Monthly Archives: September 2014

Good Posture makes all the difference!

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How Poor Posture Causes Neck Pain

Article written by: Gavin Morrison, PT    www.spine-health.com

Most neck pain that is not caused by whiplash or other trauma has a postural component as part of the underlying problem. Sitting atop the body, the health of the neck is subject to the curvature of the spine below and the position of the head above.

The neck muscle pain can be caused by the following neck muscles becoming tight:

  • Scalene muscles (three pairs of muscles that help rotate the neck)
  • Suboccipital muscles (four pairs of muscles used to rotate the head)
  • Pectoralis minor muscles (a pair of thin triangular muscles at the upper part of the chest)
  • Subscapularis muscles (a pair of large triangular muscles near each shoulder joint)
  • Levator scapulae muscles (a pair of muscles located at the back and side of the neck).

If the alignment of the head and spine is not optimal, the neck can be predisposed to injury and/or the degenerative effects of wear and tear over time.

 

Forward Head and Shoulder Posture

The most common condition that contributes to neck pain is forward head and shoulder posture. Forward head posture is when the neck slants forward placing the head in front of the shoulders. This head position leads to several problems:

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  • The forward pull of the weight of the head puts undue stress on the vertebrae of the lower neck, contributing to degenerative disc disease and other degenerative neck problems.
  • Similarly, this posture causes the muscles of the upper back to continually overwork to counterbalance the pull of gravity on the forward head.
  • This position is often accompanied by forward shoulders and a rounded upper back, which not only feeds into the neck problem but can also cause shoulder pain.

The more time spent with a forward head posture, the more likely it is that one will develop neck and shoulder problems.

 

Effects of Poor Posture on the Lower Cervical Vertebrae

The part of the neck that is particularly vulnerable to forward head posture is the lower part of the neck, just above the shoulders.

The lower cervical vertebrae (C5 and C6) may slightly slide or shear forward relative to one another as a result of the persistent pull of gravity on a forward head.

This shear force can be a problem for patients with jobs that require them to look down or forward all day, such as pharmacists who spend many hours counting pills or data entry workers who look at a computer screen.

Long-Term Negative Effects of Poor Posture

Prolonged shearing of the vertebrae from forward head posture eventually irritates the small facet joints in the neck as well as the ligaments and soft tissues.

This irritation can result in neck pain that radiates down to the shoulder blades and upper back, potentially causing a variety of conditions, including:

 

Workplace Ergonomics and Neck Pain

It is often important to look at the workplace ergonomics as part of treatment and prevention of neck pain. Perhaps the placement of the desk, computer workstation and/or placement of the computer monitor and keyboard can be improved to encourage improved upper back and neck posture.

When sitting erect at a desk and looking straight ahead:

  • Eyes should point directly at the top third of the screen.
  • Forearms should be approximately parallel with the floor when typing.
  • Elbows should be at the side.
  • Feet should be flat on the floor with the thighs parallel with the floor.

If patients have a standing work station or perform other sorts of sitting or driving tasks, make sure that one side of the body is not constantly rotated more than the other side, and that there is as much symmetry in repetitive tasks as possible.

Persistent movements to one side or constant rotation of the neck and back to the same side can often aggravate joints and soft tissues causing neck and back pain. Some patients can develop poor posture of the head, neck, and shoulders through repetitive work tasks and/or poor sitting habits.

There are stretches and exercises that are effective at helping restore good posture, thereby taking pressure off the neck and relieving pain.

See Simple Office Chair Stretch

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton  office at 540-347-9220 or our Gainesville office at 703-743-2814.

Chronic Pain Coping Techniques – Pain Management

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Article written by: Andrew R. Block, PhD   Spine-Health.com

Clinicians who specialize in treating chronic pain now recognize that it is not merely a sensation, like vision or touch, but rather chronic pain is strongly influenced by the ways in which the brain processes the pain signals.

Chronic pain can provoke emotional reactions, such as fear or even terror, depending on what we believe about the pain signals. In other cases (such as in sports or another engaging, rewarding activity), chronic pain may be perceived by the individual as merely a nuisance, a feeling to be overcome in order to be able to continue in the activity.

The important role the mind plays in chronic pain is clearly recognized in the medical literature, as well as in the International Association for the Study of Pain’s definition of pain, which states that pain is always subjective and is defined by the person who experiences it.

The corollary is that the brain can also learn how to manage the sensation of pain. Using the mind to control chronic pain, or coping strategies, for managing persistent pain, may be used alone or in tandem with other pain management therapies.

Ideally, use of the chronic pain management techniques outlined in this article can help patients feel less dependent on pain killers and feel more empowered to be able to control their pain.

Managing Chronic Pain

Of course, the first step in coping with chronic back pain or other types of persistent pain is to receive a thorough medical evaluation to determine the cause of the pain.

  • In some situations, such as a herniated disc in the spine, it may be important to pay attention to the level and type of pain so that it can serve as a warning signal of impending damage.
  • In other cases, especially when the back pain is chronic and the health condition unchangeable, one goal can be to try and keep the chronic pain from being the entire focus of one’s life.

