Most of this blog to date has focused on low back pain. In truth, more people suffer from low back pain than neck pain. Or at least that his been my experience and there is certainly statistical data that claims close to 80% of people suffer from back pain, or have suffered from back pain. That is certainly significant. However, neck pain is also very prevalent in today's society.
There is a reason that the cervical spine as well as the lumbar spine tend to break down. These are the two sections of the spine that are responsible for mobility. The low back allows you move the trunk froward, backwards and turning to either side. It allows your upper extremities more reaching mobility since the base can move around.
The neck is responsible for the mobility of the head. The ability to move your head from side to side and swivel around allows the versatility for the visual field. The mobility of the neck allows a significantly greater visual span.
As any other joint in the body increased mobility at a joint correlates with increased risk of joint wear and tear and potential for break down. In addition, we spend exponentially more time sitting. In general we spend a tremendous amount of time sitting in our cars, sitting in front of the computer, sitting in front of the television. All of these activities promote a posture of the shoulders rolling forward and the head jutting out, what we call forward head posture. This poor postural position puts extra strain on the nerve roots that exit the spinal column in the cervical spine leading to pain in the neck and can worsen to pain down the arms.
Ergonomics can make a big difference to neck pain in the work place. Most importantly to address neck pain is to make sure that you have good posture. So take a good look at your posture and see if you can work towards improving it today!
More to come on Posture on the next post.
Monday, April 27, 2009
Friday, April 24, 2009
Weight and Back pain
Recently I have started hiking in the morning before work 3 days a week. It is a great cardiovascular activity and it gives me time to just ponder different things. Today, I was thinking of the impact of weight on joints and the body. Carrying extra weight and the increased force with each step pounding through your body. The impact extra weight has on all your joints from ankle, moving up to knee, through the hip and into the low back.
If I were to hike my trail with a 30Lb pack on my back, I would certainly notice the difference through all my joints. That is comparable impact as when we move around when if overweight. For every extra pound of body weight we lug around it is an increase of 7Lbs of force through our joints. I always recall that statistic when thinking on this topic and it is staggering to me. If you are 10lbs overweight (and honestly how many of us wouldn't benefit from losing 10lbs...I know I could), you are putting an extra 70lbs of force on your joints. That would certainly increase the wear and tear on your joints and make you more susceptible to osteoarthritis. That wear and tear will also translate into increased wear and tear in your lumbar spine, and predispose you for low back injury.
Far too often low back pain is associated with obesity. And there is a direct correlation between increased adipose tissue in your abdominal region and decreased strength and therefore stability in your low back. For this reason, nutrition is paramount to help decrease low back pain. If you are overweight and suffer from low back pain, not only do you need to address the back pain, but you also need to address the potential cause of your back pain being directly linked to your obesity. As you address the low back pain and get active to strengthen the muscles that will increase stability in your low back, make nutrition a priority as well. Increased activity and proper nutrition can help to decrease your weight and decrease low back pain. So, follow my example and go for a hike!
If I were to hike my trail with a 30Lb pack on my back, I would certainly notice the difference through all my joints. That is comparable impact as when we move around when if overweight. For every extra pound of body weight we lug around it is an increase of 7Lbs of force through our joints. I always recall that statistic when thinking on this topic and it is staggering to me. If you are 10lbs overweight (and honestly how many of us wouldn't benefit from losing 10lbs...I know I could), you are putting an extra 70lbs of force on your joints. That would certainly increase the wear and tear on your joints and make you more susceptible to osteoarthritis. That wear and tear will also translate into increased wear and tear in your lumbar spine, and predispose you for low back injury.
Far too often low back pain is associated with obesity. And there is a direct correlation between increased adipose tissue in your abdominal region and decreased strength and therefore stability in your low back. For this reason, nutrition is paramount to help decrease low back pain. If you are overweight and suffer from low back pain, not only do you need to address the back pain, but you also need to address the potential cause of your back pain being directly linked to your obesity. As you address the low back pain and get active to strengthen the muscles that will increase stability in your low back, make nutrition a priority as well. Increased activity and proper nutrition can help to decrease your weight and decrease low back pain. So, follow my example and go for a hike!
