Neck Pain - Ask Dr. P - The Pain Doc

The 30 Day Pain Relief Challenge Kick Off

by Pain Doc | Jan 4, 2021 | Foot and Ankle Pain, Hand and Wrist Pain, Hip Pain, Knee Pain, Leg Pain, Low Back Pain, Neck Pain

It’s 2021 and time to kick off the 30 Day Pain Relief Challenge!

But first I want to acknowledge what’s on everyone’s mind.

2020 began with an unexpected crisis, the COVID-19 pandemic. A new corona virus strain emerged; highly contagious and deadly for certain individuals, and for which there was no vaccine. As of this writing, over 85 million people worldwide have contracted the virus, with 1.85 million dying from it. The United States is being hit the hardest, with 20.8 million cases and 352,000 dead. The numbers are expected to spike following the holiday season, thanks to many people choosing to get together in large groups and ignoring the risk. So please, remain extra vigilant the next two weeks because chances are, there are more viruses around you than there were a month ago, ready to find a new host.

As we navigate through COVID-19 in 2021, life must still go on. I know many have been hurt economically, and their number-one priority is to find a way to get back on their feet. It is not an easy thing to do, especially if you lost your job and the life skills you possess are in an industry that has been permanently impacted by the pandemic. If this describes your situation, I sincerely hope you find a way to re-position or re-invent yourself, to get back to earning a living.

While COVID-19 dominates the news and peoples’ attention, we must not lose focus on the many other challenges life presents that also need our attention. How would you rate your health at the start of the new year? How about your energy levels and endurance?

Quarantining and social distancing have a way of discouraging exercising and promoting over-eating, a terrible combination to health. When one is restricted from going outside and going to a gym (although a gym is not necessary for staying fit, but I digress…) and constantly bombarded by news of doom and gloom, the tendency is to stay home, surf the web, and eat, more than you typically do (what else is there to do in such a scenario?). And for many, the choice is high-calorie comfort food. This can lead to unwanted weight gain, muscle atrophy, joint pain, and so on.

If you are not feeling 100%, then I encourage you to open all the emails I’ll be sending over the next 30 days—the 30 Day Pain Relief Challenge is about to kick off, and email is how it will be executed.

And what exactly is the challenge? It’s about challenging yourself to get out of your comfort zone and do all the things I will suggest in the coming days so that you can get out of pain, or significantly knock it down to levels you haven’t experienced in a long time.

The other reward may be that you will lose 10 pounds or more; will have more energy, and will notice that your mind/ thinking is clearer. This is because the methods I’ll go over target your body and all its systems; not just the area of pain. It is wholistic.

But first let me explain how you will be measuring your results. After all, pain is subjective. You need some kind of tool to quantify your improvement, so read on.

Pain, aches, discomfort or whatever you want to call it affects your health. There is mental health and physical health; both important to happiness in different ways. Your physical and mental health are impacted, even just a little and perhaps unnoticeable to you, if you have chronic pain/aches/discomfort. Less-than-optimal physical and mental health impacts quality of life. Quality of life in this sense refers to your ability to physically do what you need or want to do; whether it be your job; recreational activity such as playing golf or swimming; or activities of daily living; i.e. taking care of yourself and your personal needs.

Why You Might Have a Disability if You Have Pain

If you live with chronic pain, you likely have some degree of disability.

“Me disabled?” you might be thinking. “No way!”

The word “disability” is often misconstrued. Disability doesn’t necessarily mean “disabled” and in a wheel chair. It simply means not being able to perform a certain task without some degree of difficulty or impediment; or not being able to do it at all.

Doctors (medical examiners) who issue disability certificates or write medical-legal reports are tasked to determine the degree to which someone is disabled. Their findings determine the patient’s disability compensation from the insurance company or government agency. They use observation, physical exam procedures, diagnostic tests like X-rays and nerve conduction; and instruments to measure strength, pain perception, reflexes, coordination, and range of motion. Any deficiency is expressed as a percent disabled, and there are laws that define levels of disability.

For example, in the insurance industry, the loss of both eyes, or the loss of two limbs equates to “100% disability.” Not being able to maintain a tight grip could be rated as 20% disability if the person’s occupation requires power gripping machinery.

Disability can also be subjectively quantified using Disability questionnaires where the patient rates his/ her ability to perform certain tasks on a scale of zero to some number; and the level of pain. In some questionnaires, the zero rating means you have zero difficulty doing the task (best score), while in others the zero rating means you cannot do the task at all (worst score).

