Unexplained Arm and Leg Symptoms

This post is about Central Cord Syndrome; please see the article from my last post for reference.

There is one diagnosis that is often not discovered until it is too late. It is called central cord syndrome or central cord compression. Your spinal cord is being compressed within a part of the neck, so you experience not only neck/arm symptoms but other symptoms in the lower body as well.

Neck Pain
Usual neck problems can cause neck pain and/or refer pain to the shoulder or down the arm. If this is your only symptom, you likely do not have anything compressing your spinal cord in the neck. You may have a neck diagnosis that can be treated with usual medical treatments such as medicine, Physical Therapy, injections, surgery, or other alternatives.

Back Pain
Similarly, low back problems can produce back pain and symptoms radiating into the buttock(s), hip(s) and/or leg(s). If this is your only symptom, you likely do not have Central Cord Syndrome. I highly recommend you request a prescription for Physical Therapy from your doctor in order to treat your back/leg symptoms.

Neck/arm AND Back/leg Symptoms
If you have neck/arm symptoms AND leg symptoms at the same time, you may need further medical attention quickly! Some leg symptoms are: difficulty walking, progressive loss of balance/falls, leg pain, and numbness/tingling in the leg. Other symptoms include loss of bowel/bladder control/function and/or loss of sensation in the pelvic region.

Examples:
1. You have a neck injury that appears to have resolved. But now you have progressive weakness in one or both of your legs.
2. You have knee pain that started without a knee injury. Actually it started around the time that you were in a car accident and hurt your neck. It keeps getting worse despite treatment for knee pain.
3. You have what feels like carpal tunnel syndrome in your hand(s). It has been going on for several years but is not improving with treatment. Also, your neck hurts and you have numbness in your leg(s) during the same period of time.
4. You have been treated for neck pain and it is mildly improving, but you recently notice that you cannot control your bladder like usual.
5. You have a neck injury that radiates pain and tingling down your arm. You did not notice at first, but you feel the same symptoms in your leg(s), which began at the same time.

Neck/Back Pain
If you have both neck/arm symptoms and back/leg symptoms that began at different times, then you may have 2 different problems that need to be diagnosed/treated separately. In this case, be sure to inform your doctor about all your symptoms so he/she can rule out a more serious problem such as Central Cord Syndrome.

Best Book for Self-Treatment of Painful Joints

Do you have joint pain that you cannot afford much medical treatment for? Robin McKenzie, a world-famous Physical Therapist and bestselling author, wrote a series of books about self-treating pain in various joints. I would highly recommend any of these if you have pain but cannot afford much therapy or other treatments.

Treat Your Own Back
Treat Your Own Neck
Treat Your Own Knee
Treat Your Own Shoulder

There may be various editions of these. I would recommend looking at Amazon or other websites to find the best prices, but you should be able to purchase one for $10-$15.

For more of McKenzie's exclusively-designed products such as lumbar rolls and pillows, check out OPTP.com.

Of course, if you have serious joint pain that is not resolving, please see your physician and request a prescription for Physical Therapy.

What Pillow Is Best For Your Neck?

Photo: RelaxingMusic

What pillow should I use? This is a common question I hear from my patients with neck pain. They want to know if there is a specific pillow or type of pillow that I recommend, so here is my advice.

The height of your pillow(s) is the most important factor. For back sleepers: if your pillow is too high, your neck will be in a flexed or forward-bent position throughout the night. But if the pillow is too low, your neck will be extended or too far backwards. For right-side sleepers: if your pillow is too high, your neck will be bent toward the left while you are sleeping. So how high should your pillow be? Simply find the pillow that puts your neck in a neutral sleeping position.

The firmness of the pillow you select depends on your own comfort. If you like a firm pillow, you may only need one to attain the proper height for your head. But if you prefer soft, you might need two pillows, as your head will sink down into them.

For specific brands, I do not have a recommendation. There are some very inexpensive pillows that work well, but they obviously need to be replaced more often. The only two specialty pillows I have personally used are memory foam and down-filled. The memory foam pillow is very firm and has two curves, one of which is a little larger. So it can be used two ways, depending on the size of your head/neck. I liked the way it supported my head and neck, but it was too firm for my comfort. It could potentially be comfortable for back or side sleepers. The down-filled pillow was mildy comfortable for me, but there were two reasons I stopped using it. First, the feathers were pointy sometimes, and even extra pillowcases did not smooth out the surface. Second, the pillow sunk down too low for my preferred pillow height.