Tuesday, April 14, 2009
Ergonomics - Proper Workstation Set-up
Ergonomics is the science of designing the optimal work environment. There are several elements to ergonomics but my focus is in designing the optimal work station to minimize repetitive injury associated with word duties.
The key elements to work station ergonomics are how you are seated in relation to your work space and specifically with your computer, as most people spend a majority of their work time at the computer. Here are some basic principals to make sure that your work station is ergonomically correct.
Sitting position: You should be seated in a chair with your hip angle at 90 degrees and your knees angle at 90 degrees. Your chair should have good lumbar support so that you are sitting up straight.
Keyboard Position: The keyboard should be above your legs so you have ample room for your legs. However, low enough so that your shoulders are relaxed and arms are comfortably by your side with elbows bent at 90 degrees. Also, your keyboard should be angled so that your wrist position is straight or slightly cocked up while typing.
Monitor Position: The monitor should be directly in front of you at a distance of 18-24". You should not have to turn your head to look at monitor. Also, the monitor should at the height of your line of vision. Ideally the line of vision is at the top edge of monitor so you look down slightly to see screen. You should not have to tilt head up or down to see monitor.
Sometimes it is difficult to make these adjustments due to furniture that is not adjustable, or you are not the right size for your station. You can use books to raise your computer height, you can adjust your chair higher and use a stool under your feet to optimize your position to your desk. Do what you can to optimize the computer position to you. If you accommodate your body position to your computer station you will have wear and tear on your tendons and muscles that can lead to back pain, neck pain, shoulder and wrist pain. Good ergonomic positioning can limit the risk of that damage. And ask for help if your work station is terrible, it will keep you healthier and make you more efficient at your job.
The key elements to work station ergonomics are how you are seated in relation to your work space and specifically with your computer, as most people spend a majority of their work time at the computer. Here are some basic principals to make sure that your work station is ergonomically correct.
Sitting position: You should be seated in a chair with your hip angle at 90 degrees and your knees angle at 90 degrees. Your chair should have good lumbar support so that you are sitting up straight.
Keyboard Position: The keyboard should be above your legs so you have ample room for your legs. However, low enough so that your shoulders are relaxed and arms are comfortably by your side with elbows bent at 90 degrees. Also, your keyboard should be angled so that your wrist position is straight or slightly cocked up while typing.
Monitor Position: The monitor should be directly in front of you at a distance of 18-24". You should not have to turn your head to look at monitor. Also, the monitor should at the height of your line of vision. Ideally the line of vision is at the top edge of monitor so you look down slightly to see screen. You should not have to tilt head up or down to see monitor.
Sometimes it is difficult to make these adjustments due to furniture that is not adjustable, or you are not the right size for your station. You can use books to raise your computer height, you can adjust your chair higher and use a stool under your feet to optimize your position to your desk. Do what you can to optimize the computer position to you. If you accommodate your body position to your computer station you will have wear and tear on your tendons and muscles that can lead to back pain, neck pain, shoulder and wrist pain. Good ergonomic positioning can limit the risk of that damage. And ask for help if your work station is terrible, it will keep you healthier and make you more efficient at your job.
Monday, April 13, 2009
Back Pain - First Response
What should you do when you back goes out? Common concern for those of us who have suffered from low back pain. The initial phase is incredibly painful and it hurts with all movement.
The common tendency is to lie in bad and avoid all movement. And sometimes, when the pain is bad and the spasm so severe, this is literally all you can do until some of the acute symptoms subside a bit. However, it is not he ideal treatment for the low back. In general, you want to try to keep the back loose as much as you can. Using ice and heat to control pain and inflammation and reduce spasms is an excellent approach at home, and typically is something you might have on hand. Over the counter anti-inflammatory medications (for example ibuprofen or naproxen) can help to reduce inflammation and decrease the pain. Gentle stretches can help keep the back loose as well. Pulling a knee to check and holding it for a minute, rotating bent knees back and forth in a pain free range can also be helpful. Basically any gentle movement that does not provoke back pain is an excellent way to keep the back moving.
