What is neck pain?

    Neck pain is a common condition that Physiotherapists and Massage Therapists treat with good success. They can help reduce pain, restore mobility and improve function.   Neck pain can result from an acute injury, or from a chronic condition of dysfunction. Neck pain may result from a variety of causes such as poor working mechanics (ergonomics), from  muscle strains, overuse and poor postures, from traumatic accidents and whiplash, and from diseases such as rheumatoid arthritis, degenerative disc disease and spondylolysis.    

What are some of the common causes of neck pain?

   

Muscle Strains

Typically muscle strains occur from overuse or misuse, if they occur from an accident or sudden injury, they can become chronic without proper management. When a movement pattern is repeated too many times, no matter how biomechanically sound that movement pattern is, it can cause an overuse strain.  If a movement or position is not biomechanically sound, there is greater risk of injury. Once you have sustained soft tissue or joint injury some positions and activities may no longer be tolerated such as reading in bed, working on a laptop, driving long distances, and lounging on the couch with your feet up and head propped on a pillow.  Occasionally with repetitive neck strains, sleeping becomes very difficult and patients turn to different pillows as a solution.  Neck muscles essentially become fatigued and eventually strained and chronic overuse can cause chronic pain. This chronic state becomes very frustrating for patients because over time, even the smallest deviations from optimal posture, postures that you have been able to tolerate for years, are no longer tolerable.      

Joint Sprains

Typically joint sprains occur in the small facet joints that form the articulations between each vertebra. Over time and with repeated sprains, these joints show their wear and tear.
  • Overuse is when normal forces are repeated. In this situation a pattern may be biomechanically sound and can still lead to breakdown causing tissue and joint damage. It is simply the excessive accumulation of force that produces the damage.
  • Age and how we live our life. Sometimes joint damage is a result of being too active and over stressing our joints, and sometimes from being too sedentary and not stressing our joints enough.
  • Misuse is when abnormal forces are repeated. Poor mechanics and biomechanics effects the health of our joints and bad patterns performed repetitively can sprain and strain joints.
  If not treated and prevented, osteoarthritis may result, joints may wear out, become painful and stiff. The most common sign of osteoarthritis is the loss of joint mobility and subsequent loss of joint nutrition, a feeling of stiffness and pain, and a loss of function.    

Nerve Compression

Nerves travel from the spinal cord to the periphery thru canals, recesses, and anatomical spaces. In a healthy state the amount of available space is adequate. There are a number of less than favourable conditions in the vertebrae which can reduce the amount of available space and subsequently may compress the nerve. A pinched nerve may occur from aging, damaged discs, herniated discs, bone spurs and/or traumatic injury. With age, the discs that lie between the vertebrae become less hydrated and stiff, narrowing the space in the lateral canal, and pinching the nerve. Herniated discs on the other hand create a different effect. When the inner gel-like material called the nucleus pulposus of the disc, protrudes through the outer annulus it can compress the nerve as it exits the spinal canal in the intervertebral foramen or lateral canal. This can cause arm pain, weakness, and/or symptoms of numbness and tingling in the arm and hand. Bone spurs are also characteristic of arthritic joints and can obstruct and compress adjacent nerves. Lastly, trauma and/or injuries sustained in motor vehicle accidents, falls, and sports injuries can cause acute trauma to the nerve.

Typical Risk Factors for Neck Pain

  • Age. The neck is often affected by osteoarthritis, which is a result of wear and tear and often comes with age.
  • Occupation. Your risk of neck pain may be higher if your job requires your neck to be held in one position for prolonged periods of time. Especially if this position is not one of optimal posture where the curvatures of the spine are maintained. Examples include driving and computer work. There are some positions and/or postures that stress your neck and long careers in these postures may be hazardous.
  • Bad Habits. The most common aggravating and causative factors of neck pain are poor work and/or leisure postures. The effects are cumulative, where for a long period of time there may be no signs and symptoms, be sub-clinical in nature, until one day, pain becomes evident insidiously.
  • Genetics. Some conditions that may lead to neck pain are genetic, such as osteoarthritis, rheumatoid arthritis, skeletal structural alignment, etc.  With this predisposition thru family history, you should be even more diligent in correcting your lifestyle.
   

What is the prognosis of neck pain?

