hip pain posts Archives

Sitting with your legs crossed may be contributing to your back pain

Thursday, November 10th, 2022 at 9:51 AM  

Think of some of the ways you sit. Whether taking a ride on the subway, waiting patiently at the doctor’s office, or sitting as a passenger in a car, the way we sit, especially for prolonged periods can have an effect on the pain we may experience in our low back.

 

 

 

 

 

 

 

For many of us, sitting with our legs crossed feels comfortable in the moment but have you ever considered how this can affect your back and cause pain? What happens to your spine and muscles when sitting with your legs crossed for an extended period of time? When considering good posture, a large component is keeping your spine neutral and avoiding positions that twist the spine or cause misalignment. When sitting with your legs crossed, your pelvis becomes tilted and unconsciously, we tilt our entire torso towards one side. There is a curvature towards one side in the low back which then creates problems in other areas of the spine. Naturally, with a tilt of the pelvis, the upper body will compensate by leaning the opposite direction to maintain balance. Working from the bottom up, pressure on the lumbar spine will cause curvature and misalignment in the thoracic spine. This places strain on the cervical spine to keep the head in the upright position.

 

Sitting with our legs crossed can also affect our muscles. There are two common sitting positions that we should be mindful of, knee over knee or foot over knee for a prolonged period can cause a tightness in the hamstrings, hip flexors and glute muscles. The iliopsoas, one of the major hip flexor muscles, is responsible for external rotation of the femur and an integral part in maintaining posture. This muscle may become strained due to contraction while the pelvis is tilted. You may notice soreness and tenderness in the low back and hip area. Similarly, sitting foot over knee can over time damage the muscles in the inner thigh. Most commonly, the sartorius muscle can become tight and cause discomfort when sitting with the calf over the knee. At the Norman Marcus Pain Institute, Iliacus and Psoas muscles on the hip can be treated for pain. As one of the most common muscles causing pain for patients, when treated, the Iliacus and other hip flexors can provide great relief for pain in the low back, buttock and groin.

Instead of sitting with crossed legs, sit in a chair with height necessary to place both feet flat on the floor. While sitting upright with your back against the chair, you may want to consider placing a cushion under your bottom that can add support to the low back.

References

Lee BJ, Cha HG, Lee WH. The effects of sitting with the right leg crossed on the trunk length and pelvic torsion of healthy individuals. J Phys Ther Sci. 2016 Nov;28(11):3162-3164. doi: 10.1589/jpts.28.3162. Epub 2016 Nov 29. PMID: 27942141; PMCID: PMC5140821.

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Best Posture for Reading: How to alleviate back pain

Friday, October 21st, 2022 at 9:00 AM  

There’s nothing better than snuggling into a good book. But are you experiencing back pain while sitting and reading for an extended period? Back pain can often be caused by improper posture. While reading, whether using a physical book or an electronic device, many people experience back pain in the neck and shoulder or in the low back. Here are some ways to alleviate back pain while reading.

Reading can cause strain on the neck and shoulders if there is a tilt in the neck to look down at your book or device. While sitting and reading, it’s important to place your reading material at eye level. Sitting with your head leaning forward and back hunched can cause hyperflexion of the cervical spine and lead to severe neck and back pain over time. It is best to use a stand that can be adjusted to the required height. Many have recommended raising your materials with your hand; however, this may also cause some strain on the neck and shoulders. While holding an object in front of you at eye level, either with one or both hands, your shoulder and neck muscles are in constant contraction to sustain this positioning. Even over a period of a few minutes, this can cause the muscles to spasm or cause intense strain. Using an adjustable stand will ensure that we can sit straight up, taking pressure off of the cervical spine.

