Repetitive Strain Injury and Back Pain


Zev M.Cohen, M.D.
Julie Donnelly, L.M.T.,
The Carpal Tunnel Treatment Center
New City, NY 845-268-2021 http://www.aboutcts.com

Low Back Pain – The crippling condition that prevents you from living your life fully!

Do you wake up in pain?  When you are trying to get out of bed the pain in your back takes your breath away…you move slowly…you make it into the shower and let the hot water run on your back…and finally you’re “almost ok”.  And it’s still early in the day!  As the day goes on it seems to improve a bit, until you get into the car and drive home.  By the time you try to get out of the car the pain is back with a vengeance.  This time it doesn’t seem to get any better, and you eventually go to bed – to repeat the cycle tomorrow.

Many people go to their chiropractor and it feels better for awhile, but the pain keeps returning.  There is a very logical reason that it comes back.  I’ve mentioned this in past newsletters, but it is so important that I believe it deserves to be repeated.

These conditions can all be the end result of muscle spasms!  While it seems incredible that a simple thing like a spasm can cause so much trouble, it’s easy to understand when you take a close look at the body.  There are 600 muscles in the body and 206 bones.  The only reason that bones move is because muscles pull on them (unless you have a traumatic accident), and therein lies the problem.  The muscle originates at a stationary point in the body; it then crosses over a joint and inserts onto another bone.  When a muscle contracts it pulls the insertion point toward the origination point, and the joint bends.

Although we are discussing the back, I will use the muscles of the upper arm to explain how muscles move joints.  Then we will move to the back muscles and bones.  The upper arm has two primary muscles, the biceps and triceps.  They both start at the top of your arm, near the shoulder, the biceps in the front of your shoulder, and the triceps from the back of your shoulder.  The biceps and triceps are responsible for bending the elbow.  If your arm is straight out and you contract the biceps muscle the elbow begins to bend.  At the same time, in order for the arm to completely bend, the triceps muscle must fully stretch.  If you then want to straighten your arm again the triceps must contract and the biceps must fully stretch.  If you try this, slowly, with your own arm you will understand the concept easily. 

If, for example, the triceps muscle in the back of your arm is contracted and shortened by a spasm, you will only be able to bend your arm as far as the triceps will stretch.   People think that the biceps aren’t strong enough, so they try to strengthen the biceps muscle.  They try lifting weights and other activities that use strength to bend the elbow, and the elbow gets more painful.  Many people then think that they have a problem with the elbow, while the problem is actually less serious than it appears.  All that needs to be done is to stretch the opposing muscle – the triceps.

It is the same with the back.  There are many muscles that move the back – that is the reason that we have such a variety of movements that are possible with the trunks of our bodies.  When one muscle contracts and pulls on the bone, the opposing muscle must fully relax and stretch.  If the relaxing muscle stays contracted the joint will not move.  You will feel stiff, and you will feel the pain where the muscle is pulling on the bone.  In future newsletters we will discuss the muscles that move the spine.  However the muscle that causes the greatest pain in the low back is one that originates on the lumbar vertebra.  The muscle is called the iliopsoas (psoas for short) and is pronounced “so-as”.

Restating from a previous newsletter, remember that muscles originate in one place, cross over the joint and then insert in another place.  Muscles always pull on the insertion point.  Now, visualize pulling your hair at the end.  You don’t feel it at the end where you are pulling, but you do feel it on the scalp where it inserts.  Likewise, you rarely feel the pain in the part of the muscle that is being pulled, but you do feel it at the insertion.  Going back to the biceps and triceps, pain is often felt at the elbow (where both of these muscles insert) even though the spasm is actually further up the arm in the bulk of the muscle (called the muscle belly).  Since the pain is at the elbow you think you have a condition of the elbow, but you actually have a muscle spasm in the top of your arm which is pulling at the elbow. 

I cannot stress enough the importance of stretching.  Americans work out at the gym all the time, but – we don’t stretch. 