I have seen TV ads for more expensive pillows, but I have never tried them. If you have exhausted cheaper options, you may want to purchase a higher quality or specially designed pillow. However, be sure to identify if your neck pain is only a result of sleeping or if you have a neck problem that needs medical attention. If your neck pain is present during the day or before going to bed, it may not be a pillow issue. Be sure to consult your physician if you have chronic neck pain, severe neck pain and/or neck pain that shoots down the arm(s).

Wrong Way To Use Computer, Short Video

Prevent Neck/Shoulder/Upper Back Pain With 3 Exercises

If you have pain in all of these areas, you may benefit from these exercises, which help to strengthen your postural muscles.

First, roll your shoulders in backwards circles (up, back, down) slowly. Repeat 20-30 times. Keep your arms down at your sides.

Second, squeeze your shoulder blades together. Hold for 5 seconds. Repeat at least 10 times. Do not shrug up with your shoulders as you do the exercise.

Third, tuck your chin toward your throat, as if you are creating a double chin. Hold 5 seconds. Repeat at least 10 times. Keep your head straight, without looking up or down.


If your doctor has ruled out major diagnoses as the cause of your symptoms, then your pain could simply be a result of bad posture habits. So in addition to the posture exercises, you also need to look at your postures during daily activities. Anytime you are in one position for an extended period of time, you should try to have upright posture, with your chin tucked slightly, a slight arch in your low back and your ears lined up with your shoulders and hips. Keep a small pillow or lumbar roll behind your low back when sitting at a desk or computer.

It is possible that you may need ice, heat or massage after work to decrease your pain and knots, but wouldn't it be better to prevent the pain through good posture/exercises?

Which is easier for you? Good posture or postural exercises? Please post in comments!

Wrong Way to Brush Teeth

Why Does My Baby's Head Turn to One Side?

Have you noticed your infant's head turning to one side more than the other or always resting in the same direction? If so, it may be a result of torticollis, which is a tightening of the neck muscles on one side only. It limits your baby's ability to bend and turn his/her neck fully in one direction. Among babies, this can occur from positioning inside the womb.

If you catch it early, you can begin treatment, including Physical/Occupational Therapy, stretching and positioning. Early treatment is most effective for resolving torticollis without any residual problems.

Here are some problems that potentially can occur if torticollis is not diagnosed and treated right away. The head can become flattened on one side because infants sleep and lie down on their backs so much. If the torticollis remains for several months before treatment begins, the asymmetry of the head can remain permanently. One treatment to decrease such asymmetry is a helmet/orthosis, which is fitted and adjusted by a certified prosthetist/orthotist (CPO). This may be used for several months but not beyond the age of 2 (when the skull bones are fused).

Be sure to tell to the pediatrician at your baby's initial well visits if you have noticed any head asymmetry or constant pull toward one side. Early intervention will produce the fastest recovery and prevent the need for more difficult treatments.

How Should I Stretch My Neck?

When your neck is stiff and tired from working all day or being on the computer all night, what is a good stretch? Your natural tendency is right--your neck needs to be moved and stretched.

Tuck in your chin toward your throat as if you are trying to create a double chin. Hold the position for at least 3-5 seconds. Repeat 5-10x. Do this several times throughout the day, especially when you are sitting at a desk or computer. This is an important stretch because most of us tend to have bad back and neck posture, especially when we are sitting at a computer or desk. Slumped low back posture leads to slumped upper back and neck postures, with the shoulders being rounded and the head too far forward. That is one reason why your neck may hurt at the end of each workday.

In order to prevent neck pain, stiffness and knots, be sure to improve your sitting posture by using a low back support (small pillow, lumbar roll or rolled up towel) in any chair that you are in for an extended period of time. It will be impossible to maintain a good neck position if your low back posture is slouched. Try to modify your sitting posture now because a lifetime of poor posture leads to multiple neck and back problems with increasing age.



Ref: McKenzie, Robin. Treat Your Own Neck. 2011: Orthopedic Physical Therapy Product.

The difference between Chiropractors and Physical Therapists

Let's imagine you have back pain, and you need some help. Who do you call? The good news is that you have options: primary care doctor, spine specialist, physical therapist, chiropractor or even alternative medicine (such as accupuncture).

So what is the difference between the treatment you get from a chiropractor and a physical therapist?

