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.

Image from Volunteerproject.org
click for larger view

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.

A hypothesis: Why Singaporean Kids are more likely to develop neck pain than their counterparts in South East Asia? is a post from: Musculoskeletal Consumer Review

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source: www.dailymail.co.uk

Pre-habilitation is simply a form of rehabilitation that you do before your surgery. It prepares your body to start rehabilitation after surgery and to progress as quickly as possible.

The work done during rehabilitation such as improving muscular control, strength, stamina and increasing joint mobility and flexibility are all easier to improve.

• Muscles were cut through during surgery recover faster if they were healthier to start with.
• Muscle control is easier to regain if it has done a certain pattern of activation before. It is like riding a bicycle. Say you are covering from a knee surgery. It is easier to pick up cycling again than trying to learn to do it for the first time and having to bear with the pain of recovering from surgery. It is just that much harder.
• Stiff joints loosen before surgery are simply that much less stiff after surgery to start with. The same goes for joint flexibility.
• Better joint proprioception before surgery is so much easier to learn without the hassle having to bear with the pain and stiffness immediately after surgery.

This pre-habilitation also extend to almost all type of orthopedic surgery as such as knee or hip surgery².

Better preparation simply leads to better recovery.

Reference:

1.     5 Ways to Minimize Failed Back Surgery and Continued Back Pain, Spine-Health.com, Sylvia Marten

2.     Effectiveness of Accelerated Perioperative Care and Rehabilitation Intervention Compared to Current Intervention After Hip and Knee Arthroplasty. A Before-After Trial of 247 Patients With 3-month F/U, BMC Musculoskeletal Disorders,  Kristian Larsen et al

Improving Your Chances for a Successful Back Surgery is a post from: Musculoskeletal Consumer Review

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running form

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

Different Compensation Strategies During Jogging by Low Back Pain Sufferers is a post from: Musculoskeletal Consumer Review

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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.

Plus the fact that quite often, the pain resolves itself after some days of rest. The human body is quite an amazing machine that heals itself. Also, one rarely falls very ill from back pain, though there are certain cases where you can. But by far, back pain is not a life threatening disease though it can be life-limiting.

MCR: Why is understanding the problem important from a patient’s perspective?

SH: Understanding what’s causing your pain is very important with musculoskeletal conditions – that is problems with your muscles, joints, nerves and skeletal structures. A large of part of the treatment or recovery process requires very active participation from the client. Meaning there are things to do for the client.

Take for example when a problem is caused by some movement dysfunction caused by using the wrong set of muscles. This could happen because the correct set of muscles is not working too well or the nervous system is having problem getting them to respond. After finding out what’s wrong, we need the patient to begin to re-learn using the right set of muscles. And they have to continue doing so after they leave the clinic between their sessions. They need to know exactly what they need to do and what they must not do. This is what’s going to get them better in the long run. And they are only going to be able to do this if they understand what has happened, why the change is needed and what to do and change in their lifestyles. Understanding here is key.

Movement dysfunction can be as basic as not breathing right. There are quite a few ways to breathe using different sets of muscles. Using one particular set could affect muscle activation in your lower back. If the right set of muscles supporting your lower back doesn’t function properly, you will over time have lower back problems. Breathing using the right set of muscles and how that affects your low back pain is not generally intuitive for most people.

Sylvia Ho

Education Master of Physiotherapy, University of Melbourne 1999 Bachelor of Applied Science (Physiotherapy), University of Sydney, 1994 Professional Highlights Sylvia is a Principal Physiotherapist with Core Concepts. Her area of interest is the spine. Sylvia is a regular writer on health matters. She has been interviewed for articles by health magazines such as Shape, Ezyhealth, Her World and Female magazines.

MCR: What if they don’t understand?

SH: Well, firstly at our end we try to make it as simple as possible. At Core Concepts, we don’t throw out a lot of jargons. We make it a point to communicate clearly. If someone throws a lot of jargons at you, don’t get intimidated. Stop them and ask for simpler terms.

Don’t get thrown off by terms like ‘idiopathic scoliosis’. ‘Idopathic’ simply means ‘cause is not known’. Technical terms are important. They help professionals communicate faster and more precisely with each other. But often they don’t help patients to understand their conditions better.

Secondly, we layer the solution; working on the important bits first, before moving on so as not to overwhelm the client. Usually, we have one to two approaches for a particular problem and we will try to see which one works best for the client.

MCR: What about treatment that involves electrotherapy devices such as traction and short-wave diathermy?

SH: Our approach compared to using electrotherapy devices is fundamentally different. Most electrotherapy devices are focused on relieving the immediate pain symptoms. We obviously care about relieving your pain but also making sure that you stay pain-free. We do use such device usually at the early stages of acute pain before moving to use what is known as manual therapy.

A therapist that is more dependent on electrotherapy aides usually don’t need a high level of patient education on the client’s part. Very much like if you have a fever, you just take some medication. You don’t really need to know how the pills work but just that you need to take them at the prescribed times at the right amount. Pills are fixed quantities; it is harder to get them wrong.

With more a complicated disease like diabetes, you need to know more – about the symptoms, what to do when your blood sugars get too high or too low. If you just depend on the doctor handling your condition, you are going to run into problems at some point.

MCR: Based on your experience, what’s the level of patient education these days?

SH: Obviously, there is an entire spectrum of clients with different levels of patient education.

But overall, the level has certainly risen over the past few years. I believe that the internet has made a big impact in making more information available. There are also more health talks, magazines and newspaper articles today on health. We often find clients today asking us deeper and sharper questions. They have done their research before hand. We love these sorts of clients as we usually progress faster with their treatment.

But this is a double-edged sword. With more information out there, there is also more misleading information. Some are just plain wrong.

