Archive for September, 2011

Chronic Neck and Back Pain – a Case of Over “Self-Treatment”?

Thursday, September 29th, 2011

Recently a 23-year-old female patient with no prior history of trauma or related medical conditions presented to the clinic with primary complaint of persistent neck pain and stiffness, headaches and upper-mid back pain, recurring over the last 3-4 years.  She was self-employed, and spent the majority of her day in front of a computer. 

 She had tried PT and massage which were ineffective.  She was working with her family MD on an ongoing basis, had been prescribed a low dose of Flexeril to be taken on the ‘bad’ days.  The MD had recommended an MRI scan of the neck, then referral to a chronic pain center.  However the patient has a large insurance deductible, so could not afford this route.

Examination revealed an otherwise healthy appearing young adult female of normal weight, but with very chronic-appearing, ropy, nodular muscle tissues palpated bilaterally from the upper neck down to the mid-back between the shoulder blades.  The tissues were particular rigid and tender along the lateral and posterior neck, yet the neck range of motion was entirely normal.  Misalignments of the spine were identified, particularly in the upper back, yet the bony segments of the neck were found to be somewhat hypermobile. 

Radiographs obtained from the MD were essentially normal.

Summary:  This patient’s situation is seen with uncommon frequency.  An otherwise young, healthy, non-traumatic patient, but with chronic pain and stiffness.  Further history revealed that the patient had an ‘addiction’ to frequently stretching and pulling on her head and neck to get the bones to ‘pop’.  In fact, the patient reported that as she sat in front of the computer working, it was not uncommon for her to pull on her head and neck every 5-10 minutes.

She was diagnosed with self-induced cervical strain/sprain.  In essence the patient gave herself a mild form of whiplash and was suffering from chonic inflammation and low grade spasm of the muscles, tendons and ligament.

I recommended that the patient immediately decrease the frequency of her self-treatments over time, with a goal of stopping entirely, by explaining that she was damaging her neck tissues by the repeated yanking on her neck.  I advised her that she will likely go through a withdrawal period, of sorts, during which her neck will be even more symptomatic.  To heal her injuries, we initiated her on electical muscle stimulation treatments, along with adjustments of the upper back to the segments that were misaligned.  I briefly considered placing her in a neck brace, but the patient declined.  She was given strengthing exercises.  The outcome of treatment is pending, and much depends upon her own compliance.

Saucony’s Kinvara 2 Running shoes

Wednesday, September 21st, 2011

The Kinvara 2, released in 2011 by Saucony, is best described as a semi-minimalist running shoe. If moving from a high-end standard shoe such as a Ride 4 or Gel Nimbus 13, the first thing you will notice is that the Kinvara 2’s are, by comparison, feather light. Second will be the low heel to toe ratio, which will move the foot strike toward the forefoot from the heel, which is generally a good thing to neutralize hip and knee gait related pain. Technically, it’s classified as a neutral shoe, for those with under/over pronation problems, keep that in mind.

The upper is entirely a screened mesh, extremely breathable. The screen mesh keeps rocks and sand out, but not dust/dirt. The sole is nearly 100% foam, without a continuous hardened rubber outsole. The fit is spot-on, the heel fits nicely in the cup, the inner sole is balanced, and the laces firm up the support comfortably.

They run “nice”. I’ve put 80 miles on this pair, give or take, maximum of 5 miles per outing. There is a decent foot strike, neutral handling, comfortable inners, good energy return on push-off, traction is perfectly adequate, and of course the weight, or lack thereof, should improve your mile times. It’s quite close to running barefoot, without the bruises and cuts. I suppose one could forget your are wearing shoes, they are that light.

As “nice” as they are, I’m not convinced this is the best everyday training shoe. Barefooters and minimalists will likely disagree, but the Kinvara’s minimal structure and weight may work against being an everyday running shoe for those with stuctural or injury issues. Right off, these are not highly durable, with a primarily foam sole, so with mileages above 20 per week, expect to replace these a lot more often. Secondly, heavier or taller folks, or those with joint injuries may not get enough impact absorption from the shoe.

I’m 175-lbs with a ‘bad’ (ACL) knee. The Kinvara 2’s are acceptable for training, although I did have a bit more anterior knee pain than usual; so there are better daily training shoes out there, such as the aforementioned Gel Nimbus 13, or Grid Raiders, etc. Where the Kinvara 2’s have found their niche for me are competition shoes. There is nothing like a featherweight shoe if you’re trying to trim seconds off your mile time.

Overall, the Kinvara 2’s are surprisingly stable, absorbtive, lightweight (~7 oz) minimalist shoes. They run really great on road, gravel and mixed surfaces, too. Go get your own pair!

Coming soon will be my thoughts on the Saucony Exodus 2.0 trail running shoes, and if there is enough time left in the outdoor running season we’ll analyze the outcome of Lisa’s experience with Asics Lady Gel Nimbus 13’s as it pertains to her moderate chondromalacia patellae (knee cap cartilage degeneration).

Saucily Kinvara 2 @ 80 miles (about 30 of that on gravel trails):