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.

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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

Neck Pain: The truth on Traction is a post from: Musculoskeletal Consumer Review

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A deskbound worker's posture are the main factors that will give rise to such shoulder problem. These factors are similar to those predisposing factors of shoulder pain in overhead activity athletes.
 

The image below demonstrates a slouched sitting posture with a forward head posture typical of someone who spends long hours at their desk. A few factors to notice in someone with a shoulder pain, is the position of the shoulder blade, rounding of the shoulder, and poking of the chin.

Image 1. slouch desk posture
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Narrowing of shoulder joint space from a slouched position

Try slouching your upper body and raising up your arm as high as you can, compare this to sitting or standing upright and reaching high up. You will find that it takes more effort in the former scenerio and you may feel a pinch or a block in the shoulder as you go towards the end of range. This is because the shoulder joint space (subacromial joint) is narrower in a slouched position.

Muscle Imbalance

In slouched sitting, the shoulder blade is rested on the rib cage in a forward tilt orientation. Overtime, this develop into a muscle imbalance where the muscles in front (pectoralis minor) are tightened, and the muscles at the bottom of the shoulder blade (lower trapezius) are stretched and thus weakened. As the lower trapezius is one of the vital muscles to stabilise the shoulder blade, weakness will increase instability and poor control of the shoulder joint leading to overuse of the rotator cuff muscles to compensate for the instability.

Long hours in the slouched position also develop stiffness in the joints of the upper back. This means that even if you get away from the desk, the upper back is so stiff that it's "stuck" in this slouched posture, coupled with the muscle imbalance, a person will find it increasingly more difficult to correct their posture even when in an upright standing stance, further increasing the risk of shoulder pain.

Rounded shoulder makes muscles inefficient

In a rounded shoulder, the ball of the shoulder joint will not be able sit well in the socket of the shoulder as there will be a inward rotation of the ball in the socket. Imagine a golf ball balancing on a tee, when the ball joint is not sitting well in the socket, muscles around it will have to work a lot harder to pull the ball into the socket to maintain stability. The excessive efforts from the muscles makes it tires and wears it down faster.

Shoulder pain in office workers is a post from: Musculoskeletal Consumer Review

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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
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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.

Yearning for a Good ‘Neck’ Sleep? is a post from: Musculoskeletal Consumer Review

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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.

Anti-Aging Exercise for your Lower Back – Good Nourishment is the Key is a post from: Musculoskeletal Consumer Review

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The following office exercises are a great way to prevent these symptoms from happening. These exercises involve stretching of neck, back and wrist keeping your body from becoming stiff and moving all within the comfort of your office chair.

If you have any injuries, illnesses or other conditions, please see a doctor before trying out these exercises.

1. Wrist Stretch Extend arm in front, palm up and grab the fingers with other hand. Gently pull the fingers towards you to stretch the forearm, holding for 20-30 seconds. Repeat on the other side.	wrist stretch click for larger view
2. Wrist & Forearm movement Press hands together in front of chest, elbows bent and parallel to the floor. Gently bend wrists to the right and left for 10 reps.	Wrist & Forearm movement click for larger view
3. Upper Back Stretch Sit tall and interlace both hands together and stretch up towards the ceiling, holding for 20-30 seconds.	Upper Back Stretch click for larger view
4. Side Trunk Stretch Sit tall and place one hand at the side of the chair and reach down towards the floor and raise another hand up by the side of the ear and reach up towards the ceiling simultaneously, holding for 20-30 seconds. Repeat on the other side.	Side Stretch (Right) click for larger view Side Stretch (Left) click for larger view
5. Lower back stretch Sit tall and place the left arm behind left hip. Gently twist to the left, using the right hand to deepen the stretch, holding for 20-30 seconds.  Repeat on the other side.	Lower back Stretch (Right Rotation) click for larger view Lower Back Stretch (Left rotation) click for larger view

