Trigger Point Injections vs Dry Needling
Here is another great article from my friend Kevin Christie DC on Desk Pain Prevention.
Hope you enjoy!
I discuss with many desk workers and corporations on how to avoid the ill-effects of sitting. The effects can be physically, internally, emotionally, etc. For the sake of our work, we focus on the musculoskeletal aspect. I have put together a 6-Part strategy you can easily implement in your daily routine to achieve optimal health and wellness. I have also provided you with some additional resources to check out.
Part 1: Education Training and Understanding Pain/Injuries
I truly believe the first step of preventing pain and injury, or achieving optimal health, is to first understand how pain, injury and poor health occurs in the body. Education training is a key aspect and I am going to focus here on musculoskeletal health.
The Cumulative Injury Cycle
The Cumulative Injury Cycle represents the process in which over-use injuries and pain may occur. This cycle is not limited to sitting or computer workstations, but anything you do repetitively. There is both the potential of the Chronic Cycle and the Inflammatory Cycle that we may suffer from when sitting for prolonged periods of time. Since sitting is one of the most common overuse activities that we face, this cumulative injury cycle occurs all too often in the desk worker.
P. Michael Leahy: Active Release Techniques
The chronic cycle begins with overwork, such as the long duration of sitting. This prolonged sitting may lead to a deconditioned and/or sedentary lifestyle that will develop Weak & Tense Muscles/Soft Tissue. These weak and/or tight muscles lead to excessive Friction, Pressure and Tension to the local muscles, ligaments, tendons, and fascia. In turn, this results in Decreased Circulation and Swelling and Hypoxia (lack of oxygen) to the area. Due to this hypoxic state (lack of oxygen to an area), the formation of adhesions and/or scar tissue occurs to the area, which decreases the function of the local structures. This becomes a vicious cycle that over time results in weaker and more tensed muscles and soft tissue and the cycle keeps on churning until the body sends off the alarm system that something is wrong. That alarm system comes in the form of a pain!
An example of this in action would be the prolonged sitting with poor posture leading to tightness in your upper trapezius. This is the muscle that attaches from the base of your skull to your shoulders. This leads to chronic tension in that muscle group and over time, leads to a lack of blood flow to that area and therefore lack of oxygen to the localized muscle fibers. This develops the scar tissue or “trigger point” in that muscle and you feel the “knot” in your neck that everyone complains of constantly. This type of cycle can happen in many areas of your body and is the essence of how over-use strain and pain/injury occurs.
This cycle may also start with an Acute Injury such as a tear or crush injury that leads to localized inflammation that becomes formulation of adhesive fibers/scar tissue. Once the inflammation subsides, the pain may go away but now you have entered into the chronic cycle and over time you may redevelop pain from the old injury.
Many people get confused and frustrated with over-use injuries and pain because they don’t know how it happened and don’t have an “event” or reason they can trace their injury to. The reason being that this cumulative injury cycle can lay dormant for weeks, months and even years before the straw that broke the camel’s back occurs. And again, sitting is a very common cause of falling into this cumulative injury cycle.
Part 2: Proper Ergonomics
The word ‘ergonomics’ comes from the Greek words ‘ergon’ which means work, and ‘nomos’ which means natural laws. Ergonomics can thus be defined simply as the natural laws of work. More specifically, ergonomics is the scientific study of designing the job and workplace to fit the worker, keeping in mind their capabilities and limitations. Ergonomics combines the knowledge from other scientific disciplines like anatomy and physiology, biomechanics, engineering, psychology, and statistics to ensure that workplace designs complement the strengths of people and minimize the effects of their limitations.
Ergonomics is also known as human factors, and the terms are often used interchangeably. Ergonomists and human factors specialists seek to understand how a workplace, product, tool, or system can be best designed to fit the people who need to use it. The goal is to apply this knowledge to improve the system, human performance, and productivity, while also focusing on the health, safety, and well-being of the individuals involved.
Part 3: Micro-Breaks
It is important to build micro breaks into the daily routine. As such, Stanford also provides the following ideas for making breaks a part of the workday: Move the printer to an area that requires you to stand up and walk to get a printout. Stand up when talking on the phone (the use of a stand-up desk is also helpful), Go to the restroom or get a cup of coffee/water (frequently; remember the glass of water every hour), Break up continuous computer time with tasks such as checking phone messages, reading reports, etc.
Our favorite intervention is the Micro-Break Card (see below). Make sure to implement these micro-breaks every 60 minutes.
Part 4: Body Positioning and Awareness
The key to injury prevention for the spine is to avoid improper positioning and movements that will cause undue stress. The Sternum Up, Power Zone and Abdominal Bracing will keep the spine in neutral, allow for proper bending at the hips and protect the spine. Here are easy ways you can implement this into your activities of daily living.
Sternum Up- Keeping the sternum up automatically sets the body into good posture and maintains:
a. Neutral Spine: Maintaining good spinal alignment decreases the stress placed on the spine and discs.
b. Hip Hinging: Bending at the hips, and not the low back, decreases the stress placed on the low back and increases strength & power.
Power Zone- The zone that will optimize lifting strength and injury reduction.
a. Bend your elbows at a 90-degree angle and you are in the “Primary Power Zone”
b. The area up to the shoulders and down to the hips is acceptable.
c. The more you can work in the “power zone” the less fatigue on your body
Abdominal Bracing- When all of your core muscles work together, a “Super Sti¬ffness” occurs, and all 3 layers of the abdominal wall are activated to protect and stabilize the spine and discs.
Without bending forward, contract the abdominal muscles (like you are about the get punched in your gut – feel them tighten with one hand) and the buttock muscles (as if you are holding in a bowel movement). You will feel the lower back muscles contract (with the other hand) when you contract your abs and buttocks. Activities of Daily Living
Part 5: Proper Posture
Vladimir Janda, a highly notarized Medical Physician was the first physician to define posture into the different “crossed syndromes” outlined in chapter 2. In 1979 he classified postural distortion into the three different syndromes; upper crossed lower crossed and layered syndromes. Based upon these syndromes, postural corrections were theorized to correct these musculoskeletal imbalances.
Part 6: Corrective Exercises
Corrective exercises are typically spine-sparing strategies that include movements and stretches to correct postural distortions and musculoskeletal imbalances. This would include concepts like taking micro-breaks very often at work to stretch for 20 seconds, look 20 yards away at an object to readjust the muscles in your eyes from staring at a computer screen. Other strategies for corrective exercise might include, an overhead arm reaches, Brugger’s postural relief, sitting to standing, spine mobilization exercises, and wall angels. These exercises can help open up the posture from sitting in a forward flexed position for hours at a time. Functional rehabilitation would include incorporating functional exercises that are intended to activate the core. This activation will help strengthen the body’s muscles to make the muscles stronger to endure hours of repetitive posture. Some of these exercises might include; side bridges, rows, planks, cat/camel exercises, bird dog and superman extension exercises just to name a few. Below is a small sampling of corrective exercises and functional rehabilitation that you can incorporate into your daily routine. Later in this book, we will be providing you with a self-functional assessment that will find some of your potential functional deficiencies with correlated corrective strategies.
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