Neck

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Neck Back Care

• Michelle Kwong
• B.HSci(Phty), MSPA, Cert. Clinical Pilates
• Principal Physiotherapist
• Practice Director

Http//www.painrelief.sg
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SPEAKER PROFILEMichelleKwong.com

• Qualifications
• Graduated with Bachelor of Health Science
  (Physiotherapy) in University of Sydney
• Australia Certified Clinical Pilates Instructor
• Certified Aquatic Physiotherapist
• Member of Singapore Physiotherapy Association
• Experience
• More than 7 years of clinical experience in
• Physiotherapist
• Clinical Pilates Instructor
• Ergonomics Consultant
• Personal Trainer in Prehabilitation/Rehabilitation

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SPEAKER PROFILEMichelleKwong.com

• Achievement
• Awarded GOLD Service Excellent by SPRING
  Singapore 2003
• Principal Physiotherapist and Director of
  Physiotherapy Clinic
• THE PAIN RELIEF PRACTICE
• Vision
• Highly committed to help people with
  musculoskeletal pains to speedily recovery with
  latest clinically proven physiotherapy
  technologies success in mastery of good health
  and fitness.

http//www.painrelief.sg
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TOPICS COVERED

• Structure of the Spine
• Common Spinal Condition
• Causes of Spinal Pain/ Conditions
• Pain Management
• Prevention of Neck/Back Pain
• Exercises for Neck/Back muscles.

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SPINE FACTS

• 5 sections
• Cervical (7 vertebrae)
• Thoracic (12 vertebrae)
• Lumbar (5 vertebrae)
• Sacral (5 fused vertebrae)
• Coccyx (4 fused vertebrae)

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Spine Structure

• Lumbar vertebrae
• Intervertebral disc
• Nerve roots
• Ligaments
• Muscles

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Vertebrae

• Skeleton framework
• Support for muscles tissues
• Protection of vital organs
• Storage of minerals immature blood cells

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Joints
Allows movement between bones
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Intervertebral Disc
The intervertebral disc is a jelly like
substance, which consists of annulus fibrosis and
the nucleus pulposus. Acts as a shock absorber.
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Spinal cord Nerves Roots

• Nerve roots exit through holes in the bone of
  the spine (foramen) on the right side and left
  side.
• Branch out at each level of the spine.
• The nerve roots innervate different parts of
  body.

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Ligaments
Ligaments are fibrous bands or sheets of
connective tissue. They link two or more bones,
cartilages, or structures together.
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Muscles
Muscles attach to the spinal column, pelvis, and
extremities. They serve to support the spine
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Core Muscles

• Deep trunk muscles- acts as stabilisers
• Power House

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Causes of Neck Back Pain
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Causes of Neck Back Pain
PoorCarrying Posture
PoorSitting Posture
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Causes of Neck Back Pain
PoorSleeping Posture
PoorWorking Posture
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Causes of Neck Back Pain

• Overuse e.g. repetitive bending, static posture
• Overstress e.g. heavy object, excessive turning
• Degenerative changes i.e. Wear and tear
• Trauma e.g. fall
• Genetic predisposition
• Physical inactivity
• Mental Stress
• Tumor

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Common Problems Neck Back Pain
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Common Conditions of Neck Back Pain

• Joint sprain e.g. locked joint syndrome
• Muscle and Ligament injuries
• Degenerative changes e.g. spondylosis,
  osteoarthritis, spondylolisthesis
• Prolapsed Intervertebrae disc (slipped disc)
• Nerve roots irritation
• Fractures

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Compression Fracture

• Usually due to trauma
• (very hard pressure or fall)
• Higher risk for osteoporosis/ elderly

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Disc Herniation
Stages of Disc Herniation Stages of Disc Herniation Stages of Disc Herniation
1 Disc Degeneration Chemical changes associated with aging causes discs to weaken, but without a herniation.
2 Prolapse The form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
3 Extrusion The gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
4 Sequestration or Sequestered Disc The nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal.
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Effects of position on disc
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Slipped Disc
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Spondylosis

• Degeneration
• (Wear and tear)
• Age related
• Activity related
• Previous injury/trauma

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Lumbar Spondylosis
Normal 58 yrs old Degenerative Changes
83 yrs old
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Nerve Root Irritation

• Shooting pain down the leg
• Constant pain
• Numbness
• Weakness

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Signs and Symptoms
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SIGNS SYMPTOMS

• Localised pain in the neck/ back
• Diffused pain over a wide area
• Pain radiating to the lower limb

