Search for tag: "neck"

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Scot: The podcast is called "Who Cares About Men's Health." We talk about health things here to make it seem normal, and also to educate you as well. And we're some guys that are not afraid to say we care about our health. It's cool to care about your health. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah and I also care about men's health.

Scot: No, Troy, say like you mean it. Come on. One more time, with feeling.

Troy: Scot, this is Troy. And I really care about my health and men's health. I love men's health.

Scot: Perfect. A little less sarcasm next time. And we have Dr. Chris Gee on. Go ahead. Say your thing.

Dr. Gee: How do I follow up with that, right?

Troy: You could do it a little more sincerely than I did.

Dr. Gee: Yeah, I'm Dr. Chris Gee. I'm a sports medicine physician for the University of Utah, and I care about men's health.

Scot: Today's topic: forward head posture. It's something that you see . . . do you see this a lot now? I mean, with people in their phones and their devices, looking at monitors, computer monitors, do you just walk around and go, "Oh my gosh, look at that person, look at that person, look at that person"?

Dr. Gee: For sure. Once you start thinking about it, I think we all start to adjust our posture a little bit, and I'll start talking about it to patients and notice they start to sit up more appropriately and take notice.

Scot: All right. So I'm going to make a confession. I'm going to try to keep this somewhat reasonably timed. I have this forward head posture. I think I've had it my whole life. Some other names for it, by the way . . . these are good. Have you heard other names for it, Dr. Gee?

Dr. Gee: I've heard the dowager's hump. That's one I've heard.

Scot: Yep. That's great as a guy.

Troy: Scot has a dowager's hump.

Scot: Yeah, as a guy, that's exactly what you want to hear about yourself.

Troy: Dowager. Didn't we figure dowager is like an old British lady or something like that? It's a British term for some hunched over old lady.

Scot: I think so. It's an old lady. So some other terms that they use, they call it text neck, iHunch, iPosture, nerd neck, poking chin posture, computer neck, and tech neck. I could imagine programmers looking at their monitors all day. And if your eyesight is little bad, I suppose you're probably sticking that head out just a little bit more.

Troy: I like tech neck. That's a great one.

Scot: I don't like any of them, Troy. I look at people that have the proper posture, and I'm just jealous of them all the time.

Troy: I like the term. I like the term "tech neck." I'm not asking for tech neck, but I like it.

Scot: They have that rounded hump. So I've been trying to untangle that, Dr. Gee. And I know that this is a problem that a lot of people have. So where should we start? Now, I'm going to confess, I have been doing some exercises, but I want to hear your take.

Dr. Gee: So just a little anatomy, when we look at our spines, they're not straight up and down. They actually have a normal curve. So in our lower back, it actually curves kind of with the apex of the curve towards your abdomen. In your back, your upper back, your thorax, the curve goes the opposite direction, kind of with the apex towards your back. And then our necks do the opposite. They kind of curve towards the front.

Now, what that ends up doing is when we relax our posture, when we allow our muscles to not contract, we basically start to slip or exacerbate some of those curvatures. And so our neck curves more to the front, putting our head more forward. Our back curves out, causing that hump effect.

And this is really a problem because so much of what we do logically is in front of us, and as we're focusing in on smaller items, phones, and desktops, and computers, we allow our shoulders to rotate forward, and we allow our head to move forward. And we basically lose a lot of that appropriate posture in our neck and back, and it exacerbates this and causes a lot of pain and dysfunction for people.

Scot: I mean, for me, a big part of it obviously . . . I saw a picture of myself just a couple weeks ago from the side that somebody took, and I'm just like, "Oh my God, that's terrible." I don't want to have that the rest of my life. But I also put this in the category of nagging health issues, and you can tell me . . . it sounds like you're saying the same thing. You've got a structural compromise, right? So we start making accommodations. Then, as a result, muscles stop doing the job that they're supposed to do. They atrophy or other muscles get tight, and they're not able to do the job they're supposed to do. Is that kind of what's going on there?

Dr. Gee: Exactly. If you're not using a muscle routinely, it's going to lose its strength and its control. It's not going to go away entirely. It's just not as strong. And when you look at our spines, they are surrounded with muscle. So if we tend to be looking more at something in front of us, our neck is going to pull forward, and we're going to be using the neck muscles in the front, but not in the back, and we're going to lose some of that control. And it's going to naturally go into that position where it's kind of head forward, hunched back position that none of us like to see in ourselves.

Scot: Is part of that now because when it gets worse and worse, those back neck muscles are getting weaker and weaker, so to make it better, do you just strengthen those?

Dr. Gee: Yeah. It's one thing when you . . . everybody can kind of sit up straight and bring their shoulders back. But there are some things that we should be doing to kind of keep these muscles strong. And you want to balance them. You want to think about your neck muscles maybe in the front are getting extra work. They're stronger. The muscles in the back of the neck are getting weaker.

And so you want to work on stretching those anterior muscles and strengthening the posterior muscles, or the muscles in the back, so that you effectively, if you looked at your spine kind of in cross-section or across it, you would see that the muscles that are in the front are as equally strong as in the back and they can hold position throughout the day without getting fatigued and getting into that position.

Troy: So, Chris, I'll share with you one thing, and I don't know if it's something you've tried or have used with anyone who has had this issue, but something that's helped me is a Pilates exercise. And it's called swimming, if you just Google "Pilates swimming."

So basically, you're lying flat on the ground, stomach on the ground, you lift your back legs up, and your front legs are up, and your head is back, and then you're kind of up and down alternating like you're swimming.

And I'll tell you, I've dealt with this, and have dealt with a lot of thoracic spine pain, mid-thoracic pain. I know we've talked about it before. I don't know if you've used this or recommended similar exercises or have other things you've recommended for people, but it's one thing I've tried to do that seems to help.

Dr. Gee: For sure. That's a great exercise. As we're looking at these areas, one of the other things that we'll often see is we tend to focus less on our backs and more on our anterior parts of our bodies, obviously. So, for example, in the arm, you always want to have your big biceps, right? Nobody cares as much about their triceps. And the same thing with your upper back, your thorax. You want to have a nice healthy pec muscle, but we care less about what our backs look like.

And so, because of that, we tend to have a lot more musculature there. Like you talked about in that Pilates swimming position, you're basically stretching out the anterior chest, getting those muscles kind of stretched in the pec, but at the same time, strengthening the back muscles that are going to pull your shoulder blades back, open up your chest, and get you in a better position.

So yeah, a couple of things I'll have people do is . . . you can do this in your office, or your home, or wherever. Basically, you put your hands on either side of a doorjamb and lifting your arms up to about 90 degrees and just kind of step into the doorjamb and just let that stretch your anterior chest. You'll feel kind of a pull in your in your pec muscles, your chest muscles.

You can even do it more by bringing your hands up kind of to that 90-degree position. So you bend your elbow 90 degrees with your hand up over your head, and your arm out to 90 degrees as well. And then doing that. Letting that stretch the anterior chest can be helpful.

And then working on strengthening those back muscles like Troy was talking about, there's a number of different ways you can do that. I like the swimming kind of thing. I'll have people sometimes lay down just flat on the ground, so you're on your face, and you can work on having your arms straight out to the side, and just even just lifting them up off the ground, almost like a leg lift but for your arms. You're just lifting them up off the ground. That's going to stretch the chest, strengthen the back. You can even add weights to kind of lift up some of that.

Those things can be helpful to open the chest, strengthen the back, and get you where you need to be.

Troy: This has come up before too. I've even seen just some studies that looked at just simple back exercises, essentially doing the same thing you're talking about with that motion on the ground, but just while you're sitting at your desk, just moving your shoulders back and trying to touch your scapula together behind . . . just reaching back far. And that seems to at least also give you a little bit of a stretch and maybe some strengthening in the back as well.

Dr. Gee: Exactly. So when I've had patients that are coming in and they've got a problem with this, I will basically have them set a reminder on their phone. Sometimes, it has to be every hour, sometimes a couple times a day, just their alarm goes off and they say, "Oh, yeah, I need to do my exercises."

Those are super simple where you're sitting at your desk, you just sit up a little more straight, pull your shoulder blades together, and you do that four or five times, just tightening the muscle between your shoulder blades. That'll help to kind of open that up.

And then I'll even have them do some chin translations or kind of pulling their neck back. So this might be a little weird to describe. But what people can do is you basically want to not extend your neck, so you're not tipping your head back, but you're pulling your head backwards.

So imagine if you stand up against a wall, and you push your head back against the wall, so you're kind of pushing it back there. You can do this with your hand behind your head. You can kind of push back and just work on pulling your head back, and then you push it forward to kind of stretch the muscle and pull it back and push it forward. Almost like a cobra strike. But those can be really helpful.

Troy: I was going to come up with something else. I was going to call the chicken head. It's like a chicken walk.

Dr. Gee: There you go.

Troy: That's not nearly as cool as the cobra strike, so I like your word better. Let's go with cobra strike.

Scot: If you're going to try to cure your dowager's hump, you need a really cool exercise.

