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PrintA hypothesis: Why Singaporean Kids are more likely to develop neck pain than their counterparts in South East Asia?
As a physiotherapist working in private practice, I am starting to see an increasing trend of younger clients with neck pain. The youngest has been 8, but the majority are between 13-16 years of age. I believe that this is a trend that we will continue to see with potential for even younger clients.
My thoughts: Some possible factors unique to Singapore, that may be contributing to this trend:
1. IT/ phones
Singapore is one of the most wired up countries in the world, having one of the highest IT penetration rates. Despites Singapore’s 4 million population, it has 402,992 iPhones, 76575 iPod Touch and 1,453 iPad’s totaling 480,950 iOS devices. Singapore has the highest iOS penetration , in comparison to neighbouring Indonesia which has the lowest. http://e27.sg/2010/06/10/highest-ios-pen…).
According to iDA Singapore, in the fourth quarter of 2010, Singapore’s household broadband penetration rate was 191%. This percentage suggests that almost every household had 2 broadband subscriptions.
The mobile phone penetration rate is 143%, and 3G mobile subscription totals is an overwhelming 4.7 million.
The statistics alone indicate that the Singaporean lifestyle has changed over the last 10 years. It can be inferred that almost every household will have access to a computer, a 3G mobile phone and possibly a tablet.
Most children in Singapore have access to some IT and are exposed and taught to use computers in schools. This fact, combined with the popularity of social networks like Facebook and Twitter for the older kids and Club Penguin for the younger kids, as well as the myriad of free games available on the iphone and ipads, children in Singapore spend more time in potential poor postures whilst attending to these IT tasks; and more time indoors than outdoors.
2. Decrease outdoor play
Apart from the reasons mentioned above, other factors that may influence outdoor play are:
The oppressive heat and humidity, With a constant daily humidity of 99% and a temperature of 33 degree Celsius it is understandable the kids prefer to stay indoors. Possibly aggravating the problem are the parents who also may not be as willing to accompany the younger ones to the park for the same reason.
Secondly, the lack of open spaces available for free play. Approximately 80% of the population lives in apartments, and the majority of those living in landed properties have little garden space. The physical environment in itself is not conducive to outdoor play.
It is commendable that in most housing estates, there are playgrounds for young children to play, but not much for the older kids. You will often see signs that say “no soccer allowed” in the void decks and even some open fields. With such restrictions, it is no wonder outdoor play is reduced.
Thirdly, perhaps the majority of households are dual income, parents are not able to supervise outdoor play and may not want their children to play outdoors on their own.
3. Great emphasis of academic results and sport is not seen as a priority.
There is a greater emphasis on academic performance in Singapore, compared to anywhere else in South East Asia. With no natural resource, human resource remains its main driving force leaving Singaporeans no choice but to be ahead of the game.
This translates to lots of pressure to do well in school as that is seen to lead to a good job with a good income, and thus growth for the economy.
As a result, outdoor play or pursuing ambitions of an elite sport athlete is not a priority or possibly encouraged in a practical Singapore. Such mindsets are subsequently ingrained in a young children, and is unlikely to change anytime soon in the future.
4. Parents awareness of ergonomics
As children spend increasingly longer time studying or and at the computer, it is imperative that as parents, we realize that good ergonomics is paramount in reducing the incidence of neck and back pain in this population.
The study table and chair must therefore be of the right height. The child’s back must be fully rested against the back of the chair; and feet completely supported on the floor. The table height should be lowered such that the child’s elbow can be at 90’ angle when rested on the table. When reading, the table should be inclined so that the child need not to drop their head forward to read. Investing in an ergonomic table and chair is a worthwhile investment for your child’s spinal health.
If the child has to spend a fair bit of time on the laptop, buy a laptop riser, a separate key board and mouse. Using a laptop without ergonomic modification will result in excessive loading in the neck joints leading to pain.
If your child is complaining of neck or back pain, consult your nearest Core concepts branch for advise and treatment.
