Treating Neck Pain

There are five basic components to getting better when suffering from tight muscles in the neck and shoulders.  Posture prevention.  Simple Stretches.  Helpful Heat. Meaningful Massage.  Consistency is Key.

Posture Prevention:
As mentioned in last week's post, if the head is maintained in a forward position for an extended period of time the muscles will become overworked, tight and they will spasm.  When sitting in front of a computer screen, watching television, reading a book or even knitting a scarf, take care to keep you head back so that it is being supported by the bones in your spine, not the muscles of your neck.  If you are sitting in the same position for more than thirty minutes, take a few seconds and move your neck.  Do some simple stretches (see below).  In addition to your head position, make sure that your shoulders are in a neutral position during your activity.  If your keyboard is too high and you type with the shoulders hunched up, even just a fraction of an inch, the muscles will be overworked.

Simple Stretches:

Trapezius Stretch

These are examples of three simple stretches that can be done repeatedly through the day to loosen up your muscles.  They can be done in just a minute or two.  You can do them right in your chair at work.  There are many ways to stretch.  Most of them are quite acceptable.  First, listen to your body.  If the activity causes pain which is more than simple muscle stretching, don't do it.  In the neck, especially, be careful with spinal manipulation.  If you are older or have any risk factors for hardening of the arteries, consult with your physician prior to considering treatment consisting of neck manipulation.  It can result in disruption of the blood vessel in the neck.  Though quite rare, it is a potentially devastating complication.  You Tube has many videos demonstrating how to stretch the neck and shoulders.  An example of simple neck stretching is found here.  I enjoyed another one entitled, "Yoga Spine Exercises."  In fact, signing up for a Yoga class would be a great way to learn new techniques and enhance your flexibility in general.  Another form of exercise with great results for the spine is Pilates.  An example of some basic Pilates stretching is found here.

Helpful Heat:

Tight muscles in spasm tend to stay in spasm.  Heat helps to soften them up by increasing blood flow to the area.  Ice will contract the muscles and will make it worse.  Ice is best used when there has been an injury and swelling needs to be controlled.  For stiff muscles, heat is the best.  A great way to deliver heat is a "U-shaped" pack.  They may be filled with rice, barley, corn or other materials which can then be microwaved and will retain their heat for about 10-15 minutes.  This is just the right amount of time to apply it.  When is the best time to use heat? There is no bad time to do it.  Most people get lazy and don't do it enough.  Put it around your neck as you drive to work.  Put it on as you go to bed.  Using heat prior to stretching and massage is especially helpful.


Meaningful Massage:
Massage can release the painful knots or triggers that keep the muscles tight.  Certainly, going to a massage therapist is the best way to get relief.  A good physical therapist will also utilize massage in his/her treatment plan.  Lower cost alternatives may involve a close friend or family member.  Even if untrained, you can point out where the knots are.  A golf or tennis ball can be rolled over that area.  Even a rolling pin can work!  The vibrating massage balls sold in stores are not a bad idea either.

Consistency is Key:
Our bodies have a remarkable ability to heal themselves when given the chance.  We all have a tendency to ignore aches and pains knowing that eventually we will feel better, the body will take care of itself.  However, if you have reached the point where your neck and shoulder muscles are in a state of constant tightness and spasm,  those symptoms may last for a very long time.  By consistently following the simple steps listed above, the cycle can be broken and you can get back to feeling normal again.  It takes effort, but most of all it takes persistence.  Don't give up and get discouraged if you do not have immediate results.  You will feel better, but it takes time.

A Pain in the Neck

No, I'm not talking about your boss, your homework, being stuck in traffic or even all the things on your to do list.  I'm talking about the tightness between your shoulders that can cause pain up into your head, down your arms, sometimes in your chest and can even feel like a sharp pain deep in your inner ear. To explain how and why this happens, let me start with an anatomy lesson.

