You Won't Believe What This Doctor Prescribed To His Patient With Low Back Pain

Written by Dr. Prathap Addageethala

Originally posted as a shared article from The Washington Post on January 23, 2014

My patient came to me with an alarmingly regular case of low back pain. Stiffness, soreness, tight muscles in the expected areas. His posture spoke to me of years of sitting at a desk, pecking away at keys on his keyboard, straining his eyes at his screen, and reaching awkwardly for his mouse. After a thorough examination of examining his vitals, neurological condition, and orthopedic testing, I checked his spine. Finding nothing alarming, I advised for a course of treatment with an additional special, yet important, request:

"get off your butt."

Oh no he did'n't!

Okay, the truth is the patient was someone known to me, and we had a good laugh about it. The patient, being a young man in his late 20s, readily agreed that his lack of exercise and constant sitting was more than likely the cause of his low back pain and stiffness. Our conversation went well, and we discussed the treatment plan without any issue.

Our ancestors, I'm talking all the way back to hunting and gathering, were always on the move. Their diet was rich in high calorie foods (animal fats, nuts, high sugar fruits) and it sustained them through times where foraging was more difficult. Their daily activities were varied, and their physique tended towards a leaner, muscular form. Through all of these activities, calories were being burned at a much higher rate than today. 

I agree, it was a different time, with different pressures. However one constant remains - we tend towards a much more naturally lean and healthy form when we include a good diet and exercise to our daily routines. Getting up and moving around has incredibly profound effects in improving symptoms in all kinds of issues, ranging from chronic pain to autoimmune diseases to acute postural stiffness. 

We're sitting more than ever, with our increasingly technological and automated society, and the scary thing is that we have not learned what long term repercussions are in store. In this way, "sitting is this generation's smoking" and this is a catch phrase burning through health and wellness circles all over the world (and here's just one example). Earlier, in the 30s, 40s, and 50s, smoking was so pervasive and normal. The risks were not well known then, until long term studies were being conducted. Sooner or later, we realized that smoking quite definitively caused lung cancer. Campaigns against smoking were launched, and while people still choose to smoke, NOW they are very well informed about its risks.  To put this in perspective, most public establishments only banned smoking indoors in the 90s in North America!

Sitting is leading to more and more issues that are only now becoming apparent. Check out the following graphic originally posted in the Washington Post for a much more in depth look at what I mean. Also, please see the follow up to this entry from another regular contributor, Dr. Joe Mondoux, a young, dynamic Chiropractor in Canada. His post will touch on the effects of sitting even if you are physically active.

- Dr. P

Taken from my very own Facebook page Dr. Prathap Addageethala 

Image shared from Washington Post

Are you a "Chronic Texter?"

Written by Dr. Prathap Addageethala

Originally posted September 18, 2013

Re-jigged March 17, 2015

You see it everywhere these days, people slaving over their smartphones and tablets! I imagine that if an intelligent being peeped down on us from outer space, it would wonder which was in charge- the fleshy creatures stumbling around, or the small electronic gadgets they hunched over. While the obvious strain on the pairs of unblinking eyes, terrible posture, and potentially deadly accidents are all problems associated with text mania (and addictions in some cases), I’d like to draw your attention to a new ergonomic crisis sweeping the globe – the repetitive strain injury (or RSI) – not-so-affectionately known as “Texter’s Thumb.”

Guided by GPS, they know exactly where to stop. Also notice the lane discipline!

To be fair, texting isn't the only major issue. Mobile video games, surfing the web, and other activities we normally engage in on our portable devices can also be labeled as chief causes of RSI.  Cell phone usage has exploded across the planet, other electronic devices notwithstanding. There are tablets, readers, laptops, GPS units, to name a few, all creating environments for stiff, repetitive motions to be performed. Of course, we’re also focusing here on the digits, most notably the thumb, but RSIs can occur at pretty well any joint in the body. The recipe is simple – do something in an awkward, disadvantageous, or ergonomically incorrect position, and repeat hundreds of times over several weeks. Like... pushing imaginary buttons on your phone's touch screen or obsessively swiveling the joysticks on your Playstation 4 controller.

"....braaaaaaains.....nom nom nom"

In classic “Texter’s Thumb”cases, sufferers experience pain or clicking at the base of the thumb, which is an area of high stress and chronic overuse.  At this joint, the carpometacarpal joint of the thumb, which involves the 1st metacarpal bone and the trapezium (a tiny bone in the wrist), interact at a much higher rate than the rest of the hand or wrist. Due to the involvement with the wrist, a decreased or painful range of motion might be experienced, as well as a possible decrease in grip strength.  The source of the pain can range from tendonitis (inflammation of a tendon due to acute injury) to tenosynovitis (inflammation of the sheath covering a tendon) which is simply from the repetitive nature of the action. This pain can even radiate all the way to the forearm.

In technical terms, the muscles and tendons affected are related to two muscles in the thumb – the extensor pollicis brevis and the abductor pollicis longus – which are both the main culprits in a more well known condition called “De Quervain’s Syndrome.” RSI, Texter’s Thumb, De Quervain’s Syndrome are all synonymous in this context. Although RSI can also occur in other parts of the body, this particular version seems to be on the rise. Staying active, stretching the wrists, and mobilizing the forearm should be a regular part of your day in order to avoid this emerging issue.

- Dr. P

Sensible Advice on Prevention of RSI Caused by Texting
(lovingly borrowed from http://solomonsseal.wordpress.com/2010/02/12/healing-texting-thumb-and-repetitive-stress-injuries-rsi-with-solomon%E2%80%99s-seal/)

You should always take measures to avoid any possible damage that might result from overstressing the hands, fingers or thumb. If you feel any pain or tingling, make some changes in your work, play and texting habits. The following tips are helpful:

• If texting starts to hurt. Stop. Use the other hand or call instead
• Vary the hand you use
• Vary the digits you use
• Don’t text for more than a few minutes without a break

Try these exercises. Obviously, stop if you feel any pain, otherwise you can do more harm than good.
In your texting hand:

• Tap each finger with the thumb of the same hand. Repeat 5 times (5x) Pull your thumb firmly with the other hand. Repeat 5x
• Wrap an elastic band around the tips of fingers and thumb and open your hand against the resistance. Repeat 20x
• Palms down, wrap an elastic band around each thumb and force apart. Repeat 20x
• Tap the palm and back of your hand on your thigh as quickly as you can. Repeat 20x
• Massage thumb web, back of forearm and front of forearm. 2 minutes.
• Press and rub in a circular motion the painful nodules in those muscles. 30 seconds for each nodule.
• Reach up high with both arms and shake your hands. Reach down low with both arms and shake. Repeat 3x.
• Arms at 45 degrees squeeze them behind you.
• If it still hurts after a week of doing exercises wrap an ice pack on sore hand and arm parts. Do not put ice directly on the skin but wrap in a thin cloth or piece of kitchen roll. 10 minutes on, 10 minutes off. Repeat 3x

Swiped from my own Facebook page at https://www.facebook.com/doctorprathap