Troy: Do the cobra head, the cobra strike. Exactly.

Scot: So yeah, I went into a physical therapist, and they gave me some exercises to do. But what I really like what you said that I think can help somebody as they're working through these exercises . . . because you can find I think a lot of the ones online. And if you want to have somebody work through it, then a physical therapist appointment is great.

But it's this notion of stretching and strengthening. So you're stretching one muscle and you're strengthening the opposite muscle, which, as I start doing the exercise, it took a couple weeks, but I started becoming more in touch with, "My pectoral muscles were tight," or I started coming in touch with some of my back muscles that apparently must have been tight as well.

I just really had to stick with it for a couple weeks. Now, how long is it going to take me to actually get over this?

Troy: That's a tough one, and it depends a lot on how good you are or consistent you are about doing these things. If you think about it's taken you your entire life to this point to develop that posture, it's going to take you some time, sometimes some months, to correct that posture and to get yourself into a position where you naturally just sit in that pose.

And that's where I tell people, too, sometimes they're starting off doing these exercises hourly, but sometimes it can get down to where maybe towards the end of the day, you have an alarm go off on your phone, and you go, "Oh, yeah, just check your posture. Just make sure you're doing all right," and pull yourself back up where you need to be.

Scot: I'm noticing, too, after doing the exercise, I became more aware too of my posture when I was walking, or when I was sitting, and when I'd stick my head out. I have a weird thing where I actually tip my head back. Does that make any sense?

Dr. Gee: Yeah. I mean . . .

Scot: I've got a picture of it if you want to see. But when I'm walking or sitting, instead of just having a nice straight kind of thing going on, I tip my head back. I don't know. Am I trying to support the weight by resting it on my spine or what?

Dr. Gee: Just neutralizing the size of your head maybe?

Scot: I don't know.

Troy: Your gigantic head.

Dr. Gee: Yeah. A lot of times, what I tell people is it's important to think about those things. And the fact that you have a picture and you've looked at that and said, "Hey, I'm doing this," those are very insightful.

A picture is worth a thousand words sometimes. When you see yourself sitting in a certain way, and you said, "That's my posture?" and then you realize, "Okay, I need to adjust this." And sometimes it's a different muscle group that you need to strengthen so that your posture brings back into a normal way that's not going to cause arthritis and problems down the road.

Scot: I guess what it is, is I'm constantly looking at the sky or something, as opposed to if I kind of get back into the position that these exercises have taught me that I should be in, I'm looking more straight forward or even down just a little bit.

Troy: Well, do you think you're looking back to try and compensate? Is that your way of being like, "I can't hunch over. I've got to tilt my head back"?

Scot: No. It's the way I've been carrying my body, and I don't know what started it. I don't know if it's a result of this dowager hump, and now this is just three or four steps down the chain of degradation. I don't know.

Dr. Gee: Yeah, that's interesting.

Troy: You're a medical mystery, Scot.

Scot: I am a medical mystery. True.

So as I've been doing some of these exercises and even becoming more aware of my posture and trying to get my head from that forward position back into more of a neutral position, am I going to notice some muscular tension/soreness? Is it going to get fatiguing after a while when I'm sitting the right way after I've done it wrong for so long?

Dr. Gee: That's a great point. And yes, you actually should. Like I mentioned another time, if you are working out a muscle appropriately, you're stretching it, you are kind of breaking it down a little bit, and causing it to hypertrophy and get stronger. And so if you're doing it right, you're probably going to feel a little bit of soreness in that area. It might be a little tired. I wouldn't expect it to be painful. But if you feel like, "Ah, my back is a little tired from doing this," that shows me that you're kind of doing the right thing.

Now, over the long term, as those muscles get strong and they get balanced out, you should have less pain in your back because of the fact that now everything is equal. You're not over-pulling one direction or another. And that will prevent a lot of pain down the road.

Scot: And I'm noticing it between my shoulder blades kind of gets tired after a while. Would that be one of the places?

Dr. Gee: Yes, very much so. The rhomboids are a group of muscles that sit in between your shoulder blades. And they tend to be pretty weak in most of us just because of the fact that we pull our shoulders forward, we stretch those muscles out, and they don't really get activated as much as they should.

And so, yeah, feeling a little bit of soreness in there is fine. You can always use a little heat and ice to kind of calm some of that down. But most of the time, that's a good sign that you're using the right muscles and starting to get these stronger.

Scot: What about that bump, the actual physical bony bump process, that's sticking out? Sometimes I've noticed that now starts getting kind of sore in and around there. I don't think it's the bump itself. I think it's the muscles, but . . .

Dr. Gee: Yeah, exactly. There are muscles that go right alongside the spinous processes, which are the little bumps that stick out on your neck. And they're going to get activated. Their tendons attach right on to the bone, and so as they get used, that's going to get a little sore sometimes.

And it is normal . . . I should stress to people that the C7, kind of the bottom of your neck, top of your chest naturally does stick out a little more because of the change from one angle to another within the thorax to the neck. So it's impossible to make that perfectly straight, or it shouldn't be perfectly straight.

But working on building those muscles around there will get you in a good position to offload the weight of your head and neck, and allow them to prevent degeneration and arthritis and those things.

Scot: So it seems like if somebody is suffering from this . . . I think, for me, becoming aware was the first step. And believe it or not, it was those stretches and exercises . . . it took a couple weeks. Then I started becoming even more aware as a result of those stretches and exercises, and I'll catch myself periodically throughout the day and I've got to straighten stuff out again.

So becoming aware, I'd imagine, is the first thing, and then start doing some of those stretch and strengthen exercises would be the next step. Does that sound reasonable?

Dr. Gee: Totally. Yeah, just being aware of what your posture is. And sometimes . . . well, a lot of times . . . things like this, with a podcast to just make you think of it and go, "Oh, yeah, I should improve my posture." And then you start working on doing some of those exercises. That's going to remind you when you get into a bad posture, you're going to feel it a little bit more and, "Okay, straighten things back up."

Troy: And the thing I like about this, too, Chris, it's not like you're always thinking about your posture. I think for so long, I always felt like, "Oh, I have to think about it. I have to roll my shoulders back or walk around with a book on my head to practice my posture," or something. It's more like, "Hey, let's just stretch in the right spots. Let's strengthen the right spots." And then it sounds like the posture then follows naturally as you balance out that stretching and strengthening.

Dr. Gee: Yeah, exactly. It's really one of those things that as the muscles get stronger, they're going to hold it in a better position and they're not going to let that crouch forward as often. And so, yeah, being aware, gradually increasing the strength and stability, you're going to notice that posture improve over time.

Scot: Some very good tips today. Thank you very much for helping me through this. I'll keep doing my stretches and my exercises. And thank you for caring about men's health.

Dr. Gee: Yeah, excellent. Glad to help out.

Scot: Our core four we talk about is nutrition, activity, make sure that you're mentally healthy, and get that sleep. And this falls in the mental health category.

I wanted to talk about an article I found that is titled "Five Strategies for Cultivating Hope This Year." This is from a website called The Conversation.

First of all, Troy, do you know the difference between hope and optimism? There is a difference, and I found this fascinating.

Troy: Maybe hope is more focused on a specific thing, like you're hoping for something, where optimism is more just your general outlook on life and what happens to you.

Scot: Yeah, you're pretty close. On the optimism, you got that part right. According to this article, optimism is a general expectation that good things will happen in the future. So it's about expecting good things. However, hope is defined as the tendency to see desired goals as possible.

Troy: That's interesting. It's kind of like optimism is more . . . yeah, like you said, it's more your outlook, but hope is more something that drives you to action. I like that.

Scot: And optimism, too, comes with a very dark side, which is you tend to then avoid the negative and the real sometimes, and that's not necessarily mentally healthy as well. Sometimes you do have to face that type of stuff, those roadblocks and failure, where people . . . With hope, they realize that stuff is going to happen, and they deal with it, as opposed to optimism perhaps avoiding it.

So this article, hope versus optimism, talks about then how you can cultivate hope. And the first thing you need to do is just do something. So imagine an act and start with goals. So pick something, and then decide that you're going to do it, and set some goals, set a path to help you get closer to that outcome that you want. So the first thing is just do something and start with goals.

The second thing . . . I thought this was fascinating. Nobody likes uncertainty, right? You kind of want to know what's going to happen. But number two in this article is harness the power of uncertainty. And they say that uncertainty is a reason for hope because it gives you the ability to perceive the possibility of success. It's not written in stone, "You're going to fail at this. Nobody has ever done this before." There's a chance that you might be able to achieve this. So that uncertainty actually helps feed hope.

Number three, manage your attention. They say hopeful people did not necessarily seek out emotionally positive information. However, people high on hope spend less time paying attention to emotionally sad or threatening information.

Number four, seek community. Don't go it alone. You've heard the saying "you are the five people you surround yourself with." So try to avoid negative interactions with people and connect with others who hold us accountable and remind us why our struggles matter.

