Author: Dr. Robert Speirs DC

Condition Of The Month: TOS!

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TOS.jpg

Thoracic Outlet Syndrome (TOS)

The term “thoracic outlet” describes an area at the base of your neck, just above your collarbone. Some important nerves and vessels pass through this outlet on their way into your arm. Compression of these tissues causes a condition called “thoracic outlet syndrome” which results in pain, numbness or tingling in your arm.

Several different factors can cause Thoracic Outlet Syndrome, commonly referred to as TOS. Sometimes TOS is caused from tightness in the muscles of your neck and chest, other times the space between your first rib and collarbone is too small. People who have an extra rib (cervical rib) and people who have recently suffered a neck injury may have a greater chance of having this problem.

The condition is aggravated by poor posture and by occupations that promote “slouching,” i.e., computer users, assembly line workers, supermarket checkers and students. Swimmers, volleyball players, tennis players, baseball pitchers and occupations requiring prolonged overhead activity. i.e., electricians and painters are also prime candidates for TOS.

Symptoms of TOS include arm pain, numbness, tingling and possible weakness. Neck, arm and hand pain may begin slowly and are often aggravated by elevation of the arms or excessive head movement. Loss of grip strength is possible.

Conservative treatment, like the kind we provide, has been shown to be effective at treating TOS. Through our careful exam we have identified your specific sites of compression and will use some of the following treatment to help:

You should avoid carrying heavy loads, especially on your shoulder i.e., carpet rolls. Briefcases, laptop cases or heavy shoulder bags should be lightened. Bra straps may need additional padding or consideration of replacement with a sports bra.

If you or someone you know suffers from any of these symptoms, call our office today. Our team has knowledge and tools to help you feel better quickly!

Help For Those Stuck At A Desk All Day

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Desk workers should periodically perform the “Brugger relief position” to help maintain good sitting posture.

Here’s how to do it:

  • Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed.
  • Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together.
  • Take a few deep cleansing breaths.

Learn more about proper workstation ergonomics in this video.

Brugger’s Relief Position

Lumbar Degenerative Spondylolisthesis

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Your lumbar spine (low back) is made up of five individual vertebra stacked on top of a bone called the sacrum. To allow for flexibility and movement, there is a cushion or “disc” in between each level. As we age, our discs and joints can wear and become thinner from a process called arthritis. This leads to additional changes, including loosening of the ligaments that hold your vertebra in place.

The term “degenerative lumbar spondylolisthesis” means that one of your vertebra has shifted forward on top of the one below as a result of arthritis and loosening ligaments. The condition usually comes on after age 50 and affects women six times more frequently than men. Degenerative spondylolisthesis occurs most commonly at your second lowest spinal level. (L4-5)

Sometimes, spondylolisthesis develops silently, but most patients report episodes of back pain that have occurred for many years. Patients often report increased pain when standing or when rising from a sitting position. Pain tends to increase throughout the day. If your nerve openings have become narrowed, the nerves may be pinched, and you may experience pain radiating into your legs. Leg symptoms that shift from side to side are characteristic of degenerative spondylolisthesis. Leg pain and tingling are fairly common, but be sure to tell your doctor if you notice more significant symptoms, like leg numbness, heaviness, weakness, loss of bowel or bladder function, or impotence.

Studies have shown no advantage for surgery over conservative care for most cases of degenerative spondylolisthesis. Approximately one-third of patients will experience progression of symptoms over time, and only 10-15% will ever need surgery to correct the problem. Fortunately, the majority of patients will benefit from treatment and exercises to help stabilize their spine.

You will need to perform your exercises consistently for sustained improvement. You should also try to add some type of aerobic exercise to your daily routine. Stationary cycling is a very good choice, and other options include water walking and swimming. Avoid wearing high heels. You may find some benefit for your arthritic symptoms by taking 1500mg of Glucosamine Sulfate each day. Using a hot pack for 10-15 minutes directly over your lower back may provide some benefit.

A Modern Spine Ailment

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Some great information from Spine-Health.com and Dr. Steven Shoshany DC

 

Text neck is the term used to describe the neck pain and damage sustained from looking down at your cell phone, tablet, or other wireless devices too frequently and for too long.

Text Neck

Using a mobile device often can lead to poor posture and symptoms of text neck.
Watch: Text Neck Treatment Video<spanclass=”div-video-link”></spanclass=”div-video-link”>

And it seems increasingly common. Recently, a patient came in to my practice complaining of severe upper back pain. He woke up and was experiencing severe, acute, upper back muscle strain. I told him I believe the pain is due to the hours he was spending hunched over his cell phone. Diagnosis: Text neck.

See All About Upper Back Pain

Of course, this posture of bending your neck to look down does not occur only when texting. For years, we’ve all looked down to read. The problem with texting is that it adds one more activity that causes us to look down—and people tend to do it for much longer periods. It is especially concerning because young, growing children could possibly cause permanent damage to their cervical spines that could lead to lifelong neck pain.

