Posture Related Neck and Back Pain

Neck pain can be…well, a pain in the neck. Neck and upper back pain is easily one of the most common reasons that people present to our offices. There are a lot of possible causes for neck and back pain, so getting a good evaluation is essential to uncovering the underlying reason for the problem. One of the more common underlying contributors to neck and upper back pain is posture related muscle imbalances.

Whether it’s sitting at a desk reading or working on a computer, texting or driving (and not at the same time people!), most things we do are out in front of us. For short periods, this may not be a problem. For hours on end, day in and day out it will lead to muscle imbalances that can result in pain and dysfunction.

Upper Crossed Syndrome

If our head is allowed to come forward and our shoulders protract (droop forward), we put a great deal of stress on the musculature at the back of the neck. As the head drops forward, we do not look at the ground, we look out in front of us and the skull extends where it meets the neck. This engages the muscles just below the skull (the suboccipital musculature), which become overactive. The deep neck flexors weaken and destabilize the neck.  

As the shoulders protract, our shoulder blade stabilizers (scapular stabilizers) become inhibited and weak. Muscles that are normally quiet are recruited to help stabilize the shoulder girdle. The pectoralis minor, upper trapezius and levator scapulae muscles all become overactive. Rehabilitation pioneer, Vladimir Janda, called this collection of imbalances an “Upper Crossed Syndrome”.

These imbalances often lead to neck and middle back pain, but the change in the upper extremity mechanics also makes shoulder impingement, and thoracic outlet syndrome (a common reason for hand and finger numbness) more likely.

Prevention:

The first step in prevention and treatment is identifying there is a problem. If you work on a computer, drive a car or watch TV, chances are good you need to think about preventing upper crossed syndrome. Better ergonomic setup is important if long hours are spent in front of the computer. Preventative stretching and exercise to offset the postural stresses will be especially important in preventing symptoms from occurring.

Treatment:

If the imbalances have already set in and simple self care exercises are not helping, or symptoms are progressing and getting more severe, then evaluation and treatment by a professional is certainly warranted. There are many different treatments for neck and middle back pain. What treatment is most appropriate and effective depends on the diagnosis, presentation of the problem and the particular patient. If the underlying cause is related to posture and upper crossed syndrome, then conservative treatment with chiropractic and physical therapy and soft tissue work can be very effective.

Spinal manipulative therapy or joint mobilization at the thoracic spine can decrease the middle back discomfort and increase the available range of motion. With increased range of motion, thoracic spine self mobilization exercises on and off the foam roller will be more effective. Spinal manipulative therapy may also be used at the cervical spine to address specific joint restrictions, but typically an overall increase in stability will be needed in the cervical spine. Active Release Technique^® and facilitated stretching to tight or overactive trapezius, levator scapulae and pectoral muscles is often performed in the office. Stretching for these muscles will also be taught and part of a home exercise program.

It should however be remembered that these overactive muscles are overactive for a reason and may be contributing (albeit poorly) to stability because the prime stabilizers are not. Stretching without strengthening the neck and scapula stabilizers will offer temporary relief. Strengthening exercises and drills to improve scapular control will also be an important component to that home exercise program.

Like with many problems we see, neck pain associated with poor posture is not simply a muscle problem, or a joint problem, or a ligament problem. It’s how those different tissues interact, how we move and the compensation patterns that develop that shapes the symptoms we see. Addressing all those components - the muscle and tissue quality, joint mobility and the movement patterns with a balanced approach to care will yield the best results.

Dr. Mark Pitcher DC, MSc is a chiropractor and exercise physiologist at Vail Integrative Medical Group in Vail, Edwards and Eagle, Colorado. 

Learn more at www.vailhealth.com or follow Dr. Pitcher's Blog at www.markjpitcher.com 

McGill's Big Three Stability Exercises

Good News! We are back IN Network with Cigna for Chiropractic. There was some confusion with the insurance company, but effective 04-30-2012 we are officially in Network.

Give us a call at the Edwards office (970-926-4600) if you have any questions or to schedule a chiropractic appointment.

Condition of the Week - Ilio-Tibial Band Syndrome

Condition of the Week - Ilio-tibial Band Syndrome

View more PowerPoint from Mark Pitcher DC, MSc

Rest Recovery and Regeneration

Article Today in the Vail Daily:

Living With Vitality: Rest, Recovery and Regeneration 

What are the most important days in your workout schedule? Heavy lifting days? Long run days? High intensity interval days? No; most important are your rest and recovery days.

