Self Regional Healthcare Physical Therapy Savannah Lakes 207 Holiday Road McCormick, SC Office: (864)

Transcription

1 Neck Pain Prevention Self Regional Healthcare Optimum Life Center 115 Academy Avenue Greenwood, SC Office: (864) Self Regional Healthcare Physical Therapy Savannah Lakes 207 Holiday Road McCormick, SC Office: (864) Self Regional Healthcare Physical Therapy Laurens 410 Anderson Drive Laurens, SC Office: (864)

2 DISCLAIMER The author and publisher have used their best efforts in preparing this report. The author and publisher make no representation or warranties with respect to the accuracy, applicability, fitness, or completeness of the contents of this report. The information contained in this report is strictly for educational purposes. Therefore, if you wish to apply ideas contained in this report, you are taking full responsibility for your actions. EVERY EFFORT HAS BEEN MADE TO ACCURATELY REPRESENT THIS PRODUCT AND IT S POTENTIAL. HOWEVER, THERE IS NO GUARANTEE THAT YOU WILL IMPROVE IN ANY WAY USING THE TECHNIQUES AND IDEAS IN THESE MATERIALS. EXAMPLES IN THESE MATERIALS ARE NOT TO BE INTERPRETED AS A PROMISE OR GUARANTEE OF ANYTHING. SELF-HELP AND IMPROVEMENT POTENTIAL IS ENTIRELY DEPENDENT ON THE PERSON USING OUR PRODUCT, IDEAS AND TECHNIQUES. YOUR LEVEL OF IMPROVEMENT IN ATTAINING THE RESULTS CLAIMED IN OUR MATERIALS DEPENDS ON THE TIME YOU DEVOTE TO THE PROGRAM, IDEAS AND TECHNIQUES MENTIONED, KNOWLEDGE AND VARIOUS SKILLS. SINCE THESE FACTORS DIFFER ACCORDING TO INDIVIDUALS, WE CANNOT GUARANTEE YOUR SUCCESS OR IMPROVEMENT LEVEL. NOR ARE WE RESPONSIBLE FOR ANY OF YOUR ACTIONS. MANY FACTORS WILL BE IMPORTANT IN DETERMINING YOUR ACTUAL RESULTS AND NO GUARANTEES ARE MADE THAT YOU WILL ACHIEVE RESULTS SIMILAR TO OURS OR ANYBODY ELSE S, IN FACT NO GUARANTEES ARE MADE THAT YOU WILL ACHIEVE ANY RESULTS FROM OUR IDEAS AND TECHNIQUES IN OUR MATERIAL. The author and publisher disclaim any warranties (express or implied), merchantability, or fitness for any particular purpose. The author and publisher Page 2

3 shall in no event be held liable to any party for any direct, indirect, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without warranties. As always, the advice of a competent professional should be sought. The author and publisher do not warrant the performance, effectiveness or applicability of any sites listed or linked to in this report. All links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose. Page 3

4 TABLE OF CONTENTS Disclaimer...2 Table of Contents...4 Chapter One What Is Neck Pain?...6 Chapter Two What Are The Symptoms?....7 Chapter Three How Is Neck Pain Diagnosed?....8 Chapter Four Can You Prevent Neck Pain?...9 Chapter Five Stretch Your Neck Muscles...10 Chapter Six Office Ergonomics Chapter Seven Muscle Relaxation Exercises...12 Chapter Eight What Happens with Neck Pain?...14 Chapter Nine What Increases Your Risk? Page 4

5 Chapter Ten Who Can Diagnose Neck Pain?...16 Chapter Eleven How Is it Diagnosed? Chapter Twelve How Is Neck Pain Treated?...19 Chapter Thirteen What Other Treatments Are There?...23 Chapter Fourteen What Medicine Will I Need?...25 Chapter Fifteen Will I Need Surgery?...26 Chapter Sixteen What Can I Do to Treat Neck Pain at Home? Chapter Seventeen When Should I Call My Doctor?...30 Chapter Eighteen What Exercise Can Prevent and Treat Neck Pain? Page 5

