Comfort with creativity Finding relief from pain with art PAGE 11
CoMPLEX REGIONAL PAIN Syndrome/Reflex Sympathetic Dystrophy Therapy PAGE 9
PLUS Ask the Expert ➲ p.6
Anti-inflammatory Cooking ➲ p.8
Pain Q & A ➲ p.14
Clinical Editor: Tory McJunkin, M.D. Publisher: Clayton Peck Editor/Writer: Kelli Donley, Jennifer Gitt
CONTENTS
Layout: Addie Mirabella
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Contact Us
We welcome you to the August issue!
Syndrome/Reflex Sympathetic Dystrophy Therapy By: Dr. Tiffany Moat, DC
Welcome letter
Boost Medical 9977 N 90th Street, Suite 320 Scottsdale, AZ 85258 Phone: 888-627-6121 Email: info@boostmedical.com Print Subscription Information
Complex regional pain
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Ask the Expert Depression and Pain: Recognizing the symptoms, finding help By: Kara Gasperone
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Comfort with creativity Finding relief from pain with art By: Kelli M. Donley
888-627-6121
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August Cooking In the heat of the summer, we must rely on our creativity to provide relief. These colorful recipes are healthy, antiinflammatory and aesthetically pleasing.
Published monthly by Boost Medical 9977 N 90th Street, Suite 320 Scottsdale, AZ 85258 Volume #17 Published August, 2011
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Pain Q&A What technically is “back pain?”
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August 2011
WE LCOME In our practice, patients hear u s u s e t h e w o r d s “ c o n s e rv a t i v e c a re , ” q u i t e o f t e n . C o n s e r v a t i v e c a re m e a n s we’ve tried many other o p t i o n s t o s o l v e a p a t i e n t ’s p a i n b e f o re m o v i n g f o r w a r d w i t h a s t ro n g e r d o s e o f m e d i c a t i o n , o r a s u r g i c a l p ro c e d u re . T h i s m o n t h ’s i s s u e o f A r i z o n a Pa i n M o n t h l y f o c u s e s o n a n e n t i re l y n o n traditional, yet conservat i v e , a re a o f p a i n m a n a g e m e n t – a r t t h e r a p y. H a v e y o u ever felt a rush of happiness a f t e r t a k i n g a g re a t p h o t o g r a p h ? Fe l t c a l m e d b y p u t t i n g a beautiful, aesthetic meal on the table for your family? Known your shoulders would re l a x w h e n y o u s a t d o w n t o t h e p o t t e r ’s w h e e l , p i c k e d u p knitting needles or a paint brush? We recogn ize there are many benefits to expressing oneself through art – including pain reduction. O ur feature article
Shout for joy to the Lord, all the earth, burst into jubilant song with music; make music to the Lord with the harp, with the harp and the sound of singing. Psalm 98: 4-5
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i n t e r v i e w s s e v e r a l a r t t h e r ap i s t s w h o h a v e s ee n a s t o u n ding changes in their patients. Ou r a s k t h e e x p e r t c o l u m n interviews local therapist K a r a G a s p a ro n e a b o u t t h e l i n k b e t w e e n d e p re s s i o n a n d p a i n . A n d o u r l a t e s u m m e r re c i p e s a re g e a re d t o p ro v i d e a t a s t y, fun and artsy plan to feed those you love. We h o p e y o u a re e n j o ying these last few days of s u m m e r h e a t a n d a re a s re a d y f o r c o o l a u t u m n t e m p e r a t u re s a s w e a re ! We l o o k f o r w a r d t o s e e i n g y o u i n o u r o ff i c e a n d h e a r i n g a b o u t y o u r re c o v e r y f ro m p a i n . F ro m o u r f a m i l i e s t o y o u r s , Pa u l Ly n c h , M D a n d To r y McJunkin, MD
Paul Lynch, MD and Tor y McJunkin, MD
P.S. If you have an interesting pain related story or idea you’d like to share with our editor, please email Kelli Donley: kellid@arizonapain.com
