STTING DISEASE: BACK PAIN AND NECK PAIN CAUSES

SITTING DISEASE AND ITS PROBLEMS

There are more people worldwide suffering from Neck pain and Back pain. Among the resons for this are related to Workstyle and Lifesyle. At work most people sit for long hours. Prolonged sitting has now been identified as a problem called the Sitting Disease. This is associated with diabetes, obesity and a shortened life. Other major problems are heart attack, strokes and spine problems.

It is important to break up sitting at work. Dr Prem Pillay, a Spine Specialist, recommends that you take Micro-Breaks from sitting every 30 minutes. Please stand for 30 seconds for every 30 minutes of sitting. Another option is to have a standing work desk. Combining a sitting and standing work desk is more healthy for you states Dr Prem, and can reduce the problems of Sitting Disease. Prolonged sitting can also occur on the way to work and on the way home. Sitting in a bus, MRT train, taxi and a car for long hours particularly in City traffic is harmful as well. Standing up from sitting when and where possible for a few seconds is still helpful says Dr Prem Pillay.

Many people also have a sedentary lifestyle away from work. They come home and sit on the couch or chair and watch TV for hours. This is common in older people. Younger people also often sit at home in front of a computer to interact with their friends on FaceBook and other social media; or to play computer games. It would be better to shorten these activities. Having a proper healthy lifestyle requires some outdoor activites. For older people this should include walking and even gardening or dancing. For younger working people, regular light exercise including fast walking, swimming and cyling would be suitable states Dr Prem Pillay.

Children now have bad habits from their early years with poor posture when sitting and standing.  Many children now spend their home hours playing on laptops and ipads. This is bad for their health. Dr Prem  encourages parents to encourage their children to play outdoors when they come home from school. This is especially important for children who do not do enough sports at school.

In conclusion, Dr Prem Pillay has given a list of health tips:

1.A Comfortable Sleep Enviroment helps rest the spine. Use a firm but comfortable mattress; a spine mattress is made by many manufacturers and a good thin pillow.

2. Try to manage your weight . If you are overweight,  weight reduction does reduce loading on the spine.

3. A Good Posture while sitting, standing and working will reduce stress on the spine

4. Reduce the weight of bags and briefcases that need to be carried to and from work places.

5..Recognize spine related pain early and get the right treatment from the right specialist

Furthur info:

www.spine-neuro.org

www.singaporespine.org

BACK PAIN IN EXECUTIVES

BACK PAIN IN EXECUTIVES

There is an increase in the problem of Back Pain worldwide. According to Dr Prem Pillay , a Spine and Nerve Specialist, an important reason for this is our modern 21^st Century Lifestyle. We are sitting for long hours at work and sitting for many hours at home. Many modern office workers and executives are now suffering from Back Pain as a result of this.

Back Pain used to be seen mainly in those who worked in physically demanding jobs like builders, bricklayers, plantation workers, heavy industry workers , construction workers and miners. However, nowdays , Dr Prem Pillay has noticed that there are more executives who come to him for back pain. He has identified prolonged sitting, a poor posture, overuse of computers , frequent business travel and a unhealthy executive lifestyle as major reasons for this problem. When you sit too long, he explains, there is increased pressure in the spine discs. The spine is not one bone but about 33 bones with a soft gel like substance called the disc in between. The disc  allows flexibility and movement in the spine.  Executive work with computer work and a lack of movement can cause the spine discs to break down and come out or slip out. These slipped discs can pressure on the nerves and cause back pain, leg pain, numbness, tingling, and as the problem gets worse even weakness in the legs. The worse case scenario is becoming unable to walk, unable to pass urine or pass motion. This can happen gradually or in some people it can happen suddenly.

