Category Archives: Backs and Necks

BACK PAIN AND SPORTS – Biking

Picture1111Bicycling
Bicycling mainly strengthens the muscles of your legs which is important as it takes the strain off your back when getting in and out of chairs and when lifting. It does not do much for the muscles around your spine but if you try to keep your tummy muscles tense and your back in the correct alignment then you will be teaching the muscles to stabilise your spine as you bike. Mountain biking on uneven surfaces can cause jarring and sudden compressions (squeezing) on the spine.
Tips to help make bicycling easier on your back include:.
• Select the best bicycle for your purpose. For casual bike riders, a mountain bike with higher, straight handle bars (allow more upright posture), and bigger tires (more shock absorption) may be a better option than a racing style bicycle
• Adjust the bicycle properly to fit one’s body. If possible, this is best achieved with the assistance of an experienced professional at a bicycle shop
• Use proper form when biking; distribute some weight to the arms and keep the chest up; shift positions periodically
• Periodically gently lifting and lowering the head to loosen the neck and avoid neck strain
• Discuss and review your pedaling technique with your physiotherapist or other knowledgeable professional in order to get the most out of the exercise
• Use shock absorbing bike accessories including seats and seat covers, handlebar covers, gloves, and shock absorbers on the front forks (front shocks or full suspension shocks depending on the type of riding you plan to do and the terrain)
• The muscles that bring your leg up toward your abdomen are called flexors. They are used a lot when you ride a bicycle. Keeping these muscles stretched out is important because it will help keep the proper balance in the muscles around your spine and hips.

HEADACHES AND NECK PAIN

NECK FACTS

Neck pain
Picture71This is largely due to overstressing  (see example of mechanical stress in picture below) of the various structures in the neck i.e. the discs, joints and nerves. This pain may be a deep aching pain or a burning pain and may be felt in the neck, head, arms or thoracic area. Other symptoms you may experience along with neck pain are numbness, pins and needles and weakness. Less common symptoms are nausea, dizzyness ringing in the ears and visual disturbances.
Headaches
One of the most common causes of headaches is the overstressing of the upper joints of the neck, just below the skull. This is often the result of whiplash injury or prolonged poor posture.

If the pain is felt in the arms or you are experiencing symptoms of dizzyness, nausea, visual symptoms or ringing in the ears, it is a sign of more serious trouble and you should seek immediate help from your physiotherapist or doctor.

EXAMPLE OF MECHANICAL STRESSPicture1

Hold your index finger back until you feel the strain and then hold it there for a few minutes. It will soon start feeling sore not only around the joint but the pain will spread further afield. Imagine if you did that to your neck when sitting in a slouched position for a long period of time.

 

 

GETTING TO KNOW YOUR SPINE

Your spine is composed of 24 bones called vertebra, which are separated in front by a shock absorber called an intervertebral disc and at the back by the facet joints. Through a hole in each vertebra runs the spinal cord, sprouting nerves which lead to other parts of the body. The spine has five sections; the cervical spine or neck, the thoracic spine, the lumbar spine, the sacrum, and the tailbone or coccyx. (see fig 3).

Picture2

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THE VERTEBRAE (see Fig 2.)

The vertebra are building blocks, they house and protect your spinal cord. You can feel them if you run your fingers up the middle of your back. Your vertebrae may be responsible for neck pain when:one is fractured due to the application of strong enough forces.e.g. diving into a shallow pool and hitting the head.

Physical stress over a long period of time causes the shape of your vertebrae to change (poor posture).Also certain diseases weaken them e.g.Osteoporosis.

THE INTERVERTEBRAL DISC(see Fig 4&5).

The disc sits between two vertebrae. It has a jelly like centre which acts as a shock absorber as well as allowing movements of the spine.

Injury to a disc can occur with:Picture3

  • Abnormal forces being applied to the disc causing it to tear or rupture e.g. bending forward and twisting.
  • Wear and tear or injury to your disc, causing the supporting ligaments to weaken leaving the jelly like centre to create a bulge in the disc.

HERNIATED OR RUPTURED DISC.

If the bulge in the disc is big enough it can put pressure on adjacent sensitive structures causing pain and other symptoms e.g. numbness and pins and needles. Disc pain is commonly felt in the neck alone, down into the shoulder blades, down the arm or as a headache.
THE NERVES
The nerves leave the spinal cord though holes between the vertebrae. These nerves can be pinched by a herniated disc, inflamed facet joints or bone spurs.
Injury to a nerve may give rise to a burning pain, pins and needles, numbness or weakness in the head, neck, arms and chest. Coldness or heaviness may also be experienced.

