Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (16 page)

Geri is a corporate road warrior who logs countless miles on the road and, back at the home office, too many hours sitting in meetings in uncomfortable office chairs.
She’s got the spine of a warrior too. Her MRI reveals that a couple of the disks in her cervical spine are starting to deteriorate—a combination of normal aging and the demands of her hard-charging lifestyle. That makes her more vulnerable to the contracted muscles and pain in her neck and shoulders that Dr. DeStefano has successfully treated off and on with manual therapy for five years. But when she came into his office recently, she could barely move her head. She’d just completed a big business deal, and the stress and constant air travel had triggered a major flare-up of symptoms. Dr. DeStefano worked on the scalenes and longissimus colli on the front of the neck and performed some gentle chiropractic adjustments. After two treatments Geri was ready to return to battle
.

As you age, the jellylike material that fills the inside of the vertebral disks loses water, shrinks, and hardens, which is one reason you lose height in the middle and senior years. (The disks account for a full 20 percent of your height.) The disks become less flexible and less adept at absorbing shock, which in turn can make the firm cartilage material that forms the outer layer of the disks more prone to cracking. This doesn’t mean you’re doomed to neck and back pain as you get older. But it does mean that as you subject your spine to the usual use and abuse of living, the margin of error gets smaller.

Geri’s case is typical. It’s possible that worn disks contributed to her pain. The nerves around the disks may have gotten irritated and sent distress signals to the muscles, which shut down as a protective measure. We don’t know. But we’re reasonably sure from diagnostic tests and from the on-and-off nature of her pain that the muscles are the primary issue. It just took a couple of stressful weeks of work to send them over the edge into painful dysfunction. Remember the process we described in
chapter 4
. Psychological stress caused her to unconsciously tense the muscles in her neck and shoulders, further reducing the supply of oxygen to the area, and to breathe more shallowly. The considerable time she logged in airline seats, with inadequate support for her neck and lower back, finished the job. (See the box on page 86 on how to minimize wear and tear on the road.) The solution was to bring movement back to her muscles and joints by treating them manually and to coach her on some deep-breathing exercises.

PROTECT YOUR NECK

Don’t tilt your head down when you read. If you wear reading glasses, don’t pull your head back to get the proper focus. Don’t adjust your head position to the material, adjust the material to you. Try to keep your head in a neutral position.

When you watch TV at home, make sure that your couch or chair is directly facing the TV and that your neck is adequately supported, for instance, with a pillow.

When you’re traveling by plane or train, bring a small pillow for better neck support.

Don’t sleep on your stomach. If you must, alternate the side you turn your neck to. Your pillow should support your head and keep it in line with the spine.

Don’t bend your neck down to look at the keyboard when you type. (In other words, don’t “hunt and peck.”)

Set up your computer monitor so you can look at it dead-on without tilting your head up or down.

If you spend a lot of time on the phone, invest in a headset. Do not cradle the phone receiver between your ear and your shoulder.

Take frequent, short work breaks. Move around to get the blood flowing in your upper body. A quick exercise, such as rolling your shoulders, is great.

Traumatic Neck Strain (Whiplash)

While he was a running back, Tiki Barber woke up one Monday morning so battered by Sunday night’s game that he had to use his hand to help raise his head off the pillow. He’d figured he’d done something serious like broken his shoulder blade
.
After being examined and cleared by the medical staff, he received daily treatment from the athletic trainers. Part of his treatment included work with Dr. DeStefano, who released his tight, contracted muscles and administered chiropractic adjustments. Barber was able to return to play the very next Sunday
.

If injury is chronic (i.e., from twenty years spent hunched over a computer keyboard) or acute (from one violent instant on the football field), damage to muscle creates scar tissue, and a manual therapist will treat it much the same way. But when the head and neck snap back in a “whiplash” injury (think rear-end car collision),
both muscles and ligaments are subjected to tremendous pressure. Because ligaments heal so poorly and because they are crucial for neck support, a ligament tear in the cervical spine is serious business and can result in permanent weakness and instability. Tiki Barber’s problem, fortunately, was mostly muscular. As Barber discovered, it’s amazing how incapacitating “only” a muscle problem can be, and how quickly, with the right treatment, the tissue can bounce back.

Muscle or Joint?

