Neck Pain Booklet Westminster.pu

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					          Advice for
                                                Advice for
          Neck Pain
                                                Neck Pain

                                                Physiotherapy Outpatients Department
                                                        Westminster Memorial Hospital
                                                                     Magdelene Lane
                                                                      Dorset SP7 8BD
                                                            Telephone: 01747 - 475261
                                                                  Fax: 01747 - 475242

                                                     Claire Pitts MCSP Grad. Dip. Phys.
                                                                 Senior I Physiotherapist
                                                       Westminster Memorial Hospital
Leaflet: Neck Pain / 449   Updated: June 2004
INTRODUCTION                               2
THE HUMAN SPINE                            3
CAUSES OF NECK PAIN                        4
POOR POSTURE                               5
CORRECTING POOR POSTURE                    6
    a) At work                             6
    b) In the car                          7
    c) At home                             7
    i)   Sitting                           7
    ii) Sleeping                           7
    iii) Household chores                  9
    For your neck                          9
    For your upper back                   10
    Stretches                             11
    Hold-relax exercises                  12
CONCLUSION                                14


This booklet is designed to make you more aware of the causes of
neck pain and gives you advice and exercises to follow that may help
to relieve your symptoms and improve your function in everyday life.

It is important, however, to follow the guidance of your physio-
therapist as some of the exercises may be too advanced or
unsuitable to your individual neck complaint.

2                                                                      15
CONCLUSION                                                                THE HUMAN SPINE

I hope that by now you have a better understanding of the various         Your spine is made up of vertebrae - bones that are stacked one on
causes of neck pain and have found some advice or exercises that          top of the other - there are 7 in the cervical spine, 12 in the thoracic
will be of benefit to your particular neck complaint.                     spine and 5 in the lumbar spine.

As we are all individuals, everyone's symptoms will be different, so be        Regions of the spine
guided by your physiotherapist as to which exercise you should be                                                     7 cervical vertebrae
doing and at what level. Make sure you inform him / her of any
changes that may have occurred in your symptoms at your next
appointment, so that your treatment can progress safely.                                                             12 thoracic vertebrae

                                                                                                                      5 lumbar vertebrae

                                                                          In between each vertebra, there are discs of cartilage which act as
                                                                          shock absorbers and allow movement, as their shape can alter. The
                                                                          vertebrae are held together by ligaments; tough bands of fibrous
                                                                          tissue that prevent excessive movements.

                                                                          At each vertebral level, there are also two spinal nerves that emerge
                                                                          from gaps between the vertebrae. These supply your head and arms
                                                                          with sensation and muscle power. There are also small joints in the
                                                                          neck called "facet joints", which form overlaps between the vertebrae
                                                                          and allow them to connect and move on each other.

                                                                               Spinal anatomy
                                                                                                    process                vertebrae


                                                                                                facet joint                   process

14                                                                                                                                              3
CAUSES OF NECK PAIN                                                    This same principle can be applied to the rotational and forward
1.) Muscle Strains                                                     bending movements of your neck, as the diagrams below
The muscles in the neck can be strained like any other muscle in the   demonstrate.
body and usually take a few days to settle. The pain is usually
localised to one muscle and increases when that muscle is made to          Hold-relax exercise to aid neck rotation
2.) Ligament Sprains
The ligaments holding your vertebrae together can be overstretched
by sustaining one position for a long period, or torn due to sudden
force, as often happens in whiplash injuries. These can take from a
few days to a few weeks to settle depending on the severity of the
3.) Facet Joint Problems
The small joints in your neck can become irritated either by trauma,
through overuse or due to arthritic changes affecting the joint
surfaces. This sort of problem often causes stiffness and / or             Hold-relax exercise to aid neck flexion
restriction in movement as well as pain.
4.) Disc Prolapse
The cartilage disc may become disrupted and its softer centre can
bulge out to one side, creating pressure and therefore pain on its
surrounding structures. The onset of this condition is sudden and
often results from some form of trauma, such as a blow to the head
or neck. Movements are most likely to be restricted in certain
directions by sharp pain.
5.) Trapped Nerve
The nerves emerging from the vertebrae in the neck can become
squashed by their surrounding structures, for example, by the
swelling around an inflamed facet joint or by the bulging of a disc.
This nerve impingement can often cause arm and hand symptoms
such as pain, numbness, tingling or pins and needles. If the problem
is at a high spinal level, headaches, visual disturbances and
dizziness may result.
6.) Poor posture
Poor posture often leads to long-standing or recurrent neck problems
and can hinder the recovery of other neck complaints. Postural
symptoms usually present as dull aching pains across the neck and
shoulders which often appear gradually over a number of days or
weeks. The problem can be precipitated by a change in job or
lifestyle that forces you into new and possibly awkward positions.
4                                                                                                                                   13
Hold-Relax Exercises                                                     POOR POSTURE