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Ask the Expert D e pression and Pain: Recognizing the Symptoms, Finding Help Have you ever found yourself curled up on the couch with your softest blanket and salt iest junk food, watching the umpteenth commercial for Pajamajeans because it’s 3 am and you can’t sleep again? Or perhaps you’re a worldclass scrapbooker who hasn’t had the motivation to glue a single rhinestone to a photo page in weeks. Maybe you’re suffering from a migraine for the sixth day in a row that won’t go away no matter how much water and caffeine you stubbornly consume in a dark, noiseless room. I f any of this sounds famil iar, you could be one of the estimated 7-10 percent of Americans who suffer from chronic depression. Depression can be a sneaky bedfellow that does not dis criminate against sufferers. People from every race, creed
and socioeconomic status all over the world have been f o u n d t o e x p e r i e n c e d e p re ssion. Consider the following signs and symptoms: • Lack of energy • U n u s u a l s l e e p p a tterns – either insomnia or hypersomnia • B i z a r re a p p e t i t e , a t t i m e s characterized by unusual weight loss or gain • Loss of enjoyment in things you used to love • Isolation • Po o r c o n c e n t r a t i o n o r re s t l e s s n e s s • Fe e l i n g h o p e l e s s , w o r t hless or just “empty” • P h y s i c a l p a i n t h a t d o e s n ’t go away with medical t re a t m e n t ( h e a d a c h e s , body aches, joint pain, persistent illness, etc). I f y o u h a v e re c e n t l y e x p eri e n c e d a l o s s o r t r a u m a – s u c h a s a f a m i l y m e m b e r ’s
Kara G asperone
p a s s i n g , o r a ba d c a r a c c i d e n t – s o m e o r a l l o f t h e s y m pt o m s l i s t e d a b o v e a re t o b e e x p e c t e d a s y ou p ro c e s s a c a t a s t ro p h i c e v e n t . H o w e v e r, i f t h e s e a re s y m p t o m s t h a t h a v e b e e n p re s e n t f o r m o re t h a n 2 m o n t h s , o r i f y o u a re experiencing these symptoms w i t h o u t p re re q u i s i t e t r a u m a , c o n s u l t a p r i m a r y c a re p h y s ic i a n o r a m e n t a l h e a l t h p rof e s s i o n a l ; t h i s t y p e o f d e p re ss i o n c o u l d b e c h ro n i c . Many events can cause a d e p re s s i v e re s p o n s e , m o s t n o t a b l y a n y d i ff i c u l t t r a n s it i o n e x p e r i e n c e d i n l i f e . T h e re is no one single cause of d e p re s s i o n . S c i e n t i s t s t h i n k i t ’s l i k e l y a c o m b i n a t i o n o f biochemical, cognitive and e n v i ro n m e n t a l f a c t o r s t h a t
August 2011
c ontribute to a person’s ten d ency to experience depres s ion. If you think you or a family member might be d ealing with depression, take a look at the individual’s b ehavior against the list of s ymptoms no ted above. Also, s ometimes a simple “Are you d oing okay?” can reveal so much. T he link between depres s ion and physical pain is one t hat should not be minimized. I n focus groups conducted b y the National I nstitute of Mental Health, many people s uffering from depression d idn’t know that the chronic p hysical pain they had been e xperiencing had anything to d o with depression. Chronic h eadaches, joint pain and d igestive pain are common i n people who suffer from d epression, and often these s ymptoms are treated unsuc c essfully with pain medica t ions. Psychiatric medications c an be useful aids in the t reatment of depression, yet many physici ans seek to treat t he symptoms with pain medi c ations, missing the underly i ng source of the pain. T he good news is that there a re plenty of ways to combat
depre s s i o n t h a t d o n o t requ i re t h e u s e o f p s y c h i a tric m e d i c a t i o n s . E x e rc i s e i s huge l y i m p o r t a n t . T h e e n d o rphin s y o u r b r a i n r u s t l e s u p afte r a g re a t h i k e o r b i k e r i d e can s e n d s y m p t o m s r u n n i n g for t h e h i l l s . I f y o u h a v e chro n i c p a i n , s w i m m i n g i s a n exce l l e n t l o w - i m p a c t a c t i vity. B e c a u s e e v e r y o n e e x p e r ience s d e p re s s i o n d i ff e re n t l y, it’s i m p o r t a n t t o k n o w y o u r own c o p i n g s k i l l s . W h e t h e r it’s re a d i n g a l l s e v e n H a r r y Pott