Archive for November 2013

[WATCH]: Right Sided Lower Back Pain: Abby S.

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Lower Back pain Causes- Part 1

There are many things that lead towards the starting of Lower Back Pain. Lower Back Pain itself is not a disease but it is an indication of some other Medical problem which can be serious

There are many things that lead towards the starting of Lower Back Pain. Lower Back Pain itself is not a disease but it is an indication of some other Medical problem which can be serious. 1. Improper Lower Back Pain MovementThe most common cause for Lower Back Pain is the wrong movement of Back Bone. Back Bone is the most important and complex part in the human body. One should take good care of Back Bone. All the nerves controlling the whole human body coming from the brain are inside the Back Bone. In the worst case of Lower Back Pain, the patient loses control of his/her body and it is because the nerves inside the Back Bone are damaged. Have you seen the 2004 Oscar Award winner movie “Million Dollar Baby”? I think you got the point. People lift heavy weights in terrible postures making their Back bone weak and damaged. Back Bone is the only support between the Hip Bone and the upper body. Every thing stands on the Back Bone alone so we should respect our Back Bone which most of people don?t do.

There are different kinds of jobs that people do. Some require too much running around, where some require sitting on a chair all day long. Let?s take the example of a web designer, I personally know a guy who work online and develop Web Sites. His work require when to sit on the chair for many hours and he sit in front of his computer as long as 16 hours. Awesome, he is crazy isn?t he? Actually he is my patient too and he came to me because of Back Pain. I didn?t have him any medicines, you heard it no medicines at all. Are you thinking why? Here is your answer; the problem with him and many other people is that they sit too long making things uncomfortable for their Back Bone and thus generating Back Pain. This pain is directly connected to the amount of rest you are having in your daily life.

It?s true that human Back Bone needs rest but there is another scenario where you don?t sit too long but still have Lower Back pain. This scenario is where people do things in wrong postures. These wrong postures means wrong Back Bone shape which means terrible. I think its better to explain with some figures but PLEASE don?t laugh at the pictures that I have drawn because I am a Doctor not a Graphic designer.

Let?s start with the Basic shape of human Back Bone. Please take a look at the figure below.Please obverse the Lower Back Bone area. See that curve? This is what I am talking about all the time. This area is not straight so when you sit for long period of time, this area produces pressure on the nerves that are passing through the Back Bone and thus causing the mighty Lower Back Pain. Try to have a posture, whether it is a standing, sitting or sleeping posture, in which your Lower Back Bone is as straighter as possible. The best or ideal all positions posture will be like the below picture.

So now the question arises that How to position the Lower Back Bone in the above mentioned shape?Well there are few things to remember. First of all let?s talk about sleeping posture. Take a look at the below figure, this is not presenting any Back Bone. This figure is showing only the human body shape and it has noting to do with the Back Bone. Well to be honest, it looks like the person is sitting but I want you to imagine that the person is on the bed and is sleeping. Sorry for .Jshowing you bad drawingThe point is that this is the perfect position for all human being to use while sleeping. I have some patients who sleep up side down. This is the worst sleeping posture. These patients?s greatest problem is to change their sleeping posture. I had many patients coming back to me and telling me that they tried hard to change their sleeping posture but they cannot get rid of it and they feel very uncomfortable when not sleeping upside down. Many patients cried for not sleeping for many hours trying to change their habit.

This is the hardest part for all those who have the bad habit of sleeping upside down. You can also sleep straight facing the sky but to be a little honest here; I am a doctor right? So it is my duty to tell you about every thing. There is a long term disadvantage of sleeping straight facing the sky and that is, Snoring can occur because when you sleep straight, your tongue keeps on moving backwards towards the stomach. It is very much possible that this snoring problem do not occur at all. So it?s up to you to decide which the best sleeping posture is.

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Shoulder Pain ? How Do I Tell What?s Wrong With Me?

Shoulder pain is a common problem that affects the majority of the population.  Most people will experience some degree of pain in their shoulder at some point.  The causes of the pain and the degree of the intensity of the symptoms will vary from person to person.  The recovery and return to normal function will also vary from person to person for a variety of reasons.  But how do you tell what is causing your shoulder pain?  This article addresses some common ways that the various pain generators of the shoulder are diagnosed from the perspective of an experienced Physical Therapist.

Three common pain generators of the shoulder are the rotator cuff muscles and tendons, the bursa and the shoulder capsule.  The purpose of the rotator cuff muscles and tendons is to move our shoulder in a rotating fashion (hence their name) and to help up elevate our arms over our head.  The purpose of the bursa or bursal sac is to protect the muscle from scraping on the edge of the bone.  So the bursa sits between the muscle and the bone and acts like a cushion.  Without it the rotator cuff muscles would repeatedly scrape on the edge of the bone and become easily irritated.  The shoulder capsule offers added stability to the shoulder joint.  Any one of these structures can become a pain generator if they are inflamed or injured.  Often times they will be inflamed in conjunction with each other. 

It can sometimes be tricky to diagnose the exact pain generator because the symptoms that are experienced by people with these pathologies are typically very similar to each other.  More often than not these pathologies will cause symptoms of pain, weakness, and loss of motion.  The pain is typically felt in the shoulder region and is often felt in the upper arm above the elbow.  People with shoulder pain will commonly feel an increase in pain when they are trying to raise their arm overhead or out to the side.  So if these pathologies are so similar in nature how can we tell them apart?

Well, in physical therapy there are some simple tests that can be performed that will help distinguish between the different pathologies described above.  I will describe them here briefly.

Rotator cuff tendonitis:  if one or more of the rotator cuff muscles is inflamed this is termed tendonitis.  This is diagnosed by simple manual muscle testing where the physical therapist will resist specific motions of the shoulder that the rotator cuff is responsible for.  If the patient experiences pain during a manual muscle test this is indicative of a tendonitis.
Bursitis:  this can pose a challenge for the therapist to diagnose but if they are well trained they can more easily identify this as a problem.  The tests start with manual muscle testing as described above.  If one of the manual muscle tests is painful the Physical Therapist can then perform a Pull Test.  This is a specific test that is specific to the bursa.  If it is positive then it is likely that the person has a bursitis of the shoulder. 
Adhesive capsulitis:  this is also commonly known as frozen shoulder.  To make a diagnosis of adhesive capsulitis the Physical Therapist must passively test the motions of the shoulder.  Remember as I mentioned above that any one of the pathologies discussed here can present with a limited range of motion.  Adhesive capsulitis presents with a very specific limitation in motion that will likely differ from the limited motion seen in tendonitis and bursitis. 

If the symptoms of these pathologies can be so similar then why do we need to be so specific in the diagnosis?  The reason is that although symptoms are similar the treatments for these conditions can vary slightly from each other.  Some things that I may do for an adhesive capsulitis I might not do to treat a tendonitis and so forth.  So a specific diagnosis can help guide the Physical Therapist toward a specific plan of treatment for the pathology in question.  A well-rounded treatment plan will lead to positive results in improving your painful shoulder.

Peter Harris is a licensed Physical Therapist with 17 years experience in the profession treating patients with shoulder pathology.? A painful shoulder can persist for years, significantly impacting your quality of life.? You don?t have to suffer any longer.?