Back Pain

Neck Osteoarthritis

What is it? Arthritis is defined as the presence of swelling, the presence of effusion (The escape of fluid into another part), or the presence of 2 or more of the following signs: limited range of motion (ROM), tenderness, pain on motion, or joint warmth.

Degenerative changes are common in neck or cervical spine. In some degree they are found almost universally in persons over 50yrs of age.

Statistics: Osteoarthritis of the neck is one of the most common forms of neck pain for people over the age of 50.

While a past neck injury can lead to neck osteoarthritis years later, aging is the major risk factor or cause of neck osteoarthritis. Seventy percent of women and 85% of men have x-ray evidence of neck osteoarthritis by age 60.

Whether neck pain is acute or chronic, statistics show that approximately 80% of adults are affected by some kind of neck pain condition.

Important Facts: The primary degenerative changes are initiated by injury. In other cases the condition is simply a manifestation of normal wear and tear.

In the upper limb there may be a vague, ill-defined and ill localized referred pain spreading over the shoulder region or there may be more serious symptoms from interference with one or more of the cervical nerves.

Treatment Duration: Treatments for cervical osteoarthritis are usually nonsurgical and is usually treated conservatively.

While cervical osteoarthritis tends to be chronic, the symptoms are rarely progressive and rarely require surgery. For patients with severe symptoms that are impeding their ability to function, surgery may be an option and a cervical laminectomy and/or cervical spinal fusion may be considered.

Do’s/Don’ts: Balance activity with rest. Ensure that your neck is supported at work, in the car and during your leisure time with a good pillow or chair. Check the height of your desk and chair at work and at home, and make sure that a computer screen is at eye level.

Avoid slouching in your standing position. Do not bend your neck forward or keep it in the same position for hours at a time.

Common Myths: Structural problems causing pain is a convenient and easy diagnosis to make because pictures of spinal degeneration can be pointed to on an x-ray or MRI image and named as the cause for pain. However, research has proven that structural problems are NOT the cause of most neck pain. Fortunately, there is a lot of research now showing that structural problems are usually not the cause of most neck pain.

Torticollis

What is it? A symptom, not a disease, of a twisted neck. In most instances, the head is tipped toward one side and the chin rotated toward the other. The involuntary muscle contractions in the neck region of patients with torticollis can be due to congenital defects, trauma, inflammation, tumors, and neurological or other factors.

Statistics: Congenital torticollis has been estimated to affect approximately two percent of newborn infants. The frank breech birthing position has been reportedly associated with the highest incidence of torticollis, with up to 34 percent of infants born in this position being affected. The most common type of congenital torticollis is that associated with subluxation of the upper cervical spine.

Important Facts: Congenital torticollis occurs when the neck muscle that runs up and toward the back of your baby’s neck (sternocleidomastoid muscle) is shortened. This brings your baby’s head down and to one side. This is known as congenital muscular torticollis.

Treatment Duration: Congenital muscular torticollis (CMT) is the most common cause of torticollis in childhood. This condition is usually recognized and successfully treated in infancy, but may persist in adulthood, particularly if not treated.

To treat congenital torticollis, you’ll learn to stretch your baby’s tight neck muscle several times a day. Your doctor or a physical therapist will teach you how to safely do the exercises.

Do’s/Don’ts: During feeding, hold your child in a way that makes him or her rotate the chin to the correct position. Place toys and other objects in such a way that your baby has to turn his or her head to see them and play with them.

Common Myths: Myth: Torticollis is a localized issue Reality: Is any issue ever just localized? If you have a toothache doesn’t it affect other areas of your body. For every action there is an equal opposite reaction. The only question is where is the opposite reaction in the child’s body. Finding the root issue which may be mid-chest, pelvis, hyoid, or any other area not obviously related to the neck.

Myths: Torticollis doesn’t cause delays. Reality: In many programs a diagnosis of torticollis automatically qualifies a child for Early Intervention. They do not need the quantitative % delay as the problem is more qualitative. Just as in Down Syndrome children may not present with many delays initially, but we know that eventually predictable patterns will emerge. In tort we see the predictable patterns of delays in rolling (child may only go one way and struggle with quality of rolling) delays in protective response (one side holds elbow in stiff extension and falls more – usually right side), limited range in right shoulder flexion, unilateral pronation etc. not to mention dental implications of asymmetry which may affect speech and feeding as well as a distorted visual field rotated more to one side affecting spatial awareness.

Myths: A small % of tilt isn’t an issue. Reality: Imagine having to work all day long with your head tilted 10 degrees to the side. How would that affect your overall performance? What if you did not yet have good balance skills or had not yet learned to sit up or walk? How would this impact your achievement of these skills? How would this impact your handwriting skills? If this posture became hard wired into your system what would be the effect with your growth spurt at puberty. Might this be the cause of idiopathic scoliosis?

Thoracic Outlet Syndrome

What is it? Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This can cause pain in your shoulders and neck and numbness in your fingers.

