Question
I've had neck pain on my left side since childhood. I'm 29 now, and I still feel the pain. But lately, I'm experiencing pain on my back on the left side (i just started my new job and i'm infront of the computer for 8 hrs and on raod 3 hrs everyday)and the pain goes till by left buttocks and I also feel little uneasyness on the upper side of the leg sometimes. I have noticed that sometimes my heartbeat seems to increase a little bit (maybe due to anxiety ..i'm not sure).

Is this a case of piched nerve? Is it something serious?  

Answer
Dear Jimmy,

I have a question for you...What are you waiting for?  Go get this examined.  You have had neck pain since you were a child, why don't you take care of it?

All right, enough soap box preaching.  Although neck and back pain is common in our society, it is not normal.  The body only sends pain signals to the brain because of activation of a special receptor called a "nociceptor".  Nocere means to injure, therefore when your body experiences input to the tissues that has the potential to cause or is causing damage, the brain experiences the feeling of pain.  This is a survival mechanism.

Pain is not normal (it is a warning), and it is common.  Along with trauma, pain is produced because of all the abnormal things we put our bodies through on a daily basis. Such as sitting for long periods of time, abnormal postural demands, frequent repetitive behaviors, and lets not forget all the driving, computers, tv watching, video games etc... that are promoters of modern deconditioning of the musculoskeletal system.

Concerning the neck pain...anything longstanding like you have reported should be addressed.  There is obvious biomechanical dysfunction, otherwise you wouldn't be feeling pain.  The pain must not be that bad, or you would have sought treatment by now, but that doesn't mean that the problem is not progressing.  Any dysfunction left untreated over time will lead to degeneration and chronicity.

Concerning the low back pain and radiating symptoms, this can indicate dysfunction at the nerve roots, which supply information to the buttock and lower legs, or the disk which can press on the nerve roots or cord, or there could be fixation and movement dysfunction in the lower lumbar spine and sacroiliac joints of the pelvis.  The bottom line is that you definitely have inflammation which is causing an irritation to some or all of the above mentioned structures. Whenever local pain starts to radiate into the buttock, or lower leg, I know that a problem is becoming worse, but from what you have described it does not sound serious yet.  Again, dysfunction will continue unless you have the problems addressed.

I encourage you to find a local chiropractic physician and have your complaints checked with an examination of the neck and the low back.  You should be queried about the current issues as well as earlier health matters, and a functional examination should be performed...x-rays are likely with your history of pain, as well as the radiating symptoms.  Call a few offices first and ask questions about treatment, payment, etc... to get a better working knowledge of the office and then schedule a 10 minute consult if you need to...most doctors will consult for free.

In the mean time, below you will find an article I have written on how to start combating your daily drive/work postures.  Good luck Jimmy, and let me know if you have any further questions.

Training for Stability of the Neck and Back匩ot What You Think!

A brief look around any boardroom, construction site, grocery store etc?will provide any observer an insight into poor posture and de-conditioning syndrome. A deconditioned individual has only one option for lasting pain relief which is increasing their functional capacity. The average teenager and adult have pronounced spinal displacements due to chronic poor ergonomics of basic living, poor posture, and constrained working environments.  Back or neck pain is the number one reason for a visit to the chiropractic physician and medical doctor!  Shouldn抰 you work to prevent injury and strain?  The obvious answer is yes!

The most common reasons for back and neck pains are poor lifting techniques, abnormal posture, and repetitive micro-strain coupled with the lack of stability within the muscular system, and trauma.  It is sometimes difficult to avoid trauma, but if you eliminate poor technique, improve the ergonomics of your work station, and train your spine for stability, you significantly reduce your risk of injury.  Remember that we live in a gravity controlled environment and all muscular actions are in direct opposition to gravity.  We stabilize bridges and buildings so they won抰 buckle or break, you need to do the same for your spine.  

That being said, conventional strength training with free weights and isolation machines will give general overall gains in muscular strength if utilized properly, but won抰 necessarily target stability of the core or the spine.  Muscles to target are the multifidus, rotatores, intertransversales, transverse abdominis, and the pelvic floor.  Moreover, it is important to train for balance and symmetry thereby reducing abnormal weight bearing on all joints of the body.  

Lifting technique is important for optimal health and the reduction of injury.  To execute a lift properly, the back should be fairly straight while maintaining the normal lordosis (forward arch of the low back).  This position will activate the musculature properly for stability while not recruiting the ligaments for support.  Squatting is optimal, due to its neutral spinal position and the ability to use the muscles of the legs to accomplish the lift.   Stooping should be avoided, especially with repetitive movements.  Stooping creates an unstable configuration for the disk with increased tensile pressure on the posterior portion of the disk due to increased compression on the anterior portion of the disk.  This can easily result in a rupture of the disk.  In addition, objects should not be lifted if they are placed awkwardly which may require twisting and or bending, weights should be held close to the body, and jerky movements are only appropriate for highly trained individuals such as advanced athletes under the supervision of a trainer.  The last key is to create contraction of the abdominal musculature before the lift. This provides greater stabilization the spine, and your entire core.  You can easily accomplish this by sucking the belly button in toward the spine.  This activates the transverse abdominus muscle which is key for all movements.