See Cervical Spine Anatomy and Neck Pain

What are the symptoms associated with text neck?

Text neck most commonly causes neck pain and soreness. In addition, looking down at your cell phone too much each day can lead to:

    • Upper back pain ranging from a chronic, nagging pain to sharp, severe upper back muscle spasms.
    • Shoulder pain and tightness, possibly resulting in painful shoulder muscle spasm.
    • If a cervical nerve becomes pinched, pain and possibly neurological symptoms can radiate down your arm and into your hand.

See What Is Cervical Radiculopathy?

I believe, as some studies suggest, text neck may possibly lead to chronic problems due to early onset of arthritis in the neck.

See Facet Joint Osteoarthritis

 

How common is text neck?

A recent study shows that 79% of the population between the ages 18 and 44 have their cell phones with them almost all the time—with only 2 hours of their waking day spent without their cell phone on hand.1

See Causes of Upper Back Pain

How is text neck treated?

First, prevention is key. Here are several pieces of advice for preventing the development or advancement of text neck:

    • Hold your cell phone at eye level as much as possible. The same holds true for all screens—laptops and tablets should also be positioned so the screen is at eye level and you don’t have to bend your head forward or look down to view it.

See Ten Tips for Improving Posture and Ergonomics

    • Take frequent breaks from your phone and laptop throughout the day. For example, set a timer or alarm that reminds you to get up and walk around every 20 to 30 minutes.
    • If you work in an office, make sure your screen is set up so that when you look at it you are looking forward, with your head positioned squarely in line with your shoulders and spine.

See Ergonomics of the Office and Workplace: An Overview

The bottom line is to avoid looking down with your head bent forward for extended periods throughout the day. Spend a whole day being mindful of your posture—is your head bent forward when you drive? When you watch TV? Any prolonged period when your head is looking down is a time when you are putting excessive strain on your neck.

See Office Chair, Posture, and Driving Ergonomics

Text Neck

Keeping the neck straight and your phone at eye level can help prevent text neck.
Watch: Neck Strains and Sprains Video

Next, rehabilitation is important.

Video still of woman doing the flexion neck stretch
4 Easy Stretches for Neck and Shoulder Pain Video
    • Many people don’t know this, but you need to have strong core muscles—the abdominal and lower back muscles—to support your upper body, including your neck. Your core muscles usually do not get enough exercise during normal daily activities, so you need to do specific exercises to target these muscles.

See Core Body Strength Exercises

    • You also need strong and flexible muscles the neck to minimize strain on your cervical spine and help support the weight of your head. Again, your neck will not get sufficient stretching and strengthening during normal daily activities, so it is best to learn specific neck exercises with the help of a health professional.

See Neck Stretches

Some people will also benefit from a more comprehensive treatment plan, such as a combination of manual adjustments, massage therapy, and cold laser therapy.

Learn more:

 

https://www.spine-health.com/blog/modern-spine-ailment-text-neck

How do nutritional needs change as we age?

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A great piece here from https://www.tallahassee.com/life/

Remember that high school health class? Now imagine a similar class geared toward students 65 and older.

That’s the idea behind nutrition education for older adults provided by the Family Nutrition Program, an Extension program of the University of Florida Institute of Food and Agricultural Sciences, which teaches people how to stay healthy and active on a budget.

“As we get older, our bodies change, and we are at greater risk for developing chronic diseases like high blood pressure and diabetes,” said Dr. Sharon Austin, adult programs specialist for the Family Nutrition Program. “My job is to encourage older adults to make small changes that will help them lead active, independent lives.”

The need for this kind of education is growing, Austin said. Adults over 65 are the fastest growing age group in the United States, and Florida has the highest percentage of adults 65 and older of any state, she said.

Everyone ages differently, and individual needs can be determined with your doctor, Austin said. But in general, as we get older, we may need to pay more attention to certain aspects of our eating and exercise routines to stay healthy, she said.

1. Calorie needs
As we age, our bodies typically need fewer calories because we are moving less and have less muscle mass, Austin said. “When you don’t need as many calories, you want to make sure you get more bang for your buck. That means avoiding ‘empty calories’ and choosing foods that are going to give you the nutrients you need,” she said.

2. Eating from every food group
One way to ensure that you are getting all the nutrients you need is to eat a variety of foods from every food group, Austin said. Take a look at ChooseMyPlate.gov to see how much of each food group to consume.

3.  Fiber-rich foods
“Fiber isn’t just good for digestive health. It also helps lower risk for heart disease and diabetes, which are common chronic diseases in older adults,” Austin said.
You can get your daily recommended intake of fiber from whole grains, beans, and fresh fruits and vegetables, she said.