The main muscle group involved is called the trapezius.  It is so named due to its trapezoid shape, like a kite.  It attaches high up in the neck on the scull, extends down the spine to the mid back and flares out across to the edges to the shoulders.  The upper edge that is marked with an "X" is an area where trigger points can develop.  You know these better as "knots."  They are balled up areas of spasm that make life miserable. 

Underneath the trapezius are the scalene muscles.  They hold your head up straight and get overworked when our posture is bad.  At the bottom edge of these muscles is the brachial plexus.  This is a group of blood vessels and, more importantly, nerves that go down into the arm.  Enough spasm in the scalene muscles will cause pain, tingling and even numbness down the arm that feels similar to a bulged disc in the neck.

The sternocleidomastoid muscle group attach to the skull just behind the ear and attaches to the collar bone and breast bone.  These are the muscles that turn your head from side to side.  When they are in spasm one may feel a burning pain from the shoulder into the neck and side of the head.  This is the muscle that can make it feel like there is a sharp pick down in your ear.  This can especially be bad in those who spend a long time on the phone, holding it without hands between the ear and shoulder.

The levator scapulae muscle lifts up the shoulder blade to which it is attached.  It is responsible for shrugging your shoulders.  It is well known for knotting up on people who spend much of their time in front of a key board, especially if it is too high.  Steadily holding the shoulders in a shrugged position while typing creates constant tension in this muscle group.  It is not uncommon for me to see patients who come in complaining of a deep pain in their chest and are worried that they are having heart pains.  As I talk with them I'll hear clues that this is not their heart.  As I examine them, it becomes readily apparent that they are knotted up in the trapezius and especially the levator scapulae muscle.  I say to myself, "A ha!"  for I know that when there is a spasms in that location, it puts traction on the shoulder blade, pulling it upwards.  This then puts pressure on the other muscles which are attached to it, in this case the pectoralis minor muscle.  This is a small muscle of the chest that sits under the well known pectoralis major muscle, or "pecks."  As seen in the picture, the pectoralis minor attaches to the front of the shoulder blade and extends straight down to the rib cage.  Traction on the shoulder blade then causes a reciprocal spasm in this muscle and results in chest pains.

The number one reason for tightness and spasm in these important muscles is posture.  The head weighs about 20-25 pounds and is built to be supported by the bones in our spine.  If we are hunched forward, even just an inch or two, now those 25 pounds are being supported by the muscles of the neck instead.  I am seeing more and more patients with these problems and it is mostly due to the fact that we spend more and more time in front of a computer screen typing.  I have also seen this in patients who have bad posture while reading, sewing, quilting and even wood carving.  Tune in next week and I’ll discuss ways to help you get rid of your “pain in the neck.”

Aspirin Anguish

A report this week came to my attention that has linked a higher rate of macular degeneration with those who take aspirin on a regular basis.  Macular degeneration is a slowly progressive disease leading to blindness.  It is due to abnormal blood vessels in the back of the eye and becomes worse with age.  It is a frightening diagnosis to receive.  The news media seems to have very little interest these days in education and is rather more concerned about sensationalism.  This is the type of story that they love to scare people with.  I feel this deserves more thought and consideration.

The first issue lies in the fact that the study under consideration is retrospective.  This means that they took people who have the condition and looked back at factors that could be associated with it.  These types of studies are useful for generating questions for further study but are not in and of themselves definitive.  A prospective study is much better.  In this case, a group of people would be defined and divided into two groups.  One group would receive aspirin and the other would not. After a specified period of time, the two groups would be compared to see if one developed macular degeneration at a faster rate than the other.  This is not how the current study was performed.  Looking backwards can identify associations more so than establishing cause and effect.  One needs to ask, is aspirin the cause of the macular degeneration or could there be a different association.  As macular degeneration is a vascular (blood vessel) disease, I wonder if aspirin was just a marker for those who are at higher risk for vascular disease in general.  Aspirin has been shown conclusively in men over 45 and women over 55 to lower the risk of heart disease and stroke.  This is especially true in those who have risk factors such as high blood pressure, elevated cholesterol, smokers and diabetics.  Those at higher risk for vascular disease are likely to have a higher risk for macular degeneration as well.  Given their risk factors, such patients are more likely to have aspirin recommended to them by their doctors.  It is quite possible that if the patients who are found to have macular degeneration are taken off of their aspirin, they could have worsening of their macular degeneration.  They will certainly be at higher risk for the life ending complications of heart attack and stroke.

