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.

Body Part Of The Month: The Spine

Body Part Of The Month: The Spine

For the next blog piece in our Body Part Of The Month series, our spinal specialist physio Shari tells us about the spine.

The Lumbar Spine And Lower Back Pain

At some point in our lifetime 80% of the population will suffer from lower back pain. There are a number of different causes of lower back pain and if your pain is persisting it is always recommended to seek the opinion of your health care professional.

Causes of Lower Back Pain

Sometimes the cause of back pain can be a muscular strain from being in an awkward posture after gardening or a long flight, and other times the cause may be from a structural problem.

Below are listed some of the common things I see in practice:

• Non-specific lower back pain

• Discogenic lower back pain

• Radicular pain-caused by neural impingement and often experienced as symptoms in your thigh or leg, be it pain, numbness, pins and needles or weakness

• Facet joint pain

• Spondylolisthesis: forward slip of the vertebrae

• Fractures

• Osteoarthritis

• Stenosis: narrowing of the space in your spine where the nerves are present, and associated with arthritis

• Rheumatological conditions - auto-immune conditions

• Sacro-iliac joint pain

• Pregnancy related pain

• Hypermobility associated pain

Assessing Lower Back Pain

When treating my patients initially I will take a thorough history of your condition, and ask about your past medical history, your current symptoms, medications, activity levels, stress levels, occupational requirements and goals. Then a physical assessment will be undertaken to determine your diagnosis. Occasionally scans and investigations are needed, and you may be referred to a specialist consultant doctor.

Following this we will formulate a treatment that will best address your issues whether it be improving the mobility of your spine, your pain or strength deficits.

 Treating Lower Back Pain

Exercises that address the flexibility of your spine and the surrounding joints such as your upper back, as well as your hips and pelvis can also be beneficial, as can exercises that address the activation and strength of your stabilising muscles, to help get you back to the activities that you enjoy.

Sometimes taping and belts can be helpful in the acute stages of pain or where stabilisation is needed such as in pregnancy. Occasionally medication may also be necessary to reduce the inflammatory pain in your spine so that you can undertake the prescribed exercises.

In severe cases of pain spinal injections by a specialist doctor are needed to reduce inflammation, which then can enable patients to be able to undertake their exercise rehabilitation.

In most cases it is best to maintain your mobility and activity levels as long as this isn’t aggravating your symptoms.

Words by our specialist spinal physiotherapist Shari Randall.

Injury of the month: lower back pain

Lower Back Pain

Research studies show that over 80% of our population experiences lower back pain in their lifetime. In some people this can also be persistent or recurrent lower back pain.

What is lower back pain?

Lower back pain is pain is pain anywhere from the bottom of the rib cage to the buttock creases. Sometimes people with lower back pain may also feel pain in their legs and feet.

What causes the pain?

There can several structures contributing to lower back pain and these include the spinal joints, discs, nerves and the connective tissue such as the tendons/muscles and ligaments.

Why does it occur?

This depends on whether the lower back pain is a new episode, exacerbation, acute pain or persistent pain.

A diagnosis should always be established by your health professional, as causes can sometimes include infection, fracture, inflammatory conditions, malignancy or other systemic illnesses of the body.

However most commonly the cause will be related to sedentary lifestyles or incorrect training technique and posture.

 

How can physiotherapy help?

Your physiotherapist is specially trained to help diagnose your lower back and work with you to formulate the best treatment management plan for your recovery. Often this include hands on treatments such as mobilisations, massage, postural assessment, education on prevention and self-management at home and at work as well as prescribed exercises to assist you with pain reduction, increased mobility and strength.

If you'd like an appointment with either of our Spinal Specialists, Sarah and Paul, please call us on 02030 12 12 22.

Words by Shari Randall.

Injury of the month: Headaches

Is Your Headache Really a Neck Ache?

Headaches are often caused by disorders of the neck or physical and emotional tension. For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, forehead or behind the eyes. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck or muscles can cause referred pain to your head. 

Does this sound like you?

• Pain radiates from the back to the front of your head?

• Headache with dizziness or light-headedness?

• Headache brought on or worsened by neck movement of staying in the same position for a long time?

• Headache which always feels worse on the same side of your head?

• Headache eased by pressure to the back of your skull?

• Headache which persists after your doctor has checked for other causes?

How We Can Help:

Postural neck ache can usually easily be treated with some gentle mobilisations by a   physiotherapist and a stretching programme to prevent recurrence.

Physiotherapists can successfully treat headaches originating from the neck or soft tissues and show you how to prevent the pain from occurring. Even if you think your headache doesn’t come from your neck we can often help to reduce the intensity.

1. Mobilisation

2. Manipulation

3. Massage

4. Relaxation therapy

5. Functional and rehabilitative exercise

6. Encouraging normal activity

7. Postural assessment, correction and advice

8. Muscle activation and re-education

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical ergonomic tips for work and in the home; adjusting furniture, relaxation, sleeping positions, posture and exercise.

If you'd like an appointment with our Spinal Specialist, Shari Randall, please call us on 02030 12 12 22 or send an email to info@physioremedies.com .

Words by Kara Mulvein.

Helpful Hints for the Holidays

Back and neck pain are common problems experienced when travelling or staying away from home - so here are some ideas to help you enjoy a more comfortable summer break.

In the car:

• Make sure you sit with good posture - if your car doesn’t have enough low back support use a rolled up towel (pick the right size!) or buy a purpose-designed lumbar roll.
• Don’t allow your chin to poke forwards as you peer out the windscreen - especially at night! This is a very common habit and can result in a stiff and sore neck. The back of your head should be just touching the headrest support and your chin should be tucked towards your Adam’s apple.
• Take breaks – get out and walk about every hour or so even if just for a few minutes.

On the plane:

• Don’t fall asleep in an awkward position - try and keep your back in its normal alignment (again a small lumbar roll can help with this) and use a horse shoe shaped neck support to help stop your neck kinking into the wrong position.
• Remember sustained positioning when your joints are not in neutral alignment can cause damage and pain – so avoid it.
• If you're on a long flight, get up and walk every two hours. This will also help your circulation.

In bed:

• Lots of people suffer as a result of sleeping in a strange bed. Whilst there’s not a lot you can do about the bed itself you can alter the pillows (or take your own).
• The pillow’s purpose is to fill the space between the head and neck and the mattress.  If you sleep on your back your pillow should be fairly flat.  If you’re on your side that pillow should fill the space between your shoulder and head to ensure your neck is held straight and doesn’t drop down toward the mattress (too flat pillows)  or is pushed away (too many pillows) - it should be ‘just right’.

And remember we are open throughout the summer holidays to help ease any aches and pains. Just call us on 02030 12 12 22 or send an email to info@physioremedies.com to make an appointment.

Words by Kara Mulvein.