Saanichton Physical Therapy Blog

Upper Back and Neck Pain

Upper Back and Neck Pain

Upper back and neck pain

 

Firstly, I want to be clear as to the type of problem we are talking about. This is an aching pain and muscular tension in the upper back and neck which is not due to a specific injury. It is most common in office and desk based workers and sometimes drivers who are sat in one position for extended periods.

If your neck pain is more severe such as a sharp, stabbing pain on movement or causes neural symptoms like tingling or numbness into the arms or hands then we recommend you seek medical attention. Similarly, if your neck pain has occurred after an initial injury or event such as a car accident or fall, we recommend visiting your Family Doctor or Physical Therapist.

As a sports physio, upper back and neck pain forms a large part of my workload. In fact, I would say that it is the most common problem I see. It is certainly far more common in my clinic than lower back problems, which may come as a surprise to many.

The reason for the vast majority of these problems is poor posture. This is especially true for those who spend their days sat at a desk. To fully understand why poor posture causes upper back and neck pain and how it should be treated, we need to understand the anatomy of the region.

Neck anatomy

When we refer to the neck we are talking about the cervical spine. This is the uppermost section of the spine which consists of 7 vertebrae, starting with C1 at the base of the skull, down to C7 which can be felt as the bony prominence at the base of the neck.

The main functions of the neck are to support the head and allow us to rotate, tilt and nod the head. The head is surprisingly heavy, weighing in at around 4-5Kg. Just holding this large, heavy orb on top of a relatively thin structure (the neck) is quite a challenge and places a lot of demands on our neck muscles.

There are many small muscles in the neck, deep and close to the spine. These help with small movements and stability. The larger muscles which we can see and feel tend to be the ones which we associate with being ‘tight’ and achey. These muscles almost act as guy ropes on the neck to hold the head upright. They attach to the bony areas around the shoulders such as the scapula and collar bones and course upwards to attach either to the upper C spine or the skull. Examples of these muscles include upper trapezius, levator scapulae, and sternocleidomastoid.

The muscles at the back of the neck are responsible for extending the neck and head (moving it backwards) and many also help rotate and tilt the head. The muscles at the front of the neck perform neck and head flexion (bending the neck forwards) and allow us to nod our heads. Several also help with rotation and tilting.

Poor posture

Poor posture is frequently blamed for numerous injuries and pain problems. I honestly believe there is no injury where this is truer than in the case of upper back and neck pain. In other injuries, there are often other factors and posture is just part of the problem (for example lower back pain). But in this case, it is often the sole issue.

So, what do we mean by poor posture? This is basically anything which varies from the ideal, perfect position. The most common problems for those desk based workers with upper back and neck pain include:

  • Retracted scapulae – the shoulder blades tilt and move forwards around the back (away from the spine).
  • Excess neck flexion – the neck is bent forwards, often due to straining to see a computer screen.
  • Chin poke – this refers to the chin jutting forwards rather than being tucked in.
  • Scapula elevation – the shoulders are lifted up, either due to the desk being too high, chair being low or stress causing us to hunch the shoulders.

What happens when these postural positions are maintained for any length of time is that the muscles responsible adapt to make this normal and to reduce the stress placed on them. Muscles in a shortened position (such as the chest muscles and upper fibres of trapezius) become more permanently shortened and ‘tight’. Muscles in a lengthened position often become weak and allow other muscles to do their job. Examples include the deep neck flexors and scapula stabilisors such as lower trapezius and serratus anterior

Neck pain starts to develop in response to certain muscle groups becoming tight and overworked. The most common examples include the upper Trapz, Levator scapulae, Rhomboids, Sternocleidomastoid and Scalenes. The position of the neck may also place stress on additional structures such as the ligaments which support the C spine.

Treatment mistakes

Many people will allow neck pain like this to linger on for a long, long time before they do anything about it. It may only be when other symptoms such as aching or weakness spreading into the arms or tingling in the finger tips develops that they decide enough is enough.

What most people will do is head straight for a massage and blame ‘stress’ for their neck pain. Whilst stress can be a contributing factor, it is rarely the only factor. A relaxing massage might help temporarily; a deep tissue or sports massage may have slightly longer benefits, but in both cases it doesn’t address the cause of the pain and so it will only return.

What both patients and therapists need to address is the muscle imbalances and postural issues which caused the muscle tension in the first place. There are some very simple but effective exercises which can be performed to help correct these imbalances.

Treatment methods such as massage and acupuncture can help to ease muscular tension and stress and contribute to correcting muscle imbalances and treating active trigger points. But they should not be the only form of treatment.

