I have heard repetitive stress used in relation to carpal tunnel and tennis elbow but what does repetitive stress have to do with neck, low back, or shoulder pain, which seems to be your clinic’s expertise?  Dafne

Repetitive stress injuries (RSI) are also known as repetitive motion or overuse injuries which I think are more appropriate descriptions.

Carpal tunnel seems to be the most commonly linked RSI but they can be any injury to the musculo-skeletal system or nervous system due to repetitive motions, forceful exertions, mechanical compressions or sustained or awkward positions.

One of the first questions I ask a new patient is their occupation.  More and more, what a patient does in their daily activities is a major cause of their pain.

For example, I have found that elementary school teachers have a higher incidence of neck pain.  Without boring you with too much technical information, the most compromising position for the neck is when your head is in flexion or looking down.

Elementary school teachers are constantly in flexion.  After all, they are looking down on small children all day long.  Teachers, in general, have a high incidence of neck pain.  Whether they are looking down at children or grading papers, they are in a compromised position much of their day.

On the other hand, the most compromising position for your low back is a sitting position.  People who are at a desk all day will suffer from degenerative disk disease, pinched nerves, muscular imbalances to name a few.

I think traditionally, people thought those with manual labor jobs would be the most susceptible to these injuries but the repetition of my patient’s daily activities seem to be the cause despite the fact that they are not necessarily physical in nature.

So, what do you do about it?  You can’t stop working!

The first step is attempting to ensure that your work station is ergonomically correct.  Does your chair take some of the pressure off of your back?  Is the top of your computer just below eye level?  **I have written several articles on proper ergonomics.  Contact me at buckheadpainspecialists@gmail.com if you would like a copy.

Maintaining proper posture, proper stretching routines, massage and mirror image exercises are great tools.  Remember, prevention is the key.

Of course, if you are already experiencing pain and you haven’t read the rest of the newsletter, go back and read it and stop procrastinating!  And start investing in your future.  I am always available to help you whether you are a patient or not!

“An ounce of prevention is worth a pound of cure.” Benjamin Franklin

As a doctor, it always strikes me as funny that people will spend their lives saving money, contributing to their 401k, buying stocks etc.  They call this investing in their future.

Yet, when it comes to their health, people don’t pay nearly enough time investing.  Going to the gym is investing in your health.  Eating properly is investing in your health.  Getting yearly physicals are investing in your health. 

Why do we put more of a priority in investing our money, in taking our cars to get oil changes than taking care of our health? 

We have already established that stress is the silent killer, yet the majority of us don’t do anything to counteract our stress.

It doesn’t take THAT much effort.   I hear this all the time: “I didn’t realize how bad I felt until I felt good!” 

Most people don’t even realize what stress is doing to their bodies.  Most people simply think this is a part of aging.  WELL, IT ISN’T! 

It doesn’t matter as much what you do.  Just do something! 

Research suggests that exercise is the best way to prevent mental stress from manifesting itself into physical stress.

BUT, the best advice is:  DO SOMETHING!  

You must do something to take your mind off whatever it is that causes you stress, to give your body a release. Go for a walk, hit the gym, go hiking, attend a yoga class!     

Simply choose an activity you enjoy doing, or if you hate physical activity whatever it is that you are willing to do! 

If exercise isn’t an option, massage is a great tool to utilize.

****Did you know that your insurance can pay for your massage at our office?  Co-pays as little as $5!  One of our staff members can even check your insurance for you! 

Other stress reduction options include a warm bath, reading, meditation, go out to eat with some friends, play with a pet, get a pedicure.  Something, anything for yourself! 

There is a saying that posture is the window to your spine.  I couldn't agree more.  When you are analyzing your posture you are analyzing both your skeletal and muscular balance.  There aren't  factors more crucial in preventing both low back and neck pain than to have skeletal and muscular balance. 

For the neck specifically, the most common deviation from correct posture is an anterior translation of the head or forward carrying of the head as shown in the figure below.   This puts a great amount of stress on the muscles of the base of the cervical spine where the neck and the shoulders meet. 

Other results of poor posture include:  spinal degeneration, disc thinning, scar tissue formation, nervous system dysfunction, reduced range of motion, headaches, early onset of arthritis, increased likelihood of injury, and muscular sprains and strains. 

Lastly, poor posture has an effect on the normal curves of the spine.  The curves of the spine serve as shock absorbers like shocks in a car.  When the curves are reduced or lost, the discs compress and rich lubricating fluid is unable to penetrate.  This causes premature aging in the form of dry, stiff joints making the discs more susceptible to herniations or bulging. 

