Sitting and Your Neck Pain

More people than ever sit in front of a computer for a living these days, and if you're reading this it's likely that you're one of them. So before you get back to being productive for your boss, let's review some ways you can spare your neck in the process.

First, the basics: Your head weighs, on average, about 12 pounds. You have a fairly complicated series of joints and muscles holding that weight off your shoulders and giving you the freedom to look around. Like every other complicated system, the more moving parts to deal with, the more likelihood for something to go wrong. Some of the muscles that get tweaked and stretched when your head moves too far forward (the classic computer posture) are the deep flexor muscles. That would be these guys:

These muscles work in concert with others in the posterior part of your neck to give both stability and freedom of movement to the head. They also get beat up when we get our heads too far forward and keep them there all day, like you may very well be doing right now. Interesting fact--every inch forward your head moves takes three times more power to support the weight. Makes sense--if you hold a bowling ball close to your body it's easier to support than holding it out in front. And your head weighs about the same as a bowling ball. No disrespect.

Eventually, certain muscles get too tight which causes others to turn off ("reciprocal inhibition," again). This happens because muscles activated on one side of a joint cause the muscles on the other side of the same joint to become inhibited--when you flex your bicep, your tricep has to turn off so you can perform the movement. Your neck is no different, and when it happens for hours on end in only one direction neck pain is often the result. This is sometimes referred to as "upper crossed syndrome." It looks like this:

Upper crossed syndrome can lead to a wide variety of pain and instability problems, including shoulder pain, pain around the shoulder blades (especially at the upper, inside border), and, of course, neck pain. None of which is very fun. 

Incidentally, the shoulder pain I just referred to is more than just pain, it's lack of stability. The shoulder blades are essentially the reason your shoulders move the way they do, and the serratus anterior muscles you can see in that picture (the ones that get inhibited) are important when it comes to stabilizing your shoulder joint. If they get turned off and you go try throw a softball around or swing a racket of some kind you could be in for some shoulder issues. More on that in a future post.

An ounce of prevention, as they say, so let's look at the exercise I give every patient with neck pain who walks in the door here: The Brugger. This is done while sitting on the edge of your chair. Step one--tuck your chin straight back while keeping your eyes nice and level. This will create a really nice double chin that you can be proud of. Step two--try and keep your head in position while placing your palms in a a forward facing position with your arms slightly bent and back a little. You should feel a nice stretch where your chest connects to your shoulders.You'll be in this position at the end of the movement: Hold this position for three deep breaths and then go on about your business.

Sometimes the neck pain associated with the upper crossed syndrome is due to joint restrictions in your neck. Static postures held for hours on end can cause the joints to stop moving like they should, which can often lead to pain. Classically, the base of the neck (where your neck connects to your body) gets locked up, and when the muscles of the shoulders join the party to protect the compromised joint, the combination drives people to my office. The joint right at the base of the skull is another key location for dysfunction, and the combination of those locations can cause blistering headaches with a fairly predictable pattern, such as this:

Fortunately, those headaches respond quickly to manipulation of the affected joints, especially when combined with soft tissue work to release the trigger points in the muscles. I recently had a patient leave the office with tears of joy welling up in her eyes because her chronic headache had disappeared for the first time in about a year. 

So do your Bruggers, and take your eyes off the screen and focus on something on the other side of the room while you do them. This will help your back, neck, shoulders, and your eyes, too. Why don't you start now? And if the headaches have already begun, and this doesn't make them go away, come see me at Green Chiropractic. Tell 'em the blog sent you.

Some Thoughts on Back Surgery

Yesterday I had the opportunity to see a spine surgery up close and personal. The procedure is known as a spinal fusion, and is the final stop up the totem pole when it comes to treating lumbar instability. I am very grateful to the surgeon who let me in his OR--he was quite gracious the entire time, and introduced me to the OR staff as a new chiropractor in town who wants to see what goes on in a surgical setting in order to better serve my patients, which is true. All the OR staff seemed interested in the fact that I was invested enough to come and observe, and several asked me questions about what I do. Nobody acted like I had nine heads when the word "chiropractor" was used to describe me, either. A good sign.

