Total Back Newsletter

Physical Therapy or Surgery for Back Pain?

John Naumann Uncategorized Leave a comment  

lumbar stenosisPhysical Therapy or surgery, what is the best option for back pain?

When it comes to lumbar(low-back) stenosis, physical therapy seems to be more effective!  A recent study conducted by Harvard Medical School evaluated 170 people in their 60’s diagnosed with lumbar stenosis.

These people  were randomly assigned to receive either surgery or physical therapy. The surgery removed areas of bone that were narrowing the spine and pressing on nerves. The physical therapy program lasted 6 weeks. But people in the physical therapy group were allowed to get surgery instead. More than half of them did so. People in both groups had tests of movement 10 weeks, 6 months and a year after surgery or physical therapy. They also were asked about pain. After 2 years, they filled out a survey to assess overall results. In the long term, both groups had equal reductions in pain. Both groups also had similar changes in movement and quality of life. Not everyone showed improvement. The journal Annals of Internal Medicine published the study.

A couple of key findings:

  • Symptom relief with conservative physical therapy treatment seems to be faster than surgery
  • Long-term outcomes were similar for both surgical and physical therapy patients
  • 20% of the people that opted for surgery, had to have another surgical procedure done.


Based on the results of this recent study, physical therapy should be considered as the initial option to surgery.  If results are not obtained with physical therapy treatment, the surgical procedure may be the next step.


Try Physical Therapy first when it comes to back pain

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Physical Therapy is the conservative more economical approach to back pain treatment

Competitive Pricing

A recent article in the Washington Post ” Oh, my aching wallet: MRI instead of physical therapy for low back pain leads to $4,793 higher price”, quotes recent research that has shown shows the significant cost difference between other medical treatments for back pain vs. physical therapy. A nearly $5000 difference!

While there is a time and a place for MRI, injections, and surgical procedures, often the first choice can be physical therapy.  Often during the course of treatment a physical therapist may recommend that a patient seek there physician for a more comprehensive examination and treatment for the condition.

Physical therapy helps address the underlying problem and help educate the patient, while other more expensive treatments tend to focus on alleviating the symptoms and at times doesn’t correct what caused the problem in the first place.  If you are considering the more conservative and more economical approach to treating your back pain, give physical therapy a try!

VAX-D vs Traction

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VAX-D vs Traction – Is Vax-D the same as traction?

Total Back_0020

We are often asked this question and the simple answer is “no”.  The following is a well written explanation from Pinhook Chiropractic Clinic in Lousiana

Although traction devices can stretch the lower back, the y have not demonstrated the ability to decompress the lumbar discs and spinal nerves. Traction tables have a small electric wench that attaches to the head of the table. A rope and pulley are then attached to either a cervical device or lumbar belts. Either static or intermittent traction modes can be chosen, but neither have been shown to reduce intradiscal pressure and decompress the discs and nerves.

VAX-D Therapy has been proven as an effective therapy in several separate and distinct clinical settings. In one study, radiological research was carried out in which fluoroscopic videos of patients with a myelogram were recorded while patients were undergoing VAX-D therapy. Distraction of intervertebral lumbar spaces was observed on VAX-D Therapy, and the filling defect of a myelogram from a herniated disc was decreased. Records were obtained showing a myelogram displacement, from a herniated disc at L4-5, change from a convex image of a disc bulge to a concave image, created by decompressing the intradiscal space during VAX-D Therapy.

The greatest amount of intervertebral distraction and subsequent spinal decompression is achieved at the L4-5 and L5-S1 disc space and decreases gradually toward the upper lumbar and lower thoracic levels of the spinal column.

