Archive for November, 2007
Neck Pain| Prevalence
November 24, 2007 12:22 amSaturday, November 24, 2007
Neck pain and low back are critical public health problems. The 3-month US prevalence of back and/or neck pain was 31% (low back pain: 34 million, neck pain: 9 million, both back and neck pain: 19 million). Generally, adults with low back and/or neck pain reported more comorbid conditions, exhibited more psychological distress (including serious mental illness), and engaged in more risky health behaviors than adults without either condition1.
The age-standardized one-month period prevalence of neck and upper limb pain was 44%. There were significant independent associations between neck and upper limb pain and repeated lifting of heavy objects; prolonged bending of neck; working with arms at/above shoulder height; little job control; and little supervisor support2.
In a study on older adults ages between 70-79, it was found that the correlates of both neck and shoulder pain were female gender, no education beyond high school, poorer self-rated health, depressive symptomatology and a medical history of arthritis, heart attack and angina. Increasing severity of both neck and shoulder pain was associated with an increased prevalence of joint pain at other body sites and with poor functional capacity. Measures of physical performance involving the upper extremity were also decreased3.
Independent of traumatic or non-traumatic origin of the symptoms, the prevalence of chronic low back pain is 3 times higher in individuals with chronic neck pain than in the general population. Causes other than a history of neck trauma, such as chronic musculoskeletal pain syndromes, may be important in evaluation of these cases.
The restriction of total neck movement serves as a marker of severity of neck disorders. Women are more likely than men to develop neck pain; more likely to suffer from persistent neck problems and less likely to experience resolution. Neck pain is a disabling condition with a course marked by periods of remission and exacerbation and most individuals with neck pain do not experience complete resolution of their symptoms and disability4.
1. Strine TW. Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis & Rheumatism. 57(4):656-65, 2007.
2. Sim J. Lacey RJ. Lewis M. The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study. BMC Public Health. 6:234, 2006.
3. Newman AB. Health, Aging and Body Composition Study. Neck and shoulder pain in 70- to 79-year-old men and women: findings from the Health, Aging and Body Composition Study. Spine 3(6):435-41, 2003.
4. Cote P. Cassidy JD. Carroll LJ. Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain. 112(3):267-73, 2004 Dec.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck Pain| Prevalence
Anatomical dissection showing superfical neck muscles (below)
Lower Back Pain|Prevalence
November 16, 2007 2:58 pmFriday, November 16, 2007
Lower back pain is the foremost cause of activity limitation in people below age 45 years, the 2nd most frequent reason for physician visits, the 3rd most common cause of surgical procedures and the 5th ranked cause of admission to hospitals. (Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 354(9178):581-5, 1999).
Musculoskeletal pain is commonly reported among adult populations, with almost one fifth reporting widespread pain, one third shoulder pain, and up to one half reporting low back pain in a 1-month period. It is estimated that 15% to 20% of adults have back pain during a single year and 50% to 80% experience at least one episode of back pain during a lifetime.
Low back pain afflicts all ages, from adolescents to the elderly, and is a major cause of disability in the adult working population. Prevalence generally declined with greater levels of education and increasing income.
The prevalence of degenerative changes in the lumbar spine in cadavers showed that facet joint degenerative changes (arthrosis) was common from L1-S1 levels especially at the L4-L5 level. Facet arthrosis was present in 57% of 20- to 29-year-olds, 82% of 30- to 39-year-olds, 93% of 40- to 49-year-olds, 97% in 50- to 59-year-olds, and 100% in those >60 years old. Men had a greater prevalence and degree of facet arthrosis than women at all lumbar levels. There was no difference in arthrosis between right versus left facet joints. (Eubanks JD. Lee MJ. Cassinelli E. Ahn NU. Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: an anatomic study of cadaveric specimens. Spine. 32(19):2058-62, 2007.
© 2007 copyright all rights reserved www.stopmusclepain.com Lower Back Pain| Prevalence
Dissection anatomy of the back muscles
Neck Pain | Hand Pain| Finger Pain
November 9, 2007 12:46 pmFriday, November 09, 2007
Patients with neck pain and/or neck stiffness without pain may not associate that their hand and finger pain is related to neck problems. Usually they attribute the hand and finger pain and/or stiffness to arthritis. Initially, self treatments are usually applied to the fingers in terms of using balms, ointments and lotions. Patients may also take analgesic medications and anti-inflammatory medications to help ease the pain. When the pain is severe, they may receive injections into the fingers or wrists and sometimes even surgery to release trapped tendons and nerves in the wrist and hand.
Sometimes patients may exercise the hand against resistance such as squeezing a rubber ball or some gadget hoping to strengthen the hand muscles. If the pain is chronic, these resistive activities will make the pain symptoms worse and can accelerate the progression into bony deformities in the fingers.