And then number five, when you're trying to cultivate hope this year, according to this article in The Conversation, is to look at the evidence. So hopeful people stake their trust in data, particularly in the evidence of history. For example, the example they gave here, which I love, anti-poverty activists drew hope from knowing that historically, when people join together in resistance, they are actually able to create change.

So that is the article. That's the summary. I highly encourage you to go to theconversation.com and read "Five Strategies for Cultivating Hope This Year." But it's been a year where I think all of us could use a little bit of hope. And I think also that differentiation between Are you an optimistic person? I want to strive to be an optimistic person," it might not be bad, but I think striving to be a hopeful person is better.

"Just Going To Lave This Here." It might have something to do with health or it might be something completely random. Troy, go ahead and start for us.

Troy: Scot, I'm just going to leave this here. I was thinking recently about one of my teachers, one of my attending physicians in med school. This guy's name is Tyler Cymet. Great teacher. Great guy. But he seemed like he definitely wanted something named after him in medicine. You hear these different things, and they're named after different physicians or different researchers.

So he had named something on his hand after him. He called it the Cymet bump. And it's on your ring finger. It's the place where your pencil rests. I guess if you rest your pencil or pen on your ring finger, the bump you get there. He submitted it to a medical journal, and they rejected it. I looked him up recently, and I found out he finally had something named after him. It was some rare syndrome that's on his Wikipedia page.

So following in Dr. Cymet's footsteps, I have found something I am going to name after myself, and I discovered this on myself recently. It's on my thumb. It's on my right thumb. I don't know if you experience this as well. Maybe this is a phenomenon more unique to Utah where we have very dry weather and cold dry winters. But on my thumb, on the middle part of my thumb right next to my thumbnail, it's where I tap my phone as I'm typing with my right hand or tapping on my phone, I've got what I'm now going to call the Madsen fissure. It's a crack on my thumb, next to my thumbnail.

I probably need to really do more of a survey here to find out if other people have the Madsen fissure. But if so, I'm going to submit this to a medical journal, the Madsen fissure. Just keep your eyes out for it.

Scot: So the definition would be the crack in the skin that occurs from living in a cold, dry, arid climate when you use your cell phone?

Troy: Yes. Essentially, yes. So I will go down in history as having a crack named after me.

Scot: Oh, wow. I'm so proud.

Troy: You should be.

Scot: Just going to leave this here. I found kind of a new squat form thing that you could try. It's called a dumbbell drop squat, although I use a kettlebell. You take the dumbbell or the kettlebell, and you put both hands on it, and hold it between your legs. So you're standing up straight. I guess you kind of hold it straight in front of you. You're standing up straight, and you hold it next to your body right in front of you, so it's right in front of your hips, I guess. And then you just squat straight down so it goes down in a straight line.

And what I like about that is . . . I've done traditional barbell squats, that sort of thing. This squat kind of forces you to be in a little bit better form, so you can kind of learn your form. So if you've struggled with your squat form before, this is a good way to kind of do this exercise to get what it should feel like. It's kind of tough, because you end up staying in a little bit more of an upright position.

But anyway, I thought that was cool. You could Google it if you want to, a dumbbell drop squat. But perhaps something new to add to your exercise regimen, especially if you don't feel a lot of confidence about doing back barbell squats and eventually you want to get to the point where you can.

Troy: That's a kettlebell squat then.

Scot: Well, the way I saw it, it used a dumbbell, but I used a kettlebell because that's what I have.

Troy: So either way, it works.

Scot: Yeah, you could do it either way. Exactly.

Troy: Okay, nice. I have not done that. I'll have to check it out.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. Leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

This is a transcript for the main segment of the show. You can read it if you like, but we encourage you to subscribe and listen for the full experience. It's more fun that way.

Scot: The podcast is called "Who Cares About Men's Health." We talk about health things here to make it seem normal, and also to educate you as well. And we're some guys that are not afraid to say we care about our health. It's cool to care about your health. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah and I also care about men's health.

Scot: No, Troy, say like you mean it. Come on. One more time, with feeling.

Troy: Scot, this is Troy. And I really care about my health and men's health. I love men's health.

Scot: Perfect. A little less sarcasm next time. And we have Dr. Chris Gee on. Go ahead. Say your thing.

Dr. Gee: How do I follow up with that, right?

Troy: You could do it a little more sincerely than I did.

Dr. Gee: Yeah, I'm Dr. Chris Gee. I'm a sports medicine physician for the University of Utah, and I care about men's health.

Scot: Today's topic: forward head posture. It's something that you see . . . do you see this a lot now? I mean, with people in their phones and their devices, looking at monitors, computer monitors, do you just walk around and go, "Oh my gosh, look at that person, look at that person, look at that person"?

Dr. Gee: For sure. Once you start thinking about it, I think we all start to adjust our posture a little bit, and I'll start talking about it to patients and notice they start to sit up more appropriately and take notice.

Scot: All right. So I'm going to make a confession. I'm going to try to keep this somewhat reasonably timed. I have this forward head posture. I think I've had it my whole life. Some other names for it, by the way . . . these are good. Have you heard other names for it, Dr. Gee?

Dr. Gee: I've heard the dowager's hump. That's one I've heard.

Scot: Yep. That's great as a guy.

Troy: Scot has a dowager's hump.

Scot: Yeah, as a guy, that's exactly what you want to hear about yourself.

Troy: Dowager. Didn't we figure dowager is like an old British lady or something like that? It's a British term for some hunched over old lady.

Scot: I think so. It's an old lady. So some other terms that they use, they call it text neck, iHunch, iPosture, nerd neck, poking chin posture, computer neck, and tech neck. I could imagine programmers looking at their monitors all day. And if your eyesight is little bad, I suppose you're probably sticking that head out just a little bit more.

Troy: I like tech neck. That's a great one.

Scot: I don't like any of them, Troy. I look at people that have the proper posture, and I'm just jealous of them all the time.

Troy: I like the term. I like the term "tech neck." I'm not asking for tech neck, but I like it.

Scot: They have that rounded hump. So I've been trying to untangle that, Dr. Gee. And I know that this is a problem that a lot of people have. So where should we start? Now, I'm going to confess, I have been doing some exercises, but I want to hear your take.

Dr. Gee: So just a little anatomy, when we look at our spines, they're not straight up and down. They actually have a normal curve. So in our lower back, it actually curves kind of with the apex of the curve towards your abdomen. In your back, your upper back, your thorax, the curve goes the opposite direction, kind of with the apex towards your back. And then our necks do the opposite. They kind of curve towards the front.

Now, what that ends up doing is when we relax our posture, when we allow our muscles to not contract, we basically start to slip or exacerbate some of those curvatures. And so our neck curves more to the front, putting our head more forward. Our back curves out, causing that hump effect.

And this is really a problem because so much of what we do logically is in front of us, and as we're focusing in on smaller items, phones, and desktops, and computers, we allow our shoulders to rotate forward, and we allow our head to move forward. And we basically lose a lot of that appropriate posture in our neck and back, and it exacerbates this and causes a lot of pain and dysfunction for people.

Scot: I mean, for me, a big part of it obviously . . . I saw a picture of myself just a couple weeks ago from the side that somebody took, and I'm just like, "Oh my God, that's terrible." I don't want to have that the rest of my life. But I also put this in the category of nagging health issues, and you can tell me . . . it sounds like you're saying the same thing. You've got a structural compromise, right? So we start making accommodations. Then, as a result, muscles stop doing the job that they're supposed to do. They atrophy or other muscles get tight, and they're not able to do the job they're supposed to do. Is that kind of what's going on there?

Dr. Gee: Exactly. If you're not using a muscle routinely, it's going to lose its strength and its control. It's not going to go away entirely. It's just not as strong. And when you look at our spines, they are surrounded with muscle. So if we tend to be looking more at something in front of us, our neck is going to pull forward, and we're going to be using the neck muscles in the front, but not in the back, and we're going to lose some of that control. And it's going to naturally go into that position where it's kind of head forward, hunched back position that none of us like to see in ourselves.

Scot: Is part of that now because when it gets worse and worse, those back neck muscles are getting weaker and weaker, so to make it better, do you just strengthen those?

Dr. Gee: Yeah. It's one thing when you . . . everybody can kind of sit up straight and bring their shoulders back. But there are some things that we should be doing to kind of keep these muscles strong. And you want to balance them. You want to think about your neck muscles maybe in the front are getting extra work. They're stronger. The muscles in the back of the neck are getting weaker.

And so you want to work on stretching those anterior muscles and strengthening the posterior muscles, or the muscles in the back, so that you effectively, if you looked at your spine kind of in cross-section or across it, you would see that the muscles that are in the front are as equally strong as in the back and they can hold position throughout the day without getting fatigued and getting into that position.

Troy: So, Chris, I'll share with you one thing, and I don't know if it's something you've tried or have used with anyone who has had this issue, but something that's helped me is a Pilates exercise. And it's called swimming, if you just Google "Pilates swimming."

