Archive for February, 2007
Neck| front| landmarks| vertebra
February 18, 2007 4:15 pmSunday, February 18, 2007
Neck| front| landmarks| vertebra
The neck supports, gives stability and allows the head to move. The neck vertebrae also protects the spinal cord and the spinal nerve roots.
Problems with the neck nerves will produce pain, abnormal sensation such as tingling or numbness or weakness. Symptoms are usually felt in the head, neck, upper limb and even the lower back.
You can observe yourself in the mirror to see if your head is held erect or whether it is listed to one side. If the chin is tilted to the left, you may have tightness or spasms in the right sternocleidomastoid muscle.
Check yourself to see if you are listed to one side. Is one shoulder higher than the other one? Is one side of the pelvis higher than the other side?
Look at the front of the neck. You can easily see the protuberance at the front of the neck called the Adam's apple. The structure just above the Adam's apple is the hyoid cartilage. This hyoid cartilage is at the junction of the meeting of the neck with the plane of the chin. It corresponds to the level of the C3 vertebra.
Adam's apple is part of the thyroid cartilage (larynx). The top level of the Adam's apple is at the level of the C4 vertebra and the bottom level corresponds to the level of the C5 vertebra.
Immediately below the lower border of the Adam's apple is the cricoid cartilage which corresponds to the level of C6 vertebra.
There are creases in the front of the neck which corresponds to these vertebrae. Thinning of the disc spaces between the vertebrae will make these skin creases more prominent.
Usually, the skin creases will be parallel to each other. However, if the neck muscles on one side are tighter, the skin creases on that side will be narrower.
Laryngeal prominence (Adam's apple) (below)
health, muscles, pain, upper body topics
Back pain| neck pain| exercise| intervertebral disc
February 17, 2007 11:46 pmSaturday, February 17, 2007
Back pain| neck pain| exercise| intervertebral disc
During physical activity, stresses are placed onto the spine and the discs. The discs act as buffers between the vertebral bodies, absorb the imposed compressive shock to the spine and redistribute the forces to other parts of the spine. They protect the spine in order that the spine remains stable and flexible.
The intervertebral disc is very similar to a jelly-filled doughnut. The jelly inside the doughnut is called the nucleus pulposus, outer rim of the doughnut which is firm and hard is called the annulus fibrosis and the upper and lower crusts of the doughnut are called the vertebral endplates.
When a person bends forward, backward or sideways, outer rim of the doughnut known as the annulus fibrosis bulges outward in the direction toward which the body bends (concave side). The jelly inside the doughnut also moves in the direction of the bend but in the normal spine, the jelly quickly returns to its original position once the body returns to its neutral position.
Normally, the jelly (nucleus pulposus) takes most of the compressive shocks that occurs to the spine and redistribute it to the annulus fibrosis.
With aging, the jelly solidifies making it harder and less resilient for force re-distribution.
The annulus fibrosis then is exposed to most of the loading that occurs to the spine. With vertebral compression forces, the structure that fails first is the vertebral endplates where fractures can occur.
With bending and twisting movements of the spine, stresses are most placed to the back and sides (posterolateral aspect) of the annulus fibrosus since this portion is weaker and thinner compared to the front.
When the annulus fibrosus ruptures (disc herniation), release of contents of the nucleus pulposus are irritating to the spinal nerve roots causing inflammation and pain. This usually causes acute pain. Chronic pain on the other hand has complex mechanisms.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| lower back pain| disc| herniation
MRI showing disc herniation in L5-S1 level (below)
Low back pain| neck pain| pushing|muscles
February 16, 2007 10:36 amFriday, February 16, 2007
Low back pain| neck pain| pushing| muscles
Pushing and pulling tasks account for 20% of occupational low-back injury claims.
Associated neck pain occurs since pushing activities include contraction of the large muscles of the neck and back.
Connection of the back muscles to the neck muscles occur through the myofascial envelope of the thoracolumbar fascia. Large muscles such as the latissimus dorsi which are essential for pushing activities when injured can give rise to neck and lower back pain.
Primary trunk muscle active during pushing tasks include rectus abdominis and the external and internal obliques.
Spinal compression force during the flexion tasks is about 50% greater than during extension exertions despite similar levels of trunk moment.
The more flexed the trunk, the greater the activity of the abdominal muscles and the co-contraction of the paraspinal muscles.
