But many doctors, physicians’ assistants and nurses find that while they can help these patients with their medical problems and physical recovery, treating someone with a work injury presents a unique set of challenges – not all of them medical.

Indeed, injured workers and their families must deal with a host of issues as they try to heal and rebuild their lives after being hurt on the job. There are emotional and financial burdens, and a seemingly endless amount of bureaucratic red tape to navigate when filing a workers’ compensation claim.

Additionally, injured workers face tremendous external pressure from family members, coworkers, employers and insurance companies to return to work so they can start earning a paycheck again. It’s also not unusual for injured workers to pressure themselves to return to work before they’re physically ready because they feel obligated to do so or feel “less than” because they’re out of work and collecting unemployment benefits.

When we started the Deuterman Law Group six years ago, one of our founding principles was that we would treat clients as people, not as cases, and that we would attend to the whole person. It’s our job to ensure not only that our clients receive the maximum workers’ compensation and medical benefits available to them, but also to assist them as they adjust to a new “normal” following an injury.

I believe that most healthcare professionals who are treating injured workers want the same for these patients and realize that their obligation to them extends beyond providing basic medical care. But workers’ compensation isn’t taught in medical school, so most doctors, nurses and medical office staff don’t know how else they can help these patients. And they may also be unaware of additional services available to injured workers – at no extra cost to the patient – as a result of their workers’ compensation benefits.

I offer the following suggestions and insights into the intricacies of workers’ compensation law in North Carolina that I hope physicians and other healthcare workers will find useful as they're  treating injured and disabled workers:

• If a patient comes to you with an injury resulting from an accident at work or a chronic condition that was likely caused by their job, encourage that person to report the injury, if he or she hasn’t already done so. Ideally, work injuries should be reported immediately to the employer and the N.C. Industrial Commission and, in any event, within 30 days of the accident or diagnosis that the condition is work-related.
• Keep detailed records of the patient’s treatment and any conversations you have about the injuries. Detailed medical records, which accurately reflect the patient’s symptoms, treatment and the progression of their recovery, are crucial in workers’ compensation claims. Many cases end up in litigation simply because medical records lack details or are ambiguous.
• Encourage you patient to keep a calendar or journal to document important facts relating to the work injury and ongoing treatment. In their journals, patients should record details of how the injury occurred, who witnessed it and how and when it was reported. Additionally, injured workers should make note of any medical appointments in their journals, recording any medical procedures that were conducted and instructions they received from healthcare workers. Finally, patients should write about any symptoms or additional medical problems they’re experiencing and any harassment they encounter from employers, coworkers or the insurance company regarding the work injury. Workers’ personal journals have proven to be invaluable in presenting a workers’ comp claim to the N.C. Industrial Commission.
• Some injured workers will want to return to work before they are medically able to do so. While injured workers are justified in their fear of reprisal for missing work because of an injury, strongly discourage them from returning to a job for which they are physically unprepared. Candidly explain the risk of re-injury. And while it’s true that some people are fired for filing a workers’ compensation claim – even though the law forbids such retaliation – being fired is preferable to derailing recovery or creating a worse medical problem by returning to work too soon. Let your patients know that there is legal recourse if they are fired. Patients can file a wrongful termination claim themselves with the Industrial Commission, but many will find it helpful to have an attorney advocate on their behalf.
• Injured workers may be entitled to additional benefits beyond compensation for lost wages and traditional medical care. The standard in North Carolina is whether or not the recommended treatment is reasonably likely to effect a cure, give relief from symptoms (including pain relief) or lessen the period of disability. Under this standard, in cases of catastrophic injury, North Carolina’s workers’ compensation law allows for things like home and vehicle modifications, medical devices in the home such as hospital beds, in-home attendant care, motorized wheelchairs, etc. So long as these devices/modifications meet the standard recited above and are prescribed by a treating physician, they should be covered by the Workers’ Compensation insurance company.
• Many injured workers believe that they don’t have the right to choose their own doctor and that they must see a physician assigned by the N.C. Industrial Commission or their employer’s workers’ comp insurance company. Patients have the right to ask the Industrial Commission for permission to see a doctor of their choosing. However, if an injured person is treated by a physician without first getting permission, his or her workers’ comp benefits might be in jeopardy. If a patient comes to you under these circumstances, advise them that an attorney can help ensure that benefits are protected.
• Injured workers who must travel 20 miles or more roundtrip for medical care are entitled to collect $0.55 per mile. Special consideration also is given to employees who are totally disabled.
• Chiropractic treatment is allowed for workers’ compensation patients, if the employer or the employer’s insurance company grants permission. As many as 20 visits are allowed, if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the Industrial Commission.

