tbream - Main Line Spine

Jeffery Rowe, MD, is a physical medicine and rehabilitation physician, also known as a physiatrist, with a subspecialty in pain medicine. He practices at Main Line Spine and specializes in minimally invasive interventional spine surgeries.

In this Q&A, Dr. Rowe shares how he helps patients with new technologies and advanced treatment options to relieve chronic pain of the spine, including the low back and neck.

You practice a unique subspecialty. Could you tell us more about it?

When you have chronic pain, there are two ends of the spectrum where you can seek treatment.

At one end of the spectrum are physiatrists who utilize non-surgical and minimally invasive approaches and procedures to treat your pain. These approaches might range from exercise to physical therapy, medication management, and injections such as epidural steroid injections, facet blocks, and SI joint injections. Anesthesiologists who have had a spine fellowship also traditionally use these approaches.

At the other end of the spectrum are orthopedic and neurologic surgeons. They focus on much more major surgical procedures to address spine pain issues. These procedures include lumbar and cervical fusions and decompressive laminectomies to relieve pressure on the spinal nerve roots.

Many new treatments fall in the gap between these two extremes. These are minimally invasive surgical procedures to relieve pain, appropriate when conservative treatment options haven’t provided long-term benefits. These procedures offer patients options that are far less severe surgically than those where orthopedists and neurosurgeons traditionally focus.

My surgical subspecialty is providing patients with pain relief options in this treatment gap.

What kind of treatments and procedures are we talking about in this gap?

One area in this gap includes neuromodulation devices that work by interrupting pain signals before they reach your brain. These include traditional Spinal Cord Stimulators (SCS), Dorsal Root Ganglion (DRG) stimulators, and Peripheral Nerve Stimulators (PNS).

Neuromodulation technologies have improved by leaps and bounds over the past five years, and they now incorporate improved batteries and Bluetooth technologies for programming.

Another minimally invasive treatment option is an interspinous spacer device, which can provide relief from lumbar spinal stenosis. This procedure can be an alternative to surgical decompression, such as a laminectomy.

I began to adopt these procedures four years ago when they officially became commercially available. Given that I was one of the early adopters of this treatment option, I now regularly teach other physicians and surgeons on the proper usage of this decompressive technology.

I also perform a minimally invasive SI joint fusion procedure. This procedure is often appropriate when SI joint injections fail to provide long term improvement.

In the past, SI joint fusion surgery involved a lateral approach with significant muscle disruption, requiring a lengthy recovery period. Now we use a posterior approach with a small incision to provide SI joint stabilization and fusion. This new alternative causes minimal tissue disruption and has a very short recovery period.

Beyond those, there are several other procedures that I’m currently using to provide additional minimally invasive treatment options, as well as others emerging on the horizon.

How did you end up with this specialty focus?

I have a surgical background from the start of my medical career. I completed two years of general surgery and then worked at a burn surgery center for eight years. These experiences provided me with an extensive foundation in handling complex surgical conditions.

I also completed a physical medicine and rehabilitation residency at the University of Pennsylvania Hospital and a spine fellowship. From that point, I began specializing in providing patients with access to technologies and treatments in the gap that weren’t previously available.

The sum of this training and experience enables me to consider, with a surgical perspective, how best to use these advanced procedures.

Jeffery-Rowe-MD-in-Surgery — Dr. Jeffery Rowe teaching the spinal cord stimulation procedure.

What kind of patients do you see? When is it appropriate for a patient to consult with you?

I see a broad range of patients. Some have only recently experienced an onset of pain, and others have been suffering from pain for years.

I pride myself in offering patients treatments when they have been told they exhausted all available pain treatment options. These previous failed attempts may have included epidural steroid injections, facet blocks, SI joint injections, rhizotomies, and radiofrequency nerve ablations.

For example, let’s say a patient has multi-level degenerative disc disease and they’ve had multiple injections but still have ongoing symptoms. The injections may have worked well, but the effectiveness wore off over time.

This hypothetical patient is now at a point where they need a longer-term solution with a more permanent treatment option. Neurostimulation or an interspinous spacer device may be an appropriate option for them.

My initial consultation is extensive as I tease through the issues each patient has been dealing with. I need to hear their full backstory, including how long they have been managing their condition and what they’ve done previously to attempt to alleviate their pain. I also review their diagnostic studies, including any MRIs or CT scans.

