New Parent Injuries: Neck strain

When my daughter was first born she would not go to sleep without being held and rocked for 20mins to an hour (Yes, I was that guy). She would take about 30 mins to an hour to drink her bottle (yes, she was that baby). This inevitably led to many hours of me holding and looking down at my infuriatingly stubborn but adorable child. This caused me to have some very significant neck pain; my daughter literally became a pain in my neck (insert rim shot).

The cervical spine and the spine in general, is intended to be placed in a certain position for extended periods. This “ideal position” is what we can a neutral spine. This is where the head is supported and balanced on top of the neck. This allows the head to be supported by the underlying structure of the vertebrae. When this spine is taken out of this “ideal” position it relies on other structures to support the head. The muscles of the neck are not designed to be place in sustained flexion or extension (looking up or looking down) so when placed in these positions it causes undue stress and strain across the muscles of the neck.

http://en.wikipedia.org/wiki/Cervical_vertebrae#mediaviewer/File:Cervical_vertebrae_lateral2.png

To avoid strain to the neck it’s important to avoid sustained bending of the neck. It is easy for me to say this but let me give you a few techniques to avoid sustained neck flexion.

1.       Try to place the baby higher during feedings so you do not have to look down.

2.       Try feeding baby in a baby carrier.

3.       When carrying baby in carrier, ensure that baby weight is supported by your waist and not your shoulders.

4.       Try feeding baby in a bouncer or on a bed if they are not yet mobile.

Some stretching activities will help prevent injury.  Two of the most common muscles to be injured are the upper trapezius and the levator scapulae (Pictured below). Stretching the upper trapezius and the levator scapulae will help decrease the chances of sustaining a neck injury as well as help after injury.  

http://en.wikipedia.org/wiki/Levator_scapulae_muscle#mediaviewer/File:Levator_scapulae.png

Levator Scapulae Stretch:

http://www.humankinetics.com/excerpts/excerpts/levator-scapulae-stretch

Upper Trap Stretch: 

http://babyboomerfitnesschallenge.com/

The most effective way to prevent injury is to use common sense. Do not sit in sustained flexion for prolonged periods, do not fall asleep while holding the baby (this is more for the baby’s safety than yours), do not place neck in awkward positions for prolonged periods. Improving posture throughout the day is the most effective way to prevent injury but a more indepth discussion of this topic would be necessary.

If and when you get injured make sure you Ice, rest, stretch (do not over stretch), use anti-inflammatories (Advil) and do not perform painful activities. If after 2 weeks you still feel pain, call a PT!

New Parent Complaints : Carpal Tunnel Syndrome

I am in my late 20’s and this is the time in my life where most of my female friends are either pregnant or already have kids. One complaint I hear of more than any other, especially during pregnancy is of pain, numbness and weakness in the hands. Most of the time this condition is something called carpal tunnel syndrome (CTS). What is Carpal Tunnel Syndrome?

CTS is a condition where the nerve (Median Nerve) is pinched inside the wrist because of swelling of the finger flexor tendons. There are a few reasons why the finger flexors can become swollen such as; repetitive overuse, trauma, systemic swelling, diabetes, certain medication.  

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#mediaviewer/File:Carpal_Tunnel_Syndrome.png

So what can be done about this condition? After birth most of the time this will resolve itself, however, it is possible that the condition could persist. If it does, these are some things you can do to help:

1. During pregnancy if you have gestational diabetes it important to discuss with your Doctor about how to properly control your blood sugar. High blood sugar could cause not only CTS but other systemic issues that will affect your life and your childs life.

2. Get enough exercise. Systemic swelling and edema are very common for those ladies that are sedentary. I am a male, so of course I do not understand what it is like to be 50lbs heavier than I was 3 months ago! That being said, mild forms of exercise are a good way to help the body reduce water retention and to help clear out systemic swelling.

3. Decreasing sugar and salt intake will also help the body to reduce swelling. Salt and sugar requires the body to retain water to maintain homeostasis (balance). The more sugar and salt you consume the more the body needs to retain water to balance out that excess minerals coming in.

4. If you are still working, try to use ergonomic keyboards and computer mouse. Have trained professional fit you with the proper workstation and try to stop working at least every 30mins.

