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A hypothesis: Why Singaporean Kids are more likely to develop neck pain than their counterparts in South East Asia?

As a physiotherapist working in private practice, I am starting to see an increasing trend of younger clients with neck pain. The youngest has been 8, but the majority are between 13-16 years of age. I believe that this is a trend that we will continue to see with potential for even younger clients.

My thoughts: Some possible factors unique to Singapore, that may be contributing to this trend:

1. IT/ phones
Singapore is one of the most wired up countries in the world, having one of the highest IT penetration rates. Despites Singapore’s 4 million population, it has 402,992 iPhones, 76575 iPod Touch and 1,453 iPad’s totaling  480,950 iOS devices. Singapore has the highest iOS penetration , in comparison to neighbouring Indonesia which has the lowest.  http://e27.sg/2010/06/10/highest-ios-pen…).

According to iDA Singapore, in the fourth quarter of 2010, Singapore’s household broadband penetration rate was 191%. This percentage suggests that almost every household had 2 broadband subscriptions.

The mobile phone penetration rate is 143%, and 3G mobile subscription totals is an overwhelming 4.7 million.

The statistics alone indicate that the Singaporean lifestyle has changed over the last 10 years. It can be inferred that almost every household will have access to a computer, a 3G mobile phone and possibly a tablet.

Most children in Singapore have access to some IT and are exposed and taught to use computers in schools. This fact, combined with the popularity of social networks like Facebook and Twitter for the older kids and Club Penguin for the younger kids, as well as the myriad of free games available on the iphone and ipads, children in Singapore spend more time in potential poor postures whilst attending to these IT tasks; and more time indoors than outdoors.

Image from Volunteerproject.org
click for larger view

The oppressive heat and humidity, With a constant daily humidity of 99% and a temperature of 33 degree Celsius it is understandable the kids prefer to stay indoors. Possibly aggravating the problem are the parents who also may not be as willing to accompany the younger ones to the park for the same reason.

Secondly, the lack of open spaces available for free play. Approximately 80% of the population lives in apartments, and the majority of those living in landed properties have little garden space. The physical environment in itself is not conducive to outdoor play.

It is commendable that in most housing estates, there are playgrounds for young children to play, but not much for the older kids. You will often see signs that say “no soccer allowed” in the void decks and even some open fields. With such restrictions, it is no wonder outdoor play is reduced.

Thirdly, perhaps the majority of households are dual income, parents are not able to supervise outdoor play and may not want their children to play outdoors on their own.

3. Great emphasis of academic results and sport is not seen as a priority.
There is a greater emphasis on academic performance in Singapore, compared to anywhere else in South East Asia. With no natural resource, human resource remains its main driving force leaving Singaporeans no choice but to be ahead of the game.

This translates to lots of pressure to do well in school as that is seen to lead to a good job with a good income, and thus growth for the economy.

As a result, outdoor play or pursuing ambitions of an elite sport athlete is not a priority or possibly encouraged in a practical Singapore. Such mindsets are subsequently ingrained in a young children, and is unlikely to change anytime soon in the future.

4. Parents awareness of ergonomics
As children spend increasingly longer time studying or and at the computer, it is imperative that as parents, we realize that good ergonomics is paramount in reducing the incidence of neck and back pain in this population.

The study table and chair must therefore be of the right height. The child’s back must be fully rested against the back of the chair; and feet completely supported on the floor. The table height should be lowered such that the child’s elbow can be at 90’ angle when rested on the table. When reading, the table should be inclined so that the child need not to drop their head forward to read. Investing in an ergonomic table and chair is a worthwhile investment for your child’s spinal health.

If the child has to spend a fair bit of time on the laptop, buy a laptop riser, a separate key board and mouse. Using a laptop without ergonomic modification will result in excessive loading in the neck joints leading to pain.

If your child is complaining of neck or back pain, consult your nearest Core concepts branch for advise and treatment.

Neck Pain: The truth on Traction

The amount of people working in a desk bound jobs is increasing worldwide. Unfortunately, these jobs tend to go, hand in hand with a greater chance of suffering from prolonged neck and back pain. Maybe for this very reason, currently the most common source of musculoskeletal disability is chronic neck pain.