For example, the following is one section of the Oswestry Low Back Pain Disability Questionnaire. Imagine having low back pain and rating yourself (0 to 5) on your ability to lift things:

LIFTING:

0 – I can lift heavy weights without extra pain

1 – I can lift heavy weights but it gives extra pain

2 – Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table

3 – Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

4 – I can lift very light weights

5 – I cannot lift or carry anything at all

When rating yourself, you must try to be as objective as possible—don’t over rate your ability; nor under rate it. Give each question some thought.

Then, you add up the numbers, divide it by the total number of points and multiply by 100 to get a percentage score.

If the zero rating is assigned to “full ability to do the task” (like the Oswestry above), then the score is interpreted as “percent disabled.” So, an individual with no low back disability whatsoever will score zero out of 50 and his rating will therefore be zero percent disabled; i.e. 100% functional. If his score is 30, then 30/50 x (100) = 60% disabled.

Below is an example of an Oswestry Low Back Pain Disability Questionnaire completely filled out:

oswestry low back pain disability questionnaire

In the above example, the total points out of all ten questions is 19, which is considered a Moderate disability, out of No, Mild, Moderate, Severe and Total Disability. In this case, 19/50 x 100 = 38% disabled due to low back pain. Now this person has a baseline for his condition, and can set goals to lower it each time; perhaps to 20% after a month, then 10% after three months of therapy.

If the zero rating is instead assigned to “no ability to do the task,” the score is interpreted as “percent functional.” This is how the Upper and Lower Extremity Disability questionnaires are designed. So a score of zero in this case means zero percent functional (totally disabled), and 30% means you are 30% functional (you lost 70% function in that limb).

Please note that Disability questionnaires are used as tools to quantify and set baselines for pain and functional capacity; your scores do not officially establish any disability you may have, they simply provide a more tangible interpretation of pain.

Quantifying pain/disability, even if subjective, gives you a sense of how significant it is; i.e. how much it affects your life. Secondly, it can be used as a tool to measure your improvement over time, after doing some therapy and/or rehabilitation (strength and coordination exercises). This lets you know if what you did works for your condition, and therefore, whether to continue or discontinue it.

For example, if your baseline Oswestry score was 60%, and you were prescribed some McKenzie exercises for one week and a follow- up score was 40%, it suggests that those exercises improved your condition and you should continue or progress to the next level. If it was 60% or higher, you should discontinue the exercises and try another approach.

You don’t have to see a doctor to use Disability questionnaires to subjectively assess your disability. They are fairly straightforward to use and you can download the forms from the internet (see below; I’ve done it for you).

Determine Your Pain/Disability Baseline

If you have low back pain, neck pain, shoulder pain, or lower or upper limb pain then I suggest monitoring your condition using the appropriate disability questionnaire. If you are getting therapy, your doctor should be having you fill these forms (or something similar) out each visit and going over the results with you. It’s substandard care if you don’t know if the therapy you are getting or exercises you are doing is helping; these questionnaires will prompt you to think about the change or lack of change in your functional capacity, and will help you assess your care so that you can take appropriate action.

Below you will find forms to assess any musculoskeletal pain you are having. If you wish to participate in the 30 Day Pain Relief Challenge, print out the appropriate disability questionnaire; rate your abilities as objectively as you can and calculate your score; set it aside, and be ready to fill out a new questionnaire after 30 days of diligently doing the things I will cover over the next 30 days.

My goal is for participants to experience at least a 50% improvement in their pain/ disability scores. If you have any friends who might be interested in participating, please refer them to my site, https://PainandInjuryDoctor.com and have them enter their email in the opt in form.

Download the Low Back Pain Disability Questionnaire

Download the Neck Pain Disability Questionnaire

Download the Shoulder Pain and Disability Index Questionnaire

Download the Upper Extremity Disability Questionnaire

Download the Lower Extremity Disability Questionnaire

Arm, Wrist and Hand Pain From Overuse – Things You Can Do

by Pain Doc | Mar 1, 2017 | Neck Pain, Shoulder Pain

When I ran a large chiropractic practice in San Francisco’s Financial District during the late 1990s to 2002 about half of the cases I saw involved upper extremity pain due to “overuse.” They went by the names repetitive strain injuries (RSIs), cumulative trauma disorders, tendonitis, epicondylitis, carpal tunnel syndrome, stenosing tenosynovitis or just overuse syndrome.

Symptoms typically involved pain in the wrist tendons, forearm muscles and outer elbow; weak grip strength; shooting pains in the hands and sometimes loss of finger coordination.