5. Night splints are a good method to help relieve pressure off structures that are becoming impinged.

6. ICE - Icing the wrist could help reduce pain and decrease swelling in the short term.

7. This is the most impossible one for new moms…. Try to rest your wrist as much as possible and avoid using them for prolonged periods. Try to use breast feeding pillows, bolsters, towels, baby carries to avoid placing your hands in strange and unnatural positions to accommodate that new child.

8. Talk to a medical professional. Either a medical doctor or a physical therapist.

New Parent Complaints : Biceps Tendinitis

The other day I was lifting my chubby cheeked son and I felt a sharp pain in the front of my shoulder. This was the start of something that I feared. Biceps tendinitis! Like I discussed before, tendinitis is just inflammation of a tendon because of repetitive stress. How did this happen? Your bicep tendon is a very long tendon that can be felt at the front of the shoulder. This tendon attaches to your biceps whose main purpose is to bend the elbow. Because this tendon is so long and is attached to a very strong muscle it is very susceptible to injury. The common signs of biceps tendinitis is pain when touching the front of your shoulder, pain when lifting your arm, pain when stretching your arm back behind you. When lifting and carrying children, heavy car seats and diaper bags; its very common to place too much strain through the shoulder rather than through elbow. Obviously, it is impossible to avoid these activities so what can we do to decrease our risk of injury?

http://en.wikipedia.org/wiki/Biceps#mediaviewer/File:Gray411.png

How do we avoid this?

1. Try to use a baby carrier when hold your child for extended periods >10mins.

2. Pay attention to posture when lifting your child. Keeping your shoulders back keeps your shoulder in a better mechanical positions and decreases the amount of strain on your biceps tendon.

3. Keep your child close. As stated in our last post, keeping your child as close to you body as possible will also benefit your low back.

4. Do not lift with your shoulder but from the elbow.

How do we treat this?

1. ICE ICE BABY. Applying ice to the front of your shoulder before bed for 20mins will help to decrease inflammation and decrease overall pain.

2. Continue to avoid painful activities.

3. Strengthen your shoulder. This should be directed by a PT.

Common New-Parent Complaint: Low Back Pain

As a father of two small children—a 26-month-old daughter and a 6-month-old son—I’ve had my share of new-parent body pain (minus the actual giving birth part). Sometimes you get so used to being in pain from holding your kids all day that you’re actually surprised when your body isn’t lingering from soreness. One of the most common complaints I hear about (particularly from my wife) is low back pain.

Now, there are many different types and causes of low pack pain, and all of them have a specific mechanism in which they need to be treated. But overall, low back pain is usually an issue of two things: posture and repetitive stress.

When lifting your cute little heavy potato sack of a baby, it’s important to be mindful of your posture and to have your hips, knees and legs do most of the lifting (kind of like when you’re doing a squat or lunge). This means keeping your back aligned above your pelvis and not having it so rounded—and always engaging the “core”.

What’s this word “core” that I’m throwing out here? I tell my wife all the time to contract her core. Contrary to what she may think, your core is not just your belly or your abs. The core is actually a group of muscles that stabilize the spine and pelvis. These muscles contract together to prevent unnecessary movement of the spine during simple activities like picking up your child.

So how does one correctly contract the core? Most people end up just holding their breath or contracting their abs—wrong! This kind of contraction doesn’t really engage the entire core and won’t protect your spine the way it needs to. The proper way to assess whether you’re doing it the right way is to feel it with your fingers. Place your fingers just outside of your ab muscles—yes, we all have them, even though some people's may be hidden—and dig your fingers in around belly button level (see below for a visual reference). Keeping your fingers there, I tell my patients to pull their belly button in and up (kind of like when you're sucking in your stomach, but without holding your breath). 

If you are able to feel hardening or your fingers pushing back out a little bit, then you are contracting your core the right way.

Another way to prevent low back pain is to always keep your child as close to your body when picking him or her up. Unless your child’s just pooped himself up the back (in which case you may want to hold him away from your body), pick your child up in close body contact to reduce the amount of force on your back. Think about picking up a big sack of rice. You probably wouldn’t try picking it up with your arms held out, right? In similar fashion, when picking up your child, it’s important to be in proper position: shoulder kept back, core engaged, legs and shoulders aligned with your hips. And also make sure that your shoulders aren’t extended out too much in front of your body.