Improving Your Chances for a Successful Back Surgery
Spine-Health.com recently listed 5 ways to improve your chances in their article, “5 ways to minimise failed back surgery and continued back pain”1. One of the 5 ways was – “Be Ready to Rehabilitate”. We would like to add one more way to improve your chances – Pre-Habilitation. (more…)
Different Compensation Strategies During Jogging by Low Back Pain Sufferers
I am sure all athletes have experienced the effects of muscle fatigue. You will use your body differently, trying to compensate by moving your limbs in a more comfortable way. Try going down stairs right after a marathon and you get the picture.
An interesting question is, do everyone compensate using the same strategy? Apparently not. A recent study¹ shows people with recurrent low back pain jogs with a different compensation strategy compared to healthy individuals after a set of fatiguing lower back muscle endurance exercise.
The exercise was to hold the lower back in an extended position until their muscles shows signs of fatigue on surface electromyography (EMG).
The low back pain group was found to jog with a more extended or arched lower back and had more hip movements whereas the normal healthy group runs with a more forward flexed trunk. This may be why it is a common for people with chronic low back pain to complain of hip muscle soreness and fatigue after endurance exercises.
It is a known fact that chronic low back pain sufferers have poor core muscle function. This adaptation of running with an extended back may be a strategy to stabilise the lower back without the need to use core muscles and yet able to continue running. On the other hand, healthy individuals are able to use their core muscles as a natural trunk stabiliser and prevent unnecessary movements.
Parallels can be drawn with long hours of sitting where the body requires muscle endurance to sustain in a single position. When fatigue sets in, the body may adopt a different strategy to try to protect the back and inadvertently creates a wrong movement pattern or mal-adaptation. Therefore, correcting wrong movement patterns and strengthening of the core muscles are important aspects of treating chonic low back pain.
Reference:
1. Hart JM, Kerrigan DC, Fritz JM, Ingersoll CD. Jogging Kinematics After Lumbar Paraspinal Muscle Fatigue Journal of Athletic Training. 2009; 44(5):475–481
Picture: www.amercianrunning.org
Patient Education is Crucial
Musculoskeletal Consumer Review’s editor, Cindy Tan, took an opportunity to sit with Sylvia Ho, a Principal Physiotherapist at Core Concepts to discuss about what she thought were some key issues facing patient today to help themselves get better.
MCR: What are some of the key challenges facing someone with back problems?
Sylvia Ho: The first and perhaps largest hurdle is simply first understanding the problem. Back problems are extremely common. Statistics have shown at that any one point in time, some 20% of the population is having some form of back or neck pain within the past few weeks. Perhaps the fact that it is so common, people tend not to dwell on it. Of course until they experience it themselves. (more…)
Herniated Disc or ‘Slipped’ Disc
A herniated disc is known by many names, bulging disc, compressed disc, herniated intervertebral disc, herniated nucleus pulposus, prolapsed disc, ruptured disc and, perhaps the most inaccurate of all, slipped disc. It is one of the better known spinal conditions and yet few know what it truly means. Let us that a look at the structure of the disc and understand what happens when a disc is said to herniate.
Structure of a disc
A spinal or inter-vertabral disc sits between two spinal vertebrae. It acts mainly as a cushion to take up the pressure off the spine. Most people imagine the disc as a rubber disc with a soft-jelly centre, much like a jelly donut. It is perhaps more accurate to imagine a ball of jelly wrapped around with a string over and over again until the jelly ball is completely covered. So instead of a solid rubber material, the soft center is actually covered by a ring of tough string or fibres. This ring of fibre is known as the outer annulus fibrosus, which surrounds the inner ball of jelly, nucleus pulposus.