This time, we turn to yoga, the ancient Indian mind-body practice that has become a mainstream form of exercise, stress release and pain management.

Future articles in this series will explore massage, Pilates, Reiki and other alternative treatments and pain-management techniques. You can access all articles in the Alternative Therapies Series by clicking here.

This article is presented for informational purposes only. As always, please consult with your physician and other health care providers before undertaking an exercise regimen or alternative treatment.

The following is adapted and excerpted from the National Center for Complementary and Alternative Medicine, Yoga Today and Yoga Journal.

There are many different styles of yoga - Hatha, Vinyasa, Iyengar, Bikram (or hot yoga), Ashtanga and Kindalini, for example - but all are based on the same postures. These types of yoga differ in pacing, intensity and area of emphasis, such as breathing, body alignment or flow. It's not uncommon for people who've tried yoga and disliked it to discover that they love it after participating in another type of yoga class.

While some people practice yoga for physical fitness, others use it as a method of relaxing and reducing stress.

A good primer on the different types of yoga is available online. There's also an online tool designed to help you determine your yoga type.

The gentle Iyengar form of yoga, for instance, is good for people who have suffered from injuries or who have medical conditions that require special attention. As with any exercise regimen or alternative therapy, you should always consult with your physician before taking up yoga to avoid pushing your body beyond its limits and capabilities.

Origins of Yoga

Yoga in its full form combines physical postures, breathing exercises, meditation, and a distinct philosophy. Yoga is intended to increase relaxation and balance the mind, body, and the spirit.
Early written descriptions of yoga are in Sanskrit, the classical language of India. The word "yoga" comes from the Sanskrit word yuj, which means "yoke or union." It is believed that this describes the union between the mind and the body.

The first known text, The Yoga Sutras, was written more than 2,000 years ago, although yoga may have been practiced as early as 5,000 years ago. Yoga was originally developed as a method of discipline and attitudes to help people reach spiritual enlightenment. The Sutras outline eight limbs or foundations of yoga practice that serve as spiritual guidelines:

1. yama (moral behavior)
2. niyama (healthy habits)
3. asana (physical postures)
4. pranayama (breathing exercises)
5. pratyahara (sense withdrawal)
6. dharana (concentration)
7. dhyana (contemplation)
8. samadhi (higher consciousness)

The numerous schools of yoga incorporate these eight limbs in varying proportions. Hatha yoga, the most commonly practiced in the United States and Europe, emphasizes two of the eight limbs: postures (asanas) and breathing exercises (pranayama).

According to the 2007 National Health Interview Survey (NHIS), yoga is one of the most mainstream complementary and alternative therapies being used by Americans. More than 13 million adults had practiced yoga in the previous year, an increase of 3 million people since 2002. The 2007 survey also found that more than 1.5 million children practiced yoga in the previous year.

According to Yoga Journal's most recent "Yoga in America" survey, 15.8 million people in the United States now practice yoga, spending nearly $6 billion a year on classes, equipment, clothing, vacations and yoga-related books, magazines and DVDs.
 

Yoga & Health

People use yoga for a variety of health conditions including anxiety disorders or stress, asthma, high blood pressure, and depression. People also use yoga as part of a general health regimen-to achieve physical fitness and to relax.

Research suggests that yoga might:

• Improve mood and sense of well-being
• Counteract stress
• Reduce heart rate and blood pressure
• Increase lung capacity
• Improve muscle relaxation and body composition
• Help with conditions such as anxiety, depression, and insomnia
• Improve overall physical fitness, strength, and flexibility
• Positively affect levels of certain brain or blood chemicals.

