Archive for March, 2008
Low Back Pain| Running
March 28, 2008 12:50 pmFriday, March 28, 2008
This study was to investigate the incidence, prevalence, and possible risk factors for low back pain among a group of runners and walkers. A survey with 539 responses who participated in either a 10-kilometer run or 4-mile recreational walk showed previous history of low back pain in 74% of respondents. Prevalence of low back pain at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for low back pain. (Woolf SK. Barfield WR. Nietert PJ. Mainous AG 3rd. Glaser JA. The Cooper River Bridge Run Study of low back pain in runners and walkers. Journal of the Southern Orthopaedic Association. 11(3):136-43, 2002).
Another study evaluated whether athletes with a history of low back pain would, on average, perform slower on a timed 20-m shuttle run as compared with a normal athletic population. Of 211 athletes evaluated, 27 had been treated for low back pain during the previous year. Currently asymptomatic athletes with a recent history of low back pain were slower (6.3s vs 5.8s) during performance of the timed 20-m shuttle run than athletes without low back pain (P=.0002). (Nadler SF. Moley P. Malanga GA. Rubbani M. Prybicien M. Feinberg JH. Functional deficits in athletes with a history of low back pain: a pilot study. Archives of Physical Medicine & Rehabilitation. 83(12):1753-8, 2002)
The same authors found significantly slower response time on the 20-meter shuttle run in college freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in non-freshman collegiate athletes regardless of injury history (p = 0.98). They concluded that kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. Clinical relevance of the study was that there are residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting. (Nadler SF. Malanga GA. Feinberg JH. Rubanni M. Moley P. Foye P. Functional performance deficits in athletes with previous lower extremity injury. Clinical Journal of Sport Medicine. 12(2):73-8, 2002 Mar).
Comments: The application of findings from these studies involve that even though injuries may have been presumed to be healed through absence of symptoms such as pain, subclinical involvement of motor components of the spinal nerve roots may still be ongoing. When pain fibers are not involved, that will be no pain symptoms. Athletes should be examined for presence of muscle stiffness and tightness presenting as limitation of joint range of motion. The most important sign of subclinical irritation of spinal nerve roots is presence of muscle tenderness at palpable myofascial bands or nodules. These points are known as trigger points. Athletes with such findings will be prone to injuries and it is essential that myofascial treatments that help heal the active trigger points be done prior to sporting activities. The most effective stimulation of deep myofascial trigger points is best achieved with such as eToims Twitch Relief Method.
www.stopmusclepain.com Low Back Pain| Running
lower body topics
Neck and Back Pain| Cycling
March 21, 2008 10:50 amFriday, March 21, 2008
30-70% of cyclists suffer from cervical, dorsal, or lumbar back pain. There is a tendency towards hyperextension of the pelvic/spine angle which resulted in an increase in tensile forces at the sacral promontory. These forces can easily be reduced by appropriate adjustment of the seat angle–that is, by creating an anterior inclining angle. The incidence and magnitude of back pain in cyclists can be reduced by appropriate adjustment of the angle of the saddle. (Salai M. Brosh T. Blankstein A. Oran A. Chechik A. Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. British Journal of Sports Medicine. 33(6):398-400, 1999).
It has been found that many of these cyclists suffer from discogenic disease. The number of previous sports-related injuries, was predictive of neck and back pain, and a strong tendency toward neck and back pain was observed for athletes with more total years of participation in sports due to overuse injuries. Causative factors are thought to be prolonged forward flexion, flexion-relaxation or overactivation of the erector spinae, mechanical creep and generation of high mechanical loads while being in a flexed and rotated position. A pilot study was performed to examine whether differences existed in spinal kinematics and trunk muscle activity in 9 cyclists with and 9 cyclists without non-specific chronic low back pain using electromagnetic tracking system and EMG was recorded bilaterally from selected trunk muscles. Data were collected every five minutes until back pain occurred or general discomfort prevented further cycling. Cyclists in the pain group showed a trend towards increased lower lumbar flexion and rotation with an associated loss of co-contraction of the lower lumbar multifidus. This muscle is known to be a key stabiliser of the lumbar spine. The findings suggest altered motor control and kinematics of the lower lumbar spine are associated with the development of LBP in cyclists. (Burnett AF. Cornelius MW. Dankaerts W. O'sullivan PB. Spinal kinematics and trunk muscle activity in cyclists: a comparison between healthy controls and non-specific chronic low back pain subjects-a pilot investigation. Manual Therapy. 9(4):211-9, 2004).