This thorough evaluation allows the patient and me to review the treatment options which are best suited for their condition. It also enables me to recommend a long-term treatment plan using one or more of the new technologies that sit in the gap.

Nationally, neuromodulation therapies don’t always work effectively for some patients. Why is it that you seem to get successful results with your patients?

Our ongoing successes build from a variety of factors. Patient selection is key to having a successful outcome. I take great care where I place the leads and reinforce that with strict testing protocols to make sure I’ve optimized lead placement correctly. I also use an advanced lead anchoring technique, so the leads don’t move out of position.

I additionally attribute my success to performing hundreds of neuromodulation trials and implants each year for patients across the country and teaching these procedures nationally.

What is your life like outside of the Main Line Spine medical practice?

It is very important to me that I balance my medical practice with my family life. When you work as hard as I do, it’s crucial to have a great family support system.

My family includes my wife, two daughters, a Savannah cat, and a Belgian Malinois dog. We enjoy outdoor activities including hiking and riding dirt bikes. For me, at the end of the day, it doesn’t get better than that.

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In the United States, more than 23% of all adults have arthritis. It is the swelling and tenderness of one or more of your joints. It is characterized by joint inflammation, pain, and stiffness, and it typically worsens as you get older.

There are more than 100 different kinds of arthritis and related conditions. The most common types are osteoarthritis and rheumatoid arthritis.

What’s the difference between the two? Osteoarthritis, the most common form of arthritis, involves wearing away the protective cartilage covering bones where they form a joint. On the other hand, rheumatoid arthritis is an immune system disease that attacks the joints – inflaming the protective synovial membrane, causing pain, swelling, and eventually, joint erosion.

We’ll look a little deeper at each of these conditions.

Osteoarthritis

Osteoarthritis develops as the protective cartilage that cushions the ends of your bones gradually breaks down over time. This allows the bones in joints to rub against each other. When the cartilage deteriorates, joints no longer have the padding they need to move and extend properly.

This condition causes severe joint pain and stiffness. Although osteoarthritis can affect any joint, it frequently affects joints in the hands, neck, back, knees, and hips.

Inflammatory Osteoarthritis

For years the prevailing view was that osteoarthritis was mainly the result of a lifetime of “wear-and-tear” on joints. As a result, it was easy to classify arthritis as either non-inflammatory, such as osteoarthritis, or inflammatory, such as rheumatoid arthritis.

However, there are forms of osteoarthritis that are now recognized as being inflammatory. This variant typically comes on suddenly in middle-aged women, affecting the joints of the fingers. Thus, it’s crucial to get a proper diagnosis because treatment for this inflammatory form of osteoarthritis is different from the treatment for rheumatoid arthritis or typical osteoarthritis.

Osteoarthritis Treatment

Osteoarthritis pain symptoms can be relieved with medications such as acetaminophen (Tylenol and others) and nonsteroidal anti-inflammatory drugs (Advil, Motrin IB, and others). A physical therapist can also show you exercises to strengthen the muscles around your joint, increase your flexibility, and reduce pain.

If these conservative approaches are insufficient, your doctor may recommend cortisone injections to relieve pain in your joint. If the joint in question is the knee, injections of hyaluronic acid, also known as viscosupplementation, may also offer pain relief by providing some cushioning in your knee.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic, inflammatory autoimmune disorder that can affect more than just your joints. It occurs when your immune system mistakenly attacks your own body’s tissues.

Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

Rheumatoid arthritis symptoms may include swollen joints and joint stiffness, particularly after waking, fatigue, fever, and appetite loss. Nearly half of those with rheumatoid arthritis also experience symptoms that don’t involve joints but extend to other body structures such as skin, eyes, nerve tissue, and organs.

Rheumatoid Arthritis Treatment

The goals for treating rheumatoid arthritis are to control a patient’s symptoms, prevent joint damage, and maintain a patient’s quality of life and ability to function. Since joint damage occurs within the first few years after the onset of rheumatoid arthritis, it is crucial to diagnose and treat it early to minimize long-term issues. Treatments include medications, rest, exercise, and physical therapy. In some cases, surgery is also appropriate to correct damage to a joint.