6 CHAPTER ONE WHAT IS NECK PAIN? Neck pain can happen anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread to your upper back or arms. It might limit how much you can move your head and neck. Neck pain is common, especially in people older than fifty. What causes neck pain? Most neck pain is caused by activities that strain the neck. Slouching, painting a ceiling, or sleeping with your neck twisted is some things that can cause neck pain. These kinds of activities can lead to neck strain, a spasm of the neck muscles, or swelling of the neck joints. Neck pain can also be caused by an injury. A fall from a ladder or whiplash from a car accident can cause neck pain. Some less common medical problems can also lead to neck pain, such as: An infection in the neck. Narrowing of the spinal canal in the neck (cervical spinal stenosis). Rheumatoid arthritis. Page 6

7 CHAPTER TWO WHAT ARE THE SYMPTOMS? You might feel a knot, stiffness, or severe pain in your neck. The pain might spread to your shoulders, upper back, or arms. You might get a headache. You might not be able to move or turn your head and neck easily. If there is pressure on a spinal nerve root, you might have pain that shoots down your arm. You might also have numbness, tingling, or weakness in your arm. Characteristics of neck pain include: Pain that happens from the bottom of your head to the top of your shoulders. Pain might spread to the upper back or arms. Pain that worsens with movement. Limited head and neck movement. The neck might be stiff or tender. Headaches. These are common and might persist for months. Nerve-related symptoms caused by pressure on the spinal nerve roots or spinal cord are: Numbness, weakness or tingling in the arm or hand. A burning feeling when touching the skin of the arm or hand. A pain that feels like a shock and extends into the arm or hand. Leg weakness or numbness, and loss of the ability to control the bladder or bowel.. This happens when there is considerable pressure or injury to the spinal cord. Page 7

8 If your neck pain is long-lasting (chronic), it might be difficult to cope with daily life. Typical side effects of chronic pain are: fatigue, depression, and anxiety. CHAPTER THREE HOW IS NECK PAIN DIAGNOSED? Your doctor will question you about your symptoms and do a physical examination. He or she might also ask you about any injuries, illnesses, or activities that might have caused your neck pain. During the physical examination, your doctor will check how well you are able to move your neck. He or she will also check for tenderness or numbness, tingling, or weakness in your arms or hands. If your pain started after an injury, or if it doesn t improve after a few weeks, your doctor might want to do even more tests. Imaging tests such as an X-ray, an MRI scan, or a CT scan can show the neck muscles and tissues. These tests might be done to check the neck bones, spinal discs, spinal nerve roots, and spinal cord. Page 8

9 CHAPTER FOUR CAN YOU PREVENT NECK PAIN? You can avoid neck pain caused by stress or muscle strain modifying a few harmful habits. Avoid spending a lot of time in positions that stress your neck. This includes not sitting at a computer for long periods. If your neck pain becomes worse by the end of the day, think about how you often sit during the day. Sit straight up in your chair with feet flat on the floor. Take short breaks several times each hour. If your neck pain is at its worse in the morning, check your pillow and your sleeping position. Use pillows that keep your neck straight. Avoid sleeping on your tummy with your neck bent or twisted. When you read in bed, prop up the book so you do not use your arms to raise it and bend your neck forward. Think about using wedge-shaped pillows to support your arms and to keep your neck in a neutral position. If stress is one cause to your neck pain, practice exercises for muscle relaxation. Consider having a massage. Protect and strengthen your neck by doing neck exercises at least once a day. You can help also to prevent neck pain by keeping at a healthy body weight. Page 9