    Most patients with mild to moderate neck injury heal quickly and have a full recovery with appropriate Physiotherapy treatment. In these instances, recovery is relatively short, such as in the case of a single joint sprain (for example, a “kink in the neck”) and in some cases where multiple joints are injured, recovery takes longer sometimes weeks/months to resolve. In severe and chronic cases, recovery may be significantly longer, and may require ongoing attention and lifestyle modification. Patients with chronic neck strain may also have an increased likelihood of developing degenerative changes in their joints, resulting in long term problems such as restricted movement and pain. Immediate treatment for patients with neck pain is essential to ensure a speedy recovery, and even chronic neck pain can be treated well with a strategic treatment plan.   The success rate of treatment in patients varies and is largely dictated by patient compliance. One of the key components of treatment is that the patient avoids postures and activities that increase their pain and cause repetitive strains. Your healthfx Physiotherapists and Massage Therapists can help educate you about the positions and postures that you should avoid, and provide you with videos of corrective positions and posture. Activities which place large amounts of stress on your neck should be kept to a minimum and include: prolonged sitting, standing or lying in poor posture; head looking down activities; shoulders forward activities, and lifting. Resting from aggravating activities allows the body to begin the healing process in the absence of further tissue damage. Some of the important steps to take are:
  • Avoiding hurtful postures and positions such as sitting, bending lifting,
  • Build in recovery strategies into you hard days of work
  • Seek Physiotherapy Treatment immediately when your pain is significant or frequent
  • Ensure enough quantity and quality of sleep.
Once functional movement tests are pain free, a gradual return to activities is indicated, provided there is no increase in symptoms. Your physiotherapist can assist you in this gradual progression and can help you prevent a more chronic condition.    

How can physiotherapy and massage therapy help with neck pain?

    The most common types of neck pain usually respond well to conservative treatments, modifications in habits, physiotherapy, and massage. If neck pain persists, your physiotherapist may recommend other treatments and techniques to mobilize joints, release soft tissue, and strengthen muscles.    

Manual Physiotherapy

Your Physiotherapist will begin with an examination of  range of motion to determine whether joints and/or muscles are involved and then determine the best treatment plan to improve mobility and decrease pain. The nerves will be examined to determine if there is a pinched nerve effect and/or if there is neural tension and shortening effect causing nerve like symptoms such as tingling, numbness, and “pins and needles”. Your Physiotherapist may suggest a soft collar to support your neck and help relieve acute pain by taking pressure off the structures in your neck. Manual Physiotherapists and Massage Therapists are skilled in the art and science of palpation, they are able to determine which joints are restricted and in which direction using their hands to palpate these movements. Joint motion analysis consists of manual tests called PIVOMs and PAVIMs which evaluate the small intervertebral joint movements that produce motion in the spine. With this information, your Physiotherapist can help to increase these specific articular motions and restore global neck range of motion. These small movements are known as the arthrokinematics of joint mobility. They are essential for normal function and exercises will not necessarily restore these motions.    

Massage Therapy

The goal of the Massage Therapist is to reduce pain and spasm in the affected muscles, as well as decrease disc and nerve compression. By evaluating and determining where the tone and restrictions are, massage therapy can help release and restore soft tissues. Common muscles that are involved with neck pain are upper trapezius, levator scapulae, posterior cervicals, sternocleidomastoid and scalenes. The anterior cervical fasial structures are also treated in conjunction with these muscles. Techniques used for neck pain are dependent on the stage of healing and injury state, and if acute or chronic. Myofascial and gentle Swedish Massage Techniques are used during the acute phase and then progressing to deep tissue, Swedish massage and trigger point techniques. During either stage the focus is to release and decrease tone and spasm in the musculature of the neck.    

Physiotherapy and Neck Exercises

Your Physiotherapist and massage Therapist may recommend neck exercises, stretches, and  self release techniques.  Exercises, along with Manual Physiotherapy, may improve pain by restoring muscle function, optimizing posture to prevent overload of muscle, and increasing the strength and endurance of your neck muscles. The postural approach to exercise is to reinforce corrective patterns, to focus on strengthening the back and scapular stabilizers, to stretch the chest muscles, and to mobilize the spine.  

How can exercise and physical development help after neck injury or pain?

   

Assessment of Functional Movement

We start with a functional movement screen that looks at some of the essential movement skills for daily living and also for an activity based lifestyle. This information in addition to our previous orthopaedic assessment findings will allow us to develop a personal improvement plan just for you. This plan will have specific goals, be measurable, will call you to action, will be realistic, and will be time sensitive so that you will see progress and we will monitor and support your success from a medically based standpoint and from a sports science stand point.    

