Isaiah 58

““Praise be to the Lord, the God of Israel, because he has come to his people and redeemed them. He has raised up a horn of salvation for us in the house of his servant David (as he said through his holy prophets of long ago),” Luke 1:68-70 NIV

 Isaiah 58
¹ “Shout it aloud, do not hold back.
   Raise your voice like a trumpet.
Declare to my people their rebellion
   and to the descendants of Jacob their sins.
² For day after day they seek me out;
   they seem eager to know my ways,
as if they were a nation that does what is right
   and has not forsaken the commands of its God.
They ask me for just decisions
   and seem eager for God to come near them.
³ ‘Why have we fasted,’ they say,
   ‘and you have not seen it?
Why have we humbled ourselves,
   and you have not noticed?’
   “Yet on the day of your fasting, you do as you please
   and exploit all your workers.
⁴ Your fasting ends in quarreling and strife,
   and in striking each other with wicked fists.
You cannot fast as you do today
   and expect your voice to be heard on high.
⁵ Is this the kind of fast I have chosen,
   only a day for people to humble themselves?
Is it only for bowing one’s head like a reed
   and for lying in sackcloth and ashes?
Is that what you call a fast,
   a day acceptable to the LORD?
 ⁶ “Is not this the kind of fasting I have chosen:
to loose the chains of injustice
   and untie the cords of the yoke,
to set the oppressed free
   and break every yoke?
⁷ Is it not to share your food with the hungry
   and to provide the poor wanderer with shelter—
when you see the naked, to clothe them,
   and not to turn away from your own flesh and blood?
⁸ Then your light will break forth like the dawn,
   and your healing will quickly appear;
then your righteousness^[a] will go before you,
   and the glory of the LORD will be your rear guard.
⁹ Then you will call, and the LORD will answer;
   you will cry for help, and he will say: Here am I.
   “If you do away with the yoke of oppression,
   with the pointing finger and malicious talk,
¹⁰ and if you spend yourselves in behalf of the hungry
   and satisfy the needs of the oppressed,
then your light will rise in the darkness,
   and your night will become like the noonday.
¹¹ The LORD will guide you always;
   he will satisfy your needs in a sun-scorched land
   and will strengthen your frame.
You will be like a well-watered garden,
   like a spring whose waters never fail.
¹² Your people will rebuild the ancient ruins
   and will raise up the age-old foundations;
you will be called Repairer of Broken Walls,
   Restorer of Streets with Dwellings.
 ¹³ “If you keep your feet from breaking the Sabbath
   and from doing as you please on my holy day,
if you call the Sabbath a delight
   and the LORD’s holy day honorable,
and if you honor it by not going your own way
   and not doing as you please or speaking idle words,
¹⁴ then you will find your joy in the LORD,
   and I will cause you to ride in triumph on the heights of the land
   and to feast on the inheritance of your father Jacob.”
            For the mouth of the LORD has spoken.

