What’s Holding You Back?

Approximately 80 per cent of Canadians will experience back pain at some point in their lives. Add this to our stressful schedules and work-related back injuries, and we have a virtual back pain epidemic.   

Back Pain 101

Our inactive lifestyle is damaging our backs. Many of us spend our days driving or  hunched in front of computers, often without any postural support. Studies show that sitting places significantly more pressure on the joints and discs of the spine than either standing or walking. After all, our bodies were built to move!   

We spend upwards of $21 billion annually on back pain products, including over-the-counter pain medication. Yet, amazingly, most people wait up to six months to seek treatment, while 30% do nothing at all in the hope that the back pain will eventually go away.   Nearly a third of back pain cases last longer than a month and a significant portion become chronic and persist for months to years.    

Research suggests that back pain treatments are most effective in the acute and early stage, and that the longer the problem is allowed to linger, the more difficult and lengthy the healing process may be.   

 Doctors of chiropractic are specialists, who provide drug-free, hands-on treatment that targets the source of pain. Studies show that chiropractic treatment is increasingly recognized as one of the safest and most effective solutions for most back pain sufferers.     

Are you holding back from taking charge of your back pain?   Click HERE to take an online quiz from the Canadian Chiropractic Association to find out!   

  You can also visit the Ontario Chiropractic Association Web site ator the Canadian Chiropractic Association for lots of patient information, hand-outs and more regarding chiropractic care.

What is Polymyalgia Rheumatica?

I was out last evening at an event in Oakville and a woman I was speaking with told me her story of how a chiropractor, after several painful months seeking help from any and all types of doctors, diagnosed her with Polymyalgia Rheumatica (PMR).   We discussed her condition and I thought it would be an informative blog topic. 

How common is PMR?

 Polymyalgia rheumatica (PMR) is a common disorder in the elderly population.  It is rare in people younger than 50 years of age.  The overall incidence in the general population ranges from 20 to 50 new cases per year per 100 000 people, with a four fold higher risk of women being affected compared to men.  However the incidence is often underrated because it occurs in the elderly and physicians may mistake the symptoms for simple aches and pains of aging.  When in fact a simple blood test showing elevated ESR can lead to a diagnosis.

Typical Presentation

The typical presentation of a person with recent onset of PMR would generally be pain in the neck, referred pain in the shoulders down to the elbows, and referred pain in the hip region down to the thigh; the pain is generally worst at night and in the early morning.  Morning stiffness and limited range of motion of the upper and lower extremities are also frequently reported.  The pain of PMR is usually felt on both sides of the body but in some cases it may affect a single side.  Problems performing morning activities are frequently reported because such activities depend on functionality of the shoulder and hip girdle.  These symptoms of PMR are often accompanied by anorexia, weight loss, fever, fatigue, depression and night sweats.

Diagnosis

The diagnosis of polymyalgia rheumatica is based upon recognition of a clinical syndrome, consisting of pain and stiffness in the shoulder and pelvic girdle, muscle tenderness of the upper and lower limbs and nonspecific somatic complaints. In addition, an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentration, and joint effusion as shown by ultrasound or MRI, are hallmarks of the diagnosis of PMR.

Treatment

Corticosteroids are the gold standard for treatment.  Most patients when properly diagnosed have an excellent prognosis and resolution of symptoms shortly after beginning corticosteroid treatment.  Proper monitoring and doses of the drugs is important as there are many known side effects of prolonged use of corticosteroids such as; osteoporosis, diabetes and infection.

Source:  Drugs Aging 2006; 23 (5)

Health benefits of exercise: the evidence

Do you need a reason to exercise?   There are literally hundreds, maybe thousands of reasons to exercise.  Besides the weight loss, looking good part, I am going to give you a several scientifically proven health benefits to get off the couch and exercise.

1.  You will live longer:    More than 2000kcal of exercise per week was associated with an average increase in life expectancy of 1-2 years by the age of 80.  Also people engaging in physical activity of at least moderate intensity for more than 3h/week had a 27% lower risk of dying than their inactive counterparts.

2. It is good for your heart:  Walking as little as 1 hour per week had a protective effects in women against cardiovascular-releated death.   Studies dealing with cardio rehab after diagnosis of cardiovascular diseases have shown that energy expenditures of about 1600kcal per week can halt the progression of coronary artery disease and exercise at levels of 2200 kcal per week is associated with plaque reduction. 