Massages are also another method of relieving pain. Increasingly, we see more massage ‘techniques’ appearing to solve more and more complicated problems. Often with conditions related to the muscles, joint and other supporting structures, muscles will get tight and tense. They will feel achy. Massage will help relieve that pain. But it does nothing to solve the underlying problem. If patients don’t understand this, they will walk thinking that their condition is better.

MCR: If someone is already suffering from pain, what can they do to help themselves?

SH: Seek help. Unresolved pain that lasts more than several weeks is not likely to get resolved on its own.

Find out more about your condition. Besides reading up on your own, asks lots of questions. A good doctor, physician or therapist will be more than happy to explain it to you.

Patient Education is Crucial is a post from: Musculoskeletal Consumer Review

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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

click for larger view

Stages of disc herniation

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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:

1. 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
2. Medline Plus, Herniated Disc or ‘Slipped’ Disc is a post from: Musculoskeletal Consumer Review
   

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   ]]> http://www.coreconcepts.com.sg/mcr/herniated-disc-or-slipped-disc/feed/ 6 http://www.coreconcepts.com.sg/mcr/lumbar-supports-not-particularly-effective-for-low-back-pain/ http://www.coreconcepts.com.sg/mcr/lumbar-supports-not-particularly-effective-for-low-back-pain/#comments Wed, 23 Apr 2008 01:00:40 +0000 MCR http://mcr.coreconcepts.com.sg/?p=100 Lumbar Supports Not Particularly Effective for Low Back Pain is a post from: Musculoskeletal Consumer Review
   ]]> 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,.

   Readily available at pharmacies and other retail outlets, many people use lumbar supports to bolster the back muscles. However, the reviewers found that the supports are no more effective than lifting education — or no treatment whatsoever — in preventing related pain or reducing disability in those who suffer from the condition.

   “We recommend the general population and workers not wear lumbar supports to prevent low back pain or for the management of low back pain,” said lead author Ingrid van Duijvenbode, a teacher and member of the research group at the Amsterdam School for Health Professionals in the Netherlands.

   “Low back pain is very common and a major health problem in industrialized countries,” she said. “Prevention and treatment are important both to [sufferers] and to society, which bears the expense of sick leave due to low back pain treatment.”

   She and her colleagues looked at 15 studies — seven prevention and eight treatment studies — that included more than 15,000 people. When measuring pain prevention or reduction in number of sick days used, the researchers found little or no difference between people who used supports and their peers who did not.

   “There is moderate evidence that lumbar supports do not prevent low back pain or sick leave more effectively than no intervention or education on lifting techniques in preventing long-term low back pain,” van Duijvenbode said. “There is conflicting evidence on the effectiveness of lumbar supports as treatment compared to no intervention or other interventions.”
   In an interview with Health Behavior News Service, Joel Press, M.D., associate professor of physical medicine and rehabilitation at Northwestern University’s Feinberg School of Medicine said, “This continues the line of research that shows lumbar supports make no difference in treating or preventing low back pain.” “Looking at the literature on lumbar supports, it is difficult to make any conclusions because these studies are using supports for many different causes of low back pain. It would be hard to prove any one treatment is effective for every type of back pain, just as it would be difficult to prove that any one heart medication would be good for every type of heart problem.”

   Dr. Press said that lumbar supports are useful only as an additional treatment to exercise and other interventions. He said that the bracing makes it more comfortable for some people to move around.

   “I usually tell my patients asking about lumbar supports that while there is not a lot of evidence that it is useful overall, there are still individuals who might benefit from their use,” Press said. “But it should be used as an adjunct treatment if it helps to activate patients to increase their activity and exercise.”

   Reference:

   1. 1. van Duijvenbode ICD, et al. “Lumbar supports for prevention and treatment of low back pain (Review).” Cochrane Database of Systematic Reviews 2008, Issue 2.

    

   Lumbar Supports Not Particularly Effective for Low Back Pain is a post from: Musculoskeletal Consumer Review

   

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   ]]> http://www.coreconcepts.com.sg/mcr/lumbar-supports-not-particularly-effective-for-low-back-pain/feed/ 4 http://www.coreconcepts.com.sg/mcr/physical-therapists-offer-low-cost-solutions-to-high-cost-expenditures-for-spinal-conditions/ http://www.coreconcepts.com.sg/mcr/physical-therapists-offer-low-cost-solutions-to-high-cost-expenditures-for-spinal-conditions/#comments Tue, 12 Feb 2008 09:48:42 +0000 MCR http://mcr.coreconcepts.com.sg/?p=45 Physical Therapists offer Low-Cost Solutions to High-Cost Expenditures for Spinal Conditions is a post from: Musculoskeletal Consumer Review
   ]]> 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

   Physical Therapists offer Low-Cost Solutions to High-Cost Expenditures for Spinal Conditions is a post from: Musculoskeletal Consumer Review

   

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   ]]> http://www.coreconcepts.com.sg/mcr/physical-therapists-offer-low-cost-solutions-to-high-cost-expenditures-for-spinal-conditions/feed/ 0 http://www.coreconcepts.com.sg/mcr/ladies-dont-postpone-knee-replacement-surgery/ http://www.coreconcepts.com.sg/mcr/ladies-dont-postpone-knee-replacement-surgery/#comments Thu, 17 Jan 2008 13:23:58 +0000 MCR http://mcr.coreconcepts.com.sg/ladies-dont-postpone-knee-replacement-surgery/ Ladies: Don’t Postpone Knee-replacement Surgery is a post from: Musculoskeletal Consumer Review
   ]]> 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

   Ladies: Don’t Postpone Knee-replacement Surgery is a post from: Musculoskeletal Consumer Review

   

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