Sometimes stiffness can be caused by tightness in your neck              Pain and discomfort experienced in your neck often comes from
muscles. This can be helped by hold-relax exercises. The principle of    ligaments and soft tissues that have been over-stretched and by facet
these exercises is to work the tight muscle first and then stretch it.   joints which have become stiff. Neck pain is not always caused by a
This helps to increase the length of the muscle more effectively than    specific injury; it can come on gradually due to poor posture.
stretches alone.
                                                                         Poor posture can go un-noticed for short periods, but when sustained
For example - side bending may be restricted by a tight muscle on the    for long periods, the traumatic effects accumulate and symptoms
opposite side of the neck.                                               become apparent. The only effective long term relief from posture
                                                                         related pain is achieved by correcting you body alignment. This can
     Side-bending restricted                                             be done by adapting your work or home environment and performing
     by tight neck muscles                                               postural exercises on a regular basis. Here are some examples of
                                                                         good and poor posture - exercises can be found on pages 9 and 10.

                                                                              Poor sitting posture              Good sitting posture
                                                                                             over extension
                                                                                             of the cervical                   cervical lordosis
To work the tight muscle, you put your hand against your head on the
same side as the tight muscle and push you head into your hand,                              spine
                                                                                                                               thoracic kyphosis
then apply pressure against your hand with your head so that your                            increased
head doesn't actually move. Push for a count of 3 and then relax.                            thoracic curve                    lumbar lordosis
                                                                                             no lumbar
Once the muscle has been worked, you now stretch your head to the                            lordosis
opposite side, encouraging the muscle to lengthen out, again holding
for a count of 3.
                                                                         Poor posture (left)
     Hold-relax exercise to aid side bending                             The back is allowed to become rounded, eliminating the lumbar
                                                                         lordosis and excentuating both the thoracic kyphosis and cervical
                                                                         lordosis. If sustained, this position causes the joints at the back of the
                                                                         neck to squash together and the ligament and joints of the thoracic
                                                                         spine to become over-stretched. This is known as the "jutting chin"
                                                                         Correct Posture (right)
                                                                         The three main curves of the spine are maintained. The cervical
                                                                         lordosis (inward curve), the thoracic lordisis (outward curve) and the
                                                                         lumbar lordosis. It is important that these curves are present both
     Make the muscle work….      ….then stretch it when it relaxes
                                                                         when standing and sitting, as our spines are strongest in this posture.
12                                                                                                                                                 5
CORRECTING POOR POSTURE                                                     EXERCISES TO HELP RESTORE MOVEMENT

1.   MAKE ADAPTATIONS TO YOUR SURROUNDINGS                                  Stretches
a) At work
Many people these days have sedentary jobs working at computer              The following simple exercises are designed to help you regain lost
screens or word processors. In order to work in an optimum position,        movement in your neck, or maintain movement that you may have
the relative height of your chair and desk must allow you to work at        gained during treatment. If stiffness is your main symptom, you are
waist height, so that you are not having to stoop. It helps to have an      safe to do all the exercises below and to use your hands to apply an
adjustable chair where height and back support position can be              extra stretch. When exercising, do be careful not to bounce or jerk the
changed. In addition, a lumbar cushion can automatically improve            stretch, as this can damage the small joints in your neck, but apply a
upper back and neck posture.                                                firm and even pressure with your hand and hold for the count of three.

If your work involves a lot of writing or drawing, you may find a writing   If you have pain exercising, you need only stretch to the point where
slope also improves upper body position. A paper work stand can be          your pain begins. If in doubt how far to push yourself, ask the advice
useful in preventing repetitive up and down movement of the head but        of your physiotherapist.
most importantly, make sure that frequently used equipment is to
hand to avoid twisting and over-reaching where possible.
                                                                                 Neck stretches with over-pressure
If you work at a bench, again try to ensure that you are working at
waist level, by either raising the bench or standing on a small block.                  1) Extension

     Poor working                            chin jutting forward
                  rounded back
                    - no natural                                                        2) Side Flexion
                   spinal curves
                                                           too low
               chair too low
                                                                                        3) Rotation
     Good working
     posture                                        stand for paper
                                                    work to stop
       lumbar roll                                  repetitive neck
          keeping                                   flexion                             4) Flexion
     spinal curves
                                                    desk at waist
       adjustable                                   height
      chair height

6                                                                                                                                               11
For your upper back                                                            b) In the car
                                                                               Alternatively, your occupation may involve long periods on the road.
Your upper back can easily adopt a rounded posture when sitting or             Although many modern car / lorry interiors seem comfortable, it is
standing for long periods and this too needs to be corrected to relieve        still important to be aware of your back position. The simple and
stress on joints. The following exercise may help:                             effective use of a lumbar roll can improve your spinal curves and a
                                                                               seat wedge or cushion can help to reduce an awkwardly sloping seat
       Slump and over-correction exercise                                      that could encourage rounding of your lumbar spine. When reversing
                                                                               it is worth while taking the time to undo your seat belt momentarily to
              1)              2)                  3)                           enable you to move your entire upper body and not just your neck.
                                                                                    Poor driving posture              Good driving posture

