Slipped disc – Do’s and don’ts

March 8, 2010

A slipped disc can be very painful and debilitating. However, in most cases, it should get better on its own, within six-eight weeks and there are certain things that you can do and avoid doing to aid and speed up your recovery.

What happens in a slipped disc?

Although people often mention about having a slipped disc, nothing in your spine has actually slipped out of place. Having a slipped disc means that one of the discs which sit between each of the bones in your spine has been damaged. When the disc is damaged, the soft gel-like inner pad of the disc squeezes out through a weak point in the torn outer layer, causing a bulge that often presses on nearby spinal nerves. This result in severe pain with symptoms that radiates down the leg/arm commonly referred to as sciatica. Slipped disc, also known as disc herniation, can occur in any disc in the spine but the two most common forms are lumbar disc and cervical disc herniation.

What can I do?

During the first 48 hours, a torn outer layer of the disc would result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of spinal nerve compression. This is the basis for the use of anti-inflammatory medication for pain associated with disc herniation. Thus, early treatment may include taking painkillers, anti-inflammatory medication and rest to give time for the body to reabsorb the herniated part of the disc. Before taking any medication, always see your doctor for a prescription.

Cold therapy should be applied immediately and after any activity that aggravates your symptoms as it helps to reduce pain and swelling. Use an ice pack or bag of frozen vegetables wrapped in a towel for no more than 10 minutes, every 2-3hrs. After 72hours or more Heat therapy, such as a wheat bag or warm soak can be used to promote muscle relaxation and pain relieve and may be used before performing stretching and strengthening exercises.

As the pain lessens, you will most likely to return to work and begin exercises to strengthen your back muscles and joints. Exercise is introduced to improve strength, flexibility and proper back mechanics as part of recovery. A physiotherapist will be able to give you an individually tailored exercise plan to help to strengthen any muscles that have become weak and also using techniques such as spinal manipulation to help improve the mobility of the spine. Physiotherapy would also help to correct one’s posture and use body mechanics to minimize stress and strain on any portion of your spine. This includes incorporating these exercises and posture principles into all your daily (e.g. sitting and lifting) and recreational activities.

What shall I avoid doing?

Don’t rest excessively and avoid activities. Studies have shown that it is important for one to remain active and keep up with your normal activities as much as possible.

However, it is paramount to discontinue with any activities that aggravate your symptoms such as bending over, heavy lifting and any quick twisting or jerking motions. Avoid standing or sitting (e.g. driving) for extended period of time as it would increase strain to your spine and aggravate disc pain. At home, keep away from overstuffed and low furniture, because it is difficult to stand back up after sitting in them. Don’t lie on stomach and prolonged bed rest especially during early stage post injury.

In the long run

Back pain from a slipped disc may return, whether or not you have had treatment and it is important to learn how to avoid damaging your back again.

The outcome for most people is that they will feel better within six-eight weeks; although for others it may take a while longer. With proper care through correct posture, core exercises and back ergonomics, it is possible for one to remain pain-free.

Written by Admin · Filed Under Lumbar, Spinal Conditions, Spinal Conditions | Comments

Lower Back Lumbar Segmental Instability

March 4, 2010

Someone with a lower spine that frequently moves through a larger-than-normal range of movement is more susceptible to low back pain. This tendency of moving beyond its normal range is known as lumbar segmental instability.

click for larger view

The normal range of the movement is defined as the neutral zone. A person with lumbar instability tends to move beyond the normal range of movement into the extreme end ranges.

What keeps the spine stable?

In order to understand what causes lumbar segmental instability, we first need to understand what keeps it stable in the first place. The human body holds the spine stable or steady through the help of three basic structures – the passive, active and neural structures.

Passive structures in the lumbar spine are the vertebrae, the discs, then joints and ligaments. These are structures that do not move.
Active structures are the global and local muscles. These contract or relax depending on the direction of the force required.
And finally the neural structures; nerves that control and direct the muscles. This control is also known as motor control.

A stable lumbar spine segment coordinates global and local muscles using the motor control system to supply compressive forces along the spinal passive structures for stability. This coordination helps maintain the spine's normal curvature at a segmental level as we move about.

