Tech neck: hands-on treatment, supervised exercise, or exercise on your own?
Learn which treatment methods work best when dealing with neck pain. Our chosen study highlights the power of combined supervised therapeutic exercise and hands-on manual therapy.
As COVID-19 pushes more people to work from home, we’re seeing much more cases of neck pain due to incorrect ergonomic setup and associated postural faults. While research continues to support conservative treatment methods, much debate still lies in what game plan per se yields the most positive outcomes for this population.
The study:
A randomized controlled trial of 60 participants who reported neck pain and presented with “forward head posture rounded shoulders posture” sought the effects of hands-on manual therapy (MT), stability exercises (SE) and home exercise programs (HEP), over a six-week period.
Group 1: Received MT and performed SE (3 times a week, supervised)
Group 2: Performed SE (3 times a week, supervised)
Group 3: Performed HEP (control group)
Data would be collected pre-, post-, and 1-month after intervention.
The results:
Statistically significant changes (p<0.05) were noted for the following:
Group 1 had significantly improved pain levels post-intervention and even better reports at the 1-month follow-up.
Groups 1 and 2 demonstrated significantly improved Progressive Iso-inertial Lifting Evaluation (PILE) scores (aka capacity to lift heavy things) post-intervention compared to pre-intervention.
Groups 1 and 2 also demonstrated significantly improved “forward head posture rounded shoulders posture”, measured by favorable shoulder and head angles post-intervention, compared to pre-intervention.
Group 3 participants had no significant change in symptoms, function or postural alignment throughout the study.
What this means:
People with non-specific, generalized neck pain may benefit from a combination of hands-on manual therapy and a supervised stability exercise program, as the study shows it can improve pain levels, function and postural alignment. Another important observation is that Group 3, which only partook in an unsupervised home exercise program, showed no significant improvement in symptoms. In other words, exercise can be otherwise useless if not performed correctly.
See the vid below for examples of tech neck neutralizing exercises.
REFERENCES:
Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019;20(1):86. Published 2019 Feb 18. doi:10.1186/s12891-019-2438-y
Tennis elbow: get a corticosteroid injection, wait it out, or physical therapy?
Got tennis elbow? Research shows that physical therapy may be the best-fit short- and long-term treatment option for this annoying condition.
Since COVID-19, we’ve seen two things: more people working from home, and more people hitting the tennis courts. The commonality between the two? Tennis elbow.
Tennis elbow, or lateral epicondylitis, characterized by outer elbow pain often associated with repetitive overuse of the wrist extensors, will affect 50% of all tennis players, but accounts for only 5% of all reported cases—meaning tennis elbow can most definitely happen to even those who never pick up a racket (ie. those who use a computer mouse all day).
The study:
A randomized controlled trial study by Bisset et al compared three different approaches to treating tennis elbow. 198 participants were allocated into three different groups:
Group 1: The wait-and-see group, or control group (participants received no treatment);
Group 2: The injection group (participants received a corticosteroid injection);
Group 3: The physical therapy group (participants received eight physical therapy sessions over six weeks)
The results:
By six weeks, the injection group had the greatest improvements in pain levels and pain-free grip force when compared to both the wait-and-see group and physical therapy group.
By six weeks, the physical therapy group, which combined elbow manipulation and exercise, showed greater improvements in pain levels and grip strength when compared to the wait-and-see group.
AFTER six weeks, 72% of participants in the injection group experienced a significant regression of outcomes, with increased pain and weakened grip strength.
After one year, the physical therapy and wait-and-see groups continued to experience improved function and grip strength, with outcomes more successful than the injection group.
What it means:
Physical therapy and corticosteroid injections show improved patient outcomes compared to waiting things out in the short term (within six weeks), but in the long term, injections may be inferior to physical therapy and waiting things out. Caution is advised if choosing to receive a corticosteroid injection, as the study showed 72% of participants experiencing a regression of symptoms.
Short-term winner: corticosteroid injection > physical therapy > wait-and-see
Long-term winner: physical therapy > wait-and-see > corticosteroid injection
Conclusively, the research data suggests that physical therapy is the best-fit treatment option for tennis elbow, since it shows favorable short- and long-term outcomes, as well as being the safer option, when compared to corticosteroid treatment and waiting things out.
Check out our video below to see some examples of mid-stage tennis elbow rehab exercises.
REFERENCES:
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Br Med J. 2006;333:939–941. doi: 10.1136/bmj.38961.584653.AE.
Genetically-Modified Organisms: The good, the bad, and the future
Image by Hannah Somheygi.
