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Working at Home:
Far from all of us are set up to work at home. Things to think about to avoid neck and back pain are good ergonomics and establishing routines. Starting with routines, find a place to do exercises which activate core stability and plan do do them as a break from work. There are several basic programs under Rehab Övningar. Schedule in regular walks outside, ideally in the forest and activate the core muscles which you have worked with on the floor.
Now lets look at your work station. Ergonomi (Ergonomics in the Workplace) Ideally you sit in a comfortable chair with the knees lower than the hips. The height of the desk is dictated by having a 90 degree angle at the elbow with the lower arm resting and pivoting on the desk (when using the mouse). This releases tension from the shoulder and neck. Ideally the tangent board and screen are separate. This allows you to raise the screen to an appropriate height. The screen height should be at eye height or slightly lower if you use computer glasses. The goal is to avoid creeping into the screen and finding yourself with the head positioned forward to your shoulders. The weight of the head increases the stress on the neck with about 25 kilos. Try to sit up straight and activate the core muscles so you are not hanging on your back. Think of this as a training session.
As Biomechanical specialists
We examine all the joints of the body (except the inner ear…).
What are common problems that we treat in our office?
We start at the feet. We evaluate the function of the feet and by improving the mobility of all the small joints many problems causing discomfort can be addressed. Some causes of pain or discomfort actually originate in the low back, so we are always considering this as a possibility of why a patient has foot pain. Some of the different types of problems are heel spur (hälsporre), Achilles tendonitis, Morton’s neuroma, hallux rigidus, hallux valgus, plantar fasciitis among others. In some cases we tape the foot for a period of time to address instability. Our role is to improve function by mobilizing or manipulating different parts of the foot. Once function is improved, exercises to stabilize the foot and appropriate foot wear are recommended.
The knee is a hinge joint. When function is impaired this leads to instability and strains primarily the surrounding joints. In some patients knee pain reflects a primary problem in the hip and must be differentiated. We have these important skills in differential diagnosis. Understanding the origin of the problem is the first step in the assessment of the patient. Only then can adequate treatment be performed and proper rehabilitation recommended. The goal with treatment is to restore normal function in the joint and to recommend exercises to stabilize the joint. In some cases a brace to stabilize the knee is needed.
The hip joint is a ball and socket joint that is part of the pelvis, it is a very stable. Reduced mobility in this joint directly strains the joints of the pelvis and lumbar spine. This responds well to mobilization and stabilizing exercises.
A common problem area is the pelvis, low back and hip complex. Having skills in differential diagnosis is critical to differentiate a hip problem from a pelvis or low back problem. Clinically, it is very common that a patient has been told they have a hip problem when a thorough examination reveals a problem stemming from the low back. The lumbar spine sits on top of the pelvis, in particular the sacrum. The spine is like a chain with many small parts that should be mobile. In the lumbar spine the joints are formed to move sideways and forward and backward. This area is injured most often when bending forward, twisting and lifting.
As we move up the spine to the thoracic spine, (or bröstryggen), the vertebrae are formed differently and move most easily sideways, forward and backward and in rotation. The ribs attach to the vertebrae (costovertebral joints) making up the chest and they attach in the front of the body to the sternum with the costosternal joints. The rib cage is susceptible to injury during heavy lifts and certain twisting movements. When the costovertebral joint is sprained, it can be difficult to take a deep breath or twist the upper body. This area is most commonly injured while lifting heavy things with outstretched arms. When the ribs are involved, the pain can travel around the rib and/or through the ribcage. Some people think they are having a heart or lung problem. Examination of this injury or dysfunction requires specialty education in biomechanics. We commonly treat this and show exercises which are necessary to stabilize the injured area.
The cervical spine (halsryggen) sits on top of the shoulders and bears the weight of the cranium. The cervical spine glides sideways, forward and backwards with the majority of rotation at the junction of the uppermost vertebrae and the cranium.
When parts of the “chain” or vertebrae are not moving as they should, there is a strain on the adjacent areas. The goal with treatment is to restore normal functioning and recommend exercises to make the area stable.