Chiropractors specialize in manipulating (popping) various joints and segments of the spine and pelvis. They usually take x-rays to determine the areas that are not properly aligned. Then they develop a treatment plan, which includes manipulations to many different joints of your back. Depending on the chiropractor, you may also get electric stimulation, heat, ice, and decompression (a form of traction). More rarely, you may get some exercises. Most health insurances cover chiropractic care, but you will likely have co-pays. And anything your insurance does not cover (certain procedures), you pay out of pocket. Many chiropractors recommend that you continue treatment for weeks-months and then come back periodically for spine adjustments.

Physical Therapists specialize in decreasing pain and restoring normal physical function through exercise, education, hands-on techniques (which may include tissue or joint mobilization and joint manipulations), posture/body mechanics training, functional activities, modalities (such as electric stimulation, heat, ice, decompression/traction, ultrasound), gait training (improving walking patterns), balance training, stretching and/or strengthening. All health insurance covers Physical Therapy, but you will likely have co-pays. To see a PT, you simply need a doctor's prescription (if you want your health insurance to pay for it). PT's aim to find out the cause of your pain/symptoms, to treat them and to teach you how to prevent them again in the future. The goal is to make you independent in managing your own symptoms so that you no longer need PT. Depending on your injury/surgery, you may need PT for 1-2 visits or up to several months.



References:
American Physical Therapy Association (www.apta.org)
American Chiropractic Association (www.acatoday.org)

Top 7 reasons why sitting causes back pain

1. Most people sit with slouched posture, which puts your low back in a rounded or flexed position for hours each day. Our backs were not made to stay in one position all the time. This can cause future problems in the spine such as arthrits, herniated disks, and sciatica.

2. People who sit at work typically sit for too long without changing positions. If your job involves sitting all day, standing up, stretching or walking around briefly every 30-60 minutes will help.

3. Very few people sit with lumbar support, which helps to align the low back. Good posture starts with the pelvis. Tilt your pelvis forward so that less of your buttocks are supported on the chair. That way the bottom of your pelvis is supporting your trunk and you increase the arch in your low back. Once you have that position, use a lumbar roll/pillow to maintain it.

4. A slumped low back leads to a rounded mid back with shoulders rounded forward and the neck to be excessively forward. This can lead to progressive neck problems and even shoulder pain (especially with lifting overhead).

5. Aside from sitting at work, we tend to have a sedentary lifestyle, with many leisure activities done also in the sitting position. With present technology, we can do almost everything from the convenience of our homes. While it is convenient to buy clothes and even stamps at home, it is taking a toll on our backs. Having a sedentary lifestyle leads to obesity, which carries multiple health risks.

6. We do very few activities with our spines extended backward, which is an important position to achieve regularly for optimal back health. If you do not regularly lean backward (increasing the arch in your low back), then start doing so several times daily. It can be done sitting or standing. Another way to arch backward is to lie on your tummy and prop up on your forearms.

7. Slumped sitting posture puts the back muscles (and other back tissues) in a lengthened or stretched position while also causing the muscles and tissues on the front of the hip, abdomen and chest to be in a shortened position. This imbalance can cause further posture problems, weakness and instability with greater risk for back pain and injury.

Scary PAIN Statistics

Adults who had low back pain that lasted 1 day or more in 2009:

     26% of males, 30.2% of females    (1)

Adults who had neck pain that lasted 1 day or more in 2009:

     12.6% of males, 17.5% of females   (1) 

Number of non-institutionalized adults with diagnosed arthritis in 2009:

      52.1 million (which is 23% of adults in U.S.)  (2)

Number of ER visits for unintentional injuries/accidents in 2008:

      28.4 million   (3)

Number of unintentional injury deaths in 2007:

     123,706 (which is 41 deaths per 100,000 population)    (4)

Number of doctor/hospital/ER visits for injuries in 2006:

      80 million   (5)

DON'T BECOME ANOTHER PAINFUL STATISTIC! Here is my top 1 way to prevent each of the above problems.

1. Low back pain:  BODY MECHANICS!!!!

2. Neck pain:  POSTURE!!!

3. Arthritis: WEIGHT CONTROL!!!

4. Accidents/Injuries: SAFETY PRECAUTIONS!!!

5. Unintentional injury deaths: PERSONAL AND CORPORATE SAFETY!!!

References

(1) NHIS 2009 Vital Health Statistics. Pleis JR, Ward BW, Lucas JW. Summary health statistics for U.S. Adults: N.H.I.S. 2009 (provisional report). Vital Health Stat 2010; 10(249). 

