Archive for Cervical spine dysfunction

Stop Neck and Back Pain

What is Going On?

Things were much simpler when we were younger–do you know what I mean.  Now days we are looking for the cure of our ailments and troubles of the world.  Well stop right now and open a different book or URL than what you are reading at this moment.

What we can do here?   We can look beyond what we are noticing as far as the pain.  Pain in a chronic area of the neck and/or back is poor prognosticator of the problems location.  Always consider the adjacent body areas in figuring out what to address in correcting and alleviating this common problem.

Basic Anatomy

Our spine is an interesting and integrated structure composed of three primary curves.  Most people who have neck (cervical) pain or lower back (lumbar) pain do not think of the thoracic spine.  This thoracic spine is conveniently “surrounded” by the neck and lower back spine.  This arrangement of the anatomy is a key in addressing these pains.

Remember the spine operates as an integrated structure.  This means that each area is functionally related to the others.  You must not just think that the anatomical structure as the cause of the pain–follow the connections.

Advice for Stopping Chronic Neck and Lower Back Pain

Let’s be practical here.  First you should have had a thorough medical and movement assessment.  This means that if you are having chronic pain (longer than 3 months) you should get medically cleared by your doctor.  Next it would be great to have a qualified Physical Therapist or movement expert screen and assess how your structure is moving and working.

Often in my practice I find that the thoracic area is really neglected.  It becomes stiff and a poor transmitter of spinal forces.  The areas of the cervical and lumbar are performing way too much work (many times this is in one or two directions though).  Remember the place that is complaining is certainly not the only place that should be looked at.  A myopic view of pain often distorts the larger view of functional relationships of important adjacent regions.

Exercise Approach

One simple set of exercise you can immediately start is shown below.  Here you are using sidelying to work on moving and mobilizing the thoracic spine in a variety of directions.  During these movements you are learning much more than might be evident.  A primary direction of movement is in rotation or twisting.  During this twisting of the chest you are learning to stabilize the lumbar area.  Over time you will get a very good sense of how much we over rotate the thoraco-lumbar to lumbar area.  Therefore you can appreciate how under used the thoracic are becomes.

Also you can use a foam roller very nicely for this thoracic area.  The below video emphasizes thoracic extension.  There are many variations.  One not shown is just to use the roller to massage the back muscles here.  Most people find it very useful.

 

 

There You Have It

Try these ideas for a chronic problem with your neck or lower back.  Go slowly as with anything different or new.  Don’t try to perform the exercise.  Rather use these as movements to explore your own body and what you are noticing.  Your job here (should you accept this “Mission”) is to make a change by feeling something you haven’t felt before.  This work should be in the direction of making you more comfortable and more freely moving.  So use these movements as guidelines and not just a prescription of “exactly” what to do.  That being said, please try it out this way for several weeks before you become too creative.

Remember to work with your breath once you have the basic movements.  Stay in this sidelying position for awhile–you will be greatly benefited by putting in 15-30 minutes.  These longer times really benefit from proper diaphragmatic breathing–this type of breath is not the belly expansion but the sides and all around the lower rib cage.  There is an extremely important relationship with the breathing and the thoracic spine.  It is a much more detailed topic than will be covered here.  It is one of the keys to unlocking chronic pain.

 

Train and practice daily.  Go and try out these movements.  Write to me what you have learned.

Anterior Shoulder Pain!

The following is an interesting sequence of events of a new granddad who had recently been carrying around his 20+ pound grandson.

Case Presentation

A young grandfather was in my office the other day and his main complaint was left anterior (front) shoulder joint pain.  He denied any neck symptoms and no complaint of radiating symptoms.

Observation

He sat with his left shoulder lower than right.  His trunk was side bent to the left.  His shoulder elevation was limited by 15 degrees but not painful.  Resisted flexion and rotation of his shoulder reproduced his anterior shoulder symptoms and were weakened (probably inhibited/interfered with by pain and malposition?).  Also his left shoulder was protracted and slightly subluxed anteriorly.

His neck was blocked in left side bending and rotation of the lower neck segments.  He was not aware of this difference until formal testing.  Passive range was also blocked in the lower cervical spine in this left direction.

