How do I know if I have scoliosis?
July 14, 2010
What is scoliosis?
Scoliosis refers to a medical condition in which the spine curves sideways. On an X-ray film, the normal spine looks straight, but the scoliosis spine will look like a “C” or “S”.
I suspect that I have scoliosis, how do I tell?
Besides looking at X-rays, one can look at his or her posture in order to look for possible signs of scoliosis.
Signs that may indicate scoliosis are:
- Head not centered to the body Uneven shoulders (either one is in front of the other or one’s higher than the other)
- Uneven shoulder blades: one is more prominent or higher
- Uneven waist angle: the gap between arm to trunk is wider on one side
- One hip is more prominent than the other or the hips are not leveled
- The spine line is not straight
One can use the picture below for a quick self test of scoliosis:
You can also perform a Forward Bend test (also called “Adam’s test”) to detect for possible scoliosis.
- Standing with the feet together, then bend forward as far as you can with your palms together, fingers pointing at between your toes.
- Look at the back, one side of the back (either upper or lower back region) will be higher than the other side
Hard Core Muscles for Mummies (Part 2)
July 10, 2010
In the previous article on "Hard Core Muscles for Mummies (part 1)", we have touched on the importance of strong core muscles. Now let us look at some simple exercises (that do not require equipment) people can do at home to help strengthen their core muscles.
Exercises should be done daily for 3 -4 weeks to see results.
Understanding changes to an expectant woman’s body
May 19, 2010
Extensive physical and physiological changes take place in an expectant woman through the actions of the hormones, oestrogen, progesterone and relaxin. These changes create challenges, which should never be undermined, and hence it is important to understand the effects on the woman’s body during pregnancy to learn to cope with the challenges.
Respiratory system
The demand of oxygen is increased because the basal metabolic rate and the mass of the expectant woman increase as well. It is estimated that a woman will require about 20% more oxygen than normal at term. She also exhales more carbon dioxide which triggers the already sensitive respiratory system to increase the respiratory rate slightly. Hence, it is this lowering of the carbon dioxide that leads to pregnant women to become breathless on activity. Also, many expectant women will experience the ascending uterus which progressively obstructs the descent of the diaphragm, which is needed for deep breathing. It can force the diaphragm upwards by at least 4cm towards the end of pregnancy. Hence this rising pressure pushes the rib cage out sideways and forwards, resulting in pain in the front of the lower ribs, also known as ribflare. Furthermore, rib-flaring make expectant women breathe with the top part of her chest, thereby causing breathlessness even during mild exertion during pregnany but especially so, towards the end of term.
The cardiovascular system
During pregnancy, a woman’s blood volume increases by at least 40%. However, the plasma volume increases more than the red cells, hence possibly resulted in dilution anaemia, leading to tiredness in the early weeks of pregnancy. She may also feel faint when lying on her back. This is due to enlarging fetus compressing the aorta and inferior vena cava against the lumbar spine, thereby restricting blood flow. This condition is known as pregnancy supine hypotensive syndrome and can be relieved by turning onto her side. Such a condition tend to happen more in the 3rd trimester, though it can occur any time after the 4th month of pregnancy.
Varicose veins of the legs may occur during pregnancy or worsen during this period. This is due to reduction in vascular tone and changes in collagen structure in the body (due to progesterone and relaxin) .
For the same reason, “water retention” or swelling in ankles, feet and hands in late pregnancy may lead to joint stiffness and nerve compression syndromes, such as carpal tunnel syndrome.
The musculoskeletal system
The hormone, relaxin, is produced about 2 weeks into pregnancy. Relaxin alters the composition of collagen, which exist in joints, ligaments and connective tissues. As a result, the modified collagen is more elastic and flexible, leading to more movement in joints, and thus less stability of the system. The weight bearing joints, such as the pelvis, bear the brunt of the increased stress and loading during pregnancy, and with the instability that relaxin cause, the pelvis is susceptible to injury and pain, one of the conditions known as symphysis pubis diastasis. Also, ligaments of feet become lax and with the additional weight of pregnancy, causes discomfort. This results in aching and flat feet. Hence, comfortable yet supportive foot wear is strongly recommended during this period.
