Monthly Archives: September 2016
According to the National Institutes of Health, lower back pain is the second most common form of chronic pain after headaches. Experts estimate that approximately 80% of Americans will seek help for low back pain at some point during their lives. Public health officials and insurers estimate that Americans spend $50 billion each year on treatments that are often ineffective. The standard treatment for lower back pain is to take muscle relaxants, painkillers or anti-inflammatory medications, along with physical therapy and back exercises. However, few medical interventions relieve pain reliably, and continuing to take painkillers on a long-term basis is not advised. Massage, on the other hand, has been found to be an effective way of dealing with back pain on a regular basis.
Treatment for lower back pain accounts for approximately a third of all visits to a massage therapist. A study published in the Annals of Internal Medicine found that patients suffering from the lower back pain of unknown origin were helped more by message than by conventional medical treatment. Of 401 total study participants, 133 received traditional medical care with no massage, 132 received structural massage (which addresses particular muscular and skeletal structures that cause pain) and 36 received relaxation massage (a general form of massage, such as Swedish, intended for overall relaxation).
Participants in the massage groups received one hour-long massage once a week for 10 weeks. All participants completed a questionnaire at the beginning of the study, then again at 10 weeks, 24 weeks and a year after the beginning of the study to report on their perceived pain. Both kinds of massage groups reported greater pain relief and ease of motion after 10 weeks of treatment than the medical group.
An average of 37% of the patients in the massage groups reported that their pain was almost or completely gone, while only 4% of the usual care group reported similar results. This was also the case at 26 weeks. However, at the one-year mark, the benefits to all groups were about equal. The type of massage used did not seem to matter, with both massage groups experiencing comparable levels of pain relief. The massage groups were less likely to report having used medication for their back pain after the 10 weeks of intervention, and they also reported having spent fewer days in bed and had lost fewer days of work or school than those in the usual care group.
Dr. Richard A. Deyo, professor of family medicine at Oregon Health and Science University in Portland says of the study, “I think this trial is good news in the sense that it suggests that a massage is a useful option that helps some substantial fraction of these patients. Like in most other treatments, this is not a slam dunk, and it’s not like a cure, but it’s something that seems to offer a significant benefit for a substantial number of patients.” Deyo sees massage as a way of people being able to break out of the pain-inactivity cycle. He notes, “I don’t see massage as the final solution, I see it as maybe a helpful step toward getting people more active.”
The diaphragm is a sheet of muscle lying beneath the lungs that separates the abdomen from the chest cavity. When the diaphragm involuntarily contracts, there is a quick intake of breath accompanied by a near simultaneous snapping shut of the vocal cords, which is what causes the characteristic “hic” sound of the hiccup. A hiccup is also sometimes referred to as singultus or a synchronous diaphragmatic flutter (SDF).
Hiccups occur singly or in groups, and groups of hiccups occur in a regular rhythm. Although hiccups usually last only a few minutes, there are instances in which it can continue for longer periods. If you have hiccups that last longer than 48 hours, you should consult with your physician, as it is may be an indication of an underlying illness. Eighty percent of chronic hiccups are due to a physical cause, and the remaining 20 percent may have psychological origins.
There are a number of different causes of hiccups, including:
- Eating or drinking too quickly, or drinking carbonated beverages, which introduces air into the stomach
- Eating spicy or fatty food, which can irritate the diaphragm, causing it to spasm
- Medications such as those to treat acid reflux and anti-anxiety drugs
- Irritation of the nerves in the head, neck or chest
- Abdominal surgery
- Central nervous system disorders
- Stokes and brain tumors
- Mental disorders
Increasing the level of carbon dioxide in the blood has been shown to inhibit hiccups, thus the origin of some of the hiccup “cures” that are reputed to work. Possible cures for hiccups include the following:
- Hold your breath and count slowly to 10, then gradually exhale
- Breathe into a paper bag or into your cupped hands for a minute
- Sip a glass of water, taking small, quick gulps
- Eat a spoonful of honey or peanut butter
- Gargle with water
Hiccups are usually a passing irritation that makes speaking and eating inconvenient. However, in most cases, they will disappear unaided in just a few minutes.
The aches and pains of biceps tendonitis can seriously interfere with your daily activities. It is often surprising to people to realize just how much they use their biceps in the course of a day, whether they’re picking up a bag of groceries or just brushing their teeth.
The biceps brachii muscle originates on the scapula (shoulder blade) and crosses both the shoulder and elbow joints, eventually attaching to the upper forearm. Its main function is the flexion and supination (twisting the palm to the front) of the forearm, but it also helps lift the shoulder. Weight trainers will be very familiar with the bicep curl, in which the muscle is strengthened through repeated lifting of a weight in the hand through alternately flexing and extending at the elbow.
