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Ear Wax Prevention and Treatment

How NOT to treat ear wax, and how to prevent and treat properly.

One of the most common conditions we see in the ear canal is wax.  Wax is supposed to be created in the outer quarter of our ear canals every day as a protective measure.  This forms a barrier against debris or dust that might damage the ear drum.  With normal movements of the jaw (eating, speaking, and yawning) this wax will  fall out harmlessly. 

There are a few people, however, who tend to keep their wax in one or both canals, and these are the ones that end up in my office for treatment.  There are three reasons for people to have retained ear-wax problems:

1. Bad luck.  Simply the shape of the ear canal, for example if it is quite narrow at the exit, could make a "bottleneck" effect, clogging pieces of wax. 

2. Ear pieces, for music or phone, have now become extremely popular.  Unfortunately, they also can be like a drain plug for the ear canal.  The situation only gets worse if wearers use the molded ones that really fit tightly into the canal.  For people who need hearing aids, the deeper fit is sometimes necessary to ensure good sound. In younger people, the object is to avoid needing a hearing aid, especially after loud music concerts, or exposure to loud noises such as gunfire etc. 








3. Q-tips - Instead of reaming out wax, these devilish weapons act more like a ram-rod in a rifle barrel.  

These pack the wax deep inside the canal, up against the ear drum.  This makes it almost impossible for the wax to be removed at home, and will require a visit to your doctor for syringing or curetting safely.  Some times even more damage is done, with the tip actually piercing the drum. 





So how do I prevent and remove wax in my ears?

1. Lubricate, with clear oil.  A few drops (or capful) of oil will lubricate and partially liquify dry wax in the ear canal.  Use olive oil, mineral oil, or any other clear oil.  (note to guys, NOT 10W30 ! ).  Tip your head to the side, insert the oil drops, then wait until you are bored (at least a few minutes).  Then catch the oil with a tissue, and jump into your shower (so oil won't end up dribbling onto your clothes). 


2. Do NOT use a candle.  This is about as idiotic a home remedy as one can imagine.  

 Great way to set fire to your hair.  The object is supposedly to create a vacuum in the ear, which actually never happens.  Then you get hot wax dribbling onto the side of your head, plus you look like a dolt.  If you have impacted wax, PLEASE don't try this at home!!  You will end up having your ear syringed with a FIRE HOSE!

3. Be very careful if you use a home bulb device. 

Really easy to hurt yourself if you force the issue.  Also, you are shooting blind, and could easily complicate the issue if the drum is already perforated, or if there is infection along the external canal.  Remember, even a doctor who treats himself at home has two problems: a fool for a doctor, and a fool for a patient!

4. Please see your doctor.  If you are a regular wax former, then get on a schedule to have the doctor or his assistant professionally syringe the wax out.  Then follow by regular oil every week, with revisits as required.   

Emergency Instructions: Often Missing or Muddled!

Ah, yes.  The instructions.  One of those Venus and Mars examples: women read them, men blunder ahead without them.  But even with written instructions, results are not always assured.  Just ask anyone trying to assemble a Swedish bookshelf with an Allen wrench, a bag of metal pieces and instructions in twenty languages other than your own.  To make matters worse, it seems there is always one missing Umvaart. 

But sometimes instructions are a matter of life and death.  A case in point is with emergency self-injections of adrenaline, and with puffers for acute asthma attacks.

A recent US study shows a dismal 16% rate of correct usage of prescribed adrenalin auto-injectors, like the EpiPen. If someone is highly allergic to something, such as a bee sting or foods such as peanuts or shellfish,  then swift and proper injection of adrenaline is lifesaving.  Common errors include not pushing down forcefully enough to have the needle tip penetrate through the skin, or not holding  the device in place for at least 10 seconds.  Not to mention forgetting to carry it with you on that canoe trip.

For acute asthma, where one expects to have a greater frequency of crises than food allergies, the error rate for puffers was even worse.  Only 7 % of asthma sufferers could use their puffers properly, according to the Annals of Allergy, Asthma and Immunology. 

