Articles on neck

Back & Neck Pain - Mckenzie's Approach

Dr. David Kirubakaran, Physiotherapist
Back pain and neck pain are very common in this computer era because of our sedentary life style.  Even youngsters and mid age people are not spared from spinal issues because of their poor exercise habits and nature of jobs.Robin McKenzie, a reputed Physiotherapist from New Zealand classifies the cause of spinal problems into three types. 1) Derangement –Pain caused due to changes in the position and fluid imbalance in the spinal discs.2) Dysfunction -Pain and restriction of movement caused by tightening of the soft tissues around the spine. 3) Postural syndromes– Incorrect postures that induces stress on soft tissues leading to pain  Back pain lasting more than 3- 5 days,or if the pain radiates down the back of thighs and legs, needs immediate intervention. Also, prolonged neck pain may radiate down the arms and hands,finally leading to numbness. Surgery was the only option for these types of spinal problems in the past. Hot, cold and electrical modalities can provide a temporary pain relief. But modern physiotherapy which includes manipulation of spinal joints can replace the surgical option. Manipulation is a “hands on technique”where the physiotherapist treats the affected part of the spine gently manipulating the transverse process (part of the spinal bone).  McKenzie Approach is the widely used technique in the western world. This type of approach requires active participation of patients along with the guidance of a physiotherapist.  Active participation mainly includes spinal extension type of exercises (backward bending) and sustaining in that position for a while.                                               The main goals of this type of manual approach program are: To rule out the cause of radiating pain down the legs or other areas.To bring the spine to its normal position.To avoid re-occurrence rate.Reduce the frequency of visits to clinic and the expense.Carry out the exercise program by patients themselves and obtain a pain free lifestyle.Manipulation along with McKenzie exercise regimen can effectively cure the patient’s spinal problems.