When the paraspinal muscles co-contract, there is stabilization of the spine but creates an additional spinal load on the spine making it prone to injury.
Factors that influence the spinal load and thus produces an associated risk of lower back or neck injuries during pushing activities include:
- handle or interface design and stability (the abdominal muscle groups work harder when using an unstable interface design than when using a rigid interface).
- trunk posture
- vector force direction of the applied load
- physical exertion level
- the height of upper limb placement
- foot position
- presence of muscle cocontraction
© 2007 copyright all rights reserved www.stopmusclepain.com lower back pain| neck pain| pushing| muscles
Excessive spine flexion is more likely to produce neck
lower body topics, pain, upper body topicsLower back pain| pulling activities| muscles
February 15, 2007 9:57 amThursday, February 15, 2007
Lower back pain| pulling activities
Lower back pain can be initiated or aggravated by pulling type activities.
To be able to pull effectively, lower body muscle activity is needed especially that of the paraspinal muscles, abdominal muscles, gluteus maximus, hamstrings, quadriceps, gastrocnemius and foot and ankle dorsiflexors. These muscles going to lengthening contraction to stabilize the lower limb.
During pulling, compressive forces occur at the lumbar disc region of the L5-S1 level and there are high shear forces at the shoe-floor interface. The more slippery the surface, the more the muscles have to contract to guard to stiffen the trunk to prevent the person from slipping.
The forces generated during pulling are dependent on cart resistance, the weight of the load and walking speed.
Upper extremity muscles needed for pulling type activities (also for lifting) are dependent on arm position and the direction of pulling.
The muscles that are needed for effective pulling activities are deltoid, rotator cuff muscles, triceps, latissimus dorsi and muscles at the back of the forearm and the hand muscles. These muscles undergo lengthening contractions and thus subjected to injury.
Pulling tasks require the trunk to act as a rigid cylinder to link and facilitate the force transmission between the ground and the hands.
Using a lifting belt has no effects during maximal exertions on the maximal pull forces generated or the muscle recruitment levels, irrespective of the pulling posture. The lifting belt generally does not increase the rigidity of the trunk and does not increase the pulling strength nor reduce trunk muscle forces acting on the disc.
People find it easier to pull the object behind them using one arm only. Pulling using one arm places the body in a rotated position that produces injurious forces on the spine. It is preferable to use both arms to pull to minimize the torque effect on the spine. If the load is light, and pulling with one arm is easier, then frequently rotate the use of the pulling arm to give the first arm a chance to rest.
Pulling the cart toward you and walking backwards with the load, can be alternated with pulling the cart behind you to rotate the use of different muscles. This prevents the same muscles from having to undergo repeated lengthening contractions which are injurious.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| lower back pain|pulling
Pulling with one arm tends to rotate the trunk and is injurious to the spine (below)
Use both arms to pull object toward you walking backwards (below)
Pull object behind you with both arms (below)
back, ergonomics, exercise, fitness, health, lower body topics, muscles, posture, self care topics
Back pain| lifting| health| fitness
February 14, 2007 11:52 amWednesday, February 14, 2007
Back pain| lifting| health| fitness
When lifting heavy loads, the trunk muscles of the back and abdomen contract in order to transfer some of the load away from the spine. By their contraction, the chest and abdominal cavities become rigid walled cylinders that provide external support to the spine.
Trunk rotation adversely affects the ability to increase the intra-abdominal pressure and thus makes the spine vulnerable to twisting type back injuries.
