Body Part Of The Month: The Neck

Body Part Of The Month: The Neck

For the next blog post in our Body Part Of The Month series, our spinal specialist physio Paul tells us about the neck.

The Neck

The neck is comprised of 7 vertebrae. It plays a vital role in providing the immediate base for the head to sit on and the origin point for many muscles of the neck and shoulder girdle. The vertebrae contain and protect the upper spinal cord and brain stem which can migrate down as far as the third vertebrae in certain movements. From an evolutionary perspective, good mobility is vital in the neck as a means of allowing wide range visualisation to spot danger. This mobility is maintained by good alignment of the various joints within the neck which, between the 7 vertebrae, vary considerably.

The joint between the base of the skull and the top vertebrae (atlanto-occipital joint) is shaped similar to the joint in the knee so allows hinge movements - this joint is where a large percentage of nodding (flexion and extension) occurs. The joints between the 1st and 2nd vertebrae (atlanto-axial joint) are much flatter and sloped slightly down which allows for the majority of rotation in the neck (up to 60% of neck rotation occurs at this joint alone).

There are lots of muscles that attach around the lower part of the skull and upper neck joints that when working well allow smooth movement - if they become overloaded or overstretched, this is when movement can become limited and this can have an impact upon the rest of the neck and lower down the spine. The other 5 vertebrae link with progressively steep joint angles as the cervical spine transitions towards the thoracic spine.

When your neck works well

The neck works best when weight is evenly distributed through each of the cervical vertebrae. There should be a mild front to back curve in the cervical spine (lordosis) which is concave to the rear. The head should sit squarely on the top of the neck. To allow this to happen there needs to be good support from the lower back and thoracic spine as the head is essentially balanced on top of a long stick comprised of lots of small parts stacked up vertically. Changing the position of some of the lower vertebrae means the head needs to change position to balance you properly - to test this, sit upright on a chair. Then slowly allow your lower back to bend and your pelvis to rock back - feel the effect this has on your neck (it should feel like it's sliding forwards and poking out your chin).

When your neck doesn't work well

Neck pain can be easily distracted by pain in other areas - often the shoulder and arm. Broad, vague areas of pain in the shoulder or upper limb can be more to do with some stiffness in the neck rather than local shoulder pathology. Neck joint or muscle stiffness can contribute to referral into shoulder or upper arm pain and, of course, being where the majority of sensory nerves to the arm originate, neck issues can have wide ranging impact. As well as that, disc issues in the neck can impact basic function downstream such as gait and lower limb power although this is rare. Local muscular spasm and joint stiffness can be very painful and this pain can significantly limit range of movement in one direction - when addressed quickly this can be quickly resolved.

Common neck injuries

Most neck issues we see are fairly mild and tend to be related to postural changes with prolonged sitting. Often neck pains in a whiplash style can occur following a fall where the arm or shoulder breaks a fall but the head keeps going, placing strain on the muscles to the side of the spine. Occasionally there is little immediate neck pain in this scenario, but it tends to creep up over subsequent days. Local muscular spasm is fairly common, often when turning the neck in an awkward way - this can be worse when carrying or lifting a load.

Avoiding neck pain

The key to avoiding neck pain is maintaining a good range of movement (this will vary from person to person) and a good head on neck posture. Whilst the local muscle length is important, a lot of good neck posture starts around the lower back and abdominal muscles that offer a base of support through the thoracic spine to the neck itself. Once this area is improved, local neck management can become a lot more straightforward.

As always, if you have any persistent niggles, aches or pains in your neck or other places, don't soldier on in silence making them worse. Get in touch with us if you need us.

Words by our specialist spinal physiotherapist Paul Martin.

Getting Back To Normal - Shoulder Related Tips!

Getting Back To Normal - Shoulder Related Tips!

Nick, our shoulder specialist physio, is back for face to face appointments with his shoulder and upper limb clinic on Tuesday 14th July. We asked him for his shoulder-related tips on getting back to ‘normal’ – whatever that looks like for you!

It's more than 100 days since lockdown began - how has this affected you?

How fit do you think you are following 3 months of relative inactivity? 

During lockdown you might have worked on your general fitness, but has this been sport specific fitness? We are now able to play tennis, golf and open water swim.

Tennis related injuries seen in clinic:

• Rotator cuff related shoulder pain (RCRSP): this includes subacromial pain (impingement), bursitis, rotator cuff tendinopathy and symptomatic partial and full thickness rotator cuff tears.