Nearly all patients complained of neck and shoulder pains as well. About 20% were way beyond typical neck strain; these folks suffered an unusually pervasive pain that limited shoulder and neck movement enough to cause temporary disability (I had to take them off work). The neck and shoulder muscles were always rigid while the skin above felt unusually warm and a bit swollen/ boggy to the touch.

What could explain this surge of arm, wrist and hand pain from the late 90s to 2000s?

During this time frame, a couple of things occurred:

1. Laptops started entering the scene. This was significant, because up to this point people used a separate keyboard and monitor. And, they usually had the monitor raised on a monitor stand so you didn’t have to bend your neck down for so long. With the laptop, the monitor is connected to the keypad, forcing the user into an unfamiliar, awkward and ergonomically poor position. Neck and arm muscles were not accustomed to function in this position and experienced cumulative strain.

2. The internet developed, as well as desktop applications like Microsoft Office Suite. Employers saw how the internet could increase efficiency and job descriptions increasingly involved longer hours on the computer.

3. Mobile phones came on the scene, then smart phones. BlackBerrys (“Crack Berrys”) were all over the place, then the iphones. Like the arrival of the laptop these new devices caused people to assume postures that they weren’t accustomed to: forward craned necks multiple times throughout the day; thumb typing, slouching.

Wrist braces were a common site back then, and there was an increased incidence of carpal tunnel release surgery.

Now in 2017, you don’t hear much about repetitive strain injuries or carpal tunnel syndrome. I think we’ve witnessed a sort of “micro-evolution” phenomenon, where the human body gradually adapted to using laptops and smart phones due to them being “forced” on the population, and can now handle longer hours in these awkward positions.

How Chronic Arm Pain Develops

But that doesn’t mean you are immune to these overuse injuries. If you have a job that involves prolonged sitting (about one hour+ straight) and keyboarding, then it is prudent to do things to avoid developing chronic pain in your upper extremities. I’ve seen people who worked through arm and wrist pain because their job demanded it; then, a point was reached where the pain persisted even after weeks of resting their arms, and months after they left their job.

What typically happens is, with frequent typing you rapidly contract and relax the forearm muscles that move your hands and fingers. There are several of them tightly confined in a small compartment. These muscles and tendons are protected by tissue called bursae, which are basically frictionless pads so that they can rub against each other without much problem.

But if you continually engage in these movements the bursae basically dry out and lose their ability to protect the forearm muscles and tendons. Friction increases causing small tears to form in the bursae and fascia (muscle covering), triggering inflammation and swelling. The inflammatory chemicals irritate the nerves in the arm, which can lead to things like numbness, tingling and shooting pains.

Then, scar tissue develops and undergoes sclerosis, or hardening and permanent thickening. Now you are stuck with hardened tissues rubbing against one other when you type, making matters worse. It leads to a perpetual cycle of arm, wrist and hand pain that persists with or without hand and arm exertion.

And don’t forget the neck and shoulders. As you know, it’s nearly impossible to maintain an erect sitting posture. After some time, your neck and back muscles fatigue causing you to slouch. The muscles in the neck shorten, and may even pinch your cervical plexus on one side—the bundle of nerves that go to the arm—leading to a condition called thoracic outlet syndrome. Symptoms of TOS include numbness in the arms and hands, swelling and a weak pulse.

For some people, the combination of neck, shoulder and arm pain is so bad they can no longer return to office work.

So what should you do?

First and foremost, taking periodic rest periods in between arm and hand work helps. Do neck, shoulder arm and wrist stretches during this time.

Secondly, take a hard look at your workstation ergonomics. Take note of the body positions and movement patterns required by your particular job function. Are there things you can arrange to minimize strain to your body? Think in terms of positioning frequently used equipment in a way that requires the least amount of exertion to your arms, wrists and hands. It could mean positioning the item closer to your body or further; higher or lower, and/or angled in a certain way. The slightest adjustment in a frequently used item can make all the difference.

For desk workers, I highly recommend that you get an adjustable standing desk such as the VariDesk. Set it to the standing height and stand for an hour; then effortlessly switch it back (takes all of five seconds) to the sitting position for half an hour, then back to standing. Standing gives you better posture and is actually better for your low back than sitting although it is harder on your feet and knees.

Third, think like an athlete. An athlete makes his/her body strong in order to perform the best, and to handle the physical challenges of his/her sport.

Well, sitting and typing is not exactly a sport but like a sport it puts physical demands on certain parts of your body—your low back, neck, shoulders, arms and hands. Strengthen those areas using weights and whole body functional exercises. This will make your body resilient to the physically stressful position of sitting at a desk for 8+ hours a day.