There's strong anecdotal and increasing scientific evidence that yoga can have a healing impact on certain injuries while also offering pain relief. Recently, researchers at West Virginia University found that people with chronic low-back pain reduced their pain and improved their mobility through the practice of Iyengar yoga.

The researchers found that compared with a control group who received only standard medical care, the yoga group had significantly greater reductions in functional disability, pain, and depression.

Yoga is generally considered to be safe in healthy people when practiced appropriately.

However, people with certain medical conditions should not use some yoga practices. For example, people with disc disease of the spine, extremely high or low blood pressure, glaucoma, retinal detachment, fragile or atherosclerotic arteries, a risk of blood clots, ear problems, severe osteoporosis, or cervical spondylitis should avoid some inverted poses. It's important to consult with a physician and a skilled yoga practitioner before beginning yoga.

In addition, while yoga during pregnancy is safe if practiced under expert guidance, pregnant women should avoid certain poses that may be problematic.

Finding a Yoga Class

Because of its popularity and accessibility to people of different fitness levels and physical abilities, most private health clubs and YMCAs offer yoga classes. Most communities also have private yoga studios that offer classes for a small fee. Some physician's offices and hospitals also offer yoga classes.

In addition, you can find many yoga workouts online, many designed for people with certain injuries, illnesses or types of pain:

For lower back pain

Also for lower back pain

General yoga workouts

For shoulder pain

For knee pain
 

There are many training programs for yoga teachers throughout the country. These programs range from a few days to more than 2 years. Standards for teacher training and certification differ depending on the style of yoga.

There are organizations that register yoga teachers and training programs that have complied with minimum educational standards. For example, one nonprofit group requires at least 200 hours of training, with a specified number of hours in areas including techniques, teaching methodology, anatomy, physiology, and philosophy. However, there are currently no official licensing requirements for yoga teachers in the United States.

If You Are Thinking About Yoga

• Do not use yoga as a replacement for conventional care or to postpone seeing a doctor about a medical problem.
• If you have a medical condition, consult with your health care provider before starting yoga.
• Ask about the physical demands of the type of yoga in which you are interested, as well as the training and experience of the yoga teacher you are considering.
• Look for published research studies on yoga for the health condition you are interested in.
• Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
• If you take one yoga class and don't like it, consider trying a different style of yoga or taking a class from a different teacher. Teaching methods and yoga styles vary, and you may have to try several classes before finding the one that is right for you.
• If you experience pain while practicing yoga, stop. Don't push yourself to do any pose that causes you pain.

• Injured workers who must travel 20 miles or more roundtrip for medical care are entitled to collect $0.55 per mile. Special consideration also is given to employees who are totally disabled.
• Chiropractic treatment is allowed for workers’ compensation patients, if the employer or the employer’s insurance company grants permission. As many as 20 visits are allowed, if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the Industrial Commission.

If youv'e missed any of the previous tips, find them here.

But here's the truth:

• Patients have the right to ask the Industrial Commission for permission to see a doctor of their choosing. However, if an injured person is treated by a physician without first getting permission, his or her workers’ comp benefits might be in jeopardy. If a patient comes to you under these circumstances, advise them that an attorney can help ensure that benefits are protected.

For more tips on how to help injured people navigate the complex workers' compensation system in North Carolina, click here. Our attorneys and paralegals at the Deuterman Law Group also are available to answer questions and provide counsel to injured workers.

In the haste to get back to work and to a steady paycheck, people can cause irreversible physical damage, and they may also jeopardize their ability to collect on a workers' compensation claim.

• Some injured workers will want to return to work before they are medically able to do so. While injured workers are justified in their fear of reprisal for missing work because of an injury, strongly discourage them from returning to a job for which they are physically unprepared. Candidly explain the risk of re-injury. And while it’s true that some people are fired for filing a workers’ compensation claim – even though the law forbids such retaliation – being fired is preferable to derailing recovery or creating a worse medical problem by returning to work too soon. Let your patients know that there is legal recourse if they are fired. Patients can file a wrongful termination claim themselves with the Industrial Commission, but many will find it helpful to have an attorney advocate on their behalf.

