Tag: OMT

Office worker holding his neck while seated at a desk

Cervicalgia – A Pain in the Neck

On By Dr. Scott RennieIn Orthopedic/Musculoskeletal2 Comments
shutterstock_142402684Patients frequently come into the Urgent Care clinic for problems related to neck pain.  It can be caused by a number of different factors including ligament or muscle strain, arthritis or a “pinched nerve.” It is quite common, and in fact 10% of adults have neck pain at any one time.  Most patients recover with conservative therapy regardless of the cause of the pain.  Understanding neck pain is much easier if you have a good knowledge of the structural anatomy of the neck. Brief description of the anatomy is outlined below: 1)   Cervical vertebrae:  Seven small bones the make up the cervical spine of the neck 2)   Spinal canal:  The structure through which the spinal cord (nerves) flow which is made from the cervical vertebrae as well as the supporting ligaments and overlying neck muscles. 3)   Cervical discs:  Between the neck bones, these tiny shock absorbers cushion one bone from another.  The inner part of the disc contains a gelatin-like material and when excessive pressure on the disc occurs, this gelatin-like material can protrude and cause what we call a “herniated disc.” Causes:  There are several causes for neck pain, some of which are mentioned here: 1)   Whiplash injury:  A traumatic event that causes sudden forward/backward movement of the cervical spine.  A motor vehicle accident is the most common cause. 2)   Cervical strain:  Injury to muscles of the neck that cause spasm of the neck and upper back muscles causes this type of pain.  It can be a result of physical stresses of everyday life including poor sleep habits, muscle tension from psychological stress, or poor posture. 3)    Diffuse skeletal hyperostosis:  Also called (DISH) is when there are abnormal calcifications in the ligaments and tendons along the cervical spine. 4)   Cervical spondylosis:  Abnormal wear and tear causes gradual narrowing of the disk space and loss of normal bone structure which often leads to bone spurs.  These spurs can increase the pressure on surroundings areas. 5)   Cervical discogenic pain:  The intervertebral discs of the neck function as shock absorbers that cushion the neck bones from one another.  If there are structural changes in these discs, it can cause pain. 6)   Cervical facet syndrome:  Pain involving the facet joints is common in people who repeatedly extend the neck (tilt the head backwards).  The facet joints are on the left and right of the vertebrae. 7)   Cervical radiculopathy:  When disk or neck pass pushes on or irritates a nerve root, this can cause pain, weakness or numbness/tingling of the neck and/or arm. 8)   Cervical spondylotic myelopathy:  This is narrowing of the spinal canal inside the bones of the neck, and is usually caused by either damage to the disks or degeneration from arthritis. Testing:  In order to determine the cause of the pain, your healthcare provider will examine your neck and look at the movement or range of motion to the neck and observe posture of the neck and shoulders.  In some cases there may be a radiological study such as an x-ray, MRI (magnetic resonance imaging) or CT scan (computed tomography) ordered.  The need for on of these tests depends on the patient’s history and physical examination. Treatment:  The individual treatment is tailored to the patient to help treat the underlying cause of pain.  Some possible treatments may include: 1)   Medications:  Ibuprofen, naproxen or Tylenol may be prescribed.  Other medications such as muscle relaxants or narcotics may also be prescribed depending on the circumstances. 2)   Heat:  Can be helpful for decreasing the muscle spasm in the neck.  Moist heat (from a shower, hot tub, or moist towel warmed in a microwave or with warm water) seams to work best 3)   Ice:  Can reduce the pain in many people.  Ice is applied directly to the painful area.  A bag of ice, frozen peas or a ice cubes in a plastic bag is often used, but avoid applying the blue ice that is used for coolers/camping to the skin as this can cause freezer burn. 4)   Massage:  By applying pressure on both sides of the neck and upper back, the neck muscles may be relaxed.  This is usually most helpful if done by a professional massage therapist. 5)   Stretching exercises:  Do not attempt exercises without being evaluated by a healthcare provider as they can actually make the problem worse if performed incorrectly.  Exercises can be performed to relieve stiffness and improve range of function. 6)   Stress reduction:  Neck tension can be increased due to emotional stress and can delay the recovery process.  To help with stress reduction, breathing exercises, meditation, progressive muscle relaxation, biofeedback, prayer or self-hypnosis are helpful for some patients. 7)   Posture:  It’s important to avoid extreme ranges of motion or positions that cause constant tension.  Avoid sitting in the same position for extended periods of time.  Also avoid placing backpacks, over-the-shoulder purses, or children on the shoulders.  Do not perform overhead work for prolonged periods of time.  Hold your head up and keep shoulders back and down to maintain a good posture.  Sleep with your neck in a neutral position by sleeping with a small pillow under the nape of your neck (while laying on your back).  Carry heavy objects close to your body rather than with outstretched arms. Other treatments: 1)   Osteopathic manipulative therapy (OMT)– physically manipulating the muscles, soft tissues and joints can help with neck pain 2)   Trigger Point Injection:  A local anesthetic such as lidocaine can be injected into an area of muscle spasm 3)   Accupuncture:  A needle placed into the proper body area by a healthcare professional who is trained in accupunture therapy can be helpful 4)   Electrical stimulation:  Transcutaneous electrical nerve stimulation (TENS) is a treatment that uses a mild electric current that is applied to the skin to decrease pain and increase mobility and strength.  Some people have found TENS helpful. 5)   Cervical traction:  The use of weights to pull the spinal column into alignment have been helpful for some people in the short term, however clinical studies have shown no long term benefits. 6)   Surgery:  Surgery has a role in relieving symptoms related to a pinched nerve in some cases.  Usually these patients have tried all prior treatment options before proceeding with surgery. To find an Osteopathic physician in your area, the American Osteopathic Association has a useful website:  http://www.osteopathic.org/osteopathic-health/find-a-do/Pages/default.aspx   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Flowing spine lines with botanical elements still life

