Is Your Child's Back-Pack Causing Harm?

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Each morning millions of students across the nation are racing to the school bus or scurrying to their classrooms with an overstuffed back-pack slung over one shoulder. While carrying a back-pack to school each morning might seem harmless, it can cause painful back and neck problems for your children who do not pack or carry their back packs properly.

Here are a few tips to help prevent the children in your household from the aches and pains of an injured spine caused by an overstuffed back-pack.

Weight Distribution

  • Make sure your child’s back-pack weighs no more than 5-10% of his or her body weight. Any heavier than that, the heavy back-pack will cause your child to begin to bend forward in an attempt to support the weight on his or her back rather than carrying the weight on the shoulder straps as designed. Not only does this cause stress on the neck and shoulders, but the flexing motion causes stress in the low back as well.
  • A back-pack with individualized compartments will help you distribute the weight throughout the backpack more evenly. And as a bonus, it will help to prevent your child’s sandwich from being flattened by that heavy science book.
  • When packing the back-pack make sure that pointy or bulky objects are packed away from the area that will rest on your child’s back. An uneven surface rubbing against your child’s back can cause painful blisters and cause your child to walk with an awkward posture.
  • If the back-pack is still too heavy talk to your child’s teacher. It might be possible for your child to leave the heaviest books at school and bring home only lighter hand-out materials or workbooks.

Utilizing the Shoulder Straps Effectively

  • Tell your child to use both shoulder straps, not just one. A back-pack slung over one shoulder disproportionately shifts all of the weight to one side and can cause not only neck and muscle spasms, but also low back pain.
  • Padded shoulder straps are very important. Not only will they be more comfortable than non-padded straps, they will also help prevent the straps from digging into your child’s shoulders.
  • Shoulder straps should be adjustable so the back-pack can be fitted to your child’s body. Shoulder straps that are too loose can cause the back-pack to dangle, which causes the spine to go into extension. This can lead to misalignment of the spine as well as pain.

As adults, we seem to think that back pain is not something that our young children deal with, this is not the case. Longstanding ergonomic stress to our children's spines will cause chronic issues that will bother them down the road. Talk to your child about the proper use of back-packs and help him or her understand why this and other ergonomic issues are important. A child who is educated early in life on ergonomic issues can apply this knowledge later in life at home or in the office and will be happier and healthier as a result.

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Dr. Jesse J. Suess, DC
310 N. Maple Ave. 
Ridgewood, NJ 07450

(201)447-3707
drjesse@drjessesuess.com

HOW TO SIT BETTER - 3 EASY STEPS!

One of the most common questions that I receive from my patients is how to attain proper posture. First we must understand what exactly posture is. In simple terms, posture is the relationship with the skeleton to the earth’s gravitational forces. The skeleton is designed to disperse forces from the top of the head, through the feet and eventually to the floor. With a totally “neutral” posture, the body is designed to disperse these forces with minimal impact on the surrounding tissues of the body. But when the posture is altered in any way that alters how the body perceives these forces. This leads to joints of the body taking on more force than they are designed to hold. This is the type of stress that can lead to chronic disease such as disc degeneration, osteoarthritis, chronic low back pain, sciatica, upper back and neck pain, and cervicogenic headaches to name a few. I have written a series of articles with the intent to inform you of how to maintain proper posture throughout your day so you have the knowledge to reduce the load placed on your body and live a healthier lifestyle.

As we dive further into Postural Awareness Month, we turn our attention to seated posture. Considering the majority of our culture spends more than 40 hours per week in seated position, seated ergonomics can be one of most important topics that we will discuss over the course of this month. Sitting in general is not a natural position, so there is no “perfect” position to sit. With that in mind, I understand that for some people sitting for pro-longed periods of time is unavoidable. Way back in the cave man days there were no chairs. We humans would squat in the catcher’s position much like apes when resting. This would utilize the full range of motion in the hips and keep the hip joints mobile. When sitting in a chair we are only utilizing about half of the hip joints range of motion, which leads to tight hip capsules and hip problems. I have put together a few reference points for you to remember while you're sitting. These reference points are aimed to reduce the amount of stress on your body while in a seated position.