I met this surgeon years ago, and he made the offer way back then to see a surgery if I ever wanted. I had to use Facebook to track him down, but when I finally got in touch with him he was still just as willing to let me in his world for an afternoon. We met at the hospital and he led me through the maze of behind the scenes hallways and rooms to the OR. Before that, I should mention, was a trip through the surgeon's suite, complete with drinks and buffet style food set up all for free. Free!

Just outside the OR was the "scrub in" area. We talked about his first day to ever go through the procedure, which is radically different now with all the germ killing disinfectants made for these situations. Then we went in. There, all laid out in a very organized way, were all the tools and accoutrements needed to fuse someone's lumbar spine together. It was an impressive display that took up two tables to hold it all. There was also a full time tool-getter handing off one thing and cleaning the blood and bone chips off the other.

The only word that describes the procedure itself is a word that I think is largely overused, and consequently a word I tend to avoid: surreal.

There was Christmas music, which was changed to classic rock being piped into the OR as the incision was made that revealed someone's spine. There were some rather gruesome sounds coming from the procedure itself--the muscles and soft tissue attached to the spine have to be moved out of the way to insert hardware, and there's no amount of onomatopoeia in my power to type out what that sounds like. There was also a great deal of hammering with a chisel to get the hardware inserted and aligned. Hearing Steve Miller playing Rock' N' Me while that hammering was going on may just stick in my mind forever.

To be sure the hardware was lined up in all the necessary angles and orientations, a fluoroscope was brought in. A fluoroscope is an x-ray unit that runs continuously to see things in motion. I should mention that the surgeon nailed it on the first try.

Just before closing I was invited to take a look at table side, so after even more sterilization procedures I got a look at everything from inches away. With Jefferson Airplane's White Rabbit in the background, I got an intimate view of the amazing anatomy underneath our skin: The lumbar spine that had failed this patient to the point where this entire process was necessary, the muscles around it and the sacrum below it. Although it appears that the lumbar spine is fairly close to the surface, it's actually buried farther down than you might think. This patient was petite, and her spine was about six inches deep.

The take home points for me were these:
1. The stability of the lumbar spine is important. Doing core work shouldn't be considered a fad, it should be considered a necessary component to having a healthy spine. Look for some core stability posts soon.
2. Spine surgery is hard work. The good doctor had to use some muscle several times during the procedure. He was also exceptionally focused. He has his share of back problems himself, and has even had a fusion, so he could definitely sympathize with the patient.
3.Classic rock is superior to seasonal holiday music for surgical interventions.

Desk Jockeys Continued...

In the last post we talked about tight hip flexors and how they turn your glutes (butt) off and some of the potential consequences of that scenario, none of which are good: knee pain, ankle pain, etc... And who wants that? About the same amount of people who want a weak, mushy butt.

Tight hip flexors can also lead to low back pain, too, and as you might imagine is something I find myself explaining with some regularity here at Green Chiropractic. First, let's review the anatomy:

As you can see, your hip flexors, when contracted, will lift your thigh toward your body. You'll also notice one particular group, the psoas, connects your spine to your femur. This is the reason many office workers/desk sitters/couch potatoes have low back pain. It's a matter of mechanics. When the psoas is too short the lumbar spine is pulled forward. This hyper extension puts undue stress on the facet ("fa-set") joints of the posterior lumbar spine. Once that happens pain is soon to follow.

Fortunately, treatment is fairly straight forward--spinal manipulation can open the joints up and give them some breathing room, and some simple stretches will, over time, lengthen the hip flexors that are causing all the trouble in the first place. And so as not to leave you hanging, here are some pics of those stretches:

 Pete demonstrates the basic stretch for the left hip--hard on your knees without the mat.