As the psoas causes back and hip pain

The biggest factor to hip and back pain is the psoas muscle. The number of problems caused by the psoas amazing. These include: back pain, back pain, sciatica, herniated disc, spondylolysis, scoliosis, hip degeneration, knee pain, menstrual pain, infertility and digestive problems. The list can also biomechanical problems like pelvic tilt, leg length discrepancies, kyphosis and lumbarLordosis.
What is the psoas?
The psoas (pronounced “so – Oz”) primarily flexes the hip and spine. At about 16 cm in length on average, is one of the largest and thickest muscles of the body (in animals it comes to thread). This powerful muscle runs down the spine of the middle class starting on 12 thoracic vertebrae link attached to all vertebrae, discs and transverse processes of lumbar vertebrae down across the basinthe inside of the leg to the tip of the lesser trochanter. The lower part combined with the fibers of the iliacus muscle that is located within the surface of the pelvis and sacrum, M. iliopsoas become above the pubic bone and inserts on the lesser trochanter curves.
What is the function of the psoas?
This has a number of different functions so that it is an important factor for health. The psoas muscle is a flexor of the thigh and hip of the main promenade. If the legs arestationary action, is a curvature of the spine forward, if you sit down and stabilize the balance of the body. The lower psoas brings the lumbar vertebrae forward and downward to create pelvic tilt.
When we think of a smooth, elegant and graceful in dancers and athletes, we are ideally looking psoas functioning at it. And ‘necessary for the psoas the pelvis in a neutral dynamic orientation that can move easily protect and maintain the structural integrity maintained. This creates positionsspine require less muscle strength.
What are the most common symptoms of the psoas muscle pain?
If the muscle due to injuries, poor posture, prolonged sitting or stress is committed to change, the biomechanics of the pelvis and the lumbar, thoracic and even cervical vertebrae. Typically a dysfunctional is responsible for the pain that radiates down the front of the thigh and vertically along the spine and lower. Trigger points are located above the paththe psoas on the abdomen. Often trigger points develop quadratus lumborum, and piriformis, glutes, thighs, and spinal erectors.
You can drag the spine torque left or right, forward and rotate the pelvis in various distortions. Many times it is shortened psoas and pull the spine and / or basin on our side dominant. The distortions of the spine and pelvis can also show how long or short legs. This leads to scoliosis, kyphosis, lordosis,The trigger points and spasm of the back muscles trying to resist the force of the psoas.
You can pull the spine downward, compressing the facet joints and intervertebral discs of the lumbar spine. The pressure can cause the discs to degenerate, becoming thinner and less flexible. This degeneration makes the discs more susceptible to bumps and cracks, especially with twisting and bending.
What keeps the psoas in contraction?
The psoas will stay contracted because ofpostural habits and trauma. The way we stand, sit, walk and can distort the psoas. If we stand with our chin or on foot in an overly forward position the muscle tighten. Seating is by most of the day shortened to us bio mechanically balanced in our chairs. Over the years we have developed a “normal” way to keep the psoas that is dysfunctional.
unprocessed trauma can keep the psoas responsive and quick. This is a muscle responses in the primary flight, freezing, fighting, or fear of danger. IfSurvival is at stake, it pushes the body hit the ground running. If scared, turn on the preparation of the extensor muscles (hold) to reach or run. Until the psoas muscle can draw freely and go stay in a further shortening and spasm very easily.

Neck-Stenosis-Myleopathy

Overview

Stenosis means narrowing, and when referenced to the spine means narrowing or constriction of the spinal canal, which contains the spinal cord and nerves. The neck region (cervical spine) is much less accommodating and forgiving (than the lumbar region) of neurologic compression, and when the spinal cord compression is moderate or severe, it generally manifests as myelopathy.
Myelopathy is the clinical scenario of spinal cord compression causing (upper motor neuron - UMN) neurologic dysfunction such as gait disturbance (trouble walking), pathologic reflexes (increased reflexes and spasticity), muscle weakness, and/or numbness (sensory deficits). The natural progression of this condtion is usually a slow, gradual deterioration in a step-wise fashion, although some patients present with a rapid decline of physical function and/or paralysis.

Causes

The most common cause of cervical spinal stenosis is degenerative osteoarthritis of the spine, specifically disc degeneration, formation of disc-osteophyte complex (DOC, bone spurs), hypertrophy (overgrowth) of the ligamentum flavum and the formation of large osteophytes adjacent to the facet joints. There is usually significant stiffness, and occasionally is associated with compensatory subluxation and instability. This is a gradual process that causes progressive compression of the spinal cord and neural elements. Mechanical irritation may cause a local inflammatory response, and decreased vascularity may cause decreased conduction of the nerve signals. Although aging and degeneration is the most common cause of stenosis, patients may have other medical conditions or trauma that predisposes them to develop spinal stenosis. Rarely, the posterior longitudinal ligament may become extremely calcified, and is called ossification of the posterior longitudinal ligament (OPLL).

Symptoms

The degenerative process is typically slow and relentlessly progressive. Patients often have neck pain and stiffness. Subtle changes in gait (walking) and balance may be the only symptoms present initially. Also, patients tend to have difficulty with fine motor function and coordination such as writing or buttoning a button. When the stenosis and myelopathy is severe, most patients will develop long tract signs (UMN) consisting of a wide-based gait, balance difficulties, and weakness. Patients tend to develop proximal weakness (hip flexors, quadriceps) in the legs prior to the distal groups (gastrocnemius, anterior tibialis), and may have difficulty rising from a chair. The symptoms can be gradual, and in patients with minimal neck pain, these patients may seek medical attention very late in the course of this condition. Patients may be so disabled and weak that they require the use of a wheelchair for mobility. In some instances of severe cervical spinal stenosis, a minor trauma can cause paraplegia. This condition is called central cord syndrome (a type of spinal cord injury), and requires emergent medical attention.

