Your Back Pain Checklist By Dr. Connie D’Astolfo, DC, PhD (candidate), Spine Care ExpertIs your back pain self-limiting or do you have a more serious problem like Spinal Stenosis?

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Upcoming Health WorkshopsAll Workshops are FREE and held on Thursday evenings at 7:00 pm

Location: 7611 Pine Valley Drive, Unit 1, Vaughan L4L 0A2January 16, 2014: Learn about the Risks of Spinal Stenosis and other Chronic Back Pain Conditions and how you can manage this Condition~ Dr. Connie D’Astolfo, DC, PhD (c)

RSVP’s: Space is limited. Please register early to reserve a seat by contacting Anita

at 905-850-7746 ext. 0 Refreshments will be served

Back pain can self-limiting and it can also be a sign of a more serious medical problem. What is causing your back pain?Do you have a more serious back condition than you thought? Do you have back pain for more than 3 months? Are you under 20 or over 55 years old? Do you have leg pain? Do you have numbness/tingling or weakness in your legs? Do you stumble, fall or have problems with balance and stability? Do you have mid-back pain? Is your back pain due to recent trauma, like a car accident? Do you have changes in bowel or bladder function? Do you have back pain with no apparent cause? Do you have pain at night? Do you find yourself taking excessive pain medication for your back pain? Are you suffering with depression or anxiety due to your back pain? Have you stopped working or doing your regular activities due to your back pain? Are your symptoms unaltered by body position? Do you have a previous diagnosis of cancer? Do you have recent or significant weight loss?

There are hundreds of causes of back pain, from simple sprain/strains to disc herniations, spinal stenosis, fractures or even cancer. In some cases back pain is considered benign and self-limit-ing, meaning it will resolve without therapy over a course of a few days or weeks. This is typically seen in most cases of minor spinal sprain/strains. Your back may feel stiff and achy from sitting too long at your desk or improper sleeping postures. In these cases, stretching, hot baths and spinal stabilization exercises will usually assist with recovery. When back pain persists over a few weeks, a comprehensive examination of your spine by a Spine Expert is required. Back pain in these circumstances may result from more serious injury to joint tissue, bone or may be a cumula-tive effect of multiple injuries, dysfunctions and disease. Back pain may also be a consequence of referred pain from an internal organ such as the digestive tract, pancreas or gall bladder or may be a co-morbidity associated with another illness (most commonly depression, anxiety, di-abetes, heart disease and obesity). In fact, back pain is now considered by the World Health Or-ganization as a “chronic disease” because of its complex nature and the huge impact it has on our health, productivity, our economy and qual-ity of our life.Typical warning signs of a potentially life-threatening problem from back pain include bowel and/or bladder incontinence or progres-sive pain, numbness/tingling and weakness in the legs. Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e.g. fever, unex-plained weight loss) may also indicate a serious underlying medical condition. Back pain that occurs after a trauma, such as a car accident or fall, may indicate a bone fracture or other in-jury. Back pain in individuals with a history of cancer (especially cancers known to spread to the spine like breast, lung and prostate cancer) should be evaluated to rule out metastatic dis-ease of the spine.With Canada’s aging population, there are an increasing number of people diagnosed with age related Spinal Stenosis. And more and more are coming in for treatment with Dr. Connie D’Astolfo at SPINEgroup, Vaughan’s leading Spine Centre. Most of our patients with the condition are in their 60s and older, though it can also occur at a younger age if you have a small spine, certain congenital abnormalities, or conditions like dwarfism. Baby Boomers represent a large number of our patients. It is important to stay active and Baby Boomers want to continue to stay active through delayed

retirement, sports, hiking, and active vacations. The demand for spinal stenosis treatment is go-ing up because the Boomers want to stay active, healthy and pain free.

SPINAL STENOSISWhen I see an older person in a grocery store leaning on a shopping cart as they shop, I know there’s a very good chance the shopper has spi-nal stenosis. It is not unusual for people with spinal stenosis to feel less back and leg pain when leaning forward onto a shopping cart or a walker. Leaning forward stretches the spine to relieve some of the stenosis. Leaning back or prolonged standing hurts more because the spine is compressed. The MRI images above depict spinal stenosis and compression of the spinal cord caused by an injury to the spinal disc.