Active Structures

click for larger view

The global muscles include:

Rectus abdominis,
External oblique
The thoracic part of lumbar illiocostalis (an erectae spinae muscle). ·

These three muscle groups are large torque producing muscles that provide general trunk stability and allow movement to occur.

The local muscles attach directly to the lumbar vertebrae. They are:

Lumbar multifidus,
Psoas major,
Quadratus lumborum,
Lumbar parts of lumbar illiocostalis and longissimus (more erectae spinae muscles),
Transverse abdominus,
The diaphragm and
Posterior fibres of internal oblique.
Interspinalis/ Intertransversii

click for larger view

These muscles control the segmental stability that is lacking in this condition.

The two lowest spinal segments, L4 and L5 vertebrae, are the most susceptible to segmental instability. This could be due to pathological/ degenerative changes to the passive structures that sometimes show up on x-rays. Instability can also occur if there is a loss of motor control and muscle strength/stamina within the neutral zone.

What does it feel like?

A person with lumbar segmental instability typically has a patient-history something along these lines.

Back pain may have started after a direct injury to the area, or it may have just developed gradually.
The pain tends to be recurrent and has more debilitating effects as time goes on.
That person will try to do as little as possible in an episode of pain. According to a survey (O’Sullivan 1997), people most commonly describe the pain sensation as · catching, · locking, · giving way or · feeling of instability.

Classically, the most painful postures are sitting or standing for long periods of time, or being in bent over postures.

The most painful movements are

bending forwards,
moving unexpectedly quickly,
standing up straight after being bent over, lifting or sneezing.

So basically….

The lumbar spine moves in an uncontrolled manner, causing pain. Because the big muscles and little muscles don’t work together properly and the body is unable to control each segment as the body moves.

How do I get rid of it!?

A physiotherapist will need to perform an assessment to find out what type of segmental instability is present (and the type of control that is lacking due to which structure – passive, active or neural). Based on the findings, an intervention will be planned.

In cases where the passive structures have degenerated, it is often possible to train the active and neural structures to compensate for the lower level of stability provided by the passive structures.

With this sort of condition, the exercises that are required are more ‘brain’ exercises than ‘muscle’ exercises. A new way of moving has to be re-learnt, and it requires a lot of concentration.

Written by Jessica Ellison · Filed Under Lumbar, Treatment Options | Comments

Chronic Low Back Pain – The Psychological Factors

March 1, 2010

If you are a regular reader of MCR, you know that the number of people suffering from low back pain is quite staggering. The national statistics is that one out of every 5 persons suffers from low back pain at any one time and that there is an 80% chance of a person having low back pain sometime in their lives. One of the key things in treating low back pain is the correct classification of it and understanding the contribution factors. Of these factors less often addressed by physiotherapists is the psychological factor.

With chronic low back pain (classified as those persisting 3 or more months from the onset of pain), the treatment approach needs to be multi-dimensional as there are many factors that perpetuate the pain. Some of these factors include

Pathological changes in the structure of the spine - e.g. joint degeneration, disc herniation (slipped disc), fractures
Mechanical loading of the spine- possibly due to the type of work that the back pain sufferer has to perform
Poor control of the muscles around the spine
Sensitivity of the nervous system- the brain and the nerves are over sensitised to pain, projecting pain greater than it really is
Psychological factors- clients’ emotions e.g. fear, anxiety depression, their beliefs that if they do a certain activity that their backs will go, being wheelchair bound or something catastrophic, and often wrongly reinforced by a healthcare professional.

The relative contribution and dominance of the above factors to a client’s chronic pain will differ for each patient. It is important to understand which factors are dominant and whether the client has adapted to the disorder positively or negatively so we can address the disorder more specifically.

Flickr: mag3737

One of the more common types of chronic low back pain we see are clients who have really stiff backs and have difficulty bending. Usually the original cause of the pain is due to some bending activity like lifting a child or reaching over to retrieve something. These clients may or may not have significant changes in their MRI of the spine. These people are often told that bending is bad for you and that they must hold their back upright all the time and to sit up tall, otherwise, their discs will get worse. This results in the clients’ belief that they must never, ever bend, hence, their back muscles continually contract to maintain those positions.