One of the most deleterious activities people engage in is sitting. Sitting increases disk pressure more than standing and encourages abnormal flexion (forward bending) of the neck and upper back in addition to slumping in the chair.  These postures chronically load the disks, ligaments and musculature of the spine creating micro-injury and dysfunctional movement patterns.  

Many of us spend the majority of our days at a desk, computer or workstation.  We need to consider and modify our workspace carefully.  Adding a support for the lumbar spine reduces disk pressures.  A seatback angle of 5-15 degrees from vertical will reduce low back muscle activity and disk pressure.  Proper desk height is approximately 30 centimeters from the seat of the chair.  Arm rests are important in limiting strain on the upper muscular complex of the back and neck to include the trapezius, rhomboids, and levator scapulae.  The shoulders should be able to relax with the elbows bent at 90 degrees while the hands rest on the desk surface.  

Forward movement of the head on the neck is extremely problematic. For every inch forward the head moves in relation to the neck and shoulders, the compressive forces on the lower neck increase by the entire weight of the head, 10-16 lbs. Think about the difference in holding a bowling ball close to the body, or away from the body. This illustrates the differences in muscular work needed to support the weight and the ligamentous strain.  Computer monitors should be elevated so that the center of the screen is at eye level while looking straight ahead.  This will reduce eye strain; further reduce muscular tension of the neck while limiting the forward flexion of the head, therefore reducing the abnormal loading of the ligamentous complex.  This will also help reduce those 搘ork headaches?  Placing the monitor higher to induce a slight extension of the head is permissible.

Now that you have proper technique, and your workstation is optimal, structural and functional training of the musculature on the back of your body and your core is the key.  You must have a balanced and relaxed spinal cord for optimal function.  That being said, specific training is the way to achieve spinal balance and stability, and you don抰 have to go to the gym to achieve it.  If you can appreciate that we spend most of our days in a flexed position, the way to relieve that cumulative stress is to train the small stability muscles in an extended position.  

Most people are flexed forward at the hips/pelvis, have rounded shoulders, and a forward head and neck, this is called Global Flexion.  Extending the head backwards, opening up the chest by turning the palms of your hands outward and stretching your arms backwards relieves this global flexion.  The last step is to stand up and bend backwards at the waist approximately 20 degrees. You have just accomplished the task of Global Extension.  If you flex or tighten up all you muscles while in this position it further accentuates the value of the exercise and also promotes increased blood flow and oxygen delivery to the body.  This is a relief position that everyone should use frequently throughout the day to abate cumulative postural stresses.

Moving on, posture is the next consideration.  Your posture should not be a conscious task, but with the level of deconditioning in the population, conscious postural improvements are necessary.  This is mostly common sense, and your mother has telling you to do this since you were a child.  Exercise your postural muscles while walking.  Stand up straight, hold your head up high and walk with confidence looking ahead of yourself, not at the ground.  Pull your shoulders back, breathe deeply, and take confident long strides.  This alone will bring more oxygen to your body by fully opening up the lungs, increasing blood flow, and reducing abnormal stress on spinal structures.  You can also practice this position on a physio-ball or thera-ball to improve your seated posture and balance.  Complex postural issues and stability issues need to be addressed by a professional.

Remember that weight training, aerobic activity, and general fitness types of activities are only good for you if done with proper form, balance, control and stability.  If you don抰 have good posture and spinal symmetry, a traditional workout program will only make those problems worse.  It is essential to incorporate stability into your spine and your life before starting any exercise program.  You should see a medical or chiropractic physician before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity.  If you have any cardiovascular issues, a stress test should be performed.  Many subsequent doctor visits are caused by improper fitness activities; it is better to see you doctor before rather than after.

All chiropractic physicians will be able to teach you about postural imbalances and how to improve your own posture, but many chiropractors have additional post-doctoral training in advanced postural biomechanics and structural correction to help you attain improved spinal dynamics.  Ask your chiropractic physician to tell you about their training, and provide written documentation about their qualifications.  To learn more about postural correction check out www.idealspine.com. In addition, a Certified Pilates instructor, www.nypilates.info, www.pilates-trainning.com or Certified Personal Trainer www.nsca-lift.org, www.ncsf.org  can have great benefit.  Remember to check their qualifications as well.

Respectfully,
J. Shawn Leatherman, BA, BS, DC, CCST, CCSP?br> Director of Clinical Rehabilitation
Suncoast Healthcare Professionals