Neck pain is a very common condition and most people will suffer pain in their neck at some point in their life. It can range from a mild discomfort to a more severe pain and be due to a sudden acute onset or be more of a chronic problem. Neck pain is more frequently seen in women than in men, and it can influence your ability to work, carry out day to day activities as well as effect your sleeping habits.
The neck is composed of 7 vertebrae housing and protecting the spinal cord. It has a complex arrangement of muscles, ligaments, and nerves which are enveloped, supported and strengthened by multiple layers of dense, fibrous tissue known as fascia. The vertebrae are connected to each other by joints which allow the neck to bend forwards, backwards, and side to side. In between the vertebrae are structures called discs. These have a much higher water content than bone and help to absorb pressure and load. When any one of these structures becomes worn, injured or inflammed, neck pain can occur.
When we are born the discs have a very high water content, but as we get older these discs become less hydrated and more fibrous. This is known as ‘degenerative disc disease’ (DDD). Just like grey hair and wrinkles, this is the normal ageing process and occurs at varying rates depending on the individual – it can start as early as your 20s!
With most acute neck pain the outlook is good with symptoms easing within a few days and gone after a few weeks.
Frequently there appears to be no specific reason for the onset of neck pain, however there are a number of possible causative factors:
• bad posture; it is very common in people who spend a lot of their day at their desk in front of a computer with a ‘poking chin’ posture
• trauma or injury; minor injuries or sprains to the muscles or ligaments usually caused by impact or contact with an object, surface or another person, or
• falling asleep in an awkward position; can cause a ‘wry neck’ where it becomes stuck to one side with a lot of muscles going into spasm. This can make it very difficult to move the neck back into an upright position
• worry or stress; tends to tense up the muscles of the neck and shoulders so that they become stiff and tight
• a disc problem; the intervertebral disc sits inbetween the bones of your neck and helps to provide shock absorption during movements. They can sometimes bulge beyond their normal borders causing an inflammatory reaction and pain. As the discs bulge or protrude to the side they can also irritate the nerve as it leaves the spine and travels down the arm. This can therefore cause arm pain with possible pins and needles or numbness. If the nerve’s ability to function starts to become affected you may suffer with weakness or changes in your sensation within the upper limb
• arthritis; degeneration or wear and tear of the joints between the vertebrae or the discs is a common cause of neck pain. Although you would expect this to only be present within the elderly, it can actually occur at much younger ages and progress at varying rates. It is important to remember that arthritis is the normal ageing process and although it is a common source of pain it can be managed well with exercises, advice and physiotherapy
• whiplash injury; This often occurs as a result of a road traffic accident. It involves a sudden forwards and then immediate backward movement of the neck. This can result in overstretching of the muscles, ligaments and nerves as well as irritation to the joints in the neck and therefore pain often results
For the most part, with general neck problems the pain feels like an ache with stiffness in the neck area, and pain on movement. However it can sometimes become a sharper or even burning sensation. It often radiates into the shoulder, or between the shoulder blades and can also go down the arm and into the hand. Sometimes it may cause pins and needles or a tingling sensation in the arm. The pain can also go up into the neck causing a headache and can produce a feeling of weakness in the shoulders and arms.
The spine is an ‘s’ shape and this helps to dissipate the load of your day to day activities. It is therefore important to maintain these natural curves in the neck, otherwise the ligaments, muscles, joints, nerves and discs can be put through abnormal stresses which can cause pain. We rely on the use of the deep neck muscles (‘core muscles’) to help maintain the ‘s’ curve and thus support the neck. The neck has multiple other responsibilities, including support of the head and face and coordination of movement between the head the upper body.
Posture is a key factor to neck pain. It is the way we hold and move our bodies. It is unique to each one of us and can be influenced by our mood, daily activities and environment. Certain posture types can cause muscle imbalances and again predispose us to an increase risk of poor core stability and neck pain.
However, at The Wyndham Centre the physiotherapists can guide you through both manual treatment techniques and rehabilitation in order to improve your postural habits as well as show you how to activate and strengthen the core muscles, with the aim of reducing your neck pain, and giving back the support your body needs.
Your spine is one of the strongest parts of your body. It is made of solid bony blocks (vertebrae) separated by discs (a bit like a jam donut with a firm outside and a squidgy inner part) that help to give it strength and flexibility. Strong ligaments reinforce it and large powerful muscles surround it, both help protect it.