According to a recent study, 34% of the general population experiences neck pain at some time in their life, of which 14% having symptoms lasting longer than six months.
Due to the number of  health care visits, work absenteeism, decreased productivity and disability, neck pain has huge consequences on peoples well being, and their health care expenses.

click for larger view

There are many methods that clinicians use to treat neck pain. A traditional and conservative method commonly used by physiotherapists, is cervical traction. Despite its clinical popularity, previous and current studies, looking at the effectiveness of cervical traction, remain inconclusive.

In theory, applying a controlled pulling force on the spine causes a number of physiological effects:
- It enlarges the intervertebral foramen
- It releases pressure on intervertebral discs
- It releases pressure on nerve roots and blood vessels
- Ligaments and paravertebral muscles of the neck region are being stretched
- Effects of abnormalities of the cervical facet joints are reduced

These effects are believed to release muscle tension, nerve tension and increase blood circulation in the cervical region, which ultimately should result in decrease neck pain.

In a more recent study done by the Hong Kong Polytechnic University, intermittent cervical traction on 79 patients (aged between 20 to 70 years old) with chronic neck pain, was investigated. The patients were randomly assigned into two groups. For a period of six weeks, one group received cervical traction twice a week, adminsistered by a experienced senior physiotherapist. The second group recieved placebo- infra-red (heat therapy) treatment twice a week.

At baseline, after 6 weeks, and after 3 months, the patients were asked to complete a disability questionnaire, score their pain on a pain scale, and range of motion of the cervical spine was measured.

From this study they concluded that there was no significant difference in disability, pain and range of motion between the group that received traction, and the group receiving the placebo infrared treatment. The researchers did state that there were several limitations to the study.

Several other studies in the past have found similar findings  that as a treatment method in soltaion, traction does not show significant improvements. Research supporting its benefits and use is somewhat flawed or inconclusive and therefore more methodological randomised control studies should be carried out.

In order to maximize the benefit of treatment for patients with chronic neck pain, it is important for clinicians to consider giving a combined and individualized treatment to them instead, of intermittent cervical traction alone. Studies of late are generally leaning to a combined approach of exercise therapy, education, joint mobilisation and manipulations as being the most effective method of treating neck pain

References:

Chiu, T.T., Ng, J.K., Walther-Zhang, B., Lin, R.J.H., Ortelli, L., Kuan, S (2011) A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain; Clinical Rehabilitation:1–9

Gym Users – Are you OVER-working the PECS?

If your gym workout is giving you neck and shoulder pains,  you could be  over-training your chest muscles. The key is a balanced training program that focuses on several muscle groups to prevent muscle imbalance developing and the consequent dysfunction

The effects of over developing one muscle group i.e. your chest muscles (pectorals) in the gym, whilst neglecting your back muscles, often affect your posture resulting in neck, back, and shoulder pain

To understand why this occurs, you must be familiar with the notion that most joints in our body have two or more separate and opposing sets of muscles acting on the joint. Take the elbow as an example.

When the biceps contracts and shortens, it bends the elbow joint. As the elbow bends, the opposing triceps, must relax and lengthen to allow this movement to occur. And vice-versa, for the elbow to straighten; the triceps contracts and shortens and the biceps must relax and lengthen.

To gain a well rounded physique you must consider strengthening more than just one, if not all the muscle groups. An over developed muscle (group) will create more tension on one side of the joint. Over developed muscles are also often tighter (shorter) than normal.  The balance between muscles at the joint is lost, pulling the joint away from its mid-line and changes the angle of rotation at the joint.

Muscle balance at a joint
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Muscle imbalance at a joint
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The Shoulder

The shoulder is a more complicated joint, however the same principles apply.

From personal experience as a physiotherapist, one of the most common mistakes in the gym is over-training the chest muscles.  This causes an imbalance between the muscles at the front of the body and those at the back. The shoulders with time are pulled forwards as the chest muscles get stronger, bigger and shorter, making the posture more rounded, creating pain and potential pathology.
Lateral postural Picture

Rounded posture with over-developed Pecs
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Why is a rounded posture problematic?