Physical Findings

The physical findings for most patients with cervical spinal stenosis are limited. Patients may or may not demonstrate tenderness and spasm, but usually have decreased cervical spine range-of motion. If the spinal cord is severely compressed, there may be significant numbness (loss of sensation) in the arms or legs and some of the arm and leg muscles may be focally weak. Deep tendon reflexes may be increased. There may be clonus and spasticity in the legs. Pulses and vascularity of the legs should be normal. If not, the patient may also have concomitant vascular disease and vascular claudication.

Imaging Studies

Plain x-rays of the spine will not show spinal stenosis because an x-ray only shows bone structures, not the cartilage disc, ligaments, or spinal nerves. However, the spine x-rays may reveal that the patient has severe osteoarthritis, and this would suggest a high probability of spinal stenosis if correlative symptoms were present. A magnetic resonance imaging test (MRI) is necessary to clearly define the severity and extent of spinal stenosis and neurologic compression, and is noninvasive (no needles or dye injection). Before MRI was invented, patients were required to have a CT, myelogram, or CT-myelogram in order to confirm the diagnosis of herniated nucleus pulposus. MRI is now much easier to perform and generally provides better visualization of the stenotic lesions. However, some patients are not able to have an MRI, such as those patients with a cardiac pacemaker, and must have one of the other described imaging tests.

Laboratory Tests

There are no laboratory tests used to diagnose spinal stenosis. Occasionally, specific tests are ordered to rule out infection or other causes or neck pain, radiculopathy, and myelopathy.

Diagnosis

The condition of cervical spinal stenosis and myelopathy is not uncommon, and clinicians must be aware of its possibility when evaluating patients with neck problems. It can be complicated when the symptoms or physical findings are atypical. Some patients may only complain of neck pain without overt neurologic abnormalities. All patients with significant arthritis seen on plain x-rays should be considered for additional studies such as MRI to evaluate the extent of spinal canal compromise. It is important for the clinician to conduct a thorough history and clinical examination prior to formulating a diagnosis so as not to misdiagnosis this condition. Imaging studies (and occasionally laboratory tests) must be used to clarify the diagnosis.

Treatment Options

The treatment of cervical spinal stenosis often depends on the severity of a patient's symptoms and the severity of neurologic compression. Patients with mild or moderate stenosis may respond initially to conservative treatments. Conservative treatments may consist of oral anti-inflammatory medications and pain medications. Muscle relaxant medications should be used for severe pain and muscle spasms, and only for short duration in elderly patients. Complications secondary to medications are more common in the elderly, and all medications should be closely monitored by the prescribing physician. Physical therapy and modalities may also be utilized (with caution), primarily to improve a patient's strength, endurance, and level of function. Manipulation should not be utilized. Epidural steroid injections may provide short-term improvement of pain symptoms.
When a patient has severe spinal stenosis and myelopathy, or a patient with mild or moderate stenosis has failed conservative modalities, surgical intervention is considered. Patients with severe spinal cord compression and/or severe myelopathy with weakness are indicated for surgery. The goal of surgery is to remove the compression from the spinal cord, to improve a patient's pain and level of function, as well as prevent further deterioration of function and worsening pain. If the majority of pressure is coming from osteophytes in the front (anterior) or the spine, then an anterior corpectomy with strut graft and fusion may be considered. If the majority of the compression is occurring in the back part of the spinal cord, then a laminectomy or laminaplasty may be performed. Occasionally, patients with severe, multiple level stenosis will require both front (anterior) and back (posterior) of the neck surgery to adequately decompress and stabilize the spine. Generally, a cervical spinal fusion will always be required and recommended in addition to the decompression component. Spinal instrumentation may also be utilized to impart immediate stability and increase the fusion (bone healing and mending together) rate. There is a high rate of success for patients treated surgically, however, careful preoperative evaluation and delicate perioperative and postoperative management is particularly important to ensure success and avoid complications.

