Dr. L. Matthew Schwartz

by L. Matthew Schwartz, MD, FAAPM&R

Local doctor L. Matthew Schwartz tackles your reader questions about health every two weeks. Please feel free to ask him any question about physical medicine, pain and integrative holistic medicine or wellness. Send questions to askthedoc@chestnuthilllocal.com

Dr. Schwartz’s advice is informational and not intended to be a substitute for a consultation with your primary doctor. 

What can I do to keep myself organized with respect to my health, so I get the most from my health care practitioners? – Carolyn D.

Between selecting a health insurance plan, getting pre-authorizations and referrals, and clearing your busy scheduled to seek care, navigating the health care system can be dizzying.  So what can we do to make taking care of ourselves simpler and more efficient?

Type a medical summary and keep it with you in your wallet.  It should chronologically list:

  • Former and current diagnoses
  • Allergies
  • Medications (former (and if they worked and were tolerated) and current – with doses and frequencies)
  • Diagnostic test results
  • Demographic information of your healthcare proxy
  • Name/address/contact information for past and current health care practitioners
  • Current symptoms and signs
  • Questions you want answered from your practitioner(s)

In addition to having your information handy, you can organize your health priorities and create a plan for success, a pact with yourself to:

  • Get up around the same time every day
  • Get yourself in bed earlier and get more than 7 hours of sleep per night
  • Schedule your exercise sessions in your calendar and keep your gear (and a filled water bottle) in your car
  • Bring healthy food and drink with you every day, saving time and money
  • Schedule 5 minutes of meditation daily (or more) and listen to your favorite tunes
  • Splurge on a lower cost massage at least once a month – it’s such a great neurological reset button!

A little planning and creativity and devotion to yourself will pay dividends and simplify your self-care.

I feel somewhat anxious and depressed, but I don’t think I need a psychologist or psychiatrist yet.  What can I do naturally? — Sofia B.

Our fast-paced technologically-propelled socially-disconnected and competitive lifestyle, as a backdrop, may simply represent our fear of “missing out.”  How can we bottle the feeling we have after a vacation and take a sip each day to keep that carefree mood from vanishing?

There are multiple causes of anxiety and depression that are quite common and most of us experience:

  • Drinking more than one cup of coffee per day
  • Eating too much sugar and drinking too much alcohol
  • Lack of sleep, nutritious food, and exercise
  • Endocrine imbalance (thyroid and sex hormones)
  • Insufficiently clear communication and not asking nicely for what we want
  • Unrealistic standards and expectations
  • A lack of a calming routine to manage our stress
  • Over-scheduling, “living in the future,” and not scheduling “down time”
  • Not saying “no” to things to which we are not truly committed
  • Insufficient emotional and physical intimacy, and sometimes loneliness

Well that’s quite a list!  What can I do about all of that?

  • Enjoy the present
  • Schedule social connection
  • Unplug and set your devices to “do not disturb” and leave them out of sight as often as possible
  • Get a massage at least monthly
  • Schedule daily meditation breaks for relaxation breathing – just 5 minutes is a reset
  • Cancel what you can, responsibly, and decompress
  • Workout at the gym or walk in the woods
  • Embrace failure, learn from it, and keep plugging
  • Get in bed before midnight and get 7 hours or more of sleep per night
  • Limit coffee to one cup in the morning
  • Ask for and give hugs freely
  • If necessary, see your physician. He or she can check your hormone levels, other blood tests, and consider prescribing, for temporary use, medication for anxiety or depression.

Let’s face it!  We’re all feeling the pinch.  Mindfulness, gratitude, and self-forgiveness are vital.

I have had chronic and recurring lower back pain for a long time.  I want to try a chiropractor but I heard this can cause more harm than good.  What should I do? – Kevin M.

Low back pain is very common. Most people get it at some point in their lives. The lumbosacral spine is a busy place and takes a lot of strain.  When we don’t maintain its health, we feel it, and sometimes it perpetually invades our consciousness.

Sources of low back pain include strains and sprains of the muscles and ligaments, muscular imbalance, scoliosis, herniated discs in younger people, spinal arthritis in older people (involving the discs and facet joints), inflammation of the sacroiliac joints, abnormalities of abdominal or pelvic organs with referred pain, spinal vertebral fractures in the elderly from osteoporosis, hip arthritis, spinal fracture/tumor/infection, or perhaps vitamin D deficiency, hypothyroidism, or sensitivity to gluten.

Additional biomechanical causes of low back pain include imprudent postures (with vocational and avocational pursuit) with inappropriate bending and twisting, trauma, or degenerative problems.  Most of the time, self-care leads to total resolution of back problems.

What is chiropractic? It is the practice of manual therapy that involves manipulation of muscles, ligaments, joints, and tendons around the spine to decrease traction or compression on nerves to restore normal posture, movement, and activity tolerance and, hopefully, decrease pain.

Chiropractic is safe except if underlying pathology has not been ruled out (as above).  At first, low velocity, high amplitude manipulations can stretch taut muscles.  Chiropractors use treatment tables and manual manipulation.  The goal is to rebalance alignment gently.  Higher velocity, lower amplitude adjustments could be considered.  Chiropractors very in skill, like in any profession.  Make sure that your chiropractor asks enough questions and does a thorough examination, explaining a progressive plan.  Be concerned if any chiropractor uses a cookie-cutter approach with whatever problem is presented.  If a serious diagnosis is missed, pain can be increased and instability can occur from a fracture if present.  In addition, a delay in diagnosis of a tumor or infection is a possibility.

So what is the appropriate progression of intervention?

  • Get a thorough evaluation of your back, abdomen, and pelvis from a specialist. Ask him or her to identify the source of the pain.
  • Optimize self-care including: stretching of the hamstrings, calves, hip flexors, and lumbar rotator muscles; do core strengthening; and follow proper body mechanics.
  • Consider getting a referral to a manual therapist such as a sub-specialized chiropractor, certified massage therapist, licensed physical therapist, or Yoga or Pilates practitioner.
  • If your pain is still present after 2 months, an x-ray with flexion and extension views could rule out instability from a potentially hidden fracture.
  • Consider an MRI of the back only if you would get a back injection or if you have seen a surgeon and would agree to undergoing surgery after exhaustion of all conservative efforts.
  • Remember, 6 sessions of chiropractic manipulation should produce improvement. If it does not, consider ceasing care to seek further workup.

A practical approach to low back pain can get you (and your) back in action quickly.

Dr. Schwartz practices physical, pain and integrative medicine in Wyndmoor. He is board certified in these specialty fields. He trained at Columbia University, the University of Pennsylvania, and Thomas Jefferson University. For more, see MyHealth360.org