A recent trip to China demonstrated this to Julie in a very poignant way.  While taking classes in the far outskirts of Beijing she joined many hundreds of elderly people at 6:00 AM while they did their exercises in the park.  But these weren’t exercises like she’d done in America, they were stretching programs such as Tai Chi, Chi Kung, and so many other stretching regimes that it would be impossible to count.  She watched elderly people move freely during the day, rarely using a cane or limping their way through life.  The movements they made in these early morning sessions were amazing, to say the least!  People literally hung from trees, and walked through the park swinging their arms out in wide circles around their bodies.  She came back to the United States determined to share what she had seen in China.  She knew we wanted to help people loosen the chains that were binding them in pain, and get back the spring in their step.  And, we’ve been working with our patients on a daily basis to discover the methods that will work best for Americans  - who live a far different life than the Chinese whom she had witnessed.

We’d like to share with you, the readers, a simple stretching program that is both beneficial and easy.  Stand up, or sit in an armless chair if standing is too difficult, giving yourself plenty of room to swing your arms freely in all directions.  Now, think of yourself as a large stick of cold taffy that needs to be softened.  Did you ever play with taffy when you were a child?  Remember how you gently played with it, warming it, and eventually it became easy to stretch it all the way out?  That’s how we want you to see your body. 

Begin to gently swing your arms while you turn your head.  Get into the rhythm and drop your head down toward your chest – swinging it from side to side.  Rotate your hips in the opposite direction from your shoulders.  Lift and drop your shoulders.  Hold onto a chair and swing your leg back and forth.  Do anything you can think of to move all your joints in as free and easy manner as possible.  This is a relaxing stretch, there should be no pain – just the feeling of the muscle and joint stretching easily.  If you feel a sharp pain anyplace – STOP!  If it feels good you’re doing fine.  Do this for about 5 to 10 minutes, depending on your schedule.  As you do it every day you’ll discover new moves that feel wonderful to you.  This is a time to feel like you’re releasing the tightness of a night’s sleep, or the stresses of a day’s work.  Stop when you think you’ve done enough. 

Pain in the Back

The back has a primary muscle called the Erector Spinae.  It means, in Latin, “erect spine”, and it is a group of muscles that enable us to stand erect.

There are several conditions that are adversely affected by spasms in the erector spinae group.  First of all, these muscles insert on your rib cage.  So, if there is a spasm in one of the fibers, the rib that is attached to it will not be able to move freely when you breathe.  You will either feel a stabbing pain in the rib area, or you simply won’t be able to take a nice deep breath. 

Another problem is that some of the fibers originate directly on the spine.  When they are pulling tightly they end up “stepping” on the disc.  To understand this situation consider the vertebra of the back.  Each vertebra is separated by a disk, which cushions the vertebra so it can move easily without pressing on the vertebra above or below it.  Then attached to the sides of each vertebra are muscles.  As each muscle individually contracts the vertebra moves in that direction.  When a muscle contracts tightly it pulls the two bones together; compressing the disk, impinging the nerve that is passing through, and also causing tension at the insertion point of the muscle which then causes pain similar to the hair pulling analogy.  When the vertebra are held together for a long period of time the disk will begin to get compressed, even herniated (ruptured).  This can all be prevented by simply releasing the muscle that is putting the strain on the bones.

Stretching is the way you can treat yourself for back pain.  A qualified deep muscle therapist can find, and treat, each specific muscle.  However, it must be deep treatment since a nice, relaxing massage won’t get through the strong surface muscles to get to the deeper muscles.  The treatment is a bit uncomfortable, but you are in control, tell your therapist if the treatment is approaching your tolerance level.  The therapist will back off until the pressure is perfect for you.  If you are interested in a good stretch, with pictures,  for the Erector Spinae muscles, it is featured this month as the “Hint of the Month” on our website: http://www.aboutcts.com 

