Category Archives: blog

A 32yr old man with pain in the mid-back

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Mark is 32yrs old. He came to the clinic complaining of pain in the mid-back, in between his shoulder blades. It had started about six weeks previously, for no obvious reason, and he felt it particularly badly in the morning, when he woke up. The pain seemed to come and go. He did say that he has suffered from indigestion in the past and has had an endoscopy (where they use a camera to look down into your throat and stomach). This had apparently shown some erosions, signs of inflammation) in the oesophagus. Mark said that he had just bought a house, and that his internet company was struggling a bit financially. His partner had had a baby about three months ago. He agreed that he is pretty stressed. 

His mid-back was quite tender with some spasm in the paraspinal muscles. The right side of his neck was also stiff and tender to touch. His sternum was also really tender. 

Mark’s mid-back pain is probably caused by reflux of his acidic stomach contents up his oesophagus creating inflammation in the oesophagus. This is often a problem when we lie down for a while. It is made worse by anti-inflammatory medication, like ibuprofen, and by aspirin, which irritates the stomach. Alcohol and caffeine will also aggravate the condition. He needs to reduce the intake of wine and spirits, and avoid too many cappuccinos! Food and drink that are hot in temperature and spice will also aggravate the problem. He could try taking a medication like Nexium to see if it helped in the short-term, as it reduces stomach acidity. Anything that he can do to reduce his stress levels will help. Going for a regular run is good for this. Maybe Mark should try that!

Bring Sally Up….

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Have you seen the recent ‘Bring Sally Up’ challenge about doing pushups in time with the Moby track ‘Flower’? Pushups are the ultimate triceps exercise. I find it almost impossible, but I’m working on it! The lyrics are really ‘Green Sally Up’, not ‘Bring Sally Up’, but that’s a whole other story with its roots in slavery. I’ll let you Google it!

We use the triceps muscle to push things: helping ourselves out of a chair, pushing a door, and doing pushups.  ‘Tri’, means ‘three’. The triceps has three components: the medial, the lateral and the long head. These all come together  to attach onto the olecranon of the elbow.

The triceps is the muscle that is most commonly affected by a trapped nerve in the neck, the seventh cervical nerve. A problem with this nerve can give pain in the neck and arm, and weakness of the triceps. We normally test triceps strength, comparing one side to the other. As the nerve recovers, the triceps strength improves.

Pushups are a great way to develop our core stability, working multiple muscles, as well as to support our cardiovascular fitness. They help to strengthen our shoulders. They don’t require any equipment. They are free, and it doesn’t take very long to do them.

But, they are difficult. In another video I’ll show you how you can start to do pushups at a level that suits you and how to gradually progress so that you can do push-ups at a level that helps to get you fitter and stronger!

If you feel strong enough to have a go at the challenge here is a link to a YouTube video of the track with a timer so that you can see how long you can keep going. Push yourself up and stay up with ‘Green Sally Up’ and then lower yourself down and stay down with the lyric ‘Bring Sally Down’. See how long you can keep going!

Green Sally up and green Sally down

Lift and squat, gotta tear the ground

Old Miss Lucy’s dead and gone

Left me here to weep and moan….

Is your BP monitor any good?

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This article was stimulated by me seeing an article by Dean Piccone and colleagues [1] in the JAMA. I thought that all blood pressure (BP) monitors that are sold in the UK would be equally valid, but apparently not!

Why is measuring BP important? We know that elevated systolic BP is a risk factor for death. It is estimated that 10 million people die globally each year due to high BP [2].  So, identifying patients with elevated blood pressure, therefore, makes sense, so that BP lowering interventions can be made or suggested.

I like to measure my patients BP when I first see them, and annually at their review, if they are attending for regular care. Sometimes it can be very high when I first see a patient, and this might be very relevant, if the patient is complaining of left shoulder pain, for instance. Other times I might notice that it is creeping upwards year-on-year

In-clinic measurements are commonly elevated, giving a false impression of risk, due to ‘white coat syndrome’. [3, 4]. This might result in an inappropriate referral of the patient to their GP for BP meds. We often ask patients to measure their BP at home. These patients will obviously need to have their own BP monitor.

You need to ensure that your BP monitor has been validated. Not all monitors have been validated, because the regulations governing their sale are apparently as much about electrical safety as measurement accuracy. You can check yours at the National Registry  run by the British and Irish Hypertension Society.

You can learn how to reliably measure your own BP an on-line course (yes, really) here which takes about an hour [5]. Most people just follow the instructions that come with the BP equipment that they buy

If you want to learn more, read the article by Piccone and colleagues (link below). Shout out to them for a really useful article. Awesome!

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