Executives who have back pain often go for massages to therapists. If the pain does not get better  after three visits to the therapist or comes back after massage therapy , Dr Prem recommends that you see a spine specialist. He does warm that massage therapy or physical therapy done in the wrong way by unqualified people can make the problem worse. A proper spine and nerve examination followed by an MRI of the spine can reveal and confirm the problem. X rays alone cannot show the nerves or pressure on the nerves from  a slipped disc. In some older executives, the back pain or leg pain is caused by spine stenosis. This is a narrowing in the spine canal which squeezes the spine nerves. A common story that Dr Prem hears is that the person cannot walk far without the legs feeling uncomfortable. He has to stop and rest first before walking further.

Executive back pain can often be treated without surgery. The proper medications and  therapy organized by a spine specialist can help the person recover faster and return to his normal lifestyle.

Some people require spine injections to reduce pain. The better type of spine injections treat the root of the problem. This involves a laser like spine injection to the disc to reduce the disc pressure on the nerves. This can be done as a day procedure without any surgery. In some executives the problem has become too serious and requires surgery. Fortunately modern surgery including microsurgery and microneurospine surgery has advanced to a stage that the risks are low and the recovery can be  quick.

In conclusion, more executives and office workers are suffering from back pain. If this back pain is frequent or spreads to the legs, Dr Prem Pillay recommends that you see a spine and nerve specialist for a proper check up to find out the root of the problem. A healthy lifestyle with less sitting, the right exercises and a good  diet can also lessen the chance of frequent back pain.

REFERENCE SITES:

Singapore Spine Advice

Neuro Spine and Pain Center 

Backache and Neck Pain? FAQs.

Backache and Neck Pain?
Modern Methods can help you.

Many people suffer from back and neck pain. Some have ongoing pain that gets in the way of their everyday activities. This condition affects not only the physical health of these individuals, but their social and economic well-being too. The pain can disrupt work, routine and other daily activities that they engage in. In fact, back pain and neck pain are among the most common reasons for doctor visits, and are major causes of disability, lost work days, and high healthcare costs.

1. Why Do So Many People Suffer From Back and Neck Pain?
According to Dr Prem Pillay, Consultant Neurosurgeon , there appears to be a silent epidemic of spine problems and this is related to our modern lifestyle. A poor posture and long hours sitting with computers at work and home are part of this problem. Sports activities that load our spine like road running and high impact aerobics can also cause damage. Pain in the back and neck area can be acute, which comes on suddenly and intensely, or chronic, which can last for weeks, months, or even years.

2. What Causes Back and Neck Pain?
Dr Prem Pillay states that back and neck pain may be a symptom of several different causes, including:
• muscle strain
• degeneration of the discs in the spine causing a slipped disc
• Spinal stenosis, facet degeneration and osteoporosis
. Spinal Tumors including cancer spread
. Spine Infections

3. How Can Back And Neck Pain Be Diagnosed?
Before your doctor can diagnose your condition and design a treatment plan for you, a complete history and physical examination are necessary.
Imaging tests such as X-rays and MRI (Magnetic Resonance Imaging) scans are helpful for diagnosing most episodes of neck and back pain. In most cases, they are only used if the doctor suspects a serious problem, such as a slipped disc or herniated disc, a spine fracture, or cancer, or if surgery is being considered or planned, advises Dr Prem Pillay. Some patients require additional tests like the DEXA scan to assess for osteoporosis and PET-CT scans if cancer spread to the spine is suspected as a cause of back pain.

4. What Are The Available Treatment Options?
Treatment is determined by the nature and cause of the problem and its severity. For mild slipped disc problems, they can be treated by pain medications and physiotherapy, together with lifestyle adjustments. If the pain is recurrent, prolonged or increasing in severity, a specialist consultation is necessary and a spine procedure may be recommended.

Dr Prem Pillay shares that the modern spine procedures include spine injection treatments that do not require open surgery. These treatments include spine injections mainly for pain relief such as epidural steroids , nerve blocks and facet joint blocks. Newer procedures that more directly treat the affected parts of the spine include discoplasty, annuloplasty, nucleoplasty, biacuplasty, neuroplasty , vertebroplasty, kyphoplasty and others that can be done under local anesthesia as day procedures. However, not all patients can have these done as there are criteria to be followed for a successful outcome. These procedures may give a medium term relief from pain , and may not always adequately treat the root of the problem for conditions such as disc herniations.