10 CHAPTER FIVE STRETCH YOUR NECK MUSCLES These exercises should help you feel a gentle stretch, but no pain. Neck stretch This stretch works the best if you keep your shoulder down as you lean away from it. To help you to remember this, start by relaxing your shoulders and lightly holding on to your thighs or your chair. Tilt your head towards your shoulder and hold for fifteen to thirty seconds. If you would like to do a little added stretch, use your hand to gently and steadily pull your head in the direction of your shoulder. For example, keep your right shoulder down, and lean your head to the left. Allow the weight of your head to stretch your muscles, or use your left hand to pull gently down on your head. Repeat two to four times towards each shoulder. Page 10

11 Diagonal neck stretch Turn your head slightly towards the direction you will be stretching, and tilt your head diagonally towards your chest and hold for fifteen to thirty seconds. If you would like a little added stretch, use your hand to gently and steadily pull your head forward on the diagonal. Repeat two to four times towards each side. CHAPTER SIX OFFICE ERGONOMICS Most injuries that happen at work are caused by physical stress or strain, such as sitting in the same position for long times, making repetitive movements, and overuse. These activities can cause stress and strain on your muscles, tendons, nerves, joints, blood vessels and spine. Page 11

12 Symptoms can include pain in your: Back. Hand, wrist, or arms. Neck and shoulders. You might also be at risk for problems such as tendinopathy and bursitis, which are caused by overuse and repetitive movements. Over time, these kinds of movements can make you feel bad. They can be the cause of long-term health problems; also they use up your sick time. You might be at greater risk for injuries at your work if you have other health problems, such as arthritis or emotional stress. CHAPTER SEVEN MUSCLE RELAXATION EXERCISES Certain body muscle relaxation exercises and breathing exercises help to reduce stress. Practice relaxation exercises ten to twenty minutes a day. Tell others in your home that you are going to practice your relaxation exercises, and ask them not to disturb you. Do your exercises in a comfortable place, away from distractions and noise. Lie down on your back or sit up with your back straight. Concentrate on your breathing. Make it slow and steady. Inhale through your nose. Exhale through either your nose or mouth. Page 12

13 Breathe deeply, filling up the area between your navel and your rib cage. Do not breathe with your chest. Don t hold your breath. Continue this pattern of breathing for five to ten minutes. Notice the calm feeling throughout your whole body. As you continue breathing slowly and deeply, relax by doing the following for another five to ten minutes: Tighten and then relax each muscle in your body. You can start at your toes and work your way up to your head. Imagine your muscle groups relaxing and becoming heavy. Empty your mind of all thoughts. Allow yourself to relax more and more deeply. Become aware of the state of calmness that surrounds you. When your time is over, bring yourself back to alertness by moving your fingers and toes, next your hands and feet, stretching and moving your entire body. Sometimes people fall asleep during relaxation; but they usually wake up shortly afterwards. During relaxation, you could play soothing, relaxing music. Always give yourself sufficient time to return to full alertness before you drive your car or do any other activities that might cause accidents if you are not fully alert. Never play relaxation tapes while driving a car. Page 13

14 CHAPTER EIGHT WHAT HAPPENS WITH NECK PAIN? Most cases of neck pain that are caused by activities, such as computer use or sleeping position, improve within four to six weeks with treatment that includes taking steps to relieve pain, modifying activities, and doing exercises or physical therapy. Neck pain caused by injuries, such as falls resulting in a herniated disc, usually improves within 3 months without surgical treatment. Neck pain caused by an injury such as whiplash might take longer but usually improves within six to twelve months with only occasional recurring pain. Neck pain might become long-lasting (chronic) when it happens in combination with some other health conditions, such as conditions that go with increasing age. These include narrowing of the spinal canal (cervical spinal stenosis) and arthritis of the neck (cervical spondylosis). In some cases, chronic neck pain can result from repeated and prolonged movements, such as very long hours working at a computer. Chronic neck pain might result in increased fatigue, irritability, and sleep disturbances and poor quality of life. If treatment fails, neck pain might lead to depression, chronic pain syndrome, or drug dependence Page 14