We sometimes forget that exercise stresses and fatigues our system, and it is during the recovery period where the real training effect occurs. This is where our body repairs and adapts to exercise.

Supercompensation model:  Training temporarily decreases fitness level. With recovery, our fitness level increases to and above baseline. It is during this period of  supercompensation when application of exercise can make additional gains. If no additional exercise is added we return to baseline.  

When we recover from exercise our tissues adapt returning not only to baseline but beyond, resulting in a positive training effect. If exercise is added during this period of “super compensation” further improvement will result. If no additional exercise is applied, our tissues will return to baseline levels. If exercise is applied too early in the recovery phase, the tissues with further break down and impaired performance may result. If this cycle is allowed to continue, tissue quality will decline.

Although true overtraining syndrome is rare in recreational athletes, under-recovery is common and can negatively affect tissue quality leading to overuse injury. Many factors affect recovery, but the rest period is the easiest to manipulate. Despite this, athletes, coaches and trainers often overlook the importance of building appropriate rest into workout programs.

In addition to managing rest periods, the following strategies also can aid in recovery:

Nutrition – Exercise creates micro-damage in muscle and depletes the glycogen stores. Research shows replenishing protein (0.2g-0.4g/kilogram of body weight) after exercise helps in muscle recovery. Replenishing carbohydrates (0.8g-1.2g of carbohydrate per kilogram of body weight) stimulates insulin response and maximizes glycogen synthesis, aiding in protein repair. Keep in mind, when exercise is of shorter duration, excess carbohydrates could be converted and stored as fat. Carbohydrate intake closer to the 0.8g/1kg body weight will get results while preventing excess fat gain. Post exercise nutrition is ideally taken in liquid form (a recovery shake) for faster utilization by the body. It is generally considered most effective to refuel within 30-60 minutes after exercise.

Active Recovery – This method is well supported by research and involves following bouts of hard or high volume work with low intensity, low-to-moderate duration exercise. Applied within specific exercise sessions, it can decrease lactate levels by maintaining enough blood flow to allow enough recovery to perform high intensity interval training. Used between exercise sessions, low intensity exercise, like a light run, moderate hike, or easy bicycle ride, can help speed recovery and net better results.

Contrast Water Therapy – Research remains mixed on the effect of cold water immersion and contrast water therapy (alternating hot and cold) on recovery. Cold water immersion has been shown to have acute effects on recovery from distance running, but can have a negative effect on recovery from anaerobic exercise; resulting decreased blood flow can hinder removal of waste products. However, using contrast water therapy can help create an anti-inflammatory effect, while maintaining blood flow to adequately remove metabolites.

Replace Fluids – You’ve heard that you are mostly made up of water. Beyond that, water is linked with every metabolic function in the body and is essential for distributing nutrients throughout the body. You lose fluid during exercise, which should be replaced during exercise. Drinking water after exercise is an easy way to boost recovery.

Sleep – Although seemingly obvious, a surprising number of adults live in a constant state of sleep deprivation. The restorative power of sleep is required to recover and rebuild tissues that are broken down during the day.

Sometimes great results don’t always come from maximizing your strengths, but from reducing your weaknesses. If inadequate rest and recovery is your weak link, try these recovery techniques to improve performance and get better results.

Mark Pitcher is a chiropractor, exercise physiologist and TRX instructor with Vail Integrative Medical Group at Vail Vitality Center located at Vail Mountain Lodge and Spa. He specializes in rehabilitative medicine. For information visitwww.vailvitalitycenter.com or follow Dr. Pitcher’s blog at www.markjpitcher.com

http://www.vaildaily.com/article/20120402/AE/120409979/1078&ParentProfile=1062 

The Effect of Kinesiotex Taping on Back Muscle Endurance Among Patients with Low Back Pain: A Randomized Controlled Crossover Trial

Dear research participant,

We invite you to participate in a research study looking at the effects of different therapeutic taping procedures on back muscle endurance.

Nature and Purpose of the Study

When treating patents with low back pain, it is common practice among physical therapists and chiropractors to improve back muscle function and endurance.  One way to accomplish this is through the use of therapeutic taping procedures. However, little is known about the effectiveness of different taping procedures. 

Therefore the aim of this study is to compare for differences in back muscle endurance under three treatment conditions: when two different types of tape are applied to the back and when no tape is applied.