You can find my entire series of tips here, and stay tuned throughout the week for more advice on helping injured workers under your medical care.

I've been sharing information about things that doctors, nurses and other healthcare workers can do to help injured patients as they navigate the complicated workers' comp system in North Carolina. There are quite a few unique benefits available to injured workers, but without a doctor's recommendation patients may not be able to receive these benefits.

My aim is to arm health care professionals with the information they need so they can attend to the unique needs of injured workers while providing them with medical treatment.

Did you know, for instance, that:

• Injured workers may be entitled to additional benefits beyond compensation for lost wages and traditional medical care. The standard in North Carolina is whether or not the recommended treatment is reasonably likely to effect a cure, give relief from symptoms (including pain relief) or lessen the period of disability. Under this standard, in cases of catastrophic injury, North Carolina’s workers’ compensation law allows for things like home and vehicle modifications, medical devices in the home such as hospital beds, in-home attendant care, motorized wheelchairs, etc. So long as these devices/modifications meet the standard recited above and are prescribed by a treating physician, they should be covered by the Workers’ Compensation insurance company.

Knowing more about how workers' compensation laws are structured in North Carolina will help healthcare professionals attend to the other needs of injured workers during the course of medical treatment.

You can find other entries in this series here:

Here's today's tip:

• Encourage you patient to keep a calendar or journal to document important facts relating to the work injury and ongoing treatment. In their journals, patients should record details of how the injury occurred, who witnessed it and how and when it was reported. Additionally, injured workers should make note of any medical appointments in their journals, recording any medical procedures that were conducted and instructions they received from healthcare workers. Finally, patients should write about any symptoms or additional medical problems they’re experiencing and any harassment they encounter from employers, coworkers or the insurance company regarding the work injury. Workers’ personal journals have proven to be invaluable in presenting a workers’ comp claim to the N.C. Industrial Commission.

Knowing more about how workers' compensation laws are structured in North Carolina will help healthcare professionals attend to the other needs of injured workers during the course of medical treatment.

You can find other entries in this series here:

Now for today's tip:

• Keep detailed records of the patient’s treatment and any conversations you have about the injuries. Detailed medical records, which accurately reflect the patient’s symptoms, treatment and the progression of their recovery, are crucial in workers’ compensation claims. Many cases end up in litigation simply because medical records lack details or are ambiguous.

But many doctors, physicians’ assistants and nurses find that while they can help these patients with their medical problems and physical recovery, treating someone with a work injury presents a unique set of challenges – not all of them medical. 

Indeed, injured workers and their families must deal with a host of issues as they try to heal and rebuild their lives after being hurt on the job. There are emotional and financial burdens, and a seemingly endless amount of bureaucratic red tape to navigate when filing a workers’ compensation claim.

Additionally, injured workers face tremendous external pressure from family members, coworkers, employers and insurance companies to return to work so they can start earning a paycheck again. It’s also not unusual for injured workers to pressure themselves to return to work before they’re physically ready because they feel obligated to do so or feel “less than” because they’re out of work and collecting unemployment benefits. 

When we started the Deuterman Law Group six years ago, one of our founding principles was that we would treat clients as people, not as cases, and that we would attend to the whole person. It’s our job to ensure not only that our clients receive the maximum workers’ compensation and medical benefits available to them, but also to assist them as they adjust to a new “normal” following an injury.

Given these realities, I thought it would be helpful to write a couple of blog postings explaining some of the intricacies of workers' compensation laws in North Carolina. My aim is to give healthcare providers information and extra tools that will help them when treating injured and disabled workers.

Injured workers should also take note of these tips as they include information about some of the additional benefits that are available to them under the law.

Keep checking back at the blog throughout the week; I'll be posting new tips each day.

Here's the first tip:

• If a patient comes to you with an injury resulting from an accident at work or a chronic condition that was likely caused by their job, encourage that person to report the injury, if he or she hasn’t already done so. Ideally, work injuries should be reported immediately to the employer and the N.C. Industrial Commission and, in any event, within 30 days of the accident or diagnosis that the condition is work-related.

