health reasons, or even missing out playing in that sport or participating in that hobby that you so love to be part of. Who would want to deal with the extra burden of a nagging disc herniation, a pinched nerve with leg pain, a back joint injury, or torn ligament and muscle? Why would anyone want to deal with that distraction?

A great majority of the topic centered around hyperalgesia (increased pain sensitivity) associated chronic back pain, which is  something we frequently see.  We discussed that having patients with back pain see a specialist early if they arent feeling better after 4-6 weeks of therapy and analgesics is critical to long term outcomes. I am hopeful that by raising awareness to primary care physicians and the public that early proper diagnosis and treatment tends have a strong influence as to whether or not patients will experience the very unfortunate outcome of hyperalgesia will have some impact on saving quality of lives. All too often we see patients having narcotics thrown at them which only grow another problem to be layered on the first….

Typical co-pay plans have become a huge burden on health insurance carriers because they result in a higher frequency of visits; some of which could have been avoided with the implementation of healthier lifestyle choices and readily available over-the-counter medication.

The most important aspect of the HSA is their connection to a network of docturs and hospitals, called a PPO Network.  These insurers pre-negotiate pricing for every possible procedure that a doctor or hospital can provide.  With pre-negotiated rates, the insured’s burden is greatly reduced while maintaining quality care.

Our patients benefit from our ability to quickly diagnose the source of their pain and then implement practical and effective treatments.

We specialize in treating patients with acute neck and back pain with or without nerve injuries or sciatica, as well as the chronic form of similar problems originating from spinal arthritis. Delaware Spine Institute offers state of the art techniques to our patients, empowering them to return to the daily activities they enjoy.

Our unique range of services, dedicated staff and coordinated expertise allow us to optimize the overall function and well being of our patients making us the best resource for back and neck care.