Rounded postures place the shoulder joint in a unbalanced position away from the ideal centred position. This unbalanced position leads to increased compression at the shoulder, resulting in pain and reduced function:

• Compression of muscles and other structures at the front of the shoulder joint, may cause pain in the neck, and or down the front of the shoulder and side of the arm. Pain is usually worse with overhead activities. If the compression of the tendons continues for long enough, tears of the tendons (rotator cuff) may occur.
• Rounded postures often lead to neck pain. A large number of muscle that attach to the shoulder also attach to the neck at the other end. If these muscles are affected (lengthened and weakened by the pull of the shoulders) the neck often tends to rest into a head forward ‘chin-poke’ position. This increases the pressure on the neck joints and also other pain sensitive structures around the neck that can cause symptoms (Szeto, 2005).
• The shoulder’s range of movement is significantly reduced as a result of having less space for the joint to move. (Bullock et al, 2005)

Additional contributing factors leading to rounded shoulders

Modern Lifestyles
Think about all your daily activities; washing your face and hair, driving, sitting at the computer.  People are becoming chair-shaped, and this keeps the shoulder in a rounded position.

Pain Response
Your body’s response to pain is another factor.  When you have neck and shoulder pain we often adapt a rounded posture.  This initially is good protective mechanism to prevent further damage for the first few days post-injury, however in the long term this posture keeps the shoulder in a poor/compressed position and will hinder healing.

How to correct your rounded posture?

As a guide, when looking from a side view your shoulders should be fairly central compared to the trunk, and the head should be central on the shoulders.  A ‘plumb line’ from the centre of the ear should fall through the centre of the shoulder.

Correct posture in sitting
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To get into this position roll your shoulders all the way forwards, then all the way back (your shoulder blades should touch), then find the mid-point between these two position.  When you have this, gently tuck your chin in, so that your head is positioned on top of your shoulders.

Workout program to prevent the over-training

Weight-training:
If you work the chest 2 x weekly, doing 6-9 sets of 12 repetitions, then do the same amount of work, at the same load and intensity for the opposing muscle groups – the upper back muscles.  Most chest exercises involve pushing – therefore to balance this and work the upper back you must include pulling type activity.  Some ideas are provided below.

• Lat pull down
• 45 degree angle lat-pull down
• Seated row
• Bent over row
• Pull ups
• Shoulder external rotation

Stretching
As well as strengthening (which contracts and thereby shortens muscles), you should ALWAYS stretch all the muscles you have trained (lengthen the shortened muscles ) at the beginning and end of your workout to reduce tightness of these muscles. In this scenario it is therefore strongly recommended to stretch both the pecs and back muscles.

Pec stretch
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• Hold 30 seconds
• rest 30 seconds
• repeat x 3 (4 x daily)

References:

1. Brukner and Khan. Sports Medicine
2. Bullock, M., Foster, N., Wright, C., (2005). Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Manual Therapy 10, 28–37
3. Kwok Tung Lau, Ka Yuen Cheung, kwok Bun Chan, Man Him Chan, King Yuen Lo, Thomas Tai Wing Chiu (2010). Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Manual Therapy 15 . p457-462
4. Szeto, G., Straker, L., O’Sullivan, P., (2005). A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work—2: Neck and shoulder kinematics. Manual Therapy. Vol 10. p 281–291

Arm pain or neck pain…Where is the source?

Have you ever experienced pain in the arm, but the movements of the shoulder and elbow do not seem to aggravate the pain? Or found pain on the side of your thigh or knee, but there is nothing wrong with your knee? Are you imagining the pain? Where is the pain coming from?

These pains are real. Pain in the arm can be referred from the neck and similarly the source of pain in the leg can be from the lower back.

Types of referred pain from the spine 
 

1. The most common is a deep dull ache in certain parts of the affected limb. See image below. These areas of pain correspond to where the nerves in the spine supply sensation to. There are 7 vertebrae in the neck. Depending on the level, nerves exit from the vertebra and travel to specific areas of the scalp, shoulder, arm, forearm and hand. Similarly nerves exiting between the 5 vertebra of the lower back travel to the bottom, thighs, legs and feet. These nerves supply sensation to these particular areas and are called dermatomes.  So if the exiting nerves are mildly irritated, it can refer pain to its specific dermatome. Therefore, if the structures surrounding the nerves are inflamed, immobile, strained or somehow affect the exiting nerves, pain can develop in the extremities.
2. The second type of referred pain is sharper, more acute and often described as pulling, stabbing and severe pain.  However, the site of pain remains the same. In these cases, the nerves exiting the vertebra are not only irritated but usually impinged or compressed.  The cause of the impingement is usually severe degeneration in the vertebrae, disc prolapse and swelling which reduces the canal space, for which the nerves to exit.  These types of pain can be accompanied by loss of strength of muscles in the arm and leg as well as decrease sensation as the compression affects the conduction within the nerve fibres. The impinged nerve essentially is less able to send its usual amount stimuli to the muscles it excites. 