The type of medications your doctor recommends will depend on how severe your arthritis is and how well you respond to the medications. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs), Corticosteroids, COX-2 inhibitor, disease-modifying anti-rheumatic drugs (DMARDs), and biologic agents (which tend to work rapidly).

Advances in Treatment

The effects of rheumatoid arthritis and osteoarthritis on a person’s life can range from mild to severe. While they have some similar symptoms, they have very different causes and require different treatments. Osteoarthritis usually affects fewer joints than rheumatoid arthritis and doesn’t involve autoimmune issues, making it easier to treat. The progression of rheumatoid arthritis is more challenging to predict than is osteoarthritis.

Breakthroughs in medical science are also helping researchers optimize existing treatments and develop new treatment approaches for managing rheumatoid arthritis. To learn more about the latest treatment options and how they might help you, talk to your doctor.

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Losing weight is a challenge. But not losing those extra pounds you are carrying around can have a severe negative long-term impact on your joints and musculoskeletal system.

Excess weight and obesity are linked to heart disease, stroke, some cancers, diabetes, high blood pressure, gallbladder disease, and osteoarthritis. Unhealthy weight stresses almost every organ in the body, so it is no surprise that it also increases the risk for back pain, joint pain, and muscle strain.

This issue is widespread. According to the CDC, more than 73% of all U.S. adults over the age of 20 are overweight or obese. This leads to back, neck, and joint issues that are significantly impacting the quality of their lives.

What impacts are we talking about?

Neck and Back Pain

If your weight slips into an unhealthy range, your chance of degenerative disc disease increases by 30 to 79 percent.

Every extra pound pulls your pelvis forward, adding strain to back muscles and ligaments. Discs adjust for that excess weight, and they can become herniated in the process of doing so. In turn, this damage can compress the spaces between the bones in the spine, causing pinched nerves and piriformis syndrome, where muscle spasms cause pain and sciatic nerve irritation.

If you have arthritis, extra weight can aggravate this condition and trigger the onset of osteoarthritis. Excess body fat also stimulates the production of chemicals that contribute to joint damage.

Joint Pain

Are you aware that the stress on your knees is 1.5 times your body weight when you walk on a flat surface? So, if you weigh 160 pounds, your knees experience stress that feels more like 240 pounds. When you are walking up an incline, your knees’ stress increases to 3 to 4 times your weight. So the knees of a 160-pound person can feel as much as 640 pounds of pressure.

If you are 20 pounds overweight, you are taxing your knees with up to 80 pounds of extra stress and strain. This additional weight on your knee may lead to pain or an injury. And there are similar excess weight impacts on your other joints, particularly with your spine and hips.

Studies have shown that losing just 10 percent of our body weight can make a significant difference. Following a diet and exercise program can reduce pain, improve joint function and lead to less arthritic inflammation.

Your Goal Weight Based on the Body Mass Index

How much should you weigh? The most common tool to evaluate proper weight is the body mass index (BMI). It is a number calculated from an individual’s height and weight. In most people, it represents a relative measure of body fat, although in some cases it may be inaccurate. It tends to overestimate body fat in individuals who are more muscular than the norm.

The BMI that you should target for yourself should be determined in a conversation with your healthcare provider.

BMI is classified as follows:

BMI under 18.5 is underweight.
BMI 18.5 to 24.9 is typically healthy weight.
BMI 25.0 to 29.9 may indicate overweight status.
BMI 30.0 to 39.9 may indicate obesity.

You can calculate your BMI by referring to the chart below, or using the Body Mass Calculator provided by the National Heart, Lung, and Blood Institute, found at the link HERE.

Tanita weight, body fat & body water scale.

Set Diet and Exercise Goals that Will Work for You

Some of us love exercise, others of us hate it. Regardless of your own preferences, the bottom line is that exercise and physical activity are good for you. Study after study show that individuals who exercise regularly not only live longer, they live better.

If you can’t do a vigorous exercise program, just doing everyday physical activities can provide positive impact. Gardening, walking the dog, or taking the stairs instead of an elevator are a good start. And it will help you stave off some diseases and disabilities that often occur with aging.

Studies now even suggest that people who begin exercise training in later life, such as in their 60s and 70s, can build their physical strength and also experience improved heart function.

