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NECK
What You Need To Know About Neck Pain
Your head and neck region is vulnerable to many different
stresses. Bad posture can cause misalignment of your
neck, head, and spine. Car accidents can cause whiplash.
Age and wear and tear can cause arthritis. Even activities
such as gum chewing and reading in bed can cause pain.
How do we avoid these potential problems? And if we
can't avoid them, how can we recover as quickly as possible?
In this article you will learn about:
The basic anatomy of the neck region;
Common reasons for neck pain and headaches;
Ways to reduce stress and the risk of injury;
Exercises to do at home; and
How a physical therapist can help.
Whatever the nature of your problem, physical therapy
by a licensed physical therapist can often help you
recover function quickly and teach you new habits to
minimize the risk of further pain or injury.
Anatomy Of The Neck Region
One of the most flexible regions of the spine is the
neck (cervical) region, which consists of vertebrae,
seven shock-absorbing discs, muscles, and vertebral
ligaments to hold them in place. The uppermost cervical
disc connects the top of the spinal column to the base
of the skull. The spinal cord, which sends nerve impulses
to every part of the body, runs through a canal in the
the cervical vertebrae and continues all the way down
the spine. The cervical nerves spread down into the
arms; because of this, arm pain is sometimes traceable
to a problem in the neck.
Possible Causes Of Neck Pain And Headaches
One of the most common causes of neck pain, and sometimes
headaches, is poor posture. It's easy to get into bad
posture habits without even realizing it-even an activity
as "innocent" as reading in bed can ultimately
lead to pain, headaches, and more serious problems.
The basic rule is simple: keep your neck in a "neutral"
position whenever possible. In other words, don't bend
or hunch your neck forward for long periods. Also, try
not to sit in one position for a long time. If you must
sit for an extended period, make sure your posture is
good: Keep your head in a neutral position, make sure
your back is supported, keep your knees slightly lower
than your hips, and rest your arms if possible.
Reading in bed can cause neck strain- especially if
you're propped up on several pillows, bending your neck
forward, and trying to hold your arms out in order to
support the book. If you do read in bed, make it easy
on your neck: Consider purchasing one of the products
specifically designed for this purpose, such as a wedge
pillow to prop up the book or a portable "mini
desk." Finally, remember not to stay in any single
position too long- our bodies are designed to move.
Your sleeping position is another possible source of
neck problems. Does your pillow cause you to sleep with
your neck at an angle, either too high or too low? If
so, you may want to invest in a new pillow. Feather
pillows are generally preferable to foam; they conform
easily to the shape of the neck.
Also, remember that pillows don't last forever. After
a year or so feather pillows tend to "collapse"
and may need to be replaced. In addition, a bed that
doesn't offer enough back support can also be a source
of neck discomfort.
Here are some other tips to help you avoid neck strain
and pain:
Try doing stretching exercises before bed and first
thing in the morning;
Don't sleep on your stomach-this position puts great
pressure on the neck; and
Don't "over-pillow" your neck; keep your neck
and spine in a neutral position.
The neutral position rule also holds true for people
who spend time working at computer terminals. Again,
don't bend your neck forward. Adjust your desk, monitor,
and chair to a comfortable height, so that the monitor
is at eye level and your knees are slightly lower than
your hips. Some people find that a footstool helps in
attaining this correct position. Sit close enough to
the monitor so that you don't have to bend forward in
order to see well. Use the chair's armrests-your arms
need support. Wear your eyeglasses if necessary. Consult
your physical therapist to find the set-up that is right
for you.
You should also follow the neutral position rule when
driving a car. Adjust the seat to bring you close enough
to the pedals so that you don't have to extend your
neck forward.
Proper Lifting Technique
Another cause of neck pain is poor lifting technique.
People often think of the lower back as the area at
risk, but the cervical region is nearly as vulnerable.
Here is the correct way to lift:
Stand up straight, close to the object;
Bend at your hips and knees, keeping your back in the
neutral position and your head and shoulders up;
Firmly grasp the object and rise up with your hip and
leg muscles;
Keep the object close to your body. Your hips and legs
absorb most of the weight, and you will put less strain
on your back and neck.
The feet should be positioned shoulder-width apart,
with one foot slightly ahead of the other.
In addition, you may find that placing one foot forward
and one foot back may be easier than trying to lift
an object from the "squatting" position.