 Raise your arms up to sink further into the stretch.

 The standing version

 By twisting and bending away from the hip you're stretching you can get a little more out of the movement

Attention Desk Jockeys

I'm a fan of computers and all, but sitting all day is bad for your back, bad for your neck, and bad for your sense of well being, too. I know--I'm writing this while sitting, and if it weren't for the fact that I regularly show (and therefore do myself) people exercises to help recover from the excesses of sitting, I'd likely end up with back pain myself. That scenario is not a practice builder.

What's so bad about sitting? I'm glad you asked--first off, prolonged time in any position can shorten certain muscles and lengthen others beyond the norm. Sitting though, especially at a desk in front of a computer, can really wreak havoc on the low back and neck. Let's start from the bottom, at the hip flexors. That would be these guys:

 

That one muscle, the psoas ("so-as") is especially prone to shrinking to fit the shape it's called to be conformed to all day long. As a result, we get tight in the front of our hips. Right here:

When a muscle is shortened it is essentially flexed. You have built into your muscles a mechanism (called "reciprocal inhibition") that causes muscles on the opposite side of a joint to relax to enable the contracting muscle to contract unimpeded. As an example, when you flex your biceps, your triceps relax so your arm doesn't tear off or explode with all that raw power.

In the same way, when your hip flexors are contracted, and end up shortening after all day sit-a-thons, the muscles that are forced to relax are found beneath your back pockets and are known far and wide as your glutes. Also known as your butt muscles.

When your glutes get turned off because your hip flexors are contracted and shortened and therefore always a little too activated, problems in gait (the way you walk) can be the consequence. Because, you see, your glutes help extend your hip when you walk--in other words they help with the pushing off motion of taking a step. Go ahead, touch your own and extend your leg backwards to feel them activate.

When your glutes aren't doing their job, other muscles and tissues try to compensate, but there really is no other muscles that can do the job as well. This often leads to IT Band Syndrome when runners go from desk to the track with inhibited glutes. IT band syndrome results in pain on the outside of your thigh. You can see in the following picture that the IT band is in a key location to try and do something it shouldn't be doing when the glutes are fast asleep at the wheel.

The effects of sleepy glutes can eventually lead to knee pain and ankle pain as well--it just depends on how your system compensates for the faulty movement pattern.

Short hip flexors can also cause low back pain, which we'll explore in the coming days. I'll follow up with how sitting affects your neck, and then we'll get into some stretches and exercises that will help with both ends of you. You can usually manage these things yourself, which is good, but if you're in more that the usual pain it could be something that could use a more experienced eye, and if that's the case, come see us at Green Chiropractic. If you live in Houston, that is...

A Little More on Soft Tissue Treatment

In the form of a video--I'm trained in Graston, but now use a different (although similar) set of tools...
Check it out here.

Vitamin D--A Response to the Recent Recommendations

Vitamin D has been in the spotlight more and more in the last several years. "Now with vitamin D" has become one of the latest catch phrases for different products. Sometimes the justification is bone health, sometimes it's because vitamin D has been linked to reductions in breast cancer. The list goes on, and the research keeps mounting. Recently the Institute of Medicine (IOM) released a report detailing their recommendations on the amount of D one should be supplementing/consuming every day. Those recommendations were a baby step in the right direction, and although their suggested levels will probably keep you from getting rickets, they are woefully short of what the most current research has to say about the subject.

The IOM recommends 600 IU a day, with a safe upper limit of 4,000 IU a day. Just for a reference, I easily take 10,000 IU a day and have for over a year. Before that it was 6,000 for around a year, and before that it was 2,000 for several years. The reason I've changed the amount over the years is based on the fact that I measure my blood levels with some regularity, and I've moved from Florida, where I surfed in the Atlantic as much as I could (and we lived very close to the beach), to Rhode Island, where the sun never hit my skin for months. From there is was back to Texas to open Green Chiropractic, where I happen to spend the majority of my day indoors and out of the sun.

