One of the commonest cause of people consulting a physician is neck or back pain. Many of them try to live with the pain until it stops them from working. The common cause of neck and back pain is poor posture, muscle imbalance, repeated tasks involving the area or localized degenerative changes in the vertebrae. This causes reduced range of motion of the part, reduced strength and increased pain.
POOR POSTURE: Forward headed posture or exaggerated lumbar lordosis can cause increased pressure on the surrounding structures of the vertebra this ultimately lead to segmental instability of the spine. In order to keep the part intact the muscles and other structures will adjust themselves, this will happen in a course of time. Whenever the person uses the part for a prolonged period or activity his pain and other symptoms will increase.
MUSCLE IMBALANCE : If you closely examine yourself your posture you may observe that your shoulders are round, your head is forward protruding, abdomen is week, if you stand with both the leg together and eyes closed you may feel like you are swinging and loosing the balance. These features are pointing towards your muscle weakness.
Major muscle that may get weakened are neck flexor muscles, inter scapular muscles, abdomen and buttock muscles. Major muscles that may get tightened are neck extensors, chest muscles, lower back muscles and hip flexors. Proper training of these muscles will help in reduction of neck and back discomfort.
EVALUATION: A thorough evaluation of the patient is required before stating the physiotherapy treatment, which include a detailed history of the patient, explanations regarding the site of pain, onset, previous history, lifestyle of the patient, sleep, nature of pain, assessment of strength, range of motion, swelling, warmth, functional performances, clinical investigations like X-ray, MRI, Lab report to wipeout red flags.
EXPLANATION TO THE PATIENT: Once the assessment is over the therapist will explain the treatment method to the patient, about the condition, the procedures, precautions, duration of session, total number of sessions etc. Once the patient is convinced the therapist will start the treatment after signing an informed consent.
TREATMENT: After marking the location of pain initial the treatment is given to the soft tissues around that area using techniques like deep pressure soft tissue massage to reduce muscle tightness, trigger point release therapy followed by myofascial release. Once the pain is reduced we may follow muscle energy techniques to release muscle tightness and to take the muscle to a new length.
Once the muscle pain is reduced we will mobilize the corresponding joints to correct the joint dysfuntions this will help in proper working of the joint in correct muscle length.
We teach patients self stretching exercises and progressive strengthening exercises so that they can maintain the length and strength of the structures. We may tape the part using either dynamic stretch taping (kinesiology) or static non-stretch taping (zinc oxide), which will help in holding the structure in good length and position.
We also use pain releasing modalities ultrasound therapy, interferential therapy, TENS & moist heat etc. to reduce the pain and increase the localized circulation. We also advise patients to do heat fermentation to reduce the tenderness.
Once the pain and discomforts are reduced we put patients on further stretching and strength training program like self myofascial release techniques, stretch band and weight cuff exercises with increasing the resistance.
Upon secondary evaluations we may also perform nerve mobilizations and other articular mobilizations to relieve other discomforts. We also start postural awareness training programs and core stabilization exercises to strengthen the weak muscles.
Aerobic training programs like treadmill walking, static cycling, virtual reality based games are also included in the final stage to improve the overall fitness of the patients. This helps in prevention of recurrence of pain and other discomforts.
We suggests our patients to visit us once a month for the next 3 months to make sure that they are following the exercises and also to modify the exercises if required.
Thus a tailor-made treatment physiotherapy program will help in the management of neck & back pain than a conventional treatment methods. This includes a team work of many people including the patient itself.