15 CHAPTER NINE WHAT INCREASES YOUR RISK? Risk factors for neck pain that you cannot control include: Age. People older than fifty are more likely to have a breakdown (degeneration) of discs or joints, as well as bone spurs in the neck vertebrae (cervical spondylosis). Recent injury or a history of injury. A common injury to the neck is whiplash caused by a car accident. Conditions that affect the bones and soft tissues of the neck and back, such as rheumatoid arthritis, a narrowing of the spinal canal (cervical spinal stenosis), or a severely curved spine (scoliosis). A history of having headaches. Risk factors that you can control include: Awkward positions that put stress on the neck. Stress and poor posture, at home or at work. Heavy physical work. Boredom at or unhappiness with work. Depression. Smoking. Drug abuse. Poor physical condition and lack of exercise. Page 15

16 CHAPTER TEN WHO CAN DIAGNOSE NECK PAIN? Health professionals who can assess and treat neck pain include: Emergency medicine doctors. Primary care providers. This includes: Internists. Family medicine doctors. Nurse practitioners. Physician assistants. If your neck pain is severe or long-lasting, health professionals who can treat you include: Physical therapists. Page 16

17 Orthopedists. Rheumatologists. Neurologists. Osteopathic doctors. Physiatrists. Alternative health professionals who can provide care include: Acupuncturists. Certified massage therapists. Chiropractors. We can help you with the above exercises. Contact us to learn more. CHAPTER ELEVEN HOW IS IT DIAGNOSED? Examinations and Tests Initial testing Neck pain is usually assessed by a medical history and physical examination. Your doctor will ask you about your symptoms, injuries or illnesses, any previous treatments, and any habits and activities that might be causing your neck pain. During the physical examination, your doctor will assess your neck s range of motion and check for pain caused by movement. He or she will look for areas Page 17

18 of tenderness and any nerve-related changes, such as numbness, weakness or tingling in the arm or hand. Blood tests might be done to check for an illness or infection. If you have no signs of a serious condition or recent injury, imaging tests, such as X-rays, might not be needed at first. Imaging, electromyogram, and nerve conduction tests If, after a period of treatment, your neck pain doesn t improve, you might need imaging tests, particularly when: You have signs of nerve damage. Another, different serious problem is suspected. Neck pain is chronic (lasting more than a few weeks) and has not improved with treatment. The cause of your condition cannot be clearly identified. Your doctor is asked to provide documentation about your condition, such as when legal or compensation issues arise from a neck injury. In some cases, imaging test results do not agree with symptoms or the findings of a physical examination. For example, test results might be normal, yet you might have severe symptoms. But imaging tests usually provide useful information and are frequently used. Imaging tests that might be used to assess neck pain include: X-rays, which help to evaluate the bones and joints of the neck. Magnetic resonance imaging (MRI), which helps to evaluate the spinal cord and nerve roots. MRI is useful for identifying a herniated disc and nerve root impingement (pinched nerve). Page 18

19 Computed tomography (CT) scan, which helps to evaluate the bone and spinal canal Myelogram, which can provide further detail of the spinal canal and nerve roots. Tests that are done to check the spinal cord and nerves in the neck include electromyogram and nerve conduction studies. These tests can help identify the location and nature of a nerve problem that is causing pain, numbness, or weakness in the arm or hand. CHAPTER TWELVE HOW IS NECK PAIN TREATED? Treatment for neck pain is generally by reducing the pain with ice and medicine, improving neck movement and flexibility with exercises or physical therapy, and by avoiding further neck injury by changing your activities and body mechanics, such as how you sit or sleep. The specific treatment might depend on whether Page 19