Muscles are not meant to constantly contract, it should contract when it needs to and relax when it doesn’t need to. These clients often never ever relaxes their muscles in fear that by doing so, their backs will give. Because of the constant contraction of the back muscles, the back muscle becomes overly strong and tight and can no longer switch off, leading to an excessive compression of the spine (the back muscles will approximate the vertebrae closer together, resulting in increase loading and compression). At this stage bending activities will hurt, not because of the original problem, but because the muscle now cannot relax to allow the vertebrae to move freely. These types of back pain sufferer will often be spotted NOT lounging into the chair, they will instead sit up tall without support and will have very defined back muscles. These clients have adapted negatively to their disorder, prolonging the pain.

The solution to these types of chronic pain is to change their belief, to assure the client that bending is fine, especially now that the pain is not caused by the original cause. To show them that in a relaxed stretched position that the pain actually reduces, rather than increase. This is usually done by releasing the offending muscles and testing the aggravating posture- bending or squatting. Specific exercises will be taught to facilitate the stretching and relaxation of the overactive tight muscles.

There are many other types of presentation of chronic pain, the above is only one. The concept of the treatment of chronic pain is simple- understand the underlying pain mechanism i.e. what is driving the pain and solve it as best as we possibly can. Those with a dominant psychological driver, often, a psychologist is needed to help change their beliefs.

Written by Sylvia Ho · Filed Under Spinal Conditions | Comments

Heat or Ice? When to use which?

February 17, 2010

When should you use heat or ice therapy? The answer is – it depends. In general, heat therapy is for chronic conditions and ice is useful in acute situations.

If you recently sustained an injury or aggravated an old injury, ice should be applied for a period of 15mins each time for the first 3 days. If you feel your muscles are feeling tight and stiff, a hot pack on the muscles will help to relieve the tightness.

This spectrum of acute to chronic looks at the duration since injury. If the injury is sustained within 36 hours, it is considered to be in the acute stage. At this stage the inflammation process is ongoing. Ice will help to bring down the inflammation and swelling so that the injury can heal better. Note that applying heat to this stage will increase the blood circulation, inflammation and hence swelling.

There are 2 common scenarios that cause pain, making you reach for that heat/ice pack. One of them is the acute injury (for example a fall, twisting movement or direct blow that is immediately painful) and the other is the chronic injury (happened over a period of time or from an acute injury that failed to heal). Each scenario requires a different approach to reducing your pain and speeding up your recovery.

Acute Injuries

It might be that you have just sprained your ankle playing soccer, shut your fingers in the car door or fractured your hand. All these are examples of acute injuries and will show the following signs:

Sharp, severe pain
Swelling
Redness
Increased warmth
Restricted joint movement
Unable to put weight through the structure (e.g. leg, ankle, wrist etc).

Flickr: Kyle May

For these types of injuries, we recommend managing the pain, inflammation, and swelling immediately with the use of ice. The ice cools the tissues, reduces tissue metabolic rate and constricts the blood vessels helping reduce further damage from occurring.

There are many ways of applying ice like using an ice pack; wrapping ice cubes in a wet towel or using a bag of frozen peas (sometimes that is the only thing on hand!). The cold agent should be in contact with the area for up to 20 minutes at a time and re-applied every 2-3 hours for around 3-5 days or until the swelling settles.

How does ice work?

1. Decreasing the pain

There are a few proposed theories regarding how ice decreases pain and it is possible that a combination of some of them can cause pain relief.

Decreased nerve transmission in pain fibres
Cold reduces the activity of free nerve endings
Cold raises the pain threshold
Cold causes a release in endorphins
Cold sensations over-ride the pain sensations

2. Reducing swelling

Ice cools the surface of the skin and its underlying tissues, causing narrowing of the blood vessels. This narrowing leads to a decrease in the amount of blood delivered to the area and subsequently reduces the amount of swelling. After a few minutes, the blood vessels re-open allowing blood to return to the area. The narrowing and opening repeat in cycles.