Sciatica is the common term for pain that is felt in the leg along the course of the sciatic nerve at the back of the thigh and running down into the calf. There are several different causes of sciatica and it may start suddenly or come on gradually. It can be a continual dull ache or sudden sharp shooting pains. The pain may run evenly all the way down the leg or there may be certain spots where it is more intense, commonly in the buttock, behind the knee or around the ankle. At these points the sciatic nerve is closer to the surface. There may even be numbness or tingling in the area of pain.
The nerve leaves the spinal canal between the vertebrae and this can become compressed by a bulging disc, where some of the ‘jam oozes out of the donut’. This can happen with something as trivial as sneezing, but is often due to a build up of pressure on the disc due to poor posture or bad working positions.
A short period of rest usually allows the disc to settle before physiotherapy to get you mobile again. In severe cases you may need to have an epidural injection to reduce the pain or even surgery to remove the part of the disc that is pressing on the nerve.
The joints between the vertebrae can lock up, often after gardening, which can then cause irritation of the sciatic nerve because they do not move properly. A short course of physiotherapy consisting of mobilisation or manipulation of the immobile joints can usually sort this out very quickly.
As people get older they may suffer from osteoarthritis or degeneration of the discs and vertebrae. This can cause back pain and may also irritate the nerve. Pain-killers and anti-inflammatory tablets may help, there is a natural anti-inflammatory called Serra Enzyme, along with electrotherapy or acupuncture for pain relief. You should also be given a simple series of exercises that will help you to manage your symptoms in the long term.
Sometimes you may experience similar symptoms to sciatica that may be coming from tight muscles in the buttock region or from the hip or sacro-iliac joint. A physiotherapist will assess your symptoms and give you the appropriate advice and treatment for your individual problem.
For specific stretches please give us a call to make an appointment with one of our chartered physiotherapists – Fleet Street 020 7404 0023 or Baldock 01462 893586.
- The benefits of stretching include reduced muscle soreness after exercising and even better performance.
- Do not bounce – it risks pulling or tearing the muscle you’re trying to stretch and relax.
- Stretch gradually. If a stretch is applied too quickly, the muscle responds with a quick contraction, increasing the tension. Gradual stretching decreases the muscle tension, promoting a further stretch.
- Do not overextend. This feeling is like minimal tightness / discomfort, but no pain!
- Hold and control the stretch for at least 30 seconds, repeat 2-3 times.
- Always stretch all the major muscle groups (ie calves, hamstrings, quadriceps, groin and hip flexors)
- Stretch uniformly – After stretching one leg, stretch the other, and do the same with upper body.
- Don’t overstretch an injured area – this may cause additional damage.
- Stretching is part of your cool down period, immediately following exercising (not 30-40minutes later!), and can be used after your warm-up session.
Stand with one leg in front of the other, turning the toes of
back foot inwards slightly, keeping your back straight. Lean
forwards, keeping your heel on the floor (you can lean with
your hands against a wall). You should feel a stretch in the
top of your calf muscles and behind the knee.
Calf Stretch 2:
Stand with one leg slightly forward and bend the knee. Keep
your heel on the floor. You should feel a stretch lower down
your calf. Repeat with the other leg.
Reach over your shoulder with one arm, grabbing the elbow
and gently pushing it across your body, as if you’re scratching
your back. Gently push on your elbow to guide your hand as far
down your back as it will comfortably go. Feel the stretch in
your triceps and shoulder.
Stand with the ball of your foot on a step, starting off with
your knee bent. Tilt your hips forward (sticking your tailbone
out), and bend forward slightly. Gently straighten your knee
while maintaining the hip position. You will feel the stretch
behind your knee and into your buttock.
Stand holding on to a support, bend one knee and take hold of
the ankle. Draw your heel towards your buttock, tilting the
hips forward so that your knee points to the floor. Feel the
stretch in front of your thigh.
Hip & Lower Back Stretch:
Sit on the floor with legs crossed. Lift and cross your right leg
over the left, keeping the left bent. Hug the right leg close to
your chest, while twisting your upper body to look over the
right shoulder. Change legs and repeat.
Lying on your back, knees bent and feet on floor. Lift your
hips gradually off the floor, until your body forms a flat plane.
Repeating about 10 times for 30 seconds, to stretch your
quads and lower back.
Sit on the floor with soles of your feet together as close to
your groin as you can. Push your knees down towards the floor
using your elbows, leaning forward gently.
For specific stretches please give us a call to make an appointment with one of our chartered physiotherapists – Fleet Street 020 7404 0023 or Baldock 01462 893586.
Your body is designed for a much more active lifestyle. Keeping parts of the body still for too long, such as when you sit at a desk, can lead to stress on your spine with possible damage and pain.