The Nobel Prize is named after a scientist, Alfred Nobel, who established the prizes in his will in 1885. Alfred Nobel is famous for inventing dynamite. However, he mistakenly believed that his invention would bring about a more peaceful world. He is quoted as saying, “My dynamite will sooner lead to peace than a thousand world conventions. As soon as men will find that in one instant, whole armies can be utterly destroyed, they surely will abide by golden peace” [1]. In fact, his invention led to the development of many modern tools of war.
Dynamite is a technological advancement that led to the deaths of many people. However, technological advancements have not exclusively made the world a worse place. Because of technological advancements, more people than ever before have access to tools that make life easier such as medicine, electricity, and indoor plumbing. Genetically-modified organisms (GMOs) are some of the more recent and controversial tools that have been developed. According to the companies and scientists who design new GMO crops, this new technology is harmless to humans, better for the environment, and is the only way to feed an ever-growing population [2]. On the other hand, anti-GMO groups claim that GMOs cause health problems for both humans and animals, destroy the environment, and only benefit large corporations. So, why did scientists develop these new organisms?
Crop scientists and engineers want to come up with solutions to problems facing the world, like decreased yields due to pests and weeds. For example, Roundup Ready corn was supposed to be better for the environment by decreasing the amount of herbicide farmers needed to use on their crops. Scientists also make GMOs to address health problems in the developing world. For instance, Golden Rice was developed to prevent Vitamin-A deficiency in the children of developing countries. In both of these examples, the scientists had a socially-responsible motive for creating a GMO. However, it can be difficult to predict all the effects (both good and bad) of a new technological advancement. In order to decide for ourselves what the effects of GMO use have been, we need to look at the most unbiased source of information—the scientific literature.
Herbicide-resistant corn
Herbicides are chemicals, often highly toxic, that are sprayed on weeds in order to kill them so that they do not compete with the desired crop for space and nutrients. Some are selective for certain kinds of plants. Others, including Roundup, are nonselective, and if they are sprayed on both weeds and crops, they will kill both. Scientists thought that if the crops were resistant to Roundup, use of the herbicide would be more effective. Spraying the whole field with Roundup would take less time and actually use less Roundup than spraying the weeds one by one. Using less herbicide in this way would be better for the environment as well. For these reasons, Roundup Ready corn and soybeans were created to be resistant to Roundup.
The chemical in Roundup that kills plants is called glyphosate. Glyphosate works by inhibiting the plant enzyme that helps make some of the amino acids (protein building blocks) that the plant needs to survive [3]. Roundup Ready crops contain a different version of this enzyme that is not blocked by glyphosate. Use of glyphosate-resistant crops was supposed to decrease herbicide use because less herbicide would be needed to kill the weeds, and to some extent, it has. Based on national pesticide usage data and other previously published pesticide use data from a number a sources in the scientific literature, it seems that herbicide use has decreased. From 1996 to 2011, use of herbicide-tolerant cotton reduced herbicide use by 6.1% compared to conventional cotton [4]. However, the liberal use of herbicides by farmers who grow herbicide-resistant crops has catalyzed the evolution of herbicide-resistant weeds. Since Roundup Ready crops were introduced in 1996, at least sixty-four weed species have evolved resistance [5]. Because of herbicide-resistant weeds, farmers will now have to increase herbicide use, so the recent decreases will not last. From these experiences, scientists have learned that engineering plants to be resistant to herbicides is not an effective long-term solution.
Baby steps towards Golden Rice
There is always room for improvement when new technologies are introduced, and GMOs are no different. Science is an iterative process that results in sequential improvements as a greater understanding of the problem is obtained and as better technologies are developed. Golden Rice is a strain of rice which contains a set of genes which allows it to make β-Carotene – the chemical that makes carrots orange and is turned into Vitamin A inside the body. The genes in Golden Rice that make β-Carotene come from other plants that naturally make it, like daffodils and corn. Golden Rice was developed to help combat Vitamin A deficiency problems in developing countries where diets are low in foods containing Vitamin A. Vitamin A deficiency is especially dangerous for children and pregnant mothers and commonly leads to blindness and even death [6]. Currently, Vitamin A deficiency can be prevented by taking oil-based supplements provided by international organizations, but Golden Rice may be even better at relieving Vitamin A deficiency because rice is a staple food in many countries, and it can be difficult to convince children to take vitamin supplements.