Top 5 Office Exercises is a post from: Musculoskeletal Consumer Review

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To correct a slouched posture using the Cogwheel method, you should tilts your pelvis and lower back forward, subsequently the slouch in your upper back should be reduced and your head/ neck will be pulled back on top of the shoulders. It is the movement from a slouched posture to an upright posture through the cogwheel and the practice of this movement that give one self-awareness to be able to manage his/her own posture and spinal condition.

source: Clinical Application of Neuromuscular Techniques: The Lower Body By Leon Chaitow, Judith DeLany click for larger view

Want to correct your Posture? Try Cogwheel Model. is a post from: Musculoskeletal Consumer Review

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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

Neckache from Deskbound work. Can Physiotherapy help? is a post from: Musculoskeletal Consumer Review

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So how should your work surface be setup?

First things first. The top of your work surface should be your elbow level. This means you have can comfortably place your eblows on the surface with your upper arms more or less hanging loose straight down. This is prevent your shoulder muscles from straining to hold your arms up all day.

You might see some people working on surfaces much higher than elbow height while resting your elbows or lower arms near the elbows on the work surface. Yes, while this alleviates the strain on your shoulder muscles, it reduces blood circulation.

Work zones

Once your working surface is at the right height, you now need to organise the items on the work surface. You need to sort them out into three different frequency of use – Usual work, Occsaional Work and Rare work. Work here can refer to equipment such as stationary or documents or folders.

Next you then organise the work items into their respective "semi-circular zones" (see figure for layout).

Workspace-Zones
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The principle involved is simple enough; items used frequently should be located within easy reach. The further your extend your hand, the effort and strain you have to bear. This layout also more productive as you will spend less time reaching for frequently used items.

Getting used to it.

This is a easy solution and cheap too!  But whenever we enter a new environment, it takes sometime for us to adjust. Give yourself a week or two to get use to your new working surface layout. You might be surprised with your increased productivity and better well-being.

Work Surface Layout for Better Ergonomics and Productivity is a post from: Musculoskeletal Consumer Review

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After working on the laptop for an hour, I get headaches and neck pains.  However, if I use the desk top, I seem to be able to work longer without discomfort.

The use of laptops for work is widespread. However, the screens on laptops are too low without having the head in a forward position. In the head forward position, the upper cervical is in extension and C1-3 are compressed. 

As C1-3 refer to various parts of the head, clients perceive the pains as headaches. Ideally, the first line of the computer screen should be at eye level and this is easily solved by using a laptop riser that can be purchased from computer shops.  It must be noted that typing on the keyboard that is in the incline position can result in carpal tunnel syndrome and wrist pains. We recommend that clients purchase and use a separate keyboard to minimize injuries to the wrist.

Along with the low screen, the laptop keyboard is smaller than a standard keyboard.  With a smaller keyboard, the user’s shoulders are protracted and adducted, leading to future risk of injury to the shoulders and neck. Ironically, manufacturers are now reducing the size of laptops aggravating the situation further.

Contentious issues

There are contentious issues with some of the ergonomic guidelines. One such issue is the hip angle of the user.  It is now recommended that the hip angle should not be at 90 degrees, but between 110-130 degrees. This is because it is found that the discal pressure in the lower back reduces as the hip angle increases, which follows that ideally that the chair should be adjusted such that a hip angle of 130 degrees is achieved. However at that angle, the cervical spine has to flex forward for it to be in an upright position thus affecting the superficial cervical flexors like the sternocleidomastiod muscle. It also increases loading at the C6-T1 level.  Both these factors can lead to cervical pains. 

Therefore, in the case where chairs are without head rests, perhaps the user should adjust the hip angle to 110 degrees. If head rests are available 130 degree hip angle is fine as the head is completely supported.  Another point to note is the user’s primary complaint.  If the main problem is in the cervical spine, positioning the hip angle at 110 degrees is preferred.

