The consequences of the Covid pandemic seem to have passed. But this is at first glance. In reality, some lasting consequences remained, both on the physique and on the psyche of a person. One of them is the sedentary lifestyle. Not a small part of the employees who were in home office mode and today work from home. This leads to significant immobilization and a sedentary lifestyle, which has lasting negative consequences on the musculoskeletal system.
Apart from the pandemic, the problem of adolescents and their lack of movement at an age when they are forming muscles continues to be relevant on the agenda. The lack of physical activity and extremely long sitting in front of a computer makes children's joints "lambier", and this creates prerequisites for disorders of the musculoskeletal system in their later life. What are they and how can they be avoided? These and other questions are answered by Dr. Marieta Karadjova - President of the Bulgarian Society for Manual Medicine of Vertebrogenic Diseases (BSMMVZ) in a special interview for FACTS.
Dr. Karadjova, today working on a computer is the basis of many professions. Adding to this the recent pandemic caused by coronavirus, which forced people to completely change their lifestyles by working from home, how do all these changes affect the musculoskeletal system?
Maintaining one body posture (so-called static positions) for a long time is much more demanding on the body than making a great physical effort. Prolonged sitting in one posture leads to reduced blood circulation in certain areas, which in turn prematurely ages it due to reduced nutrition.
For example, the discs that connect the vertebrae are nourished by osmosis. They do not have their own blood circulation and if all the tissues around them have a weaker blood circulation, the discs are nourished less and, accordingly, all the tissues age prematurely. This also applies to muscles. The longer a muscle is not used, the more it degenerates.
With the coronavirus, there were other factors that were related to isolation – staying at home had a very negative impact on the psyche. The lack of an active lifestyle generally depresses people, and mental health problems lead to a lower pain threshold, which means that even if many people did not suffer purely morphological damage during the coronavirus, it is quite enough to lower their pain threshold due to the fact that they were harassed and confined to their homes.
Are there many people who gained weight?
Along with the pandemic, lifestyles have changed a lot. Many people stayed home to work even after the pandemic ended, i.e. the changes to some extent were not only during the pandemic, but also remain after it. In this way, even the movement they had from home to the office is eliminated.
We see that increasingly younger people are affected by diseases that 15-20 years ago appeared in people over 70 years old, and today we see them in 35, even 30 years old …
Even in 15-year-old children. Modern children do not play outside. Even when they gather in groups, they play on electronic devices. This leads to a total change in the development of their muscles. The stability of the joints is largely determined by the condition of the muscles that surround them.
What we observe is that most modern children are much more limp than their peers from previous generations. The reason is that previous generations of children, while they were growing up, had their muscles toned in a different way from outdoor games.
So muscle atrophy begins in the process of growing up?
Yes, that's right. Their bodies, when they are formed, based on poorly conditioned muscles, lead to much greater laxity in both ligaments and joint stability.
It is also important to note that the lack of regular physical activity - whether in the form of some kind of sport, morning serenity or other activities, leads to coordination problems. We are not talking about staggering, but about minimal deviations that are not visible at first glance, but accumulate over time. There is a lack of balance between individual muscle groups, between left and right, between front and back muscles of the body, as well as hunching.
The body posture itself affects the psyche. When you stand all day hunched over and closed forward, this inevitably affects the psyche and closes you, because the person is a whole and we cannot separate him by looking at individual parts of the body.
Unfortunately, over the past 50 years, medicine has been moving towards an increasingly narrow specialization - it divides the body into parts, and this is not the right approach. We have knee specialists and others. Patients come to me with a thick folder of documents and in the end there is no one to collect all the information. That is why 7 years ago I upgraded posturology - the science of posture, which originated in France 70 years ago, and in Italy - for more than 20 years. It sees the interrelationships of the parts of the body and treats it as a whole. When you have this knowledge and the patient starts his story, it is easy to connect the symptoms and complaints, to unite them with the results of research and things can be unified.
Sciatica and herniated discs are some of the most common diseases that many people suffer from, and at an increasingly younger age. What are the novelties in the treatment of these diseases?
It is currently known that the emphasis should be on activity. The recommendations to lie down for 5 days when you “catch a herniated disc“ are outdated and very wrong. The loss of muscle condition occurs very quickly and has fatal consequences. That is why belts were invented – the so-called “lumbostats“. They can relieve the load on the lower back and allow a person to move without greatly increasing the pain. Of course, manual therapy performed by a qualified specialist under strict indications and contraindications depending on imaging studies can be beneficial, along with anti-inflammatory medications. Incorporating exercises that strengthen the abdominal and back muscles as soon as possible and with gradual loading is a guarantee of faster recovery from the attack.
How does this chronic pain caused by sciatica and disc herniation affect the patient's nervous system?
When the pain lasts for a long time, over 3 months, it is considered chronic. Any untreated pain can lead to permanent changes in the peripheral and central nervous system, expressed in hypersensitivity - spontaneous pain (without being caused by irritation of pain receptors), a feeling of pain from touch, a burning, cutting nature of the pain. It is no longer an alarm for the body that serious damage is possible, but can be spontaneous - like a "shadow" in the nervous system. It is more pronounced at night, when our body is at rest and is called neuropathic. A typical pattern of this pain is trigeminal neuralgia. It is not affected by anti-inflammatory medications and requires long-term treatment - between 6 months and 1 year. The special thing about a herniated disc affecting the sensory roots is that it can appear even before 3 months of prescription.
Would you give some advice on preventing a herniated disc or any spinal pain?
It is good to do light exercises in the morning when you get up - moving your fingers, wrists, ankles, knees. The goal is for all these joints to be bathed in the joint (synovial) fluid that nourishes them. These light, balanced exercises help the body's flexibility.
People who work behind a desk must get up every 45 minutes to provoke the work of a group of muscles that are at rest while sitting, to activate blood circulation.
It is also important to do breathing exercises at least 3-4 times a day. Proper breathing by pushing the diaphragm down when inhaling, i.e. abdominal breathing, helps balance the two parts of the autonomic nervous system.
So far, little has been said about the manual diagnosis of diseases of the spine. Could you tell us a little more about it?
Manual diagnosis of the spine is what distinguishes doctors-specialists in manual medicine from all other practitioners of manual therapy. Manual manipulation “adjustment“ should be performed only where necessary – there is irritation of the pain receptors. Manual diagnosis through provocative maneuvers in the spine area, causing pain and palpation (feeling) of the tissues innervated by the corresponding level (specific muscles and skin) reveals the corresponding symptoms. Areas not affected at the time of the examination do not react with pain and do not have the corresponding symptoms – therapy should not be performed there, because it will unnecessarily reduce stability. Last year I published a monograph of almost 300 pages. on this diagnosis.
You mentioned synovial fluid. Can it only be obtained with nutritional supplements?
And movement. It is extremely important to drink enough water. In order for all processes in the body to work well, a person should drink 30 milliliters per 1 kilogram of weight per 24 hours, but not all at once, but for example 1 glass every hour and a half. This way, both the muscles and fascia will work well.
Regarding nutrition – protein food, fluids, vegetables are important. Foods with collagen, such as pheasant, for example. The more natural the foods, the better.