20 your neck pain is caused by activities, an injury, or another medical condition. Home treatment is often all that is needed for neck pain. Because most neck pain is caused by repeated or prolonged movements to the neck s muscles, ligaments, tendons, bones, or joints, nonsurgical treatment is usually effective. Most cases of neck pain that are caused by activities are resolved within four to six weeks. Acute neck pain For sudden (acute) neck pain: Put an ice pack or cold pack over painful muscles for forty eight to seventy two hours. This will help to reduce any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, apply ice to the back of the neck. If you prefer, try an ice massage. Massage the painful place with ice for seven to ten minutes; that should be long enough to numb the pain. Ice frozen in a paper cup works fine. Make sure you do not damage your skin (frostbite). Avoid anything that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic drinks, for the first forty eight hours after an injury. After forty eight to seventy two hours, if the swelling has gone, apply heat. Use a warm pack or a heating pad set on low. Some experts recommend alternating between heat and cold treatments. Return to your normal daily activities as soon as possible. Research suggests that continuing normal activities after neck-strain injuries helps to end some symptoms faster than taking time off work and using neck immobilization. Gently massage or rub the place to relieve pain and encourage more blood flow. Do not massage the injured place if it causes pain. Nonprescription creams or gels, such as Bengay, should provide pain relief. Take pain relievers. Acetaminophen (e.g. Tylenol) should help to relieve pain. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), should help to Page 20

21 relieve pain and reduce inflammation. Do not give aspirin to anyone younger than twenty years because of the risk of Reye syndrome (Brain damage). For severe pain or muscle spasm, your doctor also might prescribe: Muscle relaxants that treat severe pain spasms when neck pain starts. They include diazepam (such as Valium), cyclobenzaprine (such as Flexeril), and carisoprodol (such as Soma). Narcotic pain relievers that are used short-term for severe neck pain. They include codeine, acetaminophen and hydrocodone (such as Vicodin, Lortab), aspirin and oxycodone (such as Percodan), and acetaminophen and oxycodone (such as Percocet). The treatment that is right for you might be not the same as the treatment for somebody else with neck pain. Some treatments have been studied more than others. Many treatments for neck pain haven t been so well researched, even if they are used a lot. A review of studies shows that exercise and manual therapy, used either separately or together, are likely to be beneficial in the treatment of uncomplicated neck pain. Your doctor might recommend you to wear a cervical collar to support your neck. Cervical collars might reduce neck pain, but they should only be used for a day or two. Chronic neck pain For long-lasting (chronic) neck pain, you can use the same treatments used for acute pain, but you do not have to worry about swelling. Your doctor might prescribe other medicines, such as antidepressants. These include doxepin (such as Sinequan) and amitriptyline. You can help healing and prevent further injury by: Page 21

22 Having physical therapy. For home treatment, you can use heat and massage. A physical therapist can teach you exercises to do at home. These can keep your neck flexible and strong and prevent stiffness. Schedule an evaluation with us so we can help you with these exercises. Changing or avoiding any activities that might be causing your neck pain, such as prolonged computer work or overhead work. Maintaining good health habits. If possible, reduce the stress and tension at work and home. Stop smoking. Smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. Trying manual therapy. A trained practitioner might use slow twisting, pulling, or pushing movements. When slow, measured movements are used, it is known as mobilization. Avoid rapid, forceful movements, which are known as manipulation. Talk to your doctor before trying manual therapy. Surgery Surgery is rarely required for neck pain. It might be considered to treat neck pain caused by pressure on the nerve roots or spinal cord, a severe injury that has broken a neck bone (vertebra), a tumor, infection, or a spinal condition such as narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis). Surgical options include: Discectomy (with or without fusion Cervical spinal fusion, in which selected bones in the neck are joined (fused) together. Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc. Page 22