Repeated overuse of the biceps muscle can lead to inflammation of the tendon, causing tendonitis. People who practice sports with repetitive ‘overhead’ actions such as tennis, baseball, and javelin throwing are at greater risk for the development of tendonitis, as are those with any kind of job or activity that involves similar repetitive movements of the shoulder. Bicep tendonitis may also often occur in combination with other shoulder problems such as rotator cuff tears, arthritis of the shoulder, shoulder instability, tears of the glenoid labrum and shoulder impingement (inflammation of the rotator cuff).
Patients with biceps tendonitis usually report feeling pain in the front of the shoulder and sometimes in the biceps muscle itself. This is made worse by overhead motion and improved by resting the arm and shoulder. The arm may feel weak when bending the elbow or turning the palm upwards. If you experience any of these symptoms, it would be wise to visit your doctor or massage therapist.
Biceps tendonitis is a common condition seen by the massage therapist, and your practitioner will want to make a thorough examination of you and your medical history in order to determine whether your condition is tendonitis or some other condition and if there are any co-occurring injuries. X-rays are rarely used initially, but may be called for later if the shoulder is not responding to treatment.
If you are diagnosed with biceps tendonitis, a range of treatment options are available. Nonsurgical interventions are the preferred first choice of the massage therapist. Resting the shoulder and avoiding exacerbating activity may be suggested in combination with other strategies such as anti-inflammatory medication and ice packs to reduce pain and swelling. Any co-morbid conditions contributing to the inflammation will also need to be treated. In extreme cases, cortisone injections may be prescribed.
The most commonly employed surgical treatment for bicep tendonitis is acromioplasty, particularly in cases where shoulder impingement is also a problem. Acromioplasty is the removal of a small piece of the acromion (a bony protuberance of the shoulder blade), which gives more space between the head of the humerus and acromion itself, relieving pressure on the tendon and other soft tissues.
Biceps Tenodesis is another surgical technique that may be utilized to treat tendonitis. In this surgery, the top of the biceps tendon is reattached to a new location. The technique has not, however, met with great success in treating tendonitis patients but may be necessary in cases where there is degeneration of the tendon or when extensive shoulder reconstruction is required.
While we generally think of arthritis as being associated with old age, shoulder arthritis is not uncommon among younger people as well. Any injury to the shoulder, such as a dislocation or a fracture, can eventually lead to shoulder arthritis.
The shoulder consists of two main joints. The first is the glenohumeral joint. This is a ball-and-socket joint in which the head of the upper arm (humerus) fits into the glenoid cavity of the scapula (shoulder blade). The second is the acromioclavicular. This joint is formed by the meeting of the collarbone (clavicle) with the top of the scapula (acromion).
Hyaline cartilage located on the ends of these bones generally allows for movement of the arm in the socket without friction, but a loss of cartilage here can cause the bones to rub against each other. Although not as common as arthritis in other parts of the body, shoulder arthritis can be extremely uncomfortable and debilitating. The principal symptom of shoulder arthritis is steadily worsening pain, especially when the arm is moved. However, patients with this condition are also likely to experience considerable stiffness in the joint and weakness at the shoulder. Sleeping may become difficult as the condition worsens, especially on the most affected side.
Shoulder arthritis may be caused by any of the following:
- Osteoarthritis. This is the degenerative wearing of cartilage, especially at the acromioclavicular joint.
- Loss of cartilage through acute traumatic injury to the shoulder, such as from a car accident, particularly when there has been a tear in the rotator cuff.
- Rheumatoid arthritis, an inflammatory autoimmune disease in which the body attacks its own cartilage.
Both osteo – and rheumatoid arthritis is more prevalent in older people (osteoarthritis, in particular, tends to occur in those over age 50). It’s not surprising that the overall incidence of shoulder arthritis is increasing as the general population ages.
Initial management of shoulder arthritis is usually non-surgical. Possible treatment options include:
- Soft Tissue therapist care
- Targeted exercise programs to increase shoulder mobility
- Heat and ice treatment
- Nutritional supplements such as glucosamine and chondroitin, both of which build cartilage and can slow joint degeneration
- Rest and shoulder immobilization
- Modifying shoulder movements to minimize irritation
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroid injections and other medications may be used in the case of rheumatoid arthritis
The National Arthritis Foundation reports that regular soft tissue therapy care can help prevent the damage caused by arthritis. Massage can help reduce pain and restore movement and increase range of motion in the shoulder joint.
In severe cases, surgery for shoulder arthritis can help to reduce pain and improve motion if non-surgical treatments are no longer working. Glenohumeral surgery can consist of either replacing just the head of the humerus with a prosthesis (hemiarthroplasty) or replacing the entire joint (both the humeral head and glenoid cavity, a total shoulder arthroplasty).
The term ergonomics stems from the Greek words ergon (work) and nomos (laws). According to the US Occupational Safety and Health Administration, ergonomics is defined as “the science of fitting workplace conditions and job demands to the capabilities of the working population.” Good ergonomics in the workplace is key to maintaining our body’s proper health and function, and it can have a major effect on the quality of our work.