These basic steps—along with some nightly massages from the loving husband—can help in reducing your risk of injury and could even decrease the amount of pain you’re currently in. But of course we recommend that low back pain sufferers always consult with a physical therapist to discuss the best plan of care for your specific condition and needs.

New Parent Injuries : Tennis Elbow

I am a parent of two, one of which is about 4 months old. Not only is my son a newborn but he is a chubby one at that! The other day my wife comes to me and tells me that her elbow is really bothering her. As the good husband and PT I am, I took a look and it was very clear that she has what is called “Tennis Elbow”. Now my wife does not play tennis, but in my years as a therapist I have treated many new moms/dads with the same issue.  “Tennis Elbow” is layman’s terms for a condition call lateral epicondylitis or epicondylalgia.  This is a very long and non-interesting name for a specific condition that affects the wrist extensors (the muscles that enable you to extend your wrists). This condition received its name because it is very common among tennis players. This is due to the intense amount of repetitive eccentric torque placed on the wrist during a strong backhand. Now you may be asking, “Why are new mom’s and dad’s prone to this issue”? Well, as it turns out babies need a lot of care and attention in their first few years of life. This translates to a lot of long hours holding, rocking, feeding and carrying very heavy objects like an 45lb car seat! Not only are you required to lift these heavy things but usually it is required that you lift these things in narrow corridors such as a back seat of a car or a narrow garage.  All this leads to repetitive stress injuries to your wrist and elbows.

http://orthoinfo.aaos.org/topic.cfm?topic=a00068

What do we do to prevent this?

- Modify the way you are lifting and holding the baby. Hold the baby with palms up rather than palms down or palms towards your body.

- Use baby carriers that place the babies weight on your hips and shoulders rather than your elbow.

- Hold car seat in the crook of your elbow rather than hands. Also, attempt to use stroller as much as possible.

How do you treat this?
- Physical therapy, of course is an excellent option to relieve pain and to help prevent further injury. If you continually irritate this condition it could lead to a tear of the common extensor tendon pictured above. 

- RICE, No not glutenous kind. Rest, Ice, Compression, Elevation.

- Rest is not always an option but not doing things that cause pain will go miles to your recover. Basically every time you feel sharp pain in your elbow you are re-aggravating the injury.

- Ice is extremely useful to help decrease pain and inflammation.

- Compression helps to decreases stress across those common tendons in the elbow. A tennis elbow strap should help to improve pain during everyday activities.

TRX Shoulder Strengthening Exercises

TRX Shoulder Circuit

As we have stated before, TRX straps are extremely useful in the rehab setting and can be used in a variety of ways. This video demonstrates a series of exercises to increase shoulder and rotator cuff (RTC) strength. A neglected component of RTC strengthening is actually stability of the core as well as the shoulder! One of the great things about the TRX straps is that it allows you  to strengthening RTC while simultaneously activating the core. 

This series of exercise strengthens each head of the RTC as well as requiring co-contraction of the RTC to stabilize the shoulder. This is important because strengthening without stabilization is useless and will most likely end in re-injury. To maintain this position the core has to activate and teaches patients to activate their core during all upper body activities. This is important because the core is the foundation for all upper body activities. Therefore, strengthening and stabilizing the RTC on a weak foundation would also be a worthless endeavor. This TRX circuit is good for all populations from athletes to weekend warriors, try it!

TRX As A Rehab Tool - Side Lunge

Continuing on with our sample of TRX exercises for the rehab setting, I am going to show you a lateral lunge. A lateral lunge is a good functional activity that simulates many functional activities throughout the day. For example reaching for an object behind the couch or quickly moving out of the way of a moving object.

TRX Lateral Lunge:

Position 1: Standing holding straps taught, lean back slightly while standing with feet together. Pull belly tight. 

Position 2: Take a step to the right with 80% of weight on right lower extremity. Use straps as needed, while keeping straps taught. Point foot lateral slightly, making sure to point knee towards foot. Pull belly tight.  Return to neutral position. Mirror position to left as well.