Aspirin use in the appropriate setting has been ranked by the U.S. Preventive Task Force as the single most effective way to save lives of any measure that we currently employ to prevent diseases.  This includes mammograms, pap smears, colonoscopies, blood pressure control, cholesterol management, etc. The single most effective!  Remember, your vision won't help you if you are dead.  Further studies are in order to determine the exact nature of the relationship between aspirin use and macular degeneration.  In the meantime, if you have risk factors for blood vessel disease, please talk to your doctor prior to considering stopping a potentially live prolonging medication, your simple aspirin a day.

Facts About Flu

This is the time of year when flu shots are administered.  It seems that you can get your flu shot just about anywhere.  The good news is that the shot is the same, no matter where you go.  Get it where ever it is most convenient.  That said, I did once ask a patient never to return to the location where she received hers.  It wasn't that I was afraid that the vaccine that she received was not effective.  It was that she received it at Krispy Kreme doughnuts.  I have a serious problem with my patients receiving their health care at such an establishment.  It just sends the wrong message.  She didn't even get out of her car.  She just rolled down her window, signed a form, stuck out her arm and picked up a doughnut.  

Why is it important to be vaccinated for flu?  First of all, many confuse a viral stomach bug as flu.  This is incorrect.  Though such an illness will make one quite ill for a few days, it tends to be short lived and not serious.  In such a case, it would not be necessary to be vaccinated.  However, flu stands for influenza.  This is a respiratory illness characterized by high recurrent fevers, shaking chills, and horrible muscle aches.  What makes it especially risky is that there is a significant risk for pneumonia to develop.  Not uncommonly this is due to staphylococcus aureus, the most deadly bacteria to cause pneumonia.  Those at particularly high risk are those at the extremes of ages-the very young and the elderly.  The illness tends to last at least 7-10 days and is quite incapacitating.

So who should get vaccinated?  Those who are over 65 years old definitely should.  Also, those who have chronic diseases should as well.  Repeated studies have shown that vaccination in these patients saves lives.  Those who work with or are in contact with such people should also strongly consider being vaccinated.  In fact, anyone who wants to avoid being out of commission for at least a week should be vaccinated.  This includes school children as well as those of you in the work force.  There is a reason why many employers provide the vaccination for free.  It is well worth the investment to keep people productive at work.

Unlike many other vaccines, the influenza vaccine must be given each year.  This is because the virus interchanges its components, evading our immune's system memory.  Certain combinations of these components are more dangerous than others.  The H1N1 epidemic (swine flu) two years ago is a good example of this.  One of our big worries is if the "bird flu" (H5N1) becomes easily transmissible to humans.  That particular strain has a mortality rate of nearly 70% in healthy adults.  Such an epidemic would decimate every community in which it traveled.  One of the reasons why it is good to get your flu shot every year is that it gives your immune system more chances at reacting to future viral rearrangements.

"I don't want to get a flu shot.  Every time I get a shot, I get sick."  I have two responses to this concern.  First, illnesses that occurs after receiving the vaccination are not influenza.  They are coincidental colds.  I realize that no one believes me when I say this.  The real consideration is to know that the flu shot is now a totally killed virus.  Past vaccines were partially live viruses which may indeed cause one to feel feverish and achy for a few days after.  That is no longer the case.  The shot is exceedingly safe with minimal effects.  Flumist, the vaccine given through the nose is partially live.  If you are concerned about feeling ill after the vaccine, get the shot.

In summary, protect yourself, protect your loved ones, protect your community.  Get your flu shot.  This is the best time to do it.  Please, just don't go to the doughnut shop!