Avoiding Neck Stress
Other bad habits to avoid include:
"Shopper's tilt"-carrying items on one shoulder
for a long period; and
Carrying items that are too heavy.
"Shopper's tilt" can be avoided by using a
back pack-style bag to more evenly distribute the weight
you're carrying. (Be sure to wear the back pack correctly,
with both arms through the shoulder loops, or the benefit
will be lost.) A variation on "shopper's tilt"-"traveler's
droop"- is a familiar experience to anyone who
has ever tried to lug a heavy suitcase across an airline
terminal. Again, a back pack can be helpful, or consider
purchasing a compact "rolling suitcase" with
wheels and a retractable handle.
Believe it or not, simply talking on the phone can
create neck problems. Some people are in the habit of
cradling the telephone receiver between the shoulder
and the neck. Not only does this put stress on the neck,
but over a long period it can cause the cervical discs
to place pressure on the nerves. If you spend a great
deal of time on the phone, you might try one of the
products designed to make it a more comfortable experience-neck
cradles, speaker phones, or a "hands-free"
headset.
TMJ Disorders
The TMJ- temporomandibular joint- is the joint at which
the jaw is hinged to the skull. Painful TMJ problems
occur in people who overuse or abuse this joint through
teeth grinding, constant clenching and unclenching of
the jaw, or excessive gum chewing. Sometimes people
are born with a misalignment of the jaw that can bring
on similar symptoms.
Because the neck and the TMJ are so closely connected,
the TMJ can cause neck pain-and vice versa. In some
cases a dentist may need to create an oral retainer
to allow the joint to rest and let healing begin. After
that, a physical therapist can help minimize the pain
in the jaw or neck through a custom-designed exercise
program.
Migraine Headaches
True migraine headaches are most likely the result
of problems affecting the blood vessels in the head,
or of an allergic reaction. However, many other types
of headaches can mimic migraines and are often misdiagnosed.
Some of these originate in the neck or jaw, such as
the TMJ disorders mentioned above.
If you don't have all the symptoms of migraines- nausea,
problems with vision, and pain-get a second opinion,
particularly if the pain is triggered by motion of the
neck. If you don't have a true migraine, a physical
therapist can help diagnose the actual source of the
pain. Once an evaluation is made, your physical therapist
will help you create a comfortable and appropriate home
and work environment and will design a program of rest
(if needed) and exercise. If the source of your headache
is in the TMJ (jaw) area, your physical therapist may
consult with your dentist who may create a special oral
retainer in order to discourage "bad habits"
such as teeth grinding.
Other Kinds Of Headaches
Most people know from experience that emotional stress
can cause headaches. These "simple" headaches
can be treated in a variety of ways, from taking nonprescription
pain relievers to practicing meditation. Most simple
headaches will go away by themselves; however, if the
headache is persistent or recurring, make sure that
neck strain, poor posture, or eyestrain isn't the culprit.
If your headache is severe or persists for more than
a few days, it is important to seek professional attention
right away. Sometimes muscles in the back of the neck
can irritate nerves in the head, causing a headache.
If you are having headaches, a physical therapist will
first make a careful evaluation of your problem (often
in consultation with a physician). After pinpointing
the problem, he or she will design a program of rest,
exercise, stretching, and other treatments that are
very effective in eliminating the cause of your headaches.
Osteoarthritis
Osteoarthritis is inflammation of the joints caused
by wear and tear. All of us experience some degree of
osteoarthritis as we grow older, but the condition can
also be caused by injuries. Osteoarthritis in the neck
is characterized by stiffness and limited range of motion.
Physical therapy can be a great help in treating osteoarthritis.
Through exercise, stretching, massage, and other therapeutic
techniques, the physical therapist can gently and slowly
help the patient ease the stiffness and increase range
of motion.
Whiplash
Whiplash -a violent back-and-forth motion of the neck-
is probably the most common traumatic injury to the
neck region. It is frequently associated with automobile
accidents, although it occasionally occurs in other
situations (such as skiing accidents or amusement park
rides). In acute cases, a device known as a cervical
collar may be appropriate in order to "rest"
the neck and calm the inflammation. Once the tissue
has been rested, a physical therapy program designed
to regain strength, function, and range of motion can
begin.
Is It Only A "Pain In The Neck"?