 THE MUSCLES

neck 1

The neck is surrounded by muscles which either serve to move the neck, or to support and stabilise the neck. As a result or poor posture, injury or bad habits an imbalance between these muscle groups may occur. One muscle group becomes strong while the other becomes weak.The body then loses its natural balance and the various structures of the spinal column become overstressed.

Pain is often felt across the top of the shoulders and is put down to stress. Usually what happens is that stress, poor posture or poor movement habits of the shoulders or neck cause the muscles across the top of the shoulder to become overused, tight, tender and painful.

THE LIGAMENTS

The ligaments are strong fibrous bands which hold the vertebrae together, limit their motion as well as protect the disc. These ligaments are most commonly injured :in quick unprotected movements as in whiplash.or slowly due to poor posture (head poked forward).

POSTURE

It is important to have a good understanding of the effect that posture and movement have on your neck. As there are may different types of neck problems it is essential that you understand what will benefit your particular neck problem.
The postures and movements which reduce or bring the pain from the periphery into the middle of your neck are the correct ones for you. If the pain moves down into your shoulder or arm then it it the wrong movement or posture for your neck.

REMEMBER if you have pain  in the arm, numbness, pins and needles, dizzyness, nausea, visual symptoms or ringing in the ears, it is sign of more serious trouble and you should seek immediate help from your physiotherapist or doctor.

CAUSES AND PREVENTION OF NECK PAIN

Neck pain can be caused

  • accidents such as a whiplash injury
  • holding sustained postures where the neck is stressed by being held at the end of the available range of movement. This happens with poor posture ( especally when sitting and driving), working overhead for long periods of time as in painting the ceiling.
  • lifting heavy objects where the muscles that stabilise the neck are not strong enough to do so

 SITTING

Most people if they have to sit for a long time will eventually slouch. They will lose the natural inward curve of their lower back and their head and neck will assume the “poked forward” position. (see Fig. 7) This results in stressing the structures of the neck, which over a long period of time will lead to pain. Initially the pain will only be there when assuming this position for hours on end. But as this position becomes a habit, the pain will become constant and there will pain with neck movements as well

neck 2

 

 

HOW TO HELP YOUR NECK

It is important to sit in the correct posture whether as a preventative measure or to relieve stress on an already painful neck. In order to maintain correct neck posture it is essential that the posture of the lower back is correct as well. When sitting you must keep the natural inward curve (or lordosis) of your lower back.This will make it easier to hold your head in the correct position neck 3(Fig 8). Your shoulders should be relaxed.
Maintaining good posture in a chair with a back rest is made easier with a lumbar roll. A lumbar roll is an especially designed cushion which provides support for the back when sitting and is available from most physiotherapists. Be careful of chairs with headrests as they tend to push your head forward unless they are exactly right for you.
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When sitting leaning forwards over a computer or a desk it is important to lean forward at the hips, keeping the lordosis in your lower back and your head in the correct position.

Fig 7

LYING AND RESTING

When lying and resting it is important that you sleep in a good position with your neck fully supported. If you experience neck pain which is worse in the morning then your sleeping position may need correcting.
PILLOWS
Pillows supply the support needed for your neck when sleeping. It is important that you can mould them by adjusting the contents of the pillows. Memory foam  pillows. moulded pillows and feather pillows(as long as you aren’t prone to asthma sinutus etc.) are examples of pillows which will give your neck good support while you are sleeping. Dacron pillows can be made more easy to mould to the shape of your neck by opening the pillow up and teasing the dacron into “cotton wool balls”.
Sleeping on your back. One pillow is usually all that is needed. It should be moulded to support the hollow at the back of your neck and the corenrs of the pillow pulled around to support the sides of your neck..
Sleeping on your side. The height of your pillow should fill the gap between your ear and the bed, supporting your neck and keeping your spine in a straight line.Therefore two pillows are usually required. The top pillow should be able to be moulded to support the hollow of your neck between the neck and shoulders so that the head and neck are correctly aligned. It is not neccessary for the bottom pillow to be able to be moulded as it supplies the bulk.
Sleeping on your stomach. This is not ideal
In this position your neck is usually turned fully to one side and kept in this position all night.This can give rise to pain due to mechanical stress. (Remember the example of mechanical stress on the first page!) This places a lot of strain on the structures of the neck and often results in neck pain which is worse in the morning and eases during the day. In this case sleeping on your stomach should be avoided.
N.B. Should you not be able to mould your pillow to support your neck, make a soft roll of foam about 8cm across and the length of your pillow. Place this inside the pillow case (at the lower edge) on top of the pillow. This will support the hollow of your neck when lying on your side or your back.
If you have trouble finding a comfortable position please ask your physiotherapist. Sometimes they might have a pillow for you to take home and try out.