Bending and compressive stresses on the spine during forward bending and lifting activities depends on:
- the angle of the knees ('squat' lift, 'stoop' lift, straddling, kneeling techniques. There is no definite research results showing which is the better lifting technique)
- the mass of the object
- its bulk
- its distance in front of the feet
- its distance away from the front to back plane of the body
- the speed of lifting
- the height at which the weight is positioned The maximum load on the low back occurs at the low lifting height (36.3 and 54.4 cm) whereas the maximum load on the shoulders occurred at the high lifting height (144.9 and 163.0 cm)
- presence of twisting movements
- repetitive incremental lifting and lowering of the objects
- duration of lifting
- floor slope
- use of one hand or two hands to lift (one-handed lifting needs support with the freehand to reduces L5-S1 loading pressure)
- development of fatigue
- use of lumbar supports. These support belts may play some role in the stabilization of the lumbar region and increase the intra-abdominal pressure during lifting. However, the effects of lifting belts are too small to provide effective protection of workers. Since the abdominal pressure decreases the more the person bends, lifting belts are more useful at small bending angles then at large bending angles. Lumbosacral support belts are not meant for increasing lifting capacity
- the bending angle (the more the spine bends, there is less intra-abdominal pressure to transfer some of the load away from the spine. To have some protective effect on the spine, lifting should be done with the spine as straight as possible in approaching the object as well as in returning to the erect position with the object in hand)
© 2007 copyright all rights reserved www.stopmusclepain.com lower back pain| lifting
lower back injuries occur when lifting with large bending angles and on keeping knees straight (below)
Lift properly by getting close to the object and prepare to lift with spine kept as straight as possible (below)
Return to the erect position with object in hand and spine kept straight (below)
back, ergonomics, fitness, health, lower body topics, muscles, myofascial, pain, posture
Low back pain|bending|lifting
February 13, 2007 2:30 pmTuesday, February 13, 2007
Low back pain|bending|lifting
Paraspinal muscles contract to restrict the range of motion of the lumbar spine, and protect the spine from injury during movements acting as spine stabilizers.
During manual lifting, the back muscles protect the spine from excessive bending (trunk flexion) but in doing so impose a high compressive force on the spine.
Repetitive lifting which induces fatigue in the back muscles such as the erector spinae muscles, will substantially increase the bending forces acting on the lumbar spine making it vulnerable to injury. When people become fatigued, they tend to focus on execution of the task than on protection of the spine.
Normally during lifting, all muscles on the side opposite to the load, except the abdominal wall work hardest while bending toward the side with the load. The abdominal muscles on both sides however contract to stabilize the trunk when bending sideways to lift.
The chances of re-injuring the lower back increases threefold when there is a previous history of lower back injury. Even though patients may be currently asymptomatic, those who have had a history of low back pain tend to have a greater lumbar motion and velocity during the initial phase of trunk straightening (extension). This may contribute to recurrent episodes of lower back pain.
Preexistent risk factors for lower back injuries also include delay in the muscle reflex responses to sudden trunk loading. Twisting the spine especially during lifting can give rise to lower back injuries.
Even without lifting, activities that call for twisting (torsion) movements of the spine used in daily activities or sports (tennis, golf, throwing activities etc.) are injurious to the spine.
Pivoting requires larger force for spine straightening but produces considerably smaller twisting forces. Thus pivoting appears to be a good compromise to avoid or minimize complex trunk postures during activities especially associated with lifting.
In a study that investigated the effects of initial load height and foot placement instruction in four lifting techniques: free, stoop (bending the back), squat (bending the knees) and a modified squat technique (bending the knees and rotating them outward) found that rotating the knees outward during squat lifts results in less compression forces than in squat lifting but larger than in stoop lifting. However, the effects are related to changes in the horizontal L5-S1 intervertebral joint position relative to the load, the upper body acceleration, and lumbar flexion. Lifting with the load positioned at 0.5m above the ground produced the least forces on the spine. (Kingma I. Bosch T. Bruins L. van Dieen JH. Foot positioning instruction, initial vertical load position and lifting technique: effects on low back loading. Ergonomics. 47(13):1365-85, 2004).
Neck pain| carpal tunnel syndrome|tingling
February 12, 2007 5:22 pmMonday, February 12, 2007 Neck pain| carpal tunnel syndrome
Carpal tunnel syndrome can commonly coexist in patients with neck pain conditions. Symptoms of tingling and numbness in the fingers can be a combination of cervical nerve root irritation and the concomitant presence of carpal tunnel syndrome. Symptoms that involve most of the palmar surface of the first three digits but not the back of the hand or the little finger are suggestive of carpal tunnel syndrome.
Such symptoms are more often associated with positive Phalen's sign where tingling and numbness can be brought about by bending the hand down 90° at the wrist. The reverse Phalen's sign where the hand is bent 90° at the wrist with the fingers pointing upward may also be positive (see pictures below for Phalen's and reverse Phalen's maneuvers).
Tinel's tests elicit a tingling sign during nerve (axonal) regeneration by tapping over the nerve with a reflex hammer. A positive test signals the progress of nerve regeneration and is used with the diagnosis of carpal tunnel syndrome and in the evaluation of regenerating peripherally injured nerves.