Education

The most important step in treating upper back and neck pain is to understand why you have this pain and what you are doing in order to try and correct it. When you understand this, it makes performing your exercises correctly and remembering about your postural corrections and desk set-up easier.

As touched on in part one, most of these neck pain conditions are due to posture issues and muscle imbalances. The most common scenario is that the patient has rounded shoulders caused by tight chest muscles and weak scapula stabilisors, as well as a forward position of the head, caused by weak deep neck flexors and tight posterior neck muscles.

Postural re-education refers to learning about good posture and applying this to your working position. Whilst simply learning the best position for you, and trying to hold this position may help to ease pain temporarily, it is difficult to do and it may result in different muscular aches and pains due to not correcting the muscle weaknesses responsible for the problem. A rehabilitation programme is needed to correct these imbalances.

Strengthening Exercises

As already established the muscle groups which are frequently weak are the scapula stabilisors (Serratus Anterior, lower Trapzius) and the deep neck flexors.

To strengthen the scapular muscles and improve their ability to hold the correct postural position, scapula setting exercises can be used:

  1. Lie on the front with the arms by the sides and rested on the couch / floor.
  2. If a breathing hole is not available, a pillow or rolled up towel should be placed under the forehead so that the head is facing straight down and the neck muscles can relax.
  3. Keeping the neck and arms relaxed, pull the shoulder blades back and together as far as possible. Imagine trying to hold a pencil between the shoulder blades.
  4. Ease off 50%, relaxing the shoulders back towards the resting position. At the halfway point, hold this position for 10 seconds.
  5. Ensure the neck muscles stay relaxed throughout.
  6. Rest and repeat 10 times.

This exercise can be progressed once it is not challenging. The next step is to lift just the hands up off the couch. After this becomes easy, the next step is to lift the whole arms up so they are hovering just an inch from the couch. This adds the weight of the arms into the equation.

To strengthen the deep neck flexor muscles:

  1. Lie on the back with the knees bent.
  2. Imagine a rod is passing straight through your skull, out of each of your ears.
  3. Rotate the head, as if rotating around this rod, tucking the chin into the neck.
  4. Rotate the skull using your hands (by your ears) for a physical cue if necessary.
  5. Hold this position for 5 seconds.
  6. Rest and repeat 10 times.

An additional challenge involves raising the head an inch off the floor once the chin is tucked in. Again hold this for 5 seconds, rest and repeat. Once mastered, this exercise can be performed in an upright position.

Stretching

Where some muscle groups are weak, their opposite (antagonist) group are tight. In most cases, this is the chest muscles (especially Pectoralis Minor) and the posterior neck muscles such as Trapezius and Levator Scapulae.

 Stretching the chest muscles

Stretching the chest muscles can be performed as described here:

  1. Stand in a doorway, with the upper arm horizontal to the floor and the elbow bent to a right angle (like a stop signal!).
  2. Place the front of the forearm against the doorframe.
  3. Lean the body forwards and rotate the body away from the stretching arm, until a stretch is felt in the chest and front of the shoulder.
  4. Hold for 20-30 seconds, rest and repeat.

To stretch the pec minor more specifically:

  • Lie lengthways on a foam roller so the roller goes along the spine.
  • Take one arm out to the side and allow it to relax down to the floor.
  • Hold this position, whilst allowing the shoulder joints to drop down and towards the floor.
  • A small weight such as a wrist or ankle weight or beanbag can be placed on the front of the shoulder to increase the stretch.
  • Hold for 60 seconds and repeat on each arm.

To stretch the posterior neck muscles:

  • Hold underneath your chair to anchor the shoulder down.
  • Bring your chin down to the chest and then take the head over to the side, away from the anchored arm.
  • You should feel a stretch between the neck and the shoulder joint.
  • Hold for 20-30 seconds, rest and repeat 2-3 times on each side.

Postural Taping

Postural Taping can be used in the early stages of treatment to provide proprioceptive feedback about the position of a patient’s shoulders and thoracic spine. Taping tends to be applied from the shoulder blades, over the top of the shoulder to the front. The tape is applied whilst the patient is in an ‘ideal’ postural position with the scapulae retracted and depressed. If the patient strays from this position, the tape pulls on the skin and acts as a reminder.

Soft Tissue Therapy

In part one of this article we commented that many people’s initial response to this form of neck pain is to go for a massage. This can be helpful on a temporary basis when used alone, but if not combined with postural re-education the benefits will be short-lived.

