TheAthletesLawyer

Clients of ABRAMS LANDAU, Ltd. are often confused by the various terms used by health care providers for what is essentially the same condition.  A “Herniated Disc,” “Disc Protrusion”, “Extrusion,” “Disc Prolapse” or “Slipped Disc” all essentially mean the same thing.  Doctors use these terms to explain the fact that some of the material inside the discs of the cervical (neck), thoracic (torso) or lumbar (lower back) spine have “escaped,” “leaked out” or been pressed out of their ring or band of fibrocartiledge and into the spinal canal.  Part of the disc has pushed out, and this disc material may be putting pressure on a nerve or creating inflammation around the spinal cord.

Doug Landau often demonstrates to clients the difference between a “bulging disc” (where the disc material is still contained within the intervertebral disc) and a truly herniated disc (where there is a break, tear or whole in the disc and contents are now outside the fibrocartiledge).  Technically speaking the diference between a Disc bulge and a disc herniation is that a disc hernation involves the inner part of the disc breaking out through the outer layers.

The disc is made up of an inner gel like part called the nucleus and an outer more cartilaginous section called the annulus.  The annulus has fibers like radial car tires.  We have all seen car tires that still operate with bulges.  But once there is a puncture, the car may no longer function properly.  So a bulge is when that annulus is pushing outward or “bulging” outward but the fibrous cover or “shell” is not broken. In a herniated disc, the inner material actually breaks through the annulus to the outside. A common analogy is a jelly donut – the nucleus is the jelly and the annulus is the rest (or the outer crust) of the donut.  If you squeeze the donut the jeely pushes toward one side bulging the donut on that side. “a bulged disc” When you squeeze that donut and the jelly comes out that is like a disc “herniation.” Either a disc bulge or herniated disc can put pressure on a nerve. Typically a herniation creates more pressure but this is not always the case.

[TriathlonTrialLawyer Doug Landau and Fairfax-Reston area Neurosurgeon Donald Hope, M.D. review the MRI films of an injured worker with a herniated lumbar disc.]

Many of the clients of ABRAMS LANDAU, Ltd., have had successful back surgery.  Herniated discs in the lumbar spine can cause disability, pain and loss of function.  However, advances in medical science and surgical techniques have lead to shorter recuperation times and smaller scars.  Clients of the Herndon Reston area injury and disability law firm have asked, “can I run after this surgery ?”

The Runners Clinic from “On the Run Events.com” addresses this question superbly

Can I run after back surgery?

“I had a lumbar discectomy 1 year ago on L5. I was told to stay away from running. But I really want to start back. Is there a easy way to get started back running without injuring myself. I didn’t injure my back from running but from lifting. Is there a reason to stay away from running?”

“you are correct in assuming that you can run. The question is “should you?” Consider that the disc is now effectively a washer between your L4 and L5 vertebral body, and that all of your upper body weight is transfered through the disc to your lower body with every step. The problem with running is that it is a repetitive pounding activity that, over time, will take it’s toll on your tissue. Now that the disc has been reduced from a shock absorber to a washer - a space holder effectively, how much pounding can you reasonably tolerate?

My advice to you is to run only on soft surfaces - dirt trails, tartan track, grass, and avoid any hard surfaces - concrete especially. Also, you must have shoes in excellent condition, and if you start to run, make sure that they stay so. Further, you must start back slowly. Begin with a one or two mile walk/jog, and gradually increase your pace, always measuring your response. Listen to your back along the way. Being in excellent condition will help prevent future episodes of back pain, so it is good that you are walking down this path…but
you have to proceed with caution, and you have to think long term. You might consider some non-impact activities like roller blades as an alternative…Also, as long as your back troubles you - use ice!”  Neil

[Shown here is the small scar from a lumbar disc surgery recently performed by the excellent spine specialists at the Commonwealth Orthopaedic Group on one of their own physicians !]

Statistics are important to sports fans. Sometime I think that baseball fans like the statistics more than the actual sport. Statistics are also important for Sports Medicine practitioners and active athletes. Tracking trends in injuries can help in the treatment and prevention of many common ailments. It is also important to track those risk factors that predispose people toward acute, chronic and overuse type injuries.