Cervical Disk Pain

Barbara, a forty-three-year-old Manhattan banker, suffered from persistent neck pain. Not only had the discomfort gotten worse in recent weeks, but she was experiencing shooting pains down her arm. The MRI showed that two of her disks were damaged and could be part of the problem. But Dr. DeStefano felt that if he could get the neck muscles to relax, he could probably bring her out of the pain. He worked on her and achieved some improvement but not enough. That suggested that the damaged disks and not the muscles were the primary culprit. He sent Barbara to Dr. Jennifer Solomon, a physiatrist at Manhattan’s Hospital for Special Surgery who specializes in the spine and sports medicine. She gave Barbara an injection of a corticosteroid anti-inflammatory near the disk, which immediately cut the pain by 90 percent. Barbara then received more manual treatment on the irritated muscles before moving on to physical therapy, where she worked on improving her posture and stretching and strengthening her neck muscles. Four months after she first walked into Dr. DeStefano’s office, her neck and arm pain were gone and life had returned to normal.

When a disk herniates, the outer, firm cartilage tears and some of the inner pulp leaks out. (The old popular term for this was
slipped disk,
which paints the wrong picture.) The innards can irritate the surrounding nerves physically, by pressing against them, or the nerves can be irritated chemically, by inflammatory proteins surrounding the injury. One solution is to surgically remove the damaged disk and fuse the two, now diskless, vertebrae together. But even the surgeons who perform this delicate surgery consider it a last resort after all less invasive measures have failed.

Considering the state of Barbara’s cervical disks, it’s logical to conclude that they
were causing the radiating arm pain. Logical but not always right. Studies show that one in five people under the age of sixty with no spine pain have herniated disks. It’s quite possible to have disk damage that isn’t the direct or most important cause of your neck or lower-back pain. The muscles in the neck, the scalenes in particular, can become inflamed and irritate the surrounding nerves, causing those disturbing symptoms of pain, numbness, or tingling. The medical establishment has an impressive-sounding diagnostic label for the condition,
scalene anticus syndrome,
but its focus is often drug therapy.

In our experience, the best approach to these kinds of spinal problems is the most conservative one. If muscle therapy doesn’t solve the problem, it should point us in the right diagnostic direction. As it turned out, Barbara’s herniated disks were impinging on the nerves, causing the muscles to shut down, which only compounded the problem. A team approach—medical treatment (the steroid injection), muscle therapy, and physical therapy—resolved the case without surgery. Research shows that most of these herniated-disk problems in the cervical (and lumbar) spine do not need surgery. Often the pain clears up on its own in months for reasons no one yet understands. Dr. Solomon, who consults with both of us on some of our toughest cases, surgical and manual, has had good success with a single corticosteroid injection that can immediately quiet the nerve irritation. By breaking the cycle of pain and inflammation even temporarily, we give the body a fighting chance to begin to heal on its own.

Joint/Orthopedic

Cervical Disk Pain (with Severe Neurological Symptoms)

If the nerve pain that radiates down through the body is severe and unrelenting, and the muscles connected to those nerves are getting progressively weaker, medical attention is crucial and surgery may be your best option.

Osteoarthritis

You may not think of a neck as being arthritic in the same way you might a knee or a hip. But the joints that hold the vertebrae together do often wear out. When that happens, vertebra rubs against vertebra, bone against bone, and pain and possibly arthritis can result.

WHAT IS A PHYSIATRIST?

A physiatrist is an M.D. who specializes in the diagnosis and treatment of muscle and joint problems, including rehabilitation, physical medicine, and pain management. If you have chronic neck or lower-back pain, you may consider getting the opinion of a physiatrist in addition to that of an orthopedist.

We can’t say for sure how much of the pain is being generated by the damaged spine itself and how much by the surrounding muscles that tighten up in response to the injury signals sent from the spine. Since no one knows how to stop arthritis in its tracks directly, manual therapy—which relaxes the muscles in the neck, providing at least some symptomatic pain relief—can be an important part of the “toolbox.” Anti-inflammatory drugs and occasional corticosteroid injections have their place. But the person living with arthritis needs to make important adjustments to put less stress on the spinal architecture: lose weight; get on a low-impact exercise program; do physical therapy to improve posture. “You have to look at the whole picture,” Dr. Solomon says. “And having the patient take control is really important.”

WHEN SURGERY IS THE BEST OPTION

There are certain spine issues that are clearly surgical cases:

1. Disk herniations with loss of motor control or strength deficit

2. Disk herniations with loss of bowel or bladder continence

3. Spinal stenosis with motor symptoms or neurogenic claudication (weakness and/or painful cramping stemming from the nerve)

Spinal Stenosis

Spinal stenosis can develop anywhere along the spine. When the vertebrae develop bone spurs or the disks protrude, for instance, the space inside the spinal column narrows, compressing the nerves that run through it. Pain, numbness, and weakness in the arms, hands, or legs can be the unhappy result.