neck 4

 

PHYSIOTHERAPY TREATMENT FOR HEADACHES AND NECK PAIN

Physiotherapy treatment depends on an accurate assessment to determine the cause of the pain. The cause may be one or all of those mentioned above.
• postural education. Retraining of good posture so that it becomes second nature. This may also require improving the movement and strength of the muscles and joints of the neck and back
• Joint mobilisations and manipulation. These are ‘hands on” techniques used to increase the movement of the joints in the neck and back
• Nerve mobilisations- these are ‘hands on” techniques used to improve the movement of the nerves through the structures and tissues of the neck
• Techniques and exercises to reduce intervertebral disc bulges
• An individualised stretching, strengthening and functional exercise plan
• Advice re returning to work or sport
• Education on how to prevent future back pain
• Onward referral for X- Ray if needed
• Onward referral to GP or specialist if needed

 

 

Back Facts

Back Facts

Eighty per cent of low back pain is due to over stressing the various structures in the lower back, i.e. the discs, ligaments, joints or nerves. This pain may be a deep aching pain, a burning pain or a twinging pain. Other associated symptoms may include numbness, pins and needles, and coldness or weakness in one or both legs. It may be felt in the back alone, in the back and one or both legs, or just in the legs. If the pain is felt in the leg it is a sign of more serious trouble and you should seek help from your physiotherapist or doctor immediately.

Picture1
Fig 1

Example of Pain Due to Mechanical Stress

Hold your index finger back until you feel a strain and then hold it there for a few minutes (See Fig 1). It will soon start feeling sore not only around the joint but the pain will spread further afield. Imagine if you did that to your back when sitting in a slouched position for a long period of time.

Getting to Know Your Spine

Your spine is composed of 24 bones called vertebra, which are separated in the front by a shock absorber called an intervertebral disc and at the back by the facet joints. Through a hole in each vertebrae runs the spinal cord, sprouting nerves that lead to other parts of the body. The spine has five sections; the cervical spine or neck, the thoracic spine, the lumbar spine, the sacrum and the tailbone or coccyx. (see fig 3)

Picture2

The Vertebrae (see Fig 2.)

The vertebrae are building blocks, they house and protect your spinal cord. You can feel them if you run your fingers up the middle of your back. Your vertebrae may be responsible for back pain when:

  • One is fractured due to the application of strong enough forces
  •  Physical stress over a long period of time causes the shape of your vertebrae to change (poor posture)
  • Certain diseases or conditions weaken them e.g. Osteoporosis, Scheuermanns disease.

 

The Facet Joints

Facet joints are formed by the overlapping of two vertebrae and are designed to help guide the movement of your spine. Pain from the facet joints is usually due to strain and inflammation of the joint which may in later stages lead to degeneration and arthritis. This can be caused by:

  • Overstressing, either slowly as in repeated twisting movements or by habitually adopting poor posture
  • A quick unprotected movement or fall

The Intervertebral Disc

The disc sits between two vertebrae. It has a jelly like centre which acts as a shock absorber as well as allowing movements of the spine. Injury to the disc can occur with:

  1. Abnormal forces being applied to the disc causing it to tear or rupture, e.g. bending forward and twisting, lifting incorrectly etc
  2. Wear and tear to your disc, causing the supporting ligaments to weaken leaving the jelly like center to create a bulge in the disc

Picture3

Herniated or Ruptured Disc

If the bulge in the disc is big enough it can put pressure on adjacent sensitive structures causing pain and other symptoms e.g. numbness and pins and needles. Disc pain is commonly felt as a deep aching pain either in the back alone or down the leg.

The Nerves

The nerves leave the spinal cord through holes between the vertebrae. These nerves can be pinched by a herniated disc, inflamed facet joints or bone spurs (see figs 4&5).
Injury to a nerve may give rise to a burning pain, pins and needles, numbness or weakness in the affected leg. Coldness or heaviness may also be experienced in the affected leg.

The Muscles

The lumbar spine is supported in front by your abdominal muscles and at the back by your spinal muscles. As a result of poor posture, injury or bad habits an imbalance between these two muscle groups can occur. The body then loses its natural balance and the various structures of the spinal column become over stressed. This is often felt as pain on prolonged standing.

The Ligaments

Picture4
The ligaments are strong fibrous bands which hold the vertebrae together, limit their motion as well as protect the disc. These ligaments are most commonly injured by too much stress as in bending and lifting or by prolonged stretching as in slouched sitting. (see fig 6).
REMEMBER: If pain is felt in the leg it is a sign of more serious trouble and you should seek immediate help from your physiotherapist or doctor.

