Back & Neck

Dr Lewi  specialises in Back Pain Treatments which are both safe and highly effective:

• We use a very hands on technique.
• We avoid using medication if at all possible.
• We only  resort to x-rays or CT scans in selected cases.
• We hope to avoid Surgery.

This treatment is an alternative to chiropractors and osteopaths because although we use some of their techniques we combine them into a medical model and we back them with medical expertise and treatment where necessary.

The Diagnosis

We make a special point of establishing a firm and relevant diagnosis on which we can base our treatment. At each examination the diagnosis is updated so as to tailor the ongoing treatment.

 

Posture

Everyday activities often places your neck and head in a position which places strain on the vertebral joints. Routine activities such as facing a computer screen are constant and if the screen is badly positioned in puts unnecessary strain on the joints of the neck.

The common errors on posture are:

• Looking to the side at documents when using a computer.
• Sleeping face down with the head turned to one side.
• Trapping the telephone against the shoulder.

We particularly focus on Improving Posture because bad posture can often lead to.

Neck Problems

These could be due bad habits such as hunching of the shoulders when leaning over the desk, 

• or having to  face a computer screen for many hours,
• or by bad positioning of the computer screen and /or the working text,
• or also sleeping face down with the head turned to one side,
• or trapping the telephone against the shoulder to become hands free.

 

Lower Back Pain

Can also be due to  bad posture.

We look for  signs of  a Flattened back – in the shape of  a decrease in the natural inward curve of the lower back.

Other postural stresses which could  be   due to faulty posture while engaged in daily activities.

The simple act of doing repeated and constant bending down carries the vertebrae forward –  and causes excess pressure on the front of the spine. 

Another faulty postural stress is that of the worker who repeatedly  favours one side of their body.   such as shovelling soil from right to left . This has the effect of  compressing one side of the spine at the expense of the other . Our treatment is addressed to reverse this maladjustment.

Physical Treatment:
 

How does Manipulation work? 
What if manipulations don’t relieve the pain? 
Massage 

As practising members of the Australian Musculoskeletal Medicine Association we use physical, hands on treatment as our first option.  Scientific studies have shown that this leads to better and quicker outcomes for treating spinal pain than hands off treatment.

We practice a gentle form of manipulation which is based on the model designed by Professor Maigne of Paris.  His form of manipulations is patient friendly and is both safe and effective

The majority of our patients improve just with these manipulations and do not need further treatment. The diagnosis of these patients is probably one of  MINOR DYSFUNCTION OF THE SPINE.

The dysfunction can occur at

• The main intervertebral joint.
• The facet joint
• The intervertebral disc.
• or an early slipping of the lumbar joint (spondylolisthesis)

How does Manipulation work?

Despite the gratifying success of manipulations, no one has given a proven explanation of how manipulations work but it could be in the following ways:

• 1. By restoring movement to malfunctioning joints that are frozen by unnecessary spasm of surrounding muscles.

• 2. By making all joints move equally and thereby relieve the workload on the injured or malfunctioning joints.
   

What if manipulations don't relieve the pain?

Realistically not everyone responds just to manipulations and therefore we offer the following alternativePhysical Treatment or Medical Treatment.
 

Massage

Gentle exercise and  massage works in cases of muscle soreness and stiffness by reducing pain and restoring mobility. We use short techniques of massage but in stubborn cases, we refer  the patient  for more intensive massage.

Medical Treatment:

X rays and Blood Tests
Medication
Other methods of relieving the pain
Dry Needling
Targeted Steroid Injections
Epidural Injection
Prolotherapy
Surgery
Radiofrequency Denervation

In cases of a torn intervertebral disc, the injury releases an enzyme which irritates the nerves of the spinal cord that lie near the joint. This effect can be so dramatic as to cause severe weakness in the limb. Antiflammatory medication by prescription and save the patient needing surgery. We will prescribe this medication in selected cases.

Xrays and Blood Tests

In most cases, we delay the use of X-rays because most   patients get better without needing these.

Note that. even disc bulges as seen on MRI often do not cause symptoms and are coincidental to the back pain , so  X-rays or even MRI don’t add   any worthwhile  information  and do not lead to a change in treatment

Nevertheless in difficult and patients and those with severe   pain and those who are in line for surgery, there is a definite need   for X-ray or CT scans and in some cases we also use blood tests.

 

Medication

Many case of spinal pain  are caused by the release of inflammatory and Neuro chemical mediators, this leads to radicular symptoms by irritating the nerves of the spinal cord that lie near the injury. The effect of this inflammation can be so dramatic as to cause severe weakness in the limb. Antiinflammatory medication will be prescribed and often be a direct antidote to these inflammatory substances.

Other methods of relieving the pain:

We use Needling techniques 
These may be

1. Dry needling or  Acupuncture
2. Prolotherapy
3. Targeted steroid injections
4. Nerve blocks or epidurals

 

Dry Needling

This is a modem form of acupuncture. Which uses the same needles as Chinese acupuncture but we insert them according to a medical model.
The aim is to target the   muscle spasms when they are excessive in nature and are the cause of pain and discomfort
The needling of the affected muscles   reduces the muscle spasm and brings about a relaxation of these muscles thereby relieving the pain.

Targeted Seroid Injections

Inflammation is often the very source of the pain and steroids being the most potent agent to reduce inflammation and pain are delivered directly into the area of this inflammation, with such a technique we are able to deliver a high dose of medication directly to the problem area and avoid side effects to the rest of the body.
 

One injection is usually sufficient but if the inflammation is severe, or if the inflammation has been around a long time, the steroid injection may need to repeated.

Epidural Injection

An epidural injection uses the technique similar to what is performed to mothers in the last stages of labour .but in cases of spinal pain, we inject steroid as well as local anaesthetic. 

We sometimes do this injection in the clinic but in difficult or resistant cases, we will refer you to the Radiology clinic to have the procedure done under X-ray control.

Similar techniques are used when the source of the pain is in the Sacroiliac Joint pain or in the facet joint pain of the spine 

The facet joints are small joints a little larger than the size of the thumb nails located in pairs on the back of the spine. They provide stability and guide motion in the low back. If the joints become painful this can cause pain in the low back, abdomen, buttocks, groin or legs. A clue to whether these joints are the cause of pain if the spine hurts when the patient leans backwards.

Prolotherapy

We use this popular new therapy when there is chronic pain due to ligament and tendon weakness.

This is a simple technique which uses   the   injection of a solution into the inflamed areas.  This leads to the deposition of new collagen, the material that ligaments and tendons are made of. This new collagen shrinks as it matures. The shrinking collagen tightens the ligament and makes it stronger. Thereby relieving the dysfunction.

Surgery

At the end of the line, having exhausted all alternatives, and in certain emergencies, some people will benefit from surgery.

The most likely reason for choosing surgery is when the spinal cord or exiting nerves are severely compressed and there is no prospect of relieving the pressure by other means,

Typically the compression show up as  

• loss of feeling in the lower body
• incontinence of bladder and/or bowel
• or Severe and uncontrollable leg pain

Realistically these cases are the minority.

 

Radiofrequency Denervation

This is another technique that we sometimes recommend.

It applies to back sufferers who have severe pain for many months and get no relief from any treatments. A radiofrequency current is applied directly to the nerves causing the pain. This provides relief for chronic pain which can last many months

We usually refer such cases to a clinic that specialises in this treatment.