Neck & Back Care

Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates

Principal Physiotherapist Practice Director

Http://www.painrelief.sg

SPEAKER PROFILEMichelleKwong.com

Qualifications Graduated with Bachelor of Health Science (Physiotherapy) in

University of Sydney Australia Certified Clinical Pilates Instructor Certified Aquatic Physiotherapist Member of Singapore Physiotherapy Association

Experience More than 7 years of clinical experience in:

Physiotherapist Clinical Pilates Instructor Ergonomics Consultant Personal Trainer in Prehabilitation/Rehabilitation

SPEAKER PROFILEMichelleKwong.com

Achievement Awarded GOLD Service Excellent by SPRING Singapore 2003 Principal Physiotherapist and Director of Physiotherapy Clinic

THE PAIN RELIEF PRACTICE

Vision Highly committed to help people with musculoskeletal pains to

speedily recovery with latest clinically proven physiotherapy technologies & success in mastery of good health and fitness.

http://www.painrelief.sg

TOPICS COVERED

Structure of the Spine

Common Spinal Condition

Causes of Spinal Pain/ Conditions

Pain Management

Prevention of Neck/Back Pain

Exercises for Neck/Back muscles.

SPINE FACTS

5 sections Cervical (7 vertebrae) Thoracic (12 vertebrae) Lumbar (5 vertebrae) Sacral (5 fused vertebrae) Coccyx (4 fused

vertebrae)

Spine Structure

Lumbar vertebrae Intervertebral disc Nerve roots Ligaments Muscles

VertebraeVertebrae

• Skeleton framework

• Support for muscles & tissues

• Protection of vital organs

• Storage of minerals & immature blood cells

Joints

Allows movement between bones

Intervertebral Disc

The intervertebral disc is a jelly like substance, which consists of annulus fibrosis and the nucleus pulposus. Acts as a shock absorber.

Spinal cord& Nerves Roots

- Nerve roots exit through holes in the bone of the spine (foramen) on the right side and left side.

- Branch out at each level of the spine.

-The nerve roots innervate different parts of body.

Ligaments

Ligaments are fibrous bands or sheets of connective tissue.

They link two or more bones, cartilages, or structures together.

Muscles

Muscles attach to the spinal column, pelvis, and extremities.

They serve to support the spine

Core Muscles

Deep trunk muscles- acts as stabilisers

‘Power House’

Causes of Neck & Back Pain

PoorPoorCarrying PostureCarrying Posture

PoorPoorSitting PostureSitting Posture

Causes of Neck & Back Pain

PoorPoorSleeping PostureSleeping Posture

PoorPoorWorking PostureWorking Posture

Causes of Neck & Back Pain

Causes of Neck & Back Pain

Overuse e.g. repetitive bending, static posture Overstress e.g. heavy object, excessive turning Degenerative changes i.e. Wear and tear Trauma e.g. fall Genetic predisposition Physical inactivity Mental Stress Tumor

Common Problems Neck & Back Pain

Common Conditions of Neck & Back Pain Joint sprain e.g. locked joint syndrome Muscle and Ligament injuries Degenerative changes e.g. spondylosis,

osteoarthritis, spondylolisthesis Prolapsed Intervertebrae disc (‘slipped’

disc) Nerve roots irritation Fractures

Compression Fracture

Usually due to trauma

(very hard pressure or fall)

Higher risk for osteoporosis/ elderly

Disc Herniation

Stages of Disc Herniation

1 Disc Degeneration

Chemical changes associated with aging causes discs to weaken, but without a herniation.

2 Prolapse The form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.

3 Extrusion The gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.

4 Sequestration or Sequestered Disc

The nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal.