One of the goals of the Winter or “off season” training period is to strengthen those weaknesses that may tend to cause injury or hamper performance during the “peak” or racing season. For example, I regularly do one-legged stationary cycling in the winter in order to develop the full circular motion of correct cycling biomechanics. I also work on lower leg strength and stability with a BOSU, tilt board or other balance enforcing equipment. Strengthening my ankles, tendons and ligaments over the years has lead to a reduction of sprains, strains, tears and “down time” during the competitive season. For an excellent graph of common running injuries and discussion of risk factors, see, “A Quick Look At Running Injuries written for Podiatry Management Magazine for practitioners and students” from Dr. Pribut’s Running Injuries Page. Dr. Stephen M. Pribut has a Podiatric Medicine and Surgery practice in Washington, D.C.

In the last post I wrote about jogging strollers and baby joggers.  They are both ways to keep in shape while spending time with little kids.  Another way to keep active after the arrival of a “wee one,” is by backpacking with one of the new baby packs.  When I was in California visiting family, I was able to try out one of these fancy rigs.  It was very comfortable and my “navigator” seemed to enjoy the view.  With a canopy to keep the sun off of sensitive skin and a water bottle close at hand, my nephew had a fine time and I was getting up a good sweat in the hills of Malibu’s state park.  It is important to make sure that all the straps are correctly fitted and that none of the baby’s parts are being pinched or rubbed.  I have had my own children fall asleep in these backpack-style baby carriers.  You can also stop on a dime and get the child out to explore some interesting thing on the way.  My own kids liked to touch turtles, collect rocks, pick berries and honeysuckle.  Get out, enjoy nature and take your pint-sixed passenger along for the ride !

When I first started running with my kids in a stroller, there was only one company making a “jogging stroller.”  The “baby jogger” came out in 1984, and our first child was in one in 1986.   It was a single stroller, with 3 wheels, very stable and only slightly portable.  We took it on planes, trains and long car trips so that the kids could share the sight, sounds, smells and surroundings of wherever we went.  It was virtually indestructible, except for the time I left it on the roof, attached with bungee cords, and in my haste to get to a race, forgot as I pulled into a parking garage to the sickening sound of metal crashing into cement.

It is important not only to properly assemble your jogging stroller but also to be careful on how you use it.  I will confess that when our son was a baby, we went on a trip with both kids and only a single baby jogger.  We hung him off the back, suspended in his “Johnny Jump-Up.”  Lest the stroller tip from the weight imbalance, we put a rock on the front of the stroller, affixed with what else - duct tape !  When I saw these strollers at Tysons Mall, I was reminded of this “new parent” indiscretion and safety faux pax.  The instructions on the mall strollers are intended for people like me.  Now for some serious tips for parents who want to run with their children in jogging strollers and baby joggers, go to  Jogging strollers: Tips for running with small kids.  And get out and have fun with the little ones.

At ABRAMS LANDAU, Ltd. car crash clients often ask if the property damage case and the personal injury can be settled at the same time. In serious injury cases, this is not a good idea. While the “dings” and damage to a car’s chassis will not “heal” on their own, the human body is remarkable, and recuperation starts right away. That is why I advise clients to settle their property damage (or “PD”) claims as soon as they have their own estimate (or “2nd opinion”). In order to avoid being “low-balled” by the insurance company, the team at our Herndon Reston area injury and disability law firm highly recommend having the damaged vehicle looked at by your service station, car dealer or other knowledgeable mechanic BEFORE agreeing to accept the property damage offer. It is also important to make sure that ALL the property that was damaged by the crash is covered. You cannot go back for an additional settlement after accepting the insurance carrier’s check for the PD claim.

SO, if your eyeglasses were smashed, cell phone ruined, stereo crushed, ipod waterlogged or trunk contents soiled; take photographs, get receipts for purchase and/or replacement and make sure you include them in your property damage demand. When you do settle the property damage claim, common sense suggests that you make sure the check does not state “FULL AND FINAL SETTLEMENT OF ALL CLAIMS.” We had one case where the unsuspecting accident victim signed off on such a check, only to find that her personal injury or “bodily injury” (”BI”) claim was being denied by the insurance company, which maintained that their check settled ALL the claims this woman had as the result of the crash. That is another reason why it is important to get legal counsel AS SOON AS POSSIBLE AFTER A MAJOR CAR WRECK OR TRUCK CRASH. At ABRAMS LANDAU, Ltd., we do not take any fee from property damage monies recovered unless the PD claim also has to be tried.

After struggling over the last 3 triathlons, and even walking for the first time in his career at the DC Nations Triathlon, Doug Landau has withdrawn from racing until further notice.