Controlling your weight can be a more complex problem. Food selection can both have an impact on packing on pounds, as well as how you age. Don’t skip breakfast. Eat a balanced morning meal that includes protein, fat, and carbs that will give you the energy you need for your day.

It’s best to talk to your doctor before starting any diet to get their guidance. But after you do, consider eating small meals with a few snacks in between, or consider fasting. Eat until you are no longer hungry, but not until you’re full. Exercise daily, even if it is only in moderation. And be wary of eating when you are stressed or starved for comfort – emotionally motivated eating can ruin any diet.

Strive for a Lower BMI – and Fewer Medical Visits

Excess weight and lack of exercise can lead to spinal disorders and neck, back, or joint problems. Specialized care is available when that happens – but it is better that you try to avoid these issues if you can.

At Main Line Spine’s practice, we see many musculoskeletal issues and pain problems daily that are the result of BMIs in the overweight range and above. By taking control of your weight, you’ll enjoy far fewer medical visits and a happier life.

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Joint pain. Millions of people live with it every day. For sufferers, it affects all aspects of their lives, from their mental health to their family life, to work, social activities, and physical health.

Joints are essential for our flexibility. Joints or series of joints give us the ability to move through an unrestricted range of motion. When that movement causes pain, it inhibits our decisions to go about everyday tasks. Going for a walk, shopping, or playing a favorite sport can seem like a burden rather than an enjoyable activity.

Illustration of potential points of joint pain across mid-body.

Joint pain can range from mild discomfort to severe pain or inflammation in any part of a joint, as well as the supporting structures around the joint. The most common causes include osteoarthritis, rheumatoid arthritis, bursitis, gout, muscular strains, ligament sprains, and broken bones.

If you are living with that pain, dealing with it is at the top of your mind throughout the day. We’ll look at home remedies and three different kinds of injections that could ease your joint pain.

Home Remedies

Yes, there are ways to treat joint pain at home, but first, a note of caution. Not all joint pain is the same. Joint pain can be a warning sign that should prompt you to talk to a health care provider. But if you are considering home remedies, there are three actions that you should take immediately after first noticing joint pain:

Rest: Rest and protect the injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
Ice: Cold will reduce pain and swelling. Apply an ice or cold pack to your joint right away to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20-minute sessions, three or more times a day.
Heat: After 48 to 72 hours, if swelling is gone, apply heat to the joint area that hurts. Do not apply ice or heat directly to the skin. Place a towel over the cold or heat pack before applying it to the skin.

After the inflammation goes away, you will need to strengthen that joint through exercise. The right set of exercises can be a long-lasting way to tame ankle, knee, hip, or shoulder pain.

Practiced regularly, joint pain relief exercises might permit you to postpone — or even avoid — surgery on a problem joint. These exercises can help address issues that have been worsening for years by strengthening key supportive muscles and restoring flexibility. Physical Therapy can provide you with a path to learn how to do these exercises properly on your own.

Injections That May Help

Depending on your pain severity, injections can be another option for easing your joint pain and getting you moving again. These injections range from:

corticosteroids, which have been actively used for decades,
to knee joint fluid replacement with hyaluronic acid
to newer orthobiologic injections like platelet-rich plasma (PRP).

Not every injection is right for every patient, and your doctor will decide which one is appropriate based on your individual needs.

Corticosteroid Injections

Cortisone injections are the first line of defense against osteoarthritis symptoms and other joint pain in the shoulders, knees, and hips. They can help relieve joint pain and inflammation.

The injections usually contain a corticosteroid medication and a local anesthetic. The number of injections you can get in a year is limited because of potential side effects.

Hyaluronic Acid Injections (Viscosupplementation)

Viscosupplementation is a procedure in which a thick fluid called hyaluronate acid is injected into the knee joint. Hyaluronic acid mimics healthy, young synovial fluid in terms of molecular weight, elasticity, and viscosity. The injection helps lubricate the joint. It is only approved for use in the knee joint.

Viscosupplementation will not cure osteoarthritis of the knee. However, this therapy aims to reduce knee pain, improve mobility, and provide a higher and more comfortable level of activity.

It is usually not considered until other treatment options have been tried and have not relieved your pain. Three to five injections, each one week apart, are typically required.