So basically, you're lying flat on the ground, stomach on the ground, you lift your back legs up, and your front legs are up, and your head is back, and then you're kind of up and down alternating like you're swimming.

And I'll tell you, I've dealt with this, and have dealt with a lot of thoracic spine pain, mid-thoracic pain. I know we've talked about it before. I don't know if you've used this or recommended similar exercises or have other things you've recommended for people, but it's one thing I've tried to do that seems to help.

Dr. Gee: For sure. That's a great exercise. As we're looking at these areas, one of the other things that we'll often see is we tend to focus less on our backs and more on our anterior parts of our bodies, obviously. So, for example, in the arm, you always want to have your big biceps, right? Nobody cares as much about their triceps. And the same thing with your upper back, your thorax. You want to have a nice healthy pec muscle, but we care less about what our backs look like.

And so, because of that, we tend to have a lot more musculature there. Like you talked about in that Pilates swimming position, you're basically stretching out the anterior chest, getting those muscles kind of stretched in the pec, but at the same time, strengthening the back muscles that are going to pull your shoulder blades back, open up your chest, and get you in a better position.

So yeah, a couple of things I'll have people do is . . . you can do this in your office, or your home, or wherever. Basically, you put your hands on either side of a doorjamb and lifting your arms up to about 90 degrees and just kind of step into the doorjamb and just let that stretch your anterior chest. You'll feel kind of a pull in your in your pec muscles, your chest muscles.

You can even do it more by bringing your hands up kind of to that 90-degree position. So you bend your elbow 90 degrees with your hand up over your head, and your arm out to 90 degrees as well. And then doing that. Letting that stretch the anterior chest can be helpful.

And then working on strengthening those back muscles like Troy was talking about, there's a number of different ways you can do that. I like the swimming kind of thing. I'll have people sometimes lay down just flat on the ground, so you're on your face, and you can work on having your arms straight out to the side, and just even just lifting them up off the ground, almost like a leg lift but for your arms. You're just lifting them up off the ground. That's going to stretch the chest, strengthen the back. You can even add weights to kind of lift up some of that.

Those things can be helpful to open the chest, strengthen the back, and get you where you need to be.

Troy: This has come up before too. I've even seen just some studies that looked at just simple back exercises, essentially doing the same thing you're talking about with that motion on the ground, but just while you're sitting at your desk, just moving your shoulders back and trying to touch your scapula together behind . . . just reaching back far. And that seems to at least also give you a little bit of a stretch and maybe some strengthening in the back as well.

Dr. Gee: Exactly. So when I've had patients that are coming in and they've got a problem with this, I will basically have them set a reminder on their phone. Sometimes, it has to be every hour, sometimes a couple times a day, just their alarm goes off and they say, "Oh, yeah, I need to do my exercises."

Those are super simple where you're sitting at your desk, you just sit up a little more straight, pull your shoulder blades together, and you do that four or five times, just tightening the muscle between your shoulder blades. That'll help to kind of open that up.

And then I'll even have them do some chin translations or kind of pulling their neck back. So this might be a little weird to describe. But what people can do is you basically want to not extend your neck, so you're not tipping your head back, but you're pulling your head backwards.

So imagine if you stand up against a wall, and you push your head back against the wall, so you're kind of pushing it back there. You can do this with your hand behind your head. You can kind of push back and just work on pulling your head back, and then you push it forward to kind of stretch the muscle and pull it back and push it forward. Almost like a cobra strike. But those can be really helpful.

Troy: I was going to come up with something else. I was going to call the chicken head. It's like a chicken walk.

Dr. Gee: There you go.

Troy: That's not nearly as cool as the cobra strike, so I like your word better. Let's go with cobra strike.

Scot: If you're going to try to cure your dowager's hump, you need a really cool exercise.

Troy: Do the cobra head, the cobra strike. Exactly.

Scot: So yeah, I went into a physical therapist, and they gave me some exercises to do. But what I really like what you said that I think can help somebody as they're working through these exercises . . . because you can find I think a lot of the ones online. And if you want to have somebody work through it, then a physical therapist appointment is great.

But it's this notion of stretching and strengthening. So you're stretching one muscle and you're strengthening the opposite muscle, which, as I start doing the exercise, it took a couple weeks, but I started becoming more in touch with, "My pectoral muscles were tight," or I started coming in touch with some of my back muscles that apparently must have been tight as well.

I just really had to stick with it for a couple weeks. Now, how long is it going to take me to actually get over this?

Troy: That's a tough one, and it depends a lot on how good you are or consistent you are about doing these things. If you think about it's taken you your entire life to this point to develop that posture, it's going to take you some time, sometimes some months, to correct that posture and to get yourself into a position where you naturally just sit in that pose.

And that's where I tell people, too, sometimes they're starting off doing these exercises hourly, but sometimes it can get down to where maybe towards the end of the day, you have an alarm go off on your phone, and you go, "Oh, yeah, just check your posture. Just make sure you're doing all right," and pull yourself back up where you need to be.

Scot: I'm noticing, too, after doing the exercise, I became more aware too of my posture when I was walking, or when I was sitting, and when I'd stick my head out. I have a weird thing where I actually tip my head back. Does that make any sense?

Dr. Gee: Yeah. I mean . . .

Scot: I've got a picture of it if you want to see. But when I'm walking or sitting, instead of just having a nice straight kind of thing going on, I tip my head back. I don't know. Am I trying to support the weight by resting it on my spine or what?

Dr. Gee: Just neutralizing the size of your head maybe?

Scot: I don't know.

Troy: Your gigantic head.

Dr. Gee: Yeah. A lot of times, what I tell people is it's important to think about those things. And the fact that you have a picture and you've looked at that and said, "Hey, I'm doing this," those are very insightful.

A picture is worth a thousand words sometimes. When you see yourself sitting in a certain way, and you said, "That's my posture?" and then you realize, "Okay, I need to adjust this." And sometimes it's a different muscle group that you need to strengthen so that your posture brings back into a normal way that's not going to cause arthritis and problems down the road.

Scot: I guess what it is, is I'm constantly looking at the sky or something, as opposed to if I kind of get back into the position that these exercises have taught me that I should be in, I'm looking more straight forward or even down just a little bit.

Troy: Well, do you think you're looking back to try and compensate? Is that your way of being like, "I can't hunch over. I've got to tilt my head back"?

Scot: No. It's the way I've been carrying my body, and I don't know what started it. I don't know if it's a result of this dowager hump, and now this is just three or four steps down the chain of degradation. I don't know.

Dr. Gee: Yeah, that's interesting.

Troy: You're a medical mystery, Scot.

Scot: I am a medical mystery. True.

So as I've been doing some of these exercises and even becoming more aware of my posture and trying to get my head from that forward position back into more of a neutral position, am I going to notice some muscular tension/soreness? Is it going to get fatiguing after a while when I'm sitting the right way after I've done it wrong for so long?

Dr. Gee: That's a great point. And yes, you actually should. Like I mentioned another time, if you are working out a muscle appropriately, you're stretching it, you are kind of breaking it down a little bit, and causing it to hypertrophy and get stronger. And so if you're doing it right, you're probably going to feel a little bit of soreness in that area. It might be a little tired. I wouldn't expect it to be painful. But if you feel like, "Ah, my back is a little tired from doing this," that shows me that you're kind of doing the right thing.

Now, over the long term, as those muscles get strong and they get balanced out, you should have less pain in your back because of the fact that now everything is equal. You're not over-pulling one direction or another. And that will prevent a lot of pain down the road.

Scot: And I'm noticing it between my shoulder blades kind of gets tired after a while. Would that be one of the places?

Dr. Gee: Yes, very much so. The rhomboids are a group of muscles that sit in between your shoulder blades. And they tend to be pretty weak in most of us just because of the fact that we pull our shoulders forward, we stretch those muscles out, and they don't really get activated as much as they should.

And so, yeah, feeling a little bit of soreness in there is fine. You can always use a little heat and ice to kind of calm some of that down. But most of the time, that's a good sign that you're using the right muscles and starting to get these stronger.

Scot: What about that bump, the actual physical bony bump process, that's sticking out? Sometimes I've noticed that now starts getting kind of sore in and around there. I don't think it's the bump itself. I think it's the muscles, but . . .

Dr. Gee: Yeah, exactly. There are muscles that go right alongside the spinous processes, which are the little bumps that stick out on your neck. And they're going to get activated. Their tendons attach right on to the bone, and so as they get used, that's going to get a little sore sometimes.

And it is normal . . . I should stress to people that the C7, kind of the bottom of your neck, top of your chest naturally does stick out a little more because of the change from one angle to another within the thorax to the neck. So it's impossible to make that perfectly straight, or it shouldn't be perfectly straight.

But working on building those muscles around there will get you in a good position to offload the weight of your head and neck, and allow them to prevent degeneration and arthritis and those things.

Scot: So it seems like if somebody is suffering from this . . . I think, for me, becoming aware was the first step. And believe it or not, it was those stretches and exercises . . . it took a couple weeks. Then I started becoming even more aware as a result of those stretches and exercises, and I'll catch myself periodically throughout the day and I've got to straighten stuff out again.