Osteopathic Medicine: An Interesting Article Worth Reading

On By Dr. Scott RennieIn Healthcare System & TechnologyLeave a comment

Alternative medicine and osteopathic medical education

by Tayson DeLengocky, DO There has been a growing public interest in complementary and alternative medicine (CAM) in recent years. Osteopathic manipulative therapy, a form of physical manipulation of the body for improvement of health and body function, has been designated as complementary and alternative medicine (CAM) by the National Institutes of Health (NIH). According to data reported in 2007 by the National Institutes of Health’s National Center for Complementary and Alternative Medicine, 38% of adults and 12% of children in the United States used some form of CAM that year. According to a 2007 report from the National Center for Statistics, Americans spent $33.9 billion out-of-pocket on CAM; of this figure, consumers spent $11.9 billion on an estimated 354.2 million visits to CAM practitioners. Most allopathic medical schools have responded to this public interest by offering some elective instructions in CAM. Even a tentative proposal of core competencies in integrative medicine in undergraduate medical curriculum in allopathic schools was advanced in hope of instilling in graduating physicians the values, knowledge, attitudes and skills to improve physician-patient communication. DOs are better positioned to respond to this public interest thanks to osteopathic medicine’s long tradition of a holistic and preventive philosophy to patient care. Musculoskeletal conditions and injuries are among the most common reasons for visits to physicians in the United States. They accounted for more than 131 million patient visits in 1995 and cost $215 billion annually. According to the National Center for Health Statistics in 2003 and 2004, 21% of individuals aged 18 to 44, 59% of those aged 45 to 54 years, and 98% of those aged 55 to 64 years reported limitation of activity due to musculoskeletal conditions. According to a 1999 survey of the Steering Committee on Collaboration among Physician Providers Involved in Musculoskeletal Care, the percentages MDs who felt adequately prepared to physically assess problems of low back pain and foot pain were, respectively, 31% and 10%. By contrast, the percentages of DOs who felt adequately prepared to assess low back pain and hand problems were, respectively, 84% and 41%. Thus, osteopathic training appears to be at the forefront of addressing major healthcare issues and fulfilling public demands for patient-focused care. Physicians who are exposed to osteopathic medicine are well-positioned to treat musculoskeletal injuries, an area that is often underemphasized in MD training programs. In the late 1990s, nine physician organizations (including the American Academy of Pediatrics, American Geriatrics Society, and the American Academy of Orthopaedic Surgeons, among others) decided to work together to improve the diagnosis and treatment of musculoskeletal injuries in a cost-effective way by sharing knowledge. As part of their research, they surveyed physicians entering their residencies to see how these new physicians felt about their training in diagnosing musculoskeletal conditions. Thirty-one percent of MDs felt that their training to diagnose lower back pain was excellent or very good (compared to 82% of DOs). Fewer DOs than MDs reported that they felt “poorly” or “very poorly” prepared to address foot pain and other categories of pain. The authors observed, “The fact that the osteopathic medical school graduates felt quite well prepared to assess these types of musculoskeletal problems indicates to us that it is possible to provide a musculoskeletal education in medical school that would improve the students’ confidence to assess musculoskeletal problems regardless of what specialties they intend to practice.” The physicians’ organizations concluded that medical schools “should place more emphasis on these conditions so that young physicians entering their residencies will feel as well prepared to deal with such conditions as they are prepared to deal with problems found in other body systems… With appropriate reforms, all physicians who treat patients with musculoskeletal problems will know the appropriate diagnostic and treatment interventions and how to deliver them in a cost-effective manner. Their patients will benefit, and their health care burdens on society will decrease.” A similar study (in 2005-06) among Harvard Medical School students found that musculoskeletal education was important (rated a 3.8 on a 5-point scale, with 1 meaning “no importance” and 5 meaning “critical importance”). At the same time, though, the students rated the amount of time spent on musculoskeletal education as poor (rated 2.1 on a 5-point scale, with 1 meaning “inadequate” and 5 meaning “excellent.”). On an exam of cognitive mastery of musculoskeletal medicine, fourth-year medical students had a passing rate of only 26%; the pass rate for third-year students (7%) was even worse. According to the study’s authors, “[R]ecent studies suggest that the discrepancy between the magnitude of musculoskeletal problems and physician competency in musculoskeletal medicine likely stems from educational deficiencies at the medical school level.” Osteopathic medical education programs, are addressing this need every day. Tayson DeLengocky is a vitreo-retinal surgeon who blogs at Eye Dr DeLengocky.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.