Stooped posture, heavy force etc.

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Vancouver
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April 9, 2012 at 7:21 am

Post count: 5

#5986

2 months ago I hurt my back at work. I am a stucco plasterer. I apply cement to exterior walls 8 hours a day 5 days a week. The required motion of applying the mud forces me into a stooped posture at all times, as well as my height of 6ft 3 and then my hard hat and boots adding to my height also forces me to stoop when on scaffolding with a scaffold deck above my head. I apply the cement with my right hand using a trowel, arms extended out 12 or more inches and reaching as high and low as I can to the wall before moving down the scaffold. I do more than 10 lifts a minute in this posture and while spreading with my right I am holding 10 or more pounds of mud in my left hand with my tool called a hawk and therefore am lifting that as well especially when stooping low. I also bend further and further to reach into the bucket the mud is in to begin with. At the time of injury it was cold out, feb 10 in Canada. I was doing a high pace repetitive task at a speed 4 times faster than normal because we were skimming the wall. I was at the end of a 390sq foot wall and stooped right over applying to the bottom part of the wall. As I stood up I felt intense pain 9 out of 10. And have been in constant pain since, couldn’t even talk for 2 weeks without pain and have lately begun getting intense pains in my calves my buttocks my thighs and feet as well as my whole back. I have been for an MRI and am waiting for the results, after the long weekend. Workers compensations doctor claims that my work activities are not injurious, that there light duty, and that I was not doing anything heavy or awkward or outside of my range of motion and therefore was denied benefits. I need the compensation so I can afford the physio or whatever I need. And so I can contribute for my family again. I am 26 years old and shouldn’t be having back problems already. What I want is an expert opinion on wether my work activities as a stucco plasterer would have caused my back injury and wether or not the incident on gen 10 would be significant in causing an injury. The medical adviser noted to that I hadn’t been working long enough that day to cause the Injury. Even though I spread 390 sq ft in 40 mins. Any head ice would be greatly appreciated thank you so much and I really find this site informative. Keep up the good positive work!!

Donald Corenman, MD, DC
Moderator

April 9, 2012 at 11:07 am

Post count: 8660

#5988

Thank you for the description of your occupation. I think your description is one of the best mechanical discussions of the day to day loading that your spine is exposed to that I have the privilege of seeing.

You perform repetitive bending with twisting and load (BLT- see website) to the lumbar spine on a minute to minute basis while working. This will contribute to annular stress and tears. The pain in your legs could be an indication of a herniated disc compressing the nerves in the canal.

You workman’s compensation doctor is incorrect. This activity is outside of non-work related normal day to day activities and in my opinion is obviously work related.

The advisor stating that you “hadn’t worked long enough” has no basis in science. Tears or herniation can occur on the first bend or on the hundredth.

I, of course cannot directly interject my comments in a workman’s compensation case in Canada but I would assume that there are level headed specialists in Canada who could chime in.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Vancouver
Member

April 9, 2012 at 1:26 pm

Post count: 5

#5989

I looked for an article for bending while twisting with a load in your website and could not find it, I’m guessing this information would be really beneficial for me to read over and perhaps use as part of my appeal. Thank you for writing me back I really appreciate it. It has been really stressful being injured and not getting the compensation and treatment I deserve. Your part about the length of time and it’s relevance to my injury was nice to read because it’s exactly what I thought.

It’s nice to know there are people out there fhat care.

The med advisor said, I do not see an activity that would be significant {heavy or awkward} enough particularly when performed over such a short period of time to cause a muscular tear(sprain strain) or potentially be causative of a disc protrusion (not confirmed by objective signs.) in conclusion even though the symptom onset was temporal to the activities performed. It is not likely that the activities were causative of the workers symptoms.

Then as you said how this is scientifically wrong. I need to present that when I appeal so that it’s obvious that is an untrue statement. Again thanks for writing back to me any further help would be massive!!

Thanks.
Paul

Donald Corenman
Keymaster

April 9, 2012 at 10:24 pm

Post count: 52

#5990

Hi,

These videos are what Dr. Corenman is referring to for advice on bending and lifting. Hope they help.

https://neckandback.com/videos/how-to-prevent-back-injuries

Best,

NeckandBack Admin

Vancouver
Member

April 25, 2012 at 3:23 pm

Post count: 5

#6116

Thanks again for writing me back, I received the results from my MRI and my family doctor says that the injury can definately be related to what I was doing. Unfortunately the injury is worse than the doctor had suspected and I was given two options. Cortisone shots or surgery. My doctor suggested I try the shots first and hopefully the swelling of the disc goes down and stops pinching the nerve. I’m getting mixed opinions on the cortisone shots.

I don’t want to seem like I’m asking to much but is there a chance I could send my MRI results to you and get a descriptive response on how the work activity as I described it could directly relate to the injury. I hope I’m not asking to much.

Thanks for reading,
Take care
Paul B

Vancouver
Member

April 25, 2012 at 3:37 pm

Post count: 5

#6117

Thank you again for responding to my last message. I received the results from my MRI and my doctor gave me 2 options cortisone shots or surgery and suggests I try the cortisone shots first. He said that the MRI results can be directly related to the work activity I described. In wondering if I can send a picture of my MRI results to you and get an answer to how my work activity as a stucco plasterer could be directly related to the injury as described on the MRI result.

I feel like if I can make some kind of difference and help someone else in the same situation sometime in the future by winning my appeal and setting a standard and understanding of the work motions of a stucco plasterer, which are very high in risk for back injury when examined then all though these are hard times without the compensation and benefits I deserve at least I will have helped someone else avoid this situation im in.

Thanks
Paul
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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