5. When Is Surgery Required?
Surgery may be indicated and give a long term solution when degenerative changes in the spine are severe or progressive that the function of the spinal cord or nerve roots is impaired or threatened, there is severe and persistent pain that goes down an arm or a leg associated with weakness of the limbs , or when conservative treatment (anti-inflammatory medication, limited activity, physiotherapy) and spine injection treatments fail.

Dr Prem Pillay explains that patients should be reassured that spine surgery in experienced hands and with the right tools can be safe and effective. Certainly with new technologies including microsurgery and endoscopy, the openings needed are smaller than before and finer instruments are used to remove the damaged parts of the disc. Nerve monitoring during spine surgery can also be helpful in reducing risks. There are now alternatives to spinal fusion such as artificial disc replacement and dynamic spinal implants that allow motion preservation of the spine. All of these methods and precision have allowed spine surgery to become more successful in returning people quickly to normal life.

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Tips for a healthy back and neck
• Be sure that your back and neck are properly supported when you sit and that your posture is correct
A Good pillow and a firm but comfortable bed mattress can reduce stress on your spine during sleep
• If your weight is causing excessive pressure to your spine, weight loss can reduce discomfort.
• Do not lift heavy loads by placing the pressure on your lower back. Always bend your knees so your arms are at the same level as the heavy object you plan to lift.
• If something you are doing causes your back to hurt, stop and rest or stop altogether.
• Talk to your doctor about combating osteoporosis – bone thinning, if you are female and above fifty

More Info at:

www.singaporespine.org

www.spine-neuro.org



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Preserving Your Spine Discs- Discoplasty

Singapore Spine : Discoplasty

Your spinal discs are prone to degeneration leading to disc prolapse, protrusion, extrusion and sequestration. This can place pressure on your spinal nerves leading to back pain, neck pain, leg pain (sciatica) and shoulder/arm pains. As this progresses sensation disturbances such as tingling, numbness and motor problems such as weakness and sometimes even paralysis can occur.

In the past the options were either conservative or spine surgery. Fortunately there are now options that are in between. They deal with the root of the problem without formal spine surgery.

These procedures can be categorized as Discoplasty or Discoplasties. A needle like device is placed under local anesthesia into the discs under CT or high quality spine imaging. An energy beam is released through via a wand placed through the needle into the center of the disc. This can vapourize abnormal disc material in the nucleus pulposus. This reduces pressure within the disc. It also allows disc repair and healing. The energy can be a laser energy using either Nd-YAG, holmium or thulium lasers. Other advanced energies are Plasma energy. This is a day procedure which takes less than an hour to perform, has little discomfort for the person treated and he is able to walk home an hour later.

I have been quite impressed in my practise how effective a single treatment of Discoplasty can be for both cervical and lumbar disc problems. Patients are often able to go to work the next day and resume recreational activities quickly.

Minimally Invasive Spine Surgery (MISS)

There are many people who need back and neck surgery but are afraid of it. Many have heard horror stories of severe pain, long recovery periods and even those who have become paralysed. There is however technology currently available that addresses these concerns. It is true however that these methods are available from only a few neurosurgeons/spine surgeons worldwide. Those of us who have listened to our patients and understood their needs have been working hard to find solutions that are minimally painful, allow quick recovery and are effective treatments.