Fourth, there is self-therapy. If you are developing pain in your arms and hands, consider doing massage therapy. Myofascial release and Active Release Technique (ART) are especially good for upper extremity strain problems. Ask around; these techniques are advanced “medical” massage techniques that not your typical massage therapist is trained to do.

If you want to try it yourself, I made a video that shows you a modified form of myofascial release using an edged instrument.

If you are having neck and shoulder issues, find a good chiropractor and get some adjustments to those areas. Adjustments can help loosen fixated joints, removing pressure to nerves and blood vessels that service your arms.

Last but not least, use nutrition as therapy. Like a marathon runner who needs certain nutrition to recover from muscle breakdown in the legs, those whose job requires frequent arm and hand exertion at work should use nutrition to compensate for muscle breakdown in the upper extremities. I recommend green juice, whey and anti-oxidants.

Click here for the specific, nutritional supplements I recommend for maintaining good musculoskeletal health.

Bottom Line: Your arms and hands are indispensable to you. If you have a job that requires frequent keyboarding or other use of hands and arms, take preventive action to ensure you don’t develop chronic strain. Most of the best things you can do to achieve this, you can do on your own, without a doctor.

Till next time,

Dr. Dan

How Neck Pain Develops, and How to Manage It

by Pain Doc | Aug 20, 2015 | Neck Pain

In terms of the most prevalent types of spinal pain affecting the general population, neck pain closely trails lower back pain.

For the low back (lumbar spine) it’s easy to see why pain in this area is common: the lumbar spine bears the weight of your upper body in the standing and sitting positions and is a fulcrum point of body movement, so it is a workhorse that gets quite a beating.

But the neck (cervical spine), while smaller than the lumbar spine and less burdened by body weight (just the weight of the head) has certain characteristics about it that make it prone to pain as well.

Here’s a breakdown of those unique characteristics:

The cervical spine is comprised of seven vertebrae. The first two under the skull are the only set of vertebrae in your spine that does not have a connecting disc. This enables greater range of motion compared to the thoracic and lumbar spine regions.
More movement comes at a cost of less strength. The cervical spine therefore cannot bear forces as well as the rest of the spine and is more vulnerable to injury/ mechanical problems (whiplash, sleeping on a bad pillow, etc).
Forces that act on the cervical spine include gravity, repetitive axial forces from walking running and jumping; abnormal static posture/ sleep positions (stomach sleepers) and trauma from car accidents, falls and sudden jolts.
Structures in the neck affected by these forces are the facet joint surfaces in the rear of the cervical spine; the uncinate joints to the sides of the cervical spine; cervical discs, spinal cord, nerve roots, muscles, fascia, and even esophagus and throat.
Osteophytes, or spondylosis occurs when projections of bone develop usually from abnormal movement over time. Problems occur when these bony protrusions encroach on nerve tissue.

If you have neck pain, chances are it is related to mechanical dysfunction. But you must also be aware of other conditions that can generate pain and/or tenderness in the neck, and rule these out with your physician if the causation/source of your pain is not clear.

Causes of Neck Pain

Red flags (requiring immediate attention) include:

fracture
lymphoma
bone tumor
spinal cord tumor (syringomyelia)
onset of rheumatoid arthritis
esophageal varices
vascular disease (atherosclerosis)

Viral infections are sometimes associated with stiff and deep aching pain in the neck

Primary hyperkalemic paralysis—a rare condition usually triggered by extreme exercise, characterized by high or low levels of potassium, an electrolyte involved in muscle contraction. Causes severe pain and spasm initially, followed by muscle atrophy and loss of tone and contraction. The condition usually resolves after a few weeks. It can occur in the neck, and other muscle groups as well.

Neck Pain of Musculoskeletal Origin

Myofascial pain related to previous trauma. Trigger points and scar tissue are characteristics of MP.
Sprains and strains from injury (whiplash, direct trauma)
Generalized muscle pain from muscle tension, fatigue or spasm related to poor ergonomics, bad posture and often stress
Spondylosis, osteophytes (osteoarthritis related to degenerative disc disease)
Spinal stenosis – the narrowing of passageways where nerves pass
Disc bulge or herniation
Cervical radiculopathy (compressed cervical nerve roots from spondylosis or disc bulge)

Living in a modern society where sitting at a desk looking at a computer monitor in front of you or work papers down in front of you is the origin of many cases of neck pain.