The agency will be focusing on specific industries, where certain injuries are common, and also will be examining whether some companies have been lax in reporting injuries, according to an article in the DemocratandChronicle.com

The U.S. Occupational Safety and Health Administration, created to enforce the large and growing number of worker safety laws and regulations, last week issued its "site-specific target" plan for the year, a warning, in effect, that the agency will be tougher on injury rates in specialized industries.

The plan mentioned nursing homes, where workers often suffer back and limb injuries in caring for patients, as an industry facing special attention.

But there is another program in the bureaucratic works — the National Emphasis Program — that is potentially more significant for local businesses that to this point either have escaped OSHA attention or are not in the usual range of targeted industries.

OSHA plans to examine companies that report low injury rates or few lost days due to injury with the idea that many companies have been underreporting or minimizing the need for thorough record-keeping.

The agency estimates that as many as 20 percent of all businesses fail to adequately report workplace-related injuries and illnesses. Other studies put the number as high as 68 percent.

This is the first in the Deuterman Law Group's series of blog articles about alternative therapies for back injuries and pain management.

In this article, we’ll explore acupuncture, a centuries-old Chinese medicine technique that has been used to treat pain chronic pain, nausea, migraines and other painful conditions. Future articles in this series will explore reiki, massage, yoga, Pilates and other alternative treatments and pain-management techniques.

This article is presented for informational purposes only. As always, please consult with your physician and other health care providers before undertaking exercise regimen or alternative treatment.

The following is excerpted from the National Institute of Health’s National Center for Complementary and Alternative Medicine.

Acupuncture

Acupuncture is among the oldest healing practices in the world. Practiced for thousands of years in China, acupuncture involves the use of thin, solid, metallic needles inserted through the skin to stimulate various points on the body.

Acupuncture is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health.

The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced—by thousands of physicians, dentists, acupuncturists, and other practitioners—for relief or prevention of pain and for various other health conditions. According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year. Between the 2002 and 2007 NHIS, acupuncture use among adults increased by three-tenths of 1 percent (approximately 1 million people).

During your first office visit, the acupuncture practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to your condition. Inform the acupuncturist about all treatments or medications you are taking and all medical conditions you have.

Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people feel energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner.

Treatment may take place over a period of several weeks or more.

Some insurance companies may cover the costs of acupuncture, while others may not. It is important to check with your insurer before you start treatment to see whether acupuncture is covered for your condition and, if so, to what extent.

Finding an Acupuncture Practitioner

Health care providers can be a resource for referral to acupuncturists, and some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations such as (which can be found through libraries or Web search engines) may provide referrals to acupuncturists.

The American Academy of Medical Acupuncture maintains a searchable database of physicians who offer acupuncture services. The National Certification Commission for Acupuncture and Oriental Medicine has listings of nationally certified acupuncture practitioners at its Web site.

Before making an appointment with an acupuncturist:

• Check a practitioner's credentials. Most states require a license to practice acupuncture; however, education and training standards and requirements for obtaining a license to practice vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. (You can search for licensed acupuncturists in North Carolina at the Web site for the North Carolina Acupuncture Licensing Board.)
• Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medical training. If you have received a diagnosis from a doctor, you may wish to ask your doctor whether acupuncture might help.

Many injured and disabled workers also will develop depression – creating a double whammy of physical and emotional pain that can prolong recovery and lead to additional health problems.

The stress and financial burdens of being out of work combined with physical pain and the loss of identity that many out-of-work people injured people experience quite often leads to associated depression, according to medical research and our own experience with clients at the Deuterman Law Group. Unfortunately, so-called secondary depression is often under diagnosed, according to a 2005 article in trade journal Risk & Insurance.

 It is important for anyone who is suffering from depression to seek treatment, especially those who have an injury or disability that prevents them from working. Studies have linked pain with depression, and there’s evidence that depression can slow recovery from an injury or illness.

