Dr. Ricky Fishman, Chiropractor, Ergonomist

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Ricky's Riffs:

Random thoughts on Travel, Education, Health, and the World in General

Why Symptoms Matter….And Why They Don’t

You’ve been at the computer for six hours and feel that familiar tug.  From your upper back, spreading slowly to your neck and grabbing the base of your skull, stiffness turns to pain and the dull ache turns sharp.  Your movement becomes restricted.  Unable to turn your head, you tell yourself that it is time to see your chiropractor.  You remember that it has been a year since you saw him last.

The bulk of my practice is devoted to the pain that develops slowly from postural strain, most often the strain of sitting.  As our work lives have shifted from manual labor to sedentary work, our bodies have become de-conditioned. Perky at 9 AM, our upright postures fueled by powerful espresso drinks, by 4 PM we are slumped into our ergonomically designed chairs, low backs rounded, heads pulled forward into our monitors.  Automatically activated to pull ourselves into balanced positions above our centers of gravity, our muscles tense, fighting the distortions work has forced upon us. These low level contractions produce the normal byproducts of muscular metabolism, a variety of biochemicals that, when combined with reduced oxygen due to sustained tension, cause localized irritation.

Under normal conditions, we consciously command our muscles to contract.  To lift an object, a message is sent from our brains to our upper extremity, muscles are contracted accordingly to complete the desired task, waste products are produced and deposited in the substance of the musculature. Upon completion, blood vessels dilate to allow the collection (flushing) of this biochemical “gunk”. However, the maintenance of distorted postures over long periods of time causes a continuous deposition of these substances without allowing for the regular clean-up of relaxed musculature by free flowing capillaries.  The result is a build up of  noxious substances and the irritation of pain sensitive nerve endings.  We become aware that there is a “problem”.  We are now symptomatic.

Compounding the pain of muscle irritation is the fact that these chronically tightened back muscles, which connect to the vertebral segments of our spines, cause a loss of motion in the spinal joints. When our joints move normally, they act (in addition to being mechanical pivots) as pumping mechanisms, pushing blood and lymphatic fluids through our joint spaces.  As the muscles tighten, these mechanisms become compromised, causing a congestion that puts pressure on the nerves traveling through the area, becoming yet another source of pain. And in addition to irritation of pain sensitive nerves, motor (motion inducing) fibers are stimulated, sending a barrage of impulses back to the already tightened muscles, causing further tension, adding to this cycle of mechanical stress, strain and pain.

A visit to the chiropractor will help address each part of this dysfunctional mechanism.  The muscles that are tightened will be loosened with a variety of bodywork techniques, and the fixated (subluxated) joints will have their motion restored with spinal manipulation. This will help relieve pain by releasing the pressure on the nerve endings at each point in this cycle. More fundamentally, the chiropractor should address the causes of the problem with a series of exercises and stretches and postural awareness training.

We are taught to rely on symptoms to tell us when we have a problem that needs treatment, whether it is a fever that sends us to the medical doctor or the back pain that sends us to the chiropractor.  And while it is true that a symptom is a reliable indicator of a problem, and its relief a sign of the problems abatement, the absence of a symptom does not mean the absence of a problem.  As in the classic case of the fifty-year old man who suddenly drops dead of a heart attack, symptoms are often absent until well into the pathological process. Plaque was building in his arteries and his blood pressure was rising.  Sadly, his first symptom was a spasmed heart and death. Similarly, as we sit hour after hour at the computer, our muscles slowly tighten, straining to maintain our sedentary upright postures, until a sudden movement—a sneeze or the lifting of a hair dryer—produces the sharp pain of back spasm.

When patients come into my office in pain, I am often asked, “What is wrong with my back?” Before I can answer, I conduct an examination, which consists of both a physical assessment—orthopedic testing, neuromuscular evaluation, and postural analysis—as well as a case history to find out about previous injuries, exercise habits, and the nature of the their work. I may be told by the patient that although they spend all day at the computer, that they have an excellent work station, and that they have been evaluated by an ergonomic expert sent by the Human Resources department of their company. So again, “What is wrong with my back?”

To this, I often respond, “The problem is not with your back, but rather with your (work) life.  Your body is simply responding normally to the mechanical stress that you are subjecting it to.  We are simply not designed to sit in front of computer screens all day, even when seated in the best ergonomic chair.” But given the demands of modern post-industrial life, this is how most people earn their livings and until our interfaces with computers are modified in such a way as to minimize the mechanical strains, we will suffer the pains of slow onset muscle and joint dysfunction.

To simply wait for the pain that will inevitably come from staring all day into our luminescent screens is to deny the reality of our modern work lives.  Steve Jobs and Bill Gates might have dictated how we will live, but it does not mean we must suffer passively. As the man with the clogged arteries must alter his diet and exercise, the sedentary computer worker must stretch, strengthen, and be sure that her joints are well mobilized—whether symptomatic or not!

We live in a society that defines health as the “absence of disease”.  But we understand that disease processes take time to develop and symptoms are often expressed far along in the process. And while symptoms provide valuable information about the state of our bodies, waiting for them often delays care, creating the need for increased treatment. The wellness model is rooted in prevention.  It is a proactive approach, focused on supporting the bodies systems with nutrition, exercise, mindful living, and modalities such as chiropractic, Traditional Chinese Medicine, and other non-invasive therapies. Symptoms are important indicators of compromised health, but treating our bodies holistically, before symptoms arise, will help to improve our quality of life, enhancing vitality while minimizing pain and dysfunction.

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