The Spine Wellness “Toolbox”



Traditional spine care treatment focuses on medication, physical therapy, surgery, injections, and in some cases, manipulation therapy. However, recent studies have shown that treatment practices continue to move further away from accepted guidelines. Despite these evidence-based guidelines, many patients are subjected to unnecessary images and narcotics, and are not provided treatments that have been shown to be effective. This has resulted in expensive care with inconsistent outcomes and low patient satisfaction.


Getting to the root cause of a person’s condition, rather than just treating the symptoms often involves a comprehensive evaluation. Such an in-depth evaluation can dramatically improve a patient’s spine health as well as their overall well-being. For example, obesity places increased stresses across the spine, which can lead to increased pain. Other systemic conditions like diabetes and autoimmune diseases can cause nerve conditions that can imitate or complicate disc herniations and lumbar stenosis. Treating the end symptoms without addressing the underlying causes may help relieve the symptoms temporarily, but may not provide relief, which can lead to future flares.


In a spine practice, we see many patients who also have diabetes and/or pre-diabetes and have elevated markers of systemic inflammation. If we are able to effectively help patients reverse these conditions with lifestyle modifications including diet, exercise, supplements and sometimes medication, we often secondarily improve their spine and nerve conditions as well.


Inactivity alone can be a significant contributing factor to spine-related pain. Prolonged sitting has clearly been shown to increase not only spine pain but also morbidity associated with other chronic health conditions. Sitting too much, quite literally can shorten your life and increase your pain. Our spines need to be moved to gain nutrients, stay supple and heal. A strong core and strong back muscles provides support for the back and the neck as well. Without this strength, pain can be present even with attempting to maintain a normal posture throughout the day. Working with patients who are on the road to recovery to plan a long-term fitness program helps not only prevent recurring spine problems, but also helps patients improve their overall health.


It is also not uncommon that we see patients with low back pain and even leg pain who fail to improve with other treatments; we sometimes discover they actually have a problem with their sacroiliac joint. Patients with prior lumbar spinal fusions are also at risk for sacroiliac joint dysfunction. Fortunately, using a comprehensive approach, we are able to significantly improve and often resolve the pain associated with this condition.


Expanding the “toolbox” to include all of the treatments that have been shown to be effective in spine care can often more effectively and more quickly help a patient take control of their spine health.


Often combining “tools” results in better outcomes than the individual “tools” themselves. Examples include combining physical therapy with medication, with supplement therapy, with massage therapy and yoga. Additionally, using tools that treat all of the factors a patient has affecting his or her spine improves outcomes. For example, using tools to improve weight and sleep can positively impact a patient’s spine health.


I am often asked, “Why would a spine surgeon want to use an expanded toolbox and not just discuss surgery as an option when talking to patients?” While surgery can be very effective for some circumstances, it certainly does not address all spine problems.   Additionally, when surgery is necessary, if we use additional tools from the “Spine Wellness Toolbox”, we get better outcomes from surgical procedures with fewer complications.


Using a patient-centered approach, with an expanded “Spine Wellness Toolbox,” helps to provide patients with a faster, more comprehensive approach to achieving spine wellness and can also improve their overall health.

Dr. Carrie Diulus is a board certified orthopaedic spine surgeon who is the Medical Director of the Crystal Clinic Spine Wellness Center in Akron, Ohio. Previously she practiced as a spine surgeon for the Cleveland Clinic Center for Spine Health. Dr. Diulus is also a recognized leader in healthcare information technology. She practices patient centered medicine, looking for all of the factors that cause and influence a patient's spinal conditions to help achieve optimal spine wellness. As a result of lessons learned from struggling with her own weight and health, Dr. Diulus devotes a great deal of her time working in the spine and wellness communities to help reduce the obesity and diabetes epidemic. She was featured in “Fat, Sick and Nearly Dead 2” a documentary about living in a healthy way in a largely unhealthy world. She has co-authored several textbook chapters, presented at national and international professional meetings, and is published in the areas of orthopaedics, pathology and biomaterials.


  1. I can confirm that a patient of mine had a fantastic initial consult with Dr. Diulus. According to my patient, Dr. Dulius quickly diced through the conventional wisdom with respect to spine care and surgery, emphasizing (in his case) the importance of reducing chronic inflammation through simple lifestyle changes. This patient of ours took Dr. Diulus’s words to heart, having heard us recommend similar approaches many times in the past and he has thus far made great strides in a few short weeks of implementing these lifestyle changes. He continues to shift his perspective on what is now possible with respect to his chronic low back/ disc conditions, knowing at the same time that he has a trusted surgeon on his side should the day ever come when conservative approaches don’t produce the desired results. Thanks so much for the words of wisdom Dr. Diulus!

  2. Informative article, exactly what I needed.

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