Inappropriate saddle positions may also be a cause of lower back pain. Partial and complete cutout saddle designs may increase anterior pelvic tilt, and saddles with a complete cutout design may increase trunk flexion angles under select cycling conditions. A saddle with a partial cutout design may be more comfortable than a standard or complete cutout saddle design. (Bressel E. Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort. (Medicine & Science in Sports & Exercise. 35(2):327-32, 2003 Feb).
A radiographic study conducted to evaluate dorso-lumbar angular values (angle between the mid-back at T12 and lower back at L3) to define the most physiological sitting position during cycling. Two different pedal unit positions were tested; the first one in a bicycle frame type with pedals in front of the saddle axis and the second one with the pedals behind the saddle axis, in order. The findings showed that the incidence and importance of low back pain in cyclists can be reduced with appropriate pedal unit position; the position with pedals behind the saddle axis permits more physiological spine angles in comparison with the classic one having the pedals in front of the saddle axis; this fact is due to a different pelvic position which coincides with lumbar angles. (Fanucci E. Masala S. Fasoli F. Cammarata R. Squillaci E. Simonetti G. Cineradiographic study of spine during cycling: effects of changing the pedal unit position on the dorso-lumbar spine angle. Radiologia Medica. 104(5-6):472-6, 2002).
www.stopmusclepain.com Neck and Back Pain| Cycling
Low Back Pain| Sitting| Stiffness
March 15, 2008 12:42 amMarch 15, 2008
Prolonged sitting may alter the passive stiffness of the lumbar spine. Consequently, performing full lumbar flexion movements after extended periods of sitting may increase the risk of low back injury.
A study was performed on 12 normal subjects to quantify time-varying changes in the passive flexion stiffness of the lumbar spine with exposure to prolonged sitting and to link these changes to lumbar postures and trunk extensor muscle activation while sitting. The participants performed deskwork for 2 hours while sitting on the seat pan of an office chair. Moment-angle relationships for the lumbar spine were derived by pulling participants through their full voluntary range of lumbar flexion on a customized frictionless table.
It was found that lumbar spine stiffness increased in men after only 1 hour of sitting, whereas the responses of women were variable over the 2-hour trial. Men appeared to compensate for this increase in stiffness by assuming less lumbar flexion in the second hour of sitting. Changes in the passive flexion stiffness of the lumbar spine may increase the risk of low back injury after prolonged sitting and may contribute to low back pain in sitting. (Beach TA. Parkinson RJ. Stothart JP. Callaghan JP. Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. Spine 5(2):145-54, 2005
Here is a study showing how to treat low back pain by drawing in the abdominal wall as a specific exercise for the transversus abdominis muscle (in cocontraction with the multifidus). Clinical effectiveness has been demonstrated to be a reduction of 3-year recurrence from 75% to 35%.
Biomechanical effect of this specific exercise on the mechanics of the sacroiliac joint was examined on 13 healthy individuals in the prone position during the two abdominal muscle patterns by means of Doppler imaging of vibrations and simultaneous electromyographic recordings.
Contraction of the transversus abdominis significantly decreases the laxity of the sacroiliac joint. This decrease in laxity is larger than that caused by a bracing action using all the lateral abdominal muscles supporting the use of independent transversus abdominis contractions for the treatment of low back pain. (Richardson CA. Snijders CJ. Hides JA. Damen L. Pas MS. Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 27(4):399-405, 2002
This is a very simple exercise that can be performed while sitting, standing, walking or lying down for those who have low back pain as well as very useful as a preventive exercise for those who are not in pain.
www.stopmusclepain.com Low Back Pain| Sitting| Stiffness
Back Pain| Alternative Medicine|eToims Differences
March 7, 2008 2:58 pmMarch 7, 2008
An article by Sherman KJ. Cherkin DC. Deyo RA, et al, discusses that patients frustrated with conventional care for back pain, turn increasingly to complementary and alternative medicine. Between 10% and 20% of visits to chiropractors, massage therapists, and acupuncturists is due to chronic back pain. Also back pain is the most common condition these providers treat.