In the first iteration of Golden Rice, children would have had to eat several kilograms (up to 10 pounds!) of rice per day to get their recommended daily value of Vitamin A [7]. Therefore, scientists re-designed and improved the rice by switching out one of the genes that came from daffodils and instead put in a related one that came from corn. According to the scientific literature, the gene from corn worked much better, and the rice contained 23 times as much Vitamin A as the earlier version [8]. The scientists also showed that the rice was as good a source of Vitamin A as β-Carotene-filled oil capsules, which contain about the recommended daily value’s worth of β-carotene for a child [9]. They did this by taking blood samples from children who had consumed either the rice or the capsules, and looked to see how much of their β-Carotene had been converted in to Vitamin A. They found that the β-Carotene in Golden Rice was converted in to Vitamin A just as well as it was for the oil capsules. Despite these promising results, a remaining concern with Golden Rice is that Vitamin A content of the rice could decrease after it has been stored a long time. There have been no studies on this yet, but you can bet that there are scientists working on it right now.
The future?
Without a doubt, technological innovations can lead to advancements that may do more harm than good. This is why rational debate based on unbiased scientific data in the literature is essential. By questioning every aspect of a new technology, possible downsides can be uncovered, and strategies for improvements can be planned. When it comes to GMOs, there are many aspects that can be improved. However, many experts believe that if the human population continues to grow, current methods of farming will not feed everyone [2]. As the author and scientist Sam Harris has said, “If questions affect human wellbeing, they have answers” [10]. Scientists are always looking for these answers. When the public is educated on the problems the world faces, and supports research that aims to create socially-responsible solutions, scientists can work to make the world a better place.
Written by Marina Santiago
References:
[1] Charlton, James. (2002) The Military Quotation Book. P114 en.wikipedia.org/wiki/Alfred_Nobel
[2] Chen, Chi-Chung and Wei-Chun Tseng (2011) Do Humans Need GMOs? – A View from a Global Trade Market. Journal of American Academy of Business 8(1): 147.
[3] Steinrucken, H.C. and N. Amrhein. (1980) The herbicide glyphosate is a potent inhibitor of 5-enolpyruvylshikimic acid-3-phosphate synthase. Biochemical and Biophysical Research Communications 94(4): 1207-1212
[4] Brookes, Graham and Peter Barfoot. (2013) Key environmental impacts of global genetically modified (GM) crop use 1996-2011. Landes Bioscience 4(2): 109-119.
[5] Heap, Ian. (2013) International Survey of Herbicide Resistant Weeds. www.weedscience.org/GRAPHS/SOAGRAPH.aspx
[6] (2013) Micronutrient Deficiencies: Vitamin A Deficiency. Nutrition. World Health Organization. www.who.int/nutrition/topics/vad/en/index.html
[7] Coghlan, Andy (2013) Is Opposition to Golden Rice “Wicked”? Slate. http://www.slate.com/articles/health_and_science/new_scientist/2013/10/golden_rice_inventor_ingo_potrykus_greenpeace_and_others_wicked_for_opposition.html
[8] Coghlan, Andy. (2005) New ‘golden rice’ carries far more vitamin. New Scientist. www.newscientist.com/article/dn7196-new-golden-rice-carries-far-more-vitamin.html
[9] Tang, Guangweng et al. (2012) β-Carotene in Golden Rice is as good as β-carotene in oil at providing vitamin A to children. The American Journal of Clinical Nutrition 96(3): 658-664.
[10] Harris Sam, (2010) Science can answer moral questions. Ted Talk. www.ted.com/talks/sam_harris_science_can_show_what_s_right.html
Lost Posture: Why Some Indigenous Cultures May Not Have Back Pain
Back pain is a tricky beast. Most Americans will at some point have a problem with their backs. And for an unlucky third, treatments won't work, and the problem will become chronic.
Believe it or not, there are a few cultures in the world where back pain hardly exists. One indigenous tribe in central India reported essentially none. And the discs in their backs showed little signs of degeneration as people aged.
An acupuncturist in Palo Alto, Calif., thinks she has figured out why. She has traveled around the world studying cultures with low rates of back pain — how they stand, sit and walk. Now she's sharing their secrets with back pain sufferers across the U.S.
About two decades ago, Esther Gokhale started to struggle with her own back after she had her first child. "I had excruciating pain. I couldn't sleep at night," she says. "I was walking around the block every two hours. I was just crippled."
Gokhale had a herniated disc. Eventually she had surgery to fix it. But a year later, it happened again. "They wanted to do another back surgery. You don't want to make a habit out of back surgery," she says.
This time around, Gokhale wanted to find a permanent fix for her back. And she wasn't convinced Western medicine could do that. So Gokhale started to think outside the box. She had an idea: "Go to populations where they don't have these huge problems and see what they're doing."
So Gokhale studied findings from anthropologists, such as Noelle Perez-Christiaens, who analyzed postures of indigenous populations. And she studied physiotherapy methods, such as the Alexander Technique and the Feldenkrais Method.