Statistics: It is difficult to diagnose thoracic outlet syndrome, as its symptoms are often mistaken for other conditions such as rotator cuff injuries, cervical disc disorders, multiple sclerosis, tumors, and others. Therefore, there are no reliable statistics that reflect how many people suffer from thoracic outlet syndrome.

Important Facts: Thoracic outlet syndrome has been described as occurring in a diverse population. It is most often the result of poor or strenuous posture but can also result from trauma or constant muscle tension in the shoulder girdle.

Static postures such as those sustained by assembly line workers, cash register operators, students of, for example, those who do needle work often result in a drooping shoulder and forward head posture. This position of the shoulders and head is also indicative of poor upper body posture. Middle aged and elderly women who suffer from osteoporosis often display this type of posture as a result of increased thoracic spinal kyphosis.

Treatment Duration: When thoracic outlet syndrome affects the nerves, the first treatment is always physical therapy. Physical therapy helps strengthen the shoulder muscles, improve range of motion, and promote better posture. Treatment may also include pain medication.

Do’s/Don’ts: By sleeping in correct, ergonomically sound positions, the body remains aligned properly, and can thereby greatly reduce the possibility of developing Thoracic Outlet Syndrome.

In general, to avoid unnecessary stress on your shoulders and muscles surrounding the thoracic outlet: maintain good posture, take frequent breaks at work, and practice relaxation techniques.

Even if you don’t have symptoms of thoracic outlet syndrome, avoid carrying heavy bags over your shoulder, because this can increase pressure on the thoracic outlet.

Common Myths: Thoracic Outlet Syndrome is a common cause of chest pain, and should be considered in all patients with chest pain because of its frequent association with cardiac and esophageal disease.

Fibromyalgia

What is it? Fibromyalgia is a chronic condition that affects about 5 million Americans. Doctors diagnose fibromyalgia based on a patient’s symptoms and physical exam. Patients experience pain and stiffness in the muscles, but there are no measurable findings on X-rays or lab tests. While fibromyalgia does not damage the joints or organs, the constant aches and fatigue can have a significant impact on daily life.

Statistics: Widespread chronic body pain for which no cause can be found is the major feature of fibromyalgia, a condition that affects an estimated 3.7 million people — mostly women — in the U.S.

Important Facts: The hallmark of fibromyalgia is muscle pain throughout the body, typically accompanied by fatigue, sleep problems, anxiety or depression, and specific tender points

Women between the ages of 25 and 60 have the highest risk of developing fibromyalgia. Doctors aren’t sure why, but women are 10 times more likely to have the condition than men. Some researchers believe genetics may play a role, but no specific genes have been identified.

Treatment Duration: Fibromyalgia was once the exclusive domain of rheumatologists. Today, the condition has captured the attention of a wide range of health care providers. Many people receive treatment through their primary care providers.

The goal of fibromyalgia treatment is to minimize pain, sleep disturbances, and mood disorders. Doctors may recommend medications that help ease your symptoms — ranging from familiar over-the-counter pain relievers to prescription drugs.

Do’s/Don’ts: Stress appears to be one of the most common triggers of fibromyalgia flare-ups. While it’s impossible to eliminate all stress from your life, you can try to reduce unnecessary stress. Determine which situations make you anxious — at home and at work — and find ways to make those situations less stressful. Experiment with yoga, meditation, or other relaxation techniques. And allow yourself to skip nonessential activities that cause stress.

Psychological Issues Are Not Common Fibromyalgia Symptoms — Mood problems have traditionally been thought to be among the most common fibromyalgia symptoms. But now researchers are saying that psychological disturbances are actually found in only a small number of patients.

Fibromyalgia a ‘Real Disease,’ Study Shows — A new brain scan study concludes that fibromyalgia is related to abnormalities of blood flow in the brain.

Radicular Pain

What is it? Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots.

Statistics: A large study in Rochester, Minnesota, has reported the annual incidence of cervical radicular symptoms to be 83.2 per 100,000 population, and its prevalence most significant within a 50- to 54-year age group. In the study, 90 percent of patients were asymptomatic or only mildly incapacitated.

Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination.

Important Facts: A common cause of neck, shoulder and arm pain is a ruptured or herniated cervical disc. Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. Certain positions or movements of the neck can intensify the pain. This pain is referred to as Radicular Pain or Cervical radiculopathy.

The pain often feels like an electric-like or throbbing sensation that shoots down your arm and hand. This pain may worsen when you cough or sneeze. In addition, it is important to be aware of signs of a problem involving your cervical spine (e.g., loss of the ability to control your bowel or bladder or difficulty with balance) that may require surgical evaluation.

Treatment Duration: About 90% of patients with cervical radicular pain recover in 12 weeks. Furthermore, it seems that there is no benefit at 12 months from having surgery or physiotherapy over no intervention. However, those having surgery generally recover quicker.2

The overall prognosis of persons with cervical radiculopathy is favorable. Most patients improve over time with a focused, nonoperative treatment course. There is little high-quality evidence on the best nonoperative therapy for cervical radiculopathy.