1. Use Your Pelvis Properly

The Problem:
The most important adjustment you can make in a seated position is to make sure that you are sitting correctly on your pelvis. Many people slouch in their chairs and roll forward onto the sacrum. When we scoot up towards the front of our chair, that transfers the weight from our upper body onto the front of the sacrum, this places a tremendous amount of pressure on the lower lumbar discs and the sacroiliac joint.

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The fix:
Simply sit back in the chair and sit up on the “sit bones” (ischial tuberosity) that are located underneath the pelvis. This will promote a more neutral orientation of the pelvis which in turn promote the normal curvature (lordosis) of the lumbar spine and take pressure off of the lumbar discs. There are products such as lumbar support cushions that help you promote this posture. Or you can take a small pillow and place it behind your chair to remind yourself not to slouch.

2. The Knee Angle

The Problem:
Very often I see people sitting with their feet folded under their chair (with the knees in an acute angle) or spread out in front of them (with an obtuse angle of the knee joint). Either of these positions places our pelvis and our hips in a position that make it harder to gain the proper posture that we mentioned above.

The Fix:
We want our feet directly under our knees at all times, which puts our knees at a nice 90 degree angle. Another thing you can do is keep your knees bent at 90 degrees and place a small stool underneath your feet in order to gain more flexion in the hip joint. Ideally we want the knees higher than the hips; whenever this is accomplished it takes a lot of pressure off of the low back.

3. Shoulder & Head Positioning

Incorrect Seated Posture!

Incorrect Seated Posture!

The Problem:
Often people have to lean forward or look downward in order to see whatever they are working on, whether it is a book or a computer screen. This causes flexion of the neck and forward weight head posture.

 

The Fix:
Remember what I told you in my first article about forward head posture and shoulder positioning, those rules still apply to a seated position. We want to make sure that our shoulders are rolled back into a neutral position and our chin remains parallel to the floor. In order to accomplish the proper chin positioning you may need to raise the computer screen about a half of a foot off of the desk. The optimal positioning of the computer monitor is to have the top of the monitor at eye level. 

 

MOST IMPORTANTLY KEEP MOVING! Remember what I said earlier, there is nothing natural about a seated posture. Avoid sitting for more than 45 minutes at a time. When we sit for more than this we place excess stress and pressure on the low back and allow blood to pool within the veins of our lower extremity. Get up, stand, and walk around for 10-15 minutes every hour to keep your blood flowing and allowing all of the blood that is pooling in the veins in your legs to get recycled back into your heart. This will help you avoid developing blood clots throughout your legs as well as keeping your joints moving properly. Motion is Lotion! 

If you feel as if you are experiencing pain related to poor posture find a Doctor of Chiropractic near you that can remove the restriction and restore mobility, as well as help educate you on proper posture. Please feel free to contact me with any questions or concerns. 

Dr. Jesse J. Suess, DC
Emery Chiropractic Group, L.L.C
310 N. Maple Ave. 
Ridgewood, NJ 07450

(201)447-3707
drjesse@drjessesuess.com

3 Easy Steps to Improve Your Posture

3 Easy Steps to Improve Your Posture

July is Postural Awareness Month. Throughout the month of July, we will be talking about the benefits of holding proper posture, and ways you can improve your posture throughout your day in order to reduce stress on yourself and on your body. 

The Great Debate: Heat vs. Ice

The Great Debate: Heat vs. Ice

When to use heat and when to use ice as a means of home treatment.

What Causes Back Pain?

What Causes Back Pain?

Written by Dr. Jesse J. Suess, DC

It is estimated that over 100 million Americans suffer from some sort of back pain throughout the calendar year, which equates to over $600 billion per year in health care costs and lost productivity according to a report by the Institute of Medicine (IOM). In layman’s terms that is suggesting that you have a 1 in 3 chance of suffering from back pain in the next year. Back pain can be one of the most confusing and frustrating ailments to treat, and the reason being is that there are so many different potential pain generators throughout the back, neck, and spine. In this article I will dive into several different common causes of back pain.

Now it is important to mention that this article is written to educate you, the patient, on common causes of low back pain and commonly presented symptomology. This article is not intended for you to self-diagnose. In order to get a full an adequate diagnosis, I strongly suggest that you seek the opinion of someone who is an expert in the field of back pain, such as a Doctor of Chiropractic.