Lighting, noise and badly-positioned furniture can all make you uncomfortable, so try to adjust things to suit you.
There is no one chair which suits everyone or every type of job. You should try to adjust your sitting position to the one that suits you best. Follow these few simple tips to help avoid back pain:
DO’S and DON’T’S
- DO try to keep the body’s natural curves. Avoid looking like a banana
- DO use a lumbar roll or a seat wedge to help maintain the back’s natural curve. A lumbar roll can be made by rolling a small towel and placing it between the chair and the lower part of your back
- DO try to keep your elbows at right angles when using a keyboard – use an armrest
- DO use a footrest if your feet don’t touch the ground or your chair can’t be lowered enough
- DO avoid excessive neck movement by using a document holder if you do a lot of typing
- DO place the keyboard where you can reach it easily and can key with either hand
- DO try and arrange your work so that you achieve a mix of sitting still and moving around
- DO get the body moving by doing a few exercises every hour or so. This will increase circulation, send more oxygen to the brain and help you stay alert
* * *
- DON’T sit for too long. Stand up and stretch every 20 minutes or so
- DON’T place things out of reach so that you have to make a lot of repetitive movements. Especially avoid twisting when sitting
- DON’T lean forward more than you have to. Your head weighs about 14lbs
- DON’T have your chair too far from your desk. The arms, if fitted, should not prevent the chair being pulled up close to the desk
This advice can help prevent back, neck and shoulder problems. However if a problem occurs, consult one of our Physiotherapists at The Wyndham Centre.
Although back pain is common, when you are the one who has it, it may seem that no-one else can truly understand your suffering. It can influence your sleeping habits, and your ability to work and function normally.
The back is composed of a complex arrangement of muscles, ligaments, bones, joints and nerves. The lower spine supports 70% of our body weight. When any one of these structures becomes worn, injured or inflammed, pain can occur. The spine is actually a stacked column of bones called ‘vertebrae’. The vertebrae are connected to each other by joints which allow the spine to bend forwards, backwards, and side to side.
One of the many structures thought to be responsible for back pain is the disc structure. The disc provides a flexible space between each vertebra, acting like a cushion, helping to absorb pressure and load throughout the spine. It is made up of a centre called the ‘nucleus pulposus’ and an outer region called ‘annulus fibrosis’.
As we age the disc can stretch or bulge and the annulus may tear causing pain and inflammation. This is known as ‘degenerative disc disease’ (DDD). Unfortunately this is a result of the normal ageing process, just like grey hair and wrinkles, it is not really a ‘disease’. Most people once they are over the big ’30’ have some degenerative changes in their discs! Those who have played strenuous sport or engaged in strenuous work may develop DDD at an earlier age. The key conditions for a disc injury involve compression, bending twisting, quick movements, and a combination of all, rather than in isolation, increases the chance of injury to the disc.
Although the disc can be a source of back pain in some cases it does not necessarily cause the symptoms of pain. In addition to bulging and stretching, discs can rupture or herniate causing material to protrude and press against a spinal nerve, nearby ligament or nerve root. The irritated nerve or structure can then cause pain and sometimes weakness in the area of the body connected to the nerve. A good example of this is pressure of the sciatic nerve root resulting in pain, weakness or numbness in the leg or foot. These symptoms are commonly called ‘sciatica’.
Joints in the back can cause problems like any other joint in the body. Minor injuries, excessive movement and arthritis can all cause joints to become inflammed, tender and painful. Other structures such as muscles, tendons, ligaments and bone can also be sources of back pain.
Faulty alignment can add stress and strain to your soft tissues, contributing to pain. Posture is how you hold and how you move, it is unique to each one of you and can be influenced by your mood, culture and environment. Your posture is balanced when your head, spine and pelvis are maintained in its natural alignment with optimum muscle effort. Habits, such as leg crossing and arm folding, are what come easiest and strongest to you, you may not be aware of them or realise the harm that they are doing to you, and it is difficult to break a habit.
Many of you sit infront of your computers all day which is equivalent to driving to Scotland and back every day! It is no wonder you may end up with back ache unless you are very careful how you sit and how you support your back. It is important when sitting at your work station that you sit well back in your chair and your low back curve is supported, your feet are flat on the floor or on a foot rest, and your computers are straight infront of you at eye level. The common thing that happens at the end of the day is that you end up slouching and your chin poking forward. This will put a great strain on the neck and shoulders and may go on to cause pain down the arms, and what is commonly known as RSI or work related upper limb disorder (WRULD).