The leader of the study, Dr. Rana Bonds from the University of Texas Medical Branch, notes that people were not trained properly in the first place, and/or “forgot the instructions over time”.   Similar studies show the problem is universal around the world.

Apart from the obvious personal distress, the financial consequences are immense.  Asthma medications constitute literally billions of dollars of expense, and if most of it is squandered, then our tax and insurance dollars are being wasted. 

So here is how to use the epipen:

For video demonstration of the epipen use:


And here is how to use your inhaler for asthma:

For video demonstration of your inhalers:



And for the use of an inhaler with the spacer, please review this video:

One last point about the inhaler, it would make far greater sense to extend the neck into a straight line, rather than expecting the inhalations to bend around a 90 degree corner to get from lips to lung.  Just as the sword-swallower at the circus knows, along with the bronchoscopy surgeon in the operating room, you need a straight line to get a straight shot.  That’s not in the instruction manual, just one of my own observations.

Be sure to discuss with your pharmacist as well, in case any different brand or model is being substituted, there may be a new set of instructions to review. 

As a precaution, remember to carry a spare.  Just like propane tanks for that big weekend bbq, inhalers are hard to check for remaining capacity.  Also remember to check stale dates, as there is no point  trusting your life to an out-of-date product. 

Please make sure you check regularly with your doctor, and follow any instructions for additional testing, monitoring, or changes of strategy. 


The Smart Phone: A Key Part of Your First Aid Kit

We already know that the cell phone has changed the world. 
At our fingertips, it can bring us countless new apps to monitor our blood pressure or calorie intake, and, in a crisis, it can help you find the nearest medical clinic, or get the fastest taxicab to a hospital. If you are lost in the wilderness, your cell phone can be traced by rescue teams, and it could save your life. 
But there are a couple of other ways you can use the basic features of your cell phone for medical purposes. These are free, and don't even involve apps.

The Back of the Phone
Label your name, a work number or email to get hold of you. If you leave your phone on the bus, and the batteries are dead, how else will a good Samaritan be able to get hold of you? However, as with the labels on your suitcases, do not list your home address, as it could invite crooks to rob you while you are gone. While you are at it, you might also put down any drug allergies or other important medical alerts; if you are unable to communicate your issues in an emergency, the medical staff will be able to see it on the back of your phone, even if the phone doesn't work. Just to be sure, also use a permanent marker to put medical alert info on the back of your driver's license or health insurance card, both of which are usually reached for by emergency staff.

The Camera
Today's cell phones have great resolution with their cameras, and almost infinite storage. You can archive photos in any way you wish. Use your cell-cam to record the following:

  • Your doctors' names and contact info, so followup info like test results or prescriptions used can be sent after the fact. In an extreme emergency, it could also help attending doctors get direct advice from your own team.
  • Any rash or other visible injury should be captured on your camera to help your doctor make a diagnosis. This is especially true if the signs have changed or gone by the time you see your doctor. This can also help document damage to your car or bike if you are in an accident; it might be important for both your medical and your insurance claims.
  • Any prescription drug you ever get! This one can save your life. If you have just returned from holiday, and are finishing the last of your pills for a local illness, take a picture of the prescription. If you break into a severe rash the day you get home, and have tossed the bottle before you climbed on the plane, please don't tell your doctor that it was a "little oval pill," or that it was "kind of pink or orange," or that it "began with the letter "C." I have worked in emergency departments, and can promise you none of us will be able to guess which drug you are talking about -- ever! Each country has its own drug colors, many use different brand names, and some have blends with different ingredients. But all of them list the generic chemical names, which are, thankfully, universal. With a simple click of your phone-cam, you can let us know what that drug was. It could be the one good drug that works better than the rest in your body, or it could be one bad drug that might kill you with the next dose. Don't leave us guessing, and don't assume that your doctor's computer can somehow capture the input from another doctor's computer. We are not like the banks with their ATM trackers; medicine is still in its computer infancy. So please back up any important medical info with a click of your camera. 

