Trapezitis

Neck pain is common and most of us have experienced it at some point. It brings with it the anxiety of a serious illness like spondylitis!  Fortunately most cases of neck pain are not due to spondylitis. One of the commoner and less understood causes is trapezitis!

The Trapezius Muscle

The trapezius is a large muscle that forms the nape of the neck. It extends from the neck to upper back and fans out to the shoulder. The muscle has many functions but the most relevant one is to lift the head to look upwards. Any work that requires the head to be stable like working on a computer, reading a book, working on a kitchen table, driving for long or watching television etc. brings the trapezius into action. With our modern lifestyle, one can imagine the extent of overuse and often abuse this muscle faces!

Fatigue and inflammation of this muscle leads to trapezitis. The symptoms are typical. It starts with mild pain or discomfort in the nape of the neck at the end of the day. Initially a good night’s rest solves the problem. In the early stages, massaging the muscle or a hot water bag brings relief. As time passes, the attacks become more frequent and painful. The muscle goes into spasm and feels hard to touch. The pain becomes constant and is not relieved easily. Eventually the pain and spasm can become unbearable. At this point, the patient seeks medical intervention and needs muscle relaxant tablets to decrease the spasm. Understandably this disorder is confused with spondylitis. However it is a different illness with a different approach to treatment.

An acute episode of trapezitis is treated with anti – inflammatory, muscle relaxant tablets. In addition, patients require physiotherapy modalities, a soft cervical collar and rest. A physiotherapist will use interferential therapy (IFT) and short wave diathermy (SWD) to reduce the spasm. The severe pain settles in 7 to 10 days.

We cannot avoid our daily routine and daily work! So how do we protect our trapezius from fatigue and bouts of inflammation? Firstly one must strengthen the muscle so that it can take the rigours of our routine. One needs to do neck and shoulder exercises regularly. Here I will emphasise the importance of doing exercises that involve the hands going above the head (overhead exercises). Swimming is an ideal exercise for trapezitis and regular swimmers seldom get such pain. The second philosophy of treatment concentrates on the ergonomics of work! Poor postures are ripe environment for trapezitis. Working with a laptop on bed or watching televisions lying down are a strict NO. Chairs at work should have a lumbar support. One should sit erect. Avoid slouching. The computer screen should be at eye level. A break is necessary every 20 minutes during long hauls in front of the computer or long drives. One should get up, move around and stretch the neck, shoulders and back.   

Trapezitis is a modern day epidemic brought on by our lifestyle. Awareness of the issue and a logical approach to the problem will help most people avoid it all together!  

Low Back Pain

Most people suffer from back pain at some point in their lives. Nowadays there is a lot of anxiety associated with back pain. The anxiety is because we constantly hear of patients undergoing an MRI for back pain and then surgery! Yes, there are surgeries that benefit certain conditions affecting the lower back and MRI is a wonderful tool that helps doctors do a detailed study of the back. But very few patients need an MRI and even less need surgery.

The spine is a complex structure of the human body. It starts from the brain and extends to the pelvis. It comprises of the neck, the upper back and the lower back. The back is made up of individual bones called vertebrae. Each vertebra is separated from the other by discs. The vertebrae conceal the spinal cord which is a downward extension of the brain. There are in addition a number of muscles in the back which make the vertebral column a mobile structure (so you can move your neck and bend your back).

In childhood the back is mobile, flexible and pain free. As a person grows older, the back ages as well. The discs degenerate and the joints wear out (arthritis and spondylitis). This is a natural process that happens to all people. Eventually in old age the back loses its flexibility and becomes stiff. Few lucky people undergo this natural process with little or no pain. Most of us however experience pain at some point during this course. This pain is the typical mechanical pain which most of us have had. It is the pain that is episodic (comes and goes). It is aggravated by exertion … sitting or standing for long periods of time. It is the pain that comes at the end of a long tiring day or during a bumpy ride. It is the pain that we get when we get up in the morning or get up after sitting for a long time. That is the commonest type of back pain and the type that we should not worry about! It does not need an X-ray and definitely not an MRI. We as doctors see this pain more nowadays because of poor lifestyle which includes unearthly working hours, poor postures while sitting, obesity and a lack of physical exercise. People who have this pain need to take rest till pain subsides, do back strengthening exercises and work on their postures while sitting, working and lifting weights. Unfortunately many such patients are unnecessarily over investigated with X-ray and MRI and some are even advised surgery! Patients need to be careful because surgery for this pain fails.

Another type of pain in the lower back occurs because of a problem elsewhere. Sometimes patients with a viral illness have fever, severe body ache and low back pain. This type of back pain is part of the illness and will disappear when the patient recovers from the viral fever. Many women get severe low back pain during pregnancy and after delivery. This is because of the strain of carrying the baby and hormonal changes. Such pain may continue for many months after delivery. But this pain is temporary and will subside on its own and one should not worry about it. Some women also get back pain during their periods. This pain is not related to the back and if it is very severe one should see a gynaecologist. At times a kidney stone causes back pain. This pain is intermittent, colicky and travels to the groin. It is usually very severe and your doctor will be able to diagnose it easily and guide you accordingly.

Which then are the types of back pain one should worry about? If the back pain is sudden and severe or unbearable, then obviously one needs to see a doctor. Most of such pains are due to a severe muscular sprain and these patients get better with rest and medication. Some of these patients have more serious problems like a slipped disc. In older patients the severe sudden pain may be due to a fracture of the fragile vertebral bone (osteoporosis).
One type of back pain that needs to be investigated is the one that doesn't get better. Especially if it interferes in the persons daily life, his/her job or recreation. And especially if routine treatments have failed.
Many times back pain is associated with shooting pain in the legs (sciatica). This is due to nerve irritation usually caused by a slipped disc.Again most patients with sciatica get better with non surgical methods of treatment and very few need an MRI and surgery.
Back pain after an accident needs to be assessed to rule out fracture or other injury.
The most serious types of back pain are due to infection or tumours. Luckily both these conditions are also the rarest.

To summarise low back pain is common. Many people suffer from it. The commonest type of low back pain is related to lifestyle issues like poor posture and lack of exercise. There is no reason to be overly anxious about low back pain. Don't be in a hurry to spend your hard earned money on an MRI!