Neck Pain

Dr. Apoorva Kumar, Spine Surgeon
What is cervical spondylosis?Cervical spondylosis, also known as cervical osteoarthritis or neck arthritis, is a common, age-related condition that affects the joints and discs in your neck. It develops from wear and tear of the cartilage and bones found in your cervical spine, which is in your neck. While it’s largely due to age, it can be caused by other factors as well.According to the Mayo Clinic, the condition is present in more than 85 percent of people over the age of 60, although some people who have it never experience symptoms.For some, it can cause chronic, severe pain and stiffness. However, many people who have it are able to conduct normal daily activities.Cervical spondylosis causesUnfortunately, the bones and protective cartilage in your neck are prone to wear and tear that can lead to cervical spondylosis. Possible causes of the condition include:Bone spursThese overgrowths of bone are the result of the body trying to grow extra bone to make the spine stronger. However, the extra bone can press on delicate areas of the spine, such as the spinal cord and nerves, resulting in pain.Dehydrated spinal disksYour spinal bones have discs between them, which are thick, pad-like cushions that absorb the shock of lifting, twisting, and other activities. The gel-like material inside these disks can dry out over time. This causes your bones (spinal vertebrae) to rub together more, which can be painful. According to the Mayo Clinic, this process can begin around age 40.Herniated disksThe spinal disks can develop cracks, which allows leakage of the internal cushioning material. This material can press on the spinal cord and nerves, resulting in symptoms such as arm numbness and sciatica.InjuryIf you’ve had an injury to your neck, such as during a fall or car accident, this can accelerate the aging process.Ligament StiffnessThe tough cords that connect your spinal bones to each other can become even stiffer over time, which affects your neck movement and makes the neck feel tight.OveruseSome occupations or hobbies involve repetitive movements or heavy lifting, such as construction work. This can put extra pressure on the spine, resulting in early wear and tear.Risk factorsThe greatest risk factor for cervical spondylosis is aging. Cervical spondylosis often develops as a result of changes in your neck joints as you age. Disk herniation, dehydration, and bone spurs are all results of aging.Factors other than aging can increase your risk of cervical spondylosis. These include:neck injurieswork-related activities that put extra strain on your neck from heavy liftingholding your neck in an uncomfortable position for prolonged periods of time or repeating the same neck movements throughout the day (repetitive stress)genetic factors (family history of cervical spondylosis)smokingbeing overweight and inactiveSymptomsMost people with cervical spondylosis don’t have significant symptoms. If symptoms do occur, they can range from mild to severe and may develop gradually or occur suddenly.One common symptom is pain around the shoulder blade. Patients will complain of pain along the arm and in the fingers. The pain might increase when:standingsittingsneezingcoughingtilting your neck backwardAnother common symptom is muscle weakness. Muscle weakness makes it hard to lift the arms or grasp objects firmly.Other common signs include:a stiff neck that becomes worseheadaches that mostly occur in the back of the headtingling or numbness that mainly affects shoulders and arms, although it can also occur in the legsSymptoms that occur less frequently often include a loss of balance and a loss of bladder or bowel control. These symptoms warrant immediate medical attention.When to see a doctorIf you have the sudden onset of numbness or tingling in the shoulder, arms, or legs or if you lose bowel or bladder control, talk to your doctor and seek medical attention as soon as possible.If your pain and discomfort start to interfere with your daily activities, you may wish to make an appointment with your doctor. Although the condition is often the result of aging, there are treatments available that can reduce pain and stiffness.Testing and diagnosingMaking a diagnosis of cervical spondylosis involves ruling out other potential conditions, such as fibromyalgia. Making a diagnosis also involves testing for movement and determining the affected nerves, bones, and muscles. Your primary care physician may treat your condition or refer you to an orthopedic specialist for further testing.Physical examYour doctor will start by asking you several questions regarding your symptoms. Then, they will run through a set of tests. Typical exams include testing your reflexes, checking for muscle weakness or sensory deficits, and testing the range of motion of your neck. Your doctor might also want to watch how you walk. All of this helps your doctor determine if your nerves and spinal cord are under too much pressure.If your doctor suspects cervical spondylosis, they will then order imaging tests and nerve function tests to confirm the diagnosis.Imaging testsX-rays can be used to check for bone spurs and other abnormalities.CT scans can provide more detailed images of your neck.MRI, which produces images using radio waves and a magnetic field, helps your doctor locate pinched nerves.In a myelogram, a dye injection is used to highlight certain areas of your spine. CT scans or X-rays are then used to provide more detailed images of these areas.An electromyogram (EMG) is used to check that your nerves are functioning normally when sending signals to your muscles. EMG measures your nerves’ electrical activity.A nerve conduction study is used to check the speed and strength of the signals your nerves send. This is done by placing electrodes on your skin where the nerve is located.Treatment optionsTreatments for cervical spondylosis focus on providing pain relief, lowering the risk of permanent damage, and helping you lead a normal life. Nonsurgical methods are usually very effective.Physical therapyYour doctor might send you to a physical therapist for treatment. Physical therapy helps you stretch your neck and shoulder muscles. This makes them stronger and ultimately helps to relieve pain. You might also have neck traction, which involves using weights to increase the space between the cervical joints and relieve the pressure on the cervical discs and nerve roots.MedicationsYour doctor might prescribe certain medications if over-the-counter drugs don’t work. These include:muscle relaxants, such as cyclobenzaprine, to treat muscle spasmsnarcotics, such as hydrocodone, for pain reliefanti-epileptic drugs, such as gabapentin, to relieve pain caused by nerve damagesteroid injections, such as prednisone, to reduce tissue inflammation and subsequently lessen painSurgeryIf your condition is severe and doesn’t respond to other forms of treatment, you might need surgery. This can involve getting rid of bone spurs, parts of your neck bones, or herniated disks to give your spinal cord and nerves more room. Surgery is rarely necessary for cervical spondylosis. However, a doctor may recommend it if the pain is severe and it’s affecting your ability to move your arms.Home treatmentIf your condition is mild, you can try a few things at home to treat it:Take an over-the-counter pain reliever, such as acetaminophen or an anti-inflammatory drug such as Advil or Aleve.Use a heating pad or a cold pack on your neck to provide pain relief for sore muscles.Exercise regularly to help you recover faster.Wear a soft neck brace or collar to get temporary relief. However, you shouldn’t wear a neck brace or collar for long periods of time because that can make your muscles weaker.OutlookCervical spondylosis is a common, often age-related condition that can cause stiffness, discomfort, and headaches related to neck pain. Your doctor may not be able to reverse the condition, but they can often recommend conservative treatments to help you overcome the discomfort and pain. 