This unnatural position of craning your neck forward while seated, over time, degrades good posture. It is unnatural because the human body is optimally designed and meant to stand and walk.

bad_posture

Exercises to Reduce Neck Pain of Musculoskeletal Origin

First, determine if you have a muscle imbalance, where your anterior (front side) neck and trunk muscles are overpowering your posterior (back side) neck and upper back muscles, pulling your head forward of the spine. Do a posture check, visualizing plumb lines from front and side. This abnormal posture is referred to as Anterior Weight Bearing of the Head (AWB). Another term for this is Forward Head Posture (FHP).

If you have AWB, the force to your cervical spine (and muscles) more than doubles compared to if your head’s center of gravity was directly over your torso/ axis of spine. This is because the weight of your head and the forward angle of the neck in AWB combine to create a moment force.

To get an appreciation of this, imagine holding an eight-pound shot put directly over your head, arm extended. It should be fairly easy to do. Then, while still holding it above your head, move the shot put just 5 degrees forward, simulating AWB of the head. Your arm muscles will quickly fatigue and even develop pain.

The increased forces to your neck in AWB of the head get absorbed by your neck muscles, your discs and vertebrae.

Use the diagram below to evaluate your posture (you may need help from another person to view your posture from the side).

Ideal human posture, viewed from front and side. From the front, a line bisecting the center of the body should have equal amount of body mass on each side (symmetrical sides). From the side, the gravity line should pass through the ear, center of shoulder, hip, knee and slightly behind ankle.

If you have AWB/FHP, engage in exercises to counter and correct AWB/FHP, with the goal being to reduce the amount of it:

Neck extension exercises – While lying face down on a mat, arms to side, contract your posterior neck muscles and lift your head straight up without arching it, as high as you can. Hold for four seconds; repeat 12 times 3x/ day.

Neck mirror image posture correction exercises – If your neck tilts to one side abnormally, stand with the opposite side shoulder contacting a wall. Using your neck muscles opposite the side of abnormal tilt, pull your head sideways towards the wall without bending your neck (keep your head level during the exercise). Hold for four seconds, repeat 12 times 3x/day until your neck is centered. Repeat as needed.

Wall angels. See this video of me demonstrating this exercise.

Isometric strengthening exercises for neck – Find a small child’s inflatable ball and place it against a bare wall, head level. Using different parts of your head each time (forehead, side of head, crown of head), press the ball against the wall and hold for 10 seconds. This isometrically contracts your neck muscles, strengthening them.

Rolled towel exercise to improve curvature- Roll up a towel to about a 5″ diameter, or better, buy a cylindrical neck pillow. Place it underneath your neck as you lie on your back. Arch your neck over the pillow and press the crown of your head onto the floor; hold for five seconds and repeat ten times. Next, with the roll still under your neck turn your neck as far as you can to the left, then right, five times for each side.

Use the Posture Pump Disc Rehydrator device

Thoracic outlet exercises: shoulder circles, corner stretches

Quadriceps stretch – Tight or shortened quadriceps muscles (your lap muscles) can rotate your pelvis forward causing your upper back to lean forward which can strain your neck as it tries to correct. To stretch, while standing bend your leg at the knee straight up keeping your knee pointed down. Grab your instep with the same side hand (balance yourself, as you will be standing on one leg) and pull it straight up. You should feel a stretch to your quadriceps muscle. Hold for ten seconds; switch sides. Repeat five times each side.

Core exercises – It’s important to have a strong core to support the lumbar spine properly, which fosters better posture overall. Do crunches, medicine ball exercises and planks to strengthen your core.

If you have any history of previous neck trauma such as sports injuries or repetitive movements, car accidents, falls etc., or spend a lot of time at a desk in a static neck posture, it’s possible that one or several of your neck vertebrae have locked together or have lost some movement which can have the effect of perpetuating discomfort. Chiropractic adjustments can be helpful in restoring motion to these segments and when combined with rehabilitative exercises, can usually resolve cases of general neck pain.

Lastly, a great way to discourage formation of AWB and encourage good posture is using a standing desk. The VariDesk is a quick and affordable solution to standing while working. Lower it, and you’ve got a traditional sit down desk; raise it (takes 5 seconds) and now you’ve got a standing desk. Alternate between sitting and standing throughout your day and notice your neck and back pain and stiffness improve!

The VariDesk can dramatically reduce low back and neck pain, and upper shoulder tightness.

Summary:

If you have neck pain and you aren’t certain of the causation/origin, see your doctor and rule out red flags.

X-rays are helpful in assessing the state of your cervical spine (alignment, disc spacing, bone density, abnormalities, level of decay).

Countering anterior weight bearing/ forward head posture, strengthening the neck muscles, improving your cervical curvature, stretching your leg muscles and strengthening your core will improve your posture and reduce strain and pain to your neck.