The decrease in swelling also allows more movement in the area and lessens the loss of function associated with the injury. Pain is also reduced as pressure from the swelling lessens. Chemicals that intensify the pain are released into the bloodstream when tissues are injured, thus the narrowing of the vessels help to minimize this release and pain.

3. Decreasing metabolic rate

Ice reduces the metabolic rate and oxygen requirements of the cells. Thus, even with the decreased blood flow and oxygen delivery that comes with narrowing of the vessels, the risk of cell death will be lessened. This prevents further injury.

Sub-acute phase

A few days following an acute injury, the pain and swelling may have decreased so much that there may be no sign of the original injury. However, the tissues are still in the process of recovery and will still benefit from modifying your activities (less vigorous) as well as using both ice and heat alternatively. This means to apply ice for 10 minutes, followed immediately by 10 minutes of heat.

How does this work?

Doing this will cause massive increases in blood flow to the area as the narrowing caused by cooling is reversed when heat is applied, resulting in an influx of blood to the damaged tissues. The increased blood flow to the area provides proteins, nutrients and oxygen for better healing. It also helps remove the products of inflammation and reduce residual swelling.
An important point to note is to ensure that inflammation has stopped before applying this technique. That means that the area should not be red, and should not be warm to touch.

Chronic Injuries

Flickr: Capture Queen

These are injuries resulting usually from overuse where some tissues are tight and inflexible causing aches. Examples include tennis elbow, golfer’s elbow, patella tendinitis and Achilles tendinopathy. Symptoms include pain when performing activities, a dull ache at rest and swelling. Occasionally, an acute injury is not allowed the time to heal properly and muscles spasm to protect it.

In order to treat these, heat should be used to help relax tight, aching muscles and joints, increase the extensibility of ligaments and tendons and promote blood flow to the area. Heat can also be used before exercise in chronic injuries to warm the muscles and increase flexibility.

Heat can be applied to the area in the form of heat packs, a warm damp towel, hot water bottles or heat rubs. If using a heat pack or hot water bottle, ensure a suitable layer of protection is placed over the skin to prevent burns. The heat should be applied for 15-20 minutes.

How does heat work?

Heat applied on the skin increases the temperature of the skin and the underlying tissues. This in turn opens up the blood vessels like your ateries, allowing more blood to flow into the area. This increase flow helps to remove waste products from cells and deliver more nutrients, relaxing tissues. The increased temperature of the blood also warms up surrounding tissues. Heat also has an effect of increasing flexibility of the soft tissues.

Both heat and ice are cheap, easy to use and effective ways of speeding up recovery when used correctly. Besides managing your injuries with these modalities, it may be a good idea to consult a physiotherapist in helping you rehabilitate and/or prevent the same injuries from occurring.

Written by MCR · Filed Under Treatment Option, Treatment Options | Comments

Heel Ergonomics – Part II

February 3, 2010

This interview continues from Handbag Ergonomics – Part I

MCR: Can high-heeled shoes change the way a person walks?

Flickr

Cheryl: Yes. The higher the heels, the more the centre of gravity (CG) of the body shifts, increasing the risk of falls. Also, high heels does change the position of one’s body. Her upper back will tend to lean backwards and her lower back will be arched more. Hence one will tend to ‘trot’ rather than ‘walk’ as the heels goes higher. Some ladies like high heels as it pulls the tummy down by anteriorly tilting the pelvis and push up the bottom, hence have instant flat tummy and perkier bottoms.

MCR: Most shoes stores these days sell a lot of high-heeled shoes and wedges, what are the potential health dangers if they are worn for too long and too often?

Cheryl: Ankle and foot injuries while wearing high heels/ stiletto shoes are commonly reported. Commonly high-heel related injuries are calf sprains, twisted ankles and injuries from falls. Wearing high heels long term can seriously harm the feet by damaging the tendons in the heel and causing blisters, bunions, corns and calluses which some of them may even require surgery. Other conditions such as hammertoes, ingrown toenails and ankle and knee joint pains. Heel pains such as inflammation of the plantar fascia (bottom connective tissue of the foot) or plantar fasciitis are very common too.