These positive findings unlike other categories of sensory disturbance, are not related to neck pain or restriction of neck movement in those who have repeated wrist and finger movements at work. There is increasing evidence that occupational factors, including forceful use of the hands, repetitive use of the hands, and hand-arm vibration, are causes for carpal tunnel syndrome.
Those who have underlying conditions such as hormonal imbalance (diabetes, hypothyroid disorders, pregnancy, etc), rheumatologic disorders, autoimmune diseases, and disorders that involve peripheral nerves etc also predisposes the person to carpal tunnel syndrome.
Tingling and numbness are common symptoms and associated condition in patients who have fibromyalgia or chronic myofascial pain. Together with the sensory deficits in the hands, these patients may also have the possibility of carpal tunnel syndrome. They may have tingling and numbness in the hands with weakness and or atrophy of the short muscles that bring about movements of the thumb.
Tingling and numbness are usually due to paroxysmal discharge and extra activity in large myelinated nerve fiber involvement whereas if there is associated pain, this is due to involvement of the small unmyelinated C-fiber nerve axons. Pain and coldness of the upper limb strongly suggest ischemia.
On physical examination, Tinel's and Phalen's signs may be present. If there is suspicion of carpal tunnel syndrome, bilateral electrophysiological tests including the median and ulnar nerves conduction studies and electromyography (EMG) of upper limb and neck muscles supplied by the cervical nerve roots need to be performed. Carpal tunnel syndrome needs to be documented electrophysiologically.
A useful maneuver that eases or abolishes tingling and numbness in carpal tunnel syndrome involves gently squeezing the heads of the knuckles of the affected hand with the palm up. In some instances stretch of the middle and ring fingers is also required. This maneuver may help in the clinical diagnosis of carpal tunnel syndrome, can be useful as a means of relieving symptoms. The authors also suggest basis for the design of an innovative splint. (Manente G. Torrieri F. Pineto F. Uncini A. A relief maneuver in carpal tunnel syndrome. Muscle & Nerve. 22(11):1587-9, 1999).
Alleviating the primary cause of the carpal tunnel syndrome is essential in the treatment of this condition. Pain, tingling and numbness of the hands severe enough to wake the patient up from sleep especially several times at night, dropping objects frequently from the hands is what brings the patient to seek medical help.
Recurrence of symptoms even after surgery is common if the patients also have concomitant proximal muscle tightness, pain and spasm due to multilevel nerve root involvement. Surgery may relieve symptoms significantly better than splinting, however, adequate conservative treatments to alleviate symptoms should be tried before surgery is considered.
Massaging the muscles of the hand especially between the first web space and the thumb muscles as well as the muscles of the back of the forearm, arm, shoulder blades and neck is essential for relieving some of the discomfort symptoms.
In the conservative management for carpal tunnel syndrome, eToims Twitch Relief Method can help in the alleviation of pain symptoms and the healing and stabilization of nerve irritability allowing these patients to have an improvement in quality of life.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| carpal tunnel syndrome| tingling
Phalen's maneuver (below)
Reverse Phalen's maneuver(below)
checking for Tinel's sign by tapping the median nerve at wrist (below)
Lower back pain| neck pain| tingling| numbness
February 11, 2007 4:42 pm Sunday, February 11, 2007
Lower back pain| neck pain| tingling| numbness
Patients with neck or lower back pain may have tingling and/or or numbness due to irritation of the nerve roots in the neck or lower spine.
Tingling and/or numbness in the first three digits of the hand are related to C5 nerve root (thumb), C6 nerve root (index) and C7 nerve root (middle finger) involvement. Similar symptoms in the last two digits (inner aspect of the ring and little fingers) are related to C8 nerve root irritation.
It is essential to rule out presence of carpal tunnel syndrome with entrapment of the median nerve at the wrist that can give rise to tingling and numbness in the first three digits of the hand. With carpal tunnel syndrome, the symptoms are restricted to the fingers.
With C6 nerve root irritation, there will also be tingling and/or numbness at the back of the forearm. C5 nerve root irritation can cause tingling and/or numbness along the outer aspect of the arm.
Tingling and numbness in the last two digits can also be related to ulnar nerve irritation at the elbow level from chronic tendency to lean on the elbows or sleep on the arm. Although there may be numbness along the inner and lower third of the back of the forearm with ulnar nerve irritation, there will not be symptoms in the inner aspect of the front of the forearm. If this region is tingling is numb, consider also involvement of the T1 nerve root.