Effects of position on disc

‘Slipped’ Disc

Spondylosis

Degeneration

(Wear and tear) Age related Activity related Previous injury/trauma

Lumbar Spondylosis

Normal 58 yrs old

Degenerative Changes 83 yrs old

Nerve Root Irritation

• Shooting pain down the leg

• Constant pain

• Numbness

• Weakness

Signs and Symptoms

SIGNS & SYMPTOMS

Localised pain in the neck/ back Diffused pain over a wide area Pain radiating to the lower limb

SEVERE SYMPTOMS

Numbness/ Pins & Needles in the upper/ lower limb Weakness Constant pain Difficulty sleeping/ awaken by pain Unsteady with walking Inability to control bowel / bladder

To seek early medical doctor/ physiotherapist advice if presence of severe symptoms

MANAGING PAIN

- Self Management- Doctor- Physiotherapy- Surgery

Acute Pain Self Management

ACUTE PAIN (1st – 2nd day) Apply ‘RICE’

R: Rest for 24-48hours (NOT Complete Bedrest!) I: Ice for 15-20mins,every 2-3hrs interval C: Compression with bandage E: Elevate

Avoid ‘HARM’ H: Heat A: Alcohol R: Running M: Massage

Pain Management Advice

Avoid activity that may cause pain especially:- Strenuous activity- Prolonged activities, repetitive movement - Heavy loads

Neck/ Back Support for acute severe pain. (Not advisable for chronic pain.)

Heat

Gentle stretching when pain reduced

Pain Management Advice

When self management does not work, SEEK HELP EARLY especially if you are suffering from any

neck/back pain and radiating pain down arms/legs.

The longer your pain condition, the harder for doctor/physiotherapist to treat, the longer the time for

recovery and more medical fees involved.

Physiotherapy

Goals of Treatment relieve pain improve joint function maintain flexibility Strengthening weak muscles Achieve a healthy lifestyle

Physiotherapy

Pain relief treatment Heat (Ultrasound, Hotpack, Shortwave) Electrical (Interferential, TENS, microcurrent) Joint mobilisation/ manipulation Massage Traction

Postural Correction Sports Taping/ Kinesio Taping Core/ Back Therapeutics Exercises Return back to sports/work

COLD LASER THERAPY - Stimulates immune system - Generate healthy cells & tissues - Promotes faster healing

EM SIGNAL THERAPY - Activate & Regenerate cells - Bone & Cartilage Repair - Significant pain reduction

ELECTROACUPUNCTURE - Non-invasive - Effects of electrical & acupuncture therapy to reduce pain & promote recovery

Spinal Decompression Therapy (DTS) - Advanced high tech Traction - Proven to reduce most neck/back symptoms >86%

ADVANCED TREATMENTS:

Physiotherapy

Education on lifestyle modifications Avoid prolong activities Avoid strenuous activities Avoid heavy load Avoid squatting/kneeling prolonged Avoid stairs climbing

Medications

Medicines doctors use to treat osteoarthritis include:

Acetaminophen, which may help relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), which

reduce inflammation and relief fever. Corticosteroid injections in the joint (intra-articular),

which reduce inflammation. Hyaluronan injections, which may relieve pain. Opioids, which may relieve moderate to severe pain.

Supplements

Chondroitin & Glucosamine sulfate natural substances found in the joint fluid. chondroitin is thought to promote an increase

in the making of the building blocks of cartilage (collagen and proteoglycans) as well as having an anti-inflammatory effect. Glucosamine may also stimulate production of the building blocks of cartilage as well as being an anti-inflammation agent.

Supplements

CH Alpha (Collagen hydrolysate) Only product with a U.S. patent for cartilage

regeneration Clinically proven to stimulate specialized cells called

chondrocytes. Chondrocytes control the rate of cartilage regeneration in joints and detect changes in the composition of the cartilage. They respond to these changes by growing more cartilage.

Studies have shown that CH-Alpha increases the concentration of collagen and proteoglycans through this stimulatory effect on chondrocytes.

SurgeryIn some cases surgery is necessary, more often it is not

necessary.Another 6-8 weeks of physiotherapy, at 3 to 5 times per

week.

Lower rate of success, dependent

- Pain- Increased danger from anesthetic- Increased danger from possible infections- Possible post operation complications (eg pneumonia, DVT, delayed union/nonunion, spinal cord

injury)- Noticeable scars

Prolonged recovery time, generally 6 to 8 weeks

Prevention of Neck & Back Pain

PREVENTION IS BETTER THAN CURE!