The same goes for an X-ray. Photos can be used to show us the exact fracture you got skiing. Or with an abnormal EKG, you can take photos so your doctor at home can see what happened.
For the same reasons, if you have any known disease, take a picture of any relevant tests before you leave for a trip. If you have any prior abnormalities, your baseline EKG or blood tests could prove very important to a new doctor that has to come to your aid in a distant city. And don't forget to take a picture of your list of medications before you leave home!

The Alarm

  • For remembering ergonomics: Set it to vibrate every 15 minutes during your work day, and you will have the perfect reminder to correct your posture and add in some movement. Straighten your spine, roll your shoulders and neck, and pull your shoulder-blades together (see our blogs on neck pain, and back pain, the postural challenge). Also, straighten and bend your knees and ankles. No longer do you need a kitchen alarm or a "cuckoo" clock on your desk or in a meeting, now you can silently remind yourself without disturbing others. 
  • For remembering pills: I have one patient who reminds herself to take her birth control pills every day at 10 minutes before noon, for 21 days in a row. Then, the alarm goes silent for a week, before starting the next cycle of 21 pills. No more mishaps! This feature is also good to ping people who are on more complicated medications, to remind them to take their eye drops, pills, or insulin shots.
  • To help with jet lag: Use your phone alarm to wake you at the proper local time, so you don't sleep until afternoon in your new time zone. Don't always assume your hotel will be perfect in its wake-up calls. If you do sleep in, you will mess up your body's clock for days, and have a miserable week of travel adaptation.

The Calendar 
To remind yourself to call for your next Pap smear, or general check up, use your phone's calendar to keep your appointments past and future. If you need to go back for repeat tests in six months, don't trust your memory, just enter it into the phone. If you can't be sure of the exact date that far in advance, just remind yourself to call in to fine-tune the details a week or two ahead.

Some of these tips may save your life. If you think of more ways your phone can be a life-saver, let us know at

Toenail Fungus Treatment Tips

Almost one in four people will get toe nail fungal infections in their lifetimes, and, for many, it seems to last a lifetime as well. The condition is fostered by warmth and dampness seen in closed shoes, and causes thickening of the nail, with pitting and yellowish discoloration. In sandal season, it looks ugly, but that is about the only problem with it. This is not a condition that invades the blood stream or causes any other health issues. However, we can’t make the same claim about some of the treatments advertised. 

The big drug companies naturally would like people to take their drugs for months or years, not just a couple of weeks every time they have an acute infection. So there is a big money motive behind all the ads we see for oral drugs to fix this problem. 

That’s the deal with toenail fungus treatments that we see advertised, showing little cartoon creatures (“fun-guy’s?”) climbing out from under your toe nails. With the usual tag of “ask your doctor”, patients are told that happiness lies in taking a prescription drug orally. Based on the rate of nail growth, this could easily take 9-18 months for a toenail to grow completely out as normal. (If you have ever dropped something on your toe, and had the whole nail turn black with a bruise, you can confirm how long it took that nail to grow out completely. Finger nails grow quicker, toenails are much slower). 

The problem I have with this is one of side effects. The oral medications are not without risks, mainly to your liver. So we need to run liver tests at intervals along with the treatment, to make sure you don’t have a serious side effect to a drug that is given for a completely non-threatening nuisance.

There are a list of topical products you can see at this site:

Toenail Fungus Reviews

However, before even using any of these products (also not cheap, as you will see in the above site), consider the basics:

Daily nail management: try to spend a few minutes on the affected toes every day. Twice daily is not a bad idea if you have the time:

  • Wash your feet in good soap to kill the fungi. As you know from pedicures, soaking the nails make them easier to trim.
  • Use nail clippers, and a nail file, preferably one made of metal or ceramic, so it can be cleaned. (The cheap cardboard nailfiles are hard to sanitize after use). Note that the fungus grows underneath the nail, so use the pointed end of your nail tools to scrape out the dead stuff. Sand off the top and tip of each affected nail, to prevent it from becoming too thick and unmanageable.
  • Apply rubbing alcohol (or pure white vinegar) with cotton balls after all the trimming, scraping and sanding is done. Just a few minutes will do the trick. This is the same alcohol we use as a swab to kill all bacteria and fungi when we insert a medical needle for lab tests. It will still kill the same fungi in the nail.
  • Consider getting a professional pedicure as an occasional treat. With the right approach, the pedicurist can dig into the edges of the nail a little better than you might be able to yourself, and this can dramatically go after some of the hiding places that fungi like.
  • If the above is not sufficient, then it makes sense to try one of the topical products mentioned in the article above. However, everything takes the same length of time as dictated by your speed of regrowth of that nail. 