Tingling and numbness in the foot in the region of the first three toes can be related to L5 nerve root irritation. The numbness may also involve the top of the foot and the outer aspect of the front of the leg. However, irritation of the peroneal nerve can also give rise to the same symptoms.
The peroneal nerve can be compressed either at the knee from tendency to cross legs habitually during sitting. The other common level where the peroneal nerve can be irritated is at the front of the ankle from tendency to cross the ankles during sitting or in bed. In this situation, the numbness may be related only to the first web space between the big toe and the second toe.
If the symptoms of tingling numbness are in the last two toes, irritation of the S1 nerve root need to be considered. The symptoms may also be felt in the sole of the foot. These same symptoms may be noted with irritation of the tibial nerve at the inner aspect of the ankle due to presence of tarsal tunnel syndrome.
However with S1 nerve root irritation, there will also be symptoms in the heel whereas in tarsal tunnel syndrome, there will be no symptoms of tingling and numbness in the heel.
The cause of the tingling or numbness must be evaluated by a physician. If conservative treatment is to be taken, massage is helpful. In the early stages, symptoms of tingling and numbness may be relieved by immediately massaging the muscles frequently as many times as possible every day.
Selective activation of muscles using eToims Twitch Relief Method can aid the recovery of the nerves and completely eliminate the tingling and numbness if the treatment can be done as soon as possible after the symptoms arise, preferably within 24 hours.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| lower back pain| tingling|numbness
Jaw pain| temporomandibular joint| masseter
February 10, 2007 10:41 pmSaturday, February 10, 2007
Jaw pain| temporomandibular joint| masseter
Jaw pain can result from pain and spasm in the masseter muscle. Overuse of this muscle occurs in repetitive jaw movements associated with chewing gum, eating nuts, biting into hard foods and fruits, etc.
Jaw pain can also result from malaligned jaw joint due to forward head posture due to neck pain. In this posture, line of action of the masseter muscle is disturbed making it prone to injury.
This muscle can be exquisitely tender at areas of myofascial nodules.
The superficial part arises from the front section of the lower border of the cheekbone (zygomatic arch). The deep portion arises from the inner aspect of the cheekbone.
It inserts into the coronoid process which is very close to the jaw joint and the angle of the jawbone. Its function is to elevate the jawbone and is also active in clenching teeth.
It is supplied by the masseter nerve from the mandibular division of the fifth cranial nerve.
© 2007 copyright all rights reserved www.stopmusclepain.com jaw pain|neck pain|masseter, temporomandibular
Low back pain|neck pain|muscles|shoes
February 9, 2007 8:21 pm Friday, February 09, 2007
Low back pain|neck pain|muscles|shoes
Lower back pain and neck pain can be exacerbated by altering the gait cycle. Improper heel heights in shoes and ill fitting shoes are common causes impairing the gait cycle.
In the normal gait cycle, the foot rolls over from the heel to the forefoot. Increased effort of the muscles involved in walking occurs when this gait is impaired.
Walking on the toes as is in wearing high heels or when there are tight heel cords increases the muscular effort. The muscles controlling the foot and ankle, knees, hips and trunk have to work harder. There is also diminished the leg venous pressure compared with walking barefooted.
Shoes therefore may increase loads on the lower extremity joints causing muscle and joint pain. Patients who already have pain can exacerbate the back and neck pain secondary to wearing improper shoes.
Even those who have no pain can experience back and neck discomfort or pain depending on the type of shoes that they wear.
In wearing high heels, the plantar pressure in the heel and midfoot shifts to the inner (medial) forefoot, and the vertical and forefoot ground reaction forces increase.
Muscles have to contract with greater force on wearing high heeled shoes since the person is walking on his/her forefoot.
Normal gait consisting of shifting the body weight to gradually roll over from the heel to the forefoot is greatly impaired. The over active contraction of the muscles will lead to pain and cramps in the calves, thigh, back and can exacerbate low back pain and neck pain.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| lower back pain|shoes
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barefoot, calf muscles not tight (below)
wearing sneakers, calf muscles slightly contracted (below)
Wearing high heels (below)
Watch Melissa's video now!
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back, blog, Chronic pain, cramps, exercise, fitness, health, lower back pain, muscles, pain, shoes, walking