If you consent to take part in this research study, it is important that you understand the purpose of the study and the tasks you will be asked to complete. Please make sure that you ask any questions you may have, and that all your questions have been answered to your satisfaction before you agree to participate.

What the Study will Involve

Potential research participants will be considered for inclusion in this study if they are between the ages of 18 and 60 years of age and are currently experiencing low back pain.  You would be excluded from participating in this study if:

1)     Your back pain radiates into the leg and beyond the knee

2)     You exhibit signs or symptoms which may indicate a potentially serious condition

3)     You have had surgery to your lower back

4)     You are currently pregnant

5)     You have a history of tape or adhesive allergy

6)     You do not think that you could tolerate the muscle endurance test.

If you decide to participate in this study, you will be asked to complete the following tasks

·         Complete 4 questionnaires that ask about:

1)     Your demographic information (e.g., age, height, weight), and details about your history of back pain.

2)     The effects of back pain on your daily activities.

3)     The intensity of your back pain.

4)     Your attitudes about the relationship between your back pain and your work related and physical activities.

Perform a back muscle endurance assessment.  This assessment will require you to lay prone (i.e., face down) with your upper body over the end of a padded examination table, and then extend your upper body against gravity until you reach a “neutral position” meaning that your back is straight. We will use three cloth straps to secure your hips and legs to the table.  These straps will be placed over your hips, knees and ankles and towels will be placed at each level to ensure that this set up is comfortable.  Once this is accomplished, you will maintain this position as long as possible while being timed by a research staff member. Before starting this assessment, the research staff member will demonstrate the test for you.  It is estimated that the questionnaires will take approximately 30 minutes to complete and the back muscle endurance assessment will take 5 minutes to complete in addition to your travel time to and from the clinic. 

  

You will be asked to complete the back muscle endurance assessment on three different occasions, each one to three days apart.  Prior to the assessment, you will be treated using one of the previously described options (Kinesiotex tape, athletic tape or no tape).  The tape will be applied to specific muscles on your back and will be removed upon completion of the back muscle endurance assessment.

Voluntary Participation and Withdrawal from the Study

Your participation in this study is entirely voluntary. You may withdraw at any time without discrimination or prejudice. If you elect not to participate or to withdraw from the study, such actions will in no way influence quality of healthcare you receive or the relationship with your healthcare provider(s). All information is treated as confidential and no names or other details that might identify you will be used in any publication arising from the research. If you withdraw, all information you have provided will be destroyed.

Benefits of the Study

It is possible that there may be no direct benefit to you from participation in this study.

While there is no guarantee that you will personally benefit, the knowledge gained from your participation may help others in the future. For example, if one of the taping procedures appears to be more effective, future patients with low back pain may benefit from this understanding.

Possible Risks

We have identified two potential risks which could be associated with your participation in this study.  First, while this type of back muscle assessment is routinely used by clinicians caring for patients with low back pan, it is possible that you may experience some discomfort either during or following the assessment. This type of response is rare, and the discomfort is typically mild and self limiting in nature.  The second risk would be the result of a tape or adhesive allergy which had gone undetected.  This would represent a very remote risk which will be minimized by only keeping the tape in contact with your skin for short durations of time. You will be monitored closely during the study and you are free to withdraw at anytime during the sessions. If you experience any unwelcome symptoms associated with your participation in this study, we will assist you by helping to arrange an appointment with your primary medical provider.

If you have any questions about this project please feel free to contact either myself, Dr. Jeffrey Hebert in Australia on +61 8 93602566 and J.Hebert@Murdoch.edu.au or, Dr Joel Dekanich in Colorado, on 970.479.6262 and Joel@vailhealth.com.  We are happy to discuss with you any concerns you may have about this study. 

Once we have analysed the information from this study we will put on our web site (http://vailhealth.com) a summary of our findings.  You can expect to receive this feedback in approximately six months.

If you are willing to consent to participation in this study, please complete the Consent Form.

Thank you for your assistance with this research project.

Sincerely

Jeffrey Hebert, DC, PhD

This study has been approved by the Murdoch University Human Research Ethics Committee (Approval xxxx/xxx).  If you have any reservation or complaint about the ethical conduct of this research, and wish to talk with an independent person, you may contact Murdoch University’s Research Ethics Office (Tel. 08 9360 6677 (for overseas studies, +61 8 9360 6677) or e-mail ethics@murdoch.edu.au). Any issues you raise will be treated in confidence and investigated fully, and you will be informed of the outcome.