Handbag Ergonomics – Part I

Musculoskeletal Consumer Review recently caught up with Cheryl Ng, an Associate Principal Physiotherapist at Core Concepts. We were curious about the term, 'handbag syndrome'. that Cheryl mentioned during her recent interviewed by Lian He Wan Bao on pains from carrying big handbags. Cheryl is also Head of Etonia, Core Concepts division for Women's Health.

MCR: Are heavy bags a potential cause of shoulder and neck aches? Why?

Flickr: chelsea steve

Cheryl Ng: Big handbags are in fashion for a couple of years now, so inevitably the amount of content these bags carry grows (i.e. Camera, mobile phone, make-up, wallet, laptop, umbrella, water bottle etc). That is the rise of heavier handbags and typically such a bag can weigh 3kg or more. Over at Core Concepts, we noted increasing cases of shoulder and neck pains due to heavy handbags usage also known as “handbag syndrome”. Though such syndrome affects mainly women, men do get such pains as there are rising trends of men who carry heavy bags (eg laptop bag).

A heavy handbag, shoulder bag, or purse can injure the neck, back and shoulders. The neck has a natural curve that evenly distributes forces on the spine. Hence, when a person carries a heavy bag on one side over a long period of time, this natural curve starts to get distorted which can lead to chronic neck and shoulder pains, back pain, and even headaches. Left untreated, it can lead to more serious injuries such as herniated discs and accelerated degeneration of the cervical spine.

MCR: What weight (of bags) is considered to be too heavy to be carried on the shoulder, and for what duration?

Cheryl: Typically, it is advised that the weight of the handbags/ shoulder bags/ laptop bags should not weigh more than 10-15 percent of your body weight. Also, check by feeling the bag on our shoulder. When you sling the bag on your shoulder, and it feels uncomfortable, especially when the weight pulling shoulder down, it is time to downsize or reduce the contents in your bag. However, I recommend lighter bags (contents included), not more than 2-3 kg as we tend to carry such bags frequently and over a extended period of time (travelling to work and back home, shopping) which can change the biomechanics of the neck , back and shoulders and lead to pain and dysfunction.

MCR: What serious problems can be caused if bags are too heavy? And what physiotherapy can be done to alleviate the aches?

Cheryl: A common problem is that one shoulder becomes slightly higher than the other. Some scenarios such as talking on mobile while carrying the heavy handbag, will worsens the problem, because in addition to balancing too much weight on one side, she is lifting the shoulder at the same time, straining the neck and shoulder ligaments and muscles.

Typically, handbag syndrome brings about neck, shoulder muscles and ligaments strain/ injuries, causing poor neck and shoulder postures. Left untreated, these can lead to more serious injuries such as herniated discs, accelerated degeneration of the spine and less commonly, traction injury of the brachial plexus, which symptoms are weakness and sensation changes (i.e. numbness over the shoulder and arm).

Physiotherapy can help resolve these pains by analyzing the structure of the your body, such as how does your head sits on your shoulders or how your posture could have brought about the biomechanical changes in your neck and shoulders causing pains. To reduce the stiffness, pain and discomfort brought about by these changes, physiotherapists apply various strategies in the restoration of spinal and shoulder girdle mobility and stability that results in a reduction in the patient’s pain and spasm. Strategies include manual techniques, such as joint mobilization and manipulation, deep tissue massage, muscle energy technique and neck and shoulder girdle stabilization exercises. However, treatment is always more effective if the problem is detected and treated early as chronic problems (more than 3 months) have poorer treatment results. Therefore, if the pain does not resolve within 3 days and seems to get worse, it is time to make an appointment with your physiotherapist.

Some tips in choosing a handbag that is ergonomical.

Choose a handbag that is proportionate to your body size and not larger than what is needed. Your handbag should not weigh more than 10 percent or less of your body weight.
Select a bag made of lightweight material such as vinyl or canvas instead of leather.
The shoulder straps should be wide, adjustable, and padded if possible. Poorly designed shoulder straps can dig deep into muscles causing strain and pinched nerves. If possible, select a strap that is long enough to sling across to the opposite side of the body to help distribute weight of the bag more evenly.
Do consider a backpack. It distributes the weight between both shoulders.
Choose a handbag that has several individual pockets instead of one large compartment. This will help to distribute the weight evenly and keep contents of the bag from shifting.
Do not wait to seek treatment for pain. You can avoid serious injury and surgery by addressing the problem early.