Ergonomics involves the physical stressors in our workplace as well as related environmental factors. For example, physical stressors are any activities that put the strain on the bones, joints and muscles. These can involve things such as performing repetitive motions, vibrations, working in awkward positions and actions using excessive force. Environmental factors that contribute to bad ergonomics include loud noise, bad indoor air quality, and improper lighting.
Bad ergonomics can increase the risk of injury to the musculoskeletal system, causing conditions such as carpal tunnel syndrome, tendonitis and neck and back pain, as well as creating a range of other health problems, including sick building syndrome, eyestrain and hearing loss. However, there are steps you can take to improve your workplace ergonomics that can help reduce health risks.
Cumulative trauma disorders, such as carpal tunnel syndrome and tendonitis, are caused by repetitive motions such as typing. To prevent this, set up your computer workstation in a way that allows your hands and wrists to be in as neutral a position as possible. When sitting at your desk, your chair should be at a height where your eyes are level with the top of your computer screen, and your arms are at a 45-degree angle for typing. Ensure that your wrists are not angled up or down or to the left or right. If your desk is too high to keep your forearms straight, raise the height of your chair and use a footrest to keep your feet from dangling.
Your chair should be at a height where your feet are flat on the floor or on a footrest while keeping your knees just slightly higher than the level of the seat. The chair should provide some light support to your lower back (use a pillow, if necessary) while allowing you to move freely. The arms of the chair should support your lower arms while letting your upper arms remain close to your torso.
To reduce eyestrain, adjust ambient lighting to diminish glare and adjust the brightness and contrast until your eyes are comfortable reading. If you are working in a noisy area, use earplugs or headphones that cut ambient sound (but not set loud enough to damage your hearing!).
Good ergonomics also involves taking frequent breaks. Move around, get some fresh air and focus your eyes on things at varying distances.
Watching a dancer her leg to her nose is an impressive sight, and many of us can perform similar feats when we’re children. But we begin to lose flexibility as we age if we do not make a conscious effort to remain limber. Inactivity causes muscles to shorten and stiffen, and muscle mass is lost with increasing years as well. However, maintaining flexibility as we get older is of great importance, since it allows us to retain our mobility and reduces the likelihood of aches, sprains and falls as we age.
Optimal flexibility means the ability of each of your joints to move fully through their natural range of motion. Simple activities such as walking or bending over to tie your shoes can become major difficulties if your flexibility is limited. Unfortunately, sitting for hours at a desk, as so many are forced to do on a daily basis, eventually, leads to a reduction in flexibility as the muscles shorten and tighten.
There are a number of different tests used to measure flexibility, but the one test that has been used as a standard for years is the sit and reach test. It measures the flexibility of your hamstrings and lowers back. The simple home version of the test requires only a step (or a small box) and a ruler.
Before the test, warm up for about 10 minutes with some light aerobic activity and do a few stretches. Then place the ruler on the step, letting the end of it extend out a few inches over your toes, and note where the edge of the step comes to on the ruler. Sit on the floor with your feet extended in front of you, flat against the bottom step (or box). With your arms extended straight out in front of you and one hand on top of the other, gradually bend forward from the hips, keeping your back straight. (Rounding the back will give you a false result). Measure where your fingertips come to on the ruler. They should ideally be able to reach at least as far as the front of the step. Any measurement past the edge of the step is a bonus. No matter how far you can reach on the first measurement, do the test periodically and try to improve your score every few weeks.
If you find that you are less flexible than you should be, some regular stretching exercises combined with visits to your Soft Tissue Therapist (Ron) can help to restore flexibility and improve range of motion, helping to ensure that you remain limber into older age.
Sciatica is a term more often than not is self-diagnosed. I often hear patients tell me they have sciatica and they point to their gluteal region, and when I ask, “When were you diagnosed by a doctor with Sciatica?” A lot of times, the patient will say I wasn’t, I just know. So let’s discuss Sciatica and what it is. Sciatica is caused by inflammation around the sciatic nerve, the source of this inflammation can be low back pain, including a bulge in the (lumbar spine) L4-L5 vertebrae putting pressure on the sciatic nerve, also known as impingement. What are some signs and symptoms of sciatica? Radiating leg pain greater than back pain increased pain with sitting, leaning forward, coughing or sneezing. If you have these symptoms, see your primary physician.
Piriformis syndrome is referring to a muscular entrapment of the sciatic nerve from the Piriformis muscle located in the buttock region. The signs and symptoms can be similar, however, Piriformis Syndrome will be present in low back pain, buttock pain, hip pain, and posterior thigh pain (back of your thigh). Pain is also aggravated by prolonged sitting. There is a close proximity in both Sciatica and Piriformis Syndrome symptoms, if indeed you are feeling more leg pain than back pain, it may not be Piriformis Syndrome. Once you have seen a doctor and have ruled out Sciatica, it’s a good thing. Muscular work can be relieved through strategically working the soft tissue entrapping the Sciatic nerve.