That’s not to say that massage and other forms of soft tissue treatment should not be used. Registered Massage Therapy, trigger point therapy and acupuncture can be very helpful in reducing muscle tension, improving flexibility and de-activating trigger points in the traps, levator scapulae and chest muscles in particular. However, they should form only a small part of the treatment regimen.

Workspace Ergonomics

This refers to the set-up and positioning of your work space In most cases, this means the chair, desk, screen, keyboard, mouse and telephone. A poor set-up can be a major contributor to upper back and neck pain and to developing and establishing poor postures.

Professional ergonomists are often employed by large companies to ensure their staff have a good office workspace. As well as changing the positions and heights etc of workspace components, they may introduce new items such as wrist supports and foot rests.

Even if this is not normal company practice, if you think your desk set-up may be less than ideal, speak to your boss to see if it is possible to get a professional in to have a look. It may even save them money on sick pay for back pain in the long run!

Here are some key points to look out for:

  • Make sure the height of your chair allows you to rest your forearms on the desk when your fingers are on the middle row of the keyboard.
  • Your elbows should be supported by the arm rests and the wrists are straight (not arched upwards).
  • Your elbows should be directly under your shoulders.
  • Keep the mouse as close to you as possible whilst the elbow is supported on the arm rest.
  • Use the hand and fingers to move the mouse, not the wrist or arm!
  • The top of your computer monitor should be at eye level and directly in front of you.
  • Good posture in the upper back and neck starts in the lower back! Ensure you sit with both feet on the floor, with the backs of the thighs on the chair seat and a natural lordotic curve in the lower back (i.e. not slumped).

In conclusion, the treatment approach for posture related upper back and neck pain should be multi-faceted. The main focus should be on correcting muscle imbalances through exercise rehabilitation and looking at desk set-up to address additional aggravators. Massage can play a role in treatment, but should not be used as the one and only form of therapy.

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Steps to Success- Running and Walking tips

Steps to Success- Running and Walking tips

By: Dr. Scott Simpson, Physiotherapist

 

Forward we go!

 

“We keep moving forward, opening new doors, and doing new things, because we’re curious and curiosity keeps leading us down new paths”  Walt Disney

 

Running is a simple sport, but it’s clearly not easy- this is what makes it such a great challenge. I’m a strong believer in doing preventative independent exercises as a means building a strong foundation. They are free, relatively easy and specific to the task of running. In my opinion this is the best way to fine tune your body for success. Lets break these foundations down a little- so we can build them up!

 

Firstly, we want to harness as much of our energy as possible in the forward direction. Energy that is spent on vertical, lateral or torsional movement slows us down and makes us more susceptible to injury.

With this in mind, we all have unique running styles, but when running, we want to move forward efficiently. Secondly, we want to ensure that all of the joints in the body have adequate range of motion, strength and stability. Most injuries that occur while running are repetitive strains and do not typically happen in isolation. In other words we can’t simply treat an injury, to a knee for example, we have to treat the individual’s movement pattern, because it might well be that something happening through the foot or hip, the knee problem.

 

 

Let me give you an example. How about I ask you to stand on one foot. Now close your eyes to take away all those visual cues. My guess is that you will feel vertical, lateral and torsional movement through your foot and ankle. This exercise would be considered a stability exercise. Since we know that these forces predispose us to injury, and that these stresses are magnified when we run, this is a very good exercise to practice. In fact, studies have shown that practicing standing on one foot with your eyes closed can help prevent ankle sprains. It all happens because there is that split second when your foot hits the ground and either you roll your ankle, or you catch it. By doing these exercises you train your body to reflexively know where your foot is relative to the ground, and thus stand a better chance of preventing the ankle sprain.

 

 

Now lets move further up the chain and visualise the knee. Anatomically, the knee is classified as a hinge joint. In other words, we are only supposed to bend it in one plane of movement- in fact we have a slew of structures that prevent it from moving in any other direction. If these structures have to work too hard they get upset. Essentially, we want our knee to track over our second toe providing movement exclusively in a forward direction. Torsion and lateral movement are the knees biggest enemies, and can lead to problems like runners knee, patellar tendonitis or IT band syndrome. So here is a good strengthening exercise to reinforce this movement pattern. Stand on one leg and try to bend your knee over your second toe. It’s not as easy as it sounds! You will feel those force enemies in action. A lot of you will feel your knee twist inwards towards your midline- this typically demonstrates a lack of strength in both the thigh and hip musculature, making us more susceptible to the aforementionned problems.

