Thursday, September 07, 2006

paraspinal muscles

Yesterday afternoon I had my appointment with Dr. Lenore Gladstone, a physiatrist affiliated with Montefiore Medical Center in the Bronx, who I last saw back in October 2003. My general practitioner referred her to me back then when I went to him complaining about lower back pain after I returned from my Watson year abroad. The lower back discomfort that I experienced then was due to the heavy knapsack that I had lugged around throughout that year abroad. This time it seems like I might have injured my back from some of the lower back stretches that I have been doing before and after exercising.

After examing me, she told me that I had a massive muscle spasm on my lower left back which is exactly where the nightly pain strikes. The area where the spasm is centered is called the paraspinal muscles, which run along the length of the spine. I wondered if my mattress was a culprit, but she said that was unlikely since my lower back pain began only in the last 4 weeks whereas I have had my mattress for close to 9 months now. The pain, both she and Andrew, her physicial therapist, explained, was most likely a combination poor posture as sit and stand as well as the stretching that I have been doing when I exercise. Andrew described my problem as "mechanical." My paraspinal muscles, he said, will heal if given the time and protected from further stress. In order to aid that process, he showed new ways that I should sleep during this restorative period. For example, one requires me to sleep on my back with my legs elevated above 2-3 pillows, my back under a towel, and my head on one pillow. This position, he said, would take stress of my lower back. Once it heals, however, then I may be able to sleep without the added pillows and towel. This sleeping position is just to aid the recovery process. He also showed me an interesting but challenging abdominal exercise aimed at strengthening my core abdominals and lower back, since its the abdominal muscles which act as the main stabilizer for the trunk of the body as well as providing support to the lower back. This I already knew from past readings about the importance of strong abdominals, but what I didn't know was the exercise that he went on to show me. Simply, I lay down, chest up, on a flat surface and concentrate on pulling my belly button in as deep as possible (toward the floor/mat). I then hold my breathe for 5 seconds before exhaling. I'm asked to do this 2-3 sets of 5-10 reps. This simple but at first challenging exercise (it's the concentration and awareness of the inner muscles at work that makes it so challenging I found) develops the transverse abdominus muscle, which lies beneath the much idolized rectus abdominus, which is of course most lauded in the form of the hallowed 6 pack. The rectus abdominus, despite its great fanfare, is really a showpiece muscle. The transverse abdominus, however, is where the real inner core strength of the torso lies, which is why it's misleading if someone has attractive washboard abs, but the deeper transverse abdominus muscle are weak or ill-developed. So, the exercise described briefly above will help to developed that deeper abdominal muscle which will also help to alleviate my lower back discomfort. Progress will be slow, however, he said. It may be at least a month before I notice any difference.

I'm scheduled to return to Dr. Gladstone's office tomorrow for some more therapy with Andrew and hopefully, a few more times next week before I depart for Chicago on the 18th.

I was ignorant of the term, "physiatrist" until my appointment yesterday. I was referring to Dr. Gladstone as an orthopedist. According to the American Academy of Physical Medicine and Rehabilitation describes a physiatrist as:

a physician specializing in physical medicine and rehabilitation. Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. They see patients in all age groups and treat problems that touch upon all the major systems in the body. These specialists focus on restoring function to people. . . .

Physiatrists treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists' patients include people with arthritis, tendonitis, any kind of back pain, and work- or sports-related injuries.


Physiatrists also treat serious disorders of the musculoskeletal system that result in severe functional limitations. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists coordinate the long-term rehabilitation process for patients with spinal cord injuries, cancer, stroke or other neurological disorders, brain injuries, amputations, and multiple sclerosis.

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