Say Goodbye to Spinal Stenosis An A to Z Guide to Lasting Relief. brought you by SpinalStenosisTips.com

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1 Say Goodbye to Spinal Stenosis An A to Z Guide to Lasting Relief brought you by SpinalStenosisTips.com 1

2 Intro What Is Spinal Stenosis? Symptoms of Spinal Stenosis Rare Symptoms Symptom-Free Who Gets Spinal Stenosis? Causes of Spinal Stenosis Degenerative Causes Non-Degenerative Causes Diagnostic Tests Treating Spinal Stenosis Pharmacological Treatments of Spinal Stenosis Therapeutic Treatments Surgical Options Risk & Recovery 2

3 Intro According to the New England Journal of Medicine it is estimated that 31 million Americans experience lower back pain at some point in their lives. What s more is that 85% of Americans will suffer some form of back or neck pain in their lives, with a small percentage experiencing acute or chronic back pain. The primary cause of this lingering back pain is refusal to seek medical attention for this pain. For some back pain sufferers the problem is a simple strained muscle caused by poor posture or improper working conditions. For those sufferers a massage or over the counter pain medication combined with exercise will help alleviate the pain. Back pain sufferers with a persistent or degenerative pain will have to undergo a thorough diagnostic process to determine the source of the pain and begin treatment. The diagnosis you receive will determine what forms of treatment will be most effective. One of the most common degenerative back disorders is spinal stenosis because it can occur in any of the three regions of the back. This guide to spinal stenosis will help you identify the symptoms and outline possible treatment solutions so you and your physician can make an informed decision. 3

4 What Is Spinal Stenosis? Spinal stenosis is the narrowing of spaces located in the spinal canal, between the vertebrae. When these spaces begin to narrow over time, pressure is placed on the spinal cord and often the nerve roots as well. While it is unlikely that stenosis (narrowing) will occur from in more than one area of the spinal column, it is more likely that it will occur in one of the following areas; The canal at the center of the spinal column where the nerve roots and spinal cord run. Vertebral openings where nerves leave the spine for other parts of the body. Spinal canal at the base of the nerves as they branch out to other body parts. Understanding spinal stenosis from symptoms to treatment requires at least a basic understanding of the anatomy of the spine. There are 26 different bones in the spine that travel from the base of the skull down to the pelvis, 24 of which are vertebrae which act like blocks to keep the spinal column stabilized to protect the nerves and spinal cord. It is between the 24 vertebrates where the narrowing is likely to occur. The nerve roots in the spine are protected by the sacrum and coccyx, located below the lumbar region. The spine is broken down into three areas: cervical, thoracic and lumbar. Where the pain and other symptoms manifest will determine what type of spinal stenosis you may have. Cervical spinal stenosis will cause symptoms in the neck and upper portion of the spine, while lumbar spinal stenosis will impact the lower back region. 4

5 When the upper back, but not the neck exhibits symptoms that could indicate thoracic spinal stenosis. By taking note of exactly where and when the symptoms occur and when the pain increases or decreases, you can help get an accurate diagnosis of your pain. Symptoms of Spinal Stenosis Symptoms of spinal stenosis will appear due to the pressure placed on the spinal cord and/or nerve roots. Just as the spine narrows progressively over time, so too do the symptoms of that narrowing. This is exactly why treating back problems such as spinal stenosis can be so difficult; it is easy to chalk up the symptoms to generic back pain when the problem could be more serious. While pain is likely the most noticeable symptom of spinal stenosis, it is rarely the primary symptom. Leg pain specifically has often been reported by patients with spinal stenosis, particularly lumbar spinal stenosis. The leg pain is most pronounced when walking and can only be relieved by brief periods of rest. The most prevalent symptom is numbness and tingling in one of the three regions in the back. This numbness and tingling, which is caused by pressure placed on the nerve roots, may travel up and down the lengths of the affected nerves. Depending on the type of spinal stenosis one has, the tingling can appear in the hands, feet, legs, arms, neck or buttocks. Muscle weakness or muscle cramping is quite possibly one of the most distinguishable symptoms of spinal stenosis, and often the one that prompts 5