MCR: What is the most serious scenario that can happen?

Cheryl: Fractures of the ankle or foot on falling and complete tear of ankle ligaments which requires a cast or ankle reconstruction operation to heal. Other more serious injuries that can be sustained on falling can be trauma to the head and shoulder fractures and strain. On a long term basis, research shows that wearing high heeled shoes regularly causes long-term health problems such as a distortion of the lower spine and arthritis in the knees which can lead to postural spinal stenosis and rapid degeneration of the lower spine (also known as lumbar spondylosis) leading to chronic low back pain and/or numbness or any other sensation changes in the legs.

MCR: What advice on choosing shoes?

Cheryl: There are no hard and fast rules about it, but it is recommended that high heel wearers take sensible precautions when going out in high heels or new and unfamiliar shoes in order to reduce injury. These include wearing shoes with ankle straps to help hold ankle and feet in place, making sure your shoes are properly fitted (size-wise), switching to flats during the day to give your calf muscles a break, and placing appropriate measures in shoes (i.e. heel pads, corn pads) to minimise the chance of blisters and painful friction.

MCR: How can physiotherapy help a person with heel pain?

Cheryl: Heel pain can be a result of bad walking posture/gait pattern, excessive walking and running (overtraining), wearing high heels frequently and/or muscle imbalance of the leg (hip, knee and ankle). Depending on the nature of the injury, be it a sprain or an accumulative stress related injury, physiotherapy help by applying various strategies in the reducing the stiffness, pain and discomfort in joints or muscles affected. Strategies include manual techniques, such as joint mobilization and manipulation, deep friction massage, stabilization exercises and electrotherapy i.e. ultrasound therapy. Should wearing heels be required on the job, the physiotherapist may make recommendations on the footwear, and advise on posture correction and specific muscle strengthening for injury prevention. Nevertheless, treatment is always more effective if the problem is detected and treated early as chronic problems (more than 3 months) have poorer treatment results. Therefore, if the pain does not resolve within 3-7 days and seems to get worse, it is time to make an appointment with your physiotherapist.

MCR: Besides heavy bags and high heels, what are the other potential fashion health hazards?

Cheryl:

Badly Fitting Bras

Studies have shown that as many as 90% of women are wearing the wrong bra size, many still hanging on to the same bra size they were fitted for years ago – irrespective of growing, losing weight or having children. Wearing the wrong bra could lead to shoulder tension, chest/ breathing restriction, headaches and chest and upper back pain. If the bra is too loose, it is not supportive enough and if too tight and restrictive, it can lead to restrictions in breathing normally, upper back pain and reduction of spinal movement.

Tight Pants/jeans

The trend for skinny jeans, hipsters/ low riding jeans tend to restrict movement and can also cause bad posture, changing the alignment of the spine. The tight, low riding jeans/ trousers can squeeze a sensory nerve under the hip bone, known as the femoral nerve, and cause a tingling sensation in the thighs (pins and needles) also called paresthesia.

Written by MCR · Filed Under Ankle & Foot (NonSport), Peripheral (NonSport), Spinal Conditions | Comments

Handbag Ergonomics – Part I

January 31, 2010

Musculoskeletal Consumer Review recently caught up with Cheryl Ng, an Associate Principal Physiotherapist at Core Concepts. We were curious about the term, 'handbag syndrome'. that Cheryl mentioned during her recent interviewed by Lian He Wan Bao on pains from carrying big handbags. Cheryl is also Head of Etonia, Core Concepts division for Women's Health.

MCR: Are heavy bags a potential cause of shoulder and neck aches? Why?

Flickr: chelsea steve

Cheryl Ng: Big handbags are in fashion for a couple of years now, so inevitably the amount of content these bags carry grows (i.e. Camera, mobile phone, make-up, wallet, laptop, umbrella, water bottle etc). That is the rise of heavier handbags and typically such a bag can weigh 3kg or more. Over at Core Concepts, we noted increasing cases of shoulder and neck pains due to heavy handbags usage also known as “handbag syndrome”. Though such syndrome affects mainly women, men do get such pains as there are rising trends of men who carry heavy bags (eg laptop bag).