What is spinal stenosis? Spinal Stenosis occurs when one or more seg-ments of your spine narrows, compressing the spinal cord, nerve roots and vasculature within the spinal canal. Spinal stenosis is typically caused by bone (calcification) and ligament over-growth as well as degeneration or thinning of discs, triggered by osteoarthritis, causing pain, numbness, tingling and weakness in the legs and back. Blood supply is also diminished due to this pressure. Other causes may include disc injuries, including herniations (when a disc protrudes into the spinal canal), lack of flexibil-ity in the spine or spinal tumors In early stages some people have mild symptoms, however the majority of patients in more advance stages of spinal stenosis present with debilitating and disabling symptoms that affect their everyday life. Usually symptoms begin gradually and worsen with time. The main symptom is leg pain or cramping when you walk or stand for a period of time. Sometimes the discomfort is worse when walking uphill or standing. In other cases the pain is worse when you walk down a hill but improves when you sit. Symptoms also can include numbness in the feet, pain in the back, shoulders, neck or arms and incontinence. Many people with spinal stenosis find that they can only walk a couple of blocks before they have to sit down to relieve the pain. People start to walk shorter and shorter distances until they can hardly walk at all.Spinal stenosis happens gradually. And that is exactly happened to one of my patients (we will refer to as Mr. Jones). Mr. Jones, a semi-retired executive had back problems for over 15 years. Over the years he had undergone two unsuc-cessful disc operations and received several ste-roid injections in the spine to manage the pain.More than a year ago Mr. Jones began expe-riencing severe leg and foot pain after getting out of bed one morning. Once he got moving, however, things seemed to feel better so he ignored the pain for a while. Over time, how-ever, the pain became worse and he began to develop numbness/tingling and weakness in both legs. This past July the pain was so severe that he could barely walk anymore and had to stop working. Mr. Jones feared his sedentary

lifestyle would lead to further muscle weakness and other conditions such as heart disease, dia-betes and obesity in the long term. Mr. Jones learned about Dr. D’Astolfo’s exper-tise in managing complex spine disorders and made an appointment to consult with her at SPINEgroup. He began treatment immediately. Our Spine Center has developed an intensive rehabilitation program for Spine Pain disor-ders including spinal stenosis. Recently exer-cise based programs for back pain referred to as “boot camp” has been receiving great deal of interest in the media. Similarly, our program aims to improve mobility and quality of life and potentially stave off surgery. We thoroughly diagnosis our patients and test physical func-tion to identify areas in need of improvement. These areas are then the focus of an intense re-hab program focused on self-management. Our patients’ hard work is often rewarded with a marked improvement of physical abilities and reduced pain.

Our Unique Spine Care ProgramOur unique treatment approach ensures that you will get better faster at the least cost with-out long term dependency on pain relieving drugs. Our program is unique in the rehab in-dustry and very successful. Because of this we often receive referrals from family physicians, orthopedic specialists and long term disability insurers. Patients regularly travel from outside

lifestyle would lead to further muscle weakness of the GTA and province to access our services. The Spine Care program has an extremely high success rate for some of the most complex spi-nal injuries and conditions including herniated discs, moderate to severe degeneration, spinal stenosis, based on our evidence based, team modelled, self-management approach.

Our program combines manual manipulation, extensive exercise “boot camp” type condi-tioning through various exercises to improve strength, stability and flexibility, motivation training and psychotherapy for chronic pain and use of various modalities, like dietary counsel-ling, ultrasound and laser therapy to facilitate tissue healing. In appropriate cases, mechani-cal spinal decompression therapy will be used to maximize flexibility and space in the spine canal. It has been shown that even millimetres of space increased within the spinal canal may reduce pain significantly, allow for proper blood circulation and prevent the need for surgery in some patients.For self-management training, patients are in-structed to protect their spines by exercising regularly, maintain good posture, learn how to pick up heavy items correctly and maintain proper weight. Dr. Connie D’Astolfo is a recognized expert in spine pain disorders. She is currently leading a study with a large medical institution in Toronto to demonstrate the effectiveness of this spine program with complex seniors and to better un-derstand the association of spine disorders like spinal stenosis with other chronic diseases such as diabetes, hypertension, obesity and depres-sion.

Dr. Connie D’Astolfo, DC, PhD (c) is the clinical di-rector of SPINEgroup ®, a rehabilitation clinic locat-ed in Vaughan. Dr. D’Astolfo is a clinical expert in the diagnosis and management of back pain and is only one of a handful of chiropractors completing a PhD. She has several published peer reviewed articles and is a chapter author for two medical texts. For more information contact us at 905-850-7746 or visit our website at www.spinegroup.ca