“Depression may increase your response to pain, or at least increase the suffering associated with pain,” according to the Mayo Clinic. “Conversely, chronic pain is stressful and depressing in itself. Sometimes pain and depression create a vicious cycle,”

A 2005 British study revealed that 20 percent to 30 percent of people injured in car accidents or on the job had their recovery impacted by depression and other psychological factors.

In workers’ compensation cases, depression that is the result of a work injury may be compensable. In other instances, depressed individuals may qualify for Social Security Disability.

If a client is experiencing symptoms of depression, it’s important that they are evaluated by a qualified medical professional, who can prescribe a course of treatment that may include therapy, anti-depressants or a combination.

It’s also important that clients share this information with their attorney and paralegal, as this may be important to the case. We may be able to we may be able to offer additional help and referrals to a support groups, community resources and medical professionals who can help our clients deal with these problems and overcome their depression.

Only a qualified medical professional diagnose depression, but the following is a list of symptoms:

• Loss of interest in normal daily activities
• Feeling sad or down
• Feeling hopeless
• Crying spells for no apparent reason
• Problems sleeping
• Trouble focusing or concentrating
• Difficulty making decisions
• Unintentional weight gain or loss
• Irritability
• Restlessness
• Being easily annoyed
• Feeling fatigued or weak
• Feeling worthless
• Loss of interest in sex
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems, such as back pain or headaches

The Mayo Clinic also offers a depression self-assessment tool online.

Not all injuries can be prevented, of course. But there are some pretty easy ways to stop painful and serious injuries in the construction industry, which has more than its fair share of job-related injuries.

However, many people are surprised that post-surgery, the pain doesn’t subside as quickly as they would like and that the return back to normal life doesn’t happen automatically.

Of course, if your symptoms worsen or you do not experience any improvement after surgery, see your doctor.

Depending on the type of surgery a patient undergoes, the recovery time can vary from days to weeks to months.

Incisions, muscles and nerves need time to heal after surgery as your body tries to build back its strength.

Your doctor will give you an estimated timeframe for your recovery and will also discuss with you appropriate activities following back surgery. Remember that a plan that gradually allows you to return to everyday activities helps prevent reinjury to your back.

Connecting with friends and others who have had similar back injuries and undergone surgery surgery is a helpful way to learn the “real deal” on recovery. Other back patients may also be able to offer helpful tips from the perspective of someone who's been there, done that and most importantly, gotten through it.

Unexpected problems or questions can arise after surgery. You may experience moodiness or even depression. And you may find that you have questions about how to do things that you once took for granted. Many people who have had surgery to treat a back injury find themselves asking questions like, “How do I take a shower?” and "What's the best way to get sleep at night. "

Learning from others who have been through a similar situation can help you get through the recovery process. There are many online groups, discussion boards and blogs that can provide greater insight into how to cope with your recovery. You can find links to back injury support groups at the Deuterman Law Group Web site and elsewhere on the Internet. The Back Pain Support Group is a good one.

You can find list of other back injury and chronic pain support groups and resources at The American Chronic Pain Association Web site.

A healthy mental attitude as well as a healthy lifestyle will bring you closer and closer to your goal of returning to a normal life free from back pain.

Remember, the information in this blog is meant for education and is not a substitute for treatment. If you are experiencing back pain, see a doctor. Do no attempt to treat yourself.

This entry concludes our Back Health Blog, but we invite you to post comments and questions for our staff and our attorneys. If there's another topic you'd like covered in our Back Health Series or on our North Carolina Workers' Compensation Law blog, please contact us, and we'll do our best to honor all requests.

Today, we take up where we left off with a discussion of other surgical treatments for back pain, namely spinal fusion, artifical disc replacement and radio frequency ablation.

Spinal fusion is surgery that is performed to prevent movement between vertebrae by fusing the two vertebrae together.

The fusion happens through stabilizing screws, a bone graft or a combination of both placed between the two vertebrae that need to be immobilized. The graft then “welds” the two vertebrae resulting in something similar to one larger vertebra.

When the vertebrae are fused, the pain that resulted from the movement of the two vertebrae is lessened.