Then over the next decade, Gokhale went to cultures around the world that live far away from modern life. She went to the mountains in Ecuador, tiny fishing towns in Portugal and remote villages of West Africa.
"I went to villages where every kid under age 4 was crying because they were frightened to see somebody with white skin — they'd never seen a white person before," she says.
Gokhale took photos and videos of people who walked with water buckets on their heads, collected firewood or sat on the ground weaving, for hours.
"I have a picture in my book of these two women who spend seven to nine hours everyday, bent over, gathering water chestnuts," Gokhale says. "They're quite old. But the truth is they don't have back pain."
She tried to figure out what all these different people had in common. The first thing that popped out was the shape of their spines. "They have this regal posture, and it's very compelling."
And it's quite different than American spines.
If you look at an American's spine from the side, or profile, it's shaped like the letter S. It curves at the top and then back again at the bottom.
But Gokhale didn't see those two big curves in people who don't have back pain. "That S shape is actually not natural," she says. "It's a J-shaped spine that you want."
In fact, if you look at drawings from Leonardo da Vinci — or a Gray's Anatomy book from 1901 — the spine isn't shaped like a sharp, curvy S. It's much flatter, all the way down the back. Then at the bottom, it curves to stick the buttocks out. So the spine looks more like the letter J.
"The J-shaped spine is what you see in Greek statues. It's what you see in young children. It's good design," Gokhale says.
So Gokhale worked to get her spine into the J shape. And gradually her back pain went away.
Then Gokhale realized she could help others. She developed a set of exercises, wrote a book and set up a studio in downtown Palo Alto.
Now her list of clients is impressive. She's helped YouTube CEO Susan Wojcicki and Matt Drudge of the Drudge Report. She has given classes at Google, Facebook and companies across the country. In Silicon Valley, she's known as the "posture guru."
Each year, doctors in the Bay Area refer hundreds of patients to Gokhale. One of them is Dr. Neeta Jain, an internist at the Palo Alto Medical Foundation. She puts Gokhale's method in the same category as Pilates and yoga for back pain. And it doesn't bother her that the method hasn't been tested in a clinical trial.
"If people are finding things that are helpful, and it's not causing any harm, then why do we have to wait for a trial?" Jain asked.
But there's still a big question looming here: Is Gokhale right? Have people in Western cultures somehow forgotten the right way to stand?
Scientists don't know yet, says Dr. Praveen Mummaneni, a neurosurgeon at the University of California, San Francisco's Spine Center. Nobody has done a study on traditional cultures to see why some have lower rates of back pain, he says. Nobody has even documented the shape of their spines.
"I'd like to go and take X-rays of indigenous populations and compare it to people in the Western world," Mummaneni says. "I think that would be helpful."
But there's a whole bunch of reasons why Americans' postures — and the shape of their spines — may be different than those of indigenous populations, he says. For starters, Americans tend to be much heavier.
"If you have a lot of fat built up in the belly, that could pull your weight forward," Mummaneni says. "That could curve the spine. And people who are thinner probably have less curvature" — and thus a spine shaped more like J than than an S.
Americans are also much less active than people in traditional cultures, Mummaneni says. "I think the sedentary lifestyle promotes a lack of muscle tone and a lack of postural stability because the muscles get weak."
Everyone knows that weak abdominal muscles can cause back pain. In fact, Mummaneni says, stronger muscles might be the secret to Gokhale's success.
In other words, it's not that the J-shaped spine is the ideal one — or the healthiest. It's what goes into making the J-shaped spine that matters: "You have to use muscle strength to get your spine to look like a J shape," he says.
So Gokhale has somehow figured out a way to teach people to build up their core muscles without them even knowing it. "Yes, I think that's correct," Mummaneni says. "You're not going to be able to go from the S- to the J-shaped spine without having good core muscle strength. And I think that's key here."
So indigenous people around the world don't have a magic bullet for stopping back pain. They've just got beefy abdominal muscles, and their lifestyle helps to keep them that way, even as they age.
Esther Gokhale's Five Tips For Better Posture And Less Back Pain
Try these exercises while you're working at your desk, sitting at the dinner table or walking around, Esther Gokhale recommends.
1. Do a shoulder roll: Americans tend to scrunch their shoulders forward, so our arms are in front of our bodies. That's not how people in indigenous cultures carry their arms, Gokhale says. To fix that, gently pull your shoulders up, push them back and then let them drop — like a shoulder roll. Now your arms should dangle by your side, with your thumbs pointing out. "This is the way all your ancestors parked their shoulders," she says. "This is the natural architecture for our species."