Also when I tried to side bend him to his left from caudal (head to tail) pressure on top of his shoulder he was easily moved.  Side bending to the right was markedly restricted in the mid thoracic (rib) spine.

Immediate investigation

I started with the hypothesis that there was a strain to the shoulder, possible due to poor stabilization of the shoulder complex–that was brought out in a more pronounced way due to having to carry around his grandson for long periods.  He could have over recruited his neck and set up very poor neurmuscular motor and sensory flow to the upper quadrant area.   Since he had such a pronounced movement dysfunction in thoracic side bending, I thought it would be interesting to see what if anything this lack of side bending may have to contribute.  (Both to mal-position of the shoulder on the opposite side and poor transference of stabilizing forces through the trunk).

  1. Tried to initiate active assisted trunk side bending to his right (remember he was already in a left side bent position).   This did not occur readily so looked lower.
  2. His right hip was carried in external rotation in sitting, his right hip internal rotation was limited.
  3. In sitting:  immediately had him place his right hip in internal rotation (foot out to the right side)–until we could cause him to shift his weight onto his left IT (sit bone) and gently start encouraging his trunk to side bend to the right–slowly as this side bending became easier we facilitated left side bending also of his lower neck segments.
  4. Had him sit straight again and noticed:  His shoulder less protracted and less subluxed.  He gained 10 degrees in shoulder elevation.  His resisted movements were much less provocative but still weak in external rotation.
  5. Finished with some activating/strengthening/stabilizing exercises for the scapula and shoulder complex.  Included cervical and thoracic active mobility also.
  6. Upon completion of the exercises, there were no reported symptoms with the previous provocative movements.

Summary

OK, not everything that walks into my office has such an easy resolution.  I just thought this case at least demonstrates some of the interesting connections that I find in working with people.  Also it has been my experience over many years that once could have started in different places and shown success.  I think success does not necessarily always mean such a quick resolution to a person’s problem.

One of the most important points I find is to see the relationships that exist.  Possibly an isolated approach of the shoulder or neck may have proved helpful.  If the whole pattern that is involved is not understood/recognized, then in more protracted cases, important elements may be ignored.

Now

Let me know what you think.  If there is any way I can be of service, please contact me here, for a consultation.  Thank you.

Stiff neck

It’s not uncommon for someone to wake up and say–“oh, oh–I can’t look to the right”,  then as they get ready to drive to work backing up the car, they say “I just can’t see behind me”.

When they get into the office to get checked out, they are really limited in cervical right rotation.  What is interesting is what they sometimes say, “I was unable to see behind in backing up my car, because my neck was so stiff.”  When I ask them to show me.  They only move their head to look behind.  Realize I’m just asking them to do whatever they have trouble in doing.  Then if I see that they are holding their chest from turning–yes they are only using the neck to look behind.

So now when they turn like they always have (maybe), they feel a new limit and often complain of discomfort/pain.  Usually you can also appreciate increased tension in the whole upper quadrant and even their mid to low back becomes tense.  Often their breath is held near and at the end range.

If you start with having them become aware in what is turning–in this case only the head from the neck (mid to upper neck only, no lower neck), you teach them how they are doing their task of looking behind.  Read More→

Introduction to Strategies for movement problems

Many of us are involved in some type of physical training.  Some of us are not, but we all are moving around.

We can notice pain and movement problems.  (Some days more than others).  For example, that noticeable stiff neck over the past several days (months or years), is really bugging me.  What to do?  That is a great question.

  1. We noticed something
  2. We asked a question

Nice start.  I often have found myself wondering what to do with pains, aches and problems moving.  What I have found very helpful in trying to figure out what “To Do” is to ask first what am I noticing as I move in the direction of the problem.

We often want to correct something first without out being aware more fully of what it is we are dealing with.  Finding out what to do in this case, implies paying attention first and then doing something next.  We must feel in order to do.

Let’s say you are out in the cold snowy mountains and you want open your pant zipper in order to pee (like real quick).  Well if you have no feeling in your un-gloved fingers, can you imagine or remember the difficulty in doing the zipper routine.  (see the comedy channel for replays) Read More→