Prevention of Neck & Back Pain

Adopt good body mechanics/posture

Adopt correct lifting technique

Exercises for a healthy back

Healthy Lifestyle

Stress Management

Strengthening Exercises

Healthy Lifestyle

Mobility

Aerobic Endurance

Flexibility

Strength

Healthy Lifestyle

PRACTICAL

Neck Mobility Exercises Neck Strengthening Exercises

Back Mobility Exercises Back Strengthening Exercises

DISCLAIMER: Exercises shown should be done with caution especially for people

suffering in pain or previous condition. In case of doubt, check with your doctor/physiotherapist with regards to your condition.

Neck Mobility Exercises

Neck Flexion/ Extension Tilt head forward and backward

as far as possible. Slow, repeat 8-10 times

Neck Side Flexion Tilt head toward shoulder keeping shoulder stationary Slow, repeat 8- 10 times

Neck Rotation Turn head from side to side as far as possible Slow, repeat 8-10 times

Neck Mobility Exercises

Neck Strengthening Exercises

Deep Neck Flexors

Tuck in Chin

Hold 10 seconds, 8 -10reps

Isometric Neck Extensors Giving resistance with clasped hands at back of head, push backwards with head. Hold 10 seconds, 8- 10 reps

Neck Strengthening Exercises

Isometric Neck Side-Flexors

Place hands on side of the head and push head against hands resistance

Hold 10seconds, 8-10reps

Back Stretching Exercises

Bent Over Stretch

Hold the back of a chair with your arms shoulder-width apart.

Walk backwards as you bend forward from the hips and straighten out your arms.

Keep your feet together, your back straight and your head between your arms in line with your spine.

Hold for 10 – 30secs

Back Stretching Exercises

BACK EXTENSION & SHOULDER BLADE PINCH

Stand with feet apart & lean backward to the point of tension with arms reaching back.

Tighten shoulder blades and lower back muscles.

Feel a mild stretch on your abdominals.

Hold for 10-30secs

Back Stretching ExercisesLower Back Stretch

Stand with feet hip-width apart.

Come into a squat position by bending your knees and pushing your buttocks backwards. Place your hands on your thighs.

Pull belly button toward your spine as you tilt or curl your pelvis under.

Return to starting position.

Stomach Hollowing

Strengthens Transverse Abdominus Breath out and relax your stomach muscles Pull lower part of stomach inwards and upwards Hold 10 seconds and perform 8-10reps Crook lying, sitting, standing

High Plank

Strengthens the chest, shoulders, triceps, buttocks, hamstrings & trunk.

Start on your hands and knees. Arms should be directly under your shoulders.

Extend one leg back at a time until your body weight is supported on your arms and toes.

Hold for 5-10seconds, perform 8-10 reps

Back Strengthening Exercises

Bridging Exercises Lie on the floor with your knees bent, feet flat. Tighten the muscles of your lower abdomen and

buttocks. Slowly raise low back and buttocks from the floor Hold for 5-10 seconds, do 8-10reps

Low Back Extensors Lie face down on a mat with your arms beside you and

your legs together. Lift your head and shoulders off the mat by squeezing

the muscles in your lower back. Keep your feet on the floor.

Slowly lower to the mat. Hold for 5-10 seconds, do 8-10reps

Back Strengthening Exercises

Summary

Prevention is better than cure.

When self management does not work, SEEK HELP EARLY if you are suffering from any neck/back pain or any radiating pain down arms/legs.

LIVE A PAIN FREE LIFE!

QUESTIONS & ANSWERS

If you have any queries, please feel free to email Michelle at michelle@painrelief.sgOr call 67355368.

THANK YOU Presented By:

Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates

Principal Physiotherapist Practice Director

World Malayali Clubhttp://groups.yahoo.com/group/worldmalayaliclub/

Disclaimer

The Pain Relief Practice Educational Material is for information only. This information is not intended to diagnose, treat, or cure any medical/health condition. It is not a substitute for formal, real world medical or physiotherapy care, and should not be considered as such. The Pain Relief Practice is not in a position to independently evaluate any of the advice or claims on behalf of any particular therapy. Any information or suggestions we provide should be discussed with your doctors or physiotherapist in real person when treating your condition. Our discussion of possible pain treatments are just options which may be significantly limited by the incomplete full physical examination of a doctor/physiotherapist.