The shoulder complex is made up of the clavicle, the shoulder blade and the head of the humerus (top of the arm). The glenohumeral joint or the moveable part of the shoulder is rather unstable compared to the hip. It is more easily injured and requires very specific training to avoid common long-term problems. The clavicle and shoulder blade are less often injured, but may not function optimally with a shoulder injury. These are addressed in treatment and rehabilitation.
The elbow and wrist are common areas of complaint. The elbow is a unique joint which bends and can rotate. Depending on the type of injury or overuse syndrome which presents treatment addresses joint function and muscles that support the joint. The wrist has many small bones and the joints here must function perfectly to avoid pain and discomfort. In recent years complaints have increased with the monotone use of the arms at the computer. Good ergonomics are critical for avoiding overuse and appropriate information is an important aspect of rehabilitation.
Pain in the shoulder, arm, elbow, wrist or hand can reflect a problem in the neck.
Our skills in differential diagnosis can determine where the problem comes from, whether it is a problem amenable to chiropractic care, or whether another specialist should examine the patient.
World Spine Day 16/10
stresses the importance of self-help for back pain
World Spine Day is organised by the World Federation of Chiropractic on behalf of the Global Alliance for Musculoskeletal Health and this year highlights the global burden of spinal pain and disability. This year’s theme, Love Your Spine, emphasises the importance of self-help in the management of back pain.
Low back pain is the biggest single global cause of years lived with disability. At any time, it is estimated that over 1 billion people around the world are suffering with low back pain, with 4 out of 5 adults experiencing at least one disabling episode during their lives. It can profoundly affect work life, home life and social life, and low back pain can lead to other health issues. People suffering with persistent back pain are three times as likely to suffer mental health issues such as depression.
This year’s World Spine Day focuses on how people can look after their spine and help prevent episodes of back pain. Under 1% of all back pain is caused by serious underlying problems, such as cancer and infection, yet people are often fearful of exercise and daily activities because they think it will make their condition worse. This is a myth, says World Spine Day Global Coordinator, Dr Robyn Brown.
“The old-fashioned advice to rest or lie on a board has never been supported by evidence. To the contrary, prolonged rest can often lead to muscle wasting and stiffness and make the problem worse. People with back pain need to know that in the vast majority of cases, getting out, moving and continuing to live a normal life is the best treatment.”
Evidence has shown that low back pain can affect people across the life course, from schoolchildren to the elderly. A long term study in Denmark involving 1400 schoolchildren showed that over a 3 year period 55% of schoolchildren aged 5-15 suffered at least one episode of spinal pain. Although this was usually short-lived and trivial, one in five children was found to be suffering with three or more episodes per year. Seventeen (17%) percent of episodes lasted more than 4 weeks. Worryingly, child back pain sufferers are more likely to become adult back pain sufferers.
World Spine Day reaches around the globe and has attracted over 500 partner organizations globally, from hospitals and clinics to schools to government agencies, all committed to raising awareness and educating the public. On World Spine Day, activities will take place around the globe to engage people around the #LoveYourSpine theme.
Earlier this year, The Lancet published a series of papers on low back pain. The papers were picked up by media around the world, and resulted in an explosion of social media attention, with over 15 million tweets alone. The findings of the authors were stark – disability due to low back pain has increased by over 50% since 1990, especially in low and middle-income countries – yet access to effective services remains poor and many myths and misconceptions remain.
Dr Brown adds: “We know that back pain is complex and that it’s not just made worse by physical factors. Attitudes and anxiety around back pain as well as social factors also play a part. We call this the biopsychosocial model of back pain. One of the biggest challenges we face is that other than in a small proportion of cases it’s not possible to identify exactly what’s causing the pain.”
“We do know that certain groups are more likely to report low back pain than others,” continues Dr Brown. “People with physically demanding jobs, people who have other physical and mental health issues, smokers and obese people are at the greatest risk of reporting low back pain.”
How do we prevent back pain and best advise people how to #LoveYourSpine?
The latest and best evidence does not support the use of drugs and surgery. The Lancet papers recommend education and self management strategies. Advice to get back to normal activities as quickly as possible and to exercise was seen to be most effective with psychological programs added to those with persistent symptoms.
The guidelines recommend limited use of medication, surgery and imaging, such as x-ray and MRI. In particular, inappropriate use of opioids and spinal injections for back pain came in for strong criticism. Chiropractic care has been shown to be effective in treating acute and chronic back pain with maintenance care reducing recurrent episodes of low back pain.