Low Back Syndrome

Pain in the low back is something that at least 70% of our chronic pain clients complain about, and it is also one of the most misunderstood conditions.  There are two muscles that move the low back.  One is called “Quadratus Lumborum” and it is right where you rub yourself when your low back is hurting.  It originates on the five lumbar vertebra and inserts onto the top of your hipbone.  As mentioned earlier, the other muscle, the one that causes the majority of low back pain, is called the psoas.  This muscle also originates on the five lumbar vertebra, however it goes forward, through the curve of your hips, and inserts onto the front of your thighbone (the femur).  When the muscle contracts you fold at the hip.  Every time you take a step, sit down, bend over, or do anything that brings your leg up or your trunk down, you are contracting the psoas muscle.  This muscle is contracted the majority of the day, and for most people, it is also contracted all night because the sleep with their legs bent.  Because of this, it is common for the muscle to become shortened.  However the origination and insertion points are still the same distance apart, so two things happen.  First, when you are lying down you are told you have a “short leg”.  The bones of your leg haven’t shortened, however the muscles are pulling your leg up toward the hip so it appears shorter.  As soon as you stand up on both of your feet your legs are equal length again. 

The second, and more serious, condition occurs when you are standing.  The muscle is still to short, so it pulls on the other attachment – the lumbar vertebra.  You now feel pain in your low back.  The lumbar vertebra are being pulled forward, the disks are being compressed, the nerves are being impinged, and again you are feeling the “hair pulling” effect on the bone.  The pain intensifies when you go from sitting to standing, and you can relieve the pain somewhat when you bend over, or sit down.  This is because as you bend at the hip you have just brought the two ends closer together, and the strain has been removed from the insertion points.  When you stand up it will again return as the muscle again pulls on the lumbar vertebra.  The answer is to stretch the muscle!

Stretching the Low Back Muscle

Stand up by your kitchen sink.  Put your hipline against the edge of the counter, and your calves against the cabinet below.  Stand up straight, without moving either of the two points from the sink/cabinet.  Often just this movement will begin to stretch the muscle.  If you feel any discomfort in your low back you can be sure that you have found the source of your problem!  When you can stand up straight without any discomfort, now, raise your chest up (as if you were taking a deep breath) and begin to slowly lean back – leading with your entire shoulder area.  Don’t bend your head back, this has nothing to do with your head or neck, and it may cause you unnecessary pain in your neck.   Go back until you feel a SLIGHT discomfort at your low back area.  Then slowly stand up straight again.  Do this movement 10 times, trying to go a little further with each movement.  On the 10th stretch, as you return curl your back forward, as if you were a Halloween cat, tuck your head down and draw your shoulders in toward your chest. 

This stretch should be done frequently during the day.  The primary reason for standing near the sink is to teach you how to do the stretch without moving your hips or knees in any manner.  Once you have learned how to do the stretch properly, and your hips and knees stay locked during the stretch, you can do it anyplace, and at anytime.

Stretching is vital to the free movement of joints, and is amazing to the healing process of repetitive strain injury.  Get in touch with your body.  Trust your intuition.  And stretch!

 About the Authors:

Zev M. Cohen, M.D. is the Medical Director of the Carpal Tunnel Treatment Center and the Julstro Muscular Therapy Center in New City, NY.  Dr. Cohen, an Internal Medicine physician, includes a specialty in the treatment of Carpal Tunnel Syndrome and Repetitive Strain Injuries.  He has been interviewed on national radio and television as an expert on carpal tunnel syndrome.  RSI and CTS questions may be directed to him at http://www.aboutcts.com 

Julie Donnelly, L.M.T. is the Principal Therapist at both Centers.  She developed and teaches Julstro Deep Muscle Therapy to licensed therapists.   She is the author of the book “How To Be Pain-less…A Beginner’s Guide to the Self Treatment of Muscle Spasms” that was written to be easy to read, and to follow.

Both Dr. Cohen and Julie teach self-treatment techniques for the relief of muscle pain and have developed the Julstro Self Treatment System for the relief of Carpal Tunnel Syndrome.   

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Last Updated: 08/31/01