Treatments given by each of these professions share certain similarities. Each has a hands-on technique at the core of its treatments (ie, needling the body, manipulating the spine, or massaging the soft tissues), although many different variations of these techniques are used. These techniques are repeatedly used during successive visits, often in conjunction with various adjunctive modalities.
Each profession has a prototypical approach. For acupuncture, the typical approach includes assessments that are foreign to the biomedical community (eg, tongue diagnosis), regular body acupuncture using the approach of Traditional Chinese Medicine, and heat. Chiropractic typically includes spinal and soft tissue examinations at the first office visit followed by spinal adjustment, most often using the “diversified technique.” Massage therapy usually includes tissue assessment and a massage involving three major treatment styles: deep tissue, Swedish, and trigger point. Self-care recommendations are also a standard part of visits to acupuncture and massage practice and chiropractors. All three professions make self-care recommendations, with exercise being part of those recommendations for all professions.
Implications for Physicians: The article also states that in advising patients about the use of CAM therapies, physicians should be guided by evidence on effectiveness and safety. The amount and quality of evidence on effectiveness varies for these therapies. Spinal manipulation appears to be superior to sham and known ineffective therapies but not superior to effective conventional treatments for chronic low back pain. Previous acupuncture studies are generally of poor quality, so the effectiveness of acupuncture for treating low back pain is unclear. Although only three studies have evaluated massage for back pain, all three studies were positive.
While there is some variability in the treatment provided to chronic back pain patients by acupuncturists, chiropractors, and massage therapists, physicians may be reassured by this study’s data that the treatments used by these practitioners are relatively well characterized and “mainstream” for these professions and rarely include modalities that can be dangerous. (Sherman KJ. Cherkin DC. Deyo RA. Erro JH. Hrbek A. Davis RB. Eisenberg DM. The diagnosis and treatment of chronic back pain by acupuncturists, chiropractors, and massage therapists. Clinical Journal of Pain. 22(3):227-34, 2006)
eToims Twitch Relief Method is an individualized therapy with similarities to the work and soft tissue healing effects provided by acupuncturists, chiropractor and massage therapists. We emphasize on self-care techniques and guided exercise to prevent or limit further trauma to already injured nerves and muscles that can occur because of activities of daily living, work, sports, recreation, etc.
However, the practice of eToims Twitch Relief Method vastly differs from the above three alternative medicine practices since eToims Twitch Relief Method is a medical system that requires a sound knowledge of anatomy and electro-physiology. The eToims practitioner has to undergo significant training to be able to have skills to be able to locate and noninvasively stimulate irritable neuromuscular junctions (trigger points) within the time affordable by the patient for a treatment session.
The treatment results are determined by the patient's ability to have immediate reduction in pain, improvement in range of motion and other measured physiologic parameters compatible with pain reduction. Muscles are individually exercised in eToims and different body positions are used so that even the deep layers of muscles can be stimulated and exercised. Tight and problematic muscles are individually stretched through active twitch muscle contraction with the stretch emanating from the neuromuscular junctions where most of the shortened muscle fibers concentrate. This relieves pain through releasing the constricting effect of the tight muscles on intramuscular nerves, blood vessels, bone surfaces and joints.
The twitch induced exercise also aids in the circulation of fresh blood to the areas where blood could not flow previously due to muscles in spasm and removes stagnant fluids and pain producing chemicals from the same region. This removes pain and encourages nerves and muscles to heal.
eToims Twitch Relief Method is safe and efficacious and is the only treatment that delivers reproducible pain relieving results in neuromuscular pain such that patients are willing to pay out of pocket for chronic durations for increasing their quality of life. After three weekly sessions of eToims Twitch Relief Method, our retention rate is 85% for weekly return visits with self-pay patients.
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