e r n o v e l s i n s u c c e ssion , f o rc i n g y o u r s e l f t o g o out w i t h f r i e n d s f o r c o ff e e , or ta c k l i n g h o m e p ro j e c t s - man a g i n g y o u r s y m p t o m s b y utili z i n g c o p i n g s k i l l s c a n b e doab l e . Ho w e v e r, i f y o u ’ v e tried t h i s a n d n o t h i n g s e e m s to b e w o r k i n g , s c h e d u l e a cons u l t a t i o n w i t h a m e n t a l heal t h p ro v i d e r. Man y m o d e r n t h e r a p i s t s w o r r y the s t i g m a o f s e e k i n g m e n t a l heal t h t re a t m e n t c a n b e a barr i e r t o p e o p l e i n n e e d o f help . M a i n t a i n i n g e m o t i o n a l and m e n t a l h e a l t h i s a s n e cessa r y a s m a i n t a i n i n g p h y s ical h e a l t h . The t a k e - h o m e m e s s a g e i s simp l y : d e p re s s i o n i s a v e r y hum a n e x p e r i e n c e . I t i s
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s o m e t h i n g t h a t e ve r y o n e w i l l experience at a time in his or her life. But when it becomes d i ff i c u l t t o f u n c t i o n o n a d a y to-day basis, when you have persistent physical pain or when you feel like you’ve lost c o n t ro l , i t ’s o k a y t o a s k f o r h e l p . I n f a c t , i t ’s n e c e s s a r y – u n t re a t e d a n d o u t o f c o n t ro l , d e p re s s i o n c a n b e c o m e c r i ppling both emotionally and p h y s i c a l l y, a n d c a n d a m a g e i m p o r t a n t re l a t i o n s h i p s . S e e k h e l p f ro m a p s y c h o l ogist or therapist that you feel has a true understanding of w h a t y o u ’ re g o i n g t h ro u g h . I p ro m i s e t h a t y o u w i l l f e e l heard and accepted when you m e e t t h e r i g h t p ro f e s s i o n a l . K a ra G a s p e ro n e i s a m a r r i a g e a n d f a m i l y t h e ra p i s t w o r k i n g t o w a r d i n d e p e n d e n t l i c e ns u re A r i z o n a . S h e w o r k s w i t h kids, families and couples. H e r p a s s i o n f o r t h e ra p y a n d m e n t a l h e a l t h w a s b o r n f ro m a d e s i re t o s h o w t h e w o r l d s e e k i n g p ro f e s s i o n a l h e l p d o e s n ’t h a v e t o b e a c o l d , formal experience – it is human. She enjoys sprinkling a pinch of personality and a heavy dose of experience on h e r a p p ro a c h t o t h e ra p y. S h e c a n b e re a c h e d a t k a ra . g a sp e ro n e @ g m a i l . c o m .
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Augus t COOKI NG
In the heat of the summer, we must rely on our creativity to provide relief. These colorful recipes are healthy, anti-inflammatory and aesthetically pleasing.
Watermelon Feta Salad Ingredients: • 1 pound plum tomatoes, diced, drained • 1 1/2 cups diced seeded watermelon • 1 large yellow bell pepper, diced • 1/2 large cucumber, diced • 1/2 cup thinly sliced radishes • 3 tablespoons olive oil, divided • 10 ounces feta cheese, broken into small cubes (about 2 1/2 cups), divided • 2 green onions, chopped, divided • 1/4 cup thinly sliced fresh mint leaves, divided
• 1/2 cup plain Greekstyle yogurt Directions: Combine first five ingredients with 2 tablespoons of olive oil in bowl. To this, add half of the cheese, onions and mint. In a food processor, mix the remaining cheese, onions and mint with yogurt. Simply blend. Add a dash of salt, pepper and cayenne if you like spice. Mix with salad.
Summer Tabbouleh Ingredients: • 1/2 cup bulgur or quinoa • 3 tablespoons olive oil • 1 cup boiling-hot water • 2 cups finely chopped fresh flat-leaf parsley • 1/2 cup finely chopped fresh mint • 2 medium tomatoes, cut into 1/4-inch pieces • 1/2 cucumber, peeled, cored, and diced • 4 tablespoons fresh lemon juice
• 3/4 teaspoon kosher salt • 1/4 teaspoon black pepper Directions: Mix bulgur or quinoa and 1 tablespoon oil in a heatproof bowl. Add boiling water, cover bowl with plastic wrap and let sit 15 minutes. Drain, pressing with a paper towel to remove any excess liquid. Place bulgur in bowl; add remaining ingredients. Drizzle 2 tablespoons oil on top. Mix well.