Dermatomes

Treatment of referred pain

The treatment for referred pain is simple.  Find the cause of the irritation or compression and remove or reduce the cause as much as possible within the realm of physiotherapy.
 

1. Type 1 Dull achy pain is usually due to poor posture, excessive mechanical loading on the spine, i.e. tight muscles, stiff and or mal-positioned facet joints.Once the mechanical fault is corrected, the structures offloaded, through manual therapy, the symptoms tend to promptly reduce.
2. Type 2 Pain which is more acute, it is more difficult to treat.  As the source of pain is from the compression /impingement of the nerve, the cause of the impingement is usually structural.  This means that the existing degeneration of the spine and the significant disc protrusion are the main reasons for the impingement.  Therefore unless that is addressed, often the pain is not completely resolved. 

The role of physiotherapy in this intance is to reduce the non structural causes such as excessive vertical loading, the narrowing of the canal and pain reduction. These non structural causes could be the result of swelling, poor posture, muscle spasm. Traction and specific exercises are therefore taught to open the canal space and reduce disc protrusion and impingement.

Pilates and Physiotherapy

What is Pilates?

Pilates is a unique body conditioning exercise designed to rebalance the body, bringing it, into its correct neutral alignment whilst targeting the deep postural muscles (Transverse abdominals and muscles of the pelvic diaphragm). In essence pilates challenges the core muscles and builds strength from the inside out, helping a person to reshape their body, adding to a leaner and more toned figure. It boasts of a perfect balance between strength and flexibility, whilst relieving unwanted stress and tension. The phenomena of pilates is a popular and growing trend in western countries amongst athletes and celebrities, as well as in the treatment of peripheral and spinal musculoskeletal dysfunction. Today pilates is evolving and is taught worldwide in gyms and hospital, benefiting millions of people. The aim of this article is a brief introduction to pilates and its clinical benefits in physiotherapy.

Background

Pilates was first discovered in Germany in the early 20th century by a keen diver, gymnast and boxer by the name of Joseph Pilates. Joseph Pilates had spent the majority of his childhood fighting rickets, asthma and rheumatic fever and this fuelled his desire to become physically immune to these ailments. Through studying a variety of different disciplines (yoga, Zen) he brought about this new notion of exercise. During the war he practised his theory of exercise, and became involved in the rehabilitation of war victims. Once the war ended, Joseph Pilates relocated to New York and soon went on to open the first pilates studio attracting elite actors, dancers and athletes.

Image from Pilates Suffolk click for larger view

Clinical Pilates vs Pilates

Clinical pilates is used to treat people with musculoskeletal injuries and is conducted by a physiotherapist certified with Clinical pilates certification. If a person experiences an injury or repetitive injuries, they may have joint stiffness, muscle spasms, poor posture or abnormal movement patterns as a cause or a result of the injury. It is therefore important to first treat the above complaints before commencing pilates.

In addition certain pilates exercises may aggravate the symptoms. An example is someone who may experience a back strain, due to too much extension in the lower back. Such individuals may have an exaggerated lordotic postures and therefore extension pilates exercises may not be advisable. This is something that would not be picked up if a person was to attend a routine pilates class, which does a combination of both flexion and extension exercises.

Not only is it important to select the right type of pilates exercise, it is also necessary to ensure that the correct and appropriate level is prescribed. Routine pilates may be too challenging for a person with back pain. This will cause the individual to compensate and utilise stronger global muscles as opposed to the core muscles, therefore negating the benefits of the pilates exercise. As a secondary result, a person may start to experience muscle spasm in the global muscles due to the increased exertion. The physiotherapist having tested your muscle strength and range of movement, will be able to ensure that the exercises are appropriate and although challenging not detrimental to recovery. 

The added benefit of clinical pilates to routine pilates is not only is it more individualised to the person and their problem, it can also be more functional. If the person for example is keen to return to an activity or a sport (swimmer, footballer, dancer) the standard exercises can be modified by the physiotherapist to strengthen the core muscles whilst carrying out the aggravating movement. This could mean that the core muscles of a footballer is challenged as he kicks, dribbles a football and not just in static postures.