So becoming aware, I'd imagine, is the first thing, and then start doing some of those stretch and strengthen exercises would be the next step. Does that sound reasonable?

Dr. Gee: Totally. Yeah, just being aware of what your posture is. And sometimes . . . well, a lot of times . . . things like this, with a podcast to just make you think of it and go, "Oh, yeah, I should improve my posture." And then you start working on doing some of those exercises. That's going to remind you when you get into a bad posture, you're going to feel it a little bit more and, "Okay, straighten things back up."

Troy: And the thing I like about this, too, Chris, it's not like you're always thinking about your posture. I think for so long, I always felt like, "Oh, I have to think about it. I have to roll my shoulders back or walk around with a book on my head to practice my posture," or something. It's more like, "Hey, let's just stretch in the right spots. Let's strengthen the right spots." And then it sounds like the posture then follows naturally as you balance out that stretching and strengthening.

Dr. Gee: Yeah, exactly. It's really one of those things that as the muscles get stronger, they're going to hold it in a better position and they're not going to let that crouch forward as often. And so, yeah, being aware, gradually increasing the strength and stability, you're going to notice that posture improve over time.

Scot: Some very good tips today. Thank you very much for helping me through this. I'll keep doing my stretches and my exercises. And thank you for caring about men's health.

Dr. Gee: Yeah, excellent. Glad to help out.

Scot: Our core four we talk about is nutrition, activity, make sure that you're mentally healthy, and get that sleep. And this falls in the mental health category.

I wanted to talk about an article I found that is titled "Five Strategies for Cultivating Hope This Year." This is from a website called The Conversation.

First of all, Troy, do you know the difference between hope and optimism? There is a difference, and I found this fascinating.

Troy: Maybe hope is more focused on a specific thing, like you're hoping for something, where optimism is more just your general outlook on life and what happens to you.

Scot: Yeah, you're pretty close. On the optimism, you got that part right. According to this article, optimism is a general expectation that good things will happen in the future. So it's about expecting good things. However, hope is defined as the tendency to see desired goals as possible.

Troy: That's interesting. It's kind of like optimism is more . . . yeah, like you said, it's more your outlook, but hope is more something that drives you to action. I like that.

Scot: And optimism, too, comes with a very dark side, which is you tend to then avoid the negative and the real sometimes, and that's not necessarily mentally healthy as well. Sometimes you do have to face that type of stuff, those roadblocks and failure, where people . . . With hope, they realize that stuff is going to happen, and they deal with it, as opposed to optimism perhaps avoiding it.

So this article, hope versus optimism, talks about then how you can cultivate hope. And the first thing you need to do is just do something. So imagine an act and start with goals. So pick something, and then decide that you're going to do it, and set some goals, set a path to help you get closer to that outcome that you want. So the first thing is just do something and start with goals.

The second thing . . . I thought this was fascinating. Nobody likes uncertainty, right? You kind of want to know what's going to happen. But number two in this article is harness the power of uncertainty. And they say that uncertainty is a reason for hope because it gives you the ability to perceive the possibility of success. It's not written in stone, "You're going to fail at this. Nobody has ever done this before." There's a chance that you might be able to achieve this. So that uncertainty actually helps feed hope.

Number three, manage your attention. They say hopeful people did not necessarily seek out emotionally positive information. However, people high on hope spend less time paying attention to emotionally sad or threatening information.

Number four, seek community. Don't go it alone. You've heard the saying "you are the five people you surround yourself with." So try to avoid negative interactions with people and connect with others who hold us accountable and remind us why our struggles matter.

And then number five, when you're trying to cultivate hope this year, according to this article in The Conversation, is to look at the evidence. So hopeful people stake their trust in data, particularly in the evidence of history. For example, the example they gave here, which I love, anti-poverty activists drew hope from knowing that historically, when people join together in resistance, they are actually able to create change.

So that is the article. That's the summary. I highly encourage you to go to theconversation.com and read "Five Strategies for Cultivating Hope This Year." But it's been a year where I think all of us could use a little bit of hope. And I think also that differentiation between Are you an optimistic person? I want to strive to be an optimistic person," it might not be bad, but I think striving to be a hopeful person is better.

"Just Going To Lave This Here." It might have something to do with health or it might be something completely random. Troy, go ahead and start for us.

Troy: Scot, I'm just going to leave this here. I was thinking recently about one of my teachers, one of my attending physicians in med school. This guy's name is Tyler Cymet. Great teacher. Great guy. But he seemed like he definitely wanted something named after him in medicine. You hear these different things, and they're named after different physicians or different researchers.

So he had named something on his hand after him. He called it the Cymet bump. And it's on your ring finger. It's the place where your pencil rests. I guess if you rest your pencil or pen on your ring finger, the bump you get there. He submitted it to a medical journal, and they rejected it. I looked him up recently, and I found out he finally had something named after him. It was some rare syndrome that's on his Wikipedia page.

So following in Dr. Cymet's footsteps, I have found something I am going to name after myself, and I discovered this on myself recently. It's on my thumb. It's on my right thumb. I don't know if you experience this as well. Maybe this is a phenomenon more unique to Utah where we have very dry weather and cold dry winters. But on my thumb, on the middle part of my thumb right next to my thumbnail, it's where I tap my phone as I'm typing with my right hand or tapping on my phone, I've got what I'm now going to call the Madsen fissure. It's a crack on my thumb, next to my thumbnail.

I probably need to really do more of a survey here to find out if other people have the Madsen fissure. But if so, I'm going to submit this to a medical journal, the Madsen fissure. Just keep your eyes out for it.

Scot: So the definition would be the crack in the skin that occurs from living in a cold, dry, arid climate when you use your cell phone?

Troy: Yes. Essentially, yes. So I will go down in history as having a crack named after me.

Scot: Oh, wow. I'm so proud.

Troy: You should be.

Scot: Just going to leave this here. I found kind of a new squat form thing that you could try. It's called a dumbbell drop squat, although I use a kettlebell. You take the dumbbell or the kettlebell, and you put both hands on it, and hold it between your legs. So you're standing up straight. I guess you kind of hold it straight in front of you. You're standing up straight, and you hold it next to your body right in front of you, so it's right in front of your hips, I guess. And then you just squat straight down so it goes down in a straight line.

And what I like about that is . . . I've done traditional barbell squats, that sort of thing. This squat kind of forces you to be in a little bit better form, so you can kind of learn your form. So if you've struggled with your squat form before, this is a good way to kind of do this exercise to get what it should feel like. It's kind of tough, because you end up staying in a little bit more of an upright position.

But anyway, I thought that was cool. You could Google it if you want to, a dumbbell drop squat. But perhaps something new to add to your exercise regimen, especially if you don't feel a lot of confidence about doing back barbell squats and eventually you want to get to the point where you can.

Troy: That's a kettlebell squat then.

Scot: Well, the way I saw it, it used a dumbbell, but I used a kettlebell because that's what I have.

Troy: So either way, it works.

Scot: Yeah, you could do it either way. Exactly.

Troy: Okay, nice. I have not done that. I'll have to check it out.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. Leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

Interviewer: You have this feeling like you have to constantly clear your throat. Dr. Katherine Kendall's a laryngologist. What's going on?

Dr. Kendall: That sensation usually starts from an irritation in the larynx from a cold or a cough, or another exposure. The feeling goes on after the original problem has resolved, and it's like scratching a mosquito bite. The more you scratch it, the more it itches. So I generally recommend that patients try to stop throat clearing.

Interviewer: So, generally, it's not caused by anything other than just a habit. So what do you do?

Dr. Kendall: I recommend substituting the response with a throat clear with something other than a throat clear, such as a hard swallow, a sip of water, chewing gum, or even snapping a rubber band on the wrist.

Interviewer: And how long until I see some results?

Dr. Kendall: Three months should do it. If not, an individual should seek care from a laryngologist.

updated: June 4, 2021
originally published: February 6, 2019

Dr. Miller: Is it time to see a spine surgeon for your back and neck pain? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope

Dr. Miller: Hi, I'm Dr. Tom Miller and I am here with Dr. Erica Bisson and she is a neurosurgeon in the Department of Neurosurgery here at the University of Utah. Erica, tell me a little bit about when it might be the right time for a person with neck or back pain to see a spine surgeon?

Dr. Bisson: What I tell most of my patients is that getting neck or back pain is a very common entity. A lot of people go out and do a lot of yard work or do excessive sporting activities wake up the next morning and feel like they have, what's considered a 'crick in the neck' or have a low backache.

Again, most of that is muscular in nature. It can be muscle spasm or some inflammation. Most of that is treated with what we consider conservative measures. This means things like anti-inflammatory, some Motrin, some Aleve, exercise or rest. Everybody is a little bit different which is better. We tend to tell people not to do strict bed rest because that's counterproductive in getting the muscles to move. Then also you can do things like heat and ice, which also help.

Dr. Miller: Now, what percent of patients actually get better with those conservative treatments?

