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Is Back and Neck Pain a ‘Lottery’?

Or can we predict those who are likely to have pain?

Spinal pain is the second largest cause of absence from work and the largest cause of loss of productivity in the workplace (Borenstein, 2004)
 

Several risk factors have been identified which may predispose an individual to develop back and neck pain.  This suggests that we may be able to predict those who are more at risk of developing pain in the future. 
 
Research shows that a proactive approach reduces the development of more serious pain (Laestadius et al, 2009).  It therefore makes sense to manage neck and back pain prior to the development of major problems.
 
So what are the key risk factors?

 
There are a number of general risk factors that are relevant to most office-based workers:
 

  •         People aged between 35 and 55
  •         Working in jobs primarily involving sitting
  •         Increased levels of stress (Borenstein, 2004)

 
Unfortunately, these general factors are often beyond the control of most individuals.
 
However, in addition to the above factors, there are also 3 key factors of great importance, which we can positively influence.  This will significantly reduce the risk of more serious pain developing in the future. 
 

  • POSTURE
  • RANGE OF MOVEMENT (ROM)
  • STABILITY

 
1.     POSTURE
 
Poor postures cause uneven loading on the joints, muscles and ligaments.  With excessive load these structures will eventually generate pain.  This process accelerates the ‘wear and tear’ of spinal joints.
 

  •    In the neck it has been shown that with an increased head forward position there is greater loss of function (Ho et al, 2008).
     
  •    In the lower back the loss of the natural curve (lordosis) increases the risk of pain (Adams et al, 1999). 

 
How can physiotherapists impact on these...

 
Physiotherapists can provide the individual with postural advice and advise on how best to modify the work environment to reduce work related pain and symptoms.  Below is a real life example of how sitting ergonomics have been altered.


 

 


 
However, even if we correct the work ergonomics, the individual may still not be able to maintain a good sitting position if they are not flexible or have the correct muscular control to sustain these positions. This is discussed below in more detail. 
 
2.     RANGE OF MOVEMENT (ROM)
 
Loss of ROM may be due to stiffness in the joints or tight muscles, which changes the mechanics at the joints.  If this continues it will reduce the suppleness and function of the back and neck significantly and will eventually produce pain.
 

  • In the neck reduced side-bending and rotational movements have been found to cause the most significant problems (Szeto et al, 2005).  
  • In the Lower back the loss of the side-bending movement alone led to most problems (Adams et al, 1999). 


How can the Physiotherapists help…
 

Physiotherapists can carry hands-on assessments to evaluate the joint mobility, range and muscle stiffness.  From these tests the therapist can promote full range and reduce stiffness via manual techniques and exercise therapy to restore the joint and muscle function.
 
3.     STABILITY

 
Studies have shown that people with neck and back pain have significantly weaker ‘core’ muscles (Rasouli et al, 2011).  The core muscles are responsible for maintaining safe neutral spine positions. However if they are weak, or not correctly functioning, spinal stability is reduced and the pressure on the neck and back is increased (Reeve, 2011). 
 
Common signs of reduced stability are muscle spasm, lack of control during movements and reduced endurance when trying to maintain upright sitting and standing postures.
 
What the Physiotherapist can do…

 
Within the Physiotherapy clinic a number of tests can be conducted to establish the effectiveness of the patient’s neck and back stability muscles.  If a problem is identified the patient will be required to complete certain core stability exercises usually over a period of 4 to 12 weeks to regain strength and endurance. 

In Conclusion

It is important to maintain a healthy back and neck to prevent more serious problems developing in the future. If you also suspect that you have reduced back and neck ROM, poor work ergonomics, or problems with stability, it is important to see a physiotherapist for detailed assessment, advice and treatment as required.

 

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