Locus Workstation

Focal Upright Furniture has a great solution to the standing/sitting desk dilemma: the Locus workstation is a desk you can lean at, which “pairs the comforts of sitting with the health benefits of standing.”

 
 

Martin Keen, who designs a terrific line of outdoor footwear, saw a need and filled it. That’s using your delightfully bald noggin, Martin.

Watch the WSJ video about Focal Upright Furniture’s seats and how they strive to promote better posture.

American Academy of Physical Medicine and Rehabilitation: Physical Medicine and Rehab Specialists

If you find the right physical medicine and rehabilitation (which you’ll most commonly see abbreviated as PM&R) doc (they are also called “physiatrists”), your back will be in excellent hands. Look for a physiatrist who has done a fellowship in spine medicine. This site lists programs that offer PM&R fellowships, so that’s a first step toward finding a good resource. Physiatrists are MDs and DOs (doctors of osteopathic medicine) who specialize in working with patients with nerve, muscle, bone, and neurological conditions. They are talented diagnosticians, skilled in discerning the source of your problem and also familiar with biomechanics and exercise physiology. If someone claims to be an “interventional physiatrist,” it means that he or she focuses on giving injections. That’s a signal that you are in the wrong place, so look some more.

Click here for the American Academy of Physical Medicine and Rehabilitation’s patient page.

For spine specifics, check here.

The doctor search function is here.

It can be quite difficult to find a PM&R doc who really focuses on the rehabilitation part, rather than the “let’s give some shots and make some money” part. Doctors who work for university hospital systems are not as compelled to perform income-producing procedures as their self-employed brethren. A phone call or email to The Association of Academic Physiatrists on this list should yield someone good.

Richard Deyo, MD, on Health Care and Back Pain Treatment

In 1998, Richard Deyo, MD, one of the most clear-thinking back pain experts in the U.S., published an article in Scientific American (paywall) explaining what was wrong with back pain treatment. Not a lot has changed. See his list of myths, complete with matching cartoons, on page 52; his book Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises is also a must-read.

 
 
National Institute of Arthritis and Musculoskeletal and Skin Diseases

For a general overview of what’s out there, visit the website of NIAMS: the National Institute of Arthritis and Musculoskeletal and Skin Diseases. It’s one of the research institutes of the National Institutes of Health. Click here to get a decent overview of options and issues. It’s not perfect—it’s possibly influenced by the FDA, an agency that is very much under the thumb of pharmaceutical companies and device manufacturers—but a it’s decent source to start with.

Implications for Health Care Reform

The Dartmouth Atlas provides shocking data about the prevalence of spine surgery here.

If you’re interested in how surgeons and device manufacturers wound up in bed together, you’ll want to have a look at the website for the Association of Medical Ethics. Use the Doctor Payments search tool to find out how much surgeons have been paid to consult on a specific product.

The investigative reporting organization called ProPublica is creating an increasingly robust and truly eye-opening source of information regarding the payments that drug and device companies make to doctors in return for promoting their drugs. This database—broken down by state, which is more convenient—has been assembled by the superb investigative reporters at ProPublica. Start with this article that explains how patients can use the database. The database is here.

Exercise/Balance Balls

Low-tech and inexpensive giant exercise balls, known as physioballs, Swiss balls and posture balls, can play an important part in your rehab – and they’re fun to have around! Working out on a ball requires balance, which means that you must recruit the deeper back muscles, rather than the large, superficial ones. Typical exercises include push-ups with the legs supported by on the ball, crunches with the back resting on the ball, and leg lifts (on your back) with the ball squeezed between the ankles. Some people use these balls as office chairs, with good results. To remain upright, you need to exercise good posture.  If you’re interested in trying one out, check out the products available at FitBALL.

Finding a Personal Trainer

Finding a highly qualified, back pain-focused personal trainer or exercise specialist is no simple task. Anyone can call himself or herself a personal trainer. To find the person you need, the American College of Sports Medicine is an excellent resource.

 
 

The NSCA is the National Strength and Conditioning Association, based in Colorado Springs, CO, which – probably not a coincidence – is also the location of the flagship training center for the U.S. Olympic Committee. Several people who definitely know told me that NSCA turns out the most qualified personal trainers, most of who have degrees in exercise science. If you look for a trainer with an NSCA-CPT (certified personal trainer) certification, you’re off to a good start. Here are some things you should look for in a trainer. And here is a not-too-great index of NSCA trainers. (You can search by state, but when you do, the results are not alphabetical.)

Physical Therapists with Orthopedic Certification

Finding a physical therapist with orthopedic certification can be challenging, but fortunately the American Physical Therapy Association has a helpful website. After you review the material there, click here to search at a very specific level. Look for therapists who have OCS and DPT after their names. This means that they have specific orthopedic training and doctoral degrees.

Pure HealthyBack Michigan Rehab and MedX

Michigan

If you’re in Michigan, count yourself lucky – you’ve got seven of the top rehab facilities scattered around the state. Pure HealthyBack Michigan uses MedX medical therapy machines, exercise machines and the McKenzie Method to treat spine patients. And spine patients are the only patients they treat. Be sure to view the excellent video demonstration of how MedX works (look for the hyperlink “Watch our video” about halfway down the page).

Spanish-Language Rehabilitation, Escuela Espanola de la Espalda

Majorca, Spain

If you speak Spanish and would like to join an functional rehab program in the Balearic Islands, have a look at the program offered by the Fundación Kovacs at S’AiguaBlava. The program is called Escuela Espanola de la Espalda. There are three facilities, each with a fantastic back-oriented gym program, and an amazing “high vitality” spa – which in much of Europe means hydrotherapy in a large pool with may stations equipped with jets at different heights. The facility I visited, on Majorca, combined physical therapy with supervised, high intensity exercise.

Here (again, in Spanish) is a video with director Dr. Mario Gestoso, explaining what goes on in the Back School.