Dr. Bisson: I would tell you about 90-plus percent patients get better with just those things alone.

Dr. Miller: In a week? Two weeks? A month?

Dr. Bisson: Most patients get better within a few days, but it's not unreasonable to think that it may take up to two to four weeks to see improvement with those conservative things.

Dr. Miller: So I would think that many of these patients would be best served by seeing their primary care physician or someone like a physical therapist who could help them work through some of the pain issues.

Dr. Bisson: Absolutely. In fact, that's what we would recommend is first maybe try some of these things at home on your own and then if it's not getting better go see your primary care because they can often help with some of the advanced treatments, again, not surgical, like physical therapy.

Dr. Miller: So for our listeners, should they also have the time they present with their neck or back pain, a study like an MRI that actually looks at their neck? Or a CT scan? What's your thought on that?

Dr. Bisson: Actually, an MRI, a CT scan and even simple X-rays are not indicated in somebody who simply has neck or back pain that we think is muscular in nature. Now, it's very important that when somebody sees their primary care and talks about these issues, that they be asked questions about any neurologic dysfunction, which we think of as maybe some numbness and tingling in the arms or legs or pain going down the arms and legs, bowel and bladder dysfunction. These are things that we consider red or yellow flags, or reasons that we would want to get imaging studies.

Dr. Miller: So bladder dysfunction would be the inability to urinate, I'm assuming. Is that what you mean?

Dr. Bisson: It is what I mean. We can have also urinary retention, which means you can't empty your bladder properly.

Dr. Miller: That would indicate a fairly serious back problem.

Dr. Bisson: Yes, it would.

Dr. Miller: Of the patients that end up seeing you, what percentage of those patients actually has surgery?

Dr. Bisson: Believe it or not, even as a surgeon, only about 10-15% of the patients that I see in my office go and end up having surgery.

Dr. Miller: So a great take-home message is that much of back pain, neck pain, can be cured with conservative measures. That's what we should focus on.

Dr. Bisson: Absolutely. In fact, I tell my patients even if they come to me with a problem that can be fixed with surgery, I still always try the maximum medical management. Meaning, all of the things I talked about, anti-inflammatories, physical therapy, maybe even some injections because I know that a good deal of those will get better without surgery. Even if I could do surgery, I tell my patients, "I'd rather you take credit for it than me take credit for it."

Dr. Miller: That's perfect. So basically, the majority of people with back and neck pain will get better in time. There are some worrisome signs and symptoms that relate to muscle weakness or numbness. Those folks should be seen rather urgently and imaging is unnecessary unless you have some of those very specific findings.

Dr. Bisson: Absolutely.

Dr. Miller: Thanks very much, Erica.

Announcer: thescoperadio.com is University of Utah's Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com

Dr. Miller: CSM. What is that? We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. Erica Bisson. She's a neurosurgeon and also specializes in spine surgery. What is CSM?

Dr. Bisson: CSM actually stands for Cervical Spondylotic Myelopathy, which is a lot of words, but let me just break it down. What it means is that your spinal cord is being pinched in your neck. When I say pinched, the canal is being narrowed and that causes spinal cord dysfunction. Essentially, the messages that are coming from your brain and going out to your arms and legs aren't getting there in a timely fashion.

Dr. Miller: Now, who gets that?

Dr. Bisson: So the average age for patients who have CSM is in the 50s and 60s. We do see older individuals as well, but this is a degenerative process. This is something that happens as we age.

Dr. Miller: Now, do you go in surgically and open the space around the spinal column in order to create room for it to operate and function?

Dr. Bisson: That's exactly what we do. So when we approach this surgically, our main goal is to give the spinal cord room to move. If you look at an MRI or an image of an individual who has CSM, often you see bone spurs and other abnormalities that are causing the narrowing of the spinal canal so we have to either remove the bone spurs or open up the bone in some way, shape or fashion to enlarge that spinal canal so that the spinal cord itself gets completely surrounded by fluid and has a cushion enabling it to move properly.

Dr. Miller: If a patient has spinal cord dysfunction or CSM as you've called it, what are the symptoms that they might have? How would they know if they have this particular problem?

Dr. Bisson: Well, I'll tell you, the symptoms can be a little bit vague. Having said that, there are specific questions that I tend to ask patients to try to better understand if they're having symptoms from spinal cord dysfunction. Things that we talk about are problems with balance, so patients often have balance difficulty, their walking doesn't feel quite right. The other thing that patients mostly complain of is dropping things or loss of hand strength. They also complain of loss of dexterity. You know, it's funny, some of my patients tell me, "I feel like I'm telling my hands to do something, but they're not just quite doing it." Other patients tell me, "You know, I go to pick up my pen or I go to pick up my change of the counter and it slips out because I'm not quite able to tell what I'm picking up. I'm not feeling or sensing it."

Dr. Miller: Sensation in their fingertips. But isn't that also a problem of aging? Don't we get a little bit of that with aging? How do you tell it apart?

Dr. Bisson: Great question. You absolutely . . . so all those things, balance, loss of hand strength can be a problem with aging. What I'll comment is that I often have people who come in and have an MRI and I'm trying to differentiate them. You know, nationally and internationally, we're trying to find some kind of measure or test where we can say, "Ooh. That's CSM for sure." We don't have that yet. People are inventing all sorts of tests and new techniques to try to understand that, but it's the constellation of symptoms together.

They also, patients, find that they, if you examine them their reflexes are a little brisk. That's something we call Upper Motor Neuron Disease. Or that they're having spinal cord problems so we see this thing called hyperreflexia or abnormal reflexes where their knee jerks or their arm jerks a little bit too much, relative to normal.

Dr. Miller: If you do reparative surgery on these patients, what's the chance of recovery from the symptoms that they have?

Dr. Bisson: Tom, that is a fantastic question. And historically, if you review all the literature, which I have done time and time again on this topic, we have always told patients that the ultimate goal of the surgery is to halt the progression of the disease. The natural history of this disease process is that patients will get worse over time. So when we intervene, we open up that spinal canal and give room with a hope that we stopped them from getting worse, not that we're going to improve . . .

Dr. Miller: . . . what's happened already.

Dr. Bisson: Exactly.

Dr. Miller: But there's a good chance the progression would cease.

Dr. Bisson: Yes, absolutely. And what I will also tell you is anecdotally, after having seen many, many patients through this, over the last many years that I've focused my career around this, I do notice improvement. And I constantly am amazed at the recovery that I see. So while I tell every single patient going into surgery, "My goal is to stop the progression," anecdotally I see improvement. And I see vast improvement, which is so encouraging for me.

Dr. Miller: Now, there are different approaches as I understand, we talked about this a little bit before. I mean do you tell patients that there is a best way to perform the surgery? Is that something that you talked to them about? Or do we even know that?

Dr. Bisson: That's a great question. I would tell you that in some patients there is an optimal way. When we approach the neck for spinal surgery, we can either come in through the front of the neck or from the back of the neck and each has its pluses and minuses. There are some patients that only can have surgery from the front because different issues with their neck, the alignment or how the neck is curved and there are some patients who are most appropriate for the back. The vast majority or a good majority of patients can actually do either way, front or back. That happens to be a question that PCORI, which is the Patient-Centered Outcomes Research Institute set up by the government and through the ACA funded a large study that we here at the University of Utah are participating in, looking at the answer to that exact question.

Dr. Miller: So this may tell us in the end whether one approach or the other, back or front is best?

Dr. Bisson: Absolutely and we're very much looking forward to that.

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Interviewer: Your doctor told you that you have a type of head and neck cancer that was caused by the HPV virus. Now what? We're going to talk about that next on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: You've been told by your doctor that you have a type of cancer that was caused by the HPV virus and it's in your head and your neck. We're going to talk about an HPV head and neck cancer right now with Dr. Marcus Monroe. He's a head and neck cancer expert in the University of Utah Health Care. Let's just start with the basic. First of all, head neck cancer caused by HPV, tell me about it? What's happened?

Dr. Monroe: So HPV is Human Papilloma Virus and it actually causes a very specific subset of head to neck cancers. Cancers in the region of the head and neck that we call the oropharynx, which includes the tonsils and the base of the tongue so the part of the tongue that's behind what you can actually see in your mouth.

The important things for a patient that has been newly diagnosed are, one, to seek out a medical team that has experience in treating head and neck cancers. Probably more than any other cancer, the treatment of head and neck cancer's really a team sport. Typically treatments can include surgery, radiation, chemotherapy and so having physicians with expertise in radiation oncology, medical oncology as well as surgical oncology are very important. It's important to seek out a team that works well together.

In addition because the head and neck, you can think of the tonsils and the back part of your throat if you've ever had a sore throat just the pain and the difficulty of getting through that infection. Treatments in the area can be particularly rough and so it's really important not only to have the physicians but to have the entire support team. And so that includes dentists, swallowing and language therapists, nutritionists, physical therapists, and really a complete support group.

Interviewer: How bad can it get? I would imagine most people are concerned, "Is this going to kill me?"

