My friend’s mom is newly diagnosed with spinal stenosis. She began to experience back pain a couple of months ago and her primary doctor referred her to physical therapy with a diagnosis of a bulging disc based upon her symptom: back pain that radiated down her leg.

Based upon her diagnosis, her therapists had her working on spinal extension exercises based upon the McKenzie method. These exercises encourage back bending of the spine and are designed to encourage the disc to migrate back into position, thereby relieving pressure on neighboring nerve roots. She did not improve, and in fact she experienced an increase in pain and further loss of function. Everyday walking and going to her gardening club became impossible.

She was then referred to a specialist who ordered an MRI. The results revealed that she has significant spinal stenosis. This condition also causes pressure on nerve roots due to arthritic changes around the spinal column which result in crowding of the canal.

In general, people with spinal stenosis respond well to flexion, or forward bending exercises, which help to open up the stiff, crowded joint spaces in the spine. This is quite the opposite of what she experienced in her first go around with physical therapy.

As a result of her negative experience, she opted to try acupuncture and steroid injections into her spine. I have tried to encourage her to resume some exercise, such as stationary cycling, or gentle water exercise. Walking, which naturally promotes spinal extension, truly aggravates her symptoms, but doing no exercise will only exacerbate the stiffness and mobility limitations within her spine. She is still reluctant, and rightfully so given her current pain level and her prior PT treatments…which were unfortunately for the incorrect diagnosis.

I don’t think her primary doctor is to blame here. Doctors must make their best educated diagnosis based upon a patient’s presenting symptoms and in these days of managed care, do try to avoid ordering expensive tests, such as an MRI until necessary. Many of my patients with back pain come to physical therapy before MRIs are performed, and many do in fact get better without having a confirmed diagnosis. In this instance, however, an earlier MRI may have resulted in a better outcome. Earlier access to the appropriate form of physical therapy or other treatment may have provided more rapid relief of pain and prevented a decline in her function and activity level.

I was reading a Scooby Doo mystery with my kids this morning and one of the villains was walking with a cane in his right hand and a cast on his right foot. The first thing that struck me about the illustration was that the character was holding the cane in the wrong hand. (The other thing was that he appeared to be walking without bearing weight on his right foot, which can’t actually be accomplished with a cane…he’d need crutches or a walker for that. But it’s just pretend, so I guess it’s OK.)

Although it may seem intuitive to use a cane on the injured side, it actually should be carried in the opposite hand. It’s a long physics equation basically, but when you hold the cane on the same side you are able to take much less weight off the involved leg than when you carry it in the opposite hand.

So if you go out and buy a cane for yourself because of an aching hip, knee, or foot, be sure to hold it on the opposite side from where you feel pain. You will get the most benefit and relief this way.

Living with the pain from arthritis can be tiring and frustrating, and its impact on your function and hobbies can really take a toll on your overall well-being. Educating yourself about the best ways to manage your condition is the first step to achieving less pain and greater freedom.

The Arthritis Foundation offers various books, videos, and publications that provide educational information about living with arthritis. Some people find it helpful to meet and talk with others also coping with arthritis in order to share experiences, vent, and gain valuable insight into ways to manage the condition. There are individual state chapters of the Arthritis Foundation that provide ways for people living with arthritis to find this support.

• In Massachusetts, for example, there is a young adult networking group designed for people between the ages of 18 and 44 to learn and share information.
• There are also groups that get together to exercise, which is one of the best ways to manage the pain of arthritis and optimize function and health.
• There are even “Joints in Motion” teams training to walk or run a marathon or half marathon to raise money for children with arthritis. Sometimes giving back to others is enough to ease some of the physical pain you experience on a daily basis.

To learn about the latest research, exercise guidelines, and find out what events and opportunities are available in your area, check out the Arthritis Foundation’s website.

“Too young to Feel Old: The Arthritis Doctor’s 28-Day Formula for Pain-Free Living,” was just released a few months ago. Written by rheumatologist, Dr. Richard Blau, this book offers recommendations and information regarding over the counter products, medications, exercise, alternative treatments, and diet. It also includes recipes designed to help improve overall health and arthritis symptoms.

The book can help to jump start you on a comprehensive way to manage your arthritis.

Your whole body is aching and you feel like you’re falling apart. Is it that virus going around that’s got you so sore? Is it from all the tension from the super bowl game the other night? (New England fans I’m sure can relate.)

Although multiple areas of aches, pains, or injury are possible (particularly if you have sustained a trauma), you may be experiencing more than a traditional musculoskeletal injury. Multi-joint aches and pains can be a sign of a systemic, or total body condition. You want to also make note of whether you have any changes in your sleep, weight loss or gain, rashes, night sweats, depression, fatigue, or other unusual symptoms. Several of the rheumatic conditions, such as rheumatoid arthritis, lupus, and scleroderma cause joint pain and swelling in multiple joints, but the treatment for these would be different than for a joint sprain or osteoarthritis.

It’s important to communicate with your primary care doctor if you have multi-joint pain so s/he can perform a thorough examination and run the appropriate lab work and diagnostic tests to allow for an accurate diagnosis. The earlier your condition is known, the sooner an effective treatment program can begin.

If you are newly diagnosed with arthritis or have been living with arthritis for many years, the book, “Arthritis: Your comprehensive guide to pain management, medication, diet, exercise, surgery, and physical therapies,” by Howard Bird is an excellent resource. As the title suggests, the book presents a vast amount of information about various types of arthritis and treatments that may be beneficial, and does so in an easy to read, user friendly way.

I particularly like this book as it covers nutrition and dietary recommendations (including vitamins, supplements, how to balance meals) as well as information about exercise, ergonomics, and weight management. There is also a section that discusses the benefits of alternative treatments, including Rolfing, Reiki, and the Feldenkreis method.

So if you’re interested in learning more about what you can do to ease the pain of arthritis, I highly recommend checking this book out from your local library.