Chronic Neck Pain or Stiffness? Get Your Neck Curvature checked

by Pain Doc | Feb 27, 2015 | Neck Pain

The cervical spine is the thinnest and most flexible part of the human spine. It is tasked with supporting the weight of the head in the upright position while allowing turning in multiple planes — looking left, right, up, down and behind. It also contains structures directly tied to life sustenance, which is why the neck is a logical target when it comes to martial arts/ self-defense and restraint (and unfortunately, murder).

Given all these vital functions, it is wise to take good care of your cervical spine in a proactive way.

The cervical spine is naturally designed to curve, where the apex is at about the level of the Adam’s apple.

This curve behaves much like a spring in a car’s suspension; or the slight upwards curve you see in any bridge design. Long ago, architects discovered that the load capacity of bridges could be dramatically increased simply by integrating curves or arcs into the design. Like a neck curve, a bridge curve or arc distributes weight over a greater area so that gravity cannot concentrate over one small area and cause structural failure.

neck_xr_flat If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?

If you lose your cervical curve over time, which could happen from years of poor posture or trauma like multiple rear-end car collisions, you will probably not notice it until several years pass. The change in biomechanics shifts a greater burden of support to your cervical discs and vertebral end plates. This promotes disc degeneration. The once thick and healthy discs lose fluid content, lose strength, allow the center material to bulge out (herniate, protrude or rupture) and cause bony protuberances called osteophytes to form all around the edges of the vertebrae and facet joints.

For some unfortunate people, the bony projections narrow the passageways where the nerve roots and spinal cord pass through (a condition called spinal stenosis) and neck surgery is necessary to prevent nerve tissue from permanent damage, paralysis and severe paresthesias (numbness, tingling) in both the arms and legs.

So the bottom line: be conscientious about the importance of the health of your cervical spine. Don’t get blind-sided by an MRI diagnosis of “multiple-level, severe degenerative disc disease with advanced neural encroachment.”

I’ve seen such cases where patients were oblivious to what was developing inside their necks. They dismissed their neck stiffness and aches to “getting older” or simple muscle strain. When massage and chiropractic provided only temporary relief, they had a cervical MRI done which revealed the formidable origin behind these symptoms, and the next step was neck surgery. Neck surgery of this nature involves removing the damaged disc, shaving off the osteophytes and inserting a bone graft to promote fusion of adjacent vertebrae.

Prevention is the best approach. You don’t have to have neck problems to start preventive measures. In fact, the vast majority of patients who have early to moderate stage degenerative disc disease have no complaints. It’s like a cavity — you don’t feel anything as the pit erodes the tooth enamel, but as soon as it hits a nerve, you will definitely be aware of its presence. But by that time, you’ll need invasive procedures. In the case of a cavity, it means either a filling or tooth extraction; in the case of a cervical disc, it might mean cervical decompression surgery.

Below is a video that summarizes the importance of maintaining a healthy cervical curve (“lordosis”) and exercises to maintain or restore your neck curve so that it can better withstand the physical demands placed on it and hopefully preclude the need to visit an orthopedic surgeon years down the road.

Also, make sure to check out this site’s Self-Care for Neck Pain video, which demonstrates home care procedures for managing musculoskeletal neck pain and/or stiffness.

Try This Device for Improving Neck and Shoulder Stiffness

by Pain Doc | Jun 19, 2014 | Neck Pain

Do you experience neck pain or stiffness? Tension headaches?

Do your upper shoulders feel like bricks and have tight, sensitive knots as big as golf balls?

Any pain, strain or weakness in your upper back between your shoulder blades?

If so, you likely have Anterior Weight Bearing of the head, or Forward Head Posture.

Appearance is the least of your worries when it comes to poor posture.

Yes, people tend to look much better when standing up straight and confident as opposed to looking like Quasimodo in his advanced years. But looks are not the main problem with a slouched posture.

You see, posture has a direct impact on your breathing quality. If your rib cage and spine are hindering your diaphragm movement and lung expansion, then your breaths will be more shallow. You’ll be getting less oxygen to your muscles and organs; you’ll expend more effort breathing, and you will likely feel fatigued more often than not.

On average, a person at rest takes about 16 breaths per minute. This means we breathe about 960 breaths an hour and 23,040 breaths a day! That’s a lot of energy expenditure, which is hindered by poor posture.

