Running Doc: Explaining spinal stenosis, which has Mets captain David Wright on the disabled list (Daily News)
David Wright has been sidelined since April with spinal stenosis
Dear Running Doc:
I am a New York Mets fan. I just read that David Wright has spinal stenosis and back pain. I hope you know something about backs. Is this career ending or does he need surgery? Could there be something else to help him?
— Johnny R. Flushing, NY.
Thank you, Johnny for the question. Yes, I do know something about back pain and have made it a subspecialty to my practice of sports medicine. Back when I was a fellow working with Dr. Allan Levy of the New York Giants, he asked me to see the patients with back pain coming into his office. At that time all back pain was treated with the same set of exercises. It was like shooting buckshot at a barn and hoping to hit a bull’s-eye. I applied sports medicine principles of finding an exact diagnosis and developing specific treatment plans depending on the diagnosis.
The spinal canal is the place where the spinal cord runs down your back and spinal nerves exitat each level of vertebra. When the canal is congenitally small it is called spinal stenosis. You can’t pick your parents and some people are just born this way. Some people never have a problem with a small canal. Others may reach a “critical mass” (like when atoms reach a certain speed there can be a nuclear explosion) at any age and the small canal results in rubbing of nerves causing inflammation and then pain.
A good history is usually enough to make the diagnosis. When the examiner asks “is there anything that you do that brings on the pain?” the patient will usually say: “Yes, when I brush my teeth in the morning I feel the pain.”
Doctors call this the “toothbrush sign.” Of course, a physical exam is important to be sure there is no neurologic symptoms. An MRI can assess how stenotic the canal actually is.
Baseball players, as they get ready to bat at home plate, with bent knees, are in this very same position. Nerves are rubbing and pain increases. That is why David Wright is having problems.
Treatment for spinal stenosis usually starts with physical therapy meant to increase flexibility of back muscles so as not to pull on the back and cause more rubbing. Picture muscles and tendons attached to the spine as strings. The shorter the string, the more movement of the spine with every motion. If you elongate the string with stretching, less movement of the spine and less nerves rubbing and therefore less pain.
If that doesn’t work there is always a surgical procedure to increase the space of the canal either done traditionally or with a laser. Both back surgeries require about one year of rehabilitation before returning to normal and there are no guarantee that the player will get back to play their sport at the same level.
Over the last few years, PRP treatments have been tried with varying success. These treatments can be done in the office and do not require pinpoint accuracy with the injection. The concept is to flood the area with structures in the platelet fluid that will bring in stem cells to naturally increase the space for the nerves. This is still an experimental procedure with which I have had good results. The only downside I see is its expense: insurance still does not reimburse for this procedure.
Johnny, I have not examined David Wright, nor have I read his records or spoken to his medical people, so I do not know how stenotic his spine is. I, like you, hope he has a mild case for which physical therapy makes a difference. Nevertheless, no matter how stenotic, everyone I know should start with physical therapy, as he is doing. It sounds like he is getting appropriate treatment. The New York Mets need him and I’m sure all the fans are rooting for him. We hope therapy works and we see him playing soon.
I hope this answers your question. If you have any more questions please feel free to write in.
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Lewis G Maharam M.D. FACSM is one of the worlds’ most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is the author of the Running Doc’s Guide to Healthy Running and is past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is the medical director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com. Want your question answered in this column? Write to runningdoc@nydailynews.com or write your questions or comments in the comments section below.