For a white boy like myself, ten to twenty minutes in that Florida/Texas sun in the middle of the day is enough for me to generate over 10,000 IUs. For my much darker skinned children (they're from Haiti), it takes at least double that amount of time. They take 2,000 IUs a day (in the form of a cinnamon flavored chewable that they really like). To round out the household, my wife takes between 5,000 and 10,000 daily. And I've gotta tell you, our record for avoiding the illness de jour around the flu season is nearly batting a thousand. One of our boys has been sick one day since we picked them up over a year and a half ago. He was fine the next day. The other boy lurches right through flu season with the unwashed hands of a 5 year old like he's bullet proof. How many four and five year olds avoid the funk that successfully?

I've been shooting to get my levels between 40-80 ng/ml of blood. When I was taking the 10,000 in Rhode Island my levels went down from my Florida levels, even though I nearly doubled the amount I was supplementing. I use the test from Grassrootshealth.net, in case you're interested. Getting your blood levels measured is really the best way to know how much you need.

The IOM is a quasi-government organization, so I'm actually shocked that they even moved in the right direction at all--they are now recommending maintaining blood levels at 20 ng/ml. That's still less than half of the recommended level coming from John Cannell, MD, who is one of the founders of the Vitamin D Council, an organization that does nothing but research the mighty D. I'll let him finish this post, so it won't  look like a crazy chiropractor ranting about the newest fad in nutrition (and one that I happen to sell, at that):

I, my family, most of my friends, hundreds of patients, and thousands of  readers of the Vitamin D Council newsletter, have been taking 5,000 IU/day for up to eight years. Not only have they reported no significant side-effects, indeed, they have reported greatly improved health in multiple organ systems.  My advice: especially for pregnant women, continue taking 5,000 IU/day until your (OH)D] is between 50 ng/ml and 80 ng/ml (the vitamin D blood levels obtained by humans who live and work in the sun and the mid-point of the current reference ranges at all American laboratories).  Gestational vitamin D deficiency is not only associated with rickets, but a significantly increased risk of neonatal pneumonia (2), a doubled risk for preeclampsia (3), a tripled risk for gestational diabetes (4), and a quadrupled risk for primary cesarean section (5). 

Yesterday, the FNB failed millions of pregnant women whose as yet unborn babies will pay the price.  Let us hope the FNB will comply with the spirit of "transparency" by quickly responding to our freedom of Information requests.

John Cannell, MD

The Vitamin D Council

1241 Johnson Avenue, #134

San Luis Obispo, CA 93401

(1) Cannell JJ.. On the aetiology of autism. Acta Paediatr. 2010 Aug;99(8):1128-30. Epub 2010 May 19.

(2)Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009;63(4):473-7.

(3) Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-22.

(4) Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One. 2008;3(11):e3753.

(5) Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009;94(3):940-5.

And They Came Bearing Gifts

Time for a Christmas post! Anyone who knows me knows that I am prone to talking about nutrition, and when that happens I'm especially likely to bring up the sub category of inflammation. In chiro school we were trained to understand the deleterious effects of chronic inflammation because one of the consequences of said inflammation is the sensitization of the pain system. I frequently demonstrate this to patients by bending back my index finger and telling them, "this doesn't hurt now, but see me in an hour. If my pain system were sensitized this might start to hurt in ten minutes. This causes situations where stimuli that is usually considered non-painful becomes painful; everything just starts to hurt." People get that, and besides, it's the truth.

Explaining the actual mechanisms of inflammation can get tricky--for one thing, most people just don't care that much about how it all works. Also, people don't have the time to invest that it takes to wrap one's mind around it. They just take some non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen and move on with life.