Once you can move around more comfortably, I strongly recommend Physical Therapy. It will help to manage pain and inflammation, strengthen the low back to help prevent the re-occurrence of low back injury. After your low back goes out it is more likely to do so again without addressing the problem. Improving mobility, strength and function is the goal of every Physical Therapy program. It can make the difference for your back health!
The common tendency is to lie in bad and avoid all movement. And sometimes, when the pain is bad and the spasm so severe, this is literally all you can do until some of the acute symptoms subside a bit. However, it is not he ideal treatment for the low back. In general, you want to try to keep the back loose as much as you can. Using ice and heat to control pain and inflammation and reduce spasms is an excellent approach at home, and typically is something you might have on hand. Over the counter anti-inflammatory medications (for example ibuprofen or naproxen) can help to reduce inflammation and decrease the pain. Gentle stretches can help keep the back loose as well. Pulling a knee to check and holding it for a minute, rotating bent knees back and forth in a pain free range can also be helpful. Basically any gentle movement that does not provoke back pain is an excellent way to keep the back moving.
Once you can move around more comfortably, I strongly recommend Physical Therapy. It will help to manage pain and inflammation, strengthen the low back to help prevent the re-occurrence of low back injury. After your low back goes out it is more likely to do so again without addressing the problem. Improving mobility, strength and function is the goal of every Physical Therapy program. It can make the difference for your back health!
Monday, April 6, 2009
Common Question: Heat vs Cold
Should I use heat or ice for my low back pain? I get this question all the time from my patients. Bottom line for low back pain use whatever helps to relieve the pain. But lets go into the principles of both ice and heat as modalities.
The rule of thumb for heat and ice is after an injury the first 24-48 hours is the acute phase and ice is the best to manage inflammation (swelling) and help to control pain. After the first 48 hours the injury moves into sub-acute and then chronic phases and heat is the best modality.
Cryotherapy or treatment of ice helps to decrease inflammation. It is a very easy to apply anti-inflammatory and can help control swelling, pain associated with swelling and decrease pain by numbing the area of pain. Ice is very effective for superficial joints like ankles, knees and shoulders. It can also have benefit to the back, however because the back is a much larger area it is hard for the ice to reach the depths of the tissue needed. Ice should be applied for 10 - 15 minutes with enough layers to protect from frostbite or frost nip. Ice can feel cold, burning and painful before it turns numb. Just make sure to have protective layers between the ice and the skin such as a pillowcase or towel depending on your sensitivity levels.
Heat is a great option to treat muscle tissue. It increases circulation to an area which can help to warm up the area. This is particularly beneficial for muscle tightness, spasm and soreness. Typically people with low back pain feel much better after lying on a hot pad or pack for 10 minutes. Associated with low back pain is muscle spasms and feelings of tightness in the low back, so heat can help to loosen this region up. Heat can be applied for 10-15 minutes at a time or longer depending on how hot the heat source is. Be careful not to burn yourself with the hot pack and use towels or protective layers to minimize risk of burns.
In general, both heat and ice can be beneficial for low back pain. Heat for the muscle tissue and ice to decrease inflammation. Both help to reduce symptoms and decrease pain. So both are helpful. Ultimately it is up to you, use the one that feels good!
The rule of thumb for heat and ice is after an injury the first 24-48 hours is the acute phase and ice is the best to manage inflammation (swelling) and help to control pain. After the first 48 hours the injury moves into sub-acute and then chronic phases and heat is the best modality.
Cryotherapy or treatment of ice helps to decrease inflammation. It is a very easy to apply anti-inflammatory and can help control swelling, pain associated with swelling and decrease pain by numbing the area of pain. Ice is very effective for superficial joints like ankles, knees and shoulders. It can also have benefit to the back, however because the back is a much larger area it is hard for the ice to reach the depths of the tissue needed. Ice should be applied for 10 - 15 minutes with enough layers to protect from frostbite or frost nip. Ice can feel cold, burning and painful before it turns numb. Just make sure to have protective layers between the ice and the skin such as a pillowcase or towel depending on your sensitivity levels.