The type of work and other activities that trigger RSI are:
- REPETITION – performing repeated movements with the same body part
- POSTURE – holding a joint towards its extreme
- FORCE – performing an activity with excessive muscular exertion
- STATIC EXERTION – holding part of the body still
- CONTACT STRESS – direct pressure on nerves or tendons
Your attitude to your job can also affect your chances of contracting RSI. Things to be aware of are:
- Little job satisfaction
- Infrequent or inflexible breaks
- Monotonous work (low activity, little variety and fast pace)
- Limited autonomy (lack of control)
- Perception of intensified workload and work
- Pressure (deadlines, monitoring, bad management)
It is important to manage this carefully and avoid problems by exercising 3 times a week and keep moving frequently at work. A healthy musculoskeletal system:
- Boosts energy levels
- Decreases pain and discomfort, inturn increasing mental agility and concentration
- Strengthens the immune system to fight infection and disease
- Stimulates the circulation and heart and lung function
- Reduces stress, tiredness and the effects of chronic illness
Any signs or symptoms require an inter-disciplinary approach. The problem cannot be resolved until the cause is found and eliminated. This may include medical screening, physiotherapy, ergonomic intervention and specialist equipment.
So, be aware, look after your back, don’t get into those bad habits and keep moving.
One of the most common is tennis elbow (lateral epicondylitis), a pain on the outside of the elbow, which can radiate down into the forearm. This involves a sprain of the tendons of the forearm where they attach onto the bony ridge on the outside of the elbow. It can cause the local tendon tissue to degenerate and may have an inflammatory reaction. This can be a stubborn problem resulting in long lasting symptoms, which are resistant to treatment and, it can be brought on by any activity involving gripping, digging, hammering or even carrying a heavy case.
New research suggests that the nerve system can play a major role in this condition and often the pain is referred from the neck and upper back and has associated sensory symptoms such as burning, pins and needles and numbness. It can be persistent and unpredictable.
Irritation of this system can be caused by bad postures and unhelpful movement patterns sometimes related to poor ergonomics at work.
Cases of tennis elbow directly related to playing the sport have many possible causes including poor tennis training methods (especially incorrect backhand technique or excess wrist flicking during service), unsuitable rackets (often too heavy), wrong grip sizes (often too small), incorrect string tension and ball weight. Treatment may involve local electrotherapy, massage, acupuncture, stretching, exercising and strapping, which when applied appropriately can reverse the local mechanical degeneration and decrease the inflammatory changes. More importantly, therapists will also assess the patient’s total body posture.
Also, advice will be given to correct bad ergonomics at work and sports specific requirements will be considered. With appropriate holistic assessment and treatment from our Physiotherapists you will all enjoy a long, hot, pain free summer playing the game you love.
Our Physiotherapists here are trained to treat all types of sports injuries and get them better as quickly as possible. Don’t forget that treatment shortens the healing process and gets you back to your game as soon as possible.
Treat yourself to a Healthy Spine
It is a requirement by law (under the 1992 Health & Safety Regulation) that companies provide a work-station/ergonomic assessment for their employees.
Our assessment is designed to increase awareness in how to use the workplace to prevent bad postural habits.
The participant will learn a better understanding of themselves and the habits that they are unaware of, to the benefit of their health.
The assessment will include:
- Looking at an employee’s workstation and making changes where necessary
- Providing a report with recommendation and advice
- Discussion on ways in which the spine is likely to become abnormal, damaged and painful in the general course of the day at work
- Discussion on ways in which to avoid these problems through being aware of posture, positioning and correct use of the workstation
- Discussion on how to keep a healthy back through activity outside of the working environment
We have a Physiotherapist with a special interest in work related injuries and ergonomics. She is an IOSH (Institute of Occupational Health & Safety) recognised workstation assessor with extensive experience in work place display screen equipment assessment. Additionally she has experience and a wide knowledge of appropriate furniture and accessories through working as a medical consultant for an ergonomic furniture supplier.
Common basic habits such as carrying heavy briefcases on one side, holding the phone between the shoulder and the ear, crossing legs, standing on one hip are highlighted and we emphasise the need to make a change in all aspect of daily living, not just in the work environment.
Simple guidelines for good ergonomics at work:
- Place your monitor directly in front of you rather than off to one side
- Have the keyboard at a comfortable height to reach with bent elbows
- Then set appropriate chair at correct height
- Use a foot, hand and mouse rest
- Learn to be ambidextrous with the mouse
- Take regular breaks and stretch