One might notice early arthritic deformities such as swelling and formation of soft nodes especially at the tip of the fingers called Heberden's nodes which begin with sub chondral bone formation as a reaction against inflammation. Eventually, these will become more calcified forming bony deformities. A recent survey has shown that one in 12 United States adults have symptomatic hand arthritis and incidence increases with age (Dillon CF. Hirsch R. Rasch EK. Gu Q. Symptomatic hand osteoarthritis in the United States: prevalence and functional impairment estimates from the third U.S. National Health and Nutrition Examination Survey, 1991-1994. [Journal Article] American Journal of Physical Medicine & Rehabilitation. 86(1):12-21, 2007 Jan).
In the early stages before hand deformities occur, pain in the hands can be helped by helping to relax the muscles on the dorsal aspect of the forearm. Neck pain due to spondylotic radiculopathy (arthritis) usually involves the C6 and C7 nerve roots. These roots supply the muscles on the dorsal aspect of the forearm among other large muscles in the shoulder and arm such as the latissimus dorsi and triceps muscles.
When these dorsal forearm muscles which move the wrist and fingers into extension become shortened due to nerve root irritation at C6 and C7 levels, they will pull and tug on the joints of the wrist, knuckles and fingers causing pain in these joints. Additionally, shortening of the dorsal muscles of the forearm places an overwork syndrome to the flexor muscles of the forearm and hand since now the long flexor muscle must work harder to counter-act the resistance provided by the tight and short dorsal forearm muscles that not only cross the wrist but extend to the fingers (extensor digitorum communis, extensor pollicis longus and brevis extensor indicis, extensor digiti minimi and others).
These flexor forearm muscles also eventually become tight and stiff making it difficult for the fingers to bend. Initially, finger bending may be slow due to stiffness but eventually it can progress to the stage of significant pain when there is development of a trigger finger. Triggering of the finger means that there is a tenosynovitis of the flexor tendon (inflammation of the synovial covering of the tendon) such that the tendon becomes thickened. There is a size mismatch between the tendon and the tunnels through which it must pass through at the level of the palmar aspect of the knuckle or the finger joints. A nodule on the flexor tendon may prevent the thickened tendon from passing through the tunnel. The finger may stay locked in flexion at the knuckle joint and there will be significant pain on trying to release it out of its locked position using the other hand. A click may sometimes be heard as the tendon is able to pass through the tunnel.
Significant tightness of the long finger flexors can also lead to tenosynovitis of the long flexors causing compression of the median nerve. This develops into carpal tunnel causing not only pain but tingling and numbness and eventually weakness in the fingers especially in the median nerve distribution (the thumb, index and middle fingers and the thumb ½ of the ring finger) interfering significantly with activities of daily living.
In the early stages, relaxation of the muscles of the forearm especially those on the dorsal aspect can be obtained by constant massaging of these muscles. Relaxation of the muscles can also be helped by using heat over the dorsal aspect of the forearm. Massage should also extend to relax all the muscles of the neck, shoulders and arms. This approach will help to treat the root cause of the finger pain rather than focus the treatments only to the fingers and hand. Activity modification must accompany all treatments in order that progressive healing can take place.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck Pain | Hand Pain| Finger Stiffness
Low back pain| Falls
November 2, 2007 10:55 amFriday, November 02, 2007
Patients with chronic low back pain have had experienced sudden buckling of the knees and have experienced near falls or actual falls. During heel strike moment of ambulation, lengthening contraction of the gluteus maximus aided by the hamstring muscles occur. If there is pain and or spasm or weakness in the gluteus maximus and hamstring muscles due to irritation of the S1 nerve root, these muscles cannot react fast enough as the center of gravity shifts forward. This allows the hip and knees to go into flexion causing the patient to fall as both the hip and knee buckle.
As the body weight is shifted forward and before the foot can be planted flat on the ground, lengthening contraction of the quadriceps muscle especially that of rectus femoris muscle occur. Lengthening contraction of the tensor fascia lata which is also a knee extensor muscle also occurs. This is the other phase of stance where falls can occur if there is pain and or spasm or weakness of the rectus femoris (L3, L4) and tensor fascia lata (L5, S1) are present.
Most patients with lower back pain are prone to be sedentary and tend to have tightness or shortening of the hip and knee flexor muscles. Thus a hip flexion contracture will also cause significant tightness of the rectus femoris and the tensor fascia lata muscle at the hip. Since sedentary positions especially that of sitting where hip and knee flexion are involved, constant flexion of the knees make the rectus femoris and tensor fascia lata muscles to be stretched out at the knee.
Additionally, hamstring muscles are tight at the knee and stretched out at the hip which aid the hip and knee instability during the stance phase of ambulation.
Training for balance is very important for patients with chronic lower back pain to prevent falls. Within the home in a clutter free environment, patients can also practice walking backward. When doing these exercises, they should hold onto a wall to prevent falls in case of loss of balance.
Patients should also practice walking on the toes and heels. They must practice walking in a straight-line with the heel of one foot following the toes of the other foot as in the drunken test.
Train oneself to be able to stand on one foot while moving the unsupported limb in flexion, extension, abduction, adduction, internal and iexternal rotation movements with knee in flexion as well as knee in extension.
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| Posture