• Tennis elbow and wrist/hand.

• Low back pain, hip and groin, knee and patella tendon, calf muscle and ankle sprains.

Golf injuries:

• Low back and neck pain

• Shoulder, elbow and wrist/hand pain

• Hip, knee and ankle pain

Swimming injuries:

• Shoulder: RCRSP

• Neck

• Knee

Tips for getting back:

1. To avoid tissue overloading and causing injuries don't go back to your chosen sport too hard or too fast. 

2. Always warm up and stretch prior to starting to exercise.

3. Aim for graded exposure and progressive loading, build up your resilience, tolerance and capacity. Increase your effort by approximately 10% per week to achieve your chosen goals.

Home working and ergonomics: 

We've probably all tried to recreate our desks at home, some more successfully than others! Prolonged sitting and working with incorrect postures can have an adverse effect your neck, upper back, shoulders, and thoracic spine. 

If you’re still working from home and are suffering from shoulder / neck pain, it’s likely that your desk set up isn’t ideal. 

Tips for better working from home:

1. Arrange a virtual workstation assessment of your home office to improve your desk set up.

2. Consider the purchase of more ergonomic office equipment such as a monitor, keyboard and mouse for your laptop, a height adjustable ergonomic office chair, a headset for your phone if you spend lots of time on it.

3. Keep active at your desk – move around every 20 minutes. Have a good stretch at lunchtime and the end of the day. Walk around if you can whilst you’re on the phone.

4. Read our blog post How To Work From Home Pain-Free for more tips.

5. Visit your physio to check out pain or niggles that persist.

Keep safe and remember movement is life!

To book an appointment with Nick or any of our other physios or a workstation review, call us on 02030 12 12 22.

Words by Nick Smith.

Help To Reduce Neck and Back Pain With Good Office Ergonomics

Not the best desk posture.

Help To Reduce Neck and Back Pain With Good Office Ergonomics

Shari, our spinal specialist physio, writes:

Many of my patients spend long hours working at their computer and poor desk set-up/ergonomics can lead to pain in our joints. I see a lot of patients in particular with neck, lower back and upper back pain exacerbated by poor office ergonomics.

I always recommend my patients have a thorough assessment of their work station by a specialist ergonomics physiotherapist or occupational therapist, but I have provided a few pointers below that may assist:

• Take micro-breaks: every 20 minutes you should take a break and complete 20 seconds of micro movements. This could be shrugging the shoulders back, rotating your upper back from side to side, turning your neck side to side etc.

• Your mouse and keyboard should be at the same height (elbow height) with your elbows close to the sides of your body ideally at 90 degrees. Make sure your mouse and keyboard aren’t too far away.

• Your wrists should be kept in a neutral position.

• You should work as close to the centre of our body as possible, i.e. not turned to one side.

• Any documents should be placed at the same height as your computer screen - try using a document holder.

• Allow your eyes to take a break from your screen by exercising them! Do this by focusing on objects in the distance regularly when you take a break from staring at your computer screen.

• Your head should be straight, shoulders relaxed, and your line of vision should be at the top third of your screen.

• Your chair should support a neutral posture and provide sufficient support for the length of the spine. Your bottom should be back in the chair and contact should also be maintained at the level of shoulder blades.

• Lumbar support such as an adjustable lumbar roll will help you maintain good spinal posture.

• Your knees should be bent at 90 degrees and not touch the under side of your work surface or the seat edge.

• Your feet should be flat on the floor and if they aren’t a foot stool is needed.

• Use a head set instead of a handheld phone. Handheld devices should be used only for short durations with the upper limb supported, which will reduce the strain through the neck.

• Handheld devices (phones, iPads, Kindles etc) should be held at eye level so to prevent strain on your neck from looking down for long periods.

• Your office should be well lit and well ventilated, with no glare from lights or windows on your screens.

• You should be able to manoeuvre yourself in/out of your desk chair without space restrictions or obstructions.

• Monitors should be centred on your desk.

• Stand hourly at a minimum.

• If you stand for prolonged periods, this also causes fatigue and your arms are not supported, so standing desks are not necessarily better than sitting desks in general which is evidence based supported. The key is taking regular breaks from static postures.

• If you use a laptop a separate mouse and keyboard should be used so that your arms are supported and your elbows bent at 90 degrees, and your laptop should be placed at a height such that your eye level when your head is straight is at the top third of the screen.

If your office set up is a pain in the neck (literally!), get in touch with us to see how we can help you.

Words by Shari Randall.