Peripheral injuries

When dealing with peripheral joint/ muscular injuries e.g. ankle instabilities the ankle is the main focus of the treatment. This makes sense and is always a good place to start to strengthen and rehabilitate local structures. However the research is beginning to move towards looking at the whole picture. Improving an individual dynamic control of their movements, will mean that person is less likely to sustain injuries. There is a growing trend to rehabilitate athletes whilst incorporating Pilates based exercises to teach a person to move more efficiently. Pilates can be used to treat hip, shoulder, knee and ankle injuries. 

Spinal Injuries

Pilates in conjunction with manual joint mobilisations and soft tissue release is an effective way to treat back pain.
Time and time again the research has shown that any form of back pain leads to a loss of function of the deep muscles (multifidus) of the spine at that level. Unfortunately these muscles do not have the capacity to turn back on again, once the initial episode of back pain has resolved, and therefore these muscles require specific training to reactivate and stabilise the spine. In the long term these muscles without exercise will continue to waste further and subsequent muscle spasm in the global and more superficial muscles is experienced. This predominately occurs as a mean to stabilise the back in the absence of the deep muscle activity. Such individuals will report recurrent flare ups of back pain in the year due to the ongoing weakness of the spine.

In addition to weakness, back injuries usually occur after an extended period of time, in a bad posture, excessively loading the joint.

Clinical pilates is a form of exercise that both facilitates the strengthening of these deep muscles whilst educating a person where a neutral spine lies. In time a person will feel that there back is stronger, as they become more aware of what sitting or standing in a good posture entails.

In the long term they will also have the endurance to sustain these better postures for longer periods, through conducting the exercises.

If a person is new to pilates one- to one sessions with a physiotherapist or very small classes is initially strongly recommended, this is to ensure a person can be taught the correct techniques and the 5 concepts of pilates accurately (breathing, neck, rib pelvis position and stabilizing). Pilates can be a little tricky and can easily be done incorrectly and therefore close supervision is required to prevent faulty patterns learnt. 

The benefits of Pilates
 
•    General fitness and body awareness greater strength and muscle tone
•    Improved flexibility
•    A flatter stomach
•    Improved efficiency of the respiratory, lymphatic and circulatory systems
•    Better posture and awareness
•    Less incidence of back pain
•    Increased joint mobility
•    Lower stress level

Which clients would benefit from Pilates?

•    Males and females
•    Pregnant: Pre and post natal
•    Athletes and dancers
•    Amputee and stroke rehabilitation clients
•    Elderly
•    Children 12 years-old +

Clinical pilates therefore  targets the musculoskeletal injury more specifically. The physiotherapist is able to identify your posture type, establish the mechanism of injury, understand what the peron is aiming to return to and work out which exercises would be of more benefit to the individual. Clinical pilates therefore looks at treating the cause as well as selecting the appropriate repertoire of exercises to strengthen the injured areas and even be done for injury prevention.

If your suffering from recurrent episodes of back pain or peripheral injuries – Clinical Pilates may be just what you need!

Yearning for a Good ‘Neck’ Sleep?

Have you ever woken up with a stiff and/or painful neck or shoulder, and wonder if it is because of the pillow that is causing the problem?

If the answer is most likely a yes, continue to read on.

A pillow that fails to support the neck probably will cause the neck to end up in a wrong position for a long period of time, which inevitably causes excessive stress to the neck and leads to pain. The question here is, how do we choose a good pillow?

A GOOD pillow is one that could help preserve the natural curvature of the neck, and the position in which the neck has its normal curvature is called the neutral position of the neck. This is important because the muscles at the neck can be supported so that they can relax and not overwork  throughout the night.  Just like a good back support could help us maintain a good back posture and prevent overworking of the back muscles, a good pillow could help us maintain a good neck posture at night.

Before we talk about how to choose the most suitable pillow for yourself, we must look at the sleeping positions. The reason is that with different sleeping positions, different support is required to maintain a neutral neck postion.

Back sleeper

When someone lies on his/ her back without a pillow, the head usually falls downwards and the chin tilts upwards. This puts a lot of stress on the neck as it aggravates the reversed “C-shape” of the neck. The situation would be worse if he / she has a stiff / hunched upper back.

A good pillow for back sleeper is one that could fill the gap between the back of the head and the upper back, so the natural curve of the neck can be maintained. There are many contour pillows that could help achieve this.