6 a visit to a back pain specialist. Muscle cramping or weakness may occur in the shoulders, neck, arms, legs or buttocks. Sciatica is often reported as a symptom of spinal stenosis due to the fact that the sciatic nerve the largest nerve in the body, traveling across much of the human body is often pinched or compressed due to a narrowing spinal column. It is very likely that most sufferers of spinal stenosis will experience some level of sciatica. The pain that occurs with a narrowing of the spine will vary in its intensity, but one of the defining symptoms of spinal stenosis is that the pain worsens sufferers are standing or walking and relief is experienced when sitting or bending forward. Most frequently pain and other symptoms present on either the left or right side of the body, regardless of which region of the spine is affected. The location of the pain as well as other symptoms will help the physician and the patient determine where the spinal canal is narrowing. The pain and other symptoms will manifest in at least one section of the back as well as surrounding body parts. Lumbar spinal stenosis will present symptoms in the lower back, but also the buttocks and even the thighs. Thoracic spinal stenosis will present with symptoms in the upper back but also the arms, and often the shoulders. Cervical spinal stenosis may cause pain in the neck, shoulders and arms. Rare Symptoms Some symptoms of spinal stenosis do not present in every case or across all types of spinal stenosis. Some of the more uncommon symptoms that arise when the problem worsens or with a specific type of spinal stenosis include; Reduction or loss of hand dexterity (cervical spinal stenosis only). 6

7 Spastic quadriparesis, or a weakening of all 4 limbs occurs in progressed cervical spinal stenosis only. Bladder or bowel incontinence occurs only in severe cases of spinal stenosis. Poor balance while walking. Difficulty urinating or having a bowel movement. Difficulty breathing (thoracic spinal stenosis only). Spasticity or uncontrolled movements (most pronounced with thoracic spinal stenosis). Hypotension or hypertension, also known as high or low blood pressure (thoracic spinal stenosis). Symptom-Free Back pain in general, but spinal stenosis specifically may present with no symptoms in some instances. This can prolong the problem because how you can one be expected to seek out help for a problem they do not feel? Fortunately very few spinal stenosis sufferers are symptom -free and often only find out during a routine checkup or if other back ailments occur. Who Gets Spinal Stenosis? Anyone can suffer back pain due to a narrowing of the spinal canal, but men and women over the age of 50 are more likely to be affected. Younger people may experience this narrowing after an injury or trauma to the spine or spinal column. Since Spinal Stenosis occurs over time, most sufferers are older. 7

8 Causes of Spinal Stenosis The primary cause of spinal stenosis is age. Although it is true that some are just born with smaller spinal canals, for the great majority a narrowing spinal canal is caused by some form of degeneration that comes with age. Many of the degenerative causes of spinal stenosis are caused by preexisting back conditions that place additional stress on the healthy parts of the spine. Degenerative Causes The leading cause of spinal stenosis is age as the spaces tend to narrow over time. The narrowing process is gradual due to inflammation or structural changes in the spine. As the body ages the ligaments in the spine can thicken and harden or the joints and bones expand, forcing the spaces between the spinal canal to narrow. A small percentage of people are born with smaller than average spinal canals, but typically spinal stenosis is caused by preexisting back problems that place additional pressure or stress on the otherwise healthy areas of the spine. When those unhealthy areas of the spine start to fail, it places stress on other parts of the spine. In fact many spinal stenosis sufferers report some other back ailment. Spinal Arthritis - causes the spinal bones and ligaments to expand and thicken. In fact any type of long term inflammation (swelling) can cause spinal stenosis. Osteoarthritis - Other forms of arthritis such as osteoarthritis wears the cartilage layer of the joints may cause an overgrowth of bones, pressing the vertebrae together and narrowing the space between the bones. 8

9 Rheumatoid arthritis - begins at a much earlier age than other forms of arthritis, giving it more time to degenerate. When soft tissue in the joints swells, spinal stenosis can occur. Although it is not highly common for rheumatoid arthritis sufferers to develop spinal stenosis, the joints, bones and ligament damage can impair joint function which can lead to a spinal stenosis diagnosis, particularly in cervical spinal stenosis. Herniated Discs - lead to a drying out of the tiny cushioned pockets in the spine that act as spinal shock absorbers between the vertebrae with age. As they dry out, they are more susceptible to cracking which can cause the insides of those cushions to seep out and place pressure on the nerve endings or roots and spinal cord. Cervical Spondylosis occurs when the bones and cartilage in the cervical vertebrae experience unusual wear and tear. This may cause bone spurs and compressed nerves and eventually grow into cervical spinal stenosis. Bone Spurs - caused by simple wear and tear of the spinal bones. Those spurs begin to grow into the spinal canal, forcing it to narrow to make space for the bone overgrowth. Paget s disease is a chronic disease that causes abnormally large or enlarged bones, the result of which is often large yet fragile bones which are susceptible to fractures and arthritis. Enlarged bones, particularly in the spine, may cause the bones to make their way into the spinal canal thereby narrowing the spaces to make room for them. Non-Degenerative Causes The majority of spinal stenosis cases are caused by degeneration, but there are instances in which the disorder is acquired. Non-degenerative causes of 9