Posture

It is important to have a good understanding of the effect that posture and movement have on your back. As there are many different types of back problems it is essential that you understand what will benefit your particular back problem.
The postures and movements which reduce or bring the pain into the middle of your back are the correct ones for you. If the pain moves down into your buttocks or legs then it is the wrong movement or posture for your back. Keep this in mind when reading about the preventative measures below.
LET PAIN BE YOUR GUIDE

Causes and Prevention of Back Pain Sitting

Picture5
Most people, if they have to sit for a long time will eventually slouch, loosing the natural inward curve (fig 7), or lordosis of the lower back. This results in stressing the structures in the lower back which over a period of time will eventually cause pain. At first you may only experience pain when sitting. If you continue to slouch day-in day-out you may find standing up painful. You have to walk in a stooped position before being able to stand upright.

How to Help Your Back

It is important to sit in the correct posture whether as a preventative measure or to relieve stress on an already painful back. You must keep the natural (not exaggerated) inward curve or lordosis in your back (Fig 8). Maintaining good posture in a chair with a back rest is made easier with a lumbar roll. A lumbar roll is an specially designed cushion (fig 8) which provides support for the back when sitting and is available from most physiotherapists.
Should you have an exaggerated lordosis in your lower back or an exaggerated roundness/hump in the area of your shoulder blades you may find that a lumbar roll does not help. In this case support in the area of your spine between your shoulder blades may help.
If sitting for a few hours, take regular breaks to reduce the stress on your back. This should be done before any pain starts. Stand up and walk around. You may find that putting your hands in your back, and bending backwards 5 or 6 times (slowly and smoothly (fig 11.)) helps any stiffness you feel in your back after sitting. It is important to maintain good sitting posture after any sport or vigorous activity as the spinal structures are particularly susceptible to stress at this time.

Lifting

Incorrect Lifting

Picture6
Lifting with your back rounded puts a lot of stress on the structures of the lumbar spine. Your spine is particularly at risk when:
· Lifting heavy objects.
· After prolonged periods of sitting (e.g. after driving).
· In the first 4-5 hours of the day.

It is important when lifting to keep the natural inward curve of your back.

Correct Lifting

  1. Stand close to the load with your feet apart, creating a stable base.
  2. Keep the natural inward curve of your back, bend your knees and go down to the load.
  3. Get a secure grip on the load and tighten your stomach muscles. You may have to lean back slightly depending on the load.
  4. To lift the load, straighten your knees.
  5. Don’t jerk, lift in a steady and controlled manner.
  6. If you have to turn, use your feet, do not twist your back.
  7. Put the load down by bending your knees and keeping your back straight. See fig 10Picture7

 

 

 

 

Working in Stooped Positions

Working in stooped positions is necessary in certain occupations, i.e. plumbers, surgeons, builders mechanics, mothers etc This places a great deal of stress on the lumbar spine and should be minimized where possible. Where possible you can minimise the amount of bending in your back by bending more at the hips.

How to Help Your Back

When you habitually work in stooped positions, interrupt your work at regular intervals, before the pain starts. Stand upright, put your hands in your back, and bend backwards slowly and smoothly 5 or 6 times.
Repeat this procedure every 15-30 mins.(Fig 11.)
REMEMBER LET PAIN BE YOUR GUIDE

Standing

Poor standing posture can be a contributing factor to low back pain. The three most common examples of this are shown here. It is therefore important to maintain correct posture:

  • Stand with your weight evenly on both feet.
  • Stand as tall as possible
  • Pull your stomach in to maintain a normal (not exaggerated) inward curve in your lumbar spinPicture9

 

Lying and Resting

When lying and resting it is important that your spine is fully supported.

Your Mattress

Your mattress should support your back so that when you lie on your side your hips and shoulders sink into the mattress just enough to keep your spine straight. Ensure your mattress does not sag or is not too hard.
If you think your mattress is too soft, try putting it on a firm hard surface (the floor is the easiest) or if it is too hard this can be helped by placing a sponge rubber topper pad on top of the mattress.Picture10

Choosing a Good Resting Position

Choosing a good resting position for your back will depend on the nature of your injury. Above are various options for resting. LET PAIN BE YOUR GUIDE when choosing the best resting position for your back. If you have trouble finding a comfortable position please ask your physiotherapist.

NB Lying on your stomach can ( but not for everyone) be a good resting position for your back but it is not advisable to sleep in this position.