Rehabilitative Exercise after Neck Pain and Injury

It is important to regain functional neck range of motion, as well as to strengthen the muscles which help to support the neck and spine. In addition to Manual hands on therapy techniques, exercises to increase range of motion can be performed at home and at physiotherapy. These include flexion (chin to chest), extension (chin to ceiling), side flexion (ear to shoulder), and rotation (turn head to look over the shoulder). Your Physiotherapist will perform manual therapy techniques to release restrictions and follow up with range of motion exercises in order to maintain this new range of motion. Maintaining range of motion exercises can help to decrease pain and improve joint health by aiding blood and nutrients in getting to the joint. The next important goal following a whiplash injury is to regain strength and correct posture. There are a series exercises to progressively develop optimal posture. Patients will start with simple posture correction exercises that both reinforce good posture but also stretch and strengthen this postural pattern. Trunk control, engaging the scapular muscles by your shoulder blades and chin retractions in supine and later in sitting and standing are effective. Scapular retractions in different planes and during different functional movements such as when driving a car or putting dishes away or working at the computer etc. We typically start with active postural correction and then with resistance using elastic bands and cables. Your Physiotherapist will advise which exercises are appropriate at which point of each patient's treatment and will progress the exercises throughout the course of treatment.    

Physical Development after Neck Pain

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your injuries, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home
   

How can low intensity laser therapy help neck pain?

    Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

  With LILT there is an increased production and release of:
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.    

What life style and self-care measures can you do for yourself to relieve acute and chronic neck pain?

  • Over-the-counter pain relievers may be recommended by your doctor to relieve pain. Try over-the-counter pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and acetaminophen (Tylenol, others).
  • Alternate heat and cold. Reduce inflammation by applying cold, such as an ice pack or ice wrapped in a towel, for up to 20 minutes several times a day. Or alternate the cold treatment with heat. Try taking a warm shower or using a heating pad on the low setting. Heat can help relax sore muscles, but it sometimes aggravates inflammation, so use it with caution.
  • Rest. Lie down from time to time during the day to give your neck a rest from holding up your head. Avoid prolonged rest, since too much inactivity can cause increased stiffness in your neck muscles.
  • Modifying your activities and postures. Your physiotherapist and massage therapist can help you determine which exercises and which activities are causing you harm than good.
  • Gentle stretching. Gently move your neck to one side and hold it for 30 seconds. Stretch your neck in as many directions as your pain allows. This may help alleviate some of the pain. If these do not improve your condition your physiotherapist will be able to assess why.
   

Prevention Neck Pain

Neck pain is often associated with poor posture during the years where age-related wear and tear occurs. To help prevent neck pain, keep your head centered over your spine, in a neutral position as we call it. Some simple changes in your daily routine may help. Consider the following:  
  • See your healthfx Physiotherapist or Massage Therapist not just in a crisis but for preventative and proactive care as part of your personal improvement plan to keep the joints that become stiff moving. Gentle joint mobilization and soft tissue techniques can keep the articulations moving
  • Take frequent breaks if you drive long distances or work long hours at your computer. Keep your head back such that your chin is tucked into your throat, your ears in line with your spine, and this will reduce neck strain. Try to avoid gritting your teeth and or eating/talking in poor posture.
  • Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests, and your shoulders pull back and down in a position of scapular retraction.
  • Avoid talking on the phone with the phone between your ear and shoulder when you talk. If you use the phone at work, use a headset.
  • Avoid lying with your head propped up on a pillow when either reading and/or working on your computer in bed or on a couch. This bad habit is the most common cause of neck pain.
  • Avoid sleeping with more than one pillow as this can cause significant neck and upper back problems and should be avoided. Instead use one narrow pillow such that when you lie on your back your ear is in line with your shoulder rather than in a forward head posture.
  • Stretch frequently if you work at a desk. Every few minutes adjust your position and pull your shoulder blades back and down such that your head comes back into line with your neutral spine. This position along with a position of chin tuck with stretch the muscles
  • Balance your muscles. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced your muscles.
  • Avoid sleeping on your stomach. This position puts your neck at the very end of its range of motion and puts excessive stress on the muscles and joints. Choose a pillow that supports the natural curve of your neck.
   

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