Whatever the medical condition, there are a number of effective strategies for coping with chronic back pain. These techniques generally include:

  • Relaxation training: Relaxation involves concentration and slow, deep breathing to release tension from muscles and relieve pain. Learning to relax takes practice, but relaxation training can focus attention away from pain and release tension from all muscles. Relaxation tapes are widely available to help you learn these skills.
  • Biofeedback: Biofeedback is taught by a professional who uses special machines to help you learn to control bodily functions, such as heart rate and muscle tension. As you learn to release muscle tension, the machine immediately indicates success. Biofeedback can be used to reinforce relaxation training. Once the technique is mastered, it can be practiced without the use of the machine.
  • Visual imagery and distraction: Imagery involves concentrating on mental pictures of pleasant scenes or events or mentally repeating positive words or phrases to reduce pain. Tapes are also available to help you learn visual imagery skills.

Distraction techniques focus your attention away from negative or painful images to positive mental thoughts. This may include activities as simple as watching television or a favorite movie, reading a book or listening to a book on tape, listening to music, or talking to a friend.

  • Hypnosis: Hypnosis can be used in two ways to reduce your perception of pain. Some people are hypnotized by a therapist and given a post-hypnotic suggestion that reduces the pain they feel. Others are taught self-hypnosis and can hypnotize themselves when pain interrupts their ability to function. Self-hypnosis is a form of relaxation training.

All of the above-describe techniques for coping with chronic back pain make use of four types of skills:

  • Deep Muscle Relaxation
  • Distraction: moving attention away from the pain signals
  • Imagery: visual, sound or other pictures and thoughts that provide a pleasant and relaxing experience
  • Dissociation: The ability to separate normally connected mental processes, leading to feelings of detachment and distance from the chronic pain.

11 Chronic Pain Control Techniques

To prepare for any chronic pain coping technique, it is important to learn how to use focus and deep breathing to relax the body. Learning to relax takes practice, especially when you are in pain, but it is definitely worth it to be able to release muscle tension throughout the body and start to remove attention from the pain.

Coping techniques for chronic pain begin with controlled deep breathing, as follows:

  • Try putting yourself in a relaxed, reclining position in a dark room. Either shut your eyes or focus on a point.
  • Then begin to slow down your breathing. Breathe deeply, using your chest. If you find your mind wandering or you are distracted, then think of a word, such as the word “Relax,” and think it in time with your breathing…the syllable “re” as you breathe in and “lax” as you breathe out.
  • Continue with about 2 to 3 minutes of controlled breathing.
  • Once you feel yourself slowing down, you can begin to use imagery techniques.

Eleven specific imagery and chronic pain control techniques that are effective for pain control include:

  1. Altered focus
    This is a favorite technique for demonstrating how powerfully the mind can alter sensations in the body. Focus your attention on any specific non-painful part of the body (hand, foot, etc.) and alter sensation in that part of the body. For example, imagine your hand warming up. This will take the mind away from focusing on the source of your pain, such as your back pain.
  2. Dissociation
    As the name implies, this chronic pain technique involves mentally separating the painful body part from the rest of the body, or imagining the body and mind as separate, with the chronic pain distant from one’s mind. For example, imagine your painful lower back sitting on a chair across the room and tell it to stay sitting there, far away from your mind.
  3. Sensory splitting
    This technique involves dividing the sensation (pain, burning, pins and needles) into separate parts. For example, if the leg pain or back pain feels hot to you, focus just on the sensation of the heat and not on the hurting.
  4. Mental anesthesia
    This involves imagining an injection of numbing anesthetic (like Novocain) into the painful area, such as imagining a numbing solution being injected into your low back. Similarly, you may then wish to imagine a soothing and cooling ice pack being placed onto the area of pain.
  5. Mental analgesia
    Building on the mental anesthesia concept, this technique involves imagining an injection of a strong pain killer, such as morphine, into the painful area. Alternatively, you can imagine your brain producing massive amount of endorphins, the natural pain relieving substance of the body, and having them flow to the painful parts of your body.
  6. Transfer
    Use your mind to produce altered sensations, such as heat, cold, anesthetic, in a non-painful hand, and then place the hand on the painful area. Envision transferring this pleasant, altered sensation into the painful area.
  7. Age progression/regression
    Use your mind’s eye to project yourself forward or backward in time to when you are pain-free or experiencing much less pain. Then instruct yourself to act “as if” this image were true.
  8. Symbolic imagery
    Envision a symbol that represents your chronic pain, such as a loud, irritating noise or a painfully bright light bulb. Gradually reduce the irritating qualities of this symbol, for example dim the light or reduce the volume of the noise, thereby reducing the pain.
  9. Positive imagery
    Focus your attention on a pleasant place that you could imagine going – the beach, mountains, etc. – where you feel carefree, safe and relaxed.
  10. Counting
    Silent counting is a good way to deal with painful episodes. You might count breaths, count holes in an acoustic ceiling, count floor tiles, or simply conjure up mental images and count them.
  11. Pain movement
    Move chronic back pain from one area of your body to another, where the pain is easier to cope with. For example, mentally move your chronic back pain slowly into your hand, or even out of your hand into the air.

Some of these techniques are probably best learned with the help of a professional, and it usually takes practice for these techniques to become effective in helping alleviate chronic pain. It is often advisable to work on pain coping strategies for about 30 minutes 3 times a week. With practice, you will find that the relaxation and chronic pain control become stronger and last longer after you are done.

Sometimes, after you are good at using the techniques, you can produce chronic pain relief and relaxation with just a few deep breaths. You can then start to use these techniques while you are engaged in any activity, working, talking, etc. With enough experience you will begin to feel a greater sense of control over the chronic pain and its effects on your life.

 

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton  office at 540-347-9220 or our Gainesville office at 703-743-2814.

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