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Neck Pain

The majority of neck ache is postural in nature. The vertebrae of the neck squeeze together when you sit in the same position for long periods of time. This causes the muscles and ligaments controlling the movement of the head, neck and shoulders to become stiff and painful. The neck has more ability to rotate than any other part of the spine and is therefore susceptible to strain. The symptoms often include waking up with a stiff neck that loosens up as the day goes on but gets stiff and sore by the end of the day. The neck will often get painful if kept in the same position for long periods of time such as sitting at the computer, watching television or driving.

Classic mistakes are turning your head slightly to one side when working on the computer or watching television at home. Also looking down for long periods when typing or reading .Using too many pillows in bed. Any and all of the above lead to changes in the postural alignment of the spine and over time leads to ache or discomfort in the neck including headaches, shoulders, between the shoulder blades and even further down the spine.

As a result of increased dependence on computers, more time is being spent at a computer each working day. It is very important that the work station is set up correctly to allow the minimum of stress through the joints. An occupational health adviser can help address any concerns you may have with the help of the physiotherapist if necessary.

Looking after your posture can go along way to helping ease the discomfort. Making sure you move away from static postures regularly helps. Stand up and have a stretch every 20 minutes at work or when watching television at home. Make sure your looking directly straight on at the computer or television and that the screen is at the correct height. Don’t hold the mouse or gear lever in your hand when your not using it and don’t put your elbow up on the window of the car when driving.

Postural neck ache can usually easily be treated with some gentle mobilisation by a physiotherapist and a stretching program to prevent recurrence. You can also prevent its onset by following the same advice as given for low back ache

  • Sit up properly and arrange your work station to best suit your height and shape.
  • Stand up every 15-20 minutes to recover the arch in your spine, both at home and at work.
  • Go for a long walk (40 minutes) per day, ideally in one go or split it in two, 20 minutes at lunch and 20 minutes when you finish work.
  • Try to stretch regularly through the day.
  • Don't drive for greater than one hour without getting out to stretch your legs.
  • See a Chartered Physiotherapist if you have pain that doesn’t settle down in 48 hours.

Trapped Nerve

Just like with the lower back, if the vertebrae of the neck get too close together they can pinch a nerve exiting the spinal cord on its way down to the arm. The nerve can be trapped as a result of increased wear and tear in the joint spaces therefore reducing the gap through which the nerve travels. It may also be squeezed by a bulging disc similarly to that described in prolapsed disc mentioned above in the back pain section. This can produce pain in various patterns throughout the course of the arm depending on which nerve is affected. The pain can range from a dull ache to severe burning pain with or without pins and needles and/or numbness.It is important to try and reduce the pressure on the nerve, therefore decreasing the arm pain and localising the symptoms back to the neck. It is possible to have a trapped nerve in your neck and not have neck pain. This can be confused with other injuries to the shoulder or arm or Thoracic spine. As with most spine injuries, stay mobile. Plenty of walking around spreads the load through the spine and reduces the stress at the level of the nerve affected. When resting keep the head supported by resting your head in a neutral position either lying flat or sitting with the head and neck supported by a pillow wrapped around the neck. Keep the neck warm by wearing a scarf or using hot packs regularly. Gently try and move your neck from side to side but only within comfortable limits.You may need medication to help with the pain and your doctor can advise you on the best course of action. This may range from simple paracetamol to anti-inflammatory drugs, muscle relaxants and in severe cases steroids. Your doctor may also prescribe anti-depressants at a low dose as these can sometimes help with nerve pain and also help people sleep and it is not necessarily because you are depressed. Physiotherapy can be useful in mobilising the spine safely to un-trap the nerve and should be considered if there is no improvement in pain in the first 48 hours.

Trigger point

When a muscle is been used or overused a lot of the time it may develop what is known as a trigger point. A trigger point is defined as a taut band within a muscle that on palpation will generate a local twitch response and causes a deep aching pain radiating from the region. These are commonly known as ‘knots’. All muscles are susceptible to developing trigger points and many muscles have what are known as dormant trigger points. A trigger point is active when it is causing pain and twitches when compressed. A common area of the body susceptible to trigger points are the muscles connecting the shoulders to the neck or upper trapezius muscles. The Upper trapezius muscles are responsible for keeping your head up straight, rotating your head away and bringing your ear down to your shoulder or vice versa bringing your shoulder up to your ear.Commonly when sitting at a computer for long periods of the day the trapezius muscles are working to maintain your head position. If your work station is unsuitable you may be increasing the load on these muscles because you are looking down at the screen, particularly the lap top, or your head is rotated slightly to one side more than the other. Not quite as common nowadays is holding the phone between your ear and shoulder but if you do this especially when using a mobile, that is most likely to cause the development of a trigger point in the muscle. In the upper trapezius muscles the trigger point will produce an aching pain deep in the shoulder blade area and can refer down the arm to the back of the elbow. It may even cause pins and needles locally. It can also radiate up the skull behind the ear and be responsible for tension headaches. In order to treat a trigger point it is essential to find the route cause of the problem. This may be something so subtle that you won’t be aware of it until it is pointed out to you. It is best to get someone to observe you as they can see you move, or not as the case may be, than you can see yourself. Common faults are the computer being at the incorrect height or angle, poor posture sleeping, having your arm up on the window frame when driving, television being in the corner of the room so you have to turn your head to see it, etc. Once the main cause is established, this of course can be altered.

To treat the trigger point the physiotherapist has a couple of options. They may try some myofascial release which will involve deep tissue palpation of the trigger point in order to desensitise it. Another option is to treat the area with what is known as trigger point needling. This involves putting a fine needle (usually an acupuncture needle although it is not acupuncture) into the muscle to deactivate the trigger point. An acute spasm is felt in the muscle and a release of tension follows. You will then be shown how to stretch the muscle and this will have to be carried out regularly. Trigger point needling may be very effective in one session or may take a number of sessions to fully resolve the pain depending on the severity of the problem.

Spinal Physiotherapy
& Sports Medicine Clinic
124 Gilbert Rd, Cambridge, CB4 3PD