Dr. Monroe: So the good news for HPV or oropharynx cancer is that when we look at that in comparison to other types of head and neck cancers, typically cancers that are caused by tobacco and alcohol use, the overall survival is better. In fact, if we look at for cancer specifically of the tonsil and the base of the tongue, the increase in survival is 25% absolute percentage points across all stages, so very significant increase in survival.

So I think the first take-home message is that if you're starting to search the Internet and you're at some of what has been recorded for head and neck cancer, you realize that, in many times, HPV-related cancers have an improved prognosis. And that's because of that some of . . . because it's a relatively new phenomenon, some of the data that we do have on there on survival is outdated and doesn't really apply to oropharynx cancer. Now, that being said, treatment in this area does carry some toxicity.

Interviewer: What does that mean?

Dr. Monroe: So toxicity means side effects from the treatment.

Interviewer: Okay. Typically, what is the treatment? Is it surgery? Is it chemotherapy?

Dr. Monroe: The treatment that's curative includes surgery and radiation. Chemotherapy given by itself . . . while the responses are high, meaning the tumor strings down, the long-term control is very, very low. So chemotherapy is typically not given by itself. The two treatments that have been shown to be associated with the cure of the diseases, surgery and radiation, are both used and it depends upon the individual patient and the individual tumor characteristics.

Across the US, the most common treatment is probably radiation based, the combination of radiation and chemotherapy. Chemotherapy is often given along with radiation to make the radiation work better. For patients with lower volume disease, meaning smaller tumors in the back part of their throat, we're beginning to evaluate the role of surgery to remove the tumors mainly so that we can achieve, one, the elimination of chemotherapy or, two, the reduction in the dose of radiation with the goal being of minimizing some of the long-term side effects of treatment. So the side effects of treatment can include difficulty swallowing long term. The radiation therapy also affects the salivary glands and so most patients will experience dry mouth.

Interviewer: So this is for the rest of their life or just immediately after treatment?

Dr. Monroe: Yeah, for the rest of their life.

Interviewer: Okay.

Dr. Monroe: And so most patients who undergo radiation treatment for the oropharynx will have increases salivary production. Now, the good news is that some of it returns over time, but it never returns to the level that it was prior to treatment. And that has important implications only just from a quality of life perspective, but the saliva has important function particularly in preserving our teeth. And so patients who undergo radiation therapy also are at higher risk of developing dental decay and it's one of the reasons why having a dentist onboard who is trained in treating patients who have radiation therapy to their mouth is important. There are specific dental precautions that can be done to minimize the risk of dental decay in patients.

Interviewer: What are some of the other concerns or considerations you get from patients after being diagnosed with HPV head and mouth cancer?

Dr. Monroe: Yes, I think that one of the most frequent questions that we get is not from the patient itself but from their loved ones or spouses. Many have gone online and read that HPV is a sexually transmitted disease and there are fears of, one, that they may acquire the infection or, two, that there's infidelity on the part of their loved one. I think there are a couple of important points to consider.

The first is that HPV is a ubiquitous infection, while over 80% of the population is exposed and many times, these infections occur decades before the actual onset of cancer. Many people have already been exposed if their loved one has HPV. The increased risk of cancer for loved ones has been demonstrated, but it's incredibly small. So we do know from studies that have done in the Scandinavian countries that women who have cervical cancer, there's a slight increase in the risk of developing oropharynx cancer or head and neck in their spouses.

Interviewer: And then you said a slight.

Dr. Monroe: A slight. It's a very small percentage of patients.

Interviewer: Okay. So not likely.

Dr. Monroe: Not likely, generally speaking.

Dr. Monroe: In Utah, studies that we have done here have demonstrated that patients with oropharyngeal cancer, there is a higher risk of cervical cancer in their spouses above the population so the converse of the studies that have been done in Europe.

So I think what this points to is that what you might expect from a disease that's sexually transmitted is that if one partner has HPV exposure then the other partner is likely to be exposed to HPV. And if they're exposed, there's a very small risk of developing cancer. As of right now, there are no recommended guidelines other than many people will have recommended spouses, female spouses of patients with head and neck . . . to undergo their already recommended cervical cancer screening.

Interviewer: I think kind of the final point then would be also that this is a completely preventable if you have vaccination when you're young before you're exposed to it. And that's kind of a tough thing, especially here in Utah. We're not getting these vaccinations taken care of.

Dr. Monroe: I think that's an incredibly important point. So vaccination rates in Utah are lower than the national average. This is a really important preventable, not just from the head and neck cancer perspective, but there are many other cancers and non-cancer conditions caused by HPV. So, prevention is really key.

Interviewer: And there's a prevention out there. It's just that we're not using it to scale.

Dr. Monroe: We're not using it, yes.

Interviewer: So if you have been diagnosed with the head and neck cancer because of the HPV virus and you have young children, then really be sure you get that vaccination taken care of.

Dr. Monroe: That's true. So I encourage all of your loved ones and children of the appropriate age to become HPV vaccinated. It's something that's relatively easy to do and has been shown to be effective for many other cancers and is thought to be effective for oropharyngeal cancer as well.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: If you're listening to this podcast, it's because you want to learn more about the HPV virus and the cancer that causes it and probably more specifically because you've heard that it's causing more cases of head and neck cancer. We're with Dr. Marcus Monroe. He is a head and neck cancer expert and let's talk about HPV. There is one type of HPV that maybe more people are familiar with, not so much the head/neck aspect. So first of all, what is HPV? Just give us the basics.

Dr. Monroe: Yeah, sure. So HPV stands for Human Papilloma Virus. It's actually a group of well over a hundred different viruses of which, about 40 are known to be transmitted in humans and of these, a few of these subtypes are known to cause cancer in humans. The most well-known association, which has been known for decades, is the link between HPV and cervical cancer. That's the reason why women are recommended to get yearly screening pap smears.

Interviewer: Thyroid Cancer, what is it, what causes it, what are the signs, and what can you do about it? That's next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Marcus Monroe is a head and neck cancer expert at University of Utah Health Care. Today, it's thyroid cancer. First of all, let's just start out with, what is your thyroid and then we'll get to what is thyroid cancer.

Dr. Monroe: So your thyroid is an endocrine gland. It's a gland that's located in the neck, just above the collar bones. It's a butterfly shaped gland and it crosses over your windpipe. Its main functions are actually quite broad. It is involved in regulating a variety of bodily functions, including blood pressure, heart rate, body temperature, energy use, metabolism. In a very basic way, your thyroid gland can be thought of as your body's thermostat.

Interviewer: And then what causes... what is thyroid cancer? Other than cancer of the thyroid.

Dr. Monroe: Yes, so thyroid cancer is actually a group of cancers. The most common types are termed well-differentiated thyroid cancer, include papillary thyroid cancer, follicular cancer, and these account for over 95% of all thyroid cancers. There are rare, inherited types of thyroid cancer called medullary thyroid cancer and then some rare aggressive variants called anaplastic thyroid cancer.

But in general, when most people speak of thyroid cancer, they're most commonly referring to those most common types of follicular and papillary thyroid cancer. Something we've demonstrated in research that is that is done here at University of Utah, demonstrating in small but increased risk of even these well differentiated thyroid cancers in family members of patients with thyroid cancer. And that's been known before, that there is probably a family link. For the medullary thyroid cancer, there is a very clear genetic component associated with mutations in the RET gene, so that's a little bit different entity but also has a very strong genetic link.

Interviewer: And, as a result of that stronger genetic link, if you know that that's in your family then you should be a little bit more aware of that, I suppose?

Dr. Monroe: Yeah, it's something to be aware of.

Interviewer: So what else causes it? There can be a genetic component, what else?

Dr. Monroe: The majority of patients we know of no specific genetic component. The number of environmental exposures that have been associated with thyroid cancer are actually pretty few. The one that has really been conclusively demonstrated is the previous exposure to radiation, and we know that from some of the follow-up studies that have been done in areas that have had nuclear fallout, like the Chernobyl region, have seen vastly increased rates of thyroid cancer.

Interestingly here in Utah, there have been studies done that have demonstrated higher rates of thyroid cancer, particularly in areas that have nuclear fallout from the nuclear testing that was done in Nevada in the 1950s and '60s.

Other risk factors for thyroid cancer that aren't quite as well established include female gender, so we know that thyroid cancer is more common in females and is thought to potentially be related to some hormones, but that hasn't really been worked out. And we also have a link with obesity. We see an increase in thyroid cancer with an increase in obesity, although these links are not as strongly linked as the one with radiation.

Interviewer: What are some of the signs? What am I looking for? How do I know that I might need to Google something or go to my doctor?

Dr. Monroe: Yeah, so thyroid cancer is a little unique in that the vast majority of patients are asymptomatic and have thyroid nodules discovered either on a routine exam for some other condition or an imaging studies performed for a completely unrelated diagnosis. Specific signs of thyroid cancer can include a lump in the neck, changes in voice or swallowing, or rarely, coughing up blood. But the vast majority of patients are actually asymptomatic at the time of diagnosis.