2. Lengthen your spine: Adding extra length to your spine is easy, Gokhale says. Being careful not to arch your back, take a deep breath in and grow tall. Then maintain that height as you exhale. Repeat: Breathe in, grow even taller and maintain that new height as you exhale. "It takes some effort, but it really strengthens your abdominal muscles," Gokhale says.
3. Squeeze, squeeze your glute muscles when you walk: In many indigenous cultures, people squeeze their gluteus medius muscles every time they take a step. That's one reason they have such shapely buttocks muscles that support their lower backs. Gokhale says you can start developing the same type of derrière by tightening the buttocks muscles when you take each step. "The gluteus medius is the one you're after here. It's the one high up on your bum," Gokhale says. "It's the muscle that keeps you perky, at any age."
4. Don't put your chin up: Instead, add length to your neck by taking a lightweight object, like a bean bag or folded washcloth, and balance it on the top of your crown. Try to push your head against the object. "This will lengthen the back of your neck and allow your chin to angle down — not in an exaggerated way, but in a relaxed manner," Gokhale says.
5. Don't sit up straight! "That's just arching your back and getting you into all sorts of trouble," Gokhale says. Instead do a shoulder roll to open up the chest and take a deep breath to stretch and lengthen the spine.
Article written by Michaeleen Doucleff
Fit Philosophy: You Were Made to Move
Most of us don’t exercise regularly because we have better things to do, right? Go to work, run errands, meet friends, etc. Yet we fit all of our daily routine activities without second thought. We brush teeth, wash up and groom without hesitation. The reason: we have daily activities that are routine, embedded and taught from a young age. We give our teeth, hair and skin the attention that they need, but often the rest of the body goes neglected.
Your body is a machine.
Everything we do is performed through a series of joint movements initiated by neurological stimulation and executed by muscular contraction. Your body is comprised of multiple pulleys that work together to produce specific movements that allow you to walk, get dressed, etc. It is a complex, sophisticated machine. And like all machines, it requires routine maintenance.
You were made to move.
A body without regular exercise will not optimally function, just as a car will have problems if it hasn’t been used in a while. Muscles will tighten, shrink and weaken, and joints will stiffen from disuse. But since your body is sophisticated, it will improvise by using other muscles and joints to get your day-to-day activities done, feeding into a vicious cycle of compensation, imbalance, and ultimately injury. Bottom line: you were made to move. What muscles were meant to do!
Wear-and-tear is normal.
In time, a car will break down. But slamming the brakes at every stop light or neglecting routine oil change can expedite that process.
Everyone at some point will suffer wear-and-tear of cartilage and joints—a natural degenerative process with aging and use. But with proper body mechanics, this degenerative process can be greatly delayed. Consider the hypothetical athlete at the gym who sacrifices form to push more weight. You may be able to push more resistance and pump out extra reps, but it will land you again into that cycle of compensation, imbalance, and injury. Your body is subject to wear-and-tear, and how you practice body mechanics will ultimately impact the longevity of your physical health. Bottom line: application of proper form will help preserve the integrity of your joints and muscles.
Excuse #1: Not enough time.
Your most time-consuming daily activity is going to work/school. Undoubtedly, work and study are two investments in bettering your financial health. Likewise, exercise is an investment to bettering your physical health. The difference is that exercise is far less time-consuming. Increased fitness also means less susceptibility to long-term diseases and complications that require dipping into your financial savings.
Excuse #2: "It’s boring".
Work is arguably more boring than exercise, yet we do it anyway because it is part of our daily routine. 20 to 30 minutes of moderate physical activity surely beats the 8-hour office grind.
Excuse #3: "I’m thin already".
Exercise is not only directed to those seeking to lose weight. There are plenty who are considered "thin", but still have a low muscle mass/high body fat content. Regardless of weight, practicing altered body mechanics can ultimately lead to excessive loading stress on joints and irreversible arthritic changes.
Excuse #4: "It hurts when I exercise".
That pain may be an indication that something is not working properly. Depending on the source, your pain may be one of many things, such as lactic acid buildup, stretching of a tightened structure, or exacerbation of an irritated body part. A physical therapist will be able to assist you in determining the source of the pain and prescribe therapeutic exercises to help alleviate the symptoms you experience.
Physical activity should be no different from brushing teeth.
No one ever says “brushing teeth is good for you.” It’s a given, and it’s already standardized as part of our daily routine. But “exercise is good for you” comes off as a motivational cliché and sounds more like an optional plus rather than a core component of our daily curriculum. If treated as an option, it will be brushed off.
Exercise should be routine, not optional—a subconscious given in our daily activities.
You were made to move. Make it a given, and your body will thank you.