Anterior weight bearing of the head, unfortunately, is very hard to avoid. Because your eyes are in front of your body and not in the back of your head, you naturally flex your neck forward to focus your eyes on what you are doing. This means bending your neck forward as you look at a computer monitor, when reading a book, or when doing just about every activity of daily living: brushing your teeth in front of the mirror, working on a hobby, playing with your children and so on. All these activities will cause you to bend your neck forward.

bad-spine

Bad posture can lead to advanced arthritis and spine decay.

Your spine, when viewed from the side, has curvatures that work like springs on a car’s suspension system. They dampen shock to the spine. Do you know that the simple act of walking puts significant forces into your spine, thanks to gravity? If you are a runner, those forces are multiplied exponentially.

In a strong, healthy spine, these forces are adequately absorbed by the curves, discs and supporting soft tissues. If you have lost some of your spinal curvatures, then the forces generated from walking, running, jumping, and yes, sitting are not going to be dispersed as well and your delicate joint surfaces will have to bear more of this burden. Over time, this can make your spinal segments look like the one below (left spinal segment):

Spinal degeneration occurs mostly in the neck and lumbar spine.

Your neck and lumbar spine are where the nerves that go to your arms and legs branch out from, so adverse alterations to these areas can lead to symptoms in your extremities: pain, numbness, tingling or weakness.

With forward head posture, your head, which weighs 10-12 pounds translates several inches in front of the spinal axis. This creates a “moment force” that is placed mostly on the back neck muscles, upper shoulder muscles and cervical discs.

To get an appreciation of this, imagine balancing an eight pound shot put in your hand, with your wrist bent and your elbow resting on a table; forearm pointing straight up supporting the shot put. It takes little effort to keep that shot put steady.

Now, while still holding the shot put, straighten your wrist and flex it forward so that the shot put is no longer in line with your wrist and forearm (analogous to forward head posture).

All of a sudden, this shift in weight changes everything: your forearm muscles tense up (analogous to your spinal muscles) and your wrist will soon experience strain (analogous to your neck muscles).

This is what happens when the center of gravity of your head moves even just a few inches forward of your spine (reference point at the base of your neck).

Here I illustrate this using a therapy weight pad:

wrist1

Normal neck curve = strong biomechanics and support, while…

Flattened or reversed neck curve = poor biomechanics and tissue strain

If you have persistently bad posture; especially forward head posture, you are setting the stage for problems. Abnormal stresses to the spine weakens discs, ligaments and cartilaginous surfaces. This is the recipe for spinal decay and increased chance of spinal cord or nerve root impingement.

So if you have forward head posture, start doing exercises that strengthen the back of your neck muscles; stretch shortened, anterior (front) neck muscles, and strengthen your lower back muscles and core. It also helps to stretch shortened muscles in your legs and pelvis that might be restricting your lumbar spine of proper movement. More on this later.

So what do you think? Do you do any exercises and stretches to improve your posture? Let me know!

Dr. P

What Should You Do For Neck Pain?

by Pain Doc | Jan 8, 2012 | Neck Pain

A recent study in the Annals of Internal Medicine compared the effectiveness of chiropractic spinal manipulation, pain medications, and home exercise and advice in treating biomechanical neck pain.

The study participants were 272 people between the ages of 18 and 65 who complained of non-specific neck pain for 2-12 weeks. They were divided into three groups, one of which took medicine only; one which received spinal manipulation to the neck only, and a third group that was just given home exercises and self-care advice. Participants were asked to rate their pain at 2 weeks, 1 month, 2 months, 3 months, 6 months, and one year. The method the study used to grade the pain was subjective rating (probably using a visual pain scale between 0 to 10, with 0 being no pain and 10 being the worst pain) and a Health Status questionnaire asking them their level of ability to engage in certain activities.

The patients treated by a chiropractor experienced the highest rate of success with 32 percent saying they were pain free, compared to 30 percent of those who exercised. Only 13 percent of patients treated with medication said they no longer experienced pain.

The conclusion of the study was that for participants with acute (recent onset) and subacute (usually meaning lasting more than two weeks) neck pain, chiropractic spinal adjustments were more effective than medication in both the short and long term. However, a few instructional sessions of home exercises and advice resulted in similar outcomes at most time points.

My comments:

Biomechanical neck pain can lower the quality of life significantly. Imagine having to struggle to turn your neck all the time, and having to avoid exercise, sports and many recreational activities due to neck pain. According to the researchers, neck pain affects 70% of adults at one point in their lives.

From my experience, biomechanical neck pain typically arises from some type of past trauma, and it doesn’t have to be major. Examples include car accidents, sports injuries/impacts, horseplaying as kids; and hard impact generating activities such as running, horseback riding, parachuting, gymnastics, boxing, martial arts, and cheer leading.