3. Helps to control diabetes:  In one study, moderate physical activity for at least 150 minutes per week was found to be more effective than metformin alone in reducing the incidence of type 2 diabetes. 

4. Prevention of Cancer:  Routine physical activity, whether part of a job or as a leisure activity, is associated with reductions in the incidence of specific cancers, in particular colon and breast cancers.  And regular physical activity appears to confer a health benefit to patients with established cancers.

5. Keep your bones strong:  Routine physical activity, especially weight bearing resistance training, prevents and even reverse bone loss associated with aging.  Exercise training also reduces the risk and number of falls which could result in broken bones and injuries.

6. Have fun and keep happy:  Exercise and physical activity are also linked with better quality of life, more enjoyment. and less reported incidences of depression.

How much exercise do I need?

Currently most governments and health agencies recommend 30 minutes of moderate activity (such as brisk walking, biking, jogging, playing sports, weight lifting,heavy gardening or household chores)  on most days of the week or 20 minutes of vigorous exercise  3 or more times per week.    The research into exercise and health supports these guidelines as beneficial and preventative for many chronic health conditions.  

I talked about exercise is a earlier blog posting titled How fast should I go? – working out at the right intensity.  Some information from that post may help you decide how intense you work out should be.  If you are new to exercise, start slow and consult a health professional for a proper assessment. 

Sources:  ARCH INTERN MED 2007; 167(22): 2453-2459.    CMAJ 2006; 174(6): 801-809.    MJA 2005; 183 (10): 538-541.   AJE 2000; 151 (3): 293-299

Does your neck crack by itself? Advice for the hypermobile neck

A chiropractic adjustment is a specific and precise release of a joint that is limited in its normal range of motion.  This is very different from someone who can “crack” their own neck or back.  “Self-cracking” is a common practice for some people.  They claim it feels good or loosens their neck.  If fact self “cracking” can create excessive movement, or hypermobility in the area, loosening muscles and ligaments, which furthers the hypermobility in the area leading to easier and more frequent “cracks”.   Below is my advice on how to stop this bad practice.

 How to stop the cracking

1. Stop the self-cracking.  It is not helping you. 
2. Get treatment. If you feel stiffness in the morning, while driving or anytime throughout the day, your body may very well be saying “I need an adjustment!” but make sure it is a real chiropractic adjustment, delivered at the correct joint by a trained chiropractor. 
3. Strengthen the area.   If your neck or back is constantly cracking, it is a good sign that the surrounding muscles are weak and/or ligaments may be loose, leading to hypermobility in the joints.

General Neck Exercises 

Here are some good general neck strengthening exercises for the muscles of the neck and upper back.  If you are experiencing pain or discomfort it is best to seek specific advice from a health professional about your exact condition.

1. Chin tuck:  

 this exercise strengthens the muscles in the front of the neck, called the deep neck flexors (longus colli and longus capitus).  As well it provides a stretch for the suboccipitals at the back of the neck.  This exercise can easily be done anywhere at any time.  While driving in the car, on a bus, sitting at your desk or even lying in bed at night.  Do this as often as you remember throughout the day.

2.  isometric range of motion.  

This activity will strengthen the global muscles of the night.  It is performed by resisting neck movements in all planes.  Put you hand on your forehand and try to bend your head down while resisting with your hand.  Hold for 10 seconds.  Then repeat trying to turn you head to the left and resisting it, turning to the right and resisting, looking upwards and resisting, and finally ear to each shoulder while resisting.

3.  middle trapezius. 

 

The trapezius muscle attaches to the lower part of the neck, to the shoulder blades and down to the mid back.  The middle fibers are this muscle are often neglected and weakened leading to neck pain and dysfunction.   To target this muscle use hold a resistance band with two hands at chest level and pull hand apart and back while pinching the shoulder blades together.  

Research into Neck Exercise

These exercises will strengthen the muscles of the neck.  In fact a study in JAMA 2003 showed that both isometric strength training exercises and dynamic endurance training exercises (ie. chin tucks and lifts) effectively decreased neck pain and disability in women with chronic neck pain during the 1 year follow up period.  And it was observed the benefits could be obtained by training as infrequently as twice per week.  Aerobic and stretching exercises were much less effective than controlled endurance and strength training of the neck muscles.  Stronger muscles mean better support and alignment of the neck, which means less pain and less cracking. 

Source:   Active neck muscle training in the treatment of chronic neck pain in women: A randomized controlled trial.   JAMA, May 21, 2003 – Vol 298 No. 19