Carrying a handbag.

Use both hands to check the weight of the handbag.
Instead of always carrying your handbag on the same shoulder, switch sides often.
Retract your shoulders while carrying the bag.

The interview continues in Heel Ergonomics – Part II

Who needs bone-building drugs?

Osteoporosis is a common debilitating condition that contributes to increase risk of fractures. To prevent possible risk of fractures, bone building drugs are available to improve bone density. However, they can have side effects and are only 50 percent effective in preventing fractures. Therefore, World Health Organisation has come up with a tool to find out who will benefit from bone building drugs.

FRAX is an online risk calculator which helps the doctors and patients to determine the possibility of potential fracture and determine whether the drug therapy might prevent fractures. The list consists of questions looking at risk factors of osteoporosis. The factors analyze the lifestyle, conditions, diseases and medications that can contribute to the risk of osteoporosis and fractures.

The formula is applicable to both men and women. It can be used independently without a person’s bone density score but having a bone density score can further enhance the accuracy of the prediction.

References

www.shef.ac.uk/FRAX/index.htm

http://mobile.nytimes.com/2009/12/29/health/29brod.xml

What not to do? The Question Less Asked.

Recently, a client asked me "Ok. So what shouldn't I do now?" And it struck me how infrequently we get such questions. As professionals we are often asked them by our clients, "What should I do?" in the belief that something 'more' is the solution to their problems; that they are missing out on something that they should be doing. This is true for most fields and healthcare is no exception.

Photo: Flickr albertopveiga

Solutions to a problem can often be found from many directions though we often prefer something from the side of complexity – the 'more' side. In healthcare, that could mean more 'tests', 'scans', 'drugs' or 'treatments'. The 'less' side is less explored, no pun intended.

In the case of musculoskeletal conditions, a small minority of conditions have their roots in the person's genetic code; meaning that they were born with it. Most have external causes – lifestyle, diet, occupational conditions or movement habits. For example low back pain from poor posture, wrist repetitive strain injury from poor ergonomic workplace setup and sports injury from overtraining.

When faced with such musculoskeletal injuries, humans don't seem to be geared up to accept simple answers. We prefer complex solutions (read machines with lots of blinking lights) over simpler ones (read manual therapy or exercises using body weight). We see this across many different situations.

The most common situation is, 'what sort of machine test will you do?' We have learnt to equate the more expensive and more complex the machine scanning us to better results. We wrote about this about a year ago, "Diagnose First, Scan Second" where a recent study found that the routine use of radiography (X-ray), MRI, or CT scans in patients with low-back pain but no indication of a serious underlying condition does not improve clinical outcomes. Combine this no-improvement outcome with the more recent reports on radiation overdoses from CT scan and it is worrying.

Another situation is the use of impressive looking machines for treatments. Will a more expensive looking exercise machine work better for me than a simple home-based type device? In the fitness industry, there is a growing trend of people moving away from machine-based exercises towards simpler functional movement-based devices like the TRX Suspension Training. Not only is it several hundred dollars cheaper if not thousands, it can be more versatile and challenging.

Surprisingly, sometimes even when it comes to treating a specific condition, the best answer may be to do nothing. In the case of whiplash, one of the recommended treatment protocols during the early stage of whiplash is to "Act As Usual". It can be quite unsettling when visiting a doctor for whiplash treatment and to be told to act normally, to do nothing different.

Of course it does not mean that the most appropriate treatment is always to do nothing or to do something less. However, it does mean that not every appropriate treatment must do something or to do something more.

Perhaps a simple rule of thumb to help you learn to do less to achieve more with your health, for every 'what can I do?' question, ask 'what shouldn't I do?".

Tennis Elbow in Children?

There are some kids, between 2-5 years old, who might complain of pain over the outside of their elbow, a common site of complain for tennis elbow. However, is it possible? Chances are, the child might be suffering from either a subluxed or dislocated radial head from the annular ligament that holds the radial head to the ulnar. (more…)

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Jointly organised by Core Concepts – Musculoskeletal Health Group and Healthway Medical Group, this public talk will cover the three of the main options of treatment for idiopathic scoliosis – surgery, bracing and physiotherapy.