Pain-Free Travel Tips

 

For many people with back pain or neck pain, the prospect of a long trip can be daunting. The seats in cars, airplanes, buses, and trains aren’t always the most comfortable and sitting still for an extended time can in and of itself aggravate painful areas in the back and neck. The following tips are offered to help reduce or avoid overall back pain and discomfort while traveling.

Lift Luggage in Stages

Back strain often occurs near the end of one’s range of motion when lifting a heavy item. For this reason, experts recommend moving slowly when lifting a heavy piece of luggage and breaking the action into smaller parts whenever possible. For example, when lifting a bag into an overhead bin, it can first be lifted to the top of the seat, then into the bin in a separate motion. Similarly, loading a suitcase in the trunk of a car can be broken into to steps, such as lifting it first to a chair or stepstool, then lifting it into the trunk. Other important lifting tips include:

• Bend at the knees and use leg muscles rather than back muscles to lift
• Avoid twisting the low back while lifting; instead, pivot with the feet
• Carry heavy items as close to the body as possible
• Distribute weight evenly on each side of the body
• If carrying one shoulder bag, switch sides often to avoid stressing one side of the back

Bring your Own Back Support

Seats in cars, trains, planes etc. often don’t provide the right type of support for the lower back and/or neck. A lumbar support pillow can be used to make your seat more comfortable and support your lower back. If you don’t have one or forget to bring it, a jacket, sweater or blanket rolled up can also provide support for the inward curve of the low back. This is often particularly important if traveling coach class on a long flight, as many airplane seats lack low back support. In this case, an airplane pillow or blanket placed between the seat and low back can work well. An inflatable travel pillow that fits around the neck can help avoid neck strain by providing head support while resting or sleeping in a sitting position during travel.

Support Your Feet

Proper support for the low back also requires bottom-up leverage from your feet. If your feet are not placed on a firm surface while sitting, additional stress is transferred to your low back. Therefore, if your seat is too high, try to rest your feet on a footrest (or something that can act as a footrest) to keep your knees at a right angle and avoid stressing the low back. While driving, resting both feet on the floor provides more support for your lower back than if one foot is on the gas, so you may consider using cruise control for longer drives.

Pack Light

A heavy bag can be more than just an inconvenience—it can cause or aggravate back pain by straining muscles and joints. To avoid unnecessary strain, it’s best to use a light suitcase with wheels and a handle for rolling it. Even when using a suitcase with wheels, you will probably need to lift it to go up or down stairs, in and out of the car, etc. Therefore, instead of stuffing one large suitcase full, it’s often better to use a few smaller bags. For some trips, the best option is simply to avoid large luggage entirely by shipping most of what you’ll need ahead of time and carrying just one small bag on your trip.

Check Your Posture

Sitting for prolonged periods adds strain to the structures of the low back, and poor posture puts even more stress on your spine. Make sure that your back is aligned against the back of your seat in a sitting position and that your headrest is supporting the middle of your head. Keep the shoulders straight and avoid hunching forward. Make sure both feet are firmly resting on the floor or a footrest. If you are driving, adjust the seat and steering wheel to a comfortable position to avoid reaching for the wheel.

Move as Much as Possible

The spine is designed to move. Sitting in one position for extended periods of time stiffens the back muscles, which can put stress on the spine. Get up and stretch and move around frequently—every 20 to 30 minutes if possible—to move your core body muscles. Importantly, movement stimulates blood flow, and blood brings important nutrients and oxygen to the structures of the back—helping prevent soft tissues in the low back from stiffening and aching after sitting for a long time. Even 10 seconds of movement and stretching is better than sitting still. Movement also helps prevent blood clots from forming in the leg (called deep vein thrombosis), which is one of the most dangerous risks of sitting still for long periods.