10 spinal stenosis are often easier to diagnose because there is a direct event or problem that prompts diagnostic procedures. Spinal Tumors are abnormal growths that form within the spinal cord as well as the membranes that protect the spine, forcing the canal to narrow to accommodate the growth. As the tumor grows, the spinal canal continues to narrow but it may also cause bone loss. Accidents or Traumas can cause spinal stenosis by dislocating or fracturing the spine. A displaced vertebrate may just damage the spinal canal or cause a bone overgrowth into the spinal canal. Any additional swelling in the spinal column may also force the canal to narrow as a means to prevent more serious spinal damage. Ossification occurs when calcium deposits form on the ligament that runs the length of the spine, known as the longitudinal ligament, and is located behind the spine and inside the canal. The calcium deposits change the fibrous tissue of the longitudinal ligament to bone (ossification), and they often press onto the nerves in the spinal canal. 10

11 Diagnostic Tests One of the reasons back pain becomes a chronic problem is that most sufferers tend to self-diagnose, mostly incorrectly. Without an accurate diagnosis treating a problem such as spinal stenosis will only get worse over time. This is particularly true when patients not only diagnose, but then treat what they suspect the problem is. When dealing with a disorder like spinal stenosis, traditional treatments such as stretching and exercise may not be sufficient and may in fact do more damage in the end. If you have been experiencing symptoms of spinal stenosis for more than a week, document the symptoms as well as when they appear to help your physician diagnose you properly. During the diagnostic phase you will undergo several different tests so the back specialist can get the clearest possible image of the spine. There will be multiple tests before you get an accurate diagnosis for your spinal stenosis. Medical history. The first step in diagnosing spinal stenosis requires the physician to take a detailed medical history from the patient and based on existing medical records. It is important to be as thorough as possible about general health, previous back problems and other preexisting conditions, current symptoms and pain levels as it can help to eliminate some back disorders. Do not omit any symptoms or problems as irrelevant since it can all help the physician figure out the next step in diagnosing spinal stenosis. Physical exam. The next step is a physical exam in which the physician will conduct an external examination of the body. This exam includes a test of your range of motion during a series of movements 11

12 that includes sitting, standing, walking and bending. These movements allow the physician to monitor the patient s response to each action, while retrieving information from you about pain levels during particular movements as well as at rest. In many physical exams the physician will check muscle strength and reflexes as this will help determine how much a disorder has progressed. X-rays. Although x-rays might not confirm a spinal stenosis diagnosis, it can highlight any injuries or tumors that may be the source of your back pain. Since a tumor or injury can cause the spinal canal to narrow, it can help the doctor determine what the next test will be to confirm their suspicions. MRI. Magnetic resonance imaging (MRI) is one of the most preferred methods of diagnosing spinal stenosis because it allows the doctor to view cross-sections of soft tissue for analysis. MRIs can detect tumors, soft tissue damage, and injury to the spinal cord and nerve roots, which allows the physician to search for signs of degeneration. This can help determine what type of degenerative disorder the patient has. Myelograms. While this diagnostic procedure cannot provide confirmation of spinal stenosis it can determine if any of the causes or risks of spinal stenosis are present. The liquid die used in a myelogram will highlight bone spurs, tumors, herniated discs and other ailments placing pressure on the spinal cord or nerve roots. 12

13 CAT scans. Computerized axial tomography (CAT) scans produces a three dimensional view of certain different of the back. Specifically it highlights the size and shape of the spinal canal, which allows the physician a close up view at the spine to look for a narrowed canal or misaligned spine. Bone scans. This method is only used to check for any damage or injury to bones. It cannot illustrate exactly what is wrong with the bone, but it will illustrate that there is something wrong. The radioactive material injected during a bone scan attaches to the bone in places where it has begun breaking down or being formed (ossification). If the material is attaching to the bone, the next step will be another test to confirm a diagnosis. The process for diagnosing spinal stenosis may seem long and arduous but each test can eliminate certain disorders and indicate others. While the diagnostic process rarely includes every single one of these tests, multiple tests are usually required for accuracy. Once an accurate diagnosis of spinal stenosis has been given, it is time to discuss treatment options and find specialists to contribute to the treatment plan. 13