Interviewer: So what should somebody do if their physician had done some other tests and discovered that they actually do have a thyroid nodule?

Dr. Monroe: The first thing that's important to realize is that thyroid nodules are incredibly common. They increase with age and, in fact, if you look with sensitive measures like ultrasound, over 50% of people will have thyroid nodules by the age of 50 or 60. So an incredibly common condition.

Interviewer: So it doesn't mean cancer?

Dr. Monroe: It does not mean cancer. In fact, the risk of cancer in any individual with thyroid nodules is actually quite low, somewhere in the range of 5 to 10%.

Interviewer: So that's kind of nice to hear.

Dr. Monroe: Yes. So I think it's nice. Now, as of right now we don't have great ways of differentiating them other than characteristics on the ultrasound and by biopsy. So for patients who are diagnosed with a thyroid nodule most will be referred to an endocrinologist or a surgeon who specializes in thyroid cancer for evaluation of the characteristics of the nodule as well as their thyroid gland function.

The testing typically begins with measurement, a blood test to measure your thyroid function, and then, in most cases then an ultrasound. There are very specific criteria that have been laid out that demonstrate which nodules harbor an increased risk of thyroid cancer and which nodules should be biopsied, so not all nodules need to be biopsied. Those that are larger in size or have worrisome characteristics by ultrasound, the next step is to then attain a fine needle aspiration, which is a small biopsy with a needle that can be done in clinic.

Interviewer: So a nodule doesn't necessarily mean cancer. If it is diagnosed and it is determined that there is cancer going on, what would be the steps after that? What's the treatment look like?

Dr. Monroe: The treatment for thyroid cancer typically involves surgery. Depending on the size and location of the cancer within the thyroid, that may involve removing either half or the entire thyroid gland. Occasionally, removal of regional lymph nodes is required if the cancer has spread to the lymph nodes or if there's a particularly high risk of cancer spreading to the lymph nodes.

Once surgery is over, a select group of patients that are at higher risk may need additional therapies. The most common of those is radioactive iodine, which is a pill that can be taken afterwards that has radiation tagged to an iodine molecule. Now the thyroid is a little bit unique in that it takes up this iodine and can concentrate the radiation to kill any remaining thyroid cancer. That's really only used in patients that are deemed higher risk for the cancer coming back afterwards.

Interviewer: And what's life look like after thyroid cancer treatment?

Dr. Monroe: The good news is that if we look at all the different shades of thyroid cancers, the most common thyroid cancer rates of survival are excellent. Survival rates at 5 and 10 years are well above 95%. Survival is great. The unfortunate thing is that we don't really have a lot of data on what sort of health problems people have after treatment, so that remains an unanswered question. But in the vast majority of cases, patients are able to go back to their normal life and function normally.

Interviewer: So for the most part, quality of life after the treatment

Dr. Monroe: Yeah, as far as I know--

Interviewer: Is normal, unaffected?

Dr. Monroe: Yeah.

Interviewer: Any final thoughts? Anything you wish I would have asked or anything you feel compelled to say?

Dr. Monroe: I think the important thing to realize is that, because survival is so good, nodules are so common, thyroid cancer is not something we recommend screening for. In fact, if we look at countries that have started screening for thyroid cancer, we see some really interesting findings. So if we look at South Korea, for instance, they started a screening program for cancers in the '90s and, as part of that, many hospitals offer ultrasound based thyroid screening. And what they have found is that thyroid cancer has now become the most common malignancy in that country, far surpassing any other cancers.

The interesting thing about it is the number of people who die of thyroid cancer has remained unchanged. So I think it's really important when we talk about screening for these cancers is that to realize that one, these cancers are actually very common, and two, they are unlikely to affect a person significantly during their lifetime. There's general though that, in many cases, the risks of screening and all the testing and biopsies that need to go into finding these nodules probably outweighs any benefit.

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Dr. Miller: If you're a cyclist and you have neck and back pain, what is the best way to avoid that or treat it? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here with Rich Kendall. Rich is a doctor of osteopathy and he is the chair of the Department of Rehabilitative Medicine. Rich is going to talk to us a little bit about how we can keep our necks and shoulders healthy when we're on the bike for long periods of time. Now Rich, I know you're an avid cyclist and so you have a good sense about these problems and probably have a lot to do with how to prevent them.

Dr. Kendall: That's true. I've been on a bike a lot of miles and done a lot of neck stretches and postural exercises to get rid of my neck pain.

Dr. Miller: Yeah, I saw you blow by me one day. You were going 100 miles an hour and I was only going about 5, so I know you're a good cyclist.

Dr. Kendall: I must have been doing my neck stretches. Yes, neck pain is very common in cyclists. The funny positions that we get ourselves into both on mountain and road bikes can really put a lot of strain on the neck, especially when most of us sit at a computer most of the day and have the head forward posture, which will increase some of the stress on our necks.

Dr. Miller: What's the best way to deal with that?

Dr. Kendall: One of the best ways is a good bike fit and making sure that your handle bars are about the level of your saddle, not trying to be in an overly aggressive arrow position for 100 mile ride because you just won't really do that unless you're a nice, pliable 25-year old. We want to make sure that everybody has a really well-supported neck, that their head is not forward, that their upper back is not rounded too much, and they are supported pretty well with their arms.

Dr. Miller: As a younger cyclist, it sounds like it's a little easier to avoid the problem, but as you get older, are there certain stretches you can do prior to getting on the bike?

Dr. Kendall: Probably the three most helpful exercises that I give to cyclists all of the time is one, they really need to stretch their hip flexors and quadriceps. So for a yoga warrior pose to really stretch your hip flexors and quadriceps out because in cyclists these are very tight. Your hip angles are very narrow and that's going to make your back round quite a bit. The other is to really strengthen your back muscles, exercises like Supermans or back extension exercises where you really can strengthen your back muscles. If you've ever gone that 100 mile ride, you come back, your triceps are the sorest muscles that you have, it's because your back isn't supporting you and you're supporting yourself with your tiny little cyclist arms the whole time.

Dr. Miller: So a professional bike fit would also help, you think or are most people able to do their own bike fitting? What do you recommend there?

Dr. Kendall: I think a professional bike fit is a good idea for most people who are going to spend more than token time on their bike. If you're riding 100 miles or more a week, you really need to have a bike fit done. Especially long term, especially early in the season where all of your muscles are tight, your chest muscles are tight, your hips are tight, you're going to want to have a nice bike fit where you're not overextending.

Dr. Miller: What happens if you're riding long enough that even if you're doing these exercises, you develop pain coming down one of the arms and your fingers or you've got pain in your neck that won't go away?

Dr. Kendall: If you've done all of these things and you are having continued neck pain or you start to get shooting pain down your arm or numbness in your hands and fingers, you really should be checked by your physician to make sure that you don't have a pinched nerve in your neck as a cause of these.

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Linda Scholl: We all know it's coming. The snow's going to fly. What we need to do is get strong so that we can face that shoveling ahead. I'm Linda Scholl, physical therapist at the Orthopedic Center and that's coming up next on The Scope.

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Linda Scholl: Oftentimes, we see individual who thinks they're super-strong and they get out there and we've seen it in the clinic, I've seen it in the clinic. They've decided that they're the ones who are going to shovel the entire walk themselves and what they do is end up having a rotator cuff strain or a tear. I'm seeing them after surgery and we're helping repair what could have been possibly prevented had they have been a little bit more heads-up on things.

The injuries happen when you're tired and you're sore and you're over-doing it. You're trying to lift something heavier than you need to and that's when the shoulder will often give out. I think it's a good idea for all of us to kind of think ahead. We know that we're going to get a big dump and it's a good idea to kind of prepare for it.

So, pull out the cans of soup, pull out some milk jugs and start strengthening your arms. I want you to pick up the milk jug and pull it like hanging down to your side and pull it up like a bicep curl. You know a milk jug weighs about 8 pounds so fill it up to what you need. You can put water in it for whatever weight you feel like is appropriate for your strength and you can start doing some bicep curls with lighter weights, like maybe a can of tomato paste or something, let's say. You can go ahead and lift your arms up straight out in front of with your elbows straight, all the way in front to overhead and all the way out to the sides like a jumping-jack. And exercises along this line will help you so that when it comes time for you to actually shovel, your shoulders won't hurt as bad and hopefully you won't be coming in here to see us. You'll be healthier.

If you do have to shovel and your shoulders are strong, it's also a good idea to make sure that you've engaged your belly muscles; you've pulled your belly button to the back of your spine. You're making sure you able to breathe helpfully and you've can dig into that snow with your knees bent and you can engage the belly and start the shovel that way. Your shoulders will be strong but your body needs to be involved too, legs and belly. We need to make sure that we engage our legs and our trunk so that the whole shoulder isn't the brunt of the activity. It's not what's going to be the injury. Shoveling is a whole-body activity. It's not just your arms and we want you to be healthy and strong so that you can enjoy the winter even though you might not enjoy the shoveling.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.