Source: Travel-contour-pillow
click for larger view

When using a contour pillow, the higher end should be inserted underneath the hollow of the neck closer to your shoulder.

What to look out for:

1. Place your hands around your neck to feel for any muscle tightness/tension. If you are in the correct position, your neck muscles will be relaxed.
2. Get someone to take a look at your neck posture from the side view. He/she should be able to draw a straight line from the ear lobe to the shoulder joint and the hip joint.

Modification:

If your pillow is too low for you, you could use towels and pile them on top of a regular pillow (the towel is the modified higher end of the contour pillow, and works to fill the gap between the back of the head and the upper back). Do not use a regular pillow that is too high or too low, which either bends the neck too much forward or allow too much backward arching of the neck.

Side sleeper

A contour pillow may best serve the purpose of maintaining a neutral neck.

Source: Physioworks.au
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The higher end of the pillow again needs to be underneath the hollow of the neck. It is also important to pull the pillow as close as possible to the top of your shoulder. The height of the contour is usually equal to the width measured from the base of the neck to the tip of the shoulder of the same side.

What to look out for:

1. As shown in the picture above, the spine should form a straight horizontal line, parallel to the floor.

Modifiation:

Again, an extra pile of towels on top of a regular pillow may be used as a modification of a contour pillow.

Tummy sleeper

Though this is not a sleeping position recommended as it forces the neck to be turned to one side and also arch backwards excessively, some people do sleep this way. For people who sleep on their tummies, it is the best to choose a regular pillow that is soft and low.

The pillow also needs to be pulled lower so that it supports the top part of the chest. Those could help prevent excessive neck rotation and backward arching.

Anti-Aging Exercise for your Lower Back – Good Nourishment is the Key

The discs in the spine age and degenerate just like all of the other structures in the body. However, today’s sedentary lifestyles often speeds up this process. We cannot apply anti-aging creams or lotions to our discs, but certain exercises can help to maximize the discs nourishment.

The Theory: Disc Nutrition

The discs are fluid filled gel like structures that act as shock absorbers in the spine. They are found between each segment of bone throughout the spine. The discs slowly lose some of this fluid through the daytime under the effects of gravity. The fluid is then drawn back into the disc when we sleep at night in an unloaded position. This movement of fluid is critical for disc health as discs nutrition is provided from this exchange, and the volume exchanged must remian balanced. Unfortunately, sedentary individuals may be encouraging a negative fluid balance. It has been shown that sitting or standing statically for as little as 1 to 2 hours significantly increases the outflow of fluid. This process leads to the first step in disc degeneration. The disc becomes ‘dehydrated’ and mechanically ineffective when it tries to distribute the body’s load. This initial change often presents as the mild ache you feel when sitting for long periods.

The Degeneration Cycle

Over time the disc reduces in height and becomes less compliant. Globally the spine loses flexibility and therefore cannot create enough pressure on the disc to effectively and sufficiently move the fluid in and out. The disc receives less nutrition and has difficulty removing waste products. The cycle continues and may cause a break down of the structure of the disc. This stage relates to when back pain becomes more chronic in nature, and additional disc damage and pain can occur from minor activities.

The good news

Traction exercise completed on a daily basis can halt and even reverse this process. The overall aim is to improve the fluid flow mechanism in the disc and ultimately increase disc height and health as it rehydrates.

Where to start?

Any exercise to ‘traction’ or ‘decompress’ the lumbar spine can help. An example is shown below using a yoga block (approx. 7cm height), placed below the belt line

Spine Decompression exercise on Yoga block
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• Spend 1 minute relaxing in this position

• Remove the block and rest for 30 seconds

• Repeat this process 3 times in 1 session

• 1 session should be completed around midday, and a further session prior to sleeping.

Other Important Factors

• The  exercise should be carried out in the evening. This is when the disc has been maximally compressed from daytime activity. Traction allows the discs to take in fluid more efficiently during the night hours when the spine is unweighted.

• If you normally exercise immediately after working at the office all day, use the traction exercise as part of your warm up to ‘decompress’ the discs. This will reduce the stress on the disc during your exercise routine.

• Added benefits This position stretches the muscles and other soft tissues at the front of the spine and hips, which are often tight from many hours spent in working postures.

• The stretch can create better alignment of the upper body making you stand straighter, which is important for maximum recovery following a lower back injury.