Posture-wise, her centre of gravity will move forward, leading to increased lower back curvature, compensatory curving of the upper back, rounding of shoulders and forward chin position. This incorrect posture exerts excessive strain and fatigue on her body, particularly in the spine, pelvis and other weight bearing joints (i.e. knees), resulting in aches and pains, such as lower back, with the pain spreading to the buttocks, thighs and down the legs.
Other muscular changes, such as the separation of the abdominal muscle, known as rectii diastasis, is associated with low back strain, as the abdominals are no longer able to support core and the spine as efficiently as before.
Therefore, with all the extensive changes in the expectant woman’s body, it is obvious that the healtier and fitter she is both before and during pregnancy, the more easily she can cope with pregnancy. If possible, she should prepare to be fit physically and emotionally before each pregnancy and maintain the fitness during the pregnancy, thereby enhancing recovery after delivery. In the next article in this series, we will look at the common physical problems affecting women during pregnancy and it’s solutions.
Tiger Wood’s real source of championship withdrawal – Inflamed Cervical Facet Joint
May 15, 2010
Recently Tiger Wood's unprecedentedly withdrew with a sore neck in Round 4 of The Players Championship, 2010. Rumour mills have been suggesting he wasn't playing to expectation and pulled out to save him from further embarrassment or maybe the sore neck came from the infamous car crash.
Regardless, an inflamed cervical facet joint as was confirmed by his MRI can cause symptoms serious enough for a typical office worker to take sick leave, let alone a professional athlete playing at the highest level.
Symptoms from an inflamed facet joint are limited range of motion due to pain and stiffness especially in rotation, muscle spasms and radiating pain. Cervical headaches can also occur as described in a previous article. http://mcr.coreconcepts.com.
So what caused Tiger's injury?
As explained by Tiger previously, he ramped up his training intensity to get himself ready for the Master's 2010 but his body was not conditioned enough to withstand the demand of high level sports. Similar to our weekend warriors, playing at a high intensity when the body is not conditioned to the sport causes excessive wear and tear and as a result, overuse syndrome.
How does a facet joint get inflamed?
A facet joint gets inflamed from excessive wear and tear especially when the joint mobility is limited or stiff. Limited joint mobility either from being in a prolonged static position like a deskbound job or when the muscles are tight and inflexible, limiting joints from moving through its full range. In fact most neck pains are caused by stiff facet joints which explains why the deskbound worker forms the largest proportion of our neck pain clientele.
Physiotherapy treatment for would include mobilisation techniques to the affected stiff facet joints to encourage mobility, stretching and strengthening exercises. Aggravating factors like prolonged static sitting position will have to be avoided and proper ergonomics advise will be given to prevent a recurrence.
Cervical Spine and Disc Anatomy
May 9, 2010
In this post, we will look at what are the musculoskeletal structures in our neck.
If you like getting your neck ‘cracked’ or thinking about it, you should know about VBI
April 23, 2010
It is not uncommon to find people in Singapore that enjoy a good crack of the neck once a while. It was particularly special way to end a hair-cut in the good old days at now-almost-extinct indian barber shops. There are also those who pop in to some massage or "chinese-sensei" shops that do these 'bone-cracking' service.
Some do it because they enjoy the loose-ness of the neck area. Others do it because they were informed that it is good maintenance to do so to keep the neck loose.
But often they are not aware of the serious risk that they face. The risk of Vertebrobasilar insufficiency (VBI), or vertebral basilar ischemia to be exact. VBI is temporary reduction in the blood flow to the back of the brain.
In other words a stroke.
Mechanical causes of VBI
VBI like other forms of stroke can be caused by blood clots, narrowing of the vessel from cholesterol or any other reasons for a reduce blood flow through the artery. A less common cause is mechanical forces, particularly in the neck region, that apply pressure on the verterbral arteries or in the worse case scenario, severe it. Particularly when the neck is cracked at its end of range. The danger lies if the technique is poor and not precise, i.e. many cracks rather than just the one intended. This puts a lot of sheer or traction force on the artery, possibly leading to tears or occlusion of the blood vessels. See diagram for more details on the anatomy.