By all means see your doctor, but don’t assume that medications belong at the front end of the treatment plan. Even with the oral drugs, you will still need to do the daily treatments anyway.

Hip Pain? Hip Tips...

One of the common complaints I see in my office is that of hip pains. Here are some useful hip tips.

One of the common complaints I see in my office is that of hip pains, which come in two varieties:  

ACUTE hip pains:   We see these cases a lot as injuries to the groin muscles on the inside aspect of the hip.  These are usually pretty obvious in their origin, for example when a hockey player collides with legs straddling the ice, or when a football player is tackled with one leg extended out to the side.  (Hip fractures are the subject for a separate blog).  These cases often respond quickly, as long as there is no serious tear in the muscle/tendon structure as it inserts from the inner thigh.  Other cases involve the outside of the hip joint, seen with cases of bursitis or capsulitis from extended exercises like rowing, biking, or running.  Treatments include rest, physical therapies like ultrasonic vibrations, electro-stimulation, and medical acupuncture are often all that is required. An anti-inflammatory medication can also help settle things down.  If this is not working, then further investigation with images can prove helpful, and more aggressive treatments like cortisone shots could be considered.  Gentle movements are encouraged, along with a graduated program of stretching and toning of the inner thigh muscles to rehab the area. Assuming the root cause was a one-time injury, recovery is usually excellent.  If continued trauma occurs, then the problems become more chronic.    

CHRONIC hip pains: These occur if the root cause is repetitive, such as the constant pounding felt by rodeo riders, snowmobilers, or moto-cross cylclists. This can lead to the destruction of the cartilage and the build-up of extra bony growth causing osteo-arthritis.   l More commonly, the root cause is just the repetitive effects of gravity as seen in the daily movements of an obese patient.  Especially with the morbidly obese ( 100 pounds or 45 kilograms over their ideal weight) this means the simple acts of standing up, walking, and stair climbing all cause daily damage to the hip joint.  Other conditions such as systemic forms of arthritis can certainly also affect the hip joint itself, leading to “bone-on-bone” instead of smooth surfaces where the hip joint is supposed to move.  Again, we look for any correctable root causes.  This would entail routine blood-work and images, to assess underlying diseases.  It would also involve corrective action for the obese patient, with proper diet and exercise regimens.  In severe cases, that are beyond any such help, replacement of the hip joint may be needed. 

In the meantime, here are some hip tips:

  • Watch your posture: Sitting is hip-hostile.  Try to stand up a few times per hour if you can.  We have already written about the benefits of sitting on a pilates ball for back pains, 
  • it also helps hip pains by introducing some movements into an otherwise frozen posture.  If you can, try to rig your work station for standing up all the time. 
  • Select non-impact exercises, like the bike or elliptical machines in the gym.  Also try yoga and pilates to help with toning and flexibility.
  • Watch your weight.  One of the rules of medicine is that pain is fattening.  If you are in pain, you can’t move much to burn off your daily calories.  This becomes a viscous circle, where any excess calories are simply added to one’s fat stores, adding to the pains of simple movements.  To compound this, junk foods such as white sugar, white flour, etc are all known to cause more inflammation, further adding to the damage to the hips and other joints.
  • See your doctor to seek out underlying diagnoses, from systemic diseases to simple things like one leg being significantly longer than the other.  Depending on the underlying causes, you may also benefit from massage, physical therapy, or chiropractic treatments. Follow their exercise tips to stretch and tone the surrounding hip structures.

For more info,

Beware the Plastics

Plastics may be great for consumer. But they are NOT meant to be consumed. With today’s busy lifestyle, more people are reaching for packaged foods, and most of these are introducing small amounts of chemicals into the foods they touch.

