How Can I Heal?

This week, Dr. Heather McGill shared in conversation with Crina Okumus on her podcast How Can I Heal. The two discussed Heather’s vision for how to build robust, durable athletes through three healthy habits. Read more about Okumus and her podcast below:

---

THIS PODCAST IS A WEEKLY CONVERSATIONS WITH PEOPLE THAT I ADMIRE TO IMPROVE YOUR OWN LIFE FOR THE BETTER.

Subscribe on Apple Podcasts

To give you a little background about me. I have an experience for more than 15 years in the fashion industry, running my company successfully selling in more than 40 countries and being highly profitable. 

One day, I received a call that my father died in a car accident and my whole life completely changed. I started to ask myself who am I and why I am here? The process of healing took more than five years, during which I was also facing my inner calling to move away from fashion and figure out what is next for me.It was certainly not an easy journey and I thought that I will never figure out what I will do for the rest of my life. But one day, I chose to listen to my heart and let it guide me to my future.

And with that decision, everything started moving in the right direction. 

The biggest insight I had during this time was that I could not change the world. I'm too small for that. But I can certainly change myself and the people around me who would be inspired by my story. And that’s when I decided to start a series of interviews with people that I love and who have made a big change in my life. 

So I hope you will join me in my journey and find inspiration in the stories of known personalities but also those of normal people. And please share your own journey with me and let's make a little change and make this world more beautiful. It’s up to us to make this change happen.

With love,
Crina

The Future of Disc Pathology Treatments

NSAIDs and rehabilitative care are the first line of treatment for the majority of low back pain patients. When appropriate, epidural injections can be utilized to reduce inflammation and allow for improved tolerance for exercise. Surgery is considered with severe disc herniations or when conservative care fails.

Given the prevalence of disc injuries, science is constantly searching for new strategies to treat patients. In recent years, there has been research in the potential for replacing and re-growing intervertebral discs! Two of these novel methods are stem cell therapy and gene therapy.  

Stem Cell Therapy

Currently, the best surgical strategy for severe disc injuries is either spinal fusions or disc removal. Both result in decreased function, and can have long term effects on joint health. Stem cell therapy aims to provide an alternative solution, either surgically or through injections. Cells from bone marrow tissue and adipose tissue have show the ability to develop into a structure very similar to the nucleus pulposus. Research hypothesizes that these cells can be used to grow vertebral discs in a lab, or be injected to support disc regeneration.

In a 2019 systematic review by Meisel et al, the team of researchers looked at stem cell therapy for the treatment of disc degeneration. They found the strength of the current evidence to be poor due to the low number of studies and that all reviewed studies were small and primarily case series. It was recommended that larger, more robust studies be performed to accurately evaluate this potential new treatment. 

Gene Therapy

Researchers argue that it is almost impossible to stop the progression of degeneration once it’s be diagnosed. Disc tissue lacks the regenerative properties that other cells in our bodies possess, and their low supply of oxygen and nutrition further challenges cell survival. Injecting genetic material in to very specific cells can alter this pattern, and help extend the life of spinal discs. There are several methods for this process, however RNA interference stands out as the best possible strategy currently.

A 2020 paper by Takeoka et al. proposes in depth the potential for gene therapy as a treatment strategy for degenerative disc disease. Despite listed obstacles, they assert “the amount of research is increasing and broadening, and so it is not unrealistic to expect a breakthrough from these studies over the coming few years.”

Both cutting edge procedures are still in the early stages of development, but show promise. However, medication nor surgery will never be the sole solution. It’s essential to assess your movement patterns, and address any strength imbalances or weakness.

To learn more, check out these articles:

1. Meisel HJ, Agarwal N, Hsieh PC, et al. Cell Therapy for Treatment of Intervertebral Disc Degeneration: A Systematic Review. Global Spine J. 2019;9(1 Suppl):39S‐52S. doi:10.1177/2192568219829024

2. Takeoka Y, Yurube T, Nishida K. Gene Therapy Approach for Intervertebral Disc Degeneration: An Update. Neurospine. 2020;17(1):3‐14. doi:10.14245/ns.2040042.021

Lumbar Disc Pathology: Part II

If you’ve experienced a disc injury before, you’ll know immediate care is all about triaging. You need strategies to help you deal with the pain now and a plan to tackle this ASAP! Depending on your symptoms and how you got hurt, we recommend making appointments with both your physician and a rehabilitation specialist.

A physician will be able to write prescriptions, as appropriate, while ATs and PTs will be able to address your pain from a mechanical perspective. There is tons of evidence supporting various treatment modalities for the management of lumbar disc pathologies. The focus is pain resolution, restoration of function and any associated neurologic deficits associated. 

At your appointment, your clinician will perform an in-depth evaluation and establish a treatment plan to address your specific and unique symptoms. This will often include:

• Mobility exercises for muscle, joint, and even nerves

• Stabilization exercises focused on trunk control and strengthening

• Proprioception, coordination, and balance training

• Functional conditioning 

• Phased return to sport / activity program

While you’re waiting for your appointment, there are several strategies you can try to safely mitigate your symptoms. Often, disc-related low back pain is aggravated by prolonged flexion, or bending at the waist.

1. Try to limit time sitting by standing or walking when you can.

2. Modify your work environment to allow for standing, taking seated breaks as needed. Get creative- using books, boxes or other household items to create an make-shift ergonomic solution.

3. When sitting, use a pillow or support behind your low back to limit rounding of the low back, or slumping.

4. Raising your seat height, whether in a desk chair or in the car, can help you avoid a posterior tilt of the pelvis. This position puts stretch through the muscles and nerves of the low back.

5. Rest lying down if unable to tolerate sitting. Try bending your knees, planting your feet on the ground to help maintain a neutral spine.

6. Use heat to help relax muscle spasm or guarding.

7. Avoid intense stretches for now- while they may feel good in the moment, this can increase muscle spasm.

8. Over the counter pain meds such as NSAIDs can help reduce pain. Double check each individual brand for dosage recommendations.

Jump Into Prenatal Fitness

The literature has shown exercise can decrease pain, improve function, and limit time off work due to pregnancy-related back and pelvic pain. In general, strengthening routines should focus on muscles of the back, core and pelvic floor. Bonus circuits can also include upper body strengthening in preparation to lifting and carrying your bundle of joy. Depending on your experience with exercise, you can choose between independent sweat sessions, or working one-on-one with a coach. Prenatal group exercise classes are recommended for individuals who find themselves needing modifications for greater than 50% of the class. But what if you feel too pregnant to exercise?

Enter water aerobics.  While the class may conjure images of senior citizens in shower caps, aquatic therapy is frequently used with patients who are pregnant. Being in the water up to chest level takes off 70% of your body weight. This can be extremely helpful for soon-to-be moms who are having painful back and pelvic girdle issues, allowing for exercise until they can tolerate more land therapy.

A 2016 systematic review of literature, found strong evidence demonstrating benefit of combined aquatic and resistance for maternal cardiorespiratory fitness and prevention of urinary incontinence. Additionally, a 2011 study found that aquatic therapy is effective in reducing peripheral edema (swelling in the ankles and feet). 

Depending on your community, access to a pool may vary. Some health clubs and specialty physical therapy clinics offer individual and group classes depending on local health regulations. Your OB-GYN can be a great resource for other options. Just be sure to double-check with your primary medical team before jumping in the nearest lake!