Tate Roberts
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Lower back pain is such a … well, a pain! A study done in 2014 found that 84.2% of nurses deal with lower back pain. 66.7% of those nurses said that this pain was of “moderate severity”. Back pain can be caused by many things. Here we are going to talk about one in particular, anterior pelvic tilt (APT). What is APT? Your pelvis plays a key role in your body. It helps you to move around, lift things off the ground, and it allows you to have good posture. APT occurs when your pelvis begins to rotate forward, curving your spine, and increasing lordosis. This usually affects the lowest two levels of the back, L4-5 and L5-S1. If this curvature is not fixed long-term problems can arise. This can include: Compressed degenerative discs Disc tears (annular tears) Disc bulges Disc herniations The muscles involved with APT fall into two groups, the primary postural muscles, and the phasic muscles. The primary postural muscles involved in APT are the iliopsoas, erector spinae, rectus femoris, and quadratus lumborum. When these muscles are fatigued, they tend to tighten. The phasic muscles involved in APT are the gluteus maximus, gluteus medius, and rectus abdominis. When these muscles are tired, they become weakened and loose. This is exaggerated by the law of reciprocal inhibition. The law of reciprocal inhibition tells us that when one muscle gets a signal to contract, the opposite muscle's ability to contract is inhibited. So the tight primary postural muscles rotate the pelvis anteriorly, and the phasic muscles may not only be tired and weak but are being neurologically inhibited by your own body. This combination creates APT. What are its Signs and Symptoms? There are a few things you can look at to help you decide if you have APT. If you have: Lower back pain Exaggerated lumbar curve Bulging abdomen despite having low body fat The waistline of your pants diagonal to the floor Failed the Thomas test The Thomas test is simple to do and can help you determine how well your pelvis is aligned. All you need to do is: Find a safe and sturdy table. Lie back on it in a way that allows your legs to hang off the edge at your knees. Pull your right leg in towards your chest. Grab your leg under your knee and hold it against your chest (or as close as you can), for a few seconds. Repeat steps 3 and 4 with your left leg. You know your hips are aligned if the back of your resting leg is touching the table, while the other leg is against your chest. If you have to extend your resting leg or rotate your leg or pelvis, there is a good chance you have APT. What are the Risk Factors? APT can be caused by the following: Genetics Back injury Too little physical activity Poor posture Sitting for long periods of time When we sit, our hip flexors are in a shortened position. Our glutes aren’t doing much, and your spinal extensors are continuously firing to keep you sitting up. When people stay this way for the majority of the day, it isn’t hard to see how they might develop APT. How Can I Fix it? Much of the time APT can be fixed through exercise. You want to find exercises that strengthen those phasic muscles. This includes planking, glute bridges, and squats. You can find entire videos on Youtube that are dedicated to strengthening these muscles and fixing APT. You can also help fix it through stretching. You want to focus on stretching, you guessed it, the primary postural muscles. This includes the half-kneeling hip flexor stretch, the kneeling quad stretch, and the runner’s lunge. Again, you can find entire Youtube videos demonstrating stretches to help fix APT. Lastly, you can change your lifestyle. In addition to adding some exercise and stretching your life, you can set reminders for yourself to get up and move around more if you work at a desk all day. Make the effort to be aware of your posture and fix it when you notice you are tilting. References Pletcher, P. (2018, September 17). 5 exercise of anterior pelvic tilt. Healthline. Derring, S. (2021, June 24). How to fix anterior pelvic tilt. Spineuniverse. Garnas, E. (n.d.). What is anterior pelvic tilt (and how to fix it). The Personal Trainer Development Center. Leonard, J. (2017, May 11). Six fixes for anterior pelvic tilt. MedicalNewsToday. Lowe, W. (2009). Orthopedic massage (second edition). Elsevier.
