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The weekend warrior.pubIf you’re like me, this weather makes you want to clean house from top to bottom, inside and out, every weekend. The work week does not allow for much household activity so we tend to make up for it during Saturday and Sunday, the well known “Weekend Warrior” effect. That satisfying feeling of seeing the fruits of our hard work unfortunately is followed by that next morning of barely being able to get out My office fills up with the very predictable increase in low back pain, sometimes to the point where people need serious medical attention. Most come in with pain across the low back, sometimes into the legs. Most have a great deal of spasm across the low back, with difficulty standing up straight sometimes to the point of being unable to walk, sit, or stand. Typical activity in the yard, or gym, forces one into repetitive bending, twisting, and lifting. This results in a great deal of uncontrolled stretching of the hamstrings, lumbar paraspinals, and gluteal muscles. These represent the “core” muscles. These are the muscles that protect the spine and serve as the dynamic stabilizers of the trunk. Our spine is surrounded by ligaments which connect to the adjacent level via the intervertebral disc. These constitute the static stabilizers of the spine. These static stabilizers in and of themselves are not strong enough to endure the stresses of everyday life. It is therefore the dynamic stabilizers that truly allow for us to experience life without sustaining any significant injury to our spinal column. If these dynamic stabilizers are deconditioned or not strong enough to withstand the rigors of our activity then injury ensues. The core as it is described consists of several layers of muscles. In the front, these muscles are the rectus abdominis or abdominal muscles. Along the sides from superficial to deep are the external obliques, internal obliques, and transverse abdominis muscles. In the back are the lumbar paraspinals which include several layers from superficial to deep. Lastly, the gluteal or buttock muscles are important due to the relationship they have on the pelvis with respect to the lumbar spine. Usually what is found on physical examination is that the patient has a significantly restricted range of motion. The patient has a great deal of muscle spasm. Because of the fact that the muscle has been injured it reacts by tightening which manifests itself as spasm. Typically the individual is leaning or listed off to the left or right. Flexed at the waist, unable to stand up straight is the rule. Usually overt neurologic deficits are absent such as weakness in the legs or sensory abnormalities. When asked to flex or extend at the waist often the spasm is evident with dysrhythmia which shows the muscles unable to move independently of one another and therefore moving in a robotic or machine-like fashion. Historically these patients would be given a period of bed rest to allow for the condition to resolve. We know now that this is the absolute wrong course of action. First and foremost maintenance of activity is of paramount importance. Any type of bed rest allows for continued deconditioning of the muscle which tends to prolong any type of recovery. Commencement of physical therapy with focus on strengthening and flexibility of the core greatly diminishes any period of recovery. The core muscles are specifically targeted and flexibility of the hamstrings and gluteal muscles are highlighted. Muscle relaxants such as Flexeril or Skelaxin, nonsteroidal anti-inflammatory medications, and occasionally narcotic analgesics are prescribed. Certainly these medications can have side effects such as drowsiness, constipation, or forgetfulness among others. The purpose of medication is to help relieve pain and spasm, and to therefore allow for early return of function. Generally these episodes will be short-lived, often resolving when treated appropriately within about 10 -14 days. On occasion they can last longer or even be a recurring theme. It is absolutely imperative that one continues with the stretching and strengthening exercises on an individual basis as this can serve to be both preventative and therapeutic. It is very unusual for an individual to continue to experience long term pain as a result of this type of injury and rarely is surgery ever required. Perhaps the moral of the story is to act in moderation, limiting one’s yard activities to several hours per day on the weekend. A home exercise program can allow for one to maintain their individual fitness and keep the perfect lawn all at the same time.
Alopecia Areata Freitas, V.M.P.²; Schmitt, A.N.H.²; Motta, R.R.²; Carvalho, V.M.C.²; Hungria, L.F.F.S.¹; Villa, R.T.¹; Bedin, V.³ (1) Professor (a) da Fundação Técnico Educacional Souza Marques e Fundação Pele Saudável (2) Pós-graduando (a) da Fundação Técnico Educacional Souza Marques e Fundação Pele Saudável (3) Coordenador da Fundação Técnico Educacio