While upcoming events of interest will continue to be posted, the Triathlon Trial Lawyer will not compete at the several races he has already registered for and he has curtailed training. In addition to cramping, especially in the legs, after T-2, Landau has been breathing louder than a race horse. At the DC Triathlon, after the first mile of the run, he felt like someone had punched him in the gut, and so he was reduced to walking around Hains Point and through the downtown Capitol area.

Ever the stubborn competitor, Landau managed to finish, walking across the finish line just as he had at the 25th Annual Reston Triathlon. Mrs. Landau thinks her “hard- headed husband” had bronchitis, bronchial pneumonia or other illness that he did not get treated until it had settled into his chest. Doug denies all of these allegations, but promised to see Reston Triathlon physician Dennis Sager. Stay tuned !

[Triathlon Trial Lawyer Doug Landau is shown here after the USAT National Aquathon Championships. Landau and Maccabiah Games Teammate Steve Schloss both qualified for the Aquathon World Championships. Landau always wants to “put his best foot forward.”]

On Sunday, October 05, 2008, at 08:00 AM TriathlonTrialLawyer Doug Landau will race at George Mason University, in the “Friends of the Orphans” 5km.

The race will start and finish on Mason Pond Drive near the Center for the Arts Concert Hall, covering the Patriot’s Circle course. This event will also be timed by Pacers running store of Alexandria.

Whether you’re a track star or a leisurely stroller, this all-ages event will be fun for everyone! All proceeds from the Fiesta 5K will benefit the children living at Nuestros Pequeños Hermanos (NPH, Spanish for “Our Little Brothers and Sisters”), homes located throughout Latin America and the Caribbean, supported by Friends of the Orphans.  Online registration can be found at Active.com

Have you ever eaten a walnut ?  Have you ever crushed a walnut shell and looked at the walnut, unbroken  ?  The shell’s insides look sort of like the inside of our skulls and the walnut looks a bit like a brain.  The big difference is that unlike the walnut, the brain is not hard and it moves around in a fluid inside the skull.  Sometimes the brain is injured because it bumps and crashes against the inside of the hard boney skull in a car crash, slip and fall or bike accident.  Other times the brain twists and torques and nerves are torn by the shearing forces.

When these nerves (or “axons”) are torn, the result is “diffuse axonal injury”  (”DAI”).  Of these, 80% will result in MICROscopic tears, so you won’t see them.  Brain injuries where there has not been a skull fracture or cut to the outside of the head with bleeding, swelling and discoloration, are hard to diagnoses.  Many times, these “closed head injuries” go undiagnosed. In fact, autopsy and histopathic studies have shown that the extent of DAI always exceed that visualized macroscopically.  Furthermore, these injuries are “Non-Hemorrhagic”, which means no bleeding, so bleeding tests for bleeding in the brain or skull will not show anything.  This is why at Abrams Landau, Ltd., our Herndon Reston area brain injury law firm tells callers it is important to get thoroughly examined after a car crash, slip and fall or bike accident that involves a blow to the head or sudden acceleration or deceleration.

After returning to Northern Virginia Saturday from the Brain Injury meeting at the State Capitol, I unpacked, rested up and then participated in the “Kit’s Miracle Mile” 10km. at the Fairfax campus of George Mason University. This event celebrated the survivors with brain injuries and raised money for Brain Injury Services (United Way #8237). Some of the things I learned:

• Did you know that 1.4 million people will sustain a Traumatic Brain Injury (”TBI”) each year in the United States ?

• Did you know that males are 1.5 times as likely as females to sustain a TBI ?

• Did you know that the leading causes of TBI are: falls; motor vehicle accidents; struck by/against; and assaults ?

These are some of the Brain Injury Facts disseminated at the 5th Annual the Fifth Annual Kit Callahan’s Miracle Mile. benefiting Brain Injury Services, Inc. Triathlon Trial Lawyer Doug Landau, who finished 5th overall, is shown here with Leesburg attorney Barbara Willliams after the race. Barbara brought her “Team BSW” to the George Mason University campus in Fairfax in order to support survivors of brain injury. This top Virginia Trial Lawyer and Landau had both attended the Brain Injury Retreat in Richmond. Both ABRAMS LANDAU, Ltd. and the Law Office of Barbara Williams help clients and the families of those who have suffered devastating injuries as the result of car crashes, falls, defective products, bike crashes, truck wrecks and other negligently caused trauma.