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Comple x Reg ional Pain
T here are many treatments t hat can help with the symp t oms of CRPS ; however, there i s no single treatment to c ure. The following treatments
nerve stimulation (TENS) t h e r a p y o r e l e c t r i c a l a c u p u n ct u re – a l l p e r f o r m e d b y c h i rop r a c t i c s t a ff .
can h e l p e a s e s y m p t o m s :
W h e n p re s c r i b e d o n e o f t h e a f o re m e n t i o n e d t re a t m e n t plans, following it is critical t o s u c c e s s t o m a xi m i z e re l i e f o f s y m p t o m s . T h e c o n s e r v at i v e t h e r a p i e s a re a s c r i t i c a l l y i m p o r t a n t a s t h e p h a r m a c ological and interventional therapies.
Phar m a c o l o g i c a l T h e r a p y : p a i n man a g e m e n t p h y s i c i a n s m a y pres c r i b e a n a p p ro p r i a t e m e dicati o n re g i m e n .
M o re s p e c i f i c a l l y, d e s e n s itization therapy is used to m o d i f y h o w s e n s i t i v e a n a re a i s t o a s p e c i f i c s t i m u l u s . It i s
Syndrome/Reflex Sympathetic D ystrophy Therapy By: Dr. Tiffany Moat, DC C RPS is a chronic neurologi c al pain syndrome. A patient’s s ymptoms may include: s evere burning pain, patho l ogical changes in bone and s kin, changes in blood flow, e xcessive sweating, tissue s welling and extreme sensi t ivity to touc h. This is typ i cally reported in the arms o r legs, but CRPS may affect a ny part of the body. In some p atients, multiple areas may b e affected a t the same time. C RPS is an error on the part o f the nervous system. Nerves misfire, sending continu o us pain signals to the brain. C RPS usually develops after s evere or mil d trauma.
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I nter v e n t i o n a l T h e r a p y : proc e d u re s – o f t e n u s i n g fluoro s c o p i c /X - r a y g u i d a n c e – pe r f o r m e d b y a n e s t h e s i o logy- t r a i n e d p a i n p h y s i c i a n s can h e l p re d u c e p a i n f u l n e r v e path w a y s . T h e s e m a y i n c l u d e : sym p a t h e t i c n e r v e b l o c k s a n d peri p h e r a l n e r v e b l o c k s ; o r spin a l c o r d s t i m u l a t i o n – a well - e s t a b l i s h e d t re a t m e n t optio n t h a t i n v o l v e s a t e m p orary t r i a l o f t h e t h e r a p y a n d optio n o f p e r m a n e n t i m p l a ntatio n o f t h e d e v i c e . Cons e r v a t i v e T h e r a p y : d e s e nsitiz a t i o n t h e r a p y re g i m e n , tran s c u t a n e o u s e l e c t r i c a l
C R P S m a y a ff e c t a n y p a r t o f t h e b o d y.
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designed to apply a stimulus to the affected area for short periods of time, which can be done frequently through out the day. Desensitization therapy often includes appli cation of unpleasant stimuli to the hypersensitive area for a short period of time. These unpleasant stimuli are things that the body is often exposed to daily; thus, they are not harmful or damaging. The items used for desensiti zation therapy vary depending on what stimuli the affected body part transmits as pain. S u c h d e s e n s i t i z a t i o n p ro grams begin with stimuli that p ro d u c e t h e l e a s t p a i n f u l re s p o n s e . O n c e t h e p a i n f u l a re a s t a r t s t o a c c l i m a t e t o the applied stimulus, the next stimulus is incorpor a t e d . Fo r e x a m p l e , a t h e r a p y p ro g r a m m a y s t a r t w i t h s o f t material such as silk, and p ro g re s s t o ro u g h e r m a t e r i a l s l i k e w o o l o r t e x t u re d f a b r i c s ( i . e . Ve l c ro ) . D e s e n s i t i z a t i o n e x e rc i s e s , s t re t c h i n g , h o t and cold stimuli, TENS unit t h e r a p y a s w e l l a s e l e c t ro a c u p u n c t u re m a y b e i n c o rp o r a t e d i n t h e t re a t m e n t t o d e c re a s e p a i n a n d n o r m a l i z e n e r v e re s p o n s e s .
D esensitization exercises, stretching, hot and cold stimuli, TE NS unit therapy as well as electro-acupuncture may be incor porated in the treatment to decrease pain and nor malize ner ve responses.