Pain in the cervical region can cause arm pain as well
as the "pain in the neck." Why? In the case
of the arms, it's because the nerves that branch out
from the neck go all the way down into the arms and
into the hands. Sometimes it's difficult to tell whether
the pain is actually originating in the neck, or the
arms, or both.
Symptoms in the arms include numbness, tingling, cold,
aching, and "pins and needles." These symptoms
can be confused with carpal tunnel syndrome (CTS), a
condition found in people who work at computer keyboards
or perform other repetitive motion tasks for extended
periods. In CTS, the nerve sheath that runs down the
center of the forearm becomes inflamed and restricts
the gliding movement of the nerve. It is possible, however,
for a nerve impingement to start much further "up
the chain," in the neck region. It's also possible
for the nerve impingement to be taking place both in
the neck and in the arm.
What To Do When Your Neck Is Hurting
When your neck hurts, and no major trauma is involved,
rest is the first order of business. But don't stuff
too many pillows under your neck- that will only make
things worse. The goal is to keep your spine and neck
in a neutralposition. Make sure that the "gap"
between the back of your neck and the bed is filled
in by a pillow (or foam support) that keeps your neck
in a neutral position.
You can also apply ice or heat. Many physical therapists
prefer ice because of its effectiveness in reducing
pain and inflammation. (To use ice, fill a plastic bag
with crushed ice, place a towel over the affected area,
then apply the ice-filled bag to the area.) Heat also
provides relief to some people, but should be used with
caution because it can sometimes make an inflamed area
worse.
Apply heat or ice for 15-20 minutes at a time, and
give yourself a 40-minute rest between applications.
If you use both heat and ice, make sure to alternate
between the two.
How Physical Therapy Can Help With Neck Pain
and Headaches
Physical therapy always begins with a detailed history
and evaluation of the problem. Your physical therapist
will take many things into account, including your age,
general health, occupation, and lifestyle. If major
trauma or disease is involved, your physical therapist
will work with you in consultation with a physician.
After a diagnosis has been made, your physical therapist
may choose from a range of treatment options, including
exercises for flexibility, strength, stability, and
restoration of range of motion. Other options include
ice, heat, electrical stimulation, traction or mobilization,
and massage. Your physical therapist may also analyze
your home and work environment in order to ensure that
you're not re-injuring yourself.
Much evidence suggests that low-impact aerobic exercise
such as swimming, walking, low-impact aerobics, and
stationary bicycling may also be helpful in decreasing
neck pain. A physical therapist can design a pain-free
exercise program just for you.
Once your physical therapy goals are met, your physical
therapist will help you continue therapy on your own
with a home program designed to fit your needs. The
goal of physical therapy is to return you to normal
activity as quickly as possible, with the knowledge
you need to minimize or eliminate your problem.
Neck And Head Pain Questions And Answers
1. Is arm pain, numbness, tingling, and weakness
related to neck pain? Will I need surgery?
Because the nerves in the cervical region radiate
down through the arms, these symptoms can sometimes
be related to neck pain. While surgery is sometimes
required to reduce pressure on the nerves, many cases
can be treated effectively through physical therapy.
2. Is surgery beneficial for chronic neck
pain?
Surgery may be the treatment of choice in isolated
cases-for example, if you have a condition known as
spinal stenosis (in which the openings for the nerve
roots or spinal cord become smaller, often due to
osteoarthritis). In most cases conservative treatment,
including physical therapy and/or medication, is preferable.
3. Is it alright to take medication such
as aspirin for my neck pain and headache?
Yes, although anti-inflammatories such as NSAIDS (non-steroidal
anti-inflammatory drugs) or aspirin can cause stomach
upset or ringing in the ears. Be aware that acetaminophen
can help with pain but not inflammation. Consult your
pharmacist about the medication you are taking. Do
not take medication that is old or previously prescribed
for someone else.
4. How long before I get better?
The nature of your injury will determine how long
it takes to heal. In general, recovery from neck sprains
or strains can take anywhere from a few weeks to a
few months, depending on the severity of the injury,
your age and ability to heal, and other factors.
Your recovery will be faster if you follow the program
designed by your physical therapist. Your program
will probably include exercises and other treatments
designed to ensure that the neck heals properly and
regains its normal range of motion. Without proper
treatment, prolonged stiffness and discomfort may
result.
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