14 Treating Spinal Stenosis Treating spinal stenosis can require a team of specialized physicians and in rare instances, surgeons. The course of treatment required for spinal stenosis and any other underlying causes such as rheumatoid arthritis or tumors will determine exactly who will be involved in your treatment plan. You may be work with a chiropractor, psychologist, physical therapist, rheumatologist or pain specialist to execute your treatment plan for both the long and short term. It is important to note that for spinal stenosis there is only treatment and currently no cure. As of yet there is no procedure or therapy that can widen the spinal canal so the treatments available pharmacological, therapeutic and surgical can only address the symptoms associated with spinal stenosis. Most patients diagnosed with spinal stenosis will require more than one form of treatment to alleviate the pain particularly, in order for therapeutic treatments to prove effective. There are many different methods to treat spinal stenosis so we suggest that patients actively participate in treatment plans and only agree to methods they are likely to follow. Being informed about treating spinal stenosis is the best way to find a treatment that works for each patient. Pharmacological Treatments of Spinal Stenosis Using medicine to treat spinal stenosis is a short-term treatment meant to address symptoms that include pain, swelling and muscle cramping. This is often the first stage in a multi-step treatment plan to improve range of motion and reflexes. 14

15 Make sure to find out about all side effects associated with each medication before agreeing to a regimen. Some drugs may interact negatively with other medications so be honest with your physician about which medicines you currently take. Muscle relaxants. Prescribed to reduce muscle spasms and cramping associated to nearly all types of spinal stenosis. Anti-seizure drugs. These are often prescribed to reduce any pain associated with nerve damage because over the counter pills have proven ineffective in treating this type of pain. NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) are simply a combination pill such as Motrin and Advil that relieves pain and reduces swelling (inflammation). These drugs are available over the counter and often much cheaper than prescription drugs. Tricyclic antidepressants. Prescribed for neuropathic pain as well as chronic pain, these pills are often taken a night to ease pain that interrupts sleep. These pills may not be right for elderly due to the adverse side effects. Oral opioids. Given for severe pain, opioids are habit forming and you may be required to see an addiction specialist during the course of the pills. Oral opioids include oxycodone, hydrocodone and other codeinerelated substances are highly habit-forming and often require therapeutic treatments to avoid addiction. Steroid injections. Often given as temporary pain relief for swollen or irritated nerve roots, these injections reduce inflammation and relieve pressure that is common around the narrowing. Since steroid injections can weaken adjacent bones, treatment is limited to a few injections each year. A review of the Spine Patient Outcomes Research 15

16 Trial (SPORT) found that patients who underwent steroid injections required a longer hospital stay when surgery was needed or when it was not. Therapeutic Treatments In addition to using drugs to treat symptoms of spinal stenosis, various forms of therapy are recommended to help relax muscles, improve range of motion and reduce further degeneration. Physicians may recommend both traditional as well as alternative forms of therapeutic treatments that have proven effective in treating spinal stenosis. Physical therapy is used to treat spinal stenosis because the exercises can strengthen muscles and improve flexibility. Physical therapy can also improve balance and stability, which will reduce the risk of future back injuries, by focusing on the muscles in the back and core. Although positive results have been seen with physical therapy no scientific evidence supports this claim, most of the evidence has been anecdotal. Massage therapy may be helpful to some spinal stenosis patients since it has been proven effective for reducing muscle tension and cramping. Furthermore massage therapy can be highly effective to reduce muscle spasms and alleviate stress associated with chronic pain. 16