                                                                                                      jutting chin due lumbar roll            corrected
                                                                               rounded                to increased      helping to            neck and
                                                                               back - no              neck extension keep                         head
                                                                               lumbar                                   lumbar                  posture
                                                                               lordosis                    seat too     lordosis
                                                                                                           close to
                                                                                                           pedals seat wedge
                                                                                                                     maintaining back posture
               slump head          exaggerate          relax
               to knees            good sitting        a little                c) At home
                                   posture                                     Relaxing at home is often a weak point when it comes to looking
                                                                               after your posture.
i)     First adopt a very poor sitting posture, slumping your head                   i)   Sitting - when resting in an easy chair, it is still important
       towards your knees and forming a complete "C" shape with your                      to use a lumbar roll to stop your shoulders from rounding
       back. (Imagine you have been punched in the stomach).                              and your chin dropping to your chest. Ideally, rest with
ii)    Next, straighten yourself up, lifting and retracting your head,                    your head supported backwards against a pillow.
       pushing your chest forwards, hollowing your lower back and                    ii) Sleeping - often people with neck problems will wake with
       pulling your shoulder blades down and together, achieving an                       pain and / or stiffness in the mornings and possibly during
       exaggerated, over-correct sitting posture.                                         the night. This can be eased by supporting your neck
iii)   Finally, allow yourself to relax back just a little and you will have         The first thing to alter may be your pillow. Ideally, pillows need
       achieved a perfect sitting posture.                                           to be made of material that will mould to the contours of your
                                                                                     head and neck, such as feathers or chopped foam. Pillows
These two exercises are important and should be practised regularly                  made of blocks of foam can be too rigid. One pillow should be
whenever you find yourself having to sustain a posture for a long                    adequate when sleeping on your back, but when on your side,
time. They will feel awkward at first, but will become easier and more               two pillows are usually necessary to fill the gap between the tip
comfortable. Doing these exercises on a regular basis will help to                   of your shoulder and your neck. Too many pillows and your
improve your posture and relive the pain of postural strain.                         head will be jacked up too far. Too few pillows and the support
10                                                                                                                                                     7
will be inadequate. In either situation, one side of the neck is                  iii) Household chores - many daily activities can be made a
stretched while the other is compressed, causing possible pain a n d                   little easier on your neck if you stop to think.
stiffness on waking (see diagrams below). Also, try to avoid sleeping             Shopping:         *    use a trolley in preference to a hand basket
on your tummy with your head turned to one side.                                                    *    carry shopping bags evenly to spread the
       Too many pillows                                                                                  weight across your shoulders
                                                                                                    *    avoid overloading yourself - buy less and
                   The neck is forced                                                                    shop more often if possible
                   into side flexion and    Ideal head support                    Ironing:          *    try sitting with the board at waist level
                   joints are forced                                                                *    limit yourself to short periods
                   together causing                                               Washing:          *    pick up half the load of washing at one time
                                            Neck is maintained in a
                   discomfort                                                                       *    lower the washing line when hanging
                                            neutral position - joints
       Too few pillows                                                                                   clothes to dry, to prevent having to strain to
                                            are not stressed
                                                                                                         look up
                    head does not have                                            Hoovering:        *    limit yourself to short periods
                    enough support so                                                               *    delegate to another member of your family
                    side bends to the                                                               *    try to stand as tall and straight as possible
                    other side, again
                    causing discomfort                                       2.   CORRECTIVE POSTURAL EXERCISES

When experiencing acute pain, the most comfortable position to lie in        For your neck
is on your back with a well supportive pillow. To adapt your pillow, you
can shake the middle out of a feather pillow so that it becomes              There is an exercise that you can do to help correct your head and
"butterfly" shaped and rest your head in the hollow with the bulky           neck alignment and teach yourself good postural habits. It is called a
"wings" supporting either side of your head. Alternatively, roll up a thin   chin tuck or "retraction" exercise.
towel and place it inside the pillow case along the bottom of a flattish
pillow so that it moulds to the hollow of your neck.                              Retraction exercise in sitting
       Butterfly pillow                                                                   (a)                                  (b)
                                                     rest head in hollow
    shake feathers                                   - the bulk of pillow
    out of centre of                                 either side will help
              pillow                                 keep your head still

       Rolled up towel pillow                         pillow maintaining     To perform the exercise, you sit tall, looking straight ahead and slide
                                                      cervical lordosis      you head back on your neck, giving yourself a double chin. Care must
     rolled towel                                                            be taken not to drop your chin or raise your nose during the exercise
          placed                                                             as this will alter its effectiveness. At first, it will feel most strange and
    inside pillow                                                            possibly even sore, but this is because it is a new movement and your
                                                                             joints are out of practice.
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