Like most things in life, though, taking a pill for what ails you isn't likely to be the wisest course of action in the long run. Long term usage of NSAIDs, for instance, can cause joint degeneration. And people often take ibuprofen daily for the aches and pains that they associate with walking on planet earth. Along with the NSAIDs are big pharma's select Cox2 inhibitors such as Vioxx (which was taken off the market) and celebrex, but those drugs have developed reputations for causing cardiac events (one of my favorite euphemisms). Besides, the Cox pathway is just one way the bad things you eat can get turned into pain. When one pathway is cut off, the other pathway gets more traffic. And so it goes.

There are times when we eat stuff we shouldn't. These times, for me at least, are often accompanied by generally high stress--such as during the holidays. Put bad eating and stress together and you've got a perfect storm of inflammation to deal with. And if you're like me, you don't want the eroded joints or heart attacks we just talked about. Fortunately, there are some natural alternatives readily available (some of which may be in your refrigerator right now). Here's a short list of the heavy hitters:

Cinnamon
Ginger
Tumeric (the stuff that makes curries and mustard that special color of yellow)
Rosemary
White Willow (what? You don't have White Willow in your fridge?)

Most any spice you can name will have properties that modulate inflammation--that is, blunt the impact of the bad aspects of inflammation while bolstering the good.

You may be wondering what any of this has to do with the title of this post or my allusion to Christmas. Well, here goes: Boswellia is a potent anti inflammatory that has been found to relieve joint pain, especially in the weight bearing joints of the knees. It also has been shown to be effective for treating asthma, and ulcerative colitis. The dried sap of the Commiphora species of trees has been shown to be a potent anti inflammatory as well. So has gold for that matter. Boswellia, by the way, is another name for frankincense, and that dried sap I just mentioned is what we call myrrh. Seems like the gifts left for the new king had layers of meaning beyond the symbolism usually attributed to those gifts.

And by the way, boswellia, along with many others from the list are found in some of the products we carry at Green Chiropractic. Have a great December.

Chiropractors: The General Practioner of the Spine

Allow me to explain. When you think of your primary care provider (PCP) you don't think of neurosurgery. What you know is that your PCP can handle most things you walk in with, and that they can recognize situations where a referral is necessary. I submit that chiropractors who follow the evidence based non surgical spine specialist model should be the person you go to first with spine pain/musculoskeletal complaints. We can diagnose most of the conditions that walk in, and we know when it's time to make the referral as well.

Chiropractors often work together with other doctors for the benefit of the patient. Common examples are pain management doctors for injections. Injections can often help the acute patient deal with their pain enough to handle the treatment prescribed by the chiropractor. In the the case of disc pain, for instance, flexion/distraction manipulation is considered one of the treatments of choice to decompress the bulging, painful disc, but sometimes the patient is in too much pain to even lie on the table, let alone handle the treatment. To which I say--steroids to the rescue.

Chiropractors are also well trained in differential diagnosis. Recognizing that your back pain is actually referred pain from your kidneys is something we should pick up on. To prove my differential diagnosis skills I can tell you that I've figured out the condition in two different episodes of House: Lyme disease, and myasthenia gravis. They were triumphant moments, and I'm still basking in the glory. But I think you get my point.

Low back pain and neck pain are often mechanical problems that need a mechanical solution. Chiropractic school is non stop, hands on, physical examination and manipulation training. Some of us go into the world of soft tissue treatments as well, which broadens our scope of practice to extremity pain of the non surgical nature. A torn tendon is out of my pay grade, but scar tissues that inhibit normal movement patterns are my turf.

One final area of expertise your chiropractor should have is a knowledge of nutrition and supplementation. This could possibly be the skill set of your chiropractor that can help you the most with your general welfare, spine pain or not. There are several diet related causes of low back pain that can also cause all sorts of other nasty conditions. Anyone who knows me knows not to get me started about diet and nutrition unless they really want to get me going. What can I say? I'm passionate.

If you're living with back pain, neck pain, or the headaches that often accompany neck pain, come see your favorite Houston chiropractor and get the help you need. I really enjoy my work--it's almost too fun to call this a job, and I look forward to meeting and serving you.