Another issue of contention is the use of a tray table for the key board.  Some would argue that a tray table is essential and that key board should never be placed on the table.  The rational for this argument comes from having the shoulders dropped and relaxed while working as most table tops are too high.  However, the drawback with the tray table is the lack of room for the mouse.  The mouse should always be placed right next to the keyboard to minimize out stretching of the arm.

In essence, although ergonomics is about maintaining the ideal body posture while we work, this should be achieved with as little physical effort as possible. How this is done is open to one’s creativity and presenting situation and environment. Ergonomics is very personal, the guidelines are readily available but there are no hard and fast rules. Adopt them only if it feels right for you.

References:

Lohman, TG, Roche AF, Martorell R (Eds). Anthropometric Standardization Reference Manual. 1988 Champaign, IL;Human Kinetics

Office Ergonomics or The Lack of It : Part II is a post from: Musculoskeletal Consumer Review

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The repetitive stress associated with our work environment can be minimized with an understanding of the flaws of mass produced furniture, combine with a little effort and common sense in altering and re-organizing our work station.  Below are some of the complaints most office workers express.

When I work at the desk, my shoulder muscles become tight and achy.  I have a huge knot in my shoulder muscles.  Get a sore neck at the end of the day.

Most tables and work benches are made far too tall for our Asian build as the parts to the furniture are cut to anglo-saxon fit.  Most table heights are between 75cm to 80cm high, where 69 cm is more appropriate for Asians.  This means that for the majority in Singapore, people are working with their arms elevated and stretched forward, leading to an overuse and constant activation of their Upper Trapezius and Levator Scapulae.

These two muscles are designed to be movers – to raise the shoulders or to pull the head back to the centre.  They perform poorly when tasked for activities that require muscle endurance like elevating the arm up constantly as demanded by the current work station design.

The result is the development of trigger points and tightness in these muscles, consequently increasing the compression in the cervical  spine leading to pain.

I have been told to sit into the back of the chair to improve my posture at work, but as much as I try, I always end up sitting on the edge of the seat.  It just feels more comfortable.

Most chairs used by office workers are regular non-ergonomic chairs.  Similar to the issue above, unless it is an ergonomically designed chair, the office chairs are designed very poorly for the Asian population. 

Firstly, seat depth.  The median thigh length of a Hong Kong chinese male is 550mm and that of a British caucasian male is  595mm. The difference between the two ethnic groups is significant. Unless the depth of mass produced chairs are made adjustable there will be many for whom the chairs do not fit. 

In Singapore, most chairs are too deep.  One should be able to sit all the way into the back of the chair and have a gap of 2-3inches between the edge of the seat pan and the back of one’s knees.

Failing this, the user will sit forward and away from the back rest, resulting in the loss of the lumbar support and promoting slouch sitting.

If the user maintains sitting into the back of an oversized chair, he or she will have to work with out-stretched arms.  This will eventually lead to an overuse in the muscles around the shoulders.

Secondly, fixed arm rest. One of the commonest issues with arm rest is that most are not adjustable. Arm rests often get in the way when the user draws the chair closer towards the work station, limiting how close the user can get to table without losing her back support. To counter this, the user either stretches out her arm causing a flexion in the upper thoracic spine and consequently a forward head posture or move away from the back support.  If purchasing an ergonomic chair is out of the question, and the current arm rests are not adjustable, it is better to not have it?

In our opinion, we feel it is better to discard the arm rests and draw the chair in close and have the arms rested on the table.

Lastly, feet support.  Ideally, the table top should be at the same level as the elbows. To achieve this, more often than not, the height of the chair will have to be raised.  As tables are already made too high and Singaporeans being generally petite, the combination of raising the height of the chair of a chair that is already too deep result in the feet not being fully supported. The lack of support forces the abdominals work.  As it is uncomfortable, the user will naturally slide forward.  Therefore a stool must be used if the chair does not have a foot rest.

Continue in Part II

Office Ergonomics or The Lack of It : Part I is a post from: Musculoskeletal Consumer Review

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