A heavy handbag, shoulder bag, or purse can injure the neck, back and shoulders. The neck has a natural curve that evenly distributes forces on the spine. Hence, when a person carries a heavy bag on one side over a long period of time, this natural curve starts to get distorted which can lead to chronic neck and shoulder pains, back pain, and even headaches. Left untreated, it can lead to more serious injuries such as herniated discs and accelerated degeneration of the cervical spine.

MCR: What weight (of bags) is considered to be too heavy to be carried on the shoulder, and for what duration?

Cheryl: Typically, it is advised that the weight of the handbags/ shoulder bags/ laptop bags should not weigh more than 10-15 percent of your body weight. Also, check by feeling the bag on our shoulder. When you sling the bag on your shoulder, and it feels uncomfortable, especially when the weight pulling shoulder down, it is time to downsize or reduce the contents in your bag. However, I recommend lighter bags (contents included), not more than 2-3 kg as we tend to carry such bags frequently and over a extended period of time (travelling to work and back home, shopping) which can change the biomechanics of the neck , back and shoulders and lead to pain and dysfunction.

MCR: What serious problems can be caused if bags are too heavy? And what physiotherapy can be done to alleviate the aches?

Cheryl: A common problem is that one shoulder becomes slightly higher than the other. Some scenarios such as talking on mobile while carrying the heavy handbag, will worsens the problem, because in addition to balancing too much weight on one side, she is lifting the shoulder at the same time, straining the neck and shoulder ligaments and muscles.

Typically, handbag syndrome brings about neck, shoulder muscles and ligaments strain/ injuries, causing poor neck and shoulder postures. Left untreated, these can lead to more serious injuries such as herniated discs, accelerated degeneration of the spine and less commonly, traction injury of the brachial plexus, which symptoms are weakness and sensation changes (i.e. numbness over the shoulder and arm).

Physiotherapy can help resolve these pains by analyzing the structure of the your body, such as how does your head sits on your shoulders or how your posture could have brought about the biomechanical changes in your neck and shoulders causing pains. To reduce the stiffness, pain and discomfort brought about by these changes, physiotherapists apply various strategies in the restoration of spinal and shoulder girdle mobility and stability that results in a reduction in the patient’s pain and spasm. Strategies include manual techniques, such as joint mobilization and manipulation, deep tissue massage, muscle energy technique and neck and shoulder girdle stabilization exercises. However, treatment is always more effective if the problem is detected and treated early as chronic problems (more than 3 months) have poorer treatment results. Therefore, if the pain does not resolve within 3 days and seems to get worse, it is time to make an appointment with your physiotherapist.

Some tips in choosing a handbag that is ergonomical.

Choose a handbag that is proportionate to your body size and not larger than what is needed. Your handbag should not weigh more than 10 percent or less of your body weight.
Select a bag made of lightweight material such as vinyl or canvas instead of leather.
The shoulder straps should be wide, adjustable, and padded if possible. Poorly designed shoulder straps can dig deep into muscles causing strain and pinched nerves. If possible, select a strap that is long enough to sling across to the opposite side of the body to help distribute weight of the bag more evenly.
Do consider a backpack. It distributes the weight between both shoulders.
Choose a handbag that has several individual pockets instead of one large compartment. This will help to distribute the weight evenly and keep contents of the bag from shifting.
Do not wait to seek treatment for pain. You can avoid serious injury and surgery by addressing the problem early.

Carrying a handbag.

Use both hands to check the weight of the handbag.
Instead of always carrying your handbag on the same shoulder, switch sides often.
Retract your shoulders while carrying the bag.

The interview continues in Heel Ergonomics – Part II

Written by MCR · Filed Under Ergonomics, Spinal Conditions, Spinal Conditions | Comments

What not to do? The Question Less Asked.