Platelet-rich plasma (PRP) Injections

Platelet-rich plasma (PRP) injections can treat osteoarthritis joint pain. PRP therapy takes a patient’s own blood, concentrates the platelets in that blood, and then reinjects them to accelerate the healing of injured tendons, ligaments, muscles, and joints. Research studies and clinical practice have also shown PRP injections can alter the immune response to help reduce inflammation.

Wrapping It Up

While many of these injections often are effective in reducing or stopping your joint pain, but it’s important to remember that they may not keep the pain from returning. They’re most effective when used with other therapies. Weight loss and physical therapy can also go a long way toward relieving pain.

If other treatments have failed, your health care provider may consider more advanced options.

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Did you know that approximately 20% of patients who have a total knee replacement continue to experience chronic pain long after the surgery? Researchers are increasingly focusing on understanding the causes of this issue, but the specifics of exactly why this happens have been hard to pin down.

Chronic pain after a total hip replacement is another common issue, which affects approximately 10% of patients.

In fact, far beyond joint replacement pain issues, you may be experiencing chronic pain symptoms in any part of your musculoskeletal system. And you may have tried an epidural, other injections, or other treatments without success.

One of the alternatives that Main Line Spine considers to help patients alleviate pain in these situations are very small and localized peripheral nerve, micro-neurostimulation devices.

What Is Neurostimulation?

At this point, we’ll pause for a moment to answer the question, “What is Neurostimulation?”

Neurostimulation works by delivering mild electrical signals that disrupt nerve pain signals before they reach your brain. In that way, you can achieve pain relief without the need for medication.

Main Line Spine has a long history and deep expertise in helping patients deal with chronic pain by using devices called “neurostimulators.” Traditionally these devices include several components:

Neurostimulator: This is a device that generates the electrical impulses and contains a battery. It is usually placed under the skin in your abdomen or upper buttock.
Leads: These are thin, insulated medical wires that deliver electrical impulses and which run from the neurostimulator to the epidural space near the spine.
Personal Programmer: This is a handheld device that a patient can use after they leave the Doctor’s office to customize their stimulation within the settings a doctor has selected.

These traditional neurostimulators have proven themselves to be very effective for many patients. However, when it comes to relieving chronic pain in a joint such as a knee or shoulder, a much smaller neurostimulator is more appropriate.

This localized approach is known as peripheral neurostimulation. The neurostimulator and leads are placed directly at the nerve identified as causing the pain.

External SPRINT PNS Pulse Generator on a leg for knee pain along with components of SPRINT PNS system. — SPRINT® is one provider of Peripheral Nerve Stimulation (PNS) systems. One application of their model is a 60-day therapy that relieves knee pain without requiring a permanent implant.

Peripheral Micro-Neurostimulators

Peripheral Micro-Neurostimulators are designed for very localized chronic pain relief. They take advantage of many technical innovations developed in recent years, including component miniaturization.

The microstimulators that Main Line Spine uses, in appropriate cases, are the smallest, most-compact neurostimulation systems available. They come with an extremely small neurostimulator that is implanted by your Doctor at your impacted joint.

These neurostimulators have small metal electrodes near the tip that create an electrical field of energy when power is applied. This electrical energy aids in blocking the pain signals that come from certain nerves.

All of these microstimulators offer a variety of programming options that enable you to experience pain relief when and how you need it.

Trial Period

If the conservative care options you’ve tried in the past have failed to alleviate your chronic-pain symptoms, this non-opioid, minimally invasive treatment option might be appropriate for you.

If you decide to move ahead, your Doctor will start you with a trial period to confirm that this peripheral neuromodulation approach will work for you.

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Platelet-Rich Plasma – PRP – often pops up in sports injury news headlines. From what we read, plasma-rich platelet injections are often a well-publicized factor in professional athletes’ treatment and recovery.

These stories stir the imagination of the public at large. If PRP treatment works for our sports heroes, will it work for our own injuries?

The answers to these questions and others are not clear at this point. Doctors are currently using PRP treatments to accelerate the healing process of soft tissues. But it is a therapy still very much in the early stages of development.

Tiger Woods was one of this therapy’s early adopters. We’ll use his example as a starting point in answering “what is PRP therapy.”

Tiger Woods’ Knee Issues

In 2008, Tiger had two major knee surgeries within a span of 10 weeks. The first happened in April of that year when he finished second in the Masters Golf Tournament. Two days later, he had arthroscopic surgery to remove cartilage damage in his left knee.