Heat is a great option to treat muscle tissue. It increases circulation to an area which can help to warm up the area. This is particularly beneficial for muscle tightness, spasm and soreness. Typically people with low back pain feel much better after lying on a hot pad or pack for 10 minutes. Associated with low back pain is muscle spasms and feelings of tightness in the low back, so heat can help to loosen this region up. Heat can be applied for 10-15 minutes at a time or longer depending on how hot the heat source is. Be careful not to burn yourself with the hot pack and use towels or protective layers to minimize risk of burns.
In general, both heat and ice can be beneficial for low back pain. Heat for the muscle tissue and ice to decrease inflammation. Both help to reduce symptoms and decrease pain. So both are helpful. Ultimately it is up to you, use the one that feels good!
Friday, April 3, 2009
The many faces of Low Back Pain
As a Physical Therapist I see people with so many types of back pain. There is the classic pain across the low back that is a low grade nagging pain. There is the pain that is much more severe with radiating pain down the leg either along the back side of the legs as far as into the heel, but typically along the back of the thigh into the knee. Or the radiating pain that wraps around the hips and deep into the groin along the front of the thigh and can go as far down as into the toes. Pain has been described to me in so many ways as "sharp", "dull", "aching", "nagging", "like a toothache", "deep", "radiating", "stiff", "tight" and "just pain". Some people have pain bending forward, others bending back. Some people have pain only when they are sleeping and feel better when they are moving around. Other people only have relief when they are sleeping. Some people have pain when they are sitting, others get relief from sitting. Some people can control their back pain by walking, others can barely walk to the bathroom because it is so painful to stand upright. Every person I treat has a very individual form of pain, manifesting itself in unique ways. There are common trends in back pain, but what I see in every person who complains about back pain is that the pain is interrupting normal day to day movement! The other common trend, is that every version of low back pain can be improved with strengthening of the lumbar stabilizers. I have seen it time and time again with my patients. It takes time for a strengthening program to take effect, but it does work. So my message to people who suffer from low back pain is get the help you need to interrupt your low back pain so it stops disrupting your day to day life!
Wednesday, April 1, 2009
Lumbar Stabilization
The key to rehabilitation of lower back pain is Lumbar Stabilization.
Lumbar stabilization is a series of exercises and stretching designed improve strength of the core muscles responsible for providing stability and support of the lumbar spine. Lumbar stabilization is a program that helps to improve patient's physical conditioning and decrease symptoms associated with low back pain. It helps with better posture, safe movements associated with lifting turning and twisting, helps with movement awareness, as well as functional strength and coordination that assists in management of low back pain.
The muscles that are critical to lumbar stabilization are the lumbar mulitfidi and the transverse abdominus muscle. The lumbar mulitfidi are the deepest layer of muscles in the back. The transversus abdominus is the deepest of the abdominal muscles. The combined action of these muscle groups as an internal corset are considered to be the most important of the lumbar stabilizers. In addition, in a weakened state they can contribute to low back pain. These weakened muscles are commonly found in those who have trouble with ongoing low back pain.
Lumbar stbailization is the exercises designed to isolate these muscles and will improve the protection and support that these muscles provide. A lumbar stabilization program will improve the strength, coordination and function of these muscles which will help to reduce symptoms associated with low back pain and help to improve daily movement.
Lumbar stabilization is a series of exercises and stretching designed improve strength of the core muscles responsible for providing stability and support of the lumbar spine. Lumbar stabilization is a program that helps to improve patient's physical conditioning and decrease symptoms associated with low back pain. It helps with better posture, safe movements associated with lifting turning and twisting, helps with movement awareness, as well as functional strength and coordination that assists in management of low back pain.
The muscles that are critical to lumbar stabilization are the lumbar mulitfidi and the transverse abdominus muscle. The lumbar mulitfidi are the deepest layer of muscles in the back. The transversus abdominus is the deepest of the abdominal muscles. The combined action of these muscle groups as an internal corset are considered to be the most important of the lumbar stabilizers. In addition, in a weakened state they can contribute to low back pain. These weakened muscles are commonly found in those who have trouble with ongoing low back pain.
Lumbar stbailization is the exercises designed to isolate these muscles and will improve the protection and support that these muscles provide. A lumbar stabilization program will improve the strength, coordination and function of these muscles which will help to reduce symptoms associated with low back pain and help to improve daily movement.
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