A second, possible cause of biomechanical neck pain is ergonomic in nature; meaning, related to positioning of the body. Long hours of desk work keeps the head relatively stationary (static) in a single position, allowing gravity to pull down on the head, over time altering the weight distribution on the joint surfaces of the bones that make up the neck. Such an “activity” also promotes muscle deconditioning around the neck. The term “deconditioned” means that the muscle is slower to respond to nerve commands, so it loses some ability to support, guard and protect the cervical spine (neck).

The worst combination is someone who has a history of impact trauma to the neck who later gets a job that involves working at a desk for long hours at a time. The trauma history sets the stage for neck pain, and the static positioning of the head accelerates the process over time.

The pain in biomechanical neck pain frequently originates in the joint surfaces of one or several cervical vertebrae, commonly the posterior facet joints (also called the zygapophyseal joints). This is where most of the movement occurs when turning and bending the neck. Orthopedic surgeons sometimes prescribe a facet block for neck pain, which is an injection of pain medications directly into the joint, usually guided by video fluoroscopy. If the patient has degenerative disc disease, pain can emanate from the intervertebral discs, either as a disc herniation or internal tear of the disc. If this is the case, neck surgery is typically the last hope. The disc herniation may be able to be reduced by surgery, but if the surgeon feels that the disc is beyond repair, discectomy (total disc removal) with surgical fusion is usually performed. However, this is like trading one evil for another. Surgeons know that when you fuse two vertebrae together, the vertebrae above and below the fusion bear an increased burden of providing the movement lost by the two fused vertebrae. This will lead to accelerated degenerative changes to those areas as well, over time.

Neck pain can also emanate from the surrounding muscles and fascia. Myofascial trigger points are focal, tender spots along a muscle that are believed to develop from trauma or microtrauma. They may actually be a concentration of nerve endings on the muscle that developed following an injury. These are best handled through manual therapies such as chiropractic, massage, exercises and stretches.

Some people get inexplicable muscle spasms of the neck. This is usually accompanied with a migraine or tension headache. A muscle spasm occurs when the nerves that control the muscle misfire, causing the muscle to maintain a constant state of hypertonus (involuntary contraction). This results in muscle pain, fatigue and low grade inflammation. Sometimes the spasm can be so intense that anti-spasmodic medications, ice, heat, and rest have no effect. In cases like this, botox injections are sometimes used. Botox injections are comprised of a weakened strain of the Botox bacteria, which has the effect of muscle paralysis.

Lastly, it should be mentioned that a poor, nutrient-deficient diet and smoking can make neck pain worse by denying the body critical nutrients needed for repair and maintenance of muscles, ligaments, tendons, nerves and bones.

The study, while emphasizing that chiropractic manipulation was superior to medications in reducing neck pain among participants, also mentions that home exercises and advice were just as effective. It therefore seems natural that a combination of spinal manipulation and home exercises would be a good strategy to reduce or eliminate biomechanical neck pain.

If you are experiencing non-specific neck pain (don’t really know what caused it) for over two weeks and desire to try chiropractic, it’s important to choose a good, qualified chiropractor. Some of the signs of a good, reputable chiropractor are:

1. Doesn’t try to convince you to purchase a long-term treatment program involving multiple adjustments per week.

2. Asks you about your complaint: the nature of your symptoms, how they started, how long you’ve had these symptoms, how they affect your ability to do certain things; and questions regarding your general health.

3. Gives you his/her diagnosis and uses standard orthopedic terminology that is consistent with what you are coming in for (doesn’t go off subject). It meshes with the information you provided in #2 above. You feel that the chiropractor listened to you, and responded with a meaningful solution that is clear to you.

4. Gives you a treatment recommendation the same day: the type of treatment and a brief description of it (spinal adjustments, modalities, supports); what to expect from the treatment, and approximately how long it will take. The chiropractor should also disclose potential risks and side effects of the treatment. In my opinion, six treatments followed by a re-evaluation is a sensible treatment approach for most cases of subacute, musculoskeletal pain.

A chiropractor like this may or may not have a lot of reviews on the internet. Use your judgement, ask friends and co-workers for referrals, and by all means, don’t be afraid to change chiropractors if your first choice turned out to be bad.

Regarding home exercises and advice for treating biomechanical neck pain, stay tuned! I will be putting up an information-packed neck pain relief video on this topic shortly.

Questions to Ask Your Doctor About Neck Pain (everydayhealth.com)
Why Do I Have Neck Pain? (everydayhealth.com)

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