However the pain and recovery following the procedure can be more intense and longer than that with other surgeries. Bone takes a long time to heal, and the recovery can last as much as 4-6 months during which time your activities will be restricted.

Artificial Disc Replacement

Artificial Disc Replacement is a relatively new procedure, first used in 2004. As the name suggests, this procedure involves the removal of a disc which is bulging or herniated and in its place, inserting an artificial disc. The idea is similar to that of a hip or knee replacement surgery. 

The artificial disc then serves as the cushion between the two vertebrae and allows for greater freedom of movement than typically occurs in spinal fusion patients. Because the procedure is still considered experimental, patients are carefully screened to be sure that they are a good candidate for an artificial disc replacement.

Radiofrequency ablation

Although the name sounds more science fiction than medical, radiofrequency ablation simply involves the destruction (ablation) of a medial branch nerve in the spine.

Medial branch nerves are located on either side of the vertebrae. The surgeon uses high frequency radio waves to generate heat that burns the nerve. When the nerve is ablated, or killed, it can no longer transmit pain impulses. Therefore the brain never receives the “pain message” from the nerve.

Radiofrequency ablation is typically an outpatient procedure performed under local anesthesia. While pain may continue for several days after the procedure, most patients are fully recovered within a month.

Remember, the information in this blog is meant for education and is not a substitute for treatment. If you are experiencing back pain, see a doctor. Do no attempt to treat yourself.

Coming next: Our Back Health Blog has covered common causes of back pain and some of the more common treatments and surgeries. In our next installment of this series, we’ll review “life after surgery” and look at what you may experience while you recover from your operation or procedure.

Coming next: We’ll be discussing other types of back surgeries, including spinal fusion, artifical disc replacement and radio frequency ablation

People who own BlackBerry devices can't seem to put them down. They're constantly typing and texting friends, family, the office. But handy devices such as the BlackBerry, Sidekicks, and Treos that make our hectic lives more manageable are wreaking havoc on our thumbs.

This article offers tips on preventing BlackBerry Thumb by making simple changes such as typing with your fingers instead of your thumbs. Spas at the Hyatt hotel chain are even offering a BlackBerry massage. Who knows if it works, but it's certainly great marketing! The thumb massages start at $80.

These terms all refer to injuries to the muscles, ligaments and tendons. Most often your doctor will refer to this type of injury as a sprain or strain.

Typically these injuries are caused by damaged muscles, tendons or ligaments perhaps from over stretching or sudden movements. (This explains all those back injuries that people suffer doing everyday chores, like unplugging the vacuum cleaner.)

The healing process can last for many weeks and the pain can be quite intense from the inflamed tissues. Generally, surgery isn’t recommended for this type of back injury and treatment consists of anti-inflammatory medicines and, of course, rest.

Disc bulge, disc herniation and annular tear

All of these diagnoses refer to injuries to the vertebrae -- the smaller bones that make up the spine -- and discs -- the softer tissue that cushions the vertebrae.

These conditions are similar in that the soft tissue of the disc has extended beyond where it’s supposed to be. When the protective wall that surrounds the disc is torn or weakened, the tissue extends too far. For more on bulging discs and herniated discs, visit the Spine Health Web site.

The extended tissue can cause overcrowding, inflammation and compression of the nerves, which results in pain that may potentially spread to the legs.

Surgery is not always recommended for treatment because most patients respond well to anti-inflammatory medicines and physical therapy.

However procedures such as laminectomy or discetomy (which will be discussed in detail in a later blog) may be recommended to relieve patients of pain.

Spondylosis

This is basically arthritis of your spine.

Most people think of arthritis affects only the hands and knees, but arthritis can affect the vertebrae of your spine as well.

Common symptoms of spondylosis tend to be stiffness, not having a full range of motion, difficulty in walking or bending, weakness, numbness or even tingling.

Most people who suffer from spondylosis respond well to non-surgical treatments such as anti-inflammatory medication, physical therapy or chiropractic treatments. However,  sometimes if the pain is intense, corticosteroids, a powerful anti-inflammatory medicine, are injected into the spine.