More Ergonomics Info
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Back Exercises
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Stretch Your Legs and Hips

Sitting can also cause stiffness and tension in the hamstrings (the muscles in the back of the thighs) and hip flexor muscles, which can put pressure on the low back. Keep your hamstrings limber with a standing or sitting hamstring stretch. Options for stretching include:

• Standing hamstring stretch. Bend forward at the waist, keeping the legs relatively straight, and try to touch the toes. Hold this position for 30 to 45 seconds.
• Sitting hamstring stretch. Sit at the edge of a chair and straighten one leg in front of the body with the heel on the floor. Then, sit up straight and try pushing the navel towards the thigh by arching the back, without leaning the trunk of the body forwards. Hold this stretch for 30 seconds, then repeat 3 times for each leg.

Stretch your hip flexor muscles while sitting with this simple technique:

• Sit on the edge of a chair, lean forward, and put one leg behind you as far as you are able, anchoring your toe on the floor.
• Then, sit up straight, keeping your leg behind you. The stretch should be felt in the front of the hip on the side of the leg extended behind you. Hold this position for 30 seconds, then repeat with the opposite leg behind you.

Quick and Easy Pain Relief

If back pain does flare up while you’re traveling, one of the fastest ways to get relief is applying a cold pack or alternating ice and heat. When traveling, materials such as ice and hot packs are usually easily accessible and affordable. For example, you can fill any type of plastic bag with ice and apply to the painful area—such as placing a small bag of ice between your low back and the seatback while you’re driving or sitting in a plane or train. There are also disposable, portable hot packs that heat up after you open them, so you can bring them on your travels and open and apply them as needed. Commercial heat wraps are available that wrap around the middle of the body and incorporate heating units in the low back area of the band. Such types of heat wraps last for several hours, making them ideal to provide back comfort during lengthy travel. However, too much heat can add to swelling and therefore, alternating ice and heat for 10-15 minutes each, and avoiding prolonged heat is best.
The above guidelines outline several steps you can take to help lessen your chances of pain during a long trip. Awareness of common mistakes such as those mentioned above will help you to avoid aggravating your pain with improper lifting or sitting postures. Thinking ahead about ways to make yourself comfortable during travel can help to remove the stress of traveling and ultimately make your journey more pleasurable.

Ron Miller, PT

Sacroilac and neck pain

Sacroiliac
I have had Sacroiliac problems for 25 years. I would ask my Doctors when having check ups,why do my calf muscles hurt and no one knew. In 2000 while at work my legs went numb so the next day I felt like I had Been hip with a sledge hammer. I tried to work but I could hardly walk. So after X-ray nothing then MRI and nothing but DDD in 3 levels so I tried to go back to work which I was a truck driver and my legs keep going numb. 2002 a MRI showed a Herniated disc in C5-C6 so I had that fixed which made my low back hurt more. After more MRI  and injections and more injections and MRI no help. In 2008 I had L5-S1 fusion then in 2011 I had L3-L5 fusion in Jan. Today I my 2nd
Sacroiliac joint injection 25 years ago I was told I don't why your calf muscles hurt. I was told that if I had if 25 years ago if I could have had the right Doctor and got my sacroiliac joint fixed I would not have had all the spinal issues. I Pray Pray!! That this helps someone.

I have had numbness in my face and headaches  for some time after neck surgery C5-C6 in 2002 with on going neck pain, shoulder and arm pain plus hip and thigh pain. I have also had low back pain with 2 back surgeries L5-S1 andL3-L5 in 08 & 11 and sacroiliac fusion Sept 11. After seeing many doctors about my neck and many test MRI , maligram and X-rays. All the test they would tell me it did not show any thing but stenosis. After having back surgery and still there is a nagging pain that will not leave. When i had sacroiliac fusion and I had to use a walker to take stress off my hip but it put a lot of pressure on my shoulder and neck so my doctor has been talking to me about a med pump! herniated disc at t9-t10 also at t3-t4 and at t2-t3 and prominent bulge at c7-c6 also c3-c4 with nerve with myelopathy with neck pain, shoulder, hand and arm pain headaches, face numbness. My Spine surgeon Dr Harold Young MCV Spine Center called me telling what he needed to do to fix it. I laid away all worrying over this after 2 surgerys this year already when does it stop. L5-L3 fusion and sacroiliac fusion.
Still though as I remain in pain it is nothing as the horrible pain Jesus Suffered!