23 What to Think About A review of studies, reports that: Exercise-reduced pain is better than medicine for muscle pain or spasm, stress management, or no exercise. There is not enough evidence to be sure whether medicines, transcutaneous electrical nerve stimulation (TENS), ice and heat, soft cervical collars, or special pillows are helpful for neck pain. In one small study, women with chronic neck pain were taught and used neck endurance and strengthening exercises for one year. Compared with people who had chronic neck pain but were not using the exercises, the exercise group had less pain and disability. Keeping your neck moving improves its function and helps it to heal. In general, cervical collars are only used after surgery or for a day or two after a neck sprain. People who have chronic pain syndrome and its linked problems, such as depression or drug dependence, might respond to treatment more slowly. Counseling in addition to medical treatment might help in recovery. CHAPTER THIRTEEN WHAT OTHER TREATMENTS ARE THERE? Other types of treatment for neck pain might help relieve your symptoms, restore movement, and strengthen the muscles around your spine to help prevent further injury. Page 23

24 Other types of treatment are: Physical therapy. At home, you can use heat and massage to improve blood flow. A physical therapist can teach you stretching and strengthening exercises that you can also do at home. Physical therapy can also include treatments like heat therapy to improve blood circulation we can help you with these home exercises. Cervical (neck) collars, which might be used for a short time to help to reduce pain by restricting neck movement. Traction, a technique used to stretch the neck and relax the spinal nerve root openings. This might be used if there is no risk of instability in the neck. Complementary and alternative treatments Complementary and alternative treatments are sometimes used to relieve pain and restore neck mobility. They include: Manual therapy, such as that found in massage and physical therapy and in chiropractic and osteopathic treatments. The goals of manual therapy include relaxation, decreased pain, and increased flexibility. Yoga, a program of exercises to help improve flexibility and breathing, decrease stress, and maintain health. The basic components of yoga are proper breathing and posture. Acupuncture, which is done by inserting very thin needles into the skin. Acupuncture is used to relieve pain and to treat many health conditions. What To Think About Although the effectiveness of some of these treatments has not been proved, they seem to be helpful for some people and might relieve stress and improve quality of life. Page 24

25 CHAPTER FOURTEEN WHAT MEDICINE WILL I NEED? Medicines can relieve neck pain and reduce inflammation of the soft tissues. Pain relief will allow you to move your neck gently, so you can start easy exercises and kick off the healing process. Although pain relievers, muscle relaxants, and antidepressants are frequently used for neck pain, none of them are well-proven treatments. Nonprescription pain relievers include: Creams or gels, such as Bengay, which are rubbed into the neck. Acetaminophen, such as Tylenol, which reduces pain. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), that can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than twenty years because of the risk of Reye syndrome.(brain damage) Prescription pain relievers include: Muscle relaxants, which are used to treat severe neck pain and spasms when neck pain begins (acute neck pain). They include diazepam (such as Valium), cyclobenzaprine (such as Flexeril), and carisoprodol (such as Soma). Narcotic pain relievers, which are used to treat severe short-term (acute) neck pain. They include codeine, acetaminophen and hydrocodone (such as Vicodin, Lortab), aspirin and oxycodone (such as Percodan), and acetaminophen and oxycodone (such as Percocet). Antidepressants, which are used to treat long-lasting (chronic) pain. They include doxepin (such as Sinequan) and amitriptyline. Page 25

26 CHAPTER FIFTEEN WILL I NEED SURGERY? Surgery is not necessary for most cases of neck pain, which are typically caused by repeated or prolonged movements to the neck s muscles, ligaments, tendons, bones, or joints. Surgery might be considered when neck pain is caused by: Traumatic injury to the neck that results in a fracture or abnormal motion (instability). Surgery might be done to stabilize the spine and prevent a bone fracture from causing instability and possible paralysis. Pressure on the spinal nerve roots or spinal cord that results in pain, numbness, or arm, hand, or leg weakness, or that causes severe pain that persists for months despite treatment, or that causes loss of bladder or bowel control. Narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis). Surgical options Surgery is used to treat neck pain caused by pressure on the nerve roots or by injury or illness include: Discectomy (with or without fusion). Cervical spinal fusion, in which selected bones in the neck are joined (fused) together. Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc. Disc replacement with an artificial disc. Some people can consider this surgery Page 26