(2) NHIS 2009 Vital Health Statistics. Pleis JR, Ward BW, Lucas JW. Summary health statistics for U.S. Adults: N.H.I.S. 2009 (provisional report). Tables 7,8.

(3) National Hospital Ambulatory Medical Care Survey: 2008. Emergency Dept Summary Tables, Table 15.

(4) CDC Fast Stats. Source: Deaths: Final Data for 2007, tables B, 18.

(5) CDC Fast Stats. Source: Ambulatory Medical Care Utilization Estimates for 2007, table 7. Average annual 2006-2007. 

PAIN PREVENTION while sitting

This is dedicated to Marti Bedell and her real estate team!

Do you sit a lot at work? Do you drive a lot at work? Excessive sitting over a lifetime can lead to back problems later in life. This is especially true if you habitually slouch. So how can you maintain a HEALTHY BACK over a lifetime of sitting?

First, try not to sit all day. Are there a few activities that you could do standing up? Mail, email, phone calls, etc? If you have a desk job, you are likely in the habit of sitting for almost all your daily tasks. But if you are creative, you could easily find at least a few minutes each hour to either stand or walk around.

Second, whenever you sit, be sure to sit with good posture. There should be a small arch in your low back, and your neck should not be strained forward. Your shoulders should be relaxed, and your forearms resting on your desk or keyboard. Your wrists should be straight.

Happy sitting (and standing)!

How to decrease BACK/NECK PAIN at work

Two easy ways to decrease back/neck pain at work are to improve your posture and to change positions more often.  So for those of you who sit at work most of the day, here are some legitimate excuses for getting away from your desk at least once every hour.

1. To go to the bathroom.
2. To get your morning coffee.
3. To refill your water bottle.
4. To get some fresh air.
5. To stand up and stretch (stand up and lean backwards at least 1-2 times).
6. To ask a coworker a question (instead of an email).
7. To walk around the building (it may be better not to do this every hour if you want to keep your job).
8. To rally up your lunch crew.
9. To simply rest your brain and eyes for a moment.
10. To talk on your cell phone briefly or to send a text (pending work regulations, of course).

If you have to sit most of the day at work, be sure to use low back support in your chair. If your work chair is not ergonomic, take the initiative to find or request a new one. Your back will thank you.

Neck pain prevention for a multi-computer work station

If you work at a desk where you have to read multiple computer monitors, here are some posture/body mechanics tips!

1. Get a chair that can easily raise up and down (the more it can go up the better). Be sure when you have to look up to raise the height of the chair so that you can look more straight forward. Or if you have to, maybe stand sometimes, when you have to read the higher monitors.

2. Get a chair that rolls easily, so that you can roll side to side when reading monitors that are farther away from the middle.

3. Get a wireless keyboard so that you can have it on your lap when you have to scoot toward the sides of the desk.

4. Get several wireless mice and position them on different parts of the table.

5. Stand up or walk around at least 1-2x every hour.

6. Consider a keyboard slideout mechanism (at least one for the center part of the desk) and maybe even 2-3 of them for when you scoot to different parts of the desk.

7. Keep your neck in a neutral position. Try not to strain your neck forward. Keep your ears lined up with your shoulders.

8. Make sure your shoulders are in a relaxed position while you are sitting/typing. You should not have your shoulders shrugged up when sitting at the compter.

9. Use a lumbar roll for low back support (or roll up a towel and place it behind your low back) when sitting to help your posture (from the bottom up).

I am happy to welcome comments/questions!

Low back pain related to sitting posture

Bad sitting posture may not cause you immediate pain, but down the road it will. This is especially true if you have a desk/computer job where you sit most of the day. Slouched sitting posture, done all day, every day, will cause progressive changes in your spine, making it less stable and more prone to injury in the future.

So here are a few tips for improving your sitting posture.

1. Adjust the height of your chair so that you are sitting upright.
2. Stand up for at least 1-2 minutes every hour that you are sitting.
3. Use a rolled up towel or small pillow behind your low back for lumbar support.
4. Make sure that there is a small arch in your low back most of the time when sitting.
5. If the chair you use most of the time forces you to have bad posture, find a different one that gives you better back support.
6. Good posture starts in the low back, not the shoulders. Once your low back is upright, the upper back, shoulders and neck will be more upright also.
7. If possible, do some work in the standing position.
8. Walk around during your lunch break or other breaks. Walk more when you are not working.

Do you have any other suggestions that have helped you to prevent back pain at work?