Dr Brown says: “The most effective strategies are those that get people back to work early and educate them about the reality of back pain, that movement is medicine and that effective collaborations between patients and their health care teams of spine care professionals work best. See someone who will help you to help yourself ”
Guidelines for Treatment of Low Back Pain
The American College of Physicians (ACP) has presented guidelines for the treatment of lowback pain based on the scientific evidence and provides clinical recommendations on noninvasive treatment of low back pain. The recommendations for all physicians treating patients with lowback pain, whether acute or chronic conditions, was to avoid prescription of pharmacological agents and instead recommend spinal manipulation. For patients with chronic lowback pain, besides spinal manipulation, other nonpharmalocgial recommendations are appropriate: exercise training to activate the core muscles; acupuncture; mindfulness; and relaxation techniques among others. As a chiropractic physician, treatment of lowback pain varies depending on the diagnosis. Critical to all patients is learning what is neutral posture, how to activate the core to support it and then appropriate exercises to slowly strengthen the core without straining the back. Techniques vary and include deep soft tissue, gentle mobilising, activator technique (an instrument used apply a graded force to a joint, particularly when low force techniques are indicated) and manipulative joint techniques appropriate to the patients size and condition.
FÖREBYGGANDE BEHANDLING MINSKAR LÄNDRYGGSBESVÄR
Patienter som kom regelbundet till Kiropraktorn i förebyggande syftet under 12 månader hade mycket mindre besvär än patienter som kom när de hade besvär (Eklund, 2018).
Under 2010 har ledare i neurologi, medicin och forskare i kiropraktik samlat ihop vetenskaplig bevis angående kiropraktik även kallat manuell medicin och hur effektiv den är. De har funnit att efter de högsta kraven när det gäller vetenskapliga bevis kan man nu säga att kiropraktisk behandling med manipulation/mobilisering är effektiv behandling för:
- ont i ländryggen, båda den akuta och mer kroniska fasen av besvär
- migrän och huvudvärk som kommer från nacken
- yrsel som orsakas av nacken
- ont i nacke, båda den akuta och mer kroniska fasen av besvär. Nya bevis inom vetenskaplig forskning.
- problem med leder i armar och ben (axel, armbåge, handled samt höft, knä, vrist och fot)
- plantar fascit, carpal tunnel syndrom, rotator cuff syndrom
Rapporten visar att det finns positiva bevis för behandling av en del andra problem än rygg o nacke, både det som gäller övrig muskulatur och leder men också andra besvär .
Stukad vrist, ont i svanskotan, ischias, käkleds besvär (TMJ), spänningshuvudvärk samt PMS, mensvärk och lunginflammation hos äldre. Patienter som svarar positivt på behandling har ett problem med funktionen i lederna, och symptomen lindras när man återställer funktionen i de drabbade leder. Det finns även indikation att behandling kan vara effektivt vid astmabesvär.
Rapporten visar att behandling är både ofarlig och lämplig för alla ovan nämnda problem.
Utan tvekan kan man nu säga att manipulation/mobilisering utförd av kiropraktorer med utländsk godkänd utbildning (se www.LKR.se för svenskar med lämplig utbildning) är viktig i behandling av rygg och nackbesvär samt ont i huvudet.
Studier bekräftar vad vi har sett i praktiken sedan länge. Behandling av patienten i sin helhet förbättrar kroppens funktion och förmåga. Normal funktion of knä och höfter gör att ländryggen fungerar optimalt. När man börjar förlora rörlighet i de leder, sliter man på ländryggen och skynda de degenerativa förändringarna. Behandling av knä och höft problem så att de inte förlorar sin rörlighet minskar risken för ländryggs besvär.
Ergonomics at home and in the work place
Here is a group of pictures showing good ergonomics at home and in school. The basic principles are to vary standing and sitting. Standing is better for you body as long as it feels good. The screen should be at eye height until you use progressive eyeglasses, when the screen is slightly lowered. Avoid tilting your head to look at a screen. This protects your neck. The angle at the elbow should be 90 degrees and the lower arm resting and pivoting on the desk. This relieves shoulder and neck tension. Depending on the angle of the spine, it can be comfortable to have one foot on a stool, stand wide based with good posture.
