Of Chairs, Posture and Pain.

A new study from Spine (the cool kids’ favorite spine journal), showed less neck/shoulder pain in sewing machine operators after they were given new ergonomic chairs. More specifically they were given “an adjustable height task chair with a curved seat pan”.

A seat pan is the part you sit on. (Click here for an example.)

My first reaction was mock applause for pointing out the obvious. But, the more I think about this, I can see some value.

When I am treating someone for neck pain or back pain or shoulder pain or whatever pain, part of my problem is to teach them how to do their normal daily activities without irritating their condition. It can be hard to get ahead if the patient spends 40 hours per week aggravating their condition.

So, I try to discuss work postures (sitting at the computer and lifting are the most common offenders) with the majority of my patients. In some cases this is as important as anything we do in the office to treat them.

Here are a few tips when troubleshooting your work postures:

1. Get some professional advice if possible.

A chiropractor, physical therapist and/or ergonomic consultant are good places to start.

2. Be persistent.

Good posture is a habit. Think of it like learning the golf swing. You can’t just do it right once and expect it to be automatic. Learning correct posture is only the starting point. You need to keep reminding yourself – you need to train, dare I say discipline (an ugly word, I know. Mea Culpa.), yourself.

3. Remember the fundamentals.

Looking at you from the side, your ears should be in line with your shoulders, which should be inline with your hips (add knees and ankles if you are standing up).

4. Don’t put a lumbar support too low.

If you use a lumbar support (a good thing), the thickest part should be three inches or so above your belt-line. It should feel like it fits naturally with your body. Remember it is a lumbar “support”, not a lumbar “force”.

5. You are not a marine or a statue.

A new posture can feel a little awkward at first, but if you feel really stiff, that is usually not right. Some movement is proof of life. It’s OK. You should be upright, but feel relatively relaxed – you should feel less pain and stress in your neck and back immediately in a correct position. (Note: If you are a marine, please disregard).

Good luck on your postural endeavors!

What kind of treatment do I need: Part II

Once we have ruled out the nasty causes of back pain (cancer, infection, etc.) and we know we are dealing with a musculoskeletal condition (disc herniation, arthritis, back sprain, etc. etc.), we can talk about treatment options. There are two main types of treatment for neck and back pain: passive care and active care.

Passive Care

Passive care includes things that are done to you. This includes massage, chiropractic adjustments, ultrasound, microcurrent, traction and more. The general rule on passive care is that it should be a bigger part of your care at the start and a smaller part of your care as you get better.

Passive care can be great. It makes you feel better! However, if you are not getting active care, more than likely you are getting less than the best treatment.

Active Care

Active care is things that you do to and for yourself. Usually active care means some type of exercise. Walking is a form of active care that everyone should do. However, general exercises like walking are not enough by themselves. Most neck and back pain needs some specific exercises to correct your specific problems.

The good news is that you almost never need any fancy or expensive equipment or a lot of time. For most, five minutes per day five days per week is enough – for your specific therapy exercises, not your exercise for general health (darn!).

An example of a specific therapy exercise that is commonly needed is in my earlier column, “The Back Pain Vaccine”.

My back hurts. What kind of treatment should I get?

It is hard to be a patient with back pain. Everywhere is conflicting advice. Surely, though, your healthcare team will give you up-to-date and unbiased advice, right?

In short, not a chance! Most (MD’s, DC’s, LMP’s, PT’s, DO’s, ABC’s, etc) are going to tell you either: a) you’ll be fine, just wait b) you need whatever it is that I do. If their treatment fails, you may get one referral to someone else that they like (personally). Otherwise, the pain is in your head…or there is nothing more to do…or just keep getting my treatment…or….

Since nobody is going to give you a straight answer, here is my guide on how to use the different providers:

Family Practitioner (MD or DO): They are going to be fairly good at ruling out a nasty cause of your pain, particularly cancer and infection. If you have an exotic arthritis, they will probably figure it out with time.

Massage Therapist (LMP): Massage is a great adjunct to other treatment, but not enough usually on it’s own. Combine with Physical therapy and/or chiropractic.

Chiropractor (DC): I wish I could say, go find a chiropractor and he will help you with what he can and manage the referrals for the other care that you need (massage, physical therapy, surgical consults, etc.). Many do this, but not most.

Chiropractic adjustments are very efficient and effective treatments for a majority of back and neck complaints. Combined with physical therapy exercises it is even better in most cases. Generally, the chiropractor should be able to guide you through the exercises that you need, which should not be too many – if so, you may need a physical therapist.

Unfortunately, many chiropractors treat everyone the same and just crack your back without good diagnosis or making sure you get the other treatment you need. Finding a good chiropractor can be difficult, but it is worth it.

Physical Therapist: For most back pain, physical therapy exercises are effective and often necessary. PT’s tend to give to many useless exercises along with the useful ones. Often a chiropractor can give you the exercises that you need more efficiently, but if it is more complicated, or your chiropractor can’t handle it, you will need a PT. You can’t throw a dart at the phone book here either and have a reasonable chance, but good PT’s are out there.

Surgeons (MD, DO): You probably should not have back surgery. Just having a herniated disk does not mean you need back surgery. However, if you do, go to a neurosurgeon that does mostly spine surgeries. You will have the best luck here.

What about cortisone injections and prolotherapy and those fancy traction machines with an “86% success rate” and…and how much treatment do I need? Next time.

Warning: This is a (very) general guide on who does what well. It is to help you find someone to treat you, not so you can diagnose yourself and ignore medical advice given to you. If you are unsure of your current treatment or diagnosis, etc, get a second opinion from a live person in the flesh, not a blog!