 

My third example would be to consider the effects of too much range of motion. For this one we will look at our mid section. I’m quite sure you will agree with me that when we run we move our lower extremity and opposite upper extremity in unison.It’s called the reciprocal gait pattern. With this in mind, we have a counterbalance system with the mid section being the zone where forces are transferred. If we have excessive movement through our upper extremity there will be an equal yet opposite force through your lower extremity. Try this, stand with your arms at your side, elbows out. Try an exaggerated wide arm swing. How does it feel on your back, hips, knees, ankles, even your feet? This is excessive motion that can lead to injury. Now try this – keep your elbows tight to your body and have your thumbs up. Move your forearms on forward plane. How does this feel on all those areas I mentioned before? Big difference eh. What’s one of the biggest causes of back pain? Twisting or torsion. It’s a lot better to prevent back pain through proper exercise, becoming self sufficient, rather than becoming dependent on treatment.

 

 

So to sum all of this up- we always want to think about the direction of movement. I’ve never been in a race that is measured in a vertical distance, or sideways, or twisting for that matter. You want to harness as much of your energy as possible in a forward direction. Above I have emphasized exercises that promote proper stability, strength and range of motion. Of course, considering we all have different running styles, there are many other specific complementary exercises that can be performed for specific weaknesses. If you can master these concepts however, you will be much less likely to get injured and you will also be able to move more quickly in the right direction.

 

Henry Ford once said “If everyone is moving forward together, then success takes care of itself”

 

Enjoy finding your path to success!

 

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Walking and Running Programs

Running and walking are both great ways to stay in shape and keep fit. If you are new to running or are starting to walk for exercise after an illness, it’s best to work with your physiotherapist to develop a program suited for you that includes warm up and cool down stretches to help prevent injury.

If you feel pain during or after running or walking, a physiotherapist can help.

 

1. Proper footwear is essential for walkers and runners.

The proper shoe can help maximize your efficiency and minimize your risk of injury. Try on many then select the shoe with the best shape for your foot. Your physiotherapist will assess whether arch supports or custom orthotics are necessary to improve your gait.

 

2. Start off slowly and build up your strength.

If you have been injured or are new to walking and running, follow a graduated program to help build your body’s tolerance to the stresses of running and walking. Too much too soon can cause re-injury and unnecessary soreness.

 

3. Walkers and runners are prone to overuse injuries.

These are often due to imbalances in strength and flexibility that you can correct through therapeutic exercises. Your physiotherapist can create a program designed specifically for you.

 

4. Choose walking or running to prevent osteoporosis later in life.

Weight bearing exercise provides controlled stress to your bones, helping to improve or maintain bone density. Your physiotherapist can help you develop a program specifically designed to maximize your bone health.

 

BC physiotherapists are the most physically active healthcare professionals in Canada and the ones physicians recommend most.

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Shoulder Pain

Shoulder Pain

Shoulder Pain

Shoulders happen to be extremely prone to injury since the ball of the upper arm is larger than the socket that holds it. This results in many problems such as sprains, strains, dislocations, rotator cuff tears and frozen shoulder.

If you have shoulder pain or suffer an injury to your shoulder, seek the advice of a physiotherapist early on to determine the exact nature of your problem. Early treatment for shoulders can result in a faster and better recovery. Be mindful however, that some shoulder problems require surgery, and professional guidance is essential during your recovery. A physiotherapist can help you avoid common complications after surgery, restore your strength and flexibility and get you back to your activities as quickly as possible.

1.Get in balance.

The shoulder joint needs the perfect balance of strength and flexibility to keep it in great shape and injury free. Your physiotherapist can assess your movement and show you how to strengthen the rotator cuff to keep the shoulder positioned optimally in the joint to prevent improper mechanics while moving the arm.

2. Correct poor postural habits.

Improving your movement, strengthening your shoulder muscles, and correcting poor postural habits can improve your shoulder function and reduce pain. Learning the right skills for your activity is important for preventing many shoulder injuries. Your physiotherapist is a movement expert who can prescribe specific exercises to improve your movement and posture.

3. Keep it loose.

Frozen shoulder is a debilitating and painful condition, which is a common complication of many shoulder injuries. Physiotherapists can help with pain relief and a faster recovery, and show you how to keep the shoulder moving through the full available range of motion to maintain optimal muscle balance around the shoulder girdle. Your physiotherapist can provide specific exercises to correct imbalances.

4. Get the right advice.

Shoulder dislocations, separations and instabilities require specialized rehabilitation to protect your injury and have you back to full activity. Consulting a physiotherapist can reduce the need for shoulder surgery; if you need surgery your physiotherapist will refer you to a physician. Your physiotherapist can help you with pain relief, protection from further injury and a full rehabilitation plan.

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