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What is a Stent? What do you think of when you hear the word, stent? Do you picture the small metal mesh that is put into some patients with heart problems? You wouldn't be wrong. These bare-metal stents are what textbooks depict. I was shocked to learn that doctors don't use these much anymore. I only recently learned about the drug-eluting stent (DES). If you are like me and have never heard of DESs, or are looking for a quick refresher, you have come to the right place. Stents are used to keep an artery open after it has been narrowed by plaque (coronary artery disease or CAD). This again allows enough blood to get to the heart, providing the oxygen and nutrients the cardiac cells need to continue to work. Research has shown that about 40 percent of those who have angioplasty without a stent are confronted with restenosis or the recurrence of a narrowing artery after corrective surgery. This usually happens 6 months after the first operation. Normally, as the body heals from the procedure, healthy cells grow. Later, scar tissue forms underneath those healthy cells. Sometimes the scar tissue is so thick that it blocks the blood flow. Other times the scar tissue allows for new plaque buildup, leading to restenosis. Bare-metal stents reduce the odds of that occurring. If used in angioplasty, the percentage of restenosis decreases to 25. The healthy cells and scar tissue form underneath the newly placed stent, and restenosis follows. What is a DES? DESs were created in the 2000s to solve some of the issues with bare-metal stents. They are very similar to bare-metal stents but have a key difference. As you might guess from the name, DESs slowly release medication into the artery. The medication aids in preventing the formation of scar tissue and blood clots. When using a DES with angioplasty, the percentage of restenosis is reduced to below 10. DESs used to be made in different ways. One was made of material similar to dissolving stitches. It would elute medication and completely dissolve in 3 years. At first, this was thought to be better, but clinical trials showed they caused more complications. Risks of DESs Today, doctors use DESs approved by the FDA. When paired with anti-clotting medication, DESs are safe and work well for many people. Like all things medical, there is always a possible risk. Possible risks of DESs include: Allergic reaction to the dye Allergic artery closure Blood clots Coronary artery closure Coronary artery rupture Damage to blood vessels due to the catheter Infection Irregular heart rhythm Stroke Patients need to consider a few things before getting a DES. Things to consider are: Do the patient's medications need to change? Medications such as aspirin can affect surgeries, medical procedures, and other medications. If the patient cannot delay a noncardiac surgery, they need to talk to their doctor about the medications they are taking. Dosages may need to be changed. Does the patient need to have another type of surgery soon? If they are considering having another surgery within a year of the proposed angioplasty, they may need to postpone it for a year. If they cannot, a bare-metal stent might be a better option. Benefits of DESs DESs provide the same benefits as other stents, plus they reduce the risk of restenosis. The benefits of getting a DES include: Prevention of plaque formation Increased blood flow to the heart Decreased angina Decreased chances of heart attack/failure Insertion of a stent is much easier than having coronary bypass surgery. Recovery time is shorter. Those who have a DES inserted recover in a few days while those with a coronary bypass surgery can take six weeks plus to recover. References Restenosis: Repeat Narrowing of a Coronary Artery Drug-eluting stents: Do they increase heart attack risk?: Mayo Clinic Drug-eluting stents: How do they work?: Healthline What to know about drug-eluting stents: WebMD
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Our brain is the part of our body that calls the shots. Your brain moves your body through electrical signals. These signals travel through neurons. It is estimated that there are about 86 billion neurons in the human brain. There are also neurons throughout our body. Those that are not found in our brain or spinal cord make up our peripheral nervous system. Peripheral neuropathy is the result of damaged neurons in the peripheral nervous system. This can come from toxins, infections, injuries, or health problems such as diabetes. Those with peripheral neuropathy use words like stabbing or burning to describe the pain caused by this problem. Most of the time symptoms can improve. Especially if they are related to a treatable condition. Certain medications have been shown to help reduce pain caused by peripheral neuropathy. Symptoms Having damaged peripheral nerves can lead to many signs and symptoms, including: Numbness Tingling in the affected area Burning, jabbing, throbbing, or sharp pain Extreme sensitivity Pain while doing activities that normally don't cause pain Poor coordination/falling Muscle weakness, cramps, and or wasting Paralysis Constipation or diarrhea Loss of bowel control Rapid heart rate Symptoms will vary depending on what groups of nerves are affected. There are three groups. These are: Autonomic: These nerves are responsible for the processes of the body that are not normally seen (breathing, digestion, heartbeat, etc.) Motor: These are responsible for the movement of muscles ( such as walking, typing, lifting patients, etc.) Sensory: These are responsible for sensing the environment (hot, cold, sharp, etc.) Causes The list of causes of peripheral neuropathy is long. It includes systemic autoimmune diseases, hormonal imbalances, kidney and liver disorders, nutritional or vitamin imbalances, alcoholism, toxins, cancers, benign tumors, chemotherapy, infections, etc. We will go into the three most common causes. The most common cause of acquired single-nerve injury is physical injury. Car accidents, sports injuries, and falls can all damage peripheral nerves. Even less severe traumas can lead to peripheral neuropathy. Broken bones can put pressure on nearby neurons. Arthritis and other joint swellings can do the same. Prolonged application of casts and repetitive, forceful activities can cause ligaments and tendons to swell, narrowing nerve pathways. The leading cause of polyneuropathy in the U.S. is diabetes. About 65% of people with diabetes have mild to severe forms of neural damage to all three nerve groups. Vascular and blood issues can lead to peripheral nerves becoming hypoxic. This can lead to severe damage. Hypertension, atherosclerosis, smoking, and diabetes can impede blood flow. This results in patchy nerve damage also called multifocal mononeuropathy or mononeuropathy multiplex. Diagnosis A doctor will likely perform a physical exam and ask questions about medical history. Other tests can be performed, including: Nerve Conduction Study: Electrodes are placed on the skin. Electricity is sent through the neurons to test how effective signals are transmitting. Electromyography: This shows how well the body's signals move to the muscles. A small needle is placed into a muscle. The doctor then asks the patient to move the muscle. The probes within the needle measure the amount of electricity that is moving throughout the muscle. Risk Factors The risk factors for peripheral neuropathy include: Autoimmune disease (lupus, rheumatoid arthritis, etc.) Alcohol misuse Diabetes Exposure to toxins Family history of neuropathy Infections Kidney disorders Liver disorders Repetitive motion Thyroid disorders Treatment Treatments vary and depend on the type of nerve damage, symptoms, and location. Medicines are used, but some people can control their symptoms without them. Many times, neuropathy will resolve itself if the underlying causes are corrected. Some common improvements in lifestyle habits that make a difference include: Maintaining optimal weight Eating a well-balanced diet Reducing exposure to toxins Correcting vitamin deficiencies Smoking cessation Exercise Strict blood glucose monitoring Use of immunosuppressive drugs such as prednisone, azathioprine, or cyclosporine. Plasmapheresis Use of other drugs such as some SSRIs, local anesthetics, anticonvulsants, and narcotics. Surgery Transcutaneous electrical nerve stimulation (TENS) Prevention The best treatment is prevention. Making healthy lifestyle choices can make all the difference later. Diets that include fruits and vegetables, whole grains, and lean protein are beneficial. Eating good foods protects against vitamin B-12 deficiency and other vitamin deficiencies. Regular exercise of at least 30 minutes a day promotes blood flow to different parts of the body. Avoiding performing repetitive motions, putting pressure on nerves for long periods, exposure to toxins, drinking high amounts of alcohol, or smoking will greatly help to prevent peripheral neuropathy. Any people have a disease that predisposes them to peripheral neuropathy. Getting it under control as best they can will help with prevention. The National Institute of Neurological Disorders and Stroke recommends that those over 50 get vaccinated against shingles and other diseases that are known to cause neuropathy. Summary Peripheral neuropathy occurs when the neurons outside the brain and spinal cord are damaged. Symptoms vary greatly and depend on multiple factors. Pain, numbness/tingling, and irregular autonomic function are a few. The groups of neurons that can be affected are autonomic, motor, and sensory. Peripheral neuropathy can be caused by many things. Three leading causes are physical injury, diabetes, and vascular/blood issues. Diagnosis often involves nerve conduction study and electromyography. Treatments differ from case to case and depend on the type of nerve damage, symptoms, and location. Much of the time, neuropathy will resolve itself if the underlying causes are fixed. Prevention of peripheral neuropathy involves making healthy lifestyle choices, avoiding risk factors, and controlling existing diseases. References Peripheral neuropathy: Healthline Peripheral Neuropathy: My Health Alberta How Many Neurons Are in the Brain?: BrainFacts Peripheral neuropathy: Mayo Clinic Peripheral Neuropathy Fact Sheet: National Institutes of Health Overview Peripheral neuropathy: United Kingdom National Health Service
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"I haven't had any problems with this patient. That wraps up my report, see you later!" "Yes, you could say he is irritable." "Thanks for coming in and covering for Sue. I can't imagine why she needed a day off." "And this is an easy patient." "... and don't mind the mess. Anyways, see you tomorrow!"
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