Caution Assessment by a Physiotherapist is strongly recommended prior to starting the above exercise. If you already have lower back pain you may also require hands-on treatment from a therapist to physically mobilise a particularly stiff spinal segment for the above exercise to be more effective.

Distinguishing Types of Headaches

We have often talked about headaches in the past and how it is linked to issues arising from the neck (Neck-Related Headaches and Causing Most of the World’s Pain, Anonymously). The type of headaches that we talk is called "Cervicogenic Headaches". But often readers ask us how do we distinguish cervicogenic headaches from other types of headaches, so we described here some of the most common types.

Flickr: TrevinC

So figure out, the most common types of headaches are tension, sinus and migraines.  How they feel like is described below:

Reference:

1. The International Classification of Headache Disorders, Cephalalgia, Volume 24 Supplement 1 2004 2nd Ed.
2. Headaches: Relieving and preventing migraine and other headaches, Harvard Medical School Special Report

Neckache from Deskbound work. Can Physiotherapy help?

"Dear Sir / Madam,

My neck has been aching on and off when I am working at my desk. Recently, I started to experience heavy headedness and I tend to lose concentration due to that. I have gone through an X-ray and I was told that I have cervical Spondylosis with a bone spur pressing onto the nerve. Are my heavy headedness and neck ache due to spondylosis? Can physiotherapy help me in my condition?" – Josh

Dear Josh,

Thank you for your enquiry.

Spondylosis is a medical term for signs of degeneration or wear and tear to the structures around the spinal bones. It is a problem faced by many people especially deskbound office workers.

There are many other underlying factor and one of them is the bone spurs which can pinch a nerve causing symptoms like pain and numbness. This may cause by excessive mechanical pressure from a poor sitting posture. According to your description, it seems like your heavy headedness is likely linked to excessive physical stress to the neck causing Spondylosis.

In a poor sitting posture, the neck is poked forward from the shoulders and the shoulders are rounded with the lower back in a slouched position. As the neck is hanging away from the shoulders, the muscles in the neck and shoulders will have to work harder to pull the neck back in order to support it. This increases the mechanical pressure on the joints which further aggravates the degenerative process. The muscles will also get fatigued and overworked, giving you the achy sensation to the neck and shoulders.

When your muscle tension becomes bad, it potentially can radiate pain up to the base of the skull. This is because there are sensitive nerves that supply to the head, eye, ear and the joints near the base of the skull . Excessive pressure over these areas can give rise to tension headache, stabbing pain behind the eye, ringing in the ears, jaw pain. The heaviness you felt from the head is most likely from the same upper neck joints at the base of the skull.

To solve your problem, our physiotherapists will

• Mobilise the neck joints to give it flexibility and reduce the mechanical pressure over the joints.
• Some soft tissue work on the muscles may need to be done to reduce your muscle tension.
• Regular stretching or range of movement exercises to reduce muscle fatigue and maintain flexibility.
• Ergonomic advise will be given on how to sit properly at work and there will be some training exercises to increase your awareness of your sitting posture so that you can decelerate the degenerative process and prevent the problem from returning.

It will usually take about 6-8 sessions to have significant improvement on such a case. You can refer to this link for more information on neck related headaches.

Neck-related headaches

Regards,

Chye Tuan

Why get manipulated in the first place?

A few months ago in April, we wrote about the risk of VBI when getting your neck cracked, "If you like getting your neck ‘cracked’ or thinking about it, you should know about VBI", a group of researchers from the University of Sydney in collaboration with University of Queensland found that that neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

Project leader, Dr. Andrew Leaver from the Faculty of Health Science, University of Sydney said, "It makes us question why patients or practitioners would favour a treatment which possibly carries risk of catastrophic outcome over an equally effective one with very few reported complications despite widespread use."

So why do then patients seem lured towards neck manipulation?

While over the longer-term results from the mobilisation and manipulation approach is identical, the short-term relief that manipulation provides can be a mis-leading siren song. Patient generally immediately feel better after a crack compared to the more gentler mobilisation. But the VBI risk doesn't seem to be worth it as little is done to improve the underlying functional problem. In fact, it opens a door towards excessive frequent weekly 'cracking' session to sustain the pain relief.

Reference:

1. Controversial study suggests neck manipulation not worth the risk, University of Sydney, 9 September 2010
2. A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain, Archives of Physical Medicine and Rehabilitation – Volume 91, Issue 9, Pages 1313-1318 (September 2010)