Depending on the severity of the condition it may be a t t i m e s m o re t o l e r a b l e t o the patient, especially early in t h e t h e r a p y, i f h e o r s h e seeks alternate modalities to help ease the discomfort. These modalities may include sympathetic nerve blocks, peripheral nerve blocks, and/ o r a n a l g e s i c m e d i c a t i o n s p rovided by our pain physicians. Desensitization therapy is
u s e d t o m i n i m i z e t h e b o d y ’s p a i n f u l re s p o n s e t o a c e r t a i n stimuli. The goal of this t h e r a p y i s t o h i n d e r o r i n t e rr u p t t h e b o d y ’s i n t e r p re t a t i o n o f ro u t i n e s t i mu l i a s p a i n f u l s t i m u l i . To b e g i n , i t i s a d v i s e d p a t i e n t s s p e a k w i t h a p h ys i c i a n , c h i ro p r a c t o r o r t h e rapist to determine if any of t h e p re v i o u s l y d i s c u s s e d t h e ra p i e s a re a p p ro p r i a t e a n d re c o m m e n d e d .
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Recognizing the link between mental health and physical pain, such therapies may help identify issues ofemotional tur moil that can then be addressed and resolved.
Co m f o r t w i th
Creativit y F i n d i n g Relief f ro m Pa in with Art By: Kelli M. Donley
Pablo Picasso once said, “Art washes from the soul the dust of everyday life.” Art – broadly defined by Webster and certainly more specific to the individual – can serve as another outlet for pain relief. May it
be paining an abstract woman, as Picasso, writing a Bachinspired concerto or simply putting together a bouquet of flowers grown in the garden, art therapy is helping many in pain find comfort.
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“The American Music Therapy Associatio n describes music therapy as a ‘clinical and evi dence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has compl eted an approved music therapy program,’” says L uciana da Fonseca, MT-BC, the former mental health coordinator and music therapist for the International Rescue Committee in Phoenix. “I like to describe it as using music, as a tool to achieve the client’s goals.” Da Fonseca, who has worked with internally displaced people, asylees and refugees in the desert southwest, says music therapy is one form of art that is unique in helping those in pain – both physical and mental – find relief. “Different then talk therapy, music therapy creates a friendly environment from the first moment that you meet the client,” she says. “The client doe s not need to know how to play any instrument. The music therapist does. We meet the client, do an assess ment – including a back ground history of emotional
Art therapy is also unique in its compatibility with patients, or clients, of all ages.
and physical concerns, and c re a t e t h e g o a l s a n d o b j e ct i v e s f o r t h e i r t re a t m e n t . ” Depending on the severity of t h e s y m p t o m s , t re a t m e n t m a y la s t 1 - 3 y e a r s , s h e s a y s . Art therapy is also unique in i t s c o m p a t i b i l i t y w i t h patients, or clients, of
all ages. A study of such modalities – published in Psychological Interventions: A Guide to Strategies – showed c re a t i o n o f a r t w o r k c a n h e l p e x p re s s e m o t i on – e s p ecially subconscious feeling. Re c o g n i z i n g t h e l i n k b e t w e e n mental health and physical pain, such therapies may help identify issues of emotional
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ther a p y, w e d o n o t o ff e r o n e spec i f i c s o l u t i o n , b u t i n s t e a d a wa y f o r t h e c l i e n t t o f i n d with i n h i m o r h e r s e l f t o c o nfron t f e a r s , a n d a c h i e v e a bett e r s t a t e o f m i n d . On e o f the i n v e n t i o n s t h a t w o r k s reall y w e l l , i f w o r k i n g w i t h teen a g e r s a n d a d u l t s , i s t o crea t e s o n g l y r i c s a b o u t a pain f u l s i t u a t i o n . ” Da Fo n s e c a , w h o i s w o r k i n g on a g r a d u a t e d e g re e i n c o u nselin g t o c o m p l e m e n t h e r stud i e s i n m u s i c t h e r a p y, s a y s she h a s s e e n t h e b e n e f i t s o f mus i c t h e r a p y f o r m a n y.
t urmoil that can then be a ddressed and resolved. “ I f the client’s goal is to reduce physical pain, we will include music relaxation a nd breathing techniques,” s ays Da Fonseca. “Afterward, t he client can use these l earned skills at home when i n pain. I f the client’s goal i s to reduce emotional pain, we would create an environ ment where he or she would f eel comfortable to express t hese feeling s. Just like talk
“We w o r k w i t h a l l t y p e s o f the p o p u l a t i o n : p s y c h i a tric, c h i l d re n w i t h d i s a b i l i t i e s – inc l u d i n g : c e re b r a l p a l s y, auti s t i c , D o w n s S y n d ro m e ; elde r l y ( s t ro k e , d e m e ntia); c h i l d re n a n d t e e n a gers a t r i s k ( b e h a v i o r s i s s u e s ) ; inma t e s ; m e d i c a l h o s p i t a l s (can c e r, p e d i a t r i c u n i t s , e t c ) ; and h o s p i c e , ” s h e s a y s . Whil e s o m e m a y n o t b e l i e v e phys i c a l d i s c o m f o r t c o u l d b e relie v e d b y l e a r n i n g t o p l a y the g u i t a r, o r b a n g i n g o n drum s , D a Fo n s e c a s a y s t h e rese a rc h i s o n t h e s i d e o f h e r prof e s s i o n .