The best posture for reading is sitting upright in a chair with lumbar support. Avoid sitting on a seat that lacks back support such as a stool or a bench. A chair with good ergonomics is one that supports the low back and provides an arm rest to place both elbows. Mentioned above, we want to avoid stiffness in the upper back and neck muscles. Placing your elbows on an arm rest that is low enough to support your arms without adding additional strain is ideal. A study examining the association of low back pain with cell phone use found that thoracolumbar kyphosis and lumbar lordosis (curvature in the spine causing a pelvis tilt) increased with prolonged sitting. Participants had a slouch and progressed spine curvature after sitting for longer than 30 mins. The study also found that those with pre-existing back pain had a significantly higher increase in lordosis and complained of more back pain. When sitting for longer than 30 minutes, take breaks. Sitting should be interrupted by standing breaks to keep blood flowing and reduce stiffness in muscles.

To summarize, here are some things we can do to minimize back pain while reading or using a device while sitting.

– Sit with back and arm support for your neck and shoulders

– Bring your reading material or device to eye level to avoid neck strain

– Take breaks and stand for a minute or so while sitting for more than 30 minutes

References

In TS, Jung JH, Jung KS, Cho HY. Spinal and Pelvic Alignment of Sitting Posture Associated with Smartphone Use in Adolescents with Low Back Pain. Int J Environ Res Public Health. 2021 Aug 7;18(16):8369. doi: 10.3390/ijerph18168369. PMID: 34444119; PMCID: PMC8391723.

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What To Do When Back Pain Causes Overdose?

Friday, February 6th, 2015 at 9:00 AM  

“We don’t appreciate what we have until it’s gone.” If only we had a dime for every time we heard this. Perhaps the reason it is such a common expression is the simple truth in it. This certainly applies to our health, but specifically our backs. We probably all take our good health in vain, until something goes wrong. By the time we are in our forties over twenty percent of us experience some form of back pain. And what do we do when we experience pain? Well, unfortunately many people will turn to strong painkillers. This means opioids, morphine-like painkillers. And, while we have written about this topic in the past, there is something new on the horizon. Evzio, the brand name of injectable Naloxone, is a prescription medicine that can block the effects of morphine and related painkillers. Approved by the FDA in April 2014, it allows a patient to quickly treat themselves or be treated by a family member if the patient has overdosed on opioids.Evzio

In the past, Evzio was difficult to obtain due to its high cost. However, recently The Clinton Foundation announced that it has negotiated a lower price for Evzio (see NYT article). This will allow municipalities to more easily purchase this medication, making it more available to those who need it.

It is a sad reality that many people will turn, in desperation, to painkillers as an answer to their aching backs. We, at the Norman Marcus Pain Institute, only use opioids as a last resort. Our method of finding the source of the pain and treating it has eliminated back pain for thousands of patients.. Nevertheless, with the rise of overdoses each year, the increased availability of naloxone to non-medical personnel will allow lives to be saved.

 

 

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Is Bad Weather To Blame For Your Lower Back Pain?

Wednesday, August 6th, 2014 at 9:30 AM  

A New York Times article Weather May Not Affect Back Pain, printed mid-July, cited a study showing that weather may not affect back pain. The purpose of the study was to explore the often-heard complaint from patients diagnosed with persistent pain related to muscles and bones (musculoskeletal pain) that weather changes cause an increase in pain. The study was based on an analysis of 993 patients who had seen their physician in 2011-2012 complaining of an episode of sudden back pain. These were not patients with a history of back pain.

So this article does not actually examine patients who already have back pain to see if the pain is increased with bad weather. In my practice, at NMPI, I have patients who can tell me a snowstorm is coming 3 days before it occurs. Although studies of the association between weather and pain are not uniformly supportive of the connection, a study done in 1995 of 558 patients with chronic pain found that 2/3 experienced an increase in pain and most of them prior to the occurrence of the bad weather.

bad weatherI have patients whose pain is so severe with bad weather that they can hardly get out of bed. Although there is no good scientific explanation for this association, some suggestions have been offered. When the barometric pressure falls, the air pressure in a painful joint may continue to be a little higher than the air pressure on the outside of the body, causing an increase in pain. Another explanation is that cold and/or inclement weather decreases the amount of time you are outside and active. Patients with musculoskeletal problems (i.e. muscle pain and arthritis) often feel worse with inactivity. In addition cold weather causes the blood vessels in the hands and feet to constrict, which can decrease the amount of available oxygen, resulting in increased muscle pain.