4.  Fortified foods
Look for foods fortified with vitamin B12, vitamin D and calcium. “Vitamin B12 helps keep the body’s nerve and blood cells healthy, and calcium and Vitamin D help support bone health,” Austin said.

5.  Drinking water
Older adults may have a decreased sense of thirst, and may more easily become dehydrated, Austin said. “One way to avoid dehydration is to sip water throughout the day from a cup or container you keep nearby during your daily routines,” she said

6.  Exercises for mobility, balance and weight management
“When we talk about exercise for older adults, the goal is to set yourself up for physical independence. In our classes, we talk about everyday activities, such as cleaning the house or gardening, which can keep us strong and flexible, and burn calories. We also practice ways to increase balance, which can help us avoid falls and injury,” Austin said.

An exercise that many participants enjoy is the ‘couch potato mambo,’ Austin said. “Next time you’re sitting watching TV, get up and dance during the commercial break. It’s a small step toward health, and it’s fun.”

Lumbar Spondylolisthesis

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Your spine is made up of 24 individual vertebrae all stacked on top of each other. The lowest five vertebrae are referred to as your lumbar spine. Each vertebra has two basic components: the “body” and the “arch.” You can envision this as a coffee mug lying on its side. The cup would represent the vertebral body, and the handle would represent the arch. The spinal cord travels through each of

the vertebral arches on its way from your brain to your tailbone. The term “lumbar isthmic spondylolisthesis” describes a condition where your arch has broken free from its anchor on the vertebral body, allowing the vertebral body to slide forward. Lumbar spondylolisthesis typically affects the lowest lumbar vertebra, L5, or occasionally the second lowest, L4.

The condition is sometimes caused by trauma, but more often follows a “stress fracture” involving the arch of the vertebra. This break and slippage is thought to result from repetitive movements, especially hyperextension (arching back) and rotation. The break usually happens during childhood but does not always cause symptoms when it occurs. Many times, the condition will lie dormant until later in life. Lumbar spondylolisthesis is present in six to seven percent of the population and affects males twice as often as females. The problem is more common in those who participate in sports. Some sports predispose children to this “break and slip”. Athletes who participate in gymnastics, rowing, diving, football, wrestling, weight lifting, swimming, tennis, volleyball, and track & field throwing sports (i.e. discus, shot put, etc) are at greatest risk.

The pain usually starts in your back but may radiate into your buttock or thigh. Your pain usually intensifies with standing upright for prolonged periods of time or leaning backwards, especially during heavy activity. Some women report increased symptoms during the later stages of pregnancy. Be sure to tell your doctor if you notice pain, numbness or tingling in your groin, a loss of bowel or bladder function, fever, night sweats, pain extending beyond your knee, or weakness in your legs.

Your doctor will “grade” your spondylolisthesis based on the percent of the vertebral body that has slipped forward. Your doctor will try to determine if your spondylolisthesis is “active”, meaning a recent break or “inactive”, referring to a long-standing problem. If your doctor has determined that your spondylolisthesis is new and has a chance of worsening, you may need to stop certain activities or sports for a period of time until your fracture heals. Sometimes a lumbar brace is used to help you recover more quickly. Patients with a long-standing “inactive” spondylolisthesis may benefit from a combination of treatments including stretching and strengthening. You should limit leaning backwards or sleeping on your stomach. Females should avoid wearing high heels.

Chiropractic and Low Back Pain

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A new review of more than 50 prior research studies concluded: “manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain. The researchers also found that “(Chiropractic) manipulation appears to produce a larger effect than (physical therapy) mobilization.”

Click here to learn more about how chiropractic manipulation can help alleviate back pain.

 

Source: https://www.thespinejournalonline.com/article/S1529-9430(18)30016- 0/fulltext

Spine Journal endorses manipulation over physical therapy for LBP

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A January 2018 systematic review of 51 studies examined the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for the treatment of chronic low back pain. The authors concluded: 

“There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.” (1)

The study also measured manipulation against other widely prescribed options: 

“Subgroup analyses showed that manipulation significantly reduced pain and disability, compared with other active comparators including exercise and physical therapy.” 

This analysis reinforces the recent LBP clinical practice guideline from the American College of Physicians recommending that physicians prescribe non-pharmacologic treatment including spinal manipulation, heat, massage, and acupuncture. (2)

As evidence-based providers, we continually assimilate new research with clinical experience. We should also recognize that our clinical experiences are sometimes clouded by habitually seeing the other profession’s failures since successfully managed patients don’t often seek supplementary consult. Evidence-based practice requires that we allow consensus evidence to guide our management decisions without anecdotal bias. 

 

 

 

References

1. Coulter ID. et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. 2018 Jan 31. pii: S1529-9430(18)30016-0.  Spine Journal. doi: 10.1016/j.spinee.2018.01.013. [Epub ahead of print]

2. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. [Epub ahead of print 14 February 2017]