27 instead of spinal fusion. Disc replacement surgery removes a spinal disc that is severely damaged and then replaces it with an artificial disc. This surgery is currently only for carefully selected patients, and it is done by specially trained surgeons. Doctors have not yet done long-term studies to know how well this works over time. Things to Consider Surgery that is done to relieve neck pain caused by pressure on the nerve roots (especially from a herniated disc) is successful in relieving pain 80% to 90% of the time. A minor surgical technique called percutaneous radiofrequency neurotomy has been used for some people with chronic facet joint pain. The facet joint is a portion of the spine in the neck that is sometimes responsible for neck pain after whiplash. One review suggests that this surgery offers short-term relief for chronic neck pain. Almost 60% of people with whiplash said they were painfree more than six months after treatment. It is a difficult surgery that requires a highly skilled staff. And the pain will most likely come back over time. CHAPTER SIXTEEN WHAT CAN I DO TO TREAT NECK PAIN AT HOME? Even if you need medical treatment such as prescription medicines for your neck pain, the following home treatment measures will help speed your recovery. For sudden (acute) neck pain: Place an ice pack or cold pack over painful muscles for forty eight to seventy two hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If Page 27

28 you prefer, try ice massage. Massage the painful area with ice for seven to ten minutes, long enough to numb the pain. Ice frozen in a paper cup works well. Be sure not to damage your skin (frostbite). Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first forty eight hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments. Return to your normal daily activities as soon as possible. One study found some evidence that continuing normal activities after an acute whiplash injury helps heal some symptoms faster than taking time off from work and using neck immobilization. Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, might provide pain relief. Take pain relievers. Acetaminophen (such as Tylenol ) can help relieve pain. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer ), ibuprofen (such as Advil ), or naproxen sodium (such as Aleve ), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than twenty years because of the risk of Reye syndrome. For long-lasting (chronic) pain, you can use the same pain relief measures used for acute pain, but you do not have to worry about swelling. You can aid healing in both acute and chronic neck pain and prevent further injury by: Doing stretching and strengthening exercises for your neck to keep your neck flexible and strong and prevent stiffness. Avoiding or modifying any activities that might be causing your neck pain, Page 28

29 such as prolonged computer work or overhead work. Having good health habits. Try to reduce stress and tension at work and home. Practice muscle relaxation exercises and think about getting a massage. Stop smoking: smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Smoking, and Fitness. You can help prevent future neck pain by paying attention to how you move and hold yourself (body mechanics). This includes: Avoiding slouching or a head-forward posture. Sit straight in your chair with your lower back supported, feet flat on the floor, and shoulders relaxed. Avoid sitting for long periods without getting up or changing positions. Take short breaks several times an hour to stretch your neck muscles. Adjusting your workstation if you work at the computer. Keep the monitor so that the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen. For more information, see the topic Office Ergonomics. Using a headset or speaker phone if you use the telephone a lot. Do not cradle the phone on your shoulder. Adjusting your car seat to a more upright position that supports your head and lower back. Make sure that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position. Using a pillow that keeps your neck straight, neither too high nor too flat. Special neck support pillows called cervical pillows or rolls might relieve neck stress. You can also fold a towel lengthwise into a pad that is four inches wide, wrap it around your neck, and pin it in position for good support. Avoid sleeping on your stomach with your neck twisted or bent Having the right posture when reading in bed. Prop the book up so you are not using your arms to hold it up and bending your neck forward. Consider using a wedge-shaped pillow to support your arms and keep your neck in a neutral position. Page 29