What is “the back”?

This is a relatively simple question, with a very complex answer. When I refer to “the back” I am speaking of the 5 areas of the spine (cervical, thoracic, lumbar, sacrum, and pelvis) as well as the different muscles, ligaments, and motion segments (joints) that are associated with the spine. There are 33 vertebrae in the human spine (7 Cervical, 12 Thoracic, 5 Lumbar, 5 sacral segments, and 4 coccygeal segments).  So when I am referring to the back I am referring to the lowest portion of the pelvis all the way up to the base of the skull.

Listed below are 5 of the most common anatomical and physiological pain generators throughout the spine, listed in no particular order.

Muscular Strain

One of the more common causes of acute low back presentation is the muscular system. As we know, muscles attach to bones. The main job of a muscle is to move a bone, and it accomplishes this goal by shortening and elongating. Most of the muscles of the back find their origin or insertion on specific vertebral segments. Muscles also have a very rich blood supply, which allows them to receive the proper nutrition to heal rather quickly. When a muscle is irritated, by either over exertion or repetitive strain, it reacts in a very unique way. For example, a traumatic injury to a muscle such as over exerting yourself on the squat rack at the gym, can lead to a tear of the muscle fibers. And as a consequence, the muscle is not able to do its job and fully shorten because the muscle fibers themselves are no longer intact. This type of injury is usually associated with a particular “ouch moment” and is usually accompanied by a good degree of swelling and possibly bruising in the area of pain. The pain is usually localized to a particular area and is usually accompanied with palpable tenderness in the area of pain.

Another example of muscular related back pain would be repetitive strain type injury. Repetitive strain can be linked to poor ergonomics or posture, and has quite a different presentation than a traumatic or acute type injury described above. When we are dealing with repetitive type injuries we are most often dealing with pain that has been manifesting itself over a period of time, also known as “chronic pain”. The muscle itself reacts to chronic pain by getting stuck in the shortened position. This often causes a buildup of muscular waste (or lactic acid) in the area, which in turn forms what are known as “trigger points” in the muscle. Because the muscles are stuck in the shortened position, the muscle begins to lose access to some of it's abundant blood supply, the muscle in return becomes much weaker. The pain presentation with this type of is a generalized “dull/achy” presentation that gets worse as the day progresses. This type of chronic presentation is usually not accompanied by a particular “ouch moment”, and is usually of unknown origin.

 Ligamentous Sprain

Although ligaments and muscles are commonly thought about as closely related, they actually function quite differently. The function of the ligament is to hold the bones together and guard against hyperextension or hyperflexion of the joint. In other words, the job of the ligament is to make sure that a joint does not exceed its natural range of motion. Another unique quality of a ligament is its lack of elasticity. Think of a muscle as a rubber band, it has high elasticity and when stretched can easily mold itself back to its initial starting point. Now think of a ligament as a piece of saltwater taffy, or for the younger generation, an “airhead” (yes the candy). Initially taffy is really tough to stretch, but when you exceed the candy's elastic barrier and are finally able to stretch the taffy (or sprain a ligament) the taffy is not very elastic and does not mold back to its initial form. The reasoning behind this is because unlike it’s muscular counterpart, the ligament has a very poor blood supply. So ligamentous injuries often take longer to heal.

Each vertebral motion segment has several different ligaments in place in order to “check” the motion of the segments and avoid hypermobility. A well-known ligamentous injury is “whiplash” type injuries.

Commonly presenting symptoms of ligamentous injury is a feeling of instability in the area. The pain is often provoked by an “ouch moment” such as a bad car accident or hard fall, but doesn’t necessarily have to be associated with trauma. The pain is commonly described as a “deep and achy” pain that is localized in nature.

 The Facet Joint

The facet joint, also known as the zygapophyseal joint, is one of the most overlooked pain generators throughout the spine. The facet joints are joints located on the posterior (or back) side of the spine. Each particular vertebra has two superior facets and two inferior facets that help it attach to the adjacent vertebrae and form a motion segment. What makes the Facet joint unique is that the nerve roots exit the spinal column directly adjacent to the facet joints.