January 18, 2010

Recently, a client asked me "Ok. So what shouldn't I do now?" And it struck me how infrequently we get such questions. As professionals we are often asked them by our clients, "What should I do?" in the belief that something 'more' is the solution to their problems; that they are missing out on something that they should be doing. This is true for most fields and healthcare is no exception.

Photo: Flickr albertopveiga

Solutions to a problem can often be found from many directions though we often prefer something from the side of complexity – the 'more' side. In healthcare, that could mean more 'tests', 'scans', 'drugs' or 'treatments'. The 'less' side is less explored, no pun intended.

In the case of musculoskeletal conditions, a small minority of conditions have their roots in the person's genetic code; meaning that they were born with it. Most have external causes – lifestyle, diet, occupational conditions or movement habits. For example low back pain from poor posture, wrist repetitive strain injury from poor ergonomic workplace setup and sports injury from overtraining.

When faced with such musculoskeletal injuries, humans don't seem to be geared up to accept simple answers. We prefer complex solutions (read machines with lots of blinking lights) over simpler ones (read manual therapy or exercises using body weight). We see this across many different situations.

The most common situation is, 'what sort of machine test will you do?' We have learnt to equate the more expensive and more complex the machine scanning us to better results. We wrote about this about a year ago, "Diagnose First, Scan Second" where a recent study found that the routine use of radiography (X-ray), MRI, or CT scans in patients with low-back pain but no indication of a serious underlying condition does not improve clinical outcomes. Combine this no-improvement outcome with the more recent reports on radiation overdoses from CT scan and it is worrying.

Another situation is the use of impressive looking machines for treatments. Will a more expensive looking exercise machine work better for me than a simple home-based type device? In the fitness industry, there is a growing trend of people moving away from machine-based exercises towards simpler functional movement-based devices like the TRX Suspension Training. Not only is it several hundred dollars cheaper if not thousands, it can be more versatile and challenging.

Surprisingly, sometimes even when it comes to treating a specific condition, the best answer may be to do nothing. In the case of whiplash, one of the recommended treatment protocols during the early stage of whiplash is to "Act As Usual". It can be quite unsettling when visiting a doctor for whiplash treatment and to be told to act normally, to do nothing different.

Of course it does not mean that the most appropriate treatment is always to do nothing or to do something less. However, it does mean that not every appropriate treatment must do something or to do something more.

Perhaps a simple rule of thumb to help you learn to do less to achieve more with your health, for every 'what can I do?' question, ask 'what shouldn't I do?".

Written by Sylvia Ho · Filed Under Ergonomics, Spinal Conditions | Comments

Whiplash Video

December 30, 2009

Following our previous articles on whiplash injuries, here is a video that shows the mechanism of whiplash.

Written by chyetuan.chng · Filed Under Cervical, Featured Video, Spinal Conditions, Video | Comments

What to do when your back hurts so much that you can’t get out of bed?

December 28, 2009

Source: Flickr erikogan

If your back suddenly hurts so much even to move up into a sitting position to get out of bed, it is likely that your spinal joints are severely inflamed and your back muscles are spasm-ing (twitching).

What you NEED to do

Reduce the inflammation:
- Either take an anti-inflammatory medication (tablet or injection). GP prescription may be required.
- If it is too painful even to go see the GP,
  - Apply a COLD press to the sore/painful area.
  - Take an over-the-counter anti-inflammatory (e.g. Voltaren Gel / Tablet). This is a weaker form of anti-inflammatory medication than what you will get from your GP.
Rest to let your body heal and reduce the inflammation naturally.

What NOT to do

Apply Heat (either through a hot pack or some of heat rub) You will further aggravate the inflammation.
Massage the sore area.

See your physiotherapist only after it doesn't feel so sore or painful the day after.

Written by Sylvia Ho · Filed Under Treatment Options | Comments

Waking up with neck pain? Try this.

December 25, 2009

How often do we wake up in the morning with stiffness and pain in the neck? You are not alone. This is one of the most common complain of most people but most people just think it’s just a sign of ageing and that they have to live with it. However, this is not true. You need not have to wake up every morning with this pain and stiffness.

Written by Calvin Sim · Filed Under Ergonomics, Spinal Conditions | Comments