Shortly after, Tiger competed in the 2008 U.S. Open in June. He played with a torn ACL (anterior cruciate ligament), an injury that dated back to just after the 2007 British Open. He also had leg stress fractures.

Despite those physical challenges, Tiger still won the tournament. But sports commentators at the time noted how much in agony Tiger looked as he hobbled to victory.

Nine days after that U.S. Open victory, Tiger had reconstructive surgery to repair the ACL in his left knee. However, the post-surgery recovery was slower than he had hoped. He was impatient and wanted to get to play again more quickly. So, he looked for a way to accelerate his healing process.

He turned to PRP, then a not widely known therapy. He received 4 PRP injections to his knee ligament. Tiger has since publicly commented that he believes the treatments were vital for his timely return to competitive golf.

Tiger Woods smiling on a golf course. — A happy Tiger Woods walks a golf course.

What Is PRP Therapy?

In the years since Tiger placed his faith in PRP, this therapy has evolved and improved dramatically. The answers to what it is begin by reviewing some fundamental basics.

Plasma

Plasma is the liquid portion of your whole blood. It includes water and proteins. It allows red blood cells, white blood cells, and platelets to circulate through your body.

Platelets

Platelets, or thrombocytes, are small, colorless cell fragments. When you cut yourself, platelets help blood clot so that you stop bleeding. They also are critical to your body’s natural healing processes.

PRP

PRP stands for platelet-rich plasma. The PRP procedure starts with your doctor drawing your blood. They then process the blood in a centrifuge to separate and concentrate your platelets.

PRP Therapy

PRP therapy involves injecting platelet-rich plasma into injured tendons, ligaments, muscles, or joints to accelerate healing. This injection focuses the natural healing components of platelets on the injury. It enables your doctor to direct biological healing processes where they are most needed.

PRP test tube and platelets illustration. — Centrifugal force is used to separate the components of blood – red blood cells (38-48%), plasma (52-62%), and platelets & leukocytes (<1% of total blood).

What is Platelet-Rich Plasma Used For?

Clinical studies have shown that platelet-rich plasma stimulates and improves the healing process. It is not a magical cure, but it does have a role in minimizing pain and improving function. For those who respond to PRP injections, it can reliably decrease inflammation and promote healing.

Platelet-rich plasma therapy may be appropriate to treat knee, elbow, shoulder, and hip osteoarthritis. It may also help with many overuse sports injuries. It is not suitable for all conditions, however.

Doctors are using PRP procedures for soft tissue injuries where there is a firm scientific rationale and sound medical evidence.

Prospective patients, however, also need to have realistic expectations. For example, platelet-rich plasma injections will not heal a rotator cuff tear without surgery. However, PRP can accelerate recovery after this kind of surgical repair.

If successful, a PRP injection generally results in long-lasting relief compared to a cortisone shot. PRP therapy stimulates injured soft tissue to heal or repair itself. In contrast, cortisone injections relieve inflammation pain without directly promoting any healing or soft-tissue repair.

Final Takeaways

PRP is a promising therapy for soft tissue repair. However, there have yet to be any clear standards that have been established for different available treatments.

There are both beneficial PRP treatments available as well as cases where marketing has gotten ahead of the science. Patients should recognize that it is a procedure still under clinical development.

Medical insurance typically does not cover PRP. The out-of-pocket costs for similar procedures can vary widely across different medical providers.

That all being said, legitimate research on PRP at some of the nation’s top medical institutions is leading to significant progress. PRP is an alternative to consider for accelerated musculoskeletal soft tissue injury recovery by patients who have done adequate due diligence.

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2020 has been a year like none of us has ever experienced. Each day we find ourselves sorting out how to navigate the ever-changing new normal of safely living our lives. With social distancing, self-isolating, and quarantining, we miss our family, our friends, our favorite restaurants, and other social gatherings.

Dr. Dani Fallin, the chair of Johns Hopkins’ Department of Mental Health, has noted that this isolation and social distancing, along with the continued barrage of difficult news, can increase symptoms of depression and anxiety. It’s perfectly normal if you are experiencing these feelings. You are not alone if you have the Covid-19 era blues.