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“Music therapists have a clinical background,” she says. “ We h a v e t o d o c o n t i n u i n g education to keep our certification, etc. Plus, it is scientifically shown to improve a c l i e n t ’s e m o t i o n a l o r p h y s i c a l need.” The American Art Therapy A s s o c i a t i o n a g re e s . O ff i c i a l s write, “Art therapy is based o n t h e b e l i e f t h a t t h e c re a t i v e p ro c e s s i n v o l v e d i n a r t i s t i c s e l f - e x p re s s i o n h e l p s p e o p l e t o re s o l v e c o n f l i c t s a n d p ro blems, develop interpersonal s k i l l s , m a n a g e b e h a v i o r, re d u c e s t re s s , i n c re a s e s e l f e s t e e m a n d s e l f - a w a re n e s s , and achieve insight.” Perhaps the answer to your nagging headaches is something you never considered before: lessons on a cello, a pottery class or learning to knit. Fo r a d d i t i o n a l re s o u rc e s , including state chapters of art therapy associations, lists of therapist and class ideas, v i s i t : w w w. a m e r i c a n a r t t h e r apyassociation.org. Fo r m o re i n f o r m a ti o n f ro m Lu c i a n a D a Fo n s e ca , e m a i l : fonseca_luciana@hotmail.com
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August 2011
v e r t e b r a e g ro wt h . T h e p re ss u re o f s t e n o s i s c a n a ff e c t sensitive nerves in the spinal cord, which sometimes causes numbness, as well as cause pain amongst vertebrae.
Pain Q&A What Technically is “ Back Pain?� Nearly every American will have back pain at some point in his or her life. Pain symptoms usually lead to a specific area of the back, which can include verte brae, the spinal cord or back muscles. Disorders within the abdomen can also cause back discomfort. What Part of My Back am I Most Likely to Injure? The lower back is the most
c o m m o n a re a f o r b a c k p a i n . After the common cold, lower back pain is the leading cause of lost workdays. W h a t a re t h e M o s t C o m m o n C a u s e s o f L o w e r B a c k Pa i n ? On e c o m m o n c a u s e o f p a i n within the lumbar vertebrae is lu m b a r s p i n a l s t e n o s i s . S p i n e s harden with age and can b e c o m e o v e r g ro w n . L u m b a r s p i n a l s t e n o s i s p u t s p re s s u re on spinal chords because of
A herniated disc is another c o m m o n l o w e r b a c k p ro b l e m . A s t h e d i s c s i n b e t w e e n v e rt e b r a e d e g e n e ra t e , t h e y b e c o m e m o re l i k e l y t o r u p t u re a n d e x p a n d . P ro t r u d i n g d i s c s o f t e n i n t e r f e re w i t h t h e s u rro u n d i n g n e r v e s , c a u s i n g p a i n and weakness. Symptoms o f h e r n i a t e d d is c s i n c l u d e muscle spasms, tingling and numbness, and shooting pain in the back and down the legs. H o w C a n I P re ve n t B a c k Pa i n ? P re v e n t i v e m e a s u re s a n d h a b i t s a re s i m p l e . G o o d p o s t u re k e e p s t h e b a c k s t ro n g a n d i n p ro p e r a l i g nment. When lifting an object, bend at the knees and keep t h e b a c k s t r a i g h t a n d p ro t e c t l u m b a r v e r t e b r a e . C o re e x e rc i s e s s t re n g t h e n t h e b a c k m u s c l e s a ro u n d t h e s p i n e , w h i c h p ro t e c t s t h e s p i n e a n d m a i n t a i n s m o b i l i t y. Av o i d c h ro n i c p a i n b y t a k i n g p ro p e r re s t a n d t re a t m e n t w h e n b a c k p a i n o c c u r s . S i m p l e p ro b l e m s like muscle strains cause back pain, and ice can be applied to limit inflammation.