17 Acupuncture and acupressure can be used to treat symptoms of spinal stenosis. Ask your therapist if this method can help as many are reluctant to advise alternative treatments such as this. Chiropractic treatments may treat a limited range of motion by manipulating the spine. Chiropractors rely on traction or electrotherapy to treat spinal stenosis. It is important to keep in constant communication with your chiropractor in regards to your level of pain throughout treatments. Lumbar braces may be worn in order to provide back support as spinal stenosis sufferers improve mobility. This type of equipment works well for elderly patients with multiple points of degeneration or those with very weak abdominal muscles. Exercise is always recommended as part of the treatment process, particularly those focused on strengthening muscles in the abdominal and back regions. Strengthening these two areas will improve spine stability. Exercises such as swimming and bicycling are recommended. Walking devices such as walkers or canes may be used in the early stages of treatment until some mobility has been regained. When bending forward makes walking painful, a walker or cane can allow pain relief until bending forward becomes easier. 17

18 Which Treatments Work Best Some of the most effective treatments are also some of the least commonly known. Thousands of people have used the following treatment options for treating spinal stenosis and various forms of back pain. 1. Muscle Balance Therapy - In order to reduce or eliminate your pain, you must first identify the root causes of your pain. Barring injury or trauma, most cases of back pain can be treated by correcting muscular imbalances that are pulling the body and spine out of alignment. This treatment is easy to do, can be done from the comfort of your own home and works wonders for many types of back pain. Click here to learn more about Muscle Balance Therapy #2 - Inversion Therapy - Inversion therapy has been used by millions of people for more than 2,000 years. This is not an overestimate. In fact, 18

19 inverting can be traced all the way back to the days of Hippocrates, the Father of medicine. Often misunderstood, the act of inverting actually decompresses the spine, providing adequate spacing between the discs and eliminates pressure and pain due to narrowing of the spine. Contrary to popular belief it is not necessary to hang completely upside down to see positive results. For some patients fully inverting can be unsafe, but even partial inversion can be very beneficial. Click here to learn more about Inversion Therapy While relieving your back pain may be your primary reason for considering inversion therapy; there are a number of additional benefits gained through a regular regimen of inversion. 19

20 Here are 7 good reasons to use inversion therapy: Maintains your height. Regularly inverting will help you avoid the shrinkage that naturally occurs as a result of gravity over a lifetime. Improves circulation. When you are inverted your blood circulation is aided by gravity rather than having to work against it. Additionally, the inverted position lets gravity take hold, which facilitates a more efficient clearing of the lymphatic system to ease symptoms of stiff muscles like aches and pain. Relieves stress. Everyone knows that a full body stretch is rejuvenating, but for some back pain sufferers it just isn t possible. An inversion table provides the same feeling of relaxation as a yoga class with a lot less effort. Many people find that they sleep better and feel more invigorated with regular inversion therapy. Heightens mental alertness. Any upside-down activity--within moderation--increases the supply of oxygen to the brain, which many experts believe helps maintain mental acuity and sharpness. Increases flexibility and range of motion. With inversion therapy the joints stay healthy and supple, allowing you to remain as active as you were before spinal stenosis made movement more difficult. Improves posture. The stretching that comes with reversing the force of gravity on your body helps you sit, stand and move with more ease and grace. After inversion therapy sitting up straight is no longer 20

21 the painful activity it once was. Realigns the spine after workouts. Running and other aerobic activities inevitably compress your spine often unevenly. One-sided activities such as golf or tennis often pull the spine out of alignment. During inversion, minor misalignments often correct themselves naturally. One study consisted of 175 participants who reported experiencing back pain bad enough that they were unable to work. After just 8 inversion sessions 88.6% of participants were able to return to their jobs full-time. This means that just 8 inversion sessions made a significant decrease in the amount of pain in 88.6% of those people Click here to learn more about Inversion Therapy #3 - Natural Anti-Inflammatory Pain Relievers (Alternatives to Prescription Drugs, NSAID s or Pain Killers) 21

22 Despite what you may have been told by your physician you do not have to rely on risky pain pills to experience pain relief. There are natural alternatives that are as effective but don t come with dangerous side effects. Click here to learn more about the top recommended natural pain relievers Proteolytic Enzymes - Research indicates these enzymes work with your entire body to help it fight inflammation, dissolve scar tissue, cleanse and thin the blood and even boost cardiovascular, respiratory and immune functions. In other words, proteolytic enzymes are the last line of defense against disease, illnesses, pain and everything else that works internally to attack your body. And unfortunately with the overly processed, nutrient-deficient food common to most diets today, the vast majority of adults today have dangerously low levels of these enzymes! Bromelain - This special natural compound is extracted from pineapple and contains several crucial proteolytic enzymes that have been shown to short circuit multiple pain pathways in the body. It has been studied extensively since its discovery in 1957 and hundreds of studies have shown that it reduces inflammation, reduces and prevents swelling and removes waste and other toxins from the blood. 22