Our fitness routines have also suffered. As infections exploded across the country, states ordered gyms and fitness centers closed, along with restaurants, movie theaters, and bars. For many exercising from home, this seemed like a good excuse to stop.

As gyms begin to reopen, entities such as the Mayo Clinic have still recommended caution until you find out how your fitness center is handling safety precautions. And Mayo recommends that if you are at higher risk, you might want to consider waiting a bit longer before returning to an exercise facility.

So it’s natural that many people have cut back on or even skipped their normal physical activity and gained a bit of weight – referred to by some as the “Quarantine 15” or so extra pounds. According to one study, more than three-quarters of Americans gained weight during the COVID-19 lockdowns.

Exercise Benefits Both the Body and Mind

The benefits of physical activity and exercise have been demonstrated across our lifespans. Physiologically, we are meant to move, and many of our body’s systems work better when we are consistently physically active.

Moreover, studies have shown that moderate exercise is not just good for your body but improves mental health as well. A recent study that appeared in the peer-reviewed medical journal, The Lancet Psychiatry, found that poor mental health days dropped by more than 40% among those who exercise.

People who exercise regularly find that it gives them an enormous sense of well-being. They feel more energetic throughout the day, sleep better at night, have sharper memories, and feel more relaxed and positive about themselves and their lives.

Getting Back to a Fitness Routine

You don’t need to devote hours each day to working out to reap all the physical and mental benefits of exercise. Just 30-minutes of moderate exercise five times a week is enough. If you want to break those sessions into two 15-minute or even three 10-minute sessions, that will work too.

At the start, if you are time-pressed, or your body tells you 30-minutes is too much, that’s OK – it is better to start slowly than do nothing at all. Start with 5- to 10-minute sessions, and then gradually increase your time. You’ll be surprised how quickly you’ll feel ready for more if you get on a regular schedule.

You also don’t have to suffer when exercising in order to get results. Research shows that moderate aerobic levels of exercise are best for most people. According to the Mayo Clinic, moderate means that:

your breath quickens, but you are not out of breath,
you develop a light sweat after about 10 minutes of activity, and
you can carry on a conversation, but you can’t sing.

You should also try to do strength training for all major muscle groups at least twice a week. If you are using weights, try to use a resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

There Are Many Ways to Exercise that Don’t Require a Gym

Not ready to head back to a fitness center to exercise? Not able to find the time to get in a long run or vigorous walk? No worries. Think through your daily routine and consider ways you might sneak in activities.

For example, walk through your neighborhood in the evening with your partner. Jog around the field when your child is at practice. Take a fast-paced walk during your coffee break at work. Use the stairs instead of the elevator. Get creative and embrace anything that gets you moving.

Go-Slow When Restarting – And You May Want to Check-In with Your Doctor First

If you haven’t been exercising for a while, you should go slowly when restarting even a moderate intensity-level exercise program.

And if you are thinking of increasing the level of your exercise intensity from moderate to vigorous, you probably should check with your doctor first. This caution is particularly true, even with moderate exercise, for men over 45 and women over 55, and those people who have diabetes or more than one risk factor for heart disease.

Time to Get Moving

Ready? Set your first goal and get moving!

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There are many potential causes of an aching back. They may be the result of an accident or due to a sports-related injury. They may originate congenitally from conditions such as scoliosis. But in most cases, upper or lower back pain develops through what we do in our day-to-day lives.

How we take care of ourselves, through exercise and a healthy weight, is important. But improving your posture can have a major impact on prevention.

The Importance of Good Posture

Posture is how you hold your body while standing, sitting, or performing tasks like lifting, bending, pulling, or reaching.

From your earliest memories, Mom told you to sit up straight. If you spend hours in your day working at a computer, and you sit with a bad posture, you are putting excess stress and strain on your spine, joints, muscles, and ligaments. But if you sit up straight, you are putting your spine and body in proper alignment, avoiding that excessive stress and strain.

Improving Your Posture

How do you change your bad habits to fix this problem? Here are a few suggestions:

Sitting at a Desk

When you sit at your desk at work, hold your shoulders and arms at a 90-degree angle. Position your monitor straight ahead at eye level – don’t place it where you have to look downward to see it.