Plastics may be great for consumer.  But they are NOT meant to be consumed. 

With today’s busy lifestyle, more people are reaching for packaged foods, and most of these are introducing small amounts of chemicals into the foods they touch.   Whether it is the fast food burger in a foam box, raw meats on a Styrofoam (made from toxic styrene) tray in the supermarket, or drinks that now come in plastic instead of glass bottles, unwanted chemicals are entering our digestive tracts, and getting into our bloodstreams.  Now scientists and doctors are starting to take notice.  Higher rates (and earlier ages of victims) of cancers and neurological diseases are starting to be noticed in areas where packaged food is the norm.  While the big food companies may argue that this is untrue, there is certainly no chance that these chemicals like BPA (BisPhenol-A) are “health foods”.  As a consequence, it makes sense to take some simple measures to reduce our exposure.

Action Items to keep plastics out of your body:

  1. Buy fresh food, whenever you can.  Try your local farmer’s markets, or at least get to know the people behind the fish and meat counters at your grocery store.  Have them wrap it in wax paper. 
  2. Buy small quantities, so you won’t have a fridge full of left-overs. Remember the best way to keep food fresh is to leave it in the store!
  3. Learn to cook.  You will save money, and save your health.  You will also save time.  Watch Jamie Oliver’s 15 minute mealson YouTube; you will learn how to make something nutritious from scratch in less time than it takes to go out (or order in) for “fast” food.
  4. Don’t buy landfill along with your groceries.  Today’s foam trays, plastic containers, and packages all end up in next week’s garbage.  Far better to have foods wrapped in paper, foil, or cardboard boxes, and to buy liquids in glass containers. To complete the green concept, take your own cloth bags to the store, instead of using any plastic ones.  You will be amazed at the reduced output when you just buy the product and not the containers.
  5. Throw out your non-stick pans, plastic utensils, and storage containers.  Use stainless steel-lined pots and pans, and glass or steel storage containers. 
  6. Use water for your main drink.  It’s a lot cheaper than sodas and juices.  Besides, you don’t have to carry tap water home!  If your tap water tastes poorly, consider a reverse osmosis water filter. To make it look more appetising, fill old wine bottles with water, and leave them to chill in the fridge.   If you do enjoy fizzy water, seek out those that still come in glass containers. 
  7. Time counts.  If you do need to bring some foods home in plastic containers, transfer them to dishes immediately.    If some of it is to be saved for later, put it in a glass container.  Try not to eat from (or store food in) original plastic containers.
  8. When you absolutely need to use plastic at times, make sure it is the "hard" kind, not the soft opaque version; the opaque one is much easier to scratch with utensils, and much more likely to leech chemicals into its contents, especially when heated for cleaning.

While we can’t control all of the chemicals that touche our foods, we can certainly take these simple measures to fight back.   

Knee pains: How to prevent and recover

Knee pains are becoming very common. Most of the orthopedic surgeons in professional football and hockey are specialists in the knee, leaving others to look after the rest of the bones in question. In looking after sports injuries in my clinic, I can attest to the high rate of knee injuries among part-time athletes as well.

Knee pains are becoming very common.  Most of the orthopedic surgeons in professional football and hockey are specialists in the knee, leaving others to look after the rest of the bones in question.  In looking after sports injuries in my clinic, I can attest to the high rate of knee injuries among part-time athletes as well. 

Some logical questions follow:

1. Why is the knee so vulnerable to sports injuries?  The main reason is its range of movement is only in one plane.  Other joints can swivel, but the knee is just like a single hinge that straightens or flexes the leg, and is integral in our ability to walk, run, and jump.  However the knee has virtually no protection to a side impact.  Nor does the knee do well with twisting or rotational forces.  With the popularity of contact sports, especially ones with  helmets and hard pads, we are seeing more collisions resulting in serious knee injuries.  

2. Even in non-contact sports, such as running, we are seeing more gradual erosion of the knee structures.  While running is one thing the human body was well designed to do, the knee is not a great shock-absorber when one runs on pavement.  

