The British Medical Journal recently published clinical practice guidelines that recommend against medical procedures like injections and nerve ablations for treating chronic spinal pain or extremity pain radiating from the spine (like sciatic). Many patients would be surprised to read the findings of this review of the research, so let's take a closer look.

Key Recommendations:
The guideline strongly recommends against the routine use of commonly performed medical procedures for chronic spine pain.

• Epidural steroid injections: These involve injecting corticosteroids into the epidural space around the spinal cord to reduce inflammation and pain. 
• Facet joint injections/medial branch blocks: These injections target the small joints in the spine (facet joints) or the nerves that supply them (medial branches).
• Radiofrequency ablation: This procedure uses heat generated by radio waves to "burn" nerve endings to interrupt pain signals.
• Sacroiliac (SI) joint injections: Targeting the joint connecting the spine to the pelvis for pain in that region.

This recommendation is based on evidence suggesting that these procedures offer "little to no benefit" when compared to placebo procedures. Furthermore, they can be "burdensome" for patients and may lead to harmful side effects.
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Who Should Follow These Spine Pain Recommendations?
This guideline applies to adults experiencing spine pain (e.g., lower back pain, neck pain) or radicular (e.g., sciatica, pain radiating down a limb) that has lasted for three months or longer. This does not include pain associated with other conditions such as cancer, infections, or inflammatory spondylarthritis.

What Options Are Recommended for Spine Pain?
BMJ has published guidelines for back pain that include drug-free treatments like chiropractic adjusting and therapy as first-line approaches, followed by anti-inflammatories and Tylenol as secondary approaches. There may be cases that benefit from spinal injections, but there is better evidence of benefit over harm when taking a conservative approach first to treat spine related pain.

​Living with allergies can be challenging, but many natural strategies can help reduce symptoms and improve your quality of life. Try these tips for significant relief.

First, minimize exposure to allergens. Some triggers are more easily avoided than others. Running the air through your house with high quality filters can help reduce a number of allergens. Showering before bed and washing bedding frequently can reduce exposure while sleeping. Saline nasal rinses using a neti pot or squeeze bottle can effectively flush allergens and mucus from nasal passages.

Next, consider dietary adjustments to reduce your level of systemic inflammation and take a load off of your immune system. Avoid inflammatory foods like sweeteners, processed oils and grains. Incorporate nutirent-rich foods like veggies and fruits that have an anti-inflammatory effect.  Omega-3 fatty acids, present in fatty fish like salmon, can reduce inflammation. Some people find relief by adding local honey to their diet, theorized to desensitize the body to local pollen. Fermented foods like probiotic yogurt and kefir support a healthy gut microbiome, which is strongly linked to immune function and can influence allergy responses

Herbal remedies and supplements can also be helpful. Two of our favorite herbal supplements to support healthy sinuses include Allergco and Sinus Forte from MediHerb. Allergco includes Albizia stem bark, Chinese Skullcap root, and Black Cumin seed extract to maintain respiratory tract function, immune, and skin health. Sinus Forte contains Eyebright and Golden Rob herbs, Echinacea root extract, Golden Seal root and rhizome, and Cayenne fruit extract to support healthy upper respiratory mucous membranes. Click the links above to learn more.
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A combination of these natural strategies can dramatically reduce your allergy symptoms. If you have more questions about these, schedule a visit with our doctors.

​Gardening is a rewarding activity, but it can also lead to aches, pains, and even serious injuries if proper precautions aren't taken. To ensure your time in the garden remains enjoyable and pain-free, follow these essential tips:
1. Warm Up and Stretch: Treat gardening like any other physical activity. Before you start, perform light stretches for your back, shoulders, arms, and wrists. A few minutes of gentle movement can significantly reduce muscle strain and stiffness.

2. Use Proper Body Mechanics: Avoid bending at the waist for prolonged periods. Instead, squat or kneel with knee pads to protect your joints and keep your back straight. When lifting heavy objects like bags of soil or mulch, bend your knees, engage your core, and lift with your legs, keeping the load close to your body. Use a wheelbarrow for transporting heavy items.

3. Invest in Ergonomic Tools: Choose tools with comfortable, wide handles that reduce strain on your hands and wrists. Long-handled tools can help you reach without excessive bending. Keep your tools sharp and well-maintained; dull tools require more force, increasing injury risk.

4. Vary Your Tasks and Take Breaks: Repetitive motions can lead to overuse injuries like tendonitis. Alternate between different gardening tasks (e.g., raking, then pruning, then planting) to engage different muscle groups. Take regular breaks every 20-30 minutes to rest, stretch, and rehydrate, especially on hot days.

5. Wear Protective Gear: Wear sturdy gardening gloves to protect your hands. Proper footwear (closed-toe shoes, not sandals) helps prevent foot injuries. It's healthy to soak up some sun, but consider a hat and sunscreen to protect against sun burns.

By incorporating these simple safety measures, you can cultivate a beautiful garden while keeping yourself healthy and injury-free. If you notice any soreness following yard work, try ice and gentle stretching movements. Schedule a visit for further evaluation and care for any persistent or severe injuries.