Image emphasizing office worker's skeletal system as they sit at a desk working with a computer screen

A 2014 study by Kenneth K. Hansraj, a spine and orthopedic surgeon in Poughkeepsie, NY, reviewed the problem of continually looking down at your phone or tablet. Dr. Hansaj found that when you hold your head in line with your shoulders, it only weighs about 10 pounds. “But for every inch that you tilt it forward, the amount of weight it places on your spine nearly doubles.”

Sit up with your back straight and your shoulders back. Your buttocks should touch the back of your chair.

Move Around As Much As You Can

A 2017 study in the Annals of Internal Medicine concluded that not only is moving around frequently important to help alleviate back pain, but failure to do so was linked to a higher risk of early mortality.

The study’s results suggest that moving every 30 minutes can keep some of the negative effects of a more sedentary lifestyle in control. As Philadelphia Magazine noted, now “you have perfectly acceptable health-related excuse to take more breaks.”

Exercises

Shoulder blade squeeze. Sit up straight in a chair with your hands resting on your thighs. Keep your shoulders down and your chin level. Slowly draw your shoulders back and squeeze your shoulder blades together. Hold for a count of five; relax. Repeat three or four times.
Upper-body stretch. Stand facing a corner with your arms raised, hands flat against the walls, elbows at shoulder height. Place one foot ahead of the other. Bending your forward knee, exhale as you lean your body toward the corner. Keep your back straight and your chest and head up. You should feel a nice stretch across your chest. Hold this position for 20-30 seconds. Relax.
Arm-across-chest stretch. Raise your right arm to shoulder level in front of you and bend the arm at the elbow, keeping the forearm parallel to the floor. Grasp the right elbow with your left hand and gently pull it across your chest so that you feel a stretch in the upper arm and shoulder on the right side. Hold for 20 seconds; relax both arms. Repeat to the other side. Repeat three times on each side.

Work to Make It a Habit

Sitting with good posture can feel unnatural at first if you have been avoiding it for years. It may take some time to get used to, but don’t let that stop you from getting back on the right track.

Make an Appointment

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KING OF PRUSSIA, PA – Dr. Jeffery Rowe of Main Line Spine recently completed the first Minuteman® G3 procedure in Pennsylvania. The Minuteman® G3 was developed by Spinal Simplicity LLC as an innovative, minimally invasive, simple solution to treat complex spinal disorders.

Dr. Jeffrey Rowe, MD (center) stands between two colleagues after completing the first Spinal Simplicity G3 procedure in Pennsylvania.

The device is intended for the temporary fixation of the thoracic, lumbar and sacral spine while awaiting bony fusion to occur. It is designed for attachment to the posterior non-cervical spine at the spinous processes through its bilateral locking plates. It is intended for use with bone graft material placed within the device.

The Minuteman® G3 is indicated to treat patients with Degenerative Disc Disease, Lumbar Spinal Stenosis, and Spondylolisthesis. Generally, patients who could be eligible for Minuteman have not found lasting relief with conservative therapies like Physical Therapy, Epidural Steroid Injections, Medial Branch Blocks, and Radio Frequency Ablations.

Dr. Rowe views the Minuteman as one of the options he now considers to treat his patients’ back and leg pain.

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KING OF PRUSSIA, PA – Main Line Spine congratulates our colleague, Dr. Roy Lerman, for his selection as a Top Doctor in the May 2020 issue of Philadelphia Magazine. This is the third consecutive year that Dr. Lerman has been part of the Top Docs™ List.

When asked about the honor, Dr. Lerman insisted that “while I appreciate the recognition, it evolves from the quality of Main Line Spine’s entire clinical team. The expertise, skills and compassion of the Doctors, Physician Assistants and staff at Main Line Spine have set a very high standard for our patient care. I strongly believe that our practice’s deep bench of talent is reflected in my selection to this list.”

You can view the entire Philadelphia Magazine Top Docs™ List by clicking HERE.

About Philadelphia Magazine’s Top Docs™ List

Each year, Philadelphia Magazine partners with healthcare researcher Castle Connolly Medical Ltd. to create a definitive list of the best doctors in the Philadelphia region. The doctors on Philadelphia Magazine’s list have been nominated by their peers as the very best in their fields and are affiliated with hospitals throughout Southeast Pennsylvania, South Jersey, and Delaware. Final selection involves an independent, rigorous screening process conducted by Castle Connolly’s physician-led team of researchers.

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