These solutions include several of the following:

1.Percutaneous Plasma Energy Discoplasty
2.Percutaneous Endoscopic Laser Disectomy-PELD
3.MicroDisectomy
4.Endoscopic Disectomy
5.Microsurgical Discetomy with Dynamic Implants
6.MicroEndoscopic Discectomy-MED
7.Microsurgical Spinal Decompression
8MicroEndoscopic Spine Microsurgery- MESM
9.Percutaneous Disc Regeneration Technology
10.Endoscopic Disc Replacement

Many of these options allow the patient to arrive at a day surgery center, have the procedure under iv sedation and local anesthesia (no general anesthesia) and leave within a few hours of a fairly short procedure. Most patients walk out of the center themselves and can return to work in a few days.

Unlike taking pain medications or pain injections; these procedures do address the root of the problem. They allow reduction in nerve pressure and therefore can prevent ongoing or future nerve damage. Spinal nerves especially the spinal cord, cannot be effectively replaced at this point in time. Stem cell treatment is still experimental and not consistently successful.

These procedures are also evolving and becoming more successful with experience, technology and the passage of time. Many of us who are Minimally Invasive Spine Surgeons believe that more spine doctors need to know and be trained to do these procedures. An informed patient can also help to accelerate these changes worldwide by insisting on the latest and least invasive spine treatments.

Question & Answers on Backache

Q: WHAT ARE THE COMMON CAUSES OF BACKACHE?

Our modern lifestyle is one of the main reasons for backache and neckache . Prolonged sitting, poor posture, air and car travel , and many hours in front of the computer can all cause backache. Many of us exercise irregularly without proper warming up and stretching. This can also lead to increased wear and tear in the spine and cause backache. Obesity also increases stress on the spine. Osteoporosis is a cause in older people.

Q: HOW CAN I PREVENT BACKACHE OR BACK PAIN.

§ PROPER POSTURE
Maintain a proper posture in performing day to day activites.

§ ERGONOMICS
This is especially important in the work place. If you sit for long periods of time, you need to make sure your chair has a proper lumbar support. You should get up every 30 minutes, and stretch before resuming your work.
Learn to lift objects correctly.

§ EXERCISING INTELLIGENTLY
Exercising irregularly and without proper warm-up can put a lot of stress on your spine muscles.
Jogging or aerobics on a hard ground (high-impact activities) without proper shoes is also stressful to the spine. Remember there is an equal upward thrust on your spine for every downward step.

§ MUSCLE RELAXATION
Hot packs , a warm shower, soaking in a warm bath can help relax your back muscles.


WHEN DO YOU NEED TO SEEK MEDICAL ATTENTION FOR BACKACHE ?

§ When your backache or back pain is persistent
§ When you have pain down your legs
§ When you have pain or loss of sensation in your leg or foot
§ When you experience “pins and needles” down your leg or foot
§ When you have weakness in the leg and foot, and have difficulty in walking
§ When you start developing problems with your bladder and bowel

We recommend that all patients with the above symptoms consult a NeuroSpine Specialist for a thorough neurological evaluation and an MRI scan of the lumbar-sacral spine before embarking on any therapy The neurological evaluation will include an assessment of sensation, strength and reflexes. X-rays or CT-scans alone may be inadequate as they cannot show spinal cord or nerve compression. A neurospine specialist can then recommend the various options for treatment depending on the severity of the disc disease and degree of any nerve compression.


WHEN DOES SURGICAL INTERVENTION BECOME NECESSARY?

Surgical intervention, such as microsurgery/micro-endosocpic surgery/endoscopic surgery becomes necessary when pain is not relieved by conservative (non-surgical) treatment or when there are neurological deficits such as weakness in the foot or leg. This is associated with the MRI showing moderate to severe nerve impingement that may be caused by a degenerated /prolapsed disc/discs, thickened ligaments, and overgrowth of bone.
The decision for surgery should be made by you and your neurosurgeon. New and advanced technology is available for the replacement of discs-Artificial Disc replacement, but there is no technology available to replace or repair damaged nerves in the spine. We therefore advise patients not to not wait until their nerves are permanently damaged.
After a microsurgical intervention, patients will still need to be put through a proper and organized spine therapy program such as aquatherapy (www.aquaphysio.com for info). This is for long term spine strengthening and preventing relapses.