3. Paradoxically, the inactivity of the modern work place also contributes to the rise of knee injuries.  With movement, the synovial membrane around the knee produces fluid, which not only lubricates the joint, but provides trace quantities of oxygen and food to the cartilege cells.  But today, we don't move our knees at work, we fold them under us like a deck chair.  At the end of day, it gets ugly, watching people trying to force their stiff legs into the standing position.


If you have injured your knee, here are some important action items:

1. Apply ice to ease swelling and pain, for about 10 minutes every half hour.  Make sure you have a layer of cloth between your skin and the ice, to protect from freezer-burn

2. See your doctor if you are not improving.  Images of Xray, Ultrasound, and MRI can help identify pathology.

3. When bending the knee, there is never any need to go beyond 90 degrees, unless you are just stretching. 

 For example, when you are doing a squat in the gym, just bend as far as if you were about to sit in a chair, then back up.  

Never bend the knees so far you can sit on your haunches if you are loading the joint with weights, or even your body weight.  If bending to pick something off the ground, bend just one knee to touch the ground, so both knees are at 90 degrees.  Its much easier to stand up, and much less likely to hurt the knee.


4. Watch your leg posture at the desk.  If your knees are hyper-flexed all day under your chair, they you will have a host of issues from dry knees, including stiffness of the surrounding muscles.  Try to set a timer to remind you to bend and flex the knee every fifteen minutes, even if you have to cradle it in your hands to get it started.  

5. Consider a soft knee brace when standing or doing activities.  

Not great for sitting with bended knee, as they tend to cut off the return blood flow if they crinkle behind the knee.  But when the knee is more straight, it can provide support, and may help reduce some of the swelling.  At the very least it will remind you which one is the sore knee, so you won't accidentally land on the wrong foot when running down the stairs for a train!

6. For rehabilitation, seek exercises that don't hurt, and that don't create impact.  Eliptical machines, bikes, swimming, skating etc are all good suggestions, along with controlled weight lifting and stretching exercises.  Make sure you seek professional guidance to make sure your ergonomics are good.  



Eye Infections - Be Sure to Treat Correctly

Pink-eye, highly contagious, but easy to treat. Here's how.

Eye infections are very common, and very important to treat correctly.

When an infection starts on the outer surface of the eye, the conjunctiva, or thin membrane that covers it, becomes inflamed.  As with any inflammation in medicine, we append the suffix “itis”  to make it into conjunctivitis, otherwise known as “Pink-Eye”. 

Considering the thousands of particles of dust laden with bacteria we have bombarding our bodies every day, one might wonder how the eye avoids constant infections.  The answer lies in its brilliant design:

  • Lids to close out sudden gusts of particles, form sand storms to sneezes, and lightning fast reflexes to operate them
  • tears to flush water under these lids to drain through the lacrimal ducts into the nasal passages
  • enzymes in the tears to destroy any invading organisms (which is why contact lens wearers can pop out a lens in an emergency, flush it under tap water or even lick it, then reinsert  without  getting infected). 

However, these defense mechanisms can still be overcome, and the result will be crust or pus forming between the lids, and a characteristic redness of what is supposed to be the “whites” of the eyes.

Parents know that this condition is an absolute reason to quarantine their child away from classmates or day care peers.  But it can also occur in adults just as easily. 

Once this yellowish material forms in your eye, it is very important to see a doctor.  While the diagnosis is pretty obvious from the history and findings, there are some important steps for follow-up to consider:

  • Pink-eye is extremely contagious.  Simply by rubbing the infected eye, one transfers the germs onto the hand.  
  • When that same hand later touches the other eye, the infection can now start there.  If that hand touches a door knob, then the next person touching that surface can get it too.  Schools and day care centers are quite right to keep pink-eye cases out of contact with the rest of the kids.  If you do catch yourself rubbing an infected eye, wash your hands immediately.
  • Try to flush it away.  In the old days, people were told to use an egg-cup full of water, which was a real mess. The simplest way is under the shower; turn the eyes into the direct spray, and open them even a little. 
  • Use disposable wipes, or tissues.  Do NOT use your towel to dry your eyes, as this will leave infection on the fabric, which will then reinfect you the next time you use it.
  • Sterilize or discard any cosmetics, sponges,brushes, that touch the eye lids or lashes.  
  • Your doctor will give you some prescription eye drops with anti-bacterial ingredients.  Use these as directed, and make sure you insert them correctly.  For directions, see  
  • After the second day, improvements should be noted, and the infection should be all gone by the fourth day.  If not, then go back to see your doctor.  At this point a more thorough exam by an eye specialist might be needed.
  • I always suggest patients use the drops for an extra day after the last of the symptoms, for good measure.