How the disc works
Imagine that you have blown up a small red balloon and ‘sandwiched’ it between two slices of bread. When you squeeze the slices of bread together, the balloon resists the squeeze and expands out of the side of the sandwich. Your disc works in exactly the same way, only that the disc’s wall is much thicker and has a jelly center instead of air. Now, instead of squeezing the balloon down evenly on both side, squeeze down the sandwich at just one end. The balloon should expand out at the other end of the sandwich. If this position is held for long time, the balloon will becoming permanently stretched at one end. When you let go of the sandwich, the balloon end will not shrink back fully but will remainly slightly loose. The more often you stretch it and the longer you hold the stretch, the looser is gets over time. The jelly center bounces back but the tougher surrouding fibres won’t. If they are over-stretched, they either break or remaining stretched.
Stages of disc herniation
Like the balloon sandwich, the disc doesn’t burst immediately unless squeezed extremely hard. Instead it will get stretched gradually over time. More accurately, each disc fibre gets stretched over time. So it is a gradual process happening over each fibre at a time. It is rarely a sudden process. You don’t wake up one morning to find a bulging disc when the disc was perfectly fine the day before.
Bulging Disc
At this early stage, the disc is stretched and doesn’t completely return to its normal shape when pressure is relieved. It retains a slight bulge at one side of the disc. Some of the inner disc fibres could be torn and the soft jelly (nucleus pulposus) is spiling outwards into the disc fibres but not out of the disc.
Prolapsed Disc
At this stage, the bulge is very prominent and the soft jelly centre has spilled out to the inner edge of the outer fibres, barely held in by the remaining disc fibres.
Herniated Disc or Extrusion
Herniation is a term to mean protrusion. In the case of a herniated spinal disc, the soft jelly has completely spilled out of the disc and now protruding out of the disc fibres.
Sequestered Disc
Here some of the jelly material is breaking off away from the disc into the surrounding area.
Can discs heal?
Unfortunately, a damaged disc cannot heal itself. It has little blood supply (only at the flat top and bottom of the disc) and the disc tissues cannot regenerate themselves. Once the disc fibres are stretched, it is currently not possible to un-stretch back to their original state.
Is there pain?
There are few nerve endings in the spinal discs, mainly in the edge of the disc facing out from your back. So there is often little or no direct pain felt from a degenerating, bulging or herniated disc.
Pain felt from a herniated disc is more often caused by the disc or its soft jelly core pressing on its surrouding tissues which have more nerve endings. So it is possible to have a herniated disc and yet experience no pain if the herniated disc does not pressed against any nerves
Another source of pain is when the disc first herniates, the nucleous pulposus reacts with the blood supply surrounding the disc to produce chemicals that can also irritate to the surrouding tissue causing inflammation.
Reference:
- P. Prithvi Raj MD, FIPP, ABIPP (2008) Intervertebral Disc: Anatomy-Physiology-Pathophysiology-Treatment , Pain Practice 8 (1) , 18–44 doi:10.1111/j.1533-2500.2007.00171.x
- Medline Plus, AKPC_IDS += "141,";
Lumbar Supports Not Particularly Effective for Low Back Pain
A new systematic review published in the Cochrane Library proved what leading musculoskeletal experts have been saying all along that lumbar or lower back supports — those large belts that people wear around their waists when they lift or carry heavy objects — are not very useful for preventing low back pain,. (more…)
Physical Therapists offer Low-Cost Solutions to High-Cost Expenditures for Spinal Conditions
Research by the American Physical Therapy Association found that Physical Therapy (physiotherapy in part of the world) is an effective treatment of choice for many back pain patients. Read the full article here
Ladies: Don’t Postpone Knee-replacement Surgery
Is getting new knees on your list of New Year’s resolutions?Research at the University of Delaware indicates that women wait longer to pursue knee-replacement surgery than men do.
By postponing surgery until they can no longer stand the pain, these women may also risk putting their mobility, and quality of life, on hold indefinitely, according to Lynn Snyder-Mackler, Distinguished Alumni Professor in UD’s Department of Physical Therapy and a certified sports physical therapist and athletic trainer.
Read the rest of the article here