Neck Pain or Neckache FAQs

COMMONLY ASKED QUESTIONS ABOUT NECK PAIN or NECKACHE :

Q: WHAT ARE THE CAUSES OF NECK PAIN?

A: The roots of neck pain lie in our modern lifestyle . At the workplace, prolonged sitting and many hours of computer use can cause neck pain. Travel with the carrying of hand luggage and laptops all contribute to neck pain. Recreational exercises performed improperly or without adequate warming up, massages with neck manipulation , poor posture etc can cause wear and tear of the discs in
the cervical spine resulting in neck pain and shoulder discomfort. Most patients with neck pain have varying degrees of spinal disc degeneration.

Q: HOW CAN I PREVENT NECK PAIN ?

A: Proper posture and Good Ergonomics.

This is especially important for those who use computers for long hours. This involves proper placement of the computer monitor such that your head is in a neutral position when viewing the computer screen; a proper chair with lumbar support and an arm rest so that your elbows are resting 90° to your work surface and your keyboard.

Stand up and take short breaks every 20 – 30 minutes, doing neck stretches and back stretches before resuming your work.
Another bad habit is talking on the phone with the receiver tucked between the neck and shoulder. This should be avoided as it puts a lot of strain on the neck muscles. Invest in a hands free device instead.

Neck strengthening exercises help but should be taught to you by a trained physiotherapist.



Q: What about Exercise and the Spine?

A: Exercising Intelligently can prevent spine problems rather than causing or aggravating them.

Exercising irregularly and without proper warm-up can put a lot of stress on your spine muscles.
Jogging or aerobics on a hard ground (high-impact activities) without proper shoes is also stressful to the spine. Remember there is an equal upward thrust on your spine for every downward step.
Swimming though a good form of an aerobic exercise, may actually aggravate neck pain especially strokes like the breast stroke and front crawl. In these strokes, the head is moved up and down or sideways to breathe.
However, specially designed exercises like Aquatic therapy (by trained physiotherapists ) is beneficial as it is specially designed to strengthen the spinal muscles.

Q: How can I relax the spine if the pain is being caused by muscle strain or tension?

A: Hot Packs, and/or a warm shower can help in relaxing the neck muscles.




Q: When do I need to seek medical attention for neck pain?

A: We recommend that patients with neck pain/discomfort consult a NeuroSpine Specialist for a thorough neurological evaluation and an MRI scan of the cervical spine before embarking on any therapy The medical evaluation will include an assessment of sensation, strength and reflexes. X-rays alone are inadequate as they cannot show spinal cord or nerve compression. Your spine specialist can then recommend the various options for treatment depending on the severity of the disc disease and any nerve compression.

Q: When does surgical intervention become necessary?

A: Surgical intervention, such as microsurgery with disc replacement, becomes necessary when pain is not relieved by conservative (non-surgical) treatment or when there are neurological deficits such as weakness in the arm or hand. This is associated with the MRI showing moderate to severe nerve impingement that may be caused by a degenerated /prolapsed disc/discs, thickened ligaments, and overgrowth of bone.
The decision for surgery should be made by you and your neurosurgeon. New and advanced technology is available for the replacement of discs but there is no technology available yet to replace or repair damaged nerves in the spine. We therefore advise patients not to not wait until their nerves are permanently damaged.
After a microsurgical intervention, patients will still need to be put through a proper and organized spine therapy program. This is for long term spine strengthening and preventing relapses. We have found in our experience that a combination of aquatic therapy with physiotherapy works best.




SURGERY MAY BE THE TREATMENT OF CHOICE IF :

§ Conservative therapy is not helping
§ Your symptoms are progressive in your arms and legs
§ Your hands are becoming more clumsy and weak
§ There is difficulty with walking and balance
§ Its preventive – prevents furthur nerve injury
§ You are in good health

Based on the Guidelines of the American Association of Neurological Surgeons.