Do’s/Don’ts: Home cervical traction units may decrease radicular symptoms. In theory, traction distracts the neural foramen and decompresses the affected nerve root. Typically, eight to 12 lbs. of traction is applied at an angle of approximately 24 degrees of flexion for 15- to 20-minute intervals. Traction is most beneficial when acute muscular pain has subsided and should not be used in patients who have signs of myelopathy.

Pain Relief Strategy: Cross Your Arms? — Crossing your arms may confuse the brain and help fight pain, according to a new study.

Neck Pain Treatments Put to the Test — Spinal manipulation and at-home exercises may be better at relieving neck pain than relying on drugs.

Statistics: whiplash symptoms last more than 6 months in 75% of patients. whiplash victims lose an average of 8 weeks of work. Whiplash is 5 times more common in women than in men. Whiplash occurs most commonly in those aged 30 to 50 years.

Neck injuries cost at least $7 billion per year in insurance claims, according to the IIHS.

#1. The “Threshold” for cervical spine soft tissue injury of a motor vehicle becomes a reality at 5 MPH.

#2. Most injuries occur at speeds below 12 MPH.

#3. Crashed vehicles can often withstand collision speeds of 10 MPH (some even more) without sustaining damage. (THUS: The concept of “No Property Damage – No Cash” has absolutely been invalidated)!

Treatment Duration: Studies have proven that 45% of the victims remained symptomatic at 12 weeks and 25% remained symptomatic at 6 months. Even the most minor cases needed at least 8 weeks to recover. The time needed to stabilize in the more severe cases took 17 weeks. THUS: The written (and often declared) notion that “Whiplash Injuries Heal In 6 To 8 Weeks” is just not true !

Most people recover completely from a whiplash injury in the first six weeks. Others’ symptoms continue to improve over the course of a year. There is a 40% chance of experiencing some symptoms after three months, and an 18% chance after two years. No reliable way exists to predict the prognosis.

Do’s/Don’ts: Try over-the-counter pain relievers like aspirin, acetaminophen, or ibuprofen. For at least 2 to 3 weeks, avoid activities that bring on or worsen your pain and stiffness. Don’t lift or carry anything heavy or participate in sports. Do not sit, especially at a desk, for long periods of time. If possible, stay active by taking short walks.

Common Myths: Children who have been involved in motor vehicle accidents are often neglected as having had “Any various types of injury“, when in actuality, they suffer from the same symptoms as adults. As a matter of fact, they’re at a greater risk for damages – – especially when it comes to “WHIPLASH”!

Posture Dysfunction

What is it? The word ‘posture’ in most common usage almost exclusively refers to the way a person sits or stands, and is generally termed ‘good posture’ or ‘bad posture’. We all have positions we spend a lot of time in. If one of these positions puts your spine and other joints out of their normal balanced alignment, this is a postural dysfunction – and your muscles will adapt and become unbalanced,

Statistics: Occupational Safety and Health Administration (OSHA) Statistics

1.‘Ergonomics in the Workplace’ – is mostly commonly referred to posture and sitting position in front of the computer.

2. On average, 95% of an office workers’ day is spent sitting in front of the computer. View Ergonomics Case Studies.

3. Musculoskeletal injuries resulting from poor workplace ergonomics account for 34% of all lost workday injuries and illnesses

Important Facts: “All crooked or constrained bodily positions affect respiration injuriously. Reading, writing, sitting, standing, speaking, and working with the trunk of the body bent forward are extremely hurtful by overstretching the muscles of the back, compressing the lungs, and pushing downwards and backwards the stomach, bowels, and abdominal muscles.”

A good posture cannot be achieved unless the base, the feet and ankles are strong and healthy. The type of shoes you wear directly affects the health of your feet. When the foundation (your feet) is crumbling, the building (your body) crumbles and eventually collapses.

Head of Olympics Soft Tissue Therapy Services, Brad Hiskins, details how he evaluates thoracic spine dysfunction. He says that, inevitably, much of postural dysfunction resides in the thoracic spine.

Do check the position of your screen. Do have your chair at the right height so your eyes are level with your screen and your knees are slightly lower than your hip joints

Don’t try to sit up straight. Don’t use your PC in low light conditions
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/posture?open

Common Myths: It is popular to believe that slouching is due to laziness, or because the person doesn’t want to sit up straight. However, the major factor which determines the way a person sits or stands is the shape of their spinal bones. That shape can be determined by an injury which occurs in a few seconds when the person is young or by poor nutrition or disease which weakens their bones and causes the change in a few weeks or months.

Correct posture at the computer eliminates discomfort and possible injury. “Picture-perfect” posture can be extremely fatiguing. If you commute to work and sit most of the day, you can be sitting for 10 to 12 hours a day.