Treatment begins with a VAX-D technician fitting you with a special lumbar belt. Then you lie down on the table and take hold of the handles at the head of the table. The tech then attaches the strap from the lumbar belt to the foot of the table.   During a treatment, the bottom half of the VAX-D table gently glides apart from the top half. Because the lumbar belt you are wearing is attached at the bottom, you will feel a very strong but painless force pull on your lower spine. This is the decompression part of the treatment, and it dramatically reduces the pressure inside the center of your injured disc. After sixty seconds, the lower half of the table glides back home again. This allows your lower back to relax for sixty seconds. Then the lower half glides away again and after another sixty seconds of decompression, it returns home for another sixty seconds of relaxation. These alternating cycles of decompression and relaxation continue for thirty to forty five minutes. The patented design of the table allows the patient to let go of the special hand grips at any time during the course of the treatment. This helps the patient to be more relaxed and causes less muscle spasms or guarding during the treatment. If spasms do occur, the tension meter recognizes this and releases pressure until the muscles relax and then it begins to pull again. In situations where the patient is unable to hold onto the hand pads due to shoulder injuries, a special shoulder harness is used to distract the spine.

The key to success of VAX-D treatments, and what makes VAX-D altogether different from traction or the flexion/distraction treatments done by physical therapist and chiropractors, is the extraordinarily low pressure that is created within the injured disc. Normally, even when you are lying down and resting, the pressure within each one of your discs is approximately 75 mm of mercury.   Upon standing this pressure can rise to as much as 180 mm of Hg. (“mm” of mercury is simply the way scientists measure the amount of pressure inside the disc.)

During VAX-D, treatments are able to reduce the pressure in the lumbar spine down to levels of –180 mm of mercury, allowing fluids and nutrients to re-enter the disc; reducing swelling and relieving the pressure on pinched nerves. This is a very low pressure. Traction and distraction devices cannot achieve this. This is important because this is what allows the magic of VAX-D to take place.

Intradiscal pressure measurements on patients undergoing VAX-D therapy have shown that the extent of decompression measured in mm of Hg follows an inverse relationship to the tension applied to the pelvic belt during therapy. The amount of decompression generated by the VAX-D table is computer controlled and guided by the use of a tension meter. The technician can also change this by simply changing the working air pressure.

Remember, while there are veins and arteries in the vertebrae around your discs, there is no blood getting from them into the discs. However, the extremely low, negative pressure created within the disc during a VAX-D treatment works like a vacuum, and that vacuum allows three things to happen. First, much of the bulging or herniated material is pulled back into the center of the disc. Second, the torn or ruptured annulus fibers are pulled together and realigned for the first time. Third and just as important, nutrients, vitamins, and minerals are sucked into the disc from the blood supply in the surrounding vertebrae.

This is vital to the healing process, and it’s actually what makes VAX-D such a clinical breakthrough. The disc is nourished, the nucleus pulposus is pulled back to the center of the disc and the bulge is eliminated, the annulus fibers are realigned and heal, and you, the patient, are no longer in pain.

So when it comes to VAX-D vs Traction, this is  primary reason The Center for Total Back Care uses VAX-D therapy to treat patients with disc bulges and herniations versus other clinics that use traction.  Contact us to learn more about how VAX-D can help you.

“Text Neck” creating chronic neck pain

John Naumann Uncategorized Leave a comment  

Text Neck

Text Neck, the new postural condition

The one thing that has become clear over the years as technology progresses, so do the new conditions related to the use of the new technology.  In the early 2000’s, physical therapy and chiropractors started seeing an increase in neck pain related to pinching the ever “smaller” cell phones between peoples neck and shoulders.  This lead to the development in hands free devices and functions on the cell phones.  By 2005 the first smartphones started to arrive on the market and texting began to become the normal form of quick communication vs. the phone call.  This lead to “Blackberry Thumb”, due to the original keyboards on the smartphones needing to be depressed to enter the text and thumbs were the primary digits for keying. This lead to the development of touch screen and auto text to decrease keying and force needed to key.

Now, the new condition is called “Text Neck”, which is related to the use of any smart phone or tablet.  This condition comes from the standard posture with the device being held low and your neck being bent forward to interact with the device.  This constant forward head posture puts significant stress on the muscles, ligaments, and joints in the neck leading to chronic neck pain. This type of pain was usually more specific to people who worked in specific industries, like, welders and dentists.