If you follow the above steps, and take your prescribed eye drops as directed, you should be quickly back to normal. 

Workplace Ergonomics: A Pain in the Neck!

Work injuries used to be from highly mobile tasks of hunting and gathering, for which the body was actually well designed. So the injuries tended to be from pure accident, rather than from enforced ergonomics. This changed with the industrial age, when we started to see work injuries to the hands from machines, or to the low back from lifting. But now that we have entered the digital age, our workplace has once again radically changed. Robots and machines do the assembly and lifting, while we sit. We don't get injuries from "hunting and gathering" in the field, we get them from "hunting and pecking" at a keyboard.

To see what hours of unremitting bad posture does to the neck, take a look at this image:

In order to see the flickering images on the screen, the head is projected drastically forward, leaving the neck almost parallel to the horizon. While this is fine for a few moments, it becomes an unremitting strain for the neck muscles after a few hours. Much the same as trying to hold two buckets of water at arms length for hours. Human muscles are built for movement, and need to be supplied with fuel and oxygen between beats. Permanent contraction becomes painful, as the muscles are literally starved of oxygen and fuel, much like we can visualize in our hands if we are having a "white knuckle" anxiety attack. We have small mucles that span the gap between each vertebra, and larger muscles along the entire spine and in layers protecting the neck. If these muscles do not relax between movements, then bad things happen.

First the muscles start to scream with pain, developing knots, and restricting simple movements. 

Secondly, over time, the disc spaces between the vertebrae become compressed, and the joint surfaces between the vertebra start to dry out. This explains most of the disc disease and osteoarthritis that we see causing neck pains as we age.
However, neck pains are rare among people who move during their work. We see inspiring examples of octagenarians with perfect posture who spend their lives as ski instructors, yogis, or dancers, or in people who seek out athletic endeavours when they are able to get away from their desk jobs.

But the age of the keyboard does not need to bring new pains to our neck, or to our lives. It simply means we need to develop a strategy to the new workplace. Take a look at the two images below:

In this one, we can see trouble already starting. The laptop is either at the right level for your hands (ie on your lap), or it is at the right level for your neck (ie on a tall table). In the former case, it is terrible for your neck, and in the latter case it is terrible for your hands (see our post on carpal tunnel). The same could be said of even smaller devices like the tablet or the phone. Never a problem for a short task, but this is a prescription for trouble when it extends for hours, days, and years without remission.  

By contrast, take a look at this person's posture. In particular, the neck is now in its normal position, as part of the spine, not a right-angle side road. The weight of the head can now be carried by the structure of the vertebrae, instead of relying on the constant pull of the mucles. Oxygen and food supplies can now be restored to the neck muscles, and knots and pains go a way (or, better yet, never get started!). 




If your work posture is giving you a literal pain in the neck, try these tips:

  1. Use a head-set or speaker feature on your phone.
  2. Have someone take a picture of you at your desk, near the end of day. How's your posture? If it is like the bad example above, then its time to do an ergonomic assessment. Many employers will have professionals who can do this, sometimes requiring a doctor's note. Or, you could follow some of the above advice to help prevent your own neck pains. In my own case, I have found a stand-up screen/keyboard works well when I am in front of my patients.
  3. Set a timer. Every fifteen minutes MOVE YOUR NECK! You can still keep your eyes on the screen if you must, but pull back your shoulder blades, roll your shoulder tips, and swivel your neck in all directions. Use something to pop up on your screen, or try a kitchen timer. Frankly, even a cuckoo clock would work (the original ones all chimed at the quarter hour, not just on the hour). The movement will restore circulation to tense muscles, and it will bring fluid back into the joint spaces. Pain and stiffness don't last long, as long as you move!
  4. When you walk, look ahead of you. Swing your arms normally, and hold your head as if you were balancing books on it. Don't hunch your neck over your cell phone or tablet while you are walking or on public transit. As a reminder, back into a wall and have a friend measure the distance between the back of your skull and the wall; your head should almost touch the wall behind you, and not be leaning towards the wall in front of you! For a video about this, see:
  5. If you have a stiff neck, see your doctor for assessment. Sometimes images are needed, like ultrasounds or X-rays. If the problem is musclular, massage can work wonders. If the problem is caused by a rigid alignment of the vertebrae, then chiropractic or physical therapy can be of great value. I have also found great results from doing medical acupuncture, with needles placed into strategic trigger points with almost instant relief. Also, consider a change of pillow, depending on whether you sleep on your back or side; some do well with the "reverse curve" pillow, others prefer a horse-shoe shaped pillow filled with air or bean husks. Be prepared to try a few variations to see what works best for you.
  6. Consider yoga or pilates, or other athletic endeavours that break away from the desk posture. Also consider the foam roll, (as seen in our blog on back posture); my patients find this an excellent daily antidote to desk posture. Lying flat on the floor with a rolled towel across the line of your neck can also restore the normal curve of your neck, and ease the muscles that create the stiff and rigid conditions of modern neck pain

Static Tension: The Non-Sports injury

One of the much more frequent injuries I see in my office today is the NON-sports injury from STATIC TENSION. Don't let this happen to you!

Sports injuries are usually not subtle.  Tension in the underlying tissues results from acute acceleration or deceleration movements.  For example, we see this with a check into the boards,

 a tackle from the side,

 or a crash over the handlebars.



  Some sports injuries are a lot less dramatic, yet still involve movement.  We see this in stress fractures, plantar fasciitis and shin splints in runners,



 or in the gradual disc degeneration in spines of  motorcycle racers.


But one of the much more frequent injuries I see in my office today is the NON-sports injury, caused by the complete LACK of movement.  Otherwise known as STATIC TENSION, the condition can best be illustrated by trying to freeze like a statue, with  two hand-weights held out to the horizon.

Even if the weights are small, this position can cause acute pains if the muscles don't move for extended times.  

Yet today, we freeze our muscles for long hours at our desks.  Even with no weights in our hands, we tense our muscles, ready to pounce on the next stroke on a keyboard. 

 This static tension produces similar results to sports injuries, such as sore shoulder tips, necks, upper and lower back muscles, stiff knees, and leg cramps.

At a cellular level, here’s how it works.   Each cell in our body needs circulation, to provide incoming food and oxygen, and to carry off the waste products of metabolism.  Our muscles get this circulation only BETWEEN beats of contraction/relaxation.  Normally, this works fine, as the human body was designed for hunting and gathering, moving all our waking hours. 

However, the modern work place has replaced movement with stasis.  With legs folded tight under our chairs, our necks craned forward, our shoulder-tips raised, and our knuckles white, we freeze our muscles in the name of progress.  Trouble is, when the work day is over and we try to stand up, it gets pretty ugly. 

Our legs betray us, our heads can hardly swivel to look for oncoming traffic, and we continue to wear our shoulders as ear-rings.  The muscles have been effectively starved of circulation for hours, and respond with expected results.  

So when you are at a work station, remember to be kind to your muscle cells.  Ease up that static tension, and move at least a few times an hour, to allow precious food and oxygen to fuel your cells again.  It could be a simple shoulder-roll, a pulling together of the shoulder blades, or standing up to twist your torso to the left and right a couple of times.  It could be as easy as straightening one leg at a time under the table during a meeting, or as subtle as rising up on your heels when you are standing in conversation or at a work station.  When you do get away from work itself, make a point of climbing stairs, walking quickly, or pursuing any active movement, from dance to tennis, or from yoga to gym work.

In any event, stop letting your work station give you the non-sports injuries of static tension.  Your muscles will definitely serve you a lot better.


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