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SEVERE SYMPTOMS

• Numbness/ Pins Needles in the upper/ lower limb
• Weakness
• Constant pain
• Difficulty sleeping/ awaken by pain
• Unsteady with walking
• Inability to control bowel / bladder
• ? To seek early medical doctor/ physiotherapist
  advice if presence of severe symptoms

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MANAGING PAIN

• Self Management
• Doctor
• Physiotherapy
• Surgery

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Acute Pain Self Management

• ACUTE PAIN (1st 2nd day)
• Apply RICE
• R Rest for 24-48hours (NOT Complete Bedrest!)
• I Ice for 15-20mins,every 2-3hrs interval
• C Compression with bandage
• E Elevate
• Avoid HARM
• H Heat
• A Alcohol
• R Running
• M Massage

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Pain Management Advice

• Avoid activity that may cause pain especially
• - Strenuous activity
• - Prolonged activities, repetitive movement
• - Heavy loads
• Neck/ Back Support for acute severe pain.
• (Not advisable for chronic pain.)
• Heat
• Gentle stretching when pain reduced

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Pain Management Advice

• When self management does not work, SEEK HELP
  EARLY especially if you are suffering from any
  neck/back pain and radiating pain down arms/legs.
• The longer your pain condition, the harder for
  doctor/physiotherapist to treat, the longer the
  time for recovery and more medical fees involved.
  

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Physiotherapy

• Goals of Treatment
• relieve pain
• improve joint function
• maintain flexibility
• Strengthening weak muscles
• Achieve a healthy lifestyle

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Physiotherapy

• Pain relief treatment
• Heat (Ultrasound, Hotpack, Shortwave)
• Electrical (Interferential, TENS, microcurrent)
• Joint mobilisation/ manipulation
• Massage
• Traction
• Postural Correction
• Sports Taping/ Kinesio Taping
• Core/ Back Therapeutics Exercises
• Return back to sports/work

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ADVANCED TREATMENTS
? COLD LASER THERAPY - Stimulates
immune system - Generate healthy cells
tissues - Promotes faster healing

• Spinal Decompression Therapy
• (DTS)
• - Advanced high tech Traction
• - Proven to reduce most neck/back
• symptoms gt86

• EM SIGNAL THERAPY
• - Activate Regenerate cells
• - Bone Cartilage Repair
• - Significant pain reduction

? ELECTROACUPUNCTURE - Non-invasive -
Effects of electrical acupuncture therapy
to reduce pain promote recovery

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Physiotherapy

• Education on lifestyle modifications
• Avoid prolong activities
• Avoid strenuous activities
• Avoid heavy load
• Avoid squatting/kneeling prolonged
• Avoid stairs climbing

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Medications

• Medicines doctors use to treat osteoarthritis
  include
• Acetaminophen, which may help relieve pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs),
  which reduce inflammation and relief fever.
• Corticosteroid injections in the joint
  (intra-articular), which reduce inflammation.
• Hyaluronan injections, which may relieve pain.
• Opioids, which may relieve moderate to severe
  pain.

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Supplements

• Chondroitin Glucosamine sulfate
• natural substances found in the joint fluid.
• chondroitin is thought to promote an increase in
  the making of the building blocks of cartilage
  (collagen and proteoglycans) as well as having an
  anti-inflammatory effect. Glucosamine may also
  stimulate production of the building blocks of
  cartilage as well as being an anti-inflammation
  agent.

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Supplements

• CH Alpha (Collagen hydrolysate)
• Only product with a U.S. patent for cartilage
  regeneration
• Clinically proven to stimulate specialized cells
  called chondrocytes. Chondrocytes control the
  rate of cartilage regeneration in joints and
  detect changes in the composition of the
  cartilage. They respond to these changes by
  growing more cartilage.
• Studies have shown that CH-Alpha increases the
  concentration of collagen and proteoglycans
  through this stimulatory effect on chondrocytes.

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Surgery
In some cases surgery is necessary, more often it is not necessary. Another 6-8 weeks of physiotherapy, at 3 to 5 times per week.
Lower rate of success, dependent
- Pain - Increased danger from anesthetic - Increased danger from possible infections - Possible post operation complications (eg pneumonia, DVT, delayed union/nonunion, spinal cord injury) - Noticeable scars
Prolonged recovery time, generally 6 to 8 weeks
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Prevention of Neck Back Pain
PREVENTION IS BETTER THAN CURE!
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Prevention of Neck Back Pain

• Adopt good body mechanics/posture
• Adopt correct lifting technique
• Exercises for a healthy back
• Healthy Lifestyle
• Stress Management

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Strengthening Exercises
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Healthy Lifestyle
Flexibility
Mobility
Aerobic Endurance
Strength
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Healthy Lifestyle
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PRACTICAL

• Neck Mobility Exercises
• Neck Strengthening Exercises
• Back Mobility Exercises
• Back Strengthening Exercises
• DISCLAIMER
• Exercises shown should be done with caution
  especially for people suffering in pain or
  previous condition. In case of doubt, check with
  your doctor/physiotherapist with regards to your
  condition.