This condition is affecting a wide range of people and starting at much earlier ages. Dr. Brad Davis, a physiatrist, or rehabilitation physician, with Carolina Spine and Neurosurgery Center in Asheville, said he sees patients every day with chronic neck pain – and more of them are young.  “From what I gather,” he said, “on average folks are spending a couple of hours a day (on these devices), which translates to hundreds of hours on an annual basis of not having the correct cervical spine and head posture.” “Over time with this repetitive stress of long durations, you end up with more of a chronic neck condition,” he said. “And once an individual starts feeling the effects of chronic pain, they learn to change their posture.”  And, Van Pelt said, the full impact this behavior has on children is not yet known.  “The worrisome part of this is that younger and younger people and people with immature spines are using these devices and over prolonged periods this may result in the spine not growing to a normal curvature,” he said. “I’m sure we’ll find out over the next 10 years the effects of it.” (Greenville Online, Smartphone use causing painful “text neck”)

So what can you do?

The best thing you can do is prevention.  Eliminating some of the poor texting habits are the keys to reducing this poor posture and neck pain.

  • Take breaks from you smart phone or tablet – This is very straight forward.  The body is amazing and can tolerate poor postures for short periods of time, but it needs time to recover. Taking a break from your device every 20 minutes will give your body a chance to recover
  • Stretch your neck during your break – The tension built up in your neck needs to be alleviated and to encourage good blood flow to the joint and tissues.  Use this neck stretch to address your forward head posture.
  • Use the voice to text function – Many of the devices have a voice to text function, use it when you can to avoid prolonged forward head posture.
  • Put the device away – We often feel the need to respond to everything immediately, but often it can wait.  When at work put the device in your desk, not on it.  Turn it to silent.
  • Teach your children good device habits – Texting was developed as a quick way to communicate when a telephone conversation wasn’t possible or unnecessary.  Call the person or talk to the person face to face, when you know the conversation is going to be longer than a few sentences. First the conversation could be quicker and secondly less painful on the neck!

It is important to look at all possible habits that might be causing your neck pain and many of us are guilty of encouraging “text neck”.  Changing your habits, along with proper treatment of your neck pain , can help you avoid chronic neck pain issues.

10 Things That Might Be Causing Your Back Pain

John Naumann Uncategorized Leave a comment  

Surprising causes of Back Pain


Your diet – The more weight we put on, the more stress we put on the back.backpain1

Not exercising – Exercise helps strengthen muscles and ligaments which help support the spine. It also helps keep weight off by burning more calories.

Slouching – You can refer to our ergonomics articles for more details on this, but studies have shown that slouching can increase stress on your back by up to 25%.

Your chair – Don’t skimp on a cheap chair or one that is ill suited for the tasks you are doing. Make sure you get the right chair for what you are doing, your back will appreciate it.

Your shoes – Ask an architect if they would put a structure up on a poor foundation! So many people wear shoes far beyond their ability to provide proper support. If they are worn, replace them.

Your mattress – Don’t wait for the springs to poke you. If the mattress is over 10 years old and you have back pain, consider getting a new mattress.

Your car – Many people spend a few hours a day in their vehicle. Making sure the seat is adjusted for you is important to making it a comfortable driving experience. Consider your seat when buying the next car if you spend a lot of time on the road.

Your shoulder bag – This could be a purse, carrying case, or laptop bag. Most people place the bag over the same shoulder every time which can lead to back pain. Either get into a habit of swapping shoulders, lighten the bag by getting rid of un-necessary items, or get a backpack to evenly distribute the weight.