Spondylolisthesis

This condition occurs when one of your vertebrae, which are normally aligned, slips out of alignment with the vertebrae below it.

There are different categories of spondylolthesis, graded on a scale of 1-5. depending on how and when the slippage occurred and the severity of the slippage,

You may not have any symptoms at all or you may feel pain in your lower back, thighs or legs; tightness in your hamstring; or difficulty with bladder control.

Some people may notice a change in their appearance such as a shorter looking torso or a swayback.

Treatments vary with each category and whether the vertebrae are continuing to slip or not.

If the vertebrae have stopped moving forward, then usually anti-inflammatory medications, physical therapy and possibly a back brace will help relieve the pain.  Physicians also may recommend bed rest or refraining from heavy lifting, twisting, or sports.

Remember, talking with your physician about your symptoms, diagnosis and treatment is the best source of information in managing your back pain.

But there are many resources on the Web that offer more information about spinal injuries and pain. Check out: SpineUniverse or the Southeastern Spine Institute for additional information and illustrations on spine health.

As always, please remember, this information is for educational purposes only. If you are suffering from back pain, please consult a doctor. Do not try to treat yourself.

Understanding the medical terminology doctors use in diagnosing and treating the causes of back pain can be confusing. While its always your right to ask your doctor for clarification, some patients may not feel comfortable asking a busy physician to take more time to explain things in simpler terms.

This series of blogs, entitled Back Health, is designed for injured people seeking more information about common back injuries, including symptoms and treatments. And we've attempted to explain things in simple terms, so you won't need a medical degree to understand what's going on with your back.

Read on for the first installment in our Back Health Series. This one focuses on the anatomy of the spine.

Please remember, this information is for educational purposes only. If you are suffering from back pain, please consult a doctor. Do not try to treat yourself.

The spine is made up of five separate and distinct parts: cervical (the area from the neck to approximately the shoulder blades); thoracic (the upper back area where the ribs are attached); lumbar (the lower back area close to the hips); sacrum (the pelvis area); and coccyx (commonly called the tailbone).

When these five parts are healthy and functioning well, your spine is able to support your weight, provide flexibility for bending and twisting, and protect your spinal cord. When your spine has been injured though, you may find that the most common of movements such as bending down to pick up a box or twisting to reach a file, can lead to intense pain.

Back injuries are surprisingly common. According to Prevention magazine, you have a 50-50 chance of suffering a debilitating back injury.

When you have a back injury, the pain may be concentrated in your back or it may radiate to other limbs, and it can range from chronic throbbing pain to sharp shooting pain.

Most patients experience back pain in the neck, the upper back and the lower back -- affecting the cervical, thoracic and lumbar regions of the spine. Depending on the type of injury or back disorder, some patients may experience more pain sitting down while others experience more pain standing.

There's no single cause of back pain. Spinal injuries may be the result of a traumatic event, such as a car accident or a fall. Or they can be the result of a long-term cause, such as repetitive movements, heavy lifting or even normal "wear and tear." You could even hurt your back doing normal household activities.

The pain in your back may be caused by disc or vertebrae injuries or damage to muscles, ligaments and tendons, the so-called soft tissues in your spine.

Coming next in our Back Health blog series: Understanding back sprains, soft-tissue injuries, bulging discs and herniated discs.

It's an interesting article that shows just how debilitating back injuries can be. The writer, a distance runner, outlines his long recovery and also highlights some of the realities of back injuries:

• The most common type of pain reported by adults in the United States, with more than one in four reporting some back pain lasting at least a day in the past three months. Eight of every 10 people in the United States will suffer from lower back pain at one point in their lives.
• The most common reason injured workers file for workers’ compensation claims, accounting for about one in every five U.S. claims for workers’ compensation.
• The leading cause of disability in the United States military.
• The leading cause of disability in people under age 45 and the third-leading cause in people older than that, after cancer and heart problems. One study found that two of every three people aged 20 to 60 reported some type of spinal pain in a given year.
• The leading cause of missed work time or doctor’s visits after headaches and cold symptoms.