Neck & Back Care Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director

Http://www.painrelief.sg

SPEAKER PROFILEMichelleKwong.com QualificationsGraduated with Bachelor of Health Science (Physiotherapy) in University of SydneyAustralia Certified Clinical Pilates Instructor Certified Aquatic PhysiotherapistMember of Singapore Physiotherapy Association Experience More than 7 years of clinical experience in:PhysiotherapistClinical Pilates InstructorErgonomics ConsultantPersonal Trainer in Prehabilitation/Rehabilitation

SPEAKER PROFILEMichelleKwong.comAchievementAwarded GOLD Service Excellent by SPRING Singapore 2003Principal Physiotherapist and Director of Physiotherapy Clinic

THE PAIN RELIEF PRACTICE

VisionHighly 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 COVEREDStructure of the Spine

Common Spinal Condition

Causes of Spinal Pain/ Conditions

Pain Management

Prevention of Neck/Back Pain

Exercises for Neck/Back muscles.

SPINE FACTS5 sectionsCervical (7 vertebrae)Thoracic (12 vertebrae)Lumbar (5 vertebrae)Sacral (5 fused vertebrae)Coccyx (4 fused vertebrae)

Spine StructureLumbar vertebraeIntervertebral discNerve rootsLigamentsMuscles

Vertebrae

Skeleton framework Support for muscles & tissues Protection of vital organs Storage of minerals & immature blood cells

JointsAllows movement between bones

Intervertebral DiscThe 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.

LigamentsLigaments are fibrous bands or sheets of connective tissue.

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

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

They serve to support the spine

Core MusclesDeep trunk muscles- acts as stabilisersPower House

Causes of Neck & Back Pain

Poor Carrying PosturePoor Sitting PostureCauses of Neck & Back Pain

Poor Sleeping PosturePoor Working PostureCauses of Neck & Back Pain

Causes of Neck & Back Pain

Overuse e.g. repetitive bending, static postureOverstress e.g. heavy object, excessive turningDegenerative changes i.e. Wear and tearTrauma e.g. fallGenetic predisposition Physical inactivityMental StressTumor

Common Problems Neck & Back Pain

Common Conditions of Neck & Back PainJoint sprain e.g. locked joint syndromeMuscle and Ligament injuriesDegenerative changes e.g. spondylosis, osteoarthritis, spondylolisthesisProlapsed Intervertebrae disc (slipped disc)Nerve roots irritationFractures

Compression FractureUsually due to trauma (very hard pressure or fall)

Higher risk for osteoporosis/ elderly

Disc Herniation

Stages of Disc Herniation1 Disc DegenerationChemical changes associated with aging causes discs to weaken, but without a herniation.2ProlapseThe form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.3ExtrusionThe gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.4Sequestration or Sequestered DiscThe nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal.

Effects of position on disc

Slipped Disc

SpondylosisDegeneration (Wear and tear)Age relatedActivity relatedPrevious 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 & SYMPTOMSLocalised pain in the neck/ backDiffused pain over a wide areaPain radiating to the lower limb

SEVERE SYMPTOMSNumbness/ Pins & Needles in the upper/ lower limbWeaknessConstant painDifficulty sleeping/ awaken by painUnsteady with walkingInability 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 ManagementACUTE PAIN (1st 2nd day) Apply RICER: Rest for 24-48hours (NOT Complete Bedrest!) I: Ice for 15-20mins,every 2-3hrs intervalC: Compression with bandageE: Elevate Avoid HARMH: HeatA: AlcoholR: RunningM: Massage

Pain Management AdviceAvoid 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.

PhysiotherapyGoals of Treatmentrelieve pain improve joint function maintain flexibilityStrengthening weak musclesAchieve a healthy lifestyle

PhysiotherapyPain relief treatmentHeat (Ultrasound, Hotpack, Shortwave)Electrical (Interferential, TENS, microcurrent)Joint mobilisation/ manipulationMassageTractionPostural CorrectionSports Taping/ Kinesio TapingCore/ Back Therapeutics ExercisesReturn back to sports/work

COLD LASER THERAPY - Stimulates immune system - Generate healthy cells & tissues - Promotes faster healingEM SIGNAL THERAPY - Activate & Regenerate cells - Bone & Cartilage Repair - Significant pain reduction

ELECTROACUPUNCTURE - Non-invasive - Effects of electrical & acupuncture therapy to reduce pain & promote recoverySpinal Decompression Therapy (DTS) - Advanced high tech Traction - Proven to reduce most neck/back symptoms >86%

ADVANCED TREATMENTS:

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

MedicationsMedicines 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.

SupplementsChondroitin & 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.

SupplementsCH Alpha (Collagen hydrolysate) Only product with a U.S. patent for cartilage regenerationClinically 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 scarsProlonged recovery time, generally 6 to 8 weeks

Prevention of Neck & Back Pain

PREVENTION IS BETTER THAN CURE!

Prevention of Neck & Back PainAdopt good body mechanics/postureAdopt correct lifting techniqueExercises for a healthy backHealthy Lifestyle Stress Management

Strengthening Exercises

Healthy LifestyleMobilityAerobic EnduranceFlexibilityStrength

Healthy Lifestyle

PRACTICAL Neck Mobility ExercisesNeck Strengthening Exercises

Back Mobility ExercisesBack 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/ ExtensionTilt 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 timesNeck Mobility Exercises

Neck Strengthening ExercisesDeep Neck Flexors Tuck in Chin Hold 1