Smoking – A smoker is twice as likely to develop back pain as a non-smoker. Smoking weaken joints and tissues which can lead to an injury

Sciatic Pain, It may be Piriformis Syndrome

John Naumann Uncategorized Leave a comment  

piriformis musclePiriformis Syndrome

The Center for Total Back Care treats many conditions including Piriformis Syndrome.  Sometimes the Piriformis muscle can be the culprit when it comes to pain related to the Sciatic nerve.  The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. It is important in stabilizing the hip and balance with weight shifts.

As you can see by the diagram to the right, the Sciatic nerve travels through or just beside the Piriformis muscle.  The Sciatic pain associated with Piriformis Syndrome is related to compression applied to the Sciatic nerve.  Many events can trigger Piriformis syndrome but pain can be increased by sitting for prolonged periods, running or stair climbing.

The good news is that even though its symptoms are similar to that of a herniated disc the treatment is usually less aggressive.  Patients will often see improvement within a few appointments.

How to Prevent Piriformis Syndrome

  • If you are very active change your shoes out.  Even when your shoes show little external wear, the cushion and support wear out about every 6 months (sooner if you are using them to exercise).  Worn out shoes put extra stress on all the joints, including the hips.
  • Avoid running long distance on uneven surfaces, which will put extra stress on your balance and hip stabilizers, like the Piriformis muscle.
  • Use proper form when squatting.  Form encourages proper joint motion and alignment, which reduces stress on the leg joints, including the hip.
  • Stretch, utilize the Piriformis stretch to target the Piriformis muscle.
  • Rest when you feel the symptoms coming on.

Please contact us at 480-633-8293 if you have questions about Piriformis Syndrome and other conditions of the Back and Neck.


What is the difference between a bulging and herniated disc in the spine?

John Naumann Uncategorized Leave a comment  

Treating a bulging or herniated disc is one of our specialties at The Center for Total Back Care.  Often we get asked, “What is the difference?”.  While they may seem similar they are very different conditions that require very specific approaches to physical therapy and chiropractic care.

To explain this, it is important to define what the disc is made of and its purpose.  The disc acts as cushions between the vertebrae in your spine. They’re outer layer of tough cartilage that surrounds softer cartilage in the center. Its design allows for mobility and protection against forces applied to the spine.

bulging disc

Disc outer cartilage(grey) and inner cartilage(blue)

Disc outer cartilage(grey) and inner cartilage(blue)

A bulging disc extends outside its normal position in the vertabrae. The bulge is created by the outer cartilage layers stretching or breaking down.  It looks similar to a hamburger(disk) in a small hamburger bun(vertebrae).  Bulging usually is considered part of the normal aging process of the disc.

A herniated disc, on the other hand, results when the fibers in the tough outer layer of cartilage break and/or rupture, allowing some of the softer inner cartilage to protrude out of the disc. Herniated discs are sometimes called slipped discs.

If you have been diagnosed or suspect you have one of these conditions, contact us at 480-633-8293 to find out what treatment options are available to you!


What you may not know about scoliosis!

John Naumann Uncategorized Leave a comment  

Did you know this about scoliosis?



Scoliosis is a common condition that we treat at The Center for Total Back Care. Our goal is to decrease pain and increase spinal stability with people affected by this condition.  Here are some things you may not know about scoliosis.

  1. Scoliosis affects about 3% of the population.  You may have scoliosis and not be aware of it!
  2. Women are more likely to have scoliosis than men.
  3. Scoliosis often doesn’t require surgery and can be treated by a physical therapist or chiropractor that specializes in spinal conditions
  4. The position and spine curve size doesn’t determine the severity of the condition.  Often people with the most severe spinal curvatures may experience little or no symptoms, while people with mild scoliosis may have very pronounced symptoms.
  5. There are 2 types of scoliosis.  One is degenerative scoliosis and the other is idiopathic scoliosis.  Degenerative scoliosis usually occurs as one ages and progresses based on normal wear and tear.  Idiopathic scoliosis develops at an earlier age and can get progressively worse as one ages.
  6. Smoking can contribute to scoliosis progression.  Recent studies suggest that smoking has a very negative impact on the spine by increasing the rate of disc degeneration.
  7. Keep exercising.  It is important to maintain a proper exercise and core stabilization program to improve symptoms and potentially reduce the degeneration of the spine related to scoliosis.  Make sure you consult with a spine care specialist before you start exercising.