Unlike the popular intervertebral disc, the facet joint is a synovial (or fluid-filled) joint which makes it similar to most other joints in your body such as the knee, shoulder, elbow, wrist, etc. Surrounding each facet joint is a “capsule” that encases the joint fluid. When the facet joint gets irritated the joint capsule tends to “swell”, very similar to how your knee or your ankle swell when you sprain those joints. This joint is commonly injured in chronic situations, when the segments are “stuck” or “locked” in a certain position over a period of time; which triggers the body’s inflammatory response, which in turn causes the joint capsule surrounding the joint to swell and irritate the adjacent nerve root.

A common presentation for this type of injury is either low back or neck pain that is localized in nature. The pain is usually provoked by certain motions, most commonly extension (bending or looking backwards). The pain can be, but is usually not associated with an “ouch moment” and is commonly involved in the chronic presentation of back pain.

The Intervertebral Disc

The intervertebral disc (or IVD) is by far the most famous joint in the spine. Each vertebral segment has two associated IVDs associated with their superior and inferior endplates, respectively. The IVD is a unique type of joint in the body because it is not considered synovial (fluid-filled), in fact the IVD is considered a fibro-cartilaginous joint. The analogy that is often used to describe the disc is a jelly donut. Much like a jelly donut, the Intervertebral disc has hard outer fibers, called annular fibers, which encase the “jelly-like” fluid in the center. As stress and strain is put on the IVD, the joint fluid begins to poke-out, or “bulge”, out of the external surface. This “bulge” can become a pain generator if it begins to push on the surrounding structures such as the spinal cord (known as spinal stenosis), or the nerve root (a common cause of sciatica).

There are different stages of disc injury such as disc bulge, disc herniation, or disc protrusion/rupture; from least severe to most.  Each of them have much different presenting symptoms. I plan on “Debunking the disc” in a future article, so for now we will talk about the most common presenting symptoms with a presenting disc issue.

The patient usually presents in what we call an “antalgic posture”, usually leaning down and away from the area of complaint. It is also common that the patient reports associated numbness or tingling with “radiating” or “shooting” pain into the extremities (i.e. Sciatica). This situation can be caused by both acute and chronic situations, so it’s hard to say whether a particular “ouch moment” is associated with this type of injury.

 The Sacroiliac Joint

The Sacroiliac (or SI joint) is a major weight-bearing joint in the body, and can be a big-time player in low back pain. The SI joint is located where the pelvis (or ilium) meets the sacrum, hence the name “Sacroiliac Joint”. The sacroiliac joint is a very unique joint because only the upper 1/3 of the joint is mobile. When this joint is fixated, it is often accompanied by some degree of pelvic rotation. We can often see pelvic rotation through leg length. The hip joints are attached to the pelvis, and when the pelvis rotates it naturally takes the hip joints with it and causes what we refer to as a “functional short leg”. This type of short leg is by no means a permanent condition, and is often the result of muscular imbalances due to the imminent pelvic rotation.

Patients who present with a problem with the SI joint often present with a localized pain near the dimples of the back. When you touch your low back you will feel two “bumps” on each side of your low back, the SI joint is located just below these bumps called the PSIS. The patient also often notes pain while bending forward and can feel pain while walking or sitting as well. The pain is not commonly associated with an “ouch moment”, and can be accompanied by some degree of tingling and radiating pain into the lower extremities, depending on the complexity of the situation.

It is important to realize that these are some of the most common mechanical pain generators throughout the spine, and that this article is meant for educational purposes. There are many other causes of back pain. Again, if you are experiencing any sort of pain in the back or neck we strongly suggest that you seek expert care from somebody who spends all day treating and diagnosing different ailments that affect the spine and its supporting structures. If you have any comments, questions, suggestions, please feel free to contact me directly. All contact information can be found on my website. If you are interested in weekly health tips via e-mail, please leave your information in our sing-up form below.

Yours in Health,

Dr. Jesse J. Suess, DC
Emery Chiropractic Group, LLC
310 North Maple Avenue

Ridgewood, NJ 07450

 

References:

Institute of Medicine: "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research."