When should I see a doctor for low back pain?

When back pain strikes, I know your first response: It will go away. Actually, at first this is a good reaction. However, if these symptoms mean you NEED to be checked out:

1. New pain that lasts longer than 2 weeks.
2. Pain that does not improve with rest.
3. Weakness in your leg (i.e. dragging your toes on one foot, etc).
4. Fever.
5. Numbness in the areas that would touch a saddle if riding a horse, or difficulty going to the bathroom (whether unusually difficult, or coming without your intention).

So, if you have any of the above you MUST go and be checked out at least. However, what if your back pain comes and goes?

If you have 3 or more episodes of the same pain that last longer than 1-2 days, you should be treated.

Now, of course, you are wondering: who should I see? what kind of treatment do I need? how much treatment do I need? We’ll get to some of these questions in the next day or so.

Cocoa or Tea for High Blood Pressure

Good news for you chocaholics out there. A report in today’s Archives of Internal Medicine looked at the studies done so far regarding high blood pressure, treated with either cocoa or tea.

They found that Cocoa consistently showed an effect, lowering diastolic blood pressure by 4.7 points and lowering systolic blood pressure by 2.8 points.

No effect for tea drinking.

However, remember that in most of the studies on chocolate use very high concentrations of cocoa. Much of the time it is more like the unsweetened baking bars than a dark chocolate dove promise….darn!

Disc Herniation: What your MRI is telling you

Disc herniation can be scary. I see patients and even doctors who shudder at it’s very name! But, are all disc herniations created equal? How do I know if mine is going to get better or not?

A new study looked at this question. They followed 154 people with sciatica and disc herniation on MRI for 14 months. The main question they were interested in was: do the patients who recover have anything different on their MRI’s from the people that don’t get better?

They found that patients with broad-based disc herniations(disc that protruded most of the way across the disc from left to right) were more likely to recover than those that had disc herniations just on one side. They also found that men were more likely to recover than women.

But, the most important nugget from this study is that they patient’s recovery had no relation to whether or not the disc herniation was still present, or even if it was still pressing on the nerve.

So remember, the question is not whether the disc is still pressing on the nerve. The question is whether your pain is bothering you and/or preventing you from doing what you want to do!

New Simple Osteoporosis Self-Screening

I know that many of you are worried about osteoporosis. If you are not, particularly if you are a woman and/or skinny, you should be.

Researchers came up with a simple self-test to see if you should go get a DXA scan. You take your weight in kilograms, subtract your age and then multiply by 0.2.

Lets work through an example for someone who is 50 years old and weighs 150 lb:

1) Get your weight in kilograms. 150 lb/2.2 = 68 kg.

2) Take your weight in kilograms and subtract your age. 68 (kg) – 50 (years) = 18.

3) Now multiply by 0.2. 18 x 0.2 = 3.6.

In the study they recommend that you get your bones checked with a DXA scan if your score on this self-test is less than 2.

I really can’t explain why they added the last step of multiplying by 0.2. It seems simpler to say that if your weight in kilograms is less than your age minus 10 get checked. So, for our example:

68 (kg) – 50 (years) = 18, which is greater than 10; OK for now.

Anyway, this does NOT mean that if you pass this quick screen you can forget about it, or ignore your doctor’s advice to get a screening. But if you fail, as Shakespeare once said, “Get thee to a DXA scanner!”

Exercising for Back Pain

To prevent back pain our focus is coordination and endurance. To get that we do what are called functional exercises. Functional exercises are those in which you use different muscles together in a (somewhat at least) natural arrangement.

This is as opposed to isolation type exercises. Two examples of functional exercises are the bench press and the squat.

In the bench press we use our chest, shoulders and triceps together in a normal way (i.e. similar to how we might use them together in normal life). An isolation exercise would be the pec butterfly. This uses only the pec (chest) muscles. And it is not very similar to how you might use it in normal life.

The squat also uses your quadraceps, buttocks, etc working together as those muscles usually do. A leg extension just works one muscle, the quadraceps, and is an isolation exercise.

It is a good idea to use functional exercises as much as possible in your workout. When you workout with functional exercises, you are less likely to miss, or underwork an important muscle. Functional exercises also engage the stabilizer muscles that we mentioned recently.

These concepts apply to all your joints, not just your spine. So next time you are at the gym, try to figure out how much of your workout is functional. (Sorry, but this is an important homework assignment).

Next time we will get back to our back pain vaccine exercises. Until then, keep working on the bird-dog.

The Back Pain Vaccine

Last time we talked about endurance exercise being important for back health. Today I’ll show you an exercise.

This exercise is called the Bird-dog, because………………it makes you look like a bird-dog. (Google that if you don’t know what that is ). This is one of the best exercises for those multifidus muscles that we showed last time.

The elements of endurance and coordination are both present in this exercise. She is making one mistake and should move her “down knee” forward until it is straight up and down. Also make sure that your pelvis is level with the floor.

You want to hold this position for 10 seconds per side. Work up to doing this 10 times per day, for a total of 100 seconds per side – easy! If you do this less than three days per week you are probably wasting your time. 3-5 days is great. More than 5 days won’t add much.

How easy, or hard this exercise is will tell you something about the shape of your back muscles. If you are bouncing, jerking and generally having a hard time holding this position, good news! You have room for improvement. : p

When this gets too easy, don’t add ankle weights or have your little brother sit on your leg. Instead, lift the arm opposite your “up leg”. So lift your right leg and left arm, for example. Still hold for 10 seconds and 10 sets per side.

This is the first step to health and happiness…or, at least, less back pain!