The Center for Total Back Care specializes in the treatment of many spinal conditions including scoliosis.  Contact us today for more information about how we can help you treat scoliosis!


Tips to cut 1000 calories from your Thanksgiving meal

John Naumann Uncategorized Leave a comment  


Thanksgiving mealDid you know the average Thanksgiving meal is over 2,000 calories and that is before you have a second serving!  Here is the average Thanksgiving meal:

  • Turkey, white & dark meat, with skin, 6 ounces
  • Gravy, 1/3 cup
  • Mashed potatoes, 1 cup
  • Cranberry sauce, 1/3 cup
  • Green bean casserole, 1 cup
  • Sweet potato casserole topped with marshmallows, 1 cup
  • Dinner roll, 1
  • Butter, 1 tablespoon
  • Apple pie, 1 slice
  • Vanilla ice cream, ½ cup


To burn 1,000 calories you would have to:

  • Run – 9 miles
  • Bike – 22 miles
  • Jump Rope – continuously for 90 minutes

For many, it may be easier to just cut 1,000 calories from the meal.  Here are some simple ways to do this.

  • Turkey – eat only 3 oz. of Turkey without the skin (Average calorie savings 200)
  • Sweet potato casserole – ½ cup, without marshmallows (Average calorie savings 270)
  • Green bean casserole – ½ cup, without the french onion topping (Average calorie savings 140)
  • Mashed potatoes – ½ cup instead of 1 cup (Average calorie savings 200)
  • Butter – Eliminate the butter for the dinner roll (Average calorie savings 100)
  • Apple pie – ½ cup low-fat vanilla or low fat whipped cream (Average calore savings 160)
  • Total calorie savings – 1060 calories!

By eating slowly you will feel the sensation of being full quickly and will be less inclined to go back for seconds.  Have a Happy and Healthy Thanksgiving!

Top Low Back Stretches: Prayer Stretch

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Top Low Back Stretches: Prayer Stretch

The prayer stretch is a great stretch that primarily targets the extensor muscles of the back.  The prayer stretch is excellent because it limits the loading placed on the low back while performing the stretch and allows you to fully relax, letting gravity do the work for you. The prayer stretch is one of the best stretches you can do to protect yourself from a low back injury and to help relieve pain during the rehabilitation from a low back injury.  When people injure their low back, the muscles surrounding the area of the injury will tighten to guard the area from further injury.  The problem is that this constant tension in these muscle groups, can increase pain when a nerve is involved and decreases blood flow to this area.  Decreased blood flow increases the time for healing.  So stretching the muscles in this area help break this cycle and allow for the body to heal.

Prayer Stretch

To perform the prayer stretch first consider the surface you are performing it on.  Due to your knees making direct contact with the surface you will probably want to perform this stretch on some form of padded surface. Also if you have knee pain you may want to place a pillow between the backs of your thighs and calves when you are kneeling.

Prayer stretchprayer stretch 2







-On your hands and knees, sit back so your buttocks is resting on your heels.

-Reach your hands forward to lengthen your spine and feel a stretch in your middle back.

-You can reach your hands to either side to focus the stretch on the opposite side of your spine.

-Hold for 10-30 seconds and perform 2-3 repetitions.

When should I perform the prayer stretch?

The prayer stretch can be performed prior to or after any workout program, especially with back loading is involved.  This will help prevent injury.  Performing this stretch after injury will help expedite the healing process.

When should I avoid performing the prayer stretch?

The prayer stretch needs to be approached with caution if you are dealing with back pain.  Some people with severe knee pain will have difficulty performing the stretch.  If you feel an increase in pain or numbness, stop and contact your doctor.


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