Head And Neck Cancer Is A Preventable Cancer

Dr. Suhail Sayed, Surgical Oncologist
What are cancers of Head and Neck?Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). Head and Neck cancer is the sixth most common cancer in the world and India constitutes 30-40 per cent of all cancers seen among men mainly in their productive age group.What are the causes of Head and Neck Cancer?The most common causes are consumption of tobacco and alcohol. Smokeless tobacco, such as gutka or paan, is a major issue in India. These agents, when taken together,increase the person’s cancer risk by eight or 10 times, accounting for 90 percent of oral cancers and 80 percent of throat cancers in our population. We are the “mouth cancer capital of world” owing to this habit. Alcohol often taken together with cigarette increase the cancer risks by 38 times. Apart from these common causes other causes like poor oral and dental hygiene, loose dentures and some viruses (Ebstien-Barr andHuman Papilloma) are also known to cause this cancer.What are the symptoms of Head and Neck Cancers?The symptoms depend on the site where this cancer develops. This cancer usually presents with a non-healing mouth ulcer, white or red patch, reduced mouth opening, difficulty in swallowing or neck swelling. All these symptoms if persist for more than two weeks need to be evaluated.How are head and neck cancers diagnosed?A thorough physical examination combined with imaging studies (CT, MRI or PET CT scan) and biopsy is mandatory for diagnosing these cancers. Based on these findings the disease can be properly staged and treatment planned accordingly. Early diagnosis by biopsy can lead to better cure rates.How are head and neck cancers treated?The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments. Early stage (1 and 2)patients have a 60% to 95% chance of cure with local treatment alone (surgery or radiotherapy), but patients with more advanced (Stage 3 & 4) disease need a more aggressive treatment (Surgery with chemo radiation) and have a greater than 50% risk of recurrence or development of disease spread throughout the body. Therefore it is very important that the disease is picked up early and patients should avoid delay in treatment. Many patients fear of the change in appearance or speech and delay treatment by taking different indigenous drugs and present to us in an advanced stage. But in the present era with the availability of microvascular surgery and Image Guided Radio therapy (IMRT,IGRT), excellent cosmesis and functional rehabilitation of patients can be offered. Thus majority of head neck cancer patients today have a good quality of life after treatment.How can I reduce my risk of developing head and neck cancers?The most important point which needs to be understood by our population is that this cancer is “preventable”. There are several policy measures of tobacco control being implemented at the national and international level to fight the battle against tobacco. However, these efforts may not directly benefit the current tobacco user as nicotine in tobacco is very addictive, making quitting difficult. It’s the will power of the person himself which plays an important role in quitting tobacco. It’s basically the first three days that the person has a severe craving for smoking/chewing, if he is able to control his mind for this period the chances of quitting the habit increase by 80%.

Text Neck: Your Smartphone Is a Pain in the Neck

Dr. Meenal Sharma (P.T), Physiotherapist
Chances are you're reading this while leaning over a table or slumped back in a chair. Your head is tilted forward; your shoulders are curved. If you're on a mobile device, your arms are bent by your side and your back hunch is even more profound.Am I right?The position you're in is probably causing you pain, whether you're aware of it yet or not. Don't worry, our physical therapists have a diagnosis for the headaches, neck cricks and achy shoulders. They call it "Text Neck”.Text neck is the term used to describe the neck pain and damage sustained from looking down at your cell phone, tablet, or other wireless devices too frequently and for too long.This posture of bending your neck to look down does not occur only when texting. For years, we've all looked down to read. The problem with texting is that it adds one more activity that causes us to look down—and people tend to do it for much longer periods. It is especially concerning because young, growing children could possibly cause permanent damage to their cervical spines that could lead to lifelong neck pain.A recent study shows that 79% of the population between the ages 18 and 44 have their cell phones with them almost all the time—with only 2 hours of their waking day spent without their cell phone on hand.Symptoms associated with text neck:Text neck most commonly causes neck pain and soreness. In addition, looking down at your cell phone too much each day can lead to:Upper back pain ranging from a chronic, nagging pain to sharp, severe upper back muscle spasms.Shoulder pain and tightness, possibly resulting in painful shoulder muscle spasm.If a cervical nerve becomes pinched, pain and possibly neurological symptoms can radiate down your arm and into your hand.Studies suggest, text neck may possibly lead to chronic problems due to early onset of arthritis in the neck.How is text neck treated?First, prevention is the key.Here are several pieces of advice for preventing the development or advancement of text neck:Hold your cell phone at eye level as much as possible. The same holds true for all screens, laptops and tablets should also be positioned so the screen is at eye level and you don't have to bend your head forward or look down to view it.Take frequent breaks from your phone and laptop throughout the day. For example, set a timer or alarm that reminds you to get up and walk around every 20 to 30 minutes.If you work in an office, make sure your screen is set up so that when you look at it you are looking forward, with your head positioned squarely in line with your shoulders and spine.The bottom line is to avoid looking down with your head bent forward for extended periods throughout the day. Spend a whole day being mindful of your posture—is your head bent forward when you drive? When you watch TV? Any prolonged period when your head is looking down is a time when you are putting excessive strain on your neck.Next, rehabilitation is important.Many people don't know this, but you need to have strong core muscles—the abdominal and lower back muscles- to support your upper body, including your neck. Your core muscles usually do not get enough exercise during normal daily activities, so you need to do specific exercises to target these muscles.You also need strong and flexible muscles the neck to minimize strain on your cervical spine and help support the weight of your head. Again, your neck will not get sufficient stretching and strengthening during normal daily activities, so it is best to learn specific neck exercises with the help of a health professional.Some people will also benefit from a more comprehensive treatment plan, such as a combination of manual adjustments and massage therapy.Good news is, Orthocure Clinic at South Point Mall in DLF Phase 5 is offering these rehabilitation programs with advanced technologies, which are successfully being used in USA & Europe for more than a decade. Orthocure Clinic is the first facility in India to offer these technologies.