If your history indicates that bad weather causes an increase in your pain, it is likely that your flare up is most likely not an indicator of physical deterioration. Additional pain can be reasonably treated with increased medication for the brief period of weather related pain.

 

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Treating widespread pain vs. the original pain generator

Monday, October 14th, 2013 at 3:01 PM  

hip joint-Norman Marcus Pain Institute blogConsidering the possible effects of central sensitization may affect the treatment plan (and in turn the outcome) for a patient in pain.

For example, take someone who injured a joint – let’s say a hip – which led to osteoarthritis and in addition diffuse, widespread hyperalgesia (increased sensitivity to pain). Sometimes when a patient is in pain for a long period of time, we concentrate on the widespread pain rather than the original pain generator, the hip. These patients may be diagnosed with fibromyalgia because of their widespread pain, with treatment concentrated on that diagnosis. If the hip is treated (for example, a hip replacement), the widespread pain may resolve. This was demonstrated in a recent article, published in May 2013, that studied 40 patients. Patients who received hip replacements had normalization of their increased sensitivity  and elimination of their widespread pain. (http://www.ncbi.nlm.nih.gov/pubmed/23400951)

Let’s take a look at a contrasting scenario in my next blog.

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Bedside Manner and the power of suggestion in back pain

Sunday, June 30th, 2013 at 6:30 PM  

Prior to drawing blood, saying a word to patients that suggested pain increased the likelihood of them experiencing pain. You might think of this study as just another example of the importance of “Bedside manner”- the awareness of the importance of the behavior and speech of the physician or other care-takers, on the feeling of well-being of the patient. Eugene Bauer, M.D., a Viennese physician, said in 1931: “A word in the mouth of a physician is as important as the scalpel in the hands of a surgeon”. Words can cut, soothe, and rattle. How you are approached by a doctor is determined not only by their personality but also by the beliefs concerning your problem.

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Hip pain and surgery

Tuesday, November 15th, 2011 at 6:27 PM  

A bony abnormality of the hip called Femoral Acetabular Impingement Syndrome (FAIS), where the head of the femur (the thigh bone) is found to be irregularly shaped rather than its “normal” spherical shape, is sometimes treated with a surgical procedure to shave the head of the femur. FAIS can affect young individuals in contrast to osteoarthritis (OA) of the hip which usually occurs in older patients. It is thought that FAIS can cause pain in the hip, and can in addition if left untreated, result in OA. Read the rest of this entry

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Activity and quality of life

Tuesday, May 18th, 2010 at 7:18 PM  

A recent article showed that even gentle but regular physical activity in middle aged women reduced the incidence of hip fractures. Lack of exercise contributes to many of the health problems with which we are confronted- obesity, heart disease, diabetes, hypertension, dementia, arthritis, and osteoporosis. At a time when the cost of health care is so important to each of us as Americans, awareness of inexpensive interventions and self responsibility for our well being should be foremost in our minds.

Proper exercise should take into account your level of conditioning before you begin any program. Many new exercisers will strain their weak or stiff muscles causing pain and disillusionment with their new found passion and quit. Remember the most important thing about your exercise plan is that you are able to and actually return for your next scheduled session.
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Back Pain Treatment

Thursday, April 22nd, 2010 at 7:27 PM  

Please refer back to the past two blogs to find the background material for todays blog. Although the number of CARF approved pain centers in the US halved, the number of outpatient pain centers mushroomed. The services provided however focused on two areas:

  1. Medication management
  2. Nerve blocks and other invasive procedures.

Although many patients could be helped with one or both of these approaches, many patients in need of physical therapy and psychological services that were integrated with the overall treatment plan, would no longer receive optimal treatment. Reimbursement would be the driver of care rather than the needs of the patient. Centers could not stay in business and provide care that insurance companies would not cover. The shift toward procedures became an accepted standard of care and new organizations of pain physicians were formed whose membership focused predominantly on invasive procedures.
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