For more information and pictures follow the link Ergonomi
Idrottare
En idrottare är allt från barn som lär sig en sport, ungdomar som tränar, vuxna som tävlar till vuxna och äldre som håller sig igång. Som ung är det viktig att träningen är anpassad efter ålder, detta för att minimera risken för skada. Björn är engagerad som tränare och kiropraktor för barn från sex åringar och uppåt i ålder i båda hockey och fotboll och har utbildning som fokuserar på förebyggande av skada och ålders anpassade träning. Senaste forsking från Danmark visar tydligt att barn klarar sig bättre från allvarliga idrottsskador genom att inte specialisera sig för tidigt. Helst ska man träna olika sporter medan kroppen utvecklas.
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Behandling av den skadade idrottaren sker i flera steg. Först måste man ha kunskap för att diagnostisera problemet, vilket betyder att man måste förstå vad som är fel. Behandlingen har som mål att återställa funktionen, främja läkningen av den skadade vävnaden och sedan lära ut övningar som stabiliserar området. Stabilitet i bålen är grunden till balansen och kontroll i hela kroppen. Stabilitetsträning av bålen hör till träningen i alla åldersgrupper och alla sporter. För de som redan har haft nack- eller ryggbesvär är råd om lämplig träning viktig så man inte överanstränger det skadade området. Det är viktigt att titta på hela idrottaren. Förutom rygg eller nackbesvär är det vanligt med axel, arm, handled, höft, knä, fot eller ljumsksmärta hos idrottare. Det är viktigt att titta på hela individen och inte bara symtom området. Vid knä besvär eller lårmuskelproblem är det även viktigt att titta på bäcken, höft o ländrygg, (se nedan). När hela kroppen fungerar optimalt, kan man prestera maximalt. Råd om kost och näring är viktig för alla som tränar flera gånger i veckan.
Referenser:
Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C. 2018. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLoS ONE 13(9): e0203029. https://doi.org/10.1371/journal.pone.0203029
Qaseem A, Wilt T, McLean R, ForcieM. 2017. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine; 166(7):514-530.
Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, Faber-Dobrescu M, Andres C, Graham N, Goldsmith CH, Brønfort G, Hoving JL, LeBlanc F. 2015. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev.;9:CD004249. doi: 10.1002/14651858.CD004249.pub4.
Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. 2014. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap;22(1):12. doi: 10.1186/2045-709X-22-12.
Bronfort G, Haas M et al. (2010). Effectiveness of manual therapies: The UK evidence report. Chiropractic & Osteopathy.18:3. Doi:10.1186/174601340018-3.
Haldeman S, Underwood M. (2010). Commentary on the United Kingdom Evidence Report about the effectiveness of manual therapies. Chiropractic & Osteopathy.18:4. Doi:10.1186/174601340018-4.
Hondras MA, Long CR, et al. (2009). A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low-back pain. JMPT;32:330-43.
Senna MK, Machaly SA (2011) Does Maintained Spinal Manipulation Therapy for Chronic Non-Specific Low-Back Pain Result in Better Long Term Outcome? Spine DOI: 10.1097/BRS.0b013e3181f5dfe0.
Haldeman S, Chapman-Smith DA, Peterson DM eds (1993) Guidelines for Chiropractic Quality Assurance and Practice Parameters. Aspen Publishers, Gaithersburg, MD.
Henderson D, Chapman-Smith DA, Mior S, Vernon H eds (1994) Clinical Guidelines for Chiropractic Practice in Canada Suppl to JCCA 38(1).
Bigos S, Bowyer O, Braen G et al. (1994) Acute Low-Back Problems in Adults. Clinical Practice Guidelines No. 14. Rockville, Maryland: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services AHC PR Publication No. 95-0642.
Murata Y, Takahashi K, Yamagata M, Hanaoka E, Moriya H. 2003. The knee-spine syndrome: Association between lumbar lordosis and extension of the knee; J Bone Joint Surg [Br];85-B:95-9.
Offierski CM, Macnab I. 1983. Hip-spine syndrome. Spine;8:316-21.
Chaibi , Russel M, Tuchin P. 2011. Manual therapies for migraine: a systematic review. J Headache Pain;12:127–133.