Also to note, that the 'cracking' or manipulation in this article refers to the manipulation of the neck. It is generally consider safe to manipulate the thoracic or lumbar spine, that's the mid and lower back. Before manipulating the cervical spine, the practitioner should first perform a test for VBI symptoms.
How often does VBI result from manipulation?
It has been difficult to accurately determine the incident rate of Vertebrobasilar Accidents (VBA) due to under reporting. One study reviewing published literature found an incident rate that ranged from 1 per 20,000 patients to 1 per 1-million cervical manipulations1. To get a sense of these numbers, in 2009 for air travel in the US, there was 0.0036 accidents per 1 million miles flown and 2.55 accidents per 1 million flight departures2.
Regardless of the actual incident rate, one should be clear about the risk and that cervical manipulation should be applied selectively. Cervical manipulation has a place in the specific treatment of neck related condition3. But often it is useful to bear in mind that there are alternative approaches to treatment that may be more effective over the long term but not as easing in the immediate short-term.
Anecdotally, there appears to be an increasing trend amongst senior experienced therapist to minimise the use of cervical manipulation in favour of other treatment approaches.
Reference
- Assendelft WJ, Bouter LM, Knipschild PG. Complications of spinal manipulation: a comprehensive review of the literature. J Fam Pract. 1996; 42: 475–480.[Medline]
- Table 6. Accidents, Fatalities, and Rates, 1990 through 2009, for U.S. Air Carriers Operating Under 14 CFR 121, Scheduled Service (Airlines) NSTB Aviataion Accident Statistics
- Use of high and low velocity cervical manipulative therapy procedures by Australian manipulative physiotherapists, G. Jull, Australian Journal of Physiotherapy 2002 Vol. 48: 189-193
- Ernst E (January 2002). "Spinal manipulation: its safety is uncertain". CMAJ 166 (1): 40–1
Which posture type are you?
April 7, 2010
What are the different types of posture and the possible musculoskeletal issues?
Before knowing what are the different types of postures. We need to know what ideal alignment that many people envy about. If there is a plumb line dropping from head to toe, a straight line can be drawn down from the just below the ear (mastoid process), shoulder (acromion), lumbar 3th vertebral body, hip (greater trochanter) and lastly at the front of the bony ankle protrusion (anterior malleolus).
The three main types of bad postures are flat back, kyphosis/lordosis and sway back.
| Types of posture | Alignment | Tight/ overactive muscles | Inhibited/ weaken muscles | Possible musculoskeletal issues |
|---|---|---|---|---|
| Flat back |
Forward head posture ↓ Thoracic kyphosis (hunch forward) ↓ Lumbar lordosis (Reduce curve at the spine) Neutral to Posterior (pelvis rotating backward) Hips resting in increased extension Knees hyperextended |
|
|
Pain or discomfort in prolong sitting, bending, driving Other common conditions include: Degenerated disc Herniated disc |
| Kyhosis/ Lordosis |
Forward head posture ↑ Thoracic Kyphosis (increase C shape of upper back) ↑ Lumbar Lordosis ↑ Anterior pelvic tilt (forward rotation of pelvis) Slightly Hyperextended knee |
|
|
Pain/ discomfort during prolong standing, walking, lying face down) |
| Sway back |
Forward head posture ↑ Thoracic Kyphosis ↓ Lumbar Lordosis ↑ Hip extension Hyperextended knee Forward translation of the pelvis Neutral/ posterior pelvic tilt |
|
|
Pain/ discomfort during Prolonged sitting , driving, bending, cycling Or during Prolonged standing, walking downhill, reaching overhead. |
What to do next?
After knowing what muscles are tight and inhibited, the next step is to carry out appropriate exercises to release the tight muscles and strengthen the inhibited muscles, sometimes it is also necessary to release the stiff joints to achieve better mobility of the joints. If all of the above, it would be easier to retrain the body into the ideal posture.
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.
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.
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
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
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.
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
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.
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or SMS us at +65 9232 2661 or email us at enquiry@coreconcepts.com.
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