For more information, visit http://scoliosis.coreconcepts.com.sg/publictalk/

"Hi MCR, I keep hearing about ultrasound therapy but I get confused with the seemingly different answers I get about them. There appears to be one for healing bruises and swells. And another to 'see' inside and another to blast off pieces of our bones at the heel of our foot. Are they all the same thing?" – Swee Yong

Dear Swee Yong,

Thanks for your question. Yes, indeed it can be confusing because medical professionals tend to just to refer to it as 'ultrasound', leaving their specific context to mean which type of ultrasound.

Therapeutic Ultrasound

The first one you mentioned about healing swelling is what is called 'Therapeutic Ultrasound'. Used in physiotherapy, this is a high frequency (0.7 to 3.3Mhz) but low energy sound wave. Absoprtion of these sounds waves by the tissues causes the cells to vibrate. The vibrational energy stimulates the cell-repair effects which helps to expedite the healing process. Also, when the sound waves are absorbed into the tissues, they are converted to heat energy which helps to improve circulation.

Compared to other types of 'heat' treatments such as a hot pack, ultrasound is able to penetrate deep into the affected area. When we say 'ultrasound' in the physiotherapy context, we actually mean this form of ultrasound.

Usually at Core Concepts, we use 'therapeutic ultrasound' as an adjunct to our main treatment option as healing the tissue is not enough. We first need to fix the reason behind the tissue injury.

Ultrasound Imaging

The second type of ultrasound you mentioned to 'see' inside, is 'Ultrasound Imaging'. This the type of ultrasound device used by your OBGY to see the baby inside. Much like the 'sonar' of a submarine, sound is used to look inside. The higher the frequency of the sound, the image is sharper but does not penetrate as deeply. (7-18Mhz) for structures nearer the skins such as muscle and 1-6Mhz for deeper body parts such as livers and kidneys. Gyneas and OBGY means this when they say, 'ultrasound'.

At Core Concepts, we use a similar version of Real-Time Ultrasound Imaging to help our clients visually and confirm deeep muscle contraction, particularly for their core muscles.

Shock-wave Therapy

The last type of ultrasound you mentioned is commonly referred to as Extracorporeal Shockwave Therapy (ESWT). Compared to the continuous lower-energy waves of'therapeutic ultrasound, ESWT machines send higher-energy pulses 2 or 3 times per second. These high-energy shockwaves blast off hard structures like heel spurs or kidney stones. The high-pressure waves also help promote healing. ESWT is never referred to as ultrasound though all three types use sound waves.

Hope this helps clear up some of the confusion.

Tips to Run Pain Free

Recently our physiotherapist, Lenia, was featured in Shape magazine Jan 2010. Here is an excerpt from the article.

Shin splints are caused by weak shin muscles or faulty running biomechanics while plantar fasciitisis the result of tight calf muscles that reduce the foot's ability to absorb shock. Here are some tips to stay on track. (more…)

Tendon Disorders: Inflammation and Degeneration

One common form of musculoskeletal injury is tendon-related disorders like tennis elbow and Achilles tendonitis. Your tendon is the connector that transfers power from your muscle generators to your skeletal structure to create movement. Under normal circumstances, healthy tendons glide easily and smoothly as the muscles contract. When tendons are injured, they cause pain, especially during movement. (more…)

TENS – Not effective for Chronic Low Back Pain according to latest guidelines

The American Academy of Neurology (AAN) recently published an evidence-based guidelines on the use of TENS ( transcutaneous electric nerve stimulation) is not recommended for the treatment of chronic low-back pain due to lack of proven efficacy. This supports our views at Core Concepts as a large number of chronic back pain cases is mechanical in nature.

A TENS device
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"The strongest evidence showed that there is no benefit for people using TENS for chronic low-back pain," said guideline author Richard M. Dubinsky, MD, MPH, of Kansas University Medical Center in Kansas City and a Fellow of the American Academy of Neurology. "Doctors should use clinical judgment regarding TENS use for chronic low-back pain. People who are currently using TENS for their low-back pain should discuss these findings with their doctors."

TENS however, continues to be recommended for TENS can be effective in treating diabetic nerve pain.

Reference:

Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
American Academy of Neurology (2009, December 31). Widely used device for pain therapy not recommended for chronic low back pain. ScienceDaily. Retrieved January 1, 2010, from http://www.sciencedaily.com /releases/2009/12/091230174120.htm