30 Using proper lifting techniques. Lifting with your knees, not your back can also help to prevent neck pain. Your doctor might recommend that you wear a cervical collar to support your neck. Cervical collars might reduce neck pain, but they should be used only for a day or two. When the pain begins to get better, start doing gentle neck exercises. CHAPTER SEVENTEEN WHEN SHOULD I CALL MY DOCTOR? Call 911or other emergency services immediately if you have been injured and you have: A severe neck injury, such as an injury caused by a: Serious car accident. Fall from a height of fifteen feet or more. Major sports-related injury. Very forceful blow to the head or neck. High-energy blow on the top of the head. Penetrating injury, such as a stab or gunshot wound. Signs of a spinal cord injury, such as: Weakness or inability to move the arms or legs. Continuous numbness of one or both arms or legs. Loss of bowel or bladder control. Neck pain that comes with chest pain and other symptoms of a heart attack. Page 30

31 These include: Chest pain that is crushing or squeezing or feels like a heavy weight on the chest. Chest pain that comes with: Sweating, shortness of breath, nausea, or vomiting. Pain that spreads from the chest to the back, neck, or jaw, or one or both shoulders or arms. Dizziness or lightheadedness. A fast or irregular pulse. Call your doctor immediately if you have: A stiff neck and/or severe headache, fever, confusion vomiting, and/or difficulty staying awake or alert. Neck pain and severe arm pain. Neck pain and suddenly developing numbness, tingling, or weakness in one or both of your arms. Severe neck pain following an injury. Severe neck pain with no known cause. A new weakness in your arms and legs. A new loss of bladder or bowel control. Call your doctor today if you have: Severe restriction of neck movements. Neck pain or stiffness after starting a new medicine. Constant numbness or tingling in one arm or hand. Constant weakness in one arm. Page 31

32 Moderate pain following an injury. Arm weakness, numbness, or tingling that has become worse since you were evaluated by your doctor. Ongoing (chronic) pain that is getting worse. Observational Waiting Observational waiting is a period of time during which you and your doctor observe your symptoms or condition without using any medical treatment. Most neck pain does not require medical care. In general, pain relief and neck movement should get better after a couple of days of home treatment that includes: Limiting the activities that increase neck pain. Taking nonprescription pain relievers together with using ice to reduce pain. Doing gentle exercises to keep the neck flexible. If you have severe neck pain that has not gone after one or two days and you are not able to perform your normal daily activities, call your doctor. CHAPTER EIGHTEEN WHAT EXERCISES CAN PREVENT AND TREAT NECK PAIN? The following exercises will help to strengthen the muscles in your neck as well as stopping existing neck pain. You do not need to do every exercise. Do the ones that help you the most. Discontinue any exercise that increases pain. Do each exercise slowly. We can help you to learn and practice these exercises Dorsal glide stretches the back of the neck. If you feel pain, do not glide so far back. Some people find this exercise easier to do while lying on their backs with an ice pack on the neck. Page 32

33 Sit or stand tall and look straight ahead. Slowly tuck your chin in as you glide your head backwards over your body. Hold for a count of six, and then relax for up to ten seconds. Repeat eight to twelve times. Chest and shoulder stretch Sit or stand tall and glide your head backward as in exercise one. Raise both arms so that your hands are alongside your ears. Take a deep breath, and as you breathe out, lower your elbows downwards and behind your back. You will feel your shoulder blades slide down and closer together, and at the same time you will feel a stretch across your chest and at the front of your shoulders. Hold for about six seconds, and then relax for up to ten seconds. Repeat eight to twelve times. Shoulder lifts Lie facedown with your arms beside your body. Lift your head and shoulders straight up from the floor as high as you can without causing pain. Keep looking at the floor so you do not arch your neck back. Keep your torso and hips pressed to the floor. Hold for about six seconds, and then relax for up to ten seconds. Repeat eight to twelve times. Page 33

34 Hands on head Move your head backwards, forwards, and side to side against gentle pressure from your hands, holding each position for about six seconds. Repeat eight to twelve times. Page 34