The truth is that posture is one of the most important factors of health, yet one of the most ignored. 

The good news is that poor posture can be corrected if done properly.   Remember, an ounce of prevention is worth a pound of cure! 

I sit at my laptop at work and by the end of the day my neck is extremely painful.   I have tried massage but it only seems to work for a few days.  What do you suggest?

----Donald

Donald, this is becoming an ever increasing problem for my patients.  Most people are using laptops now rather than desktops.

The number one problem with laptops is that typically, they aren’t set up ergonomically correct. 

Specific to the cervical spine, incorrect ergonomics puts a great deal of stress on the muscles, ligaments, skeleton and nerves of the neck.

1.        The top of your laptop should be at eye level directly centered in front of you.  It should be about an arm’s length in front of you.

2.       Your desk surface should be roughly belly button level and your elbows should be at 90 degree angle.

3.       Your feet should be flat on the floor with your knees at a 90 degree angle.

Lastly, pertaining to the temporary effect of massage, it tells me that the muscular symptoms are secondary to another underlying problem. 

This is most common with those individuals whose pain or discomfort is a result of a skeletal condition such as nerve or disk compression.  Often it is associated with radicular symptoms such as shoulder or arm pain, burning or numbness.

If this describes you Donald, I would get examined immediately before it gets worse.

I have a secret for you about the treatment of low back pain that you need to know…the truth about low back pain and its treatment.  A truth that healthcare providers would rather you not know.

First, some important background.  Low back pain is the number two reason for doctor’s visits in the US.  In fact, there are 179 million office visits at a cost of 17.6 Billion annually for low back pain.   Low back pain is also one of the most misunderstood conditions.  Ask different healthcare professionals their advice on how to treat low back pain and you will get as many different answers.

So why is that?  The reason is simple.  There are many different causes for low back pain. Is it a muscular or a skeletal condition?  Is there nerve compression or disc compression?  Could it be facet syndrome, arthritis or a visceral cause?  How about something as serious as tumors or as simple as a sprain or strain?

To make it even more complicated, there are different healthcare providers who specialize in one or more of these specific causes. 

Let me give you an example of what we are talking about.  If your low back pain is caused by some muscular weakness a great treatment option would be to seek the care of a physical therapist.

 If your pain is caused by muscular tightness, you would want to seek the care of a massage therapist. 

For skeletal conditions, a chiropractor would be a great choice.

So here is what seems to happen.  You have low back pain and your friend tells you he or she had great success going to a physical therapist.

 Great, you will try that.  But what if your condition isn’t the same as your friends?  What if the cause of your pain isn’t muscular?  Do you think you will enjoy similar success under these circumstances? 

Or do you think you are more likely to get frustrated because you wasted your time and money and walk away thinking physical therapy doesn’t work.  

Physical therapy DOES work, if you have a condition which warrants physical therapy!  But that is the ONLY time it works. 

Lets take this further, how confident are you that the physical therapist will diagnose you with a condition that he can treat?  Either, he convinces himself that it IS such a condition or he realizes that it isn’t and he treats you anyway. 

Further, what if there is a muscular component (and therefore a physical therapist could be of assistance) BUT that is not the initial cause of the low back pain but simply a secondary condition caused by an original skeletal condition.

Confused yet?  You should be.  The truth is that healthcare providers tend to have narrowed focus.  They tend to believe their discipline or method of treatment is good for all conditions.  This is the first truth:  That simply is not true.  There is NO one answer to low back pain.  Everything has its time and place depending on the specific cause of the patient’s pain.

But as a patient how do you determine which method of care is right for you?  After all, you can’t diagnose yourself and you certainly don’t want to waste time and money through trial and error.  And so you have the answer to why treating low back pain is so frustrating. 

So what is the answer?  It is simple, find a clinic who offers every treatment option available.  Makes sense, right! 

 Find a clinic that has many different healthcare providers who practice different methods to ensure you won’t be sent from place to place searching for your answer.

Another truth is that very rarely, does a low back condition have one singular cause.  Most often, by the time a patient walks into our office, it is more of a complex, meaning there are some muscular and skeletal components for example.

The Ultimate Truth:  THERE IS NO ONE WAY THAT IS BEST TO TREAT LOW BACK PAIN.

The truth is that incorporating more than one philosophy, more than one discipline, more than one kind of treatment is the key to successful low back pain cure.

It will save you time, frustration, and most of all pain in the long run.

I know my colleagues don’t want you to know that but it is time that patients are equipped with the knowledge to rid themselves forever from low back pain.

But remember, you didn’t hear it from me!