23 For example, in one study 77 patients taking Bromelain experienced significant reduction in pain and swelling. Turmeric Extract - Turmeric has the unique ability of using its antioxidant powers to seek out and destroy free radicals in the body which contribute to pain and swelling. A recent study done at the prestigious Sloan-Kettering Cancer Research Center in New York found that turmeric was more safe and precise than aspirin in stopping inflammation by shutting down the COX-2 enzyme responsible for pain. And turmeric caused none of typical gastrointestinal irritation found in aspirin users! There are many other natural pain fighters that you can use to wipe out your aches and pains Click here to learn more about the top recommended natural pain relievers Surgical Options (Last Resort Only) In some instances the underlying conditions causing spinal stenosis cannot be cured or altered permanently with pharmacological and therapeutic treatments. For some patients these methods are temporary measures that provide limited relief. However before surgery is considered a viable treatment for spinal stenosis, a combination of other methods should be tried for at least six months. 23

24 One of the few instances in which surgery may be considered necessary before other methods is if the symptoms are already severe, such as impaired bowel, urinal or neurological functions. When muscle weakness or numbness makes walking impossible, the physician may immediately recommend surgery. However responsible physicians will at least attempt non-surgical options as surgery can be risky and costly. Surgery for spinal stenosis should be considered in the following circumstances; 1. The symptoms have disabled the patient. 2. The health of the patient is sufficient enough to warrant the risk of surgery. 3. Less intrusive treatments have proven ineffective. Surgery for spinal stenosis is intended to alleviate pressure on the nerves or spinal cord. Additionally surgery can restore spinal strength and alignment, by removing or trimming the bone overgrowth causing the spinal canal to narrow. The most common surgical treatment of spinal stenosis is referred to as a decompressive laminectomy. The purpose of this surgery is to remove the lamina (or roof) of at least one vertebrae to create more space. In some instances the surgeon may fuse vertebrae in addition to removing the lamina, but in cases of achondroplasia a simple laminectomy is sufficient without fusion. Risk & Recovery There are many risks associated with choosing surgical treatment for spinal stenosis, particularly because this disorder most often affects those of an advanced age. However surgery carries inherent risks due to anesthesia and the possibility for infection. 24

25 Specifically, surgery for spinal stenosis carries the risk of membrane tearing around the spinal cord or the formation of blood clots. While these problems can be easily remedied, they will increase the recovery time, which can have a greater impact on the symptoms of spinal stenosis. Finally any other preexisting disorders and diseases can prolong recovery time and increase the risk of infection. It is important to note that while surgery may prove effective, more effective than non-surgical treatments for some patients, according to a 2010 study it still will only relieve pain or pressure associated with symptoms. Recommended Resources: We have secured a limited number of copies of this fabulous book "The 7-Day Back Pain Cure" with the publisher and I'd like to offer one of them to you as special gift, free of charge 25

26 Click here to request your FREE book now before they're gone This is a real paperback book pages full of some of the best myth busting and pain relief information you can find anywhere... including all of the little-known treatments and cures you'll never hear about from your doctor! This book is for sale at amazon and other book stores, but DON'T go buy it... right now you can grab a totally FREE copy. Click here to request your FREE book now before they're gone Simply follow the simple step-by-step self-treatment protocol outlined on page 234 and in just days (maybe hours) you can be free from your sciatica! This is 100% real... while this may sound too good to be true, it's not... Here are several success stories from people just like you who used this free book to put an end to their pain: Relieved my Sciatica Pain "I first had back pains in It was clear what the trigger point was. Yet I self-limited to physiotherapy which only reduces the pain but does not resolve the root cause of the problem. For 11 years I have been coming and going. Now thanks to Jesse I know what to do. 26

27 I have a clear path to success. I said path, not pathology because muscle balanced therapy is ahead of me to live the life of my dreams" Jorge Zuazola A Must Read Book "I wish that I had found this book earlier. It has helped me more than the pain management doctor. I really did not want to manage the pain - I wanted rid of it and wanted to get back to my normal activities. The exercises have helped greatly. I am pleased with my progress and continue to exercise, watch what I eat and take NO pain medicines. Kathryn A. Kindel Click here to request your FREE book now before they're gone 27