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Neck Mobility Exercises

• Neck Flexion/ Extension
• Tilt head forward and backward as far as
  possible.
• Slow, repeat 8-10 times

• Neck Side Flexion
• Tilt head toward shoulder keeping shoulder
  stationary
• Slow, repeat 8- 10 times

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Neck Mobility Exercises

• Neck Rotation
• Turn head from side to side as far as possible
• Slow, repeat 8-10 times

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Neck Strengthening Exercises

• Deep Neck Flexors
• Tuck in Chin
• Hold 10 seconds, 8 -10reps

• Isometric Neck Extensors
• Giving resistance with clasped hands at back of
  head, push backwards with head.
• Hold 10 seconds, 8- 10 reps

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Neck Strengthening Exercises

• Isometric Neck Side-Flexors
• Place hands on side of the head and push head
  against hands resistance
• Hold 10seconds, 8-10reps

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Back Stretching Exercises

• Bent Over Stretch
• Hold the back of a chair with your arms
  shoulder-width apart.
• Walk backwards as you bend forward from the hips
  and straighten out your arms.
• Keep your feet together, your back straight and
  your head between your arms in line with your
  spine.
• Hold for 10 30secs

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Back Stretching Exercises

• BACK EXTENSION SHOULDER BLADE PINCH
• Stand with feet apart lean backward to the
  point of tension with arms reaching back.
• Tighten shoulder blades and lower back muscles.
• Feel a mild stretch on your abdominals.
• Hold for 10-30secs

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Back Stretching Exercises

• Lower Back Stretch
• Stand with feet hip-width apart.
• Come into a squat position by bending your knees
  and pushing your buttocks backwards. Place your
  hands on your thighs.
• Pull belly button toward your spine as you tilt
  or curl your pelvis under.
• Return to starting position.

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Stomach Hollowing

• Strengthens Transverse Abdominus
• Breath out and relax your stomach muscles
• Pull lower part of stomach inwards and upwards
• Hold 10 seconds and perform 8-10reps
• Crook lying, sitting, standing

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High Plank

• Strengthens the chest, shoulders, triceps,
  buttocks, hamstrings trunk.
• Start on your hands and knees. Arms should be
  directly under your shoulders.
• Extend one leg back at a time until your body
  weight is supported on your arms and toes.
• Hold for 5-10seconds, perform 8-10 reps

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Back Strengthening Exercises

• Bridging Exercises
• Lie on the floor with your knees bent, feet flat.
• Tighten the muscles of your lower abdomen and
  buttocks.
• Slowly raise low back and buttocks from the floor
  
• Hold for 5-10 seconds, do 8-10reps

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Back Strengthening Exercises

• Low Back Extensors
• Lie face down on a mat with your arms beside you
  and your legs together.
• Lift your head and shoulders off the mat by
  squeezing the muscles in your lower back. Keep
  your feet on the floor.
• Slowly lower to the mat.
• Hold for 5-10 seconds, do 8-10reps

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Summary

• Prevention is better than cure.
• When self management does not work,
  SEEK HELP EARLY if you are suffering from any
  neck/back pain or any radiating pain down
  arms/legs.
• LIVE A PAIN FREE LIFE!

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QUESTIONS ANSWERS

• If you have any queries, please feel free to
  email Michelle at michelle_at_painrelief.sg
• Or call 67355368.

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THANK YOU
Presented By Michelle Kwong
B.HSci(Phty), MSPA, Cert. Clinical Pilates
Principal Physiotherapist Practice
Director
World Malayali Club http//groups.yahoo.com/group/worldmalayaliclub/
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Disclaimer

• The Pain Relief Practice Educational Material is
  for information only. This information is not
  intended to diagnose, treat, or cure any
  medical/health condition. It is not a substitute
  for formal, real world medical or physiotherapy
  care, and should not be considered as such. The
  Pain Relief Practice is not in a position to
  independently evaluate any of the advice or
  claims on behalf of any particular therapy. Any
  information or suggestions we provide should be
  discussed with your doctors or physiotherapist in
  real person when treating your condition. Our
  discussion of possible pain treatments are just
  options which may be significantly limited by the
  incomplete full physical examination of a
  doctor/physiotherapist.